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    Clinical Trial Results:
    A Double-Blind, Randomized, Parallel-Group, Active-Control Study to Compare the Efficacy and Safety of CHS-0214 Versus Enbrel® in Subjects With Rheumatoid Arthritis and Inadequate Response to Treatment With Methotrexate (CHS-0214-02) (RApsody)

    Summary
    EudraCT number
    2014-000443-33
    Trial protocol
    HU   IT   GB   ES   DE   PL  
    Global end of trial date
    27 Apr 2016

    Results information
    Results version number
    v1(current)
    This version publication date
    13 May 2017
    First version publication date
    13 May 2017
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    CHS-0214-02
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT02115750
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Coherus BioSciences, Inc.
    Sponsor organisation address
    333 Twin Dolphin Drive, Suite 600, Redwood City, United States, CA 94065
    Public contact
    Barbara K. Finck, Coherus BioSciences, Inc., +1 650 649 3530,
    Scientific contact
    Barbara K. Finck, Coherus BioSciences, Inc., +1 650 649 3530,
    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
    31 May 2016
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    21 Oct 2015
    Global end of trial reached?
    Yes
    Global end of trial date
    27 Apr 2016
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    The primary objective of Part 1 of this study was to compare the efficacy and safety of CHS-0214 to Enbrel (EU) at 24 weeks in subjects with rheumatoid arthritis (RA) who had an inadequate response to methotrexate and no more than 3 other non-biologic disease-modifying anti-rheumatic drugs and who were naïve to biologic therapies. The objectives of Part 2 of the study were to evaluate the longer-term safety and the durability of response to open-label CHS-0214.
    Protection of trial subjects
    The study was conducted in accordance with the Declaration of Helsinki and with all applicable laws and regulations of the locale and country where the study was conducted, and in compliance with the International Conference on Harmonisation E6 Good Clinical Practice Guidelines. The rationale of the study, procedural details, and investigational goals were explained to each subject, along with potential risks and benefits. Each subject was assured of his/her right to withdraw from the study at any time. Prior to the initiation of any study procedures, each subject signed and dated an approved informed consent form.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    13 May 2014
    Long term follow-up planned
    Yes
    Long term follow-up rationale
    Safety, Efficacy
    Long term follow-up duration
    12 Months
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Poland: 83
    Country: Number of subjects enrolled
    Spain: 3
    Country: Number of subjects enrolled
    United Kingdom: 2
    Country: Number of subjects enrolled
    France: 1
    Country: Number of subjects enrolled
    Germany: 10
    Country: Number of subjects enrolled
    Hungary: 12
    Country: Number of subjects enrolled
    Italy: 1
    Country: Number of subjects enrolled
    Belarus: 75
    Country: Number of subjects enrolled
    Israel: 6
    Country: Number of subjects enrolled
    Japan: 193
    Country: Number of subjects enrolled
    Russian Federation: 80
    Country: Number of subjects enrolled
    South Africa: 56
    Country: Number of subjects enrolled
    United States: 125
    Worldwide total number of subjects
    647
    EEA total number of subjects
    112
    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)
    568
    From 65 to 84 years
    79
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    -

    Pre-assignment
    Screening details
    4-week screening period (Weeks -4 to 0)

    Period 1
    Period 1 title
    Part 1
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator, Monitor, Data analyst, Carer, Assessor

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    CHS-0214
    Arm description
    Subjects were assigned the treatment group as randomized.
    Arm type
    Experimental

    Investigational medicinal product name
    CHS-0214
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Injection
    Routes of administration
    Subcutaneous use
    Dosage and administration details
    A 50 mg dose of CHS-0214 was administered once a week (QW) by subcutaneous (SC) injection, from Week 0 Day 0 through Week 24.

    Arm title
    Enbrel (EU)
    Arm description
    Subjects were assigned the treatment group as randomized.
    Arm type
    Active comparator

    Investigational medicinal product name
    Enbrel (EU)
    Investigational medicinal product code
    Other name
    etanercept
    Pharmaceutical forms
    Injection
    Routes of administration
    Subcutaneous use
    Dosage and administration details
    A 50 mg dose of Enbrel (EU) was administered once a week (QW) by subcutaneous (SC) injection, from Week 0 Day 0 through Week 24.

