Arthritis, Rheumatoid
Conditions
Brief summary
This study is a multicenter, double-blind, study to evaluate the safety and effectiveness of treatment with LY2127399 (in addition to the standard of care treatment, methotrexate) for participants with Rheumatoid Arthritis. Participants will receive three intravenous doses of LY2127399 or placebo. Participants will participate in 10 or more visits to the study site, over 6 months. Evaluation of safety and efficacy will be conducted throughout the study.
Interventions
30 mg, 60 mg or 160 mg, IV (in the vein) in weeks 0, 3 and 6. Treatment duration: 6 weeks.
IV (in vein) in weeks 0, 3 and 6. Treatment duration: 6 weeks.
Sponsors
Study design
Eligibility
Inclusion criteria
* Male or female between the ages of 18 and 75 years * Have given written informed consent approval * Women must not be at risk to become pregnant during study participation * Diagnosis of Rheumatoid Arthritis according to the 1987 revised American Rheumatism Association (ARA) criteria for the classification of RA * Serum C-reactive protein (CRP) measurement greater than the upper limit of normal (ULN, 0.574 mg/dL), or erythrocyte sedimentation rate (ESR) ≥28 mm/hr * Current, regular use of Methotrexate, at a stable dose * Biologic DMARD naïve, and have had an insufficient response (in the opinion of the investigator) to an adequate therapeutic dose of at least 1 oral DMARD
Exclusion criteria
* Use of excluded medications (reviewed by study doctor) * Surgical treatment of a joint with 2 months of study enrollment that is to be assessed in the study * Are unable to ambulate; that is, confined to bed or wheelchair bound * Have medical findings which, in the opinion of the study doctor, put participant at an unacceptable risk for participation in the study * Have had recent or ongoing infection which, in the opinion of the study doctor put participant at an unacceptable risk for participation.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants Achieving American College of Rheumatology 20% Response (ACR20) (Effectiveness of LY2127399 in Treating Rheumatoid Arthritis Using the ACR20 Scale) | Week 16 | ACR Responder Index is a Composite of clinical, laboratory, and functional measures of rheumatoid arthritis (RA). ACR20 Responders: had ≥20% improvement from baseline in both tender and swollen joint counts and ≥20% improvement in at least 3 of 5 criteria: participant's and physician's global assessment of disease activity, Health Assessment Questionnaire-Disability Index (HAQ-DI) (which measured participants' perceived degree of difficulty performing daily activities), visual analog pain scale, and erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Evaluation of the Pharmacokinetics of LY2127399: Clearance | 2 hours pre-dose, pre-dose, 1 hour and 4 hour(s) post dose | Population estimate of constant clearance as determined by population PK analysis. A 2-compartment model was used in PK modeling. Constant clearance is the PK parameter which describes the linear elimination of LY2127399 from serum. |
| Percentage of Participants Achieving ACR 50 and ACR70 | Baseline through Week 24 | ACR Responder Index: composite of clinical, laboratory, and functional measures of Rheumatoid Arthritis (RA). ACR50 and ACR70 Responder: had either a ≥50% or ≥70% improvement from baseline in both tender and swollen joint counts and either a ≥50% or ≥70% improvement in at least 3 of 5 criteria: participant's (Pt's) and physician's global assessment of disease activity, HAQ-DI (measured Pts' perceived degree of difficulty performing daily activities), joint pain, and CRP (respectively). |
| Change From Baseline in the Disease Activity Score 28 Joint Count (DAS28-CRP) | Baseline, Week 24 | Disease Activity Score (DAS) modified to include 28 joint count (DAS28) consisted of composite score of following variables: tender joint count (TJC28), swollen joint count (SJC28), CRP \[milligrams per liter (mg/L)\], and participant's global assessment of disease activity using visual analog scale (VAS) (participant global VAS). DAS28-CRP=0.56\*square root (sqrt)(TJC28)+0.28\*sqrt(SJC28)+0.36\*natural log(CRP+1)+0.014\*participant global VAS+0.96. Scores ranged from 1.0-9.4, where lower scores indicated less disease activity and remission is DAS28-CRP \<2.6. A negative change indicated an improvement. |
| Number of Participants With Treatment Emergent Adverse Events (TEAE) (Safety of Repeat Doses (3) of LY2127399 Through Evaluation of Laboratory Tests, Vital Signs and Electrocardiograms) | Baseline through Study Completion (Up to 19 Months) | Treatment-emergent adverse events (TEAEs) were defined as those AEs with start date and time equal to or after the start of study medication infusion. In the case of a missing onset time for an AE, an AE with a start date equal to or greater than the dosing date was considered treatment-emergent. A summary of other nonserious AEs, and all SAE's, regardless of causality, is located in the Reported Adverse Events section. All participants who received at least one dose of study drug. Due to dosing errors (a participant received 60 mg LY2127399 in the placebo group), the safety population was adjusted to account for actual treatment received. |
