E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Artritis reumatoide (AR)
Rheumatoid arthritis (RA) |
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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 | LLT |
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 |
1. To investigate the efficacy of rituximab (1000 mg x 2) in the inhibition of joint structural damage progression assessed by using MRI in patients with an inadequate clinical response to MTX 2. To investigate the efficacy of rituximab (1000 mg x 2) in the improvement of synovitis and osteitis measured by MRI in patients with an inadequate clinical response to MTX 3. To explore the efficacy of rituximab (500 mg x 2) in the inhibition of joint structural damage progression and in the improvement of synovitis and osteitis assessed by using MRI in patients with an inadequate clinical response to MTX 4. To investigate the efficacy and safety of repeated courses of rituximab 5. To evaluate additional exploratory endpoints, including those relating to MRI of targeted joints and surrounding structures.
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E.2.2 | Secondary objectives of the trial |
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E.2.3 | Trial contains a sub-study | No |
E.2.3.1 | Full title, date and version of each sub-study and their related objectives |
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E.3 | Principal inclusion criteria |
1. Able and willing to give written informed consent and comply with the requirements of the study protocol 2. Patients with active RA for at least 3 months diagnosed according to the revised 1987 American College of Rheumatology (ACR) criteria for the classification of RA 3. Disease duration ≤ 10 years 4. Either anti-cyclic citrullinated peptide (anti-CCP) (≥ 20 Units) or rheumatoid factor positive (≥20 IU/mL) or both 5. Active disease as defined by DAS28-CRP ≥ 3.2 6. Evidence of erosive disease and/or clinical synovitis in a signal (MRI) joint (metacarpophalangeal and/or wrist) • RA duration > 1 year: at least one erosion evaluated by a radiograph at the X-ray screening visit and evidence of clinical synovitis • RA duration ≤ 1 year: evidence of clinical synovitis* 7. Age ≥ 18 and ≤ 80 years 8. Glucocorticoids ≤10 mg/day prednisolone or equivalent permitted if stable for at least 4 weeks prior to baseline 9. Use of non-steroidal anti inflammatory drugs is permitted if stable for at least 4 weeks prior to baseline 10. For patients of reproductive potential (males and females), use of a reliable means of contraception (e.g., hormonal contraceptive, patch, intrauterine device, physical barrier) throughout study participation 11. Experiencing inadequate response to MTX at a dose of 12.5 25 mg/week (p.o. or parenteral) for at least 12 weeks, with the last 4 weeks prior to baseline maintained at a stable dose. Minimal MTX doses of 7.5 or 10 mg/week are permitted only in case of documented intolerance to higher doses.
*In the event that clinical synovitis is not confirmed by MRI assessment at baseline, the patient will be excluded from the study |
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E.4 | Principal exclusion criteria |
Exclusion criteria related to RA: 1. Rheumatic autoimmune disease other than RA, or significant systemic involvement secondary to RA (including but not limited to vasculitis, pulmonary fibrosis or Felty’s syndrome). Secondary Sjögren’s syndrome or secondary limited cutaneous vasculitis with RA is permitted 2. Bed-bound or wheelchair bound patients 3. History of, or current, inflammatory joint disease other than RA (e.g., gout, reactive arthritis, psoriatic arthritis, seronegative spondyloarthropathy, Lyme disease) or other systemic autoimmune disorder (e.g., systemic lupus erythematosus, inflammatory bowel disease, scleroderma, inflammatory myopathy, mixed connective tissue disease or any overlap syndrome) 4. Diagnosis of juvenile idiopathic arthritis, also known as juvenile RA and/or RA before age 16.
