Rheumatoid Arthritis
Conditions
Brief summary
This single arm study will assess the safety and efficacy of MabThera in combination with methotrexate in patients with rheumatoid arthritis who have had an inadequate response or intolerance to one or more anti-TNF agents. Patients will receive MabThera 1000mg i.v. on days 1 and 15, and methotrexate (10-25mg/week p.o. or parenteral), together with methylprednisolone 100mg i.v. prior to infusion of MabThera. The anticipated time on study treatment is 3-12 months, and the target sample size is \<100 individuals.
Interventions
1000mg iv on days 1 and 15
10-25mg/week po or parenteral
Sponsors
Study design
Eligibility
Inclusion criteria
* adult patients, \>=18 years of age; * active rheumatoid arthritis; * receiving outpatient treatment; * an inadequate response, or intolerance, to \>=1 anti-TNF agent.
Exclusion criteria
* other rheumatic autoimmune disease or inflammatory joint disease; * concurrent treatment with any anti-TNF-alpha therapy; * joint or osseous surgery during 8 weeks prior to recruitment.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change From Baseline in Disease Activity Score Based on 28-Joint Count (DAS28) | Week 24 | DAS28 was calculated from the number of swollen joints, or swollen joint count (SJC) and tender joint count (TJC) using the 28 joints count, the erythrocyte sedimentation rate (ESR) (measured in millimeters per hour \[mm/hr\]), and Patient Global Assessment of Disease Activity (participant rated arthritis activity assessment) with transformed scores ranging 0 to 10; higher scores indicated greater affectation due to disease activity. A clinically significant improvement in DAS28 was a change of at least 1.2 units. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants Achieving American College of Rheumatology (ACR) Response | Week 24 | ACR20/50/70 response defined as greater than or equal to (≥)20 percent (%), 50%, or 70% improvement, respectively, in TJC and SJC, and ≥20%/50%/70% improvement in at least 3 of 5 remaining ACR core measures: Patient Assessment of Pain, Patient Global Assessment of Disease Activity, Physician Global Assessment of Disease Activity, self-assessed disability based on the Health Assessment Questionnaire-Disability Index (HAQ-DI), and C-Reactive Protein (CRP). |
| Percentage of Participants Achieving a Response by European League Against Rheumatism (EULAR) Category | Week 24 | Percentage of participants with a EULAR response at Week 24 based on a scale of good response, moderate response, or no response. The DAS28-based EULAR response criteria were used to measure individual response as none, good, and moderate, depending on the extent of change from baseline and the level of disease activity reached. Good responders have a change from baseline greater than (\>)1.2 with DAS28 less than or equal to (≤)3.2; moderate responders have a change from baseline \>1.2 with DAS28 \>3.2 to ≤5.1 or change from baseline \>0.6 to ≤1.2 with DAS28 ≤5.1; non-responders have a change from baseline ≤0.6 or change from baseline \>0.6 and ≤1.2 with DAS28 \>5.1. |
| Change From Baseline in HAQ-DI Score | Week 24 | The Stanford HAQ-DI is a patient-reported questionnaire specific for rheumatoid arthritis. It consists of 20 questions referring to 8 component sets: dressing/grooming, arising, eating, walking, hygiene, reach, grip, and activities. Responses in each component set are scored from 0 (without any difficulty) to 3 (unable to do). The highest score recorded for any question in a category determines the score for the category, unless aids, devices, or help from another person is required. The HAQ-DI score is calculated as the sum of the category scores divided by the number of categories scored, giving a possible range of scores from 0 to 3. Scores of 0 to 1 are generally considered to represent mild to moderate difficulty, 1 to 2 as moderate to severe disability, and 2 to 3 as severe to very severe disability. |
Countries
Taiwan
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Rituximab + MTX Participants received rituximab 1000 mg IV, and 100 mg methylprednisolone IV on Days 1 and 15. Participants were to be receiving background MTX (10-25 mg weekly, oral or parenteral dose). | 36 |
| Total | 36 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Adverse Event | 1 |
Baseline characteristics
| Characteristic | Rituximab + MTX |
|---|---|
| Age, Continuous | 50.72 years STANDARD_DEVIATION 13.42 |
| Sex: Female, Male Female | 33 Participants |
| Sex: Female, Male Male | 3 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 22 / 36 |
| serious Total, serious adverse events | 3 / 36 |
Outcome results
Change From Baseline in Disease Activity Score Based on 28-Joint Count (DAS28)
DAS28 was calculated from the number of swollen joints, or swollen joint count (SJC) and tender joint count (TJC) using the 28 joints count, the erythrocyte sedimentation rate (ESR) (measured in millimeters per hour \[mm/hr\]), and Patient Global Assessment of Disease Activity (participant rated arthritis activity assessment) with transformed scores ranging 0 to 10; higher scores indicated greater affectation due to disease activity. A clinically significant improvement in DAS28 was a change of at least 1.2 units.
