Clinical Trial Results:
A Randomized, Double-Blind, Placebo-Controlled, Parallel Group Study to Evaluate the Efficacy of Tocilizumab as a Remission-Induction and Glucocorticoid-Sparing Regimen in Subjects with New-Onset Polymyalgia Rheumatica (PMR-SPARE)
Summary
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EudraCT number |
2016-004990-42 |
Trial protocol |
AT |
Global end of trial date |
02 Jun 2020
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Results information
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Results version number |
v1(current) |
This version publication date |
14 Nov 2021
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First version publication date |
14 Nov 2021
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Other versions |
Trial Information
Subject Disposition
Baseline Characteristics
End Points
Adverse Events
More Information
Subject Disposition
Baseline Characteristics
End Points
Adverse Events
More Information
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Trial identification
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Sponsor protocol code |
PMR-SPARE
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Additional study identifiers
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ISRCTN number |
- | ||
US NCT number |
- | ||
WHO universal trial number (UTN) |
- | ||
Sponsors
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Sponsor organisation name |
Medical University Vienna, Department of Internal Medicine III
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Sponsor organisation address |
Währinger Gürtel 18-20, Vienna, Austria, 1090
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Public contact |
Principal Investigator, Department of Medicine III, Division of Rheumatology, daniel.aletaha@meduniwien.ac.at
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Scientific contact |
Principal Investigator - Daniel Aletaha, Department of Medicine III, Division of Rheumatology, +43 4040043000, daniel.aletaha@meduniwien.ac.at
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Paediatric regulatory details
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Is trial part of an agreed paediatric investigation plan (PIP) |
No
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Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial? |
No
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Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial? |
No
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Results analysis stage
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Analysis stage |
Final
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Date of interim/final analysis |
02 Jun 2020
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Is this the analysis of the primary completion data? |
Yes
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Primary completion date |
02 Jun 2020
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Global end of trial reached? |
Yes
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Global end of trial date |
02 Jun 2020
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Was the trial ended prematurely? |
No
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General information about the trial
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Main objective of the trial |
Objectives: To assess the efficacy and safety of a tocilizumab-based regimen compared with placebo on top of rapidly tapered GC treatment in a double-blind, controlled fashion, focusing on GC-free remission of disease.
Methodology: In this double-blind, parallel group study, 36 patients with PMR will be recruited from three rheumatology centres and will be randomized in a 1:1 ratio to tocilizumab or placebo over the course of 16 weeks, accompanied by a rapid tapering GC scheme over 11 weeks in both arms. The primary endpoint is GC-free remission at week 16, and follow-up will be performed until week 24 for safety and sustained efficacy. Patients will receive either the subcutaneous preparation of 162 mg tocilizumab weekly or matching placebo injections.
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Protection of trial subjects |
The investigator informed each subject comprehensively regarding the nature, significance, impact and risks of this clinical trial. During this instruction the subjects were made aware of the fact that they can withdraw their consent – without giving reasons – at any time without their further medical care being influenced in any way. In addition, subjects also received a written patient information sheet in comprehensible language, explaining the nature and purpose of the study and its progress. The patient information sheet was approved by ethics committee. The consent form was signed and dated by the subject and the physician who conducted the informed consent discussion before any study related procedure was performed. Additionally, the subjects were given a copy of the signed informed consent form.
The subjects had agreed to the possibility of study-related data being passed on to relevant authorities. According to the stipulations of the Austrian Data Protection Law, confidentiality and pseudonymity of the volunteers were assured. After giving written consent the subject underwent the first screening investigations.
During their participation in the clinical trial all subjects were insured as defined by legal requirements. The investigator of the clinical trial received a copy of the insurance conditions and filed the copy in the Investigator Site file for reference. The sponsor provided insurance to indemnify (legal and financial coverage) the investigator/center against claims arising from the study, except for claims that arise from malpractice and/or negligence. The compensation of the subject in the event of study-related injuries complied with the applicable regulations.
