A Study of Tocilizumab in Chinese Participants With Systemic Juvenile Idiopathic Arthritis (sJIA)

Study Overview
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Brief Summary
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This Phase IV, multicenter, single-arm, open-label study will evaluate the efficacy and safety of tocilizumab in Chinese participants with sJIA with persistent activity and an inadequate response to non-steroidal anti-inflammatory drugs (NSAIDs) and steroid therapy.

Official Title
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A Phase IV, Multicenter, Single-Arm, Open-Label Study to Assess the Efficacy and Safety of Tocilizumab in Chinese Patients With Systemic Juvenile Idiopathic Arthritis

Conditions
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Juvenile Idiopathic Arthritis

Intervention / Treatment
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* Drug: Tocilizumab
* Drug: NSAIDs
* Drug: CSs
* Drug: MTX


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Participants meeting International League of Associations for Rheumatology (ILAR) classification for sJIA Greater than (>) 6 months of documented persistent sJIA activity prior to screening Active disease hsCRP >4.3 milligrams per liter (mg/L) or 0.43 milligrams per deciliter (mg/dL) Participant who has recovered from any symptomatic serositis for at least 30 days prior to the screening visit, and requires a dose of CSs at baseline of </=30 mg/day or </=0.5 mg/kg/day, whichever is less Participants meeting one of the following: Participant who is not receiving MTX or discontinued MTX >/=4 weeks prior to baseline visit; participant who has been taking MTX >/=12 weeks immediately prior to the baseline visit and on a stable dose of </=20 mg/m^2 for >/=8 weeks prior to the baseline visit, together with either folic acid or folinic acid according to local standard of care Participant who was never treated with biologics or, if was previously treated with biologics, discontinued etanercept (or Yisaipu, Qiangke, or Anbainuo) >/=2 weeks, infliximab or adalimumab >/=8 weeks, anakinra >/=1 week, or abatacept >/=12 weeks prior to the baseline visit Participant who is not currently receiving oral CSs, or is taking oral CSs at a stable dose for >/=2 weeks prior to the baseline visit at </=30 mg/day or </=0.5 mg/kg/day, whichever is less Participant who is not taking NSAIDs, or taking </=1 type of NSAID at a stable dose for >/=2 weeks prior to the baseline visit and is less than or equal to the maximum recommended daily dose Exclusion Criteria: Wheelchair bound or bedridden participant Any other autoimmune, rheumatic disease, or overlap syndrome other than sJIA Participant who is not fully recovered from recent surgery or <6 weeks since surgery at the time of screening visit; or planned surgery during the initial 12 weeks of the study Lack of peripheral venous access Any significant concurrent medical or surgical condition that would jeopardize the participant's safety or ability to complete the trial Evidence of serious uncontrolled concomitant diseases Asthma for which the participant has required the use of oral or parenteral CSs for >/=2 weeks within 6 months prior to the baseline visit Known human immunodeficiency (HIV) infection or other acquired forms of immune compromise or congenital conditions characterized by a compromised immune system Any active acute, subacute, chronic, or recurrent bacterial, mycobacterial, viral, or systemic fungal infection or opportunistic infection Any major episode of infection requiring hospitalization or treatment during screening, treatment with IV antibiotics completing within 4 weeks of the screening visit, or oral antibiotics completing within 2 weeks of the screening visit History of atypical tuberculosis (TB) Active TB requiring treatment within 2 years prior to screening visit Positive purified protein derivative (PPD) or T-spot test (interferon-gamma [IFN-γ]-based test) at screen Positive for latent TB History of reactivation or new onset of a systemic infection such as herpes zoster or Epstein-Barr virus (EBV) within 2 months of the screening visit Hepatitis B surface antigen (Ag)- or hepatitis C antibody (Ab)-positive History of macrophage activation syndrome (MAS) within 3 months prior to the screening visit Evidence of active malignant disease or diagnosed malignancies Uncontrolled diabetes mellitus Previous treatment with tocilizumab Intra-articular, intramuscular, IV, or long-acting CSs administration within 28 days prior to the baseline visit Treatment with non-biologic disease-modifying antirheumatic drugs (DMARDs; other than MTX) within 6 weeks prior to the baseline visit Treatment with leflunomide that was not followed by standardized cholestyramine washout and documented to be below the limit of detection prior to the baseline visit Treatment with cyclophosphamide, etoposide (VP16) and statins within 90 days prior to the baseline visit Treatment with growth hormone and androgens within 4 weeks prior to the baseline visit Administration of IV immunoglobulin within 28 days prior to the baseline visit Treatment with any cell-depleting therapies Stem cell transplant at any time Participant who has received live or attenuated vaccines within 4 weeks prior to the baseline visit, or intending to receive while on study drug or 3 months following the last dose of study drug