| Change From Baseline (CFB) in Serum Immunoglobulins IgG, IgA and IgM | Baseline, Week 24 | Immunoglobulins (Ig), or antibodies, are large proteins used by the immune system to identify and neutralize foreign particles such as bacteria and viruses. Their normal blood levels indicate proper immune status. A negative change indicates a decrease in Ig levels. |
| Change From Baseline in CD20+ B Cell Number Count | Baseline, Week 24 | CD20+ B-cells are a disease-related peripheral blood biomarker used to assess disease progression of Rheumatoid Arthritis (RA). A reduction in CD20+ B-cell values may indicate an improvement in RA symptoms. |
| European League Against Rheumatism (EULAR28) Response: Percentage of Participants With Combined Good and Moderate Responses | Baseline, Week 24 | EULAR Responder index based on 28 joint counts categorizes clinical response based on improvement since baseline in DAS28-CRP. DAS28-CRP scores range from 1.0-9.4, where lower scores indicated less disease activity. High disease activity: DAS28-CRP \>5.1, low disease activity: DAS28-CRP \<3.2, and remission: DAS28-CRP \<2.6. Participants are categorized as EULAR responders or non-responders (NR) based on improvement of DAS28-CRP scores from baseline. EULAR DAS28-CRP responder index defines a good (absolute: \<3.2 or \>1.2 improvement from baseline), moderate (absolute: 3.2-5.1 or 0.6-1.2 improvement from baseline), or no response (absolute: \>5.1 or \<0.6 improvement from baseline). Percentage of participants with DAS28-CRP based EULAR response =(number of participants with specific response) / (number of participants analyzed in the group) \* 100. |
Countries
Romania
Participant flow
Recruitment details
Study populations are based on randomized treatment groups. Safety and Pharmacokinetic (PK) populations were adjusted due to dosing errors and account for actual treatment received.
Pre-assignment details
Completers were defined as having completed 3 infusions and required follow-up visits.
Participants by arm
| Arm | Count |
|---|---|
| Placebo Placebo administered IV in weeks 0, 3 and 6. Treatment duration: 6 weeks. | 34 |
| 30 mg LY2127399 30 milligram (mg) LY2127399 administered Intravenously (IV) in weeks 0, 3 and 6. Treatment duration: 6 weeks. | 34 |
| 60 mg LY2127399 60 mg LY2127399 administered Intravenously (IV) in weeks 0, 3 and 6. Treatment duration: 6 weeks. | 34 |
| 160 mg LY2127399 160 mg LY2127399 administered Intravenously (IV) in weeks 0, 3 and 6. Treatment duration: 6 weeks. | 34 |
| Total | 136 |
Baseline characteristics
| Characteristic | Total | 160 mg LY2127399 | 60 mg LY2127399 | 30 mg LY2127399 | Placebo |
|---|---|---|---|---|---|
| ACR functional class Class I | 18 Participants | 7 Participants | 3 Participants | 4 Participants | 4 Participants |
| ACR functional class Class II | 69 Participants | 16 Participants | 19 Participants | 19 Participants | 15 Participants |
| ACR functional class Class III | 49 Participants | 11 Participants | 12 Participants | 11 Participants | 15 Participants |
| Age, Customized <=18 years | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Age, Customized >=73 years | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Age, Customized Between 18 and 73 years | 136 Participants | 34 Participants | 34 Participants | 34 Participants | 34 Participants |
| Ethnicity (NIH/OMB) Hispanic or Latino | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 136 Participants | 34 Participants | 34 Participants | 34 Participants | 34 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 136 Participants | 34 Participants | 34 Participants | 34 Participants | 34 Participants |
| Sex: Female, Male Female | 115 Participants | 29 Participants | 26 Participants | 31 Participants | 29 Participants |
| Sex: Female, Male Male | 21 Participants | 5 Participants | 8 Participants | 3 Participants | 5 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk |
|---|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — | — / — |
| other Total, other adverse events | 15 / 33 | 14 / 34 | 15 / 35 | 15 / 34 |
| serious Total, serious adverse events | 3 / 33 | 2 / 34 | 0 / 35 | 3 / 34 |
Outcome results
Percentage of Participants Achieving American College of Rheumatology 20% Response (ACR20) (Effectiveness of LY2127399 in Treating Rheumatoid Arthritis Using the ACR20 Scale)
ACR Responder Index is a Composite of clinical, laboratory, and functional measures of rheumatoid arthritis (RA). ACR20 Responders: had ≥20% improvement from baseline in both tender and swollen joint counts and ≥20% improvement in at least 3 of 5 criteria: participant's and physician's global assessment of disease activity, Health Assessment Questionnaire-Disability Index (HAQ-DI) (which measured participants' perceived degree of difficulty performing daily activities), visual analog pain scale, and erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP).