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Background therapy |
All patients will be treated openly with 20 mg/day of prednisone at randomization. A pre-specified taper regimen will be followed over 11 weeks (for details on the taper regimen see Table 2). In case of relapse (as defined by the investigators, who were all also blinded to CRP/ESR results), patients in either the tocilizumab or placebo group, should increase the prednisone dose by 5 mg for 1 week. Given remission is then re-achieved, the GC dose will be tapered within 4 weeks to the pre-relapse dose (within this 4-weeks period tapering is conducted at the discretion of the investigator). Subsequently, the pre-specified tapering protocol will be followed again. In case remission is not achieved by the dose increment of 5mg, or relapses occur on GC doses >5mg, the GC dose may be further increased at the discretion of the investigator. Subsequent tapering will also be at the discretion of the physician until the pre-relapse dose is achieved. Then, the pre-specified protocol will be followed. | ||
Evidence for comparator |
- | ||
Actual start date of recruitment |
01 Sep 2017
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Long term follow-up planned |
No
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Independent data monitoring committee (IDMC) involvement? |
No
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Population of trial subjects
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Number of subjects enrolled per country |
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Country: Number of subjects enrolled |
Austria: 36
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Worldwide total number of subjects |
36
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EEA total number of subjects |
36
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Number of subjects enrolled per age group |
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In utero |
0
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Preterm newborn - gestational age < 37 wk |
0
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Newborns (0-27 days) |
0
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Infants and toddlers (28 days-23 months) |
0
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Children (2-11 years) |
0
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Adolescents (12-17 years) |
0
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Adults (18-64 years) |
10
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From 65 to 84 years |
25
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85 years and over |
1
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Recruitment
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Recruitment details |
- | ||||||||||||||||||||||||
Pre-assignment
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Screening details |
Diagnosis of PMR (at, or up to 2 weeks before the screening visit) as confirmed by the investigator at screening and at baseline + fulfilment of the provisional 2012 ACR-EULAR classification criteria + GC naïve or on GC treatment for a maximum of 2 weeks at screening with an initial dose between 12.5 and 25 mg/day prednisone. | ||||||||||||||||||||||||
Period 1
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Period 1 title |
Overall trial (overall period)
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Is this the baseline period? |
Yes | ||||||||||||||||||||||||
Allocation method |
Randomised - controlled
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Blinding used |
Double blind | ||||||||||||||||||||||||
Roles blinded |
Investigator, Monitor, Subject, Data analyst, Carer, Assessor | ||||||||||||||||||||||||
Blinding implementation details |
Blinding was maintained throughout the 24-week treatment phase of this study by the provision of tocilizumab and matching placebo for tocilizumab in pre-filled syringes in a matching presentation for the first 16 weeks and maintenance of the blinding until week 24. The investigators involved in patient assessment remained blinded to the results of the fasting lipids, ALT/AST, CRP and ESR.
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Arms
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Are arms mutually exclusive |
Yes
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Arm title
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Tocilizumab 162mg s.c. once weekly | ||||||||||||||||||||||||
Arm description |
- | ||||||||||||||||||||||||
Arm type |
Experimental | ||||||||||||||||||||||||
Investigational medicinal product name |
Tocilizumab
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Investigational medicinal product code |
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Other name |
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Pharmaceutical forms |
Injection
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Routes of administration |
Subcutaneous use
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Dosage and administration details |
162mg of Tocilizumab were administered subcutaneously via self-injection for 16 weeks.
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Arm title
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Placebo s.c. once weekly | ||||||||||||||||||||||||
Arm description |
Placebo injections were administered via self-injection every week. | ||||||||||||||||||||||||
Arm type |
Placebo | ||||||||||||||||||||||||
Investigational medicinal product name |
No investigational medicinal product assigned in this arm
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Baseline characteristics reporting groups
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Reporting group title |
Tocilizumab 162mg s.c. once weekly
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Reporting group description |
- | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reporting group title |
Placebo s.c. once weekly
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Reporting group description |
Placebo injections were administered via self-injection every week. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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End points reporting groups
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Reporting group title |
Tocilizumab 162mg s.c. once weekly
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Reporting group description |
- | ||
Reporting group title |
Placebo s.c. once weekly
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Reporting group description |
Placebo injections were administered via self-injection every week. |
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End point title |
Patients in glucocorticoid-free remission at wk 16 | ||||||||||||
End point description |
The primary efficacy endpoint was the achievement of glucocorticoid-free remission at week 16.
