Clinical trial NCT04079374: Comparative Efficacy, Safety and Immunogenicity Study of Etanercept and Enbrel
Official title: Open, Randomized, Comparative, Multicenter Study in Parallel Groups of the Efficacy, Safety, Immunogenicity of Etanercept and Enbrel, Lyophilisates for Solution for Subcutaneous Injection, in Patients With Rheumatoid Arthritis
Study type: INTERVENTIONAL
Overall status: UNKNOWN
Phase: PHASE3
Conditions: Rheumatoid Arthritis
Keywords: Etanercept
Enbrel
Lead sponsor: Joint Stock Company "Farmak"
Sponsor class: INDUSTRY
Collaborators: name: Sunshine Guojian Pharmaceutical (Shanghai) Co., Ltd.
First posted: 2019-09-06
Enrollment: 160
Sex: ALL
Minimum age (years): 18
Maximum age (years): 75
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: Parallel assignment
Primary purpose: TREATMENT

Brief summary: The Study objectives are:

1. To compare the efficacy and safety of Etanercept, lyophilisate for solution for injection and Enbrel, lyophilisate for solution for subcutaneous injection, which are used as subcutaneous injections at a dose of 25 mg 2 times a week for 24 weeks in combination with methotrexate in patients with rheumatoid arthritis.
2. To prove the therapeutic equivalence of Etanercept, lyophilisate for solution for injection and Enbrel, lyophilisate for solution for subcutaneous injection in patients with rheumatoid arthritis.
3. To evaluate the immunogenicity of Etanercept, lyophilisate for solution for injection.

Detailed description: This is an open-label, randomized, comparative, multicentre study in parallel groups of the efficacy, safety and immunogenicity of Etanercept, lyophilisate for solution for injection and Enbrel, lyophilisate for solution for subcutaneous injection, in patients with rheumatoid arthritis.

Total duration of patient participation in the study will be 49-52 weeks. Of these: screening - up to 4 weeks, treatment - 24 weeks, follow-up after treatment - 4 weeks, evaluation of the study drug immunogenicity - 52 weeks after the treatment initiation.

Patients receive Etanercept or Enbrel (depending on the group) in the form of subcutaneous injections at a dose of 25 mg 2 times a week for 24 weeks.

Eligibility criteria: Inclusion Criteria:

* patients of both sexes, from 18 to 75 years old;
* body weight \> 45 kg;
* patients diagnosed with: rheumatoid arthritis (RA) of moderate and high activity, according to the classification of RA criteria of the American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR) of 2010;
* functional class I, II or III according to the Classification of the Functional Class of the RA of the American College of Rheumatology (ACR);
* number of painful joints (NPJ) ≥ 6 (68 joints examined), number of swollen joints (NSJ) ≥6 (66 joints examined);
* ESR (Erythrocyte sedimentation rate)≥ 28 mm/hour or СRP (C - reactive protein) \> 7.0 mg/dl;
* patient who receive methotrexate for at least 12 weeks at doses of 7.5-20 mg/week (orally or parenterally), and the dose and route of administration of methotrexate was not changed for 4 weeks before randomization;
* patient who stopped therapy with other basic antirheumatic drugs, except methotrexate, and completed the wash-out period for these drugs of at least five half-life periods, but not less than 2 weeks (whichever is longer);
* if a patient takes NSAIDs (Nonsteroidal anti-inflammatory drugs), the dose of the drug should be stable within 2 weeks before randomization;
* if a patient takes oral glucocorticosteroids, the dose should be ≤10 mg/day of prednisolone (or equivalent) and be stable for 2 weeks before randomization;
* women of childbearing age and men who have partners, who have agreed to use reliable contraceptive methods during the entire study period and within 3 months after its termination. Reliable methods of contraception include: intrauterine devices, double-barrier method or state after surgical sterilization and vasectomy;
* signed informed consent of participants to participate in this study, which was obtained before any screening procedures, including discontinuation of forbidden-drugs.

Exclusion Criteria:

