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    Clinical Trial Results:
    Multi-Center, Open Label, Single Arm Phase IIIB Study on Safety and Efficacy of Subcutaneous Tocilizumab in Monotherapy or in Combination With Methotrexate or Other Non-Biologic Disease Modifying Antirheumatic Drugs in Rheumatoid Arthritis Patients With an Inadequate Response to Non-Biologic DMARDs – OSCAR

    Summary
    EudraCT number
    2013-000342-19
    Trial protocol
    NL  
    Global end of trial date
    26 May 2016

    Results information
    Results version number
    v1(current)
    This version publication date
    04 Jun 2017
    First version publication date
    04 Jun 2017
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    ML28702
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT01987479
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    F. Hoffmann-La Roche AG
    Sponsor organisation address
    Grenzacherstrasse 124, Basel, Switzerland, CH-4070
    Public contact
    Roche Trial Information Hotline, F. Hoffmann-La Roche AG, +41 61 6878333, global.trial_information@roche.com
    Scientific contact
    Roche Trial Information Hotline, F. Hoffmann-La Roche AG, +41 61 6878333, global.trial_information@roche.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
    10 Oct 2016
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    26 May 2016
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    This multi-center, open-label single arm Phase IIIb study evaluated the safety and efficacy of subcutaneous (SC) tocilizumab administered as monotherapy and/or in combination with methotrexate or other non-biologic disease modifying antirheumatic drugs (DMARDs) in participants with rheumatoid arthritis (RA) with an inadequate response to non-biologic DMARDs.
    Protection of trial subjects
    This study was conducted in full conformance with the International Conference on Harmonisation (ICH) E6 guideline for Good Clinical Practice (GCP) and the principles of the Declaration of Helsinki, or the laws and regulations of the country in which the research was conducted, whichever afforded the greater protection to the individual.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    30 Jan 2014
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Netherlands: 150
    Worldwide total number of subjects
    150
    EEA total number of subjects
    150
    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)
    122
    From 65 to 84 years
    27
    85 years and over
    1

    Subject disposition

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    Recruitment
    Recruitment details
    -

    Pre-assignment
    Screening details
    A total of 174 participants were screened, out of which 150 participants met eligibility criteria and were enrolled into the study.

    Period 1
    Period 1 title
    Overall Study (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Not applicable
    Blinding used
    Not blinded

    Arms
    Arm title
    Tocilizumab Alone or in Combination with Methotrexate or DMARD
    Arm description
    Participants received a weekly SC injection of tocilizumab 162 milligrams (mg) as monotherapy or in combination with methotrexate or other non-biologic DMARDs for 24 weeks.
    Arm type
    Experimental

    Investigational medicinal product name
    Tocilizumab
    Investigational medicinal product code
    Other name
    RoActemra, Actemra
    Pharmaceutical forms
    Solution for injection
    Routes of administration
    Subcutaneous use
    Dosage and administration details
    Tocilizumab 162 mg was administered once a week by SC injection and as a single fixed dose, irrespective of body weight, for the treatment duration of 24 weeks.

    Number of subjects in period 1
    Tocilizumab Alone or in Combination with Methotrexate or DMARD
    Started
    150
    Completed
    133
    Not completed
    17
         Physician decision
    2
         Adverse event, non-fatal
    7
         Unspecified
    5
         Lost to follow-up
    1
         Protocol deviation
    1
         participant/legal guardian decision to withdraw
    1

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Tocilizumab Alone or in Combination with Methotrexate or DMARD
    Reporting group description
    Participants received a weekly SC injection of tocilizumab 162 milligrams (mg) as monotherapy or in combination with methotrexate or other non-biologic DMARDs for 24 weeks.

    Reporting group values
    Tocilizumab Alone or in Combination with Methotrexate or DMARD Total
    Number of subjects
    150 150
    Age Categorical
    Units: Subjects
    Age Continuous
    Units: years
        arithmetic mean (standard deviation)
    55.85 ± 11.2 -
    Gender Categorical
    Units: Subjects
        Female
    110 110
        Male
    40 40

    End points

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    End points reporting groups
    Reporting group title
    Tocilizumab Alone or in Combination with Methotrexate or DMARD
    Reporting group description
    Participants received a weekly SC injection of tocilizumab 162 milligrams (mg) as monotherapy or in combination with methotrexate or other non-biologic DMARDs for 24 weeks.

    Primary: Percentage of Participants With Adverse Events

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    End point title
    Percentage of Participants With Adverse Events [1]
    End point description
    An adverse event was any untoward medical occurrence in a participant who received study drug without regard to possibility of causal relationship. Adverse events included serious as well as non-serious adverse events. Full Analysis Set (FAS) population included all participants who received at least one dose of SC tocilizumab.
    End point type
    Primary
    End point timeframe
    Baseline up to Week 32
    Notes
    [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: No statistical analyses were planned for this endpoint but descriptive statistics only
    End point values
    Tocilizumab Alone or in Combination with Methotrexate or DMARD
    Number of subjects analysed
    150
    Units: percentage of participants
        number (not applicable)
    91.3
    No statistical analyses for this end point

    Secondary: Change From Baseline in Disease Activity Score 28-Erythrocyte Sedimentation Rate (DAS28-ESR) Score at Weeks 2, 4, 8, 12, 16, 20, 24, and Early Withdrawal

