Adalimumab in Alleviating Inflammation in Patients With Axial Spondyloarthritis
Status:
Unknown status
Trial end date:
2017-12-01
Target enrollment:
Participant gender:
Summary
Axial spondyloarthritis is an inflammatory rheumatic disease mainly affecting joints in the
spine and the sacroiliac joints. Inflammatory pathways are likely the central link from axial
spondyloarthritis to the known increased risk of atherosclerotic morbidity. Positron emission
tomography (PET) is the most sensitive method to detect inflammatory foci in clinical
practice. A few small studies have demonstrated that PET imaging together with computed
tomography (PET/CT) detects inflamed tissues in relevant patient groups. One study suggested
that antirheumatic treatment diminishes the inflammation detected in PET/CT. No study so far
has disclosed whether aortic inflammation is present in patients with spondyloarthritis, and
whether the inflammation would wane with efficient antirheumatic treatment. The current study
is aimed to grade the articular and aortic inflammatory signals in the PET/CT imaging before
and after antirheumatic treatment of clinically active axial spondyloarthritis.
Sixty patients aged 18-75 years with axial spondyloarthritis and radiologic sacroiliitis as
detected either by MRI or X-ray will be recruited. Twenty of those are DMARD-naive, and 40
patients have axial spondyloarthritis resistant to sulfasalazine or other conventional
antirheumatic drug. In addition, approximately 30 patients without spondyloarthritis but with
stable coronary heart disease and approximately 20 healthy controls will be taken as
historical controls. All the axial spondyloarthritis patients are PET/CT scanned after
inclusion in the study. The DMARD-naive patients (n=20) are started sulfasalazine-based
regimen for 12 weeks, which is the time point for a second PET scan for this subgroup.
Adalimumab will be commenced for those without remission at 12 weeks. After another 16 weeks,
those with adalimumab will be scanned with PET/CT for the third time. The subgroup with
active disease in spite of prior conventional treatment (n=40) is also scanned with PET/CT
right after the enrolment and after 16-week treatment with adalimumab. The first 15 patients
form a pilot group, which is used to check the validity of the power calculation.
The project will give essential new information on PET-detectable inflammation in the
patients with axial spondyloarthritis. The results will be published in international
publication series. The publications will form the basis for a doctoral thesis. Funding for
the project comes from Abbvie Ltd.