Time frame: Week 16
Population: All participants who received at least 1 dose of study drug who had a baseline and at least 1 post-baseline ACR value.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo | Percentage of Participants Achieving American College of Rheumatology 20% Response (ACR20) (Effectiveness of LY2127399 in Treating Rheumatoid Arthritis Using the ACR20 Scale) | 29.4 percentage of participants |
| 30 mg LY2127399 | Percentage of Participants Achieving American College of Rheumatology 20% Response (ACR20) (Effectiveness of LY2127399 in Treating Rheumatoid Arthritis Using the ACR20 Scale) | 57.6 percentage of participants |
| 60 mg LY2127399 | Percentage of Participants Achieving American College of Rheumatology 20% Response (ACR20) (Effectiveness of LY2127399 in Treating Rheumatoid Arthritis Using the ACR20 Scale) | 67.6 percentage of participants |
| 160 mg LY2127399 | Percentage of Participants Achieving American College of Rheumatology 20% Response (ACR20) (Effectiveness of LY2127399 in Treating Rheumatoid Arthritis Using the ACR20 Scale) | 51.5 percentage of participants |
Change From Baseline (CFB) in Serum Immunoglobulins IgG, IgA and IgM
Immunoglobulins (Ig), or antibodies, are large proteins used by the immune system to identify and neutralize foreign particles such as bacteria and viruses. Their normal blood levels indicate proper immune status. A negative change indicates a decrease in Ig levels.
Time frame: Baseline, Week 24
Population: All participants who received one dose of study drug and had post baseline serum immunoglobulin data.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Placebo | Change From Baseline (CFB) in Serum Immunoglobulins IgG, IgA and IgM | IgG | 6.2 milligrams per deciliter (mg/dL) | Standard Deviation 141.29 |
| Placebo | Change From Baseline (CFB) in Serum Immunoglobulins IgG, IgA and IgM | IgA | -18.9 milligrams per deciliter (mg/dL) | Standard Deviation 44 |
| Placebo | Change From Baseline (CFB) in Serum Immunoglobulins IgG, IgA and IgM | IgM | 1.6 milligrams per deciliter (mg/dL) | Standard Deviation 15.99 |
| 30 mg LY2127399 | Change From Baseline (CFB) in Serum Immunoglobulins IgG, IgA and IgM | IgM | -7.1 milligrams per deciliter (mg/dL) | Standard Deviation 41.76 |
| 30 mg LY2127399 | Change From Baseline (CFB) in Serum Immunoglobulins IgG, IgA and IgM | IgG | -26.7 milligrams per deciliter (mg/dL) | Standard Deviation 185.55 |
| 30 mg LY2127399 | Change From Baseline (CFB) in Serum Immunoglobulins IgG, IgA and IgM | IgA | -11.1 milligrams per deciliter (mg/dL) | Standard Deviation 42.28 |
| 60 mg LY2127399 | Change From Baseline (CFB) in Serum Immunoglobulins IgG, IgA and IgM | IgG | -97.2 milligrams per deciliter (mg/dL) | Standard Deviation 313.71 |
| 60 mg LY2127399 | Change From Baseline (CFB) in Serum Immunoglobulins IgG, IgA and IgM | IgM | -18.6 milligrams per deciliter (mg/dL) | Standard Deviation 55.5 |
| 60 mg LY2127399 | Change From Baseline (CFB) in Serum Immunoglobulins IgG, IgA and IgM | IgA | -27.5 milligrams per deciliter (mg/dL) | Standard Deviation 58 |
| 160 mg LY2127399 | Change From Baseline (CFB) in Serum Immunoglobulins IgG, IgA and IgM | IgM | -29.0 milligrams per deciliter (mg/dL) | Standard Deviation 33.72 |
| 160 mg LY2127399 | Change From Baseline (CFB) in Serum Immunoglobulins IgG, IgA and IgM | IgA | -32.6 milligrams per deciliter (mg/dL) | Standard Deviation 39.71 |
| 160 mg LY2127399 | Change From Baseline (CFB) in Serum Immunoglobulins IgG, IgA and IgM | IgG | -72.0 milligrams per deciliter (mg/dL) | Standard Deviation 163.2 |
Change From Baseline in CD20+ B Cell Number Count
CD20+ B-cells are a disease-related peripheral blood biomarker used to assess disease progression of Rheumatoid Arthritis (RA). A reduction in CD20+ B-cell values may indicate an improvement in RA symptoms.
