A Phase 4 Trial Assessing the ImPact of Residual Inflammation Detected Via Imaging TEchniques, Drug Levels and Patient Characteristics on the Outcome of Dose TaperIng of Adalimumab in Clinical Remission Rheumatoid ArThritis (RA) Subjects (PREDICTRA)

• ClinicalTrials.gov Identifier: NCT02198651
• Recruitment Status: Completed
• First Posted: July 24, 2014
• Results First Posted: June 25, 2019
• Last Update Posted: June 25, 2019
• Sponsor: AbbVie
• Information provided by (Responsible Party): AbbVie

Study Description

Brief Summary:

The primary objective of the study was to investigate the association between residual disease activity at Baseline as detected by Magnetic Resonance Imaging (MRI) and the occurrence of flares in participants with rheumatoid arthritis (RA) randomized to an adalimumab dose tapering regimen controlled by adalimumab withdrawal.

Condition or disease	Intervention/treatment	Phase
Rheumatoid Arthritis; Musculoskeletal and Connective Tissue Diseases	Biological: Adalimumab; Other: Placebo	Phase 4

Detailed Description:

This was a Phase 4, multicenter, randomized, double-blind, parallel-group study. The study included a Screening period of up to 28 days (unless extended with justification approved by study-designated physician), a 4-week Lead-In Period with open label (OL) 40 mg adalimumab administered subcutaneously (sc) every other week (eow), and a randomized 36-week double-blind period with 40 mg adalimumab sc every 3 weeks (q3wks; tapering arm) or placebo sc q3wks (withdrawal arm). Participants were randomized in a 5:1 ratio (tapering arm: withdrawal arm) after confirmation of meeting the disease activity score (DAS) criteria. Participants who experienced a protocol-defined flare at any time were to enter a rescue arm with OL 40 mg adalimumab administered sc eow for 16 weeks.

Study Design

• Study Type: Interventional (Clinical Trial)
• Actual Enrollment: 149 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
• Primary Purpose: Treatment
• Official Title: A Phase 4 Trial Assessing the ImPact of Residual Inflammation Detected Via Imaging TEchniques, Drug Levels and Patient Characteristics on the Outcome of Dose TaperIng of Adalimumab in Clinical Remission Rheumatoid ArThritis (RA) Subjects (PREDICTRA)
• Actual Study Start Date: January 5, 2015
• Actual Primary Completion Date: May 3, 2018
• Actual Study Completion Date: August 8, 2018

Arms and Interventions

Arm	Intervention/treatment
Experimental: Adalimumab 40 mg eow; 40 mg adalimumab administered subcutaneously every other week (eow) from Week 0 to Week 4 (Lead-in Period)	Biological: Adalimumab; Pre-filled syringe, administered by subcutaneous injection; Other Names: ABT-D2E7; Humira
Active Comparator: Adalimumab Tapering; 40 mg adalimumab administered subcutaneously every three weeks from Week 4 to Week 40 (Double-blind Period)	Biological: Adalimumab; Pre-filled syringe, administered by subcutaneous injection; Other Names: ABT-D2E7; Humira
Placebo Comparator: Adalimumab Withdrawal Arm; Placebo administered subcutaneously every three weeks from Week 4 to Week 40 (Double-blind Period)	Other: Placebo; Pre-filled syringe, administered by subcutaneous injection in the Double-blind period
Experimental: Adalimumab 40 mg eow Rescue Arm; 40 mg adalimumab administered subcutaneously every other week from Flare Week 0 to Flare Week 16 (Open-label Rescue Period)	Biological: Adalimumab; Pre-filled syringe, administered by subcutaneous injection; Other Names: ABT-D2E7; Humira

Outcome Measures

Primary Outcome Measures :

1. Association Between Baseline Hand and Wrist Synovitis Rheumatoid Arthritis Magnetic Resonance Imaging Scoring System (RAMRIS) Score and Flare up to Week 40 in the Tapering Arm [ Time Frame: From Week 4 to Week 40 ]
   Synovitis was assessed in three wrist regions (the distal radioulnar joint; the radiocarpal joint; the intercarpal and carpometacarpal joints) and in each Metacarpophalangeal joint (MCP) joint. The first carpometacarpal joint and the first MCP joint are not scored. The scale is 0-3. Score 0 is normal, and 1-3 (mild, moderate, severe) are by thirds of the presumed maximum volume of enhancing tissue in the synovial compartment. Flare is defined as an increase from Double-blind Baseline in DAS (Disease Activity Score) 28 erythrocyte sedimentation rate (ESR) of > 0.6 AND DAS28 [ESR] > 2.6, OR an increase in DAS28 (ESR) of ≥ 1.2 irrespective of the resulting DAS28 [ESR]. The association between baseline hand and wrist synovitis RAMRIS score and occurrence of rheumatoid arthritis flare up to Week 40 in the Tapering arm was examined using logistic regression, and the 95% confidence interval of the odds ratio was calculated.
2. Association Between Baseline Bone Marrow Edema RAMRIS Score and Flare up to Week 40 in the Tapering Arm [ Time Frame: From Week 4 to Week 40 ]
   Bone marrow edema in each bone was scored separately. The scale is 0-3 based on the proportion of bone with edema, as follows-0: no edema; 1: 1-33% of bone edematous; 2: 34-66% of bone edematous; 3: 67-100%. Flare is defined as an increase from Double-blind Baseline in DAS (Disease Activity Score) 28 erythrocyte sedimentation rate (ESR) of > 0.6 AND DAS28 [ESR] > 2.6, OR an increase in DAS28 (ESR) of ≥ 1.2 irrespective of the resulting DAS28 [ESR]. The association between baseline bone marrow edema rheumatoid arthritis MRI scoring system (RAMRIS) score and occurrence of rheumatoid arthritis flare up to Week 40 in the Tapering arm was examined using logistic regression, and the 95% confidence interval of the odds ratio was calculated.
3. Association Between a Composite of Baseline Hand and Wrist Synovitis and Bone Marrow Edema RAMRIS Scores and Flare up to Week 40 in the Tapering Arm [ Time Frame: From Week 4 to Week 40 ]
   The composite score is the sum of the baseline hand and wrist synovitis and bone marrow edema RAMRIS scores. Flare is defined as an increase from Double-blind Baseline in DAS (Disease Activity Score) 28 erythrocyte sedimentation rate (ESR) of > 0.6 AND DAS28 [ESR] > 2.6, OR an increase in DAS28 (ESR) of ≥ 1.2 irrespective of the resulting DAS28 [ESR]. The association between the composite baseline hand and wrist synovitis score and baseline bone marrow edema rheumatoid arthritis MRI scoring system (RAMRIS) score and occurrence of rheumatoid arthritis flare up to Week 40 in the Tapering arm was examined using logistic regression, and the 95% confidence interval of the odds ratio was calculated.

