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    Summary
    EudraCT Number:2012-002535-28
    Sponsor's Protocol Code Number:R4-RA
    National Competent Authority:Portugal - INFARMED
    Clinical Trial Type:EEA CTA
    Trial Status:Completed
    Date on which this record was first entered in the EudraCT database:2014-02-25
    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 ConcernedPortugal - INFARMED
    A.2EudraCT number2012-002535-28
    A.3Full title of the trial
    A Randomised, open labelled study in anti-TNFa inadequate responders to investigate the mechanisms for Response - Resistance to Rituximab versus Tocilizumab in RA (R4-RA)
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    Not applicable
    A.3.2Name or abbreviated title of the trial where available
    R4-RA
    A.4.1Sponsor's protocol code numberR4-RA
    A.7Trial is part of a Paediatric Investigation Plan No
    A.8EMA Decision number of Paediatric Investigation Plan
    B. Sponsor Information
    B.Sponsor: 1
    B.1.1Name of SponsorJoint Research & Development Office (Barts and The London School of Medicine & Dentistry) - Queen Mary University London
    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 supportJoint Research & Development Office (Barts and The London School of Medicine & Dentistry) - Queen Mary University London
    B.4.2CountryUnited Kingdom
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationJoint Research & Development Office (Barts and The London School of Medicine & Dentistry) - Queen Mary University London
    B.5.2Functional name of contact pointGerry Leonard
    B.5.3 Address:
    B.5.3.1Street Address5 Walden street
    B.5.3.2Town/ cityLondon
    B.5.3.3Post codeE1 2EF
    B.5.3.4CountryUnited Kingdom
    B.5.4Telephone number004402078827260
    B.5.5Fax number004402078827276
    B.5.6E-mailsponosrsrep@bartshealth.nhs.uk
    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 MabThera
    D.2.1.1.2Name of the Marketing Authorisation holderRoche Registration Ltd.
    D.2.1.2Country which granted the Marketing AuthorisationEuropean Union
    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 nameMabThera
    D.3.4Pharmaceutical form Concentrate for solution for infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNRITUXIMAB
    D.3.9.1CAS number 174722-31-7
    D.3.9.4EV Substance CodeSUB12570MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number500
    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) No
    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 No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) Yes
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    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 RoleComparator
    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 RoActemra
    D.2.1.1.2Name of the Marketing Authorisation holderRoche Registration Limited
    D.2.1.2Country which granted the Marketing AuthorisationEuropean Union
    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 nameRoActemra
    D.3.4Pharmaceutical form Concentrate for solution for infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNTocilizumab
    D.3.9.1CAS number 375823-41-9
    D.3.9.3Other descriptive nameTOCILIZUMAB
    D.3.9.4EV Substance CodeSUB20313
    D.3.10 Strength
    D.3.10.1Concentration unit mg/kg milligram(s)/kilogram
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number8
    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) No
    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 No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) Yes
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    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
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Rheumatoid Arthritis
    Artrite Reumatóide
    E.1.1.1Medical condition in easily understood language
    Rheumatoid Arthritis
    Artrite Reumatóide
    E.1.1.2Therapeutic area Diseases [C] - Musculoskeletal Diseases [C05]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.0
    E.1.2Level LLT
    E.1.2Classification code 10003268
    E.1.2Term Arthritis rheumatoid
    E.1.2System Organ Class 100000004859
    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 this project is to test the hypothesis that the presence or absence of specific synovial cellular and molecular signatures(B cells and B cell-associated signatures), assessed following a synovial tissue biopsy, will enrich for response / non-response to the B cell depleting anti-CD20 monoclonal antibody (mAb) Rituximab.

    The primary aim of this project is to show that in patients failing anti-TNF therapy, with a B cell poor synovial pathotype, Rituximab is inferior to Tocilizumab therapy.
    O objetivo principal deste projeto é testar a hipótese de que a presença ou ausência de assinaturas celulares e moleculares sinoviais específicas (células B e assinaturas associadas a células B), avaliada após uma biópsia de tecido sinovial, prediz a resposta/ não resposta ao anticorpo monoclonal depletor de células B Rituximab.

    O objetivo primário deste projeto é demonstrar que em doentes com resposta inadequada à terapia anti-TNF, com patotipo sinovial pobre em células B, o Rituximab é inferior ao Tocilizumab.
    E.2.2Secondary objectives of the trial
    In addition to the primary objective previously stated, we will address the following questions:
    1) Can a diagnostic synovial biopsy showing a B-cell “rich/poor pathotype” define specific disease responsive/resistant subsets for patient stratification and help rationalize biologic drug choice?
