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    Clinical Trial Results:
    A randomised, double-blind, placebo-controlled, dose-ranging Phase 2b study to investigate the efficacy and safety of MBS2320 with background methotrexate (MTX) in participants with moderate to severe active rheumatoid arthritis (RA) who have had an inadequate response to MTX alone

    Summary
    EudraCT number
    2020-005496-13
    Trial protocol
    CZ   PL   BG  
    Global end of trial date
    28 Dec 2023

    Results information
    Results version number
    v1(current)
    This version publication date
    03 Apr 2025
    First version publication date
    03 Apr 2025
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    IST-06
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT05460832
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Modern Biosciences Ltd.
    Sponsor organisation address
    2nd Floor, 3 Pancras Square, London, United Kingdom, N1C 4AG
    Public contact
    ist06@istesso.co.uk, Modern Biosciences Ltd., +44 207 444 0066, ist06@istesso.co.uk
    Scientific contact
    ist06@istesso.co.uk, Modern Biosciences Ltd., +44 207 444 0066, ist06@istesso.co.uk
    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 Sep 2024
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    28 Dec 2023
    Global end of trial reached?
    Yes
    Global end of trial date
    28 Dec 2023
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    To evaluate the efficacy of MBS2320 (5 mg once daily, 20 mg once daily, and 40 mg once daily) compared with placebo in participants with active Rheumatoid arthritis (RA) on stable background Methotrexate (MTX) who have had an inadequate response to MTX alone, with confirmed intra-articular (IA) synovitis on baseline magnetic resonance imaging (MRI)
    Protection of trial subjects
    The study was performed in accordance with the ethical principles that have their origin in the Declaration of Helsinki, ICH GCP, and all applicable regulations. The investigator was responsible for providing written summaries of the progress and status of the study at intervals not exceeding 1 year or as otherwise specified by the IEC. The investigator promptly supplied the sponsor or its designee, the IEC, and, where applicable, the institution, with written reports on any changes significantly affecting the conduct of the study or increasing the risk to participants.
    Background therapy
    Participants had to be on a stable once-weekly MTX dose regimen (15 to 25 mg per week, either as an oral or parenteral dose) for at least 56 days prior to the baseline visit. Participants also had to be on a stable dose of folic acid (or equivalent) for at least 56 days prior to the baseline visit. The investigator monitored for MTX toxicity for the duration of the study and adjusted the dose according to current clinical guidelines. Participants continued their prescribed dosing regimen of MTX and folic acid (or equivalent) throughout the study. Participants were permitted to use oral corticosteroid background therapy for RA as prescribed by a physician, unless otherwise excluded (see below), as long as the doses were stable for at least 4 weeks prior to the baseline visit and the daily dose did not exceed 10 mg prednisolone (or equivalent). Participants were also permitted to use oral or topical (but not both) NSAID background therapy for RA or therapies for other conditions as prescribed by a physician, unless otherwise excluded (see below), as long as the doses were stable for at least 4 weeks prior to the baseline visit. Short-term (up to 7 total days) of NSAIDs or analgesics for other indications (e.g. headaches) were permitted during the study.
    Evidence for comparator
    This study is placebo-controlled and placebo is used for comparator.
    Actual start date of recruitment
    25 Jul 2022
    Long term follow-up planned
    Yes
    Long term follow-up rationale
    Safety, Efficacy
    Long term follow-up duration
    2 Months
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Bulgaria: 17
    Country: Number of subjects enrolled
    Poland: 27
    Country: Number of subjects enrolled
    Czechia: 10
    Country: Number of subjects enrolled
    Bosnia and Herzegovina: 8
    Country: Number of subjects enrolled
    Chile: 60
    Country: Number of subjects enrolled
    Guatemala: 30
    Country: Number of subjects enrolled
    Mexico: 80
    Country: Number of subjects enrolled
    Serbia: 16
    Worldwide total number of subjects
    248
    EEA total number of subjects
    54
    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)
    209
    From 65 to 84 years
    39
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    Approximately 224 participants were planned to be enrolled into the 4 treatment groups (56 participants per group).

    Pre-assignment
    Screening details
    In total 414 participants were screened - 154 failed to meet inclusion/exclusion criteria and 12 withdrew consent during screening period.Remaining 248 participants were randomised and received at least one dose of either MBS2320 (186 participants: 62 randomised to 5 mg, 63 randomised to 20 mg and 61 randomised to 40 mg) or placebo (62 participants

    Period 1
    Period 1 title
    Treatment 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

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    MBS2320 5 mg
    Arm description
    MBS2320 5 mg once daily for 12 weeks
    Arm type
    Experimental

    Investigational medicinal product name
    MBS2320
    Investigational medicinal product code
    Other name
    Leramistat
    Pharmaceutical forms
    Capsule
    Routes of administration
    Oral use
    Dosage and administration details
    MBS2320 5 mg once daily for 12 weeks used as an adjunct therapy to MTX (15 to 25 mg per week, either as an oral or parenteral dose)

