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    Summary
    EudraCT Number:2016-000570-37
    Sponsor's Protocol Code Number:GS-US-417-0303
    National Competent Authority:Spain - AEMPS
    Clinical Trial Type:EEA CTA
    Trial Status:Completed
    Date on which this record was first entered in the EudraCT database:2017-01-13
    Trial results View results
    Index
    A. PROTOCOL INFORMATION
    B. SPONSOR INFORMATION
    C. APPLICANT IDENTIFICATION
    D. IMP IDENTIFICATION
    D.8 INFORMATION ON PLACEBO
    E. GENERAL INFORMATION ON THE TRIAL
    F. POPULATION OF TRIAL SUBJECTS
    G. INVESTIGATOR NETWORKS TO BE INVOLVED IN THE TRIAL
    N. REVIEW BY THE COMPETENT AUTHORITY OR ETHICS COMMITTEE IN THE COUNTRY CONCERNED
    P. END OF TRIAL
    Expand All   Collapse All
    A. Protocol Information
    A.1Member State ConcernedSpain - AEMPS
    A.2EudraCT number2016-000570-37
    A.3Full title of the trial
    A Randomized, Double-blind, Placebo-and Active-controlled, Multicenter, Phase 3 Study to Assess the Efficacy and Safety of Filgotinib Administered for 52 Weeks Alone and in Combination with Methotrexate (MTX) to Subjects with Moderately to Severely Active Rheumatoid Arthritis Who Are Naïve to MTX Therapy
    Estudio en fase III, aleatorizado, multicéntrico, con doble enmascaramiento, controlado con placebo y con principio activo, para evaluar la eficacia y la seguridad de filgotinib al administrarlo durante 52 semanas en monoterapia y en combinación con metotrexato (MTX) a pacientes con artritis reumatoide activa de moderada a grave que no han sido tratados previamente con MTX
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    Filgotinib Alone or in Combination With Methotrexate in Adults With Moderately to Severely Active Rheumatoid Arthritis Who Have Not Yet Started Methotrexate Treatment
    Filgotinib solo o en combinación con Metrotrexato en Adultos con artritis reumatoide activa de moderada a grave que no hayan empezado el tratamiento con Metrotrexato.
    A.4.1Sponsor's protocol code numberGS-US-417-0303
    A.7Trial is part of a Paediatric Investigation Plan No
    A.8EMA Decision number of Paediatric Investigation Plan
    B. Sponsor Information
    B.Sponsor: 1
    B.1.1Name of SponsorGilead Sciences, Inc.
    B.1.3.4CountryUnited States
    B.3.1 and B.3.2Status of the sponsorCommercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportGilead Sciences, Inc.
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationGilead Sciences International Ltd.
    B.5.2Functional name of contact pointClinical Trials Mailbox
    B.5.3 Address:
    B.5.3.1Street AddressFlowers Building, Granta Park
    B.5.3.2Town/ cityAbington, Cambridge
    B.5.3.3Post codeCB21 6GT
    B.5.3.4CountryUnited Kingdom
    B.5.4Telephone number+441223897476
    B.5.6E-mailclinical.trials@gilead.com
    D. IMP Identification
    D.IMP: 1
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameFilgotinib
    D.3.2Product code GS-6034
    D.3.4Pharmaceutical form Film-coated tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNFILGOTINIB
    D.3.9.3Other descriptive nameFILGOTINIB
    D.3.9.4EV Substance CodeSUB182273
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number200
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 2
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameFilgotinib
    D.3.2Product code GS-6034
    D.3.4Pharmaceutical form Film-coated tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNFILGOTINIB
    D.3.9.3Other descriptive nameFILGOTINIB
    D.3.9.4EV Substance CodeSUB182273
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number100
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 3
