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Moderate to Severe Active Axial SpondyloarthritisPhase 2NCT00844142

Enbrel-Sulfasalazin-Early-Axial Spondyloarthritis (AS)

A Phase 2 study testing Etanercept 25mg and Sulfasalazine in people with Moderate to Severe Active Axial Spondyloarthritis, run by Charite University, Berlin, Germany at 9 sites in Germany.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

Efficacy - To assess efficacy of etanercept versus sulfasalazine when added to NSAIDs in patients with moderate to severe active early axial spondyloarthritis duration of ongoing axial symptoms of less than 5 years. Read more about this study

Who is it for?
Ages 18 to 65 years
What is being tested?
Etanercept 25mg and Sulfasalazine
Could I receive a placebo?
No, everyone receives an active treatment
How many people
80 participants
Where
9 sitesGermany
Study dates
Nov 2005to Jul 2013
Phase
Phase 2
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 65 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Patients 18 - 50 years of age who have moderate to severe active axial spondyloarthritis.
  • Diagnosis made by :Chronic low back pain (duration > 3 months, onset < 45 years of age)plus 3 out of the 6 following criteria if imaging is positive or 4 out of the following 6 criteria if imaging is negative ·
  • Inflammatory back pain:
  • Good or very good response to NSAIDs
  • One or more of the following extraspinal manifestations: uveitis, peripheral arthritis, enthesitis, HLA-B27 positive
  • Positive imaging: MRI showing acute inflammatory lesions in spine or SIJ (in the past) or bilateral sacroiliitis grade 2-4 or unilateral sacroiliitis grade 3-4 in x-ray not older than 12 months
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  • Positive family history for SpA
  • MRI at screening showing acute inflammatory lesions in SIJ or spine
  • Active disease is defined as:
  • a BASDAI score of >=4
  • back pain score (BASDAI question 2) of >= 4 despite concurrent NSAID therapy, or intolerance to NSAIDs.
  • Other inclusion criteria include, if on prednisone:
  • <7.5 mg per day
  • stable for 4 weeks prior to baseline
  • Women of child bearing potential must have a negative pregnancy test at study baseline and use an adequate, effective method of contraception for a duration of 6 months after stop of etanercept therapy. Sexual active men must use an accepted method of contraception for a duration of 6 months after stop of etanercept therapy.
  • Reading a normal chest/lung x-ray which should have been performed within the last 12 weeks before inclusion
  • Able to self-administer injectable drug supplies or have a caregiver who will do so.
  • Able to store injectable test article at 2° to 8° C.

Who cannot join

  • Disease duration of longer than 5 years
  • History of active tuberculosis (TB), histoplasmosis or listeriosis.
  • History of positive HIV status, known hepatitis B or C
  • History of malignancy other than carcinoma in situ of the cervix or adequately treated non-metastatic squamous or basal cell skin carcinoma.
  • Antibiotic treatment within 3 weeks prior to screening.
  • Previous treatment with TNF-alpha blockers
  • Treatment with sulasalazine in the last 6 months before participation in the clinical trial
  • severe internal medical diseases such as severe cardiac, hepatic, gastrointestinal, neurological, psychiatric diseases

Trial locations and contacts

9 sites in 1 country.