    2) Is clinical response associated with inhibition of B cell-linked pathways within the synovium and dependent on local B cell lineage depletion?
    3) Is survival of auto-reactive B cells within “protected” synovial niches responsible for B-cell joint re-population and disease resistance-relapse?
    Adicionalmente ao objetivo primário previamente estabelecido, iremos ainda avaliar as seguintes questões:
    1) Poderá uma biópsia sinovial diagnóstica, evidenciando patotipo “rico/pobre” em células B, definir subgrupos de doença específicos de resposta/resistência para estratificar doentes e ajudar a racionalizar a escolha da terapêutica biológica?
    2) Estará a resposta clínica associada à inibição das vias associadas às células B na membrana sinovial e dependente da depleção local das células de linhagem B?
    3) Será a sobrevivência de células B auto-reativas dentro de nichos sinoviais "protegidos" responsável ​​pelo reaparecimento de células B nas articulações e resistência a recidiva de doença?
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    Patients will be recruited with active RA:
    1. Patients who have failed anti-TNF therapy (inadequate responders – ir). Note: this includes patients that have failed anti-TNF therapy because of reactions.
    2. Who are eligible for Rituximab therapy according NICE guidlines
    3. Patients should be receiving a stable dose Methotrexate for at least 4 weeks prior to the biopsy visit.
    4. 2010 ACR / EULAR Rheumatoid Arthritis classification criteria for a diagnosis of Rheumatoid Arthritis.
    5. Over 18 years of age
    6. Patient must be capable of giving informed consent
    7. Willingness and ability to comply with scheduled visits, treatment plans and laboratory tests and other study procedures
    Serão recrutados doentes com AR ativa:
    1. Doentes com falência à terapêutica anti-TNF (resposta inadequada-ir). Nota: são incluídos doentes que tenham falência à terapêutica anti-TNF devido a reações adversas.
    2. Elegíveis para terapêutica com rituximab de acordo com as guidelines NICE.
    3. Os doentes devem estar a receber uma dose estável de metotrexato por pelo menos 4 semanas antes da visita de biópsia.
    4. Critérios de classificação do ACR/EULAR 2010 para o diagnóstico da Artrite Reumatóide.
    5. Idade superior a 18 anos.
    6. O doente deve ser capaz de dar o seu consentimento informado.
    7. Ter disponibilidade e aceitar cumprir as visitas planeadas, planos de tratamento e exames laboratoriais e outros procedimentos do estudo.
    E.4Principal exclusion criteria
    1. Women who are pregnant or breast-feeding
    2. Women of child-bearing potential, or males whose partners are women of child-bearing potential, unwilling to use effective contraception during the study and for at least 12 months after stopping study treatment.
    3. History of or current primary inflammatory joint disease, or primary rheumatological autoimmune disease other than RA (if secondary to RA, then the patient is still eligible).
    4. Prior exposure to Rituximab or Tocilizumab for the treatment of RA
    5. Treatment with any investigational agent ≤ 4 weeks prior to baseline (or < 5 half- lives of the investigational drug, whichever is the longer).
    6. Intra articular or parenteral corticosteroids ≤ 4 weeks prior to biopsy visit (Visit 2)
    7. Oral prednisolone more than 10mg per day or equivalent ≤ 4 weeks prior to biopsy visit (Visit 2)
    8. Active infection.
    9. Septic arthritis within a native joint within the last 12 months.
    10. Sepsis of a prosthetic joint within 12 months or indefinitely if the joint remains in situ.
    11. Known HIV or active hepatitis B/C infection. Hepatitis B screening test must be performed at or in the preceding 3 months of screening visit.
    12. Latent TB infection unless they have completed adequate antibiotic prophylaxis.
    13. Malignancy (other than basal cell carcinoma) within the last 10 years
    14. New York Heart Association (NYHA) grade 3 or 4 congestive cardiac failure.
    15. Demyelinating disease.
    16. Latex allergy or allergy to any excipients of Rituximab or Tocilizumab
    17. Any other contra-indication to the study medications as detailed in their summaries of product characteristics (SmPC), including low IgG levels at clinician’s discretion.
    18. Receipt of live vaccine <4 weeks prior to first infusion
    19. Major surgery in 3 months prior to first infusion
    20. Presence of a transplanted organ (with the exception of a corneal transplant >3 months prior to screening)
    21. Known recent substance abuse (drug or alcohol)
    22. Poor tolerability of venepuncture or lack of adequate venous access for required blood sampling during the study period.
