Uncontrolled Study to Evaluate Efficacy of Tocilizumab in Patients With Moderate or Severe Rheumatoid Arthritis

May 21, 2015 updated by: Spanish Foundation of Rheumatology

Uncontrolled Study to Evaluate Efficacy of Tocilizumab in Patients With Moderate or Severe Rheumatoid Arthritis and Candidates With a Biological Monotherapy

The purpose of this project is to evaluate the efficacy of Tocilizumab (TCZ) given as monotherapy in patients with active rheumatoid arthritis (RA) according to EULAR response at 24 weeks after treatment initiation.

The study design is an intervention study, uncontrolled, multicenter, prospective, 32-weeks, two cohorts of patients with poor compliance or with any contraindication or intolerance to methotrexate.

One cohort naive to previous biological therapy and the other one treated previously with a biological treatment.

Study Overview

Status

Unknown

Conditions

Intervention / Treatment

Study Type

Interventional

Enrollment (Anticipated)

122

Phase

  • Phase 4

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Spain
      • Barcelona, Spain, 08035
        • Recruiting
        • Hospital Universitari Vall d´Hebrón
        • Principal Investigator:
          • Sara Marsal Barril, MD; PhD
      • Cádiz, Spain, 11009
        • Active, not recruiting
        • Hospital Universitario Puerta del Mar
      • Córdoba, Spain, 14004
        • Recruiting
        • Hospital Universitario Reina Sofia
        • Principal Investigator:
          • Eduardo Collantes
      • Granada, Spain, 18012
        • Recruiting
        • Hospital San Cecilio
        • Principal Investigator:
          • Enrique Raya
      • Guadalajara, Spain, 19002
        • Active, not recruiting
        • Hospital Universitario de Guadalajara
      • La Coruña, Spain, 15006
        • Recruiting
        • Complejo Hospitalario Universitario de A Coruña
        • Principal Investigator:
          • Francisco Blanco
      • León, Spain, 24080
        • Active, not recruiting
        • Complejo Asistencial Universitario de León
      • Madrid, Spain, 28006
        • Recruiting
        • Hospital Universitario de La Princesa
        • Principal Investigator:
          • Rosario García de Vicuña
      • Málaga, Spain, 29009
        • Recruiting
        • Hospital Civil
        • Principal Investigator:
          • María Ángeles Belmonte, MD
      • Valencia, Spain, 46010
        • Recruiting
        • Hospital Clinico Universitario de Valencia
        • Principal Investigator:
          • Pilar Trenor
      • Valencia, Spain, 46017
        • Recruiting
        • Hospital Universitario Dr. Peset
        • Principal Investigator:
          • Juan José Alegre
    • Alava
      • Vitoria-Gasteiz, Alava, Spain, 01009
        • Active, not recruiting
        • Hospital Universitario Araba (Sede Txagorritxu)
    • Alicante
      • Orihuela, Alicante, Spain, 03314
        • Recruiting
        • Hospital del la Agencia Valenciana de Salud Vega Baja
        • Principal Investigator:
          • María Isabel Tevar
    • Barcelona
      • Hospitalet de Llobregat, Barcelona, Spain, 08907
        • Active, not recruiting
        • Hospital Universitari de Bellvitge
    • Cantabria
      • Santander, Cantabria, Spain, 39008
        • Active, not recruiting
        • Hospital Universitario Marques de Valdecilla
    • Islas Baleares
      • Ibiza, Islas Baleares, Spain, 07800
        • Recruiting
        • Hospital Can Misses
        • Principal Investigator:
          • Ana Urruticoechea
      • Mallorca, Islas Baleares, Spain, 07120
        • Active, not recruiting
        • Hospital Universitari Son Espases
    • Santa Cruz de Tenerife
      • San Cristóbal de La Laguna, Santa Cruz de Tenerife, Spain, 38320
        • Recruiting
        • Hospital Universitario de Canarias
        • Principal Investigator:
          • Sagrario Bustabad
    • Valencia
      • Sagunto, Valencia, Spain, 46520
        • Recruiting
        • Hospital de Sagunto
        • Principal Investigator:
          • Antonio Gracia
    • Vizcaya
      • Galdácano, Vizcaya, Spain, 48960
        • Active, not recruiting
        • Hospital Galdakao-Usansolo

