Arthritis, Arthritis, Rheumatoid, Autoimmune Diseases
Conditions
Keywords
humira, remicade, rheumatoid arthritis, enbrel failure, humira failure, arthritis, enbrel
Brief summary
The purpose of this study is to evaluate the efficacy and safety of switching rheumatoid arthritis (RA) participants who have an inadequate response to their current treatment with either etanercept + methotrexate or adalimumab + methotrexate to treatment with golimumab 50 milligram (mg) subcutaneous (SC) injection (a needle inserted under the skin in the back of upper arm, upper thigh or stomach area) every 4 weeks + methotrexate. This study is also designed to evaluate the benefit and safety of switching participants from treatment with golimumab 50 mg subcutaneous injection every 4 weeks + methotrexate to golimumab 2 milligram per kilogram (mg/kg) intravenous every 8 weeks + methotrexate, for those who do not achieve a marked improvement of their RA at Week 16.
Detailed description
The study consists of a main study and a voluntary, open-label (participants and researchers are aware about the treatment participants are receiving), 24-week study extension. The main study includes a Screening Run-in Period (Week -6 to Week 0), an Open-label Treatment Period (Week 0 to Week 16), an Open-label or Double-blind Treatment Period (Week 16 to Week 52). The main study also includes a Follow-up Period from Week 52 through Week 64 for those participants who will not participate in the 24-week study extension. Participants, participating in 24-week extension (at Week 52), will receive open-label golimumab SC injections every 4 weeks from Week 52 up to Week 72 and will be followed-up up to Week 88. All eligible participants will initiate the treatment with open-label golimumab SC injection every 4 weeks up to Week 12. At Week 16, depending upon the treatment response either participants will continue to receive open-label golimumab SC injection every 4 weeks up to Week 48 or participants will be randomly assigned to receive following 2 treatments: 1- golimumab 50mg SC injection every 4 weeks along with placebo intravenous infusion every 8 weeks through Week 48; 2- Placebo SC injection every 4 weeks along with golimumab 2mg/kg intravenous infusion every 8 weeks through Week 48. At Week 52, participants who choose to participate in the 24-week study extension will receive open-label golimumab 50 mg SC injections every 4 weeks through Week 72. Participants' safety will be monitored throughout the study.
Interventions
Golimumab 50 milligram (mg) subcutaneous (SC) injection every 4 weeks.
Golimumab 2 milligram per kilogram (mg/kg) intravenous infusion every 8 weeks.
Participants will continue taking their current Methotrexate (MTX) treatment regimen.
Placebo matched to golimumab SC injection every 4 weeks.
Placebo matched to golimumab intravenous infusion every 8 weeks.
Sponsors
Study design
Eligibility
Inclusion criteria
* Have inadequate RA disease control prior to the first administration of study agent despite treatment with etanercept (Enbrel) + methotrexate or adalimumab (Humira) + methotrexate (MTX) * Must have received a stable dose of MTX greater than or equal to (\>=) 7.5 milligram (mg) per week to less than or equal to (\<=) 25 mg per week for at least 4 consecutive weeks prior to the first screening visit and must plan to maintain that dose throughout the study * Participants must have received etanercept or adalimumab in combination with MTX for a minimum of 3 months prior to the first visit * Negative tuberculosis (TB) test * Are capable of providing informed consent, which must be obtained prior to any study-related procedures
Exclusion criteria
* Have a history of latent or active granulomatous infection, including TB, histoplasmosis, or coccidioidomycosis, or are frequently in contact with individuals who carry active TB infection * Have inflammatory diseases other than RA, including but not limited to psoriatic arthritis, ankylosing spondylitis, systemic lupus erythematosus, primary Sjogren's or Lyme disease * Have demonstrated a discernible improvement in disease activity between screening and prior to the first golimumab injection at Week 0 * Have any known malignancy or have a history of malignancy within the previous 5 years (with the exception of a nonmelanoma skin cancer that has been treated with no evidence of recurrence) * Have a history of lymphoproliferative disease, including lymphoma, or signs and symptoms suggestive of possible lymphoproliferative disease such as lymphadenopathy of unusual size or location
