Psoriatic ArthritisNCT05329896
Ticopa Serum Analysis: an Analysis of Blood Samples From the TICOPA Study
An observational study of Psoriatic Arthritis, run by University of Leeds at 1 site in United Kingdom.
Trial summary
A range of different drugs are available to treat psoriatic arthritis (PsA) inflammation. However, clinicians are unable to predict who will respond well to a given drug, who will fail to respond and who will develop side effects. Responder/non-responder effects may also differ for the skin and joint domains of PsA. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Psoriatic Arthritis
- How many people
- 82 participants
- Where
- 1 siteUnited Kingdom
- Study dates
- 1 Apr 2022to 31 Mar 2024
- Phase
- Observational
- Are there results?
- None posted in the registry
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
Study population: Patients attending out patient clinics who had active untreated psoriatic arthritis and who had blood samples for research at several time points after treatment started
Who may be able to join
- treatment naive patients with early psoriatic arthritis
Who cannot join
- previous treatment with systemic therapy
- other inflammatory arthritis
Trial locations and contacts
1 site in 1 country.
About this study
Official title: Analysis of TICOPA (TIght COntrol of Psoriatic Arthritis) Serum Samples
A range of different drugs are available to treat psoriatic arthritis (PsA) inflammation. However, clinicians are unable to predict who will respond well to a given drug, who will fail to respond and who will develop side effects. Responder/non-responder effects may also differ for the skin and joint domains of PsA. Patients currently undergo a trial and error phase of treatment, sometimes withstanding a period of nonresponse, and thus pain and discomfort, for a period of time. Treatment failures also waste resources and undermine patient confidence. There is a pressing need to identify predictors for response / non response and side effects, and this study will utilise novel bioinformatics approaches to address this need. The samples and clinical information collected from participants in the TICOPA (Effect of tight control of inflammation in early psoriatic arthritis) study (1) are a valuable resource. The investigators aim to use these existing serum samples to determine the potential of molecular markers to predict patients' response to treatment both with regard to effects and side effects. This analysis could potentially lead to the identification of serum and clinical parameters which when measured in a defined combination would be predictive of patients' response to treatment.
1 https://doi.org/10.1016/S0140-6736(15)00347-5
Read the detailed description
- INTRODUCTION 1.1. Background Psoriatic Arthritis (PsA) is estimated to occur in 10-15% of individuals with psoriasis, and accounts for 13% of people attending early arthritis clinics.Two thirds of patients with PsA suffer chronic inflammation causing progressive joint damage, disability and reduced life expectancy. With an increasing awareness of the poor outcomes associated with PsA, and the availability of new effective, but costly, treatments, there is an urgent need to establish the optimal treatment for patients with PsA. The TICOPA study was a UK multicentre, open-label, randomised controlled, parallel group trial of 206 patients with early PsA, randomised on a 1:1 basis to receive either standard care (12 weekly review) or intensive management (4 weekly review) for a period of 48 weeks. Patients assigned to the intensive management group followed a strict treatment protocol whereby dose continuation/escalation was determined through the objective assessment of the minimal disease activity (MDA) criteria. Patients assigned to the standard care group received standard care as felt appropriate by the treating clinician, with no set protocol. The aim of the TICOPA study was to establish whether, in treatment naïve early PsA patients, intensive management with evidence based therapies would improve clinical outcome, the principle hypothesis being that tight control of inflammation in psoriatic arthritis using a treatment protocol and pre-defined objective targets for treatment would lead to an improvement in patients disease activity. The trial aimed to establish the superiority of intensive management as compared to standard care as defined by the ACR 20 (American Society of Rheumatology). The TICOPA trial provided direct evidence that the use of early and intensive treatment in PsA in routine clinical care leads to an improvement in patients' disease activity. Participants received the following systemic therapies: MTX (methotrexate), sulfasalazine, TNFi (tumor necrosis factor inhibitor), leflunomide and CsA (cyclosporine). Almost all patients received initial or ongoing treatment with MTX. The folic acid antagonist MTX remains in clinical use as a standard systemic therapy for psoriatic inflammation of both the skin and joint components of PsA. MTX inhibits dihydrofolate-reductase competitively, reducing metabolism dihydrofolic acid to tetrahydrofolic acid which results in suppression of the intracellular synthesis of various folic acid derivatives. MTX has a range of known side-effects , particularly hepatotoxicity.5 Quite a significant proportion of patients discontinue MTX due to side effects, including nausea and hepatotoxicity. Clinicians are currently