    Number of subjects in period 1
    CHS-0214 Enbrel (EU)
    Started
    324
    323
    Completed
    312
    301
    Not completed
    12
    22
         Consent withdrawn by subject
    7
    7
         Disease progression
    -
    1
         Adverse event, non-fatal
    2
    10
         Other
    1
    4
         Lost to follow-up
    1
    -
         Protocol deviation
    1
    -
    Period 2
    Period 2 title
    Part 2
    Is this the baseline period?
    No
    Allocation method
    Not applicable
    Blinding used
    Not blinded

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    CHS-0214/CHS-0214
    Arm description
    Part 2 was an open-label period.
    Arm type
    Experimental

    Investigational medicinal product name
    CHS-0214
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Injection
    Routes of administration
    Subcutaneous use
    Dosage and administration details
    Following Part 1 (during which a 50 mg dose of CHS-0214 was administered QW by SC injection, from Week 0 Day 0 through Week 24), subjects continued on CHS-0214 in Part 2. A 50 mg dose of CHS-0214 was administered QW by SC injection, starting at Week 25, through Week 47.

    Arm title
    Enbrel (EU)/CHS-0214
    Arm description
    Part 2 was an open-label period.
    Arm type
    Experimental

    Investigational medicinal product name
    CHS-0214
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Injection
    Routes of administration
    Subcutaneous use
    Dosage and administration details
    Following Part 1 (during which a 50 mg dose of Enbrel (EU) was administered QW by SC injection, from Week 0 Day 0 through Week 24), subjects switched to CHS-0214 in Part 2. A 50 mg dose of CHS-0214 was administered QW by SC injection, starting at Week 25, through Week 47.

    Number of subjects in period 2 [1]
    CHS-0214/CHS-0214 Enbrel (EU)/CHS-0214
    Started
    284
    280
    Completed
    272
    269
    Not completed
    12
    11
         Consent withdrawn by subject
    3
    2
         Physician decision
    1
    1
         Adverse event, non-fatal
    5
    5
         ACR20 not met at Week 24
    -
    1
         Other
    1
    -
         Conversion of TB test to positive
    1
    1
         Lost to follow-up
    -
    1
         Protocol deviation
    1
    -
    Notes
    [1] - The number of subjects starting the period is not consistent with the number completing the preceding period. It is expected the number of subjects starting the subsequent period will be the same as the number completing the preceding period.
    Justification: Not all subjects qualified for Part 2. Only subjects who completed the 24-week, double-blind portion of the study (Part 1), attained at least a 20% improvement according to American College of Rheumatology (ACR) criteria (ie, ACR20) response at Week 24, and tolerated study drug in Part 1 with no serious adverse events or unresolved Grade 3 or higher adverse events related to study drug (per Investigator) were eligible for Part 2 and received open-label CHS-0214 50 mg QW SC beginning at Week 25.

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    CHS-0214
    Reporting group description
    Subjects were assigned the treatment group as randomized.

    Reporting group title
    Enbrel (EU)
    Reporting group description
    Subjects were assigned the treatment group as randomized.

    Reporting group values
    CHS-0214 Enbrel (EU) Total
    Number of subjects
    324 323 647
    Age categorical
    Units: Subjects
        In utero
    0 0 0
        Preterm newborn infants (gestational age < 37 wks)
    0 0 0
        Newborns (0-27 days)
    0 0 0
        Infants and toddlers (28 days-23 months)
    0 0 0
        Children (2-11 years)
    0 0 0
        Adolescents (12-17 years)
    0 0 0
        Adults (18-64 years)
    285 283 568
        From 65-84 years
    39 40 79
        85 years and over
    0 0 0
    Gender categorical
    Units: Subjects
        Female
    260 257 517
        Male
    64 66 130
    Subject analysis sets

    Subject analysis set title
    CHS-0214 - FAP Part 1
    Subject analysis set type
    Full analysis
    Subject analysis set description
    The Full Analysis Population (FAP) included all subjects randomized who received 1 or more doses of the study drug after the study was restarted, and was the primary efficacy analysis population.

