Intervention: Piclidenoson
Trial phase: Phase 2
SMILES: CNC(=O)[C@H]1O[C@@H](n2cnc3c(NCc4ccc(I)cc4)ncnc32)[C@H](O)[C@@H]1O
Sex: All
Age groups: Adult | Older Adult
Healthy volunteers: No
Participants at risk: 42
Group description: CF101 1mg q12 for 12 weeks
Eligibility criteria:
Inclusion Criteria:

Males and females ages 18-75 years
Meet the criteria of the American College of Rheumatology for RA (Arnett FC et al. Arthritis Rheum 1988;31:315-324, Appendix 1)
Not bed- or wheelchair-bound
Active RA, as indicated by the presence of (a) >=6 swollen joints (28 joint count); AND (b) >=6 tender joints (28 joint count); AND either: (c) Westergren ESR of >=28 mm/hour; OR (d) CRP level above the upper limit of normal for the central reference laboratory
Elevated PBMC A3AR expression level, defined as >= 1.5-fold over a predetermined normal population standard, following the appropriate DMARD/biologic washout period (see Exclusion Criteria) but within 2 weeks of beginning dosing
If taking a nonsteroidal anti-inflammatory agent (NSAID), dose has been stable for at least 1 month prior to the A3AR Qualification Visit, and will remain unchanged during protocol participation
If taking an oral corticosteroid, dose is <=10 mg/day prednisone or equivalent, has been stable for at least 1 month prior to the A3AR Qualification Visit, and will remain unchanged during protocol participation
In the Investigator's opinion, the ability to understand the nature of the study and any hazards of participation, and to communicate satisfactorily with the Investigator and to participate in, and to comply with, the requirements of the entire protocol
Negative screening serum pregnancy test for female patients of childbearing potential
Females of childbearing potential must utilize, throughout the course of the trial, 2 methods of contraception deemed adequate by the Investigator (for example, oral contraceptive pills plus a barrier method)
All aspects of the protocol explained and written informed consent obtained

Exclusion Criteria:

Receipt of any of the following for at least a 1 month washout period prior to the A3AR Qualification Visit: methotrexate, sulfasalazine, oral or injectable gold, azathioprine, minocycline, penicillamine, anakinra
Receipt of etanercept for at least a 6 week washout period prior to the A3AR Qualification Visit
Receipt of chloroquine, hydroxychloroquine, cyclosporine, infliximab, golimumab or adalimumab for at least a 2 month washout period prior to the A3AR Qualification Visit
Receipt of leflunomide for at least a 2 month washout period prior to the A3AR Qualification Visit, unless patient has undergone cholestyramine washout at least 1 month prior to testing
Receipt of cyclophosphamide for at least a 6 month period prior to the A3AR Qualification Visit
Receipt of rituximab at any previous time
Previous failure to respond to methotrexate or any anti-rheumatic biological agent
Participation in a previous trial CF101 trial
Use of oral corticosteroids >10 mg of prednisone, or equivalent, per day
Change in NSAID dose level for 1 month prior to the A3AR Qualification Visit
Change in oral corticosteroid dose level during the 1 month prior to the A3AR Qualification Visit
Receipt of parenteral or intra-articular corticosteroids during the 1 month prior to the A3AR Qualification Visit