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Flare Prevention Study of Canakinumab in Patients With Active Systemic Juvenile Idiopathic Arthritis (SJIA)

A Randomized, Double-blind, Placebo Controlled, Withdrawal Study of Flare Prevention of Canakinumab (ACZ885) in Patients With Systemic Juvenile Idiopathic Arthritis (SJIA) and Active Systemic Manifestations

Status
Completed
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT00889863
Acronym
β-SPECIFIC 2
Enrollment
177
Registered
2009-04-29
Start date
2009-07-31
Completion date
2011-09-30
Last updated
2012-10-16

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

Conditions

Systemic Juvenile Idiopathic Arthritis With Active Flare

Keywords

Flare, arthritis, IL-1beta antagonist, systemic juvenile idiopathic arthritis, Juvenile rheumatoid

Brief summary

This two-part study assessed the sustained efficacy of canakinumab in the double-blind Part II and the ability to taper steroids in the open label Part I.

Interventions

DRUGcanakinumab

Canakinumab 4 mg/kg dose subcutaneous injection supplied as 6 mL glass vials each containing 150 mg canakinumab as a lyophilized cake.

DRUGplacebo

Placebo powder matching canakinumab supplied as 6 mL glass vials containing a lyophilized cake for subcutaneous injection every 4 weeks in Part II.

Sponsors

Pediatric Rheumatology International Trials Organization
CollaboratorOTHER
Novartis Pharmaceuticals
Lead SponsorINDUSTRY

Study design

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

Eligibility

Sex/Gender
ALL
Age
2 Years to 19 Years
Healthy volunteers
No

Inclusion criteria

* Confirmed diagnosis of systemic juvenile idiopathic arthritis as per International League Against Rheumatism (ILAR) definition that must have occurred at least 2 months prior to enrollment with onset of disease \< 16 years of age. -Arthritis in one or more joints with or preceded by fever of at least 2 weeks duration that is documented to be daily for at least 3 days with accompanying symptoms * Active disease at the time of enrollment defined as follows: * At least 2 joints with active arthritis (using American College of rheumatology) ACR definition of active joint) * Documented spiking, intermittent fever (body temperature \> 38oC) for at least 1 day during the screening period within 1 week before first study drug dose * C-reactive protein \> 30 mg/L (normal range \< 10 mg/L) * No concomitant use of second line agents such as disease-modifying and/ or immunosuppressive drugs will be allowed with the exception of: * Stable dose of methotrexate for at least 8 weeks prior to the screening visit, and/or folic/folinic acid per standard medical practice * Stable dose of no more than one non-steroidal anti-inflammatory drug for at least 2 weeks prior to the screening visit * Stable dose of steroid treatment \< or = to 1.0 mg/kg/day in 1-2 doses per day of oral prednisone or equivalent

Exclusion criteria

* Diagnosis of active macrophage-activation syndrome (MAS) within the last 6 months * Risk factors for tuberculosis * Patients with active or recurrent bacterial, fungal or viral infection at the time of enrollment, including patients with evidence of HIV infection, Hepatitis B and Hepatitis C infection Other protocol inclusion/

Design outcomes

Primary

MeasureTime frameDescription
Part I: Percentage of Patients Who Were on Steroids at Entry Into Part I and Who Were Able to Taper Steroid as Per Protocol in at Least 25% of the Patients Who Entered the Study Taking a Steroid32 WeeksAbility to taper oral steroids: if dose reduced from start of Part I to end of Part Ic from \> 0.8 mg/kg/day to ≤ 0.5 mg/kg/day, or from ≥ 0.5 mg/kg/day and ≤ 0.8 mg/kg/day by at least 0.3 mg/kg, or from any initial dose to ≤ 0.2 mg/kg/day, while maintaining a minimum adapted ACR 30 pediatric criterion. Patients on oral steroids at study entry who did not enter Part 1c are considered steroid tapering failures.
Part II: Survival Estimate of Time to FlarePart II was event driven. The study was stopped when the required number of 37 flares had occurred (88 weeks)Kaplan Meier estimate of the probability to experience a flare. Flare was defined as at least 1 of the following. * Reappearance of fever (\>38°C, lasting for at least 2 consecutive days) not due to infections * Flare according to the JIA pediatric criteria for flare (all criteria must have been met): * ≥ 30% worsening in at least 3 of the first 6 response variables * ≥ 30% improvement in not more than 1 of the first 6 response variables Patients who discontinued the study while in Part II were counted as flared unless they discontinued because of inactive disease for at least 24 weeks in Part II.