9 sites in 1 country

Germany9 sites, 9 recruiting
  • Charité Campus Mitte, Rheumatology

    Berlin, 10117

    Gerd-Ruediger Burmester, MD, 0049-30-450513 ext. 025, gerd.burmester@charite.de

    Recruiting
  • Praxis Mielke

    Berlin, 12627

    Mielke, MD, 0049-30-994 ext. 21 22

    Recruiting
  • Praxis Zinke

    Berlin, 13055

    Silke Zinke, MD, 0049-30-98695 ext. 231, dr.silke.zinke@t-online.de

    Recruiting
  • Klinikum Buch

    Berlin, 13125

    Andreas Krause, MD, 0049-30-94792 ext. 380, a.krause@immanuel.de

    Recruiting
  • Waldkrankenhaus

    Berlin, 13589

    Ulrich Prothmann, MD, 0049-30-3702- ext. 1302, u.prothmann@waldkrankenhaus.com

    Recruiting
  • Schlossparkklinik, Rheumatology

    Berlin, 14059

    Rieke Alten, MD, 0049-303264- ext. 1333, rieke.alten@schlosspark-klinik.de

    Recruiting
  • Immanuel Krankenhaus

    Berlin, 14109

    Andreas Krause, MD, 0049-30-80505- ext. 293, a.krause@immanuel.de

    Recruiting
  • Praxis Klopsch

    Neubrandenburg, 17033

    Thilo Klopsch, MD, 0049-395- 775 ext. 43 24, dr.thilo.klopsch@t-online.de

    Recruiting
  • Praxis Bohl-Bühler

    Potsdam, 14469

    Martin Bohl-Bühler, MD, 0049-331- 647352 ext. 1, info@Rheumahaus.de

    Recruiting

Other trials in Germany

About this study

Official title: Randomized Controlled 12 Months Trial With Etanercept (Enbrel ®) vs. Sulfasalazine in Early Axial Spondyloarthritis With Focus on Improvement of Acute Inflammatory Lesions as Detected by MRI. Amendment 4: 1-Year Extension of Study

Efficacy - To assess efficacy of etanercept versus sulfasalazine when added to NSAIDs in patients with moderate to severe active early axial spondyloarthritis duration of ongoing axial symptoms of less than 5 years. Primary outcome is change of active inflammatory lesions in sacroiliac joints and spine as detected by MRI at 12 months. Secondary outcome parameters are clinical and laboratory efficacy parameters and MRI changes at 6 months and 2 years. Comparisons will be made within the two treatment arms and compared to baseline. At the 1 year extension phase comparisons will be also made between year 1 and year 2. At the end of the extended study a pelvic x-ray is planned.

Read the detailed description

Randomized controlled study with two treatment arms (Phase II), 1 year open extension

Efficacy - To assess efficacy of etanercept vs. sulfasalazine when added to NSAIDs in patients with moderate to severe active early axial spondyloarthritis duration of ongoing axial symptoms of less than 5 years. Primary outcome is change of active inflammatory lesions in sacroiliac joints and spine as detected by MRI at 12 months. Secondary outcome parameters are clinical and laboratory efficacy parameters and MRI changes at 6 months and 2 years. Comparisons will be made within the two treatment arms and compared to baseline. At the 1 year extension phase comparisons will be also made between year 1 and year 2. At the end of the extended study a pelvic x-ray is planned. For etanercept group: To assess whether etanercept will show sustained long term response over 1 more year. To assess whether etanercept will slow or stop progression as shown by MRI.For sulfasalazine group: to assess whether etanercept will show long term response over 1 year. To assess whether etanercept will slow or stop progression as shown by MRI. For all patients who are in remission the duration of remission will be assessed for a maximum of one year. In case of a flare of the disease these patients will be (re-) treated with etanercept and efficacy will be assessed. Safety - To study the long-term safety of etanercept in patients with moderate to severe active early axial spondyloarthritis compared to patients treated with sulfasalazine over a period of one year.

Patients will be treated for 1 year either with etanercept 2x25mg per week subcutaneously or with sulfasalazine 2g/ day given orally. Following screening and baseline evaluations, patients will be assessed at week 2, 4, 6, 8, 10, 12, 24, 36 and 48. Efficacy and safety measurements will be recorded throughout the entire study. The study will be followed by a 60 weeks follow-up phase after week 48 (end of treatment phase). In case of flare they will be (re-)treated with etanercept for further 60 weeks (until week 108). All patients from the former etanercept group who are not in remission will continue to be treated with etanercept for 60 weeks (weeks 60, 72, 84, 96, 108). All patients from the former sulfasalazine group who are not in remission will be switched to etanercept for 60 weeks (at weeks 50, 54, 60, 72, 84, 96, 108).

Treatment arms:Arm 1: 40 patients receive etanercept 2x25 mg weekly subcutaneous injectionArm 2: 40 patients receive sulfasalazine up to 2 g/day (up to 3 g/ per day)

Duration of the study:12 months. For patients in remission a 12 months follow up period will be enclosed. Treatment will be continued for patients in case of flare or in patients who did not achieve remission for 60 weeks. The study is planned start at September 2005. Patients will be recruited over a 12 months period. Altogether the duration of the study is up to 51 months. All patients who are willing to participate in the extension will be treated for another 60 weeks.

Patient Population:Only active axial SpA patients with a disease duration (measured from time of ongoing spinal symptoms) of less than 5 years will be included. This implies that patients with both radiological evidence of sacroiliitis (fulfilling the modified New York criteria for AS) and without radiological evidence of sacroiliitis (see inclusion criteria) will be included.