    23. Patients unable to tolerate synovial biopsy or in whom this is contraindicated including(e.g. patients on anti-coagulants (oral anti-platelet agents are permitted)).
    24. Patients currently recruited to other clinical trial(s) involving an investigational medicinal product (except any observational follow-up periods not involving an IMP).trials.
    25. Other severe acute or chronic medical or psychiatric condition, or laboratory abnormality that would impart, in the judgment of the investigator, excess risk associated with study participation or study drug administration, or which, in the judgment of the investigator, would make the patient inappropriate for entry into this study.
    1. Mulheres grávidas ou em aleitamento.
    2. Mulheres em idade fértil, ou homens cujas parceiras estejam em idade fértil, que não estejam dispostos a utilizar métodos contraceptivos eficazes durante o estudo e pelo menos até 12 meses após a interrupção do tratamento.
    3. História prévia ou atual, de doença reumatológica inflamatória articular ou autoimune reumatológica primária que não AR (se secundária AR, então o doente ainda é elegível )
    4. Exposição anterior a Rituximab ou Tocilizumab para o tratamento da AR.
    5. Tratamento com qualquer medicamento experimental ≤ 4 semanas antes da visita de “baseline” ou < 5 semi-vidas do medicamento experimental, qual deles seja o mais longo
    6. Corticosteróides intra-articulares ou parentéricos ≤ 4 semanas antes da visita da biópsia (V2)
    7. Prednisolona oral mais do que 10 mg dia ou equivalente inferior ou igual a 4 semanas antes da visita de biópsia (V2)
    8. Infeção ativa.
    9. Artrite séptica de uma articulação não intervencionada nos últimos 12 meses.
    10. Sépsis de uma articulação prostésica nos últimos 12 meses ou indefinidamente se a articulação permanecer in situ.
    11. HIV ou hepatite B/C activa conhecida. O teste de screening para Hepatite B deve ser efectuado até ou aos 3 meses antes da visita de screening.
    12. TB latente, exceto se o doente tiver completado profilaxia antibiótica adequada.
    13. Doença oncológica (exceto carcinoma de células basais) nos últimos 10 anos.
    14. Insuficiência cardíaca congestiva classe 3 ou 4 pela NYHA.
    15. Doença desmielinizante.
    16. Alergia ao látex ou a quaisquer excipientes do Rituximab ou Tocilizumab
    17. Qualquer outra contraindicação aos medicamentos experimentais conforme descrito nos RCM, incluindo diminuição dos níveis de IgG de acordo com critério clinico
    18. Ter recebido uma vacina viva <4 semanas antes da primeira infusão.
    19. Cirurgia major nos 3 meses antes da primeira infusão.
    20. Presença de um órgão transplantado (com exceção de transplante de córnea >3 meses antes da visita de “screening”).
    21. Abuso de substâncias (droga ou álcool) conhecido.
    22. Baixa tolerância a punção venosa ou sem acesso venoso adequado para colheitas de sangue necessárias durante o estudo.
    23. Doentes incapazes de tolerar uma biopsia sinovial ou em que esta seja contraindicada incluindo doentes com tratamento anticoagulante ( anticoagulantes orais são permitidos).
    24. Doentes actualmente recrutados para outros ensaios clínicos envolvendo um medicamento experimental (excepto se observacional no período de follow up não envolvendo um IMP).
    25. Outras condições médicas ou psiquiátricas severas agudas ou crónicas, ou alterações laboratoriais que impliquem, na opinião do investigador, um excessivo risco associado à participação no estudo ou à administração da medicação, ou que, na opinião do investigador, torne o doente inadequado para entrar neste estudo.
    E.5 End points
    E.5.1Primary end point(s)
    The main aim of this project is to test the hypothesis that the presence or absence of specific synovial cellular and molecular signatures (B cells and B cell-associated signatures), assessed following a synovial tissue biopsy, will enrich for response/non-response to the B cell depleting anti-CD20 monoclonal antibody (mAb) Rituximab.

    Therefore, while this study can be thought of as three distinct clinical trials in separate synovial histomorphological phenotypes (1. B cell rich, 2. B cell poor and 3. Germinal centres)with each sub group randomised to Rituximab or Tocilizumab; the Primary outcome measure is the proportion of patients achieving a CDAI (Clinical disease activity index) response at 16 weeks from baseline.

    The primary analysis will focus on whether there is a superiority of Tocilizumab over Rituximab in histologically defined ‘B cell poor patients’.



    E.5.1.1Timepoint(s) of evaluation of this end point
    The timepoint for evaluation of the primary end point will be at 16 weeks from baseline.
