[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"trial:NCT04692493":3,"trial-entities:NCT04692493":781,"trial-summary:NCT04692493":784},{"id":4,"nct_id":4,"org_study_id":5,"brief_title":6,"official_title":7,"overall_status":8,"completion_date":9,"status_verified_date":10,"last_update_date":11,"start_date":12,"sponsor_name":13,"lead_sponsor_class":14,"has_dmc":15,"brief_summary":16,"detailed_description":17,"conditions":18,"keywords":20,"study_type":21,"primary_purpose":22,"phases":23,"enrollment_info":25,"interventions":28,"primary_outcomes":38,"secondary_outcomes":43,"sex":44,"minimum_age":45,"maximum_age":46,"healthy_volunteers":47,"eligibility_criteria":48,"std_ages":52,"locations":55,"central_contacts":768,"overall_officials":777,"references":779,"see_also_links":780},"NCT04692493","IRB-300006596","RA-PRO PRAGMATIC TRIAL","A Real-World Comparative Effectiveness Trial of Treatment Strategies in Patients With Rheumatoid Arthritis: The RA-PRO Pragmatic Trial (RA-PROPR)","RECRUITING","2029-07-31","2026-07","2026-07-17","2021-09-22","University of Alabama at Birmingham","OTHER",true,"The 2021 ACR RA treatment guideline, based on widely acknowledged low to moderate quality evidence, recommends switching to a non-tumor necrosis factor (TNFi) biologic (choose among existing medications, currently, rituximab, abatacept, tocilizumab, or sarilumab) or a targeted synthetic DMARD arm (tsDMARD; choose among existing medications, currently, tofacitinib, baricitinib, upadacitinib) in patients with active RA despite the use of a TNFi-biologic. In practice, most patients receive another TNFi-biologic, i.e., a second TNFi-biologic first. This is not based on solid evidence, but on arbitrary algorithms often proposed by health insurance plans, and\u002For physician experience and habit (TNFis launched 22 yrs ago vs. the first tsDMARD 8 years ago vs. first non-TNF-biologic launched 17 years ago). This study will fill a critical knowledge gap by generating CER data for important PROs between these treatment options, switching to a non-TNFi biologic or a tsDMARD in patients with active RA despite the use of a TNFi-biologic.","Treatment of RA with a non-TNFi biologic (rituximab, abatacept, tocilizumab, or sarilumab) was associated with improved function, quality of life, and productivity. TsDMARDs (tofacitinib, baricitinib, upadacitinib) were similarly effective. No meaningful differences were noted in non-TNFi-biologic vs. tsDMARD, but head-to-head studies of biologics are lacking. HAQ is a sensitive outcome for RA trials. A PCORI systematic review for early RA treatment concluded that \"Evidence was insufficient to evaluate any differences between biologics for their impact on either functional capacity or HRQOL\", a key knowledge gap our study will fill.\n\nThe 2021 ACR RA treatment guideline, based on widely acknowledged low to moderate quality evidence, recommends switching to a non-TNFi biologic or a tsDMARD in patients with active RA despite the use of a TNFi-biologic. In practice, most patients receive another TNFi-biologic first, i.e., a second TNFi. This is not based on solid evidence, but on arbitrary algorithms often proposed by health insurance plans, and physician experience (first TNFi launched 22 yrs ago vs. the first tsDMARD 8 yrs ago vs. first non-TNF-biologic launched 17 years ago). This study will fill a critical knowledge gap by generating CER data for important PROs between these treatment options. This will facilitate informed decision-making, since PROs may be more sensitive to different mechanisms of action, and are highly relevant to patients.