    Subject analysis set title
    Enbrel (EU) - FAP Part 1
    Subject analysis set type
    Full analysis
    Subject analysis set description
    The Full Analysis Population (FAP) included all subjects randomized who received 1 or more doses of the study drug after the study was restarted and was the primary efficacy analysis population.

    Subject analysis sets values
    CHS-0214 - FAP Part 1 Enbrel (EU) - FAP Part 1
    Number of subjects
    256
    256
    Age categorical
    Units: Subjects
        In utero
    0
    0
        Preterm newborn infants (gestational age < 37 wks)
    0
    0
        Newborns (0-27 days)
    0
    0
        Infants and toddlers (28 days-23 months)
    0
    0
        Children (2-11 years)
    0
    0
        Adolescents (12-17 years)
    0
    0
        Adults (18-64 years)
    231
    226
        From 65-84 years
    25
    30
        85 years and over
    0
    0
    Age continuous
    Units:
        
    ±
    ±
    Gender categorical
    Units: Subjects
        Female
    208
    206
        Male
    48
    50

    End points

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    End points reporting groups
    Reporting group title
    CHS-0214
    Reporting group description
    Subjects were assigned the treatment group as randomized.

    Reporting group title
    Enbrel (EU)
    Reporting group description
    Subjects were assigned the treatment group as randomized.
    Reporting group title
    CHS-0214/CHS-0214
    Reporting group description
    Part 2 was an open-label period.

    Reporting group title
    Enbrel (EU)/CHS-0214
    Reporting group description
    Part 2 was an open-label period.

    Subject analysis set title
    CHS-0214 - FAP Part 1
    Subject analysis set type
    Full analysis
    Subject analysis set description
    The Full Analysis Population (FAP) included all subjects randomized who received 1 or more doses of the study drug after the study was restarted, and was the primary efficacy analysis population.

    Subject analysis set title
    Enbrel (EU) - FAP Part 1
    Subject analysis set type
    Full analysis
    Subject analysis set description
    The Full Analysis Population (FAP) included all subjects randomized who received 1 or more doses of the study drug after the study was restarted and was the primary efficacy analysis population.

    Primary: ACR20 at Week 24

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    End point title
    ACR20 at Week 24
    End point description
    The primary efficacy endpoint in Part 1 was the percentage of subjects who achieved ACR20 at Week 24 compared to baseline (last non-missing value prior to first dose). Subjects were considered an ACR20 responder if, when compared to baseline (last non-missing value prior to first dose), they achieved a 20% decrease in SJC, 20% decrease in TJC, and 20% improvement in 3 of the following 5 measures: • High sensitivity C-reactive protein (hs-CRP); • Health Assessment Questionnaire-Disability Index (HAQ-DI); • Subject’s global assessment of pain (ie, subject’s pain assessment [SPA]-visual analog scale [VAS]); • Subject’s global assessment of disease activity (SGA-VAS); and • Physician’s global assessment of disease activity (PGA-VAS).
    End point type
    Primary
    End point timeframe
    From Baseline to Week 24
    End point values
    CHS-0214 - FAP Part 1 Enbrel (EU) - FAP Part 1
    Number of subjects analysed
    256
    256
    Units: percent
        number (not applicable)
    91
    90.6
    Statistical analysis title
    Percentage of subjects achieving ACR20
    Comparison groups
    CHS-0214 - FAP Part 1 v Enbrel (EU) - FAP Part 1
    Number of subjects included in analysis
    512
    Analysis specification
    Pre-specified
    Analysis type
    equivalence [1]
    Method
    Parameter type
    Estimated treatment difference, weighted
    Point estimate
    0.41
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -4.55
         upper limit
    5.37
    Variability estimate
    Standard error of the mean
    Dispersion value
    2.531
    Notes
    [1] - Cochran-Mantel-Haenszel (CMH) test for bioequivalence, weight adjusted. Equivalence was based upon the 95% (2-sided) confidence interval (CI) for the difference in ACR20 rates at Week 24 compared to baseline (last non-missing value prior to first dose). If the 95% CI was contained within the pre-specified equivalence range, equivalence was established.