    D.1.2 and D.1.3IMP RoleComparator
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name Methotrexate tablets 2.5 mg
    D.2.1.1.2Name of the Marketing Authorisation holderHospira UK Limited
    D.2.1.2Country which granted the Marketing AuthorisationUnited Kingdom
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameMethotrexate
    D.3.4Pharmaceutical form Capsule
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNMETHOTREXATE
    D.3.9.3Other descriptive nameMETHOTREXATE
    D.3.9.4EV Substance CodeSUB08856MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number2.5
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.8 Information on Placebo
    D.8 Placebo: 1
    D.8.1Is a Placebo used in this Trial?Yes
    D.8.3Pharmaceutical form of the placeboFilm-coated tablet
    D.8.4Route of administration of the placeboOral use
    D.8 Placebo: 2
    D.8.1Is a Placebo used in this Trial?Yes
    D.8.3Pharmaceutical form of the placeboFilm-coated tablet
    D.8.4Route of administration of the placeboOral use
    D.8 Placebo: 3
    D.8.1Is a Placebo used in this Trial?Yes
    D.8.3Pharmaceutical form of the placeboCapsule
    D.8.4Route of administration of the placeboOral use
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Moderately to severely active rheumatoid arthritis
    Artritis reumatoide activa de moderada a grave
    E.1.1.1Medical condition in easily understood language
    Rheumatoid arthritis
    Artritis reumatoide
    E.1.1.2Therapeutic area Diseases [C] - Musculoskeletal Diseases [C05]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 19.1
    E.1.2Level PT
    E.1.2Classification code 10039073
    E.1.2Term Rheumatoid arthritis
    E.1.2System Organ Class 10028395 - Musculoskeletal and connective tissue disorders
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    The primary objective of this study is to evaluate the effects of filgotinib in combination with MTX versus MTX alone for the treatment of signs and symptoms of rheumatoid arthritis (RA) as measured by the proportion of subjects achieving an American College of Rheumatology 20% improvement response (ACR20) at Week 24
    El objetivo principal de este estudio es evaluar los efectos de filgotinib en combinación con MTX frente a MTX solo para el tratamiento de los signos y síntomas de la artritis reumatoide (AR) determinados por la proporción de sujetos con una mejora del 20% en su respuesta según el criterio del Colegio Estadounidense de Reumatología (American College of Rheumatology 20% improvement response (ACR20) en la semana 24
    E.2.2Secondary objectives of the trial
    For a complete list of the secondary objective for this trial, please refer to the study protocol (section 2).
    1) To evaluate the effect of filgotinib in combination with MTX versus MTX alone:
    - on physical function as measured by change from Baseline in the Health Assessment Questionnaire Disability Index (HAQ-DI) score at Week 24
    - for the treatment of signs and symptoms of RA as measured by the proportion of subjects achieving Disease Activity Score for 28 joint count using C-reactive protein (DAS28 [CRP]) < 2.6 at Week 24
    2) To evaluate the effect of filgotinib alone versus MTX alone:
    - for the treatment of signs and symptoms of RA as measured by the proportion of subjects achieving ACR20 at Week 24
    - on physical function as measured by change from Baseline in HAQ-DI score at Week 24
    - for the treatment of signs and symptoms of RA as measured by the proportion of subjects achieving DAS28(CRP) <2.6 at Week 24
    Para una lista completa de los objetivos secundarios de este ensayo, refiérase al protocolo del estudio (sección 2).