\n\nThe proposed study will also provide needed evidence for real-world treatment decisions made by public and private payers. This head-to-head pragmatic trial will be the first to provide CER data for improvement in key PROs with recommended strategies in active RA despite the use of a TNFi-biologic and addresses PCORI and IOM priority areas by comparing the two most commonly used RA treatment strategies for people with active RA despite the use of a TNFi-biologic. This research is patient-centered, as study outcomes were identified by patients and payers. Currently, treatment choices are based on physician experience and insurance payer limitations. Investigators will generate evidence to help patients make decisions for themselves based on outcomes they care most about based on the relative efficacy of outcomes.\n\nInvestigators will: (1) compare improvements in PROs with RA treatment strategies to each other using a state-of-the-art real-world pragmatic effectiveness study design, which will for the first time include most RA patients with comorbidities;(2) compare their toxicity in a real-world population for TNFi-biologic vs. tsDMARD. To our knowledge, no previous RCT comparing these drugs has examined a PRO as a primary outcome in RA, which our study will pioneer by using HAQ. HAQ is sensitive to change with effective treatments.",[19],"Rheumatoid Arthritis",[],"INTERVENTIONAL","TREATMENT",[24],"PHASE3",{"count":26,"type":27},924,"ESTIMATED",[29,34],{"type":30,"name":31,"description":32,"armGroupLabels":33},"DRUG","targeted synthetic DMARD class","Switching to a targeted synthetic DMARD (choice from targeted synthetic DMARDs; currently available are tofacitinib, baricitinib, upadacitinib) in people with active RA despite current treatment",[31],{"type":30,"name":35,"description":36,"armGroupLabels":37},"non-TNFi-biologic class","Switching to a non-TNFi-biologic (choice from non-TNFi-biologics; currently available are rituximab, abatacept, tocilizumab, or sarilumab) in people with active RA despite current treatment,",[35],[39],{"measure":40,"description":41,"timeFrame":42},"Functional Limitation","Function limitation assessed by Health assessment questionnaire (HAQ); HAQ assesses difficulty in 20 items in 8 categories (dressing, arising, eating, walking, hygiene, reaching, gripping, and outside activity), the total score ranges from 0 (no disability) to 3 (complete disability). Higher score is worse, and indicates poor function.","Change from baseline to 12 months",[],"ALL","18 Years",null,false,{"inclusion":49,"exclusion":50,"raw_text":51},[],[],"Inclusion Criteria:\n\n1. Patients with active, disabling RA (CDAI ≥10 and HAQ ≥0.5) despite the use\u002Fexperience of a TNFi-biologic OR discontinued the medication(s) due to intolerability or toxicity irrespective of treatment duration prior to the first dose of study drug ;\n2. If receiving glucocorticoids (≤10 mg\u002Fday of prednisone of equivalent) or NSAIDs, on stable doses for ≥2 weeks prior to randomization; and\n3. Insurance plan or patient assistance program allows access to at least 1 drug in each of the two treatment strategies, TNFi-biologic vs. tsDMARD.(TNFi-biologic and tsDMARD) will be obtained through insurance plan or a patient assistance program\u002Fplan.