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

Study Overview
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Brief Summary
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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.

Detailed Description
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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).

Official Title
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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

Conditions
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Adult-Onset Still's Disease

Intervention / Treatment
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* Drug: anakinra
* Drug: comparators


Participation Criteria
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Eligibility Criteria
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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.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Anakinra<br>experimental drug of study | Drug: anakinra<br>* 100 mg subcutaneous injection daily<br>* Other names: Interleukin-1 receptor antagonist;|
| Active Comparator: comparator<br>comparators:methotrexate, azathioprine, leflunomide or supfasalazine | Drug: comparators<br>* po drugs, comparators<br>* Other names: methotrexate, azathioprine, leflunomide, sufalalazine;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 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 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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adult-onset Still's disease, anakinra, prednisolone, disease-modifying antirheumatic drug, methotrexate, efficacy, patients