Clinical trial NCT02819726: PK, PD, Safety, and Efficacy of SAIT101 Versus MabThera® Versus Rituxan® in Patients With Rheumatoid Arthritis
Official title: A Randomized, Double-blind, Parallel Group, Multicenter Study to Compare the Pharmacokinetics, Pharmacodynamics, Safety, and Efficacy of SAIT101 Versus MabThera® Versus Rituxan® in Patients With Rheumatoid Arthritis (RA)
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE1
Conditions: Rheumatoid Arthritis
Keywords: an inadequate response to anti -TNF therapy
Lead sponsor: Archigen Biotech Limited
Sponsor class: INDUSTRY
First posted: 2016-06-30
Enrollment: 294
Sex: ALL
Minimum age (years): 18
Maximum age (years): 80
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: In Part A, patients are randomized in a 1:1:1 ratio to receive one course (baseline and Week 2) of SAIT101 (n=94) versus Rituxan® (n=94) versus MabThera® (n=94).

At Week 24, patients are evaluated for the second course (Week 24 and 26) of the infusion.

In Part B, eligible patients in the SAIT101 arm receive the second course of SAIT101 treatment. Eligible patients in the MabThera® arm receive the second course of MabThera® treatment. Eligible patients in the Rituxan® arm are randomized in a 1:1 ratio to receive SAIT101 or Rituxan® treatment. Patients are followed up for safety until Week 52.
Primary purpose: TREATMENT

Brief summary: A randomised, double blind, parallel group, multicentre study yo compare the pharmacokinetics, pharmacokinetics, safety and efficacy of SAIT101 versus MabThera® versus Rituxan® in patients with rheumatoid arthritis.

Detailed description: This is a randomized, double-blind, parallel group, multicenter study to compare the pharmacokinetics (PK), pharmacodynamics (PD), safety, efficacy, tolerability, and immunogenicity of SAIT101 (biosimilar rituximab) versus MabThera® versus Rituxan® in patients with rheumatoid arthritis (RA). This study will take place globally across approximately 75 study centers in order to randomize approximately 282 patients. The study consists of Part A from baseline for PK and efficacy analysis, followed by Part B from Week 24 to 52 for safety follow-up in which collects transition data.

Eligibility criteria: Inclusion Criteria:

1. Severe RA defined as:

* Diagnosis of RA according to the revised (1987) American College of Rheumatology (ACR) criteria for the classification of RA for at least 3 months prior to screening visit (see Appendix 3).
* And ≥6 swollen joints and ≥6 tender/painful joints (from the 66/68 joint count system).
* And C-reactive protein (CRP) ≥1.0 mg/dL or an erythrocyte sedimentation rate (ESR) ≥28 mm/hour at Screening.
* And positive rheumatoid factor (RF) (≥20 units/mL) or anti cyclic citrullinase peptide (CCP) antibodies (≥10 units/mL) at Screening.

  2. Patients with severe RA who have had an inadequate response to at least 3 months' treatment (according to the approved treatment and dosage) or intolerance (at Investigator's discretion and/or experience of intolerable AE or toxicity such as infusion related reaction, hypersensitivity, anaphylaxis or severe toxicity) to anti-tumour necrosis factor (TNF) therapy (experience of severe adverse event (AE) or toxicity).

  3. Current treatment for RA on an outpatient basis:
* Receiving methotrexate (MTX) 7.5 - 25mg/week (oral or parenteral) for at least 12 weeks, including the last 4 weeks prior to Day 1 at a stable dose, via the same route of administration, dose, and formulation. Patients receiving a lower dose of MTX (\<10 mg/week), stable for 4 weeks prior to Day 1, should be doing so as a result of a documented evidence of intolerance to higher doses of MTX.

