Safety and Efficacy Study of Prefilled Liquid Etanercept(Yisaipu) for Active Ankylosing Spondylitis

Safety and Efficacy of Prefilled Liquid Etanercept(Yisaipu) for Active Ankylosing Spondylitis on the Basis of NSAID Therapy: A Multicenter Randomized, Double-blind, Parallel Group Phase III Trial

This randomized, double-blind, phase III parallel-group non-inferiority study aimed to investigate the efficacy and safety of prefilled liquid etanercept (Yisaipu) versus lyophilized etanercept powder (Yisaipu) in active ankylosing spondylitis patients.

Study Overview

• Status: Completed
• Conditions: Ankylosing Spondylitis
• Intervention / Treatment: Drug: prefilled liquid etanercept(Yisaipu); Drug: lyophilized etanercept powder(Yisaipu)

Detailed Description

The study carried out between March 6, 2014 and July 13, 2015 across multiple medical centers in China enrolled adult active ankylosing spondylitis patients aged between 18 and 65 years. Patients were randomized in a 3:1:1 ratio to receive twice weekly 25 mg prefilled liquid etanercept for totally 24 injections (group I) or once weekly 50 mg prefilled liquid etanercept for totally 48 injections (group II), or 25 mg twice weekly lyophilized etanercept powder for totally 48 injections (group III). The primary efficacy outcome was the proportion of patients who achieved ASAS20 at week 24.

• Study Type: Interventional
• Enrollment (Actual): 640
• Phase: Phase 3

Contacts and Locations

Study Locations

• China
  • Beijing
    • Beijing, Beijing, China, 100853
      • Chinese PLA General Hospital clinical trial center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 65 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• age 18-65，male or female
• Sign the informed consent
• Fulfill the 1966 AS New York criteria for axial spondyloarthritis(SpA)
• Active disease phase of SpA, defined as BASDAI≥4 or night back pain≥4 at screening
• Inadequate response to NSAID≥4 week
• Application of NSAID with stable dose for no less than 2 weeks at screening
• Stable dose of prenisone for at least four weeks at ≤10mg per day if used at screening, or stop oral use for at least 4 weeks or stop local injection at least 12 weeks
• Stable dose of any DMARD for at least four weeks if used at screening, or stop use for at least 4 weeks
• Stop and receiving washing out for at least 4 week if receiving Chinese traditional drug for AS, physical treatment, vaccication or IVIG
• Stop and receiving washing out for at least 12 week if receiving other biologics or other drug trials
• The lab exam should achieve the criteria as below
• Hb≥85g/L, 3.5×109/L≤WBC count≤10×109/L, PLT≥ lower limit of normal range, ALT≤2 fold of upper limit of normal range, serum creatine ≤upper limit of normal range. Negative pregnacy test for female patients. And promise to carry out contraception during the trial and 6 weeks after the trial is ended

Exclusion Criteria:

• Allergic condition or Allergic to IgG or any element of Yisaipu®
• Clinical or radiographic evidence of Complete ankylosis of spine
• Previous receiving TNF-a blockers therapy ≥3 months with poor response

• Achieve any following tuberculosis criteria

  1. History of active tubercolosis, or radiographic evidence of present or previous history of pulmonary tubercolosis
  2. close contact with patients with tubercolosis, or with high risk of infection of tubercolosis such as immune suppression status
  3. Strong positive of PPD skin test with diameter ≥10mm. at screen or within 3 weeks prior to screen
• Presence of acute infection or acute onset of chronic infection at screen
• Invasive fungal infection or conditional infection within 6 months prior to screen
• HBS-Ag or HBC-Ab positive at screen or history of HBS/HBC infection
• History of infection on artifitial joints
• Organ transplantation surgery within 6 months prior to screen
• Presence of other autoimmune diseases, including IBD, psoriasis, uveitis, SLE, multiple sclerosis, etc.
• History of congestive heart failure
• History of malignancies within 5 years prior to screen, excluding complete resection of squamous cell carcinoma, or basal cell carcinoma or cervical carcinoma in situ.
• AIDS or HIV infection
• History of lymphoma or lymphoproliferative disorders
• Presence of serious disorder of important organs or system
• Presence of factors which may influence the compliance

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Triple

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: group I; twice weekly 25 mg prefilled liquid etanercept	Drug: prefilled liquid etanercept(Yisaipu)
Experimental: group II; once weekly 50 mg prefilled liquid etanercept	Drug: prefilled liquid etanercept(Yisaipu)
Active Comparator: group III; 25 mg twice weekly lyophilized etanercept powder	Drug: lyophilized etanercept powder(Yisaipu)

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
the proportion of patients who achieved ASAS20	Axial SpondyloArthritis international Society (ASAS) ASAS20 was defined as an improvement of at least 20% in at least three of the following four domains: 1) patient global assessment VAS, 2) nocturnal back pain and total back pain VAS, 3) Bath AS Function Index (BASFI) VAS, and 4) inflammation (mean of intensity and duration of morning stiffness components from the an improvement at least one unit relative to baseline VAS score; no worsening in the remaining fourth domain.	at week 24