\n\nParticipants will be allowed to continue their conventional synthetic DMARD (csDMARD) therapy if they had been using it for ≥ 3 months and on a stable dose for ≥ 4 weeks prior to the first dose of study drug. The following csDMARDs are allowed: methotrexate (MTX), sulfasalazine, hydroxychloroquine, and leflunomide\n\nExclusion Criteria:\n\n1. Prior treatment with more than three biologics, defined as TNFi-biologic or non-TNFi biologic\n2. Prior treatment with targeted synthetic DMARD\n3. Concomitant use of leflunomide, sulfasalazine, cyclosporine, or azathioprine within 2-months before randomization;\n4. History of sensitivity to all 4 non-TNF-biologic or a targeted synthetic DMARD;\n5. Glucocorticoid injection (intravenous, intramuscular, or intraarticular) within 1 month of study entry;\n6. Live vaccine within 90 days of study entry;\n7. Acute or chronic infections with parenteral antibiotics or hospitalization (including tuberculosis, bacterial sepsis; invasive fungal infections (such as histoplasmosis)) within 1 month or oral antibiotics within 2 weeks of study entry;\n8. History of HIV or any opportunistic infection;\n9. New York Heart Association Class III or IV heart failure;\n10. Latent TB for which anti-tubercular treatment has not been started;\n11. Untreated Hepatitis B or C infection;\n12. History of deep venous thrombosis or pulmonary embolism; or\n13. Pregnant or nursing women; or\n14. History of herpes zoster or shingles in the previous 12 months and not subsequently vaccinated with herpes zoster vaccine.",[53,54],"ADULT","OLDER_ADULT",[56,74,87,101,117,131,146,157,172,185,199,212,224,239,250,264,279,296,310,325,338,352,367,382,396,412,428,442,458,472,486,497,512,523,538,553,572,588,603,618,632,648,662,678,692,707,722,735,751],{"facility":57,"status":8,"city":58,"state":59,"zip":60,"country":61,"contacts":62,"geoPoint":71},"East Alabama Arthritis Center PC","Auburn","Alabama","36830","United States",[63,68],{"name":64,"role":65,"phone":66,"email":67},"Adahli Massey, MD","CONTACT","334-501-4424","dra.massey@aara.care",{"name":69,"role":65,"phone":66,"email":70},"Millionnah Thompson, N\u002FA","m.thompson@aara.care",{"lat":72,"lon":73},32.60986,-85.48078,{"facility":75,"status":8,"city":76,"state":59,"zip":77,"country":61,"contacts":78,"geoPoint":84},"Bendcare, LLC","Birmingham","35244",[79,81],{"name":80,"role":65},"Howard Busch, MD",{"name":82,"role":65,"email":83},"Debra Stevenson","debra@illuminations.health",{"lat":85,"lon":86},33.52066,-86.80249,{"facility":13,"status":8,"city":76,"state":59,"zip":88,"country":61,"contacts":89,"geoPoint":100},"35294",[90,94,97],{"name":91,"role":65,"phone":92,"email":93},"Rouhin Sen","205-275-2405","rsen@uabmc.edu",{"name":95,"role":96},"Jasvinder Singh, MD","PRINCIPAL_INVESTIGATOR",{"name":98,"role":99},"Rouhin Sen, MD","SUB_INVESTIGATOR",{"lat":85,"lon":86},{"facility":102,"status":8,"city":103,"state":104,"zip":105,"country":61,"contacts":106,"geoPoint":114},"SunValley Arthritis Center, Ltd","Peoria","Arizona","85381",[107,111],{"name":108,"role":65,"phone":109,"email":110},"Joy Schectman, MD","623-566-3350","drj.schectman@aara.care",{"name":112,"role":65,"phone":109,"email":113},"Jack Tuber, DO","drj.tuber@aara.care",{"lat":115,"lon":116},33.5806,-112.23738,{"facility":118,"status":8,"city":119,"state":104,"zip":120,"country":61,"contacts":121,"geoPoint":128},"University of Arizona","Tucson","85724",[122,124],{"name":123,"role":65},"Kent C Kwoh, MD",{"name":125,"role":65,"phone":126,"email":127},"Gina Schwartzberg","520-626-3618","gxs@email.arizona.edu",{"lat":129,"lon":130},32.22174,-110.92648,{"facility":132,"status":8,"city":133,"state":134,"zip":135,"country":61,"contacts":136,"geoPoint":143},"Pacific Arthritis Care Center","Los Angeles","California","90045",[137,139],{"name":138,"role":65},"Dan Furst, MD",{"name":140,"role":65,"phone":141,"email":142},"Omar