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Escape II Myocardium

This study is currently recruiting participants. (see Contacts and Locations)
Verified January 2013 by Columbia University
Sponsor:
Collaborator:
Information provided by (Responsible Party):
Joan M. Bathon, Columbia University
ClinicalTrials.gov Identifier:
NCT01548768
First received: March 6, 2012
Last updated: January 14, 2013
Last verified: January 2013
  Purpose

Data on a small number of patients with Rheumatoid Arthritis (RA) show that patients with RA may have a smaller heart size and altered heart function. There is limited evidence that general inflammation due to RA and inflammation within the heart may lead to a smaller heart size which may precede heart failure in RA. Preliminary data show that all these may improve with treatment with a specific class of medications called Tumor Necrosis Factor (TNF) inhibitors. The investigators hypothesize that RA affects the size and function of the heart via inflammation and that treatment with TNF inhibitors may improve the heart size and function and possibly prevent the development of heart failure in RA.

In order to investigate these hypotheses the investigators are going to identify 50 patients who have joint inflammation that has not responded to treatment with methotrexate. As it would happen under standard of care (even without participation in the study) these patients will receive additional treatment to control their joint disease. The investigators will randomly assign these patients to receive one of two equivalent treatments that are commonly prescribed in clinical practice and in the context of standard of care: either a TNF inhibitor OR the medications sulfasalazine and hydroxychloroquine will be added to methotrexate after randomization. It is known that these two different treatments are equivalent in controlling joint inflammation but is not known if one or the other has a more favorable effect on the heart size and function. The patients will be evaluated at baseline and return 6 months after randomization and will have imaging of their heart with PET scanning and echocardiogram at both time points. Participants will also provide information about their RA, other diseases and will offer blood for testing. The investigators assume (hypothesize) that patients randomly assigned to TNF inhibitor will have improved heart size and better heart function and less inflammation in the heart compared to patients assigned to take the oral medications sulfasalazine and hydroxychloroquine.


Condition Intervention
Rheumatoid Arthritis
Drug: Triple Therapy
Drug: TNF inhibitors

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Single Blind (Outcomes Assessor)
Primary Purpose: Prevention
Official Title: ESCAPE II MYOCARDIUM: How Rheumatoid Arthritis (RA) and Tumor Necrosis Factor (TNF) Inhibitors Affect the Myocardial Structure and Function.

Resource links provided by NLM:


Further study details as provided by Columbia University:

Primary Outcome Measures:
  • Improvement of left ventricular mass [ Time Frame: 6 months after treatment with TNF inhibitors versus triple therapy ] [ Designated as safety issue: No ]
    We will evaluate the differential effect TNF inhibitors vs "triple therapy" on LV mass after 6 months of treatment.

  • Improvement of Left Ventricular Ejection Fraction. [ Time Frame: After 6 months of treatment with TNF inhibitor versus triple therapy ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Improvement in the degree of myocardial inflammation (as indicated by FDG uptake in PET scanning) [ Time Frame: 6 months after treatment with TNF inhibitor versus triple therapy ] [ Designated as safety issue: No ]

Estimated Enrollment: 50
Study Start Date: October 2011
Estimated Study Completion Date: October 2015
Estimated Primary Completion Date: October 2015 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: TNF Inhibitors Drug: TNF inhibitors

Patients will receive one of the FDA approved TNF inhibitors at the approved dosage regimen.

Patients will be evaluated during safety visits scheduled every 8 weeks between the 0 and 6 month study visits. At the time of the first safety visit medication tolerability and safety will be evaluated. At the time of the second safety visit if joint disease activity is still moderate or high an increase in the dose or frequency of the TNF inhibitor or a switch to treatment to an alternative/equivalent TNF inhibitor will take place ( there are 5 TNF inhibitors approved at the moment).

Other Names:
  • Infliximab
  • Adalimumab
  • Etanercept
  • Certolizumab pegol
  • Golimumab
  • Remicade
  • Humira
  • Enbrel
  • Cimzia
  • Simponi
Active Comparator: Triple Therapy (SSZ+MTX+Plaquenil) Drug: Triple Therapy

Patients on triple therapy will be started on 1 gram of sulfasalazine twice daily along with weight adjusted daily Hydroxychloroquine. MTX treatment will be continued.

Patients will be evaluated during safety visits scheduled every 8 weeks between the 0 and 6 month study visits.

In the first safety visit if joint disease activity is still moderate or high sulfasalazine will be increased to 3 grams daily. At the time of the second safety visit if disease activity remains moderate or high, SSZ and Hydroxychloroquine will be stopped and patients will be switched to Leflunomide (Arava) 10 mg plus methotrexate.

