Phase ll Study of Pirfenidone in Patients With RAILD (TRAIL1)

July 20, 2022 updated by: Hilary J. Goldberg, M.D., Brigham and Women's Hospital

Phase 2 Study of Safety, Tolerability and Efficacy of Pirfenidone in Patients With Rheumatoid Arthritis Interstitial Lung Disease (TRAIL1)

The purpose of this study is to to assess the safety and tolerability of pirfenidone 2403 mg/day for the treatment of RA-associated interstitial lung disease.

Study Overview

Detailed Description

This is a phase 2, randomized, double blind, placebo controlled trial of pirfenidone for the treatment of RA associated interstitial lung disease. Approximately 270 subjects will be randomized to receive Pirfenidone 2403 mg per day or placebo in a 1:1 ratio. The primary outcome of this study is to assess the efficacy of pirfenidone 2403 mg/day versus placebo in patients with RA associated interstitial lung disease, as defined by progression free survival over the 52 weeks of treatment. Patients will receive blinded study treatment from the time of randomization until the Week 52 Visit.

Eligible patients aged 18 to 85 years must meet 2010 ACR/EULAR criteria for RA (Aletaha, Neogi et al. 2010) as well as RA-associated ILD, as determined by imaging and, when available, lung biopsy. Patients will be required to have a % predicted FVC ≥40 and % predicted DLCO or TLCO ≥30 at screening.

The dose of study treatment will be titrated over 14 days. Patients will receive a telephone assessment at Weeks 1 and 2, and visit the clinic at Weeks 4, 8, 13, 19, 26, 39, and 52. Subjects will have a follow up phone call 28 days after completion of the study drug. Patients should complete a compliance diary between visits. If patients discontinue study treatment for any reason before the end of the study, they should continue with all scheduled study procedures through Week 52. If subjects are unable to complete the study visits as scheduled, all efforts should be made to complete an early termination visit.

The primary outcome variable of this study will be progression free survival, defined as progression free from decline in FVC of 10% or greater during the 52 week study period.

More information can be found at www.ralung.org.

Study Type

Interventional

Enrollment (Actual)

123

Phase

  • Phase 2

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

      • Camperdown, Australia, 2050
        • The Prince Charles Hospital
    • Queensland
      • Brisbane, Queensland, Australia, 4032
        • Royal Brompton
    • Sydney
      • Camperdown, Sydney, Australia, NSW 2050
        • Royal Prince Alfred Hospital
    • Victoria
      • Melbourne, Victoria, Australia, 3004
        • Melbourne Alfred Hospital
    • Alberta
      • Calgary, Alberta, Canada, T3M 1M4
        • University of Calgary Cummings School of Medicine
    • British Columbia
      • Vancouver, British Columbia, Canada, V6Z1Y6
        • St. Paul's Hospital - Providence Health Care
    • Ontario
      • Hamilton, Ontario, Canada, L8N 4A6
        • St. Joseph's Healthcare
      • Toronto, Ontario, Canada, M5G 2C4
        • Toronto General Hospital
      • Bristol, United Kingdom, BS10 5NB
        • North Bristol NHS Trust Headquarters, Southmead Hospital
      • Cambridge, United Kingdom, CB23 3RE
        • Papworth Hospital NHS Foundation Trust
      • Exeter, United Kingdom, EX2 5DW
        • Royal Devon and Exeter NHS Foundation
      • Leeds, United Kingdom, LS9 7TF
        • Leeds Teaching Hospitals NHS Trust
      • Leicester, United Kingdom, LE3 9QP
        • University Hospitals of Leicester NHS Foundation Trust
      • Liverpool, United Kingdom, L9 7AL
        • Aintree University Hospitals NHS Foundation Trust
      • London, United Kingdom, SW3 6NP
        • Royal Brompton and Harefield NHS Foundation Trust
      • Manchester, United Kingdom, M23 9LT
        • Manchester University NHS Foundation Trust (South) Wythenshawe Hospita
      • Newcastle Upon Tyne, United Kingdom, NE1 4LP
        • Newcastle upon Tyne Hospitals NHS Foundation Trust
      • Norwich, United Kingdom, NR4 7UY
        • Norfolk and Norwich University Hospitals NHS Foundation Trust
      • Oxford, United Kingdom, OX3 7LE
        • Oxford University Hospitals NHS Foundation Trust
      • Southhampton, United Kingdom, SO16 6YD
        • University Hospital Southampton NHS Foundation Trust
    • Alabama
      • Birmingham, Alabama, United States, 35294
        • University of Alabama Site at Birmingham
    • California
      • San Francisco, California, United States, 94143
        • University of California San Francisco
    • Colorado
      • Denver, Colorado, United States, 80206
        • National Jewish Health
    • Florida
      • Miami, Florida, United States, 33136
        • University of Miami
    • Louisiana
      • New Orleans, Louisiana, United States, 70112
        • Tulane Medical Center
    • Maryland
      • Baltimore, Maryland, United States, 21224
        • John Hopkins Medicine
    • Massachusetts
      • Boston, Massachusetts, United States, 02115
        • Brigham and Women's Hospital
    • Michigan
      • Ann Arbor, Michigan, United States, 48109
        • University of Michigan
    • Minnesota
      • Rochester, Minnesota, United States, 55905
        • Mayo Clinic
    • New York
      • New York, New York, United States, 10065
        • Weill Cornell Medicine
    • Tennessee
      • Nashville, Tennessee, United States, 37232
        • Vanderbilt University Medical Center
    • Utah
      • Salt Lake City, Utah, United States, 84132
        • University of Utah Health Care
    • Washington
      • Seattle, Washington, United States, 98195
        • University of Washington