Secondary

MeasureTime frameDescription
Part I: Percentage of Participants on Steroids at the Start of 1c Who Were Able to Taper Steroids by the End of Part 1cStart of Part Ic (After Week 8) to End of Part Ic (Week 28)
Part I: Percentage of Participants With Minimum American College of Rheumatology (ACR) 30/50/70/90/100 at the End of Part IBaseline, 32 WeeksAdapted ACR Pediatric 30/50/70/90/100 criteria are defined as meeting all of the following: * improvement from baseline of ≥ 30%, ≥ 50%, ≥ 70%, ≥ 90%, or 100%, in at least 3 of the first 6 response variables 1. Physician's global assessment of disease activity 2. CHAQ-patient's overall well-being 3. CHAQ-Functional ability 4. \# of joints with active arthritis 5. \# of joints with limitation of motion 6. C-Reactive Protein. * no intermittent fever in the preceding week * no more than one of the first 6 response variables worsening by more than 30%
Part I: Time to First Minimum American College of Rheumatology (ACR50) and Normal C-Reactive ProteinBaseline, Week 32Duration in days in the study to the first minimum adapted ACR Pediatric 50 criteria and a normal (\<10mg/L) C-Reactive Protein
Part I: Time to First Minimum American College of Rheumatology (ACR70) and Normal C-Reactive ProteinBaseline, Week 32Duration in days in the study to the first minimum adapted ACR Pediatric 70 criteria and a normal (\<10mg/L) C-Reactive Protein
Part I: Percentage of Participants With Body Temperature ≤ 38 Degrees Celsius at Day 3 in Part 1aDay 3
Part I: Change in Disability Over Time in the Child Health Assessment Questionnaire-Disability Index (CHAQ-DI) From Baseline to End of Part IBaseline, End of Part I (Week 32)The childhood health assessment questionnaire, CHAQ was used to assess physical ability and functional status of patients as well as quality of life. The disability dimension consists of 20 multiple choice items concerning difficulty in performing eight common activities of daily living; dressing and grooming, arising, eating, walking, reaching, personal hygiene, gripping and other activities. Parents choose from four response categories, ranging from 0(without any difficulty) to 3(unable to do). A negative change indicates improvement.
Part II: Change in Disability Over Time by the Child Health Assessment Questionnaire-Disability Index (CHAQ-DI)Start of Part II (Week 32), End of Part II ( total duration-88 weeks)CHAQ-DI assessed physical ability and functional status of patients and quality of life. 20 multiple choice items concerning difficulty in performing 8 common activities of daily living; dressing and grooming, arising, eating, walking, reaching, personal hygiene, gripping and other activities. Parents choose from 4 response categories, ranging from 0(without any difficulty) to 3(unable to do). Repeated measures Analysis of Covariance with treatment group, visit day, prednisone (or equivalent) dose and adapted ACR 70 response reached at the end of Part Id as covariates.
Part I: Change in Health Related Quality of Life Over Time by Child Health Questionnaire (CHQ-PF50)Baseline, End of Part I ( Week 32)The CHQ-PF50© is an instrument used to measure Health Related Quality of Life in children 5-18 from the parent's perspective. The questionnaire measures the following concepts: Physical functioning, Role/social emotional, Role/social behavior, Role/social physical, Bodily pain, General behavior, Mental health, Self-esteem, General health perception, Change in health, Parental impact - emotional, Parental impact - time, Family activities, and Family cohesion. Summaries are provided for Physical Health and Psychosocial Health. Scores range from 0-100. Increase in score represents improvement.
Part II: Change in Health Related Quality of Life Over Time by Child Health Questionnaire (CHQ-PF50)Start Part II (Week 32), End Part II (total duration - 88 Weeks)CHQ-PF50 measures Physical functioning, Role/social emotional, behavior and physical, Bodily pain, General behavior, Mental health, Self-esteem, General health perception, Change in health, Parental impact-emotional, Parental impact-time, Family activities and cohesion. Summaries are provided for Physical Health and Psychosocial Health. An increase in score indicates improvement. Repeated measures Analysis of Covariance change from start of Part II with treatment group, visit day, prednisone(or equivalent) dose and adapted ACR70 Pediatric response reached at the end of Part Id as covariates.
Part II: Survival Analysis of Time to a Worsening in American College of Rheumatology (ACR) ResponsePart II was event driven. The study was stopped when the required number of 37 flares had occurred (88 weeks)Kaplan Meier estimate of the time in days to the probability of worsening of the ACR response. ACR response is determined by the following items: 1. Physician's global assessment of disease activity 2. CHAQ-patient's overall wellbeing 3. CHAQ-Functional ability 4. Number of joints with active arthritis 5. Number of joints with limitation of motion 6. C-Reactive Protein. 7. No intermittent fever in the preceding week
Part I: Percentage of Patients on Steroids at Study Start Who Reached a Steroid Dose ≤0.2 mg/kg at End of Part Ic28 Weeks