Secondary Outcome Measures :

1. Median Time to Flare [ Time Frame: From Week 4 to Week 40 ]
   Time to flare was defined as the number of weeks from the date of the first dose of study drug in the Double-blind period to the date of flare.
2. Physicians' Assessment of Flare Severity [ Time Frame: At the Flare Week 0 Visit ]
   Physicians rated the severity of flare at the Flare Week 0 visit from 0 (not severe) to 10 (very severe). The number of participants within each level of flare severity is presented.
3. Participants' Assessment of Flare Severity [ Time Frame: At the Flare Week 0 Visit ]
   Participants rated the severity of flare at the Flare Week 0 visit from 0 (not severe) to 10 (very severe). The number of participants within each level of flare severity is presented.
4. Percentage of Participants With a Flare [ Time Frame: From Week 4 to Week 40 ]
   Flare was defined as an increase from Double-blind Baseline in DAS (Disease Activity Score) 28 erythrocyte sedimentation rate (ESR) of > 0.6 AND DAS28 [ESR] > 2.6, OR an increase in DAS28 (ESR) of ≥ 1.2 irrespective of the resulting DAS28 [ESR].
5. Number of Participants Who Regained Clinical Remission in the Open-Label Rescue Arm Over Time [ Time Frame: From Flare Week 0 to Flare Week 16 ]
   The Disease Activity Score 28 (DAS28) is a validated index of rheumatoid arthritis disease activity. Twenty-eight tender joint counts, 28 swollen joint counts, the erythrocyte sedimentation rate (ESR; mm/hour), and the participant's assessment of global disease activity (on a visual analog scale [VAS] from 0 to 10 cm) are included in the DAS28 (ESR) score. Scores on the DAS28 range from 0 to 10; higher scores indicate more disease activity. Clinical remission was defined as DAS28 (ESR) < 2.6.
6. Median Time to Clinical Remission From the Occurrence of Flare [ Time Frame: From Flare Week 0 to Flare Week 16 ]
   The Disease Activity Score 28 (DAS28) is a validated index of rheumatoid arthritis disease activity. Twenty-eight tender joint counts, 28 swollen joint counts, the erythrocyte sedimentation rate (ESR; mm/hour), and the participant's assessment of global disease activity (on a visual analog scale [VAS] from 0 to 10 cm) are included in the DAS28 (ESR) score. Scores on the DAS28 range from 0 to 10; higher scores indicate more disease activity. Clinical remission was defined as DAS28 (ESR) < 2.6. Time to clinical remission was defined as the number of weeks from the occurrence of flare to the first date of clinical remission.
7. Mean Change From Double-blind Baseline in Disease Activity Score 28 (DAS28) [ Time Frame: From Week 4 to Week 40 and from Flare Week 0 to Flare Week 16 ]
   The Disease Activity Score 28 (DAS28) is a validated index of rheumatoid arthritis disease activity. Twenty-eight tender joint counts, 28 swollen joint counts, the erythrocyte sedimentation rate (ESR; mm/hour), and the participant's assessment of global disease activity (on a visual analog scale [VAS] from 0 to 10 cm) are included in the DAS28 (ESR) score. Scores on the DAS28 range from 0 to 10; higher scores indicate more disease activity. Negative values indicate improvement from baseline.
8. Mean Change From Double-blind Baseline in Clinical Disease Activity Index (CDAI) Score [ Time Frame: From Week 4 to Week 40 and from Flare Week 0 to Flare Week 16 ]
   The CDAI is a validated measure of rheumatoid arthritis disease activity. Twenty-eight tender joint counts, 28 swollen joint counts, global health assessed by the participant on a visual analogue scale from 0 to 10 (cm), and global health assessed by an investigator on a visual analogue scale from 0 to 10 (cm) were included in the CDAI score. Scores on the CDAI range from 0 to 76; higher scores indicate more disease activity. Negative values indicate improvement from the Double-blind baseline score.
9. Mean Change From Double-blind Baseline in Simplified Disease Activity Index (SDAI) Score [ Time Frame: From Week 4 to Week 40 and from Flare Week 0 to Flare Week 16 ]
   The SDAI is a validated measure of rheumatoid arthritis disease activity. Twenty-eight tender joint counts, 28 swollen joint counts, global health assessed by the participant on a visual analogue scale from 0 to 10 (cm), global health assessed by an investigator on a visual analogue scale from 0 to 10 (cm), and serum levels of C-reactive protein levels (mg/dL) were included in the SDAI score. Scores on the SDAI range from 0 to 86; higher scores indicate more disease activity. Negative values indicate improvement from the Double-blind baseline score.
10. Number of Participants Maintaining Clinical Remission Defined By DAS28 (ESR) < 2.6, SDAI ≤ 3.3, and CDAI ≤ 2.8 at Each Visit By Treatment Arm [ Time Frame: From Week 4 to Week 40 and from Flare Week 0 to Flare Week 16 ]
    The maintenance of clinical remission after regaining remission during the Open-label rescue period was defined as either Disease Activity Score 28 (DAS28 ESR) < 2.6, Simplified Disease Activity Index (SDAI) score ≤ 3.3, or Clinical Disease Activity Index (CDAI) score ≤ 2.8).
11. Mean Change From Double-blind Baseline to Week 40 or Final Visit in Magnetic Resonance Imaging (MRI) Synovitis Score [ Time Frame: From Week 4 to Week 40 or Final visit ]
    Synovitis was assessed in three wrist regions (the distal radioulnar joint; the radiocarpal joint; the intercarpal and carpometacarpal joints) and in each Metacarpophalangeal joint (MCP) joint. The first carpometacarpal joint and the first MCP joint are not scored. The scale is 0-3. Score 0 is normal, and 1-3 (mild, moderate, severe) are by thirds of the presumed maximum volume of enhancing tissue in the synovial compartment.
