E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
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E.1.1.1 | Medical condition in easily understood language |
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E.1.1.2 | Therapeutic area | Diseases [C] - Immune System Diseases [C20] |
MedDRA Classification |
E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
To evaluate the safety and the systemic and local tolerability of repeated doses of BI 655064 (120 mg/mL in buffer solution for injection), administered s.c. at doses of 80, 120, 180 and 240 mg every week in healthy volunteers (HVs) (treatment duration 4 weeks per dose group) and 120 mg every week in rheumatoid arthritis (RA) patients with prior inadequate response to methotrexate (MTX) therapy (treatment duration 12 weeks per dose group). |
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E.2.2 | Secondary objectives of the trial |
1. To evaluate PK and PD parameters of BI 655064 administered in repeated doses in HVs and in RA patients
2. To evaluate the clinical effect of BI 655064 of 120mg s.c. q1w after 12 weeks of treatment in RA patients with prior inadequate response to MTX – establishing the proof of concept in RA. |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
Part 1 (HVs):
1. Healthy males and females according to the investigator’s assessment, as based on the following criteria: a complete medical history including a physical examination, vital signs (BP, PR), 12-lead ECG, and clinical laboratory tests
2. Age ≥ 18 and ≤ 60 years
3. Body Mass Index ≥ 18.5 and ≤ 29.9 kg/m2
4. Signed and dated written informed consent prior to admission to the study in accordance with GCP and the local legislation
5. Female subjects who meet any of the following criteria from at least 30 days before the first study drug administration and until 30 days after trial completion: - using adequate contraception, e.g. any of the following methods plus condom: implants, injectables, combined oral contraceptives, intrauterine device (IUD) - sexually abstinent - have a vasectomised sexual partner (vasectomy at least 1 year prior to enrolment) - surgically sterilised (including hysterectomy) - postmenopausal defined as at least 1 year of spontaneous amenorrhea (in questionable cases a blood sample with simultaneous levels of follicle stimulating hormone (FSH) above 40 U/L and estradiol below 30 ng/L is confirmatory)
Part 2 (RA Patients):
1. Age ≥ 18 and ≤ 70 years
2. Patients classified as having RA according to the 1987 ACR Classification Criteria
3. Inadequate clinical response to methotrexate monotherapy defined as moderate/high active disease after oral or s.c. MTX treatment given continuously for at least 3 months and for the last 6 weeks before screening at a stable weekly dose ≥15mg. For patients who do not tolerate the minimum weekly dose of at least 15 mg due to side effects, a stable weekly dose as low as 7.5 mg is also permitted.
4. DAS28 4v-CRP ≥ 3.5 with ≥ 6 tender and ≥ 6 swollen joints out of 68/66 joint count at screening and confirmed by ≥ 6 tender and ≥ 6 swollen joints out of 68/66 joint count only at randomisation visit (Visit 2)
5. Serum CRP level ≥ 0.8 mg/dL or ESR ≥ 28 mm/1h at screening
6. Anti-CCP2 or Rheumatoid Factor positivity as per the limits of used assay at screening
7. Female patients who meet any of the following criteria from at least 30 days before the first study drug administration and until at least 6 months after last dose of MTX taken in the current trial:
using adequate contraception, e.g. any of the following methods plus condom: implants, injectables, combined oral contraceptives, intrauterine device (IUD)
- sexually abstinent
- have a vasectomised sexual partner (vasectomy at least 1 year prior
to enrolment)
- surgically sterilised (including hysterectomy)
- postmenopausal defined as at least 1 year of spontaneous amenorrhea (in questionable cases a blood sample with simultaneous levels of follicle stimulating hormone (FSH) above 40 U/L and estradiol below 30 ng/L is confirmatory)
OR
Male patients who:
- are documented to be sterile or consistently and correctly use a condom while their female partners (if of childbearing potential) agree to use any of the following adequate contraception methods: implants, injectables, combined oral contraceptives, intrauterine device (IUD) from the date of screening until at least 6 months after the last dose of MTX taken in the current trial
- don’t donate any sperm sample for procreation purposes, from the date of screening until at least 6 months after last dose of MTX taken in the current trial.
