REduCed Dose of TNFi in Patients With Ankylosing SpondyliTis (RECAST)

NCT ID: NCT05164198

Last Updated: 2021-12-20

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

PHASE4

Total Enrollment

448 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-01-15

Study Completion Date

2024-10-31

Brief Summary

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Participants maintaining stable disease activity of Ankylosing Spondylitis (AS) with standard-dose tumor necrosis factor inhibitor (TNFi) treatment will randomly split into two groups: maintaining standard-dose TNFi, versus reduced-dose TNFi. The proportion of participants not underwent flare between the two groups will be analyzed.

Detailed Description

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Conditions

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Ankylosing Spondylitis Axial Spondyloarthritis

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Phase 4, randomized, parallel, non-inferiority, open-label, multi-center clinical trial
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Open-label reduced-dose TNFi

Participants in the experimental arm will receive one of the intervention below according to the TNFi agent used at baseline:

1. Adalimumab 40mg subcutaneous every 3 weeks (Q3W) from week 0 to week 48.
2. Etanercept 50mg subcutaneous every 10 days (Q10D) from week 0 to week 48.
3. Golimumab 50mg (100mg if a participant's body weight ≥ 100kg) subcutaneous every 5 weeks (Q5W) from week 0 to week 48.
4. Remsima SC 120mg subcutaneous every 3 weeks (Q3W) from week 0 to week 48.

Group Type EXPERIMENTAL

Adalimumab and its biosimilars

Intervention Type BIOLOGICAL

1. Active substance: Adalimumab
2. Pharmaceutical form: Prefilled syringe
3. Concentration: 100mg/mL
4. Route of administration: Subcutaneous injection

Biological: Etanercept and its biosimilars

Intervention Type BIOLOGICAL

1. Active substance: Etanercept
2. Pharmaceutical form: Prefilled syringe
3. Concentration: 50mg/mL
4. Route of administration: Subcutaneous injection

Golimumab

Intervention Type BIOLOGICAL

1. Active substance: Adalimumab
2. Pharmaceutical form: Prefilled syringe
3. Concentration: 100mg/mL
4. Route of administration: Subcutaneous injection

Infliximab biosimilar

Intervention Type BIOLOGICAL

1. Active substance: Infliximab
2. Pharmaceutical form: Prefilled syringe
3. Concentration: 120mg/mL
4. Route of administration: Subcutaneous injection

Open-label full-dose TNFi

Participants in the comparator arm will receive one of the intervention below according to the TNFi agent used at baseline:

1. Adalimumab 40mg subcutaneous every 2 weeks (Q2W) from week 0 to week 48.
2. Etanercept 50mg subcutaneous every week (QW) from week 0 to week 48.
3. Golimumab 50mg (100mg if a participant's body weight ≥ 100kg) subcutaneous every 4 weeks (Q4W) from week 0 to week 48.
4. Remsima SC 120mg subcutaneous every 2 weeks (Q2W) from week 0 to week 48.

Group Type ACTIVE_COMPARATOR

Adalimumab and its biosimilars

Intervention Type BIOLOGICAL

1. Active substance: Adalimumab
2. Pharmaceutical form: Prefilled syringe
3. Concentration: 100mg/mL
4. Route of administration: Subcutaneous injection

Biological: Etanercept and its biosimilars

Intervention Type BIOLOGICAL

1. Active substance: Etanercept
2. Pharmaceutical form: Prefilled syringe
3. Concentration: 50mg/mL
4. Route of administration: Subcutaneous injection

Golimumab

Intervention Type BIOLOGICAL

1. Active substance: Adalimumab
2. Pharmaceutical form: Prefilled syringe
3. Concentration: 100mg/mL
4. Route of administration: Subcutaneous injection

Infliximab biosimilar

Intervention Type BIOLOGICAL

1. Active substance: Infliximab
2. Pharmaceutical form: Prefilled syringe
3. Concentration: 120mg/mL
4. Route of administration: Subcutaneous injection

Interventions

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Adalimumab and its biosimilars

1. Active substance: Adalimumab
2. Pharmaceutical form: Prefilled syringe
3. Concentration: 100mg/mL
4. Route of administration: Subcutaneous injection