12. Mean Change From Double-blind Baseline to Week 40 or Final Visit in Bone Marrow Edema (BME) Score [ Time Frame: From Week 4 to Week 40 or Final visit ]
    Bone edema in each bone was scored separately. The scale is 0-3 based on the proportion of bone with edema, as follows-0: no edema; 1: 1-33% of bone edematous; 2: 34-66% of bone edematous; 3: 67-100%.
13. Mean Change From Double-blind Baseline to Week 40 or Final Visit in Bone Erosions Rheumatoid Arthritis Magnetic Resonance Imaging Scoring System (RAMRIS) Score [ Time Frame: From Week 4 to Week 40 or Final Visit ]
    Bone erosions in each bone (wrists: carpal bones, distal radius, distal ulna, metacarpal bases; MCP joints: metacarpal heads, phalangeal bases) were scored separately. The scale is 0-10, based on the proportion of eroded bone compared to the ''assessed bone volume'', judged on all available images-0: no erosion; 1: 1-10% of bone eroded; 2; 11-20%, etc.
14. Mean Change From Double-blind Baseline in Health Assessment Questionnaire- Disability Index (HAQ-DI) Score Over Time [ Time Frame: From Week 4 to Week 40 and from Flare Week 0 to Flare Week 16 ]
    The Health Assessment Questionnaire - Disability Index (HAQ-DI) is a participant-reported questionnaire specific for rheumatoid arthritis. It consists of 20 questions referring to eight domains: dressing/grooming, arising, eating, walking, hygiene, reach, grip, and daily activities. Participants assessed their ability to do each task over the past week using the following response categories: without any difficulty (0); with some difficulty (1); with much difficulty (2); and unable to do (3). Scores on each task were summed and averaged to provide an overall score ranging from 0 to 3, where zero represents no disability and three very severe, high-dependency disability. The minimal clinically important difference (MCID) defined for the HAQ-DI is ≥ 0.22.
15. Number of Participants With Health Assessment Questionnaire- Disability Index (HAQ-DI) Score ≤ 0.5 at Double-blind Baseline and at Week 40 [ Time Frame: Week 4 and Week 40 ]
    The Health Assessment Questionnaire - Disability Index (HAQ-DI) is a participant-reported questionnaire specific for rheumatoid arthritis. It consists of 20 questions referring to eight domains: dressing/grooming, arising, eating, walking, hygiene, reach, grip, and daily activities. Participants assessed their ability to do each task over the past week using the following response categories: without any difficulty (0); with some difficulty (1); with much difficulty (2); and unable to do (3). Scores on each task were summed and averaged to provide an overall score ranging from 0 to 3, where zero represents no disability and three very severe, high-dependency disability. The number of participants with HAQ-DI score ≤ 0.5 (considered to be normal) was recorded.
16. Mean Change From Double-blind Baseline in Routine Assessment of Patient Index Data (RAPID3) Questionnaire Scores Assessed During In-office Visits [ Time Frame: From Week 4 to Week 40 and from Flare Week 0 to Flare Week 16 ]
    The RAPID3 is an activity index derived from the Multi-dimensional Health Assessment Questionnaire (MD-HAQ). It includes an assessment of physical function, a pain Visual Analog Scale (VAS), and a participant global assessment of disease activity VAS. The total RAPID3 score ranges from 0 to 30 where higher scores represent severe disease. Negative values indicate improvement from the Double-blind baseline score.
17. Mean Change From Flare Week 0 in Routine Assessment of Patient Index Data (RAPID3) Questionnaire Scores Assessed at Home [ Time Frame: Flare Week 0 and Flare Weeks 1, 2, 3, 5, 6, 7, 8, 9, 11, 12, 13, 14, 15 ]
    The RAPID3 is an activity index derived from the Multi-dimensional Health Assessment Questionnaire (MD-HAQ). It includes an assessment of physical function, a pain Visual Analog Scale (VAS), and a participant global assessment of disease activity VAS. The total RAPID3 score ranges from 0 to 30 where higher scores represent severe disease. Negative values indicate improvement from the Double-blind baseline score.
18. Mean Change From Double-blind Baseline in Swollen Joint Count 28 [ Time Frame: From Week 4 to Week 40 and from Flare Week 0 to Flare Week 16 ]
    Twenty-eight joints, excluding hip joints, were assessed for swelling by physical examination. Swelling of each joint was classified as present (1) or absent (0), for a total possible score of 0 (0 joints with swelling) to 28 (worst possible score/28 joints with swelling). Negative values indicate improvement from baseline.
19. Mean Change From Double-blind Baseline in Swollen Joint Count 66 [ Time Frame: From Week 4 to Week 40 and from Flare Week 0 to Flare Week 16 ]
    Sixty-six joints were assessed for swelling by physical examination. Swelling of each joint was classified as present (1) or absent (0), for a total possible score of 0 (0 joints with swelling) to 66 (worst possible score/66 joints with swelling). Negative values indicate improvement from baseline.
20. Mean Change From Double-blind Baseline in Tender Joint Count 28 [ Time Frame: From Week 4 to Week 40 and from Flare Week 0 to Flare Week 16 ]