* known hypersensitivity to Etanercept or other components of the study drugs;
* other rheumatic diseases, autoimmune diseases, connective tissue diseases, immunodeficiency (e.g. psoriasis, psoriatic arthritis, primary Sjogren syndrome, systemic lupus erythematosus or demyelinating diseases such as multiple sclerosis);
* septic arthritis within 12 months before screening; purulent arthritis of prosthetic joints;
* acute or frequent recurrent chronic, local or generalized infections (bacterial/fungal/viral) or sepsis, or history of recurrent infections, or increased risk of developing infections or sepsis;
* an active form of tuberculosis; the history of the ineffective treatment of tuberculosis; latent tuberculosis or risk of developing tuberculosis (e.g., contact with patients who have an active form of tuberculosis, shortly before screening);
* severe interstitial lung diseases (bronchial asthma, chronic obstructive pulmonary disease, bronchiectasis, fibrosis);
* malignant diseases, including history (except successfully treated non-metastatic basal cell or squamous cell skin cancer or cervical cancer);
* congestive heart failure of class III or IV, according to New York Heart Association criteria, or unstable angina;
* uncontrolled diabetes mellitus, uncontrolled arterial hypertension;
* abnormal laboratory parameters at screening:
* haemoglobin \< 100.0 g/L;
* platelets \< 125 \*10\^9 cell/L;
* leukocytes \< 3.5 \*10\^9 cell/L,
* absolute neutrophil count \< 1.5 \*10\^9 cell/L;
* absolute lymphocyte count \< 0.8 \*10\^9 cell/L;
* ASТ (Aspartate aminotransferase), АLТ (Alanine aminotransferase) 3 and more times higher than the upper limit of normal and serum total bilirubin 2 and more times higher than the upper limit of normal;
* serum creatinine 2 times or higher than the upper limit of normal;
* history of clinically significant or uncontrolled diseases of the respiratory system, liver, kidney, blood, gastrointestinal tract, endocrine system, immune system, skin, nervous system (including demyelinating disorders), cardiovascular system, or history of an autoimmune or mental disorder, or any condition which, in the opinion of the Investigator, can pose a threat to the safety of a patient, affect the study results or prevent a patient from completing the study;
* hepatitis В, С;
* scheduled surgical intervention including joint replacement during the study;
* recent chickenpox;
* oral and gastrointestinal ulcers;
* pregnancy, breastfeeding;
* history of alcohol or drug abuse;
* vaccination with live or attenuated vaccines within 4 weeks before the screening, or scheduled vaccination during the study, or within 3 months after the last dose of the study/reference drug;
* previous treatment with any other GEBD (genetically engineered biological drugs) (GEBD) for rheumatoid arthritis (including, tocilizumab, adalimumab, anakinra, abatacept, infliximab, rituximab, golimumab, Etanercept, certolizumab) or tofacitinib;
* use of systemic or intraarticular corticosteroids, except prednisolone at a dose of≤10 mg/day orally, or equivalent to GCS (Glucocorticosteroids) within 2 weeks before randomization;
* use of alkylating agents (e.g. cyclophosphamide, chlorambucil) within 6 months before randomization;
* use of intravenous or oral antimicrobial agents 4 weeks before randomization; simultaneous participation in any other clinical study, or participation in a clinical study within 3 months before screening.

Primary outcomes:
measure: Number of patients with ACR20 (American College of Rheumatology 20 criteria) response
timeFrame: at 24 week of treatment.
Secondary outcomes:
measure: Number of patients with ACR50 (American College of Rheumatology 50 criteria) response
timeFrame: at 4, 8 and 12 weeks of treatment
measure: Number of patients with ACR70 (American College of Rheumatology 70 criteria)
timeFrame: at 4, 8 and 12 weeks of treatment
measure: Number of patients who achieved remission (DAS28(Disease Activity Score 28)<2.6) and low disease activity (DAS28≤3.2)
timeFrame: at 12 and 24 weeks of treatment
measure: Changes in activity index DAS28
timeFrame: at 4, 8, 12 and 24 weeks of treatment
measure: Changes in functional state of patients according to questionnaire HAQ -(Health Assessment Questionnaire- data)
timeFrame: at 4, 8, 12 and 24 weeks of treatment compared to baseline.
Other outcomes:
Locations:
city: Kryvyi Rih
country: Ukraine
facility: PU Kryvyi Rih City Clinical Hospital №2 of the Dnipropetrovsk regional council
state: Dnipropetrovsk Region
city: Kryvyi Rih
country: Ukraine
facility: PU Kryvyi Rih City Clinical Hospital №8 of the Dnipropetrovsk regional council
state: Dnipropetrovsk Region
city: Ivano-Frankivsk
country: Ukraine
facility: Ivano-Frankivsk Central City Clinical Hospital
state: Ivano-Frankivsk Region
city: Kharkiv
country: Ukraine
facility: Communal non-commercial enterprise of Kharkiv Regional Council Regional Hospital of the war veterans
state: Kharkiv Region
city: Kharkiv
country: Ukraine
facility: Municipal nonprofit enterprise City Multidisciplinary Hospital № 18 of Kharkiv City Council
state: Kharkiv Region
city: Khmelnytskyi
country: Ukraine
facility: Khmelnytskyi Regional Hospital
state: Khmelnytskyi Region
city: Lviv
country: Ukraine
facility: Communal noncommercial enterprise of Lviv Regional Council Lviv Regional Clinical Hospital
state: Lviv Region
city: Ternopil'
country: Ukraine
facility: Ternopil University Hospital
state: Ternopil' Region
city: Vinnitsa
country: Ukraine
facility: Vinnitsa Regional Clinical Hospital Named After N.I.Pirogov
state: Vinnitsa Region
city: Zhytomyr
country: Ukraine
facility: Municipal Institution O.Herbachevskiy Regional State Clinical Hospital
state: Zhytomyr Region
Study officials:
affiliation: Vinnitsa Regional Clinical Hospital Named after N.I.Pirogov
name: Mykola Stanislavchuk, MD, PhD
role: PRINCIPAL_INVESTIGATOR
References: