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Seronegative Oligoarthritis of the Knee Study (SOKS) (SOKS)

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ClinicalTrials.gov Identifier: NCT01216631
Recruitment Status : Terminated (Unable to recruit)
First Posted : October 7, 2010
Results First Posted : May 13, 2016
Last Update Posted : May 13, 2016
Sponsor:
Collaborator:
Centocor, Inc.
Information provided by (Responsible Party):
Laura Coates, University of Leeds

Brief Summary:
The aim of this study is to establish the efficacy and duration of effect of intra-articular (IA) infliximab vs intravenous infliximab vs current standard care (IA steroid injections) in seronegative oligoarthritis. All patients will have seronegative arthritis affecting less than 5 joints but including at least one knee. 10 patients will receive IA infliximab injections to the affected knee, 10 will receive IA steroid injections to the affected knee and 10 will receive a course of intravenous infliximab. Patients will not be aware of their group as this is a placebo-controlled study.

Condition or disease Intervention/treatment Phase
Spondylarthropathies Drug: methylprednisolone Drug: Infliximab Phase 2

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 1 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Intra-articular and Intravenous Infliximab in the Treatment of Resistant Seronegative Oligoarthritis of the Knee
Study Start Date : September 2010
Actual Primary Completion Date : August 2011
Actual Study Completion Date : August 2011

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Active Comparator: IA steroid
Intra-articular injection of steroid (80mg depomedrone)
Drug: methylprednisolone
intra-articular injection of methylprednisolone (80mg given at baseline only)
Other Name: depomedrone

Experimental: IA infliximab
intra-articular injection of 100mg infliximab
Drug: Infliximab
intra-articular injection of 100mg infliximab given at baseline only
Other Name: remicade

Experimental: IV infliximab
intravenous infusions of infliximab given at 0, 2, 6 and 14 weeks at a dose of 5mg/kg (patient body weight)
Drug: Infliximab
intravenous infliximab at a dose of 5mg/kg (as per patient weight) given at week 0, 2, 6 and 14
Other Name: remicade




Primary Outcome Measures :
  1. Ultrasound Synovitis Score [ Time Frame: 8 weeks ]
    reduction of ultrasound synovitis score of the affected knee at 8 weeks following intiation of treatment


Secondary Outcome Measures :
  1. US Synovitis Score [ Time Frame: 2 weeks ]
    Change in US synovitis score of the affected knee at 2 and 8 weeks after treatment initiation

  2. Pain Visual Analogue Scale [ Time Frame: 2 weeks ]
    Change in patient's assessment of pain by a 100mm visual analogue score

  3. Psoriatic Arthritis Quality of Life Scale (PsQOL) [ Time Frame: 2 weeks ]
    Change in PsQOL score from baseline

  4. Rheumatoid Arthritis Outcome Score (RAOS) [ Time Frame: 2 weeks ]
    Change in RAOS questionnaire score

  5. US Synovitis Score [ Time Frame: 16 weeks ]
    Change in US synovitis score of the affected knee at 2 and 8 weeks after treatment initiation

  6. Pain Visual Analogue Scale [ Time Frame: 6 weeks ]
    Change in patient's assessment of pain by a 100mm visual analogue score

  7. Pain Visual Analogue Scale [ Time Frame: 8 weeks ]
    Change in patient's assessment of pain by a 100mm visual analogue score

  8. Pain Visual Analogue Scale [ Time Frame: 14 weeks ]
    Change in patient's assessment of pain by a 100mm visual analogue score

  9. Pain Visual Analogue Scale [ Time Frame: 16 weeks ]
    Change in patient's assessment of pain by a 100mm visual analogue score