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants Achieving Erythrocyte Sedimentation Rate (ESR)-Based American College of Rheumatology [ACR] 20 Response at Week 14 | Week 14 | Erythrocyte Sedimentation Rate (ESR)-based ACR 20 response: greater than or equal to (\>=) 20 percent (%) improvement from Baseline in tender (68 joints assessed) and swollen (66 joints assessed) joint counts and \>=20% improvement from Baseline in 3 of the following 5 assessments: 1- Participant's assessment of pain using Visual Analog Scale (VAS) (0 to 10 centimeters \[cm\]), 2- Participant's global assessment of disease activity using VAS (0 to 10 cm), 3- Physician's global assessment of disease activity using VAS (0 to 10 cm), 4- Participant's assessment of physical function as measured by the Disability Index of the Health Assessment Questionnaire (HAQ-DI) (score of 0-3 in 8 functional areas), 5- ESR. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants Who Achieved Erythrocyte Sedimentation Rate (ESR)-Based ACR20 Response at Week 2 | Within 2 weeks of initiating therapy | Erythrocyte Sedimentation Rate (ESR)-based ACR 20 response: greater than or equal to (\>=) 20 percent (%) improvement from Baseline in tender (68 joints assessed) and swollen (66 joints assessed) joint counts and \>=20% improvement from Baseline in 3 of the following 5 assessments: 1- Participant's assessment of pain using Visual Analog Scale (VAS) (0 to 10 centimeters \[cm\]), 2- Participant's global assessment of disease activity using VAS (0 to 10 cm), 3- Physician's global assessment of disease activity using VAS (0 to 10 cm), 4- Participant's assessment of physical function as measured by the Disability Index of the Health Assessment Questionnaire (HAQ-DI) (score of 0-3 in 8 functional areas), 5- ESR. |
| Percentage of Participants Who Achieved Erythrocyte Sedimentation Rate (ESR)-Based Disease Activity Score (DAS28) Response at Week 16 and Maintained Response Through Week 52 | Week 52 | Erythrocyte Sedimentation Rate (ESR)-based disease activity score for 28-joints count (DAS28) as defined by European League Against Rheumatism (EULAR), response criteria was used to assess individual response as none, moderate, or good, depending on the extent of change from Baseline and the level of disease activity reached. A participant was classified as having achieved a DAS28 good response if, DAS28 was less than or equal to (\<=) 3.2 at a given visit and improvement from Baseline was \>1.2. Percentage of participants, who achieved ESR-based DAS 28 good response at Week 16 and maintained that response through Week 52, is reported. |
| Percentage of Participants Who Achieved Erythrocyte Sedimentation Rate (ESR)-Based ACR20 Response at Week 52 Relative to Week 16 | Week 52 | Erythrocyte Sedimentation Rate (ESR)-based ACR 20 response: \>=20 % improvement from Week 16 in tender (68 joints assessed) and swollen (66 joints assessed) joint counts and \>=20% improvement from Week 16 in 3 of the following 5 assessments: 1- Participant's assessment of pain using VAS (0 to 10 cm), 2- Participant's global assessment of disease activity using VAS (0 to 10 cm), 3- Physician's global assessment of disease activity using VAS (0 to 10 cm), 4- Participant's assessment of physical function as measured by the Disability Index of the Health Assessment Questionnaire (HAQ-DI) (score of 0-3 in 8 functional areas), 5- ESR. Percentage of participants, who achieved ESR-based ACR 20 responses at Week 52 relative to Week 16, is reported. |
| Percentage of Participants Who Achieved ESR-based and C-Reactive Protein (CRP)-Based ACR20 Response at Week 76 Relative to Week 16 | Week 76 | Erythrocyte Sedimentation Rate (ESR)-based/ C Reactive Protein (CRP)-based ACR 20 response: \>=20 % improvement from Week 16 in tender (68 joints assessed) and swollen (66 joints assessed) joint counts and \>=20% improvement from Week 16 in 3 of the following 5 assessments: 1- Participant's assessment of pain using VAS (0 to 10 cm), 2- Participant's global assessment of disease activity using VAS (0 to 10 cm), 3- Physician's global assessment of disease activity using VAS (0 to 10 cm), 4- Participant's assessment of physical function as measured by the Disability Index of the Health Assessment Questionnaire (HAQ-DI) (score of 0-3 in 8 functional areas), 5- ESR or CRP. Percentage of participants, who achieved ESR/ CRP-based ACR 20 responses at Week 76 relative to Week 16, is reported. |
