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 | 12.0 |
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 compare efficacy of CP 690,550 5 mg BID & 10 mg BID vs placebo for treatment of signs & symptoms of RA, in patients with RA on background MTX who have had an inadequate response (IR) to a TNF-i as measured by ACR20 response rates at M3 2. To compare physical function status of patients with active RA on bkg MTX who have had IR to a TNF-i after administration of CP 690,550 5 mg BID & 10 mg BID vs placebo, as measured by HAQ DI response at M3 3. To compare rate of achieving DAS284(ESR) <2.6 at Month 3 in patients with active RA on bkg MTX who have had IR to a TNF-i after administration of CP-690,550 5 mg BID & 10 mg BID vs placebo 4. To compare the safety and tolerability of CP-690,550, in doses of 5 mg BID and 10 mg BID, vs placebo in patients with RA on background methotrexate who have had an inadequate response to a TNF inhibitor. |
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E.2.2 | Secondary objectives of the trial |
1. To compare efficacy of CP 690,550 5 mg BID & 10 mg BID vs placebo for treatment of signs & symptoms of RA in patients with RA on bkg MTX who have had IR to a TNF-i at all other time points as measured by ACR20, ACR50, ACR70 & DAS28 response rates 2. To compare incidence of DAS28<2.6 & DAS28 ≤3.2 at each visit. 3. To compare effects on all health outcomes measures at each visit as appropriate for the specific outcome compared to baseline |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
To be eligible for inclusion in this study, patients must meet all of these criteria: 1. Active rheumatoid arthritis (RA); 2. Ongoing treatment with an adequate and stable dose of methotrexate; 3. In the opinion of the investigator, at least one approved TNF-inhibiting biologic agent administered in accordance with its labeling recommendations was inadequately effective and/or not tolerated. 4. All other inclusion criteria. Active Rheumatoid Arthritis 1. Meet the ACR classification criteria for RA 2. Must have active disease at both screening and baseline, as defined by having both: a. ≥6 tender/painful joints on motion (out of 68 joints assessed); and; b. ≥6 swollen joints (out of 66 joints assessed). 3. Must also have active disease, as defined by one of the following criteria at screening: a. Erythrocyte sedimentation rate (ESR) (Westergren method) >28 mm/hr; or b. C- reactive protein (CRP) >7 mg/L in the central laboratory. 4. Must meet Class I, II or III of the ACR 1991 Revised Criteria for Global Functional Status in RA. Background Methotrexate 1. Must have taken oral or parenteral methotrexate continuously for at least 4 months prior to the first dose of study medication and be on a stable dose of 7.5 mg to 25 mg weekly, for at least 6 weeks prior to the first dose of study medication. Stable weekly doses less than 15 mg are allowed only in the presence of intolerance to or toxicity from higher doses or where higher doses would violate the local label. Doses higher than 25 mg weekly are not permitted under any circumstances. 2. Patients should be on an adequate and stable dose of folic acid (not less than 5 mg weekly, unless higher doses would violate the local label) for at least 4 weeks prior to the first dose of study medication. 1. Evidence of a signed and dated informed consent document. 2. Must be at least 18 years of age. 3. Sexually active women of childbearing potential and men whose partners are women of childbearing potential are required to use adequate contraceptive methods during participation in this study. 4. No evidence of active or latent or inadequately treated infection with Mycobacterium tuberculosis (TB) as described in the protocol 5. For traditional DMARDS, the following minimum washout criteria apply: • Minocycline, Penicillamine, Sulfasalazine: must have been discontinued for 4 weeks prior to the first dose of study drug. • Leflunomide (Arava®) must have been discontinued 8 weeks prior to the first dose of study drug if no elimination procedure is followed. Alternately, it should have been discontinued with the specified elimination procedure at least 4 weeks prior to the first dose of study drug. • Auranofin (Ridaura®), Injectable Gold (aurothiglucose or aurothiomalate): must have been discontinued for 8 weeks prior to first dose of study drug. • Antimalarials (Hydroxychloroquine, Chloroquine): Antimalarials will be allowed in this study. If discontinued, they must be discontinued for 4 weeks prior to the first dose of study drug. If continued, the dose must be stable for at least 8 weeks prior to first dose of study drug. 6. Biologic Response Modifiers. All must be discontinued for entry into this study: • Anakinra (Kineret®), Enbrel (Etanercept®); Discontinued for 4 weeks prior to the first dose of study drug; • Adalimumab (Humira®): Discontinued for 6 weeks prior to first dose of study drug; • Infliximab (Remicade®): Discontinued for 8 weeks prior to the first dose of study drug; •Golimumab (Simponi TM): Discontinued for 10 weeks prior to the first dose of study drug; • Abatacept (Orencia®), Tocilizumab (Actemra®), Certolizumab pegol (Cimzia®): Discontinued for 12 weeks prior to first dose of study drug; • Rituximab or other selective B lymphocyte depleting agents (either marketed or investigational): Discontinued for 1 year prior to the first dose of study drug and if D19/20+ counts are normal by FACS analysis; 7. Other: a. Oral corticosteroids: Patients who are already on oral corticosteroids must be on a stable dose of ≤10 mg/day of prednisone or equivalent for 4 weeks prior to first dose of study drug. b. Intraarticular, intramuscular, or intravenous corticosteroids: None may be administered within 4 weeks prior to first dose of study drug. c. cyclosporine, Tacrolimus, Azathioprine: All must be discontinued 4 weeks prior to the first dose of study drug. d. Prosorba Device/Column: This must be discontinued 4 weeks prior to the first dose of study drug. e. Experimental NSAIDS (including Cox-2 inhibitors): These must be discontinued 4 weeks prior to the first dose of study drug. f. Any investigational treatment not mentioned elsewhere must be discontinued for 4 weeks or 5 half lives, whichever is longer. |
