A 6-Months Infliximab Or Placebo Study In UA At High Risk Of RA:Clinical,Radiological And Synovial Benefit

Study Overview
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Brief Summary
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Patient with undifferentiated arthritis and the presence of anti-citruline (anti-CCP) antibodies are at high risk to develop RA. The presence of anti-CCP is associated with a higher rate of erosion and a higher risk of progressive and severe RA. The investigators have demonstrated in the CIERA study that MTX/IFX combination therapy is superior to MTX alone to reduce MRI signs of synovitis and bone edema and is clinically more effective. The immunopathogenesis of undifferentiated arthritis is poorly understood. However, synovial studies from patients with early arthritis suggest that UA and RA may share common immunopathogenic mechanisms. One biopsy study of asymptomatic joints in patients with early arthritis demonstrates synovitis in more than half of the joints samples with prominent T cell and macrophage infiltration, similar to Rheumatoid Arthritis (RA). Thus intensive treatment with anti-TNF antibodies (infliximab) may have an impact on multiple immune mechanisms driving synovitis in undifferentiated arthritis and may influence the clinical outcome. Recently, Methotrexate has been demonstrated to improve the course of undifferentiated arthritis and prevent the development of RA. Short regimen of more intensive therapy with Infliximab could alter the radiological, immunopathological and clinical outcome.

Detailed Description
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not necessary

Official Title
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A Comparative Study Of A 6-Month Infliximab (Remicade®) Or Placebo Regimen In Undifferentiated Arthritis At High Risk For The Development Of Rheumatoid Arthritis (RA) : Clinical, Radiological (MRI) And Synovial Benefit P1200/001.

Conditions
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Undifferentiated Arthritis

Intervention / Treatment
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* Drug: Infliximab
* Drug: sodium chloride


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Diagnosis of UA Absence of American College of Rheumatology (ACR) criteria Active UA defined by a swollen joint count ≥ 1 and < 4 Positive anti-CCP Disease duration < 2 years DMARDs naive No chronic treatment with steroids (> 3 months), if needed washout of 4 weeks NSAIDs stable Exclusion Criteria: Other rheumatic inflammatory diagnosis Contraindication to MRI (pace-maker, etc.) Congestive heart disease Active or latent tuberculosis
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: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Infliximab<br>Group I: Infliximab 3 mg/kg wk 0,2,6 | Drug: Infliximab<br>* Infliximab 3 mg/kg wk 0,2,6<br>* Other names: FR-BR7794;|
| Placebo Comparator: sodium chloride<br>RA 1 solution for infusion, intravenous use Sterile normal saline 0.9% sodium chloride | Drug: sodium chloride<br>* Group II : Placebo wk 0,2,6<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Primary objective To compare the induction therapy with infliximab versus placebo on the MRI synovitis and erosion score in undifferentiated arthritis. | not necessary | 2 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| To test the hypothesis that induction therapy with infliximab is followed by a better clinical outcome over a 2 year follow-up and defined as a lower rate of patients with ACR criteria at 6, 12 and 24 months. | no necessary | 2 years | 
| To assess the effects of infliximab on synovial histopathology of UA. | no necessary | 2 years | 
| To test the hypothesis that infliximab can influence the presence of anti CCP antibodies. | no necessary | 2 years | 
| To assess physical function and health-related quality of life using the Disability Index of HAQ (HAQ) and questionnaire SF-36 instruments, respectively | no necessary | 2 years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Undifferentiated Arthritis, Rheumatoid Arthritis, Infliximab