    1) evaluar el efecto de filgotinib en combinación con MTX frente a MTX solo:
    -en la función física medida desde el nivel basal según el cuestionario del índice discapacidad (HAQ-DI) en semana 24
    -para el tratamiento de signos y síntomas de la AR medidos por la proporción de sujetos que alcanzan puntuación de actividad de la enfermedad a partir del recuento de 28 articulaciones y usando la proteína C-reactiva (DAS28 [CRP]) < 2.6 en semana 24
    2) para evaluar el efecto de filgotinib solo en comparación con MTX solo:
    -para el tratamiento de signos y síntomas de la AR medido por la proporción de sujetos con una mejora ACR20 en semana 24
    -en la función física medida por el cambio respecto al valor basal en la puntuación del HAQ-DI en la semana 24
    -para el tratam. signos y síntomas de AR medido como la proporción de sujetos que alcanzan DAS28(CRP) < 2.6 en semana 24
    E.2.3Trial contains a sub-study Yes
    E.2.3.1Full title, date and version of each sub-study and their related objectives
    MRI of Hand/Wrist: At selected sites, subjects may consent to participate in an optional Magnetic Resonance Imaging (MRI) substudy. In a subset of subjects (approximately 50 per dosing arm) who consent to the MRI substudy, MRI scans of a single hand/wrist will be performed at three time points: post-randomization (within 7 days of the first dose), Week 12, and Week 24. Determination of whether to image the subject’s right or left hand/wrist will be up to the judgment of the investigator, depending on clinical findings for disease activity at Day 1; the same hand/wrist should be scanned for the Week 12 and 24 MRIs. Subjects who fail the radiologic entry criteria of the MRI substudy with the first MRI, or who do not continue on to the Week 12 MRI, may be replaced by consenting additional subjects. Further details of the MRI substudy and procedural requirements will be provided to
    participating sites in a separate MRI manual.

    Inclusion criteria
    1) Subjects must fulfill entry criteria to the main study as described in protocol sections 4.2 and 4.3 above, and must provide written, informed consent to the MRI substudy.
    2) RA involvement of a minimum of one hand or wrist as confirmed by the investigator at screening; Screening (the same hand/wrist should be imaged at subsequent MRIs)
    3) Subject’s baseline MRI must fulfill radiologic entry criteria (by central reading) of either:
    a) Definitive intra-articular MRI synovitis (Rheumatoid Arthritis Magnetic Resonance Imaging Score (RAMRIS) Grade ≥2 in any applicable hand or wrist joint, or RAMRIS Grade 1 in ≥2 applicable joints)
    b) Definitive MRI osteitis (RAMRIS Grade ≥1) in any applicable bone.

    Exclusion criteria
    1) Inability to undergo an MRI examination (e.g., presence of a pacemaker, defibrillator, or other contraindicated implanted metallic device, such as anterior interbody cages, aneurysm clip or pedicle screws, severe claustrophobia or weight >350 lb)
    2) Metallic pigment-containing tattoos in the area of examination
    3) Known allergy to gadolinium-based contrast agents
    4) Difficult peripheral intravascular access
    Resonancia magnética de mano/muñeca: en los centros seleccionados, los sujetos pueden dar su consentimiento para participar en un subestudio opcional de imagen por resonancia magnética (IRM). En un subgrupo de sujetos (aproximadamente 50 sujetos por brazo) que consienten en participar en el subestudio, la RM de una sola mano/muñeca se llevará a cabo en tres momentos: la aleatorización (dentro de 7 días de la primera dosis), semana 12 y la semana 24.
    La determinación de si realiza la imagen de la mano/muñeca derecha o izquierda del sujeto será a criterio del investigador, dependiendo de los resultados clínicos de actividad de la enfermedad en el día 1; la misma mano/muñeca debe analizarse por IRM en la semana 12 y 24. Sujetos que no cumplen con los criterios radiológicos para ser incluidos en el subestudio de IRM, o que no continúan en la IRM de la semana 12, pueden ser reemplazados por otros sujetos que consientan. Más detalles sobre el subestudio de IRM y de los procedimientos necesarios se proporcionan en un manual IRM separado.
    Criterios de inclusión
    1) Los pacientes deben cumplir los criterios de entrada del studio principal, tal y como se describe en las secciones 4.2 y 4.3 más arriba, y deben proporcionar consentimiento informado por escrito al subestudio de RM.
    2) afectación de AR en al menos una mano o muñeca, confirmado por el investigador en la selección; Selección ( en las subsecuentes RMs se debe tomar imágenes de la misma mano/muñeca)
    3) la RM basal del sujeto debe cumplir con los criterios radiológicos de entrada( por lectura centralizada) o también:
    Sinovitis definitiva intra-articular por RM (RAMRIS Grado ≥2 en cualquier articulación, mano o muñeca aplicable, o RAMRIS Grado 1 en dos o más articulaciones aplicables.

