Rheumatoid Arthritis
Conditions
Brief summary
This study will look at whether this new drug is effective in the treatment of rheumatoid arthritis, and at whether it is safe and well-tolerated by participants with the disease.
Interventions
MK-0873 1.25 mg twice daily for 12 weeks
Matching placebo to MK-0873 1.25 mg twice daily for 12 weeks
Sponsors
Study design
Eligibility
Inclusion criteria
* Rheumatoid arthritis, according to the American College of Rheumatology criteria, with active disease despite current medications * Other criteria also apply
Exclusion criteria
* Other major illnesses * Past history of certain other disorders * Certain prohibited medications
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change From Baseline in Swollen Joint Count | Baseline and the average of Treatment Weeks 8, 10 and 12 | Swollen joint count (SJC) was determined by assessing 66 joints (33 right side, 33 left side) for swelling using the following grading system: 0=Absent, 1=Detectable synovial thickening without loss of bony contours, 2=Loss of distinctiveness of bony contours, or 3=Bulging synovial proliferation with cystic characteristics. The total number of joints graded 1, 2, or 3 were then counted to yield the SJC. SJC ranged from 1-66, with increasing score indicating greater number of swollen joints. SJC was averaged over weeks 8, 10 and 12 to yield a Treatment Period Mean. Change from Baseline = Treatment Period Mean SJC - Baseline SJC. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change From Baseline in Tender Joint Count | Baseline and the average of Treatment Weeks 8, 10 and 12 | Tender joint count (TJC) was to be determined by assessing 68 joints (34 right side, 34 left side) for pain using the following grading system: 0=No pain, 1=Patient states that there is pain, 2=Patient states that there is pain and winces, or 3=Patient states that there is pain, winces, and withdraws. The total number of joints graded 1, 2, or 3 were then to be counted to yield the TJC. TJC ranges from 1-68, with increasing score indicating greater number of tender joints. TJC was to be averaged over weeks 8, 10, and 12 to yield a Treatment Period Mean. Change from Baseline = Treatment Period Mean TJC - Baseline TJC. |
| Patient Global Assessment of Disease Activity | The average of Treatment Weeks 8, 10 and 12 | At each clinic visit, participants were to assess disease activity using a 100 mm visual analog scale (VAS) in reponse to the question: Considering all the ways your arthritis affects you, mark an (X) through the line for how well you are doing. The VAS ranges from Very Well (0) to Very Poor (100). The mean score at Treatment Weeks 8, 10 and 12 was calculated. A lower score indicates a better disease activity. |
| Investigator Global Assessment of Disease Activity | Treatment Week 12 | At each clinic visit, the Investigator was to make a global assessment of participant disease activity on a 5-point Likert scale with grading as follows: 1=Very well, 2=Well, 3=Fair, 4=Poor, or 5=Very poor (scale range: 1-5). A lower score indicates a more positive assessment of participant disease activity. |
| Percentage of Participants With American College of Rheumatology 20% Response [ACR20] | Baseline and the average of Treatment Weeks 8, 10 and 12 | Participants were categorized as meeting ACR20 criteria when they had at least 20% improvement from Baseline in tender and swollen joint counts, and improvement from Baseline in at least 3 of 5 of the following domains: Pain Visual Analog Scale (VAS), Patient Global Assessement, Physician Global Assessment, Patient Physical Function (Disability) Score and acute-phase reactant (Erythrocyte Sedimentation Rate \[ESR\] or C-Reactive Protein \[CRP\]). The average percentage of participants that met the ACR20 responder criteria over Treatment Weeks 8, 10 and 12 was calculated. |
| Health Assessment Questionnaire Disability Index | The average of Treatment Weeks 8, 10 and 12 | The Stanford Health Assessment Questionnaire Disability Index assesses participant functional ability based on 20 questions in 8 categories of functioning: dressing, rising, eating, walking, hygiene, reach, grip, and usual activities. Responses range from 0=No disability to 3=Completely disabled. The score for each category subscale is the single response within the category with the highest score (greatest difficulty). The overall score for the Disability Index is the mean of the 8 category scores and also ranges from 0-3, with a lower score indicating less disability. |