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    From Baseline to Week 48
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    17.0
    Reporting groups
    Reporting group title
    CHS-0214/CHS-0214, Parts 1 and 2
    Reporting group description
    -

    Reporting group title
    Enbrel (EU)/CHS-0214, Parts 1 and 2
    Reporting group description
    -

    Serious adverse events
    CHS-0214/CHS-0214, Parts 1 and 2 Enbrel (EU)/CHS-0214, Parts 1 and 2
    Total subjects affected by serious adverse events
         subjects affected / exposed
    15 / 324 (4.63%)
    24 / 320 (7.50%)
         number of deaths (all causes)
    0
    0
         number of deaths resulting from adverse events
    0
    0
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Benign ovarian tumour
         subjects affected / exposed
    0 / 324 (0.00%)
    1 / 320 (0.31%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Bladder neoplasm
         subjects affected / exposed
    0 / 324 (0.00%)
    1 / 320 (0.31%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Breast cancer
         subjects affected / exposed
    0 / 324 (0.00%)
    2 / 320 (0.63%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cervix carcinoma
         subjects affected / exposed
    1 / 324 (0.31%)
    1 / 320 (0.31%)
         occurrences causally related to treatment / all
    0 / 1
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Invasive ductal breast carcinoma
         subjects affected / exposed
    1 / 324 (0.31%)
    0 / 320 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pancreatic carcinoma
         subjects affected / exposed
    0 / 324 (0.00%)
    1 / 320 (0.31%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Papillary thyroid cancer
         subjects affected / exposed
    0 / 324 (0.00%)
    1 / 320 (0.31%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Vascular disorders
    Hypertension
         subjects affected / exposed
    1 / 324 (0.31%)
    1 / 320 (0.31%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Reproductive system and breast disorders
    Endometrial hyperplasia
         subjects affected / exposed
    1 / 324 (0.31%)
    0 / 320 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Alveolitis allergic
         subjects affected / exposed
    0 / 324 (0.00%)
    1 / 320 (0.31%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Bronchospasm
         subjects affected / exposed
    1 / 324 (0.31%)
    0 / 320 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Chronic obstructive pulmonary disease
         subjects affected / exposed
    0 / 324 (0.00%)
    1 / 320 (0.31%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Investigations
    Blood creatine phosphokinase increased
         subjects affected / exposed
    1 / 324 (0.31%)
    0 / 320 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Injury, poisoning and procedural complications
    Facial bones fracture
         subjects affected / exposed
    0 / 324 (0.00%)
    1 / 320 (0.31%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Peripheral nerve injury
         subjects affected / exposed
    1 / 324 (0.31%)
    0 / 320 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Wound dehiscence
         subjects affected / exposed
    1 / 324 (0.31%)
    0 / 320 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Wrist fracture
         subjects affected / exposed
    0 / 324 (0.00%)
    1 / 320 (0.31%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cardiac disorders
    Acute myocardial infarction
         subjects affected / exposed
    2 / 324 (0.62%)
    0 / 320 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Angina unstable
         subjects affected / exposed
    1 / 324 (0.31%)
    0 / 320 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Myocardial infarction
         subjects affected / exposed
    1 / 324 (0.31%)
    0 / 320 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Myocardial ischaemia
         subjects affected / exposed
    1 / 324 (0.31%)
    0 / 320 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Ventricular tachycardia
         subjects affected / exposed
    0 / 324 (0.00%)
    1 / 320 (0.31%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Nervous system disorders
    Cerebrovascular accident
         subjects affected / exposed
    0 / 324 (0.00%)
    1 / 320 (0.31%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Ischaemic stroke
         subjects affected / exposed
    0 / 324 (0.00%)
    1 / 320 (0.31%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Blood and lymphatic system disorders
    Leukocytosis
         subjects affected / exposed
    0 / 324 (0.00%)
    1 / 320 (0.31%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Eye disorders
    Age-related macular degeneration
         subjects affected / exposed
    0 / 324 (0.00%)
    1 / 320 (0.31%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gastrointestinal disorders
    Gastrointestinal motility disorder
         subjects affected / exposed
    1 / 324 (0.31%)
    0 / 320 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Hepatobiliary disorders
    Cholecystitis
         subjects affected / exposed
    1 / 324 (0.31%)
    0 / 320 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cholelithiasis
         subjects affected / exposed
    1 / 324 (0.31%)
    0 / 320 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Skin and subcutaneous tissue disorders
    Skin ulcer
         subjects affected / exposed
    0 / 324 (0.00%)
    1 / 320 (0.31%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Renal and urinary disorders
