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    Clinical Trial Results:
    A Phase 3b, Randomized, Active Controlled Trial to Evaluate the Efficacy and Safety of Abatacept SC in Combination with Methotrexate in Inducing Clinical Remission Compared to Methotrexate Monotherapy in Adults with Very Early RA

    Summary
    EudraCT number
    2010-018674-20
    Trial protocol
    FR   DE   BE   SE   FI   DK   IT  
    Global end of trial date
    27 Oct 2014

    Results information
    Results version number
    v1(current)
    This version publication date
    01 Apr 2016
    First version publication date
    01 Apr 2016
    Other versions

    Trial information

    Close Top of page
    Trial identification
    Sponsor protocol code
    IM101-226
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT01142726
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Bristol Myers Squibb
    Sponsor organisation address
    Chaussee de la Hulpe 185, Brussels, Belgium,
    Public contact
    Bristol Myers Squibb Study Director, Bristol Myers Squibb, clinical.trials@bms.com
    Scientific contact
    Bristol Myers Squibb Study Director, Bristol Myers Squibb, clinical.trials@bms.com
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    27 Oct 2014
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    27 Oct 2014
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    The main objectives of the study were to compare the clinical efficacy of abatacept in combination with methotrexate (MTX) to MTX alone on the following: • The proportion of randomized and treated subjects with Disease Activity Score 28 based on C-reactive protein (DAS28-CRP) <2.6 at Month 12 • The proportion of randomized and treated subjects with DAS28-CRP <2.6 at both Month 12 and Month 18.
    Protection of trial subjects
    The study was in compliance with the ethical principles derived from the Declaration of Helsinki and in compliance with all International Conference on Harmonization Good Clinical Practice Guidelines. All the local regulatory requirements pertinent to safety of trial subjects were followed.
    Background therapy
    -
    Evidence for comparator
    MTX is a standard of care for early treatment of Rheumatoid arthritis. Hence MTX was selected as the active comparator and Based on the results of study NCT00989235, it was hypothesized that the addition of abatacept to MTX will be superior to MTX in inducing DAS28 clinical remission after a year of treatment in subjects who have serologically positive early RA and are MTX naive. MTX was supplied as 2.5 mg tablets for weekly oral administration during the Treatment Period, and was titrated over a period of 6 to 8 weeks based on tolerability.
    Actual start date of recruitment
    10 Dec 2010
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Australia: 42
    Country: Number of subjects enrolled
    Belgium: 32
    Country: Number of subjects enrolled
    Canada: 6
    Country: Number of subjects enrolled
    Denmark: 2
    Country: Number of subjects enrolled
    Finland: 4
    Country: Number of subjects enrolled
    Germany: 46
    Country: Number of subjects enrolled
    Italy: 4
    Country: Number of subjects enrolled
    Korea, Republic of: 40
    Country: Number of subjects enrolled
    Mexico: 102
    Country: Number of subjects enrolled
    Poland: 53
    Country: Number of subjects enrolled
    South Africa: 66
    Country: Number of subjects enrolled
    Sweden: 23
    Country: Number of subjects enrolled
    United States: 73
    Country: Number of subjects enrolled
    France: 18
    Worldwide total number of subjects
    511
    EEA total number of subjects
    182
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    458
    From 65 to 84 years
    53
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    Subjects were enrolled from 73 sites in 14 countries.

    Pre-assignment
    Screening details
    A total of 511 subjects were enrolled in the study, and 351 were randomized. Reasons that 160 enrolled subjects were not randomized were failure to meet study criteria (130/160), withdrawal of consent (20/160), poor/non-compliance (3/160), administrative reason by sponsor (2/160), lost to follow-up (1/160), and other reasons (4/160).

    Period 1
    Period 1 title
    Treatment Phase: Day 1 Through Month 12
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Abatacept, 125 mg, Plus Methotrexate, 2.5 mg
    Arm description
    Subjects received abatacept, 125 mg subcutaneously, plus methotrexate (MTX), 2.5 mg orally as tablets, with a target dose range of 10-20 mg weekly, during the 12-month Treatment Period. Subjects with a Low Disease Activity Score (LDAS) defined as DAS28-CRP score of <3.2 at Month 12 (end of Treatment Period) entered the Withdrawal Period for up to 12 months, during which all study medication was withdrawn. Subjects with a DAS28-CRP score of >3.2 were discontinued from the study. All MTX and corticosteroids, if not already discontinued, were to be tapered off during the first month of the Withdrawal Period. Subjects who experienced a worsening of rheumatoid arthritis (RA) symptoms or a RA flare after at least 3 months in the Withdrawal Period were eligible to enroll into a 6-month Re-exposure Period, during which they received open-label treatment with abatacept subcutaneous (SC) 125 mg/week and MTX.
    Arm type
    Experimental

    Investigational medicinal product name
    Methotrexate
    Investigational medicinal product code
    Other name
    Rheumatrex
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Methotrexate 2.5 mg orally as tablets, with a target dose range of 10-20 mg weekly during the 12-month Treatment Period.

    Investigational medicinal product name
    Abatacept
    Investigational medicinal product code
    BMS 188667
    Other name
    Orencia
    Pharmaceutical forms
    Injection
    Routes of administration
    Subcutaneous use
    Dosage and administration details
    Abatacept 125 mg was administered as subcutaneous injection once weekly during the 12-month Treatment Period.

    Arm title
    Abatacept, 125 mg, Plus Methotrexate Placebo
    Arm description
    Subjects received abatacept, 125 mg subcutaneously, plus methotrexate placebo tablets orally, once weekly during the 12-month Treatment Period. Subjects with a Low Disease Activity Score (LDAS) defined as DAS28-CRP score of <3.2 at Month 12 (end of Treatment Period) entered the Withdrawal Period for up to 12 months, during which all study medication was withdrawn. Subjects with a DAS28-CRP score of >3.2 were discontinued from the study. Subjects who experienced a worsening of rheumatoid arthritis (RA) symptoms or a RA flare after at least 3 months in the Withdrawal Period were eligible to enroll into a 6-month Re-exposure Period, during which they received open-label treatment with abatacept SC (125 mg/week) and MTX.
    Arm type
    Experimental

    Investigational medicinal product name
    Methotrexate placebo
    Investigational medicinal product code
    Other name
    Rheumatrex
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Methotrexate matching placebo 2.5 mg tablet was administered orally once weekly during the 12-month Treatment Period.

    Investigational medicinal product name
    Abatacept
    Investigational medicinal product code
    BMS 188667
    Other name
    Orencia
    Pharmaceutical forms
    Injection
    Routes of administration
    Subcutaneous use
    Dosage and administration details
    Abatacept 125 mg was administered as subcutaneous injection once weekly during the 12-month Treatment Period.

    Arm title
    Methotrexate, 2.5 mg, Plus Abatacept Placebo
    Arm description
    Subjects received methotrexate, 2.5 mg orally as tablets, with a target dose range of 10-20 mg weekly, plus abatacept placebo subcutaneously, once weekly during the 12-month Treatment Period. Subjects with a Low Disease Activity Score (LDAS) defined as DAS28-CRP score of < 3.2 at Month 12 (end of Treatment Period) entered the Withdrawal Period for up to 12 months, during which all study medication was withdrawn. Subjects with a DAS28-CRP score of >3.2 were discontinued from the study. All MTX and corticosteroids, if not already discontinued, were to be tapered off during the first month of the Withdrawal Period. Subjects who experienced a worsening of rheumatoid arthritis (RA) symptoms or a RA flare after at least 3 months in the Withdrawal Period were eligible to enroll into a 6-month Re-exposure Period, during which they received open-label treatment with abatacept SC (125 mg/week) and MTX.
    Arm type
    Active comparator

    Investigational medicinal product name
    Methotrexate
    Investigational medicinal product code
    Other name
    Rheumatrex
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    2.5 mg orally as tablets, with a target dose range of 10-20 mg weekly during the 12-month Treatment Period.

    Investigational medicinal product name
    Abatacept Placebo
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Injection
    Routes of administration
    Subcutaneous use
    Dosage and administration details
    Abatacept matching placebo 125-mg was administered as subcutaneous injection once weekly during the 12-month Treatment Period.

    Number of subjects in period 1 [1]
    Abatacept, 125 mg, Plus Methotrexate, 2.5 mg Abatacept, 125 mg, Plus Methotrexate Placebo Methotrexate, 2.5 mg, Plus Abatacept Placebo
    Started
    119
    116
    116
    Completed
    103
    91
    96
    Not completed
    16
    25
    20
         Consent withdrawn by subject
    4
    9
    3
         Adverse event, non-fatal
    5
    8
    5
         Poor compliance/noncompliance
    1
    -
    -
         Lost to follow-up
    1
    2
    1
         Lack of efficacy
    5
    6
    11
    Notes
    [1] - The number of subjects reported to be in the baseline period are not the same as the worldwide number enrolled in the trial. It is expected that these numbers will be the same.
    Justification: The number of subjects reported in the baseline period are different from the worldwide number enrolled in the trial, as 160 enrolled subjects were not randomized. Reasons were failure to meet study criteria (130/160), withdrawal of consent (20/160), poor/non-compliance (3/160), administrative reason by sponsor (2/160), lost to follow-up (1/160), and other reasons (4/160).
    Period 2
    Period 2 title
    Withdrawal Phase: Month 12 up to 24
    Is this the baseline period?
    No
    Allocation method
    Not applicable
    Blinding used
    Not blinded

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Abatacept, 125 mg, Plus Methotrexate, 2.5 mg
    Arm description
    Subjects received abatacept, 125 mg subcutaneously, plus methotrexate (MTX), 2.5 mg orally as tablets, with a target dose range of 10-20 mg weekly, during the 12-month Treatment Period. Subjects with a Low Disease Activity Score (LDAS) defined as DAS28-CRP score of <3.2 at Month 12 (end of Treatment Period) entered the Withdrawal Period for up to 12 months, during which all study medication was withdrawn. Subjects with a DAS28-CRP score of >3.2 were discontinued from the study. All MTX and corticosteroids, if not already discontinued, were to be tapered off during the first month of the Withdrawal Period. Subjects who experienced a worsening of rheumatoid arthritis (RA) symptoms or a RA flare after at least 3 months in the Withdrawal Period were eligible to enroll into a 6-month Re-exposure Period, during which they received open-label treatment with abatacept subcutaneous (SC) 125 mg/week and MTX.
    Arm type
    Experimental

    Investigational medicinal product name
    Methotrexate
    Investigational medicinal product code
    Other name
    Rheumatrex
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    2.5 mg orally as tablets, with a target dose range of 10-20 mg weekly during the 12-month Treatment Period.

    Investigational medicinal product name
    Abatacept
    Investigational medicinal product code
    BMS 188667
    Other name
    Orencia
    Pharmaceutical forms
    Injection
    Routes of administration
    Subcutaneous use
    Dosage and administration details
    Abatacept 125 mg was administered as subcutaneous injection once weekly during the 12-month Treatment Period.

    Arm title
    Abatacept, 125 mg, Plus Methotrexate Placebo
    Arm description
    Subjects received abatacept, 125 mg subcutaneously, plus methotrexate placebo tablets orally, once weekly during the 12-month Treatment Period. Subjects with a Low Disease Activity Score (LDAS) defined as DAS28-CRP score of <3.2 at Month 12 (end of Treatment Period) entered the Withdrawal Period for up to 12 months, during which all study medication was withdrawn. Subjects with a DAS28-CRP score of >3.2 were discontinued from the study. Subjects who experienced a worsening of rheumatoid arthritis (RA) symptoms or a RA flare after at least 3 months in the Withdrawal Period were eligible to enroll into a 6-month Re-exposure Period, during which they received open-label treatment with abatacept SC (125 mg/week) and MTX.
    Arm type
    Experimental

    Investigational medicinal product name
    Methotrexate placebo
    Investigational medicinal product code
    Other name
    Rheumatrex
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Methotrexate matching placebo 2.5 mg tablet was administered orally once weekly during the 12-month Treatment Period.

    Investigational medicinal product name
    Abatacept
    Investigational medicinal product code
    BMS 188667
    Other name
    Orencia
    Pharmaceutical forms
    Injection
    Routes of administration
    Subcutaneous use
    Dosage and administration details
    Abatacept 125 mg was administered as subcutaneous injection once weekly during the 12-month Treatment Period.

    Arm title
    Methotrexate, 2.5 mg, Plus Abatacept Placebo
    Arm description
    Subjects received methotrexate, 2.5 mg orally as tablets, with a target dose range of 10-20 mg weekly, plus abatacept placebo subcutaneously, once weekly during the 12-month Treatment Period. Subjects with a Low Disease Activity Score (LDAS) defined as DAS28-CRP score of < 3.2 at Month 12 (end of Treatment Period) entered the Withdrawal Period for up to 12 months, during which all study medication was withdrawn. Subjects with a DAS28-CRP score of >3.2 were discontinued from the study. All MTX and corticosteroids, if not already discontinued, were to be tapered off during the first month of the Withdrawal Period. Subjects who experienced a worsening of rheumatoid arthritis (RA) symptoms or a RA flare after at least 3 months in the Withdrawal Period were eligible to enroll into a 6-month Re-exposure Period, during which they received open-label treatment with abatacept SC (125 mg/week) and MTX.
    Arm type
    Active comparator

    Investigational medicinal product name
    Methotrexate
    Investigational medicinal product code
    Other name
    Rheumatrex
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    2.5 mg orally as tablets, with a target dose range of 10-20 mg weekly during the 12-month Treatment Period.