| Change in ESR-based DAS28 Score at Week 76 Relative to Week 52 | Week 52, 76 | Erythrocyte Sedimentation Rate (ESR)-based disease activity score for 28-joints count (DAS28) was calculated from number of swollen joint counts (SJC) and tender joint counts (TJC) using 28 joints count, ESR, and patient global assessment of disease activity (participant rated arthritis activity assessment with scores ranging 0 to 10; higher scores indicated greater disease activity). Total ESR-based DAS28 score range: 0 to 9.4, higher score=more disease activity. |
Countries
Austria, Belgium, Canada, Germany, Greece, Sweden, United Kingdom, United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| OL Overall Group: Golimumab 50 mg SC + MTX All enrolled and dosed participants received golimumab 50 mg SC injection every 4 weeks + MTX from Week 0 to Week 12. | 433 |
| Total | 433 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 | FG003 | FG004 |
|---|---|---|---|---|---|---|
| OL/Double-Blind (DB) Period (Week 16-52) | Adverse Event | 0 | 1 | 5 | 6 | 0 |
| OL/Double-Blind (DB) Period (Week 16-52) | Death | 0 | 0 | 0 | 1 | 0 |
| OL/Double-Blind (DB) Period (Week 16-52) | Lack of Efficacy | 0 | 2 | 24 | 37 | 0 |
| OL/Double-Blind (DB) Period (Week 16-52) | Lost to Follow-up | 0 | 3 | 1 | 3 | 0 |
| OL/Double-Blind (DB) Period (Week 16-52) | Protocol Violation | 0 | 3 | 3 | 4 | 0 |
| OL/Double-Blind (DB) Period (Week 16-52) | Withdrawal by Subject | 0 | 1 | 4 | 7 | 0 |
| OL Study Extension (Week 52 - 76) | Adverse Event | 0 | 0 | 0 | 0 | 2 |
| OL Study Extension (Week 52 - 76) | Lack of Efficacy | 0 | 0 | 0 | 0 | 10 |
| OL Study Extension (Week 52 - 76) | Protocol Violation | 0 | 0 | 0 | 0 | 4 |
| OL Study Extension (Week 52 - 76) | Withdrawal by Subject | 0 | 0 | 0 | 0 | 2 |
| Open-label (OL) Period (Week 0 - 16) | Adverse Event | 20 | 0 | 0 | 0 | 0 |
| Open-label (OL) Period (Week 0 - 16) | Lack of Efficacy | 15 | 0 | 0 | 0 | 0 |
| Open-label (OL) Period (Week 0 - 16) | Lost to Follow-up | 2 | 0 | 0 | 0 | 0 |
| Open-label (OL) Period (Week 0 - 16) | Protocol Violation | 29 | 0 | 0 | 0 | 0 |
| Open-label (OL) Period (Week 0 - 16) | Withdrawal by Subject | 17 | 0 | 0 | 0 | 0 |
Baseline characteristics
| Characteristic | OL Overall Group: Golimumab 50 mg SC + MTX |
|---|---|
| Age, Continuous | 55.7 years STANDARD_DEVIATION 11.52 |
| Region of Enrollment Austria | 1 participants |
| Region of Enrollment Belgium | 9 participants |
| Region of Enrollment Canada | 37 participants |
| Region of Enrollment Germany | 7 participants |
| Region of Enrollment Greece | 8 participants |
| Region of Enrollment Italy | 12 participants |
| Region of Enrollment Sweden | 1 participants |
| Region of Enrollment United Kingdom | 9 participants |
| Region of Enrollment United States | 349 participants |
| Sex: Female, Male Female | 358 Participants |
| Sex: Female, Male Male | 75 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk | EG004 affected / at risk |
|---|---|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — | — / — | — / — |
| other Total, other adverse events | 123 / 433 | 21 / 75 | 30 / 91 | 54 / 184 | 61 / 212 |
| serious Total, serious adverse events | 20 / 433 | 2 / 75 | 4 / 91 | 10 / 184 | 10 / 212 |
Outcome results
Percentage of Participants Achieving Erythrocyte Sedimentation Rate (ESR)-Based American College of Rheumatology [ACR] 20 Response at Week 14
Erythrocyte Sedimentation Rate (ESR)-based ACR 20 response: greater than or equal to (\>=) 20 percent (%) improvement from Baseline in tender (68 joints assessed) and swollen (66 joints assessed) joint counts and \>=20% improvement from Baseline in 3 of the following 5 assessments: 1- Participant's assessment of pain using Visual Analog Scale (VAS) (0 to 10 centimeters \[cm\]), 2- Participant's global assessment of disease activity using VAS (0 to 10 cm), 3- Physician's global assessment of disease activity using VAS (0 to 10 cm), 4- Participant's assessment of physical function as measured by the Disability Index of the Health Assessment Questionnaire (HAQ-DI) (score of 0-3 in 8 functional areas), 5- ESR.
