Arthritis, Psoriatic
Conditions
Brief summary
The purpose of this study is to characterize the safety, efficacy and dose response of BMS-945429 in subjects with active Psoriatic Arthritis and an inadequate response to Nonsteroidal anti-inflammatory drugs (NSAIDs) and non-biologic Disease modifying anti-rheumatic drugs (DMARDs).
Interventions
Injection, Subcutaneous, 0 mg, every 4 weeks, Short term:24 weeks, Long term: After 24 Wk, selected dose, open-label
Injection, Subcutaneous, 25 mg, every 4 weeks, Short term:24 weeks, Long term: After 24 Wk, selected dose, open-label
Sponsors
Study design
Eligibility
Inclusion criteria
* Must be on a stable background Methotrexate (MTX) therapy prior to Day1/Randomization. Subjects must have taken MTX for at least 3 months at a dose ≥ 15 mg/week to a maximum weekly dose of ≤ 25 mg/week, and be at a stable dose for 4 weeks prior to randomization (Day 1). Methotrexate dose ≥ 15 mg/week that was not efficacious and that was decreased due to toxicity as low as 10 mg/week is allowed * Inadequate response to NSAID and/or non-biologic DMARD * Minimum of 3 swollen and 3 tender joints * Active psoriatic skin lesions over minimum 3% body surface area * high sensitivity C-reactive protein (hsCRP) ≥ 0.3 mg/dL
Exclusion criteria
* Previously received or currently receiving concomitant biologic therapy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percent of Participants Achieving American College of Rheumatology Criteria 20% Response Rate (ACR20) | At 16 weeks | The ACR20/50/70 is a composite measure defined as both improvement of 20%, 50% or 70% in the number of tender and number of swollen joints, and a 20%, 50% or 70% improvement in three of the following five criteria: patient global assessment, physician global assessment, functional ability measure \[most often Health Assessment Questionnaire (HAQ)\], visual analog pain scale, and erythrocyte sedimentation rate or C-reactive protein (CRP). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percent of Participants Achieving ACR50 and ACR70 Response Rate | Week 16 and Week 24 | The ACR20/50/70 is a composite measure defined as both improvement of 20%, 50% or 70% in the number of tender and number of swollen joints, and a 20%, 50% or 70% improvement in three of the following five criteria: patient global assessment, physician global assessment, functional ability measure \[most often Health Assessment Questionnaire (HAQ)\], visual analog pain scale, and erythrocyte sedimentation rate or C-reactive protein (CRP). |
| Percent of Participants Achieving ACR20 Response Rate at Week 24 | Week 24 | The ACR20/50/70 is a composite measure defined as both improvement of 20%, 50% or 70% in the number of tender and number of swollen joints, and a 20%, 50% or 70% improvement in three of the following five criteria: patient global assessment, physician global assessment, functional ability measure \[most often Health Assessment Questionnaire (HAQ)\], visual analog pain scale, and erythrocyte sedimentation rate or C-reactive protein (CRP). |
| Percent of Participants Achieving a Health Assessment Questionnaire (HAQ) Response | Weeks 16 and Week 24 | For each item, there is a four-level difficulty scale that is scored from 0 to 3, representing normal (no difficulty) (0), some difficulty (1), much difficulty (2), and unable to do (3). There are 20 questions in eight categories of functioning - dressing, rising, eating, walking, hygiene, reach, grip, and usual activities. The highest component score in each category determines the score for the category, unless aids or devices are required. Dependence on equipment or physical assistance increases a lower score to the level of 2 to more accurately represent underlying disability. The eight category scores are averaged into an overall HAQ score on a scale from zero (no disability) to three (completely disabled). The scale is not truly continuous but has 25 possible values (i.e., 0, 0.125, 0.250, 0.375 … 3). Response is measured by a reduction of at least 0.3 unit from baseline in HAQ index. |
| Percent of Participants Achieving Psoriasis Area Severity Index (PASI) 75 Response Rate | Week 16 and Week 24 | To calculate the PASI score, the psoriasis plaques found on each body region are graded for their combined redness, thickness, and scaliness. The severity of the plaques in each region is graded on a 0 to 4 scale, with 0 meaning no involvement and 4 meaning severe involvement. Next, the amount of surface area on each body region that is covered by the plaques is calculated. The total surface area affected by psoriasis is graded from 0 to 6, with 0 meaning no involvement and 6 meaning greater than 90 percent of the region covered in plaques. These grades are then fed into an equation to determine the patient's PASI score. The PASI score then is used as a clinical assessment of the patient's psoriasis involvement. A person free of psoriasis has a score of 0 and the score could be as high as 72. PASI 75 means that the person's PASI score dropped by 75 percent as a result of the psoriasis treatment. |
