Capability of Tofacitinib or Etanercept to Accelerate Tapering of NSAID and Treat-to-target Guided De-escalation of Corticosteroids in RA Patients

Study Overview
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Brief Summary
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Patients with active rheumatic arthritis (RA) and lack of efficacy of at least one csDMARD (Disease-modifying anti-rheumatic drug) treatment will be randomized to receive either Tofacitinib (TOFA) or etanercept (ETA). The study will be separated into two parts: The capability to decrease and discontinue pain-reducing treatment with a NSAID (non-steroidal anti-inflammatory drug) over the first 12 weeks of treatment will be measured for primary outcome measured using a visual analogue scale (VAS) at week 12 compared to baseline between the two treatment groups. Starting at week 12, the capability to taper corticosteroid (CS) treatment using a treat-to-target strategy, i.e. when at least low disease activity (LDA-DAS28) is achieved, will be measured in both groups.

Detailed Description
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In this clinical study, a design was chosen to reflect European standards recommended by EULAR for treatment of active RA by comparison of a Treat-to- target (T2T) approach in two treatment groups: Patients with active RA and lack of efficacy of at least one csDMARD treatment will be randomized to receive either TOFA or ETA. The study will be separated into two parts: The capability to decrease and discontinue pain-reducing treatment with a NSAID (Celecoxib, two times 200 mg as maximum standard dosage for RA) over the first 12 weeks of treatment will be measured for primary outcome. The proportion of patients with successful discontinuation of Celecoxib and significant and clinical relevant decrease of pain-levels measured using a visual analogue scale (VAS) with a reduction of at least 30% at week 12 compared to baseline will be compared between the two treatment groups. Starting at week 12, the capability to taper CS treatment using a treat-to-target strategy, i.e. when at least low disease activity (LDA-DAS28) is achieved, will be measured in both groups. In addition to efficacy assessments (DAS28, ACR-response, SJC, TJC), patient reported outcomes, Quality of Life (QoL) measurements and patient satisfaction will be evaluated. Safety (severity and frequency of adverse events) will be evaluated over the 24-week treatment period.

Official Title
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Capability of Tofacitinib or Etanercept to Accelerate Clinical Relevant Tapering of Non-steroidal Anti-inflammatory Drugs (NSAID) and Treat-to-target Guided De-escalation of Corticosteroids in Patients With Active Rheumatoid Arthritis (RA) and an Inadequate Response to Previous csDMARD Therapy (AcceleRAte)

Conditions
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Rheumatic Arthritis

Intervention / Treatment
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* Drug: Tofacitinib
* Biological: Etanercept


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients with active RA and an inadequate response to up to two previous conventional synthetic Disease modifying anti-rheumatic drug (csDMARD) treatments (methotrexate (MTX), leflunomide (LEF),sulfasalazine (SSZ)) with or without ongoing csDMARD therapy RA according to ACR classification criteria Age 18 - 65 years Active RA is defined as DAS28 > 3.2 and TJC ≥ 3 and SJC ≥ 3 VAS-pain ≥ 60 mm (0-100 mm) Accompanying CS treatment for RA with a stable dosage of ≥ 2mg/d and ≤ 10 mg/d 2 weeks prior to BL (not more than 30% of patients without CS) Accompanying need of NSAID or analgesic treatment due to arthritis and in dosages not exceeding the maximum dose according to Summary of Product characteristics (SmPC) If ongoing csDMARD treatment, stable treatment will be defined as either MTX treatment with a dosage of ≥ 10 mg/week and ≤ 25 mg/week, continuously for at least 12 weeks prior to Screening (SCR) with a stable dose of MTX for at least 2 weeks prior to BL or LEF treatment with a dosage between 10 to 20 mg/day, continuously for at least 12 weeks prior to SCR with a stable dose of LEF for at least 2 weeks prior to BL or SSZ treatment with dosage between 1 to 3 g/day, continuously for at least 12 weeks prior to SCR with a stable dose of SSZ for at least 2 weeks prior to BL Presence of documented negative results for testing of Hepatitis B and C Completed SARS-CoV-2-immunisation as currently recommended by the Standing Committee of Vaccination Written informed consent obtained prior to the initiation of any protocol-required procedures Willingness to comply to study