  10. Psoriatic Arthritis Quality of Life Scale (PsQOL) [ Time Frame: 26 weeks ]
    Change in PsQOL score from baseline

  11. Psoriatic Arthritis Quality of Life Scale (PsQOL) [ Time Frame: 6 weeks ]
    Change in PsQOL score from baseline

  12. Psoriatic Arthritis Quality of Life Scale (PsQOL) [ Time Frame: 8 weeks ]
    Change in PsQOL score from baseline

  13. Psoriatic Arthritis Quality of Life Scale (PsQOL) [ Time Frame: 14 weeks ]
    Change in PsQOL score from baseline

  14. Psoriatic Arthritis Quality of Life Scale (PsQOL) [ Time Frame: 16 weeks ]
    Change in PsQOL score from baseline

  15. Rheumatoid Arthritis Outcome Score (RAOS) [ Time Frame: 6 weeks ]
    Change in RAOS questionnaire score

  16. Rheumatoid Arthritis Outcome Score (RAOS) [ Time Frame: 8 weeks ]
    Change in RAOS questionnaire score

  17. Rheumatoid Arthritis Outcome Score (RAOS) [ Time Frame: 14 weeks ]
    Change in RAOS questionnaire score

  18. Rheumatoid Arthritis Outcome Score (RAOS) [ Time Frame: 16 weeks ]
    Change in RAOS questionnaire score

  19. Rheumatoid Arthritis Outcome Score (RAOS) [ Time Frame: 26 weeks ]
    Change in RAOS questionnaire score



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
Criteria

Inclusion Criteria:

  • Inflammatory oligoarthritis (4 or less active joints) with at least one swollen knee joint of at least 3 months duration
  • Rheumatoid factor and anti-CCP Ab negative
  • Either arthritis onset at <45 years of age, or arthritis onset at ≥45 years of age with early morning stiffness>30mins or raised inflammatory markers
  • If under 40 years of age, clinical exclusion of a diagnosis of gout.
  • If 40 years or older at screening, a prior normal examination of synovial fluid from the affected joint excluding crystal arthropathy or infection.
  • Failure of methotrexate (inefficacy after >3 month trial, intolerance or contra-indication)
  • Have the capacity to understand and sign an informed consent form.
  • Gender: male or female
  • 18 years of age or over.
  • Women must be either postmenopausal (no menstrual period for a minimum of 1 year) or surgically sterilized or in use of adequate birth control measures and have a negative serum pregnancy test on entry in the study.
  • Men and women of childbearing potential must use adequate birth control measures (e.g., abstinence, oral contraceptives, intrauterine device, barrier method with spermicide, implantable or injectable contraceptives or surgical sterilization) for the duration of the study and should continue such precautions for 6 months after receiving the last infusion.
  • Are considered eligible according to the tuberculosis (TB) eligibility assessment, screening, and early detection of reactivation rules defined in the protocol
  • The screening laboratory test results must meet the following criteria

    • WBC (white blood cell count): >3.5 x 109/L
    • ANC (absolute neutrophil count): >1.5 x 109/L
    • Hemoglobin: >10g/dL
    • Platelets: >120 x 109/L
    • SGPT (ALT - alanine aminotransferase) < 1.5 times upper normal limit (i.e. 60iu/L)
  • Have no history of latent or active TB prior to screening. An exception is made for subjects with a history of latent TB and documentation of having completed appropriate treatment for latent TB (see Appendix 3) within 3 years prior to the first administration of study agent. It is the responsibility of the investigator to verify the adequacy of previous anti-tuberculous treatment and provide appropriate documentation.
  • Have no signs or symptoms suggestive of active TB upon medical history and/or physical examination.
  • Have had no recent close contact with a person with active TB or, if there has been such contact, will be referred to a physician specializing in TB to undergo additional evaluation and, if warranted, receive appropriate treatment for latent TB prior to the first administration of study agent.
  • Within 6 weeks prior to the first administration of study agent, either have a negative QuantiFeron test result (see Appendix 3) or have a newly identified positive QuantiFeron test result during screening in which active TB has been ruled out and for which appropriate treatment for latent TB has been initiated prior to the first administration of study agent.
  • Have a chest radiograph (posterior-anterior view and if required, a lateral view), taken within 3 months prior to the first administration of study agent and read by a qualified radiologist, with no evidence of current, active TB or old, inactive TB.

