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    Clinical Trial Results:
    A Phase I Pharmacokinetic and Safety Study of Tocilizumab (TCZ) in Patients Less Than 2 Years Old with Active Systemic Juvenile Idiopathic Arthritis (sJIA)

    Summary
    EudraCT number
    2015-000435-33
    Trial protocol
    DE   HU   BE   ES   PL   GB   FR  
    Global end of trial date
    13 Jul 2017

    Results information
    Results version number
    v2
    This version publication date
    10 Aug 2017
    First version publication date
    12 Feb 2017
    Other versions
    v1 , v3
    Version creation reason

    Trial information

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    Trial identification
    Sponsor protocol code
    NP25737
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT01455701
    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?
    Yes
    Results analysis stage
    Analysis stage
    Interim
    Date of interim/final analysis
    28 Jul 2016
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    28 Jul 2016
    Global end of trial reached?
    Yes
    Global end of trial date
    13 Jul 2017
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    To evaluate the pharmacokinetics of tocilizumab over 12 weeks in participants less than 2 years of age with sJIA.
    Protection of trial subjects
    The investigator ensured that this study was conducted in full conformance with the principles of the “Declaration of Helsinki” or with the laws and regulations of the country in which the research was conducted, whichever afforded the greater protection to the individual. The study fully adhered to the principles outlined in current “Guideline for Good Clinical Practice” International Conference on Harmonization (ICH) Tripartite Guideline or with local law if it afforded greater protection to the participant.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    26 Oct 2012
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Argentina: 1
    Country: Number of subjects enrolled
    Belgium: 2
    Country: Number of subjects enrolled
    Germany: 1
    Country: Number of subjects enrolled
    Spain: 1
    Country: Number of subjects enrolled
    Hungary: 1
    Country: Number of subjects enrolled
    United States: 5
    Worldwide total number of subjects
    11
    EEA total number of subjects
    5
    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)
    11
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    0
    From 65 to 84 years
    0
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    -

    Pre-assignment
    Screening details
    Total 11 participants were enrolled, all of which were treated by tocilizumab.

    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
    Arm description
    Participants received tocilizumab intravenous (IV) infusion at a dose of 12 milligrams per kilogram (mg/kg) every two weeks (Q2W) during main evaluation period of 12 weeks (a total of 6 infusions including one at baseline visit). Participants had the option to be treated in an optional extension period after completion of main evaluation period. In optional extension period, participants received tocilizumab 12 mg/kg IV infusion Q2W from Week 12 until the participant reached 2 years of age or had been treated for one year from baseline, whichever was longer.
    Arm type
    Experimental

    Investigational medicinal product name
    Tocilizumab
    Investigational medicinal product code
    RO4877533
    Other name
    RoActemra; Actemra
    Pharmaceutical forms
    Concentrate for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Tocilizumab was administered as indicated in the arm description.

    Number of subjects in period 1
    Tocilizumab
    Started
    11
    Completed
    7
    Not completed
    4
         Adverse event
    4

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Tocilizumab
    Reporting group description
    Participants received tocilizumab intravenous (IV) infusion at a dose of 12 milligrams per kilogram (mg/kg) every two weeks (Q2W) during main evaluation period of 12 weeks (a total of 6 infusions including one at baseline visit). Participants had the option to be treated in an optional extension period after completion of main evaluation period. In optional extension period, participants received tocilizumab 12 mg/kg IV infusion Q2W from Week 12 until the participant reached 2 years of age or had been treated for one year from baseline, whichever was longer.

    Reporting group values
    Tocilizumab Total
    Number of subjects
    11 11
    Age Categorical
    Units: Subjects
        Infants and toddlers (28 days - 23 months)
    11 11
    Age Continuous
    Units: months
        arithmetic mean (standard deviation)
    15.9 ( 4 ) -
    Gender Categorical
    Units: Subjects
        Female
    7 7
        Male
    4 4

    End points

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    End points reporting groups
    Reporting group title
    Tocilizumab
    Reporting group description
    Participants received tocilizumab intravenous (IV) infusion at a dose of 12 milligrams per kilogram (mg/kg) every two weeks (Q2W) during main evaluation period of 12 weeks (a total of 6 infusions including one at baseline visit). Participants had the option to be treated in an optional extension period after completion of main evaluation period. In optional extension period, participants received tocilizumab 12 mg/kg IV infusion Q2W from Week 12 until the participant reached 2 years of age or had been treated for one year from baseline, whichever was longer.