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 to 85 years (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Patients must fulfill all of the following criteria to be eligible for enrollment in the study:

  1. Age 18 through 85 years, inclusive, at Screening
  2. Probable or definite diagnosis of RA according to revised 2010 ACR/EULAR criteria, without evidence or suspicion of an alternative diagnosis that may contribute to their interstitial lung disease.
  3. Diagnosis of ILD

    1. supported by clinically indicated HRCT, and when available, surgical lung biopsy (SLB), prior to Screening, and
    2. presence of fibrotic abnormality affecting more than 10% of the lung parenchyma, with or without traction bronchiectasis or honeycombing, on screening and confirmed by adjudicated HRCT prior to Baseline
  4. No features supporting an alternative diagnosis on transbronchial biopsy, or SLB, if performed prior to Screening
  5. Attainment of the following centralized spirometry criteria (based on local spirometry on standardized equipment and centralized quality controlled):

    1. percent predicted FVC ≥ 40% at Screening
    2. change in pre-bronchodilator FVC (measured in liters) between Visit 1 (Screening) and Visit 2 (Randomization) must be a <10% relative difference, calculated as: 100% * [absolute value (Visit 1 FVC - Visit 2 FVC) / Visit 1 FVC]
    3. percent predicted DLCO or TLCO ≥25 % at Screening
    4. Screening (Visit 1) pre-bronchodilator(BD) and Post-BD spirometry meets ATS quality criteria as determined by a central reviewer
    5. Baseline (Visit 2) Pre-BD spirometry meets ATS quality criteria as determined by the site Investigator or the central reviewer
  6. Able to understand and sign a written informed consent form.
  7. For women of childbearing potential: agreement to remain abstinent (refrain from heterosexual intercourse) or use two adequate methods of contraception, including at least one method with a failure rate of <1% per year, during the 52 week treatment period and for at least 118 days after the last dose of study drug.