Aly","310-297-6812","omar.pa.clinicalresearch@gmail.com",{"lat":144,"lon":145},34.05223,-118.24368,{"facility":147,"status":8,"city":133,"state":134,"zip":148,"country":61,"contacts":149,"geoPoint":156},"University of California, Los Angeles","90095",[150,152],{"name":151,"role":65},"Veena K. Ranganath, MD",{"name":153,"role":65,"phone":154,"email":155},"Michelle Ramirez","310-825-9956","MichelleRa@mednet.ucla.edu",{"lat":144,"lon":145},{"facility":158,"status":8,"city":159,"state":134,"zip":160,"country":61,"contacts":161,"geoPoint":169},"Arthritis Medical Center","Nipomo","93444",[162,166],{"name":163,"role":65,"phone":164,"email":165},"Frank Scott, M\u002FD","805-473-4001","drf.scott@aara.care",{"name":167,"role":65,"phone":164,"email":168},"Adrienne Abu-Assal, N\u002FA","a.abuassal@aara.care",{"lat":170,"lon":171},35.04275,-120.476,{"facility":173,"status":8,"city":174,"state":134,"zip":175,"country":61,"contacts":176,"geoPoint":182},"Turlock Arthritis & Osteoporosis Center,","Turlock","95382",[177,181],{"name":178,"role":65,"phone":179,"email":180},"Iraj Sabahi, M\u002FD","209-634-3898","dri.sabahi@aara.care",{"role":65,"phone":179},{"lat":183,"lon":184},37.49466,-120.84659,{"facility":186,"status":8,"city":187,"state":134,"zip":188,"country":61,"contacts":189,"geoPoint":196},"Center for Rheumatology Research","Woodland Hills","91364",[190,194],{"name":191,"role":65,"phone":192,"email":193},"Lauren Jackson","818-598-0000","firoozcoordinator1@gmail.com",{"name":195,"role":96},"Nazanin Firooz",{"lat":197,"lon":198},34.16834,-118.60592,{"facility":200,"status":8,"city":201,"state":202,"zip":203,"country":61,"contacts":204,"geoPoint":209},"George Munoz MD, PC","Aventura","Florida","33180",[205],{"name":206,"role":65,"phone":207,"email":208},"George Munoz, MD","305-682-1441","drg.munoz@aara.care",{"lat":210,"lon":211},25.95648,-80.13921,{"facility":213,"status":8,"city":214,"state":202,"zip":215,"country":61,"contacts":216,"geoPoint":221},"American Arthritis and Rheumatology Associates LLC","Clearwater","33765",[217],{"name":218,"role":65,"phone":219,"email":220},"Robert Levin, MD","727-734-6631","drr.levin@aara.care",{"lat":222,"lon":223},27.96585,-82.8001,{"facility":225,"status":8,"city":226,"state":202,"zip":227,"country":61,"contacts":228,"geoPoint":236},"CZ Rheumatology","Coral Springs","33065",[229,233],{"name":230,"role":65,"phone":231,"email":232},"Conrad Ziembinski, MD","954-341-5034","c.ziembinski@aara.care",{"name":234,"role":65,"phone":231,"email":235},"Fredder Guanipa, N\u002FA","f.guanipa@aara.care",{"lat":237,"lon":238},26.27119,-80.2706,{"facility":213,"status":8,"city":240,"state":202,"zip":241,"country":61,"contacts":242,"geoPoint":247},"Fort Lauderdale","33309",[243],{"name":244,"role":65,"phone":245,"email":246},"Yvonne Sherrar, MD","954-229-7030","dry.sherrar@aara.care",{"lat":248,"lon":249},26.12231,-80.14338,{"facility":251,"status":8,"city":252,"state":202,"zip":253,"country":61,"contacts":254,"geoPoint":261},"Mayo Clinic Jacksonville","Jacksonville","32224",[255,257],{"name":256,"role":65},"Vikas Majithia, MD",{"name":258,"role":65,"phone":259,"email":260},"Tiffany Cribb","904-953-4525","Cribb.Tiffany@mayo.edu",{"lat":262,"lon":263},30.33218,-81.65565,{"facility":265,"status":8,"city":266,"state":202,"zip":267,"country":61,"contacts":268,"geoPoint":276},"Palm Beach Rheumatology and Wellness","Jupiter","33458",[269,273],{"name":270,"role":65,"phone":271,"email":272},"Reshma Khan, MD","561-316-7033","drr.khan@aara.care",{"name":274,"role":65,"phone":271,"email":275},"Rebecca