    Nephrotic syndrome
         subjects affected / exposed
    0 / 324 (0.00%)
    1 / 320 (0.31%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Musculoskeletal and connective tissue disorders
    Osteoarthritis
         subjects affected / exposed
    1 / 324 (0.31%)
    1 / 320 (0.31%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Rheumatoid arthritis
         subjects affected / exposed
    0 / 324 (0.00%)
    1 / 320 (0.31%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Infections and infestations
    Abscess limb
         subjects affected / exposed
    0 / 324 (0.00%)
    1 / 320 (0.31%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Bronchitis
         subjects affected / exposed
    1 / 324 (0.31%)
    0 / 320 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gastroenteritis
         subjects affected / exposed
    0 / 324 (0.00%)
    1 / 320 (0.31%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pilonidal cyst
         subjects affected / exposed
    0 / 324 (0.00%)
    1 / 320 (0.31%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pneumocystis jirovecii pneumonia
         subjects affected / exposed
    1 / 324 (0.31%)
    0 / 320 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pyelonephritis
         subjects affected / exposed
    0 / 324 (0.00%)
    1 / 320 (0.31%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Sepsis
         subjects affected / exposed
    0 / 324 (0.00%)
    1 / 320 (0.31%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Wound infection
         subjects affected / exposed
    1 / 324 (0.31%)
    0 / 320 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Metabolism and nutrition disorders
    Diabetic ketoacidosis
         subjects affected / exposed
    0 / 324 (0.00%)
    1 / 320 (0.31%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 2%
    Non-serious adverse events
    CHS-0214/CHS-0214, Parts 1 and 2 Enbrel (EU)/CHS-0214, Parts 1 and 2
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    240 / 324 (74.07%)
    243 / 320 (75.94%)
    Investigations
    Alanine aminotransferase increased
         subjects affected / exposed
    13 / 324 (4.01%)
    15 / 320 (4.69%)
         occurrences all number
    14
    16
    Aspartate aminotransferase increased
         subjects affected / exposed
    7 / 324 (2.16%)
    13 / 320 (4.06%)
         occurrences all number
    7
    14
    Vascular disorders
    Hypertension
         subjects affected / exposed
    11 / 324 (3.40%)
    12 / 320 (3.75%)
         occurrences all number
    12
    12
    Nervous system disorders
    Headache
         subjects affected / exposed
    20 / 324 (6.17%)
    8 / 320 (2.50%)
         occurrences all number
    30
    10
    General disorders and administration site conditions
    Injection site reaction
         subjects affected / exposed
    9 / 324 (2.78%)
    44 / 320 (13.75%)
         occurrences all number
    11
    78
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    7 / 324 (2.16%)
    8 / 320 (2.50%)
         occurrences all number
    8
    8
    Gastrointestinal disorders
    Diarrhoea
         subjects affected / exposed
    6 / 324 (1.85%)
    7 / 320 (2.19%)
         occurrences all number
    6
    7
    Nausea
         subjects affected / exposed
    9 / 324 (2.78%)
    5 / 320 (1.56%)
         occurrences all number
    9
    6
    Respiratory, thoracic and mediastinal disorders
    Cough
         subjects affected / exposed
    12 / 324 (3.70%)
    11 / 320 (3.44%)
         occurrences all number
    12
    11
    Skin and subcutaneous tissue disorders
    Rash
         subjects affected / exposed
    7 / 324 (2.16%)
    4 / 320 (1.25%)
         occurrences all number
    8
    4
    Musculoskeletal and connective tissue disorders
    Arthralgia
         subjects affected / exposed
    5 / 324 (1.54%)
    7 / 320 (2.19%)
         occurrences all number
    6
    11
    Back pain
         subjects affected / exposed
    8 / 324 (2.47%)
    10 / 320 (3.13%)
         occurrences all number
    8
    10
    Rheumatoid arthritis
         subjects affected / exposed
    10 / 324 (3.09%)
    11 / 320 (3.44%)
         occurrences all number
    11
    13
    Infections and infestations
    Bronchitis
         subjects affected / exposed
    10 / 324 (3.09%)
    13 / 320 (4.06%)
         occurrences all number
    10
    14
    Cystitis
         subjects affected / exposed
    8 / 324 (2.47%)
    7 / 320 (2.19%)
         occurrences all number
    8
    7
    Herpes zoster
         subjects affected / exposed
    7 / 324 (2.16%)
    5 / 320 (1.56%)
         occurrences all number
    7
    5
    Nasopharyngitis
         subjects affected / exposed
    46 / 324 (14.20%)
    39 / 320 (12.19%)
         occurrences all number
    58
    49
    Oral herpes
         subjects affected / exposed
    7 / 324 (2.16%)
    10 / 320 (3.13%)
         occurrences all number
    7
    12
    Respiratory tract infection viral
         subjects affected / exposed
    8 / 324 (2.47%)
    3 / 320 (0.94%)
         occurrences all number
    10
    4
    Sinusitis
         subjects affected / exposed
    9 / 324 (2.78%)
    10 / 320 (3.13%)
         occurrences all number
    11
    11
    Upper respiratory tract infection
         subjects affected / exposed
    16 / 324 (4.94%)
    32 / 320 (10.00%)
         occurrences all number
    19
    39
    Urinary tract infection
         subjects affected / exposed
    22 / 324 (6.79%)
    17 / 320 (5.31%)
         occurrences all number
    31
    18