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    End point title
    Change From Baseline in Disease Activity Score 28-Erythrocyte Sedimentation Rate (DAS28-ESR) Score at Weeks 2, 4, 8, 12, 16, 20, 24, and Early Withdrawal
    End point description
    DAS28 was calculated from swollen joint count (SJC) and tender joint count (TJC) using 28 joints count, erythrocyte sedimentation rate (ESR; millimeters per hour [mm/hour]), and patient’s global assessment of disease activity (measured on a 0 to 100 mm Visual Analog Scale [VAS] where 0 mm=no disease activity and 100 mm=worst disease activity). DAS28 scores were calculated as [0.56 × square root of TJC] + [0.28 × square root of SJC] + [0.70 × natural log (ESR)] + [0.014 × VAS]. Total score range: 0-10, higher score=higher disease activity. DAS28-ESR less than or equal to (≤) 3.2 implied low disease activity and greater than (>) 3.2 to 5.1 implied moderate to high disease activity, and DAS28-ESR less than (<) 2.6 implied clinical remission. FAS population. Here, “n” = participants who were evaluable at the specified timepoint.
    End point type
    Secondary
    End point timeframe
    Baseline, Weeks 2, 4, 8, 12, 16, 20, 24, and at Early Withdrawal (up to Week 24)
    End point values
    Tocilizumab Alone or in Combination with Methotrexate or DMARD
    Number of subjects analysed
    150
    Units: units on a scale
    arithmetic mean (standard deviation)
        Baseline (n=150)
    4.8 ± 1.3
        Change at Week 2 (n=148)
    1.337 ± 0.989
        Change at Week 4 (n=144)
    2.037 ± 0.991
        Change at Week 8 (n=136)
    2.635 ± 1.098
        Change at Week 12 (n=133)
    2.908 ± 1.135
        Change at Week 16 (n=128)
    3.014 ± 1.24
        Change at Week 20 (n=122)
    3.169 ± 1.17
        Change at Week 24 (n=121)
    3.232 ± 1.247
        Change at early withdrawal visit (n=27)
    1.653 ± 1.562
    No statistical analyses for this end point

    Secondary: Percentage of Participants Achieving an American College of Rheumatology Criteria 20 (ACR20) Response

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    End point title
    Percentage of Participants Achieving an American College of Rheumatology Criteria 20 (ACR20) Response
    End point description
    A participant had an ACR20 response if there was at least a 20 percent (%) improvement, ie, reduction from Baseline, in TJC and SJC (28 assessed joints) and in at least 3 of the following 5 parameters: 1) Physician's Global Assessment of Disease Activity [VAS: 0 mm=no disease activity to 100 mm=maximum disease activity]; 2) Patient's Global Assessment of Disease Activity [VAS: 0 mm=no disease activity to 100 mm=maximum disease activity]; 3) Patient's Assessment of Pain [VAS: 0 mm=no pain to 100 mm=unbearable pain]; 4) Health Assessment Questionnaire [20 questions, 8 components: dressing/grooming, arising, eating, walking, hygiene, reach, grip, and activities, 0=without difficulty to 3=unable to do] and 5) an acute-phase reactant (either C-reactive protein [CRP] or ESR). FAS population. Here, “n” = participants who were evaluable at specified timepoint.
    End point type
    Secondary
    End point timeframe
    Baseline, Weeks 2, 4, 8, 12, 16, 20, 24, and at Early Withdrawal (up to Week 24)
    End point values
    Tocilizumab Alone or in Combination with Methotrexate or DMARD
    Number of subjects analysed
    150
    Units: percentage of participants
    number (not applicable)
        Week 2 (n=148)
    20.3
        Week 4 (n=144)
    40.3
        Week 8 (n=136)
    58.1
        Week 12 (n=133)
    69.9
        Week 16 (n=130)
    71.5
        Week 20 (n=123)
    78.9
        Week 24 (n=121)
    82.6
        Early withdrawal visit (n=27)
    37
    No statistical analyses for this end point

    Secondary: Percentage of Participants Achieving an ACR50 Response

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    End point title
    Percentage of Participants Achieving an ACR50 Response
    End point description
    A participant had an ACR50 response if there was at least a 50% improvement, ie, reduction from Baseline, in TJC and SJC (28 assessed joints) and in at least 3 of the following 5 parameters: 1) Physician's Global Assessment of Disease Activity [VAS: 0 mm=no disease activity to 100 mm=maximum disease activity]; 2) Patient's Global Assessment of Disease Activity [VAS: 0 mm=no disease activity to 100 mm=maximum disease activity]; 3) Patient's Assessment of Pain [VAS: 0 mm=no pain to 100 mm=unbearable pain]; 4) Health Assessment Questionnaire [20 questions, 8 components: dressing/grooming, arising, eating, walking, hygiene, reach, grip, and activities, 0=without difficulty to 3=unable to do] and 5) an acute-phase reactant (either CRP or ESR). FAS population. Here, “n” = participants who were evaluable at specified timepoint.
    End point type
    Secondary
    End point timeframe
    Baseline, Weeks 2, 4, 8, 12, 16, 20, 24, and at Early Withdrawal (up to Week 24)
    End point values
    Tocilizumab Alone or in Combination with Methotrexate or DMARD
    Number of subjects analysed
    150
    Units: percentage of participants
    number (not applicable)
        Week 2 (n=148)
    6.1
        Week 4 (n=144)
    18.1
        Week 8 (n=136)
    33.1
        Week 12 (n=133)
    43.6
        Week 16 (n=130)
    52.3
        Week 20 (n=123)
    54.5
        Week 24 (n=121)
    62
        Early withdrawal visit (n=27)
    18.5
    No statistical analyses for this end point