Ages Eligible for Study
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Minimum Age: 2 Years
Maximum Age: 17 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Tocilizumab<br>Participants weighing greater than or equal to (>/=) 30 kilograms (kg) will receive tocilizumab 8 milligrams per kilogram (mg/kg) intravenous (IV) infusion every 2 weeks (Q2W), and participants weighing less than (<) 30 kg will receive tocilizumab 12 mg/kg IV infusion Q2W for 52 weeks. After Week 12, the dose of tocilizumab can be adjusted for non-transient changes in body weight (shifting from <30 to >/=30 kg) over a minimum of three consecutive dosing visits. MTX, NSAIDs, and oral corticosteroids (CSs) are permitted but not required during the study. | Drug: Tocilizumab<br>* Tocilizumab will be administered as per the schedule specified in the arm description.<br>* Other names: RO4877533;Drug: NSAIDs<br>* Participants may receive NSAIDs up to the maximum recommended stable daily dose. Study protocol does not enforce any particular NSAID.<br>Drug: CSs<br>* Participants may receive CSs at a stable dose of 30 milligrams per day (mg/day) or 0.5 milligrams per kilogram per day (mg/kg/day), whichever is less. Study protocol does not enforce any particular CS.<br>Drug: MTX<br>* Participants may receive MTX at a stable dose of less than or equal to (</=) 20 milligrams per square meter (mg/m^2).<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percentage of Participants Achieving Juvenile Idiopathic Arthritis (JIA) American College of Rheumatology (ACR) 30 (JIA ACR30) Response With Absence of Fever, at Week 12 |  | Week 12 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percentage of Participants Achieving JIA ACR30 Response With Absence of Fever, at Week 52 |  | Week 52 | 
| Percentage of Participants With 30 Percent (%), 50%, 70%, and 90% Improvement From Baseline in JIA Core Set Parameters |  | Baseline, Weeks 12, 24, and 52 | 
| Percentage of Participants With Inactive Disease Assessed According to Criteria for Inactive Disease and Clinical Remission of sJIA (Wallace et. al. 2011 Criteria) |  | Weeks 24 and 52 | 
| Percentage of Participants With Clinical Remission Assessed According to Criteria for Inactive Disease and Clinical Remission of sJIA (Wallace et. al. 2011 Criteria) |  | Week 52 | 
| Percentage of Participants With an Elevated High-Sensitivity C-Reactive Protein (hsCRP) Levels at Baseline Who Have Normal hsCRP Levels at Weeks 12, 24, and 52 |  | Baseline, Weeks 12, 24, and 52 | 
| Mean Glucocorticoid Dose |  | Baseline up to Week 52 | 
| Mean Methotrexate (MTX) Dose |  | Baseline up to Week 52 | 
| Change From Baseline in Glucocorticoid Dose |  | From Baseline to Week 52 | 
| Change From Baseline in MTX Dose |  | From Baseline to Week 52 | 
| Pain Visual Analog Scale (VAS) Score |  | Baseline, Weeks 4, 8, 12, 16, 20, 24, 28, 32, 36, 40, 44, 48, and 52 | 
| Change From Baseline in Pain VAS Score |  | Baseline, Weeks 4, 8, 12, 16, 20, 24, 28, 32, 36, 40, 44, 48, and 52 | 
| Percentage of Participants Who Discontinue Permitted Concomitant Medication for sJIA |  | Baseline up to Week 52 | 
| Percentage of Participants With Adverse Events (AEs) |  | Baseline up to end of study (up to Week 60) |