    Criterios de exclusión
    1) incapacidad de realizarse un examen de RM ( ej: presencia de un, marcapasos, desfibrilador, o cualquier otro dispositivo métalico contraindicado, como caja intercorporal anterior, clip de aneurisma o tornillos en la piel, claustrofobia severa o peso mayor de 350 lb)
    2) Pigmento metálicos contenidos en tatuajes en el área de examen.
    3) Alergias conocidas al agentes de contraste basados en gadolinio.
    4) Dificultad en el acceso intravascular periférico.
    E.3Principal inclusion criteria
    For a complete list of study inclusion criteria, please refer to study protocol (Sections 4.2):
    1) Male or female subjects who are ≥18 years of age, on the day of signing informed consent.
    2) Have a diagnosis of RA (2010 ACR/EULAR criteria), and are ACR functional class I-III
    3) Have ≥6 swollen joints (from a SJC66) and ≥6 tender joints (from a TJC68) at both Screening and Day 1 (need not be the same joints)
    4) Must meet at least one of the Screening parameters defined in the protocol (section 4.2)
    5) Have limited or no prior treatment with MTX, ie, no more than 3 doses of MTX ≤25 mg each in the subject’s lifetime for the treatment of RA, with the last dose at least 28 days prior to Day 1, and are an appropriate candidate for MTX therapy, as per investigator judgment
    6) Females of childbearing potential (as defined in Appendix 5) must have a negative pregnancy test at Screening and Day 1
    7) Male subjects and female subjects of childbearing potential who engage in heterosexual intercourse must agree to use protocol specified method(s) of contraception
    8) Lactating female subjects must agree to discontinue nursing from Screening through the end of their study participation.
    9) Meet one of the tuberculosis (TB) Screening criteria described in the protocol (section 4.2)
    10) Able and willing to sign the informed consent as approved by the IEC/IRB. Written consent must be provided before initiating any screening evaluations. Subjects must have read and understood the informed consent form (ICF), must fully understand the requirements of the trial, and must be willing to comply with all trial visits and assessments; subjects who cannot read or understand the ICF may not be enrolled by a guardian or any other individual.
    11) Subjects receiving non-prohibited medication for any reason should be on a stable dose (defined as no change in prescription) within 7 days or 5 half-lives (whichever is longer) prior to the first administration of study drug on Day 1.
    Para una lista completa de los criterios de inclusión del estudio consulte el protocolo del estudio (secciones 4.2):
    1)Pacientes de ambos sexos, de edad ≥18 años en la fecha de firma del consentimiento informado.
    2)Con diagnóstico de AR (criterios ACR/EULAR de 2010) dentro de las clases funcionales I-III del ACR.
    3)Con un número de articulaciones inflamadas ≥6 (de SJC66) y de articulaciones dolorosas ≥6 (de TJC68) en la selección y el día 1.(no tienen por qué ser las mismas articulaciones)
    4)Con al menos uno de los siguientes parámetros de selección definidos en el Protocolo (sección 4.2)
    5)Tener un tratamiento limitado o ningún tratamiento en curso con MTX, no más de 3 dosis de MTX ≤25 mg cada una para el tratamiento de AR, con la última dosis por lo menos 28 días antes del día 1, y que según el criterio del investigador sea un candidato apropiado para terapia con MTX.

    6)Las mujeres en edad fértil deben tener un test de emabarazo negativo
    en la selección y en el Día 1.
    7)Pacientes de ambos sexos en edad fértil que tengan relaciones
    heterosexuales deben aceptar utilizar los métodos de contracepción
    específicados en el protocolo.
    8) Las mujeres en lactancia deben aceptar abandonar la lactancia desde
    la selección hasta el final de su participación en el estudio.
    9) Cumplir uno de los criterios de selección de tuberculosis (TB)
    descritos en el protocolo (sección 4.2).
