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Psoriatic ArthritisNOR-SPRINTNCT05291819

Imaging Treat-to-target Strategy vs Conventional Treat-to-target Strategy in Psoriatic Arthritis

A study testing Imaging informed treat-to-target and Conventional treat-to-target in people with Psoriatic Arthritis, run by Diakonhjemmet Hospital at 12 sites in Norway.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

The main objective is to assess if a treat-to-target strategy implementing structured imaging assessments leads to better patient outcome in terms of sustained remission compared to a conventional treat-to-target strategy in psoriatic arthritis. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Psoriatic Arthritis
What is being tested?
Imaging informed treat-to-target and Conventional treat-to-target
Could I receive a placebo?
No, everyone receives an active treatment
How many people
202 participants
Where
12 sitesNorway
Study dates
14 Mar 2022to 31 Dec 2027
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Adult (>18 years of age)
  • Clinical diagnosis of PsA
  • Indication for treatment with DMARDs according to treating physician (including having attempted ≥2 non-steroidal anti-inflammatory drugs (NSAIDs) for a minimum of 4 weeks in total in predominantly axial and/or entheseal disease)
  • Fulfillment of CASPAR criteria for PsA

Who cannot join

  • Verified arthritis >1 year prior to inclusion
  • Previous DMARD treatment for PsA
  • Systemic glucocorticoid use within the last 3 months
  • Local glucocorticoid injections within the last 4 weeks
  • Major co-morbidities, including but not limited to relevant malignancies, severe diabetes mellitus, severe infections, uncontrolled hypertension, severe cardiovascular disease (NYHA class III or IV) and/or severe respiratory diseases and cirrhosis.
  • Indications of active or latent tuberculosis (TB) as assessed by chest radiograph and TB interferon gamma release assay (IGRA). Patients with documented adequately treated latent TB can be included.
Show all 14Show fewer
  • Any other medical condition that according to the treated physician and/or local guidelines makes adherence to treatment protocol impossible
  • Abnormal renal function, defined as serum creatinine >142 µmol/L in female and >168 µmol/L in male, or estimated glomerular filtration rate (eGFR) <40 mL/min/1.73 m2
  • Abnormal liver function (defined as Aspartate Transaminase (AST) and/or Alanine Transaminase (ALT) >1.5 x upper normal limit), active or recent hepatitis
  • Significant anemia, leukopenia and/or thrombocytopenia
  • Inadequate birth control, pregnancy, and/or breastfeeding (current at screening or planned within the duration of the study)
  • Contraindications to magnetic resonance imaging
  • Severe psychiatric or mental disorders, alcohol abuse or other substance abuse, language barriers or other factors which makes adherence to the study protocol impossible
  • Established or suspected widespread-pain syndrome/fibromyalgia

Trial locations and contacts

12 sites in 1 country. Contact the study team or a site near you to ask about taking part.

Siri Lillegraven, MD, MPH, PhD contact

+4722451500

siri.lillegraven@diakonsyk.no

Even Lillejordet, MD contact

even.lillejordet@diakonsyk.no

12 sites in 1 country

Norway12 sites, 12 recruiting
  • Department of Rheumatology, Helse Møre og Romsdal HF

    Ålesund, 6026

    Maud-Kristine Aga Ljoså, MD

    Recruiting
  • Department of Rheumatology, Haukeland University Hospital, Helse Bergen HF

