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Rheumatoid ArthritisRABEXNCT05215509

Exercise-induced Cardiac Adaptions in Rheumatoid Arthritis Patients During IL-6 vs. TNF Antibody Therapy

A study testing Exercise and No exercise in people with Rheumatoid Arthritis, run by Copenhagen University Hospital, Rigshospitalet at 1 site in Denmark.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The present study will investigative the physiological effects of the cytokines interleukin-6 (IL-6) and tumor necrosis factor (TNF) on the adaptive changes to exercise in patients with rheumatoid arthritis. Read more about this study

Who is it for?
Ages 18 to 70 yearsHealthy volunteers can take part
Conditions the study is for
Rheumatoid Arthritis
What is being tested?
Exercise and No exercise
Could I receive a placebo?
No, everyone receives an active treatment
How many people
69 participants
Where
1 siteDenmark
Study dates
1 Jan 2021to 31 Dec 2023
Phase
Interventional
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 70 years
  • All sexes
  • Healthy volunteers accepted
  • Adult, Older adult

Who may be able to join

  • Age >= 18 and <70 years
  • Informed consent
  • Diagnosed RA based on the 2010 American College of Rheumatology/ EULAR criteria. In biological treatment with either IL-6rB og TNFi over four months prior to enrollment
  • Low RA disease activity, based on the Disease Activity Score-28 ESR for Rheumatoid Arthritis (DAS28) <=3.2
  • An electrocardiogram without features of left ventricular hypertrophy defined by the European Society of Cardiology
  • Females of childbearing potential have to use one or more of the following highly effective methods for contraception in order to be included:
Show all 16Show fewer
  • Vasectomized partner
  • Bilateral tubal occlusion
  • Sexual abstinence
  • Intrauterine device
  • Hormonal contraception
  • Females who are considered to have no childbearing potential are
  • Bilateral tubal ligation
  • Bilateral oophorectomy
  • Complete hysterectomy
  • Postmenopausal defined as 12 months with no menses without an alternative medical cause

Who cannot join

  • Health conditions that prevent participating in the exercise intervention determined by the Project Coordinator
  • Subjects who cannot undergo MRI scans (metallic implants or claustrophobia)
  • Corticosteroid use per os > 10 mg/day within seven days of study enrollment
  • Intramuscular corticosteroid within 3 weeks of the study enrollment
  • Grade 2 hypertension (systolic BP > 160 mmHg and/or diastolic BP >100 mmHg) despite the use of antihypertensive drugs.
  • Pregnancy
  • Subjects with insulin dependent Diabetes

Trial locations and contacts

1 site in 1 country.

Denmark1 site
  • Rigshospitalet

    Copenhagen, 2100

Other trials in Denmark

About this study

Official title: Exercise-induced Cardiac Adaptions in Rheumatoid Arthritis Patients During Interleukin-6 vs. Tumor Necrosis Factor Antibody Therapy: a Randomised, Controlled Study.

The present study will investigative the physiological effects of the cytokines interleukin-6 (IL-6) and tumor necrosis factor (TNF) on the adaptive changes to exercise in patients with rheumatoid arthritis. The investigators hypothesize that blockage of IL-6 receptors will decrease the cardiac and metabolic adaptations to exercise training compared to the inhibition of TNF. 80 patients will be included in a 12-week investigator blinded randomised exercise training intervention study.

Read the detailed description

80 patients with rheumatoid arthritis who are being treated with either interleukin-6 receptor blockers (IL-6Rb) or tumor necrosis factor inhibitors (TNFi) for a minimum of four months prior to enrollment will be recruited and undergo baseline testing, including examination, biochemistry, ECG, DXA, OGTT, pulmonary function, VO2max, echocardiography, cardiac MRI.

After baseline testing, 40 patients in IL-6 receptor blocker treatment and 40 patients in TNF inhibitor treatment.will be randomly allocated into one group receiving standard of care (control group) or a group performing supervised high-intensity interval training three times a week over a period of 12 weeks. The randomization procedure involves a computer-generated block randomization schedule in a ratio of 1:1 stratified by sex by an independent person. Following the 12-week intervention period, all groups will complete a series of follow-up tests (as baseline testing).

