The objective of this study is to investigate the efficacy and safety of the humanized anti-human IL-6 receptor monoclonal antibody tocilizumab (TCZ) either in monotherapy or in combination therapy with methotrexate (MTX) in patients with an inadequate response to treatment with MTX. Furthermore, in patients who have been able to achieve control of disease activity via the above therapy, we investigate the possibility of stopping TCZ and verify safety when TCZ is restarted after disease recurrence.
In this study, we aim to prospectively and randomly evaluate efficacy for changes in clinical remission and joint destruction in RA patients in treatment with TCZ monotherapy(SWITCH) and in combination therapy with MTX(ADD-ON), and also to investigate the best therapeutic approach to achieve discontinuation.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
233
Tocilizumab 8mg/kg 4weeks (i.v.) plus methotrexate up to 52weeks.The dosage of MTX will be fixed at least 24 weeks from the start of the study.
tocilizumab 8mg/kg/4weeks (i.v.) up to 52weeks.
DAS28-ESR remission at 24 weeks
Step 1: Investigation of the efficacy and safety of TCZ in combination therapy with MTX
Time frame: at 24 week
Changes over time in the number of patients maintaining discontinuation (maintenance rate)
Step 2: Investigation of discontinuation
Time frame: Week 52 to Week 104
Change in TSS score
Step 1
Time frame: at 52 weeks (after treatment initiation)
Change of DAS28-ESR remission rate
Step 1
Time frame: Week 0 to Week 52
Change of ACR response rate
Step 1
Time frame: Week 0 to Week 52
EQ5D scores over time
Step 1
Time frame: Week 0 to Week 52
J-HAQ/HAQ scores over time
Step 1
Time frame: Week 0 to Week 52
SDAI, CDAI, and Boolean remission rates
Step 1
Time frame: Week 0 to Week 52
TNF-α over time
Step 1
Time frame: Week 0 to Week 52
Between-group comparison of the discontinuation rate after an achievement of remission
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Hokkaido Medical Center for Rheumatic Diseases Hospital
Sapporo, Hokkaido, Japan
Utazu Hama Clinic
Ayautagun, Japan
Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
Bunkyō City, Japan
Fukushima Red-Cross Hospital
Fukushima, Japan
Higashihiroshima Memorial Hospital
Higashihiroshima, Japan
Tokyo Dental College Ichikawa General Hospital
Ichikawa, Japan
Itabashi Medical Center
Itabashi-ku, Japan
Shimane University Faculty of Medicine
Izumo, Japan
Saitama Medical Center, Saitama Medical University
Kawagoe, Japan
Kagawa University
Kida-gun, Japan
...and 20 more locations
Step 2
Time frame: Week 0 to Week 104
Factor analysis of patients maintaining discontinuation
Step 2
Time frame: Week 0 to Week 104
Time course of DAS28 after restarting TCZ (between-group comparison)
Step 2
Time frame: Week 52 to Week 104
Change in TSS score
Step 2
Time frame: Week 52 to Week 104
Time course of DAS28 after restarting MTX following suspension of discontinuation in the TCZ monotherapy group in Step 1
Step 2
Time frame: Week 52 to Week 104
SDAI, CDAI, and Boolean remission rates
Time frame: Week 52 to Week 104