Rheumatoid Arthritis
Conditions
Brief summary
This is a Phase III, randomized, double-blind, placebo-controlled, multicenter study evaluating the efficacy of retreatment with rituximab in subjects with active rheumatoid arthritis (RA) who are receiving Methotrexate (MTX).
Interventions
DRUGplacebo
Intravenous repeating dose
DRUGrituximab
Intravenous repeating dose
DRUGmethotrexate
Oral or parenteral repeating dose
DRUGfolate
Intravenous repeating dose
Sponsors
Genentech, Inc.
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Investigator)
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* Signed informed consent form * Ability and willingness to comply with the requirements of the study protocol * Age 18-80 years * Diagnosis of RA for at least 6 months * Receiving treatment for RA on an outpatient basis * Documented moderate to severe active RA activity at screening and Day 1 * Documented inadequate response to previous or current treatment with one or more of the following: etanercept, infliximab, and/or adalimumab because of toxicity or inadequate efficacy * Use of MTX 10-25 mg/wk for ≥ 12 weeks prior to Day 1 at a stable dose for ≥ 4 weeks * Willingness to receive oral folic acid * If taking a background corticosteroid, use of the corticosteroid must be at a stable dose during the 4 weeks prior to Day 1 * Use of one NSAID is permitted if the dose is stable for ≥ 2 weeks prior to Day 1 * For men and women of reproductive potential, willingness to use a reliable means of contraception for ≥ 30 days prior to Day 1 and for the study duration or the duration that the subject's peripheral CD19 B cells are depleted, whichever is longer
Exclusion criteria
* Rheumatic autoimmune disease other than RA or significant systemic involvement secondary to RA; Secondary Sjogren's syndrome with RA is permitted. * History of or current inflammatory joint disease other than RA or other systemic rheumatic disorder (e.g., systemic lupus erythematosus, inflammatory bowel disease, scleroderma, inflammatory myopathy, or overlap syndrome) * History of deep space/tissue infection within 52 weeks prior to Day 1 * Diagnosis of juvenile idiopathic arthritis (JIA), juvenile rheumatoid arthritis (JRA), and/or RA before age 16 * Functional Class IV, as defined by the ACR Classification of Functional Status in Rheumatoid Arthritis * Any surgical procedure, including bone/joint surgery/synovectomy (including joint fusion or replacement), within 12 weeks prior to Day 1 or planned within 48 weeks after Day 1 * Known hypersensitivity to any component of a humanized or murine monoclonal antibody * Receipt of any vaccination within 4 weeks prior to Day 1 * Significant cardiac or pulmonary disease, including obstructive pulmonary disease * Evidence of significant uncontrolled concomitant disease, such as, but not limited to nervous system, renal, hepatic, endocrine, or gastrointestinal disorders * Known active bacterial, viral, fungal, mycobacterial, or other infection (including tuberculosis or atypical mycobacterial disease but excluding fungal infections of the nail beds) or any major episode of infection requiring hospitalization or treatment with IV antibiotics within 4 weeks of Day 1 or oral antibiotics within 2 weeks of Day 1 * History of serious recurrent or chronic infection (a chest X-ray will be performed at screening if one has not been performed within 12 weeks of screening that showed no clinically significant abnormality) * History of or currently active primary or secondary immunodeficiency, including HIV infection * History of cancer, including solid tumors and hematologic malignancies (except basal cell or squamous cell carcinoma of the skin that has been excised and cured) * History of significant cytopenias or other bone marrow disorders * History of alcohol, drug, or chemical abuse within 24 weeks prior to Day 1 * Pregnancy or lactation * Neuropathies and neurovasculopathies that might interfere with pain evaluation * Poor peripheral venous access * Intolerance or contraindications to oral or IV corticosteroids * Positive hepatitis B surface antigen or hepatitis C antibody serology * For women of childbearing potential (including those who have had a tubal ligation), a positive serum pregnancy test at screening * Current use of any DMARD other than MTX * Concurrent treatment with any biologic agent * Treatment with any investigational agent within 4 weeks prior to Day 1 or five half-lives of the investigational drug (whichever is longer) * Any previous treatment with rituximab or other cell-depleting therapies, including CAMPATH, anti-CD4, anti-CD5, anti-CD3, anti-CD19, anti-CD11a, anti-CD22, anti-BLys/ BAFF, and other anti-CD20 agents * Previous treatment with a co-stimulation blocking agent, including abatacept * Previous treatment with an anti-\<alpha\> 4 integrin agent, including natalizumab * Previous treatment within 6 months of screening with IV & globulin or the Prosorba(R) Column * Intra-articular or parenteral corticosteroids within 4 weeks prior to Day 1