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E.4 | Principal exclusion criteria |
Patients presenting with any of the following will not be included in the study: 1. Any prior treatment with non B lymphocyte-selective lymphocyte depleting agents/therapies, such as alemtuzumab (Campath®) OR alkylating agents (eg, cyclophosphamide or chlorambucil) OR total lymphoid irradiation, etc. Patients who have received rituximab or other selective B lymphocyte depleting agents (including experimental agents) are eligible if they have not received such therapy for at least 1 year prior to study baseline and have normal CD 19/20+ counts by FACS analysis. 2. Pregnant or lactating females. 3. Blood dyscrasias including confirmed: - Hemoglobin <9 g/dL or Hematocrit <30%; - White blood cell count <3.0 x 10^9/L; - Absolute neutrophil count <1.2 x 10^9/L; - Platelet count <100 x 10^9/L. 4. Estimated GFR less than 40 ml/min based on Cockcroft-Gault calculation. 5. AST or ALT more than 1.5 times the upper limit of normal at screening visit. 6. Current or recent history of uncontrolled clinically significant renal, hepatic, hematological, gastrointestinal, endocrine, metabolic, pulmonary, cardiac, or neurological disease. 7. History of any other autoimmune rheumatic disease other than Sjogren’s syndrome. 8. History of an infected joint prosthesis at any time, with the prosthesis still in situ. 9. History of any lymphoproliferative disorder, such as Epstein Barr Virus (EBV) related lymphoproliferative disorder, history of lymphoma, leukemia, or signs and symptoms suggestive of current lymphatic disease. 10. History of infection requiring hospitalization, parenteral antimicrobial therapy, or as otherwise judged clinically significant by the investigator, within the 6 months prior to the first dose of study drug. 11. History of any infection requiring antimicrobial therapy within 2 weeks prior to the first dose of study drug. 12. A history of recurrent (more than one episode) herpes zoster, disseminated (a single episode) herpes zoster or disseminated (a single episode) herpes simplex. 13. A patient who was vaccinated or exposed to a live or attenuated vaccine within the 6 weeks prior to the first dose of study drug, expects to be vaccinated or exposed to these vaccines during treatment, or during the 6 weeks following discontinuation of study drug. (See Section 4.5.2. for further information regarding avoidance of household contacts who may be vaccinated). 14. A patient with any condition possibly affecting oral drug absorption, eg, gastrectomy, clinically significant diabetic gastroenteropathy, or certain types of bariatric surgery such as gastric bypass. Procedures such as gastric banding, that simply divide the stomach into separate chambers, are NOT exclusionary. 15. History of alcohol or substance abuse, unless in full remission for greater than 6 months prior to first dose of study drug. 16. Screening 12-lead ECG that demonstrates clinically relevant abnormalities which may affect patient safety or interpretation of study results. 17. A patient with a first-degree relative with a hereditary immunodeficiency. 18. A patient with a malignancy or with a history of malignancy, with the exception of adequately treated or excised non-metastatic basal cell or squamous cell cancer of the skin or cervical carcinoma in situ. 19. Significant trauma or major surgery within 1 month of screening visit. 20. A patient requiring prohibited concomitant medications including prohibited dietary supplements. Prohibited concomitant medications must be discontinued at least 4 weeks prior to the first dose of study drug, with the exception of amiodarone which must be discontinued for at least 290 days prior to the first dose of study drug. 21. A patient infected with human immunodeficiency virus (HIV) or hepatitis B or C viruses. 22. A patient who has previously participated in any study of CP-690,550. 23. A patient who has an allergy/hypersensitivity to methotrexate, or previous serious toxicity when administered methotrexate. 24. Other severe acute or chronic medical or psychiatric condition or laboratory abnormality that may increase the risk associated with study participation or study drug administration or may interfere with the interpretation of study results and, in the judgment of the investigator, would make the patient inappropriate for entry into this study. 25. A patient who, in the opinion of the Investigator or Pfizer, will be uncooperative or unable to comply with study procedures. |
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E.5 End points |
E.5.1 | Primary end point(s) |
1. American College of Rheumatology 20 (ACR20) responder rate versus placebo at the Month 3 visit. 2. Change from baseline in the Health Assessment Questionnaire (HAQ-DI) vs. placebo at the Month 3 visit. 3. Incidence rate for DAS28-4 (ESR) <2.6 versus placebo at the Month 3 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 | 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 | Yes |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | Yes |
E.6.13.1 | Other scope of the trial description |
Optional Molecular Profiling Supplement |
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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 | 3 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 30 |
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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End of Trial os defined in the protocol amd 2, dated 10th May 2010, section 13. End of Trial in all participating countries is defined as Last Patient Last Visit. |
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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 | 6 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 1 |
E.8.9.2 | In all countries concerned by the trial months | 6 |
E.8.9.2 | In all countries concerned by the trial days | 0 |