E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
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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 |
To assess the safety of tocilizumab (TCZ) monotherapy or in combination with non-biologic DMARDs in in patients with moderate to severe active RA. |
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E.2.2 | Secondary objectives of the trial |
To assess the efficacy of TCZ monotherapy or in combination with non-biologic DMARDs in patients with moderate to severe active RA. |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. Male or non-pregnant, non-nursing female 2. ≥ 18 years of age 3. Diagnosis of moderate to severe active RA: ≥6 swollen and ≥6 tender joints, CRP≥28 (mg/l) and/or ESR≥30 (mm/hr) 4. Receiving treatment on an outpatient basis 5. Patients on ≥ 1 non-biologic DMARDs at a stable dose for a period ≥ 8 weeks prior to treatment (day 1) 6. Patients with inadequate clinical response to a stable dose of non-biologic DMARD 7. If patients are receiving an oral corticosteroid, the dose must have been stable for at least 25 out of 28 days prior to treatment (day 1) 8. Able and willing to give written informed consent and comply with the requirements of the study protocol |
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E.4 | Principal exclusion criteria |
Disease 1. Major surgery (including joint surgery) within 8 weeks prior to screening or planned major surgery within 6 months following randomization, 2. Rheumatic autoimmune disease other than RA, Sjögren’s Syndrome with RA is permitted, 3.Functional class IV as defined by the ACR Classification of Functional Status in RA (largely or wholly incapacitated with patient bedridden or confined to wheel chair, permitting little or no self-care)
Drug-specific 4.Treatment with any investigational agent within 4 weeks (or 5 half-lives of investigational agent, whichever is longer) before screening, 5.Previous treatment with any cell-depleting therapies, including investigational agents (e.g. CAMPATH, anti-CD4, anti-CD5, anti-CD3, anti-CD19 and anti-CD20), 6.Previous treatment with abatacept, adalimumab, etanercept, infliximab or remicade, 7.Treatment with IV gamma globulin, plasmapheresis or Prosorba® column within 6 months before baseline, 8.Immunization with a live/attenuated vaccine within 4 weeks prior to baseline, 9.Previous treatment with TCZ (an exception to this criterion may be granted for single-dose exposure upon application to the sponsor on a case by case basis), 10.Any previous treatment with alkylating agents, such as cyclophosphamide or chlorambucil, or with total lymphoid irradiation
Laboratory analyses (at screening) 11.Serum creatinine > 142 μmol/L (1.6 mg/dL) in female patients and > 168 μmol/L (1.9 mg/dL) in male patients and no active renal disease, 12.ALT (SGPT) or AST (SGOT) > 1.5 ULN (If initial sample yields ALT [SGPT] or AST [SGOT] > 1.5 ULN, a second sample may be taken and tested during the screening period), 13.Platelet count < 100 x 109/L (100,000/mm3), 14.Hemoglobin < 85 g/L (8.5 g/dL; 5.3 mmol/L), 15.WBC count < 3.0 x 109/L (3000/mm3), ANC < 0.5 x 109/L (500/mm3), 16.ALC < 0.5 x 109/L (500/mm3), 17.Positive hepatitis B surface antigen (HBsAg) or hepatitis C antibody, 18.Total bilirubin > ULN (If initial sample yields bilirubin > ULN, a second sample may be taken and tested during the screening period), 19.Triglycerides > 10 mmol/L (> 900 mg/dL) at screening (non-fasted)
General medical 20.Pregnant women or nursing (breastfeeding) mothers, 21.Females of child-bearing potential who are not using a reliable means of contraception, e.g. physical barrier (patient and partner), contraceptive pill or patch, spermicide and barrier, or IUD, 22.History of severe allergic or anaphylactic reactions to human, humanized, or murine monoclonal antibodies, 23.CXR evidence of any clinically significant abnormality, 24.Evidence of serious uncontrolled concomitant cardiovascular, nervous system, pulmonary (including obstructive pulmonary disease), renal, hepatic, endocrine (including uncontrolled diabetes mellitus) or GI disease, 25.In patients with a history of diverticulitis or diverticulosis requiring antibiotic treatment, the treating physician needs to consider the benefit-risk ratio, 26.A history of chronic ulcerative lower GI disease such as Crohn’s disease, ulcerative colitis, diverticulitis or other symptomatic lower GI conditions that might predispose to perforations, 27.Uncontrolled disease states, such as asthma, psoriasis or inflammatory bowel disease where flares are commonly treated with oral or parenteral corticosteroids, 28.Current liver disease as determined by principal investigator. Patients with prior history of ALT (SGPT) elevation are not excluded, 29.Known active current 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 CXR as determined by the investigator, 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 4 weeks of screening, or oral antibiotics within 2 weeks prior to screening, 30.History of or currently active primary or secondary immunodeficiency, 31.Evidence of active malignant disease, malignancies diagnosed within the previous 5 years (including hematological malignancies and solid tumors, except non-melanoma skin cancer that has been excised and cured), or breast cancer diagnosed within the previous 5 years, 32.Active tuberculosis (TB) requiring treatment within the previous 3 years. Patients with a positive purified protein derivative tuberculin skin test (PPD) at screening as per local guidelines are not eligible for the study unless they complete treatment for latent TB and have a negative CXR at enrollment. Patients treated for tuberculosis with no recurrence in 3 years are permitted, 33.HIV positive patient, 34.History of alcohol, drug or chemical abuse within the 6 months prior to screening, 35.Patients with lack of peripheral venous access, 36.Body weight of > 150 kg
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E.5 End points |
E.5.1 | Primary end point(s) |
Incidence of adverse events and serious adverse events during 24 weeks of TCZ monotherapy or combined treatment with TCZ and one or more of the background non-biologic disease modifying anti-rheumatic drugs (DMARDs) approved for rheumatoid arthritis (RA) in patients with moderate to severe active RA |
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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 | No |
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 | 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) | Information not present in EudraCT |
E.8.2.2 | Placebo | Information not present in EudraCT |
E.8.2.3 | Other | Information not present in EudraCT |
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 | 6 |
E.8.5 | The trial involves multiple Member States | No |
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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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | |
E.8.9.1 | In the Member State concerned months | 11 |
E.8.9.1 | In the Member State concerned days | |