Other Names:
  • Sulfasalazine
  • Hydroxychloroquine
  • Leflunomide
  • Arava
  • Methotrexate
  • Plaquenil
  • MTX
  • SSZ
  • Azulfidine

  Show Detailed Description

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   Yes
Criteria

INCLUSION CRITERIA

  • Diagnosis of Rheumatoid Arthritis by 2010 American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR) diagnostic criteria
  • Age>18 years old
  • Moderate to high RA disease activity defined by a CDAI of >10
  • Stable dose of Methotrexate for 6 weeks prior to enrollment;
  • Stable doses of Nonsteroidal anti-inflammatory drug (NSAID) and prednisone (if already taking these medications) for 2 weeks prior to study

EXCLUSION CRITERIA

  • Prior self reported or physician diagnosed CV event (MI; angina; stroke or Transient Ischemic Attach (TIA); Heart Failure (HF); prior CV procedure (e.g., coronary artery bypass graft, angioplasty, valve replacement, pacemaker);
  • Contraindications to having a PET-CT scan or receive adenosine or Fludeoxyglucose (FDG).
  • Active treatment for Cancer
  • Uncontrolled hypertension
  • Diabetes
  • Smoking
  • Treatment with a TNF inhibitor or other biologic currently or within the last 6 months
  • Treatment with any non-biologic disease-modifying antirheumatic drug (DMARD) other than MTX in the past two months;
  • Untreated positive (tuberculosis skin test) PPD or active tuberculosis
  • History of Lymphoma and Melanoma
  • Ejection Fraction (EF) < 40% (if not known in advance then the Study Visit I Echocardiogram results will be used to exclude the patient from randomization and follow up)
  • Change in NSAID/Prednisone dosage in last 2 weeks
  • Participation in other research studies involving imaging/radiation exposure

For control participation (15 controls):

INCLUSION CRITERIA

  • Age>18 years old
  • Absence of diagnosis of RA. EXCLUSION CRITERIA
  • Prior self reported or physician diagnosed CV event (MI; angina; stroke or Transient Ischemic Attach (TIA); Heart Failure (HF); prior CV procedure (e.g., coronary artery bypass graft, angioplasty, valve replacement, pacemaker);
  • Contraindications to having a PET-CT scan or receive adenosine or FDG.
  • Uncontrolled hypertension.
  • Participation in other research studies involving imaging/radiation exposure
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01548768

Contacts
Contact: Afshin Zartoshti, MS 2123054114 az2200@columbia.edu
Contact: Dimitrios Pappas, MD 2123056327 dp2544@columbia.edu

Locations
United States, New York
Columbia University Medical Center Recruiting
New York, New York, United States, 10032
Contact: Afshin Zartoshti, MS    212-305-4114    az2200@columbia.edu   
Contact: Dimitrios Pappas, MD    2123056327    dp2544@columbia.edu   
Principal Investigator: Joan M Bathon, MD         
Sponsors and Collaborators
Columbia University
Investigators
Principal Investigator: Joan M Bathon, MD Columbia University
  More Information

Additional Information:
No publications provided

Responsible Party: Joan M. Bathon, Professor Medicine, Rheumatology, Columbia University
ClinicalTrials.gov Identifier: NCT01548768     History of Changes
Other Study ID Numbers: AAAI1026, 7R01AR050026-07
Study First Received: March 6, 2012
Last Updated: January 14, 2013
Health Authority: United States: Institutional Review Board
United States: Food and Drug Administration

Keywords provided by Columbia University:
Rheumatoid Arthritis
Cardiovascular disease
Myocardium
TNF-alpha inhibitors
ESCAPE
Co-morbidities

Additional relevant MeSH terms:
Arthritis
Arthritis, Rheumatoid
Autoimmune Diseases
Connective Tissue Diseases
Immune System Diseases
Joint Diseases
Musculoskeletal Diseases
Rheumatic Diseases
Certolizumab pegol
Hydroxychloroquine
Methotrexate
Sulfasalazine
Abortifacient Agents
Abortifacient Agents, Nonsteroidal
Analgesics
Analgesics, Non-Narcotic
Anti-Infective Agents
Anti-Inflammatory Agents
Anti-Inflammatory Agents, Non-Steroidal
Antimalarials
Antimetabolites
Antimetabolites, Antineoplastic
Antineoplastic Agents
Antiparasitic Agents
Antiprotozoal Agents
Antirheumatic Agents
Central Nervous System Agents
Dermatologic Agents
Enzyme Inhibitors
Folic Acid Antagonists

ClinicalTrials.gov processed this record on November 20, 2014