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End point type |
Primary
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End point timeframe |
at week 16
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Statistical analysis title |
GC-free remission (wk 16) | ||||||||||||
Statistical analysis description |
The primary and key secondary endpoints were tested between the groups using either Fisher’s exact tests for categorical variables, Kruskal-Wallis tests for non-normally distributed continuous data, or Kaplan-Meier estimator for time-to-event data. To control for type I error of the secondary endpoints, we applied a strategy of hierarchical testing, by which hypothesis testing continues until reaching the first non-significance.
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Comparison groups |
Tocilizumab 162mg s.c. once weekly v Placebo s.c. once weekly
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Number of subjects included in analysis |
36
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Analysis specification |
Pre-specified
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Analysis type |
superiority | ||||||||||||
P-value |
= 0.002 | ||||||||||||
Method |
Fisher exact | ||||||||||||
Confidence interval |
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End point title |
Patients in glucocorticoid-free remission at wk 12 | ||||||||||||
End point description |
To control for type I error of the secondary endpoints, we applied a strategy of hierarchical testing, by which hypothesis testing continues until reaching the first non-significance. The pre-determined hierarchy for testing secondary endpoints was: proportion of subjects in glucocorticoid-free remission at week 12 proportion of subjects in glucocorticoid-free remission at week 24 -> time to first relapse -> cumulative dose of prednisone at week 16 -> cumulative dose of prednisone at week 24 -> proportion of subjects with increased ESR >20mm/h, or increased CRP levels >5mg/L at week 24 -> patient pain (VAS) at week 16 -> patient global assessment of disease activity (VAS) at week 16 -> Evaluator global assessment (VAS) at week 16 -> SF-36 at week 16 -> HAQ at week 16.
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End point type |
Secondary
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End point timeframe |
at week 12
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Statistical analysis title |
Glucocorticoid-free remission at week 12 | ||||||||||||
Comparison groups |
Tocilizumab 162mg s.c. once weekly v Placebo s.c. once weekly
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Number of subjects included in analysis |
36
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Analysis specification |
Pre-specified
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Analysis type |
superiority | ||||||||||||
P-value |
= 0.02 | ||||||||||||
Method |
Fisher exact | ||||||||||||
Confidence interval |
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End point title |
Patients in glucocorticoid-free remission at wk 24 | ||||||||||||
End point description |
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End point type |
Secondary
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End point timeframe |
week 24
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Statistical analysis title |
Glucocorticoid-free remission at week 24 | ||||||||||||
Comparison groups |
Tocilizumab 162mg s.c. once weekly v Placebo s.c. once weekly
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Number of subjects included in analysis |
36
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Analysis specification |
Pre-specified
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Analysis type |
superiority | ||||||||||||
P-value |
= 0.02 | ||||||||||||
Method |
Fisher exact | ||||||||||||
Confidence interval |
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End point title |
Time to first relapse (days) | ||||||||||||
End point description |
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End point type |
Secondary
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End point timeframe |
Baseline to week 24
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Statistical analysis title |
Time to first relapse (days) | ||||||||||||
Comparison groups |
Tocilizumab 162mg s.c. once weekly v Placebo s.c. once weekly
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Number of subjects included in analysis |
36
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Analysis specification |
Pre-specified
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Analysis type |
superiority | ||||||||||||
P-value |
= 0.007 | ||||||||||||
Method |
Kruskal-wallis | ||||||||||||
Confidence interval |
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End point title |
Cumulative prednisone dose (wk 16) | ||||||||||||
End point description |
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End point type |
Secondary
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End point timeframe |
Baseline to week 16
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Statistical analysis title |
Cumulative prednisone dose at week 16 | ||||||||||||
Comparison groups |
Tocilizumab 162mg s.c. once weekly v Placebo s.c. once weekly
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Number of subjects included in analysis |
36
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Analysis specification |
Pre-specified
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Analysis type |
superiority | ||||||||||||
P-value |
= 0.003 | ||||||||||||
Method |
Kruskal-wallis | ||||||||||||
Confidence interval |
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End point title |
Cumulative prednisone dose (wk 24) | ||||||||||||
End point description |
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End point type |
Secondary
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End point timeframe |
baseline to week 24
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Statistical analysis title |
Cumulative prednisone dose at week 24 | ||||||||||||
Comparison groups |
Tocilizumab 162mg s.c. once weekly v Placebo s.c. once weekly