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Retreated Subjects With an American College of Rheumatology 20% (ACR20) Response at Week 48 Relative to Baseline | 48 Weeks | ACR20 response was defined as a ≥ 20% improvement compared with baseline in both tender joint count (TJC) \[68 joints\] and swollen joint count (SJC) \[66 joints\] as well as a ≥ 20% improvement in three of five additional measurements: 1) Physician's Global Assessment of disease activity \[visual analog scale: 0=no disease activity to 100=maximum disease activity\]; 2) Patient's Global Assessment of Disease Activity \[visual analog scale: 0=no disease activity to 100=maximum disease activity\]; 3) Patient's Assessment of Pain \[visual analog scale: 0=no pain to 100=unbearable pain\]; 4) Health Assessment Questionnaire \[20 questions, 8 components: dressing/grooming, arising, eating, walking, hygiene, reach, grip, and activities, 0=without difficulty to 3=unable to do\] and 5) erythrocyte sedimentation rate. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change From Baseline in the Disease Activity Score Using 28 Joint Counts (DAS28-ESR) at Week 48 | 48 weeks | The DAS28 score is a measure of the patient's disease activity calculated using the tender joint count (TJC) \[28 joints\], swollen joint count (SJC) \[28 joints\], patient's global assessment of disease activity \[visual analog scale: 0=no disease activity to 100=maximum disease activity\] and the erythrocyte sedimentation rate (ESR) for a total possible score of 2 to 10. Higher values indicate higher disease activity. A negative change from baseline indicates improvement. |
| Change From Baseline in Disease Activity Score (DAS28-CRP) at Week 48 | Baseline, Week 48 | The DAS28 score is a measure of the patient's disease activity calculated using the tender joint count (TJC) \[28 joints\], swollen joint count (SJC) \[28 joints\], patient's global assessment of disease activity \[visual analog scale: 0=no disease activity to 100=maximum disease activity\] and C-Reactive Protein (CRP) for a total possible score of 2 to 10. Higher values indicate higher disease activity. A negative change from baseline indicates improvement. |
| Percentage of Retreated Subjects With a European League Against Rheumatism (EULAR) Response at Week 48 | Baseline, Week 48 | Change of the Disease Activity Score 28 score from baseline was used to determine EULAR responses of good, moderate, or no response. For a post-baseline score ≤ 3.2, a change from baseline of \< -1.2 was a good response, \< -0.6 to ≥ -1.2 was a moderate response, and ≥ -0.6 was no response. For a post-baseline score \> 3.2 to ≤ 5.1, a change from baseline of \< -0.6 was a moderate response and ≥ -0.6 was no response. For a post-baseline score \> 5.1, a change from baseline \< -1.2 was a moderate response and ≥ -1.2 was no response. A good response could not be achieved for post-baseline scores \> 3.2. |
| Change From Baseline in American College of Rheumatology (ACR) Core Set Component: Swollen Joint Count at Week 48 | Baseline, Week 48 | A Rheumatologist or an skilled arthritis assessor evaluated 66 joints at baseline and at Week 48. A negative change from baseline in Swollen Joint Count indicates improvement. |
| Change From Baseline in American College of Rheumatology (ACR) Core Set Component: Tender Joint Count at Week 48 | Baseline, Week 48 | A Rheumatologist or an skilled arthritis assessor evaluated 68 joints at baseline and at Week 48. A negative change from baseline in the Tender Joint Count indicates improvement. |
| Change From Baseline in American College of Rheumatology (ACR) Core Set Component: Health Assessment Questionnaire Disability Index (HAQ-DI) at Week 48 | Baseline, Week 48 | The Stanford Health Assessment Questionnaire disability index (HAQ-DI) is a patient completed questionnaire specific for rheumatoid arthritis. It consists of 20 questions referring to 8 domains: dressing/grooming, arising, eating, walking, hygiene, reach, grip,and common daily activities. Each domain has at least two component questions. There are four possible responses for each component ranging from 0(without any difficulty) to 4 (unable to do).HAQ-DI=sum of worst scores in each domain divided by the number of domains answered. A negative change from baseline indicates improvement. |
| Change From Baseline in American College of Rheumatology (ACR) Core Set Component: Subject's Global Assessment of Disease Activity at Week 48 | Baseline, Week 48 | Participants rated their disease activity at baseline and Week 48 using the Visual Analog Scale (VAS) on a scale of 0 (best) to 100 (worse). A negative change from baseline indicates improvement. |
| Change From Baseline in American College of Rheumatology (ACR) Core Set Component: Physician's Global Assessment of Disease Activity at Week 48 | Baseline, Week 48 | A Rheumatologist or a skilled Arthritis assessor rated the patient's disease activity at baseline and Week 48 using the Visual Analog Scale (VAS) on a scale of 0 (best) to 100 (worse). A negative change from baseline indicates improvement. |
| Change From Baseline in American College of Rheumatology (ACR) Core Set Component: Subject's Assessment of Pain at Week 48 | Baseline, Week 48 | Patients rated their pain at baseline and Week 48 using the Visual Analog Scale (VAS) on a scale of 0 (none) to 100 (unbearable pain). A negative change from baseline indicates improvement. |