| Mean Change From Baseline at Week 24 in SF-36 Scores | Baseline and Week 24 | The SF-36 questionnaire consists of eight scales yielding two summary measures: physical and mental health. The physical health measure includes four scales of physical functioning (10 items), role-physical (4 items), bodily pain (2 items), and general health (5 items). The mental health measure is composed of vitality (4 items), social functioning (2 items), role-emotional (3 items), and mental health (5 items). To score the SF-36, scales are standardized with a scoring algorithm to obtain a score ranging from 0 to 100. Higher scores indicate better health status. |
| Number of Participants With Anti-clazakizumab Antibodies | Up to 24 weeks | — |
| Mean Change From Baseline at Week 16 in Short Form (36) [SF-36] Scores | Baseline and Week 16 | The SF-36 questionnaire consists of eight scales yielding two summary measures: physical and mental health. The physical health measure includes four scales of physical functioning (10 items), role-physical (4 items), bodily pain (2 items), and general health (5 items). The mental health measure is composed of vitality (4 items), social functioning (2 items), role-emotional (3 items), and mental health (5 items). To score the SF-36, scales are standardized with a scoring algorithm to obtain a score ranging from 0 to 100. Higher scores indicate better health status. |
Countries
Argentina, Australia, Canada, Czechia, Germany, Hungary, Italy, Mexico, Poland, Russia, South Africa, Spain, United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Placebo Subcutaneous, every 4 weeks for 24 weeks | 41 |
| Clazakizumab (25mg) Subcutaneous, 25 mg, every 4 weeks, for 24 weeks | 41 |
| Clazakizumab (100mg) Subcutaneous, 100 mg, every 4 weeks, for 24 weeks | 42 |
| Clazakizumab (200mg) Subcutaneous, 200 mg, every 4 weeks, for 24 weeks | 41 |
| Total | 165 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 | FG003 |
|---|---|---|---|---|---|
| Period 1 | Adverse Event | 0 | 0 | 0 | 5 |
| Period 1 | Lack of Efficacy | 2 | 0 | 3 | 0 |
| Period 1 | No longer met study criteria | 0 | 1 | 1 | 0 |
| Period 1 | Request to discontinue treatment | 1 | 0 | 0 | 0 |
| Period 1 | Withdrawal by Subject | 0 | 0 | 0 | 3 |
| Period 2 | Adverse Event | 1 | 1 | 0 | 1 |
| Period 2 | Lack of Efficacy | 0 | 0 | 0 | 1 |
| Period 2 | Lost to Follow-up | 0 | 0 | 0 | 2 |
| Period 2 | Withdrawal by Subject | 1 | 0 | 0 | 0 |
Baseline characteristics
| Characteristic | Placebo | Clazakizumab (25mg) | Clazakizumab (100mg) | Clazakizumab (200mg) | Total |
|---|---|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 3 Participants | 7 Participants | 2 Participants | 1 Participants | 13 Participants |
| Age, Categorical Between 18 and 65 years | 38 Participants | 34 Participants | 40 Participants | 40 Participants | 152 Participants |
| Age, Continuous | 48.0 years STANDARD_DEVIATION 10.53 | 49.8 years STANDARD_DEVIATION 14.05 | 49.3 years STANDARD_DEVIATION 10.84 | 44.7 years STANDARD_DEVIATION 13.75 | 47.9 years STANDARD_DEVIATION 12.43 |
| Sex: Female, Male Female | 23 Participants | 23 Participants | 20 Participants | 20 Participants | 86 Participants |
| Sex: Female, Male Male | 18 Participants | 18 Participants | 22 Participants | 21 Participants | 79 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk |
|---|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 41 | 0 / 41 | 0 / 42 | 0 / 41 |
| other Total, other adverse events | 19 / 41 | 22 / 41 | 20 / 42 | 27 / 41 |
| serious Total, serious adverse events | 2 / 41 | 2 / 41 | 2 / 42 | 4 / 41 |
Outcome results
Percent of Participants Achieving American College of Rheumatology Criteria 20% Response Rate (ACR20)
The ACR20/50/70 is a composite measure defined as both improvement of 20%, 50% or 70% in the number of tender and number of swollen joints, and a 20%, 50% or 70% improvement in three of the following five criteria: patient global assessment, physician global assessment, functional ability measure \[most often Health Assessment Questionnaire (HAQ)\], visual analog pain scale, and erythrocyte sedimentation rate or C-reactive protein (CRP).
Time frame: At 16 weeks
Population: Modified Intent-to-Treat (MITT) defined as all randomized subjects that received at least one dose of the study medication.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo | Percent of Participants Achieving American College of Rheumatology Criteria 20% Response Rate (ACR20) | 29.3 percentage of participants |
| Clazakizumab (25mg) | Percent of Participants Achieving American College of Rheumatology Criteria 20% Response Rate (ACR20) | 46.3 percentage of participants |
| Clazakizumab (100mg) | Percent of Participants Achieving American College of Rheumatology Criteria 20% Response Rate (ACR20) | 52.4 percentage of participants |
| Clazakizumab (200mg) | Percent of Participants Achieving American College of Rheumatology Criteria 20% Response Rate (ACR20) | 39.0 percentage of participants |
Mean Change From Baseline at Week 16 in Short Form (36) [SF-36] Scores
The SF-36 questionnaire consists of eight scales yielding two summary measures: physical and mental health. The physical health measure includes four scales of physical functioning (10 items), role-physical (4 items), bodily pain (2 items), and general health (5 items). The mental health measure is composed of vitality (4 items), social functioning (2 items), role-emotional (3 items), and mental health (5 items). To score the SF-36, scales are standardized with a scoring algorithm to obtain a score ranging from 0 to 100. Higher scores indicate better health status.
