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Treatment of Refractory Adult-onset Still's Disease With Anakinra: a Randomized Study

NCT01033656 — Phase 2, Completed, 23 participants, University of Helsinki

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An Open, Randomized Study Treating Refractory Adult-onset Still's Disease With Interleukin-1 Receptor Antagonist Anakinra (Kineret), Compared to an Established, Single Anti-rheumatic Drug Treatment

RegistryNCT01033656, acronym NordicAOSD05
StatusCompleted
PhasePhase 2
Study typeInterventional; randomized, parallel, masking: none, treatment
Enrollment23 (Actual)
SponsorUniversity of Helsinki (Other); collaborators: Uppsala University Hospital, Helse Stavanger HF, Tampere University Hospital, Turku University Hospital, Oulu University Hospital, Kuopio University Hospital, Jyväskylä Central Hospital, Satakunta Central Hospital, University Hospital, Umeå, University Hospital, Linkoeping
ConditionsAdult-Onset Still's Disease
Interventionsanakinra, comparators (Drug)
Datesstart 2005-12-01, primary completion 2010-03-01, completion 2010-04-01, first posted 2009-12-16, last updated 2017-03-06
Locations1 site in Sweden

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-Summary

An open, randomized, parallel-group, comparative, multicentre study. Patients on corticosteroids (plus conventional therapy) will be randomized to receive anakinra (Kineret®), or one of the following: methotrexate, azathioprine, leflunomide, cyclosporin A or sulphasalazine. Patients enter the study if considered refractory to corticosteroids (prednisolone equivalent ≥10 mg/day) at the time of randomization.

The randomized phase of the study will be followed by an open-label extension (OLE) phase, to follow-up drug survival, efficacy, tolerability and disease-related parameters of long-term treatment with anakinra or one of the study DMARDs or a combination of study drugs for additional 28 weeks.

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+Detailed description

Product: Kineret (anakinra) Comparative agents: Methotrexate or azathioprine or leflunomide or cyclosporin A or sulphasalazine Protocol title: An open, randomized study treating refractory adult-onset Still's disease with IL-1ra anakinra (Kineret, compared to an established, single anti-rheumatic treatment Target Disease: Adult-onset Still's disease Patients: 23 patients diagnosed with AOSD, living in the four Nordic countries.

Study Objectives: To follow the changes in clinical status and disease activity in patients receiving anakinra, compared to those treated with an established DMARD, in addition to corticosteroids in patients with refractory AOSD. To compare the changes in disease-related parameters (global health, patient's assessment on disease, laboratory values) in the two randomized groups. To assess the safety of anakinra in AOSD. To follow-up drug survival, efficacy, tolerability and disease-related parameters of long-term treatment in AOSD (open phase).

+Arms and interventions

ArmTypeInterventionsDescription
AnakinraExperimentalDrug: anakinraexperimental drug of study
comparatorActive comparatorDrug: comparatorscomparators:methotrexate, azathioprine, leflunomide or supfasalazine
  • anakinra (Drug), also known as Interleukin-1 receptor antagonist: 100 mg subcutaneous injection daily
  • comparators (Drug), also known as methotrexate, azathioprine, leflunomide, sufalalazine: po drugs, comparators

+Outcome measures

Primary outcomes

  • Number of patients reaching remission of the disease, after eight weeks of the randomized study treatment (Remission: afebrile and normalization of acute phase reactants) [8 weeks]

+Eligibility

Sex: All, ages: 18 Years to any

Inclusion Criteria:

* Must be diagnosed with AOSD according to preliminary classification by Yamaguchi (1992).
* Other diseases with similar symptoms must be excluded. Has been exposed to a corticosteroid for ≥2 months prior to randomization for AOSD.
* Needs a prednisolone dose ≥10 mg/day or equivalent, yet unacceptable disease activity determined by the investigator.
* Anti-TNF agents must be discontinued 4 to 8 weeks prior to commencing study medication.

Exclusion Criteria:

* Use of corticosteroids (prednisolone equivalent <10 mg/day.
* History of recurrent or chronic infection, including:

  * tuberculosis
  * any malignancy
  * any other major chronic inflammatory disease syndrome
  * drug or alcohol abuse
  * known positivity for hepatitis B, C or HIV.
* Use of anti-TNF agents during ≤4 weeks (etanercept) or≤8 weeks (infliximab or adalimumab) prior to randomization.

+Locations (1)

FacilityCityCountryStatus
Ann Kataja KnightUppsalaSweden

+Publications

  • Results publication: Nordstrom D, Knight A, Luukkainen R, van Vollenhoven R, Rantalaiho V, Kajalainen A, Brun JG, Proven A, Ljung L, Kautiainen H, Pettersson T. Beneficial effect of interleukin 1 inhibition with anakinra in adult-onset Still's disease. An open, randomized, multicenter study. J Rheumatol. 2012 Oct;39(10):2008-11. doi: 10.3899/jrheum.111549. Epub 2012 Aug 1. PMID 22859346

+Investigators

+Funding

NIH grants: 2005

My Notes