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    Clinical Trial Results:
    A Randomized, Double-Blind, Parallel Group, Multicenter Study to Assess the Immunogenicity and Safety of Transitioning Subjects With Rheumatoid Arthritis to Biosimilar Rituximab (DRL_RI) or Continued Treatment With Rituxan® or MabThera®

    Summary
    EudraCT number
    2019-002810-37
    Trial protocol
    HU   DE   LT   PL   BG  
    Global end of trial date
    20 Apr 2022

    Results information
    Results version number
    v1(current)
    This version publication date
    29 Apr 2023
    First version publication date
    29 Apr 2023
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    RI-01-007
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT04268771
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Dr. Reddy’s Laboratories S.A.
    Sponsor organisation address
    Elisabethenanlage 11, Basel, Switzerland, CH-4051
    Public contact
    Dr. Narendra Maharaj, Dr. Reddy’s Laboratories Ltd., +91 4044644000, narendramaharaj@drreddys.com
    Scientific contact
    Dr. Vinu Jose, Dr. Reddy’s Laboratories Ltd., +91 4044644000, vinujosem@drreddys.com
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    30 Jan 2023
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    20 Apr 2022
    Global end of trial reached?
    Yes
    Global end of trial date
    20 Apr 2022
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    To assess the immunogenicity of transitioning subjects with RA to DRL_RI (biosimilar rituximab) from US rituximab/EU rituximab to continued treatment with US rituximab/EU rituximab. To assess the safety of transitioning subjects with RA to DRL_RI from US rituximab/EU rituximab to continued treatment with US rituximab/EU rituximab.
    Protection of trial subjects
    Insured, Investigator care
    Background therapy
    Methotrexate
    Evidence for comparator
    MabThera in combination with methotrexate is indicated for the treatment of adult patients with severe active rheumatoid arthritis who have had an inadequate response or intolerance to other disease-modifying anti-rheumatic drugs (DMARD) including one or more tumour necrosis factor (TNF) inhibitor therapies. MabThera has been shown to reduce the rate of progression of joint damage as measured by X-ray and to improve physical function, when given in combination with methotrexate.
    Actual start date of recruitment
    21 Jan 2020
    Long term follow-up planned
    Yes
    Long term follow-up rationale
    Safety
    Long term follow-up duration
    6 Months
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    United States: 45
    Country: Number of subjects enrolled
    Poland: 4
    Country: Number of subjects enrolled
    Bulgaria: 44
    Country: Number of subjects enrolled
    Czechia: 3
    Country: Number of subjects enrolled
    Germany: 13
    Country: Number of subjects enrolled
    Hungary: 21
    Country: Number of subjects enrolled
    Lithuania: 10
    Worldwide total number of subjects
    140
    EEA total number of subjects
    95
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    86
    From 65 to 84 years
    52
    85 years and over
    2

    Subject disposition

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    Recruitment
    Recruitment details
    A total of 140 subjects were randomly assigned to receive DRL_RI or US-rituximab/EU-rituximab: 70 subjects received DRL_RI and 70 subjects received US-rituximab (Rituxan, n=22) or EU-rituximab (MabThera, n=48).

    Pre-assignment
    Screening details
    Screening period (Days -14 to 0)

    Pre-assignment period milestones
    Number of subjects started
    224 [1]
    Number of subjects completed
    140

    Pre-assignment subject non-completion reasons
    Reason: Number of subjects
    Eligibility criteria not met: 77
    Reason: Number of subjects
    Withdrawn consent: 6
    Reason: Number of subjects
    Eligibility criteria not met and withdrew consent: 1
    Notes
    [1] - The number of subjects reported to have started the pre-assignment period are not the same as the worldwide number enrolled in the trial. It is expected that these numbers will be the same.
    Justification: A total of 224 subjects were screened of whom 84 failed the screening. The primary reason for screen failure was eligibility criteria not met (77 subjects), 6 subjects had withdrawn consent and 1 had met eligibility criteria & withdrew consent. 140 subjects were enrolled in the study (70 for each treatment group).
    Period 1
    Period 1 title
    Double-blind period (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator, Monitor, Data analyst, Carer, Assessor
    Blinding implementation details
    The investigators and the subjects were unaware of the treatment assignment. Study center staff involved in study treatment administration and study endpoints assessments, CRO personnel, and the sponsor team including study statistician were blinded. The clinical laboratories analyzing the blood/plasma samples and the concentration/incidence of anti-rituximab antibodies were also blinded.

