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Golimumab in Rheumatoid Arthritis Participants With an Inadequate Response to Etanercept (ENBREL) or Adalimumab (HUMIRA)

A Golimumab Phase 3b, Multicenter, Switch Assessment of Subcutaneous and Intravenous Efficacy in Rheumatoid Arthritis Patients Who Have Inadequate Disease Control Despite Treatment With Etanercept (ENBREL) or Adalimumab (HUMIRA)

Status
Completed
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT01004432
Enrollment
433
Registered
2009-10-30
Start date
2009-12-31
Completion date
2013-10-31
Last updated
2015-04-30

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

Conditions

Arthritis, Arthritis, Rheumatoid, Autoimmune Diseases

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

DRUGGolimumab 50 mg SC

Golimumab 50 milligram (mg) subcutaneous (SC) injection every 4 weeks.

Golimumab 2 milligram per kilogram (mg/kg) intravenous infusion every 8 weeks.

DRUGMethotrexate (MTX)

Participants will continue taking their current Methotrexate (MTX) treatment regimen.

DRUGPlacebo SC

Placebo matched to golimumab SC injection every 4 weeks.

DRUGPlacebo IV

Placebo matched to golimumab intravenous infusion every 8 weeks.

Sponsors

Merck Sharp & Dohme LLC
CollaboratorINDUSTRY
Janssen Biotech, Inc.
Lead SponsorINDUSTRY

Study design

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

Eligibility

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

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

MeasureTime frameDescription
Percentage of Participants Achieving Erythrocyte Sedimentation Rate (ESR)-Based American College of Rheumatology [ACR] 20 Response at Week 14Week 14Erythrocyte 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

MeasureTime frameDescription
Percentage of Participants Who Achieved Erythrocyte Sedimentation Rate (ESR)-Based ACR20 Response at Week 2Within 2 weeks of initiating therapyErythrocyte 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 52Week 52Erythrocyte 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 16Week 52Erythrocyte 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 16Week 76Erythrocyte 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 52Week 52, 76Erythrocyte 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

ArmCount
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
Total433

Withdrawals & dropouts

PeriodReasonFG000FG001FG002FG003FG004
OL/Double-Blind (DB) Period (Week 16-52)Adverse Event01560
OL/Double-Blind (DB) Period (Week 16-52)Death00010
OL/Double-Blind (DB) Period (Week 16-52)Lack of Efficacy0224370
OL/Double-Blind (DB) Period (Week 16-52)Lost to Follow-up03130
OL/Double-Blind (DB) Period (Week 16-52)Protocol Violation03340
OL/Double-Blind (DB) Period (Week 16-52)Withdrawal by Subject01470
OL Study Extension (Week 52 - 76)Adverse Event00002
OL Study Extension (Week 52 - 76)Lack of Efficacy000010
OL Study Extension (Week 52 - 76)Protocol Violation00004
OL Study Extension (Week 52 - 76)Withdrawal by Subject00002
Open-label (OL) Period (Week 0 - 16)Adverse Event200000
Open-label (OL) Period (Week 0 - 16)Lack of Efficacy150000
Open-label (OL) Period (Week 0 - 16)Lost to Follow-up20000
Open-label (OL) Period (Week 0 - 16)Protocol Violation290000
Open-label (OL) Period (Week 0 - 16)Withdrawal by Subject170000

Baseline characteristics

CharacteristicOL Overall Group: Golimumab 50 mg SC + MTX
Age, Continuous55.7 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 typeEG000
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 / 43321 / 7530 / 9154 / 18461 / 212
serious
Total, serious adverse events
20 / 4332 / 754 / 9110 / 18410 / 212

Outcome results

Primary

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.

ArmMeasureValue (NUMBER)
OL Overall Group: Golimumab 50 mg SC + MTXPercentage of Participants Achieving Erythrocyte Sedimentation Rate (ESR)-Based American College of Rheumatology [ACR] 20 Response at Week 1434.9 percentage of participants
Comparison: null hypothesis: proportion \<=0.2p-value: <0.000195% CI: [30.4, 39.4]Chi-squared
Secondary

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).