    1. A woman is considered to be of childbearing potential if she is postmenarcheal, has not reached a postmenopausal state (≥ 12 continuous months of amenorrhea with no identified cause other than menopause), and has not undergone surgical sterilization (removal of ovaries and/or uterus).
    2. Examples of contraceptive methods with a failure rate of <1% per year include bilateral tubal ligation, male sterilization, established and proper use of hormonal contraceptives that inhibit ovulation, hormone-releasing intrauterine devices, and copper intrauterine devices.
    3. The reliability of sexual abstinence should be evaluated in relation to the duration of the clinical trial and the preferred and usual lifestyle of the patient. Periodic abstinence (e.g., calendar, ovulation, symptothermal, or postovulation methods) and withdrawal are not acceptable methods of contraception.
  8. For men who are not surgically sterile: agreement to remain abstinent (refrain from heterosexual intercourse) or use contraceptive measures, and agreement to refrain from donating sperm, as defined below:

    1. With female partners of childbearing potential, men must remain abstinent or use a condom plus an additional contraceptive method that together result in a failure rate of < 1% per year during the treatment period and for at least 118 days after the last dose of study drug.
    2. Men must refrain from donating sperm during this same period.

PARTICIPANT EXCLUSION CRITERIA

  1. Not a suitable candidate for enrollment or unlikely to comply with the requirements of this study, in the opinion of the investigator
  2. Cigarette smoking or vaping within 3 months of Screening or unwilling to avoid tobacco products throughout the study
  3. History of clinically significant environmental exposure known to cause pulmonary fibrosis (PF), including but not limited to drugs (such as amiodarone), asbestos, beryllium, radiation, and domestic birds
  4. Concurrent presence of the following conditions:

    1. Other interstitial lung disease, related to but not limited to radiation, drug toxicity, sarcoidosis, hypersensitivity pneumonitis, or bronchiolitis obliterans organizing pneumonia
    2. Medical history including Human Immunodeficiency Virus (HIV)
    3. Medical history of viral hepatitis (positive Hep A antibody in the absence of elevated liver enzymes is not an exclusion)
  5. Concurrent presence of other pleuropulmonary manifestations of RA, including but not limited to rheumatoid nodular disease of the lung, pleuritis/pleural thickening, and obliterative bronchiolitis
  6. Post-bronchodilator FEV1/FVC <0.65 at Screening
  7. Presence of pleural effusion occupying more than 20% of the hemithorax on Screening HRCT
  8. Clinical diagnosis of a second connective tissue disease or overlap syndrome (including but not limited to scleroderma, sjogren's, polymyositis/dermatomyositis, systemic lupus erythematosus but excluding Raynaud's phenomena)
  9. Coexistent clinically significant COPD/emphysema or asthma in the opinion of the site principal investigator
  10. Clinical evidence of active infection, including but not limited to bronchitis, pneumonia, sinusitis, urinary tract infection, or cellulitis. The infection should be resolved per PI assessment prior to enrollment. Any use of antibiotics must be completed 2weeks prior to the screening visit. Note that prophylactic antibiotics are not contraindicated or exclusionary
  11. Any history of malignancy diagnosed within 5 years of screening, other than basal cell carcinoma of the skin, squamous cell carcinoma of the skin, or low grade cervical carcinoma, and/or low grade prostate cancer.

    Criteria for low grade prostate cancer:

    • Patients with suspicion for prostate cancer based on PSA and/or DRE should have been evaluated by urology
    • Patients with NCCN very low risk prostate cancer (∙ T1c and Grade Group 1 (Gleason 6) and PSA <10 ng/mL and Fewer than 3 prostate biopsy fragments/cores positive, ≤50% cancer in each fragment/coreg and ∙ PSA density <0.15 ng/mL/g) can be monitored without intervention and enrolled in study.
    • Patients with NCCN low risk prostate cancer can be monitored on a case by case basis (T1-T2a and Grade Group 1 (Gleason 6) and ∙ PSA <10 ng/mL) and enrolled in study.
    • All other patients should be excluded.
  12. History of LFT abnormalities as outlined below, or imaging, laboratory or other clinical information suggesting liver dysfunction, advanced liver disease or cirrhosis. Evidence of hepatic impairment that in the opinion of the investigator could interfere with drug metabolism or increase the risk of the known hepatotoxicity of study drug.