Intervention Type BIOLOGICAL

Biological: Etanercept and its biosimilars

1. Active substance: Etanercept
2. Pharmaceutical form: Prefilled syringe
3. Concentration: 50mg/mL
4. Route of administration: Subcutaneous injection

Intervention Type BIOLOGICAL

Golimumab

1. Active substance: Adalimumab
2. Pharmaceutical form: Prefilled syringe
3. Concentration: 100mg/mL
4. Route of administration: Subcutaneous injection

Intervention Type BIOLOGICAL

Infliximab biosimilar

1. Active substance: Infliximab
2. Pharmaceutical form: Prefilled syringe
3. Concentration: 120mg/mL
4. Route of administration: Subcutaneous injection

Intervention Type BIOLOGICAL

Other Intervention Names

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Humira Adaloce Enbrel Eucept Etalace Simponi Remsima

Eligibility Criteria

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Inclusion Criteria

* Documented diagnosis of Ankylosing spondylitis (AS) and meet the modified New York classification criteria for AS.
* Subjects maintaining stable disease (Bath Ankylosing Spondylitis Disease Activity Index \[BASDAI\] \< 4) with standard-dose subcutaneous tumor-necrosis factor inhibitor (TNFi) treatment during previous 6 months from screening.
* Ankylosing Spondylitis Disease Activity Score (ASDAS) \< 2.1 at screening and 12 weeks prior to screening
* In subjects treated with methotrexate or sulfasalazine, the dose should be maintained (methotrexate≤ 25mg/day, sulfasalazine ≤ 3 g/day) during previous 4 weeks before screening.
* In subjects treated with systemic glucocorticoids, the dose should be less than 10mg/day of predinisolone or equivalent during at least 2 weeks from the screening
* Subjects with stable dose of concomitant NSAID (including Cox2 inhibitors) during the 2 weeks from the randomization

Exclusion Criteria

* Exposure to more than 1 TNFi
* History of hypersensitivity reaction to any TNFis
* Subjects with concomitant fibromyalgia, as determined by the investigator
* Subjects who have received any TNFis with reduced dosage
* Presence of total spinal ankylosis ('Bamboo spine')
* Female subjects who are breastfeeding, pregnant, or plan to become pregnant during the study
* Subjects with a history of malignancies and lymphoproliferative disorder including lymphoma within 5 years (Basal cell carcinoma treated within previous 3 months and showing no evidence of recurrence, actinic keratosis, and treated cervical/colon carcinoma in situ were allowed.)
* Subjects with current or history of severe, progressive, and/or uncontrolled renal, hepatic, hematological, endocrine, pulmonary, cardiac or neurological disease, as determined by the investigator
* Subjects with significant laboratory abnormalities included but not limited to:

1. AST/ALT \> 3.0 X ULN
2. White blood cell (WBC) \< 3000/μL and/or absolute neutrophil count (ANC) \< 1500/μL
3. Platelet count \<100,000/μL and/or hemoglobin level \<8.5 g/dL
4. Serum creatinine ≥ 1.5 X ULN
* Subjected with any high-potency opioids (ex. methadone, hydromorphone, morphine, oxycodone, oxymorphone, fentanyl, levorphanol, buprenorphine, meperidine)
* Subjects with current acute or chronic viral hepatitis B or C or with human immunodeficiency virus (HIV) infection
* Subjects planning to receive any live attenuated vaccinations after screening
* Subjects has history of chronic alcohol abuse or drug abuse within 6 months from screening
* Subjects concomitantly treated with systemic glucocorticoid (\>10mg/day of prednisolone or equivalent doses)
* Subjects with any other condition that, in the Investigator's judgment, would make the subject unsuitable for inclusion in the study
Minimum Eligible Age

18 Years

Maximum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Linical Korea

INDUSTRY

Sponsor Role collaborator

Hanyang University Seoul Hospital

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Tae-Hwan Kim, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Hanyang University

Central Contacts

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Tae-Hwan Kim, MD, PhD

Role: CONTACT

Phone: 82-2-2290-9245

Email: [email protected]

Ji Hui Shin

Role: CONTACT

Phone: 82-2-2290-9252

Email: [email protected]

Other Identifiers

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HC21C0076

Identifier Type: -

Identifier Source: org_study_id