Being tested
Exercise, No exercise
Keywords
Cardiac adaptations, Metabolic adaptations, High intensity interval training
Medical subject headings
Arthritis, Rheumatoid

What participants receive

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

  • ExerciseBehavioural

    Also called High intensity interval training

    Supervised high-intensity interval training for 12 weeks three times per week. The supervision may be physical or online supervision

  • No exerciseBehavioural

    Control group, therefore no supervised exercise regime

Study groups in NCT05215509
Study groupRoleWhat they receive
RA patients TNFi ExerciseExperimentalThe patients will be randomized to 12-week supervised exercise training intervention or no exercise training. The exercise training program includes three supervised sessions per week over a 12-week period. The program consists of high intensity endurance training on ergometer bicycles. The intensity will progress throughout the 12 weeks of training. The training consists of 10 minutes of warm up at 40-60% maximum heart rate (HRmax), followed by 25 minutes of high intensity interval training (4 bouts of 4 min at >85% HRmax interspaced by 3 minutes of low intensity training at 40-60% Hrmax) and finally a 5 min cool-down of 50% Hrmax
Receives: Behavioral: Exercise
RA patients TNFi ControlActive comparatorThis group will be allocated to "control" and therefore no supervised exercise regimen
Receives: Behavioral: No exercise
RA patients IL-6Rb ExerciseExperimentalThe patients will be randomized to 12-week supervised exercise training intervention or no exercise training. The exercise training program includes three supervised sessions per week over a 12-week period. The program consists of high intensity endurance training on ergometer bicycles. The intensity will progress throughout the 12 weeks of training. The training consists of 10 minutes of warm up at 40-60% maximum heart rate (HRmax), followed by 25 minutes of high intensity interval training (4 bouts of 4 min at >85% HRmax interspaced by 3 minutes of low intensity training at 40-60% Hrmax) and finally a 5 min cool-down of 50% Hrmax
Receives: Behavioral: Exercise
RA patients IL-6Rb ControlActive comparatorThis group will be allocated to "control" and therefore no supervised exercise regimen
Receives: Behavioral: No exercise

What is being measured

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

  1. Change in left ventricular mass

    measured by MRI scan

    Measured: 12 weeks

Secondary outcomes (32)
  1. Visceral adipose tissue mass

    measured by MRI scan

    Measured: 12 weeks

  2. Stroke volume

    Structural cardiac parameter: measured by MRI scan and echocardiography

    Measured: 12 weeks

  3. Left ventricular and atrial end-diastolic volume

    Structural cardiac parameter: measured by MRI scan and echocardiography

    Measured: 12 weeks

  4. LVEF

    Functional cardiac parameters: measured by MRI scan and echocardiography

    Measured: 12 weeks

  5. Global longitudinal strain

    Functional cardiac parameters: measured by MRI scan and echocardiography

    Measured: 12 weeks

  6. E/A ratio

    Functional cardiac parameters: measured by MRI scan and echocardiography

    Measured: 12 weeks

  7. E/é

    Functional cardiac parameters: measured by MRI scan and echocardiography

    Measured: 12 weeks

  8. Left ventricular and atrial end-systolic volume

    Structural cardiac parameter: measured by MRI scan and echocardiography

    Measured: 12 weeks

  9. Left atrial volume index

    Structural cardiac parameter: measured by MRI scan and echocardiography

    Measured: 12 weeks

  10. Interventricular septum thickness

    Structural cardiac parameter: measured by MRI scan and echocardiography

    Measured: 12 weeks

  11. Left ventricular posterior wall thickness

    Structural cardiac parameter: measured by MRI scan and echocardiography

    Measured: 12 weeks

  12. Aortic and pulmonary distensibility and pulse wave velocity

    Functional vascular parameter: measured by MRI

    Measured: 12 weeks

  13. Subcutaneous, visceral and epicardial adipose tissue

    Measured by MRI and MR spectroscopy

    Measured: 12 weeks

  14. Intramyocardial triglyceride content

    Measured by MRI and MR spectroscopy

    Measured: 12 weeks

  15. Cardiorespiratory fitness

    Measured with an incremental VO2 protocol on exercise bike

    Measured: 12 weeks

  16. Dynamic spirometry

    Pulmonary function testing

    Measured: 12 weeks

  17. Whole body plethysmography

    Pulmonary function testing

    Measured: 12 weeks

  18. Diffusion capacity

    Pulmonary function testing

    Measured: 12 weeks

  19. Body composition

    Measured by a DXA scan

    Measured: 12 weeks

  20. Oral glucose tolerance test

    75g of glucose taken while fasting

    Measured: 12 weeks

  21. Axial accelerometer-based physical activity monitors

    Free-living physical activity is measured using axial accelerometer-based physical activity monitors (AX3; Axivity, Newcastle upon Tyne, UK) for a 5-day period

    Measured: 5 days in week 6 of the intervention/control

  22. Dietary intake

    Self reported intake of all foods and liquids

    Measured: 3 days in the week 6 of intervention/control

  23. Blood sample

    Change in fasting total cholesterol, low-density lipoprotein (LDL)-cholesterol and high-density lipoprotein (HDL)-cholesterol (mmol/L). Following an overnight fast (10 hours), blood samples are collected and processed by a trained laboratory technician and analysed according to standard procedures.