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Arm A - Treatment arm
    Arm description
    DRL_RI
    Arm type
    Experimental

    Investigational medicinal product name
    Rituximab
    Investigational medicinal product code
    DRL_RI
    Other name
    NIL
    Pharmaceutical forms
    Concentrate for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    The study drugs were administered as two 1000-mg IV infusions separated by 2 weeks.

    Arm title
    Arm B - Reference arm
    Arm description
    US-rituximab or EU-rituximab
    Arm type
    Active comparator

    Investigational medicinal product name
    Rituximab
    Investigational medicinal product code
    Other name
    Rituxan®, MabThera®
    Pharmaceutical forms
    Concentrate for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    The study drugs were administered as two 1000-mg IV infusions separated by 2 weeks.

    Number of subjects in period 1
    Arm A - Treatment arm Arm B - Reference arm
    Started
    70
    70
    Completed
    66
    68
    Not completed
    4
    2
         Consent withdrawn by subject
    2
    -
         Adverse event, non-fatal
    1
    -
         Subject safety restriction for COVID-19
    -
    1
         Lost to follow-up
    1
    1

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Arm A - Treatment arm
    Reporting group description
    DRL_RI

    Reporting group title
    Arm B - Reference arm
    Reporting group description
    US-rituximab or EU-rituximab

    Reporting group values
    Arm A - Treatment arm Arm B - Reference arm Total
    Number of subjects
    70 70 140
    Age categorical
    Units: Subjects
        Adults (18-64 years)
    47 39 86
        From 65-84 years
    22 30 52
        85 years and over
    1 1 2
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    59.5 ± 11.66 60.1 ± 11.80 -
    Gender categorical
    Units: Subjects
        Female
    54 61 115
        Male
    16 9 25
    Subject analysis sets

    Subject analysis set title
    Safety population
    Subject analysis set type
    Full analysis
    Subject analysis set description
    Safety population: The safety population included all subjects who were randomly assigned and received at least 1 dose of study drug.

    Subject analysis set title
    Immunogenicity population
    Subject analysis set type
    Sub-group analysis
    Subject analysis set description
    Immunogenicity population: The immunogenicity population included all subjects with at least 1 post-dose ADA assessment result available.

    Subject analysis sets values
    Safety population Immunogenicity population
    Number of subjects
    140
    137
    Age categorical
    Units: Subjects
        Adults (18-64 years)
    86
    85
        From 65-84 years
    52
    50
        85 years and over
    2
    2
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    59.8 ± 11.69
    59.75 ± 11.69
    Gender categorical
    Units: Subjects
        Female
    115
    113
        Male
    25
    24

    End points

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    End points reporting groups
    Reporting group title
    Arm A - Treatment arm
    Reporting group description
    DRL_RI

    Reporting group title
    Arm B - Reference arm
    Reporting group description
    US-rituximab or EU-rituximab

    Subject analysis set title
    Safety population
    Subject analysis set type
    Full analysis
    Subject analysis set description
    Safety population: The safety population included all subjects who were randomly assigned and received at least 1 dose of study drug.

    Subject analysis set title
    Immunogenicity population
    Subject analysis set type
    Sub-group analysis
    Subject analysis set description
    Immunogenicity population: The immunogenicity population included all subjects with at least 1 post-dose ADA assessment result available.