| Retreated Subjects With American College of Rheumatology 50% (ACR50) Response and American College of Rheumatology 70% (ACR70) Response at Week 48 Relative to Baseline | Baseline, Week 48 | ACR50 or ACR70 response was defined as a ≥ 50% or 70% improvement compared with baseline in both tender joint count (TJC) \[68 joints\] and swollen joint count (SJC) \[66 joints\] as well as a ≥ 50% or 70% improvement in three of five additional measurements: 1) Physician's Global Assessment of disease activity \[visual analog scale: 0=no disease activity to 100=maximum disease activity\]; 2) Patient's Global Assessment of Disease Activity \[visual analog scale: 0=no disease activity to 100=maximum disease activity\]; 3) Patient's Assessment of Pain \[visual analog scale: 0=no pain to 100=unbearable pain\]; 4) Health Assessment Questionnaire \[20 questions, 8 components: dressing/grooming, arising, eating, walking, hygiene, reach, grip, and activities, 0=without difficulty to 3=unable to do\] and 5) erythrocyte sedimentation rate. |
| Change From Baseline in American College of Rheumatology (ACR) Core Set Component: Erythrocyte Sedimentation (ESR) at Week 48 | Baseline, Week 48 | Blood was collected for Erythrocyte Sedimentation Rate, an inflammatory marker, at Baseline and Week 48. A negative change from baseline indicates improvement. |
| Percentage of Retreated Subjects With a Change ≥ 0.22 From Baseline in HAQ-DI at Week 48 | Baseline, Week 48 | The Stanford Health Assessment Questionnaire disability index (HAQ-DI) is a patient completed questionnaire specific for rheumatoid arthritis. It consists of 20 questions referring to 8 domains: dressing/grooming, arising, eating, walking, hygiene, reach, grip and common daily activities. Each domain has at least two component questions. There are four possible responses for each component ranging from 0(without any difficulty) to 4 (unable to do). HAQ-DI=sum of worst scores in each domain divided by the number of domains answered. |
| Percentage of Retreated Subjects With a Change ≥ 0.3 From Baseline in HAQ-DI at Week 48 | Baseline, Week 48 | The Stanford Health Assessment Questionnaire disability index (HAQ-DI) is a patient completed questionnaire specific for rheumatoid arthritis. It consists of 20 questions referring to 8 domains: dressing/grooming, arising, eating, walking, hygiene, reach, grip and common daily activities. Each domain has at least two component questions. There are four possible responses for each component ranging from 0(without any difficulty) to 4 (unable to do).HAQ-DI=sum of worst scores in each domain divided by the number of domains answered. |
| ACRn in Retreated Subjects at Week 48 | Baseline, Week 48 | The ACRn is calculated for each participant by taking the lowest percentage improvement in (1) swollen joint count or (2) tender joint count or (3) the median of the remaining 5 components of the ACR response (participant's assessment of disease activity; participant's global assessment of pain; physician's assessment of disease activity; participant's assessment of physical function; an acute phase reactant value - CRP). A positive ACRn Score indicates an improvement. |
| Change From Baseline in SF-36 Health Summary Scores at Week 48 in Retreated Subjects | Baseline, Week 48 | The SF-36 is a questionnaire used to assess physical functioning and is made up of eight domains: Physical Functioning, Role Physical, Bodily Pain, General Health, Vitality, Social Functioning, Role-Emotional and Mental Health. Transforming and standardizing these domains leads to the calculation of the Physical (PCS) and Mental (MCS) Component Summary measures. Scores ranging from 0 to 100, with 0=worst score (or quality of life) and 100=best score. A positive change from baseline indicates improvement. |
| Change From Baseline in Functional Assessment of Chronic Illness Therapy Fatigue (FACIT-F) at Week 48 in Retreated Subjects | Baseline, Week 48 | FACIT-F is a 13-item questionnaire. Patients scored each item on a 5-point scale: 0 (Not at all) to 4 (Very much). The larger the patient's response to the questions (with the exception of 2 negatively stated), the greater the patient's fatigue. For all questions, except for the 2 negatively stated ones, the code was reversed and a new score was calculated as (4 minus the patient's response). The sum of all responses resulted in the FACIT-Fatigue score for a total possible score of 0 (worse score) to 52 (better score). A higher score reflects an improvement in the patient's health status. |
| Percentage of Retreated Subjects Achieving DAS28-ESR Remission at Week 48 | Week 48 | DAS28-ESR remission was defined as a DAS28-ESR \< 2.6 |
| Percentage of Retreated Subjects Achieving DAS28-ESR Low Disease at Week 48 | Week 48 | The DAS28-ESR score is a measure of the subject's disease activity. It is based on the tender joint count (28 joints), swollen joint count (28 joints), patient's global assessment of disease activity (mm), and ESR. DAS28-ESR scores range from 0 - 10. Low disease activity is defined as achieving a DAS28-ESR score of less than or equal to 3.2. |
| Change From Baseline in American College of Rheumatology (ACR) Core Set Component: C-Reactive Protein at Week 48 | Baseline, Week 48 | Blood was collected for C-Reactive Protein, an inflammatory marker, at Baseline and Week 48. A negative change from baseline indicates improvement. |
Participant flow
Pre-assignment details
559 participants received initial treatment open label rituximab. 84 of these participants were not randomized to Retreatment.