Exclusion Criteria:

1. Females who are pregnant, breastfeeding, or planning a pregnancy during the Treatment Period of and 12 months after the last infusion of study drug.
2. Class IV as per the Classification of Global Functional Status in Rheumatoid Arthritis (as per ACR 1991 Revised Criteria) (see Appendix 4) or wheelchair/bed bound.
3. History of or current inflammatory joint disease other than RA (including but not limited to gout, reactive arthritis, psoriatic arthritis, seronegative spondyloarthropathy or Lyme disease).
4. History of or current systemic autoimmune disorder (including but not limited to systemic lupus erythematosus, inflammatory bowel disease, pulmonary fibrosis, Felty syndrome, scleroderma, inflammatory myopathy, fibromyalgia, juvenile idiopathic arthritis, mixed connective tissue disease, vasculitis or other overlap syndrome), with the exception of the secondary Sjögren's syndrome.
5. Primary or secondary immunodeficiency (history of, or currently active), including known history of human immunodeficiency virus (HIV) infection or positive test at screening.
6. History of opportunistic infection.
7. History of deep space/tissue infection (e.g., fasciitis, abscess, osteomyelitis) and infected prosthetic joint.
8. Active infection of any kind (excluding fungal infection of nail beds) or any major episode of infection requiring hospitalization or treatment with i.v. anti infective agents within 4 weeks prior to Screening or oral anti-infective agents within 2 weeks prior to Screening or use of antibiotic therapy three or more times in the last six months prior to Screening
9. Positive serological test for hepatitis B surface antigen (HBsAg), hepatitis B core antibody (HBcAb) or hepatitis C serology.

   * Patients with a negative HBsAg and positive HBcAb must have a hepatitis B virus (HBV) deoxyribonucleic acid (DNA) level \<20 IU/mL (or 112 copies/mL) by polymerase chain reaction (PCR). These HBV patients must be willing to undergo monthly PCR HBV DNA testing during treatment and may participate following consultation with a hepatitis expert regarding monitoring and use of HBV antiviral therapy, and provided they agree to receive treatment as indicated. An HBV re-test will be performed monthly including Day 1, Weeks 4, 8, 12, 16, 20, 24, 36, 52, and unscheduled visit if required.
   * Patients with a positive test because of HBV vaccine may be included (i.e., anti-HBs+ and anti HBc-).
   * Patients positive for hepatitis C virus (HCV) antibody are eligible only if PCR is negative for HCV ribonucleic acid (RNA).
10. Confirmed current active tuberculosis (TB). • Patients with latent TB as determined by positive QuantiFERON-TB test may be enrolled if such patients have written confirmation from health care provider (e.g., Pulmonologist or Infection Specialist) of adequate prophylaxis before or within the screening period and no evidence of tuberculosis on a chest X-ray performed within 3 months from Day 1.

    • Screening period can be extended to 60 days for prophylaxis of latent TB.

    • QuantiFERON-TB test can be re-tested, if inconclusive.
11. Any significant cardiac disease (e.g., coronary artery disease with unstable angina, coronary heart failure New York Heart Association Class III and IV, familial long QT syndrome, uncontrolled cardiac disease).
12. History of moderate to severe chronic obstructive pulmonary disease (COPD) and/or history of severe COPD exacerbation(s) within the last 12 months of Screening.
13. Vaccination with live or attenuated vaccines within 6 weeks prior to first dose of study drug or planned administration during study participation or within 4 weeks following last dose of study drug. Treatment with IV Gamma Globulin or the Prosorba® Column within 6 months prior to Day 1.
14. History of a severe allergic reaction or anaphylactic reaction to a biological agent or history of hypersensitivity to any component of the study drug including known hypersensitivity or allergy to a murine product.
15. Hypogammaglobulinemia at screening (Immunoglobulin G (IgG) \<600 mg/dL).
16. Patients with hemoglobin \<8.5 g/dL, absolute neutrophil count (ANC) \<1,500 cells/µL or platelet count \<75,000 cells/µL at Screening. If a patient has findings marginally below this limit, re testing is allowed, at the Investigator's discretion, within the 30 day period between Visit 1 and Visit 2.

• Creatinine clearance \< 50 mL/min (Cockcroft-Gault formula)

• Liver function: Total bilirubin \>2.0 mg/dL (\>34 µmol/L) except for patients with Gilbert's Syndrome or hemolysis. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) \>3 × upper limit of normal (ULN). Patients with total bilirubin \>2.0 mg/dL possibly due to Gilbert's Syndrome should have a direct bilirubin checked. If the direct bilirubin is normal and medical history is suggestive/positive for Gilbert's Syndrome, the patient successfully meets the criteria.

The AST and ALT may be repeated once within the Screening period if the initial result exceeds this limit, and the lesser value accepted if it meets this criterion.