    Any of the following liver function abnormalities:

    1. Total bilirubin above the upper limit of normal (ULN), excluding patients with Gilbert's syndrome;
    2. Aspartate or alanine aminotransferase (AST/SGOT or AST/SGPT) > 3 X ULN;
    3. Alkaline phosphatase > 2.5 X ULN.
  13. History of end-stage renal disease requiring dialysis
  14. History of unstable or deteriorating cardiac disease, or unstable cardiac arrhythmia or arrhythmia requiring modification of drug therapy, myocardial infarction within the previous year, heart failure requiring hospitalization.
  15. Any condition that, in the opinion of the investigator, might be significantly exacerbated by the known side effects associated with the administration of pirfenidone
  16. History of alcohol or substance abuse in the past 2 years, at the time of Screening
  17. Family or personal history of long QT syndrome
  18. Any of the following test criteria above specified limits:

    1. Estimated glomerular filtration rate <30 mL/min/1.73m2
    2. ECG with a QTc interval >500 msec at Screening
  19. Prior use of pirfenidone or known hypersensitivity to any of the components of study treatment
  20. Use of any of the following therapies within 28 days before Screening and during participation in the study:

    1. Investigational therapy, defined as any drug that has not been approved for marketing for any indication in the country of the participating site
    2. Potent inhibitors of CYP1A2(e.g. fluvoxamine, enoxacin)
    3. Potent inducers of CYP1A2.
    4. Sildenafil (daily use). Note: intermittent use for erectile dysfunction is allowed
  21. Introduction and/or modification of dose of corticosteroids or any cytotoxic, immunosuppressive, or cytokine modulating or receptor antagonist agent for the management of pulmonary manifestations of RA, within 3 months of screening, is an exclusion criterion for enrollment, with the exception of dose modification of systemic corticosteroids that are maintained at or below 20 mg prednisone daily or the equivalent.

    However, introduction and/or modification of dose of corticosteroids or any cytotoxic, immunosuppressive, or cytokine modulating or receptor antagonist agent for the management of extrapulmonary manifestations of RA is not an exclusion criterion for enrollment.

  22. Any use of an approved anti-fibrotic medication within 28 days of screening.

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: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Triple

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Pirfenidone
Pirfenidone 2403 mg/d for 52 weeks
Pirfenidone three times daily (2403 mg) for 52 weeks
Other Names:
  • Esbriet
Placebo Comparator: Placebo
Placebo for 52 weeks
Placebo three times daily for 52 weeks

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Number of Participants Who Developed Any Element of the Composite Endpoint
Time Frame: 52 weeks
Number of participants who developed any element of the composite endpoint of decline in percent predicted FVC of 10% or greater or death.
52 weeks

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Number of Participants With FVC Decline From Baseline of 10% or Greater
Time Frame: 52 weeks
Number of participants with decline from baseline in percent predicted FVC of 10% or greater during the study period.
52 weeks
Number of Participants With Progressive Disease
Time Frame: 52 weeks
Number of participants with progressive disease as defined by OMERACT: FVC% relative decline of >=10% or FVC% change in >=5< 10% and >=15% diffusing capacity (DLCO)
52 weeks
Change in Absolute Value FVC Over the 52 Week Study Period
Time Frame: 52 weeks
Change from baseline to end of study in absolute value of FVC over the 52 week study period
52 weeks
Change in % Predicted FVC From Baseline to End of Study Over the 52 Week Study Period
Time Frame: 52 weeks
Change from baseline to end of study of percent predicted FVC over the 52 week study period
52 weeks
Time to Composite of Decline in FVC or Death
Time Frame: 52 weeks
Time to decline of 10% or greater in percent predicted FVC or death while on study
52 weeks
Change in PRO of Dyspnea
Time Frame: 52 weeks
Change from Baseline to end of study in dyspnea, as measured by the Dyspnea 12 questionnaire - Total scores range from 0 to 36, with higher scores corresponding to greater severity.
52 weeks
All-cause Mortality
Time Frame: 52 weeks
Number of participants experiencing mortality due to all causes
52 weeks
All Cause Hospitalization
Time Frame: 52 weeks
Number of participants requiring hospitalization for any cause
52 weeks
Hospitalization for Respiratory Cause
Time Frame: 52 weeks
Number of participants requiring hospitalization for respiratory cause
52 weeks
Acute Exacerbations Requiring Hospitalization
Time Frame: 52 weeks
Number of participants experiencing acute exacerbation requiring hospitalization
52 weeks
Treatment-emergent Adverse Events (AEs)
Time Frame: 52 weeks
Number of participants with treatment-emergent adverse events (AEs)
52 weeks
Treatment-emergent Serious Adverse Events (SAEs)
Time Frame: 52 weeks
Number of participants with treatment-emergent serious adverse events (SAEs) in the as treated population
52 weeks
Treatment-emergent/Treatment-related AEs
Time Frame: 52 weeks
Number of participants with treatment-emergent/treatment-related AEs
52 weeks
Treatment-emergent/Treatment-related SAEs
Time Frame: 52 weeks
Number of participants with treatment-emergent/treatment-related SAEs
52 weeks
AEs Leading to Early Discontinuation of Study Treatment
Time Frame: 52 weeks
Number of participants with AEs leading to early discontinuation of study treatment
52 weeks
Treatment-emergent Death or Transplant
Time Frame: 52 weeks
Number of participants who experienced treatment-emergent death or transplant
52 weeks
Treatment-emergent RA-ILD-related Mortality
Time Frame: 52 weeks
Number of participants who experienced treatment-emergent RA-ILD-related mortality
52 weeks

