E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Rheumatoid arthritis with moderate to low disease activity |
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MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 9.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10039073 |
E.1.2 | Term | Rheumatoid arthritis |
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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 clinical efficacy of certolizumab pegol as an add-on therapy in demonstrating clinical remission at both Week 20 and Week 24 (defined as Clinical Disease Activity Index [CDAI] of ≤ 2.8). |
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E.2.2 | Secondary objectives of the trial |
To compare the efficacy of 2 treatment arms in Achievement of clinical remission at W20 and W24 (defined as 28- joint count [DAS28-ESR] of < 2.6) Achievement of clinical remission at W20 and W24 (defined as [SDAI] of ≤ 3.3) Maintenance of remission between W24 and W52 (based on CDAI, SDAI and DAS28) Reduction of signs and symptoms of the disease at W24 as measured by ACR criteria Improvement in patients physical function as measured by the Health Assessment Questionnaire Disability Index at W24 Improvement in patients Health-Related Quality of Life as measured by the Short Form 36 - items Health Survey (SF-36) Physical and Mental Component Summary scores and SF-36 domains at W24 Relief in patient's pain, fatigue and disease activity as measured by Patients Assessment of Arthritis Pain-Visual Analogue Scale (VAS), Fatigue Assessment of Disease Activity -VAS at Week 24 Safety: To evaluate thetolerability and safety of certolizumab pegol therapy |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. Patients must be at least 18 years old at the screening visit. 2. Female patients must be either postmenopausal for at least one year, surgically incapable of childbearing, or effectively practicing an acceptable method of contraception (i.e. either oral/parenteral/implantable hormonal contraceptives, intrauterine device or barrier and spermicide). Abstinence only is not an acceptable method. Patients must agree to use adequate contraception during the study and for 12 weeks after the last dose of certolizumab pegol. 3. Patients must have a diagnosis of adultonset RA (of at least six months duration but not longer than ten years) as defined by the 1987 American College of Rheumatology classification criteria. 4. Patients must have moderate to low disease activity as defined by all of the following: CDAI > 6 and ≤ 16 at Screening and Baseline ≥ 2 tender joints (28 joint count) at Screening and Baseline ≥ 2 swollen joints (28 joint count) at Screening and Baseline fulfilling 1 of the following 2 criteria at Screening: ≥28 mm/hour ESR (Westergren), or CRP >10 mg/L 5. Patients must have received combination or mono DMARD therapy ((i.e., Sulfasalazine ≤ 3g/day; Leflunomide ≤ 20mg/day; Hydroxychloroquine ≤ 400mg/day; MTX ≤ 25mg/week) for at least six months prior to the Baseline visit. The dose and route of administration of the DMARD therapy must have been stable for at least 2 months prior to the baseline visit. 6. Patients must be able to understand the information provided to them and to give written Informed Consent. 7. Patients must be able and willing to comply with the requirements of the study protocol. |
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E.4 | Principal exclusion criteria |
Patients must not have a diagnosis of any other inflammatory arthritis (e.g., psoriatic arthritis, ankylosing spondylitis or connective tissue disease). 2. Patients must not have a secondary, noninflammatory type of arthritis (e.g. osteoarthritis or fibromyalgia) that in the Investigators opinion is symptomatic enough to interfere with evaluation of the effect of study drug on the patients primary diagnosis of RA. 3. Patients must not have a history of an infected joint prosthesis at any time with that prosthesis still in situ. 4. Patients must be free of prohibited medication as detailed in the table on page 45. 5. Patients must not have received any previous biological therapy for RA. 6. Patients must not have received any experimental nonbiological therapy, within or outside a clinical trial in the three months prior to Baseline visit. Medical History Exclusion: 7. Female patients who are breast feeding, pregnant, or plan to become pregnant during the trial or for three months following last dose of study drug. 8. Patients with a history of chronic infection (more than 4 episodes requiring antibiotics/antivirals during the preceding year), recent serious or lifethreatening infection within 6 months (including herpes zoster), or any current sign or symptom that may indicate an infection. 9. Patients with active TB (or history of active TB) or positive chest Xray for TB or positive (defined as induration of ≥ 5mm) PPD skin test or patients having close contact with an individual with active TB. Patients having a PPD skin test greater or equal to 5 mm can enter the study, provided that active TB is excluded and provided that they are adequately treated for latent tuberculosis (e.g., isonicotinic acid hydrazide [INH therapy] for 9 months [with vitamin B6]) and provided that treatment is initiated at least 1 month prior to first administration of certolizumab pegol. For Germany, only patients having a chest X-Ray performed in their usual practice within 3 months before baseline can be included, waiting for the approval of the Radiation Board. 10. Patients at a high risk of infection (e.g. leg ulcers, indwelling urinary catheter andpersistent or recurrent chest infections and patients who are permanently bed ridden or wheelchair bound). 11. Patients with a history of a lymphoproliferative disorder including lymphoma or signs and symptoms suggestive of lymphoproliferative disease at any time. 12. Patients with known concurrent acute or chronic viral hepatitis B or C. 13. Patients with known human immunodeficiency virus (HIV) infection. 14. Patients receiving any vaccination (live or attenuated) within eight weeks prior to Baseline. (However, influenza and pneumococcal vaccines are allowed) 15. Concurrent malignancy or a history of malignancy (other than carcinoma of the cervix or basal cell carcinoma successfully treated more than five years prior to screening). 16. Patients with a history of blood dyscrasias. 17. Patients with a current or recent history, as determined by the Investigator, of severe, progressive, and/or uncontrolled renal, hepatic, hematological, gastrointestinal, endocrine, pulmonary, cardiac, neurological, or cerebral disease. 18. Patients with class III or IV congestive heart failure. New York Heart Association (NYHA) 1964. |
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E.5 End points |
E.5.1 | Primary end point(s) |
The primary efficacy variable is the proportion of subjects in CDAI remission (CDAI ≤ 2.8) at both Week 20 and Week 24 visits. |
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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 | No |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | Yes |
E.6.7 | Pharmacodynamic | No |
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 | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | Yes |
E.8.1.5 | Parallel group | Yes |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | Yes |
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 | 10 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | No |
E.8.6.2 | Trial being conducted completely outside of the EEA | Information not present in EudraCT |
E.8.7 | Trial has a data monitoring committee | No |
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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La fine dello studio e' definita come la data dell'ultima visita (Week 62) dell'ultimo paziente. |
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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 | 2 |
E.8.9.1 | In the Member State concerned months | 0 |
E.8.9.1 | In the Member State concerned days | |
E.8.9.2 | In all countries concerned by the trial years | 2 |
E.8.9.2 | In all countries concerned by the trial months | 0 |