procedures and study protocol Exclusion Criteria: Previous use of Tofacitinib or other Janus-Kinase (JAK)-inhibitors Previous use of Etanercept Previous use of any biological agent for RA which was stopped due to lack of efficacy one previous use of biological stopped due to intolerance will be allowed CS treatment with dosages >10 mg at BL Known hypersensitivity to any component of the study medication (TOFA, ETA, Celecoxib) Previous use of Celecoxib as analgesic therapy which was stopped due to lack of efficacy or intolerance Concomitant diseases with chronic pain syndrome or need of extended dosages or long-term treatment with the maximum dosages of NSAID/analgesics (according to SmPC) due to other concomitant diseases/pain symptoms in discretion of the treating physician Exclusion criteria related to general health Patients with other chronic inflammatory articular disease or systemic autoimmune disease Patients with active Tuberculosis (Tb) (evaluation of Tb according to local standards in clinical care) Patients with latent Tb, that are not pre-treated for at least 1 month and planned to be treated 9 months in total with Isozid once a day Any active infection, a history of recurrent clinically significant infections (e.g. human immune deficiency virus (HIV)), or a history of recurrent bacterial infections with encapsulated organisms Primary or secondary immunodeficiency Current malignancy or history of malignancies except adequately treated or excised basal cell or squamous cell carcinoma or cervical carcinoma in situ. Patients of 50 years and older, if they have one or more cardiovascular risk factors (CVRF) defined as: Current cigarette smoking, Known diagnosis of hypertension, HDL <40 mg/dl, Diabetes mellitus, History of coronary artery disease: history of revascularization procedure, coronary artery bypass grafting, myocardial infarction, cardiac arrest, unstable angina, acute coronary syndrome or History of premature coronary heart disease or sudden death documented in first degree relatives (male relative before 55 years, female relative before 65 years) Evidence of significant uncontrolled concomitant diseases or serious and/or uncontrolled diseases that are likely to interfere with the evaluation of the patient's safety and with the study outcome History of a severe psychological illness or condition Known hypersensitivity to sulfonamides Active peptic ulceration or gastrointestinal (GI) bleeding Patients who have experienced asthma, acute rhinitis, nasal polyps, angioneurotic oedema, urticaria or other allergic-type reactions after taking acetylsalicylic acid (aspirin) or other NSAIDs including Cyclooxigenase (COX)-2 inhibitors Risk for or history of thrombotic events (e.g. pulmonary embolism or thrombosis) Severe hepatic dysfunction (serum albumin < 25 g/L or Child-Pugh score ≥ 10) Patients with estimated creatinine clearance < 30 mL/min Inflammatory bowel disease Congestive heart failure (New York Heart Association (NYHA) II-IV) Established ischaemic heart disease, peripheral arterial disease and/or cerebrovascular disease Women lactating, pregnant, nursing or of childbearing potential with a positive pregnancy test Males or females of reproductive potential not willing to use effective contraception (e.g. contraceptive pill, intrauterine device (IUD), physical barrier) Alcohol, drug or chemical abuse Exclusion criteria related to prior treatments Current participation in another interventional clinical trial or participation within the last 90 days Exclusion criteria related to formal aspects Underage or incapable patients

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 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
Interventional Model Description: two arm, randomized, open-label, parallel group
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Tofacitinib<br>Tofacitinib (Xeljanz®; 5 mg twice daily, p.o.) | Drug: Tofacitinib<br>* 5 mg twice daily, p.o.<br>* Other names: TOFA, Xeljanz;|
| Active Comparator: Etanercept<br>Etanercept (Enbrel®; 50 mg once per week, s.c.) | Biological: Etanercept<br>* 50 mg once per week, s.c.<br>* Other names: Enbrel, ETA;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Discontinuation of Celecoxib treatment and clinically relevant improvement in pain | Proportion of patients who can discontinue Celecoxib treatment and in whom clinically relevant improvement in pain levels are measured, defined as reduction in VAS pain of ≥ 30% | Baseline to week 12 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mean dosage of Celecoxib in patients | Mean dosage of Celecoxib in patients | at 12 weeks | 
