E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Rheumatoid Arthritis |
Artritis reumatoide |
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E.1.1.1 | Medical condition in easily understood language |
Rheumatoid Arthritis |
Artritis reumatoide |
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E.1.1.2 | Therapeutic area | Diseases [C] - Immune System Diseases [C20] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 19.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10039073 |
E.1.2 | Term | Rheumatoid arthritis |
E.1.2 | System Organ Class | 10028395 - Musculoskeletal and connective tissue disorders |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
To compare the efficacy of tofacitinib MR 11mg monotherapy to tofacitinib MR 11mg with continued MTX, as measured by the change in the Disease Activity Score utilizing 4 components including erythrocyte sedimentation rate (DAS28-4 (ESR)) from randomization (at Week 24) to the end of the double-blind MTX withdrawal phase (at Week 48). |
Comparar la eficacia de tofacitinib 11 mg LM en monoterapia con la de tofacitinib 11 mg LM con tratamiento continuado con MTX, medida por el cambio en la puntuación de actividad de la enfermedad (Disease Activity Score, DAS) utilizando 4 componentes, incluida la velocidad de sedimentación globular (DAS28-4(VSG)) desde la aleatorización (en la semana 24) hasta el final de la fase de retirada con doble enmascaramiento del MTX (en la semana 48). |
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E.2.2 | Secondary objectives of the trial |
•To compare the efficacy of tofacitinib MR 11mg monotherapy to tofacitinib MR 11mg with continued MTX in the double-blind MTX withdrawal phase (at Week 36), as measured by DAS28-4 (ESR). •To compare the efficacy of tofacitinib MR 11mg monotherapy to tofacitinib MR 11mg with continued MTX in the double-blind MTX withdrawal phase (at Weeks 48 and 36), as measured by Disease Activity Score 28-4 (C reactive protein) (DAS28-4 (CRP)), Clinical Disease Activity Index (CDAI), Simplified Disease Activity Index (SDAI), Low Disease Activity (LDA), remission, ACR20, ACR 50, and ACR 70. •To compare effects of tofacitinib MR 11mg monotherapy to tofacitinib MR 11mg with continued MTX on health outcome measures in the double-blind MTX withdrawal phase (at Weeks 48 and 36). •To evaluate the safety and tolerability of tofacitinib MR 11mg monotherapy versus tofacitinib MR 11mg with continued MTX. |
Comparar eficacia de tofacitinib 11mg LM en monoterapia con tofacitinib 11mg LM con tratamiento continuado con MTX en fase de retirada con doble enmascaramiento de MTX (semana 36), medida por DAS28-4(VSG). Comparar eficacia de tofacitinib 11mg LM en monoterapia con tofacitinib 11mg LM con tratamiento continuado con MTX en fase de retirada con doble enmascaramiento de MTX (Semanas 48 y 36), medida por puntuación de actividad de enfermedad 28-4 (proteína C reactiva) (DAS28-4(PCR)), índice clínico de actividad de enfermedad, índice simplificado de actividad de enfermedad, baja actividad de enfermedad, remisión, ACR20, ACR50 y ACR70. Comparar efecto de tofacitinib 11mg LM en monoterapia con tofacitinib 11mg LM con tratamiento continuado con MTX en indicadores de salud en fase de retirada con doble enmascaramiento de MTX (Semanas 48 y 36) Evaluar seguridad y tolerabilidad de tofacitinib 11mg LM en monoterapia en comparación con tofacitinib 11mg LM con tratamiento continuado con MTX. |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
Key Inclusion Criteria - Must be 18 years of age or older. Have a score of 6 or greater on the 2010 American College of Rheumatology/European League Against Rheumatism Classification Criteria for Rheumatoid Arthritis at and/or prior to Screening Visit. •Have >=4 tender/painful joints on motion and >=4 swollen joints (28 joint counts) at both Screening Visit and Baseline Visit (Visit 1). •Have moderate to severe disease activity as defined by CDAI>10 and DAS28-4(ESR) >=3.2 at Baseline Visit. •Have taken an oral MTX treatment regimen (15-25mg/week) continuously for at least 4 months prior to the screening visit and has taken a stable weekly dose of oral MTX with supplemental folic acid or folinic acid for at least 4 weeks prior to the baseline visit (conversion from parenteral MTX to oral MTX will require stabilization of the treatment regimen for at least 1 month). •Male subjects able to father children and female subjects of childbearing potential and at risk for pregnancy must agree to use highly effective contraception throughout the study and for at least 6 months after the last dose of assigned treatment. •Subjects must screen negative for active tuberculosis or inadequately treated tuberculosis infection (active or latent). |