| Patient's Assessment of Pain | Treatment Week 12 | At each clinic visit, participants were to assess their amount of pain due to arthritis during the previous 48 hours on a 100 mm visual analog scale (VAS) that ranged from No pain (0) to Extreme pain (100). A lower score indicates less pain. |
| Ratio of On-treatment C-Reactive Protein to Baseline C-Reactive Protein | Baseline and the average of Treatment Weeks 8, 10 and 12 | C-reactive protein levels rise in response to inflammation in the body. The ratio of On-treatment serum C-reative protein:Baseline serum C-reactive protein was calculated to determine a treatment effect. On-treatment C-reactive protein = the mean of serum C-reactive protein levels for Treatment Weeks 8, 10 and 12. A ratio of less than 1.0 is consistent with lower inflammation and was to be considered an improvement. |
| Patient Global Assessment of Response to Therapy | Treatment Week 12 | Participants were to rate their overall response to the study drug on a 5-point Likert scale with grading as follows: 0=None, 1=Poor, 2=Fair, 3=Good, or 4=Excellent (scale range: 0-4). A higher score indicates a more positive response to study drug. |
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| MK-0873 Participants receive MK-0873 1.25 mg twice daily for 12 weeks | 53 |
| Placebo Participants receive matching placebo to MK-0873 twice daily for 12 weeks | 53 |
| Total | 106 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Adverse Event | 2 | 1 |
| Overall Study | Lack of Efficacy | 7 | 6 |
| Overall Study | Protocol Violation | 1 | 1 |
| Overall Study | Withdrawal by Subject | 1 | 3 |
Baseline characteristics
| Characteristic | MK-0873 | Placebo | Total |
|---|---|---|---|
| Age, Continuous | 51.0 years STANDARD_DEVIATION 9.3 | 53.5 years STANDARD_DEVIATION 8.99 | 52.3 years STANDARD_DEVIATION 9.19 |
| Sex: Female, Male Female | 35 Participants | 40 Participants | 75 Participants |
| Sex: Female, Male Male | 18 Participants | 13 Participants | 31 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 10 / 53 | 4 / 53 |
| serious Total, serious adverse events | 1 / 53 | 2 / 53 |
Outcome results
Change From Baseline in Swollen Joint Count
Swollen joint count (SJC) was determined by assessing 66 joints (33 right side, 33 left side) for swelling using the following grading system: 0=Absent, 1=Detectable synovial thickening without loss of bony contours, 2=Loss of distinctiveness of bony contours, or 3=Bulging synovial proliferation with cystic characteristics. The total number of joints graded 1, 2, or 3 were then counted to yield the SJC. SJC ranged from 1-66, with increasing score indicating greater number of swollen joints. SJC was averaged over weeks 8, 10 and 12 to yield a Treatment Period Mean. Change from Baseline = Treatment Period Mean SJC - Baseline SJC.
Time frame: Baseline and the average of Treatment Weeks 8, 10 and 12
Population: The All Patients Treated (APT) population consisted of all participants with a baseline and at least one postbaseline observation.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) |
|---|---|---|
| MK-0873 | Change From Baseline in Swollen Joint Count | -7.20 score on a scale |
| Placebo | Change From Baseline in Swollen Joint Count | -8.68 score on a scale |
Change From Baseline in Tender Joint Count
Tender joint count (TJC) was to be determined by assessing 68 joints (34 right side, 34 left side) for pain using the following grading system: 0=No pain, 1=Patient states that there is pain, 2=Patient states that there is pain and winces, or 3=Patient states that there is pain, winces, and withdraws. The total number of joints graded 1, 2, or 3 were then to be counted to yield the TJC. TJC ranges from 1-68, with increasing score indicating greater number of tender joints. TJC was to be averaged over weeks 8, 10, and 12 to yield a Treatment Period Mean. Change from Baseline = Treatment Period Mean TJC - Baseline TJC.
Time frame: Baseline and the average of Treatment Weeks 8, 10 and 12
Population: No additional analyses were performed if the primary (Swollen Joint Count) and major secondary (ACR20) outcome measures resulted in a p-value of \>0.05.
Health Assessment Questionnaire Disability Index
The Stanford Health Assessment Questionnaire Disability Index assesses participant functional ability based on 20 questions in 8 categories of functioning: dressing, rising, eating, walking, hygiene, reach, grip, and usual activities. Responses range from 0=No disability to 3=Completely disabled. The score for each category subscale is the single response within the category with the highest score (greatest difficulty). The overall score for the Disability Index is the mean of the 8 category scores and also ranges from 0-3, with a lower score indicating less disability.