Exclusion criteria related to general health: 1. Any surgical procedure, including bone/joint surgery/synovectomy (including joint fusion or replacement) within 12 weeks prior to baseline or planned within 24 weeks of randomization 2. Lack of peripheral venous access 3. Pregnancy or breast feeding 4. Significant cardiac or pulmonary disease, including obstructive pulmonary disease 5. Evidence of significant, uncontrolled, concomitant disease such as, but not limited to, nervous system, renal, hepatic, endocrine, or gastrointestinal disorders which, in the investigator’s opinion, would preclude patient participation 6. Primary or secondary immunodeficiency (history of, or currently active), including known history of HIV infection 7. Known active infection of any kind (excluding fungal infections of nail beds), or any major episode of infection requiring hospitalization or treatment with i.v. anti infectives within 4 weeks prior to baseline or completion of oral anti-infectives within 2 weeks prior to baseline 8. History of deep space/tissue infection (e.g., fasciitis, abscess, osteomyelitis) within 52 weeks prior to baseline 9. History of serious recurrent or chronic infection (patients will be screened for chest infections using a chest radiograph at screening if not previously performed within the 12 weeks prior to screening) 10. History of cancer, including solid tumors, hematologic malignancies and carcinoma in situ (except basal cell or squamous cell carcinoma of the skin that has been excised and cured) 11. Any neurological (congenital or acquired), vascular or systemic disorder which could affect any of the efficacy assessments, in particular, joint pain and swelling (e.g., Parkinson’s disease, cerebral palsy, diabetic neuropathy) 12. Currently active alcohol or drug abuse or history of alcohol or drug abuse within 24 weeks prior to baseline.
Exclusion criteria related to medications: 1. History of a severe allergic or anaphylactic reaction to a biologic agent or known hypersensitivity to any component of rituximab or to murine proteins 2. Previous treatment with any approved or investigational biologic agent for RA 3. Previous treatment with an anti-alpha 4 integrin antibody or co stimulation modulator 4. Previous treatment with any B cell modulating or cell depleting therapies, including investigational agents (e.g., CAMPATH, anti CD4, anti-CD5, anti CD3, anti CD19, anti-CD11a, anti-CD22, anti BLys/BAFF, and anti-CD20) 5. Treatment with any investigational agent within 28 days of baseline or five half lives of the investigational drug (whichever is the longer) 6. Receipt of any vaccine within 28 days prior to baseline. It is recommended that a patient’s vaccination record and the need for immunization prior to receiving study drug be carefully investigated 7. Intra-articular or parenteral glucocorticoids within 4 weeks prior to baseline 8. Intolerance or contraindications to i.v. glucocorticoids.
Exclusion criteria related to MRI: 1. Patients who have a metal device affected by MRI (e.g., any type of electronic, mechanical, or magnetic implant; cardiac pacemaker; aneurysm clip[s]; implanted cardiac defibrillator) or have history of orbit trauma by a potential ferromagnetic foreign body (metal slivers, metal shavings, other metal objects) for which they have sought medical attention 2. Allergy or other contraindications to an i.v. injection of gadolinium diethylenetriamine pentaacetic acid 3. Severe active or dominant hand joint subluxations and/or contractures 4. Claustrophobia sufficient to interfere with the patient undergoing the MRI scan.
Exclusion criteria related to laboratory findings: 1. Positive serum human chorionic gonadotropin measured prior to the first infusion of study drug 2. Positive test for HBsAg or for hepatitis C serology 3. Positive HBcAb associated with positive HBV detection (> 29 IU/L or > 169 copies/mL) 4. Hemoglobin < 8.0 g/dL 5. Absolute neutrophil count < 1.5 x 10 to the power of 3 micrograms per litre 6. Concentration of serum IgG and/or IgM below 5.0 and 0.40 mg/mL, respectively.
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E.5 End points |
E.5.1 | Primary end point(s) |
The change in the MRI bone erosion score (assessed using RAMRIS) between baseline and week 24 in patients receiving rituximab 1000 mg i.v. x 2 compared to those receiving placebo i.v. x 2. |
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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 | No |
E.6.7 | Pharmacodynamic | Yes |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | Yes |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
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 | 8 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 38 |
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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Week 52 is defined as the end of the trial. |
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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 | 1 |
E.8.9.1 | In the Member State concerned months | |
E.8.9.1 | In the Member State concerned days | |
E.8.9.2 | In all countries concerned by the trial years | 1 |