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Patients with ability and willing to provide written informed consent and comply with the requirements of the study protocol.
  • Patients with active moderate or severe rheumatoid arthritis, according to 1987 ACR criteria, diagnosed at least 6 months before inclusion.
  • 18 years old or older
  • DAS28 index greater than 3.2 at baseline.
  • If patients are receiving corticosteroid the dose will have to be ≤ 10 mg of prednisone (or equivalent) and the patient must have been stable for at least one month previous to initiating treatment with Tocilizumab (day 1). Patients may have been treated with nonsteroidal antiinflammatory drug (NSAIDs) at stable doses during the previous month to inclusion.
  • Patients receiving outpatient treatment.
  • Women of childbearing potential and men with childbearing potential partners may only participate in the study if they use reliable contraception (eg barrier methods [the patient or her partner], oral or patch contraceptives, spermicide and barrier method or intrauterine device) during the study period and at least 3 months after receiving the last dose of Tocilizumab.
  • In women of childbearing potential the pregnancy test must be negative at the screening visit and at baseline.
  • Patients on methotrexate monotherapy or combined treatment with a biological agent, or patients on biological treatment monotherapy, who show or have ever shown intolerance or poor compliance or safety issues with methotrexate.
  • Patients judge to be candidates to biological monotherapy by the researcher, without excluding previous use of other disease-modifying antirheumatic drug (DMARDs) different to methotrexate.

Exclusion Criteria:

  • Patients with no peripheral venous access.
  • Patients with previous failure to more than two biological treatments.
  • Previous treatment with Tocilizumab at any time before the baseline visit.
  • Treatment with any other agent on research during the four weeks previous to the screening visit (or equivalent period to its five half-lives) Considering the longest period.
  • Previous treatment with cell depletion therapies, including experimental treatments or approved agents, as for examples: CAMPATH, antiCD4, antiCD5, antiCD3, antiCD19 and antiCD20).
  • Treatment with intravenous gammaglobulin or plasmapheresis in the 6 months previous to the baseline visit.
  • Intra-articular or parenteral corticosteroids within 4 weeks previous to the baseline visit.
  • Immunization with a live / attenuated vaccine in the previous 4 weeks to the baseline visit.
  • Previous treatment with alkylating agents such as chlorambucil, or full lymphoid irradiation.
  • History of severe allergic or anaphylactic reactions to human, humanized or murine, monoclonal antibodies.
  • Evidence of serious uncontrolled concomitant disease: cardiovascular, nervous system, lung (including chronic obstructive pulmonary disease), renal, hepatic, endocrine (including uncontrolled diabetes mellitus) or gastrointestinal.
  • History of diverticulitis, diverticulosis requiring treatment with antibiotics, or chronic lower gastrointestinal ulcer disease, Crohn's disease, ulcerative colitis or any other lower gastrointestinal symptomatic conditions that could predispose to perforations.
  • Known active Infections, or a history of known recurring infections: Mycobacterial, fungal, viral or bacterial type (included, but not limited to, tuberculosis, atypical mycobacterial disease, hepatitis B and C, herpes zoster, but excluding nail bed fungal infections).
  • Any major episode of infection that required hospitalization or treatment with intravenous antibiotics within 4 weeks previous to the screening visit or oral antibiotics within 2 weeks previous to the screening visit.
  • Active tuberculosis requiring treatment in the past year. Latent tuberculosis screening will be perform on all patients according to Spanish Society of Rheumatology/Spanish Agency for Medicines and Health Products (SER/AEMPS) guidelines of the. Patients treated for tuberculosis without recurrence in the past 3 years will not be excluded.
  • Ongoing liver disease as determined by the principal investigator.
  • Evidence of active malignancy, malignancies diagnosed in the previous 10 years (including solid and hematologic tumors, except basal cell carcinoma and squamous cell skin or removed and cured in situ cervix carcinoma), or breast cancer diagnosed in the previous 20 years.
  • Pregnant or breastfeeding women.
  • Patients with reproductive potential who are unwilling to use effective contraception.
  • History of alcoholism, drug abuse or addiction in the previous year to the screening visit.
  • Neuropathies or other painful conditions that may interfere with pain assessment.
  • Serum creatinine >1,4 mg/dl (124 mol/l) in women and >1.6 mg/dl (141 mol/l) in men.
  • Alanine aminotransferase or aspartate aminotransferase > 1.5 times the upper limit of normal.
  • Total bilirubin greater than the upper limit of normal.
  • Platelet count minor than 100 x 10^9/l (100.000/mm3).
  • Hemoglobin minor than 85 g/L (<8,5 g/dL, 5,3 mmol/L).
  • Leukocytes minor than 3,0 x 10^9/L (3000/mm3).
  • Neutrophils, absolute value minor than 2,0 x 10^9/L (2000/mm3).
  • Lymphocytes, absolute value minor than 0,5 x 10^9 /L (500/mm3).

