Time Required to Dissolve Urate Deposits

NCT ID: NCT06669000

Last Updated: 2024-11-01

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

NOT_YET_RECRUITING

Total Enrollment

250 participants

Study Classification

OBSERVATIONAL

Study Start Date

2024-11-30

Study Completion Date

2032-11-30

Brief Summary

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Gout is characterized by episodes of acute arthritis of the lower limbs due to intermittent activation of innate immunity in the joints where urate crystals have formed. These crystals occur when serum urate (SUA) levels have been above 70 mg/L for many years. They can be dissolved by lowering SUA levels to at least 60 mg/L (treat-to-target - T2T - strategy). Once the crystals are dissolved, patients are no longer symptomatic and are considered to be in remission (treat-to-dissolve - T2D - strategy).

The presence of crystals and their dissolution during treatment can be monitored by repeated ultrasound (US) scans of the feet and knees.

The time required for complete dissolution varies from patient to patient. ReViGore40 is a cohort designed to i) determine the time to complete dissolution of urate deposits in joints when SUA levels are maintained below 40 mg/L, ii) determine the factors (clinical, biological, genetic) associated with the time required for complete dissolution of urate deposits within joints.

Detailed Description

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Patients with newly diagnosed gout according to the 2015 ACR/Eular criteria, not treated with urate-lowering therapy and with US evidence of urate deposition (feet, knees; ultrasound score ≥ 2/24) will be enrolled in the ReViGore40 cohort.

In all patients, SUA levels will be lowered with allopurinol or febuxostat (XOI) depending on renal function (eGFR greater or less than 30 ml/mn/m2) or uricosurics, by starting medications at a low dose and subsequent titration. The target SUA levels is less than 40 mg/L in all patients.

Patients will then be monitored by US every 6 months until complete urate crystals dissolution. An ultrasound score (min 0- max 24; 0 meaning no urate deposits and 24 the highest value for quantifying the extent of deposits) will be calculated for each US scan. Dissolution is considered to have been achieved when a score of 0/24 is reached on two successive US scans performed 6 months apart.

The Predictive Factors (clinical, biological, genetic) associated with the complete dissolution of urate deposits will be determined.

DECT (feet) will be performed only in tophaceous patients at M0 and M24. Each patient will receive a capillary urate point of care device for self-urate measurement. Patients will be contacted monthly by nurses for the first 6 months to ensure treatment compliance and SUA target attainment.

Blood samples will be collected at M0, M6, M24 and M36 for omic and epigenetic studies. Clinical data will be collected at M0, M6, M12, M24, M36 and M48. Change in Protein, Epigenetic and omic profils will be determined.

DNA for genetic studies will be collected at M0. Co-morbidities, particularly cardiovascular and hepatic, will be assessed at M6: coronary artery calcium (CAC) scoring and liver fibroscan.

Conditions

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Gout

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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Gout patients treated according to a Treat-to-Dissolve strategy

Patients initiated with ULT (urate target less than 40 mg/L), and followed every 6 months with Ultrasound until complete urate dissolution

Standard X-Rays

Intervention Type DIAGNOSTIC_TEST

\- Standard X-Rays: feet (Month 0)

Ultrasound

Intervention Type DIAGNOSTIC_TEST

\- Ultrasound (score 0-24): assessment for DC (Double Contour) sign (0-3), aggregates (0-3), tophi (0-3) at MTP1s (first metatarsophalangeal joints) and DC sign (0-3) at both knees, according to the OMERACT, every 6 months until complete dissolution of urate deposits.

DECT of feet

Intervention Type DIAGNOSTIC_TEST

DECT of feet: in tophaceous patients only (Month 0, Month 24)

DNA sample

Intervention Type BIOLOGICAL

DNA will be collected at Month 0

Serum collection

Intervention Type BIOLOGICAL

\- Serum will be collected at Month 0, Month 6, Month 12, Month 18, Month 24 , Month 36 and Month 48. For OMICs and epigenetic studies: Month 0, Month 6, Month 24 and Month 36.

Interventions

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Standard X-Rays

\- Standard X-Rays: feet (Month 0)

Intervention Type DIAGNOSTIC_TEST

Ultrasound

\- Ultrasound (score 0-24): assessment for DC (Double Contour) sign (0-3), aggregates (0-3), tophi (0-3) at MTP1s (first metatarsophalangeal joints) and DC sign (0-3) at both knees, according to the OMERACT, every 6 months until complete dissolution of urate deposits.

Intervention Type DIAGNOSTIC_TEST

DECT of feet

DECT of feet: in tophaceous patients only (Month 0, Month 24)

Intervention Type DIAGNOSTIC_TEST

DNA sample

DNA will be collected at Month 0

Intervention Type BIOLOGICAL

Serum collection

\- Serum will be collected at Month 0, Month 6, Month 12, Month 18, Month 24 , Month 36 and Month 48. For OMICs and epigenetic studies: Month 0, Month 6, Month 24 and Month 36.

Intervention Type BIOLOGICAL

Eligibility Criteria

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Inclusion Criteria

* Age over 18 years
* Gout according to the ACR/Eular 2015 criteria
* SUA levels greater than 60 mg/L
* US score (MTP1s, knees) ≥2/24
* Informed consent Dated and signed voluntarily

Exclusion Criteria

* Ongoing urate lowering therapy
* Severe and uncontrolled diseases such as cancer, cardiovascular or neurovegetative diseases
* Pregnant or breast-feeding women
* No affiliation to the French National Social Security System
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Institut National de la Santé Et de la Recherche Médicale, France

OTHER_GOV

Sponsor Role collaborator

ART VIGGO Association for Research

UNKNOWN

Sponsor Role collaborator

Assistance Publique - Hôpitaux de Paris

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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APHP, Lariboisière Hospital, Rheumatology departement

Paris, , France

Site Status

Countries

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France

Central Contacts

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Pascal RICHETTE, PR

Role: CONTACT

0149956314

Other Identifiers

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2024-A00937-40

Identifier Type: OTHER

Identifier Source: secondary_id

APHP240644

Identifier Type: -

Identifier Source: org_study_id

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