Grants and Contracts Details
Description
When funded, this will be a 4-year PCORI contract with no allowance for no-cost extension.
PCORI contract mandates adherence to strict milestones and deliverables from the primary site.
The anticipated period of funding is from Jan 2021 to Dec 2024. We need 1 person randomized
per site per month for the 28-month randomization period (n=28 at least per site; randomized in
years 1-3 of the contract period).
RA-PRO is a 12-month, 2-arm, open-label, RCT pragmatic study to test whether adding
TNFbiologic strategy is superior to the alternative approach of small molecule Jak-kinase inhibitor in
RA patients with active disease despite adequate trial of methotrexate, i.e. MTX-inadequate
responder (IR), in a variety of clinical care settings across the U.S. at multiple sites. There is
equipoise between these two strategies in RA.
Patients with active RA despite a stable MTX dose of at least 15 mg weekly (oral or
subcutaneous) for at least 3-months will be recruited at 25-27 geographically-diverse
RA/rheumatology clinics in the U.S. All study procedures, including study enrollment including
randomization, patient assessments including surveys, and study follow-up assessments will be
done at the time of regular clinic visits by the patients. Both strategies are standard of care
treatment options in MTX-IR. All standard care costs (medication, laboratory monitoring etc.) will
be covered by patient’s insurance coverage (or patient assistance programs), as the standard of
care practice.
Participants randomized/assigned to each arm will be started on the standard approved doses
of one of the small molecule Jak-kinase inhibitor or one of the TNFi-biologic as chosen by the
patient-physician dyad, based on age/sex/comorbidity and preferences (self-injections vs. IV;
frequency; type of drug) and insurance co-pay/deductible, added to background MTX (oral or
subcutaneous). Both treatment strategies (under study) are in wide clinical use for treatment of
patients with active RA with an inadequate response to MTX. This study will assess the impact
of TNF-First treatment strategy vs. comparator on physical function (primary outcome), disease
activity, inflammation (C-reactive protein), sleep, fatigue, quality of life, treatment satisfaction
and adverse events.
If the score on the Clinical Disease Activity Index (CDAI) decreases by =6 (moderate activity) or
by =12 (high activity) at 4-months, the initial therapy will be continued. If CDAI improvements are
lower, patient will be switched to the alternative regimen at 4-months. Participants will continue
to receive nonsteroidal anti-inflammatory drugs (NSAIDs) and prednisone (up to 10 mg/day of
prednisone of equivalent). For serious AEs or safety risk, patients can switch to the other arm
sooner than 4-months, and in rare cases, be dropped from the study for patient safety.
Status | Finished |
---|---|
Effective start/end date | 5/1/21 → 4/30/23 |
Funding
- University of Alabama at Birmingham: $71,680.00
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