The Effect of Nicotinamide on the Clinical Outcome of Rheumatoid Arthritis Patients

NCT ID: NCT06640309

Last Updated: 2024-10-16

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

RECRUITING

Clinical Phase

PHASE2

Total Enrollment

70 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-12-02

Study Completion Date

2025-06-30

Brief Summary

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A randomized controlled interventional study to evaluate the efficacy and safety of nicotinamide supplementation in rheumatoid arthritis patients receiving conventional synthetic disease modifying anti-rheumatic drugs.

Detailed Description

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Study design:

A prospective randomized controlled interventional parallel open label study.

Patient randomization:

All patients fulfilling the inclusion criteria will be randomly assigned by simple randomization into either nicotinamide group or control group as follows:

* Nicotinamide group: consists of thirty-five patients who will receive nicotinamide 1000mg tablet once daily.in addition to their conventional therapy.
* Control group: consists of thirty-five patients who will receive their conventional therapy only.

Methodology:

At baseline, the following will be obtained through patients' interview:

1. Demographic data.
2. Medical history and comorbidities.
3. The disease activity; identified through patients' physical examination and serum C-Reactive Protein (CRP) levels as prerequisites for Disease Activity Score-28 (DAS-28-CRP).
4. The disease duration.
5. Current medications history.

Evaluation of the efficacy and safety of nicotinamide will be assessed at baseline and after three months through:

1. Blood sampling will be collected from patients for serum CRP , Erythrocyte sedimentation rate (ESR) and analysis of Interleukin-10 .These samples will be directly centrifuged at 1000 x g for fifteen minutes and then plasma will be separated and collected in capped test tubes, then will be stored at -80 °C until analysis.

Interleukin-10 serum level will be measured using an Enzyme Linked Immunosorbent Assay (ELISA) technique.
2. Disease Activity will be calculated based on tender joint count (TJC) and swollen joint count (SJC) following the assessment of twenty-eight joints, serum CRP level, and the patient's global health assessment (PGA) on a scale from zero to one hundred. The score will be calculated using the following equation:

DAS-28-CRP = 0.56\* √(TJC28) + 0.28\* √(SJC28) + 0.36\*ln (CRP + 1) +0.014\*(PGA) + 0.96
3. Patient's QOL will be assessed by using the Health Assessment Questionnaire-Disability Index (HAQ-DI)
4. Patients will be educated about the side effects and/or adverse effects of nicotinamide, where, safety and tolerability will be monitored by reporting the incidence of any side effect and /or adverse effect such as stomach upset, flatulence, dizziness, headache, and rash.

Blood samples will be collected for complete blood count (CBC), alanine transaminase (ALT), aspartate transaminase (AST), serum creatinine (Scr.) levels analysis to monitor adverse effects of conventional synthetic disease-modified antirheumatic (csDMARDs) drugs and nicotinamide.

Conditions

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Rheumatoid Arthritis

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

A prospective randomized controlled interventional parallel open label study.
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Nicotinamide group

Patients will receive nicotinamide 1000mg tablet once daily.in addition to their conventional therapy for three months.

Group Type EXPERIMENTAL

Nicotinamide Tablet

Intervention Type DRUG

Nicotinamide is anti-inflammatory and antioxidant.

conventional synthetic antirheumatic drugs

Intervention Type DRUG

methotrexate- leflunomide- sulfasalazine- hydroxychloroquine

control group

Patients will receive their conventional therapy only.

Group Type ACTIVE_COMPARATOR

conventional synthetic antirheumatic drugs

Intervention Type DRUG

methotrexate- leflunomide- sulfasalazine- hydroxychloroquine

Interventions

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Nicotinamide Tablet

Nicotinamide is anti-inflammatory and antioxidant.

Intervention Type DRUG

conventional synthetic antirheumatic drugs

methotrexate- leflunomide- sulfasalazine- hydroxychloroquine

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Adult patients (18-65 years).
* Patients with a diagnosis of established rheumatoid arthritis.
* Patients presenting with moderate to high disease activity identified as disease activity score-28 based on C-reactive protein levels (DAS-28-CRP) \>3.2.
* Receiving stable regimen of one or more conventional disease modifying antirheumatic drugs for at least the past three months.
* Patients willing to sign an informed consent.

Exclusion Criteria

* Patients with a known history of hypersensitivity or drug allergies to nicotinamide
* Patients receiving nicotinamide for any other indications.
* Receiving any dosage forms/ dosage regimen of vitamin B3 supplementation
* Receiving biologic disease modified antirheumatic drugs therapy.
* Impaired liver functions (liver transaminases level ≥ three times upper normal limits).
* Impaired kidney functions (estimated glomerular filtration rate (eGFR) \< 30 ml/min)
* Pregnancy and lactation.
* Patients with other auto-immune diseases.
Minimum Eligible Age

18 Years

Maximum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Ain Shams University

OTHER

Sponsor Role lead

Responsible Party

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Sara ahmed raslan

clinical pharmacist at Ain Shams University Hospitals

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Lamia El wakeel, Professor

Role: STUDY_DIRECTOR

Professor and head of department of Clinical Pharmacy at Faculty of Pharmacy Ain Shams University

May Ahmed, Asst. professor

Role: STUDY_DIRECTOR

Assistant professor of Clinical Pharmacy, Ain Shams University-Faculty of Pharmacy

Locations

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Ain Shams University Hospitals

Cairo, , Egypt

Site Status RECRUITING

Countries

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Egypt

Central Contacts

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Sara A. Raslan, Bachelor

Role: CONTACT

+20 1020145174

Dalia Abdelmohsen, Professor

Role: CONTACT

+20 100 1580007

Facility Contacts

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Dalia Abdelmohsen, Professor

Role: primary

+20 100 1580007

References

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Kamat JP, Devasagayam TP. Nicotinamide (vitamin B3) as an effective antioxidant against oxidative damage in rat brain mitochondria. Redox Rep. 1999;4(4):179-84. doi: 10.1179/135100099101534882.

Reference Type BACKGROUND
PMID: 10658823 (View on PubMed)

Miesel R, Kurpisz M, Kroger H. Modulation of inflammatory arthritis by inhibition of poly(ADP ribose) polymerase. Inflammation. 1995 Jun;19(3):379-87. doi: 10.1007/BF01534394.

Reference Type BACKGROUND
PMID: 7628865 (View on PubMed)

Ungerstedt JS, Blomback M, Soderstrom T. Nicotinamide is a potent inhibitor of proinflammatory cytokines. Clin Exp Immunol. 2003 Jan;131(1):48-52. doi: 10.1046/j.1365-2249.2003.02031.x.

Reference Type BACKGROUND
PMID: 12519385 (View on PubMed)

Other Identifiers

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NAM/RA/1223

Identifier Type: -

Identifier Source: org_study_id

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