| E.1 Medical condition or disease under investigation |
| E.1.1 | Medical condition(s) being investigated |
|
| E.1.1.1 | Medical condition in easily understood language |
| Rheumatoid Arthritis (RA) is a chronic, systemic inflammatory autoimmune disease, characterised by a symmetrical polyarthritis that is associated with substantial disability and morbidity |
|
| E.1.1.2 | Therapeutic area | Diseases [C] - Musculoskeletal Diseases [C05] |
| MedDRA Classification |
| E.1.2 Medical condition or disease under investigation |
| E.1.2 | Version | 21.0 |
| 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 |
|
| 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 GSK3196165 at doses of 90 mg and 150 mg weekly versus placebo for the treatment of participants with moderately to severely active RA who are on a stable background of MTX and who have had an inadequate response to MTX. |
|
| E.2.2 | Secondary objectives of the trial |
To compare:
- Efficacy of GSK3196165 at doses of 90 mg and 150 mg weekly versus tofacitinib for the treatment of participants with moderately to severely active RA who are on a stable background of MTX and who have had an inadequate response to MTX.
- Effect of GSK3196165 on Patient Reported Outcomes (PROs) versus placebo and the active comparator tofacitinib
- Safety and tolerability of GSK3196165 versus placebo and the active
comparator tofacitinib
- To determine the immunogenic potential of GSK3196165 |
|
| E.2.3 | Trial contains a sub-study | No |
| E.3 | Principal inclusion criteria |
1. Age ≥18 years at the time of signing informed consent.
2. Meets ACR/EULAR 2010 RA Classification Criteria (see study reference manual [SRM]) with a duration of RA disease of ≥6 months at time of screening and participant not diagnosed before 16 years of age.
3. Must have active disease at both screening and baseline, as defined by having both:
a. ≥6/68 tender/painful joints (TJC), and
b. ≥6/66 swollen joints (SJC).
If surgical treatment of a joint has been performed, that joint cannot be counted in the TJC or SJC for enrolment purposes
4. Must have a high sensitivity C-reactive protein (hsCRP)measurement ≥3 mg/L at screening.
5. Must meet Class I, II or III of the ACR 1991 Revised Criteria for Global Functional Status in RA (see SRM).
6. Must have at least 1 bone erosion present on hand/wrist or foot radiographs confirmed by central reading at screening.
7. Must have inadequate response, despite currently taking Methotrexate (MTX): weekly 15-25 mg oral or injected, for at least 12 weeks at the maximum tolerated dose prior to Day 1, with no change in route of administration in this time. MTX dose must be stable and tolerated for at least 8 weeks prior to Day 1. A lower dose of ≥7.5 mg/week is acceptable if reduced for reasons of intolerance to MTX, e.g. nausea/vomiting, hepatic or hematologic toxicity, or per local requirement (there must be clear documentation in the medical record).
8. Body weight ≥40 kg
9. Male or female participants are eligible to participate so long as they meet and agree
to abide by the contraceptive criteria detailed in Appendix 4 of protocol.
10. Capable of giving signed informed consent which includes compliance with the requirements and restrictions listed in the informed consent form (ICF) and in this protocol.
11. Willing to continue or initiate treatment with oral folic acid (at least 5 mg/week) or equivalent and be treated during the entire study (mandatory co-medication for MTX treatment). |
|
| E.4 | Principal exclusion criteria |
1. Active infections (including localised infections), or history of recurrent infections (excluding recurrent fungal infections of the nail bed), or has required management of acute or chronic infections, as described in the protocol.
2. Symptomatic herpes zoster within 3 months prior to screening.
3. Hereditary or acquired immunodeficiency disorder, including immunoglobulin deficiency.
4. Known infection with human immunodeficiency virus (HIV) or positive test at screening.
5. History of infected joint prosthesis at any time, with the prosthesis still in situ. History of chronic leg ulcers,
permanent in-dwelling catheters,chronic sinusitis,recurrent chest infections or recurrent urinary tract infections.
6. Any baseline symptomatology that in the investigator’s opinion would confound the early detection of pulmonary alveolar proteinosis based upon clinical features, such as persistent cough (CTC Grade ≥2) or persistent dyspnea(dyspnoea scale Grade ≥2).
7. Current unstable liver or biliary disease per investigator assessment defined by the presence of ascites, encephalopathy, coagulopathy, hypoalbuminaemia, oesophageal or gastric varices, persistent jaundice, or cirrhosis.
8. Current acute or chronic Hepatitis B and/or Hepatitis C.
9. Current or history of renal disease or estimated glomerular filtration rate (eGFR) by Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI) calculation <60 mL/min/1.73m2 at screening.
10. Breast cancer within the past 10 years or lymphoma, leukaemia, or any other malignancy within the past 5 years except for cervical carcinoma in situ that has been resected with no evidence of recurrence or metastatic disease, or basal cell or squamous epithelial cancers of the skin that have been resected with no evidence of
recurrence or metastatic disease for at least 3 years.
11. History of any lymphoproliferative disorder, such as Epstein Barr Virus (EBV) related lymphoproliferative disorder, or signs and symptoms suggestive of current lymphatic disease.
