Arthritis, High Dose, Rheumatoid
Conditions
Keywords
Rheumatrex, High Dose
Brief summary
This Investigation is to be performed for the purpose of assessing the following information in the long-term post-marketing daily medical practice in the patients who receive REUMATOLEX 2 mg Capsule for the treatment of Rheumatoid Arthritis (RA) at the dose higher than 8 mg/week. 1. Condition of occurrence of ADRs 2. Factors considered to affect safety 3. Verification of efficacy
Detailed description
Implemented as a Special Investigation by Central Registration System
Interventions
Methotrexate should be administered at the weekly dose of 6 mg orally once a week or twice or three times a week by subdividing the weekly dose into the relevant number of portions. When administering the subdivided doses, MTX should be administered at the interval of 12 hours on Day 1 to Day 2. When the weekly dose is subdivided into two portions, suspend the administration for the remaining 6 days. When the weekly dose is subdivided into three portions, suspend the administration on the remaining 5 days. Repeat this weekly cycle. The dose should be adjusted as appropriate depending on the age, symptom, tolerability, and response to the MTX Preparation in individual patients. The weekly dose should not be higher than 16 mg.
Sponsors
Study design
Eligibility
Inclusion criteria
* Patients need to be administered Rheumatrex in order to be enrolled in the survey * Patients who receive the Rheumatrex at the dose higher than 8 mg/week for the treatment of Rheumatoid Arthritis
Exclusion criteria
* Patients who have been treated with Rheumatrex at the dose higher than 8 mg/week since the days when the high dose therapy for RA was not approved * Patients who have been treated MTX other than Rheumatrex administered Rheumatrex
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change From Baseline in Disease Activity Score (DAS28)-4CRP | Baseline and 24 Weeks | Disease activity score based on 28-joint count and C-reactive protein (4 variables) (DAS28-4 \[CRP\]) was calculated from swollen joint count (SJC) and tender joint count (TJC) using 28 joints count, C-reactive protein (CRP, mg/dL) and VAS of general health. Mean change from baseline in the DAS28-4 (CRP) at Week 24 is calculated. The total scale range can not be specified. |
| Disease Activity Score (DAS28)-4ESR | Baseline and 24 Weeks | Disease activity score based on 28-joint count and erythrocyte sedimentation rate (4 variables) (DAS28-4 \[ESR\]) was calculated from swollen joint count (SJC) and tender joint count (TJC) using 28 joints count, ESR (mm/hour) and visual analogue scale (VAS) of general health assessed by participant or investigator. Higher score indicated more disease activity. The total scale range of DAS28-4 (ESR) , minimum is 0.0 and maximum can not be specified. DAS28-4 (ESR) \>5.1 indicated high disease activity, ?3.2 to ?5.1 indicated moderate disease activity, \<3.2 indicated low disease activity, and \<2.6 indicated remission. |
| Disease Activity Score (DAS28)-4CRP | Baseline and 24 Weeks | Disease activity score based on 28-joint count and C-reactive protein (4 variables) (DAS28-4 \[CRP\]) was calculated from swollen joint count (SJC) and tender joint count (TJC) using 28 joints count, C-reactive protein (CRP, mg/dL) and VAS of general health. The total scale range of DAS28-4 (ESR) , minimum is 0.0 and maximum can not be specified. DAS28-4 (CRP) \>4.1 indicated high disease activity, ≥2.7 to 4.1 indicated moderate disease activity, \<2.7 indicated low disease activity, and \<2.3 indicated remission. |
| Change From Baseline in Disease Activity Score (DAS28)-4ESR | Baseline and 24 Weeks | Disease activity score based on 28-joint count and erythrocyte sedimentation rate (4 variables) (DAS28-4 \[ESR\]) was calculated from swollen joint count (SJC) and tender joint count (TJC) using 28 joints count, ESR (mm/hour) and visual analogue scale (VAS) of general health assessed by participant or investigator. Mean change from baseline in the DAS28-4 (ESR) at Week 24 is calculated. The total scale range can not be specified. |