Time frame: Week 14
Population: Modified Intent To Treat (mITT) population included all enrolled participants who had Week 0 measurements and received at least 1 dose of study drug.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| OL Overall Group: Golimumab 50 mg SC + MTX | Percentage of Participants Achieving Erythrocyte Sedimentation Rate (ESR)-Based American College of Rheumatology [ACR] 20 Response at Week 14 | 34.9 percentage of participants |
Change in ESR-based DAS28 Score at Week 76 Relative to Week 52
Erythrocyte Sedimentation Rate (ESR)-based disease activity score for 28-joints count (DAS28) was calculated from number of swollen joint counts (SJC) and tender joint counts (TJC) using 28 joints count, ESR, and patient global assessment of disease activity (participant rated arthritis activity assessment with scores ranging 0 to 10; higher scores indicated greater disease activity). Total ESR-based DAS28 score range: 0 to 9.4, higher score=more disease activity.
Time frame: Week 52, 76
Population: Study extension mITT population. Here 'N' (number of participants analyzed) = participants evaluable for this measure and 'n' = participants evaluable at specified time point for each arm, respectively. Participants reported in other groups are subgroups of 'Study Extension OL Group' by treatment received in the OL/DB phase (Weeks 16-52).
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| OL Overall Group: Golimumab 50 mg SC + MTX | Change in ESR-based DAS28 Score at Week 76 Relative to Week 52 | Week 52 (n = 61, 40, 95, 196) | 3.182 units on a scale | Standard Deviation 1.1109 |
| OL Overall Group: Golimumab 50 mg SC + MTX | Change in ESR-based DAS28 Score at Week 76 Relative to Week 52 | Change at Week 76 (n = 57, 33, 84, 174) | -0.136 units on a scale | Standard Deviation 1.2095 |
| DB Group 2b: Golimumab 2 mg/kg IV & Placebo SC + MTX | Change in ESR-based DAS28 Score at Week 76 Relative to Week 52 | Change at Week 76 (n = 57, 33, 84, 174) | 0.209 units on a scale | Standard Deviation 1.2253 |
| DB Group 2b: Golimumab 2 mg/kg IV & Placebo SC + MTX | Change in ESR-based DAS28 Score at Week 76 Relative to Week 52 | Week 52 (n = 61, 40, 95, 196) | 4.070 units on a scale | Standard Deviation 0.8037 |
| DB Group 2b: Golimumab 2 mg/kg IV & Placebo SC + MTX | Change in ESR-based DAS28 Score at Week 76 Relative to Week 52 | Week 52 (n = 61, 40, 95, 196) | 4.394 units on a scale | Standard Deviation 1.2389 |
| DB Group 2b: Golimumab 2 mg/kg IV & Placebo SC + MTX | Change in ESR-based DAS28 Score at Week 76 Relative to Week 52 | Change at Week 76 (n = 57, 33, 84, 174) | -0.017 units on a scale | Standard Deviation 1.0518 |
| OL Study Extension Group: Golimumab 50 mg SC + MTX | Change in ESR-based DAS28 Score at Week 76 Relative to Week 52 | Week 52 (n = 61, 40, 95, 196) | 3.950 units on a scale | Standard Deviation 1.2379 |
| OL Study Extension Group: Golimumab 50 mg SC + MTX | Change in ESR-based DAS28 Score at Week 76 Relative to Week 52 | Change at Week 76 (n = 57, 33, 84, 174) | -0.013 units on a scale | Standard Deviation 1.1386 |
Percentage of Participants Who Achieved Erythrocyte Sedimentation Rate (ESR)-Based ACR20 Response at Week 2