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    15 Apr 2014
    - Revised study objectives to specify subjects should be naïve to biologic therapies and clarified how study drug was to be referenced - Specified how study drug dosing was transitioned from Part 1 to Part 2 and from Part 2 to OLSES - Inclusion and exclusion criteria were edited to better define the selection of the study population - Clarified removal of subjects from therapy or assessment - Clarified treatments administered, selection, and timing of doses in study - Specified blind was to be maintained until last subject completed Part 2 - Added details regarding study drug dispensing - Clarified prior and concomitant medications - Explained serum samples regarding treatment compliance - Added instructions for dosing subjects in Part 2 - Specified requirement to assess all previous injection sites at all visits after Day 0 - Added further specification and explanation regarding primary efficacy variables (ACR20, 66/68 SJC/TJC, CRP, HAQ-DI, subject’s pain assessment, SGA, and PGA) - Added instructions for calculating DAS28-CRP(4) and explained scores - Defined response duration variables for Part 2 - Added respiratory rate to vital sign measurements and clarified methods and timing of vital signs and electrocardiogram assessments - Clarified use for and retention of serum samples - Specified analyses to be performed by local and central laboratories - Defined the PK Concentration Population and described use of serum samples for PK analysis - Added details regarding Data Safety Monitoring Board evaluation at end of Part 1
    22 May 2014
    - Added instruction that subjects who discontinue study drug for any reason during Part 1 should return for all Part 1 study visits per protocol - Inclusion and exclusion criteria were edited to better define the selection of the study population: added approved kinase inhibitors as DMARDs; added that subjects with recent known exposure to a patient with TB should be excluded; added that patients with an indeterminate QuantiFERON-TB Gold test could be rescreened 1 time and if a negative result, the subject could participate in the study; and added that male subjects whose partners may become pregnant or who may breastfeed during the study are not eligible to participate - Clarified removal of subjects from therapy or assessment - Revised handling of used syringes and specified subjects were not required to bring unused syringes to each visit - Clarified that oral corticosteroids and methotrexate doses could be reduced during the study for safety considerations only - Clarified ISRs regarding first dose of study drug and reporting as an “ISR” adverse event - Specified that if the subject’s normal dosing schedule coincides with a study visit the subject should be reminded to hold their dose until after the study visit - Added that the online DAS28-CRP(4) calculator was provided to sites by Medpace - Clarified QuantiFERON-TB Gold test screening and chest x-ray
    26 Aug 2014
    - Clarified that joints injected at screening will not be calculated in the screening joint count assessment but will be included in the baseline joint count assessment - Clarified that joints injected during Part 2 will not be eliminated in subsequent joint counts but should be noted as swollen and tender - Inclusion and exclusion criteria were edited to better define the selection of the study population: removed CRP criteria from the definition of active disease and added DAS28-CRP(4) as an inclusion criterion; added abstinence as an allowable form of birth control for women of childbearing potential; clarified that other disease processes, not only evidence of TB, demonstrated on abnormal chest x-ray would exclude subjects; also clarified that a chest x-ray should be obtained during screening if one is not available with in the previous 6 months; and clarified possible regional infections