unable to predict who is likely to suffer from side effects leading to discontinuation of the drug. This study will seek to predict which treatment works best for a given patient and which treatment will cause side effects. The samples and clinical information collected from participants in the TICOPA study are a valuable resource. The investigators aim to use existing serum samples to determine the potential of molecular markers to predict patients' response to treatment both with regard to effects and side effects. This analysis could potentially lead to the identification of serum and clinical parameters which when measured in a defined combination would be predictive of patients' response to treatment. Previously, blood samples from the TICOPA study have undergone mass spectrometry (MS) analysis which identified over 200 candidate peptides that might predict treatment response.6 However MS analysis is limited in its ability to detect proteins in low abundance, and this is true for pathogenetic relevant cytokines and other inflammation and metabolic related mediators. Furthermore, MS analysis is restricted to proteins and - as performed - fail to measure lipid mediators or small RNA molecules such as microRNAs. For these reasons, the investigators propose to analyse these samples using ELISA (enzyme-linked immunosorbent assay)based techniques. By using multiplex ELISA based, and other standard techniques to measure inflammation or metabolic related parameters in these serum samples, and performing AI (artificial intelligence) based analysis methods, the investigators aim to identify predictive "markers and patterns" for response to therapy in this well-defined patient cohort. 1.2. Rationale for the proposed study A range of different drugs are available to treat psoriatic arthritis (PsA) inflammation. However, clinicians are unable to predict who will respond well to a given drug, who will fail to respond and who will develop side effects. Responder / non-responder effects may also differ for the skin and joint domains of PsA. Patients currently undergo a trial and error phase of treatment, sometimes withstanding a period of nonresponse, and thus pain and discomfort, for a period of time. Treatment failures also waste resources and undermine patient confidence. There is a pressing need to identify predictors for response / non response and side effects, and this study will utilise novel bioinformatics approaches to address this need.
- STUDY AIM AND OBJECTIVES 2.1. Study aim This study aims to analyse inflammation and metabolic parameters utilizing serum samples provided by a cohort of TICOPA study participants. These results will be used in combination with TICOPA clinical data to determine the predictive value of parameters regarding patients' response to therapy. The analysis will make use of AI analysis methods to achieve this goal. 2.2. Primary objective Predict effects and response to therapy using TICOPA clinical data in combination with measured serum parameters. 2.3. Secondary objective(s) Predict response to therapy using TICOPA clinical data in combination with measured serum parameters specific to the skin and MSK (musculoskeletal) components of PsA.
- STUDY ENDPOINTS Primary Endpoint Completion of an AI prediction model for AE Secondary Endpoint(s) Completion of an AI prediction model for treatment response
- SELECTION AND WITHDRAWAL OF SUBJECTS The sample pool comprises those TICOPA participants who signed an informed consent form allowing their data and samples to be used for future studies.
- METHODS OF ASSESSMENT 5.1. Data handling All patient clinical data and serum samples were collected in line with the ethics of the original TICOPA trial. Data involved in this project is linked-anonymised with only the patients' trial number available as reference. Only the CI and research coordinator have access to this linkage, which is held on the University of Leeds' password protected secure server. The CI for this study was the CI for the TICOPA study and the research coordinator was also involved in the TICOPA study. No other members of the current study team will have access to the linkage. 5.2. Sample handling Samples are currently held in storage at the Leeds Institute of Rheumatic and Musculoskeletal Medicine (UoL) laboratory based at Chapel Allerton Hospital, aliquots will be transported to the UoL School of Molecular and Cellular Biology for analysis by one of the study team. Analysis will mainly use ELISA based multiplex techniques for inflammation and metabolic related parameters. However, if indicated by new findings in the literature relevant lipid mediators or microRNAs may also be determined using appropriate standard laboratory techniques.
- DATA EVALUATION Univariate analysis will be performed for each new variable measured and the predictive targets of this project. Predictive algorithms such as random forest and support vector machines will then be trained and evaluated on the identified predictive targets using the data set as a whole and selected subsets.
- Conditions
- Psoriatic Arthritis
- Medical subject headings
- Arthritis, Psoriatic
What is being measured
The primary outcome is the main question the study is designed to answer.
Serum markers
The investigators will measure inflammatory mediators as expressed by the innate immune cells and leukocyte subpopulations. We will also include mediators related to metabolic status.