| discontinuation of CS-treatment | Proportion of patients with discontinuation of CS-treatment at week 24 | at week 24 | 
| rescue treatment | Proportion of patients who require rescue treatment at week 12 | at week 12 | 
| Mean dosage of Corticosteroids (CS) in the patients who achieve Low Disease activity (LDA) in the two treatment groups | Mean dosage of CS in the patients who achieve LDA at week 24 in the two treatment groups | at week 24 | 
| Mean dosage of Corticosteroids (CS) | Mean dosage of CS at week 24 (W24) | at week 24 | 
| NSAID treatment | Number of patients with NSAID treatment at W24 | at week 24 | 
| re-started NSAID treatment | Proportion of patients who re-started NSAID treatment after week 12 (W12) until W24 | week 12 to week 24 | 
| Absolute pain levels | Absolute pain levels measured by visual analogue scale (VAS). minimum is 0 mm, maximum is 100 mm whereas 0 is no pain and 100 is worst | at week 2 | 
| Absolute pain levels | Absolute pain levels measured by visual analogue scale (VAS). minimum is 0 mm, maximum is 100 mm whereas 0 is no pain and 100 is worst | at week 4 | 
| Absolute pain levels | Absolute pain levels measured by visual analogue scale (VAS). minimum is 0 mm, maximum is 100 mm whereas 0 is no pain and 100 is worst | at week 8 | 
| Absolute pain levels | Absolute pain levels measured by visual analogue scale (VAS). minimum is 0 mm, maximum is 100 mm whereas 0 is no pain and 100 is worst | at week 12 | 
| Absolute pain levels | Absolute pain levels measured by visual analogue scale (VAS). minimum is 0 mm, maximum is 100 mm whereas 0 is no pain and 100 is worst | at week 16 | 
| Absolute pain levels | Absolute pain levels measured by visual analogue scale (VAS). minimum is 0 mm, maximum is 100 mm whereas 0 is no pain and 100 is worst | at week 20 | 
| Absolute pain levels | Absolute pain levels measured by visual analogue scale (VAS). minimum is 0 mm, maximum is 100 mm whereas 0 is no pain and 100 is worst | at week 24 | 
| relative (percent) pain levels | relative (percent) pain levels measured by visual analogue scale (VAS). minimum is 0 mm, maximum is 100 mm whereas 0 is no pain and 100 is worst | at week 2 | 
| relative (percent) pain levels | relative (percent) pain levels measured by visual analogue scale (VAS). minimum is 0 mm, maximum is 100 mm whereas 0 is no pain and 100 is worst | at week 4 | 
| relative (percent) pain levels | relative (percent) pain levels measured by visual analogue scale (VAS). minimum is 0 mm, maximum is 100 mm whereas 0 is no pain and 100 is worst | at week 8 | 
| relative (percent) pain levels | relative (percent) pain levels measured by visual analogue scale (VAS). minimum is 0 mm, maximum is 100 mm whereas 0 is no pain and 100 is worst | at week 12 | 
| relative (percent) pain levels | relative (percent) pain levels measured by visual analogue scale (VAS). minimum is 0 mm, maximum is 100 mm whereas 0 is no pain and 100 is worst | at week 16 | 
| relative (percent) pain levels | relative (percent) pain levels measured by visual analogue scale (VAS). minimum is 0 mm, maximum is 100 mm whereas 0 is no pain and 100 is worst | at week 20 | 
| relative (percent) pain levels | relative (percent) pain levels measured by visual analogue scale (VAS). minimum is 0 mm, maximum is 100 mm whereas 0 is no pain and 100 is worst | at week 24 | 
| Change in pain levels | Change in pain levels measured by visual analogue scale (VAS) compared to BL. minimum is 0 mm, maximum is 100 mm whereas 0 is no pain and 100 is worst | at week 2 | 
| Change in pain levels | Change in pain levels visual analogue scale (VAS) compared to BL. minimum is 0 mm, maximum is 100 mm whereas 0 is no pain and 100 is worst | at week 4 | 
| Change in pain levels | Change in pain levels visual analogue scale (VAS) compared to BL. minimum is 0 mm, maximum is 100 mm whereas 0 is no pain and 100 is worst | at week 8 | 
| Change in pain levels | Change in pain levels visual analogue scale (VAS) compared to BL. minimum is 0 mm, maximum is 100 mm whereas 0 is no pain and 100 is worst | at week 12 | 
| Change in pain levels | Change in pain levels visual analogue scale (VAS) compared to BL. minimum is 0 mm, maximum is 100 mm whereas 0 is no pain and 100 is worst | at week 16 | 
| Change in pain levels | Change in pain levels visual analogue scale (VAS) compared to BL. minimum is 0 mm, maximum is 100 mm whereas 0 is no pain and 100 is worst | at week 20 | 
| Change in pain levels | Change in pain levels visual analogue scale (VAS) compared to BL. minimum is 0 mm, maximum is 100 mm whereas 0 is no pain and 100 is worst | at week 24 | 
| Determination of flares | Determination of flares (measured by FLARE questionnaire) between week 12 and week 24 | between week 12 and week 24 | 
