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The William Harvey Research Institute Queen Mary Barts CTU UKCRC

The STRAP and STRAP-EU trials are now closed to recruitment.
An update will be provided once the results have been published.

STRAP stands for Stratification of Biologic Therapies for RA by Pathobiology. It is a phase III randomised, open-label, biopsy-driven stratification trial in disease modifying antirheumatic drug (DMARD)-inadequate responder rheumatoid arthritis (RA) patients randomised to Etanercept, Tocilizumab or Rituximab.

Rheumatoid arthritis (RA) is one of the most important chronic inflammatory disorders in the UK. The treatment of RA has improved considerably over the past 20 years with the earlier initiation of therapy and the development of new biologic agents. Unfortunately there are still significant numbers of patients who fail to achieve low disease activity with conventional DMARDs. Rituximab, Tocilizumab and Etanercept are all licensed for use in RA at different stages of the disease after DMARD failure. The three drugs work in different ways:

  • Rituximab targets B cells (a white blood cell important in inflammation within joints).
  • Tocilizumab targets a protein called IL-6 which causes inflammation of the joints.
  • Etanercept works by interfering with the role of a specific protein called TNF alpha that is responsible for initiating and increasing inflammation.


Currently there is no way to predict which patient who fails conventional DMARDs will respond to each one of these biologic therapies and these drugs are prescribed on a trial-and-error basis. In this study, we will investigate whether the most effective choice of drug may be directed by examining the joint tissue (synovial tissue) and, in particular, whether different levels of B cells within the joint can predict response to treatment. 

We aim to identify treatment response predictors which will allow the allocation of patients to strata defined by the therapy they are most likely to respond to, early in the disease process.

This study is jointly funded by MRC and ARUK | Copyright © Experimental Medicine & Rheumatology Department, Queen Mary University London, 2014 - 2023