    Twenty-eight joints were assessed for tenderness by physical examination. Pain or tenderness of each joint was classified as present (1) or absent (0), for a total possible score of 0 (0 joints with tenderness) to 28 (worst possible score/28 joints with tenderness). Negative values indicate improvement from baseline.
21. Mean Change From Double-blind Baseline in Tender Joint Count 68 [ Time Frame: From Week 4 to Week 40 and from Flare Week 0 to Flare Week 16 ]
    Sixty-eight joints were assessed for tenderness by physical examination. Pain or tenderness of each joint was classified as present (1) or absent (0), for a total possible score of 0 (0 joints with tenderness) to 68 (worst possible score/68 joints with tenderness). Negative values indicate improvement from baseline.
22. Mean Change From Double-blind Baseline in Participant's Global Assessment of Disease Activity [ Time Frame: From Week 4 to Week 40 and from Flare Week 0 to Flare Week 16 ]
    Participants rated the severity of their rheumatoid arthritis symptoms and how well they were doing during the last 24 hours by placing a vertical mark on a line with a range of 0 (very well) to 100 mm (very poorly). Negative values indicate improvement from baseline.
23. Mean Change From Double-blind Baseline in Participant's Global Assessment of Rheumatoid Arthritis Pain [ Time Frame: From Week 4 to Week 40 and from Flare Week 0 to Flare Week 16 ]
    Participants rated the severity of their rheumatoid arthritis pain in the past week by placing a vertical mark on a line with a range of 0 (no pain) to 100 mm (severe pain). Negative values indicate improvement from baseline.
24. Mean Change From Double-blind Baseline in Physician's Global Assessment of Disease Activity [ Time Frame: From Week 4 to Week 40 and from Flare Week 0 to Flare Week 16 ]
    Physicians assessed participants' current rheumatoid arthritis disease activity at the time of the visit (independent of the participant's self-assessment) by placing a vertical mark on a line with a range of 0 (very low) to 100 mm (very high). Negative values indicate improvement from baseline.
25. Mean Change From Double-blind Baseline in Morning Stiffness Duration [ Time Frame: From Week 4 to Week 40 and from Flare Week 0 to Flare Week 16 ]
    The duration of morning stiffness was reported by participants as the average daily length during the past week in minutes (from time of awaking to time of maximal improvement). Negative values indicate improvement from baseline.
26. Mean Change From Double-blind Baseline in Morning Stiffness Severity [ Time Frame: From Week 4 to Week 40 and from Flare Week 0 to Flare Week 16 ]
    Morning stiffness severity was assessed by a numeric rating-scale (NRS). Participants rated the severity of morning stiffness during the past week from 0 to 10 with 0 representing "not severe" and 10 "very severe". Negative values indicate improvement from baseline.
27. Mean Change From Double-blind Baseline in Participant's Assessment of Sleep Disturbance [ Time Frame: From Week 4 to Week 40 and from Flare Week 0 to Flare Week 16 ]
    Participants rated the severity of their sleep disturbance in the past week by placing a vertical mark on a line with a range of 0 (sleep is no problem) to 100 mm (sleep is a major problem). Negative values indicate improvement from baseline.
28. Mean Change From Double-blind Baseline in Treatment Satisfaction Questionnaire for Medication (TSQM) Effectiveness Score [ Time Frame: At Weeks 4, 16, 28, and 40 and from Flare Week 0 to Flare Week 16 ]
    Participants completed the 14-item Treatment Satisfaction Questionnaire for Medication (TSQM; Version 1.4) to assess satisfaction with their current rheumatoid arthritis treatment over the previous 2-3 weeks or since the last time that they took the medication. The TSQM consists of fourteen items over four domains (effectiveness, side effects, convenience, and global satisfaction). The 14 questions are answered either with yes/no or by means of a five or seven stage scale (ranging from very unsatisfied to satisfied). TSQM Scale scores for each domain range from 0 to 100 and higher scores represent higher satisfaction. Negative values indicate worsening from baseline.
29. Mean Change From Double-blind Baseline in Treatment Satisfaction Questionnaire for Medication (TSQM) Side Effects Score [ Time Frame: At Weeks 4, 16, 28, and 40 and from Flare Week 0 to Flare Week 16 ]
    Participants completed the 14-item Treatment Satisfaction Questionnaire for Medication (TSQM; Version 1.4) to assess satisfaction with their current rheumatoid arthritis treatment over the previous 2-3 weeks or since the last time that they took the medication. The TSQM consists of fourteen items over four domains (effectiveness, side effects, convenience, and global satisfaction). The 14 questions are answered either with yes/no or by means of a five or seven stage scale (ranging from very unsatisfied to satisfied). TSQM Scale scores for each domain range from 0 to 100 and higher scores represent higher satisfaction. Negative values indicate worsening from baseline.
30. Mean Change From Double-blind Baseline in Treatment Satisfaction Questionnaire for Medication (TSQM) Convenience Score [ Time Frame: At Weeks 4, 16, 28, and 40 and from Flare Week 0 to Flare Week 16 ]
