E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
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E.1.1.1 | Medical condition in easily understood language |
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E.1.1.2 | Therapeutic area | Diseases [C] - Musculoskeletal Diseases [C05] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 14.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10039073 |
E.1.2 | Term | Rheumatoid arthritis |
E.1.2 | System Organ Class | 10028395 - Musculoskeletal and connective tissue disorders |
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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 identify the first time point the OMERACT RAMRIS score for the activity of synovitis is statistically significantly reduced compared to Baseline in response to CZP therapy. |
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E.2.2 | Secondary objectives of the trial |
• To identify the efficacy of CZP on synovitis in dynamic MRI parameters of IRE, ME, and Nvox with Plateau and Washout pattern
• Correlation of reduction of synovitis as measured by MRI at Week 16 with:
◦ EULAR response
◦ ACR20, ACR50, and ACR70 response
◦ DAS28 response
◦ X-ray changes in bone mineral density
• Change from Baseline for the OMERACT RAMRIS synovitis scores at Week 1 and Week 2 will be analyzed and compared between treatment groups (CZP versus PBO).
• Assessment of clinical response during double-blind and OLE periods |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. An Institutional Review Board (IRB)/Independent Ethics Committee (IEC) approved
written informed consent is signed and dated by the subject or by the parent(s) or legal representative.
2. Subject/legal representative is considered reliable and capable of adhering to the protocol (eg, able to understand and complete diaries), visit schedule or medication intake according to the judgment of the Investigator.
3. Subjects must be at least 18 years old at the Screening Visit.
4. Female subjects must be either postmenopausal for at least 1 year, surgically incapable of childbearing, or effectively practicing an acceptable method of contraception (either oral/parenteral/implantable hormonal contraceptives, intrauterine device, or barrier and spermicide). Abstinence only is not an acceptable method. Subjects must agree to use adequate contraception during the study and for 10 weeks after their last dose of CZP (or longer if required by local regulations).
5. Subjects must have a diagnosis of adult-onset RA of at least 3 months duration but not longer than 15 years as defined by the 1987 American College of Rheumatology classification criteria.
6. Subjects must be rheumatoid factor positive and/or anti-CCP positive.
7. Inclusion Criterion 7 was deleted in Protocol Amendment 2.
8. Subjects must have active RA disease as defined by the protocol.
9. Subjects must be on DMARD therapy for at least 12 weeks and the dose and route of administration should be stable for at least 8 weeks prior to Baseline. The eligibility for TNF therapy will be based upon appropriate medical judgment and as defined in local regulations and guidance and accoring to medical practice.
10. Subjects must be able and willing to comply with the requirements of the study protocol.
11. Subjects must have a normal renal function with creatinine within normal limits at screening.
12. The normal renal function being defined as eGFR (MDRD) > 60 ml/min/1.732 body surface
area at Screening and calculated according to the formula eGFR = 175 x (serum creatinine)^- 1.154 x (age)^0.203 x (0.742 if female) x (1.212 if African American). |
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E.4 | Principal exclusion criteria |
1. Subject has previously participated in this study or subject has previously been assigned to treatment in a study of the medication under investigation in this study.
2. Subject has a history of chronic alcohol or drug abuse within the last 6 months).
3. Subject has any medical or psychiatric condition that, in the opinion of the Investigator, could jeopardize or would compromise the subject’s ability to participate in this study.
4. Subject has a known hypersensitivity to any components of the IMP as stated in the protocol.
5. Subjects must not have a secondary, noninflammatory type of musculoskeletal condition that in the Investigator’s opinion is symptomatic enough to interfere with evaluation of the effect of study drug on the subject’s primary diagnosis of RA.
6. Subjects must not have a diagnosis of any other inflammatory arthritis.
7. Subjects must not have a history of an infected joint prosthesis at any time with that prosthesis still in situ.
8. Subjects must not have received any of the prohibited medication as detailed in the protocol.
9. Subjects must not have received any experimental nonbiological therapy in the 3 months or within 5 half-lives prior to Baseline (whichever is longer).
10. Subjects must not have received any experimental biological agent in the past 3 months or within 5 half-lives prior to Baseline (whichever is longer).
11. Subjects must not have received infliximab or abatacept therapy in the 3 months prior to Baseline.
12. Subjects must not have received adalimumab, golimumab or etanercept therapy in the 2 months prior to Baseline.
13. Subjects must not have received treatment with rituximab and tocilizumab.
14. Subjects must not have received more than 1 biological agent.
15. Subjects must not have been primary failures (ie, never achieved meaningful improvement) to prior anti-TNF therapy.
16. Subjects must not have contraindications for MRI and contrast agent.
17. Female subjects who are breastfeeding, pregnant, or plan to become pregnant during the trial or within 12 weeks following last dose of study drug.