    Primary: Maximum Serum Concentration (Cmax) of Tocilizumab

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    End point title
    Maximum Serum Concentration (Cmax) of Tocilizumab [1]
    End point description
    Pharmacokinetic profile of tocilizumab was evaluated in terms of model predicted Cmax at steady state. Pharmacokinetic-evaluable population included all participants who provided at least one serum pharmacokinetic sample with valid concentration data.
    End point type
    Primary
    End point timeframe
    Pre-infusion (Hour 0) on Days 1, 15, 29, 43, 57, 71, and 85; at the end of infusion on Days 1, 29 and 71; and anytime on Days 8, 36, and 78 (infusion length = 1 hour)
    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 analysis was planned for this study.
    End point values
    Tocilizumab
    Number of subjects analysed
    11
    Units: micrograms per milliliter (mcg/mL)
        arithmetic mean (standard deviation)
    288 ( 40.4 )
    No statistical analyses for this end point

    Primary: Minimum Serum Concentration (Cmin) of Tocilizumab

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    End point title
    Minimum Serum Concentration (Cmin) of Tocilizumab [2]
    End point description
    Pharmacokinetic profile of tocilizumab was evaluated in terms of observed Cmin at day 85. Pharmacokinetic-evaluable population.
    End point type
    Primary
    End point timeframe
    Pre-infusion (Hour 0) on day 85; (infusion length = 1 hour)
    Notes
    [2] - 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 analysis was planned for this study.
    End point values
    Tocilizumab
    Number of subjects analysed
    11
    Units: mcg/mL
        arithmetic mean (standard deviation)
    69.21 ( 42.02 )
    No statistical analyses for this end point

    Primary: Model predicted Area Under the Serum Concentration-Time Curve from Time Zero to End of Dosing (AUCtau) of Tocilizumab

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    End point title
    Model predicted Area Under the Serum Concentration-Time Curve from Time Zero to End of Dosing (AUCtau) of Tocilizumab [3]
    End point description
    AUCtau is the model-predicted area under the tocilizumab serum concentration versus time curve from time zero to the end of dosing interval (2 weeks). Pharmacokinetic-evaluable population.
    End point type
    Primary
    End point timeframe
    Pre-infusion (Hour 0) on Days 1, 15, 29, 43, 57, 71, and 85; at the end of infusion on Days 1, 29 and 71; and anytime on Days 8, 36, and 78 (infusion length = 1 hour)
    Notes
    [3] - 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 analysis was planned for this study.
    End point values
    Tocilizumab
    Number of subjects analysed
    11
    Units: micrograms*day per milliliter
        arithmetic mean (standard deviation)
    947.4 ( 231.2 )
    No statistical analyses for this end point

    Secondary: Number of Participants With Adverse Events (AEs) and Serious AEs

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    End point title
    Number of Participants With Adverse Events (AEs) and Serious AEs
    End point description
    Number of participants with categorized AEs and serious AEs is reported. Detailed information of AEs is provided in the AEs section.
    End point type
    Secondary
    End point timeframe
    Baseline up to end of the study (up to approximately 60 weeks)
    End point values
    Tocilizumab
    Number of subjects analysed
    11
    Units: participants
        AE with fatal outcome
    0
        Serious AE
    3
        Serious AE leading to withdrawal
    3
        Serious AE leading to dose modification
    0
        Related Serious AE
    3
        AE leading to withdrawal
    4
        AE leading to dose modification
    1
        Related AE
    6
        Related AE leading to withdrawal
    4
        Related AE leading to dose modification
    1
        Total number of patients with at least one AE
    10
        Total number of deaths
    0
        Total number of patients withdrawn due an AE
    4
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Baseline up to end of the study (up to approximately 60 weeks)
    Assessment type
    Non-systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    19.0
    Reporting groups
    Reporting group title
    Tocilizumab
    Reporting group description
    Participants received tocilizumab intravenous (IV) infusion at a dose of 12 milligrams per kilogram (mg/kg) every two weeks (Q2W) for up to 10 weeks (a total of 6 infusions including one at baseline visit) in main evaluation period (12-week period) and 12 mg/kg every Q2W from week 12 until participant reached 2 years of age or had been treated for one year from baseline in optional extension period.