    Participants completed the 14-item Treatment Satisfaction Questionnaire for Medication (TSQM; Version 1.4) to assess satisfaction with their current rheumatoid arthritis treatment over the previous 2-3 weeks or since the last time that they took the medication. The TSQM consists of fourteen items over four domains (effectiveness, side effects, convenience, and global satisfaction). The 14 questions are answered either with yes/no or by means of a five or seven stage scale (ranging from very unsatisfied to satisfied). TSQM Scale scores for each domain range from 0 to 100 and higher scores represent higher satisfaction. Negative values indicate worsening from baseline.
31. Mean Change From Double-blind Baseline in Treatment Satisfaction Questionnaire for Medication (TSQM) Global Satisfaction Score [ Time Frame: At Weeks 4, 16, 28, and 40 and from Flare Week 0 to Flare Week 16 ]
    Participants completed the 14-item Treatment Satisfaction Questionnaire for Medication (TSQM; Version 1.4) to assess satisfaction with their current rheumatoid arthritis treatment over the previous 2-3 weeks or since the last time that they took the medication. The TSQM consists of fourteen items over four domains (effectiveness, side effects, convenience, and global satisfaction). The 14 questions are answered either with yes/no or by means of a five or seven stage scale (ranging from very unsatisfied to satisfied). TSQM Scale scores for each domain range from 0 to 100 and higher scores represent higher satisfaction. Negative values indicate worsening from baseline.
32. Mean Change From Double-blind Baseline in Work Productivity and Activity Impairment (WPAI) Overall Work Impairment and Activity Impairment Scores [ Time Frame: At Weeks 4, 28, and 40 and Flare Weeks 0, 10, and 16 ]
    The Work Productivity and Activity Impairment (WPAI) questionnaire for general health is a validated tool in rheumatoid arthritis consisting of 6 questions, based on participant recall of the previous 7 days. WPAI assesses work time missed due to illness (absenteeism), impairment at work due to health (presenteeism), overall work impairment due to health (an aggregate measure of both absenteeism and presenteeism), and total non-occupational activity impairment due to health. WPAI scores are expressed as impairment percentages, with higher scores indicating worse outcomes. A negative change from baseline indicates improvement.
33. Mean Change From Double-blind Baseline in Short-Form 36 Version 2 Health Survey (SF-36v2) Physical Component Summary (PCS) Score [ Time Frame: At Weeks 4, 28, and 40 and from Flare Week 0 to Flare Week 16 ]
    The SF-36v2 is a non-disease specific Health Related Quality of Life (HRQoL) instrument. The SF-36v2 comprises 36 total items (questions) targeting a subject's functional health and well-being in 8 domains (physical functioning, role physical, bodily pain, general health, vitality, social functioning, role emotional and mental health) with a recall period of four weeks. Domain scores are aggregated into a Physical Component Summary (PCS) score and a Mental Component Summary (MCS) score. SF-36v2 scores for each domain and PCS/MCS range from 0-100: higher scores indicate a better state of health and a decrease from baseline represents worsening.
34. Mean Change From Double-blind Baseline in Short-Form 36 Version 2 Health Survey (SF-36v2) Mental Component Summary (MCS) Score [ Time Frame: At Weeks 4, 28, and 40 and from Flare Week 0 to Flare Week 16 ]
    The SF-36v2 is a non-disease specific Health Related Quality of Life (HRQoL) instrument. The SF-36v2 comprises 36 total items (questions) targeting a subject's functional health and well-being in 8 domains (physical functioning, role physical, bodily pain, general health, vitality, social functioning, role emotional and mental health) with a recall period of four weeks. Domain scores are aggregated into a Physical Component Summary (PCS) score and a Mental Component Summary (MCS) score. SF-36v2 scores for each domain and PCS/MCS range from 0-100: higher scores indicate a better state of health and a decrease from baseline represents worsening.
35. Mean Change From Double-blind Baseline in Functional Assessment of Chronic Illness Therapy (FACIT) Fatigue Scale [ Time Frame: At Weeks 4, 16, 28, and 40 and from Flare Week 0 to Flare Week 16 ]
    The FACIT-Fatigue questionnaire is a participant questionnaire that consists of 13 questions designed to measure the degree of fatigue experienced by participants in the previous 7 days. Participants respond to the questions on a scale from 'not at all' (0) to 'very much' (4). The scale score is computed by summing the item scores, after reversing those items that are worded in the negative direction. The FACIT-Fatigue subscale score ranges from 0 to 52, where higher scores represent less fatigue. A negative change from baseline indicates worsening.
36. Mean Change From Double-blind Baseline in Serum Levels of C-reactive Protein (CRP) [ Time Frame: From Week 4 to Week 40 and from Flare Week 0 to Flare Week 16 ]
    C-Reactive Protein (CRP; mg/L) was measured from blood samples as a marker for inflammation. Higher levels are indicative of more inflammation. Negative values indicate improvement from baseline.
37. Mean Change From Double-blind Baseline in Serum Levels of Erythrocyte Sedimentation Rate (ESR) [ Time Frame: From Week 4 to Week 40 and from Flare Week 0 to Flare Week 16 ]
    Erythrocyte sedimentation rate (ESR; mm/hour) indirectly measures how much inflammation is in the body. A higher ESR is indicative of increased inflammation. Negative values indicate improvement from baseline.