| Proportion of LDA | Proportion of patients who achieve LDA (Disease Activity Score 28 (DAS28) calculated by Erythrocyte sediment rate (ESR) (DAS28 (ESR) ≤ 3.2) | at week 4 | 
| Proportion of LDA | Proportion of patients who achieve LDA (Disease Activity Score 28 (DAS28) calculated by Erythrocyte sediment rate (ESR) (DAS28 (ESR) ≤ 3.2) | at week 12 | 
| Proportion of LDA | Proportion of patients who achieve LDA (Disease Activity Score 28 (DAS28) calculated by Erythrocyte sediment rate (ESR) (DAS28 (ESR) ≤ 3.2) | at week 16 | 
| Proportion of LDA | Proportion of patients who achieve LDA (Disease Activity Score 28 (DAS28) calculated by Erythrocyte sediment rate (ESR) (DAS28 (ESR) ≤ 3.2) | at week 20 | 
| Proportion of LDA | Proportion of patients who achieve LDA (Disease Activity Score 28 (DAS28) calculated by Erythrocyte sediment rate (ESR) (DAS28 (ESR) ≤ 3.2) | at week 24 | 
| Proportion of DAS remission | Proportion of patients who achieve DASremission (Disease Activity Score 28 (DAS28) calculated by Erythrocyte sediment rate (ESR) DAS28 (ESR) ≤ 2.6) | at week 4 | 
| Proportion of DAS remission | Proportion of patients who achieve DASremission (Disease Activity Score 28 (DAS28) calculated by Erythrocyte sediment rate (ESR) DAS28 (ESR) ≤ 2.6) | at week 12 | 
| Proportion of DAS remission | Proportion of patients who achieve DASremission (Disease Activity Score 28 (DAS28) calculated by Erythrocyte sediment rate (ESR) DAS28 (ESR) ≤ 2.6) | at week 16 | 
| Proportion of DAS remission | Proportion of patients who achieve DASremission (Disease Activity Score 28 (DAS28) calculated by Erythrocyte sediment rate (ESR) DAS28 (ESR) ≤ 2.6) | at week 20 | 
| Proportion of DAS remission | Proportion of patients who achieve DASremission (Disease Activity Score 28 (DAS28) calculated by Erythrocyte sediment rate (ESR) DAS28 (ESR) ≤ 2.6) | at week 24 | 
| Proportion of ACR20 response | Proportion of patients who achieve ACR20 response - measure based on American College of Rheumatology (ACR) criteria improvement of at least 20% | at week 4 | 
| Proportion of ACR20 response | Proportion of patients who achieve ACR20 response - measure based on American College of Rheumatology (ACR) criteria improvement of at least 20% | at week 12 | 
| Proportion of ACR20 response | Proportion of patients who achieve ACR20 response - measure based on American College of Rheumatology (ACR) criteria improvement of at least 20% | at week 16 | 
| Proportion of ACR20 response | Proportion of patients who achieve ACR20 response - measure based on American College of Rheumatology (ACR) criteria improvement of at least 20% | at week 20 | 
| Proportion of ACR20 response | Proportion of patients who achieve ACR20 response - measure based on American College of Rheumatology (ACR) criteria improvement of at least 20% | at week 24 | 
| Proportion of ACR 50 response | Proportion of patients who achieve ACR50 response - measure based on American College of Rheumatology (ACR) criteria improvement of at least 50% | at week 4 | 
| Proportion of ACR 50 response | Proportion of patients who achieve ACR50 response - measure based on American College of Rheumatology (ACR) criteria improvement of at least 50% | at week 12 | 
| Proportion of ACR 50 response | Proportion of patients who achieve ACR50 response - measure based on American College of Rheumatology (ACR) criteria improvement of at least 50% | at week 16 | 
| Proportion of ACR 50 response | Proportion of patients who achieve ACR50 response - measure based on American College of Rheumatology (ACR) criteria improvement of at least 50% | at week 20 | 
| Proportion of ACR 50 response | Proportion of patients who achieve ACR50 response - measure based on American College of Rheumatology (ACR) criteria improvement of at least 50% | at week 24 | 
| Proportion of ACR 70 response | Proportion of patients who achieve ACR70 response - measure based on American College of Rheumatology (ACR) criteria improvement of at least 70% | at week 4 | 
| Proportion of ACR 70 response | Proportion of patients who achieve ACR70 response - measure based on American College of Rheumatology (ACR) criteria improvement of at least 70% | at week 12 | 
| Proportion of ACR 70 response | Proportion of patients who achieve ACR70 response - measure based on American College of Rheumatology (ACR) criteria improvement of at least 70% | at week 16 | 
| Proportion of ACR 70 response | Proportion of patients who achieve ACR70 response - measure based on American College of Rheumatology (ACR) criteria improvement of at least 70% | at week 20 | 
| Proportion of ACR 70 response | Proportion of patients who achieve ACR70 response - measure based on American College of Rheumatology (ACR) criteria improvement of at least 70% | at week 24 | 