| Number of Participants With Treatment-Related Adverse Events | 24 Weeks | A treatment-related adverse event was any untoward medical occurrence attributed to methotrexate in a participant who received methotrexate. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants With Treatment Related Pre-specified Important Serious Adverse Events | 24 Weeks | Pre-specified important adverse events were 1) Interstitial pneumonia, 2) Pulmonary fibrosis, 3) Hepatic impairment, 4) Renal impairment, 5) Hematopoietic disorder, 6) Infection, and 7) Lymphoma. A treatment-related adverse event was any untoward medical occurrence attributed to methotrexate in a participant who received methotrexate. A treatment-related serious adverse event was a treatment-related adverse event resulting in any of the following outcomes or deemed significant for any other reason: death; initial or prolonged inpatient hospitalization; lifethreatening experience (immediate risk of dying); persistent or significant disability/incapacity; congenital anomaly. Relatedness to methotrexate was assessed by the investigator. |
| Clinical Efficacy Rate | 24 Weeks | Clinical efficacy rate, which was defined as the percentage of participants who achieved clinical effectiveness over the total number of assesable effectiveness analysis population, was presented along with the corresponding 2-sided 95% CI. Clinical effectiveness of methotrexate was assessed as effective or ineffective by the investigator. The assessment was based on the baseline condition of disease control and degree of alleviation from baseline in clinical symptoms and laboratory data. |
| Number of Participants With Treatment-Related Serious Adverse Events | 24 Weeks | A treatment-related adverse event was any untoward medical occurrence attributed to methotrexate in a participant who received methotrexate. A treatment-related serious adverse event was a treatment-related adverse event resulting in any of the following outcomes or deemed significant for any other reason: death; initial or prolonged inpatient hospitalization; lifethreatening experience (immediate risk of dying); persistent or significant disability/incapacity; congenital anomaly. Relatedness to methotrexate was assessed by the investigator. |
Countries
Japan
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Methotrexate | 2,838 |
| Total | 2,838 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | No Visit After First Day of Treatment | 12 |
| Overall Study | Protocol Violation | 10 |
Baseline characteristics
| Characteristic | Methotrexate |
|---|---|
| Age, Customized ≥15 to <65 years | 2014 Participants |
| Age, Customized ≥65 years | 804 Participants |
| Age, Customized Unknown | 20 Participants |
| History of Methotrexate Therapy 0.5 to ˂1 year | 254 Participants |
| History of Methotrexate Therapy ˂0.5 year | 737 Participants |
| History of Methotrexate Therapy 1 to ˂3 years | 547 Participants |
| History of Methotrexate Therapy 3 to ˂5 years | 300 Participants |
| History of Methotrexate Therapy ≥5 years | 436 Participants |
| History of Methotrexate Therapy Not used Methotrexate Previously | 10 Participants |
| History of Methotrexate Therapy Unknown | 554 Participants |
| Morbidity Period 1 to ˂3 years | 512 Participants |
| Morbidity Period <1 year | 443 Participants |
| Morbidity Period 3 to ˂5 years | 313 Participants |
| Morbidity Period ≥5 years | 1148 Participants |
| Morbidity Period Unknown | 422 Participants |
| Sex/Gender, Customized Female | 2176 Participants |
| Sex/Gender, Customized Male | 659 Participants |
| Sex/Gender, Customized Unknown | 3 Participants |
| Steinbrocker Class Class 1 | 794 Participants |
| Steinbrocker Class Class 2 | 1641 Participants |
| Steinbrocker Class Class 3 | 301 Participants |
| Steinbrocker Class Class 4 | 16 Participants |
| Steinbrocker Class Unknown | 86 Participants |
| Steinbrocker Stage Stage III (Progressive) | 613 Participants |
| Steinbrocker Stage Stage II (Medium) | 948 Participants |
| Steinbrocker Stage Stage I (Initial) | 695 Participants |
| Steinbrocker Stage Stage IV (Terminal) | 524 Participants |
| Steinbrocker Stage Unknown | 58 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 340 / 2,838 |
| serious Total, serious adverse events | 69 / 2,838 |
Outcome results
Change From Baseline in Disease Activity Score (DAS28)-4CRP
Disease activity score based on 28-joint count and C-reactive protein (4 variables) (DAS28-4 \[CRP\]) was calculated from swollen joint count (SJC) and tender joint count (TJC) using 28 joints count, C-reactive protein (CRP, mg/dL) and VAS of general health. Mean change from baseline in the DAS28-4 (CRP) at Week 24 is calculated. The total scale range can not be specified.