    Primary: The incidence of ADAs

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    End point title
    The incidence of ADAs [1]
    End point description
    To assess the immunogenicity of transitioning subjects with RA to DRL_RI (biosimilar rituximab) from US-rituximab/EU-rituximab to continued treatment with US-rituximab/EU-rituximab. - The incidence of ADAs - The incidence of Nabs
    End point type
    Primary
    End point timeframe
    The immunogenicity endpoint was measured while on study over up to 12 weeks or until death, regardless of use of prohibited therapies or treatment missed/discontinuation due to any other reasons.
    Notes
    [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: No statistical analysis has been provided, instead all data is included in Descriptive summary statistics.
    End point values
    Arm A - Treatment arm Arm B - Reference arm Immunogenicity population
    Number of subjects analysed
    69
    68
    137
    Units: number
    4
    2
    6
    No statistical analyses for this end point

    Primary: The incidence of Nabs

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    End point title
    The incidence of Nabs [2]
    End point description
    To assess the immunogenicity of transitioning subjects with RA to DRL_RI (biosimilar rituximab) from US-rituximab/EU-rituximab to continued treatment with US-rituximab/EU-rituximab. - The incidence of ADAs - The incidence of Nabs
    End point type
    Primary
    End point timeframe
    The immunogenicity endpoint was measured while on study over up to 12 weeks or until death, regardless of use of prohibited therapies or treatment missed/discontinuation due to any other reasons.
    Notes
    [2] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: No statistical analysis has been provided, instead all data is included in Descriptive summary statistics.
    End point values
    Arm A - Treatment arm Arm B - Reference arm Immunogenicity population
    Number of subjects analysed
    69
    68
    137
    Units: number
    1
    0
    1
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Investigators and other site personnel informed, as appropriate, the sponsor’s designated safety services of any SAEs that occurred (whether or not attributable to the study drug) in the course of the study within 24 hours of awareness.
    Adverse event reporting additional description
    Follow-up information on SAEs and a nonserious AE became serious, this and other relevant follow-up information was also provided to sponsor within 24 hours of awareness. All SAEs were reported. All SAEs were recorded in the CRF. The investigator was responsible for informing the IEC/IRB of the SAEs per local requirements.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    25.0
    Reporting groups
    Reporting group title
    Arm A - Treatment arm
    Reporting group description
    DRL_RI

    Reporting group title
    Arm B - Reference arm
    Reporting group description
    US-rituximab or EU-rituximab

    Serious adverse events
    Arm A - Treatment arm Arm B - Reference arm
    Total subjects affected by serious adverse events
         subjects affected / exposed
    4 / 70 (5.71%)
    2 / 70 (2.86%)
         number of deaths (all causes)
    1
    0
         number of deaths resulting from adverse events
    1
    0
    Cardiac disorders
    Myocardial infarction
         subjects affected / exposed
    1 / 70 (1.43%)
    0 / 70 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Surgical and medical procedures
    Intestinal resection
         subjects affected / exposed
    1 / 70 (1.43%)
    0 / 70 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Nervous system disorders
    Embolic stroke
         subjects affected / exposed
    0 / 70 (0.00%)
    1 / 70 (1.43%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gastrointestinal disorders
    Enteritis
         subjects affected / exposed
    0 / 70 (0.00%)
    1 / 70 (1.43%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Infections and infestations
    COVID-19 pneumonia
         subjects affected / exposed
    2 / 70 (2.86%)
    0 / 70 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    Cystitis
         subjects affected / exposed
    0 / 70 (0.00%)
    1 / 70 (1.43%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Empyema
         subjects affected / exposed
    0 / 70 (0.00%)
    1 / 70 (1.43%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Septic shock
         subjects affected / exposed
    0 / 70 (0.00%)
    1 / 70 (1.43%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 3%
    Non-serious adverse events
    Arm A - Treatment arm Arm B - Reference arm
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    3 / 70 (4.29%)
    17 / 70 (24.29%)
    Nervous system disorders
    Headache
         subjects affected / exposed
    0 / 70 (0.00%)
    5 / 70 (7.14%)
         occurrences all number
    0
    5
    Gastrointestinal disorders
    Diarrhoea
         subjects affected / exposed
    2 / 70 (2.86%)
    5 / 70 (7.14%)
         occurrences all number
    2
    6
    Infections and infestations
    COVID-19
         subjects affected / exposed
    1 / 70 (1.43%)
    4 / 70 (5.71%)
         occurrences all number
    1
    4
    Nasopharyngitis
         subjects affected / exposed
    0 / 70 (0.00%)
    3 / 70 (4.29%)
         occurrences all number
    0
    3

