Interleukin-1 Receptor Antagonist (IL-1RA) (ANAKINRA) IN SEVERE SYSTEMIC-ONSET JUVENILE IDIOPATHIC ARTHRITIS

NCT00339157 | Completed Phase 2

• 1 other identifier: C05-40
• Study Type: interventional
• Target: 24
• Locations: 1 country
• Sites: 6

Brief Summary

1. 1.Main objective: To test the efficacy of anakinra treatment in children or young adults with corticosteroid-resistant or -dependent Systemic-Onset Juvenile Idiopathic Arthritis (SO-JIA)
2. 2.Design: Double blind, randomized trial testing the efficacy of one month Anakinra treatment versus placebo (2 groups of 12 patients each). All the patients will be treated with anakinra during the following 11 months and the dose of corticosteroids will be gradually tapered (= descriptive part of the trial to assess the tolerance and efficacy over 12 months).
3. 3.Hypothesis: 70% significant improvement after 1 month in Anakinra-treated patients versus no more than 10% in the placebo group.
4. 4.Main inclusion criteria : diagnosis of SO-JIA (Durban consensus conference criteria), age: 2 to 20 years at inclusion, active, corticosteroid-resistant or -dependent disease, no previous IL-1ra treatment.

Conditions

Systemic-Onset Juvenile Idiopathic Arthritis

Keywords

IDIOPATHIC JUVENILE ARTHRITIS; PEDIATRICS; ORPHAN DISEASE; INTERLEUKIN - 1; RECEPTORS , INTERLEUKINS; ANTAGONISTS

Outcome Measures

Primary Outcomes (8)

• 30% improvement of JIA activity after 1 month compared to day 1 according to Giannini's core-set criteria, ie 30% improvement of at least 3 of the 6 items and no more than one item worsened by 30% or more.

  Day 1, 1 Month

• Number of active arthritis

  Day 1, 1 Month

• Number of joints with limitation of motion

  Day 1, 1 Month

• Physician assessment of disease activity

  Day 1, 1 Month

• Parent or patient's assessment of disease activity

  Day 1, 1 Month

• Childhood health assessment questionnaire

  Day 1, 1 Month

• First hour ESR)

  First hour

• Improvement of systemic symptoms between day 1 and month 1 as assessed by the resolution of the fever if present initially, by a 50% decrease or a normalization of the C-reactive protein and of the first hour ES

  Day 1, 1 Month

Secondary Outcomes (7)

• Number, severity and type of adverse events over 12 months

  Over 12 Months

• Proportion of patients reaching 50%, 70% and 100% improvement of JIA activity according to Giannini's core-set criteria at each visit (day 15, month 1 to 6, month 9 and month 12)

  Day 15, Month 1 to 6, Month 9 and Month 12

• Proportion of patients in whom the daily dose of corticosteroids can be reduced to less than 0.3 mg/kg (less than 10 mg in patients over 34 kg) at month 6

  Month 6

• Proportion of patients with a normalization of the glycosylated ferritin / ferritin ratio (if lower than 1/4 initially) after 1, 2 and 6 months

  1 Month, Month 2, Month 6

• Variation of cytokine expression by PBMC between Day 1 and Month 1 and Month 6

  Day 1, Month 1, Month 6

Study Arms (2)

Teatment with ANAKINRA (2 mg/kg SC daily, maximum 100 mg)

ACTIVE COMPARATOR

Anakinra is injected subcutaneously once a day , for a dosage of 2 mg/kg per day with a maximum of 100 mg per day. The dose should be administered at approximately the same time every day. The treatment should be administered with no interruption during the whole study period.

Drug: Anakinra; Biological: Pneumo23

Placebo treatment

PLACEBO COMPARATOR

Placebo is injected subcutaneously once a day using the same volume as the anakina treatment (dosage of 2 mg/kg per day of anakinra with a maximum of 100 mg per day). The dose should be administered at approximately the same time every day. The placebo treatment should be administered with no interruption during the whole study period.

Biological: Pneumo23

Interventions

Anakinra DRUG

Teatment with ANAKINRA (2 mg/kg SC daily, maximum 100 mg)

Pneumo23 BIOLOGICAL

Placebo treatment; Teatment with ANAKINRA (2 mg/kg SC daily, maximum 100 mg)

Eligibility Criteria

• Age: 2 Years - 20 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64)

You may qualify if:

• SO-JIA (Edmonton's revision of Durban's consensus conference criteria)
• Age: at least 2 years and less than 20 years at treatment initiation
• Disease duration of at least 6 months
• Failure of corticosteroid treatment or requirement for corticosteroid treatment at a daily dose equal to or over 0.3 mg/kg (10 mg in patients whose weight is over 34 kg)
• Active and severe systemic symptoms and/or arthritis as assessed by an experienced pediatric Rheumatologists, with at least 3 of the following criteria when assessing Giannini's core-set items: 1) physician global assessment of disease activity of at least 20/100; 2) parent/patient assessment of disease effect on overall well-being of at least 20/100; 3) functional disability with a Children Health Assessment Questionnaire (CHAQ, Ref \[9\]) score equal to or higher than 0.375/3; 4) 2 joints or more with active arthritis 5) 2 joints or more with non-irreversible limited range of motion (irreversible limited range of motion will be defined by radiological evidence of irreversible joint damage and ankylosis) 6) erythrocyte sedimentation rate (ESR) equal to or higher than 20.
• In the absence of disease-related fever, either CRP or first hour ESR or both have to be over the upper limit of normal values so that treatment effect on the systemic part of the disease can be objectively evaluated.
• Patients with polyarthritis (at least 5 joints with inflammation and/or limitation of motion) will be eligible for this study only if at least 50% of the affected joints do not present radiological evidence of irreversible damage.
• Informed consent signed by the parents or the person legally responsible for the patient if the patient is less than 18, and by the patient if old enough
• Teenager girls or young women with childbearing potential must use a contraceptive method (including abstinence
• tuberculin test performed before Day 1 and must either be negative or positivity must be related to previous immunization and of normal intensity according to the investigator's judgment

You may not qualify if:

• Previous treatment with IL-1Ra
• intra-articular injection or change in the doses of non-steroidal anti-inflammatory drugs and corticosteroids in the 4 weeks preceding the initiation of anakinra treatment
• Contra-indication to the use of anakinra including ongoing active infection or allergy to E Coli's derivate or other components of the drug
• Previous history of malignancy or heart insufficiency
• Patients with asthma require to be previously assessed by a pneumonologist
• Obvious need of therapeutic intervention before study completion such as surgery, intra-articular injection, life vaccine administration
• Any of the following: leucocyte counts \< 3.6 x 10e9/L, polymorphonuclear neutrophil counts \< 1.5 x 10e9/L, platelets \< 150 000/mm3, serum creatinin \> 1.5 the upper limit of normal range for age, serum alanine and aspartate transaminases \> 2 times the upper limit of the normal range, serum bilirubin \> 2 times the upper limit of the normal range

Sponsors & Collaborators

• Institut National de la Santé Et de la Recherche Médicale, France: lead

Study Sites (6)

Bordeaux CHU

Bordeaux, 33000, France

Location

Hopital Lyon Edouard Herriot

Lyon, 69437, France

Location

Nancy Hopital d'Enfants

Nancy, 54511, France

Location

Pediatric Immuno-Hematology and Rheumatology Unit, Necker-Enfants Malades Hospital, 149 rue de Sevres

Paris, 75015, France

Location

Robert Debre Hospital

Paris, 75019, France

Location

Kremlin-Bicetre Hospital

Paris, 94270, France

Location

Related Publications (1)

• Quartier P, Allantaz F, Cimaz R, Pillet P, Messiaen C, Bardin C, Bossuyt X, Boutten A, Bienvenu J, Duquesne A, Richer O, Chaussabel D, Mogenet A, Banchereau J, Treluyer JM, Landais P, Pascual V. A multicentre, randomised, double-blind, placebo-controlled trial with the interleukin-1 receptor antagonist anakinra in patients with systemic-onset juvenile idiopathic arthritis (ANAJIS trial). Ann Rheum Dis. 2011 May;70(5):747-54. doi: 10.1136/ard.2010.134254. Epub 2010 Dec 20.

  PMID: 21173013 RESULT

MeSH Terms

Conditions

Arthritis, Juvenile; Rare Diseases

Interventions

Interleukin 1 Receptor Antagonist Protein; Pneumococcal Vaccines

Condition Hierarchy (Ancestors)

Arthritis; Joint Diseases; Musculoskeletal Diseases; Rheumatic Diseases; Connective Tissue Diseases; Skin and Connective Tissue Diseases; Autoimmune Diseases; Immune System Diseases; Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Intervention Hierarchy (Ancestors)

Cytokines; Intercellular Signaling Peptides and Proteins; Peptides; Amino Acids, Peptides, and Proteins; Proteins; Biological Factors; Streptococcal Vaccines; Bacterial Vaccines; Vaccines; Biological Products; Complex Mixtures

Study Officials

• Pierre Quartier-dit-Maire, MD

  Pediatric Immuno-Hematology and Rheumatology Unit, Necker-Enfants Malades Hospital, 149 rue de Sevre, 75015 Paris, France

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: phase 2
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, INVESTIGATOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER GOV
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: June 16, 2006
• First Posted: June 20, 2006
• Study Start: May 11, 2006
• Primary Completion: June 10, 2008
• Study Completion: June 10, 2008
• Last Updated: February 19, 2026

Record last verified: 2010-07

Locations

FR (6)