Erythrocyte Sedimentation Rate (ESR)-based ACR 20 response: greater than or equal to (\>=) 20 percent (%) improvement from Baseline in tender (68 joints assessed) and swollen (66 joints assessed) joint counts and \>=20% improvement from Baseline in 3 of the following 5 assessments: 1- Participant's assessment of pain using Visual Analog Scale (VAS) (0 to 10 centimeters \[cm\]), 2- Participant's global assessment of disease activity using VAS (0 to 10 cm), 3- Physician's global assessment of disease activity using VAS (0 to 10 cm), 4- Participant's assessment of physical function as measured by the Disability Index of the Health Assessment Questionnaire (HAQ-DI) (score of 0-3 in 8 functional areas), 5- ESR.
Time frame: Within 2 weeks of initiating therapy
Population: Modified Intent To Treat (mITT) population included all enrolled participants who had Week 0 measurements and received at least 1 dose of study drug.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| OL Overall Group: Golimumab 50 mg SC + MTX | Percentage of Participants Who Achieved Erythrocyte Sedimentation Rate (ESR)-Based ACR20 Response at Week 2 | 24.5 percentage of participants |
Percentage of Participants Who Achieved Erythrocyte Sedimentation Rate (ESR)-Based ACR20 Response at Week 52 Relative to Week 16
Erythrocyte Sedimentation Rate (ESR)-based ACR 20 response: \>=20 % improvement from Week 16 in tender (68 joints assessed) and swollen (66 joints assessed) joint counts and \>=20% improvement from Week 16 in 3 of the following 5 assessments: 1- Participant's assessment of pain using VAS (0 to 10 cm), 2- Participant's global assessment of disease activity using VAS (0 to 10 cm), 3- Physician's global assessment of disease activity using VAS (0 to 10 cm), 4- Participant's assessment of physical function as measured by the Disability Index of the Health Assessment Questionnaire (HAQ-DI) (score of 0-3 in 8 functional areas), 5- ESR. Percentage of participants, who achieved ESR-based ACR 20 responses at Week 52 relative to Week 16, is reported.
Time frame: Week 52
Population: Double-blind modified Intent To Treat (mITT) population included participants who were randomized at Week 16 to SC or IV golimumab (Groups 2a and 2b) and received at least 1 dose of study drug after randomization.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| OL Overall Group: Golimumab 50 mg SC + MTX | Percentage of Participants Who Achieved Erythrocyte Sedimentation Rate (ESR)-Based ACR20 Response at Week 52 Relative to Week 16 | 13.2 percentage of participants |
| DB Group 2b: Golimumab 2 mg/kg IV & Placebo SC + MTX | Percentage of Participants Who Achieved Erythrocyte Sedimentation Rate (ESR)-Based ACR20 Response at Week 52 Relative to Week 16 | 9.2 percentage of participants |
Percentage of Participants Who Achieved Erythrocyte Sedimentation Rate (ESR)-Based Disease Activity Score (DAS28) Response at Week 16 and Maintained Response Through Week 52
Erythrocyte Sedimentation Rate (ESR)-based disease activity score for 28-joints count (DAS28) as defined by European League Against Rheumatism (EULAR), response criteria was used to assess individual response as none, moderate, or good, depending on the extent of change from Baseline and the level of disease activity reached. A participant was classified as having achieved a DAS28 good response if, DAS28 was less than or equal to (\<=) 3.2 at a given visit and improvement from Baseline was \>1.2. Percentage of participants, who achieved ESR-based DAS 28 good response at Week 16 and maintained that response through Week 52, is reported.
