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Cohort profile
Cohort profile: The Applied Public-Private Research enabling OsteoArthritis Clinical Headway (IMI-APPROACH) study: a 2-year, European, cohort study to describe, validate and predict phenotypes of osteoarthritis using clinical, imaging and biochemical markers
  1. Eefje M van Helvoort1,
  2. Willem E van Spil1,
  3. Mylène P Jansen1,
  4. Paco M J Welsing1,
  5. Margreet Kloppenburg2,3,
  6. Marieke Loef3,
  7. Francisco J Blanco4,
  8. Ida K Haugen5,
  9. Francis Berenbaum6,
  10. Jaume Bacardit7,
  11. Christoph H Ladel8,
  12. John Loughlin9,
  13. Anne C Bay-Jensen10,
  14. Ali Mobasheri11,
  15. Jonathan Larkin12,
  16. Janneke Boere13,
  17. Harrie H Weinans1,14,
  18. Agnes Lalande15,
  19. Anne C A Marijnissen1,
  20. Floris P J G Lafeber1
  1. 1Rheumatology and Clinical Immunology, UMC Utrecht, Utrecht, The Netherlands
  2. 2Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
  3. 3Rheumatology, Leiden Universitair Medisch Centrum, Leiden, The Netherlands
  4. 4Servicio de Reumatologia, INIBIC-Hospital Universitario A Coruña, A Coruña, Spain
  5. 5Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
  6. 6Rheumatology, Sorbonne Université, Paris, France
  7. 7School of Computing Science, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
  8. 8Merck Serono Research, Merck KGaA, Darmstadt, Germany
  9. 9Musculoskeletal Research Group, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
  10. 10Biomarkers and Research, Nordic Bioscience, Herlev, Denmark
  11. 11Regenarative Medicine, State Research Institute Center of Innovative Medicine, Vilnius, Lithuania
  12. 12GlaxoSmithKline USA, Philadelphia, Pennsylvania, USA
  13. 13Lygature, Utrecht, The Netherlands
  14. 14Orthopaedics, Erasmus University Medical Center, Rotterdam, The Netherlands
  15. 15Institut de Recherches Internationales Servier, Suresnes, France
  1. Correspondence to Dr Eefje M van Helvoort; E.M.vanHelvoort-3{at}


Purpose The Applied Public-Private Research enabling OsteoArthritis Clinical Headway (APPROACH) consortium intends to prospectively describe in detail, preselected patients with knee osteoarthritis (OA), using conventional and novel clinical, imaging, and biochemical markers, to support OA drug development.

Participants APPROACH is a prospective cohort study including 297 patients with tibiofemoral OA, according to the American College of Rheumatology classification criteria. Patients were (pre)selected from existing cohorts using machine learning models, developed on data from the CHECK cohort, to display a high likelihood of radiographic joint space width (JSW) loss and/or knee pain progression.

Findings to date Selection appeared logistically feasible and baseline characteristics of the cohort demonstrated an OA population with more severe disease: age 66.5 (SD 7.1) vs 68.1 (7.7) years, min-JSW 2.5 (1.3) vs 2.1 (1.0) mm and Knee injury and Osteoarthritis Outcome Score pain 31.3 (19.7) vs 17.7 (14.6), except for age, all: p<0.001, for selected versus excluded patients, respectively. Based on the selection model, this cohort has a predicted higher chance of progression.

Future plans Patients will visit the hospital again at 6, 12 and 24 months for physical examination, pain and general health questionnaires, collection of blood and urine, MRI scans, radiographs of knees and hands, CT scan of the knee, low radiation whole-body CT, HandScan, motion analysis and performance-based tests.

After two years, data will show whether those patients with the highest probabilities for progression experienced disease progression as compared to those wit lower probabilities (model validation) and whether phenotypes/endotypes can be identified and predicted to facilitate targeted drug therapy.

Trial registration number NCT03883568

  • qualitative research
  • protocols & guidelines
  • rheumatology

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  • Contributors WEvS, PMJW, JBa, CHL, JLo, ACB-J, AM, JLa, JBo, HHW, AL, ACAM and FPJGL were responsible for designing the study protocol. WEvS, EMvH, MPJ, MK, ML, FJB, IKH and FB were responsible for data acquisition. EMvH was responsible for data analyses. EMvH was responsible for drafting the manuscript. All authors revised the manuscript thoroughly and aggreed with the final version.