Eligibility Criteria

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

Criteria

Inclusion Criteria:

1. Participant had a diagnosis of rheumatoid arthritis (RA) as defined by the 1987 revised American College of Rheumatology (ACR) classification criteria and/or the ACR /European League Against Rheumatism (EULAR) 2010 classification criteria (any duration since diagnosis).

2. Participant must have met the following criteria:

   • Must have been treated with adalimumab 40 mg subcutaneously every other week (sc eow) for at least 12 months prior to Week 0 Visit
   • Must have been treated with concomitant methotrexate (MTX) at a stable dose (oral, sc or intramuscular (im) at any dose) for at least 12 weeks prior to Week 0 Visit or if not on MTX, must have been treated with other allowed conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) at a stable dose for at least 12 weeks prior to Week 0 Visit or if not treated with csDMARDs must maintain this regimen for at least 12 weeks prior to Week 0 Visit.

3. Participant must be in sustained clinical remission based on the following:

   • At least one documented 4 or 3 (if Patient's Global Assessment ; PGA is not available) variables Disease Activity Score 28 Erythrocyte sedimentation rate (DAS28 ESR) or DAS28 C-reactive protein (CRP) < 2.6 (or calculated based on documented components of the DAS28) in the participant's chart 6 months or longer prior to the Screening Visit;
   • 4 variables DAS28 (ESR) assessed at Screening < 2.6, with all components including ESR assessed at Screening.
4. If participant was receiving concomitant allowed csDMARDs (in addition or not to MTX) the dose must have been stable for at least 12 weeks prior to the Week 0 Visit (e.g., chloroquine, hydroxychloroquine, sulfasalazine, gold formulations [including auranofin, gold sodium thiomalate, and aurothioglucose] and/or leflunomide).
5. If participant was receiving concomitant oral corticosteroids, prednisone or equivalent must have been < 10 mg/day and the dose must have been stable for at least 4 weeks prior to the Week 0 Visit.
6. If participant was receiving concomitant non-steroidal anti-inflammatory drugs (NSAIDs), tramadol or other equivalent opioids and/or non-opioid analgesics, the dose and/or therapeutic scheme must have been stable for at least 4 weeks prior to the Week 0 Visit.
7. Participant must have been able and willing to provide written informed consent and comply with the requirements of this study protocol.

Exclusion Criteria:

1. Any 4 or 3 (if PGA is not available) variables DAS28 (ESR) or DAS28 (CRP) (or calculated based on documented components of the DAS28) assessed within 6 months prior to the Screening Visit ≥ 2.6.
2. Participant was on an additional concomitant biological disease-modifying anti-rheumatic drug (bDMARD) (including but not limited to abatacept, anakinra, certolizumab, etanercept, golimumab, infliximab, rituximab or tocilizumab).
3. Participant had been treated with intra-articular or parenteral corticosteroids within the last four weeks before Screening.
4. Participant had undergone joint surgery within 12 weeks of Screening (at joints to be assessed by magnetic resonance imaging (MRI) and/or ultrasound).
5. Participant had a medical condition precluding an MRI (e.g. magnetic activated implanted devices - cardiac pace-maker, insulin pump, neuro stimulators, etc. and metallic devices or fragments or clips in the eye, brain or spinal canal and in the hand/wrist undergoing MRI)
6. Participant had a medical condition precluding a contrast MRI with gadolinium [e.g. nephrogenic systemic fibrosis, previous anaphylactic/anaphylactoid reaction to gadolinium containing contrast agent, pregnancy or breast feeding, severe renal insufficiency with an estimated Glomerular Filtration Rate (eGFR) below 30 mL/min/1.73m^2 at Screening, hepato-renal syndrome, severe chronic liver function impairment]
7. Participant had been treated with any investigational drug of chemical or biologic nature within a minimum of 30 days or five half-lives (whichever is longer) of the drug prior to the Screening Visit.