    Arm title
    MBS2320 20 mg
    Arm description
    MBS2320 20 mg once daily for 12 weeks
    Arm type
    Experimental

    Investigational medicinal product name
    MBS2320
    Investigational medicinal product code
    Other name
    Leramistat
    Pharmaceutical forms
    Capsule
    Routes of administration
    Oral use
    Dosage and administration details
    MBS2320 20 mg once daily for 12 weeks used as an adjunct therapy to MTX (15 to 25 mg per week, either as an oral or parenteral dose)

    Arm title
    MBS2320 40 mg
    Arm description
    MBS2320 40 mg once daily for 12 weeks
    Arm type
    Experimental

    Investigational medicinal product name
    MBS2320
    Investigational medicinal product code
    Other name
    Leramistat
    Pharmaceutical forms
    Capsule
    Routes of administration
    Oral use
    Dosage and administration details
    MBS2320 40 mg once daily for 12 weeks used as an adjunct therapy to MTX (15 to 25 mg per week, either as an oral or parenteral dose)

    Arm title
    Placebo
    Arm description
    Matching placebo capsules were provided containing the same excipients as the MBS2320 capsules but minus the active drug. The dosing instructions were the same as for MBS2320.
    Arm type
    Placebo

    Investigational medicinal product name
    Placebo
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Capsule
    Routes of administration
    Oral use
    Dosage and administration details
    Placebo once daily for 12 weeks used as an adjunct therapy to MTX (15 to 25 mg per week, either as an oral or parenteral dose)

    Number of subjects in period 1
    MBS2320 5 mg MBS2320 20 mg MBS2320 40 mg Placebo
    Started
    62
    63
    61
    62
    Completed
    61
    54
    57
    57
    Not completed
    1
    9
    4
    5
         Withdrawal of Consent
    -
    1
    3
    3
         Study terminated
    -
    1
    1
    -
         Physician decision
    1
    1
    -
    -
         Consent withdrawn by subject
    -
    2
    -
    -
         Disease progression
    -
    1
    -
    -
         Randomised by mistake
    -
    1
    -
    -
         Adverse event, non-fatal
    -
    2
    -
    -
         Lost to follow-up
    -
    -
    -
    1
         Protocol deviation
    -
    -
    -
    1

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    MBS2320 5 mg
    Reporting group description
    MBS2320 5 mg once daily for 12 weeks

    Reporting group title
    MBS2320 20 mg
    Reporting group description
    MBS2320 20 mg once daily for 12 weeks

    Reporting group title
    MBS2320 40 mg
    Reporting group description
    MBS2320 40 mg once daily for 12 weeks

    Reporting group title
    Placebo
    Reporting group description
    Matching placebo capsules were provided containing the same excipients as the MBS2320 capsules but minus the active drug. The dosing instructions were the same as for MBS2320.

    Reporting group values
    MBS2320 5 mg MBS2320 20 mg MBS2320 40 mg Placebo Total
    Number of subjects
    62 63 61 62 248
    Age categorical
    Units: Subjects
        Adults (18-64 years)
    49 54 54 52 209
        From 65-84 years
    13 9 7 10 39
    Age continuous
    Units: years
        median (full range (min-max))
    54.0 (21.0 to 73.0) 55.0 (23.0 to 73.0) 53.0 (25.0 to 75.0) 55.5 (22.0 to 73.0) -
    Gender categorical
    Units: Subjects
        Female
    52 59 54 48 213
        Male
    10 4 7 14 35

    End points

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    End points reporting groups
    Reporting group title
    MBS2320 5 mg
    Reporting group description
    MBS2320 5 mg once daily for 12 weeks

    Reporting group title
    MBS2320 20 mg
    Reporting group description
    MBS2320 20 mg once daily for 12 weeks

    Reporting group title
    MBS2320 40 mg
    Reporting group description
    MBS2320 40 mg once daily for 12 weeks

    Reporting group title
    Placebo
    Reporting group description
    Matching placebo capsules were provided containing the same excipients as the MBS2320 capsules but minus the active drug. The dosing instructions were the same as for MBS2320.

    Primary: ACR20 response at Week 12

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    End point title
    ACR20 response at Week 12
    End point description
    Participants who achieved composite clinical response at week 12 according to the criteria for ACR20
    End point type
    Primary
    End point timeframe
    12 weeks
    End point values
    MBS2320 5 mg MBS2320 20 mg MBS2320 40 mg Placebo
    Number of subjects analysed
    62
    63
    61
    62
    Units: percent
    number (confidence interval 95%)
        Successful ACR20Ic CCR Rate (%)
    49.2 (36.1 to 62.3)
    42.4 (28.7 to 56.1)
    54.7 (41.4 to 68.0)
    48.4 (34.8 to 62.0)
    Statistical analysis title
    Logistic Regression model
    Statistical analysis description
    Logistic regression model included treatment and prognostic categorical factors: baseline use of corticosteroids for RA and qualitative screening ACPA.
    Comparison groups
    MBS2320 5 mg v MBS2320 40 mg v MBS2320 20 mg v Placebo
    Number of subjects included in analysis
    248
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.963
    Method
    Regression, Logistic
    Parameter type
    Difference in ACR20Ic CCR Rate (%)
    Point estimate
    0.4
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -15.3
         upper limit
    16