Participants by arm
| Arm | Count |
|---|---|
| Arm A: Rituximab Retreatment 1000 mg rituximab intravenous initial treatment on day 1 and day 15 plus 10-25 mg/week methotrexate followed by re-treatment during weeks 24 -40 consisting of two additional doses of 1000 mg rituximab 14 days apart plus 10-25 mg/week methotrexate. | 318 |
| Arm B: Placebo Retreatment 1000 mg rituximab initial treatment on day 1 and day 15 plus 10-25 mg/wk methotrexate followed by re-treatment during weeks 24 -40 consisting of two doses of placebo 14 days apart plus 10-25 mg/wk methotrexate. | 157 |
| Total | 475 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 |
|---|---|---|---|---|
| Initial Treatment | Adverse Event | 0 | 0 | 13 |
| Initial Treatment | Lost to Follow-up | 0 | 0 | 6 |
| Initial Treatment | Physician decision to withdraw | 0 | 0 | 12 |
| Initial Treatment | Pregnancy | 0 | 0 | 1 |
| Initial Treatment | Subject/Guardian decision to withdraw | 0 | 0 | 45 |
| Retreatment: Up to Week 48 | Adverse Event | 7 | 7 | 0 |
| Retreatment: Up to Week 48 | Death | 1 | 0 | 0 |
| Retreatment: Up to Week 48 | Lost to Follow-up | 3 | 0 | 0 |
| Retreatment: Up to Week 48 | Physician's Decision to Withdraw | 4 | 2 | 0 |
| Retreatment: Up to Week 48 | Pregnancy | 1 | 0 | 0 |
| Retreatment: Up to Week 48 | Subject/Guardian Decision to Withdraw | 11 | 14 | 0 |
| Retreatment: Week 48 to Week 72 | Adverse Event | 6 | 2 | 0 |
| Retreatment: Week 48 to Week 72 | Death | 1 | 1 | 0 |
| Retreatment: Week 48 to Week 72 | Lost to Follow-up | 1 | 0 | 0 |
| Retreatment: Week 48 to Week 72 | Physician's Decision to Withdraw | 15 | 10 | 0 |
| Retreatment: Week 48 to Week 72 | Subject/Guardian Decision to Withdraw | 41 | 29 | 0 |
Baseline characteristics
| Characteristic | Arm A: Rituximab Retreatment | Arm B: Placebo Retreatment | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 52 Participants | 24 Participants | 76 Participants |
| Age, Categorical Between 18 and 65 years | 266 Participants | 133 Participants | 399 Participants |
| Age Continuous | 54.2 years STANDARD_DEVIATION 10.57 | 53.9 years STANDARD_DEVIATION 10.52 | 54.1 years STANDARD_DEVIATION 10.54 |
| Sex: Female, Male Female | 257 Participants | 124 Participants | 381 Participants |
| Sex: Female, Male Male | 61 Participants | 33 Participants | 94 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — |
| other Total, other adverse events | 291 / 320 | 148 / 155 | 71 / 84 |
| serious Total, serious adverse events | 42 / 320 | 19 / 155 | 9 / 84 |
Outcome results
Primary
Retreated Subjects With an American College of Rheumatology 20% (ACR20) Response at Week 48 Relative to Baseline
ACR20 response was defined as a ≥ 20% improvement compared with baseline in both tender joint count (TJC) \[68 joints\] and swollen joint count (SJC) \[66 joints\] as well as a ≥ 20% improvement in three of five additional measurements: 1) Physician's Global Assessment of disease activity \[visual analog scale: 0=no disease activity to 100=maximum disease activity\]; 2) Patient's Global Assessment of Disease Activity \[visual analog scale: 0=no disease activity to 100=maximum disease activity\]; 3) Patient's Assessment of Pain \[visual analog scale: 0=no pain to 100=unbearable pain\]; 4) Health Assessment Questionnaire \[20 questions, 8 components: dressing/grooming, arising, eating, walking, hygiene, reach, grip, and activities, 0=without difficulty to 3=unable to do\] and 5) erythrocyte sedimentation rate.
Time frame: 48 Weeks
Population: Intent-to-treat population includes all participants randomized to Retreatment.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Arm A: Rituximab Retreatment | Retreated Subjects With an American College of Rheumatology 20% (ACR20) Response at Week 48 Relative to Baseline | 170 Participants |
| Arm B: Placebo Retreatment | Retreated Subjects With an American College of Rheumatology 20% (ACR20) Response at Week 48 Relative to Baseline | 70 Participants |
p-value: 0.0195Cochran-Mantel-Haenszel
Secondary
ACRn in Retreated Subjects at Week 48
The ACRn is calculated for each participant by taking the lowest percentage improvement in (1) swollen joint count or (2) tender joint count or (3) the median of the remaining 5 components of the ACR response (participant's assessment of disease activity; participant's global assessment of pain; physician's assessment of disease activity; participant's assessment of physical function; an acute phase reactant value - CRP). A positive ACRn Score indicates an improvement.