Contacts and Locations

Locations

United States, Alabama

J Michael Grelier Research /ID# 149772

Tuscaloosa, Alabama, United States, 35406

United States, California

Westlake Medical Research (WMR) Clinical Trials /ID# 155386

Thousand Oaks, California, United States, 91360-3994

United States, Florida

University of Florida /ID# 144851

Jacksonville, Florida, United States, 32209

United States, Georgia

North Georgia Rheumatology Grp /ID# 155225

Lawrenceville, Georgia, United States, 30045

United States, Louisiana

The Arthritis & Diabetes Clinic, Inc. /ID# 149017

Monroe, Louisiana, United States, 71203

United States, Michigan

Aa Mrc Llc /Id# 151933

Grand Blanc, Michigan, United States, 48439

United States, Mississippi

North Mississippi Med Clinics /ID# 149443

Tupelo, Mississippi, United States, 38801

United States, New York

Montefiore Medical Center /ID# 155013

Bronx, New York, United States, 10461

United States, North Carolina

Shanahan Rheuma & Immuno /ID# 148689

Raleigh, North Carolina, United States, 27617

United States, Pennsylvania

Altoona Ctr Clinical Res /ID# 148448

Duncansville, Pennsylvania, United States, 16635

United States, South Carolina

Low Country Rheumatology, PA /ID# 154198

Summerville, South Carolina, United States, 29486

United States, Tennessee

West Tennessee Research Inst /ID# 148391

Jackson, Tennessee, United States, 38305

United States, Texas

Arthritis Centers of Texas /ID# 152843

Dallas, Texas, United States, 75246

Australia, New South Wales

Royal Prince Alfred Hospital /ID# 154649

Camperdown, New South Wales, Australia, 2050

Optimus Clinical Research Pty. /ID# 133881

Kogarah, New South Wales, Australia, 2217

John Hunter Hospital /ID# 133884

Newcastle, New South Wales, Australia, 2305

Australia, Queensland

Rheumatology Research Unit /ID# 133883

Maroochydore, Queensland, Australia, 4558

Austria

AKH Wien /ID# 133885

Vienna, Wien, Austria, 1090

Canada, Ontario

St. Joseph's Healthcare /ID# 149233

Hamilton, Ontario, Canada, L8N 4A6

The Arthritis Program Res Grp /ID# 129056

Newmarket, Ontario, Canada, L3Y 3R7

Canada, Quebec

Institut de Rhum. de Montreal /ID# 129055

Montreal, Quebec, Canada, H2L 1S6

Groupe de Recherche en Maladies Osseuses /ID# 129057

Sainte-foy, Quebec, Canada, G1V 3M7

CIUSSS de l'Estrie - CHUS /ID# 144839

Sherbrooke, Quebec, Canada, J1G 2E8

France

CHU de la miletrie /ID# 133928

Poitiers, Poitou-Charentes, France, 86021

CHU Amiens Picardie /ID# 144846

Amiens CEDEX 1, Somme, France, 80054

Hospital Louis Pasteur /ID# 134708

Chartres, France, 28630

CHU de Grenoble - Albet Michal /ID# 135953

Grenoble, France, 38043

Germany

Asklepios Klinik /ID# 129146

Bad Abbach, Germany, 93077

Immanuel-Krankenhaus /ID# 129143

Berlin-buch, Germany, 13125

Charité Universitätsmedizin Campus Mitte /ID# 129142

Berlin, Germany, 10117

Krankenhaus Porz am Rhein /ID# 129147

Cologne, Germany, 51149

Rheumaforschungszentrum II /ID# 148554

Hamburg, Germany, 20095

Klinikum der Univ Munich /ID# 129144

Munich, Germany, 80337

Rheumazentrum Ratingen /ID# 129148

Ratingen, Germany, 40882

Rheumatologische Praxis /ID# 151979

Rendsburg, Germany, 24768

Greece

University General Hospital "Attikon" /ID# 134709

Athens, Attiki, Greece, 12462

General Hospital of Athens /ID# 129202

Athens, Greece, 11527

General UH of Heraklion /ID# 134712

Heraklion, Greece, 71110

Hungary

Budai Irgalmasrendi Korhaz /ID# 134714

Budapest, Hungary, 1023

Orszagos Reumatologiai es Fizi /ID# 134710

Budapest, Hungary, 1023

Debreceni Egyetem Klinikai Koz /ID# 134715

Debrecen, Hungary, 4032

Ireland

St Vincent's University Hosp /ID# 129210

Dublin, Ireland, D04 T6F4

Italy

AP Romano Umberto I /ID# 132895

Rome, Lazio, Italy, 00161

A.O. Univ Consorziale Policlin /ID# 133932

Bari, Italy, 70124

Azienda Istituto Gaetano Pini /ID# 132964

Milan, Italy, 20122

Fondazione IRCCS Policlinico /ID# 133886

Pavia, Italy, 27100

A.O.U.I. di Verona Policlinico /ID# 132973

Verona, Italy, 37134

Netherlands

Jan van Breemen Instituut /ID# 133887

Amsterdam, Netherlands, 1056 AB

Rijnstate Hospital /ID# 129206

Arnhem, Netherlands, 6815 AD

Medisch Centrum Leeuwarden /ID# 133888

Leeuwarden, Netherlands, 8934 AD

UMC Utrecht /ID# 132896

Utrecht, Netherlands, 3584 CX

Spain

Hospital Parc de Salut del Mar /ID# 148670

Barcelona, Spain, 08003

Hosp Sant J. Despi-Moises Brog /ID# 135368

Barcelona, Spain, 08906

Hospital Universitario Basurto /ID# 135529

Bilbao, Spain, 48013

