Anti-TNFα Use During Elective Foot and Ankle Surgery in Patients With Rheumatoid Arthritis
Status:
Unknown status
Trial end date:
2019-10-01
Target enrollment:
Participant gender:
Summary
Rheumatoid arthritis (RA) is a frequent inflammatory arthritis that can lead to severe joint
deformity and often requires orthopaedic surgical interventions. Anti-Tumor Necrosis Factor α
(anti-TNFα) are biological disease-modifying antirheumatic drugs (DMARDs) increasingly used
in the treatment of rheumatoid arthritis. An increased risk of opportunistic infection was
demonstrated in patients treated with those drugs. This observation led many national
committees to recommend anti-TNFα suspension in the perioperative period to avoid a raise in
the postoperative infection risk in those patients. This approach is not supported by the
data available in the current literature and it exposes patients to an increased risk of
inflammatory flare ups of their disease during and after anti-TNFα suspension, which can
compromise their postoperative rehabilitation and their quality of life.
The objective of this prospective randomized multicentric trial is to determine the effect of
anti-TNFα suspension in the perioperative period on the postoperative infection risk.
Overall, 660 rheumatoid arthritis patients requiring an elective foot or ankle surgery will
be randomized into two groups. In the first group, anti-TNFα will be stopped 3 half-lives
before the surgery while they will be continued in the second group. The postoperative
infection rate will be compared between the two groups. Postoperative complication rates,
flares and revision surgeries as well as the functional improvement will be compared.
The study hypothesis is that there is no significant difference in the risk of postoperative
infection between the two groups.
Results from this study will help determine the optimal way to use anti-TNFα in the
perioperative period and will therefore improve the quality of life of rheumatoid arthritis
patients.
Phase:
Phase 4
Details
Lead Sponsor:
Centre Hospitalier Universitaire de Québec, CHU de Québec CHU de Quebec-Universite Laval