    Investigational medicinal product name
    Abatacept Placebo
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Injection
    Routes of administration
    Subcutaneous use
    Dosage and administration details
    Abatacept matching placebo 125-mg was administered as subcutaneous injection once weekly during the 12-month Treatment Period.

    Number of subjects in period 2 [2]
    Abatacept, 125 mg, Plus Methotrexate, 2.5 mg Abatacept, 125 mg, Plus Methotrexate Placebo Methotrexate, 2.5 mg, Plus Abatacept Placebo
    Started
    84
    66
    75
    Completed
    14
    10
    17
    Not completed
    70
    56
    58
         No longer met study criteria
    1
    -
    -
         Consent withdrawn by subject
    1
    1
    2
         Non-specified
    -
    1
    1
         Adverse event, non-fatal
    -
    -
    1
         Pregnancy
    1
    -
    1
         Lost to follow-up
    2
    -
    -
         Lack of efficacy
    65
    54
    53
    Notes
    [2] - The number of subjects starting the period is not consistent with the number completing the preceding period. It is expected the number of subjects starting the subsequent period will be the same as the number completing the preceding period.
    Justification: Out of all subjects who completed treatment period 67 subjects did not enter the withdrawal period. 2 subjects in the MTX monotherapy arm entered the Withdrawal Period after the data cutoff date for the first analysis.
    Period 3
    Period 3 title
    Re-Exposure Phase: Months 24 up to 30
    Is this the baseline period?
    No
    Allocation method
    Not applicable
    Blinding used
    Not blinded

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Abatacept, 125 mg, Plus Methotrexate, 2.5 mg
    Arm description
    Subjects received abatacept, 125 mg subcutaneously, plus methotrexate (MTX), 2.5 mg orally as tablets, with a target dose range of 10-20 mg weekly, during the 12-month Treatment Period. Subjects with a Low Disease Activity Score (LDAS) defined as DAS28-CRP score of <3.2 at Month 12 (end of Treatment Period) entered the Withdrawal Period for up to 12 months, during which all study medication was withdrawn. Subjects with a DAS28-CRP score of >3.2 were discontinued from the study. All MTX and corticosteroids, if not already discontinued, were to be tapered off during the first month of the Withdrawal Period. Subjects who experienced a worsening of rheumatoid arthritis (RA) symptoms or a RA flare after at least 3 months in the Withdrawal Period were eligible to enroll into a 6-month Re-exposure Period, during which they received open-label treatment with abatacept subcutaneous (SC) 125 mg/week and MTX.
    Arm type
    Experimental

    Investigational medicinal product name
    Methotrexate
    Investigational medicinal product code
    Other name
    Rheumatrex
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    2.5 mg orally as tablets, with a target dose range of 10-20 mg weekly during the 12-month Treatment Period.

    Investigational medicinal product name
    Abatacept
    Investigational medicinal product code
    BMS 188667
    Other name
    Orencia
    Pharmaceutical forms
    Injection
    Routes of administration
    Subcutaneous use
    Dosage and administration details
    Abatacept 125 mg was administered as subcutaneous injection once weekly during the 12-month Treatment Period.

    Arm title
    Abatacept, 125 mg, Plus Methotrexate Placebo
    Arm description
    Subjects received abatacept, 125 mg subcutaneously, plus methotrexate placebo tablets orally, once weekly during the 12-month Treatment Period. Subjects with a Low Disease Activity Score (LDAS) defined as DAS28-CRP score of <3.2 at Month 12 (end of Treatment Period) entered the Withdrawal Period for up to 12 months, during which all study medication was withdrawn. Subjects with a DAS28-CRP score of >3.2 were discontinued from the study. Subjects who experienced a worsening of rheumatoid arthritis (RA) symptoms or a RA flare after at least 3 months in the Withdrawal Period were eligible to enroll into a 6-month Re-exposure Period, during which they received open-label treatment with abatacept SC (125 mg/week) and MTX.
    Arm type
    Experimental

    Investigational medicinal product name
    Methotrexate placebo
    Investigational medicinal product code
    Other name
    Rheumatrex
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Methotrexate matching placebo 2.5 mg tablet was administered orally once weekly during the 12-month Treatment Period.

    Investigational medicinal product name
    Abatacept
    Investigational medicinal product code
    BMS 188667
    Other name
    Orencia
    Pharmaceutical forms
    Injection
    Routes of administration
    Subcutaneous use
    Dosage and administration details
    Abatacept 125 mg was administered as subcutaneous injection once weekly during the 12-month Treatment Period.

    Arm title
    Methotrexate, 2.5 mg, Plus Abatacept Placebo
    Arm description
    Subjects received methotrexate, 2.5 mg orally as tablets, with a target dose range of 10-20 mg weekly, plus abatacept placebo subcutaneously, once weekly during the 12-month Treatment Period. Subjects with a Low Disease Activity Score (LDAS) defined as DAS28-CRP score of < 3.2 at Month 12 (end of Treatment Period) entered the Withdrawal Period for up to 12 months, during which all study medication was withdrawn. Subjects with a DAS28-CRP score of >3.2 were discontinued from the study. All MTX and corticosteroids, if not already discontinued, were to be tapered off during the first month of the Withdrawal Period. Subjects who experienced a worsening of rheumatoid arthritis (RA) symptoms or a RA flare after at least 3 months in the Withdrawal Period were eligible to enroll into a 6-month Re-exposure Period, during which they received open-label treatment with abatacept SC (125 mg/week) and MTX.
    Arm type
    Active comparator

    Investigational medicinal product name
    Methotrexate
    Investigational medicinal product code
    Other name
    Rheumatrex
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    2.5 mg orally as tablets, with a target dose range of 10-20 mg weekly during the 12-month Treatment Period.

    Investigational medicinal product name
    Abatacept Placebo
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Injection
    Routes of administration
    Subcutaneous use
    Dosage and administration details
    Abatacept matching placebo 125-mg was administered as subcutaneous injection once weekly during the 12-month Treatment Period.

    Number of subjects in period 3
    Abatacept, 125 mg, Plus Methotrexate, 2.5 mg Abatacept, 125 mg, Plus Methotrexate Placebo Methotrexate, 2.5 mg, Plus Abatacept Placebo
    Started
    14
    10
    17
    Completed
    54
    46
    40
    Not completed
    1
    2
    3
         Consent withdrawn by subject
    1
    1
    1
         Adverse event, non-fatal
    -
    -
    1
         Pregnancy
    -
    -
    1
         Lack of efficacy
    -
    1
    -
    Joined
    41
    38
    26
         Re-joined in Period 3
    41
    38
    26

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Abatacept, 125 mg, Plus Methotrexate, 2.5 mg
    Reporting group description
    Subjects received abatacept, 125 mg subcutaneously, plus methotrexate (MTX), 2.5 mg orally as tablets, with a target dose range of 10-20 mg weekly, during the 12-month Treatment Period. Subjects with a Low Disease Activity Score (LDAS) defined as DAS28-CRP score of <3.2 at Month 12 (end of Treatment Period) entered the Withdrawal Period for up to 12 months, during which all study medication was withdrawn. Subjects with a DAS28-CRP score of >3.2 were discontinued from the study. All MTX and corticosteroids, if not already discontinued, were to be tapered off during the first month of the Withdrawal Period. Subjects who experienced a worsening of rheumatoid arthritis (RA) symptoms or a RA flare after at least 3 months in the Withdrawal Period were eligible to enroll into a 6-month Re-exposure Period, during which they received open-label treatment with abatacept subcutaneous (SC) 125 mg/week and MTX.

    Reporting group title
    Abatacept, 125 mg, Plus Methotrexate Placebo
    Reporting group description
    Subjects received abatacept, 125 mg subcutaneously, plus methotrexate placebo tablets orally, once weekly during the 12-month Treatment Period. Subjects with a Low Disease Activity Score (LDAS) defined as DAS28-CRP score of <3.2 at Month 12 (end of Treatment Period) entered the Withdrawal Period for up to 12 months, during which all study medication was withdrawn. Subjects with a DAS28-CRP score of >3.2 were discontinued from the study. Subjects who experienced a worsening of rheumatoid arthritis (RA) symptoms or a RA flare after at least 3 months in the Withdrawal Period were eligible to enroll into a 6-month Re-exposure Period, during which they received open-label treatment with abatacept SC (125 mg/week) and MTX.

    Reporting group title
    Methotrexate, 2.5 mg, Plus Abatacept Placebo
    Reporting group description
    Subjects received methotrexate, 2.5 mg orally as tablets, with a target dose range of 10-20 mg weekly, plus abatacept placebo subcutaneously, once weekly during the 12-month Treatment Period. Subjects with a Low Disease Activity Score (LDAS) defined as DAS28-CRP score of < 3.2 at Month 12 (end of Treatment Period) entered the Withdrawal Period for up to 12 months, during which all study medication was withdrawn. Subjects with a DAS28-CRP score of >3.2 were discontinued from the study. All MTX and corticosteroids, if not already discontinued, were to be tapered off during the first month of the Withdrawal Period. Subjects who experienced a worsening of rheumatoid arthritis (RA) symptoms or a RA flare after at least 3 months in the Withdrawal Period were eligible to enroll into a 6-month Re-exposure Period, during which they received open-label treatment with abatacept SC (125 mg/week) and MTX.

    Reporting group values
    Abatacept, 125 mg, Plus Methotrexate, 2.5 mg Abatacept, 125 mg, Plus Methotrexate Placebo Methotrexate, 2.5 mg, Plus Abatacept Placebo Total
    Number of subjects
    119 116 116 351
    Age categorical
    Units: Subjects
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    46.4 ( 13.2 ) 45.4 ( 11.92 ) 49.1 ( 12.36 ) -
    Gender categorical
    Units: Subjects
        Female
    95 89 89 273
        Male
    24 27 27 78
    Race/Ethnicity
    Units: Subjects
        White
    100 95 102 297
        Asian
    14 13 9 36
        Black/African American
    2 4 2 8
        American Indian/Alaska native
    1 1 1 3
        Other
    2 3 2 7
    Rheumatoid factor status
    Units: Subjects
        Positive
    113 111 110 334
        Negative
    6 5 6 17
    Duration of rheumatoid arthritis
    Units: Years
        arithmetic mean (standard deviation)
    0.58 ( 0.5 ) 0.59 ( 0.522 ) 0.5 ( 0.488 ) -
    Disease Activity Score 28 based on C-reactive protein (DAS28-CRP)
    Units: Units on a scale
        arithmetic mean (standard deviation)
    5.528 ( 1.2501 ) 5.463 ( 1.1493 ) 5.315 ( 1.333 ) -
    Health Assessment Questionnaire Disability Index (HAQ-DI) score
    Units: Units on a scale
        arithmetic mean (standard deviation)
    1.452 ( 0.6778 ) 1.419 ( 0.6587 ) 1.383 ( 0.6493 ) -
    Tender joint count
    Units: Joints
        arithmetic mean (standard deviation)
    24.3 ( 15.74 ) 23.9 ( 14.47 ) 21.7 ( 14 ) -
    Swollen joint count
    Units: Joints
        arithmetic mean (standard deviation)
    16.5 ( 12.43 ) 17.2 ( 12.88 ) 15.7 ( 11.78 ) -

    End points

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    End points reporting groups
    Reporting group title
    Abatacept, 125 mg, Plus Methotrexate, 2.5 mg
    Reporting group description
    Subjects received abatacept, 125 mg subcutaneously, plus methotrexate (MTX), 2.5 mg orally as tablets, with a target dose range of 10-20 mg weekly, during the 12-month Treatment Period. Subjects with a Low Disease Activity Score (LDAS) defined as DAS28-CRP score of <3.2 at Month 12 (end of Treatment Period) entered the Withdrawal Period for up to 12 months, during which all study medication was withdrawn. Subjects with a DAS28-CRP score of >3.2 were discontinued from the study. All MTX and corticosteroids, if not already discontinued, were to be tapered off during the first month of the Withdrawal Period. Subjects who experienced a worsening of rheumatoid arthritis (RA) symptoms or a RA flare after at least 3 months in the Withdrawal Period were eligible to enroll into a 6-month Re-exposure Period, during which they received open-label treatment with abatacept subcutaneous (SC) 125 mg/week and MTX.