    10)Ser capaz y querer firmar el consentimiento informados que haya
    sido aprobado por el Comité Ético Independiente(CEI)/Comité de
    Revisión Institucional (IRB). El consentimiento por escrito debe darse
    antes de iniciar ninguna evaluacion de selección. Los pacientes deben
    haber leido y entendido el formulario de consentimiento informado
    (ICF), deben entender por completo los requisitos del estudio, y deben
    querer cumplir con todas las visitas y valoraciones del estudio. Los
    pacientes que no puedan leer o entender el ICF no deben ser incluidos
    por un tutor u otra persona.
    11)Ser capaz y estar dispuesto a realizar autoinyecciones subcutáneas o
    tener un cuidador capaz, dispuesto y disponible para administrar las
    inyecciones.
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    12) Los pacientes recibiendo medicaciones no prohibidas por la razón
    que sea, deben estar en dosis estables (definido como sin cambios en la
    prescripción) durante 7 días o 5 vidas medias (lo que sea más largo)
    antes de la primera administración de fármaco del estudio en el Día 1.
    E.4Principal exclusion criteria
    For a complete list of study exclusion criteria, please refer to study protocol (Sections 4.3):
    1) Prior treatments for RA as defined in Section 4.3 of the protocol
    2) Known hypersensitivity or allergy to the study drug(s), its metabolites, or formulation excipients.
    3) Known hypersensitivity or allergy to the MTX, its metabolites, or formulation excipients.
    4) Oral steroids at a dose >10 mg/day of prednisone (or equivalent) or a prescription for oral steroids which has changed within 4 weeks of Day 1.
    5) Receipt of an intra-articular or other injectable corticosteroid within 4 weeks prior to Day 1.
    6) Use of non-steroidal anti-inflammatory drugs which have not been at a stable dose (defined as no change in prescription) for at least 2 weeks prior to Day 1. NOTE: subjects are permitted to take acetylsalicylic acid at a dose of ≤325mg daily for cardiac prophylaxis, or occasional NSAIDs for non-RA indications.
    7) Administration of a live/attenuated vaccine within 30 days from Day 1, or planned during the study.
    8) Participation in any clinical study of an investigational drug/device within 4 weeks or 5 half-lives prior to Screening, whichever is longer. Exposure to investigational biologics are excluded as outlined in 1d.
    9) Have undergone surgical treatments for RA, including synovectomy or arthroplasty in >4 joints
    10) Have any chronic, uncontrolled medical condition, which would put the subject at increased risk during study participation, such as uncontrolled: diabetes, hypertension, morbid obesity, thyroid, adrenal, pulmonary, hepatic, renal, neurologic or psychiatric disease, or other disease of concern, as per judgment of investigator.
    11) Have a history of major surgery (requiring regional block or general anesthesia) within the last 3 months prior to Screening or planned major surgery during the study.
    12) Have a moderately to severely active, generalized musculoskeletal disorder that would interfere with assessment of study parameters or increase risk to the subject by participating in the study
    13) Active autoimmune disease other than those listed above, that would interfere with assessment of study parameters or increase risk to the subject by participating in the study
    14) Any known condition or contraindication as addressed in the local labeling or local clinical practice for MTX that would preclude the subject from participating in this study.
    15) History of or current moderate to severe congestive heart failure (NYHA class III or IV), or within the last 6 months, a cerebrovascular accident, myocardial infarction, unstable angina, unstable arrhythmia new or significant ECG finding at Screening, or any other cardiovascular condition which, in the opinion of the Investigator, would put the subject at risk by participation in the protocol.
    16) History of malignancy within the past 5 years prior to Screening (except for adequately treated basal cell carcinoma or non-metastatic squamous cell carcinoma of the skin or cervical carcinoma in situ with no evidence of recurrence).
    17) History of lymphoproliferative disease or current lymphoproliferative disease.
    18) History of gastrointestinal perforation.
    19) History of organ or bone marrow transplant.