    Secondary: Percentage of Participants Achieving an ACR70 Response

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    End point title
    Percentage of Participants Achieving an ACR70 Response
    End point description
    A participant had an ACR70 response if there was at least a 70% improvement, ie, reduction from Baseline, in TJC and SJC (28 assessed joints) and in at least 3 of the following 5 parameters: 1) Physician's Global Assessment of Disease Activity [VAS: 0 mm=no disease activity to 100 mm=maximum disease activity]; 2) Patient's Global Assessment of Disease Activity [VAS: 0 mm=no disease activity to 100 mm=maximum disease activity]; 3) Patient's Assessment of Pain [VAS: 0 mm=no pain to 100 mm=unbearable pain]; 4) Health Assessment Questionnaire [20 questions, 8 components: dressing/grooming, arising, eating, walking, hygiene, reach, grip, and activities, 0=without difficulty to 3=unable to do] and 5) an acute-phase reactant (either CRP or ESR). FAS population. Here, “n” = participants who were evaluable at specified timepoint.
    End point type
    Secondary
    End point timeframe
    Baseline, Weeks 2, 4, 8, 12, 16, 20, 24, and at Early Withdrawal (up to Week 24)
    End point values
    Tocilizumab Alone or in Combination with Methotrexate or DMARD
    Number of subjects analysed
    150
    Units: percentage of participants
    number (not applicable)
        Week 2 (n=148)
    1.4
        Week 4 (n=144)
    6.9
        Week 8 (n=136)
    14
        Week 12 (n=133)
    21.1
        Week 16 (n=130)
    29.2
        Week 20 (n=123)
    38.2
        Week 24 (n=121)
    35.5
        Early withdrawal visit (n=27)
    14.8
    No statistical analyses for this end point

    Secondary: Percentage of Participants Achieving an ACR90 Response

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    End point title
    Percentage of Participants Achieving an ACR90 Response
    End point description
    A participant had an ACR90 response if there was at least a 90% improvement, ie, reduction from Baseline, in TJC and SJC (28 assessed joints) and in at least 3 of the following 5 parameters: 1) Physician's Global Assessment of Disease Activity [VAS: 0 mm=no disease activity to 100 mm=maximum disease activity]; 2) Patient's Global Assessment of Disease Activity [VAS: 0 mm=no disease activity to 100 mm=maximum disease activity]; 3) Patient's Assessment of Pain [VAS: 0 mm=no pain to 100 mm=unbearable pain]; 4) Health Assessment Questionnaire [20 questions, 8 components: dressing/grooming, arising, eating, walking, hygiene, reach, grip, and activities, 0=without difficulty to 3=unable to do] and 5) an acute-phase reactant (either CRP or ESR). FAS population. Here, “n” = participants who were evaluable at specified timepoint.
    End point type
    Secondary
    End point timeframe
    Baseline, Weeks 2, 4, 8, 12, 16, 20, 24, and at Early Withdrawal (up to Week 24)
    End point values
    Tocilizumab Alone or in Combination with Methotrexate or DMARD
    Number of subjects analysed
    150
    Units: percentage of participants
    number (not applicable)
        Week 2 (n=148)
    0
        Week 4 (n=144)
    1.4
        Week 8 (n=136)
    2.9
        Week 12 (n=133)
    6.8
        Week 16 (n=130)
    9.2
        Week 20 (n=123)
    11.4
        Week 24 (n=121)
    15.7
        Early withdrawal visit (n=27)
    3.7
    No statistical analyses for this end point

    Secondary: Percentage of Participants With European League Against Rheumatism (EULAR) Response (Good, Moderate or No Response) Based on DAS28-ESR

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    End point title
    Percentage of Participants With European League Against Rheumatism (EULAR) Response (Good, Moderate or No Response) Based on DAS28-ESR
    End point description
    DAS28-ESR was calculated from SJC and TJC using 28 joints count, ESR (mm/hour), and patient's global assessment of disease activity (VAS: 0 mm=no disease activity to 100 mm=maximum disease activity). DAS28-ESR=[0.56×square root of TJC]+[0.28× square root of SJC]+[0.70×natural log (ESR)]+[0.014×VAS]. DAS28-ESR based EULAR response criteria were used to measure individual response as none, good, and moderate, depending on the extent of change from baseline and level of disease activity reached. Good responders had a change from baseline >1.2 with a DAS28 score ≤3.2; moderate responders had a change from baseline >1.2 with a DAS28 score >3.2 or a change from baseline >0.6 to ≤1.2 with a DAS28 score ≤5.1. Participants with change from baseline >0.6 to ≤1.2 with a DAS28 score >5.1, or any score with change from baseline ≤0.6, were assessed as non-responders. FAS population. “n”=participants who were evaluable at specified timepoint.
    End point type
    Secondary
    End point timeframe
    Baseline, Weeks 2, 4, 8, 12, 16, 20, 24, and at Early Withdrawal (up to Week 24)
    End point values
    Tocilizumab Alone or in Combination with Methotrexate or DMARD
    Number of subjects analysed
    150
    Units: percentage of participants
    number (not applicable)
        Week 2: Good response (n=148)
    34.5
        Week 2: Moderate response (n=148)
    41.9
        Week 2: No response (n=148)
    23.6
        Week 4: Good response (n=144)
    59.7
        Week 4: Moderate response (n=144)
    34
        Week 4: No response (n=144)
    6.3
        Week 8: Good response (n=136)
    78.7
        Week 8: Moderate response (n=136)
    17.6
        Week 8: No response (n=136)
    3.7
        Week 12: Good response (n=133)
    85
        Week 12: Moderate response (n=133)
    12
        Week 12: No response (n=133)
    3
        Week 16: Good response (n=128)
    89.1
        Week 16: Moderate response (n=128)
    7
        Week 16: No response (n=128)
    3.9
        Week 20: Good response (n=122)
    91.8
        Week 20: Moderate response (n=122)
    5.7
        Week 20: No response (n=122)
    2.5
        Week 24: Good response (n=121)
    92.6
        Week 24: Moderate response (n=121)
    5
        Week 24: No response (n=121)
    2.5
        Early withdrawal visit: Good response (n=27)
    44.4
        Early withdrawal visit: Moderate response (n=27)
    29.6
        Early withdrawal visit: No response (n=27)
    25.9
    No statistical analyses for this end point