| Changes in ACR core set | Changes in ACR core set | at baseline | 
| Changes in ACR core set | Changes in ACR core set | at week 4 | 
| Changes in ACR core set | Changes in ACR core set | at week 12 | 
| Changes in ACR core set | Changes in ACR core set | at week 16 | 
| Changes in ACR core set | Changes in ACR core set | at week 20 | 
| Changes in ACR core set | Changes in ACR core set change | at week 24 | 
| DAS28 (ESR) | DAS28 (ESR) change compared to BL | at baseline | 
| DAS28 (ESR) | DAS28 (ESR) change compared to BL | at week 4 | 
| DAS28 (ESR) | DAS28 (ESR) change compared to BL | at week 12 | 
| DAS28 (ESR) | DAS28 (ESR) change compared to BL | at week 16 | 
| DAS28 (ESR) | DAS28 (ESR) change compared to BL | at week 20 | 
| DAS28 (ESR) | DAS28 (ESR) change compared to BL | at week 24 | 
| SJC (66), | Swollen joint count (66 joints) change compared to BL | at baseline | 
| SJC (66), | Swollen joint count (66 joints) change compared to BL | at week 4 | 
| SJC (66), | Swollen joint count (66 joints) change compared to BL | at week 12 | 
| SJC (66), | Swollen joint count (66 joints) change compared to BL | at week 16 | 
| SJC (66), | Swollen joint count (66 joints) change compared to BL | at week 20 | 
| SJC (66), | Swollen joint count (SJC) (66 joints) change compared to BL | at week 24 | 
| TJC (68) | tender joint count (TJC) - 68 joints change compared to BL | at baseline | 
| TJC (68) | tender joint count (TJC) - 68 joints change compared to BL | at week 4 | 
| TJC (68) | tender joint count (TJC) - 68 joints change compared to BL | at week 12 | 
| TJC (68) | tender joint count (TJC) - 68 joints change compared to BL | at week 16 | 
| TJC (68) | tender joint count (TJC) - 68 joints change compared to BL | at week 20 | 
| TJC (68) | tender joint count (TJC) - 68 joints change compared to BL | at week 24 | 
| Quality of Life: SF36 (36 items short form health survey) | Quality of Life: SF36 scores | at baseline | 
| Quality of Life: SF36 (36 items short form health survey) | Quality of Life: SF36 scores.SF36 is a 36 items short form health survey and consists of eight scaled scores, which are the weighted sums of the questions in their section. Each scale is directly transformed into a 0-100 scale on the assumption that each question carries equal weight. The lower the score the more disability. The higher the score the less disability i.e., a score of zero is equivalent to maximum disability and a score of 100 is equivalent to no disability. | at week 4 | 
| Change in Quality of Life: SF36 (36 items short form health survey) | Quality of Life: SF36 change to BL. SF36 is a 36 items short form health survey and consists of eight scaled scores, which are the weighted sums of the questions in their section. Each scale is directly transformed into a 0-100 scale on the assumption that each question carries equal weight. The lower the score the more disability. The higher the score the less disability i.e., a score of zero is equivalent to maximum disability and a score of 100 is equivalent to no disability. | at week 4 | 
| Quality of Life: SF36 (36 items short form health survey) | Quality of Life: SF36 scores. SF36 is a 36 items short form health survey and consists of eight scaled scores, which are the weighted sums of the questions in their section. Each scale is directly transformed into a 0-100 scale on the assumption that each question carries equal weight. The lower the score the more disability. The higher the score the less disability i.e., a score of zero is equivalent to maximum disability and a score of 100 is equivalent to no disability. | at week 12 | 
| Change in Quality of Life: SF36 (36 items short form health survey) | Quality of Life: SF36 change to BL. SF36 is a 36 items short form health survey and consists of eight scaled scores, which are the weighted sums of the questions in their section. Each scale is directly transformed into a 0-100 scale on the assumption that each question carries equal weight. The lower the score the more disability. The higher the score the less disability i.e., a score of zero is equivalent to maximum disability and a score of 100 is equivalent to no disability. | at week 12 | 
| Quality of Life: SF36 (36 items short form health survey) | Quality of Life: SF36 scores. SF36 is a 36 items short form health survey and consists of eight scaled scores, which are the weighted sums of the questions in their section. Each scale is directly transformed into a 0-100 scale on the assumption that each question carries equal weight. The lower the score the more disability. The higher the score the less disability i.e., a score of zero is equivalent to maximum disability and a score of 100 is equivalent to no disability. | at week 16 | 
