1. Study identification
EU PAS Register NumberEUPAS3393
Official titleEvaluation of a Standardized Protocol for Dose Reduction in Patients With Spondylarthropathies and Clinical Remission With Anti-TNF Therapy
Study title acronymREDES-TNF/2012
Study typeClinical trial; EUDRACT number: 2011-005871-18
Brief description of the studyIt has been shown that the withdrawal of treatment follows with a flare of the disease in a short time after the suspension but it has not been evaluated in controlled trials if remission could be maintained with a lower dose. A multicenter, national, open-label, randomized and controlled clinical trial of 3 years duration (2 years for inclusion + 1 year follow-up) is proposed to address this issue. The study will include 190 patients with Spondylarthropathies in stable treatment with any single anti-TNF agent and compliance with criteria of clinical remission for at least 4 months. Patients will be randomized to intervention or control arm, with stratification according to the antiTNF product thet were receiving prior to inclusion. Patients will be followed with the calendar of visits recommended by the Spanish Society of Rheumatology for clinical practice. The proposed hypothesis is of non-inferiority of the experimental arm with dose reduction versus the control arm with standard treatment.
Was this study requested by a regulator?No
Is the study required by a Risk Management Plan (RMP)?
Regulatory procedure number (RMP Category 1 and 2 studies only)
Other study registration identification numbers and URLs as applicable
2. Research centres and Investigator details
Coordinating study entity
Centre nameCorporació Sanitaria Parc Tauli - Reumatology Service
Centre locationSabadell, Spain
Details of (Primary) lead investigator
Title Dr
Last name Gratacós
First name Jordi
Is this study being carried out with the collaboration of a research network?
Yes
GRESSER-SEFC (REDES)
Other centres where this study is being conducted
Multiple centres
In total how many centres are involved in this Study?31
Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
Hospital Monte Naranco, Oviedo, Asturias, Spain
Hospital General de Llerena-Zafra, Llerena, Badajoz, Spain
Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
Corporació Sanitària Parc Taulí, Sabadell, Barcelona, Spain
Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Barcelona, Spain
Hospital Comarcal de Palamós, Palamós, Girona, Spain
Hospital Son Llàtzer, Palma de Mallorca, Illes Balears, Spain
Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Las Palmas, Spain
Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
Countries in which this study is being conducted
National study
Spain
3. Study timelines: initial administrative steps, progress reports and final report
PlannedActual
Date when funding contract was signed19/01/2012
Start date of data collection02/07/201202/07/2012
Start date of data analysis19/12/2014
Date of interim report, if expected
Date of final study report30/09/2015
4. Sources of funding
Please provide estimates of the percentage of funding by source for this study
Names(s)Approximate % funding
Pharmaceutical companies
Charities
Government bodyInstituto de Salud Carlos III100
Research councils
EU funding scheme
5. Contact details for enquiries
Scientific Enquiries
Title Dr
Last name Pontes
First name Caridad
Address line 1Parc Taulí, 1
Address line 2
Address line 3
CitySabadell
Postcode08208
CountrySpain
Phone number (incl. country code)34937231010
Alternative phone number
Fax number (incl. country code)
Public Enquiries
Title Dr
Last name Gratacós
First name Jordi
Address line 1Parc Taulí, 1
Address line 2
Address line 3
CitySabadell
Postcode08208
CountrySpain
Phone number (incl. country code)34937231010
Alternative phone number
Fax number (incl. country code)
11. Scope of the study
What is the scope of the study?
Risk assessment
Effectiveness evaluation
Primary scope : Effectiveness evaluation
12. Main objective(s)
What is the main objective of the study?
The purpose of this study is to demonstrate that patients with Spondylarthropathies in remission under antiTNF therapy, can maintain the remission with a maintenance dose inferior to the currently recommended dose schedule.
Are there primary outcomes?Yes
1) Proportion of patients who are kept in the acceptable therapeutic objective according Spanish Rheumatology Society (SER)consensus, after 1 year, not designated as safety issue
2) Proportion of patients who are kept in acceptable therapeutic objective according SER consensus (BASDAI < 4, globaclinical impression by physician <4, by patient < 4 and axial nocturnal pain <4) after 1 year.
Are there secondary outcomes?Yes
1) Proportion of patients in remission one year after inclusion in the study, not as safety issue
2) Proportion of patients in remission, defined as ASDAS-C score <1.3, after 1 year from inclusion
3) Proportion of patients who experience a clinical reactivation (up to 3 years or December 2014) ]
And other 8 secondary outcomes.
13. Study design
What is the design of the study?
Randomised controlled trial
14. Follow-up of patients
Will patients be followed up?Yes
Please describe duration of follow up
3 years.
15. Data analysis plan
Please provide a brief summary of the analysis method
Study main objective of non-inferiority will be assessed by estimating the between treatment difference rate (95% confidence interval (95%CI)) and, checking it against the pre-defined non-inferiority margin of 17%. Rates will be estimated using a log-binomial regression model including the treatment and the stratification factor. In the unexpected event that the model does not fit, the Poisson link distribution function will be used instead. A sensibility analysis will be conducted using the Mantel-Haenzel method. Time to decompensation will be estimated by the Kaplan-Meier approach and treatments will be compared with the stratified log-rank test; Cox regression models will be used to estimate Hazard Risks and 95%CI. Rest of variables will be compared depending on type of variables: the Fisher’s exact text for nominal variables, for quantitative variables with Gaussian distribution, the Student's t-test, and for ordinal and continuous non Gaussian variables, the Mann-Whitney test.