Novel optical spectral transmission (OST)-guided versus conventionally disease activity-guided treatment: study protocol of a randomized clinical trial on guidance of a treat-to-target strategy for early rheumatoid arthritis

Trials. 2019 Apr 17;20(1):226. doi: 10.1186/s13063-019-3285-8.

Abstract

Background: Assessment of disease activity is a critical component of tight-control, treat-to-target treatment strategies of rheumatoid arthritis (RA). Recently, the HandScan has been validated as a novel method for objectively assessing RA disease activity in only 1.5 min, using optical spectral transmission (OST) in hands and wrists. We describe the protocol of a randomized controlled clinical trial (RCT) to investigate whether HandScan-guided treatment aimed at 'HandScan remission' (HandScan arm) is at least as effective as and more cost-effective than clinically guided treatment aimed at ACR/EULAR 2011 Boolean remission (DAS arm).

Methods/design: The study is a multi-center, double-blind, non-inferiority RCT of 18 months duration. Patients ≥ 18 years with newly diagnosed, disease-modifying antirheumatic drug (DMARD)-naïve RA according to the ACR 2010 classification criteria, will be randomized to the DAS arm or the HandScan arm. The efficacy of the arms will be compared by evaluating Health Assessment Questionnaire (HAQ) scores (primary outcome) after 18 months of DMARD therapy, aimed at remission. The equivalence margin in HAQ scores between study arms is 0.2. Secondary outcomes are differences in cost-effectiveness and radiographic joint damage between treatment arms. The non-inferiority sample size calculation to obtain a power of 80% at a one-sided p value of 0.05, with 10% dropouts, resulted in 61 patients per arm. In both arms, DMARD strategy will be intensified monthly according to predefined steps until remission is achieved; in both arms DMARDs and treatment steps are identical. If sustained remission, defined as remission that persists consistently over three consecutive months, is achieved, DMARD therapy will be tapered.

Discussion: The study protocol and the specifically designed decision-making software application allow for implementation of this RCT. To test a novel method of assessing disease activity and comparing (cost-)effectiveness with the contemporary method in treat-to-target DMARD strategies in early RA patients.

Trial registration: Dutch Trial Register, NTR6388. Registered on 6 April 2017 ( NL50026.041.14 ). Protocol version 3.0, 19-01-2017.

Keywords: Optical spectral transmission (OST) treat-to-target; Randomized controlled trial (RCT); Rheumatoid arthritis; Tight-control treatment; remission.

Publication types

  • Clinical Trial Protocol
  • Comparative Study

MeSH terms

  • Antirheumatic Agents / administration & dosage*
  • Arthritis, Rheumatoid / diagnostic imaging
  • Arthritis, Rheumatoid / drug therapy*
  • Arthritis, Rheumatoid / economics
  • Arthritis, Rheumatoid / physiopathology
  • Clinical Decision-Making
  • Cost-Benefit Analysis
  • Double-Blind Method
  • Equivalence Trials as Topic
  • Hand Joints / diagnostic imaging
  • Hand Joints / drug effects*
  • Hand Joints / physiopathology
  • Health Care Costs
  • Humans
  • Multicenter Studies as Topic
  • Netherlands
  • Optical Imaging / economics
  • Optical Imaging / methods*
  • Predictive Value of Tests
  • Remission Induction
  • Severity of Illness Index
  • Time Factors
  • Treatment Outcome
  • Wrist Joint / diagnostic imaging
  • Wrist Joint / drug effects*
  • Wrist Joint / physiopathology

Substances

  • Antirheumatic Agents

Grants and funding