Countries

Argentina, Belgium, Brazil, Canada, France, Germany, Hungary, Israel, Italy, Netherlands, Norway, Peru, Poland, South Africa, Spain, Sweden, Switzerland, Turkey (Türkiye), United States

Participant flow

Participants by arm

ArmCount
Canakinumab
In Part I participants received open label 4 mg/kg canakinumab subcutaneous injection every 4 weeks for up to 32 weeks. For the first 8 weeks Part Ia (4 weeks) and Ib (4 weeks) patients maintained a stable oral steroid dose (prednisone or equivalent) followed by Ic an up to 20 week steroid tapering period and then Id a 4 week stable steroid dose period. Participants were then randomized to receive either 4 mg/kg canakinumab subcutaneous injection or Placebo comparator in Part II and remained on the stable oral steroid dose for 24 weeks. At 24 weeks in Part II participants with a \>0.2 mg/kg and ≤ 0.5 mg/kg and no flare could restart steroid tapering. If the steroid dose was ≤ 0.2 mg/kg participants continued to maintain their current dose for the remainder of Part II.
177
Total177

Withdrawals & dropouts

PeriodReasonFG000FG001
Part II: Randomized Double BlindAdverse Event04
Part II: Randomized Double BlindProtocol deviation01
Part II: Randomized Double BlindUnsatisfactory therapeutic effect1120
Part II: Randomized Double BlindWithdrawal by Subject01
Part I: Open LabelAdverse Event40
Part I: Open LabelDeath10
Part I: Open LabelUnsatisfactory therapeutic effect720

Baseline characteristics

CharacteristicCanakinumab
Age Continuous8.7 years
STANDARD_DEVIATION 4.46
Sex: Female, Male
Female
98 Participants
Sex: Female, Male
Male
79 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
EG002
affected / at risk
deaths
Total, all-cause mortality
— / —— / —— / —
other
Total, other adverse events
138 / 17740 / 5035 / 50
serious
Total, serious adverse events
15 / 1776 / 506 / 50

Outcome results

Primary

Part II: Survival Estimate of Time to Flare

Kaplan Meier estimate of the probability to experience a flare. Flare was defined as at least 1 of the following. * Reappearance of fever (\>38°C, lasting for at least 2 consecutive days) not due to infections * Flare according to the JIA pediatric criteria for flare (all criteria must have been met): * ≥ 30% worsening in at least 3 of the first 6 response variables * ≥ 30% improvement in not more than 1 of the first 6 response variables Patients who discontinued the study while in Part II were counted as flared unless they discontinued because of inactive disease for at least 24 weeks in Part II.