  • Funding The research leading to these results have received support from the Innovative Medicines Initiative Joint Undertaking under Grant Agreement no 115770, resources of which are composed of financial contribution from the European Union’s Seventh Framework Programme (FP7/2007-2013) and EFPIA companies’ in kind contribution. See and

  • Disclaimer This communication reflects the views of the authors and neither IMI nor the European Union and EFPIA are liable for any use that may be made of the information contained herein.

  • Competing interests EMvH has nothing to disclose; WEvS reports grants from The Innovative Medicines Initiative Joint Undertaking under Grant Agreement no 115770, resources of which are composed of financial contribution from the European Union’s Seventh Framework Programme (FP7/2007-2013) and EFPIA companies’ in kind contribution, during the conduct of the study; MPJ has nothing to disclose; PMJW has nothing to disclose. MK reports grants from IMI-APPROACH, grants from Dutch Arthritis Association, during the conduct of the study; other from GlaxoSmithKline, Pfizer, Merck-Serono, Kiniksa, Abbvie, outside the submitted work; ML reports grants from Inovative Medicines Initative, during the conduct of the study; FJB reports grants from Gebro Pharma, grants from BIOIBERICA, grants from AB Science, grants from Abbvie, grants from Ablynx N.V., grants from Amgen, grants from Archigen Biotech, grants from Boehringer, grants from Bristol-Myers, grants from Celgene Int., grants from Eli Lilly and Company, grants from F. Hoffmann- La Roche, grants from Galapagos, grants from Gedeon, grants from Genentech, grants from Gideal Sciences, NC, grants from Glaxosmithkline, grants from Hospira, grants from INC Research UK, grants from Inventiv Health Clinical, grants from Janssen, grants from Lilly, grants from Nichi-IKO Pharmaceutical, grants from Novartis, grants from ONO Pharma, grants from Pfizer, grants from Pharmaceutical Research, grants from Regeneron, grants from Roche, grants from SA UCB Pharma, grants from Sanofi, grants from TRB Chemedica, grants from UCB Biosciences GMBH, outside the submitted work; In addition, FJB has a patent Molecular block-matching method for gel image analysis issued, a patent Targeting A Specific Receptor On Cells With A Specific Compound For Use In The Treatment And/Or The Prevention Of Osteoarthritis And Rheumatoid Arthritis pending, a patent Genetic markers for osteoarthritis issued, a patent Method for the diagnosis of osteoarthritis issued, a patent Genetic markers for osteoarthritis pending, a patent Method for the diagnosing Arthrosis pending, a patent Method for diagnosing Arthrosis pending, a patent Method for the diagnosis of osteoarthritis pending, and a patent Anti-connexin compounds for use in the prevention and/or treatment of degenerative joint diseases. pending; IKH reports personal fees from AbbVie, grants from Pfizer, outside the submitted work; FB reports personal fees from Boehringer, Bone Therapeutics, Expanscience, Galapagos, Gilead, GSK, Merck Sereno, MSD, Nordic, Novartis, Pfizer, Regulaxis, Roche, Sandoz, Sanofi, Servier, UCB, Peptinov, TRB Chemedica, 4P Pharma, outside the submitted work; CHL reports other from Merck KGaA, during the conduct of the study; JLo has nothing to disclose; ACB-J reports non-financial support from Nordic Bioscience, personal fees from Nordic Bioscience, during the conduct of the study; AM has nothing to disclose; JLa reports personal fees and other from GlaxoSmithKline, outside the submitted work; and Current employee and shareholder of GlaxoSmithKline; JBo reports grants from Innovative Medicines Initiative (IMI-1), during the conduct of the study; and one of Lygature's other project receives part of its funding directly from Merck KgaA. This project is in the field of schistosomiasis and has no relationship whatsoever with the APPROACH project; HHW has nothing to disclose; ACAM has nothing to disclose; FPJGL has nothing to disclose.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Patient consent for publication Not required.

  • Ethics approval The study is being conducted in compliance with the protocol, Good Clinical Practice (GCP), the Declaration of Helsinki, and the applicable ethical and legal regulatory requirements (for all countries involved), and is registered under nr: NCT03883568. All participants have received oral and written information and provided written informed consent.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available. In order to gain and govern access to the central APPROACH databases, tranSMART and XNAT, access has to be approved by the APPROACH Steering Committee.

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