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
the proportion of patients who achieved ASAS40, ASAS partial remission	Axial SpondyloArthritis international Society (ASAS) ASAS40 was defined as improvement of at least 40% in at least three of the four abovementioned domains and an absolute improvement of at least two versus baseline VAS scores and no worsening versus the baseline in the remaining fourth domain. ASAS partial remission was defined as VAS scores ≤2 in each of the four abovementioned domains.	at weeks 12 and 24
the proportion of patients who achieved ASAS 5/6	Axial SpondyloArthritis international Society (ASAS) ASAS 5/6 was defined as an improvement of at least 20% in at least five of the following six domains: 1) C-reactive protein (CRP), and 2) spinalmobility (scoliosis) in addition to the four above mentioned domains	at weeks 12 and 24
the proportion of patients who achieved the ASDAS clinically important and major improvement and inactive disease		at weeks 12 and 24
the proportion of patients who achieved BASDAI50	Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) BASDAI50 was defined as a 50% or greater improvement versus the baseline BASDAI.	at weeks 12 and 24
the proportion of patients who achieved improvement in BASDAI	It was evaluated with a 6-question questionnaire,including: 1) fatigue; 2)spinal pain; 3) pain and swelling of peripheral joints; 4) pain at entheseal sites; 5) severity of morning stiffness and 6) duration of morning stiffness by using a single-item visual analog scale (VAS), with scores ranging from 0-10 cm. After taking the answer of each question out of 10 , the BASDAI score was calculated by formula 0.2 [1+2+3+4+0.5(5+6)].	at weeks 12 and 24
the proportion of patients who achieved improvement in BASFI	Bath AS Function Index (BASFI)	at weeks 12 and 24
the proportion of patients who achieved improvement in BASMI scores	The Bath Ankylosing Spondylitis Metrology Index (BASMI) is a combined measure of spinal mobility and hip function.Cervical rotation, tragus-wall distance, lateral lumbar flexion( the distance of the middle fingertip moves on the side of the thigh), anterior lumbar flexion(modified schober) , intermalleolar distance were measured. And according to the measurement result, each score with 0, 1, 2 points was recorded.	at weeks 12 and 24
the proportion of patients who achieved improvement in Maastricht Ankylosing Spondylitis Enthesitis Score (MASES)	The (MASES) index based on 13 entheses. Enthesial sites assessed include the bilateral 1st costochondral joints(L and R), 7th costochondral joints(L and R), posterior superior iliac spines(L and R), anterior superior iliac spines(L and R), iliac crests(L and R), proximal insertion of Achilles tendons(L and R), and the 5th lumbar spinous process.The score of each part with 0 or 1 points was recorded.	at weeks 12 and 24
the proportion of patients who achieved improvement in nocturnal back pain and total back pain VAS	Nocturnal back pain and total back pain in the past week was assessed using a single-item visual analog scale (VAS), with scores ranging from 0-10 cm, where 0 represented no pain and 10 represented worst possible pain.	at weeks 12 and 24
the proportion of patients who achieved improvement in patient global assessment and physician global assessment	Patient global assessment (PGA,disease activity rated by the patient) was recorded on a VAS from 0 to 10 cm, where 0 represented very good and 10 represented very worse. Physician global assessment (PhGA,disease activity rated by the physician) was recorded on a VAS from 0 to 10 cm, where 0 defined as no disease activity state and 10 defined as most serious disease activity state .	at weeks 12 and 24
the proportion of patients who achieved improvement in number of swollen joints and number of tender joints		at weeks 12 and 24
the proportion of patients who achieved improvement in ESR and CRP		at weeks 12 and 24

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
AEs	To assesse the safety	at weeks 2, 4, 8, 12, 16, 20 and 24

Collaborators and Investigators

• Sponsor: Sunshine Guojian Pharmaceutical (Shanghai) Co., Ltd.

Publications and helpful links

General Publications

• Zhao D, He D, Bi L, Wu H, Liu Y, Wu Z, Li Y, Wang G, Li X, Bao C, Jiang L, Zhang Z, Xiao W, Tong G, Wang D, Huang F. Safety and Efficacy of Prefilled Liquid Etanercept-Biosimilar Yisaipu for Active Ankylosing Spondylitis: A Multi-Center Phase III Trial. Rheumatol Ther. 2021 Mar;8(1):361-374. doi: 10.1007/s40744-021-00276-1. Epub 2021 Feb 9.

Study record dates

Study Major Dates

• Study Start (Actual): March 6, 2014
• Primary Completion (Actual): July 13, 2015
• Study Completion (Actual): July 20, 2015

Study Registration Dates

• First Submitted: April 3, 2020
• First Submitted That Met QC Criteria: April 10, 2020
• First Posted (Actual): April 14, 2020

Study Record Updates

• Last Update Posted (Actual): April 14, 2020
• Last Update Submitted That Met QC Criteria: April 10, 2020
• Last Verified: April 1, 2020

More Information

Terms related to this study

• Keywords: ankylosing spondylitis; prefilled liquid etanercept; lyophilized etanercept powder
• Additional Relevant MeSH Terms: Infections; Joint Diseases; Musculoskeletal Diseases; Arthritis; Spinal Diseases; Bone Diseases; Spondylarthropathies; Bone Diseases, Infectious; Ankylosis; Spondylitis; Spondylarthritis; Spondylitis, Ankylosing; Physiological Effects of Drugs; Peripheral Nervous System Agents; Analgesics; Sensory System Agents; Anti-Inflammatory Agents, Non-Steroidal; Analgesics, Non-Narcotic; Anti-Inflammatory Agents; Antirheumatic Agents; Immunosuppressive Agents; Immunologic Factors; Gastrointestinal Agents; Etanercept
• Other Study ID Numbers: C301S-AS III

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No