Efficacy of Golimumab in Early Axial Spondyloarthritis in Relation to Gut Inflammation

Study Overview
=================
Brief Summary
-----------------
The hypothesis of the study is that the presence of (subclinical) gut inflammation at baseline in patients with early active axial spondyloarthritis predisposes to a more severe disease defined as more need to use anti-tumor necrosis factor α therapy and a shorter time to relapse after stopping anti-tumor necrosis factor α therapy after obtaining sustained clinical remission. Overall, the investigators hypothesize that subclinical gut inflammation is an important predictor in therapy response and outcome. These data could provide better insights into the complex interactions between gut and joint inflammation and guide the physicians in the therapeutic approach.

Official Title
-----------------
Efficacy of Golimumab in Early Axial Spondyloarthritis in Relation to Gut Inflammation, an Early Remission Induction Study

Conditions
-----------------
Axial Spondyloarthritis

Intervention / Treatment
-----------------
* Drug: Golimumab


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Subject must have a diagnosis of axSpA and classified according to ASAS criteria. Subject has at least 3 months and maximum 1 year (almost) daily chronic back pain. Subject has an active disease defined as a positive MRI (according to ASAS definition) or elevated CRP (in patients who are HLA-B27+) and an ASDAS score > 2.1 (at least high disease activity). Exclusion Criteria: Full anti-inflammatory dose of NSAIDs for more than 4 weeks for the duration of the axSpA symptoms. Prior exposure to any biologic therapy with a potential therapeutic impact on SpA, including anti-TNF therapy. Exposure to disease-modifying drugs (DMARDSs; i.e. methotrexate and sulfasalazine) in the last 3 months before the ileocolonoscopy. Exposure to systemic corticosteroid treatment in the last 14 days before the ileocolonoscopy. Infection(s) requiring treatment with intravenous antibiotics/antivirals/antifungals within 30 days prior to the baseline visit or oral antibiotics/antivirals/antifungals within 14 days prior to the baseline visit. Have a known hypersensitivity to human immunoglobulin proteins or other components of golimumab. History of central nervous system (CNS) demyelinating disease or neurologic symptoms suggestive of CNS demyelinating disease. History of listeriosis, histoplasmosis, chronic of active hepatitis B infection, hepatitis C infection, human immunodeficiency virus (HIV) infection, immunodeficiency syndrome, chronic recurring infections or active tuberculosis. Have a history of, or concurrent, chronic heart failure, including medically controlled, asymptomatic congestive heart failure. Evidence of dysplasia or history of malignancy (including lymphoma and leukemia) other than a successfully treated non-metastatic cutaneous squamous cell or basal cell carcinoma or localized carcinoma in situ of the cervix. Have received, or are expected to receive, any live virus or bacterial vaccination within 3 months prior to the first administration of study agent, during the trial, or within 6 months after the last administration of study agent. Positive pregnancy test at screening. Female subjects who are breast-feeding or considering becoming pregnant during the study. Female subjects who do not use contraceptives. History of clinically significant drug or alcohol abuse in the last 12 months. Clinically significant abnormal screening laboratory results as evaluated by the investigator. Positive rheumatoid factor (RF) or anti-cyclic citrullinated peptide (anti-CCP) antibody at screening if the titers are crossing 3 times the upper limit of the normal. Subject with diagnosis and current symptoms of fibromyalgia. Any medical or psychological condition that, in the opinion of the investigator, could jeopardize or compromise the subject's ability to participate in this study.

Ages Eligible for Study
-----------------
Minimum Age: 18 Years
Maximum Age: 46 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Arm 1: Golimumab<br> | Drug: Golimumab<br>* Axial spondyloarthritis patients who don't have a good treatment response on 2 NSAIDs, will be treated with golimumab. After remission, the therapy will be stopped. All patients will undergo a ileocoloscopy at baseline and, if positive, at time of remission.<br>* Other names: ileocoloscopy;|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| clinical remission | Ankylosing Spondylitis Disease Activity Score (ASDAS) < 1.3 | week 16 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| intestinal mucosal healing | evaluated by ileocolonoscopy | week 16 |