    Reporting group title
    Abatacept, 125 mg, Plus Methotrexate Placebo
    Reporting group description
    Subjects received abatacept, 125 mg subcutaneously, plus methotrexate placebo tablets orally, once weekly during the 12-month Treatment Period. Subjects with a Low Disease Activity Score (LDAS) defined as DAS28-CRP score of <3.2 at Month 12 (end of Treatment Period) entered the Withdrawal Period for up to 12 months, during which all study medication was withdrawn. Subjects with a DAS28-CRP score of >3.2 were discontinued from the study. Subjects who experienced a worsening of rheumatoid arthritis (RA) symptoms or a RA flare after at least 3 months in the Withdrawal Period were eligible to enroll into a 6-month Re-exposure Period, during which they received open-label treatment with abatacept SC (125 mg/week) and MTX.

    Reporting group title
    Methotrexate, 2.5 mg, Plus Abatacept Placebo
    Reporting group description
    Subjects received methotrexate, 2.5 mg orally as tablets, with a target dose range of 10-20 mg weekly, plus abatacept placebo subcutaneously, once weekly during the 12-month Treatment Period. Subjects with a Low Disease Activity Score (LDAS) defined as DAS28-CRP score of < 3.2 at Month 12 (end of Treatment Period) entered the Withdrawal Period for up to 12 months, during which all study medication was withdrawn. Subjects with a DAS28-CRP score of >3.2 were discontinued from the study. All MTX and corticosteroids, if not already discontinued, were to be tapered off during the first month of the Withdrawal Period. Subjects who experienced a worsening of rheumatoid arthritis (RA) symptoms or a RA flare after at least 3 months in the Withdrawal Period were eligible to enroll into a 6-month Re-exposure Period, during which they received open-label treatment with abatacept SC (125 mg/week) and MTX.
    Reporting group title
    Abatacept, 125 mg, Plus Methotrexate, 2.5 mg
    Reporting group description
    Subjects received abatacept, 125 mg subcutaneously, plus methotrexate (MTX), 2.5 mg orally as tablets, with a target dose range of 10-20 mg weekly, during the 12-month Treatment Period. Subjects with a Low Disease Activity Score (LDAS) defined as DAS28-CRP score of <3.2 at Month 12 (end of Treatment Period) entered the Withdrawal Period for up to 12 months, during which all study medication was withdrawn. Subjects with a DAS28-CRP score of >3.2 were discontinued from the study. All MTX and corticosteroids, if not already discontinued, were to be tapered off during the first month of the Withdrawal Period. Subjects who experienced a worsening of rheumatoid arthritis (RA) symptoms or a RA flare after at least 3 months in the Withdrawal Period were eligible to enroll into a 6-month Re-exposure Period, during which they received open-label treatment with abatacept subcutaneous (SC) 125 mg/week and MTX.

    Reporting group title
    Abatacept, 125 mg, Plus Methotrexate Placebo
    Reporting group description
    Subjects received abatacept, 125 mg subcutaneously, plus methotrexate placebo tablets orally, once weekly during the 12-month Treatment Period. Subjects with a Low Disease Activity Score (LDAS) defined as DAS28-CRP score of <3.2 at Month 12 (end of Treatment Period) entered the Withdrawal Period for up to 12 months, during which all study medication was withdrawn. Subjects with a DAS28-CRP score of >3.2 were discontinued from the study. Subjects who experienced a worsening of rheumatoid arthritis (RA) symptoms or a RA flare after at least 3 months in the Withdrawal Period were eligible to enroll into a 6-month Re-exposure Period, during which they received open-label treatment with abatacept SC (125 mg/week) and MTX.

    Reporting group title
    Methotrexate, 2.5 mg, Plus Abatacept Placebo
    Reporting group description
    Subjects received methotrexate, 2.5 mg orally as tablets, with a target dose range of 10-20 mg weekly, plus abatacept placebo subcutaneously, once weekly during the 12-month Treatment Period. Subjects with a Low Disease Activity Score (LDAS) defined as DAS28-CRP score of < 3.2 at Month 12 (end of Treatment Period) entered the Withdrawal Period for up to 12 months, during which all study medication was withdrawn. Subjects with a DAS28-CRP score of >3.2 were discontinued from the study. All MTX and corticosteroids, if not already discontinued, were to be tapered off during the first month of the Withdrawal Period. Subjects who experienced a worsening of rheumatoid arthritis (RA) symptoms or a RA flare after at least 3 months in the Withdrawal Period were eligible to enroll into a 6-month Re-exposure Period, during which they received open-label treatment with abatacept SC (125 mg/week) and MTX.
    Reporting group title
    Abatacept, 125 mg, Plus Methotrexate, 2.5 mg
    Reporting group description
    Subjects received abatacept, 125 mg subcutaneously, plus methotrexate (MTX), 2.5 mg orally as tablets, with a target dose range of 10-20 mg weekly, during the 12-month Treatment Period. Subjects with a Low Disease Activity Score (LDAS) defined as DAS28-CRP score of <3.2 at Month 12 (end of Treatment Period) entered the Withdrawal Period for up to 12 months, during which all study medication was withdrawn. Subjects with a DAS28-CRP score of >3.2 were discontinued from the study. All MTX and corticosteroids, if not already discontinued, were to be tapered off during the first month of the Withdrawal Period. Subjects who experienced a worsening of rheumatoid arthritis (RA) symptoms or a RA flare after at least 3 months in the Withdrawal Period were eligible to enroll into a 6-month Re-exposure Period, during which they received open-label treatment with abatacept subcutaneous (SC) 125 mg/week and MTX.

    Reporting group title
    Abatacept, 125 mg, Plus Methotrexate Placebo
    Reporting group description
    Subjects received abatacept, 125 mg subcutaneously, plus methotrexate placebo tablets orally, once weekly during the 12-month Treatment Period. Subjects with a Low Disease Activity Score (LDAS) defined as DAS28-CRP score of <3.2 at Month 12 (end of Treatment Period) entered the Withdrawal Period for up to 12 months, during which all study medication was withdrawn. Subjects with a DAS28-CRP score of >3.2 were discontinued from the study. Subjects who experienced a worsening of rheumatoid arthritis (RA) symptoms or a RA flare after at least 3 months in the Withdrawal Period were eligible to enroll into a 6-month Re-exposure Period, during which they received open-label treatment with abatacept SC (125 mg/week) and MTX.

    Reporting group title
    Methotrexate, 2.5 mg, Plus Abatacept Placebo
    Reporting group description
    Subjects received methotrexate, 2.5 mg orally as tablets, with a target dose range of 10-20 mg weekly, plus abatacept placebo subcutaneously, once weekly during the 12-month Treatment Period. Subjects with a Low Disease Activity Score (LDAS) defined as DAS28-CRP score of < 3.2 at Month 12 (end of Treatment Period) entered the Withdrawal Period for up to 12 months, during which all study medication was withdrawn. Subjects with a DAS28-CRP score of >3.2 were discontinued from the study. All MTX and corticosteroids, if not already discontinued, were to be tapered off during the first month of the Withdrawal Period. Subjects who experienced a worsening of rheumatoid arthritis (RA) symptoms or a RA flare after at least 3 months in the Withdrawal Period were eligible to enroll into a 6-month Re-exposure Period, during which they received open-label treatment with abatacept SC (125 mg/week) and MTX.

    Primary: Percentage of Subjects Who Achieved Remission by Disease Activity Score 28 Based on C-reactive Protein (DAS28-CRP) Criteria at Month 12 and at Both Months 12 and 18

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    End point title
    Percentage of Subjects Who Achieved Remission by Disease Activity Score 28 Based on C-reactive Protein (DAS28-CRP) Criteria at Month 12 and at Both Months 12 and 18 [1]
    End point description
    DAS28-CRP remission defined as <2.6; TP=treatment phase; WP=withdrawal phase. The DAS 28-CRP is a measure of disease activity in rheumatoid arthritis (RA) that assesses the 28 joints RA commonly affects; the score includes the number of tender and swollen joints (out of 28), CRP level (a measure of inflammation in the blood), and the subject’s global assessment of health (ranging from very good to very bad). These measures are then fed into a complex mathematical formula to produce the overall DAS (a score greater than 5.1 implies active disease; less than 3.2, well controlled disease; and less than 2.6, remission). Analysis was performed in all the randomized subjects who received at least 1 dose of double-blind study medication in the Treatment Period. Percentage calculated as a/b, where a=number of subjects who achieved remission at Month 12 and at both Months 12 and 18, and b=number of subjects in the analysis. n=number of evaluable subjects.
    End point type
    Primary
    End point timeframe
    Randomization to Months 12 and 18
    Notes
    [1] - The end point is not reporting statistics for all the arms in the baseline period. It is expected all the baseline period arms will be reported on when providing values for an end point on the baseline period.
    Justification: The endpoint was planned to be assessed for these reporting arms only.
    End point values
    Abatacept, 125 mg, Plus Methotrexate, 2.5 mg Methotrexate, 2.5 mg, Plus Abatacept Placebo
    Number of subjects analysed
    119
    116
    Units: Percentage of subjects
    number (confidence interval 95%)
        Month 12 (TP Day 365) (n=115, 115)
    60.9 (51.95 to 69.79)
    45.2 (36.12 to 54.31)
        Both Months 12 & 18 (WP Day 169) (n=115, 115)
    14.8 (8.3 to 21.27)
    7.8 (2.92 to 12.73)
    Statistical analysis title
    DAS28-CRP Remission at Month 12
    Statistical analysis description
    Power estimate assumed 2-sided alpha level of 5% and that 60% of ABA + MTX subjects would be in DAS28-CRP remission at Month 12 compared with 38% of MTX monotherapy subjects. Also assumed that 48% of abatacept monotherapy subjects would be in DAS28-CRP remission at Month 12, yielding an expected treatment difference from MX of 10% in favor of ABA monotherapy; 116 subjects randomized to ABA monotherapy would yield a half-length of the 95% CI around that 10% treatment difference of 13.5%.
    Comparison groups
    Abatacept, 125 mg, Plus Methotrexate, 2.5 mg v Methotrexate, 2.5 mg, Plus Abatacept Placebo
    Number of subjects included in analysis
    235
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.01
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    2.01
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    1.18
         upper limit
    3.43
    Variability estimate
    Standard error of the mean
    Dispersion value
    0.55
    Statistical analysis title
    DAS28-CRP Remission at Both Month 12 and 18
    Statistical analysis description
    Conditional on statistical significance of the 1st co-primary efficacy analysis (CEA), a sample of 116 subjects per arm would provide 98% power for the 2nd CEA comparison of the percentage of subjects in DAS28-CRP remission at Months 12 and 18 between the abatacept (ABA)+methotrexate (MTX) arm and the MTX monotherapy arm for intent-to treat population. This sample size calculation assumed 30% remission in the ABA+MTX arm and 8% in the monotherapy arm at Month 18 and a 2-sided alpha level of 5%.
    Comparison groups
    Abatacept, 125 mg, Plus Methotrexate, 2.5 mg v Methotrexate, 2.5 mg, Plus Abatacept Placebo
    Number of subjects included in analysis
    235
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.045
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    2.51
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    1.02
         upper limit
    6.18
    Variability estimate
    Standard error of the mean
    Dispersion value
    1.15

    Secondary: Percentage of Subjects Who Received Monotherapy and Achieved Remission by Disease Activity Score 28 Based on C-reactive Protein (DAS28-CRP) Criteria at Month 12 and at Both Months 12 and 18

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    End point title
    Percentage of Subjects Who Received Monotherapy and Achieved Remission by Disease Activity Score 28 Based on C-reactive Protein (DAS28-CRP) Criteria at Month 12 and at Both Months 12 and 18 [2]
    End point description
    TP=treatment period; WP=withdrawal period. Remission defined as DAS28-CRP<2.6. The DAS 28-CRP is a measure of disease activity in rheumatoid arthritis (RA) that assesses the 28 joints RA commonly affects; the score includes the number of tender and swollen joints (out of 28), CRP level (a measure of inflammation in the blood), and the subject’s global assessment of health (ranging from very good to very bad). DAS-CRP scores range from 0 to 10, with higher values indicating greater disease activity. Individual measures are fed into a complex mathematical formula to produce the overall DAS (a score >5.1 implies active disease; <3.2, well controlled disease; and <2.6, remission). All randomized subjects who received at least 1 dose of double-blind monotherapy in the Treatment Period. Percentage calculated as a/b, where a=number of subjects who achieved remission at Month 12 and at both Months 12 and 18, and b=number of subjects in the analysis. n=number of evaluable subjects.
    End point type
    Secondary
    End point timeframe
    Randomization to Months 12 and 18
    Notes
    [2] - The end point is not reporting statistics for all the arms in the baseline period. It is expected all the baseline period arms will be reported on when providing values for an end point on the baseline period.
    Justification: The endpoint was planned to be assessed for these reporting arms only.
    End point values
    Abatacept, 125 mg, Plus Methotrexate Placebo Methotrexate, 2.5 mg, Plus Abatacept Placebo
    Number of subjects analysed
    116
    116
    Units: Percentage of subjects
    number (confidence interval 95%)
        At Month 12 (TP Day 365) (n=113, 115)
    42.5 (33.36 to 51.59)
    45.2 (36.12 to 54.31)
        At both Months 12 & 18 (WP Day 169) (n=113, 115)
    12.4 (6.31 to 18.46)
    7.8 (2.92 to 12.73)
    Statistical analysis title
    DAS28-CRP Remission- Month 12 (Monotherapy)
    Statistical analysis description
    Odds ratio was based on an Adjusted Logistic Regression test, including treatment, baseline DAS28-CRP value as well as the stratification factor (corticosteroid use at baseline (yes/no))
    Comparison groups
    Methotrexate, 2.5 mg, Plus Abatacept Placebo v Abatacept, 125 mg, Plus Methotrexate Placebo
    Number of subjects included in analysis
    232
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    0.92
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.55
         upper limit
    1.57
    Variability estimate
    Standard error of the mean
    Dispersion value
    0.25
    Statistical analysis title
    DAS28-CRP Remission- Month 12 and 18 (Monotherapy)
    Statistical analysis description
    Odds ratio was based on an Adjusted Logistic Regression test, including treatment, baseline DAS28-CRP value as well as the stratification factor (corticosteroid use at baseline (yes/no))
    Comparison groups
    Abatacept, 125 mg, Plus Methotrexate Placebo v Methotrexate, 2.5 mg, Plus Abatacept Placebo
    Number of subjects included in analysis
    232
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    2.04
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.81
         upper limit
    5.14
    Variability estimate
    Standard error of the mean
    Dispersion value
    0.96