Time frame: Baseline, Week 24
Population: All participants who received one dose of study drug and had post baseline CD20+ cell data.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Placebo | Change From Baseline in CD20+ B Cell Number Count | -46.9 Cells per microLiter | Standard Deviation 74.51 |
| 30 mg LY2127399 | Change From Baseline in CD20+ B Cell Number Count | -56.3 Cells per microLiter | Standard Deviation 84.75 |
| 60 mg LY2127399 | Change From Baseline in CD20+ B Cell Number Count | -135.9 Cells per microLiter | Standard Deviation 179.6 |
| 160 mg LY2127399 | Change From Baseline in CD20+ B Cell Number Count | -59.2 Cells per microLiter | Standard Deviation 81.31 |
Change From Baseline in the Disease Activity Score 28 Joint Count (DAS28-CRP)
Disease Activity Score (DAS) modified to include 28 joint count (DAS28) consisted of composite score of following variables: tender joint count (TJC28), swollen joint count (SJC28), CRP \[milligrams per liter (mg/L)\], and participant's global assessment of disease activity using visual analog scale (VAS) (participant global VAS). DAS28-CRP=0.56\*square root (sqrt)(TJC28)+0.28\*sqrt(SJC28)+0.36\*natural log(CRP+1)+0.014\*participant global VAS+0.96. Scores ranged from 1.0-9.4, where lower scores indicated less disease activity and remission is DAS28-CRP \<2.6. A negative change indicated an improvement.
Time frame: Baseline, Week 24
Population: All participants who received at least 1 dose of study drug who had a baseline and at least 1 post-baseline ACR value.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Placebo | Change From Baseline in the Disease Activity Score 28 Joint Count (DAS28-CRP) | -0.78 units on a scale | Standard Deviation 0.835 |
| 30 mg LY2127399 | Change From Baseline in the Disease Activity Score 28 Joint Count (DAS28-CRP) | -1.68 units on a scale | Standard Deviation 0.862 |
| 60 mg LY2127399 | Change From Baseline in the Disease Activity Score 28 Joint Count (DAS28-CRP) | -1.62 units on a scale | Standard Deviation 1.007 |
| 160 mg LY2127399 | Change From Baseline in the Disease Activity Score 28 Joint Count (DAS28-CRP) | -1.46 units on a scale | Standard Deviation 0.899 |
European League Against Rheumatism (EULAR28) Response: Percentage of Participants With Combined Good and Moderate Responses
EULAR Responder index based on 28 joint counts categorizes clinical response based on improvement since baseline in DAS28-CRP. DAS28-CRP scores range from 1.0-9.4, where lower scores indicated less disease activity. High disease activity: DAS28-CRP \>5.1, low disease activity: DAS28-CRP \<3.2, and remission: DAS28-CRP \<2.6. Participants are categorized as EULAR responders or non-responders (NR) based on improvement of DAS28-CRP scores from baseline. EULAR DAS28-CRP responder index defines a good (absolute: \<3.2 or \>1.2 improvement from baseline), moderate (absolute: 3.2-5.1 or 0.6-1.2 improvement from baseline), or no response (absolute: \>5.1 or \<0.6 improvement from baseline). Percentage of participants with DAS28-CRP based EULAR response =(number of participants with specific response) / (number of participants analyzed in the group) \* 100.
Time frame: Baseline, Week 24
Population: All participants who received at least 1 dose of study drug who had a baseline and at least 1 post-baseline ACR value.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo | European League Against Rheumatism (EULAR28) Response: Percentage of Participants With Combined Good and Moderate Responses | 52.9 percentage of participants |
| 30 mg LY2127399 | European League Against Rheumatism (EULAR28) Response: Percentage of Participants With Combined Good and Moderate Responses | 90.9 percentage of participants |
| 60 mg LY2127399 | European League Against Rheumatism (EULAR28) Response: Percentage of Participants With Combined Good and Moderate Responses | 88.2 percentage of participants |
| 160 mg LY2127399 | European League Against Rheumatism (EULAR28) Response: Percentage of Participants With Combined Good and Moderate Responses | 81.8 percentage of participants |
Evaluation of the Pharmacokinetics of LY2127399: Clearance
Population estimate of constant clearance as determined by population PK analysis. A 2-compartment model was used in PK modeling. Constant clearance is the PK parameter which describes the linear elimination of LY2127399 from serum.