Bautista, N\u002FA","r.bautista@aara.care",{"lat":277,"lon":278},26.93422,-80.09421,{"facility":280,"status":8,"city":281,"state":202,"zip":282,"country":61,"contacts":283,"geoPoint":293},"Arthritis & Rheumatology Center of South Florida","Margate","33063",[284,288,291],{"name":285,"role":65,"phone":286,"email":287},"Jigar Shah, MD","(954) 281-8891","drj.shah@aara.care",{"name":289,"role":65,"phone":286,"email":290},"Ruth Tecier, N\u002FA","d.hodaei@aara.care",{"name":292,"role":96},"Jigar Shah",{"lat":294,"lon":295},26.24453,-80.20644,{"facility":297,"status":8,"city":298,"state":202,"zip":299,"country":61,"contacts":300,"geoPoint":307},"Life Medical Research Group","Miami Gardens","33014",[301,305],{"name":302,"role":65,"phone":303,"email":304},"Marisley Benitez","305-705-4111","marisley@lifemedicalresearchgroup.com",{"name":306,"role":96},"Luis Arias",{"lat":308,"lon":309},25.94204,-80.2456,{"facility":311,"status":8,"city":312,"state":202,"zip":313,"country":61,"contacts":314,"geoPoint":322},"Southwest Florida Rheumatology","Riverview","33569",[315,319],{"name":316,"role":65,"phone":317,"email":318},"Shanmugapriya Reddy, MD","305-300-4990","drs.reddy@aara.care",{"name":320,"role":65,"phone":317,"email":321},"Michelle Stojkov, N\u002FA","m.stojkov@aara.care",{"lat":323,"lon":324},27.86614,-82.32648,{"facility":326,"status":8,"city":327,"state":328,"zip":329,"country":61,"contacts":330,"geoPoint":335},"Southeast Georgia Physician Associates-Rheumatology","Brunswick","Georgia","31520",[331],{"name":332,"role":65,"phone":333,"email":334},"Erick Bournigal, MD","912-466-7310","dre.bournigal@aara.care",{"lat":336,"lon":337},31.15013,-81.49147,{"facility":339,"status":8,"city":340,"state":341,"zip":342,"country":61,"contacts":343,"geoPoint":349},"Indiana University Health","Carmel","Indiana","46280",[344,348],{"name":345,"role":65,"phone":346,"email":347},"Sneha Pai","(917) 375-3112","spai1@IUHEALTH.ORG",{"name":345,"role":96},{"lat":350,"lon":351},39.97837,-86.11804,{"facility":353,"status":8,"city":354,"state":355,"zip":356,"country":61,"contacts":357,"geoPoint":364},"Johns Hopkins University","Baltimore","Maryland","21224",[358,360],{"name":359,"role":65},"Uzma Haque, MD",{"name":361,"role":65,"phone":362,"email":363},"Marilyn Towns","410-550-0579","mctowns@jhmi.edu",{"lat":365,"lon":366},39.29038,-76.61219,{"facility":368,"status":8,"city":369,"state":370,"zip":371,"country":61,"contacts":372,"geoPoint":379},"Tufts University","Boston","Massachusetts","02111",[373,375],{"name":374,"role":65},"Sreelakshmi Panginikkod, MD",{"name":376,"role":65,"phone":377,"email":378},"Madison Negron","617-636-3224","madison.negron@tuftsmedicine.org",{"lat":380,"lon":381},42.35843,-71.05977,{"facility":383,"status":8,"city":384,"state":370,"zip":385,"country":61,"contacts":386,"geoPoint":393},"University of Massachusetts Chan Medical School","Worcester","01655",[387,389],{"name":388,"role":65},"Jonathan Kay, MD",{"name":390,"role":65,"phone":391,"email":392},"Chelsea Botang","774-455-3528","Chelsea.Boateng@umassmed.edu",{"lat":394,"lon":395},42.26259,-71.80229,{"facility":397,"status":8,"city":398,"state":399,"zip":400,"country":61,"contacts":401,"geoPoint":409},"American Arthritis and Rheumatology Associates -Mi PLLC","Okemos","Michigan","48864",[402,406],{"name":403,"role":65,"phone":404,"email":405},"Srijana Bakshi, MD","860-679-3605","drs.bakshi@aara.care",{"name":407,"role":65,"phone":404,"email":408},"Angela Arsenault, N\u002FA","a.arsenault@aara.care",{"lat":410,"lon":411},42.72226,-84.42747,{"facility":413,"status":8,"city":414,"state":415,"zip":416,"country":61,"contacts":417,"geoPoint":425},"Saint