| Change in Quality of Life: SF36 (36 items short form health survey) | Quality of Life: SF36 change to BL. SF36 is a 36 items short form health survey and consists of eight scaled scores, which are the weighted sums of the questions in their section. Each scale is directly transformed into a 0-100 scale on the assumption that each question carries equal weight. The lower the score the more disability. The higher the score the less disability i.e., a score of zero is equivalent to maximum disability and a score of 100 is equivalent to no disability. | at week 16 | 
| Quality of Life: SF36 (36 items short form health survey) | Quality of Life: SF36 scores. SF36 is a 36 items short form health survey and consists of eight scaled scores, which are the weighted sums of the questions in their section. Each scale is directly transformed into a 0-100 scale on the assumption that each question carries equal weight. The lower the score the more disability. The higher the score the less disability i.e., a score of zero is equivalent to maximum disability and a score of 100 is equivalent to no disability. | at week 20 | 
| Change in Quality of Life: SF36 (36 items short form health survey) | Quality of Life: SF36 change to BL. SF36 is a 36 items short form health survey and consists of eight scaled scores, which are the weighted sums of the questions in their section. Each scale is directly transformed into a 0-100 scale on the assumption that each question carries equal weight. The lower the score the more disability. The higher the score the less disability i.e., a score of zero is equivalent to maximum disability and a score of 100 is equivalent to no disability. | at week 20 | 
| Quality of Life: SF36 (36 items short form health survey) | Quality of Life: SF36 scores. SF36 is a 36 items short form health survey and consists of eight scaled scores, which are the weighted sums of the questions in their section. Each scale is directly transformed into a 0-100 scale on the assumption that each question carries equal weight. The lower the score the more disability. The higher the score the less disability i.e., a score of zero is equivalent to maximum disability and a score of 100 is equivalent to no disability. | at week 24 | 
| Change in Quality of Life: SF36 (36 items short form health survey) | Quality of Life: SF36 change to BL. SF36 is a 36 items short form health survey and consists of eight scaled scores, which are the weighted sums of the questions in their section. Each scale is directly transformed into a 0-100 scale on the assumption that each question carries equal weight. The lower the score the more disability. The higher the score the less disability i.e., a score of zero is equivalent to maximum disability and a score of 100 is equivalent to no disability. | at week 24 | 
| Quality of Life HAQ-DI (health assessment questionnaire - disability index) | Quality of Life HAQ-DI scores The HAQ-DI is a health assessment questionnaire - disability index that consists of 8 subcategories. For each the single scales range from 0 (no difficulty) to 3 (unable to do). | at baseline | 
| Quality of Life HAQ-DI (health assessment questionnaire - disability index) | Quality of Life HAQ-DI scores. The HAQ-DI is a health assessment questionnaire - disability index that consists of 8 subcategories. For each the single scales range from 0 (no difficulty) to 3 (unable to do). | at week 4 | 
| Change in Quality of Life HAQ-DI (health assessment questionnaire - disability index) | Quality of Life HAQ-DI change to BL. The HAQ-DI is a health assessment questionnaire - disability index that consists of 8 subcategories. For each the single scales range from 0 (no difficulty) to 3 (unable to do). | at week 4 | 
| Quality of Life HAQ-DI (health assessment questionnaire - disability index) | Quality of Life HAQ-DI scores. The HAQ-DI is a health assessment questionnaire - disability index that consists of 8 subcategories. For each the single scales range from 0 (no difficulty) to 3 (unable to do). | at week 12 | 
| Change of Quality of Life HAQ-DI (health assessment questionnaire - disability index) | Quality of Life HAQ-DI change to BL. The HAQ-DI is a health assessment questionnaire - disability index that consists of 8 subcategories. For each the single scales range from 0 (no difficulty) to 3 (unable to do). | at week 12 | 
| Quality of Life HAQ-DI (health assessment questionnaire - disability index) | Quality of Life HAQ-DI scores. The HAQ-DI is a health assessment questionnaire - disability index that consists of 8 subcategories. For each the single scales range from 0 (no difficulty) to 3 (unable to do). | at week 16 | 