18. History of cancer within the last 5 years prior to Screening, treated with anti-cancer chemotherapy, including solid tumors and hematologic malignancies and carcinoma in situ (except basal cell and squamous cell carcinomas of the skin or carcinoma in situ of the cervix uteri that have been excised and cured).

19. Major surgical procedure within 4 weeks prior to or planned within 24 weeks of Day 1, with the exception of surgical procedures for dental prosthesis.

20. Previous treatment with a B cell modulating or B cell depletion therapy, such as, but not limited to rituximab, belimumab, atacicept, tabalumab, ocrelizumab, ofatumumab, obinutuzumab, epratuzumab and other experimental treatments.

21. Injectable corticosteroids within 6 weeks prior to Day 1.

22. Participation in a previous clinical study within 4 weeks of Screening or having received treatment with a drug that has not received regulatory approval for any indication within a minimum of 5 half-lives prior to Day 1.

23. Patients who, based on the Investigator's judgment, have a clinically significant or unstable medical or surgical condition that may preclude safe and complete study participation. Conditions may also include cardiovascular, vascular, pulmonary, hepatic, renal, endocrine or neurological conditions as determined by medical history, physical examination, laboratory tests or electrocardiogram (ECG).

24. Patients who, in the judgment of the Investigator, are likely to be non-compliant or uncooperative during the study.

25. History of substance abuse (alcohol or drug).

26. History of demyelinating disorders (such as multiple sclerosis or Guillain-Barré syndrome).

27. Patients at risk of progressive multifocal leukoencephalopathy (PML):

* Patients with immune deficiency such as transplant patients on immunosuppressive medications
* Patients receiving certain kinds of chemotherapy
* Patients receiving natalizumab (Tysabri®) for multiple sclerosis
* Patients with psoriasis on longer term efalizumab (Raptiva®) or patients with acquired immunodeficiency syndrome (AIDS)