Measured: 12 months
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted15 Apr 2022
- Study start1 Apr 2022
- Primary completion31 Mar 2023 (estimated)
- Study completion31 Mar 2024 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Psoriatic ArthritisStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Cohort
- Time perspective
- Retrospective
- Enrolment
- 82 participants (actual)
Sponsor and investigators
- Lead sponsor
- University of Leeds
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Philip Helliwell, University of Leeds
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT05329896
- Sponsor's protocol ID
- 310813
- Other IDs
- 22/EM/0059
- Status last verified
- Apr 2022
- First submitted
- 6 Apr 2022
- Last updated
- 15 Apr 2022
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Study at a glance
From the registry record, last updated by the sponsor on 15 Apr 2022. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Analysis of TICOPA (TIght COntrol of Psoriatic Arthritis) Serum Samples
- ClinicalTrials.gov ID
- NCT05329896
- Acronym / sponsor ID
- 310813
- Conditions
- Psoriatic Arthritis
- Study type
- Observational
- Recruitment status
- Unknown status
- Enrolment
- 82 participants (actual)
- Lead sponsor
- University of LeedsUniversity, hospital or other
- Study start
- 1 Apr 2022 (actual)
- Primary completion
- 31 Mar 2023 (estimated)
- Study completion
- 31 Mar 2024 (estimated)
- First posted
- 15 Apr 2022 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
A range of different drugs are available to treat psoriatic arthritis (PsA) inflammation. However, clinicians are unable to predict who will respond well to a given drug, who will fail to respond and who will develop side effects. Responder/non-responder effects may also differ for the skin and joint domains of PsA. Patients currently undergo a trial and error phase of treatment, sometimes withstanding a period of nonresponse, and thus pain and discomfort, for a period of time. Treatment failures also waste resources and undermine patient confidence. There is a pressing need to identify predictors for response / non response and side effects, and this study will utilise novel bioinformatics approaches to address this need. The samples and clinical information collected from participants in the TICOPA (Effect of tight control of inflammation in early psoriatic arthritis) study (1) are a valuable resource. The investigators aim to use these existing serum samples to determine the potential of molecular markers to predict patients' response to treatment both with regard to effects and side effects. This analysis could potentially lead to the identification of serum and clinical parameters which when measured in a defined combination would be predictive of patients' response to treatment.
1 https://doi.org/10.1016/S0140-6736(15)00347-5
Detailed description
- INTRODUCTION 1.1. Background Psoriatic Arthritis (PsA) is estimated to occur in 10-15% of individuals with psoriasis, and accounts for 13% of people attending early arthritis clinics.Two thirds of patients with PsA suffer chronic inflammation causing progressive joint damage, disability and reduced life expectancy. With an increasing awareness of the poor outcomes associated with PsA, and the availability of new effective, but costly, treatments, there is an urgent need to establish the optimal treatment for patients with PsA. The TICOPA study was a UK multicentre, open-label, randomised controlled, parallel group trial of 206 patients with early PsA, randomised on a 1:1 basis to receive either standard care (12 weekly review) or intensive management (4 weekly review) for a period of 48 weeks. Patients assigned to the intensive management group followed a strict treatment protocol whereby dose continuation/escalation was determined through the objective assessment of the minimal disease activity (MDA) criteria. Patients assigned to the standard care group received standard care as felt appropriate by the treating clinician, with no set protocol. The aim of the TICOPA study was to establish whether, in treatment naïve early PsA patients, intensive management with evidence based therapies would improve clinical outcome, the principle hypothesis being that tight control of inflammation in psoriatic arthritis using a treatment protocol and pre-defined objective targets for treatment would lead to an improvement in patients disease activity. The trial aimed to establish the superiority of intensive management as compared to standard care as defined by the ACR 20 (American Society of Rheumatology). The TICOPA trial provided direct evidence that the use of early and intensive treatment in PsA in routine clinical care leads to an improvement in patients' disease activity. Participants received the following systemic therapies: MTX (methotrexate), sulfasalazine, TNFi (tumor necrosis factor inhibitor), leflunomide and CsA (cyclosporine). Almost all patients received initial or ongoing treatment with MTX. The folic acid antagonist MTX remains in clinical use as a standard systemic therapy for psoriatic inflammation of both the skin and joint components of PsA. MTX inhibits dihydrofolate-reductase competitively, reducing metabolism dihydrofolic acid to tetrahydrofolic acid which results in suppression of the intracellular synthesis of various folic acid derivatives. MTX has a range of known side-effects , particularly hepatotoxicity.5 Quite a significant proportion of patients discontinue MTX due to side effects, including nausea and hepatotoxicity. Clinicians are currently unable to predict who is likely to suffer from side effects leading to discontinuation of the drug. This study will seek to predict which treatment works best for a given patient and which treatment will cause side effects. The samples and clinical information collected from participants in the TICOPA study are a valuable resource. The investigators aim to use existing serum samples to determine the potential of molecular markers to predict patients' response to treatment both with regard to effects and side effects. This analysis could potentially lead to the identification of serum and clinical