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Note: This record shows only 22 elements of the WHO Trial Registration Data Set. To view changes that have been made to the source record, or for additional information about this trial, click on the URL below to go to the source record in the primary register.
Register: EUCTR
Last refreshed on: 2 March 2022
Main ID:  EUCTR2017-004079-30-BE
Date of registration: 19/02/2018
Prospective Registration: Yes
Primary sponsor: Joint Research & Development Office (QMUL)
Public title: Stratification of biologic Therapies for Rheumatoid Arthritis by Pathobiology
Scientific title: Stratification of Biologic Therapies for RA by Pathobiology (STRAP)-EU: A randomised, open-labelled biopsy-driven stratification trial in DMARD inadequate responder patients randomised to Etanercept, Tocilizumab or Rituximab. - STRAP-EU
Date of first enrolment: 19/02/2018
Target sample size: 219
Recruitment status: Not Recruiting
URL:  https://www.clinicaltrialsregister.eu/ctr-search/search?query=eudract_number:2017-004079-30
Study type:  Interventional clinical trial of medicinal product
Study design:  Controlled: yes
Randomised: yes
Open: yes
Single blind: no
Double blind: no
Parallel group: no
Cross over: no
Other: no
If controlled, specify comparator, Other Medicinial Product: yes
Placebo: no
Other: no
Number of treatment arms in the trial: 3
 
Phase:  Human pharmacology (Phase I): no Therapeutic exploratory (Phase II): no Therapeutic confirmatory - (Phase III): yes Therapeutic use (Phase IV): no
Countries of recruitment
Belgium Italy Portugal Spain
Contacts
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Key inclusion & exclusion criteria
Inclusion criteria:
Patients will be recruited with active RA:
1. 2010 ACR / EULAR Rheumatoid Arthritis classification criteria for a diagnosis of RA *
2. Patient with DMARD failure eligible for anti-TNF-a therapy as per UK NICE guidelines **
3. 18 years of age and over
4. Patients must be capable of giving informed consent and the consent must be obtained prior to any screening procedures

*The ACR/EULAR classification for a diagnosis of RA could have been at any time in the patient’s disease history; the score does not need to be 6 or more at screening.
** According to the National Institute for Health and Care Excellence (NICE) guidelines (TA 130), the TNF-a inhibitors are recommended as options for the treatment of adults who have both of the following characteristics:
1. Active RA as measured by DAS28>5.1 confirmed on at least two occasions, 1 month apart.
2. Have undergone trials of two DMARDs, including MTX (unless contraindicated). A trial of a DMARD is defined as being normally of 6 months, with 2 months at standard dose, unless significant toxicity has limited the dose or duration of treatment.

Are the trial subjects under 18? no
Number of subjects for this age range: 0
F.1.2 Adults (18-64 years) yes
F.1.2.1 Number of subjects for this age range 10
F.1.3 Elderly (>=65 years) yes
F.1.3.1 Number of subjects for this age range 5

Exclusion criteria:
Patients will be excluded if they have any contraindication to Etanercept, Rituximab or Tocilizumab therapy:
1. Women who are pregnant or breast-feeding
2. Women of child-bearing potential or males whose partners are women of child-bearing potential, unwilling to use an effective method of contraception (recommend double contraception) throughout the trial and beyond the end of trial treatment for the duration as defined in the relevant SmPC or IB; 12 months for Rituximab, at least 3 weeks for Etanercept, and at least 3 months for Tocilizumab.
3. History of or current primary inflammatory joint disease or primary rheumatological autoimmune disease other than RA (if secondary to RA, then the patient is still eligible).
4. Prior exposure to Rituximab, any anti-TNF, Tocilizumab, or any biologic for treatment of RA
5. Treatment with any investigational agent = 4 weeks prior to baseline or < 5 half-lives of the investigational drug (whichever is the longer)
6. Intra-articular or parenteral corticosteroids = 4 weeks prior to baseline synovial biopsy.
7. Oral prednisolone more than 10mg/d or equivalent = 4 weeks prior to baseline synovial biopsy.
8. Active infection
9. Known HIV, active Hepatitis B/C. Hepatitis B screening test must be performed at or in the preceding 3 months of screening visit.
10. Septic arthritis of a native joint within the last 12 months
11. Septic arthritis of a prosthetic joint within 12 months or indefinitely if the joint remains in situ
12. Latent TB infection unless they have completed adequate antibiotic prophylaxis
13. Malignancy (other than basal cell carcinoma) within the last 10 years
14. New York Heart Association (NYHA) grade III or IV congestive heart failure
15. Demyelinating disease
16. Known latex allergy; known allergy to Rituximab, Tocilizumab or Etanercept
17. Any other contra-indication to the study medications as detailed in their SmPC, including low IgG levels, at physician’s discretion
18. Receipt of live vaccine <4 weeks prior to first infusion
19. Major surgery in 3 months prior to first infusion
20. Presence of a transplanted organ (with the exception of a corneal transplant >3 months prior to screening)
21. Known recent substance abuse (drug or alcohol)
22. Poor tolerability of venepuncture or lack of adequate venous access for required blood sampling during the study period
23. Patients unable to tolerate synovial biopsy or in whom this is contraindicated (e.g. patients on anti-coagulants may not be suitable). However, assessment of suitability for the biopsy procedure will be a local clinical decision.
24. Patients currently recruited to other clinical trials
25. Other severe acute or chronic medical or psychiatric condition, or laboratory abnormality that would impart, in the judgment of the investigator, excess risk associated with study participation or study drug administration, or which, in the judgment of the investigator, would make the patient inappropriate for entry into this study.