    Bergen, 5021

    Bjørg-Tilde Fevang, MD PhD

    Recruiting
  • Department of Rheumatology, Drammen Hospital, Vestre Viken HF

    Drammen, 3004

    Ada S. Wierød, MD

    Recruiting
  • Helse Førde

    Førde

    Anja Myhre Hjelle, MD, PhD

    Recruiting
  • Haugesunds Sanitetsforening Revmatismesykehus

    Haugesund, 5504

    Mathias M Braaten, MD

    Recruiting
  • Sørlandet Sykehus

    Kristiansand

    Jintana B Andersen, MD PhD

    Recruiting
  • Revmatismesykehuset AS

    Lillehammer

    Yi Hu, MD, PhD, Yi.Hu@revmatismesykehuset.no

    Recruiting
  • Helgelandssykehuset, Mo i Rana

    Mo i Rana, 8613

    Inger M Hansen, MD

    Recruiting
  • Department of Rheumatology, Diakonhjemmet Hospital

    Oslo, 0319

    Even Lillejordet, MD, +22451500, even.lillejordet@diakonsyk.no

    Recruiting
  • Martina Hansens Hospital AS

    Sandvika, 1306

    Annicken Slagsvold, MD

    Recruiting
  • University Hospital of Northern Norway

    Tromsø

    Gunnstein Bakland, MD, PhD

    Recruiting
  • Department of Rheumatology, St Olavs Hospital HF

    Trondheim, 7006

    Agnete Malm Gulati, MD, PhD

    Recruiting

Other trials in Norway

About this study

Official title: A NORwegian Randomized Strategy Trial in PsoRiatic Arthritis: ImagiNg Treat-to-target vs Conventional Treat-to-target

The main objective is to assess if a treat-to-target strategy implementing structured imaging assessments leads to better patient outcome in terms of sustained remission compared to a conventional treat-to-target strategy in psoriatic arthritis.

Main inclusion criteria are: >18 years of age, Clinical diagnosis of psoriatic arthritis (PsA), Fulfillment of ClASsification of Psoriatic Arthritis (CASPAR) criteria, Indication for treatment with disease modifying anti-rheumatic drugs according to treating physician

Read more

Primary endpoint: Sustained remission, defined as Very Low Disease Activity (VLDA) at 16, 20 and 24 months

Secondary endpoints: Individual and composite disease activity measures and remission criteria, inflammation assessed by ultrasound, health related quality of life and adverse events.

Study design: A two-arm, parallel-group, single-blind, treatment strategy study where patients are randomized 1:1 to a conventional treat-to-target follow-up strategy with structured clinical assessment of disease activity or an imaging informed treat-to-target follow-up strategy with both structured clinical assessment of disease activity and structured imaging assessment of disease activity. Duration of follow-up is 24 months.

All patients are treated according to an algorithm based on current European recommendations. The conventional treatment target, applicable to both arms and the sole target in the conventional arm, is all of: Disease Activity index in Psoriatic Arthritis (DAPSA) remission (≤3), Enthesitis ≤1, Psoriasis Body Surface Area ≤3%

Intervention: A treat-to-target treatment strategy incorporating information from ultrasound assessment of joints, tendons and entheses (at every visit), and magnetic resonance imaging (MRI) of spine and sacroiliac (SI)-joints at baseline and 1 year, in addition to clinical information. Specifically, this means that these additional measures will be added to conventional treat to target:

  • If evidence of enthesitis or axial inflammation on imaging the patient will progress directly to biological disease modifying antirheumatic drug in the treatment algorithm
  • If evidence of ongoing inflammation (power Doppler>0) on ultrasound assessment of joints, tendons or enthesis, the patient will be classified as not having reached their treatment target
Read the detailed description

This project addresses the challenges associated with psoriatic arthritis (PsA), which is a diverse disease which is difficult to assess clinically. Ultrasound and magnetic resonance imaging (MRI) visualize inflammation that is not apparent on clinical examination, but whether treating patients according to these findings improves outcomes is unknown.

The main objective is to assess if a treat-to-target strategy implementing structured imaging assessments leads to better patient outcome in terms of sustained remission compared to a conventional treat-to-target strategy in psoriatic arthritis.

Primary endpoint: Sustained remission, defined as Very Low Disease Activity (VLDA) at all of the 16, 20 and 24 month visits.

Secondary endpoints include Individual and composite disease activity measures and remission criteria, inflammation assessed by ultrasound, health related quality of life and adverse events.

Study design: A two-arm, parallel-group, single-blind, treatment strategy study where patients are randomized 1:1 to a conventional treat-to-target follow-up strategy with structured clinical assessment of disease activity or an imaging informed treat-to-target follow-up strategy with both structured clinical assessment of disease activity and structured imaging assessment of disease activity. Duration of follow-up is 24 months.