Paul Rheumatology, P.A.","Eagan","Minnesota","55121",[418,422],{"name":419,"role":65,"phone":420,"email":421},"David Ridley, MD","651-644-4277","drd.ridley@aara.care",{"name":423,"role":65,"phone":420,"email":424},"Yolanda Fabelo, N\u002FA","y.fabelo@aara.care",{"lat":426,"lon":427},44.80413,-93.16689,{"facility":429,"status":8,"city":430,"state":415,"zip":431,"country":61,"contacts":432,"geoPoint":439},"Mayo Clinic Rochester","Rochester","55905",[433,435],{"name":434,"role":65},"Lynne Peterson, MD",{"name":436,"role":65,"phone":437,"email":438},"Amber Woltzen","507-422-6732","woltzen.amber@mayo.edu",{"lat":440,"lon":441},44.02163,-92.4699,{"facility":443,"status":8,"city":444,"state":445,"zip":446,"country":61,"contacts":447,"geoPoint":455},"Dr. Jayashree Sinha","Clovis","New Mexico","88101",[448,452],{"name":449,"role":65,"phone":450,"email":451},"Jayashree Sinha, MD","575-935-5051","drj.sinha@aara.care",{"name":453,"role":65,"phone":450,"email":454},"Lanthan Hicks, N\u002FA","l.hicks@aara.care",{"lat":456,"lon":457},34.4048,-103.20523,{"facility":459,"status":8,"city":460,"state":445,"zip":461,"country":61,"contacts":462,"geoPoint":469},"Inspire Santa Fe Medical Group","Santa Fe","87505",[463,467],{"name":464,"role":65,"phone":465,"email":466},"Arianna Lundquist","412-578-5676","alundquist@sfrheumatology.com",{"name":468,"role":96},"Hillary E Norton",{"lat":470,"lon":471},35.68698,-105.9378,{"facility":473,"status":8,"city":474,"state":474,"zip":475,"country":61,"contacts":476,"geoPoint":483},"New York University","New York","10016",[477,479],{"name":478,"role":65},"Pamela Rosenthal, MD",{"name":480,"role":65,"phone":481,"email":482},"Claudine Davis","646.501.7379","Claudine.Davis@nyulangone.org",{"lat":484,"lon":485},40.71427,-74.00597,{"facility":487,"status":8,"city":474,"state":474,"zip":488,"country":61,"contacts":489,"geoPoint":496},"Hospital for Special Surgery","10021",[490,492],{"name":491,"role":65},"Susan Goodman, MD",{"name":493,"role":65,"phone":494,"email":495},"Chloe Heiting","212-774-7045","heitingc@HSS.EDU",{"lat":484,"lon":485},{"facility":498,"status":8,"city":499,"state":500,"zip":501,"country":61,"contacts":502,"geoPoint":509},"University Hospital Cleveland Medical Ctr","Cleveland","Ohio","44106",[503,505],{"name":504,"role":65},"Marina N Magrey, MD",{"name":506,"role":65,"phone":507,"email":508},"Alexis Anderson","216-286-8159","alexis.anderson@uhhospitals.org",{"lat":510,"lon":511},41.4995,-81.69541,{"facility":513,"status":8,"city":499,"state":500,"zip":514,"country":61,"contacts":515,"geoPoint":522},"The MetroHealth System","44109",[516,518],{"name":517,"role":65},"Nora Singer, MD",{"name":519,"role":65,"phone":520,"email":521},"Emma Barnboym","216-778-3752","ebarnboym@metrohealth.org",{"lat":510,"lon":511},{"facility":524,"status":8,"city":525,"state":500,"zip":526,"country":61,"contacts":527,"geoPoint":535},"Arthritis and Rheumatology of Southwest Ohio","Liberty Township","45069",[528,532],{"name":529,"role":65,"phone":530,"email":531},"Soha Mousa, MD","513-779-5610","drs.mousa@aara.care",{"name":533,"role":65,"phone":530,"email":534},"Allison Koelblin, N\u002FA","a.koelblin@aara.care",{"lat":536,"lon":537},39.39861,-84.38278,{"facility":539,"status":8,"city":540,"state":500,"zip":541,"country":61,"contacts":542,"geoPoint":550},"Southern Ohio Rheumatology","Wheelersburg","45694",[543,547],{"name":544,"role":65,"phone":545,"email":546},"Rajesh Kataria, MD","740-355-8562","drr.kataria@aara.care",{"name":548,"role":65,"phone":545,"email":549},"Angela