| Change of Quality of Life HAQ-DI (health assessment questionnaire - disability index) | Quality of Life HAQ-DI change to BL. The HAQ-DI is a health assessment questionnaire - disability index that consists of 8 subcategories. For each the single scales range from 0 (no difficulty) to 3 (unable to do). | at week 16 | 
| Quality of Life HAQ-DI (health assessment questionnaire - disability index) | Quality of Life HAQ-DI scores.The HAQ-DI is a health assessment questionnaire - disability index that consists of 8 subcategories. For each the single scales range from 0 (no difficulty) to 3 (unable to do). | at week 20 | 
| Change of Quality of Life HAQ-DI (health assessment questionnaire - disability index) | Quality of Life HAQ-DI change to BL. The HAQ-DI is a health assessment questionnaire - disability index that consists of 8 subcategories. For each the single scales range from 0 (no difficulty) to 3 (unable to do). | at week 20 | 
| Quality of Life HAQ-DI (health assessment questionnaire - disability index) | Quality of Life HAQ-DI scores. The HAQ-DI is a health assessment questionnaire - disability index that consists of 8 subcategories. For each the single scales range from 0 (no difficulty) to 3 (unable to do). | at week 24 | 
| Change of Quality of Life HAQ-DI (health assessment questionnaire - disability index) | Quality of Life HAQ-DI change to BL. The HAQ-DI is a health assessment questionnaire - disability index that consists of 8 subcategories. For each the single scales range from 0 (no difficulty) to 3 (unable to do). | at week 24 | 
| Correlation of SF36 and HAQ-DI results | Correlation of SF36 and HAQ-DI results. The HAQ-DI is a health assessment questionnaire - disability index that consists of 8 subcategories. For each the single scales range from 0 (no difficulty) to 3 (unable to do). SF36 is a 36 items short form health survey and consists of eight scaled scores, which are the weighted sums of the questions in their section. Each scale is directly transformed into a 0-100 scale on the assumption that each question carries equal weight. The lower the score the more disability. The higher the score the less disability i.e., a score of zero is equivalent to maximum disability and a score of 100 is equivalent to no disability. | through study completion, an average of 24 weeks | 
| Treatment satisfaction: TSQM-14 scores | Treatment Satisfaction Questionnaire for Medication (TSQM-14) scores. The TSQM items are answered on 5- or 7-point Likert type scale and cover four domains: effectiveness; side effects; convenience and global satisfaction. A score can be obtained for each domain by summing of the corresponding items transformed on a 0-100 scale; higher values indicate higher satisfaction, better perceived effectiveness, lower burden associated to side-effects, better convenience. | at week 4 | 
| Treatment satisfaction: TSQM-14 scores | Treatment Satisfaction Questionnaire for Medication (TSQM-14) scores. The TSQM items are answered on 5- or 7-point Likert type scale and cover four domains: effectiveness; side effects; convenience and global satisfaction. A score can be obtained for each domain by summing of the corresponding items transformed on a 0-100 scale; higher values indicate higher satisfaction, better perceived effectiveness, lower burden associated to side-effects, better convenience. | at week 12 | 
| Treatment satisfaction: TSQM-14 scores | Treatment Satisfaction Questionnaire for Medication (TSQM-14) scores. The TSQM items are answered on 5- or 7-point Likert type scale and cover four domains: effectiveness; side effects; convenience and global satisfaction. A score can be obtained for each domain by summing of the corresponding items transformed on a 0-100 scale; higher values indicate higher satisfaction, better perceived effectiveness, lower burden associated to side-effects, better convenience. | at week 16 | 
| Treatment satisfaction: TSQM-14 scores | Treatment Satisfaction Questionnaire for Medication (TSQM-14) scores. The TSQM items are answered on 5- or 7-point Likert type scale and cover four domains: effectiveness; side effects; convenience and global satisfaction. A score can be obtained for each domain by summing of the corresponding items transformed on a 0-100 scale; higher values indicate higher satisfaction, better perceived effectiveness, lower burden associated to side-effects, better convenience. | at week 24 | 
| Patient's expectation on treatment | Patient's expectation on treatment asked and documented as free text | at baseline | 
