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    Summary
    EudraCT Number:2010-023910-30
    Sponsor's Protocol Code Number:RR10/9592
    National Competent Authority:UK - MHRA
    Clinical Trial Type:EEA CTA
    Trial Status:Completed
    Date on which this record was first entered in the EudraCT database:2011-02-28
    Trial results View results
    Index
    A. PROTOCOL INFORMATION
    B. SPONSOR INFORMATION
    C. APPLICANT IDENTIFICATION
    D. IMP IDENTIFICATION
    D.8 INFORMATION ON PLACEBO
    E. GENERAL INFORMATION ON THE TRIAL
    F. POPULATION OF TRIAL SUBJECTS
    G. INVESTIGATOR NETWORKS TO BE INVOLVED IN THE TRIAL
    N. REVIEW BY THE COMPETENT AUTHORITY OR ETHICS COMMITTEE IN THE COUNTRY CONCERNED
    P. END OF TRIAL
    Expand All   Collapse All
    A. Protocol Information
    A.1Member State ConcernedUK - MHRA
    A.2EudraCT number2010-023910-30
    A.3Full title of the trial
    A Prospective, Single-centre, Randomised Study Evaluating the Clinical, Imaging and Immunological Depth of Remission Achieved by Very Early versus Delayed Etanercept in patients with Rheumatoid Arthritis (VEDERA)
    A.3.2Name or abbreviated title of the trial where available
    Very Early versus Delayed Etanercept in patients with RA (VEDERA)
    A.4.1Sponsor's protocol code numberRR10/9592
    A.7Trial is part of a Paediatric Investigation Plan Information not present in EudraCT
    A.8EMA Decision number of Paediatric Investigation Plan
    B. Sponsor Information
    B.Sponsor: 1
    B.1.1Name of SponsorUniversity of Leeds
    B.1.3.4CountryUnited Kingdom
    B.3.1 and B.3.2Status of the sponsorNon-Commercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing support
    B.4.2Country
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisation
    B.5.2Functional name of contact point
    D. IMP Identification
    D.IMP: 1
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name Enbrel 50mg pre-filled pen
    D.2.1.1.2Name of the Marketing Authorisation holderWyeth Europa Limited
    D.2.1.2Country which granted the Marketing AuthorisationUnited Kingdom
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameEtanercept (Enbrel)
    D.3.2Product code EU/1/99/126/020
    D.3.4Pharmaceutical form Solution for injection
    D.3.4.1Specific paediatric formulation Information not present in EudraCT
    D.3.7Routes of administration for this IMPSubcutaneous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNEtanercept
    D.3.9.1CAS number 185243-69-0
    D.3.9.2Current sponsor codeRR10/9592
    D.3.9.3Other descriptive nameEnbrel
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number50
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) Information not present in EudraCT
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy Information not present in EudraCT
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product Information not present in EudraCT
    D.3.11.10Medicinal product containing genetically modified organisms Yes
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 2
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name Enbrel 50mg pre-filled syringe
    D.2.1.1.2Name of the Marketing Authorisation holderWyeth Europa Limited
    D.2.1.2Country which granted the Marketing AuthorisationUnited Kingdom
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameEtanercept (Enbrel)
    D.3.2Product code EU/1/99/126/017
    D.3.4Pharmaceutical form Solution for injection
    D.3.4.1Specific paediatric formulation Information not present in EudraCT
    D.3.7Routes of administration for this IMPSubcutaneous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNEtanercept
    D.3.9.1CAS number 185243-69-0
    D.3.9.2Current sponsor codeRR10/9592
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number50
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) Information not present in EudraCT
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy Information not present in EudraCT
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product Information not present in EudraCT
    D.3.11.10Medicinal product containing genetically modified organisms Yes
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.8 Information on Placebo
    D.8 Placebo: 1
    D.8.1Is a Placebo used in this Trial?Yes
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Rheumatoid Arthritis
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 13.1
    E.1.2Level PT
    E.1.2Classification code 10039073
    E.1.2Term Rheumatoid arthritis
    E.1.2System Organ Class 10028395 - Musculoskeletal and connective tissue disorders
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    The main aim of the study is compare remission (absence of symptoms and signs of arthritis) achieved with very early etanercept therapy to that achieved by current standard care (methotrexate and a treat to target regimen) with or without delayed etanercept, in patients with early, untreated rheumatoid arthritis. We will compare differences in: a. the proportion of patients achieving initial remission. b. the proportion of patients who remain in sustained remission. c. the depth of remission. For example, we will look for signs of active arthritis on ultrasound scans and using sensitive MRI techniques. We will also look to see the body's immune response (in rheumatoid arthritis part of the body's defence system does not act normally and attacks its own joint tissues). We will assess if it has returned to normal using blood and urine tests and examining joint tissue (synovial biopsy tissue).