    Secondary: Change From Baseline in Simplified Disease Activity Index (SDAI) at Weeks 2, 4, 8, 12, 16, 20, 24, and Early Withdrawal

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    End point title
    Change From Baseline in Simplified Disease Activity Index (SDAI) at Weeks 2, 4, 8, 12, 16, 20, 24, and Early Withdrawal
    End point description
    The SDAI is the numerical sum of five outcome parameters: TJC and SJC based on a 28-joint assessment, patient and physician global assessment of disease The SDAI is the numerical sum of five outcome parameters: TJC and SJC based on a 28-joint assessment, patient and physician global assessment of disease activity assessed on 0-10 centimeter (cm) VAS (0 cm= no disease activity and 10 cm= worst disease activity), and CRP in milligrams per liter (mg/L). SDAI total score = 0-86. SDAI <=3.3 indicates clinical remission, >3.4 to 11 = low disease activity, >11 to 26 = moderate disease activity, and >26 = high (or severe) disease activity. FAS population. Here, “Number of subjects analysed” = participants who were evaluable for this outcome. “n” = participants who were evaluable at specified timepoint.
    End point type
    Secondary
    End point timeframe
    Baseline, Weeks 2, 4, 8, 12, 16, 20, 24, and at Early Withdrawal (up to Week 24)
    End point values
    Tocilizumab Alone or in Combination with Methotrexate or DMARD
    Number of subjects analysed
    145
    Units: units on a scale
    arithmetic mean (standard deviation)
        Baseline (n=145)
    26.03 ± 12.55
        Change at Week 2 (n=97)
    -6.2 ± 7.4
        Change at Week 4 (n=78)
    -11.3 ± 8
        Change at Week 8 (n=64)
    -14.4 ± 9.2
        Change at Week 12 (n=63)
    -17.2 ± 10.8
        Change at Week 16 (n=67)
    -18.5 ± 11.1
        Change at Week 20 (n=57)
    -19.7 ± 11.2
        Change at Week 24 (n=56)
    -19.9 ± 11.8
        Change at early withdrawal visit (n=18)
    -8 ± 10.7
    No statistical analyses for this end point

    Secondary: Change From Baseline in Clinical Disease Activity Index (CDAI) at Weeks 2, 4, 8, 16, 20, 24, and Early Withdrawal

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    End point title
    Change From Baseline in Clinical Disease Activity Index (CDAI) at Weeks 2, 4, 8, 16, 20, 24, and Early Withdrawal
    End point description
    The CDAI is the numerical sum of four outcome parameters: TJC and SJC based on a 28-joint assessment, patient and physician’s global assessment of disease activity assessed on 0-10 cm VAS (0 cm= no disease activity and 10 cm= worst disease activity). CDAI total score = 0-76. CDAI <= 2.8 indicates clinical remission, >2.8 to 10 = low disease activity, >10 to 22 = moderate disease activity, and >22 = high (or severe) disease activity. FAS population. Here, “n” = participants who were evaluable at specified timepoint.
    End point type
    Secondary
    End point timeframe
    Baseline, Weeks 2, 4, 8, 12, 16, 20, 24, and at Early Withdrawal (up to Week 24)
    End point values
    Tocilizumab Alone or in Combination with Methotrexate or DMARD
    Number of subjects analysed
    150
    Units: units on a scale
    arithmetic mean (standard deviation)
        Baseline (n=150)
    24.32 ± 11.84
        Change at Week 2 (n=148)
    -4.7 ± 7.3
        Change at Week 4 (n=144)
    -9.4 ± 7.2
        Change at Week 8 (n=135)
    -13.4 ± 8.7
        Change at Week 12 (n=132)
    -15.4 ± 9.2
        Change at Week 16 (n=129)
    -16.7 ± 10.1
        Change at Week 20 (n=122)
    -17.8 ± 10.2
        Change at Week 24 (n=121)
    -18.3 ± 11.1
        Change at early withdrawal visit (n=27)
    -6.4 ± 10.3
    No statistical analyses for this end point

    Secondary: Change From Baseline in Total TJC at Weeks 2, 4, 8, 12, 16, 20, 24, and Early Withdrawal