Time frame: Baseline, Week 48
Population: Participants from the Intent-to-treat population, that includes all participants randomized to Retreatment, with data available for analyses.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Arm A: Rituximab Retreatment | ACRn in Retreated Subjects at Week 48 | 22.1 Score on a scale | Standard Deviation 45.29 |
| Arm B: Placebo Retreatment | ACRn in Retreated Subjects at Week 48 | 10.7 Score on a scale | Standard Deviation 62.08 |
Secondary
Change From Baseline in American College of Rheumatology (ACR) Core Set Component: C-Reactive Protein at Week 48
Blood was collected for C-Reactive Protein, an inflammatory marker, at Baseline and Week 48. A negative change from baseline indicates improvement.
Time frame: Baseline, Week 48
Population: Intent-to-treat Population includes all participants randomized to Retreatment.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Arm A: Rituximab Retreatment | Change From Baseline in American College of Rheumatology (ACR) Core Set Component: C-Reactive Protein at Week 48 | -0.8 mg/dL | Standard Deviation 2.55 |
| Arm B: Placebo Retreatment | Change From Baseline in American College of Rheumatology (ACR) Core Set Component: C-Reactive Protein at Week 48 | -0.6 mg/dL | Standard Deviation 2.95 |
Secondary
Change From Baseline in American College of Rheumatology (ACR) Core Set Component: Erythrocyte Sedimentation (ESR) at Week 48
Blood was collected for Erythrocyte Sedimentation Rate, an inflammatory marker, at Baseline and Week 48. A negative change from baseline indicates improvement.
Time frame: Baseline, Week 48
Population: Participants from the Intent-to-treat population, that includes all participants randomized to Retreatment, with data available for analyses.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Arm A: Rituximab Retreatment | Change From Baseline in American College of Rheumatology (ACR) Core Set Component: Erythrocyte Sedimentation (ESR) at Week 48 | -15.0 millimeter/hour (mm/hr) | Standard Deviation 25.03 |
| Arm B: Placebo Retreatment | Change From Baseline in American College of Rheumatology (ACR) Core Set Component: Erythrocyte Sedimentation (ESR) at Week 48 | -10.9 millimeter/hour (mm/hr) | Standard Deviation 24 |
Secondary
Change From Baseline in American College of Rheumatology (ACR) Core Set Component: Health Assessment Questionnaire Disability Index (HAQ-DI) at Week 48
The Stanford Health Assessment Questionnaire disability index (HAQ-DI) is a patient completed questionnaire specific for rheumatoid arthritis. It consists of 20 questions referring to 8 domains: dressing/grooming, arising, eating, walking, hygiene, reach, grip,and common daily activities. Each domain has at least two component questions. There are four possible responses for each component ranging from 0(without any difficulty) to 4 (unable to do).HAQ-DI=sum of worst scores in each domain divided by the number of domains answered. A negative change from baseline indicates improvement.
Time frame: Baseline, Week 48
Population: Participants from the Intent-to-treat population, that includes all participants randomized to Retreatment, with data available for analyses.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Arm A: Rituximab Retreatment | Change From Baseline in American College of Rheumatology (ACR) Core Set Component: Health Assessment Questionnaire Disability Index (HAQ-DI) at Week 48 | -0.3 Score on a scale | Standard Deviation 0.53 |
| Arm B: Placebo Retreatment | Change From Baseline in American College of Rheumatology (ACR) Core Set Component: Health Assessment Questionnaire Disability Index (HAQ-DI) at Week 48 | -0.2 Score on a scale | Standard Deviation 0.6 |
Secondary
Change From Baseline in American College of Rheumatology (ACR) Core Set Component: Physician's Global Assessment of Disease Activity at Week 48
A Rheumatologist or a skilled Arthritis assessor rated the patient's disease activity at baseline and Week 48 using the Visual Analog Scale (VAS) on a scale of 0 (best) to 100 (worse). A negative change from baseline indicates improvement.
Time frame: Baseline, Week 48
Population: Intent-to-treat population includes all participants randomized to Retreatment.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Arm A: Rituximab Retreatment | Change From Baseline in American College of Rheumatology (ACR) Core Set Component: Physician's Global Assessment of Disease Activity at Week 48 | -31.5 millimeter (mm) | Standard Deviation 27 |
| Arm B: Placebo Retreatment | Change From Baseline in American College of Rheumatology (ACR) Core Set Component: Physician's Global Assessment of Disease Activity at Week 48 | -25.5 millimeter (mm) | Standard Deviation 29.59 |
Secondary
Change From Baseline in American College of Rheumatology (ACR) Core Set Component: Subject's Assessment of Pain at Week 48
Patients rated their pain at baseline and Week 48 using the Visual Analog Scale (VAS) on a scale of 0 (none) to 100 (unbearable pain). A negative change from baseline indicates improvement.
Time frame: Baseline, Week 48
Population: Participants from the Intent-to-treat population, that includes all participants randomized to Retreatment with data available for analyses.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Arm A: Rituximab Retreatment | Change From Baseline in American College of Rheumatology (ACR) Core Set Component: Subject's Assessment of Pain at Week 48 | -24.0 millimeter (mm) | Standard Deviation 28.99 |
| Arm B: Placebo Retreatment | Change From Baseline in American College of Rheumatology (ACR) Core Set Component: Subject's Assessment of Pain at Week 48 | -19.3 millimeter (mm) | Standard Deviation 30.32 |
Secondary
Change From Baseline in American College of Rheumatology (ACR) Core Set Component: Subject's Global Assessment of Disease Activity at Week 48
Participants rated their disease activity at baseline and Week 48 using the Visual Analog Scale (VAS) on a scale of 0 (best) to 100 (worse). A negative change from baseline indicates improvement.