    E.2.2Secondary objectives of the trial
    1. If there are differences in efficacy of very early compared to delayed etanercept therapy, what are the reasons for this? Are there differences in very early, untreated disease, compared to later disease which mean patients are more responsive to a TNF inhibitor? We will evaluate differences in the appearance of joints (on ultrasound and MRI) and the body's immune cells and chemical signalling between immune cells in blood, urine and joint tissue samples. 2. Why do some patients respond to etanercept and others do not? We will look for factors which may predict response to etanercept: in the appearance of joints (on ultrasound and MRI), the immune system (in blood, urine and joint tissue) and genetic factors (a persons DNA, the information in their body cells they inherit from their parents will be examined by a single blood test at the start of the study). 3. In patients achieving clinical remission (absence of symptoms and signs of arthritis) are there ongoing signs o
    E.2.3Trial contains a sub-study Yes
    E.2.3.1Full title, date and version of each sub-study and their related objectives
    A Prospective, Single-centre, Randomised Study Evaluating the Clinical, Imaging and Immunological Depth of Remission Achieved by Very Early versus Delayed Etanercept in patients with Rheumatoid Arthritis (VEDERA: CARDIOVASCULAR SUB-STUDY) In the cardiovascular substudy we will investigate the effect of treatment on the structure and function of blood vessels and the heart and on blood tests associated with an increased risk of cardiovascular diseases such as heart disease or stroke.
    E.3Principal inclusion criteria
    Male and female patients aged between 18 and 80 years. Diagnosis of rheumatoid arthritis (new 2010 ACR/EULAR RA classification criteria). Symptom onset within the preceding 12 months. Patients with active RA at baseline: clinical evidence of synovitis (or imaging evidence of synovitis in cases of uncertainty/subclinical disease) and DAS28-ESR≥3.2. Presence of anti-citrullinated peptide antibody (ACPA) or if ACPA negative, presence of power Doppler in at least 1 joint on ultrasound imaging. Naïve to disease-modifying therapy. Active synovitis in hand and/or wrist joints evaluable by ultrasound and MRI. All male and female subjects biologically capable of having children must agree to use a reliable method of contraception for the duration of the study and 24 weeks after the end of the study period. Acceptable methods of contraception are surgical sterilisation, oral, implantable or injectable hormonal methods, intrauterine devices or barrier contraceptives.
    E.4Principal exclusion criteria
    Previous treatment with disease-modifying anti-rheumatic drugs (for example, methotrexate, sulfasalazine or hydroxychloroquine). Intramuscular, oral or intra-articular (of non-target joint for synovial biopsy) corticosteroid within 28 days of the screening visit or intra-articular corticosteroid of the chosen target joint within 12 weeks of screening visit. Use of more than one non-steroidal anti-inflammatory (NSAID), change in NSAID or change in dose of NSAID within 28 days of the baseline visit. Contraindications to MRI (e.g. pacemaker) or unable or unwilling to attend for all imaging assessments. Unable or unwilling to attend for all synovial biopsies. Pregnancy or breastfeeding. Other contraindications to TNF inhibitor as determined by local prescribing guidelines and physician discretion. Whilst some of the below are absolute contraindications, physician discretion will be applied as in usual clinical practice: active infection, open leg ulcers, previously infected prosthetic joint (unless completely removed), septic arthritis in last year, HIV, Hepatitis B or Hepatitis C carriers, previous malignancy within 10 years (except basal cell carcinoma), severe heart failure (New York Heart Association grade 3 or more), any history of demyelinating disease, uncontrolled diabetes, pulmonary fibrosis, bronchiectasis, previous PUVA therapy (of >1000 Joules), history of TB or positive Purified Protein Derivative test (in this event, a TB gold quanteferon blood test will be performed: if negative a patient may be included, if positive a patient may be included if treated with isoniazid and pyridoxine one month before starting the study and for a further 6 months whilst on study treatments). History of other significant medical conditions, including: o Severe pulmonary disease, defined as requiring previous hospital admission or supplemental oxygen. o Active or severe cardiovascular disease: uncontrolled hypertension, myocardial infarction within 12 months of screening, angina within 6 months of screening. o Other immunodeficiency disorders. o Connective tissue diseases, e.g. Sjogren’s syndrome, systemic sclerosis, systemic lupus erythematosus, polymyositis. o Psoriasis. o Renal impairment (creatinine 175µmol/L). o Neutropenia (neutrophils < 2.0 x 109/L). o Thrombocytopenia (platelets < 125 x 109/L). o Abnormal liver function (alanine transaminase > 3 x upper limit of normal). o Anaemia (haemoglobin < 8 g/dL).