Time frame: Baseline and 24 Weeks
Population: The effectiveness analysis set comprised of participants in the safety analysis set who had effectiveness evaluation (CRP) at least once. Participants with observed change in DAS28-4 (CRP) were included in table.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Methotrexate | Change From Baseline in Disease Activity Score (DAS28)-4CRP | -0.89 Score | Standard Deviation 1.117 |
Change From Baseline in Disease Activity Score (DAS28)-4ESR
Disease activity score based on 28-joint count and erythrocyte sedimentation rate (4 variables) (DAS28-4 \[ESR\]) was calculated from swollen joint count (SJC) and tender joint count (TJC) using 28 joints count, ESR (mm/hour) and visual analogue scale (VAS) of general health assessed by participant or investigator. Mean change from baseline in the DAS28-4 (ESR) at Week 24 is calculated. The total scale range can not be specified.
Time frame: Baseline and 24 Weeks
Population: The effectiveness analysis set comprised of participants in the safety analysis set who had effectiveness evaluation (ESR) at least once. Participants with observed change in DAS28-4(ESR) were included in table.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Methotrexate | Change From Baseline in Disease Activity Score (DAS28)-4ESR | -0.88 Score | Standard Deviation 1.156 |
Disease Activity Score (DAS28)-4CRP
Disease activity score based on 28-joint count and C-reactive protein (4 variables) (DAS28-4 \[CRP\]) was calculated from swollen joint count (SJC) and tender joint count (TJC) using 28 joints count, C-reactive protein (CRP, mg/dL) and VAS of general health. The total scale range of DAS28-4 (ESR) , minimum is 0.0 and maximum can not be specified. DAS28-4 (CRP) \>4.1 indicated high disease activity, ≥2.7 to 4.1 indicated moderate disease activity, \<2.7 indicated low disease activity, and \<2.3 indicated remission.
Time frame: Baseline and 24 Weeks
Population: The effectiveness analysis set comprised of participants in the safety analysis set who had effectiveness evaluation (CRP) at least once. Participants with observed DAS28-4(CRP) were included in table.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Methotrexate | Disease Activity Score (DAS28)-4CRP | At Baseline | 3.55 Score | Standard Deviation 1.148 |
| Methotrexate | Disease Activity Score (DAS28)-4CRP | At 24 Weeks | 2.66 Score | Standard Deviation 1.076 |
Disease Activity Score (DAS28)-4ESR
Disease activity score based on 28-joint count and erythrocyte sedimentation rate (4 variables) (DAS28-4 \[ESR\]) was calculated from swollen joint count (SJC) and tender joint count (TJC) using 28 joints count, ESR (mm/hour) and visual analogue scale (VAS) of general health assessed by participant or investigator. Higher score indicated more disease activity. The total scale range of DAS28-4 (ESR) , minimum is 0.0 and maximum can not be specified. DAS28-4 (ESR) \>5.1 indicated high disease activity, ?3.2 to ?5.1 indicated moderate disease activity, \<3.2 indicated low disease activity, and \<2.6 indicated remission.