    Serious adverse events
    Tocilizumab
    Total subjects affected by serious adverse events
         subjects affected / exposed
    3 / 11 (27.27%)
         number of deaths (all causes)
    0
         number of deaths resulting from adverse events
    Immune system disorders
    Hypersensitivity
         subjects affected / exposed
    2 / 11 (18.18%)
         occurrences causally related to treatment / all
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    Skin and subcutaneous tissue disorders
    Urticaria
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Musculoskeletal and connective tissue disorders
    Juvenile idiopathic arthritis
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Infections and infestations
    Hand-foot-and-mouth disease
         subjects affected / exposed
    1 / 11 (9.09%)
         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
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    8 / 11 (72.73%)
    Investigations
    Transaminases increased
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Blood and lymphatic system disorders
    Neutropenia
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Thrombocytopenia
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    General disorders and administration site conditions
    Injection site reaction
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Immune system disorders
    Hypersensitivity
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Gastrointestinal disorders
    Chapped lips
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Dental caries
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Vomiting
         subjects affected / exposed
    2 / 11 (18.18%)
         occurrences all number
    2
    Respiratory, thoracic and mediastinal disorders
    Allergic respiratory symptom
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Skin and subcutaneous tissue disorders
    Dermatitis
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Rash
         subjects affected / exposed
    2 / 11 (18.18%)
         occurrences all number
    2
    Endocrine disorders
    Cushingoid
         subjects affected / exposed
    2 / 11 (18.18%)
         occurrences all number
    2
    Infections and infestations
    Ear infection
         subjects affected / exposed
    2 / 11 (18.18%)
         occurrences all number
    2
    Nasopharyngitis
         subjects affected / exposed
    2 / 11 (18.18%)
         occurrences all number
    2
    Respiratory tract infection viral
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Upper respiratory tract infection
         subjects affected / exposed
    4 / 11 (36.36%)
         occurrences all number
    4
    Metabolism and nutrition disorders
    Dehydration
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Hypercalcaemia
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Hyperlipidaemia
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    11 Oct 2011
    Protocol was amended for removal of sampling for anti-tocilizumab antibody, tocilizumab pharmacokinetics, and soluble interleukin-6 receptor (sIL-6R) at Week 18.
    30 Jan 2012
    Protocol was amended for making steroid tapering non-mandatory to remain stable for 6 weeks.
    29 Oct 2014
    Protocol was amended to change the time between diagnosis of sJIA and treatment with biologics from a 3-month delay to a 1-month delay.
    01 Jun 2015
    Protocol was amended to address concerns raised in the protocol review during the voluntary harmonization procedure in Europe. An exclusion criterion was amended to clarify that previous history of significant allergic or infusion reactions to any of the excipients listed in tocilizumab product labeling documents was part of this exclusion criterion.
    10 Feb 2016
    Protocol was amended mainly to clarify an inclusion criterion that it was intended to refer to the 1 month period of symptoms subsequent to the diagnosis of sJIA, before being considered for treatment with a biologic therapy, consistent with the updated American College of Rheumatology (ACR) recommendations for the treatment of sJIA that outlined the use of biologic therapy.

    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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    The status and protocol content of GB trials is no longer updated since 1 January 2021. For the UK, as of 31 January 2021, EU Law applies only to the territory of Northern Ireland (NI) to the extent foreseen in the Protocol on Ireland/NI. Legal notice
    As of 31 January 2023, all EU/EEA initial clinical trial applications must be submitted through CTIS . Updated EudraCT trials information and information on PIP/Art 46 trials conducted exclusively in third countries continues to be submitted through EudraCT and published on this website.

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