    20) Positive serology for human immunodeficiency virus (HIV) 1 or 2.
    21) Evidence of active Hepatitis C Virus (HCV) infection.
    22) Evidence of active Hepatitis B Virus (HBV) infection.
    23) History of opportunistic infection or immunodeficiency syndrome which would put the subject at risk, as per investigator judgment.
    24) Active infection that is clinically significant, as per judgment of the investigator, or any infection requiring hospitalization or treatment with intravenous anti-infectives within 60 days of Screening; or any infection requiring oral anti-infective therapy within 30 days of Screening.
    25) Currently on any therapy for chronic infection or past history of disseminated staphylococcus aureus or disseminated Herpes simplex infection.
    26) History of symptomatic herpes zoster within 12 weeks prior to Screening or have history of disseminated/complicated herpes zoster infection
    27) History of an infected joint prosthesis or other implanted device with retention of the prosthesis or device in situ.
    28) Current drug, tobacco or alcohol abuse, per investigator judgment.
    29) Any condition including active fibromyalgia that based on the investigator’s opinion would make it difficult to appropriately assess RA activity for the purposes of this study.
    30) Any condition or circumstances which in the opinion of the Investigator or Sponsor may make a subject unlikely or unable to complete the study or comply with study procedures and requirements.
    31) Use of prohibited medication as outlined in section 5.4 of the study protocol.
    32) Tests performed at the central laboratory at Screening as defined in study protocol (Section 4.3).
    Para una lista completa de los criterios de exclusión del estudio consulte el protocolo del estudio:
    1)Tratamientos previos para la AR como se definen en el Protocolo.
    2)Hipersensibilidad o alergias conocidas a los fármacos del estudio, sus metabolitos, o los excipientes en la formulación.
    3) Hipersensibilidad o alergias conocidas al MTX, sus metabolitos, o los excipientes en la formulación.
    4)Esteroides orales en dosis >10 mg/dia de prednisona (o equivalente) o una prescripción de esteroides orales que haya cambiado en las 4 semanas previas al Dia 1.
    5)Haber recibido una inyección intrarticular o parenteral de corticosteroides en las 4 semanas previas al Dia 1.
    6) Uso de fármacos antiinflamatorios no esteroideos (AINES) que no hayan estado prescritos en una dosis estable al menos por 2 semanas antes del Dia 1. NOTA: Se permite ácido acetilsalicilico en una dosis ≤325mg diarios para profilaxiis cardiaca, o AINES ocasionales para indicación distinta de AR
    7) Administración de una vacuna viva/atenuada dentro de 30 días desde el día 1 o prevista durante el estudio.
    8)Participación en un estudio clínico de fármaco o dispostivo en investigación durante las 4 semanas o 5 vidas medias previas a la selección, lo que sea más largo. Exposición a biológicos en investigación tiene que ser discutida con el Promotor.
    9)Haber pasado por tratamientos quirúrgicos para la AR, incluyendo sinovectomia o artroplastia en más de 4 articulaciones.
    10)Tener alguna condición médica crónica, no controlada, que pueda poner al paciente en un riesgo mayor durante la participación en el ensayo, como no controlada: diabetes, hipertensión, obesidad mórbida, enfermedad de tiroides, adrenal, pulmonar, hepática, renal, neurologica o psiquiatrica , u otra enfermedad a juicio del investigador.
    11)Tener antecedentes de cirugía mayor (con un bloqueo general o anestesia general) en los últimos 3 meses previos a la selección, o cirugías mayores planeadas durante el estudio.
    12)Tener un desorden musculoesqueletico generalizado de moderado a grave y activo que pueda interferir en las valoraciones de los parámetros del estudio o que aumente el riesgo del paciente participando en el estudio.
    13)Enfermedad autoinmune activa que pueda interferir en las valoraciones de los parámetros del estudio o que aumente el riesgo del paciente participando en el estudio.
    14) cualquier condición conocida o contraindicación como se indica en el etiquetado o en la práctica clínica local de MTX que impediría la participación del sujeto en este estudio.