    Secondary: Percentage of Subjects With Remission by Disease Activity Score 28 Based on C-reactive Protein (DAS28-CRP) Criteria Over Time - Intent to Treat Population

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    End point title
    Percentage of Subjects With Remission by Disease Activity Score 28 Based on C-reactive Protein (DAS28-CRP) Criteria Over Time - Intent to Treat Population
    End point description
    TP=treatment period; WP=withdrawal period. Remission defined as DAS28-CRP<2.6. The DAS 28-CRP is a measure of disease activity in rheumatoid arthritis (RA) and assesses the 28 joints RA commonly affects; the score includes the number of tender and swollen joints (out of 28), CRP level (a measure of inflammation in the blood), and the subject’s global assessment of health (ranging from very good to very bad). DAS-CRP scores range from 0 to 10, with higher values indicating greater disease activity. Individual measures are fed into a complex mathematical formula to produce the overall DAS (a score greater than 5.1 implies active disease; less than 3.2, well controlled disease; and less than 2.6, remission). Analysis was performed in all the randomized subjects who received at least 1 dose of double-blind study medication in Treatment Period. Percentage calculated as a/b, where a=number of subjects who achieved remission, and b=number of subjects in analysis (intent to treat).
    End point type
    Secondary
    End point timeframe
    Randomization to Month 24
    End point values
    Abatacept, 125 mg, Plus Methotrexate, 2.5 mg Abatacept, 125 mg, Plus Methotrexate Placebo Methotrexate, 2.5 mg, Plus Abatacept Placebo
    Number of subjects analysed
    119
    116
    116
    Units: Percentage of subjects
    number (confidence interval 95%)
        TP Day 29
    13.4 (7.32 to 19.57)
    8.6 (3.51 to 13.73)
    6 (1.7 to 10.37)
        TP Day 57
    24.4 (16.66 to 32.08)
    11.2 (5.47 to 16.95)
    9.5 (4.15 to 14.81)
        TP Day 85
    36.1 (27.5 to 44.77)
    21.6 (14.07 to 29.03)
    17.2 (10.37 to 24.12)
        TP Day 113
    37.8 (29.1 to 46.53)
    29.3 (21.03 to 37.59)
    19 (11.83 to 26.1)
        TP Day 141
    45.4 (36.43 to 54.32)
    29.3 (21.03 to 37.59)
    25 (17.12 to 32.88)
        TP Day 169
    45.4 (36.43 to 54.32)
    32.8 (24.22 to 41.3)
    26.7 (18.67 to 34.78)
        TP Day 197
    52.1 (43.13 to 61.08)
    36.2 (27.46 to 44.95)
    25.9 (17.89 to 33.83)
        TP Day 225
    57.1 (48.25 to 66.03)
    40.5 (31.58 to 49.95)
    30.2 (21.82 to 38.53)
        TP Day 253
    62.2 (53.47 to 70.9)
    37.9 (29.1 to 46.76)
    30.2 (21.82 to 38.53)
        TP Day 281
    51.3 (42.28 to 60.24)
    42.2 (33.25 to 51.23)
    32.8 (24.22 to 41.3)
        TP Day 309
    56.3 (47.39 to 65.21)
    37.9 (29.1 to 46.76)
    36.2 (27.46 to 44.95)
        TP Day 337
    63 (54.35 to 71.7)
    43.1 (34.09 to 52.12)
    33.6 (25.02 to 42.22)
        TP Day 365
    61.3 (52.6 to 70.09)
    43.1 (34.09 to 52.12)
    45.7 (36.62 to 54.75)
        WP Day 29
    51.3 (42.28 to 60.24)
    36.2 (27.46 to 44.95)
    27.6 (19.45 to 35.72)
        WP Day 57
    40.3 (31.52 to 49.15)
    25 (17.12 to 32.88)
    18.1 (11.1 to 25.11)
        WP Day 85
    31.1 (22.78 to 39.41)
    18.1 (11.1 to 25.11)
    18.1 (11.1 to 25.11)
        WP Day 169
    19.3 (12.23 to 26.42)
    12.9 (6.82 to 19.04)
    9.5 (4.15 to 14.81)
        WP Day 253
    17.6 (10.8 to 24.5)
    9.5 (4.15 to 14.81)
    13.8 (7.52 to 20.07)
        WP Day 365
    9.2 (4.04 to 14.45)
    6 (1.7 to 10.37)
    6 (1.7 to 10.37)
    No statistical analyses for this end point

    Secondary: Adjusted Mean Change From Baseline in Disease Activity Score 28 Based on C-reactive Protein (DAS28-CRP) at Months 6, 12, and 18

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    End point title
    Adjusted Mean Change From Baseline in Disease Activity Score 28 Based on C-reactive Protein (DAS28-CRP) at Months 6, 12, and 18
    End point description
    TP=treatment period; WP=withdrawal period. The DAS 28-CRP is a measure of disease activity in rheumatoid arthritis (RA) that assesses the 28 joints RA commonly affects; the score includes the number of tender and swollen joints (out of 28), CRP level (a measure of inflammation in the blood), and the subject’s global assessment of health (ranging from very good to very bad). DAS-CRP scores range from 0 to 10, with higher values indicating greater disease activity. Individual measures are fed into a complex mathematical formula to produce the overall DAS (a score greater than 5.1 implies active disease; less than 3.2, well controlled disease; and less than 2.6, remission). Analysis was performed in all the randomized subjects who received at least 1 dose of double-blind study medication in the Treatment Period. n=number of evaluable subjects.
    End point type
    Secondary
    End point timeframe
    Baseline to Month 18
    End point values
    Abatacept, 125 mg, Plus Methotrexate, 2.5 mg Abatacept, 125 mg, Plus Methotrexate Placebo Methotrexate, 2.5 mg, Plus Abatacept Placebo
    Number of subjects analysed
    119
    116
    116
    Units: Units on scale
    arithmetic mean (standard error)
        Month 6 (TP Day 169) (n=102, 96, 101)
    -2.72 ( 0.12 )
    -2.33 ( 0.12 )
    -1.93 ( 0.12 )
        Month 12 (TP Day 365) (n=95, 84, 91)
    -3.09 ( 0.13 )
    -2.75 ( 0.13 )
    -2.58 ( 0.13 )
        Month 18 (WP Day 169) (n=41, 31, 32)
    -1.54 ( 0.26 )
    -1.51 ( 0.29 )
    -1.06 ( 0.29 )
    No statistical analyses for this end point

    Secondary: Percentage of Subjects Who Achieved Remission by Criteria of the Simplified Disease Activity Index (SDAI) at Months 12 and 18

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    End point title
    Percentage of Subjects Who Achieved Remission by Criteria of the Simplified Disease Activity Index (SDAI) at Months 12 and 18
    End point description
    TP=treatment period; WP=withdrawal period. SDAI-defined remission= ≤3.3. The SDAI was the simple linear sum of 5 outcome parameters: tender joint count (TJC) and swollen joint count (SJC) (based on a 28-joint assessment); subject’s and physician's global assessments of disease activity (assessed on 0-10 cm visual analog scale, on which higher scores=greater affection due to disease activity); and C-reactive protein level (mg/dL). SDAI total score=0-86. SDAI <=3.3 indicates disease remission, >3.4 to 11=low, >11 to 26=moderate, and >26=high disease activity. TJC was assessed at each visit as no swelling=0, swelling=1. TJC was assessed at each visit as no tenderness =0, tenderness = 1. Higher score indicates greater affection due to disease activity. Analysis was performed in all randomized subjects who received at least 1 dose of double-blind study medication in TP. Percentage calculated as a/b, where a=number of subjects who achieved remission, and b=number of subjects in analysis.
    End point type
    Secondary
    End point timeframe
    Randomization to Month 18
    End point values
    Abatacept, 125 mg, Plus Methotrexate, 2.5 mg Abatacept, 125 mg, Plus Methotrexate Placebo Methotrexate, 2.5 mg, Plus Abatacept Placebo
    Number of subjects analysed
    119
    116
    116
    Units: Percentage of subjects
    number (confidence interval 95%)
        Month 12 (TP Day 365)
    40.2 (33.15 to 50.89)
    29.3 (21.03 to 37.59)
    25 (17.12 to 32.88)
        Month 18 (WP Day 169)
    10.9 (5.32 to 16.53)
    8.6 (3.51 to 13.73)
    6.9 (2.29 to 11.51)
    No statistical analyses for this end point

    Secondary: Adjusted Mean Change From Baseline in Scores on Simplified Disease Activity Index (SDAI) Over Time

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    End point title
    Adjusted Mean Change From Baseline in Scores on Simplified Disease Activity Index (SDAI) Over Time
    End point description
    TP=treatment period; WP=withdrawal period. SDAI-defined remission= ≤3.3. The SDAI is the simple linear sum of 5 outcome parameters: swollen joint count (SJC) and tender joint count (TJC) (based on a 28-joint assessment); subject’s and physician's global assessments of disease activity (assessed on 0-10 cm visual analog scale, on which higher scores=greater affection due to disease activity); and C-reactive protein level (mg/dL). SDAI total score=0-86. SDAI score <=3.3 indicates disease remission, >3.4 to 11=low, >11 to 26=moderate, and >26=high disease activity. SJC is assessed with no swelling=0, swelling=1 (higher score indicates greater swelling). TJC is assessed through identification of painful joints under pressure or to passive motion, with no tenderness=0, tenderness=1 (higher score indicates greater affection due to disease activity). The analysis was performed in Intent to Treat (ITT) population. n= number of subjects with both post baseline and baseline measurements.
    End point type
    Secondary
    End point timeframe
    Randomization to Month 18
    End point values
    Abatacept, 125 mg, Plus Methotrexate, 2.5 mg Abatacept, 125 mg, Plus Methotrexate Placebo Methotrexate, 2.5 mg, Plus Abatacept Placebo
    Number of subjects analysed
    119
    116
    116
    Units: units on a scale
    arithmetic mean (standard error)
        TP Day 29 (n=109, 101, 107)
    -13.11 ( 1.33 )
    -12.14 ( 1.37 )
    -10.12 ( 1.33 )
        TP Day 57 (n=108, 101, 103)
    -18.9 ( 1.25 )
    -15.83 ( 1.28 )
    -15.99 ( 1.26 )
        TP Day 85 (n=108, 99, 103)
    -24.13 ( 1.16 )
    -20.51 ( 1.2 )
    -19.55 ( 1.17 )
        TP Day 113 (n=103, 98, 101)
    -25.4 ( 1.12 )
    -23.56 ( 1.15 )
    -21.02 ( 1.13 )
        TP Day 141 (n=104, 96, 104)
    -27.15 ( 1.1 )
    -25.99 ( 1.13 )
    -22.14 ( 1.1 )
        TP Day 169 (n=102, 96, 100)
    -28.42 ( 1.08 )
    -26.2 ( 1.11 )
    -22.8 ( 1.09 )
        TP Day 197 (n=103, 97, 96)
    -29.66 ( 1.01 )
    -27.57 ( 1.03 )
    -24.37 ( 1.02 )
        TP Day 225 (n=99, 94, 92)
    -30.13 ( 1.04 )
    -28.39 ( 1.06 )
    -24.73 ( 1.06 )
        TP Day 253 (n=98, 94, 91)
    -31.14 ( 1.04 )
    -28.39 ( 1.06 )
    -25.8 ( 1.05 )
        TP Day 281 (n=96, 93, 89)
    -30.98 ( 1.1 )
    -28.16 ( 1.12 )
    -26.23 ( 1.12 )
        TP Day 309 (n=91, 87, 92)
    -30.82 ( 1.16 )
    -27.79 ( 1.18 )
    -26.36 ( 1.17 )
        TP Day 337 (n=93, 84, 87)
    -31.11 ( 1.15 )
    -29.34 ( 1.19 )
    -27.26 ( 1.17 )
        TP Day 365 (n=95, 84, 91)
    -31.24 ( 1.17 )
    -28.88 ( 1.21 )
    -28.34 ( 1.19 )
        WP Day 29 (n=73, 59, 64)
    -30.42 ( 1.32 )
    -28.05 ( 1.39 )
    -23.52 ( 1.36 )
        WP Day 57 (n=69, 54, 59)
    -27.68 ( 1.59 )
    -24.17 ( 1.74 )
    -17.94 ( 1.68 )
        WP Day 85 (n=67, 47, 52)
    -22 ( 2.18 )
    -21.55 ( 2.57 )
    -17.54 ( 2.44 )
        WP Day 169 (n=41, 31, 32)
    -17.43 ( 2.82 )
    -19.13 ( 3.25 )
    -13.64 ( 3.19 )
    No statistical analyses for this end point

