Gout
Conditions
Keywords
Metabolism, Inborn Errors, Allopurinol, Metabolic Disease, Genetic Diseases, Inborn, Musculoskeletal Diseases, Joint Diseases, Arthritis, Rheumatic Diseases, Metabolic disorder, Purine Pyrimidine Metabolism, Inborn Errors, Gout, Intercritical Gout
Brief summary
The purpose of this clinical research study is to determine the safety and effectiveness of an experimental drug called rilonacept in subjects with gout who are on urate-lowering therapy. Subjects will participate in this study for approximately 20 weeks. Rilonacept is being studied for use in preventing gout flares in subjects on urate-lowering therapy.
Interventions
Rilonacept 160 mg subcutaneous injection once a week
Placebo subcutaneous injection once a week
Sponsors
Study design
Eligibility
Inclusion criteria
* Male or female 18 to 80 years of age; * Previously met the preliminary criteria of American Rheumatism Associatio (ARA) for the classification of acute gout arthritis of primary gout; * Subjects with history of gout, initiating or currently on urate lowering; therapy who are at risk of gout flare.
Exclusion criteria
* Acute gout flare within 2 weeks prior to the screening visit and during the screening visit; * Persistent chronic or active infections; * History of an allergic reaction to allopurinol; * History or presence of cancer within 5 years of the Screening Visit;;;
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants With Treatment-Emergent Adverse Events (TEAEs) | Baseline up to Week 20 | Any untoward medical occurrence in a participant who received investigational medicinal product (IMP) was considered an AE without regard to possibility of causal relationship with this treatment. Treatment-emergent adverse events (TEAEs) were defined as AEs that developed or worsened or became serious during on-treatment period (time from the administration of first dose of study drug up to 35 days after the last dose of study drug). A serious adverse event (SAE) was defined as any untoward medical occurrence that resulted in any of the following outcomes: death, life-threatening, required initial or prolonged in-patient hospitalization, persistent or significant disability/incapacity, congenital anomaly/birth defect, or considered as medically important event. Any TEAE included participants with both serious and non-serious AEs. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of Gout Flares Per Participant Assessed From Day 1 to Day 112 (Week 16) | Day 1 to Day 112 (Week 16) | A gout flare was defined as participant reported acute articular pain typical of a gout attack that required treatment with an anti-inflammatory therapeutic: had at least 3 of the following 4 signs or symptoms: joint swelling, tenderness, redness, and pain and with at least 1 of the following: rapid onset of pain, decreased range of motion, joint warmth or other symptoms similar to a prior gout flare. Number of gout flares per participant was reported for this outcome measure. For drop-outs, only flares occurred before Day 112 were counted, regardless whether the flares occurred during the treatment period or not. |
| Percentage of Participants With at Least One Flare From Day 1 to Day 112 (Week 16) | Day 1 to Day 112 (Week 16) | A gout flare was defined as participant reported acute articular pain typical of a gout attack that required treatment with an anti-inflammatory therapeutic: had at least 3 of the following 4 signs or symptoms: joint swelling, tenderness, redness, and pain and with at least 1 of the following: rapid onset of pain, decreased range of motion, joint warmth or other symptoms similar to a prior gout flare. Percentage of participants with at least one gout flare was reported for this outcome measure. For drop-outs, only flares occurred before Day 112 were counted, regardless whether the flares occurred during the treatment period or not. |
| Percentage of Participants With at Least Two Flares From Day 1 to Day 112 (Week 16) | Day 1 to Day 112 (Week 16) | A gout flare was defined as participant reported acute articular pain typical of a gout attack that required treatment with an anti-inflammatory therapeutic: had at least 3 of the following 4 signs or symptoms: joint swelling, tenderness, redness, and pain and with at least 1 of the following: rapid onset of pain, decreased range of motion, joint warmth or other symptoms similar to a prior gout flare. Percentage of participants with at least two gout flare was reported for this outcome measure. For drop-outs, only flares occurred before Day 112 were counted, regardless whether the flares occurred during the treatment period or not. |
| Number of Gout Flare Days Per Participant From Day 1 to Day 112 (Week 16) | Day 1 to Day 112 (Week 16) | A gout flare was defined as participant reported acute articular pain typical of a gout attack that required treatment with an anti-inflammatory therapeutic: had at least 3 of the following 4 signs or symptoms: joint swelling, tenderness, redness, and pain and with at least 1 of the following: rapid onset of pain, decreased range of motion, joint warmth or other symptoms similar to a prior gout flare. Number of gout flares per participant was reported for this outcome measure. Flare days were counted up to Week 16, regardless of whether or not the flares occurred during the treatment period. |
Countries
Germany, India, Indonesia, South Africa, Taiwan, United States
Participant flow
Recruitment details
The study was conducted at 71 study sites in United States and rest of world (ROW) between 23 March 2009 and 14 January 2011. A total of 2311 participants were screened in the study.
Pre-assignment details
Out of 2311 participants, 1315 were randomized and treated in the study. Participants were randomized in 3:1 ratio to receive Rilonacept 160 mg or placebo.