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    12 Aug 2019
    The following is a summary of the major changes implemented with Protocol Amendment 1, Version 2.0, dated 12 Aug 2019: • Updated exclusion criterion 2 for clarity. • Added exclusion criterion 18: Subjects with hypogammaglobulinemia (low IgG) are immunocompromised and more susceptible for both infections and side effects; hence, such subjects should be excluded. • Guidance in Section 5.4.1 Packaging was reworded for better clarity. Sentence modified to: “Rituximab concentrate for solution for infusion will be packaged in a carton or kit.” • Added the following text in Section 6.1 of Schedule of Assessments to clarify data capture at unscheduled visits: “If any unscheduled visits happen at any time during the study, visit details/appropriate data including reason will be captured in the eCRF.” • Added assessment of IgG (Section 6.1.1) to align with addition of new exclusion criterion 18 to exclude the subjects with low IgG. • Added clarification for estimation of rituximab concentration in Section 3.1.2 and Section 6.2.1: time-matched blood samples for estimation of rituximab concentration were added to aid in subsequent data interpretation as and if needed. Relevant procedures (i.e., time-matched blood sample collection and blood loss for estimation of rituximab concentration) were added in Section 6.1.2, Section 6.1.3, Section 6.1.4, Section 6.5, and Appendix 1.
    10 Jul 2020
    Summary of the major changes implemented with Protocol Amendment 2, Version 3.0 dated 10 Jul 2020: • Study was extended to 6 months and included an additional follow-up visit at Week 26 with safety and serum pregnancy test in WOCBP. • Reconsent was mandated for additional follow-up. • A new Section 3.2 was included for contingency measures to be taken for smooth functioning of the study during the COVID-19 pandemic. • Exclusion criterion 6 was revised to update the requirement of historical “severe” hypersensitivity to reference product or any of its excipients. • Exclusion criterion 16 was updated to include definition of WOCBP and birth control measures • Exclusion criterion 17 was updated to clarify that sexually active male subjects, who do not agree to use one of the highly effective methods of birth control during treatment and for at least 12 months after the last administration of study drug, will be excluded from the study. • Section 4.2.2 was revised to emphasize that subjects could take their own independent decision to withdraw from study drug and/or study participation at any time. • Section 6.1 and Appendix 1 were updated to include information that complete physical examination was to be performed at all study visits. • Information regarding immunological testing in humans was included in Section 6.2.2 • Detailed definitions of IRRs and hypersensitivity reactions were added in Section 6.3 • Section 6.3.1.2 was updated to clarify that all ongoing SAEs were to be followed up until resolution or stabilization or until a predefined outcome was reached. • Text was clarified regarding the assessment of adverse events outcome in Section 6.3.1.4 • ANC count was added to Section 6.3.4 • Clarified requirement of serum FSH testing (Section 6.3.4). • A note of clarification was added for HBcAb evaluation in across protocol • Clarified that the study sites were advised to follow local or country-specific guidelines while obtaining consent.

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported
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    The status and protocol content of GB trials is no longer updated since 1 January 2021. For the UK, as of 31 January 2021, EU Law applies only to the territory of Northern Ireland (NI) to the extent foreseen in the Protocol on Ireland/NI. Legal notice
    As of 31 January 2023, all EU/EEA initial clinical trial applications must be submitted through CTIS . Updated EudraCT trials information and information on PIP/Art 46 trials conducted exclusively in third countries continues to be submitted through EudraCT and published on this website.

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