that may be covered by regional guidelines - Added that a positive QuantiFERON-TB Gold test at any time during the study is cause for termination of the subject from the study - Added that females using abstinence as birth control will have a urine pregnancy test at each study visit; also added for Argentina only that females of childbearing potential and not surgically sterile will have a monthly urine pregnancy test - Clarified instructions for subject disposal of used syringes - Clarified that baseline labs did not need to be repeated if screening labs were drawn within 2 weeks prior to baseline visit - Added clarification for recording ISRs as adverse events
    06 Nov 2014
    Excluded Japan. - Removed language that 200 subjects had to complete Part 2 for the Part 1 database to be cleaned and locked and that the Data Safety Monitoring Board had to meet after the last subject completes the 24-week evaluations during Part 1 - Prohibited administration of a live vaccine within 4 weeks prior to screening - Specified that study drug syringes were to be inspected by study personnel prior to dispensation - Revised for consistency that a steroid injection for a single joint at or after Week 24 should be noted as swollen and tender going forward - Updated testing methods for positive HIV results
    26 Feb 2015
    - Added information defining when subjects should have returned for their Follow-up Visit in relation to when they discontinued study drug - Revised text throughout to reflect the decision to offer OLSES in selected countries - Specified that for subjects who were taking leflunomide, cholestyramine should have been administered to facilitate excretion of leflunomide 2 weeks prior to screening - Clarified the requirements for the use of abstinence as a means of birth control - Clarified the TB testing entry criteria and what results permitted a repeat test - Increased sample size to account for the number of subjects who were randomized prior to study drug suspension - Clarified use of a topical NSAID as an allowed NSAID - Added verbiage to comply with Japanese Society of Hematology guidelines for management of hepatitis B - Specified that subjects were to bring back all unused study drug at their Week 24 Visit - Added definition for unexpected adverse events - Added that adverse event outcomes were to be recorded by the Investigator - Clarified Sponsor reporting requirements of serious adverse events and/or suspected unexpected serious adverse events - Updated analysis plan based on study drug dosing suspension - Specified that Population 1 and Population 2 were to be analyzed separately - Revised definitions of Full Analysis and Safety Populations and Japanese Population based on study drug dosing suspension - Clarified restrictions for administration of live vaccines to be within 4 week prior to screening or at any time during the course of the study

    Interruptions (globally)

    Were there any global interruptions to the trial? Yes
    Date
    Interruption
    Restart date
    30 Oct 2014
    During the conduct of the study, enrollment and dosing of subjects was voluntarily suspended by the Sponsor. During routine visual inspection of study drug in storage, 4 syringes containing CHS-0214 from a lot in use in Study CHS-0214-04 were observed to contain small dark particles. In the interest of patient safety, dosing of the ongoing Phase 3 clinical trials was immediately stopped, and an investigation was initiated to determine the cause and incidence of the observed particulate. A chemical analysis by an independent laboratory determined that the particles were not the result of drug product instability or formulation. Upon conclusion of the investigation, the lot was replaced in clinical inventory, and enrollment and dosing were resumed.
    05 Nov 2014

    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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