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Non-Randomized
  • Interventional Model: Single Group Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Other: Naive biological treatment

Rheumatoid arthritis patients with intolerance or poor compliance or contraindication to methotrexate and who have not received previous biological treatment.

Tocilizumab dose 8mg/kg administered every 4 weeks for 24 weeks
Drug: Tocilizumab
Tocilizumab dose 8mg/kg administered every 4 weeks during 24 weeks.
Other Names:
  • RoActemra
Other: Previous Biological treatment

Rheumatoid arthritis patients with intolerance or poor compliance or contraindication to methotrexate and who have not received more than two previous biological treatments.

Tocilizumab dose 8mg/kg administered every 4 weeks for 24 weeks
Drug: Tocilizumab
Tocilizumab dose 8mg/kg administered every 4 weeks during 24 weeks.
Other Names:
  • RoActemra

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Percentage of patients achieving good or moderate European League Against Rheumatism (EULAR) response.
Time Frame: At 24 weeks of treatment.
To evaluate the efficacy of Tocilizumab monotherapy administered in patients with active rheumatoid arthritis, in terms of percentage of patients achieving good or moderate European League Against Rheumatism (EULAR) response. To be classified as a good response, patients must have a clinically significant change (> 1.2) in DAS28 index as well as achieving low disease activity. Moderate answer assumes DAS28 index decreases between 0.6 and 1,2, long as it reaches low or moderate disease activity (DAS28 ≤ 5.1), or clinically significant (> 1.2) in the DAS28 in patients with a moderate or high activity (DAS28> 3.2) is achieved.
At 24 weeks of treatment.

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Changes in the mean of DAS28 index.
Time Frame: Between baseline and week 24.
To evaluate the efficacy of Tocilizumab monotherapy administered in patients with active rheumatoid arthritis, in terms of Disease Activity Score 28 (DAS28) change by the response EULAR criteria.
Between baseline and week 24.
Changes in the mean of Simplex Disease Activity Index (SDAI), Clinical Disease Activity Index (CDAI).
Time Frame: At 24 weeks of treatment.
To evaluate the activity of rheumatoid arthritis by the Simplex Disease Activity Index (SDAI), Clinical Disease Activity Index (CDAI) using the mean change in these index.
At 24 weeks of treatment.
Percentage of patients complying American College of Rheumatology (ACR) criteria (ACR20, ACR50 and ACR70).
Time Frame: At 24 weeks of treatment
To evaluate the efficacy by the American College of Rheumatology (ACR) criteria.
At 24 weeks of treatment
Changes in the mean of DAS28 index into several subgroups.
Time Frame: between baseline and week 24

To evaluate the efficacy in patients with active rheumatoid arthritis treated with Tocilizumab monotherapy by the change in DAS28 index between baseline and week 24 in the following subgroups:

Baseline DAS28: greater than 3.2 and less than 5.1 Baseline DAS28: greater than or equal to 5.1 Cohort A: Patients who have never been treated with biological therapy. Cohort B: Patients who have been previously treated with biological therapy.
between baseline and week 24
Percentage of patients with a DAS28 index less than or equal to 3.2
Time Frame: At week 24 of treatment.
At week 24 of treatment.
Number of non-serious, serious or unexpected adverse events.
Time Frame: At the end of study (32 weeks).
To evaluate the safety of Tocilizumab monotherapy during the study period.
At the end of study (32 weeks).
Changes in the mean of Health-Related Quality of Life (HRQOL) index into several subgroups.
Time Frame: between baseline and week 24.

To evaluate the Health-Related Quality of Life (HRQOL) of patients with rheumatoid arthritis treated with Tocilizumab monotherapy in the following subgroups:

Baseline DAS28: greater than 3.2 and less than 5.1 Baseline DAS28: greater than or equal to 5.1 Cohort A: Patients who have never been treated with biological therapy. Cohort B: Patients who have been previously treated with biological therapy.
between baseline and week 24.

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Spanish Foundation of Rheumatology

Collaborators

Roche Farma, S.A

Investigators

  • Principal Investigator: Sara Marsal Barril, MD; PhD, Hospital Vall d'Hebron

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

May 1, 2014

Primary Completion (Anticipated)

December 1, 2015

Study Completion (Anticipated)

July 1, 2016

Study Registration Dates

First Submitted

March 6, 2014

First Submitted That Met QC Criteria

March 12, 2014

First Posted (Estimate)

March 14, 2014

Study Record Updates

Last Update Posted (Estimate)

May 22, 2015

Last Update Submitted That Met QC Criteria

May 21, 2015

Last Verified

May 1, 2015

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • FER-TOC-2013-01
  • 2013-004051-20 (EudraCT Number)

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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