Primary outcomes:
measure: Area Under the Concentration Time Cure From Time 0 to Last Quantifiable Concentration (AUC0-t)
timeFrame: Samples for pharmacokinetic evaluation were taken at Baseline and Weeks 0, 1, 2, 3, 4, 8, 12, 16, 20 and 24. Unscheduled visit samples were taken at the discretion of the investigator.
measure: Area Under the Plasma Concentration Versus Time Curve (AUC0-∞)
timeFrame: Samples for pharmacokinetic evaluation were taken at Baseline and Weeks 0, 1, 2, 3, 4, 8, 12, 16, 20 and 24. Unscheduled visit samples were taken at the discretion of the investigator.
measure: Area Under the Plasma Concentration Versus Time Curve (AUC0-D15)
timeFrame: Samples for pharmacokinetic evaluation were taken at Baseline and Weeks 0, 1, 2, 3, 4, 8, 12, 16, 20 and 24. Unscheduled visit samples were taken at the discretion of the investigator.
measure: Peak Plasma Concentration (Cmax) After Day 15 Infusion
timeFrame: Samples for pharmacokinetic evaluation were taken at Baseline and Weeks 0, 1 and 2 (Pre-dose 2). Unscheduled visit samples were taken at the discretion of the investigator.
measure: Trough Concentration (Ctrough) Before the Second Infusion on Day 15
timeFrame: Samples for pharmacokinetic evaluation were taken at Baseline and Weeks 0, 1 and 2 (Pre-dose 2). Unscheduled visit samples were taken at the discretion of the investigator.
measure: Change From Baseline in DAS28-CRP at Week 24
timeFrame: Baseline and Week 24
Secondary outcomes:
measure: Area Under the Concentration Time Curve Week 2 to Week 24 (AUC(w2-24)
timeFrame: Samples for pharmacokinetic evaluation were taken at Baseline and Weeks 0, 1, 2, 3, 4, 8, 12, 16, 20 and 24. Unscheduled visit samples were taken at the discretion of the investigator.
measure: Area Under the Concentration Time Curve Day 0 to Week 12 (AUC(0-w12))
timeFrame: Samples for pharmacokinetic evaluation were taken at Baseline and Weeks 0, 1, 2, 3, 4, 8 and 12. Unscheduled visit samples were taken at the discretion of the investigator.
measure: Time to Maximum Plasma Concentration (Tmax) (Dose 1)
timeFrame: Samples for pharmacokinetic evaluation were taken at Baseline and Weeks 0, 1, 2, 3, 4, 8, 12, 16, 20 and 24. Unscheduled visit samples were taken at the discretion of the investigator.
measure: Time to Maximum Plasma Concentration (Tmax) (Dose 2)
timeFrame: Samples for pharmacokinetic evaluation were taken at Baseline and Weeks 0, 1, 2, 3, 4, 8, 12, 16, 20 and 24. Unscheduled visit samples were taken at the discretion of the investigator.
measure: Apparent Terminal Rate Constant (λz)
timeFrame: Samples for pharmacokinetic evaluation were taken at Baseline and Weeks 0, 1, 2, 3, 4, 8, 12, 16, 20 and 24. Unscheduled visit samples were taken at the discretion of the investigator.
measure: Systemic Clearance (CL)
timeFrame: Samples for pharmacokinetic evaluation were taken at Baseline and Weeks 0, 1, 2, 3, 4, 8, 12, 16, 20 and 24. Unscheduled visit samples were taken at the discretion of the investigator.
measure: Volume of Distribution (VD)
timeFrame: Samples for pharmacokinetic evaluation were taken at Baseline and Weeks 0, 1, 2, 3, 4, 8, 12, 16, 20 and 24. Unscheduled visit samples were taken at the discretion of the investigator.
measure: Terminal Half-life (T1/2)
timeFrame: Samples for pharmacokinetic evaluation were taken at Baseline and Weeks 0, 1, 2, 3, 4, 8, 12, 16, 20 and 24. Unscheduled visit samples were taken at the discretion of the investigator.
measure: Change From Baseline in DAS28-CRP at Weeks 8, 16, 36 and 52
timeFrame: Baseline and Weeks 8, 16, 24, 36 and 52 (EOS)
measure: American Collage of Rheumatology 20% Response Criteria (ACR20) Response Rates at Weeks 8, 16, 24, 36 and 52
timeFrame: Baseline and Weeks 8, 16, 24, 36 and 52 (EOS)
measure: American Collage of Rheumatology 50% Response Criteria (ACR50) Response Rates and American Collage of Rheumatology 70% Response Criteria (ACR70) at Weeks 8, 16, 24, 36 and 52
timeFrame: Baseline and Weeks 8, 16, 24, 36 and 52 (EOS)
measure: Individual Components of the ACR Improvement Criteria on Day 1 and at Weeks 8, 16, 24, 36 and 52: Swollen Joint Count (SJC) and Tender Joint Count (TJC) (the 66/68 Joint Count System)
timeFrame: Baseline and Weeks 8, 16, 24, 36 and 52 (EOS)
measure: Individual Components of the ACR Improvement Criteria on Day 1 and at Weeks 8, 16, 24, 36 and 52: Physicians Global Assessment of Disease Activity (Assessed on 1 to 100 mm Visual Analog Scale [VAS])