Time frame: Week 24
Population: ITT Population
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Rituximab + MTX | Change From Baseline in Disease Activity Score Based on 28-Joint Count (DAS28) | Baseline | 5.51 scores on a scale | Standard Deviation 1.05 |
| Rituximab + MTX | Change From Baseline in Disease Activity Score Based on 28-Joint Count (DAS28) | Week 24 | 4.39 scores on a scale | Standard Deviation 1.21 |
| Rituximab + MTX | Change From Baseline in Disease Activity Score Based on 28-Joint Count (DAS28) | Change from Baseline to Week 24 | -1.12 scores on a scale | Standard Deviation 1.19 |
Change From Baseline in HAQ-DI Score
The Stanford HAQ-DI is a patient-reported questionnaire specific for rheumatoid arthritis. It consists of 20 questions referring to 8 component sets: dressing/grooming, arising, eating, walking, hygiene, reach, grip, and activities. Responses in each component set are scored from 0 (without any difficulty) to 3 (unable to do). The highest score recorded for any question in a category determines the score for the category, unless aids, devices, or help from another person is required. The HAQ-DI score is calculated as the sum of the category scores divided by the number of categories scored, giving a possible range of scores from 0 to 3. Scores of 0 to 1 are generally considered to represent mild to moderate difficulty, 1 to 2 as moderate to severe disability, and 2 to 3 as severe to very severe disability.
Time frame: Week 24
Population: ITT Population
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Rituximab + MTX | Change From Baseline in HAQ-DI Score | Baseline | 1.07 scores on a scale | Standard Deviation 0.69 |
| Rituximab + MTX | Change From Baseline in HAQ-DI Score | Week 24 | 0.81 scores on a scale | Standard Deviation 0.65 |
| Rituximab + MTX | Change From Baseline in HAQ-DI Score | Change from Baseline to Week 24 | -0.26 scores on a scale | Standard Deviation 0.52 |
Percentage of Participants Achieving American College of Rheumatology (ACR) Response
ACR20/50/70 response defined as greater than or equal to (≥)20 percent (%), 50%, or 70% improvement, respectively, in TJC and SJC, and ≥20%/50%/70% improvement in at least 3 of 5 remaining ACR core measures: Patient Assessment of Pain, Patient Global Assessment of Disease Activity, Physician Global Assessment of Disease Activity, self-assessed disability based on the Health Assessment Questionnaire-Disability Index (HAQ-DI), and C-Reactive Protein (CRP).
Time frame: Week 24
Population: ITT Population
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Rituximab + MTX | Percentage of Participants Achieving American College of Rheumatology (ACR) Response | ACR20 | 2.78 percentage of participants |
| Rituximab + MTX | Percentage of Participants Achieving American College of Rheumatology (ACR) Response | ACR50 | 0 percentage of participants |
| Rituximab + MTX | Percentage of Participants Achieving American College of Rheumatology (ACR) Response | ACR70 | 0 percentage of participants |
Percentage of Participants Achieving a Response by European League Against Rheumatism (EULAR) Category
Percentage of participants with a EULAR response at Week 24 based on a scale of good response, moderate response, or no response. The DAS28-based EULAR response criteria were used to measure individual response as none, good, and moderate, depending on the extent of change from baseline and the level of disease activity reached. Good responders have a change from baseline greater than (\>)1.2 with DAS28 less than or equal to (≤)3.2; moderate responders have a change from baseline \>1.2 with DAS28 \>3.2 to ≤5.1 or change from baseline \>0.6 to ≤1.2 with DAS28 ≤5.1; non-responders have a change from baseline ≤0.6 or change from baseline \>0.6 and ≤1.2 with DAS28 \>5.1.
Time frame: Week 24
Population: ITT Population
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Rituximab + MTX | Percentage of Participants Achieving a Response by European League Against Rheumatism (EULAR) Category | Good response | 0 percentage of participants |
| Rituximab + MTX | Percentage of Participants Achieving a Response by European League Against Rheumatism (EULAR) Category | Moderate response | 58.33 percentage of participants |
| Rituximab + MTX | Percentage of Participants Achieving a Response by European League Against Rheumatism (EULAR) Category | No response | 41.67 percentage of participants |