Montelukast Use in Rheumatoid Arthritis

Study Overview
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Brief Summary
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Montelukast is widely used in patients with asthma. Several preclinical data suggest that it could be repositioned as novel strategy for managing rheumatic patients by decreasing inflammatory mediators. Considering the probable enhanced antiarthritic effects of montelukast; it could be hypothesized that its adjuvant use might improve treatment outcomes in rheumatic patients who remain poorly controlled despite initial optimal guidelines directed medical treatment. Therefore, this study aims to evaluate the potential added benefits of montelukast use in conjunction with csDMARDs in RA patients with moderate and high disease activity.

Official Title
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Clinical Study Evaluating the Efficacy and Safety of Adjunctive Use of Montelukast in Rheumatoid Arthritis Patients

Conditions
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Rheumatoid Arthritis

Intervention / Treatment
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* Drug: Montelukast
* Drug: Placebo
* Drug: Conventional DMARDs


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adult patients ages ≥ 18 years old. Patients diagnosed with RA according to American College of Rheumatology/European league Against Rheumatism (ACR/ EULAR) 2010 criteria (25) presented with disease activity score-28 based on C-reactive protein (CRP) levels (DAS-28-CRP) >3.2. Patient received stable regimen of one or more csDMARDs for at least the past 3 months. Exclusion Criteria: Patient taking biological DMARDs. Known hypersensitivity to montelukast. Patients receive montelukast for any other indications. Patients with impaired liver functions (liver transaminases level ≥ three times upper normal limits). Patients with impaired kidney (estimated glomerular filtration rate (eGFR) < 30 ml/min). Pregnancy and lactation. Patients with active or severe infections. Patients with other inflammatory or autoimmune diseases and malignancies. Patients with any psychiatric disorder. Patients taking IV, IM, orally (dose > 10 mg daily) or intra articular corticosteroides, Smokers.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Montelukast Group<br>Patients will receive conventional DMARDs plus montelukast 10 mg tablet once daily for 16 weeks. | Drug: Montelukast<br>* Montelukast 10 mg oral tablet once daily for RA patients with moderate to high disease activity provided by DAS-28 score greater than 3.2<br>Drug: Conventional DMARDs<br>* methotrexate, leflunomide, hydroxychloroquine or sulfasalazine<br>|
| Placebo Comparator: Control Group<br>Patients will receive conventional DMARDs plus placebo tablet daily for 16 weeks | Drug: Placebo<br>* Oral tablet once daily<br>Drug: Conventional DMARDs<br>* methotrexate, leflunomide, hydroxychloroquine or sulfasalazine<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Disease activity score in 28 joints (DAS-28) | Scale assessing severity of rheumatoid arthritis based on number of tender , swollen joints , CRP levels ,and patient self-assessment of his condition (global health assessment) . Whereas 28 describes the number of different joints including in the measurement :proximal interphalangeal joints (10 joints),metacarpophalangeal joints (10),wrists (2),elbows (2),shoulders (2),knees (2). A DAS-28 value < 2.6 corresponds to remission,value between 2.6 and 3.2 corresponds to a low disease activity, value between 3.2 and 5.1 corresponds to a moderate disease activity, and DAS28 value >5.1 corresponds to a high disease activity. | 16 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Assessment of patient's QOL using Health Assessment Questionnaire Disability index (HAQ-DI) | It comprises eight categories assessing the ability of patients to perform activities of daily living. Each category includes two or three questions scored from 0 (without any difficulty) to 3 (unable to do). The score of each category is the highest score among the scores of the included questions. If an aid or assistance device is used or if help is required from another individual, then the minimum score for that section is 2. The final score is calculated by summation of the scores for various categories divided by the number of categories. Resulting in a score from 0 to 3. | 16 weeks |