Time frame: Baseline, Week 48
Population: Participants from the Intent-to-treat population, that includes all participants randomized to Retreatment, with data available for analyses.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Arm A: Rituximab Retreatment | Change From Baseline in American College of Rheumatology (ACR) Core Set Component: Subject's Global Assessment of Disease Activity at Week 48 | -26.9 millimeter (mm) | Standard Deviation 29.04 |
| Arm B: Placebo Retreatment | Change From Baseline in American College of Rheumatology (ACR) Core Set Component: Subject's Global Assessment of Disease Activity at Week 48 | -23.0 millimeter (mm) | Standard Deviation 28.72 |
Secondary
Change From Baseline in American College of Rheumatology (ACR) Core Set Component: Swollen Joint Count at Week 48
A Rheumatologist or an skilled arthritis assessor evaluated 66 joints at baseline and at Week 48. A negative change from baseline in Swollen Joint Count indicates improvement.
Time frame: Baseline, Week 48
Population: Intent-to-treat population includes all participants randomized to Retreatment.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Arm A: Rituximab Retreatment | Change From Baseline in American College of Rheumatology (ACR) Core Set Component: Swollen Joint Count at Week 48 | -12.5 Joint Count | Standard Deviation 12.31 |
| Arm B: Placebo Retreatment | Change From Baseline in American College of Rheumatology (ACR) Core Set Component: Swollen Joint Count at Week 48 | -10.2 Joint Count | Standard Deviation 13.3 |
Secondary
Change From Baseline in American College of Rheumatology (ACR) Core Set Component: Tender Joint Count at Week 48
A Rheumatologist or an skilled arthritis assessor evaluated 68 joints at baseline and at Week 48. A negative change from baseline in the Tender Joint Count indicates improvement.
Time frame: Baseline, Week 48
Population: Intent-to-treat population includes all participants randomized to Retreatment.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Arm A: Rituximab Retreatment | Change From Baseline in American College of Rheumatology (ACR) Core Set Component: Tender Joint Count at Week 48 | -15.3 Joint Count | Standard Deviation 15.28 |
| Arm B: Placebo Retreatment | Change From Baseline in American College of Rheumatology (ACR) Core Set Component: Tender Joint Count at Week 48 | -14.7 Joint Count | Standard Deviation 18.71 |
Secondary
Change From Baseline in Disease Activity Score (DAS28-CRP) at Week 48
The DAS28 score is a measure of the patient's disease activity calculated using the tender joint count (TJC) \[28 joints\], swollen joint count (SJC) \[28 joints\], patient's global assessment of disease activity \[visual analog scale: 0=no disease activity to 100=maximum disease activity\] and C-Reactive Protein (CRP) for a total possible score of 2 to 10. Higher values indicate higher disease activity. A negative change from baseline indicates improvement.
Time frame: Baseline, Week 48
Population: Participants from the Intent-to-treat population that includes all participants randomized to Retreatment with data available for analyses.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Arm A: Rituximab Retreatment | Change From Baseline in Disease Activity Score (DAS28-CRP) at Week 48 | -1.8 Units on a scale | Standard Deviation 1.4 |
| Arm B: Placebo Retreatment | Change From Baseline in Disease Activity Score (DAS28-CRP) at Week 48 | -1.5 Units on a scale | Standard Deviation 1.5 |
Secondary
Change From Baseline in Functional Assessment of Chronic Illness Therapy Fatigue (FACIT-F) at Week 48 in Retreated Subjects
FACIT-F is a 13-item questionnaire. Patients scored each item on a 5-point scale: 0 (Not at all) to 4 (Very much). The larger the patient's response to the questions (with the exception of 2 negatively stated), the greater the patient's fatigue. For all questions, except for the 2 negatively stated ones, the code was reversed and a new score was calculated as (4 minus the patient's response). The sum of all responses resulted in the FACIT-Fatigue score for a total possible score of 0 (worse score) to 52 (better score). A higher score reflects an improvement in the patient's health status.
Time frame: Baseline, Week 48
Population: Participants from the Intent-to-treat population, that includes all randomized participants, with data available for analyses.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Arm A: Rituximab Retreatment | Change From Baseline in Functional Assessment of Chronic Illness Therapy Fatigue (FACIT-F) at Week 48 in Retreated Subjects | -5.0 Score on a scale |
| Arm B: Placebo Retreatment | Change From Baseline in Functional Assessment of Chronic Illness Therapy Fatigue (FACIT-F) at Week 48 in Retreated Subjects | -4.0 Score on a scale |
Secondary
Change From Baseline in SF-36 Health Summary Scores at Week 48 in Retreated Subjects
The SF-36 is a questionnaire used to assess physical functioning and is made up of eight domains: Physical Functioning, Role Physical, Bodily Pain, General Health, Vitality, Social Functioning, Role-Emotional and Mental Health. Transforming and standardizing these domains leads to the calculation of the Physical (PCS) and Mental (MCS) Component Summary measures. Scores ranging from 0 to 100, with 0=worst score (or quality of life) and 100=best score. A positive change from baseline indicates improvement.
