Effects of Tofacitinib vs Methotrexate on Rheumatoid Arthritis Interstitial Lung Disease

• Status: Recruiting
• Trial end date: 2024-11-30
• Target enrollment: 0
• Participant gender: All

Summary

Pulmonary abnormalities are present in up to 60% of patients with early rheumatoid arthritis (RA), and up to 10% of the patients will develop clinical interstitial lung disease (ILD). Recent data indicate that inhibition of Janus kinase is beneficial for this extra-articular manifestation. Our goal is to determine whether tofacitinib is an effective and safe treatment, compared to standard-of-care methotrexate, for subclinical and clinical ILD in patients with early RA. The study also explores disease mechanisms in lungs and joints, to identify potential biomarkers for diagnosis, prognosis, and response to treatment of RA-ILD.

• Phase: Phase 4
• Accepts Healthy Volunteers?: No

Details

• Lead Sponsor: Vastra Gotaland Region
• Collaborator: Göteborg University
• Treatments: Methotrexate; Tofacitinib

Criteria

Inclusion Criteria:

1. The subject has given written consent to participate in the study.

2. Diagnosis of seropositive (i.e., presence of RF and/or anti-CCP antibodies) rheumatoid arthritis (RA) according to the ACR/EULAR 2010 criteria within 24 months.

3. No previous treatment with disease modifying anti-rheumatic drugs (DMARDs). History of prednisone use is allowed but should have been discontinued 2 weeks before baseline measurement.

4. Active disease with ≥2 painful and ≥2 swollen joints in 66/68 joints and CRP ≥2.0 mg/dl

5. Aged 18-80 years

6. Willing to undergo HRCT and pulmonary function tests (PFTs)

Exclusion Criteria:

1. Current active inflammatory joint disease other than RA.

2. Significant and/or uncontrolled cardiac, pulmonary disease, nervous system, renal, hepatic, endocrine or gastrointestinal disorders or severe RA which in the investigator's opinion would preclude patient participation.

3. Malignancy within the past 5 years, except for successfully treated cervical carcinoma in situ, basal cell and squamous cell carcinoma of the skin, with no evidence of recurrence or metastatic disease for at least 3 years.

4. Primary or secondary immunodeficiency (history of, or currently active), including known history of HIV infection.

5. Active infection (excluding fungal infections of nail beds) requiring i.v. anti-infectives within 4 weeks, or oral anti-infectives within 2 weeks prior to baseline.

6. Women of childbearing potential not willing or able to use highly effective methods of birth control per ICH M3 (R2) for 28 days prior and 3 months after end of study.

7. Pregnant or lactating women.

8. Positive tests for hepatitis B (HBsAg or HBV DNA) or hepatitis C serology.

9. History of herpes zoster infection during last 10 years.

10. History of venous thromboembolism or diverticulitis.

11. Positive tuberculosis history and/or positive Quantiferon test.

12. Hemoglobin <90 g/L.

13. Absolute neutrophil count < 1500 cells/uL.

14. ASAT or ALAT >2.0 times the upper limit of normal.