All patients are treated according to an algorithm based on current European recommendations. The conventional treatment target, applicable to both arms and the sole target in the conventional arm, is all of: Disease Activity index in Psoriatic Arthritis (DAPSA) remission (≤3), Enthesitis ≤1, Psoriasis Body Surface Area ≤3%

Intervention: A treat-to-target treatment strategy incorporating information from ultrasound assessment of joints, tendons and entheses (at every visit), and magnetic resonance imaging (MRI) of spine and sacroiliac (SI)-joints at baseline and 1 year, in addition to clinical information. Specifically, this means that these additional measures will be added to conventional treat to target:

If evidence of enthesitis or axial inflammation on imaging the patient will progress directly to biological disease modifying antirheumatic drug in the treatment algorithm If evidence of ongoing inflammation (power Doppler>0) on ultrasound assessment of joints, tendons or enthesis, the patient will be classified as not having reached their treatment target

Being tested
Imaging informed treat-to-target, Conventional treat-to-target
Keywords
Imaging, Treat-to-target
Medical subject headings
Arthritis, Psoriatic

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Imaging informed treat-to-targetOther

    A treat-to-target treatment strategy incorporating information from ultrasound assessment of joints, tendons and entheses (at every visit), and magnetic resonance imaging (MRI) of spine and sacroiliac (SI)-joints at baseline and 1 year, in addition to clinical information

    Specifically, this means that these additional measures will be added to conventional treat to target:

    • If evidence of enthesitis (power Doppler>0 in enthesis) or axial inflammation (SPARCC score ≥ 2* in SI-joint or SPARCC score ≥ 5 in presence of clinical symptoms of axial disease) on imaging the patient will progress directly to biological disease modifying antirheumatic drug in the treatment algorithm
    • If evidence of ongoing inflammation (power Doppler>0) on ultrasound assessment of joints, tendons or enthesis, the patient will be classified as not having reached their treatment target
  • Conventional treat-to-targetOther

    Patients are treated according to an algorithm based on current European recommendations. The conventional treatment target, applicable to both arms and the target in the conventional arm, is all of: Disease Activity index in PSoriatic Arthritis (DAPSA) remission (≤4), Enthesitis ≤1, Psoriasis Body Surface Area ≤3%

Study groups in NCT05291819
Study groupRoleWhat they receive
Conventional treat-to-targetOtherConventional treat-to-target follow-up strategy with structured clinical assessment of disease activity
Receives: Other: Conventional treat-to-target
Imaging informed treat-to-targetExperimentalImaging informed treat-to-target follow-up strategy with both structured clinical assessment of disease activity and structured imaging assessment of disease activity.
Receives: Other: Imaging informed treat-to-target

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Sustained Remission

    Sustained remission defined as a combination of Very Low Disease Activity (VLDA) at all of the time points 16, 20 and 24 months.

    VLDA requires all of the following to be met: Tender joint count (68) ≤ 1, swollen joint count (66) ≤ 1, Psoriasis Body Surface Area ≤ 3, Enthesitis≤ 1, Patient global assessment of disease severity VAS (0-100) ≤ 20, Pain VAS (0-100) ≤ 15 and Health Assessment Questionnaire Disability Index ≤ 0.5.

    Measured: Sustained remission is defined by the patient meeting VLDA at all of 16, 20 and 24 month follow-up visits

Secondary outcomes (21)
  1. Patient global assessment of disease activity

    Patient global assessment of disease activity on a 0-100 visual analogue scale (VAS), with higher scores Indicating more disease activity

    Measured: 12 and 24 months

  2. Patient pain assessment

    Patient pain assessment on a 0-100 visual analogue scale, with higher scores Indicating more pain

    Measured: 12 and 24 months

  3. Patient fatigue assessment

    Patient fatigue assessment on a 0-100 visual analogue scale, with higher scores Indicating more fatigue

    Measured: 12 and 24 months

  4. 66 joint count for swollen joints

    Structured 66 joint count for swollen joints

    Measured: 12 and 24 months

  5. 68 joint count for tender joints

    Structured 68 joint count for tender joints

    Measured: 12 and 24 months

  6. Tender dactylitis count

    Structured tender dactylitis count

    Measured: 12 and 24 months

  7. Spondyloarthritis Research Consortium of Canada Enthesitis Index (SPARCC entheseal index)

    SPARCC magnetic resonance imaging entheseal index

    Measured: 12 and 24 months

  8. Body surface area of skin psoriasis

    Body surface area of skin psoriasis in percentage

    Measured: 12 and 24 months

  9. Modified Nail Psoriasis Severity Index (mNAPSI)

    Modified Nail Psoriasis Severity Index (mNAPSI)