    E.5 End points
    E.5.1Primary end point(s)
    The primary outcome is the proportion of patients with early, treatment-naïve rheumatoid arthritis that achieve clinical remission at 48 weeks, following either: 1. Initial etanercept and methotrexate treatment. 2. Initial methotrexate with 'Treat to Target' regimen: escalation to combination therapy (methotrexate, sulfasalazine and hydroxychloroquine) at 12 weeks and switch to etanercept and methotrexate at/after 24 weeks if indicated by disease activity. The definition for clinical remission used in the primary endpoint will be DAS28-ESR remission (DAS28-ESR<2.6) or physician judgement of clinical remission with DAS28-ESR low disease activity (DAS28-ESR<3.2). DAS28-ESR is a composite score using: - the numbers of swollen and tender joints (out of 28 specified joints). - patient self-assessment of their current general health (using a visual analogue scale). - Erythrocyte Sedimentation Rate (marker of inflammation in blood).
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy Yes
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic No
    E.6.7Pharmacodynamic No
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic Yes
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others No
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) No
    E.7.1.1First administration to humans Information not present in EudraCT
    E.7.1.2Bioequivalence study Information not present in EudraCT
    E.7.1.3Other Information not present in EudraCT
    E.7.1.3.1Other trial type description
    E.7.2Therapeutic exploratory (Phase II) No
    E.7.3Therapeutic confirmatory (Phase III) No
    E.7.4Therapeutic use (Phase IV) Yes
    E.8 Design of the trial
    E.8.1Controlled Yes
    E.8.1.1Randomised Yes
    E.8.1.2Open Yes
    E.8.1.3Single blind No
    E.8.1.4Double blind No
    E.8.1.5Parallel group Yes
    E.8.1.6Cross over No
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) Yes
    E.8.2.2Placebo No
    E.8.2.3Other Yes
    E.8.2.3.1Comparator description
    Standard care(see cover letter) with treatment with the IMP if not acheiving remission at 6 months
    E.8.3 The trial involves single site in the Member State concerned Yes
    E.8.4 The trial involves multiple sites in the Member State concerned No
    E.8.4.1Number of sites anticipated in Member State concerned1
    E.8.5The trial involves multiple Member States No
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA No
    E.8.6.2Trial being conducted completely outside of the EEA Information not present in EudraCT
    E.8.7Trial has a data monitoring committee No
    E.8.8 Definition of the end of the trial and justification where it is not the last visit of the last subject undergoing the trial
    Last visit of the last subject.
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years5
    E.8.9.1In the Member State concerned months61
    E.8.9.1In the Member State concerned days
    E.8.9.2In all countries concerned by the trial years5
    E.8.9.2In all countries concerned by the trial months61
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 No
    F.1.1.1In Utero Information not present in EudraCT
    F.1.1.2Preterm newborn infants (up to gestational age < 37 weeks) Information not present in EudraCT
    F.1.1.3Newborns (0-27 days) Information not present in EudraCT
    F.1.1.4Infants and toddlers (28 days-23 months) Information not present in EudraCT
    F.1.1.5Children (2-11years) Information not present in EudraCT
    F.1.1.6Adolescents (12-17 years) Information not present in EudraCT
    F.1.2Adults (18-64 years) Yes
    F.1.3Elderly (>=65 years) Yes
    F.2 Gender
    F.2.1Female Yes
    F.2.2Male Yes
    F.3 Group of trial subjects
    F.3.1Healthy volunteers No
    F.3.2Patients Yes
    F.3.3Specific vulnerable populations No
    F.3.3.1Women of childbearing potential not using contraception Information not present in EudraCT
    F.3.3.2Women of child-bearing potential using contraception Information not present in EudraCT
    F.3.3.3Pregnant women Information not present in EudraCT
    F.3.3.4Nursing women Information not present in EudraCT
    F.3.3.5Emergency situation Information not present in EudraCT
    F.3.3.6Subjects incapable of giving consent personally Information not present in EudraCT
    F.3.3.7Others Information not present in EudraCT
    F.4 Planned number of subjects to be included
    F.4.1In the member state120
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 120
    F.4.2.2In the whole clinical trial 120
    F.5 Plans for treatment or care after the subject has ended the participation in the trial (if it is different from the expected normal treatment of that condition)
    Patients will be followed-up in the rheumatology clinic and treated according to current standards of practice. Methotrexate, sulfasalazine and hydroxychloroquine, if tolerated, may be continued. Etanercept may be continued in patients who fulfill the criteria set by NICE (National Institute for Health and Clinical Excellence). This will apply for patients in the Treat to Target group who commenced etanercept when activity of their arthritis was severe (DAS28>5.1) and at least two other sta
    G. Investigator Networks to be involved in the Trial
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2011-03-23
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2011-02-23
    P. End of Trial
    P.End of Trial StatusCompleted
    P.Date of the global end of the trial2019-02-25
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    The status and protocol content of GB trials is no longer updated since 1 January 2021. For the UK, as of 31 January 2021, EU Law applies only to the territory of Northern Ireland (NI) to the extent foreseen in the Protocol on Ireland/NI. Legal notice
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