    Secondary: Percentage of Subjects Achieving a Health Assessment Questionnaire (HAQ) Response Over Time

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    End point title
    Percentage of Subjects Achieving a Health Assessment Questionnaire (HAQ) Response Over Time
    End point description
    HAQ response defined as a reduction of at least 0.3 units from baseline in score on the Health Assessment Questionnaire Disability Index (HAQ-DI), which assesses subject’s functional ability by rating their abilities over the previous week. The HAQ-DI includes at least 2 questions from each of 8 categories: dressing and grooming, hygiene, arising, reach, eating, grip, walking, and common daily activities. Subjects rate difficulty performing specific tasks: 0=without difficulty, 1=with some difficulty, 2=with much difficulty, and 3=unable to do. The sum of the categories score (the highest scored item in the category) is divided by the number of categories answered, yielding a score from 0-3. Analysis was performed in all randomized subjects who received at least 1 dose of double-blind study medication in the Treatment Period. Percentage calculated as a/b, where a=number of subjects who achieved remission, and b=number of subjects in the analysis.
    End point type
    Secondary
    End point timeframe
    Randomization to Month 24
    End point values
    Abatacept, 125 mg, Plus Methotrexate, 2.5 mg Abatacept, 125 mg, Plus Methotrexate Placebo Methotrexate, 2.5 mg, Plus Abatacept Placebo
    Number of subjects analysed
    119
    116
    116
    Units: percentage of subjects
    arithmetic mean (confidence interval 95%)
        TP Day 29
    42 (33.15 to 50.89)
    31 (22.62 to 39.45)
    21.6 (14.07 to 29.03)
        TP Day 57
    55.5 (46.53 to 64.39)
    44 (34.93 to 53)
    37.9 (29.1 to 46.76)
        TP Day 85
    63 (54.35 to 71.7)
    45.7 (36.62 to 54.75)
    41.4 (32.42 to 50.34)
        TP Day 113
    63 (54.35 to 71.7)
    49.1 (40.04 to 58.24)
    45.7 (36.62 to 54.75)
        TP Day 141
    62.2 (53.47 to 70.9)
    51.7 (42.63 to 60.82)
    44 (34.93 to 53)
        TP Day 169
    63.9 (55.23 to 72.5)
    56 (47 to 65.07)
    41.4 (32.42 to 50.34)
        TP Day 197
    66.4 (57.9 to 74.87)
    59.5 (50.55 to 68.42)
    41.4 (32.42 to 41.4)
        TP Day 225
    66.4 (57.9 to 74.87)
    57.8 (48.77 to 66.75)
    38.8 (29.93 to 47.66)
        TP Day 253
    68.9 (60.59 to 77.22)
    55.2 (46.12 to 64.22)
    45.7 (36.62 to 54.75)
        TP Day 281
    64.7 (56.12 to 73.29)
    56.9 (47.88 to 65.91)
    46.6 (37.47 to 55.63)
        TP Day 309
    65.5 (57.01 to 74.08)
    56.99 (47.88 to 65.91)
    46.6 (37.47 to 55.63)
        TP Day 337
    64.7 (56.12 to 73.29)
    55.2 (46.12 to 64.22)
    46.6 (37.47 to 55.63)
        TP Day 365
    67.2 (58.79 to 75.66)
    52.6 (43.5 to 61.67)
    44 (34.93 to 53)
        WP Day 29
    52.1 (43.13 to 61.08)
    39.7 (30.75 to 48.56)
    37.1 (28.28 to 45.86)
        WP Day 57
    43.7 (34.79 to 52.61)
    34.5 (25.83 to 43.13)
    26.7 (18.67 to 34.78)
        WP Day 85
    39.5 (30.71 to 48.28)
    28.4 (20.24 to 36.66)
    23.3 (15.59 to 30.97)
        WP Day 169
    22.7 (15.16 to 30.21)
    16.4 (9.64 to 23.11)
    10.3 (4.8 to 15.89)
        WP Day 253
    15.1 (8.69 to 21.56)
    9.5 (4.15 to 14.81)
    6.9 (2.29 to 11.51)
        WP Day 365
    10.1 (4.67 to 15.49)
    6.9 (2.29 to 11.51)
    5.2 (1.14 to 9.2)
    No statistical analyses for this end point

    Secondary: Adjusted Mean Change From Baseline in Health Assessment Questionnaire Disability Index (HAQ-DI) Response Over Time

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    End point title
    Adjusted Mean Change From Baseline in Health Assessment Questionnaire Disability Index (HAQ-DI) Response Over Time
    End point description
    HAQ response defined as a reduction of at least 0.3 units from baseline in score on the Health Assessment Questionnaire Disability Index (HAQ-DI), which assesses subject’s functional ability by rating their abilities over the previous week. The HAQ-DI includes at least 2 questions from each of 8 categories: dressing and grooming, hygiene, arising, reach, eating, grip, walking, and common daily activities. Subjects rate difficulty performing specific tasks: 0=without difficulty, 1=with some difficulty, 2=with much difficulty, and 3=unable to do. The sum of the categories score (the highest scored item in the category) is divided by the number of categories answered, yielding a score from 0-3. Analysis was performed in all randomized subjects who received at least 1 dose of double-blind study medication in the Treatment Period. Percentage calculated as a/b, where a=number of subjects who achieved remission at Day x, and b=number of subjects in the analysis.
    End point type
    Secondary
    End point timeframe
    Randomization to Month 24
    End point values
    Abatacept, 125 mg, Plus Methotrexate, 2.5 mg Abatacept, 125 mg, Plus Methotrexate Placebo Methotrexate, 2.5 mg, Plus Abatacept Placebo
    Number of subjects analysed
    119
    116
    116
    Units: Units on a scale
    arithmetic mean (standard error)
        TP Day 29 (n=104, 103, 91)
    -0.33 ( 0.05 )
    -0.21 ( 0.05 )
    -0.09 ( 0.05 )
        TP Day 57 (n=102, 100, 93)
    -0.48 ( 0.05 )
    -0.38 ( 0.05 )
    -0.32 ( 0.05 )
        TP Day 85 (n=105, 97, 88)
    -0.64 ( 0.05 )
    -0.45 ( 0.05 )
    -0.4 ( 0.05 )
        TP Day 113 (n=105, 98, 90)
    -0.67 ( 0.05 )
    -0.55 ( 0.05 )
    -0.5 ( 0.05 )
        TP Day 141 (n=100, 98, 88)
    -0.72 ( 0.05 )
    -0.53 ( 0.05 )
    -0.46 ( 0.06 )
        TP Day 169 (n=95, 95, 85)
    -0.74 ( 0.05 )
    -0.59 ( 0.05 )
    -0.52 ( 0.06 )
        TP Day 197 (n=99, 96, 83)
    -0.78 ( 0.05 )
    -0.62 ( 0.06 )
    -0.54 ( 0.06 )
        TP Day 225 (n=98, 95, 83)
    -0.79 ( 0.06 )
    -0.67 ( 0.06 )
    -0.56 ( 0.06 )
        TP Day 253 (n=96, 91, 84)
    -0.82 ( 0.05 )
    -0.65 ( 0.06 )
    -0.63 ( 0.06 )
        TP Day 281 (n=90, 93, 81)
    -0.82 ( 0.06 )
    -0.65 ( 0.06 )
    -0.62 ( 0.06 )
        TP Day 309 (n=89, 88, 82)
    -0.81 ( 0.06 )
    -0.67 ( 0.06 )
    -0.66 ( 0.06 )
        TP Day 337 (n=88, 85, 80)
    -0.84 ( 0.06 )
    -0.7 ( 0.06 )
    -0.7 ( 0.06 )
        TP Day 365 (n=90, 82, 77)
    -0.87 ( 0.06 )
    -0.73 ( 0.06 )
    -0.72 ( 0.06 )
        WP Day 29 (n=70, 55, 55)
    -0.84 ( 0.06 )
    -0.67 ( 0.07 )
    -0.63 ( 0.07 )
        WP Day 57 (n=66, 53, 54)
    -0.67 ( 0.07 )
    -0.58 ( 0.08 )
    -0.39 ( 0.08 )
        WP Day 85 (n=65, 45, 46)
    -0.54 ( 0.08 )
    -0.48 ( 0.09 )
    -0.37 ( 0.09 )
        WP Day 169 (n=34, 28, 26)
    -0.52 ( 0.1 )
    -0.49 ( 0.11 )
    -0.33 ( 0.12 )
    No statistical analyses for this end point

    Secondary: Adjusted Mean Change From Baseline at Months 6, 12, and 18 in Physical Component Summary (PCS) and Mental Component Summary (MCS) Scores of Short Form-36 (SF-36)

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    End point title
    Adjusted Mean Change From Baseline at Months 6, 12, and 18 in Physical Component Summary (PCS) and Mental Component Summary (MCS) Scores of Short Form-36 (SF-36)
    End point description
    TP=treatment period; WP=withdrawal period. The SF-36 is a 36-item self-administered questionnaire developed to assess health-related quality of life (QOL) and comprises 8 domains, including 4 physical (physical health, bodily pain, physical functioning and physical role limitations) and 4 mental (mental health, vitality, social functioning, and emotional role limitation) subscales. Responses are used to derive physical and mental component summary scores, ranging from 0 to 100, with higher scores indicating better QOL (0=Poorest Health; 100=Best Health). Mean change from baseline=post baseline value-baseline value; a higher value signifies improvement. Analysis was performed in all randomized subjects who received at least 1 dose of double-blind study medication in the Treatment Period. n=number of subjects evaluable.
    End point type
    Secondary
    End point timeframe
    Randomization to Months 6, 12, and 18
    End point values
    Abatacept, 125 mg, Plus Methotrexate, 2.5 mg Abatacept, 125 mg, Plus Methotrexate Placebo Methotrexate, 2.5 mg, Plus Abatacept Placebo
    Number of subjects analysed
    119
    116
    116
    Units: Units on a scale
    arithmetic mean (standard error)
        PCS score TP Day 169 (n=106, 95, 96)
    11.68 ( 0.82 )
    9.16 ( 0.86 )
    7.47 ( 0.85 )
        PCS score TP Day 365 (n=94, 88, 91)
    13.91 ( 0.93 )
    10.23 ( 0.97 )
    10.92 ( 0.95 )
        PCS score WP Day 169 (n=48, 36, 37)
    6.16 ( 1.45 )
    4.59 ( 1.65 )
    6.27 ( 1.63 )
        MCS score TP Day 169 (n=106, 95, 96)
    6.11 ( 0.92 )
    3.99 ( 0.97 )
    4.69 ( 0.95 )
        MCS score TP Day 365 (n=94, 88, 91)
    7.67 ( 1.04 )
    5.48 ( 1.08 )
    7.23 ( 1.06 )
        MCS score WP Day 169 (n=48, 36, 37)
    2.75 ( 1.44 )
    4.36 ( 1.64 )
    2.23 ( 1.63 )
    No statistical analyses for this end point

    Secondary: Adjusted Mean Change From Baseline Over Time in Findings on Magnetic Resonance Imaging (MRI)