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    The safety profile of MBS2320 in this 12-week study was favourable, with all doses assessed being generally well tolerated.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    26.1
    Reporting groups
    Reporting group title
    MBS2320 5 mg
    Reporting group description
    -

    Reporting group title
    MBS2320 20 mg
    Reporting group description
    -

    Reporting group title
    MBS2320 40 mg
    Reporting group description
    -

    Reporting group title
    Placebo
    Reporting group description
    -

    Serious adverse events
    MBS2320 5 mg MBS2320 20 mg MBS2320 40 mg Placebo
    Total subjects affected by serious adverse events
         subjects affected / exposed
    0 / 62 (0.00%)
    0 / 63 (0.00%)
    2 / 61 (3.28%)
    0 / 62 (0.00%)
         number of deaths (all causes)
    0
    0
    0
    0
         number of deaths resulting from adverse events
    0
    0
    0
    0
    Gastrointestinal disorders
    Constipation
         subjects affected / exposed
    0 / 62 (0.00%)
    0 / 63 (0.00%)
    1 / 61 (1.64%)
    0 / 62 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Infections and infestations
    Abscess limb
         subjects affected / exposed
    0 / 62 (0.00%)
    0 / 63 (0.00%)
    1 / 61 (1.64%)
    0 / 62 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    MBS2320 5 mg MBS2320 20 mg MBS2320 40 mg Placebo
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    16 / 62 (25.81%)
    8 / 63 (12.70%)
    13 / 61 (21.31%)
    4 / 62 (6.45%)
    Investigations
    Blood bicarbonate decreased
         subjects affected / exposed
    4 / 62 (6.45%)
    4 / 63 (6.35%)
    0 / 61 (0.00%)
    4 / 62 (6.45%)
         occurrences all number
    4
    4
    0
    4
    Gastrointestinal disorders
    Nausea
         subjects affected / exposed
    0 / 62 (0.00%)
    0 / 63 (0.00%)
    4 / 61 (6.56%)
    0 / 62 (0.00%)
         occurrences all number
    0
    0
    4
    0
    Infections and infestations
    Nasopharyngitis
         subjects affected / exposed
    0 / 62 (0.00%)
    0 / 63 (0.00%)
    4 / 61 (6.56%)
    0 / 62 (0.00%)
         occurrences all number
    0
    0
    4
    0
    Urinary tract infection
         subjects affected / exposed
    4 / 62 (6.45%)
    4 / 63 (6.35%)
    0 / 61 (0.00%)
    0 / 62 (0.00%)
         occurrences all number
    4
    4
    0
    0
    Metabolism and nutrition disorders
    Metabolic acidosis
         subjects affected / exposed
    8 / 62 (12.90%)
    0 / 63 (0.00%)
    5 / 61 (8.20%)
    0 / 62 (0.00%)
         occurrences all number
    8
    0
    5
    0

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    20 Dec 2021
    Protocol Version 1.0 - Original protocol
    12 Jan 2023
    Protocol Version 2.0 - This amendment made the following changes: • Updated the objectives and estimands to include participants with confirmed condition of IA synovitis on baseline MRI. • Updated the primary endpoint to add that the successful composite clinical response at Weeks 4 and 8 according to the criteria for ACR20 were to be achieved without discontinuing treatment due to tolerability issues or lack of efficacy or requiring any increase in RA medications. • Endpoint descriptions have been modified: o Addition of DAS28-hsCRP <3.2 at Weeks 4, 8, and 12. o Addition of change in CARLOS from baseline to Week 12. o Change in ACPA levels from screening to Week 12. • Inclusion criteria updated to include: o Acceptance of one repeat assessment for CRP as per the investigator’s discretion if all other eligibility criteria were met. o Updates to the conditions for discontinuation of oral DMARDs for ≥8 weeks prior to baseline visit to include oral cyclosporine. o Updates to the language in the criteria for participants taking NSAIDs or acetaminophen. • Exclusion criteria updated to include: o Clarification on the clinically significant features of arthroses that could interfere with study assessments and objectives. o Updates to the language on male and female contraception. o The exclusion due to major surgery for RA within 56 days prior to the baseline visit was deleted. o History of other major surgery timelines were changed from screening to baseline. • Study design was updated to change the study intervention dosage instructions at home during study visits 3, 4 and 5. • Efficacy assessments had the following minor changes: o VAS value for measuring disease activity, arthritis pain, and assessment of health removed. o Included that the CARLOS determined by MRI will be assessed using a previously validated 9-point CARLOS scale. • Sample size summary was modified. • Changes made to the statistical analyses.

    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
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