    Measured: 12 and 24 months

  10. Physician global assessment of disease activity

    Physician global assessment of disease activity on a 0-100 visual analogue scale, with higher scores Indicating more disease activity

    Measured: 12 and 24 months

  11. C-reactive protein (CRP)

    C-reactive protein (CRP), higher scores indicating more inflammation

    Measured: 12 and 24 months

  12. Erythrocyte sedimentation rate (ESR)

    Erythrocyte sedimentation rate (ESR), higher scores indicating more inflammation

    Measured: 12 and 24 months

  13. Disease activity in Psoriatic arthritis Score (DAPSA)

    Disease activity in Psoriatic arthritis Score (DAPSA), higher scores indicating more disease activity

    Measured: 12 and 24 months

  14. Minimal Disease Activity (MDA)

    Minimal Disease Activity (MDA). MDA is a composite assessment of disease activity state in PsA. It includes 7 components: tender joint count (68) ≤ 1, swollen joint count (66) ≤ 1, Psoriasis Area Severity Index ≤ 1/Body Surface Area ≤ 3, enthesitis≤ 1, patient global assessment of disease activity VAS ≤ 20, pain VAS ≤ 15 and HAQ-DI ≤ 0.5. MDA requires 5 out of 7 components to be met.

    Measured: 12 and 24 months

  15. Psoriatic Arthritis Disease Activity Score (PASDAS)

    Psoriatic Arthritis Disease Activity Score (PASDAS) is a composite disease activity index, with higher scores indicating more disease activity

    Measured: 12 and 24 months

  16. American College of Rheumatology (ACR) 20 response

    American College of Rheumatology (ACR) 20 response is defined as ≥ 20 % improvement in swollen and tender joint counts plus ≥ 20 % improvement in 3 of the 5 remaining ACR core set variables; pain VAS, physician global VAS, Health Assessment Questionnaire Disability Index (HAQ-DI) and CRP/ESR.

    Measured: 12 and 24 months

  17. Structured assessment of joints by musculoskeletal ultrasound according to a predefined protocol

    Structured assessment of joints by musculoskeletal ultrasound according to a predefined protocol

    Measured: 12 and 24 months

  18. Structured assessment of entheses by musculoskeletal ultrasound according to a predefined protocol

    Structured assessment of entheses by musculoskeletal ultrasound according to a predefined protocol

    Measured: 12 and 24 months

  19. Structured assessment of tendons by musculoskeletal ultrasound according to a predefined protocol

    Structured assessment of tendons by musculoskeletal ultrasound according to a predefined protocol

    Measured: 12 and 24 months

  20. Health Related Quality of Life

    Assessed by Short Form 36 (SF-36) questionnaire

    Measured: 12 and 24 months

  21. Adverse events

    Number and nature of adverse events and serious adverse events

    Measured: 0-24 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted23 Mar 2022
  2. Study start14 Mar 2022
  3. Primary completion31 Dec 2027 (estimated)
  4. Study completion31 Dec 2027 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
A two-arm, parallel-group, single-blind, treatment strategy study where patients are randomized 1:1 to a conventional treat-to-target follow-up strategy with structured clinical assessment of disease activity or an imaging informed treat-to-target follow-up strategy with both structured clinical assessment of disease activity and structured imaging assessment of disease activity.
Masking
None (open label)
Enrolment
202 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05291819
Sponsor's protocol ID
NOR-SPRINT protocol ver4_1
Acronym
NOR-SPRINT
Status last verified
Oct 2024
First submitted
2 Mar 2022
Last updated
4 Oct 2024
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No

Questions about this trial

What is this clinical trial studying?

A study testing Imaging informed treat-to-target and Conventional treat-to-target in people with Psoriatic Arthritis, run by Diakonhjemmet Hospital at 12 sites in Norway.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 14 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 4 Oct 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 12 sites in Norway. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Siri Lillegraven, MD, MPH, PhD (+4722451500, siri.lillegraven@diakonsyk.no), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Sustained Remission (time frame: Sustained remission is defined by the patient meeting VLDA at all of 16, 20 and 24 month follow-up visits). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 4 Oct 2024.

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