    15)Antecedente o historia actual de ataque cardiaco congestivo de severo a moderado ([NYHA] clase III o IV), o en los últimos 6 meses, accidente cerebrovascular, infarto de miocardio, angina inestable, arritmia inestable, hallazgo significativo en ECG en la selección o cualquier otra condición cardiovascular que en opinion del investigador pueda poner al paciente en riesgo en el estudio.
    16)Historia de malignidad en los últimos 5 años anteriores a la selección (excepto el carcinoma de células basales adecuadamente tratado o carcinoma de célula squamous de la piel no metastáticos o carcinoma cervical in situ sin evidencia de recurrencia).
    17)Antecedente o actual enfermedad linfoproliferativa.
    18)Antecedente de perforación gastrointestinal.
    19)Antecedente de trasplante de órgano o médula ósea.
    20)Serologia positiva para el Virus Humano de Inmunodeficiencia adquirida (VIH) 1 o 2.
    21)Evidencia de Infección por Virus de Hepatitis C (VHC).
    22)Evidencia de Infección activa por Virus de HepatitisB (VHB).
    23)Antecedentes de infecciones oportunistas o sindrome de inmunodeficiencia, que pueda poner al paciente en riesgo.
    24)Infeccion activa que sea clinicamente significativa, o cualquier infección que requiera hospitalización o tratamiento con antiinfecciosos intravenosos en los 60 dias antes de la selección; o cualquier infección que requiera antiinfecciosos orales en los 30 días previos a la selección.
    25) Terapia anterior o actual para infección crónica. Antecedente de Staphylococcus aureus o Infección por Herpes simple diseminada.
    26) Antecedentes de infección sintomática por herpes zoster en las 12 semanas previas a la Selección o tener antecedente de infección por herpes zoster.
    27) Antecedente de infección en protesis articular o de otra protesis o dispositivo con retención de la protésis o dispositivo in situ.
    28) Abuso actual de drogas, tábaco o alcohol a juicio del investigador.
    29) Cualquier condición, incluida la fibromialgia que basandose en la opinión del investigador pueda hacer dificil valorar correctamente la actividad AR para el propósito de este estudio.
    30) Cualquier condición o circunstancia que en opinion del investigador o promotor haga a un paciente inapropiado o incapaz de completar el estudio o de cumplir con sus procedimientos y requisitos.
    31)Uso de medicaciones prohibidas según la Sección 5.4
    32)Test realizados en lab central en la selección como define sección 4.3
    E.5 End points
    E.5.1Primary end point(s)
    The primary endpoint is the proportion of subjects who achieve an ACR20 response at Week 24.
    El criterio de valoración principal es la proporción de pacientes con una respuesta ACR20 en la semana 24.
    E.5.1.1Timepoint(s) of evaluation of this end point
    Week 24
    Semana 24
    E.5.2Secondary end point(s)
    The key secondary endpoints are:
    - Change from Baseline in the HAQ-DI score at Week 24
    - The proportion of subjects who achieve DAS28 (CRP)<2.6 at Week 24
    - Change from Baseline in mTSS at Week 24
    Los criterios de valoración secundarios son:
    -El cambio con respecto al valor basal en la puntuación HAQ-DI en la semana 24.
    - La proporción de pacientes con DAS28 (CRP) <2,6 en la semana 24.
    - El cambio con respecto al valor basal en la mTSS en la semana 24.