Time frame: Part II was event driven. The study was stopped when the required number of 37 flares had occurred (88 weeks)

Population: Full Analysis Set in Part II

ArmMeasureValue (MEDIAN)
CanakinumabPart II: Survival Estimate of Time to FlareNA Days
PlaceboPart II: Survival Estimate of Time to Flare236.0 Days
Primary

Part I: Percentage of Patients Who Were on Steroids at Entry Into Part I and Who Were Able to Taper Steroid as Per Protocol in at Least 25% of the Patients Who Entered the Study Taking a Steroid

Ability to taper oral steroids: if dose reduced from start of Part I to end of Part Ic from \> 0.8 mg/kg/day to ≤ 0.5 mg/kg/day, or from ≥ 0.5 mg/kg/day and ≤ 0.8 mg/kg/day by at least 0.3 mg/kg, or from any initial dose to ≤ 0.2 mg/kg/day, while maintaining a minimum adapted ACR 30 pediatric criterion. Patients on oral steroids at study entry who did not enter Part 1c are considered steroid tapering failures.

Time frame: 32 Weeks

Population: Participants from the Full Analysis Set who were taking oral steroids at the beginning of Part I.

ArmMeasureValue (NUMBER)
CanakinumabPart I: Percentage of Patients Who Were on Steroids at Entry Into Part I and Who Were Able to Taper Steroid as Per Protocol in at Least 25% of the Patients Who Entered the Study Taking a Steroid44.5 Percentage of participants
Secondary

Part I: Change in Disability Over Time in the Child Health Assessment Questionnaire-Disability Index (CHAQ-DI) From Baseline to End of Part I

The childhood health assessment questionnaire, CHAQ was used to assess physical ability and functional status of patients as well as quality of life. The disability dimension consists of 20 multiple choice items concerning difficulty in performing eight common activities of daily living; dressing and grooming, arising, eating, walking, reaching, personal hygiene, gripping and other activities. Parents choose from four response categories, ranging from 0(without any difficulty) to 3(unable to do). A negative change indicates improvement.

Time frame: Baseline, End of Part I (Week 32)

Population: Participants from the Full Analysis Set Part I with data at baseline and End of Part I.

ArmMeasureValue (MEDIAN)Dispersion
CanakinumabPart I: Change in Disability Over Time in the Child Health Assessment Questionnaire-Disability Index (CHAQ-DI) From Baseline to End of Part I-0.8750 Score on a scaleFull Range 0.86492
Secondary

Part I: Change in Health Related Quality of Life Over Time by Child Health Questionnaire (CHQ-PF50)

The CHQ-PF50© is an instrument used to measure Health Related Quality of Life in children 5-18 from the parent's perspective. The questionnaire measures the following concepts: Physical functioning, Role/social emotional, Role/social behavior, Role/social physical, Bodily pain, General behavior, Mental health, Self-esteem, General health perception, Change in health, Parental impact - emotional, Parental impact - time, Family activities, and Family cohesion. Summaries are provided for Physical Health and Psychosocial Health. Scores range from 0-100. Increase in score represents improvement.

Time frame: Baseline, End of Part I ( Week 32)

Population: Participants from the Full Analysis Set Part I-age 5 to 18 years.

ArmMeasureGroupValue (MEDIAN)Dispersion
CanakinumabPart I: Change in Health Related Quality of Life Over Time by Child Health Questionnaire (CHQ-PF50)Physical Health Score21.8050 Score on a scaleFull Range 16.10377
CanakinumabPart I: Change in Health Related Quality of Life Over Time by Child Health Questionnaire (CHQ-PF50)Psychosocial Health Score8.2223 Score on a scaleFull Range 11.50688
Secondary

Part II: Change in Disability Over Time by the Child Health Assessment Questionnaire-Disability Index (CHAQ-DI)

CHAQ-DI assessed physical ability and functional status of patients and quality of life. 20 multiple choice items concerning difficulty in performing 8 common activities of daily living; dressing and grooming, arising, eating, walking, reaching, personal hygiene, gripping and other activities. Parents choose from 4 response categories, ranging from 0(without any difficulty) to 3(unable to do). Repeated measures Analysis of Covariance with treatment group, visit day, prednisone (or equivalent) dose and adapted ACR 70 response reached at the end of Part Id as covariates.