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    End point title
    Change From Baseline in Total TJC at Weeks 2, 4, 8, 12, 16, 20, 24, and Early Withdrawal
    End point description
    Number of tender joints was determined by examining 28 joints for TJC28 and 68 joints for TJC68, and identified the joints that were painful under pressure or to passive motion. The number of tender joints was recorded on the joint assessment form at each visit, no tenderness = 0, tenderness = 1; total was calculated by adding all the joints for a maximum score of 28 for a TJC28 and 68 for a TJC68. A reduction in number of tender joints compared to baseline indicates improvement. FAS population. Here, “n” = participants who were evaluable at specified timepoint.
    End point type
    Secondary
    End point timeframe
    Baseline, Weeks 2, 4, 8, 12, 16, 20, 24, and at Early Withdrawal (up to Week 24)
    End point values
    Tocilizumab Alone or in Combination with Methotrexate or DMARD
    Number of subjects analysed
    150
    Units: tender joints
    arithmetic mean (standard deviation)
        TJC28: Baseline (n=150)
    7.7 ± 6.5
        TJC28: Change at Week 2 (n=148)
    -1.38 ± 3.71
        TJC28: Change at Week 4 (n=144)
    -2.94 ± 3.89
        TJC28: Change at Week 8 (n=136)
    -4.33 ± 4.82
        TJC28: Change at Week 12 (n=133)
    -4.68 ± 5.05
        TJC28: Change at Week 16 (n=130)
    -5.36 ± 5.55
        TJC28: Change at Week 20 (n=123)
    -5.79 ± 5.24
        TJC28: Change at Week 24 (n=121)
    -5.96 ± 5.67
        TJC28: Change at early withdrawal visit (n=27)
    -1.07 ± 4.59
        TJC68: Baseline (n=150)
    13.2 ± 10
        TJC68: Change at Week 2 (n=148)
    -2.4 ± 5.84
        TJC68: Change at Week 4 (n=144)
    -5.15 ± 6.25
        TJC68: Change at Week 8 (n=136)
    -7.19 ± 7.57
        TJC68: Change at Week 12 (n=133)
    -7.98 ± 8.46
        TJC68: Change at Week 16 (n=130)
    -9.45 ± 9.07
        TJC68: Change at Week 20 (n=123)
    -9.86 ± 9.04
        TJC68: Change at Week 24 (n=121)
    -10.02 ± 8.94
        TJC68: Change at early withdrawal visit (n=27)
    -1.93 ± 8.53
    No statistical analyses for this end point

    Secondary: Change From Baseline in Total SJC at Weeks 2, 4, 8, 12, 16, 20, 24, and Early Withdrawal

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    End point title
    Change From Baseline in Total SJC at Weeks 2, 4, 8, 12, 16, 20, 24, and Early Withdrawal
    End point description
    Number of swollen joints was determined by examination of 28 joints for SJC28 and 66 joints for SJC66 and identifying when swelling was present. The number of swollen joints was recorded on the joint assessment form at each visit, no swelling = 0, swelling =1; total was calculated by adding all the joints for a maximum score of 28 for a SJC28 and 66 for a SJC66. A reduction in number of swollen joints compared to baseline indicates improvement. FAS population. Here, “n” = participants who were evaluable at specified timepoint.
    End point type
    Secondary
    End point timeframe
    Baseline, Weeks 2, 4, 8, 12, 16, 20, 24, and at Early Withdrawal (up to Week 24)
    End point values
    Tocilizumab Alone or in Combination with Methotrexate or DMARD
    Number of subjects analysed
    150
    Units: swollen joints
    arithmetic mean (standard deviation)
        SJC28: Baseline (n=150)
    6.2 ± 5.4
        SJC28: Change at Week 2 (n=148)
    -1.18 ± 3.04
        SJC28: Change at Week 4 (n=144)
    -2.44 ± 3.33
        SJC28: Change at Week 8 (n=136)
    -3.62 ± 3.86
        SJC28: Change at Week 12 (n=133)
    -4.24 ± 4.17
        SJC28: Change at Week 16 (n=130)
    -4.61 ± 4.14
        SJC28: Change at Week 20 (n=123)
    -4.92 ± 4.24
        SJC28: Change at Week 24 (n=121)
    -5.23 ± 4.63
        SJC28: Change at early withdrawal visit (n=27)
    -1.33 ± 4.18
        SJC66: Baseline (n=150)
    9.1 ± 7.3
        SJC66: Change at Week 2 (n=148)
    -1.84 ± 4.16
        SJC66: Change at Week 4 (n=144)
    -3.94 ± 4.35
        SJC66: Change at Week 8 (n=136)
    -5.61 ± 4.74
        SJC66: Change at Week 12 (n=133)
    -6.5 ± 5.79
        SJC66: Change at Week 16 (n=130)
    -6.78 ± 5.95
        SJC66: Change at Week 20 (n=123)
    -7.52 ± 6.44
        SJC66: Change at Week 24 (n=121)
    -7.8 ± 6.86
        SJC66: Change at early withdrawal visit (n=27)
    -2.33 ± 4.89
    No statistical analyses for this end point

    Secondary: Percentage of Participants With Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) Dose Reductions or Discontinuation Categorized by Reasons

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    End point title
    Percentage of Participants With Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) Dose Reductions or Discontinuation Categorized by Reasons
    End point description
    Results are reported for percentage of participants who had NSAIDs dose reductions or discontinuation by reasons for dose reductions or discontinuation (unknown reasons, safety reasons, other reasons, lack of efficacy, and discomfort). FAS population
    End point type
    Secondary
    End point timeframe
    From Week 16 and before Week 20; From Week 20 and before Week 24
    End point values
    Tocilizumab Alone or in Combination with Methotrexate or DMARD
    Number of subjects analysed
    150
    Units: percentage of participants
    number (not applicable)
        Unknown reasons (Week 16 to Week 20)
    0
        Safety reasons (Week 16 to Week 20)
    0.7
        Other reasons (Week 16 to Week 20)
    0.7
        Lack of efficacy (Week 16 to Week 20)
    0
        Discomfort (Week 16 to Week 20)
    0
        Unknown reasons (Week 20 to Week 24)
    0
        Safety reasons (Week 20 to Week 24)
    0
        Other reasons (Week 20 to Week 24)
    0
        Lack of efficacy (Week 20 to Week 24)
    0
        Discomfort (Week 20 to Week 24)
    0
    No statistical analyses for this end point