Principales criterios de inclusión -Tener 18 años de edad como mínimo. - Tener una puntuación de 6 o más alta en los criterios de la clasificación de la artritis reumatoide de 2010 del Colegio Estadounidense de Reumatología (American College of Rheumatology) y la Liga Europea contra el Reumatismo (European League Against Rheumatism) en y/o antes de la visita de selección. - Tener >= 4 articulaciones hipersensibles o dolorosas al movimiento y >= 4 articulaciones inflamadas (recuentos de 28 articula ciones) tanto en la visita de selección como en la visita inicial (visita 1). - Tener enfermedad de actividad moderada o intensa, definida por un CDAI > 10 y una DAS28-4(VSG) >= 3,2 en la visita inicial. - Haber recibido un tratamiento por vía oral con MTX (15-25 mg/semana) de forma continuada durante al menos 4 meses antes de la visita de selección y haber tomado una dosis semanal estable de MTX por vía oral con suplemento de ácido fólico o ácido folínico durante al menos 4 semanas antes de la visita inicial (la conversión de MTX por vía parenteral a MTX por vía oral exigirá la estabilización del tratamiento durante al menos 1 mes) - Los pacientes de sexo masculino capaces de engendrar hijos y las mujeres con capacidad de concebir que estén en riesgo de embarazo deben aceptar el uso de anticonceptivos de alta eficacia durante todo el estudio y al menos durante 6 meses después de la última dosis del tratamiento asignado -Pacientes con resultados negativos para la tuberculosis activa o para la tuberculosis inadecuadamente tratada (activa o latente). |
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E.4 | Principal exclusion criteria |
Key Exclusion Criteria Pregnant female subjects; breastfeeding female subjects; male subjects with partners currently pregnant; male subjects able to father children and female subjects of childbearing potential who are unwilling or unable to use highly effective contraception as outlined in this protocol for the duration of the study and for at least 6 months after the last dose of investigational product. •Subjects with infection or infection history; subjects with any current malignancy or a history of malignancy (except adequately treated or excised non-metastatic basal cell or squamous cell cancer of the skin or cervical carcinoma in situ); subjects with history of, or current evidence for, severe gastrointestinal narrowing (pathologic or iatrogenic); and subjects with history of documented diverticulitis. •Subjects with a history of insufficient response to >=2 biologics, regardless of the class. •Subjects screened in Belgium, Czech Republic, Germany, Hungary, Italy, Poland, Spain, and the United Kingdom who have resided or traveled in areas with endemic tuberculosis or endemic mycoses will be excluded. |
Principales criterios de exclusion: -Mujeres embarazadas, mujeres en período de lactancia, hombres con parejas actualmente embarazadas, hombres con capacidad de engendrar hijos y mujeres con capacidad de concebir que no estén dispuestos o no puedan utilizar anticonceptivos de alta eficacia tal como se explica en este protocolo durante todo el estudio y al menos 6 meses después de la última dosis del producto en investigación. -Sujetos con infección o antecedentes de infección; Sujetos con cualquier neoplasia maligna actual o antecedentes de neoplasias malignas (exceptuados el carcinoma basocelular o de células escamosas de la piel o el cáncer cervical localizado, no metastásico y adecuadamente tratado o extirpado); antecedentes de diverticulitis documentada en la documentación original. -Sujetos con antecedentes de respuesta insuficiente a >= 2 fármacos biológicos, con independencia de su clase. -Sujetos seleccionados en Bélgica, República Checa, Alemania, Hungría, Italia, Polonia, España y el Reino Unido que han residido o que han viajado a zonas en donde la tuberculosis o las micosis son endémicas, serán excluidos. |