parameters which when measured in a defined combination would be predictive of patients' response to treatment. Previously, blood samples from the TICOPA study have undergone mass spectrometry (MS) analysis which identified over 200 candidate peptides that might predict treatment response.6 However MS analysis is limited in its ability to detect proteins in low abundance, and this is true for pathogenetic relevant cytokines and other inflammation and metabolic related mediators. Furthermore, MS analysis is restricted to proteins and - as performed - fail to measure lipid mediators or small RNA molecules such as microRNAs. For these reasons, the investigators propose to analyse these samples using ELISA (enzyme-linked immunosorbent assay)based techniques. By using multiplex ELISA based, and other standard techniques to measure inflammation or metabolic related parameters in these serum samples, and performing AI (artificial intelligence) based analysis methods, the investigators aim to identify predictive "markers and patterns" for response to therapy in this well-defined patient cohort. 1.2. Rationale for the proposed study A range of different drugs are available to treat psoriatic arthritis (PsA) inflammation. However, clinicians are unable to predict who will respond well to a given drug, who will fail to respond and who will develop side effects. Responder / non-responder effects may also differ for the skin and joint domains of PsA. Patients currently undergo a trial and error phase of treatment, sometimes withstanding a period of nonresponse, and thus pain and discomfort, for a period of time. Treatment failures also waste resources and undermine patient confidence. There is a pressing need to identify predictors for response / non response and side effects, and this study will utilise novel bioinformatics approaches to address this need.
- STUDY AIM AND OBJECTIVES 2.1. Study aim This study aims to analyse inflammation and metabolic parameters utilizing serum samples provided by a cohort of TICOPA study participants. These results will be used in combination with TICOPA clinical data to determine the predictive value of parameters regarding patients' response to therapy. The analysis will make use of AI analysis methods to achieve this goal. 2.2. Primary objective Predict effects and response to therapy using TICOPA clinical data in combination with measured serum parameters. 2.3. Secondary objective(s) Predict response to therapy using TICOPA clinical data in combination with measured serum parameters specific to the skin and MSK (musculoskeletal) components of PsA.
- STUDY ENDPOINTS Primary Endpoint Completion of an AI prediction model for AE Secondary Endpoint(s) Completion of an AI prediction model for treatment response
- SELECTION AND WITHDRAWAL OF SUBJECTS The sample pool comprises those TICOPA participants who signed an informed consent form allowing their data and samples to be used for future studies.
- METHODS OF ASSESSMENT 5.1. Data handling All patient clinical data and serum samples were collected in line with the ethics of the original TICOPA trial. Data involved in this project is linked-anonymised with only the patients' trial number available as reference. Only the CI and research coordinator have access to this linkage, which is held on the University of Leeds' password protected secure server. The CI for this study was the CI for the TICOPA study and the research coordinator was also involved in the TICOPA study. No other members of the current study team will have access to the linkage. 5.2. Sample handling Samples are currently held in storage at the Leeds Institute of Rheumatic and Musculoskeletal Medicine (UoL) laboratory based at Chapel Allerton Hospital, aliquots will be transported to the UoL School of Molecular and Cellular Biology for analysis by one of the study team. Analysis will mainly use ELISA based multiplex techniques for inflammation and metabolic related parameters. However, if indicated by new findings in the literature relevant lipid mediators or microRNAs may also be determined using appropriate standard laboratory techniques.
- DATA EVALUATION Univariate analysis will be performed for each new variable measured and the predictive targets of this project. Predictive algorithms such as random forest and support vector machines will then be trained and evaluated on the identified predictive targets using the data set as a whole and selected subsets.
Study design
- Observational model
- Cohort
- Time perspective
- Retrospective
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
- Study population
- Patients attending out patient clinics who had active untreated psoriatic arthritis and who had blood samples for research at several time points after treatment started
Key inclusion criteria (1 listed)
- treatment naive patients with early psoriatic arthritis
Key exclusion criteria (2 listed)
- previous treatment with systemic therapy
- other inflammatory arthritis
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Primary outcome
Serum markers
Time frame: 12 months
The investigators will measure inflammatory mediators as expressed by the innate immune cells and leukocyte subpopulations. We will also include mediators related to metabolic status.
Results and safety
Results are not available in the source record.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 15 Apr 2022.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
The record lists no contact. Use the official record to reach the sponsor.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of Psoriatic Arthritis, run by University of Leeds at 1 site in United Kingdom.
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 1 inclusion and 2 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: status not confirmed, as of the sponsor's last update on 15 Apr 2022. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in United Kingdom. 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?
Results are not available in the source record.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Serum markers (time frame: 12 months). 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 15 Apr 2022.