Time frame: The average of Treatment Weeks 8, 10 and 12
Population: No additional analyses were performed if the primary (Swollen Joint Count) and major secondary (ACR20) outcome measures resulted in a p-value of \>0.05.
Investigator Global Assessment of Disease Activity
At each clinic visit, the Investigator was to make a global assessment of participant disease activity on a 5-point Likert scale with grading as follows: 1=Very well, 2=Well, 3=Fair, 4=Poor, or 5=Very poor (scale range: 1-5). A lower score indicates a more positive assessment of participant disease activity.
Time frame: Treatment Week 12
Population: No additional analyses were performed if the primary (Swollen Joint Count) and major secondary (ACR20) outcome measures resulted in a p-value of \>0.05.
Patient Global Assessment of Disease Activity
At each clinic visit, participants were to assess disease activity using a 100 mm visual analog scale (VAS) in reponse to the question: Considering all the ways your arthritis affects you, mark an (X) through the line for how well you are doing. The VAS ranges from Very Well (0) to Very Poor (100). The mean score at Treatment Weeks 8, 10 and 12 was calculated. A lower score indicates a better disease activity.
Time frame: The average of Treatment Weeks 8, 10 and 12
Population: No additional analyses were performed if the primary (Swollen Joint Count) and major secondary (ACR20) outcome measures resulted in a p-value of \>0.05.
Patient Global Assessment of Response to Therapy
Participants were to rate their overall response to the study drug on a 5-point Likert scale with grading as follows: 0=None, 1=Poor, 2=Fair, 3=Good, or 4=Excellent (scale range: 0-4). A higher score indicates a more positive response to study drug.
Time frame: Treatment Week 12
Population: No additional analyses were performed if the primary (Swollen Joint Count) and major secondary (ACR20) outcome measures resulted in a p-value of \>0.05.
Patient's Assessment of Pain
At each clinic visit, participants were to assess their amount of pain due to arthritis during the previous 48 hours on a 100 mm visual analog scale (VAS) that ranged from No pain (0) to Extreme pain (100). A lower score indicates less pain.
Time frame: Treatment Week 12
Population: No additional analyses were performed if the primary (Swollen Joint Count) and major secondary (ACR20) outcome measures resulted in a p-value of \>0.05.
Percentage of Participants With American College of Rheumatology 20% Response [ACR20]
Participants were categorized as meeting ACR20 criteria when they had at least 20% improvement from Baseline in tender and swollen joint counts, and improvement from Baseline in at least 3 of 5 of the following domains: Pain Visual Analog Scale (VAS), Patient Global Assessement, Physician Global Assessment, Patient Physical Function (Disability) Score and acute-phase reactant (Erythrocyte Sedimentation Rate \[ESR\] or C-Reactive Protein \[CRP\]). The average percentage of participants that met the ACR20 responder criteria over Treatment Weeks 8, 10 and 12 was calculated.
Time frame: Baseline and the average of Treatment Weeks 8, 10 and 12
Population: The APT population consisted of all participants with a baseline and at least one postbaseline observation.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| MK-0873 | Percentage of Participants With American College of Rheumatology 20% Response [ACR20] | 39.62 percentage of participants |
| Placebo | Percentage of Participants With American College of Rheumatology 20% Response [ACR20] | 45.28 percentage of participants |
Ratio of On-treatment C-Reactive Protein to Baseline C-Reactive Protein
C-reactive protein levels rise in response to inflammation in the body. The ratio of On-treatment serum C-reative protein:Baseline serum C-reactive protein was calculated to determine a treatment effect. On-treatment C-reactive protein = the mean of serum C-reactive protein levels for Treatment Weeks 8, 10 and 12. A ratio of less than 1.0 is consistent with lower inflammation and was to be considered an improvement.
Time frame: Baseline and the average of Treatment Weeks 8, 10 and 12
Population: The APT population consisted of all participants with a baseline and at least one postbaseline observation.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) |
|---|---|---|
| MK-0873 | Ratio of On-treatment C-Reactive Protein to Baseline C-Reactive Protein | 0.90 ratio |
| Placebo | Ratio of On-treatment C-Reactive Protein to Baseline C-Reactive Protein | 1.08 ratio |