    Secondary: Percentage of Participants With Corticosteroid Dose Reductions or Discontinuation Categorized by Reasons

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    End point title
    Percentage of Participants With Corticosteroid Dose Reductions or Discontinuation Categorized by Reasons
    End point description
    Results are reported for percentage of participants who had corticosteroid dose reductions or discontinuation by reasons for dose reductions or discontinuation (unknown reasons, safety reasons, other reasons, lack of efficacy, and discomfort). FAS population
    End point type
    Secondary
    End point timeframe
    From Week 16 and before Week 20; From Week 20 and before Week 24
    End point values
    Tocilizumab Alone or in Combination with Methotrexate or DMARD
    Number of subjects analysed
    150
    Units: percentage of participants
    number (not applicable)
        Unknown reasons (Week 16 to Week 20)
    0
        Safety reasons (Week 16 to Week 20)
    1.3
        Other reasons (Week 16 to Week 20)
    0.7
        Lack of efficacy (Week 16 to Week 20)
    0
        Discomfort (Week 16 to Week 20)
    0
        Unknown reasons (Week 20 to Week 24)
    0
        Safety reasons (Week 20 to Week 24)
    0
        Other reasons (Week 20 to Week 24)
    1.3
        Lack of efficacy (Week 20 to Week 24)
    0.7
        Discomfort (Week 20 to Week 24)
    0
    No statistical analyses for this end point

    Secondary: Time to Discontinuation or First Dose Reduction of Corticosteroids or NSAIDs

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    End point title
    Time to Discontinuation or First Dose Reduction of Corticosteroids or NSAIDs
    End point description
    Time to discontinuation or first dose reduction of corticosteroids or NSAIDs (weeks) = (Date of the first dose reduction or end date of corticosteroids or NSAIDs treatment - date of first drug intake of this study) + 1. FAS population. Time to discontinuation or first dose reduction was based on first occurring event (corticosteroid discontinuation or corticosteroid first dose reduction or NSAIDs discontinuation or NSAIDs first dose reduction, whichever occurred first).
    End point type
    Secondary
    End point timeframe
    Baseline up to Week 32
    End point values
    Tocilizumab Alone or in Combination with Methotrexate or DMARD
    Number of subjects analysed
    150
    Units: weeks
        median (confidence interval 95%)
    25.3 (25 to 28)
    No statistical analyses for this end point

    Secondary: Serum Levels of Tocilizumab

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    End point title
    Serum Levels of Tocilizumab
    End point description
    FAS population. Here, “n” = participants who were evaluable at specified timepoint.
    End point type
    Secondary
    End point timeframe
    Baseline, Weeks 12 and 24, Early Withdrawal (up to Week 24), Follow-up Visit (8 weeks after last dose of tocilizumab, up to 32 weeks)
    End point values
    Tocilizumab Alone or in Combination with Methotrexate or DMARD
    Number of subjects analysed
    150
    Units: micrograms per milliliter (mcg/mL)
    arithmetic mean (standard deviation)
        Baseline (n=4)
    0.5 ± 0.3
        Week 12 (n=123)
    42.3 ± 25.2
        Week 24 (n=112)
    46.5 ± 29.2
        Early withdrawal (n=17)
    16.8 ± 19.3
        Follow-up visit (n=3)
    60.9 ± 29.7
    No statistical analyses for this end point

    Secondary: Serum Levels of Soluble Interleukin-6 Receptors (sIL-6Rs)

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    End point title
    Serum Levels of Soluble Interleukin-6 Receptors (sIL-6Rs)
    End point description
    FAS population. Here, “n” = participants who were evaluable at specified timepoint.
    End point type
    Secondary
    End point timeframe
    Baseline, Weeks 12 and 24, Early Withdrawal (up to Week 24), Follow-up Visit (8 weeks after last dose of tocilizumab, up to 32 weeks)
    End point values
    Tocilizumab Alone or in Combination with Methotrexate or DMARD
    Number of subjects analysed
    150
    Units: nanograms per milliliter (ng/mL)
    arithmetic mean (standard deviation)
        Baseline (n=139)
    38.3 ± 10.4
        Week 12 (n=126)
    516.6 ± 137.7
        Week 24 (n=115)
    536.5 ± 161.6
        Early withdrawal (n=21)
    380.4 ± 215.2
        Follow-up visit (n=26)
    117.5 ± 194.3
    No statistical analyses for this end point