Time frame: Baseline and 24 Weeks
Population: The effectiveness analysis set comprised of participants in the safety analysis set who had effectiveness evaluation (ESR) at least once. Participants with observed DAS28-4(ESR) were included in table.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Methotrexate | Disease Activity Score (DAS28)-4ESR | At Baseline | 4.09 Score | Standard Deviation 1.235 |
| Methotrexate | Disease Activity Score (DAS28)-4ESR | At 24 Weeks | 3.21 Score | Standard Deviation 1.235 |
Number of Participants With Treatment-Related Adverse Events
A treatment-related adverse event was any untoward medical occurrence attributed to methotrexate in a participant who received methotrexate.
Time frame: 24 Weeks
Population: The safety analysis set comprised of participants who satisfied the inclusion criteria and had received methotrexate at least once.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Methotrexate | Number of Participants With Treatment-Related Adverse Events | 608 Participants |
Clinical Efficacy Rate
Clinical efficacy rate, which was defined as the percentage of participants who achieved clinical effectiveness over the total number of assesable effectiveness analysis population, was presented along with the corresponding 2-sided 95% CI. Clinical effectiveness of methotrexate was assessed as effective or ineffective by the investigator. The assessment was based on the baseline condition of disease control and degree of alleviation from baseline in clinical symptoms and laboratory data.
Time frame: 24 Weeks
Population: The effectiveness analysis set comprised of participants in the safety analysis set who had effectiveness evaluation (clinical efficacy rate) at least once. Participants with observed effectiveness data were included in table.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Methotrexate | Clinical Efficacy Rate | 80.2 Percentage of Participants |
Number of Participants With Treatment Related Pre-specified Important Serious Adverse Events
Pre-specified important adverse events were 1) Interstitial pneumonia, 2) Pulmonary fibrosis, 3) Hepatic impairment, 4) Renal impairment, 5) Hematopoietic disorder, 6) Infection, and 7) Lymphoma. A treatment-related adverse event was any untoward medical occurrence attributed to methotrexate in a participant who received methotrexate. A treatment-related serious adverse event was a treatment-related adverse event resulting in any of the following outcomes or deemed significant for any other reason: death; initial or prolonged inpatient hospitalization; lifethreatening experience (immediate risk of dying); persistent or significant disability/incapacity; congenital anomaly. Relatedness to methotrexate was assessed by the investigator.
Time frame: 24 Weeks
Population: The safety analysis set comprised of participants who satisfied the inclusion criteria and had received methotrexate at least once.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Methotrexate | Number of Participants With Treatment Related Pre-specified Important Serious Adverse Events | Interstitial Pneumonia | 7 Participants |
| Methotrexate | Number of Participants With Treatment Related Pre-specified Important Serious Adverse Events | Pulmonary Fibrosis | 0 Participants |
| Methotrexate | Number of Participants With Treatment Related Pre-specified Important Serious Adverse Events | Hepatic Impairment | 1 Participants |
| Methotrexate | Number of Participants With Treatment Related Pre-specified Important Serious Adverse Events | Renal Impairment | 1 Participants |
| Methotrexate | Number of Participants With Treatment Related Pre-specified Important Serious Adverse Events | Hematopoietic Disorder | 3 Participants |
| Methotrexate | Number of Participants With Treatment Related Pre-specified Important Serious Adverse Events | Infection | 28 Participants |
| Methotrexate | Number of Participants With Treatment Related Pre-specified Important Serious Adverse Events | Lymphoma | 4 Participants |
Number of Participants With Treatment-Related Serious Adverse Events
A treatment-related adverse event was any untoward medical occurrence attributed to methotrexate in a participant who received methotrexate. A treatment-related serious adverse event was a treatment-related adverse event resulting in any of the following outcomes or deemed significant for any other reason: death; initial or prolonged inpatient hospitalization; lifethreatening experience (immediate risk of dying); persistent or significant disability/incapacity; congenital anomaly. Relatedness to methotrexate was assessed by the investigator.
Time frame: 24 Weeks
Population: The safety analysis set comprised of participants who satisfied the inclusion criteria and had received methotrexate at least once.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Methotrexate | Number of Participants With Treatment-Related Serious Adverse Events | 47 Participants |