E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
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MedDRA Classification |
E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
To assess the long-term safety of 8 mg/kg tocilizumab (MRA) as monotherapy or in combination with background DMARD therapy(ies) with regard to adverse events and laboratory result abnormalities. |
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E.2.2 | Secondary objectives of the trial |
•To explore the possibility of reducing concomitant steroid treatment •To determine the long-term efficacy of 8 mg/kg tocilizumab (MRA) with regard to reduction in signs and symptoms
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1) Completion of treatment as specified in the core studies, and scheduled to receive the first tocilizumab (MRA) infusion in WA18696 between 4 and 12 weeks after the last iv infusion in the core studies. Patients that are prevented from enrollment prior to 12 weeks after the last infusion in the core studies due to administrative delays outside the control of the investigator and upon discussion with Roche may be included if they meet all other inclusion criteria, but will undergo a separate analysis of the study results. 2) Able and willing to give written informed consent and comply with the requirements of the study protocol. 3) Have received MTX or other allowable DMARD at a stable dose and route of administration since the last administration of study drug in the core studies. Patients enrolled from study WA17824, will receive tocilizumab (MRA) 8 mg/kg monotherapy or combination therapy at the discretion of the investigator. 4) Oral corticosteroids (≤10 mg/day prednisone or equivalent) and NSAIDS (up to the maximum recommended dose) are permitted if dose stable since the last administration of study drug in the core studies. 5) If taking MTX, must be willing to receive oral folate (at least 5 mg/week). 6) Females of child-bearing potential and males with female partners of child-bearing potential may participate in this trial only if using a reliable means of contraception (e.g. physical barrier (patient and partner), contraceptive pill or patch, spermicide and barrier, or IUD). 7) If female and of child-bearing potential, the patient must have a negative urine pregnancy test at baseline. |
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E.4 | Principal exclusion criteria |
1) Treatment with any investigational agent since the last administration of study drug in the core studies. 2) Previous treatment with any cell depleting therapies, including investigational agents (e.g. CAMPATH, anti-CD4, anti-CD5, anti-CD3, anti-CD19 and anti-CD20) 3) Treatment with iv gamma globulin, plasmapheresis or Prosorba™ column since the last administration of study drug in the core studies. 4) Treatment with an anti-TNF or anti-IL1 agent, or a T-cell costimulation modulator or any biologic or participation in any research study since the last administration of study drug in the core studies. 5) Parenteral, intramuscular or intra-articular corticosteroids within 6 weeks prior to baseline in WA18696. 6) Immunization with a live/attenuated vaccine since the last administration of study drug in the core studies. 7) Any previous treatment with alkylating agents such as cyclophosphamide or chlorambucil, or with total lymphoid irradiation. 8) History of severe allergic or anaphylactic reaction to human, humanized or murine monoclonal antibodies. 9) Evidence of serious uncontrolled concomitant cardiovascular, nervous system, pulmonary (incl. obstructive pulmonary disease), renal, hepatic, endocrine (incl. uncontrolled diabetes mellitus), immunologic or gastrointestinal disease; history of diverticulitis, diverticulosis requiring antibiotic treatment or chronic ulcerative lower GI disease such as Crohn’s disease, ulcerative colitis or other symptomatic lower GI conditions that might predispose to perforations for whom a favourable benefit/risk assessment for study continuation cannot be documented. 10) Known active or history of recurrent bacterial, viral, fungal, mycobacterial or other infections (including but not limited to tuberculosis and atypical mycobacterial disease, clinically significant abnormalities on chest X-ray as determined by the investigator, HIV, hepatitis B and C, and Herpes zoster, but excluding fungal infections of nail beds), or any major episode of infection requiring hospitalization or treatment with iv antibiotics within four weeks prior to baseline or oral antibiotics within two weeks prior to baseline. 11) Evidence of active malignant disease, including solid tumors and hematologic malignancies diagnosed within the previous 10 years (except basal cell carcinoma of the skin that has been excised and cured), breast cancer diagnosed within the previous 20 years. 12) Patients whose AST or ALT ≥ 3 times ULN, bilirubin > 2 times ULN or > 2.5 mg/dL (43 umol/L), neutrophils < 1000/cubic millimetre (1 x 10 to the power 3/uL or 1 GI/L), or who have an infection.
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E.5 End points |
E.5.1 | Primary end point(s) |
The primary parameters of interest are safety and long-term efficacy. The following endpoints will be summarized descriptively: • The safety of MRA with regard to adverse events and laboratory result abnormalities. • Concomitant steroid treatment will be summarized by visit. • Number of patients who withdraw from treatment. • The proportion of patients achieving an ACR20, ACR50 and ACR70 response by visit. • The proportion of patients who maintain an ACR20, ACR50 or ACR70 response consecutively for 24, 48, 96 and 264 weeks. • The individual components of the ACR core set will be summarized by visit. • Change in Disease Activity Score (DAS28) from baseline to weeks 24, 48, 96 and 264. • The proportion of patients who are categorical DAS28 responders (EULAR response) by visit. • The proportion of patients who remain categorical DAS28 responders (EULAR response) consecutively for 24, 48, 96 and 264 weeks. • The proportion of patients who change from monotherapy to combination treatment by visit.
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | Yes |
E.6.7 | Pharmacodynamic | Yes |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | Yes |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | Yes |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | No |
E.8.1.1 | Randomised | Information not present in EudraCT |
E.8.1.2 | Open | Information not present in EudraCT |
E.8.1.3 | Single blind | Information not present in EudraCT |
E.8.1.4 | Double blind | Information not present in EudraCT |
E.8.1.5 | Parallel group | Information not present in EudraCT |
E.8.1.6 | Cross over | Information not present in EudraCT |
E.8.1.7 | Other | Information not present in EudraCT |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | No |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 1 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 63 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | Information not present in EudraCT |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
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E.8.7 | Trial has a data monitoring committee | Yes |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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The end of the trial will occur when the last participating patient completes the last scheduled visit, or when the sponsor decides to discontinue the development program |
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 7 |
E.8.9.1 | In the Member State concerned months | 4 |
E.8.9.1 | In the Member State concerned days | |
E.8.9.2 | In all countries concerned by the trial years | 7 |
E.8.9.2 | In all countries concerned by the trial months | 4 |