Bahl, N\u002FA","a.bahl@aara.care",{"lat":551,"lon":552},38.73035,-82.85545,{"facility":554,"status":8,"city":555,"state":556,"zip":557,"country":61,"contacts":558,"geoPoint":569},"Oregon Health and Science University","Portland","Oregon","97239",[559,561,565,567],{"name":560,"role":65},"Cong-Qiu Chu, MD",{"name":562,"role":65,"phone":563,"email":564},"Kim Nguyen","503-494-5571","nguykimp@ohsu.edu",{"name":566,"role":96},"Cong-Qiu Chu",{"name":568,"role":99},"Atul Deodhar",{"lat":570,"lon":571},45.52345,-122.67621,{"facility":573,"status":8,"city":574,"state":575,"zip":576,"country":61,"contacts":577,"geoPoint":585},"Altoona Center for Clinical Research","Duncansville","Pennsylvania","16635",[578,580],{"name":579,"role":65},"Alan J Kivitz, MD, CPI",{"name":581,"role":65,"phone":582,"phoneExt":583,"email":584},"Ashli Lutz, RN","814-693-0300","154","ashlilutz@altoonaresearch.com",{"lat":586,"lon":587},40.42341,-78.4339,{"facility":589,"status":8,"city":590,"state":575,"zip":591,"country":61,"contacts":592,"geoPoint":600},"Rheumatology and Arthritis Care Center","Exton","19341-2547",[593,597],{"name":594,"role":65,"phone":595,"email":596},"Sucharitha Shanmugam, MD","484-206-4447","drs.shanmugam@aara.care",{"name":598,"role":65,"phone":595,"email":599},"Melissa Netzel, N\u002FA","m.netzel@aara.care",{"lat":601,"lon":602},40.029,-75.62077,{"facility":604,"status":8,"city":605,"state":575,"zip":606,"country":61,"contacts":607,"geoPoint":615},"Allegheny Health Network","Pittsburgh","15212",[608,611,613],{"name":609,"role":65,"phone":465,"email":610},"Paige Rutter","paige.rutter@ahn.org",{"name":612,"role":96},"Tarun Sharma",{"name":614,"role":99},"Sonia Manocha",{"lat":616,"lon":617},40.44062,-79.99589,{"facility":619,"status":8,"city":620,"state":575,"zip":621,"country":61,"contacts":622,"geoPoint":629},"PA Regional Center for Arthritis and Osteoporosis Research","Wyomissing","19610",[623,627],{"name":624,"role":65,"phone":625,"email":626},"Dana Cullen","610-374-8133","dcullen@emkeyarthritis.com",{"name":628,"role":96},"Gregory Emkey",{"lat":630,"lon":631},40.32954,-75.96521,{"facility":633,"status":8,"city":634,"state":635,"zip":636,"country":61,"contacts":637,"geoPoint":645},"Cumberland Rhematology","Crossville","Tennessee","38555",[638,642],{"name":639,"role":65,"phone":640,"email":641},"Sivalingam Kanagasegar, MD","931-459-7720","drs.kanagasegar@aara.care",{"name":643,"role":65,"phone":640,"email":644},"Wendy LaFever, N\u002FA","w.lafever@aara.care",{"lat":646,"lon":647},35.94896,-85.0269,{"facility":649,"status":8,"city":650,"state":635,"zip":651,"country":61,"contacts":652,"geoPoint":659},"Vanderbilt University","Nashville","37235",[653,655],{"name":654,"role":65},"Kevin W Byram, MD",{"name":656,"role":65,"phone":657,"email":658},"Pam Krueger","615-875-8356","pamela.krueger@vumc.org",{"lat":660,"lon":661},36.16589,-86.78444,{"facility":663,"status":8,"city":664,"state":665,"zip":666,"country":61,"contacts":667,"geoPoint":675},"Heritage Rheumatology and Arthritis Care","Colleyville","Texas","76034",[668,672],{"name":669,"role":65,"phone":670,"email":671},"Dhiman Basu, MD","8175900880","drd.basu@aara.care",{"name":673,"role":65,"phone":670,"email":674},"Natalie Pachinger, N\u002FA","n.pachinger@aara.care",{"lat":676,"lon":677},32.88096,-97.15501,{"facility":679,"status":8,"city":680,"state":665,"zip":681,"country":61,"contacts":682,"geoPoint":689},"Southwest Medical Center","Dallas","75235",[683,687],{"name":684,"role":65,"phone":685,"email":686},"Safia Shaikh","469-893-1242","sshaikh@swmedicalgroup.com",{"name":688,"role":96},"Chrisette