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Number of subjects included in analysis |
36
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Analysis specification |
Pre-specified
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Analysis type |
superiority | ||||||||||||
P-value |
= 0.001 | ||||||||||||
Method |
Kruskal-wallis | ||||||||||||
Confidence interval |
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End point title |
subjects with increased ESR or CRP at wk 24 | |||||||||||||||
End point description |
subjects with increased ESR (>20mm/h) or increased CRP (> 5mg/L)
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End point type |
Secondary
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End point timeframe |
at week 24
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Statistical analysis title |
Subjects with increased ESR (>20mm/h) at wk 24 | |||||||||||||||
Comparison groups |
Tocilizumab 162mg s.c. once weekly v Placebo s.c. once weekly
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Number of subjects included in analysis |
36
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Analysis specification |
Pre-specified
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Analysis type |
superiority | |||||||||||||||
P-value |
> 0.05 [1] | |||||||||||||||
Method |
Fisher exact | |||||||||||||||
Confidence interval |
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Notes [1] - not significant |
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Statistical analysis title |
subjects with increased CRP (> 5mg/L) at wk 24 | |||||||||||||||
Comparison groups |
Tocilizumab 162mg s.c. once weekly v Placebo s.c. once weekly
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Number of subjects included in analysis |
36
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Analysis specification |
Pre-specified
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Analysis type |
superiority | |||||||||||||||
P-value |
> 0.05 [2] | |||||||||||||||
Method |
Fisher exact | |||||||||||||||
Confidence interval |
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Notes [2] - not significant |
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End point title |
Pain (VAS) at wk 16 | ||||||||||||
End point description |
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End point type |
Secondary
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End point timeframe |
at week 16
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No statistical analyses for this end point |
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End point title |
Patient global assessement (VAS) at wk 16 | ||||||||||||
End point description |
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End point type |
Secondary
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End point timeframe |
at week 16
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No statistical analyses for this end point |
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End point title |
Evaluator global assessment (VAS) at wk 16 | ||||||||||||
End point description |
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End point type |
Secondary
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End point timeframe |
at week 16
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No statistical analyses for this end point |
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End point title |
Short Form-36 (Physical Component Score) at wk 16 | ||||||||||||
End point description |
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End point type |
Secondary
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End point timeframe |
at week 16
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No statistical analyses for this end point |
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End point title |
Health Assessment Questionnaire (0-3) at wk 16 | ||||||||||||
End point description |
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End point type |
Secondary
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End point timeframe |
at week 16
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No statistical analyses for this end point |
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Adverse events information
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Timeframe for reporting adverse events |
24 weeks
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Adverse event reporting additional description |
In total, 19 patients were exposed to tocilizumab treatment (162mg s.c. every week) and 17 patients received placebo treatment in the course of this study. As shown in Table 7, the total in-trial duration was 8.2 patient years for the tocilizumab group and 6.3 patient years for the placebo group.
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Assessment type |
Systematic | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary used for adverse event reporting
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Dictionary name |
MedDRA | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary version |
24.1
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Reporting groups
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Reporting group title |
Tocilizumab 162mg s.c. every week
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Reporting group description |
- | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reporting group title |
Placebo s.c. every week
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Reporting group description |
- | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Frequency threshold for reporting non-serious adverse events: 1% | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Substantial protocol amendments (globally) |
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Were there any global substantial amendments to the protocol? No | |||
Interruptions (globally) |
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Were there any global interruptions to the trial? No | |||
Limitations and caveats |
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Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data. | |||
None reported |