Efficacy Variables:Primary endpoint:· Reduction of active inflammatory lesions in MRI at 12 monthsSecondary endpoints:

  • ASAS 20%, 40%, 70% response, ASAS criteria for partial remission· BASDAI 20%, 50%, 70% improvement · BASFI · Mobility examinations: BASMI, Chest Wall Expansion· disease controlling antirheumatic therapy criteria (DC-ART20) (5 out of 6)*· CRP, ESR· Quality of Life: SF-36· Numeric Rating Scale (NRS) - physicians global, patients global, general pain, nocturnal pain · Enthesitis index (Maastricht scale)· swollen joint count· EQ-5D· Socio-economic questionnaire· Chronic changes in MRI at 6, 12 months and 108 weeks· Reduction of active inflammatory lesions in MRI at 6 months and chronic lesions at 6 and 12 months and 108 weeks
Being tested
Etanercept 25mg, Sulfasalazine
Keywords
ankylosing spondylitis, axial spondyloarthritis, magnetic resonance imaging, etanercept, sulfasalazine
Medical subject headings
Spondylitis, Ankylosing, Axial Spondyloarthritis

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Etanercept 25mgDrug

    patients will receive etanercept 25mg twice weekly

  • SulfasalazineDrug

    in this arm patients will receive sulfasalazine 2000- 3000mg per os daily

Study groups in NCT00844142
Study groupRoleWhat they receive
1Otheretanercept 25mg twice weekly
Receives: Drug: Etanercept 25mg
2Active comparatorSulfasalazine 2000- 3000mg daily
Receives: Drug: Sulfasalazine

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Primary outcome: Reduction of active inflammatory lesions in MRI at 12 months.

    Measured: 108 weeks

Secondary outcomes (1)
  1. Secondary outcome: ASAS 20%, 40%, 70% response, ASAS criteria for partial remission· BASDAI 20%, 50%, 70% improvement · BASFI ·

    Measured: 108 weeks

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted13 Feb 2009 (estimated)
  2. Study startNov 2005
  3. Primary completionJul 2013 (estimated)
  4. Study completionJul 2013 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
80 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT00844142
Sponsor's protocol ID
M01
Other IDs
Enbrel-Sulfa-Early-AS
Status last verified
Feb 2009
First submitted
12 Feb 2009
Last updated
13 Feb 2009
Results posted
No
Data monitoring committee
Yes

Publications

  • Torgutalp M, Rademacher J, Proft F, Hermann KG, Althoff C, Haibel H, Protopopov M, Sieper J, Rios Rodriguez V, Poddubnyy D. Association between resolution of MRI-detected inflammation and improved clinical outcomes in axial spondyloarthritis under long-term anti-TNF therapy. RMD Open. 2025 Jan 6;11(1):e004921. doi: 10.1136/rmdopen-2024-004921.

    PubMed 39762123
  • Song IH, Hermann KG, Haibel H, Althoff CE, Poddubnyy D, Listing J, Weiss A, Lange E, Freundlich B, Rudwaleit M, Sieper J. Prevention of new osteitis on magnetic resonance imaging in patients with early axial spondyloarthritis during 3 years of continuous treatment with etanercept: data of the ESTHER trial. Rheumatology (Oxford). 2015 Feb;54(2):257-61. doi: 10.1093/rheumatology/keu263. Epub 2014 Aug 19.

    PubMed 25140041
  • Song IH, Hermann KG, Haibel H, Althoff CE, Poddubnyy D, Listing J, Weiss A, Buss B, Freundlich B, Lange E, Alten R, Rudwaleit M, Sieper J. Consistently Good clinical response in patients with early axial spondyloarthritis after 3 years of continuous treatment with etanercept: longterm data of the ESTHER trial. J Rheumatol. 2014 Oct;41(10):2034-40. doi: 10.3899/jrheum.140056. Epub 2014 Jul 15.

    PubMed 25028375
  • Weiss A, Song IH, Haibel H, Listing J, Sieper J. Good correlation between changes in objective and subjective signs of inflammation in patients with short- but not long duration of axial spondyloarthritis treated with tumor necrosis factor-blockers. Arthritis Res Ther. 2014 Jan 30;16(1):R35. doi: 10.1186/ar4464.

    PubMed 24476416

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Etanercept 25mg and Sulfasalazine in people with Moderate to Severe Active Axial Spondyloarthritis, run by Charite University, Berlin, Germany at 9 sites in Germany.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 18 inclusion and 8 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: status not confirmed, as of the sponsor's last update on 13 Feb 2009. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 9 sites in Germany. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

Contact Joachim Sieper, MD (0049-30-8445 ext. 4535, joachim.sieper@charite.de), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Primary outcome: Reduction of active inflammatory lesions in MRI at 12 months. (time frame: 108 weeks). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT00844142, which also lists 4 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 13 Feb 2009.

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