The Study objectives are: 1. To compare the efficacy and safety of Etanercept, lyophilisate for solution for injection and Enbrel, lyophilisate for solution for subcutaneous injection, which are used as subcutaneous injections at a dose of 25 mg 2 times a week for 24 weeks in combination with methotrexate in patients with rheumatoid arthritis. 2. To prove the therapeutic equivalence of Etanercept, lyophilisate for solution for injection and Enbrel, lyophilisate for solution for subcutaneous injection in patients with rheumatoid arthritis. 3. To evaluate the immunogenicity of Etanercept, lyophilisate for solution for injection.
This is an open-label, randomized, comparative, multicentre study in parallel groups of the efficacy, safety and immunogenicity of Etanercept, lyophilisate for solution for injection and Enbrel, lyophilisate for solution for subcutaneous injection, in patients with rheumatoid arthritis. Total duration of patient participation in the study will be 49-52 weeks. Of these: screening - up to 4 weeks, treatment - 24 weeks, follow-up after treatment - 4 weeks, evaluation of the study drug immunogenicity - 52 weeks after the treatment initiation. Patients receive Etanercept or Enbrel (depending on the group) in the form of subcutaneous injections at a dose of 25 mg 2 times a week for 24 weeks.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
160
Subcutaneous injections
Subcutaneous injections
PU Kryvyi Rih City Clinical Hospital №2 of the Dnipropetrovsk regional council
Kryvyi Rih, Dnipropetrovsk Oblast, Ukraine
RECRUITINGPU Kryvyi Rih City Clinical Hospital №8 of the Dnipropetrovsk regional council
Kryvyi Rih, Dnipropetrovsk Oblast, Ukraine
RECRUITINGIvano-Frankivsk Central City Clinical Hospital
Ivano-Frankivsk, Ivano-Frankivsk Oblast, Ukraine
RECRUITINGCommunal non-commercial enterprise of Kharkiv Regional Council Regional Hospital of the war veterans
Kharkiv, Kharkiv Oblast, Ukraine
RECRUITINGMunicipal nonprofit enterprise City Multidisciplinary Hospital № 18 of Kharkiv City Council
Kharkiv, Kharkiv Oblast, Ukraine
RECRUITINGKhmelnytskyi Regional Hospital
Khmelnytskyi, Khmelnytskyi Oblast, Ukraine
RECRUITINGCommunal noncommercial enterprise of Lviv Regional Council Lviv Regional Clinical Hospital
Lviv, Lviv Oblast, Ukraine
RECRUITINGTernopil University Hospital
Ternopil, Ternopil Oblast, Ukraine
RECRUITINGVinnitsa Regional Clinical Hospital Named After N.I.Pirogov
Vinnitsa, Vinnitsa Region, Ukraine
RECRUITINGMunicipal Institution O.Herbachevskiy Regional State Clinical Hospital
Zhytomyr, Zhytomyr Oblast, Ukraine
RECRUITINGNumber of patients with ACR20 (American College of Rheumatology 20 criteria) response
ACR20 responders are subjects with at least 20% improvement from Baseline for tender joint count (TJC), swollen joint count (SJC), and at least 3 of the 5 remaining core set measures: 1. Health Assessment Questionnaire-Disability Index (HAQ-DI), 2. C-reactive Protein (CRP), 3. Patient's Assessment of Arthritis Pain-Visual Analog Scale (PAAP-VAS), 4. Patient's Global Assessment of Disease Activity-Visual Analog Scale (PtGADA-VAS), 5. Physician's Global Assessment of Disease Activity-Visual Analog Scale (PhGA-VAS)
Time frame: at 24 week of treatment.