8. Signed and dated written informed consent prior to admission to the study in accordance with GCP and local legislation |
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E.4 | Principal exclusion criteria |
Part 1 (HVs):
1. Any finding in the medical examination (including BP, PR or ECG) deviating from normal and judged clinically relevant by the investigator
2. Any laboratory value outside the reference range that the investigator considers to be of clinical relevance
3. Any evidence of a concomitant disease judged clinically relevant by the investigator
4. Gastrointestinal, hepatic, renal, respiratory, cardiovascular, metabolic, immunological or hormonal disorders
5. Diseases of the central nervous system (such as epilepsy), other neurological disorders or psychiatric disorders
6. History of relevant orthostatic hypotension, fainting spells, or blackouts
7. History of relevant allergy/hypersensitivity (including allergy to the trial medication or its excipients)
8. Intake of drugs with a long half-life (>24 hours) within 30 days or less than 10 half-lives of the respective drug prior to administration of trial medication
9. Within 10 days prior to administration of trial medication, use of drugs that might reasonably influence the results of the trial
10. Participation in another trial with investigational drug administration within 60 days prior to administration of trial medication
11. Smoker (more than 10 cigarettes or 3 cigars or 3 pipes/day)
12. Alcohol abuse (consumption of more than 140 g/week in females and 210 g/week in males)
13. Drug abuse or positive drug screen
14. Blood donation (more than 100 mL within 30 days prior to administration of trial medication or intended during the trial)
15. Intention to commence new exercise regimen within one week prior to administration of trial medication or during the trial
16. Inability to comply with dietary regimen of trial site
17. Chronic or relevant acute infections, including but not limited to HIV, Hepatitis B and C and tuberculosis (including a history of clinical TB and/or a positive QuantiFERON TB-Gold test)
18. Subject is assessed by the investigator as unsuitable for inclusion e.g. considered not able to understand and comply with study requirements or has a condition that would not allow safe participation in the study
19. Positive pregnancy test, pregnancy or plans to become pregnant within 30 days after study completion
20. Lactation
Part 2 (RA patients):
Part 1 exclusion criteria 7, 9, 12, 13 and 17-20 plus:
1. Current or previous use of more than two anti-TNF biologic drugs or use of other biologic agent targeting any other approved mechanism (any biologic drug with mechanism of action other than direct anti-TNF blockade, (e.g. CTLA4, anti-IL6, or anti CD-20) or new oral compounds targeting any other approved mechanism (e.g. JAK inhibitors) for treating RA.
2. Current or previous participation in a clinical trial testing an investigational drug for RA within 3 months prior to screening or within 5 half-lives of the investigational drug, whichever is longer , except of previous participation in trials testing NSAIDs, corticosteroids, analgesics or patients documented as receiving placebo in previous RA trials.
3. DAS28 < 3.2 in at least 2 occasions during the last 6 months before screening
Note: DAS28 results during the last 6 months before screening visit will be provided as source documents if available. However, patients with less than 2 DAS28 results available during this time will not be excluded.
4. RA patients with severe disability (functional class IV) or with confirmed severe systemic manifestations e.g. known amyloidosis, Felty´s syndrome, lymphoproliferative disorders, rheumatoid vasculitis
5. Treatment with any standard DMARD except MTX (including but not limited to sulfasalazine, leflunomide, hydroxychloroquine, D-penicillamine, azathioprine, cyclosporin, gold salts) continuing after randomisation
Note: If patient is on treatment with any other standard DMARD (except MTX) at the time of the screening visit, this should be tapered and stopped before randomisation. MTX should be continued during the screening period at a stable dose between 15-25mg per week.
6. Impaired hepatic function, defined as serum AST/ALT, bilirubin or alkaline phosphatase levels > 2 x ULN
7. Impaired renal function defined as calculated creatinine clearance < 50ml/min
8. Pre-existing blood dyscrasias e.g. bone marrow hypoplasia, significant anaemia, leucopenia or thrombocytopenia
9. Hypersensitivity to MTX or any of its excipients
10. Previous intolerance to MTX as the main cause for stopping treatment (instead of lack of efficacy)
11. Any active or suspected malignancy or history of documented malignancy within the last 5 years before screening, except appropriately treated basal cell carcinoma of the skin or in situ carcinoma of uterine cervix. |
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E.5 End points |
E.5.1 | Primary end point(s) |
There are no primary safety, PK, PD endpoints in a statistical sense in this study.
Primary Endpoint(s) of efficacy - Part 2:
• ACR20 response rate
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
At Week12 (Day 85) from the initiation of study treatment |
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E.5.2 | Secondary end point(s) |
• ACR50 and 70 response rates
• EULAR Response Criteria (DAS28 4v-CRP and DAS28 4v-ESR)
• Percentage of patients with a decrease in DAS28 4v-CRP of >1.2
• Change in DAS28-4v at Week 12 (Day 85) compared to baseline |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
- At Week 12 (Day 85)
- At Week 12 (Day 85)
- At Week 12 (Day 85) compared to baseline
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | Yes |
E.6.7 | Pharmacodynamic | Yes |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | Yes |
E.6.10 | Pharmacogenetic | Yes |
E.6.11 | Pharmacogenomic | Yes |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | Yes |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | Yes |
E.7.1.3.1 | Other trial type description |
Multiple rising dose in HVs |
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E.7.2 | Therapeutic exploratory (Phase II) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | Yes |
E.8.1.5 | Parallel group | Yes |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | Yes |
E.8.1.7.1 | Other trial design description |
Multiple rising dose for Part 1 |
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E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | Yes |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 2 |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 8 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 29 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
Czech Republic |
Germany |
Netherlands |
New Zealand |
Poland |
Spain |
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E.8.7 | Trial has a data monitoring committee | Yes |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 1 |
E.8.9.1 | In the Member State concerned months | 1 |
E.8.9.1 | In the Member State concerned days | |
E.8.9.2 | In all countries concerned by the trial years | 1 |
E.8.9.2 | In all countries concerned by the trial months | 5 |