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    End point title
    Adjusted Mean Change From Baseline Over Time in Findings on Magnetic Resonance Imaging (MRI)
    End point description
    TP=treatment period; WP=withdrawal period. MRI was used to assess joint damage progression at Months 6, 12, and 18. If >20% of joints with a missing score for a parameter (erosion, osteitis, and synovitis), the MRI score of each parameter was considered missing. If ≤20% of joints had a missing score for a parameter, the MRI score was carried forward from the previous MRI assessment, or carried backward from the next MRI assessment, if missing score occurred at baseline. MRI total score ranged from 0 (best outcome) to 4 (worst outcome). A gadolinium-enhanced MRI of the dominant hand-wrist was performed on all randomized subjects at 5 points. MRI examination was standardized to ensure sufficient image quality for the evaluation of radiographic progression of rheumatoid arthritis. Analysis was performed in all randomized subjects who received at least 1 dose of double-blind study medication in the Treatment Period. n=number of subjects with both baseline and post-baseline measurements.
    End point type
    Secondary
    End point timeframe
    Randomization to Month 18
    End point values
    Abatacept, 125 mg, Plus Methotrexate, 2.5 mg Abatacept, 125 mg, Plus Methotrexate Placebo Methotrexate, 2.5 mg, Plus Abatacept Placebo
    Number of subjects analysed
    119
    116
    116
    Units: Units on a scale
    arithmetic mean (standard error)
        Osteitis TP Day 169 (n=93, 94, 89)
    -2.03 ( 0.47 )
    -1.13 ( 0.47 )
    -0.73 ( 0.48 )
        Osteitis TP Day 365 (n=83, 74, 78)
    -2.32 ( 0.46 )
    -1.3 ( 0.46 )
    -0.9 ( 0.46 )
        Osteitis WP Day 169 (n=31, 30, 25)
    -1.94 ( 0.88 )
    0.98 ( 0.89 )
    -0.33 ( 0.96 )
        Erosion TP Day 169 (n=93, 94, 89)
    0.26 ( 0.28 )
    1.15 ( 0.28 )
    1.15 ( 0.28 )
        Erosion TP Day 365 (n=83, 74, 78)
    0.34 ( 0.35 )
    1.57 ( 0.28 )
    1.56 ( 0.36 )
        Erosion WP Day 169 (n=31, 30, 25)
    0.2 ( 0.47 )
    2.16 ( 0.48 )
    1.89 ( 0.5 )
        Synovitis TP Day 169 (n=93, 94, 89)
    -1.82 ( 0.21 )
    -0.93 ( 0.21 )
    -0.78 ( 0.21 )
        Synovitis TP Day 365 (n=83, 74, 78)
    -2.38 ( 0.29 )
    -1.36 ( 0.3 )
    -0.77 ( 0.3 )
        Synovitis WP Day 169 (n=31, 30, 25)
    -1.71 ( 0.45 )
    -0.95 ( 0.45 )
    -0.71 ( 0.49 )
    No statistical analyses for this end point

    Secondary: Number of Subjects With Death as Outcome, Serious Adverse Events (SAEs), Related SAEs, Discontinuations Due to SAEs, Related Adverse Events (AEs), and Discontinuations Due to AEs During the Treatment Period

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    End point title
    Number of Subjects With Death as Outcome, Serious Adverse Events (SAEs), Related SAEs, Discontinuations Due to SAEs, Related Adverse Events (AEs), and Discontinuations Due to AEs During the Treatment Period
    End point description
    AE=any new unfavorable symptom, sign, or disease or worsening of a preexisting condition that may not have a causal relationship with treatment. SAE=a medical event that at any dose results in death, persistent or significant disability/incapacity, or drug dependency/abuse; is life-threatening, an important medical event, or a congenital anomaly/birth defect; or requires or prolongs hospitalization. Related=having certain, probable, possible, or unknown relationship to study drug. Analysis was performed in all the randomized subjects who received at least 1 dose of double-blind study medication in the Treatment Period.
    End point type
    Secondary
    End point timeframe
    Day 1 to up to 56 days following the last dosing day (Day 365); all deaths during study period, including those that occurred >56 days after last dose in Treatment Period
    End point values
    Abatacept, 125 mg, Plus Methotrexate, 2.5 mg Abatacept, 125 mg, Plus Methotrexate Placebo Methotrexate, 2.5 mg, Plus Abatacept Placebo
    Number of subjects analysed
    119
    116
    116
    Units: Subjects
        Deaths
    0
    0
    2
        SAEs
    8
    14
    9
        Related SAEs
    3
    3
    1
        Discontinuations due to SAEs
    2
    5
    3
        Related AEs
    53
    48
    51
        Discontinuations due to AEs
    4
    8
    5
    No statistical analyses for this end point

    Secondary: Number of Subjects With Adverse Events (AEs) of Interest During the Treatment Period

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    End point title
    Number of Subjects With Adverse Events (AEs) of Interest During the Treatment Period
    End point description
    AE=any new unfavorable symptom, sign, or disease or worsening of a preexisting condition that may not have a causal relationship with treatment. SAE=a medical event that at any dose results in death, persistent or significant disability/incapacity, or drug dependency/abuse; is life-threatening, an important medical event, or a congenital anomaly/birth defect; or requires or prolongs hospitalization. Related=having certain, probable, possible, or unknown relationship to study drug. AEs of special interest are events potentially associated with the drug or disease under study. Analysis was performed in all the randomized subjects who received at least 1 dose of double-blind study medication in the Treatment Period.
    End point type
    Secondary
    End point timeframe
    Day 1 to 56 days following last dosing day (Day 365)
    End point values
    Abatacept, 125 mg, Plus Methotrexate, 2.5 mg Abatacept, 125 mg, Plus Methotrexate Placebo Methotrexate, 2.5 mg, Plus Abatacept Placebo
    Number of subjects analysed
    119
    116
    116
    Units: Subjects
        Infections
    68
    64
    63
        Malignancy
    1
    2
    1
        Autoimmune disorders (pre-specified)
    1
    2
    3
        Local injection site reactions (pre-specified)
    2
    0
    0
    No statistical analyses for this end point

    Secondary: Number of Subjects With Results on Hematology and Clinical Laboratory Tests Meeting the Criteria for Marked Abnormality During Treatment Period

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    End point title
    Number of Subjects With Results on Hematology and Clinical Laboratory Tests Meeting the Criteria for Marked Abnormality During Treatment Period
    End point description
    Lower limit of normal (LLN); Upper limit of normal (ULN); Pretreatment (preRX). Criteria for marked abnormality: Platelet count (*10^9 c/µL) >1.5*ULN; potassium, serum (mEq) <0.9*LLN, or if preRX <LLN, use <0.9*preRX; blood urea nitrogen (mg/dL) >2*preRX; creatinine (mg/dL) >1.5*preRX; ALT (U/L) >3*ULN, or if preRX>ULN, use >4*preRX; AST (U/L) >3*ULN, or if preRX>ULN, use >4*preRX; ALP (U/L) >2*ULN, or if preRX>ULN, use >3*preRX; GGT (U/L) >2*ULN, or if preRX>ULN, use >3*preRX; glucose, fasting (mg/dL) <0.8*LLN or >1.5*ULN, or if preRX<LLN use <0.8*preRX or >ULN if preRX >ULN, use >2.0*preRX or OR <LLN; glucose, serum (mg/dL) <65 or >220; uric acid (mg/dL)>1.5*ULN, or if preRX, use >2*preRX; albumin (g/dL) <0.9*LLN, or if preRX<LLN, use <0.75*preRX; hemoglobin (g/dL)>3 decrease from preRX; hematocrit (%) <0.75*preRX. Analysis was performed in all randomized subjects who received at least 1 dose in Treatment Period. n=number of evaluable subjects.
    End point type
    Secondary
    End point timeframe
    Day 1 up to 56 days following the last dosing day in the Treatment Period (Day 365)
    End point values
    Abatacept, 125 mg, Plus Methotrexate, 2.5 mg Abatacept, 125 mg, Plus Methotrexate Placebo Methotrexate, 2.5 mg, Plus Abatacept Placebo
    Number of subjects analysed
    119
    116
    116
    Units: Subjects
        Platelet count (high) (n=119, 116, 115)
    2
    0
    0
        Potassium, serum (low)
    1
    1
    1
        Blood urea nitrogen (high)
    4
    1
    2
        Creatinine (high)
    2
    1
    3
        Alanine aminotransferase (ALT)(high)
    3
    0
    2
        Aspartate aminotransferase (AST)(high)
    2
    0
    1
        G-glutamyl transferase (GGT) (high)
    3
    1
    1
        Glucose, fasting (low) (n=78, 72, 75)
    2
    0
    2
        Glucose, fasting (high) (n=78, 72, 75)
    1
    2
    1
        Glucose, serum (low) (n=84, 78, 75)
    5
    6
    2
        Glucose, serum (high) (n=84, 78, 75)
    1
    4
    3
        Uric acid (high)
    0
    1
    0
        Albumin (low)
    1
    1
    4
        Hemoglobin (low) (n=119, 116, 115)
    0
    2
    0
        Hematocrit (low) (n=119, 116, 115)
    0
    2
    0
    No statistical analyses for this end point

    Secondary: Percentage of Subjects With Remission by Disease Activity Score 28 Based on C-reactive Protein (DAS28-CRP) Criteria Over Time During Withdrawal Period- Treated subjects in Remission at Month 12

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    End point title
    Percentage of Subjects With Remission by Disease Activity Score 28 Based on C-reactive Protein (DAS28-CRP) Criteria Over Time During Withdrawal Period- Treated subjects in Remission at Month 12
    End point description
    WP=withdrawal period. Remission defined as DAS28-CRP<2.6. The DAS 28-CRP is a measure of disease activity in rheumatoid arthritis (RA) and assesses the 28 joints RA commonly affects; the score includes the number of tender and swollen joints (out of 28), CRP level (a measure of inflammation in the blood), and the subject’s global assessment of health (ranging from very good to very bad). DAS-CRP scores range from 0 to 10, with higher values indicating greater disease activity. The overall DAS score greater than 5.1 implies active disease; less than 3.2, well controlled disease; and less than 2.6, remission. Percentage= number of subjects with remission divided by number of subjects who were analyzed (all treated subjects who were in remission at end of treatment period and entered the Withdrawal Period). Analysis was performed in all the treated subjects who were in remission at Month 12 (DAS28-CRP<2.6) and entered the Withdrawal Period. (N=number of subjects analyzed).
    End point type
    Secondary
    End point timeframe
    End of Treatment Period (Month 12) to End of Withdrawal Period (Month 24)
    End point values
    Abatacept, 125 mg, Plus Methotrexate, 2.5 mg Abatacept, 125 mg, Plus Methotrexate Placebo Methotrexate, 2.5 mg, Plus Abatacept Placebo
    Number of subjects analysed
    73
    50
    53
    Units: percentage of subjects
    number (confidence interval 95%)
        WP Day 29
    75.3 (65.46 to 85.23)
    72 (59.55 to 84.45)
    54.7 (41.32 to 68.12)
        WP Day 57
    58.9 (47.62 to 70.19)
    56 (42.24 to 69.76)
    32.1 (19.51 to 44.64)
        WP Day 85
    42.5 (31.13 to 53.8)
    40 (26.42 to 53.58)
    35.8 (22.94 to 48.76)
        WP Day 169
    26 (15.96 to 36.09)
    30 (17.3 to 42.7)
    17 (6.87 to 27.09)
        WP Day 253
    20.5 (11.28 to 29.82)
    22 (10.52 to 33.48)
    20.8 (9.84 to 31.67)
        WP Day 365
    12.3 (4.79 to 19.87)
    14 (4.38 to 23.62)
    11.3 (2.79 to 19.85)
    No statistical analyses for this end point

    Secondary: Percentage of Subjects Who Achieved Remission by Criteria of the Simplified Disease Activity Index (SDAI) Over Time in Treatment Period (TP) and Withdrawal Period (WP)