Exclusion Criteria:

  • Grade 4 osteoarthritis (Kellgren-Lawrence score) on plain radiograph of the knee
  • Rheumatoid Arthritis (defined by the ACR criteria for the diagnosis of RA, 1987)
  • Ankylosing Spondylitis (defined by the modified New York Criteria)
  • Clinical diagnosis of gout or previous evidence of crystal arthropathy on synovial fluid aspirates
  • Women who are pregnant, nursing, or planning pregnancy within 6 months after the last infusion (this includes father's who plan on fathering a child within 6 months after their last infusion).
  • Have had any previous treatment with biological therapies.
  • History of receiving human/murine recombinant products or a known allergy to murine products. A known allergy to murine product is definitely an exclusion criterion
  • Previous intra-muscular, intra-articular or intra-venous steroids within 4 weeks prior to baseline.
  • Previous oral steroids at a dose >10mg/day prednisolone or equivalent for 4 weeks prior to baseline.
  • Documentation of seropositive for human immunodeficiency virus (HIV).
  • Documentation of a positive test for hepatitis B surface antigen or hepatitis C.
  • Have a history of alcohol or substance abuse within the preceding 6 months that, in the opinion of the investigator, may increase the risks associated with study participation or study agent administration, or may interfere with interpretation of results.
  • Have a known history of serious infections (e.g., hepatitis, pneumonia, or pyelonephritis) in the previous 3 months.
  • Have or have had an opportunistic infection (e.g., herpes zoster [shingles], cytomegalovirus, Pneumocystis carinii, aspergillosis, histoplasmosis, or mycobacteria other than TB) within 6 months prior to screening
  • Have had a Bacille Calmette-Guérin (BCG) vaccination within 12 months of screening.
  • Are considered ineligible according to the TB eligibility assessment, screening, and early detection of reactivation rules described in Appendix 3.
  • Have a chest radiograph within 3 months prior to the first administration of study agent that shows an abnormality suggestive of a malignancy or current active infection.
  • Have a history of lymphoproliferative disease, including lymphoma or signs suggestive of possible lymphoproliferative disease such as lymphadenopathy of unusual size or location (e.g., nodes in the posterior triangle of the neck, infraclavicular, epitrochlear, or periaortic area), or splenomegaly.
  • Currently have any known malignancy other than the condition being treated or have a history of malignancy, with the exception of basal cell or squamous cell carcinoma of the skin that has been fully excised with no evidence of recurrence.
  • Have current signs or symptoms of severe, progressive or uncontrolled renal, hepatic, hematologic, gastrointestinal, endocrine, pulmonary, cardiac, neurologic, or cerebral disease.
  • Are unable or unwilling to undergo multiple venipunctures because of poor tolerability or lack of easy access.
  • Use of any investigational drug within 30 days prior to screening or within 5 half-lives of the investigational agent, whichever is longer.
  • Presence of a transplanted solid organ (with the exception of a corneal transplant > 3 months prior to screening).
  • Have a concomitant diagnosis or history of congestive heart failure.

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): NCT01216631


Locations
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United Kingdom
Leeds Teaching Hospitals NHS Trust
Leeds, West Yorkshire, United Kingdom, LS7 4SA
Sponsors and Collaborators
University of Leeds
Centocor, Inc.
Investigators
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Principal Investigator: Philip G Conaghan, FRCP University of Leeds

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Responsible Party: Laura Coates, NIHR Clinical Lecturer, University of Leeds
ClinicalTrials.gov Identifier: NCT01216631     History of Changes
Other Study ID Numbers: 2009-015810-23
First Posted: October 7, 2010    Key Record Dates
Results First Posted: May 13, 2016
Last Update Posted: May 13, 2016
Last Verified: May 2016
Keywords provided by Laura Coates, University of Leeds:
seronegative
oligoarthritis
infliximab
intraarticular
Additional relevant MeSH terms:
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Spondylarthropathies
Spondylarthritis
Spondylitis
Spinal Diseases
Bone Diseases
Musculoskeletal Diseases
Arthritis
Joint Diseases
Methylprednisolone
Methylprednisolone Acetate
Methylprednisolone Hemisuccinate
Prednisolone
Prednisolone acetate
Infliximab
Prednisolone hemisuccinate
Prednisolone phosphate
Anti-Inflammatory Agents
Antiemetics
Autonomic Agents
Peripheral Nervous System Agents
Physiological Effects of Drugs
Gastrointestinal Agents
Glucocorticoids
Hormones
Hormones, Hormone Substitutes, and Hormone Antagonists
Neuroprotective Agents
Protective Agents
Antineoplastic Agents, Hormonal
Antineoplastic Agents
Dermatologic Agents