timeFrame: Baseline and Weeks 8, 16, 24, 36 and 52 (EOS)
measure: Individual Components of the ACR Improvement Criteria on Day 1 and at Weeks 8, 16, 24, 36 and 52: Participants Assessment of Pain (Assessed on 1 to 100 mm Visual Analog Scale [VAS])
timeFrame: Baseline and Weeks 8, 16, 24, 36 and 52 (EOS)
measure: Individual Components of the ACR Improvement Criteria on Day 1 and at Weeks 8, 16, 24, 36 and 52: Participants Global Assessment of Disease Activity (Assessed on 1 to 100 mm VAS)
timeFrame: Baseline and Weeks 8, 16, 24, 36 and 52 (EOS)
measure: Individual Components of the ACR Improvement Criteria on Day 1 and at Weeks 8, 16, 24, 36 and 52: Participants Assessment of Disability (Health Assessment Questionnaire-Disability Index [HAQ-DI])
timeFrame: Baseline and Weeks 8, 16, 24, 36 and 52 (EOS)
measure: Individual Components of the ACR Improvement Criteria on Day 1 and at Weeks 8, 16, 24, 36 and 52: C-reactive Protein (CRP) Level
timeFrame: Baseline and Weeks 8, 16, 24, 36 and 52 (EOS)
measure: Change From Baseline DAS28-erythrocyte Sedimentation Rate (ESR) at Weeks 8, 16, 24, 36 and 52
timeFrame: Baseline and Weeks 8, 16, 24, 36 and 52 (EOS)
measure: Number of Participants With a Major Clinical Response (Continuous ACR70) for at Least 24 Weeks
timeFrame: Baseline and Weeks 8, 16, 24, 36 and 52 (EOS)
measure: Number of Participants With a Clinical Remission Response (CRR) at Weeks 8, 16, 24, 36 and 52
timeFrame: Baseline and Weeks 8, 16, 24, 36 and 52 (EOS)
measure: Proportion of Participants With European League Against Rheumatism (EULAR) Response at Weeks 8, 16, 24 36 and 52
timeFrame: Baseline and Weeks 8, 16, 24, 36 and 52 (EOS)
measure: Pharmacodynamic Endpoint: Change From Baseline in Immunoglobulin (IgG, IgM and IgA Levels)
timeFrame: Baseline (Day 1) and Weeks 8, 16, 24, 36 and 52 (EOS)
Other outcomes:
measure: Pharmacodynamic Endpoint: Depletion of B-lymphocyte Antigen CD19 (CD19+) B-cell Count up to Week 24
timeFrame: Samples for pharmacodynamic evaluation (CD19+ B-cell) were taken at Baseline and Weeks 0, 1, 2, 3, 4, 8, 12, 16, 20 and 24. Unscheduled visit samples were taken at the discretion of the investigator.
measure: Pharmacodynamic Endpoint: Time Needed to CD19+ B-cell Depletion
timeFrame: Samples for pharmacodynamic evaluation (CD19+ B-cell) were taken at Baseline and Weeks 0, 1, 2, 3, 4, 8, 12, 16, 20, 24, 36 and 52. Unscheduled visit samples were taken at the discretion of the investigator.
measure: Pharmacodynamic Endpoint: Duration of CD19+ B-cell Depletion
timeFrame: Samples for pharmacodynamic evaluation (CD19+ B-cell) were taken at Baseline and Weeks 0, 1, 2, 3, 4, 8, 12, 16, 20, 24, 36 and 52. Unscheduled visit samples were taken at the discretion of the investigator.
measure: Pharmacodynamic Endpoint: Number of Participants With CD19+ B-cell Count Recover Versus Baseline
timeFrame: Samples for pharmacodynamic evaluation (CD19+ B-cell) were taken at Baseline and Weeks 0, 1, 2, 3, 4, 8, 12, 16, 20, 24, 36 and 52. Unscheduled visit samples were taken at the discretion of the investigator.
measure: Pharmaco Endpoint: Area Under the Concentration Time Curve of CD19 B-cell Count Change at Day 15 and Week 24
timeFrame: Samples for pharmacodynamic evaluation (CD19+ B-cell) were taken at Baseline and Weeks 0, 1, 2, 3, 4, 8, 12, 16, 20, 24, 36 and 52. Unscheduled visit samples were taken at the discretion of the investigator.
measure: Pharmacodynamic Endpoint: Change From Baseline in CD19+ B-cell Count During the Study Period
timeFrame: Samples for pharmacodynamic evaluation (CD19+ B-cell) were taken at Baseline and Weeks 0, 1, 2, 3, 4, 8, 12, 16, 20 and 24. Unscheduled visit samples were taken at the discretion of the investigator.
measure: Pharmacodynamic Endpoint: Change From Baseline in C-reactive Protein (CRP) Levels at Weeks 8, 16, 24, 36 and 52
timeFrame: Baseline (Day 1) and Weeks 8, 16, 24, 26 & 52 (EOS)
Locations:
city: Anniston
country: United States
facility: Research Site
state: Alabama
city: El Cajon
country: United States
facility: Research Site
state: California
city: La Mesa
country: United States
facility: Research Site
state: California
city: Lakewood
country: United States
facility: Research Site
state: California
city: Los Angeles
country: United States
facility: Research Site-1
state: California
city: Los Angeles
country: United States