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    End point title
    Percentage of Subjects Who Achieved Remission by Criteria of the Simplified Disease Activity Index (SDAI) Over Time in Treatment Period (TP) and Withdrawal Period (WP)
    End point description
    SDAI-defined remission as ≤3.3. The SDAI is simple linear sum of 5 outcome parameters: tender joint count (TJC); swollen joint count (SJC) (based on a 28-joint assessment); subject’s and physician's global assessments of disease activity (assessed on 0-10 cm visual analog scale, higher score=greater affection due to disease activity); and C-reactive protein level (mg/dL). SDAI total score=0-86. SDAI <=3.3 indicates disease remission, >3.4 to 11=low, >11 to 26=moderate, and >26=high disease activity. TJC was assessed as no swelling=0, swelling=1. SJC is assessed through painful joints under pressure or to passive motion. TJC is assessed as no tenderness =0, tenderness = 1. Higher score=greater affection due to disease activity. Percent=number with remission/number evaluated. Analysis was performed in all randomized subjects who received at least 1 dose in TP. Subjects were grouped according to treatment regimen to which they were randomized. N= number of subject evaluated.
    End point type
    Secondary
    End point timeframe
    Randomization to Month 24
    End point values
    Abatacept, 125 mg, Plus Methotrexate, 2.5 mg Abatacept, 125 mg, Plus Methotrexate Placebo Methotrexate, 2.5 mg, Plus Abatacept Placebo
    Number of subjects analysed
    119
    116
    116
    Units: percentage of subjects
    number (confidence interval 95%)
        TP Day 29
    4.2 (1.38 to 9.53)
    3.4 (0.95 to 8.59)
    1.7 (0.21 to 6.09)
        TP Day 57
    9.2 (4.71 to 15.94)
    6 (2.46 to 12.04)
    1.7 (0.21 to 6.09)
        TP Day 85
    17.6 (10.8 to 24.5)
    8.6 (3.51 to 13.73)
    6 (1.7 to 10.37)
        TP Day 113
    23.5 (15.91 to 31.15)
    17.2 (10.37 to 24.12)
    7.8 (2.89 to 12.63)
        TP Day 141
    31.9 (23.56 to 40.31)
    23.3 (15.59 to 30.97)
    10.3 (4.8 to 15.89)
        TP Day 169
    31.1 (22.78 to 39.41)
    20.7 (13.32 to 28.06)
    11.2 (5.47 to 16.95)
        TP Day 197
    33.6 (25.13 to 42.1)
    21.6 (14.07 to 29.03)
    12.9 (6.82 to 19.04)
        TP Day 225
    38.7 (29.91 to 47.4)
    25.9 (17.89 to 33.83)
    14.7 (8.22 to 21.09)
        TP Day 253
    37.8 (29.1 to 46.53)
    25 (17.12 to 32.88)
    13.8 (7.52 to 20.07)
        TP Day 281
    37.8 (29.1 to 46.53)
    26.7 (18.67 to 34.78)
    18.1 (11.1 to 25.11)
        TP Day 309
    40.3 (31.52 to 49.15)
    26.7 (18.67 to 34.78)
    19 (11.83 to 26.1)
        TP Day 337
    41.2 (32.33 to 50.02)
    31 (22.62 to 39.45)
    19 (11.83 to 26.1)
        TP Day 365
    42 (33.15 to 50.89)
    29.3 (21.03 to 37.59)
    25 (17.12 to 32.88)
        WP Day 29
    38.7 (29.91 to 47.4)
    26.7 (18.67 to 34.78)
    14.7 (8.22 to 21.09)
        WP Day 57
    26.9 (18.92 to 34.86)
    20.7 (13.32 to 28.06)
    10.3 (4.8 to 15.89)
        WP Day 85
    21 (13.69 to 28.33)
    15.5 (8.93 to 22.11)
    14.7 (8.22 to 21.09)
        WP Day 169
    11.8 (5.98 to 17.55)
    9.5 (4.15 to 14.81)
    6.9 (2.29 to 11.51)
        WP Day 253
    11.8 (5.98 to 17.55)
    9.5 (4.15 to 14.81)
    7.8 (2.89 to 12.63)
        WP Day 365
    6.7 (2.22 to 11.22)
    4.3 (0.61 to 8.01)
    4.3 (0.61 to 8.01)
    No statistical analyses for this end point

    Secondary: Number of Subjects With Death as Outcome, Serious Adverse Events (SAEs) and Discontinuations Due to AEs During the Full Study (All Periods)

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    End point title
    Number of Subjects With Death as Outcome, Serious Adverse Events (SAEs) and Discontinuations Due to AEs During the Full Study (All Periods)
    End point description
    AE=any new unfavorable symptom, sign, or disease or worsening of a preexisting condition that may not have a causal relationship with treatment. SAE=a medical event that at any dose results in death, persistent or significant disability/incapacity, or drug dependency/abuse; is life-threatening, an important medical event, or a congenital anomaly/birth defect; or requires or prolongs hospitalization. Includes data up to last active dose date +56 days if the subjects discontinued the Treatment Period or did not enter the Withdrawal Period, up to the day of discontinuation in the Withdrawal Period for subjects discontinuing the Withdrawal Period without entering the Re-exposure Period (RP), up to Day 729 visit (Month 24) for subjects who complete the Withdrawal Period, and up to 56 days post last active dose in Re-exposure Period for subjects entering the Re-exposure Period. Analysis was performed in all the randomized subjects who received at least 1 dose of study medication.
    End point type
    Secondary
    End point timeframe
    Day 1 to 56 days post last dose (TP: Day 365; WP: >56 days after last dose in TP, up to Month 24; RP: first dose to last dose + 56 days, up to Month 30
    End point values
    Abatacept, 125 mg, Plus Methotrexate, 2.5 mg Abatacept, 125 mg, Plus Methotrexate Placebo Methotrexate, 2.5 mg, Plus Abatacept Placebo
    Number of subjects analysed
    119
    116
    116
    Units: Subjects
        Death
    0
    0
    2
        SAE
    11
    15
    15
        Discontinued Due to AE
    4
    8
    7
    No statistical analyses for this end point

    Secondary: Number of subjects with Adverse Events (AEs) of Interest During the Withdrawal Period AE=any new unfavorable symptom, sign, or disease or worsening of a preexisting condition that may not have a causal relationship with treatment. SAE=a medical event that

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    End point title
    Number of subjects with Adverse Events (AEs) of Interest During the Withdrawal Period AE=any new unfavorable symptom, sign, or disease or worsening of a preexisting condition that may not have a causal relationship with treatment. SAE=a medical event that
    End point description
    AE=any new unfavorable symptom, sign, or disease or worsening of a preexisting condition that may not have a causal relationship with treatment. SAE=a medical event that at any dose results in death, persistent or significant disability/incapacity, or drug dependency/abuse; is life-threatening, an important medical event, or a congenital anomaly/birth defect; or requires or prolongs hospitalization. AEs of special interest are events potentially associated with the drug or disease under study. Includes events with an onset date on or after 57 days post last dosing day (active abatacept or active MTX whichever is the later) in the Treatment Period (TP) and up to end of Withdrawal Period. Treatment groups represent treatment received during the TP. Analysis was performed in all the randomized subjects who received at least 1 dose of double-blind study medication in the TP and entered the Withdrawal Period.
    End point type
    Secondary
    End point timeframe
    Last dose in TP + 57 days, up to Month 24
    End point values
    Abatacept, 125 mg, Plus Methotrexate, 2.5 mg Abatacept, 125 mg, Plus Methotrexate Placebo Methotrexate, 2.5 mg, Plus Abatacept Placebo
    Number of subjects analysed
    84
    66
    75
    Units: Subjects
        Infections
    8
    6
    10
        Malignancy
    1
    0
    1
        Auto-immune disorders (pre-specified)
    0
    0
    1
        Local injection site reactions (pre-specified)
    0
    0
    0
    No statistical analyses for this end point

    Secondary: Number of subjects with Adverse Events (AEs) of Interest During the Re-exposure Period

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    End point title
    Number of subjects with Adverse Events (AEs) of Interest During the Re-exposure Period
    End point description
    AE=any new unfavorable symptom, sign, or disease or worsening of a preexisting condition that may not have a causal relationship with treatment. SAE=a medical event that at any dose results in death, persistent or significant disability/incapacity, or drug dependency/abuse; is life-threatening, an important medical event, or a congenital anomaly/birth defect; or requires or prolongs hospitalization. AEs of special interest are events potentially associated with the drug or disease under study. Includes data up to 56 days post the last dosing day (active abatacept or active MTX, whichever is the later) in the Re-exposure Period. Treatment groups represent Treatment received during Treatment Period.
    End point type
    Secondary
    End point timeframe
    End of Withdrawal Period (up to Month 24) up to last dose of Re-exposure Period + 56 days
    End point values
    Abatacept, 125 mg, Plus Methotrexate, 2.5 mg Abatacept, 125 mg, Plus Methotrexate Placebo Methotrexate, 2.5 mg, Plus Abatacept Placebo
    Number of subjects analysed
    55
    48
    43
    Units: Subjects
        Infections
    17
    8
    12
        Malignancy
    0
    0
    0
        Auto-immune Disorders (pre-specified)
    0
    0
    0
        Local Injection site reactions (pre-specified)
    0
    0
    0
    No statistical analyses for this end point

    Secondary: Number of Subjects With Results on Hematology and Clinical Laboratory Tests Meeting the Criteria for Marked Abnormality in Withdrawal Period

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    End point title
    Number of Subjects With Results on Hematology and Clinical Laboratory Tests Meeting the Criteria for Marked Abnormality in Withdrawal Period
    End point description
    LLN=lower limit of normal; ULN=upper limit of normal; preRX=pretreatment. Criteria for marked abnormality on laboratory test results: creatinine (mg/dL) >1.5*preRX; ALT (U/L) >3*ULN, or if preRX>ULN, use >4*preRX; G-glutamyl transferase (GGT) (U/L) >2*ULN, or if preRX>ULN, use >3*preRX; glucose, fasting (mg/dL) <0.8*LLN or >1.5*ULN, or if preRX<LLN use <0.8*preRX or >ULN if preRX >ULN, use >2.0*preRX or OR <LLN; glucose, serum (mg/dL) <65 or >220; uric acid (mg/dL)>1.5*ULN, or if preRX, use >2*preRX; hemoglobin (g/dL)>3 decrease from preRX. Analysis was performed in all the randomized subjects who received at least 1 dose of study drug in the Treatment Period, entered the Withdrawal Period, and had values available. n=number of subjects evaluable.
    End point type
    Secondary
    End point timeframe
    End of Withdrawal Period (up to Month 24) up to last dose of Re-exposure Period + 56 days
    End point values
    Abatacept, 125 mg, Plus Methotrexate, 2.5 mg Abatacept, 125 mg, Plus Methotrexate Placebo Methotrexate, 2.5 mg, Plus Abatacept Placebo
    Number of subjects analysed
    84
    66
    75
    Units: Subjects
        Hemoglobin Low (n=60, 52, 48)
    1
    2
    0
        Creatinine High (n=60, 52, 48)
    1
    2
    2
        Alanine aminotransferase (ALT) High (n=60, 52, 48)
    1
    0
    0
        GGT High (n=60, 52, 48)
    1
    0
    0
        Fasting Glucose High (30, 28, 25)
    0
    2
    1
        Glucose Low (n=36,31,27)
    5
    3
    0
        Glucose High (n=36, 31, 27)
    0
    1
    1
    No statistical analyses for this end point

    Secondary: Number of Subjects With Results on Hematology and Clinical Laboratory Tests Meeting the Criteria for Marked Abnormality in Re-exposure Period

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    End point title
    Number of Subjects With Results on Hematology and Clinical Laboratory Tests Meeting the Criteria for Marked Abnormality in Re-exposure Period
    End point description
    LLN=lower limit of normal; ULN=upper limit of normal; preRX=pretreatment. Criteria for marked abnormality on laboratory test results: creatinine (mg/dL) >1.5*preRX; ALT (U/L) >3*ULN, or if preRX>ULN, use >4*preRX; AST (U/L) >3*ULN, or if preRX>ULN, use >4*preRX; ALP (U/L) >2*ULN, or if preRX>ULN, use >3*preRX; G-glutamyl transferase U/L) >2*ULN, or if preRX>ULN, use >3*preRX; glucose, fasting (mg/dL) <0.8*LLN or >1.5*ULN, or if preRX<LLN use <0.8*preRX or >ULN if preRX >ULN, use >2.0*preRX or OR <LLN; glucose, serum (mg/dL) <65 or >220; hemoglobin (g/dL)>3 decrease from preRX; hematocrit (%) < 0.75*preRX. Analysis was performed in all all the treated subjects entering the Re-exposure Period and having measurements available were analyzed. n= number of subjects evaluable. Treatment groups represent Treatment received during Treatment Period.
    End point type
    Secondary
    End point timeframe
    Start of re-exposure period to 56 days post last dose, up to Month 30
    End point values
    Abatacept, 125 mg, Plus Methotrexate, 2.5 mg Abatacept, 125 mg, Plus Methotrexate Placebo Methotrexate, 2.5 mg, Plus Abatacept Placebo
    Number of subjects analysed
    55
    48
    43
    Units: Subjects
        Hematocrit Low (n=55,47,43)
    0
    1
    0
        Hemoglobin Low (n=55,48, 43)
    0
    2
    0
        Creatinine High (n=55, 48, 43)
    0
    1
    0
        ALT High (n=55, 48, 43)
    2
    0
    2
        ALP High (n=55, 48, 43)
    1
    0
    0
        AST High (n=55, 48, 43)
    2
    0
    1
        GGT High (n=55, 48, 43)
    2
    0
    1
        Fasting Glucose Low (n=33, 32, 28)
    1
    0
    0
        Fasting Glucose High (n=33, 32, 28)
    0
    2
    1
        Glucose Low (n=27,24,18)
    0
    2
    0
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Day 1 to last dose + 56 days, up to 30 Months
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    17.1
    Reporting groups
    Reporting group title
    Abatacept, 125 mg, Plus Methotrexate, 2.5 mg
    Reporting group description
    Subjects received abatacept, 125 mg subcutaneously, plus methotrexate (MTX), 2.5 mg orally as tablets, with a target dose range of 10-20 mg weekly, during the 12-month Treatment Period. Subjects with a Low Disease Activity Score (LDAS) defined as DAS28-CRP score of <3.2 at Month 12 (end of Treatment Period) entered the Withdrawal Period for up to 12 months, during which all study medication was withdrawn. Subjects with a DAS28-CRP score of >3.2 were discontinued from the study. All MTX and corticosteroids, if not already discontinued, were to be tapered off during the first month of the Withdrawal Period. Subjects who experienced a worsening of rheumatoid arthritis (RA) symptoms or a RA flare after at least 3 months in the Withdrawal Period were eligible to enroll into a 6-month Re-exposure Period, during which they received open-label treatment with abatacept subcutaneous (SC) 125 mg/week and MTX.