The PI reserves the right to exclude patients at his centre, if they have concerns regarding compliance with the study procedures or any other aspect of the study eligibility not necessarily limited to the above exclusion criteria.


Age minimum:
Age maximum:
Gender:
Female: yes
Male: yes
Health Condition(s) or Problem(s) studied
Therapeutic area: Diseases [C] - Musculoskeletal Diseases [C05]
Rheumatoid Arthritis
MedDRA version: 20.0 Level: LLT Classification code 10003268 Term: Arthritis rheumatoid System Organ Class: 100000004859
Intervention(s)

Trade Name: MabThera
Product Name: MabThera
Pharmaceutical Form: Concentrate for solution for infusion

Trade Name: RoActmera
Product Name: RoActmera
Pharmaceutical Form: Solution for injection

Trade Name: Enbrel
Product Name: Enbrel
Pharmaceutical Form: Solution for injection in pre-filled pen

Primary Outcome(s)
Primary end point(s): The primary end point will assess the difference in the ACR 20 response between Rituximab and other treatments (Tocilizumab and Etanercept therapy treated together for analysis) at 16 weeks from baseline in the B-cell poor pathotype sub-group.
Main Objective: The main aim of this project is to test the hypothesis that the presence or absence of specific synovial cellular and molecular signatures (B cells and B cell-associated signatures), assessed following a synovial tissue biopsy, will enrich for response / non-response to the B cell depleting anti-CD20 monoclonal antibody (mAb) Rituximab.

The primary aim of this project is to show that in patients failing DMARD therapy, with a B cell poor synovial pathotype, Rituximab is inferior to Tocilizumab and Etanercept (treated together for analysis) therapy.
Timepoint(s) of evaluation of this end point: 16 weeks
Secondary Objective: In addition to the primary objective previously stated, we will address the following questions:
1) Can a diagnostic synovial biopsy showing a B-cell “rich/poor pathotype” define specific disease responsive/resistant subsets for patient stratification and help rationalize biologic drug choice?
2) Is clinical response associated with inhibition of B cell-linked pathways within the synovium and dependent on local B cell lineage depletion?
3) Is survival of auto-reactive B cells within “protected” synovial niches responsible for B-cell joint re-population and disease resistance-relapse?

For the B-cell-rich synovial pathotypes, we aim to compare the treatment effects of Rituximab to the other two treatment options (Tocilizumab and Etanercept, treated together for analysis). Finally, we aim to examine the interaction between treatments and B-cell status (rich and poor).
Secondary Outcome(s)
Secondary end point(s): 1. Patients deemed treatment failures at 16 weeks, will be switched to the other therapeutic option. Such patients will be considered a new patient starting at week 0 with treatment response assessed again at 16 weeks for ACR20 response.
2. For the B-cell-rich synovial pathotype sub-group, we aim to compare the treatment effects of Rituximab to the other two treatment options (Tocilizumab and Etanercept, treated together for analysis)
3. To examine the interaction between treatments and B-cell status (rich and poor).
Timepoint(s) of evaluation of this end point: 48 weeks.
Secondary ID(s)
STRAP_ReDA_012206
Source(s) of Monetary Support
Arthritis Research UK
Medical Research Council
Secondary Sponsor(s)
Ethics review
Status: Approved
Approval date: 01/02/2018
Contact:
Results
Results available: Yes
Date Posted: 16/12/2021
Date Completed: 23/01/2021
URL: https://www.clinicaltrialsregister.eu/ctr-search/trial/2017-004079-30/results
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