SPondyloArthritis inducing drug free Remission by early TNF Alpha bloCkade Under guidance of Single cell RNA sequencing


Antibody based therapeutics (biologics) have revolutionized treatment of a wide range of diseases. One of the most successful therapeutic areas in medicine includes immune-mediated inflammatory diseases such as rheumatic diseases, skin disorders, and intestinal pathology. However, the high costs of these drugs and the need for continuous use in most of these diseases represents a major challenge for all health care systems worldwide. 

Spondyloarthritis (SpA) is a form of chronic arthritis. It typically affects a young population in their early thirties, the time when most people start a family and develop their professional career. The overall prevalence of SpA is estimated to be around 1% of the population and taking this into account the estimated expenditure for TNF biologics for this indication is at least 40 million euro annually. It was shown that response to treatment was markedly higher in early forms of disease with high rates of clinical remission. This suggests there could also be a ‘window of opportunity’ for drug-free remission. Our hypothesis is that first line use of biologics will elicit a better response. We have tested this in a proof of concept (POC) study, in which 82% of all included patients experienced a complete resolution of symptoms after which treatment could be discontinued. Intriguingly, over 50% of patients were staying in drug-free remission. 

This inspired us to establish the SPARTACUS trial, which aims to pave the path to use a precision medicine approach to delineate the patient population that may benefit from such an early intervention approach, define the precise time window amenable to inducing drug-free remission and establish now biomarkers predicting drug-free clinical response across Flanders. SPARTACUS will be the first worldwide trial to compare efficacies and overall costs of standard of care treatment with initial TNF inhibition in early spondyloarthritis. 

The project consortium focuses on:
  • Investigating the possible superiority of early treatment of psoriatic SpA patients with biologic treatment as compared to standard of care.
  • Delineating the window of opportunity for pSpA: a transient time frame in which a disease is more susceptible to treatment. 
  • Unraveling new biomarkers of therapy response using cutting-edge single cell technology and epigenetic profiling.
  • Determining health-economic and societal impact of earlier and more biologic intensive treatment of patients with recent onset pSpA.
  • Increasing awareness among referring physicians and patient-advocacy groups about the value of early recognition and treatment in rheumatology. 

Project funding: 
€2.5 million 

 

 Spartacus: Better Treatment Options for Spondyloarthritis

 
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Participants
 
VIB-UGent

Koen Venken
Martin Guilliams

VIB-UGent-UZ Gent

Dirk Elewaut​ (promotor-spokesperson)​
Philippe Caron
Filip Van den Bosch
Peggy Jacques

KU Leuven-UZ Leuven

Rik Lories
Frederik De Smet

Maastricht UMC

Annelies Boonen

BeGiant consortium 

UZ Gent
Maria Middelares
ASZ Aalst
AZ Sint-Jan Brugge
AZ Sint-Lucas Brugge
ZNA Antwerpen
Sint-Augustinus Antwerpen
UZ Leuven
Reuma Instituut Hasselt

-> Go back to the overview page of 'VIB Grand Challenges Program​
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This is what Dirk Elewaut has to say about the VIB Grand Challenges Program " We are thrilled with having Spartacus approved as a VIB Grand Challenges project. Spartacus has the ambition to revolutionize the outcome of patients suffering from early peripheral spondyloarthritis (one of the most common forms of chronic arthritis) by reverting a chronic disease demanding lifelong medication into a temporary one by inducing drug free remission through early but temporary treatment with biologics. By coupling a randomized clinical trial with high end molecular profiling in synovial tissue we additionally aim to  develop  tools facilitating prediction of patients that could benefit from such a strategy. Importantly, Spartacus will also assess the health economic benefit of such an early intervention strategy”​.

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Dirk Elewaut​