Other Outcome Measures

Outcome Measure
Measure Description
Time Frame
Disease Activity Score (DAS)
Time Frame: 52 weeks
Change from Baseline to end of study in Disease Activity Score (DAS)
52 weeks
RAPID3 Score
Time Frame: 52 weeks
Change from baseline to end of study in Routine Assessment of Patient Index Data 3 (RAPID3) score
52 weeks
Erythrocyte Sedimentation Rate (ESR)
Time Frame: 52 weeks
Change from Baseline to end of study in Erythrocyte Sedimentation Rate (ESR)
52 weeks
CRP
Time Frame: 52 weeks
Change from Baseline to end of study in C-Reactive Protein (CRP) 5. Candidate
52 weeks
Biomarker Expression
Time Frame: 52 weeks
Candidate biomarker expression in the peripheral blood of patients with RA-ILD over the 52 weeks of treatment
52 weeks
HRCT Parameters
Time Frame: 52 weeks
Changes from Baseline to end of study in high resolution computed tomography (HRCT) parameters evaluated by quantitative functional imaging
52 weeks
SGRQ
Time Frame: 52 weeks
Changes from Baseline to Week 13, 26, 39 and final visit in the St. George's Respiratory Questionnaire (SGRQ)
52 weeks
Dyspnea 12
Time Frame: 52 weeks
Changes from Baseline to Week 13, 26, 39 and final visit in Dyspnea 12 questionnaire
52 weeks
LCQ
Time Frame: 52 weeks
Changes from Baseline to Week 13, 26, 39 and final visit in Leicester Cough Questionnaire (LCQ)
52 weeks
Patient Global Assessment
Time Frame: 52 weeks
Changes from Baseline to Week 13, 26, 39 and final visit in the Patient global assessment
52 weeks
Health Assessment Questionnaire
Time Frame: 52 weeks
Changes from Baseline to Week 13, 26, 39 and final visit in the Health assessment questionnaire
52 weeks

Collaborators and Investigators

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

Investigators

  • Principal Investigator: Ivan O. Rosas, M.D., Brigham and Women's Hospital

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.

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 (Actual)

April 7, 2017

Primary Completion (Actual)

April 7, 2021

Study Completion (Actual)

April 7, 2021

Study Registration Dates

First Submitted

March 20, 2016

First Submitted That Met QC Criteria

June 17, 2016

First Posted (Estimate)

June 22, 2016

Study Record Updates

Last Update Posted (Actual)

August 16, 2022

Last Update Submitted That Met QC Criteria

July 20, 2022

Last Verified

July 1, 2022

More Information

Terms related to this study

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

No

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

Yes

Studies a U.S. FDA-regulated device product

No

product manufactured in and exported from the U.S.

Yes

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.

Clinical Trials on Rheumatoid Arthritis Interstitial Lung Disease

Clinical Trials on Pirfenidone

Subscribe