Number of patients with ACR50 (American College of Rheumatology 50 criteria) response
ACR50 responders are subjects with at least 50% improvement from Baseline for tender joint count (TJC), swollen joint count (SJC), and at least 3 of the 5 remaining core set measures: 1. Health Assessment Questionnaire-Disability Index (HAQ-DI), 2. C-reactive Protein (CRP), 3. Patient's Assessment of Arthritis Pain-Visual Analog Scale (PAAP-VAS), 4. Patient's Global Assessment of Disease Activity-Visual Analog Scale (PtGADA-VAS), 5. Physician's Global Assessment of Disease Activity-Visual Analog Scale (PhGA-VAS)
Time frame: at 4, 8 and 12 weeks of treatment
Number of patients with ACR70 (American College of Rheumatology 70 criteria)
ACR70 responders are subjects with at least 70% improvement from Baseline for tender joint count (TJC), swollen joint count (SJC), and at least 3 of the 5 remaining core set measures: 1. Health Assessment Questionnaire-Disability Index (HAQ-DI), 2. C-reactive Protein (CRP), 3. Patient's Assessment of Arthritis Pain-Visual Analog Scale (PAAP-VAS), 4. Patient's Global Assessment of Disease Activity-Visual Analog Scale (PtGADA-VAS), 5. Physician's Global Assessment of Disease Activity-Visual Analog Scale (PhGA-VAS)
Time frame: at 4, 8 and 12 weeks of treatment
Number of patients who achieved remission (DAS28(Disease Activity Score 28)<2.6) and low disease activity (DAS28≤3.2)
The DAS28 is a combined index for measuring disease activity in RA. The index includes swollen (range 0-28) and tender (range 0-28) joint counts, acute phase response (ESR in mm/hr), and general health status (participant global assessment of disease activity using VAS, range 1-100 mm). DAS28, which uses a 28-joint count, is derived from the original DAS, which includes a 44-swollen joint count. The DAS28 scale ranges from 0 to 10, where higher scores indicate worsening. DAS28 \<2.6 equals (=) remission
Time frame: at 12 and 24 weeks of treatment
Changes in activity index DAS28
Changes in activity index compared to baseline. The DAS28 index takes into account information on safety and swelling of 28 joints, ESR and patients' global health assessment according to VAS. Calculate DAS28 from the expression: DAS28 = 0.56√NPJ + 0.28√NSJ + 70lnESR + 0.014PGAH, where NPJ - number of painful joints at palpation (28 examined), NSJ - number of swollen joints (28 examined), PGAH - patient's global assessment of health in millimetres in 100 mm Visual Analog Scale (VAS), ESR - rate of erythrocyte sedimentation in mm/h, ln - natural logarithm. According to the ACR criteria, the levels of the disease activity depending on the values of DAS28, are ranked as: remission - DAS28 \<2.6; low - DAS28 ≤3.2; moderate - DAS28 3.3-5.1; high - DAS28 \>5.1. To calculate DAS28, use the official online calculator: http://www.das-score.nl/das28/DAScalculators/dasculators.html and https://www.das-score.nl/das28/DAScalculators/dasculators.html
Time frame: at 4, 8, 12 and 24 weeks of treatment
Changes in functional state of patients according to questionnaire HAQ -(Health Assessment Questionnaire- data)
Changes in functional state of patients according to questionnaire HAQ DI -(Health Assessment Questionnaire Disability Index) compared to baseline. It includes the categories of dressing and grooming, arising, eating, walking, hygiene, reach, grip and common daily activities. It asks patients about the amount of difficulty they experience in these activities as well as the use of aids and/or devices. The HAQ has a numeric rating scale (NRS) (13) to assess pain on a scale from 0 to 10.Grades to evaluate the treatment efficacy using the HAQ DI. The minimal clinically significant change in the HAQ DI, which corresponds to the difference in parameters before and after treatment, is equal to 0.22. НАQ \< 0.22 points - no effect; 0.22 ≤ ∆ НАQ ≤ 0.36 - lowest effect (20% improvement according to ACR criterion); 0.36 ≤ ∆ HAQ \< 0.80 - satisfactory effect (50% improvement according to ACR criterion); HAQ ≥ 0.80 points - highest effect (70% improvement according to ACR criterion).
Time frame: at 4, 8, 12 and 24 weeks of treatment compared to baseline.
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