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Review of Safety Using Rilonacept in Preventing Gout Exacerbations (RE-SURGE)

A Multi-Center, Randomized, Double-Blind, Placebo Controlled Trial of the Safety of Rilonacept for the Prophylaxis of Gout Flares in Patients on Urate- Lowering Therapy

Status
Completed
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT00856206
Enrollment
1315
Registered
2009-03-05
Start date
2009-03-31
Completion date
2011-01-31
Last updated
2017-04-28

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Gout

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

BIOLOGICALRilonacept

Rilonacept 160 mg subcutaneous injection once a week

OTHERPlacebo

Placebo subcutaneous injection once a week

Sponsors

Regeneron Pharmaceuticals
Lead SponsorINDUSTRY

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)

Eligibility

Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No

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

MeasureTime frameDescription
Percentage of Participants With Treatment-Emergent Adverse Events (TEAEs)Baseline up to Week 20Any 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

MeasureTime frameDescription
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

ArmCount
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
Total1,315

Withdrawals & dropouts

PeriodReasonFG000FG001
Overall StudyAdverse Event1046
Overall StudyDeath22
Overall StudyDecision by the Sponsor48
Overall StudyLack of Efficacy12
Overall StudyLost to Follow-up1339
Overall StudyOther than specified above310
Overall StudyProtocol Violation618
Overall StudyWithdrawal by Subject1536

Baseline characteristics

CharacteristicRilonacept 160 mgTotalPlacebo
Age, Continuous52.8 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 Participants49 Participants11 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
947 Participants1266 Participants319 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
0 Participants0 Participants0 Participants
Race (NIH/OMB)
American Indian or Alaska Native
7 Participants9 Participants2 Participants
Race (NIH/OMB)
Asian
115 Participants162 Participants47 Participants
Race (NIH/OMB)
Black or African American
202 Participants272 Participants70 Participants
Race (NIH/OMB)
More than one race
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
3 Participants4 Participants1 Participants
Race (NIH/OMB)
Unknown or Not Reported
0 Participants0 Participants0 Participants
Race (NIH/OMB)
White
658 Participants868 Participants210 Participants
Sex: Female, Male
Female
128 Participants161 Participants33 Participants
Sex: Female, Male
Male
857 Participants1154 Participants297 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
— / —— / —
other
Total, other adverse events
74 / 330266 / 985
serious
Total, serious adverse events
13 / 33031 / 985

Outcome results

Primary

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.

ArmMeasureGroupValue (NUMBER)
PlaceboPercentage of Participants With Treatment-Emergent Adverse Events (TEAEs)With TEAEs resulting in drug withdrawal3.3 percentage of participants
PlaceboPercentage of Participants With Treatment-Emergent Adverse Events (TEAEs)With at least 1 TEAE59.1 percentage of participants
PlaceboPercentage of Participants With Treatment-Emergent Adverse Events (TEAEs)With serious TEAEs resulting in drug withdrawal1.8 percentage of participants
PlaceboPercentage of Participants With Treatment-Emergent Adverse Events (TEAEs)With TEAEs leading to study discontinuation3.0 percentage of participants
PlaceboPercentage of Participants With Treatment-Emergent Adverse Events (TEAEs)With TEAEs related to study drug13.0 percentage of participants
PlaceboPercentage of Participants With Treatment-Emergent Adverse Events (TEAEs)With serious TEAE leading to study discontinuation1.5 percentage of participants
PlaceboPercentage of Participants With Treatment-Emergent Adverse Events (TEAEs)Treatment emergent deaths0.3 percentage of participants
PlaceboPercentage of Participants With Treatment-Emergent Adverse Events (TEAEs)With serious TEAEs3.9 percentage of participants
Rilonacept 160 mgPercentage of Participants With Treatment-Emergent Adverse Events (TEAEs)Treatment emergent deaths0.2 percentage of participants
Rilonacept 160 mgPercentage of Participants With Treatment-Emergent Adverse Events (TEAEs)With TEAEs related to study drug27.5 percentage of participants
Rilonacept 160 mgPercentage of Participants With Treatment-Emergent Adverse Events (TEAEs)With serious TEAEs resulting in drug withdrawal1.1 percentage of participants
Rilonacept 160 mgPercentage of Participants With Treatment-Emergent Adverse Events (TEAEs)With serious TEAE leading to study discontinuation1.0 percentage of participants
Rilonacept 160 mgPercentage of Participants With Treatment-Emergent Adverse Events (TEAEs)With serious TEAEs3.1 percentage of participants
Rilonacept 160 mgPercentage of Participants With Treatment-Emergent Adverse Events (TEAEs)With TEAEs resulting in drug withdrawal5.0 percentage of participants
Rilonacept 160 mgPercentage of Participants With Treatment-Emergent Adverse Events (TEAEs)With TEAEs leading to study discontinuation4.7 percentage of participants
Rilonacept 160 mgPercentage of Participants With Treatment-Emergent Adverse Events (TEAEs)With at least 1 TEAE66.6 percentage of participants
Secondary

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.

ArmMeasureValue (MEAN)Dispersion
PlaceboNumber of Gout Flare Days Per Participant From Day 1 to Day 112 (Week 16)7.66 Gout flare DaysStandard Deviation 11.79
Rilonacept 160 mgNumber of Gout Flare Days Per Participant From Day 1 to Day 112 (Week 16)2.66 Gout flare DaysStandard Deviation 7.69
Secondary

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.

ArmMeasureValue (MEAN)Dispersion
PlaceboNumber of Gout Flares Per Participant Assessed From Day 1 to Day 112 (Week 16)1.73 Gout flaresStandard Deviation 2.69
Rilonacept 160 mgNumber of Gout Flares Per Participant Assessed From Day 1 to Day 112 (Week 16)0.51 Gout flaresStandard Deviation 1.17
Secondary

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).

ArmMeasureValue (NUMBER)
PlaceboPercentage of Participants With at Least One Flare From Day 1 to Day 112 (Week 16)51.1 percentage of participants
Rilonacept 160 mgPercentage of Participants With at Least One Flare From Day 1 to Day 112 (Week 16)25.7 percentage of participants
Secondary

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).

ArmMeasureValue (NUMBER)
PlaceboPercentage of Participants With at Least Two Flares From Day 1 to Day 112 (Week 16)34.7 percentage of participants
Rilonacept 160 mgPercentage of Participants With at Least Two Flares From Day 1 to Day 112 (Week 16)11.7 percentage of participants

Source: ClinicalTrials.gov · Data processed: Mar 7, 2026