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E.5 End points |
E.5.1 | Primary end point(s) |
Change in DAS28-4 (ESR) score from randomization (at Week 24) to the end of doubleblind MTX withdrawal phase (at Week 48). |
Cambio en la puntuación DAS28-4(VSG) desde la aleatorización (en la semana 24) hasta el final de la fase de retirada con doble enmascaramiento del MTX (en la semana 48). |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
From week 24 to week 48 |
Desde la semana 24 hasta la semana 48 |
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E.5.2 | Secondary end point(s) |
•Change in the DAS28-4(ESR) from Week 24 to Week 36; •Changes in the DAS28-4 (CRP), CDAI and SDAI, respectively, from Week 24 to Week 48 and from Week 24 to Week 36; •LDA as assessed by DAS28 4(ESR) <3.2, DAS28-4(CRP) <3.2, CDAI<=10 and SDAI<=11, respectively, at Weeks 48 and 36; •Remission as assessed by ACR-EULAR Boolean remission criteria,11 DAS28 4 (ESR)<2.6, DAS28 4 (CRP)<2.6, CDAI<=2.8 and SDAI<=3.3, respectively, at Weeks 48 and 36; •ACR20, ACR 50, and ACR70 responses, respectively, at Weeks 48 and 36; •Change in the HAQ-DI, the SF-36 (8 domain scores and 2 component scores), WPAI, EuroQol EQ-5D and the FACIT-Fatigue scale score, respectively, from Week 24 to Week 48 and from Week 24 to Week 36; •HAQ-DI response (ie, decrease of at least 0.22) at Weeks 48 and 36. |
• Cambio en la DAS28-4(VSG) desde la semana 24 hasta la semana 36. • Cambios en la DAS28-4(PCR), el CDAI y el SDAI, respectivamente, desde la semana 24 hasta la semana 48 y desde la semana 24 hasta la semana 36. • LDA evaluada por medio de DAS28-4(VSG) < 3,2, DAS28-4(PCR) < 3,2, CDAI <= 10 y SDAI <= 11, respectivamente, en las semanas 48 y 36. • Remisión evaluada según los criterios de remisión booleana de ACR-EULAR11, DAS28-4(VSG) < 2,6, DAS28-4(PCR) < 2,6, CDAI <= 2,8 y SDAI <= 3,3, respectivamente, en las semanas 48 y 36. • Respuestas ACR20, ACR50 y ACR70, respectivamente, en las semanas 8 y 36. • Cambio en el HAQ-DI, el SF-36 (puntuaciones de 8 dominios y puntuaciones de 2 componentes), el WPAI, el EuroQol EQ-5D y la puntuación de la escala FACIT-fatiga, respectivamente, desde la semana 24 hasta la semana 48 y desde la semana 24 hasta la semana 36. • Respuesta HAQ-DI (esto es, disminución de al menos 0,22) en las semanas 48 y 36. |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
From week 24 to week 48 |
Desde la semana 24 hasta la semana 48 |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | Yes |
E.6.12 | Pharmacoeconomic | Yes |
E.6.13 | Others | Yes |
E.6.13.1 | Other scope of the trial description |
Tolerability |
Tolearbilidad |
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E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | Yes |
E.7.4 | Therapeutic use (Phase IV) | Yes |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | Yes |
E.8.1.5 | Parallel group | Yes |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | Yes |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 2 |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 3 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 60 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
Australia |
Belgium |
Brazil |
Bulgaria |
Canada |
Colombia |
Czech Republic |
Germany |
Greece |
Hungary |
Italy |
Korea, Republic of |
Mexico |
Philippines |
Poland |
Russian Federation |
Slovakia |
South Africa |
Spain |
Ukraine |
United Kingdom |
United States |
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E.8.7 | Trial has a data monitoring committee | Yes |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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LVLS |
Última visita del último paciente |
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 2 |
E.8.9.1 | In the Member State concerned months | 7 |
E.8.9.1 | In the Member State concerned days | |
E.8.9.2 | In all countries concerned by the trial years | 2 |
E.8.9.2 | In all countries concerned by the trial months | 7 |