Time frame: Start of Part II (Week 32), End of Part II ( total duration-88 weeks)

Population: Full Analysis set Part II.

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
CanakinumabPart II: Change in Disability Over Time by the Child Health Assessment Questionnaire-Disability Index (CHAQ-DI)0.1184 Score on a scaleStandard Error 0.17592
PlaceboPart II: Change in Disability Over Time by the Child Health Assessment Questionnaire-Disability Index (CHAQ-DI)0.1258 Score on a scaleStandard Error 0.18241
Secondary

Part II: Change in Health Related Quality of Life Over Time by Child Health Questionnaire (CHQ-PF50)

CHQ-PF50 measures Physical functioning, Role/social emotional, behavior and physical, Bodily pain, General behavior, Mental health, Self-esteem, General health perception, Change in health, Parental impact-emotional, Parental impact-time, Family activities and cohesion. Summaries are provided for Physical Health and Psychosocial Health. An increase in score indicates improvement. Repeated measures Analysis of Covariance change from start of Part II with treatment group, visit day, prednisone(or equivalent) dose and adapted ACR70 Pediatric response reached at the end of Part Id as covariates.

Time frame: Start Part II (Week 32), End Part II (total duration - 88 Weeks)

Population: Full Analysis Set Part II-patients aged 5-18 years.

ArmMeasureGroupValue (LEAST_SQUARES_MEAN)Dispersion
CanakinumabPart II: Change in Health Related Quality of Life Over Time by Child Health Questionnaire (CHQ-PF50)Physical Health Score3.9 Score on a scaleStandard Error 2.54
CanakinumabPart II: Change in Health Related Quality of Life Over Time by Child Health Questionnaire (CHQ-PF50)Psychosocial Health Score2.5 Score on a scaleStandard Error 1.88
PlaceboPart II: Change in Health Related Quality of Life Over Time by Child Health Questionnaire (CHQ-PF50)Physical Health Score-0.3 Score on a scaleStandard Error 2.53
PlaceboPart II: Change in Health Related Quality of Life Over Time by Child Health Questionnaire (CHQ-PF50)Psychosocial Health Score-0.5 Score on a scaleStandard Error 1.86
Secondary

Part II: Survival Analysis of Time to a Worsening in American College of Rheumatology (ACR) Response

Kaplan Meier estimate of the time in days to the probability of worsening of the ACR response. ACR response is determined by the following items: 1. Physician's global assessment of disease activity 2. CHAQ-patient's overall wellbeing 3. CHAQ-Functional ability 4. Number of joints with active arthritis 5. Number of joints with limitation of motion 6. C-Reactive Protein. 7. No intermittent fever in the preceding week

Time frame: Part II was event driven. The study was stopped when the required number of 37 flares had occurred (88 weeks)

Population: Full Analysis Set Part II

ArmMeasureValue (MEDIAN)
CanakinumabPart II: Survival Analysis of Time to a Worsening in American College of Rheumatology (ACR) ResponseNA Days
PlaceboPart II: Survival Analysis of Time to a Worsening in American College of Rheumatology (ACR) Response141.0 Days
Secondary

Part I: Percentage of Participants on Steroids at the Start of 1c Who Were Able to Taper Steroids by the End of Part 1c

Time frame: Start of Part Ic (After Week 8) to End of Part Ic (Week 28)

Population: Participants from the Full Analysis set who were taking oral steroids at the start of Part Ic.

ArmMeasureValue (NUMBER)
CanakinumabPart I: Percentage of Participants on Steroids at the Start of 1c Who Were Able to Taper Steroids by the End of Part 1c62.0 Percentage of participants
Secondary

Part I: Percentage of Participants With Body Temperature ≤ 38 Degrees Celsius at Day 3 in Part 1a

Time frame: Day 3

Population: Participants from the Full Analysis Set Part I with temperature readings at Day 3.