Participants by arm
| Arm | Count |
|---|---|
| Placebo Two subcutaneous injections of Placebo (for Rilonacept) as a loading dose on Day 1 followed by a single injection qw from Week 1 to Week 15. | 330 |
| Rilonacept 160 mg Two subcutaneous injections of Rilonacept 160 mg (for a total of 320 mg) as a loading dose on Day 1, followed by a single 160 mg injection of Rilonacept qw from Week 1 to Week 15. | 985 |
| Total | 1,315 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Adverse Event | 10 | 46 |
| Overall Study | Death | 2 | 2 |
| Overall Study | Decision by the Sponsor | 4 | 8 |
| Overall Study | Lack of Efficacy | 1 | 2 |
| Overall Study | Lost to Follow-up | 13 | 39 |
| Overall Study | Other than specified above | 3 | 10 |
| Overall Study | Protocol Violation | 6 | 18 |
| Overall Study | Withdrawal by Subject | 15 | 36 |
Baseline characteristics
| Characteristic | Rilonacept 160 mg | Total | Placebo |
|---|---|---|---|
| Age, Continuous | 52.8 years STANDARD_DEVIATION 11.48 | 52.7 years STANDARD_DEVIATION 11.25 | 52.4 years STANDARD_DEVIATION 10.55 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 38 Participants | 49 Participants | 11 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 947 Participants | 1266 Participants | 319 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 7 Participants | 9 Participants | 2 Participants |
| Race (NIH/OMB) Asian | 115 Participants | 162 Participants | 47 Participants |
| Race (NIH/OMB) Black or African American | 202 Participants | 272 Participants | 70 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 3 Participants | 4 Participants | 1 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 658 Participants | 868 Participants | 210 Participants |
| Sex: Female, Male Female | 128 Participants | 161 Participants | 33 Participants |
| Sex: Female, Male Male | 857 Participants | 1154 Participants | 297 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 74 / 330 | 266 / 985 |
| serious Total, serious adverse events | 13 / 330 | 31 / 985 |
Outcome results
Percentage of Participants With Treatment-Emergent Adverse Events (TEAEs)
Any untoward medical occurrence in a participant who received investigational medicinal product (IMP) was considered an AE without regard to possibility of causal relationship with this treatment. Treatment-emergent adverse events (TEAEs) were defined as AEs that developed or worsened or became serious during on-treatment period (time from the administration of first dose of study drug up to 35 days after the last dose of study drug). A serious adverse event (SAE) was defined as any untoward medical occurrence that resulted in any of the following outcomes: death, life-threatening, required initial or prolonged in-patient hospitalization, persistent or significant disability/incapacity, congenital anomaly/birth defect, or considered as medically important event. Any TEAE included participants with both serious and non-serious AEs.
Time frame: Baseline up to Week 20
Population: Safety analysis set that included all participants who received any study drug and safety analyses were based on the treatment received.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Placebo | Percentage of Participants With Treatment-Emergent Adverse Events (TEAEs) | With TEAEs resulting in drug withdrawal | 3.3 percentage of participants |
| Placebo | Percentage of Participants With Treatment-Emergent Adverse Events (TEAEs) | With at least 1 TEAE | 59.1 percentage of participants |
| Placebo | Percentage of Participants With Treatment-Emergent Adverse Events (TEAEs) | With serious TEAEs resulting in drug withdrawal | 1.8 percentage of participants |
| Placebo | Percentage of Participants With Treatment-Emergent Adverse Events (TEAEs) | With TEAEs leading to study discontinuation | 3.0 percentage of participants |
| Placebo | Percentage of Participants With Treatment-Emergent Adverse Events (TEAEs) | With TEAEs related to study drug | 13.0 percentage of participants |
| Placebo | Percentage of Participants With Treatment-Emergent Adverse Events (TEAEs) | With serious TEAE leading to study discontinuation | 1.5 percentage of participants |
| Placebo | Percentage of Participants With Treatment-Emergent Adverse Events (TEAEs) | Treatment emergent deaths | 0.3 percentage of participants |
| Placebo | Percentage of Participants With Treatment-Emergent Adverse Events (TEAEs) | With serious TEAEs | 3.9 percentage of participants |
| Rilonacept 160 mg | Percentage of Participants With Treatment-Emergent Adverse Events (TEAEs) | Treatment emergent deaths | 0.2 percentage of participants |
| Rilonacept 160 mg | Percentage of Participants With Treatment-Emergent Adverse Events (TEAEs) | With TEAEs related to study drug | 27.5 percentage of participants |
| Rilonacept 160 mg | Percentage of Participants With Treatment-Emergent Adverse Events (TEAEs) | With serious TEAEs resulting in drug withdrawal | 1.1 percentage of participants |
| Rilonacept 160 mg | Percentage of Participants With Treatment-Emergent Adverse Events (TEAEs) | With serious TEAE leading to study discontinuation | 1.0 percentage of participants |
| Rilonacept 160 mg | Percentage of Participants With Treatment-Emergent Adverse Events (TEAEs) | With serious TEAEs | 3.1 percentage of participants |
| Rilonacept 160 mg | Percentage of Participants With Treatment-Emergent Adverse Events (TEAEs) | With TEAEs resulting in drug withdrawal | 5.0 percentage of participants |
| Rilonacept 160 mg | Percentage of Participants With Treatment-Emergent Adverse Events (TEAEs) | With TEAEs leading to study discontinuation | 4.7 percentage of participants |
| Rilonacept 160 mg | Percentage of Participants With Treatment-Emergent Adverse Events (TEAEs) | With at least 1 TEAE | 66.6 percentage of participants |
Number of Gout Flare Days Per Participant From Day 1 to Day 112 (Week 16)
A gout flare was defined as participant reported acute articular pain typical of a gout attack that required treatment with an anti-inflammatory therapeutic: had at least 3 of the following 4 signs or symptoms: joint swelling, tenderness, redness, and pain and with at least 1 of the following: rapid onset of pain, decreased range of motion, joint warmth or other symptoms similar to a prior gout flare. Number of gout flares per participant was reported for this outcome measure. Flare days were counted up to Week 16, regardless of whether or not the flares occurred during the treatment period.