Hosp Clinico Virgen Arrixaca /ID# 137020

El Palmar, Spain, 30120

Hospital General Universitario Gregorio Maranon /ID# 133889

Madrid, Spain, 28007

Hospital Universitario La Paz /ID# 135369

Madrid, Spain, 28046

Hospital Univ De Mostoles /ID# 134489

Mostoles, Spain, 28935

Complejo Hosp Santiago /ID# 133890

Santiago de Compostela, Spain, 15706

Hosp General Univ de Valencia /ID# 134488

Valencia, Spain, 46014

Sweden

Akademiska Sjukhuset /ID# 148669

Uppsala, Uppsala Lan, Sweden, 751 85

Uppsala University Hospital /ID# 133891

Uppsala, Sweden, 75185

Vastmanlands Sjukhus /ID# 133892

Vasteras, Sweden, 72189

United Kingdom

Whipps Cross Univ Hospital /ID# 133893

London, London, City Of, United Kingdom, E11 1NR

Guy's and St Thomas' NHS Found /ID# 132965

London, London, City Of, United Kingdom, SE1 9RT

Mid Essex Hospitals NHS Trust /ID# 151636

Chelmsford, United Kingdom, CM1 7ET

Western General Hospital /ID# 132966

Edinburgh, United Kingdom, EH4 2XU

Chapel Allerton Hospital /ID# 129208

Leeds, United Kingdom, LS7 4SA

University Hospital Aintree /ID# 132980

Liverpool, United Kingdom, L9 7AL

Queen Alexandra Hospital /ID# 132982

Portsmouth, United Kingdom, PO6 3LY

Sponsors and Collaborators

AbbVie

Investigators

• Study Director: AbbVie Inc.; AbbVie

  Study Documents (Full-Text)

Documents provided by AbbVie:

Study Protocol  [PDF] February 25, 2016

Statistical Analysis Plan  [PDF] July 19, 2018

More Information

Additional Information:

Related Info 

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Emery P, Burmester GR, Naredo E, Sinigaglia L, Lagunes I, Koenigsbauer F, Conaghan PG. Adalimumab dose tapering in patients with rheumatoid arthritis who are in long-standing clinical remission: results of the phase IV PREDICTRA study. Ann Rheum Dis. 2020 Aug;79(8):1023-1030. doi: 10.1136/annrheumdis-2020-217246. Epub 2020 May 13.

Emery P, Burmester GR, Naredo E, Zhou Y, Hojnik M, Conaghan PG. Design of a phase IV randomised, double-blind, placebo-controlled trial assessing the ImPact of Residual Inflammation Detected via Imaging TEchniques, Drug Levels and Patient Characteristics on the Outcome of Dose TaperIng of Adalimumab in Clinical Remission Rheumatoid ArThritis (RA) patients (PREDICTRA). BMJ Open. 2018 Feb 28;8(2):e019007. doi: 10.1136/bmjopen-2017-019007.

• Responsible Party: AbbVie
• ClinicalTrials.gov Identifier: NCT02198651
• Other Study ID Numbers: M14-500; 2014-001114-26 ( EudraCT Number )
• First Posted: July 24, 2014
• Results First Posted: June 25, 2019
• Last Update Posted: June 25, 2019
• Last Verified: June 2019

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: Yes
• Plan Description: AbbVie is committed to responsible data sharing regarding the clinical trials we sponsor. This includes access to anonymized, individual and trial-level data (analysis data sets), as well as other information (e.g., protocols and clinical study reports), as long as the trials are not part of an ongoing or planned regulatory submission. This includes requests for clinical trial data for unlicensed products and indications.
• Supporting Materials: Study Protocol; Statistical Analysis Plan (SAP); Clinical Study Report (CSR); Analytic Code
• Time Frame: Data requests can be submitted at any time and the data will be accessible for 12 months, with possible extensions considered.
• Access Criteria: Access to this clinical trial data can be requested by any qualified researchers who engage in rigorous, independent scientific research, and will be provided following review and approval of a research proposal and Statistical Analysis Plan (SAP) and execution of a Data Sharing Agreement (DSA). For more information on the process, or to submit a request, visit the following link.
• URL: https://www.abbvie.com/our-science/clinical-trials/clinical-trials-data-and-information-sharing/data-and-information-sharing-with-qualified-researchers.html

• Studies a U.S. FDA-regulated Drug Product: Yes
• Studies a U.S. FDA-regulated Device Product: No

Keywords provided by AbbVie:

Rheumatoid Arthritis; Adalimumab; Taper; Flare; Arthritis; Anti-rheumatic drugs; Remission; Magnetic Resonance Imaging; Ultrasound; Biomarker; Drug Level; Reduced dose

Additional relevant MeSH terms:

Arthritis; Arthritis, Rheumatoid; Connective Tissue Diseases; Inflammation; Joint Diseases; Musculoskeletal Diseases; Pathologic Processes; Rheumatic Diseases; Autoimmune Diseases; Immune System Diseases; Adalimumab; Anti-Inflammatory Agents; Antirheumatic Agents