    Secondary: Patient Global Assessment of Disease Activity VAS Scores

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    End point title
    Patient Global Assessment of Disease Activity VAS Scores
    End point description
    Patient global assessment of disease activity was measured on a 0 to 100 mm horizontal VAS where 0 mm=no disease activity and 100 mm=maximum disease activity. FAS population. Here, “n” = participants who were evaluable at specified timepoint.
    End point type
    Secondary
    End point timeframe
    Baseline, Weeks 2, 4, 8, 12, 16, 20, 24, and Early withdrawal (up to Week 24)
    End point values
    Tocilizumab Alone or in Combination with Methotrexate or DMARD
    Number of subjects analysed
    150
    Units: mm
    arithmetic mean (standard deviation)
        Baseline (n=150)
    54.8 ± 22.3
        Week 2 (n=148)
    43.6 ± 23
        Week 4 (n=144)
    35.5 ± 23
        Week 8 (n=136)
    27.2 ± 21.8
        Week 12 (n=133)
    22.2 ± 20.3
        Week 16 (n=129)
    21.3 ± 21
        Week 20 (n=123)
    19.2 ± 18.6
        Week 24 (n=121)
    18.8 ± 19.5
        Early withdrawal (n=27)
    40.4 ± 30.9
    No statistical analyses for this end point

    Secondary: Patient Pain VAS Scores

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    End point title
    Patient Pain VAS Scores
    End point description
    This assessment represents the participant’s assessment of his/her current level of pain on a 100 mm horizontal VAS where 0 mm = no pain to 100 mm = unbearable pain. FAS population. Here, “n” = participants who were evaluable at specified timepoint.
    End point type
    Secondary
    End point timeframe
    Baseline, Weeks 2, 4, 8, 12, 16, 20, 24, and Early withdrawal (up to Week 24)
    End point values
    Tocilizumab Alone or in Combination with Methotrexate or DMARD
    Number of subjects analysed
    150
    Units: mm
    arithmetic mean (standard deviation)
        Baseline (n=150)
    52.5 ± 22.1
        Week 2 (n=148)
    44.4 ± 21.9
        Week 4 (n=144)
    35.8 ± 22.3
        Week 8 (n=136)
    27.6 ± 21.3
        Week 12 (n=133)
    21.7 ± 19
        Week 16 (n=129)
    20.9 ± 20.2
        Week 20 (n=123)
    19.5 ± 18
        Week 24 (n=121)
    19.6 ± 18.8
        Early withdrawal (n=27)
    42.8 ± 30.4
    No statistical analyses for this end point

    Secondary: Health Assessment Questionnaire-Disability Index (HAQ-DI) Score

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    End point title
    Health Assessment Questionnaire-Disability Index (HAQ-DI) Score
    End point description
    The HAQ-DI questionnaire measures functional status (disability) and health-related quality of life. It measures the participant's ability to perform everyday tasks. The index consists of 20 questions regarding the function of the upper and lower extremities. These questions are summarized in 8 categories: dressing and grooming, arising, eating, walking, hygiene, reach, grip, and common activities over past week. Each question is evaluated according to the degree of severity on a 4-point scale. Total score for HAQ-DI was the average of all questions and ranges from 0 = without any difficulty to 3 = unable to do. FAS population. Here, “n” = participants who were evaluable at specified timepoint.
    End point type
    Secondary
    End point timeframe
    Baseline, Weeks 2, 4, 8, 12, 16, 20, 24, and early withdrawal (up to Week 24)
    End point values
    Tocilizumab Alone or in Combination with Methotrexate or DMARD
    Number of subjects analysed
    150
    Units: units on a scale
    arithmetic mean (standard deviation)
        Baseline (n=147)
    1.2329 ± 0.5708
        Week 2 (n=147)
    1.0978 ± 0.5906
        Week 4 (n=143)
    0.9673 ± 0.5734
        Week 8 (n=134)
    0.8249 ± 0.5587
        Week 12 (n=131)
    0.746 ± 0.533
        Week 16 (n=129)
    0.6996 ± 0.5682
        Week 20 (n=122)
    0.662 ± 0.5333
        Week 24 (n=119)
    0.6681 ± 0.5745
        Early withdrawal (n=27)
    1.2315 ± 0.6853
    No statistical analyses for this end point

    Secondary: Percentage of Participants Compliant to Tocilizumab Treatment as Measured by Diary Cards and Return Records

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    End point title
    Percentage of Participants Compliant to Tocilizumab Treatment as Measured by Diary Cards and Return Records
    End point description
    A diary card was provided to participants to record home injections. Participants were asked to return all empty drug supply boxes, unused pre-filled syringe, and diary cards to the clinic at each visit as a measure of drug accountability and participant compliance. A participant was considered compliant if the participant correctly administered all scheduled doses of SC tocilizumab during the assessment period. FAS population. Here, “n” = participants who were evaluable at specified timepoint.
    End point type
    Secondary
    End point timeframe
    Weeks 2, 4, 8, 12, 16, 20, 24, and early withdrawal (up to Week 24)
    End point values
    Tocilizumab Alone or in Combination with Methotrexate or DMARD
    Number of subjects analysed
    150
    Units: percentage of participants
    number (not applicable)
        Week 2 (n=148)
    90.5
        Week 4 (n=144)
    95.8
        Week 8 (n=136)
    91.9
        Week 12 (n=133)
    97.7
        Week 16 (n=130)
    93.8
        Week 20 (n=123)
    95.1
        Week 24 (n=121)
    92.6
        Early withdrawal (n=27)
    88.9
    No statistical analyses for this end point