Time frame: Day 1 to Day 112 (Week 16)
Population: FAS that included all randomized participants who received any study medication, and was based on the treatment allocated by the IVRS at randomization (as randomized). Here, number of participants analyzed=participants with available data for this endpoint.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Placebo | Number of Gout Flare Days Per Participant From Day 1 to Day 112 (Week 16) | 7.66 Gout flare Days | Standard Deviation 11.79 |
| Rilonacept 160 mg | Number of Gout Flare Days Per Participant From Day 1 to Day 112 (Week 16) | 2.66 Gout flare Days | Standard Deviation 7.69 |
Number of Gout Flares Per Participant Assessed From Day 1 to Day 112 (Week 16)
A gout flare was defined as participant reported acute articular pain typical of a gout attack that required treatment with an anti-inflammatory therapeutic: had at least 3 of the following 4 signs or symptoms: joint swelling, tenderness, redness, and pain and with at least 1 of the following: rapid onset of pain, decreased range of motion, joint warmth or other symptoms similar to a prior gout flare. Number of gout flares per participant was reported for this outcome measure. For drop-outs, only flares occurred before Day 112 were counted, regardless whether the flares occurred during the treatment period or not.
Time frame: Day 1 to Day 112 (Week 16)
Population: Full analysis set (FAS) that included all randomized participants who received any study medication, and was based on the treatment allocated by the Interactive voice response system (IVRS) at randomization (as randomized). Here, number of participants analyzed=participants with available data for this endpoint.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Placebo | Number of Gout Flares Per Participant Assessed From Day 1 to Day 112 (Week 16) | 1.73 Gout flares | Standard Deviation 2.69 |
| Rilonacept 160 mg | Number of Gout Flares Per Participant Assessed From Day 1 to Day 112 (Week 16) | 0.51 Gout flares | Standard Deviation 1.17 |
Percentage of Participants With at Least One Flare From Day 1 to Day 112 (Week 16)
A gout flare was defined as participant reported acute articular pain typical of a gout attack that required treatment with an anti-inflammatory therapeutic: had at least 3 of the following 4 signs or symptoms: joint swelling, tenderness, redness, and pain and with at least 1 of the following: rapid onset of pain, decreased range of motion, joint warmth or other symptoms similar to a prior gout flare. Percentage of participants with at least one gout flare was reported for this outcome measure. For drop-outs, only flares occurred before Day 112 were counted, regardless whether the flares occurred during the treatment period or not.
Time frame: Day 1 to Day 112 (Week 16)
Population: FAS that included all randomized participants who received any study medication, and was based on the treatment allocated by the IVRS at randomization (as randomized).
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo | Percentage of Participants With at Least One Flare From Day 1 to Day 112 (Week 16) | 51.1 percentage of participants |
| Rilonacept 160 mg | Percentage of Participants With at Least One Flare From Day 1 to Day 112 (Week 16) | 25.7 percentage of participants |
Percentage of Participants With at Least Two Flares From Day 1 to Day 112 (Week 16)
A gout flare was defined as participant reported acute articular pain typical of a gout attack that required treatment with an anti-inflammatory therapeutic: had at least 3 of the following 4 signs or symptoms: joint swelling, tenderness, redness, and pain and with at least 1 of the following: rapid onset of pain, decreased range of motion, joint warmth or other symptoms similar to a prior gout flare. Percentage of participants with at least two gout flare was reported for this outcome measure. For drop-outs, only flares occurred before Day 112 were counted, regardless whether the flares occurred during the treatment period or not.
Time frame: Day 1 to Day 112 (Week 16)
Population: FAS that included all randomized participants who received any study medication, and was based on the treatment allocated by the IVRS at randomization (as randomized).
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo | Percentage of Participants With at Least Two Flares From Day 1 to Day 112 (Week 16) | 34.7 percentage of participants |
| Rilonacept 160 mg | Percentage of Participants With at Least Two Flares From Day 1 to Day 112 (Week 16) | 11.7 percentage of participants |