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Methotrexate Polyglutamate Levels as a Marker for the Clinical Outcome in the Treatment of Rheumatoid Arthritis

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ClinicalTrials.gov Identifier: NCT00695188
Recruitment Status : Completed
First Posted : June 11, 2008
Results First Posted : February 15, 2011
Last Update Posted : February 17, 2011
Information provided by:
Ludwig-Boltzmann Institut fuer Rheumatologie, Balneologie und Rehabilitation

Brief Summary:
The primary objective is to determine whether erythrocyte polyglutamate levels are associated with objective clinical response in patients with rheumatoid arthritis after oral administration of low-dose methotrexate.The secondary aim of this study is to compare the efficacy and safety of standard dose methotrexate versus a higher starting dose.

Condition or disease Intervention/treatment Phase
Rheumatoid Arthritis Drug: methotrexate Phase 4

Detailed Description:
The folate antagonist methotrexate (MTX) is currently one of the most widely used drugs for the treatment of rheumatoid arthritis (RA).Although MTX is very effective and well tolerated, the major drawback is the large interpatient variability in the clinical response.MTX is intracellularly converted by folylpolyglutamate synthetase (FPGS) to methotrexate polyglutamates (MTXPGs), which enhance the intracellular retention of MTX. Furthermore, the γ-linked sequential addition of glutamic acid residues inhibits finals steps in the de novo purine and pyrimidine biosynthesis, resulting in anti-proliferative and anti-inflammatory effects.76 adult, MTX-naive patients who fulfill the American College of Rheumatology criteria (ACR) for RA with a Disease Activity Score in 28 joints (DAS-28) > 3.2 are enrolled at two sites in Vienna (Austria).Clinical status is assessed by the number of joint counts and the Health Assessment Questionnaire (HAQ).Patients are randomly assigned to receive either a standard dose or a higher starting dose of 25 mg orally. In week 5, a subcutaneous dose of 25 mg is administered to each patient to get a reference level (bioavailability of 100%).The patients participate for 16 weeks, in which blood samples are collected at weeks 1, 2, 5, 6, 10 and 11 to perform pharmacokinetic analyses and metabolite measurements.The determination of erythrocyte MTXPG-levels is performed by using a HPLC technique.The primary outcome is the objective clinical response (measured in a rheumatic score, DAS-28), secondary outcome parameters are quality of life and routine laboratory parameters used in rheumatology. This clinical outcome will be correlated with MTX pharmacokinetics in blood, MTXPG kinetics in erythrocytes, and their impact on the folate pathway.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 19 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary Purpose: Treatment
Official Title: Methotrexate Polyglutamate Levels as a Marker for the Clinical Outcome in the Treatment of Rheumatoid Arthritis A Multicenter, Randomized, Double-blind, Controlled Phase IV Trial
Study Start Date : May 2008
Actual Primary Completion Date : December 2010
Actual Study Completion Date : December 2010

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Standard dose
Escalating dose
Drug: methotrexate
oral administration Escalating dose (15, 20, 25 mg)

Active Comparator: High dose
25 mg
Drug: methotrexate
25 mg oral administration

Primary Outcome Measures :
  1. DAS-28 (Disease Activity Score in 28 Joints) [ Time Frame: 16 weeks ]

    DAS stands for "Disease Activity Score" and is a measure of the activity of rheumatoid arthritis. In Europe the DAS is the recognized standard in research and clinical practice.

    The following parameters are included in the calculation:

    • Number of joints tender to the touch (TEN)
    • Number of swollen joints (SW)
    • Erythrocyte sedimentation rate (ESR)
    • Patient assessment of disease activity (VAS; mm)

    The DAS-28 is evaluated using a scale:

    0 - 3.2: low disease activity 3.2 - 5.1: moderate disease activity > 5.1: severe disease activity

Secondary Outcome Measures :
  1. HAQ (Health Assessment Questionnaire) [ Time Frame: 16 weeks ]

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • MTX-naive
  • Age > 18 years
  • DAS-28 > 3.2
  • American College of Rheumatology-criteria for RA
  • Chest-X-ray
  • Informed consent
  • Prednisolon < 10 mg a day

Exclusion Criteria:

  • Pregnancy
  • Lactation
  • Renal and hepatic impairment
  • Malignant diseases (last 5 years)
  • Contraindications
  • Human Immunodeficiency Virus (HIV), Hepatitis B and C

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00695188

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Wien, Austria, 1100
Rheumazentrum Wien Oberlaa
Wien, Austria, 1100
Sponsors and Collaborators
Ludwig-Boltzmann Institut fuer Rheumatologie, Balneologie und Rehabilitation
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Principal Investigator: Hans Broell, Prof. Dr. Ludwig-Boltzmann-Institut fuer Rheumatologie und Balneologie
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
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Responsible Party: Prim. Univ.-Prof. Dr. Hans Broell, Ludwig-Boltzmann Institut fuer Rheumatologie und Balneologie
ClinicalTrials.gov Identifier: NCT00695188    
Other Study ID Numbers: PROMTX2007_01
EudraCT: 2007-006288-56
First Posted: June 11, 2008    Key Record Dates
Results First Posted: February 15, 2011
Last Update Posted: February 17, 2011
Last Verified: August 2009
Keywords provided by Ludwig-Boltzmann Institut fuer Rheumatologie, Balneologie und Rehabilitation:
rheumatoid arthritis
MTX polyglutamates
clinical outcome
Additional relevant MeSH terms:
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Arthritis, Rheumatoid
Joint Diseases
Musculoskeletal Diseases
Rheumatic Diseases
Connective Tissue Diseases
Autoimmune Diseases
Immune System Diseases
Abortifacient Agents, Nonsteroidal
Abortifacient Agents
Reproductive Control Agents
Physiological Effects of Drugs
Antimetabolites, Antineoplastic
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents
Dermatologic Agents
Enzyme Inhibitors
Folic Acid Antagonists
Immunosuppressive Agents
Immunologic Factors
Antirheumatic Agents
Nucleic Acid Synthesis Inhibitors