    E.5.2Secondary end point(s)
    In addition we will also examine:
    1. For the B-cell rich synovial pathotypes, we aim to show non-inferiority of Rituxumab compared to Tocilizumab.
    2. Germinal Centre pathotypes will constitute an exploratory component to the trial as insufficient power will be generated to show a significant difference in clinical response between each treatment.
    3. Area under the curve (AUC) of mean improvement in DAS28 over time between 0, 16 and 48 weeks.
    4. Percentage of patients with low disease activity (DAS28 < 3.2) at 12, 24, 36, 48, 96 weeks
    5. Percentage of patients in remission (DAS28 < 2.6) at 16 and 48 weeks
    6. Percentage of patients with ACR 20, 50 and 70 response rates at 16, 48 and 96 weeks
    7. Percentage of patients with a low clinical disease activity index score (CDAI)
    8. Mean % change in DAS28 between baseline and 16, 48 and 96 weeks
    9. Mean % change in SF-36 score between baseline and 16, 48 and 96
    weeks
    10. Mean % change in clinical disease activity index score (CDAI) between baseline and 16, 48 and 96 weeks10.
    11. Mean change in HAQ score between baseline and 16, 48 and 96 weeks
    12. Change in Fatigue score between baseline and 16, 48 and 96 weeks
    13. Serious adverse events over 12 months; the rate of serious adverse events in the 16 week period following a switch from one technology to the other will be compared
    14. Mean change in erosive score by the van der Heijde/Sharp scoring
    system at baseline and week 24.
    15. Reduction in US 2D grey scale and power Doppler signal at baseline,
    16 and 48 weeks.
    16. Mean change in synovial immune cell infiltrate determined
    immunohistologically (C20, CD68, CD138, CD3) between baseline, 16
    and 48 weeks
    17. Mean change in synovial gene expression between baseline, 16
    weeks and 48 weeks

    Exploratory endpoint:
    The association between synovial histology and ultrasound measures of
    inflammation, and drug response rates, disease outcome and disability.
    E.5.2.1Timepoint(s) of evaluation of this end point
    The timepoints for evaluation of secondary end points will be up to 96 weeks from baseline.
    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 No
    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 No
    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 No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other No
    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 No
    E.8.1.3Single blind Yes
    E.8.1.4Double blind No
    E.8.1.5Parallel group No
    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 No
    E.8.2.4Number of treatment arms in the trial2
    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.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA20
    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 No
    E.8.7Trial has a data monitoring committee Yes
    E.8.8 Definition of the end of the trial and justification where it is not the last visit of the last subject undergoing the trial
    The end of the study (data collection period) will be triggered when
    the last recruited patient completes the treatment phase of the trial at
    48 weeks + 30 days (post-treatment Safety Follow-up Visit/ phone
    call) (Last Patient Last Visit LPLV).
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years4
    E.8.9.1In the Member State concerned months0
    E.8.9.1In the Member State concerned days30
    E.8.9.2In all countries concerned by the trial years4
    E.8.9.2In all countries concerned by the trial months0
    E.8.9.2In all countries concerned by the trial days30
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 No
    F.1.1Number of subjects for this age range: 0
    F.1.1.1In Utero No
    F.1.1.1.1Number of subjects for this age range: 0
    F.1.1.2Preterm newborn infants (up to gestational age < 37 weeks) No
    F.1.1.2.1Number of subjects for this age range: 0
    F.1.1.3Newborns (0-27 days) No
    F.1.1.3.1Number of subjects for this age range: 0
    F.1.1.4Infants and toddlers (28 days-23 months) No
    F.1.1.4.1Number of subjects for this age range: 0
    F.1.1.5Children (2-11years) No
    F.1.1.5.1Number of subjects for this age range: 0
    F.1.1.6Adolescents (12-17 years) No
    F.1.1.6.1Number of subjects for this age range: 0
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 5
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 3
    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 No
    F.3.3.2Women of child-bearing potential using contraception No
    F.3.3.3Pregnant women No
    F.3.3.4Nursing women No
    F.3.3.5Emergency situation No
    F.3.3.6Subjects incapable of giving consent personally No
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state8
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 53
    F.4.2.2In the whole clinical trial 160
    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)
    Both therapies are approved in Portugal for use in this patients' population with RA. Therefore, patients will continue to receive the treatment after termination of this trial.
    G. Investigator Networks to be involved in the Trial
    G.4 Investigator Network to be involved in the Trial: 1
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2014-03-18
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2014-06-06
    P. End of Trial
    P.End of Trial StatusCompleted
    P.Date of the global end of the trial2019-07-10
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