Mechanistic Study of GSK3196165 Plus Methotrexate (MTX) in Subjects With Active Rheumatoid Arthritis
Condition: Arthritis, Rheumatoid
MeSH terms: Arthritis; Arthritis, Rheumatoid
Intervention: GSK3196165; Placebo; MTX; Folic (or folinic) acid
Intervention description: GSK3196165 is supplied as liquid and will be administered as SC injection.; 0.9% weight by volume (w/v) sodium chloride solution administered as SC injection.; Capsule, tablet or liquid administered orally or as SC injection.; Capsule, tablet or liquid and will be administered orally.
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Enrollment: 39.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: No
Keywords: GSK3196165; magnetic resonance imaging (MRI); disease-modifying antirheumatic drugs (DMARDs); granulocyte-macrophage colony stimulating factor (GM-CSF); Rheumatoid Arthritis; Methotrexate

Summary:

      This study is designed to explore the activity of granulocyte-macrophage colony stimulating
      factor (GM-CSF) signaling pathway in subjects with rheumatoid arthritis (RA), the potential
      impact of inhibition of this axis by GSK3196165, and to evaluate whether there are any
      differences in the GM-CSF axis between subjects with early RA compared with those with more
      established disease. This study also aims to establish the potential impact of GSK3196165 on
      inflammatory structural joint damage in the hand/wrist using magnetic resonance imaging
      (MRI). This is a randomized Phase IIa, multi-center, double-blind, placebo-controlled
      parallel group study. Approximately 40 subjects with active RA despite treatment with
      disease-modifying antirheumatic drugs (DMARDs) (including conventional or biologic) will be
      randomized into the study, following a screening period of up to 6 weeks. The total treatment
      period is up to 10 weeks, with a 12-week follow-up period after the last dose (Week 22).
    

Eligibility criteria:

        Inclusion Criteria:

          -  Age >=18 years at the time of signing informed consent.

          -  Meets American College of Rheumatology (ACR)/European League Against Rheumatism
             (EULAR) 2010 RA Classification Criteria AND subject not diagnosed before age of 16
             years.

          -  Functional class I, II or III defined by the 1992 ACR Classification of Functional
             Status in RA.

          -  Active disease as defined by:

               -  Swollen joint count of >=4 (66-joint count) and tender joint count of >=4
                  (68-joint count) at screening and Day 1.

        AND • Disease activity score for 28 different joints with C-reactive protein (CRP) value
        (DAS28[CRP]) >=3.2 at screening.

        AND

        • CRP >=3.0 milligrams (mg)/liter (L).

          -  Signs of inflammation such as synovitis in the MRI scan of the most-affected hand.

          -  Must be currently taking MTX (15-25 mg weekly) (oral/injected) for at least 12 weeks
             before screening, with no change in route of administration, with a stable and
             tolerated dose for >=4 weeks prior to Day 1. A stable dose of MTX >=7.5 mg/week is
             acceptable, if the MTX dose has been reduced for reasons of documented intolerance to
             MTX, example (e.g.) hepatic or hematologic toxicity, or per local requirement.

          -  Body weight >=45 kilograms (kg).

          -  Male or female subjects are eligible to participate so long as they meet and agree to
             abide by the contraceptive criteria.

          -  Capable of giving signed informed consent as described in protocol which includes
             compliance with the requirements and restrictions listed in the consent form and in
             the protocol.

          -  Willing to continue or initiate treatment with oral folic acid (at least 5 mg/week) or
             equivalent and be treated during the entire study (mandatory co-medication for MTX
             treatment).

          -  Diffusing capacity of the lung for carbon monoxide (DLCO) >=60% predicted; forced
             expiratory volume in 1 second (FEV1) >=70% predicted.

          -  No evidence of active or latent infection with Mycobacterium tuberculosis (TB).

        Exclusion Criteria:

          -  Pregnant or lactating, or women planning to become pregnant or initiating
             breastfeeding.

          -  History of other inflammatory rheumatologic or autoimmune disorders, other than
             Sjögren's syndrome secondary to RA.

          -  History of any respiratory disease which (in the opinion of the investigator) would
             compromise subject safety or the ability of the subject to complete the study (e.g.
             significant interstitial lung disease, such as pulmonary fibrosis, chronic obstructive
             pulmonary disease (COPD), moderate-severe asthma, bronchiectasis, previous pulmonary
             alveolar proteinosis [PAP]).

          -  Clinically-significant (in the opinion of the investigator) persistent cough or
             clinically significant or unstable dyspnea that is unexplained.

          -  Significant unstable or uncontrolled acute or chronic disease which, in the opinion of
             the investigator, could confound the results of the study or put the subject at undue
             risk.

          -  A history of malignancy.

          -  Contraindication to MRI scanning.

          -  Current/previous Hepatitis B virus (HBV), Hepatitis C virus (HCV) or human
             immunodeficiency virus (HIV) 1 or 2 infection.