    E.5.2.1Timepoint(s) of evaluation of this end point
    Week 24
    Semana 24
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy Yes
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic Yes
    E.6.7Pharmacodynamic No
    E.6.8Bioequivalence No
    E.6.9Dose response Yes
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic Yes
    E.6.12Pharmacoeconomic No
    E.6.13Others No
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) No
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other No
    E.7.1.3.1Other trial type description
    E.7.2Therapeutic exploratory (Phase II) No
    E.7.3Therapeutic confirmatory (Phase III) Yes
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled Yes
    E.8.1.1Randomised Yes
    E.8.1.2Open No
    E.8.1.3Single blind No
    E.8.1.4Double blind Yes
    E.8.1.5Parallel group Yes
    E.8.1.6Cross over No
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) Yes
    E.8.2.2Placebo Yes
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial4
    E.8.3 The trial involves single site in the Member State concerned No
    E.8.4 The trial involves multiple sites in the Member State concerned Yes
    E.8.4.1Number of sites anticipated in Member State concerned7
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA84
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA Yes
    E.8.6.2Trial being conducted completely outside of the EEA No
    E.8.6.3If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned
    Argentina
    Australia
    Belgium
    Brazil
    Canada
    Chile
    Colombia
    Czech Republic
    France
    Germany
    Hong Kong
    Hungary
    India
    Ireland
    Israel
    Italy
    Japan
    Korea, Republic of
    Malaysia
    Mexico
    New Zealand
    Peru
    Romania
    Russian Federation
    Serbia
    Slovakia
    South Africa
    Spain
    Switzerland
    Taiwan
    Thailand
    Ukraine
    United Kingdom
    United States
    E.8.7Trial has a data monitoring committee Yes
    E.8.8 Definition of the end of the trial and justification where it is not the last visit of the last subject undergoing the trial
    End of Study is defined as when the last subject has completed 52 weeks of dosing plus the 4 week post treatment visit or has entered the LTE.
    El Fin del Estudio se define como cuando el último paciente haya completado las 52 semanas de dosis más las 4 semanas de visita post tratamiento, o haya entrado en el estudio de extensión a largo plazo.
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years4
    E.8.9.1In the Member State concerned months0
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years4
    E.8.9.2In all countries concerned by the trial months0
    E.8.9.2In all countries concerned by the trial days0
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 No
    F.1.1.1In Utero No
    F.1.1.2Preterm newborn infants (up to gestational age < 37 weeks) No
    F.1.1.3Newborns (0-27 days) No
    F.1.1.4Infants and toddlers (28 days-23 months) No
    F.1.1.5Children (2-11years) No
    F.1.1.6Adolescents (12-17 years) No
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 600
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 600
    F.2 Gender
    F.2.1Female Yes
    F.2.2Male Yes
    F.3 Group of trial subjects
    F.3.1Healthy volunteers No
    F.3.2Patients Yes
    F.3.3Specific vulnerable populations Yes
    F.3.3.1Women of childbearing potential not using contraception No
    F.3.3.2Women of child-bearing potential using contraception Yes
    F.3.3.3Pregnant women No
    F.3.3.4Nursing women No
    F.3.3.5Emergency situation No
    F.3.3.6Subjects incapable of giving consent personally No
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state34
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 451
    F.4.2.2In the whole clinical trial 1200
    F.5 Plans for treatment or care after the subject has ended the participation in the trial (if it is different from the expected normal treatment of that condition)
    All subjects who meet criteria for clinical response per protocol, and who complete 52 weeks of study assessments will be offered an opportunity to participate in a LTE study GS-US-417-0304. Subjects who discontinue early from the main study, or switch to standard of care treatment during the study, are not eligible for the LTE. The long term care of subjects who do not qualify for the LTE or choose not to participate in the LTE will remain the responsibility of their primary treating physician.
    A todos los pacientes que cumplan criterios de resp. clínica (por protocolo), y que completen las 52 semanas de evaluaciones del estudio, se les ofrecerá la oportunidad de participar en el estudio ELP(GS-US-417-0304). Los pacientes que discontinuen antes del estudio ppal, o cambien al tratamiento estándar durante el estudio, no serán elegibles para el ELP. El cuidado a largo plazo de los pacientes que no sean elegibles o decidan no participar en el ELP seguirá siendo responsabilidad del médico.
    G. Investigator Networks to be involved in the Trial
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2017-01-13
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2016-12-28
    P. End of Trial
    P.End of Trial StatusCompleted
    P.Date of the global end of the trial2019-05-08
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