ArmMeasureGroupValue (MEAN)Dispersion
OL Overall Group: Golimumab 50 mg SC + MTXChange in ESR-based DAS28 Score at Week 76 Relative to Week 52Week 52 (n = 61, 40, 95, 196)3.182 units on a scaleStandard Deviation 1.1109
OL Overall Group: Golimumab 50 mg SC + MTXChange in ESR-based DAS28 Score at Week 76 Relative to Week 52Change at Week 76 (n = 57, 33, 84, 174)-0.136 units on a scaleStandard Deviation 1.2095
DB Group 2b: Golimumab 2 mg/kg IV & Placebo SC + MTXChange in ESR-based DAS28 Score at Week 76 Relative to Week 52Change at Week 76 (n = 57, 33, 84, 174)0.209 units on a scaleStandard Deviation 1.2253
DB Group 2b: Golimumab 2 mg/kg IV & Placebo SC + MTXChange in ESR-based DAS28 Score at Week 76 Relative to Week 52Week 52 (n = 61, 40, 95, 196)4.070 units on a scaleStandard Deviation 0.8037
DB Group 2b: Golimumab 2 mg/kg IV & Placebo SC + MTXChange in ESR-based DAS28 Score at Week 76 Relative to Week 52Week 52 (n = 61, 40, 95, 196)4.394 units on a scaleStandard Deviation 1.2389
DB Group 2b: Golimumab 2 mg/kg IV & Placebo SC + MTXChange in ESR-based DAS28 Score at Week 76 Relative to Week 52Change at Week 76 (n = 57, 33, 84, 174)-0.017 units on a scaleStandard Deviation 1.0518
OL Study Extension Group: Golimumab 50 mg SC + MTXChange in ESR-based DAS28 Score at Week 76 Relative to Week 52Week 52 (n = 61, 40, 95, 196)3.950 units on a scaleStandard Deviation 1.2379
OL Study Extension Group: Golimumab 50 mg SC + MTXChange in ESR-based DAS28 Score at Week 76 Relative to Week 52Change at Week 76 (n = 57, 33, 84, 174)-0.013 units on a scaleStandard Deviation 1.1386
Secondary

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.

ArmMeasureValue (NUMBER)
OL Overall Group: Golimumab 50 mg SC + MTXPercentage of Participants Who Achieved Erythrocyte Sedimentation Rate (ESR)-Based ACR20 Response at Week 224.5 percentage of participants
Secondary

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.

ArmMeasureValue (NUMBER)
OL Overall Group: Golimumab 50 mg SC + MTXPercentage of Participants Who Achieved Erythrocyte Sedimentation Rate (ESR)-Based ACR20 Response at Week 52 Relative to Week 1613.2 percentage of participants
DB Group 2b: Golimumab 2 mg/kg IV & Placebo SC + MTXPercentage of Participants Who Achieved Erythrocyte Sedimentation Rate (ESR)-Based ACR20 Response at Week 52 Relative to Week 169.2 percentage of participants
Secondary

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.

ArmMeasureValue (NUMBER)
OL Overall Group: Golimumab 50 mg SC + MTXPercentage of Participants Who Achieved Erythrocyte Sedimentation Rate (ESR)-Based Disease Activity Score (DAS28) Response at Week 16 and Maintained Response Through Week 5222.7 percentage of participants
Secondary

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).

ArmMeasureGroupValue (NUMBER)
OL Overall Group: Golimumab 50 mg SC + MTXPercentage of Participants Who Achieved ESR-based and C-Reactive Protein (CRP)-Based ACR20 Response at Week 76 Relative to Week 16ESR-based ACR 20 Response7.9 percentage of participants
OL Overall Group: Golimumab 50 mg SC + MTXPercentage of Participants Who Achieved ESR-based and C-Reactive Protein (CRP)-Based ACR20 Response at Week 76 Relative to Week 16CRP-based ACR 20 Response7.9 percentage of participants
DB Group 2b: Golimumab 2 mg/kg IV & Placebo SC + MTXPercentage of Participants Who Achieved ESR-based and C-Reactive Protein (CRP)-Based ACR20 Response at Week 76 Relative to Week 16CRP-based ACR 20 Response8.5 percentage of participants
DB Group 2b: Golimumab 2 mg/kg IV & Placebo SC + MTXPercentage of Participants Who Achieved ESR-based and C-Reactive Protein (CRP)-Based ACR20 Response at Week 76 Relative to Week 16ESR-based ACR 20 Response8.5 percentage of participants
DB Group 2b: Golimumab 2 mg/kg IV & Placebo SC + MTXPercentage of Participants Who Achieved ESR-based and C-Reactive Protein (CRP)-Based ACR20 Response at Week 76 Relative to Week 16ESR-based ACR 20 Response15.7 percentage of participants
DB Group 2b: Golimumab 2 mg/kg IV & Placebo SC + MTXPercentage of Participants Who Achieved ESR-based and C-Reactive Protein (CRP)-Based ACR20 Response at Week 76 Relative to Week 16CRP-based ACR 20 Response17.6 percentage of participants
OL Study Extension Group: Golimumab 50 mg SC + MTXPercentage of Participants Who Achieved ESR-based and C-Reactive Protein (CRP)-Based ACR20 Response at Week 76 Relative to Week 16ESR-based ACR 20 Response11.8 percentage of participants
OL Study Extension Group: Golimumab 50 mg SC + MTXPercentage of Participants Who Achieved ESR-based and C-Reactive Protein (CRP)-Based ACR20 Response at Week 76 Relative to Week 16CRP-based ACR 20 Response12.7 percentage of participants

Source: ClinicalTrials.gov · Data processed: Feb 28, 2026