Time frame: Baseline, Week 48
Population: Participants from the Intent-to-treat population, that includes all participants randomized to Retreatment, with data available for analyses.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Arm A: Rituximab Retreatment | Change From Baseline in SF-36 Health Summary Scores at Week 48 in Retreated Subjects | Mental Health Score | 4.6 Score on a scale | Standard Deviation 11.8 |
| Arm A: Rituximab Retreatment | Change From Baseline in SF-36 Health Summary Scores at Week 48 in Retreated Subjects | Physical Health Score | 6.4 Score on a scale | Standard Deviation 8.76 |
| Arm B: Placebo Retreatment | Change From Baseline in SF-36 Health Summary Scores at Week 48 in Retreated Subjects | Mental Health Score | 3.9 Score on a scale | Standard Deviation 13.5 |
| Arm B: Placebo Retreatment | Change From Baseline in SF-36 Health Summary Scores at Week 48 in Retreated Subjects | Physical Health Score | 4.8 Score on a scale | Standard Deviation 8.97 |
Secondary
Change From Baseline in the Disease Activity Score Using 28 Joint Counts (DAS28-ESR) at Week 48
The DAS28 score is a measure of the patient's disease activity calculated using the tender joint count (TJC) \[28 joints\], swollen joint count (SJC) \[28 joints\], patient's global assessment of disease activity \[visual analog scale: 0=no disease activity to 100=maximum disease activity\] and the erythrocyte sedimentation rate (ESR) for a total possible score of 2 to 10. Higher values indicate higher disease activity. A negative change from baseline indicates improvement.
Time frame: 48 weeks
Population: Participants from the Intent-to-treat population, that includes all participants randomized to Retreatment, with data available for analyses.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Arm A: Rituximab Retreatment | Change From Baseline in the Disease Activity Score Using 28 Joint Counts (DAS28-ESR) at Week 48 | -2.1 Units on a scale | Standard Deviation 1.55 |
| Arm B: Placebo Retreatment | Change From Baseline in the Disease Activity Score Using 28 Joint Counts (DAS28-ESR) at Week 48 | -1.8 Units on a scale | Standard Deviation 1.69 |
Comparison: Assessed using an analysis of variance (ANOVA) model, with retreatment group, baseline DAS28-ESR score, baseline RF status, and ≥20% improvement in both SJC and TJC at Week 24 from baseline (yes/no) as explanatory terms in the model.95% CI: [-0.7, -0.1]ANOVA
Secondary
Percentage of Retreated Subjects Achieving DAS28-ESR Low Disease at Week 48
The DAS28-ESR score is a measure of the subject's disease activity. It is based on the tender joint count (28 joints), swollen joint count (28 joints), patient's global assessment of disease activity (mm), and ESR. DAS28-ESR scores range from 0 - 10. Low disease activity is defined as achieving a DAS28-ESR score of less than or equal to 3.2.
Time frame: Week 48
Population: Participants from the Intent-to-treat population, that includes all participants randomized to Retreatment, with data available for analyses.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Arm A: Rituximab Retreatment | Percentage of Retreated Subjects Achieving DAS28-ESR Low Disease at Week 48 | 21.1 Percentage of participants |
| Arm B: Placebo Retreatment | Percentage of Retreated Subjects Achieving DAS28-ESR Low Disease at Week 48 | 18.5 Percentage of participants |
Secondary
Percentage of Retreated Subjects Achieving DAS28-ESR Remission at Week 48
DAS28-ESR remission was defined as a DAS28-ESR \< 2.6
Time frame: Week 48
Population: Participants from the Intent-to-treat population, that includes all participants randomized to Retreatment, with data available for analyses.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Arm A: Rituximab Retreatment | Percentage of Retreated Subjects Achieving DAS28-ESR Remission at Week 48 | 10.4 Percentage of participants |
| Arm B: Placebo Retreatment | Percentage of Retreated Subjects Achieving DAS28-ESR Remission at Week 48 | 8.9 Percentage of participants |
Secondary
Percentage of Retreated Subjects With a Change ≥ 0.22 From Baseline in HAQ-DI at Week 48
The Stanford Health Assessment Questionnaire disability index (HAQ-DI) is a patient completed questionnaire specific for rheumatoid arthritis. It consists of 20 questions referring to 8 domains: dressing/grooming, arising, eating, walking, hygiene, reach, grip and common daily activities. Each domain has at least two component questions. There are four possible responses for each component ranging from 0(without any difficulty) to 4 (unable to do). HAQ-DI=sum of worst scores in each domain divided by the number of domains answered.