Time frame: 2 hours pre-dose, pre-dose, 1 hour and 4 hour(s) post dose
Population: All participants who received at least one dose of LY2127399 and had evaluable PK data.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Placebo | Evaluation of the Pharmacokinetics of LY2127399: Clearance | 0.0079 Liters per Hour (L/Hr) | Standard Deviation 0.0031 |
| 30 mg LY2127399 | Evaluation of the Pharmacokinetics of LY2127399: Clearance | 0.0062 Liters per Hour (L/Hr) | Standard Deviation 0.0023 |
| 60 mg LY2127399 | Evaluation of the Pharmacokinetics of LY2127399: Clearance | 0.0054 Liters per Hour (L/Hr) | Standard Deviation 0.0021 |
Number of Participants With Treatment Emergent Adverse Events (TEAE) (Safety of Repeat Doses (3) of LY2127399 Through Evaluation of Laboratory Tests, Vital Signs and Electrocardiograms)
Treatment-emergent adverse events (TEAEs) were defined as those AEs with start date and time equal to or after the start of study medication infusion. In the case of a missing onset time for an AE, an AE with a start date equal to or greater than the dosing date was considered treatment-emergent. A summary of other nonserious AEs, and all SAE's, regardless of causality, is located in the Reported Adverse Events section. All participants who received at least one dose of study drug. Due to dosing errors (a participant received 60 mg LY2127399 in the placebo group), the safety population was adjusted to account for actual treatment received.
Time frame: Baseline through Study Completion (Up to 19 Months)
Population: All participants who received at least one dose of study drug. Due to dosing errors (a participant received 60 mg LY2127399 in the placebo group), the safety population was adjusted to account for actual treatment received.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Placebo | Number of Participants With Treatment Emergent Adverse Events (TEAE) (Safety of Repeat Doses (3) of LY2127399 Through Evaluation of Laboratory Tests, Vital Signs and Electrocardiograms) | 15 Participants |
| 30 mg LY2127399 | Number of Participants With Treatment Emergent Adverse Events (TEAE) (Safety of Repeat Doses (3) of LY2127399 Through Evaluation of Laboratory Tests, Vital Signs and Electrocardiograms) | 14 Participants |
| 60 mg LY2127399 | Number of Participants With Treatment Emergent Adverse Events (TEAE) (Safety of Repeat Doses (3) of LY2127399 Through Evaluation of Laboratory Tests, Vital Signs and Electrocardiograms) | 15 Participants |
| 160 mg LY2127399 | Number of Participants With Treatment Emergent Adverse Events (TEAE) (Safety of Repeat Doses (3) of LY2127399 Through Evaluation of Laboratory Tests, Vital Signs and Electrocardiograms) | 15 Participants |
Percentage of Participants Achieving ACR 50 and ACR70
ACR Responder Index: composite of clinical, laboratory, and functional measures of Rheumatoid Arthritis (RA). ACR50 and ACR70 Responder: had either a ≥50% or ≥70% improvement from baseline in both tender and swollen joint counts and either a ≥50% or ≥70% improvement in at least 3 of 5 criteria: participant's (Pt's) and physician's global assessment of disease activity, HAQ-DI (measured Pts' perceived degree of difficulty performing daily activities), joint pain, and CRP (respectively).
Time frame: Baseline through Week 24
Population: All participants who received at least 1 dose of study drug who had a baseline and at least 1 post-baseline ACR value.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Placebo | Percentage of Participants Achieving ACR 50 and ACR70 | ACR50 | 20.6 percentage of participants |
| Placebo | Percentage of Participants Achieving ACR 50 and ACR70 | ACR70 | 2.9 percentage of participants |
| 30 mg LY2127399 | Percentage of Participants Achieving ACR 50 and ACR70 | ACR70 | 24.2 percentage of participants |
| 30 mg LY2127399 | Percentage of Participants Achieving ACR 50 and ACR70 | ACR50 | 57.6 percentage of participants |
| 60 mg LY2127399 | Percentage of Participants Achieving ACR 50 and ACR70 | ACR70 | 17.6 percentage of participants |
| 60 mg LY2127399 | Percentage of Participants Achieving ACR 50 and ACR70 | ACR50 | 55.9 percentage of participants |
| 160 mg LY2127399 | Percentage of Participants Achieving ACR 50 and ACR70 | ACR70 | 9.1 percentage of participants |
| 160 mg LY2127399 | Percentage of Participants Achieving ACR 50 and ACR70 | ACR50 | 42.4 percentage of participants |