Dharma",{"lat":690,"lon":691},32.78306,-96.80667,{"facility":693,"status":8,"city":694,"state":665,"zip":695,"country":61,"contacts":696,"geoPoint":704},"Texas Arthritis Center, PA","El Paso","77902",[697,701],{"name":698,"role":65,"phone":699,"email":700},"Sanjay Chabra, MD","915-317-1660","drs.chabra@aara.care",{"name":702,"role":65,"phone":699,"email":703},"Monica Chabra, N\u002FA","m.chabra@aara.cara",{"lat":705,"lon":706},31.75872,-106.48693,{"facility":708,"status":8,"city":709,"state":665,"zip":710,"country":61,"contacts":711,"geoPoint":719},"American Arthritis and Rheumatology Associates-Tx PLLC","Harlingen","78550",[712,716],{"name":713,"role":65,"phone":714,"email":715},"Naiara Alvarez, MD","956-422-3122","drn.alvarez@aara.care",{"name":717,"role":65,"phone":714,"email":718},"Heather Margain, N\u002FA","h.margain@aara.care",{"lat":720,"lon":721},26.19063,-97.6961,{"facility":723,"status":8,"city":724,"state":665,"zip":725,"country":61,"contacts":726,"geoPoint":732},"Baylor University","Houston","77030",[727,731],{"name":728,"role":65,"phone":729,"email":730},"Kalpana Bhairavarasu","713-798-3390","kalpana.bhairavarasu@bcm.edu",{"name":728,"role":96},{"lat":733,"lon":734},29.76328,-95.36327,{"facility":736,"status":8,"city":737,"state":738,"zip":739,"country":61,"contacts":740,"geoPoint":748},"Northern Virginia Center for Arthritis-Reston","Reston","Virginia","20190",[741,745],{"name":742,"role":65,"phone":743,"email":744},"Phong Nguyen, MD","703-293-5239","drp.nguyen@aara.care",{"name":746,"role":65,"phone":743,"email":747},"Lynn Kincaid, N\u002FA","l.kincaid@aara.care",{"lat":749,"lon":750},38.96872,-77.3411,{"facility":752,"status":8,"city":753,"state":754,"zip":755,"country":756,"contacts":757,"geoPoint":765},"Mount Sinai Hospital (Canada)","Toronto","Ontario","M5T 3L9","Canada",[758,760],{"name":759,"role":65},"Bindee Kuriya, MD",{"name":761,"role":65,"phone":762,"phoneExt":763,"email":764},"Shafina Hasmani","416-586-4800","5489","Shafina.hasmani@sinaihealth.ca",{"lat":766,"lon":767},43.70643,-79.39864,[769,773],{"name":770,"role":65,"phone":771,"email":772},"Jasvinder Singh","205-975-2405","Jsingh@uabmc.edu",{"name":774,"role":65,"phone":775,"email":776},"Jeff Foster, MPH","205-996-6086","pjfoster@uabmc.edu",[778],{"name":95,"affiliation":13,"role":96},[],[],{"nct_id":4,"conditions":782,"biomarkers":783},[19],[],{"nct_id":4,"found":15,"summary":785,"prompt_version":795},{"design":786,"status":787,"heading":788,"summary":789,"follow_up":790,"word_count":791,"commitments":792,"compensation":793,"drugs_mentioned":794},"This is an interventional study with a planned enrollment of 924 participants. It compares two different drug classes for treating rheumatoid arthritis.","completed","RA-PRO Pragmatic Trial for Rheumatoid Arthritis","This study is for people with active rheumatoid arthritis (RA) whose current treatment isn't working well. We are comparing two different approaches to changing your medication: switching to a targeted synthetic DMARD (like tofacitinib, baricitinib, or upadacitinib) or switching to a non-TNFi biologic (like rituximab, abatacept, tocilizumab, or sarilumab). The goal is to see which approach leads to better functional ability over 12 months. You may be able to join if you are 18 or older and have active, disabling RA despite using a TNFi-biologic, or if you stopped your previous medication due to side effects. The study aims to enroll 924 participants.","Your functional ability will be measured for 12 months after starting the new treatment.",103,"Not specified in the trial record.","Not stated in the trial record.",[],"v2"]