Time frame: Baseline, Week 48
Population: Participants from the Intent-to-treat population, that includes all participants randomized to Retreatment, with data available for analyses.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Arm A: Rituximab Retreatment | Percentage of Retreated Subjects With a Change ≥ 0.22 From Baseline in HAQ-DI at Week 48 | 57.3 Percentage of participants |
| Arm B: Placebo Retreatment | Percentage of Retreated Subjects With a Change ≥ 0.22 From Baseline in HAQ-DI at Week 48 | 51.0 Percentage of participants |
Secondary
Percentage of Retreated Subjects With a Change ≥ 0.3 From Baseline in HAQ-DI at Week 48
The Stanford Health Assessment Questionnaire disability index (HAQ-DI) is a patient completed questionnaire specific for rheumatoid arthritis. It consists of 20 questions referring to 8 domains: dressing/grooming, arising, eating, walking, hygiene, reach, grip and common daily activities. Each domain has at least two component questions. There are four possible responses for each component ranging from 0(without any difficulty) to 4 (unable to do).HAQ-DI=sum of worst scores in each domain divided by the number of domains answered.
Time frame: Baseline, Week 48
Population: Participants from the Intent-to-treat population, that includes all participants randomized to Retreatment, with data available for analyses.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Arm A: Rituximab Retreatment | Percentage of Retreated Subjects With a Change ≥ 0.3 From Baseline in HAQ-DI at Week 48 | 45.9 Percentage of participants |
| Arm B: Placebo Retreatment | Percentage of Retreated Subjects With a Change ≥ 0.3 From Baseline in HAQ-DI at Week 48 | 39.5 Percentage of participants |
Secondary
Percentage of Retreated Subjects With a European League Against Rheumatism (EULAR) Response at Week 48
Change of the Disease Activity Score 28 score from baseline was used to determine EULAR responses of good, moderate, or no response. For a post-baseline score ≤ 3.2, a change from baseline of \< -1.2 was a good response, \< -0.6 to ≥ -1.2 was a moderate response, and ≥ -0.6 was no response. For a post-baseline score \> 3.2 to ≤ 5.1, a change from baseline of \< -0.6 was a moderate response and ≥ -0.6 was no response. For a post-baseline score \> 5.1, a change from baseline \< -1.2 was a moderate response and ≥ -1.2 was no response. A good response could not be achieved for post-baseline scores \> 3.2.
Time frame: Baseline, Week 48
Population: Intent-to-treat population includes all participants randomized to Retreatment.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Arm A: Rituximab Retreatment | Percentage of Retreated Subjects With a European League Against Rheumatism (EULAR) Response at Week 48 | Moderate Response | 47.5 Percentage of participants |
| Arm A: Rituximab Retreatment | Percentage of Retreated Subjects With a European League Against Rheumatism (EULAR) Response at Week 48 | Good Response | 20.8 Percentage of participants |
| Arm B: Placebo Retreatment | Percentage of Retreated Subjects With a European League Against Rheumatism (EULAR) Response at Week 48 | Good Response | 18.5 Percentage of participants |
| Arm B: Placebo Retreatment | Percentage of Retreated Subjects With a European League Against Rheumatism (EULAR) Response at Week 48 | Moderate Response | 42.7 Percentage of participants |
Secondary
Retreated Subjects With American College of Rheumatology 50% (ACR50) Response and American College of Rheumatology 70% (ACR70) Response at Week 48 Relative to Baseline
ACR50 or ACR70 response was defined as a ≥ 50% or 70% improvement compared with baseline in both tender joint count (TJC) \[68 joints\] and swollen joint count (SJC) \[66 joints\] as well as a ≥ 50% or 70% improvement in three of five additional measurements: 1) Physician's Global Assessment of disease activity \[visual analog scale: 0=no disease activity to 100=maximum disease activity\]; 2) Patient's Global Assessment of Disease Activity \[visual analog scale: 0=no disease activity to 100=maximum disease activity\]; 3) Patient's Assessment of Pain \[visual analog scale: 0=no pain to 100=unbearable pain\]; 4) Health Assessment Questionnaire \[20 questions, 8 components: dressing/grooming, arising, eating, walking, hygiene, reach, grip, and activities, 0=without difficulty to 3=unable to do\] and 5) erythrocyte sedimentation rate.
Time frame: Baseline, Week 48
Population: Intent-to-treat population includes all participants randomized to Retreatment.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Arm A: Rituximab Retreatment | Retreated Subjects With American College of Rheumatology 50% (ACR50) Response and American College of Rheumatology 70% (ACR70) Response at Week 48 Relative to Baseline | ACR50 | 92 Participants |
| Arm A: Rituximab Retreatment | Retreated Subjects With American College of Rheumatology 50% (ACR50) Response and American College of Rheumatology 70% (ACR70) Response at Week 48 Relative to Baseline | ACR70 | 44 Participants |
| Arm B: Placebo Retreatment | Retreated Subjects With American College of Rheumatology 50% (ACR50) Response and American College of Rheumatology 70% (ACR70) Response at Week 48 Relative to Baseline | ACR50 | 41 Participants |
| Arm B: Placebo Retreatment | Retreated Subjects With American College of Rheumatology 50% (ACR50) Response and American College of Rheumatology 70% (ACR70) Response at Week 48 Relative to Baseline | ACR70 | 21 Participants |