Application of the Personalized N-of-1 Trial Design in Patients With Rheumatoid Arthritis

NCT06016517 | Not Yet Recruiting

• 1 other identifier: 00003917
• Study Type: observational
• Target: 18
• Locations: 1 country
• Sites: 1

Brief Summary

The goal of this N-of-1 study is to learn about treatment for individual patients who have rheumatoid arthritis (RA,) for which many treatments are available. The treatments are different in how they work, the way they are given, side- effects, and cost. While treatment guidelines are available, finding the best treatment order of treatments is often based on physician choice. The main question this study aims to answer are:

• What are the effects of different treatments on RA symptoms and condition for each individual patient
• What is the effectiveness of different treatments across all patients enrolled in the N-of-1 study Participants will be enrolled and randomized to a sequence of three U.S. Food and Drug Administration (FDA) approved RA medications: 1. etanercept, 2. adalimumab, 3. upadacitinib 4. tocilizumab. Participants will be asked to complete questionnaires about their condition and quality of life fortnightly, monthly and/or quarterly (either in clinic or remotely) and report their level of pain on alternate days (remotely).

Conditions

Arthritis, Rheumatoid

Outcome Measures

Primary Outcomes (1)

• Change in Disease Activity Score (DAS) 28

  Evaluates patient and physician overall assessment of disease activity, including the number of swollen and painful joints (out of 28 joints),

  Baseline and week 12 of each treatment period

Secondary Outcomes (6)

• Change in The Routine Assessment of Patient Index Data 3 (RAPID3)

  Baseline, and weeks 2, 4, 6, 8, 10, 12 of each treatment period

• Change in American College of Rheumatology 20 (ACR20)

  Baseline and week 12 of each treatment period

• Change in American College of Rheumatology 50 (ACR50)

  Baseline and at week 12 of each treatment period

• Change in American College of Rheumatology 70 (ACR70)

  Baseline and at week 12 of each treatment period

• The Medical Outcome Study Short-Form 12- item Health Survey (SF-12)

  Baseline and at week 4, 8, and 12 of each treatment period

Interventions

Adalimumab DRUG

40 mg subcutaneously every 2 weeks

Also known as: Humira

Upadacitinib DRUG

15 mg orally once daily with subcutaneous placebo injection every 2 weeks

Also known as: Rinvoq

Tocilizumab DRUG

162 mg administered SQ every 2 weeks

Etanercept DRUG

50 mg subcutaneously weekly

Also known as: Enbrel

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

Outpatients 18 years of age or older with newly diagnosed RA following initial treatment with MTX, to which they are partial responders or non-responders.