    Secondary: Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) Score

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    End point title
    Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) Score
    End point description
    The FACIT-F score was calculated according to a 13-item questionnaire that assesses self-reported fatigue and its impact upon daily activities and function. FACIT-F is a 13-item questionnaire. Participants scored each item on a 5-point scale: 0 (Not at all) to 4 (Very much). The larger the participant's response to the questions (with the exception of 2 negatively stated), the greater the participants fatigue. For all questions, except for the 2 negatively stated ones, the code was reversed and a new score was calculated as (4 minus the participant's response). The sum of all responses resulted in the FACIT-Fatigue score for a total possible score of 0 (worse score) to 52 (better score). FAS population. Here, “n” = participants who were evaluable at specified timepoint.
    End point type
    Secondary
    End point timeframe
    Baseline, Weeks 2, 4, 8, 12, 16, 20, 24, and early withdrawal (up to Week 24)
    End point values
    Tocilizumab Alone or in Combination with Methotrexate or DMARD
    Number of subjects analysed
    150
    Units: units on a scale
    arithmetic mean (standard deviation)
        Baseline (n=133)
    29.84 ± 9.43
        Week 2 (n=134)
    33.07 ± 9.34
        Week 4 (n=133)
    35.1 ± 10.37
        Week 8 (n=126)
    37.34 ± 9.25
        Week 12 (n=126)
    37.89 ± 8.52
        Week 16 (n=122)
    37.93 ± 9.11
        Week 20 (n=118)
    39.65 ± 8.87
        Week 24 (n=114)
    39.93 ± 8.65
        Early withdrawal (n=27)
    33.48 ± 12.06
    No statistical analyses for this end point

    Secondary: Percentage of Participants With Anti-Tocilizumab Antibodies

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    End point title
    Percentage of Participants With Anti-Tocilizumab Antibodies
    End point description
    FAS population. Here, “n” = participants who were evaluable at specified timepoint.
    End point type
    Secondary
    End point timeframe
    Baseline, Weeks 12 and 24, early withdrawal (up to Week 24), follow-up visit (8 weeks after last dose of tocilizumab, up to 32 weeks)
    End point values
    Tocilizumab Alone or in Combination with Methotrexate or DMARD
    Number of subjects analysed
    150
    Units: percentage of participants
    number (not applicable)
        Baseline (n=147)
    6.1
        Week 12 (n=5)
    40
        Week 24 (n=121)
    7.4
        Early withdrawal (n=22)
    9.1
        Follow-up visit (n=26)
    11.5
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Baseline up to Week 32
    Adverse event reporting additional description
    FAS population
    Assessment type
    Non-systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    19.0
    Reporting groups
    Reporting group title
    Tocilizumab Alone or in Combination with Methotrexate or DMARD
    Reporting group description
    Participants received a weekly SC injection of tocilizumab 162 mg as monotherapy or in combination with methotrexate or other non-biologic DMARDs for 24 weeks.

    Serious adverse events
    Tocilizumab Alone or in Combination with Methotrexate or DMARD
    Total subjects affected by serious adverse events
         subjects affected / exposed
    14 / 150 (9.33%)
         number of deaths (all causes)
    0
         number of deaths resulting from adverse events
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    B-cell lymphoma
         subjects affected / exposed
    1 / 150 (0.67%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Bowen's disease
         subjects affected / exposed
    1 / 150 (0.67%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Injury, poisoning and procedural complications
    Scapula fracture
         subjects affected / exposed
    1 / 150 (0.67%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Tibia fracture
         subjects affected / exposed
    1 / 150 (0.67%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Vascular disorders
    Aortic aneurysm
         subjects affected / exposed
    1 / 150 (0.67%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Surgical and medical procedures
    Hip arthroplasty
         subjects affected / exposed
    1 / 150 (0.67%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Prophylaxis
         subjects affected / exposed
    1 / 150 (0.67%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Gastrointestinal disorders
    Diverticular perforation
         subjects affected / exposed
    1 / 150 (0.67%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Skin and subcutaneous tissue disorders
    Toxic skin eruption
         subjects affected / exposed
    1 / 150 (0.67%)
         occurrences causally related to treatment / all
    3 / 3
         deaths causally related to treatment / all
    0 / 0
    Psoriasis
         subjects affected / exposed
    1 / 150 (0.67%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Musculoskeletal and connective tissue disorders
    Arthralgia
         subjects affected / exposed
    1 / 150 (0.67%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Joint range of motion decreased
         subjects affected / exposed
    1 / 150 (0.67%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Infections and infestations
    Appendicitis
         subjects affected / exposed
    1 / 150 (0.67%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Arthritis bacterial
         subjects affected / exposed
    1 / 150 (0.67%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Skin infection
         subjects affected / exposed
    1 / 150 (0.67%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Tocilizumab Alone or in Combination with Methotrexate or DMARD
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    77 / 150 (51.33%)
    Nervous system disorders
    Dizziness
         subjects affected / exposed
    11 / 150 (7.33%)
         occurrences all number
    12
    General disorders and administration site conditions
    Fatigue
         subjects affected / exposed
    18 / 150 (12.00%)
         occurrences all number
    19
    Blood and lymphatic system disorders
    Leukopenia
         subjects affected / exposed
    8 / 150 (5.33%)
         occurrences all number
    8
    Gastrointestinal disorders
    Nausea
         subjects affected / exposed
    18 / 150 (12.00%)
         occurrences all number
    20
    Diarrhoea
         subjects affected / exposed
    9 / 150 (6.00%)
         occurrences all number
    10
    Respiratory, thoracic and mediastinal disorders
    Oropharyngeal pain
         subjects affected / exposed
    8 / 150 (5.33%)
         occurrences all number
    9
    Skin and subcutaneous tissue disorders
    Rash
         subjects affected / exposed
    8 / 150 (5.33%)
         occurrences all number
    9
    Infections and infestations
    Nasopharyngitis
         subjects affected / exposed
    35 / 150 (23.33%)
         occurrences all number
    42

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? No

    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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