The purpose of this study is to asses the compared efficacy, safety and immunogenicity of ENERCEPTAN® with ENBREL® in combination with Methotrexate for the treatment of patients with rheumatoid arthritis.
Randomized, , non-inferiority, two parallel arms, 32 weeks, blind for the assessor. Subjects should be with inadequate response to methotrexate with stable dosis ≥ 15 and ≤ 25 mg/week 28 days before randomization. Randomization will be 2:1 Enerceptan® to Enbrel® with concomitant medication of MTX
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
168
Instituto Medico CER
Bs As, Argentina
ACR (American College of Rheumatology) 20
The percentage of patients who achieved ACR20 at Week 32 is the primary end point. Signs and symptoms are assessed with a composite rating scale of the ACR (American College of Rheumatology) that includes 7 variables: * Tender Joints Count * Swollen Joints Count * Levels of an acute phase reactant (CRP level) * Patient's assessment of pain * Patient's global assessment of disease activity * Physician's global assessment of disease activity * Patient's assessment of physical function
Time frame: 32 weeks of treatment
ACR (American College of Rheumatology) 50
ACR50 is defined as the percentage of patients who achieve at least 50% improvement in both tender joint count and swollen joint count, and at least 50% improvement in at least 3 of the 5 other assessments.
Time frame: 32 weeks of treatment
ACR (American College of Rheumatology) 70
ACR70 is defined as the percentage of patients who achieve at least 70% improvement in both tender joint counts and swollen joint counts and at least 70% improvement in at least 3 of the 5 other assessments of the ACR
Time frame: 32 weeks of treatment
DAS (Disease activity state)
It will be measured using the DAS (Disease activity state) 28. DAS28 is a composite score that includes 4 variables: * Tender Joints Count (based on 28 joints) * Swollen Joints Count (based on 28 joints) * Patient's global assessment of disease activity * Marker of inflammation: C REACTIVE PROTEIN
Time frame: 32 weeks of treatment
EULAR (European League Against Rheumatism) response criteria
* Good response = Percentage of patients with an improvement of \>1.2 and a present DAS score ≤3.2. * Moderate response = Percentage of patients with either an improvement of \>0.6 to ≤1.2 and a present score ≤5.1, or an improvement \>1.2 and a present score \>3.2 * Non response = Percentage of patients with either an improvement of ≤0.6 or an improvement \>0.6 to ≤1.2 and a present score \>5.1
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Time frame: 32 weeks of treatment
Time to onset of benefit
ACR20, will be also analyzed at every clinic visit to allow an analysis of the time to onset of benefit for achievement of ACR
Time frame: 32 weeks of treatment
Change in modified van der Heijde Sharp score
• The Sharp method is a composite X-ray scoring system used to assess structural (joint) disease progression in rheumatoid arthritis. The method evaluates both joint erosions (JE) and joint space narrowing (JSN) in bilateral hand and foot joints
Time frame: 32 weeks of treatment
Physical function
• Improvement in physical function is assessed by change from baseline in HAQ (Health Assessment Questionnaire) at Week 32.The HAQ-DI (disability index) is composed of 8 categories as follows: dressing and grooming, arising, eating, walking, hygiene, reach, grip and activities, for which there are at least 2 questions by category. The patient will be asked to score how difficult he/she feels it is to perform such activities using a 0 to 3 scoring (0=without any difficulty, 1=with some difficulty, 2=with much difficulty and 3=unable to do). If the patient is using assistance for any of these activities, scoring may be adjusted. For each category, the highest score given for one of the question is attributed to the category. The total score is the sum of all categories' scores divided by the number of answered categories (at least 3 categories should be answered)
Time frame: 32 weeks of treatment
Functional Assessment of Chronic Illness Therapy Fatigue scale (FACIT-Fatigue)
The FACIT-Fatigue is a 13-item questionnaire rated 0 to 4. The patient will be asked to answer to 13 questions rated 0 to 4 (0=not at all, 1=a little bit, 2=some what, 3=quite a bit, 4=very much
Time frame: 32 weeks of treatment
Incidence of Treatment-Emergent Adverse Events [Safety and Tolerability]).
Infections, hematological disorders, neurologic disorders and malignancies. Adverse Drug Reactions. Incidence, seriousness and severity. Serum Hematological and chemistry values.Local Adverse Drug Reactions
Time frame: 32 weeks of treatment
Steady state concentration
Etanercept concentration measure
Time frame: At week 16 and 32
Immunogenicity
Antibodies anti-Etanercept measure
Time frame: At week 16 and 32