Time frame: Week 52
Population: Open-label modified Intent To Treat (mITT) population included all participants, who received at least 1 open-label golimumab 50 mg SC injection during the continued open-label/ double-blind treatment period.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| OL Overall Group: Golimumab 50 mg SC + MTX | Percentage of Participants Who Achieved Erythrocyte Sedimentation Rate (ESR)-Based Disease Activity Score (DAS28) Response at Week 16 and Maintained Response Through Week 52 | 22.7 percentage of participants |
Percentage of Participants Who Achieved ESR-based and C-Reactive Protein (CRP)-Based ACR20 Response at Week 76 Relative to Week 16
Erythrocyte Sedimentation Rate (ESR)-based/ C Reactive Protein (CRP)-based ACR 20 response: \>=20 % improvement from Week 16 in tender (68 joints assessed) and swollen (66 joints assessed) joint counts and \>=20% improvement from Week 16 in 3 of the following 5 assessments: 1- Participant's assessment of pain using VAS (0 to 10 cm), 2- Participant's global assessment of disease activity using VAS (0 to 10 cm), 3- Physician's global assessment of disease activity using VAS (0 to 10 cm), 4- Participant's assessment of physical function as measured by the Disability Index of the Health Assessment Questionnaire (HAQ-DI) (score of 0-3 in 8 functional areas), 5- ESR or CRP. Percentage of participants, who achieved ESR/ CRP-based ACR 20 responses at Week 76 relative to Week 16, is reported.
Time frame: Week 76
Population: Study extension mITT population included all participants, who were enrolled into the 24-week study extension period at Week 52, and received at least 1 golimumab SC injection during the study extension period. Participants reported in other groups are subgroups of 'Study Extension OL Group' by treatment received in the OL/DB phase (Weeks 16-52).
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| OL Overall Group: Golimumab 50 mg SC + MTX | Percentage of Participants Who Achieved ESR-based and C-Reactive Protein (CRP)-Based ACR20 Response at Week 76 Relative to Week 16 | ESR-based ACR 20 Response | 7.9 percentage of participants |
| OL Overall Group: Golimumab 50 mg SC + MTX | Percentage of Participants Who Achieved ESR-based and C-Reactive Protein (CRP)-Based ACR20 Response at Week 76 Relative to Week 16 | CRP-based ACR 20 Response | 7.9 percentage of participants |
| DB Group 2b: Golimumab 2 mg/kg IV & Placebo SC + MTX | Percentage of Participants Who Achieved ESR-based and C-Reactive Protein (CRP)-Based ACR20 Response at Week 76 Relative to Week 16 | CRP-based ACR 20 Response | 8.5 percentage of participants |
| DB Group 2b: Golimumab 2 mg/kg IV & Placebo SC + MTX | Percentage of Participants Who Achieved ESR-based and C-Reactive Protein (CRP)-Based ACR20 Response at Week 76 Relative to Week 16 | ESR-based ACR 20 Response | 8.5 percentage of participants |
| DB Group 2b: Golimumab 2 mg/kg IV & Placebo SC + MTX | Percentage of Participants Who Achieved ESR-based and C-Reactive Protein (CRP)-Based ACR20 Response at Week 76 Relative to Week 16 | ESR-based ACR 20 Response | 15.7 percentage of participants |
| DB Group 2b: Golimumab 2 mg/kg IV & Placebo SC + MTX | Percentage of Participants Who Achieved ESR-based and C-Reactive Protein (CRP)-Based ACR20 Response at Week 76 Relative to Week 16 | CRP-based ACR 20 Response | 17.6 percentage of participants |
| OL Study Extension Group: Golimumab 50 mg SC + MTX | Percentage of Participants Who Achieved ESR-based and C-Reactive Protein (CRP)-Based ACR20 Response at Week 76 Relative to Week 16 | ESR-based ACR 20 Response | 11.8 percentage of participants |
| OL Study Extension Group: Golimumab 50 mg SC + MTX | Percentage of Participants Who Achieved ESR-based and C-Reactive Protein (CRP)-Based ACR20 Response at Week 76 Relative to Week 16 | CRP-based ACR 20 Response | 12.7 percentage of participants |