    Reporting group title
    Abatacept, 125 mg, Plus Methotrexate Placebo
    Reporting group description
    Subjects received abatacept, 125 mg subcutaneously, plus methotrexate placebo tablets orally, once weekly during the 12-month Treatment Period. Subjects with a Low Disease Activity Score (LDAS) defined as DAS28-CRP score of <3.2 at Month 12 (end of Treatment Period) entered the Withdrawal Period for up to 12 months, during which all study medication was withdrawn. Subjects with a DAS28-CRP score of >3.2 were discontinued from the study. Subjects who experienced a worsening of rheumatoid arthritis (RA) symptoms or a RA flare after at least 3 months in the Withdrawal Period were eligible to enroll into a 6-month Re-exposure Period, during which they received open-label treatment with abatacept SC (125 mg/week) and MTX.

    Reporting group title
    Methotrexate, 2.5 mg, Plus Abatacept Placebo
    Reporting group description
    Subjects received methotrexate, 2.5 mg orally as tablets, with a target dose range of 10-20 mg weekly, plus abatacept placebo subcutaneously, once weekly during the 12-month Treatment Period. Subjects with a Low Disease Activity Score (LDAS) defined as DAS28-CRP score of < 3.2 at Month 12 (end of Treatment Period) entered the Withdrawal Period for up to 12 months, during which all study medication was withdrawn. Subjects with a DAS28-CRP score of >3.2 were discontinued from the study. All MTX and corticosteroids, if not already discontinued, were to be tapered off during the first month of the Withdrawal Period. Subjects who experienced a worsening of rheumatoid arthritis (RA) symptoms or a RA flare after at least 3 months in the Withdrawal Period were eligible to enroll into a 6-month Re-exposure Period, during which they received open-label treatment with abatacept SC (125 mg/week) and MTX.

    Serious adverse events
    Abatacept, 125 mg, Plus Methotrexate, 2.5 mg Abatacept, 125 mg, Plus Methotrexate Placebo Methotrexate, 2.5 mg, Plus Abatacept Placebo
    Total subjects affected by serious adverse events
         subjects affected / exposed
    11 / 119 (9.24%)
    15 / 116 (12.93%)
    15 / 116 (12.93%)
         number of deaths (all causes)
    0
    0
    2
         number of deaths resulting from adverse events
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Basal cell carcinoma
         subjects affected / exposed
    1 / 119 (0.84%)
    0 / 116 (0.00%)
    0 / 116 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Bowen's disease
         subjects affected / exposed
    0 / 119 (0.00%)
    1 / 116 (0.86%)
    0 / 116 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Carcinoid tumour pulmonary
         subjects affected / exposed
    0 / 119 (0.00%)
    1 / 116 (0.86%)
    0 / 116 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Colon adenoma
         subjects affected / exposed
    0 / 119 (0.00%)
    0 / 116 (0.00%)
    1 / 116 (0.86%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Invasive ductal breast carcinoma
         subjects affected / exposed
    0 / 119 (0.00%)
    0 / 116 (0.00%)
    1 / 116 (0.86%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Prostate cancer
         subjects affected / exposed
    1 / 119 (0.84%)
    0 / 116 (0.00%)
    0 / 116 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Uterine cancer
         subjects affected / exposed
    0 / 119 (0.00%)
    0 / 116 (0.00%)
    1 / 116 (0.86%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Uterine neoplasm
         subjects affected / exposed
    0 / 119 (0.00%)
    0 / 116 (0.00%)
    1 / 116 (0.86%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    General disorders and administration site conditions
    Strangulated hernia
         subjects affected / exposed
    0 / 119 (0.00%)
    1 / 116 (0.86%)
    0 / 116 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Immune system disorders
    Myocardial infarction
         subjects affected / exposed
    0 / 119 (0.00%)
    1 / 116 (0.86%)
    0 / 116 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Reproductive system and breast disorders
    Endometrial disorder
         subjects affected / exposed
    0 / 119 (0.00%)
    1 / 116 (0.86%)
    0 / 116 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Emphysema
         subjects affected / exposed
    0 / 119 (0.00%)
    1 / 116 (0.86%)
    0 / 116 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Respiratory failure
         subjects affected / exposed
    0 / 119 (0.00%)
    0 / 116 (0.00%)
    1 / 116 (0.86%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    Psychiatric disorders
    Depression
         subjects affected / exposed
    0 / 119 (0.00%)
    1 / 116 (0.86%)
    0 / 116 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Investigations
    Hepatic enzyme
         subjects affected / exposed
    1 / 119 (0.84%)
    0 / 116 (0.00%)
    1 / 116 (0.86%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Transaminases increased
         subjects affected / exposed
    1 / 119 (0.84%)
    0 / 116 (0.00%)
    0 / 116 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Injury, poisoning and procedural complications
    Hand fracture
         subjects affected / exposed
    0 / 119 (0.00%)
    1 / 116 (0.86%)
    0 / 116 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Overdose
         subjects affected / exposed
    3 / 119 (2.52%)
    1 / 116 (0.86%)
    2 / 116 (1.72%)
         occurrences causally related to treatment / all
    2 / 3
    0 / 1
    1 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Post procedural complication
         subjects affected / exposed
    1 / 119 (0.84%)
    0 / 116 (0.00%)
    0 / 116 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Tendon rupture
         subjects affected / exposed
    1 / 119 (0.84%)
    0 / 116 (0.00%)
    0 / 116 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Cardiac disorders
    Myocarditis post infection
         subjects affected / exposed
    0 / 119 (0.00%)
    1 / 116 (0.86%)
    0 / 116 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Nervous system disorders
    Carotid artery occlusion
         subjects affected / exposed
    0 / 119 (0.00%)
    1 / 116 (0.86%)
    0 / 116 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Sciatica
         subjects affected / exposed
    0 / 119 (0.00%)
    1 / 116 (0.86%)
    1 / 116 (0.86%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    0 / 119 (0.00%)
    1 / 116 (0.86%)
    0 / 116 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Pancytopenia
         subjects affected / exposed
    1 / 119 (0.84%)
    0 / 116 (0.00%)
    0 / 116 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Gastrointestinal disorders
    Incarcerated inguinal hernia
         subjects affected / exposed
    0 / 119 (0.00%)
    0 / 116 (0.00%)
    1 / 116 (0.86%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Small intestinal obstruction
         subjects affected / exposed
    0 / 119 (0.00%)
    0 / 116 (0.00%)
    1 / 116 (0.86%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Hepatobiliary disorders
    Cholangitis
         subjects affected / exposed
    1 / 119 (0.84%)
    0 / 116 (0.00%)
    0 / 116 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Cholecystitis
         subjects affected / exposed
    1 / 119 (0.84%)
    0 / 116 (0.00%)
    1 / 116 (0.86%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Cholelithiasis
         subjects affected / exposed
    0 / 119 (0.00%)
    0 / 116 (0.00%)
    1 / 116 (0.86%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Renal and urinary disorders
    Renal failure
         subjects affected / exposed
    0 / 119 (0.00%)
    0 / 116 (0.00%)
    1 / 116 (0.86%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    Musculoskeletal and connective tissue disorders
    Bursitis
         subjects affected / exposed
    0 / 119 (0.00%)
    0 / 116 (0.00%)
    1 / 116 (0.86%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Foot deformity
         subjects affected / exposed
    0 / 119 (0.00%)
    0 / 116 (0.00%)
    1 / 116 (0.86%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Osteoarthritis
         subjects affected / exposed
    1 / 119 (0.84%)
    0 / 116 (0.00%)
    0 / 116 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Rheumatoid arthritis
         subjects affected / exposed
    0 / 119 (0.00%)
    0 / 116 (0.00%)
    1 / 116 (0.86%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Infections and infestations
    Abscess limb
         subjects affected / exposed
    0 / 119 (0.00%)
    1 / 116 (0.86%)
    0 / 116 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Herpes zoster
         subjects affected / exposed
    0 / 119 (0.00%)
    1 / 116 (0.86%)
    0 / 116 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Pneumonia
         subjects affected / exposed
    1 / 119 (0.84%)
    1 / 116 (0.86%)
    0 / 116 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Pyelonephritis
         subjects affected / exposed
    0 / 119 (0.00%)
    0 / 116 (0.00%)
    1 / 116 (0.86%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Urinary tract infection
         subjects affected / exposed
    0 / 119 (0.00%)
    0 / 116 (0.00%)
    1 / 116 (0.86%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Viral infection
         subjects affected / exposed
    0 / 119 (0.00%)
    1 / 116 (0.86%)
    0 / 116 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Abatacept, 125 mg, Plus Methotrexate, 2.5 mg Abatacept, 125 mg, Plus Methotrexate Placebo Methotrexate, 2.5 mg, Plus Abatacept Placebo
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    81 / 119 (68.07%)
    64 / 116 (55.17%)
    78 / 116 (67.24%)
    Vascular disorders
    Hypertension
         subjects affected / exposed
    4 / 119 (3.36%)
    2 / 116 (1.72%)
    6 / 116 (5.17%)
         occurrences all number
    4
    2
    6
    Pregnancy, puerperium and perinatal conditions
    Pharyngitis
         subjects affected / exposed
    3 / 119 (2.52%)
    6 / 116 (5.17%)
    7 / 116 (6.03%)
         occurrences all number
    5
    6
    8
    Nervous system disorders
    Headache
         subjects affected / exposed
    8 / 119 (6.72%)
    8 / 116 (6.90%)
    7 / 116 (6.03%)
         occurrences all number
    10
    9
    7
    Gastrointestinal disorders
    Abdominal pain upper
         subjects affected / exposed
    5 / 119 (4.20%)
    6 / 116 (5.17%)
    6 / 116 (5.17%)
         occurrences all number
    5
    6
    10
    Gastritis
         subjects affected / exposed
    4 / 119 (3.36%)
    1 / 116 (0.86%)
    7 / 116 (6.03%)
         occurrences all number
    4
    1
    7
    Diarrhoea
         subjects affected / exposed
    5 / 119 (4.20%)
    8 / 116 (6.90%)
    4 / 116 (3.45%)
         occurrences all number
    6
    8
    4
    Gastrooesophageal reflux disease
         subjects affected / exposed
    6 / 119 (5.04%)
    1 / 116 (0.86%)
    1 / 116 (0.86%)
         occurrences all number
    9
    1
    1
    Mouth ulceration
         subjects affected / exposed
    6 / 119 (5.04%)
    5 / 116 (4.31%)
    2 / 116 (1.72%)
         occurrences all number
    10
    5
    2
    Nausea
         subjects affected / exposed
    18 / 119 (15.13%)
    8 / 116 (6.90%)
    16 / 116 (13.79%)
         occurrences all number
    26
    8
    18
    Vomiting
         subjects affected / exposed
    6 / 119 (5.04%)
    3 / 116 (2.59%)
    1 / 116 (0.86%)
         occurrences all number
    6
    3
    1
    Respiratory, thoracic and mediastinal disorders
    Cough
         subjects affected / exposed
    4 / 119 (3.36%)
    9 / 116 (7.76%)
    7 / 116 (6.03%)
         occurrences all number
    4
    12
    7
    Infections and infestations
    Bronchitis
         subjects affected / exposed
    8 / 119 (6.72%)
    6 / 116 (5.17%)
    10 / 116 (8.62%)
         occurrences all number
    8
    7
    12
    Gastroenteritis
         subjects affected / exposed
    6 / 119 (5.04%)
    3 / 116 (2.59%)
    8 / 116 (6.90%)
         occurrences all number
    6
    3
    11
    Influenza
         subjects affected / exposed
    5 / 119 (4.20%)
    9 / 116 (7.76%)
    6 / 116 (5.17%)
         occurrences all number
    5
    12
    7
    Nasopharyngitis
         subjects affected / exposed
    28 / 119 (23.53%)
    20 / 116 (17.24%)
    22 / 116 (18.97%)
         occurrences all number
    45
    35
    28
    Sinusitis
         subjects affected / exposed
    9 / 119 (7.56%)
    4 / 116 (3.45%)
    2 / 116 (1.72%)
         occurrences all number
    11
    4
    3
    Upper respiratory tract infection
         subjects affected / exposed
    15 / 119 (12.61%)
    15 / 116 (12.93%)
    20 / 116 (17.24%)
         occurrences all number
    21
    24
    25
    Urinary tract infection
         subjects affected / exposed
    14 / 119 (11.76%)
    15 / 116 (12.93%)
    15 / 116 (12.93%)
         occurrences all number
    23
    16
    17

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    17 May 2011
    Incidences of Disease Activity Score was updated to Disease Activity Score 28 using C-reactive protein and time frame for stable oral corticosteroid use as well as routes of administration were updated.

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported
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