| Patient's expectation on treatment | Patient's expectation on treatment asked and documented as free text | at week 12 | 
| Patient's expectation on treatment | Patient's expectation on treatment asked and documented as free text | at week 24 | 
| Correlation of TSQM-14 results and patient's expectation on treatment | Correlation of TSQM-14 results and patient's expectation on treatment | through study completion, an average of 24 weeks | 
| drug accountability | Evaluation of results of treatment adherence (drug accountability) using patient diary | at week 4 | 
| drug accountability | Evaluation of results of treatment adherence (drug accountability) using patient diary | at week 12 | 
| drug accountability | Evaluation of results of treatment adherence (drug accountability) using patient diary | at week 16 | 
| drug accountability | Evaluation of results of treatment adherence (drug accountability) using patient diary | at week 20 | 
| drug accountability | Evaluation of results of treatment adherence (drug accountability) using patient diary | at week 24 | 
| eGFR (estimated glomerular filtration rate) | eGFR value | at baseline | 
| eGFR (estimated glomerular filtration rate) | eGFR value | at week 4 | 
| change in eGFR (estimated glomerular filtration rate) | eGFR change to BL | at week 4 | 
| eGFR (estimated glomerular filtration rate) | eGFR value | at week 12 | 
| change in eGFR (estimated glomerular filtration rate) | eGFR change to BL | at week 12 | 
| change in eGFR (estimated glomerular filtration rate) | eGFR change to BL | at week 16 | 
| eGFR (estimated glomerular filtration rate) | eGFR value | at week 16 | 
| change in eGFR (estimated glomerular filtration rate) | eGFR change to BL | at week 20 | 
| eGFR (estimated glomerular filtration rate) | eGFR value | at week 24 | 
| change in eGFR (estimated glomerular filtration rate) | eGFR change to BL | at week 24 | 
| blood pressure (mmHg) | blood pressure (mmHg) Systolic or Diastolic Blood Pressure | at baseline | 
| blood pressure (mmHg) | blood pressure (mmHg) Systolic or Diastolic Blood Pressure | at week 4 | 
| change in blood pressure (mmHg) | blood pressure (mmHg) Systolic or Diastolic Blood Pressure change to BL | at week 4 | 
| blood pressure (mmHg) | blood pressure (mmHg) Systolic or Diastolic Blood Pressure | at week 12 | 
| change in blood pressure (mmHg) | blood pressure (mmHg) Systolic or Diastolic Blood Pressure change to BL | at week 12 | 
| blood pressure (mmHg) | blood pressure (mmHg) Systolic or Diastolic Blood Pressure | at week 16 | 
| change in blood pressure (mmHg) | blood pressure (mmHg) Systolic or Diastolic Blood Pressure change to BL | at week 16 | 
| blood pressure (mmHg) | blood pressure (mmHg) Systolic or Diastolic Blood Pressure | at week 20 | 
| change in blood pressure (mmHg) | blood pressure (mmHg) Systolic or Diastolic Blood Pressure change to BL | at week 20 | 
| blood pressure (mmHg) | blood pressure (mmHg) Systolic or Diastolic Blood Pressure | at week 24 | 
| change in blood pressure (mmHg) | blood pressure (mmHg) Systolic or Diastolic Blood Pressure change to BL | at week 24 | 
| pain characteristics measured by QST (quantitative sensory testing) | Correlation of pain characteristics measured by QST, VAS pain and pain relief | at Baseline | 
| pain characteristics measured by QST (quantitative sensory testing) | Correlation of pain characteristics measured by QST, VAS pain and pain relief | at week 4 | 
| pain characteristics measured by QST (quantitative sensory testing) | Correlation of pain characteristics measured by QST, VAS pain and pain relief | at week 8 | 
| pain characteristics measured by QST (quantitative sensory testing) | Correlation of pain characteristics measured by QST, VAS pain and pain relief | at week 12 | 
| pain characteristics measured by QST (quantitative sensory testing) | Correlation of pain characteristics measured by QST, VAS pain and pain relief | at week 24 | 
| adverse events (AEs) | Documentation of type, frequency and seriousness of adverse events (AEs) | through study completion, an average of 24 weeks | 
| Infections | Incidence rates of serious infection events (SIEs), | through study completion, an average of 24 weeks | 
| Documentation of all lab abnormalities | incidence rates of lab abnormalities | through study completion, an average of 24 weeks | 
| Cardiovascular events | incidence rates of cardio vascular events | through study completion, an average of 24 weeks | 
| Malignencies | incidence rates of malignancies | through study completion, an average of 24 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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treat-to-target, pain