facility: Research Site-2
state: California
city: San Leandro
country: United States
facility: Research Site
state: California
city: Orlando
country: United States
facility: Research Site
state: Florida
city: Tampa
country: United States
facility: Research Site
state: Florida
city: Tampa
country: United States
facility: Research Site
state: Florida
city: Boise
country: United States
facility: Research Site
state: Idaho
city: Kansas City
country: United States
facility: Research Site
state: Kansas
city: Lansing
country: United States
facility: Research Site
state: Michigan
city: Waco
country: United States
facility: Research Site
state: Texas
city: Tacoma
country: United States
facility: Research Site
state: Washington
city: Mostar
country: Bosnia and Herzegovina
facility: Research Site
city: Sarajevo
country: Bosnia and Herzegovina
facility: Research site
city: Plovdiv
country: Bulgaria
facility: Research Site-1
city: Plovdiv
country: Bulgaria
facility: Research Site-2
city: Sofia
country: Bulgaria
facility: Research Site
city: Sofia
country: Bulgaria
facility: Research Site
city: Brno
country: Czechia
facility: Research site
city: Ostrava
country: Czechia
facility: Research site
city: Praha 2
country: Czechia
facility: Research site
city: Uherské Hradiště
country: Czechia
facility: Research site
city: Bad Doberan
country: Germany
facility: Research site
state: Mecklegurg-Vorpommern
city: Ratingen
country: Germany
facility: Research site
state: Nordrhein-Westfalen
city: Vogelsang
country: Germany
facility: Research site
state: Sachsen-Anhalt
city: Dresden
country: Germany
facility: Research site
state: Sachsen
city: Hamburg
country: Germany
facility: Research site
city: Rendsburg
country: Germany
facility: Research site
city: Budapest
country: Hungary
facility: Research Site
city: Budapest
country: Hungary
facility: Research Site
city: Bangalore
country: India
facility: Research site
state: Karnataka
city: Hubli
country: India
facility: Research site
state: Karnataka
city: Pune
country: India
facility: Research site
state: Maharashtra
city: Pune
country: India
facility: Research site
state: Maharashtra
city: Pune
country: India
facility: Research site
state: Maharashtra
city: Bīkaner
country: India
facility: Research site
state: Rajasthan
city: Jaipur
country: India
facility: Research site
state: Rajasthan
city: Kolkata
country: India
facility: Research site
state: West Bengal
city: Anyang
country: Korea, Republic of
facility: Research Site
city: Busan
country: Korea, Republic of
facility: Research Site
city: Busan
country: Korea, Republic of
facility: Research Site
city: Daegu
country: Korea, Republic of
facility: Research Site
city: Daegu
country: Korea, Republic of
facility: Research Site
city: Daejeon
country: Korea, Republic of
facility: Research Site
city: Gwangju
country: Korea, Republic of
facility: Research Site
city: Jeju
country: Korea, Republic of
facility: Research Site
city: Seoul
country: Korea, Republic of
facility: Research Site
city: Seoul
country: Korea, Republic of
facility: Research Site
city: Seoul
country: Korea, Republic of
facility: Research Site
city: Suwon
country: Korea, Republic of
facility: Research Site
city: Durango
country: Mexico
facility: Research Site
city: Mexico City
country: Mexico
facility: Research Site
city: Mexico City
country: Mexico
facility: Research Site
city: Gdańsk
country: Poland
facility: Research site
city: Kraków
country: Poland
facility: Research site
city: Kraków
country: Poland
facility: Research site
city: Kłodzko
country: Poland
facility: Research site
city: Nowa Sól
country: Poland
facility: Research site
city: Oświęcim
country: Poland
facility: Research site
city: Poznań
country: Poland
facility: Research site
city: Poznań
country: Poland
facility: Research site
city: Tychy
country: Poland
facility: Research site
city: Warszawa
country: Poland
facility: Research site
city: Warszawa
country: Poland
facility: Research site
city: Wrocław
country: Poland
facility: Research site
city: Zamość
country: Poland
facility: Research site
city: Fuenlabrada
country: Spain
facility: Research Site
city: La Coruña
country: Spain
facility: Research Site
city: La Coruña
country: Spain
facility: Research Site
city: La Coruña
country: Spain
facility: Research Site
city: Sevilla
country: Spain
facility: Research Site
city: Sevilla
country: Spain
facility: Research Site
Study officials:
References: