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Methotrexate (Rheumatrex) High Dose Special Investigation (Regulatory Post Marketing Commitment Plan)

Rheumatrex High Dose Special Investigation (Regulatory Post Marketing Commitment Plan)

Status
Completed
Phases
Unknown
Study type
Observational
Source
ClinicalTrials.gov
Registry ID
NCT01414257
Enrollment
2860
Registered
2011-08-11
Start date
2011-05-31
Completion date
2014-03-31
Last updated
2018-08-06

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

Conditions

Arthritis, High Dose, Rheumatoid

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

DRUGMethotrexate (MTX)

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

Pfizer
Lead SponsorINDUSTRY

Study design

Observational model
CASE_ONLY
Time perspective
PROSPECTIVE

Eligibility

Sex/Gender
ALL
Age
17 Years to 99 Years
Healthy volunteers
No

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

MeasureTime frameDescription
Change From Baseline in Disease Activity Score (DAS28)-4CRPBaseline and 24 WeeksDisease 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)-4ESRBaseline and 24 WeeksDisease 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)-4CRPBaseline and 24 WeeksDisease 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)-4ESRBaseline and 24 WeeksDisease 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 Events24 WeeksA treatment-related adverse event was any untoward medical occurrence attributed to methotrexate in a participant who received methotrexate.

Secondary

MeasureTime frameDescription
Number of Participants With Treatment Related Pre-specified Important Serious Adverse Events24 WeeksPre-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 Rate24 WeeksClinical 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 Events24 WeeksA 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

ArmCount
Methotrexate2,838
Total2,838

Withdrawals & dropouts

PeriodReasonFG000
Overall StudyNo Visit After First Day of Treatment12
Overall StudyProtocol Violation10

Baseline characteristics

CharacteristicMethotrexate
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 typeEG000
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

Primary

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.

ArmMeasureValue (MEAN)Dispersion
MethotrexateChange From Baseline in Disease Activity Score (DAS28)-4CRP-0.89 ScoreStandard Deviation 1.117
Primary

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.

ArmMeasureValue (MEAN)Dispersion
MethotrexateChange From Baseline in Disease Activity Score (DAS28)-4ESR-0.88 ScoreStandard Deviation 1.156
Primary

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.

ArmMeasureGroupValue (MEAN)Dispersion
MethotrexateDisease Activity Score (DAS28)-4CRPAt Baseline3.55 ScoreStandard Deviation 1.148
MethotrexateDisease Activity Score (DAS28)-4CRPAt 24 Weeks2.66 ScoreStandard Deviation 1.076
Primary

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.

ArmMeasureGroupValue (MEAN)Dispersion
MethotrexateDisease Activity Score (DAS28)-4ESRAt Baseline4.09 ScoreStandard Deviation 1.235
MethotrexateDisease Activity Score (DAS28)-4ESRAt 24 Weeks3.21 ScoreStandard Deviation 1.235
Primary

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.

ArmMeasureValue (NUMBER)
MethotrexateNumber of Participants With Treatment-Related Adverse Events608 Participants
Secondary

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.

ArmMeasureValue (NUMBER)
MethotrexateClinical Efficacy Rate80.2 Percentage of Participants
Secondary

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.

ArmMeasureGroupValue (NUMBER)
MethotrexateNumber of Participants With Treatment Related Pre-specified Important Serious Adverse EventsInterstitial Pneumonia7 Participants
MethotrexateNumber of Participants With Treatment Related Pre-specified Important Serious Adverse EventsPulmonary Fibrosis0 Participants
MethotrexateNumber of Participants With Treatment Related Pre-specified Important Serious Adverse EventsHepatic Impairment1 Participants
MethotrexateNumber of Participants With Treatment Related Pre-specified Important Serious Adverse EventsRenal Impairment1 Participants
MethotrexateNumber of Participants With Treatment Related Pre-specified Important Serious Adverse EventsHematopoietic Disorder3 Participants
MethotrexateNumber of Participants With Treatment Related Pre-specified Important Serious Adverse EventsInfection28 Participants
MethotrexateNumber of Participants With Treatment Related Pre-specified Important Serious Adverse EventsLymphoma4 Participants
Secondary

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.

ArmMeasureValue (NUMBER)
MethotrexateNumber of Participants With Treatment-Related Serious Adverse Events47 Participants

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026