    Measured: 12 weeks

  24. Blood sample

    Change in triglycerides (mmol/L). Following an overnight fast (10 hours), blood samples are collected and processed by a trained laboratory technician and analysed according to standard procedures.

    Measured: 12 weeks

  25. RA disease specific outcomes 1

    Change in measures of the international Core Outcome Set for rheumatoid arthritis : 66/68 tender and swollen joint count

    Measured: 12 weeks

  26. RA disease specific outcomes 2

    Change in visual analogue scale (VAS) pain, VAS physician global assessment, VAS patient global assessment

    The Visual Analogue Scale (VAS) is a self-report measure consisting simply of a 100 mm horixontal line with a statement at each end representing one extreme (0mm = nothing, 100mm = extreme)

    Measured: 12 weeks

  27. RA disease specific outcomes 3

    Change in Health Assessment Questionnaire (HAQ-DI)

    Total score is between 0-3.0. Increasing scores indicate worse functioning with 0 indicating no functional impairment and 3 indicating complete impairment.

    Measured: 12 weeks

  28. RA disease specific outcomes 4

    Change in Short Form 36 (SF-36) Health Survey Questionnaire

    A 8-scale score within 8 domains.All items are scored so that a high score defines a more favorable health state.

    Measured: 12 weeks

  29. RA disease specific outcomes 5

    Change in the composite Disease Activity Score-28 ESR for Rheumatoid Arthritis (DAS28).

    A DAS28 of greater than 5.1 implies active disease, less than 3.2 low disease activity, and less than 2.6 remission

    Measured: 12 weeks

  30. RA disease specific outcomes 6

    Change in response criteria will be assessed according the clinical disease activity index (CDAI).

    The CDAI composite index quantifies disease activity in RA, by utilising four clinical parameters including tender and swollen joints and global assessment from both patient and assessor on a vasual analogue scale.

    CDAI interpretation score CDAI ≥ 22,1: High Activity CDAI < 22,1 og ≥10,1: Moderate Activity CDAI <10,0 og ≥ 2,9: Low Activity CDAI <2,9: Remission

    Measured: 12 weeks

  31. RA disease specific outcomes 7

    Change in response criteria will be assessed according the American College of Rheumatology (ACR 20/50/70) response

    Measured: 12 weeks

  32. RA disease specific outcomes 8

    Change in response criteria will be assessed according the European League Against Rheumatism (EULAR none/good/moderate response)

    Measured: 12 weeks

Timeline

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

  1. First posted31 Jan 2022
  2. Study start1 Jan 2021
  3. Primary completion10 Aug 2023
  4. Study completion31 Dec 2023

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 N/A
Primary purpose
Health services research
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Investigator
Enrolment
69 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05215509
Sponsor's protocol ID
H-21010559
Acronym
RABEX
Status last verified
Feb 2024
First submitted
16 Nov 2021
Last updated
2 Feb 2024
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: Anonymised IPD obtained through this study may be provided to qualified researchers upon reasonable request.

Publications

  • Jonck S, Adamsen ML, Rasmussen IE, Lytzen AA, Lok M, Vonsild Lund MA, Dreyer L, Jorgensen PG, Vejlstrup N, Kober L, Christensen R, Jacobsen S, Pedersen BK, Ellingsgaard H, Hojgaard P, Berg RMG, Christensen RH. IL-6 Inhibitors and TNF Inhibitors: Impact on Exercise-induced Cardiac Adaptations in Patients With Rheumatoid Arthritis. JACC Basic Transl Sci. 2025 May;10(5):551-563. doi: 10.1016/j.jacbts.2024.11.010. Epub 2025 Feb 5.

    PubMed 40436519
  • Jonck S, Adamsen ML, Hojgaard P, Rasmussen IE, Ellingsgaard H, Lund MAV, Jorgensen PG, Jacobsen S, Kober L, Vejlstrup N, Dreyer L, Pedersen BK, Berg RMG, Christensen RH. Effect of a 12-week high-intensity exercise intervention: a comparison of cardiac exercise adaptations during biological disease-modifying antirheumatic drug treatment (TNF inhibitors vs IL-6 signalling inhibitors) in patients with rheumatoid arthritis - study protocol for a randomised controlled trial. BMJ Open. 2023 May 11;13(5):e068600. doi: 10.1136/bmjopen-2022-068600.

    PubMed 37169504

Questions about this trial

What is this clinical trial studying?

A study testing Exercise and No exercise in people with Rheumatoid Arthritis, run by Copenhagen University Hospital, Rigshospitalet at 1 site in Denmark.

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 16 inclusion and 7 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: finished, as of the sponsor's last update on 2 Feb 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Denmark. 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.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

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

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Change in left ventricular mass (time frame: 12 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 NCT05215509, which also lists 2 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 2 Feb 2024.

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