ArmMeasureValue (NUMBER)
CanakinumabPart I: Percentage of Participants With Body Temperature ≤ 38 Degrees Celsius at Day 3 in Part 1a98.6 Percentage of participants
Secondary

Part I: Percentage of Participants With Minimum American College of Rheumatology (ACR) 30/50/70/90/100 at the End of Part I

Adapted ACR Pediatric 30/50/70/90/100 criteria are defined as meeting all of the following: * improvement from baseline of ≥ 30%, ≥ 50%, ≥ 70%, ≥ 90%, or 100%, in at least 3 of the first 6 response variables 1. Physician's global assessment of disease activity 2. CHAQ-patient's overall well-being 3. CHAQ-Functional ability 4. \# of joints with active arthritis 5. \# of joints with limitation of motion 6. C-Reactive Protein. * no intermittent fever in the preceding week * no more than one of the first 6 response variables worsening by more than 30%

Time frame: Baseline, 32 Weeks

Population: Participants from the full analysis set with an assessment at the given time-point.

ArmMeasureGroupValue (NUMBER)
CanakinumabPart I: Percentage of Participants With Minimum American College of Rheumatology (ACR) 30/50/70/90/100 at the End of Part INon-Responders22.9 Percentage of participants
CanakinumabPart I: Percentage of Participants With Minimum American College of Rheumatology (ACR) 30/50/70/90/100 at the End of Part IACR 30 Response77.1 Percentage of participants
CanakinumabPart I: Percentage of Participants With Minimum American College of Rheumatology (ACR) 30/50/70/90/100 at the End of Part IACR 50 Response73.1 Percentage of participants
CanakinumabPart I: Percentage of Participants With Minimum American College of Rheumatology (ACR) 30/50/70/90/100 at the End of Part IACR 70 Response64.6 Percentage of participants
CanakinumabPart I: Percentage of Participants With Minimum American College of Rheumatology (ACR) 30/50/70/90/100 at the End of Part IACR 90 Response51.4 Percentage of participants
CanakinumabPart I: Percentage of Participants With Minimum American College of Rheumatology (ACR) 30/50/70/90/100 at the End of Part IACR 100 Response34.3 Percentage of participants
Secondary

Part I: Percentage of Patients on Steroids at Study Start Who Reached a Steroid Dose ≤0.2 mg/kg at End of Part Ic

Time frame: 28 Weeks

Population: Participants from the Full Analysis set who were taking oral steroids at the start of the study.

ArmMeasureGroupValue (NUMBER)
CanakinumabPart I: Percentage of Patients on Steroids at Study Start Who Reached a Steroid Dose ≤0.2 mg/kg at End of Part Icsteroid free32.8 Percentage of participants
CanakinumabPart I: Percentage of Patients on Steroids at Study Start Who Reached a Steroid Dose ≤0.2 mg/kg at End of Part Ic>0 and ≤ 0.2 mg/kg/day18.8 Percentage of participants
Secondary

Part I: Time to First Minimum American College of Rheumatology (ACR50) and Normal C-Reactive Protein

Duration in days in the study to the first minimum adapted ACR Pediatric 50 criteria and a normal (\<10mg/L) C-Reactive Protein

Time frame: Baseline, Week 32

Population: Participants from the Full Analysis Set Part I with ACR 50 and a Normal CRP.

ArmMeasureValue (MEAN)Dispersion
CanakinumabPart I: Time to First Minimum American College of Rheumatology (ACR50) and Normal C-Reactive Protein20.4 DaysStandard Deviation 8.7
Secondary

Part I: Time to First Minimum American College of Rheumatology (ACR70) and Normal C-Reactive Protein

Duration in days in the study to the first minimum adapted ACR Pediatric 70 criteria and a normal (\<10mg/L) C-Reactive Protein

Time frame: Baseline, Week 32

Population: Participants from the Full Analysis Set Part I with ACR 70 and a Normal CRP.

ArmMeasureValue (MEAN)Dispersion
CanakinumabPart I: Time to First Minimum American College of Rheumatology (ACR70) and Normal C-Reactive Protein24.5 DaysStandard Deviation 21.58

Source: ClinicalTrials.gov · Data processed: Mar 24, 2026