Switching Anti-TNF-Alpha Agents in Rheumatoid Arthritis (RA)
Condition: Rheumatoid Arthritis
MeSH terms: Arthritis; Arthritis, Rheumatoid
Intervention: Adalimumab; Adalimumab placebo; Etanercept
Intervention description: 40 mg injection of adalimumab administered subcutaneously; 1.0 ml .9% saline placebo administered subcutaneously; 50 mg dimeric fusion protein administered subcutaneously
Intervention MeSH terms: Adalimumab; Etanercept
Phase: Phase 4
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Investigator)
Enrollment: 13.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: No

Summary:

      Rheumatoid Arthritis (RA) is a systemic inflammatory autoimmune disorder that leads to
      inflammation and progressive joint damage affecting 2.5 million people in the United States.
      The primary purpose of this study is to determine the effectiveness of switching to an
      alternative Tumor Necrosis Factor (TNF) alpha inhibitor in comparison to continuing treatment
      with an existing TNF-alpha inhibitor in adults suffering from RA in a setting of inadequate
      clinical response to etanercept or adalimumab.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Diagnosis of Rheumatoid Arthritis

          -  Current treatment with either etanercept or adalimumab for at least 12 weeks prior to
             randomization

          -  Disease Activity Score (DAS) C-reactive Protein (CRP) 28 ≥ 4.4

          -  Treatment with concomitant Disease-Modifying Anti-Rheumatic Drugs (DMARDs) is
             permitted but not required as described below:

               1. Methotrexate - maximum dose of 25 mg per os (PO), intra-muscular (IM), or SQ
                  weekly.

               2. Leflunomide - maximum dose of 20 mg PO daily.

               3. Sulfasalazine - maximum dose of 1,500 mg PO twice daily.

               4. Hydroxychloroquine - maximum dose of 400 mg PO daily.

          -  If taking DMARD(s), subjects must be on stable doses for at least 12 weeks prior to
             randomization.

          -  If treated with prednisone (or equivalent corticosteroid), on a stable dose of <= 10
             mg/day for 28 days prior to randomization.

          -  Agree to use appropriate form of contraception. More information on this criterion can
             be found in the protocol.

        Exclusion Criteria:

          -  Diagnosis of another autoimmune disease likely to require immunosuppression. More
             information on this criterion can be found in the protocol.

          -  Failing treatment with etanercept if previously treated with adalimumab

          -  Failing treatment with adalimumab if previously treated with etanercept

          -  Intraarticular injection within 4 weeks prior to randomization

          -  Concomitant use of DMARDs other than those described in Inclusion Criteria within 12
             weeks of randomization.

          -  Concurrent use of any biologic agent other than etanercept or adalimumab

          -  Concomitant immunosuppressive therapy other than the Disease-Modifying Anti-Rheumatic
             Drugs (DMARDs), non-steroidal anti-inflammatory drugs (NSAIDs), or corticosteroids
             specified in the protocol

          -  Presence of open leg ulcers

          -  Chronic or persistent infection that may be worsened by immunosuppressive treatment.
             More information on this criterion can be found in the protocol.

          -  Active infection or severe infections requiring hospitalization or treatment with
             intravenous antibiotics, antivirals, or antifungals within 30 days prior to
             randomization

          -  History of positive Purified Protein Derivative (PPD) or chest x-ray findings
             indicative of prior tuberculosis infection

          -  Any medical condition or treatment that, in the opinion of the investigator, would put
             the subject at risk by participation in the study

          -  History of malignancy. More information on this criterion can be found in the
             protocol.

          -  Certain abnormal laboratory values. More information on this criterion can be found in
             the protocol.

          -  Investigational biological or chemical agents within 4 weeks prior to randomization.

          -  History of drug or alcohol abuse within a year prior to randomization

          -  Treatment with natalizumab, rituximab, or another B-cell depleting therapy within a
             year prior to randomization

          -  Treatment with infliximab, abatacept, tocilizumab, golimumab, or certolizumab pegol
             within 12 weeks prior to randomization.

          -  Known allergy or hypersensitivity to study products

          -  Any psychiatric disorder that prevents the participant from providing informed consent

          -  Inability to follow protocol instructions

          -  Pregnant or breastfeeding