12. History or presence of significant other concomitant illness according to the Investigator judgment such as, but not limited to cardiovascular (including Stage III or IV cardiac failure according to New York Heart Association classification, myocardial infarction within 3 months, unstable angina pectoris, uncontrolled
hypertension, uncontrolled hypercholesterolemia), uncontrolled diabetes mellitus, VTE requiring anticoagulation), neurological, endocrinological, gastrointestinal (including diverticulitis), hepatic disease, metabolic, lymphatic disease, or previous renal transplant that would adversely affect the participant's participation
13. Any condition or contraindication as addressed in the local product information or local clinical practice for tofacitinib that would preclude the participant from participating in this protocol.For all participants, investigators should carefully review potential risk factors related to VTE, including deep vein thrombosis (DVT) and pulmonary embolism (PE) and review the risk of infection in participants older than 65 years of age.
14. History of other inflammatory rheumatologic or systemic autoimmune disorder, other than Sjögren’s syndrome secondary to RA, that may confound the evaluation of the effect of the study intervention such as mixed connective tissue disease, psoriatic arthritis, juvenile chronic arthritis, spondyloarthritis, Felty’s Syndrome, systemic lupus erythematosus, scleroderma, Crohn’s disease, ulcerative colitis, or vasculitis.
15. Presence of fibromyalgia that, in the investigator’s opinion, would make it difficult to appropriately assess RA activity for the purposes of this study.
16. Undergone any major surgery within 8 weeks prior to study entry or will require major surgery during the study that, in the opinion of the investigator would pose an unacceptable risk to the participant.
17. Current or previous active Mycobacterium tuberculosis (TB) regardless of treatment.
18. Evidence of latent TB (as documented by a positive QuantiFERON-TB Gold plus test or T-SPOT.TB test at screening, no findings on medical history or clinical examination consistent with active TB, and a normal chest radiograph) except for participants that either:
-Are willing to complete at least 4 weeks of anti-TB therapy as per WHO/national guidelines prior to randomisation and agree to complete the remainder of treatment while in the study OR
-Are documented as having evidence of satisfactory anti-TB treatment as per WHO/national guidelines within the last 5 years following review by a physician specialising in TB.
19. Previous close contact with a person with active TB and did not receive satisfactory anti-tuberculosis treatment as per WHO/national guidelines.
20. Significant allergies to humanised monoclonal antibodies.
21. Clinically significant multiple or severe drug allergies or severe post-treatment hypersensitivity reactions |
|
| E.5 End points |
| E.5.1 | Primary end point(s) |
| Proportion of participants achieving ACR20 |
|
| E.5.1.1 | Timepoint(s) of evaluation of this end point |
|
| E.5.2 | Secondary end point(s) |
1) Major Secondary Efficacy Endpoints
Week 12 versus placebo:
- Proportion of participants achieving CDAI
total score ≤10 (CDAI LDA).
- Change from baseline in HAQ-DI.
Non-inferiority versus tofacitinib at Week 12:
- Proportion of participants achieving ACR20.
Other Secondary Efficacy Endpoints
Week 12 (vs. placebo and vs. tofacitinib), Week 24 and Week 52 (vs. tofacitinib):
Proportion of participants achieving:
- CDAI total score ≤10 (CDAI LDA).
- CDAI total score ≤2.8 (CDAI Remission).
- ACR20/50/70.
- DAS28-CRP ≤3.2 and DAS28(ESR) ≤3.2 (DAS28 LDA.
- DAS28-CRP <2.6 and DAS28(ESR) <2.6 (DAS28 Remission).
- A good/moderate EULAR response.
- ACR/EULAR Remission.
- No radiographic progression defined as a change from baseline in
van der Heijde mTSS score of ≤0.5.
Change from baseline in:
- CDAI total score.
- DAS28-CRP/DAS28-ESR.
- van der Heijde mTSS.
2) Change from baseline at Week 12 (vs. placebo and vs. tofacitinib), Week 24 and Week 52 (vs. tofacitinib) in:
- HAQ-DI.
- Arthritis pain VAS.
- SF-36 physical and mental component scores, and domain scores.
- FACIT-Fatigue.
3) - Incidence of AEs, SAEs and AESIs.
- Change from baseline in key laboratory parameters at weeks 12,24 and 52
- Proportion of participants with NCICTCAE ≥Grade 3
haematological/clinical chemistry abnormalities.
4) Safety Biomarker Endpoints
- GM-CSF autoantibody concentrations.
- Anti-GSK3196165 antibodies. |
|
| E.5.2.1 | Timepoint(s) of evaluation of this end point |
| At various timepoint up to week 52 as defined in the protocol |
|
| 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 | Yes |
| E.6.7 | Pharmacodynamic | Yes |
| E.6.8 | Bioequivalence | No |
| E.6.9 | Dose response | Yes |
| E.6.10 | Pharmacogenetic | No |
| E.6.11 | Pharmacogenomic | No |
| E.6.12 | Pharmacoeconomic | No |
| E.6.13 | Others | Yes |
| E.6.13.1 | Other scope of the trial description |
- Immunogenicity
- Research on Biomarkers
- Optional Genetics research |
|
| 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) | No |
| 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) | Yes |
| E.8.2.2 | Placebo | Yes |
| E.8.2.3 | Other | No |
| E.8.2.4 | Number of treatment arms in the trial | 6 |
| 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 | 7 |
| E.8.5 | The trial involves multiple Member States | Yes |
| E.8.5.1 | Number of sites anticipated in the EEA | 75 |
| 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 |
| Argentina |
| Brazil |
| Canada |
| China |
| Czech Republic |
| Hungary |
| India |
| Italy |
| Latvia |
| Lithuania |
| Malaysia |
| Mexico |
| Philippines |
| Poland |
| Russian Federation |
| Serbia |
| South Africa |
| Spain |
| Ukraine |
| United Kingdom |
| United States |
|
| 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
|
|
| 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 | 9 |
| 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 | 9 |
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