18. Subjects with a history of chronic infection (more than 4 episodes requiring antibiotics/antivirals during the preceding year), recent serious or life–threatening infection within 6 months (including herpes zoster), or any current sign or symptom that may indicate an infection.
19. Known TB disease, high risk of acquiring TB infection, or latent TB infection (as defined in the protocol).
20. Subjects at a high risk of infection (as stated in the protocol).
21. Subjects with a history of a lymphoproliferative disorder including lymphoma or signs and symptoms suggestive of lymphoproliferative disease.
22. Subjects with concurrent acute or chronic viral hepatitis B or C.
23. Subjects with known human immunodeficiency virus (HIV) infection.
24. Subjects receiving live or attenuated vaccination within 8 weeks prior to Baseline (as stated in the protocol).
25. Concurrent malignancy or a history of malignancy (other than carcinoma of the cervix or basal cell carcinoma successfully treated more than 5 years prior to Screening).
26. Subjects with a current or recent history of severe, progressive, and/or uncontrolled renal, hepatic, hematological, gastrointestinal, endocrine, pulmonary, cardiac, neurological or cerebral disease.
27. Subjects with class III or IV congestive heart failure according to the New York Heart Association (NYHA) 1964 classification criteria.
28. Subjects with a history of, or suspected, demyelinating disease of the central nervous system.
29. Subjects with any other condition which in the Investigator’s judgment would make the subject unsuitable for inclusion in the study. |
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E.5 End points |
E.5.1 | Primary end point(s) |
Primary efficacy variable:
Change from Baseline (Day 0) in OMERACT RAMRIS synovitis score measured with MRI (gadolinium-containing contrast agent) of 1 hand and wrist at Weeks 1, 2, 4, 8, and 16.
Safety variables:
- Adverse events and serious adverse events
- Physical examination (including signs and symptoms of latent or active tuberculosis) and vital signs
- Clinical laboratory values (hematology, serum biochemistry, and urinalysis) |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
16 week double-blind, placebo controlled (during the initial 2 weeks) randomized period, followed by a 24 week open-label extension. |
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E.5.2 | Secondary end point(s) |
• Dynamic MRI parameters of IRE, ME, and Nvox at Day 0 and Weeks 1, 2, 4, 8, and 16 during the double-blind period.
• EULAR response at Weeks 2, 4, 6, 8, 10, 12, 14, and 16 during the double-blind period, then every 8 weeks during the OLE period, and at the Completion/Withdrawal Visit.
• ACR20, ACR50, and ACR70 at Weeks 2, 4, 6, 8, 10, 12, 14, and 16 during the double blind period, then every 8 weeks during the OLE period, and at the Completion/Withdrawal Visit.
• Change from Baseline in DAS28-CRP at Weeks 2, 4, 6, 8, 10, 12, 14, and 16 during the double-blind period, then every 8 weeks during the OLE period, and at the Completion/Withdrawal Visit.
• DAS28-CRP remission status at Weeks 2, 4, 6, 8, 10, 12, 14, and 16 during the double blind period, then every 8 weeks during the OLE period, and at the Completion/Withdrawal Visit.
• Change from Baseline in bone mineral density (g/cm2) as measured by DXR at Week 16.
• Change from Baseline in ACR components: tender joints and swollen joints, and Health Assessment Questionnaire - Disability Index (HAQ-DI) at Weeks 1, 2, 4, 6, 8, 10, 12, 14, and 16 during the double-blind period, then every 8 weeks during the OLE period, and at the Completion/Withdrawal Visit.
• Ratio to Baseline for C-reactive protein (CRP) at Weeks 2, 4, 6, 8, 10, 12, 14, and 16 during the double-blind period, then every 8 weeks during the OLE period, and at the Completion/Withdrawal Visit. |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
16 week double-blind, placebo controlled (during the initial 2 weeks) randomized period, followed by a 24 week open-label extension. |
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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 | 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 | Yes |
E.8.1.7.1 | Other trial design description |
study is placebo-controlled during the initial 2 weeks and there is a 24-week open-label extension |
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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.8.2.4 | Number of treatment arms in the trial | 2 |
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 | 4 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 11 |
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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The end of the study is defined as the date of the last Safety Follow-Up phone contact of the last subject in the study. |
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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 | 4 |
E.8.9.1 | In the Member State concerned days | 0 |
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 | 4 |
E.8.9.2 | In all countries concerned by the trial days | 0 |