In order to be eligible to participate in this study, a subject must meet all the following criteria: * Newly diagnosed adult-onset Rheumatoid Arthritis (RA) as defined by the American College of Rheumatology/ European League Against Rheumatism (ACR/EULAR) 2021 Criteria for the Classification of RA * Moderately to severely active RA defined as the presence of at least 6/68 tender joints and at least 6/66 swollen joints * C-reactive protein (CRP) or high-sensitivity C-reactive protein (hsCRP) measurement ≥ 1 time the upper limit of normal * First-line therapy with MTX for at least the 12 weeks prior to study entry with a continuous, non-changing dose for at least 8 weeks prior to study entry but continue to exhibit active RA * Had to discontinue MTX due to intolerability or toxicity, irrespective of treatment duration * Have never received etanercept, adalimumab, upadacitinib, or tocilizumab prior to first dose of study drug. * Provision of informed consent in English or another language in which a validated consent form is available, or via short-form consent with the assistance of a qualified interpreter. * Stated willingness to comply with all study procedures and availability for the duration of the study * 18 years of age or older * Ability to take oral medication and be willing to adhere to all treatment periods * Patients are eligible whether their disease responded partially or inadequately to first-line MTX or if they were intolerant to first-line MTX * Enrollment in an insurance plan that participates in or is subscribed to this trial An individual who meets any of the following criteria will be excluded from participation in this study: * History of any arthritis with onset prior to age 17 years or current diagnosis of inflammatory joint disease other than RA * Has received intra-articular, intravenous, intramuscular corticosteroids within 28 days prior to baseline * Known allergic reactions to components of any of the investigative biologic agents * Is currently receiving corticosteroids at doses \> (greater than) 10 mg per day of prednisone (or equivalent) or have been receiving an unstable dosing regimen of corticosteroids within 2 weeks of study entry or within 6 weeks of planned randomization * Has experienced any of the following within 12 weeks of study entry: myocardial infarction, unstable ischemic heart disease, stroke, or have New York Heart Association stage IV heart failure * Tuberculosis infection * Hepatitis B or C infection * History of venous thromboembolic event (deep vein thrombosis, pulmonary embolism) * Has a history or presence of cardiovascular, respiratory, hepatic, gastrointestinal, endocrine, hematological, neurological, or neuropsychiatric disorders or any other serious and/or unstable illness that, in the opinion of the investigator, could constitute a risk or could interfere with the interpretation of data * Has an estimated glomerular filtration rate (eGFR) based on the most recent available serum creatinine of \< (less than) 40 milliliter per minute per 1.73 m\^2 (mL/min/1.73 m\^2) * Has a history of chronic liver disease with the most recent available aspartate aminotransferase (AST) or alanine aminotransferase (ALT) \>1.5 times the ULN or the most recent available total bilirubin ≥1.5 times the ULN * Has a history of, lymphoproliferative disease; or have signs or symptoms suggestive of possible lymphoproliferative disease, including lymphadenopathy or splenomegaly; or have active primary or recurrent malignant disease; or have been in remission from clinically significant malignancy for \<5 years * Has been exposed to a live vaccine within 12 weeks prior to planned randomization or are expected to need/receive a live vaccine during the course of the study (with the exception of herpes zoster vaccination) * Has a current or recent clinically serious viral, bacterial, fungal, or parasitic infection * Has had symptomatic herpes zoster infection within 12 weeks prior to study entry * Has immunocompromising condition and, in the opinion of the investigator, are at an unacceptable risk for participating in the study and using these medications * Has a history of active hepatitis B virus (HBV), hepatitis C virus (HCV), or human immunodeficiency virus (HIV)\* * Has evidence of active or latent tuberculosis (TB) * Current hospitalization or requiring hospital admission at screening * Pregnant or breastfeeding * Of childbearing potential, unwilling to use effective birth control method (highly effective contraceptive measure (e.g., combined (estrogen and progestogen containing) hormonal contraception; intrauterine device) * Participation in another therapeutic clinical trial for RA * Lack of internet access to telehealth platform State who will determine eligibility. Note that those who are designated to determine eligibility must have appropriate training, expertise, and oversight, for example a physician PI or Co-I on a biomedical study: Eligibility will be determined by the appropriately trained and delegated physician investigator or physician Co- investigator.

Contact the study team to discuss eligibility requirements. They can help determine if this study is right for you.

Sponsors & Collaborators

• Tufts Medical Center: lead

Study Sites (1)

Tufts Medical Center

Boston, Massachusetts, 02111, United States

Location

MeSH Terms

Conditions

Arthritis, Rheumatoid

Interventions

Etanercept; Adalimumab; upadacitinib; tocilizumab

Condition Hierarchy (Ancestors)

Arthritis; Joint Diseases; Musculoskeletal Diseases; Rheumatic Diseases; Connective Tissue Diseases; Skin and Connective Tissue Diseases; Autoimmune Diseases; Immune System Diseases

Intervention Hierarchy (Ancestors)

Immunoglobulin Fc Fragments; Immunoglobulin Fragments; Peptide Fragments; Peptides; Amino Acids, Peptides, and Proteins; Immunoglobulin Constant Regions; Immunoglobulins; Immunoproteins; Blood Proteins; Proteins; Serum Globulins; Globulins; Receptors, Tumor Necrosis Factor; Receptors, Cytokine; Receptors, Immunologic; Receptors, Cell Surface; Membrane Proteins; Antibodies, Monoclonal, Humanized; Antibodies, Monoclonal; Antibodies

Study Officials

• Harry P Selker, MD

  Tufts Medical Center

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Maple Goh, MBChB, MPH

CONTACT

8574139870; maple.goh@tuftsmedicine.org

Harry P Selker, MD

CONTACT

6176365009; hselker@tuftsmediaclcenter.org

Study Design

• Study Type: observational
• Observational Model: OTHER
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: June 26, 2023
• First Posted: August 29, 2023
• Study Start: May 1, 2026
• Primary Completion (Estimated): December 15, 2027
• Study Completion (Estimated): December 1, 2028
• Last Updated: April 13, 2026

Record last verified: 2026-04

Locations

US (1)