Clinical trial NCT00351273: Combination Antibiotic Treatment for Reactive Arthritis Caused by Chlamydia Bacteria
Official title: Phase 3 Trial to Assess the Efficacy of Long-term (6 Months) Combination Antibiotics as a Treatment for Chlamydia-induced Reactive Arthritis
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE3
Conditions: Arthritis, Reactive
Reiter Disease
Keywords: Chlamydia
Lead sponsor: University of South Florida
Sponsor class: OTHER
Collaborators: name: National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
First posted: 2006-07-12
Enrollment: 42
Sex: ALL
Minimum age (years): 18
Maximum age (years): 70
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: Reactive arthritis, also known as Reiter's syndrome, is a form of arthritis that occurs as a reaction to an infection elsewhere in the body. It is characterized by inflammation of the joints, tendons, urogenital tract, and eyes. Pain and swelling in the knees, ankles, and feet are common. This study will determine the effectiveness of antibiotic therapy in treating people with chlamydia-induced reactive arthritis that has lasted for more than 6 months.

Detailed description: The initial infection that causes reactive arthritis is caused by one of two bacteria: Chlamydia trachomatis, which is usually acquired through sexual contact, or Chlamydia pneumoniae, which can cause respiratory infections. Most people recover fully from the initial flare of arthritis symptoms. However, about 20% of people with reactive arthritis experience long-lasting symptoms. In these individuals, the Chlamydia bacteria exist in a persistent metabolically active state within the joint tissue, even years after the initial exposure. The bacteria produce heat shock proteins (HSPs), which are thought to play a key role in the chronic persistent state of Chlamydia and which may stimulate the immune inflammatory response seen in reactive arthritis. This indicates the need for antimicrobial therapy that can reduce Chlamydia's HSP production and block its metabolism. The purpose of this study is to determine the effectiveness of long-term combination antibiotic therapy in treating people with chronic reactive arthritis. The study will use two different combinations of common antibiotics: doxycycline paired with rifampin and azithromycin paired with rifampin.

This study will entail 6 months of treatment followed by 3 months of follow-up. After screening, eligible participants will be randomly assigned to one of three treatment groups: rifampin once a day plus doxycycline twice a day; rifampin once a day plus azithromycin once a day for 5 days, then twice weekly; or placebo. Study visits will occur at baseline and Months 1, 3, 6, and 9. At all visits, participants will undergo an interview, a physical examination, and blood collection. They will also complete a questionnaire related to their symptoms and functional status. At screening and Month 6, a synovial biopsy may be performed. This will involve taking a sample of the tissue that lines the joints.

Eligibility criteria: Inclusion Criteria:

* Meet the following European Spondyloarthropathy Study Group Criteria:

  1. inflammatory spinal pain OR
  2. synovitis AND
  3. one or more of the following:

     1. positive family history
     2. urethritis or cervicitis within 1 month prior to onset of arthritis
     3. buttock pain
     4. enthesopathy
     5. sacroiliitis
* Disease duration of at least 6 months
* Negative pregnancy test at study baseline and willing to use an effective method of contraception other than combined oral contraceptives for the duration of the study (for women of childbearing age)

Exclusion Criteria:

* Sensitivity or history of allergic reaction to rifampin, doxycycline, or azithromycin
* Currently taking any medications that may interact with the study medications, specifically rifampin
* Liver transaminases greater than or equal to two times the normal level
* Significant abnormalities in the complete blood count (CBC)
* Pregnant
* Current psoriasis
* Diagnosis of inflammatory bowel disease
* Diagnosis of ankylosing spondylitis
* Previous prolonged exposure to antibiotics (more than 2 weeks) as a potential treatment for reactive arthritis

Primary outcomes:
measure: Investigate Whether a 6 Month Course of Combined Antibiotics Was Effective Treatment.
timeFrame: Month 6
Secondary outcomes:
measure: Number of Patients With a Complete Response (Resolution of All Symptoms)
timeFrame: Months 6 and 9
measure: Erythrocyte Sedimentation Rate (ESR)
timeFrame: Baseline Month 1, 3, 6 and 9
measure: hsCRP
timeFrame: Baseline, Month 1, 3, and 6
measure: HAQ DI Score
timeFrame: Baseline, Month 1,3,6 and 9
measure: PhGA Assessment
timeFrame: Baseline, month 1,3,6 and 9
measure: Swollen 76 Joint Count (SJC)
timeFrame: Baseline, month 1,3,6 and 9
measure: 78 Tender Joint Count (TJC)
timeFrame: Baseline, Month 1, 3, 6 and 9
Other outcomes:
Locations:
city: Tampa
country: United States
facility: University of South Florida
state: Florida
city: New Orleans
country: United States
facility: Louisiana State University
state: Louisiana
city: Toronto
country: Canada
facility: University of Toronto
state: Ontario
Study officials:
affiliation: University of South Florida
name: John D. Carter, MD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Carter JD, Valeriano J, Vasey FB. Doxycycline versus doxycycline and rifampin in undifferentiated spondyloarthropathy, with special reference to chlamydia-induced arthritis. A prospective, randomized 9-month comparison. J Rheumatol. 2004 Oct;31(10):1973-80.
citation: Carter JD, Espinoza LR, Inman RD, Sneed KB, Ricca LR, Vasey FB, Valeriano J, Stanich JA, Oszust C, Gerard HC, Hudson AP. Combination antibiotics as a treatment for chronic Chlamydia-induced reactive arthritis: a double-blind, placebo-controlled, prospective trial. Arthritis Rheum. 2010 May;62(5):1298-307. doi: 10.1002/art.27394.