Time frame: Baseline and Week 16
Population: MITT
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Placebo | Mean Change From Baseline at Week 16 in Short Form (36) [SF-36] Scores | Mental component | 1.4 score on a scale | Standard Error 1.507 |
| Placebo | Mean Change From Baseline at Week 16 in Short Form (36) [SF-36] Scores | Physical component | 4.4 score on a scale | Standard Error 1.236 |
| Clazakizumab (25mg) | Mean Change From Baseline at Week 16 in Short Form (36) [SF-36] Scores | Physical component | 6.5 score on a scale | Standard Error 1.236 |
| Clazakizumab (25mg) | Mean Change From Baseline at Week 16 in Short Form (36) [SF-36] Scores | Mental component | 1.2 score on a scale | Standard Error 1.502 |
| Clazakizumab (100mg) | Mean Change From Baseline at Week 16 in Short Form (36) [SF-36] Scores | Mental component | 3.7 score on a scale | Standard Error 1.478 |
| Clazakizumab (100mg) | Mean Change From Baseline at Week 16 in Short Form (36) [SF-36] Scores | Physical component | 4.6 score on a scale | Standard Error 1.217 |
| Clazakizumab (200mg) | Mean Change From Baseline at Week 16 in Short Form (36) [SF-36] Scores | Mental component | 1.1 score on a scale | Standard Error 1.516 |
| Clazakizumab (200mg) | Mean Change From Baseline at Week 16 in Short Form (36) [SF-36] Scores | Physical component | 4.1 score on a scale | Standard Error 1.248 |
Mean Change From Baseline at Week 24 in SF-36 Scores
The SF-36 questionnaire consists of eight scales yielding two summary measures: physical and mental health. The physical health measure includes four scales of physical functioning (10 items), role-physical (4 items), bodily pain (2 items), and general health (5 items). The mental health measure is composed of vitality (4 items), social functioning (2 items), role-emotional (3 items), and mental health (5 items). To score the SF-36, scales are standardized with a scoring algorithm to obtain a score ranging from 0 to 100. Higher scores indicate better health status.
Time frame: Baseline and Week 24
Population: MITT
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Placebo | Mean Change From Baseline at Week 24 in SF-36 Scores | Mental component | 3.6 score on a scale | Standard Error 1.646 |
| Placebo | Mean Change From Baseline at Week 24 in SF-36 Scores | Physical component | 4.9 score on a scale | Standard Error 1.42 |
| Clazakizumab (25mg) | Mean Change From Baseline at Week 24 in SF-36 Scores | Physical component | 8.2 score on a scale | Standard Error 1.36 |
| Clazakizumab (25mg) | Mean Change From Baseline at Week 24 in SF-36 Scores | Mental component | 1.4 score on a scale | Standard Error 1.538 |
| Clazakizumab (100mg) | Mean Change From Baseline at Week 24 in SF-36 Scores | Mental component | 3.9 score on a scale | Standard Error 1.548 |
| Clazakizumab (100mg) | Mean Change From Baseline at Week 24 in SF-36 Scores | Physical component | 5.7 score on a scale | Standard Error 1.363 |
| Clazakizumab (200mg) | Mean Change From Baseline at Week 24 in SF-36 Scores | Mental component | 2.1 score on a scale | Standard Error 1.689 |
| Clazakizumab (200mg) | Mean Change From Baseline at Week 24 in SF-36 Scores | Physical component | 6.4 score on a scale | Standard Error 1.461 |
Number of Participants With Anti-clazakizumab Antibodies
Time frame: Up to 24 weeks
Population: MITT
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo | Number of Participants With Anti-clazakizumab Antibodies | 1 participants |
| Clazakizumab (25mg) | Number of Participants With Anti-clazakizumab Antibodies | 0 participants |
| Clazakizumab (100mg) | Number of Participants With Anti-clazakizumab Antibodies | 1 participants |
Percent of Participants Achieving ACR20 Response Rate at Week 24
The ACR20/50/70 is a composite measure defined as both improvement of 20%, 50% or 70% in the number of tender and number of swollen joints, and a 20%, 50% or 70% improvement in three of the following five criteria: patient global assessment, physician global assessment, functional ability measure \[most often Health Assessment Questionnaire (HAQ)\], visual analog pain scale, and erythrocyte sedimentation rate or C-reactive protein (CRP).
Time frame: Week 24
Population: MITT
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo | Percent of Participants Achieving ACR20 Response Rate at Week 24 | 34.1 percentage of participants |
| Clazakizumab (25mg) | Percent of Participants Achieving ACR20 Response Rate at Week 24 | 56.1 percentage of participants |
| Clazakizumab (100mg) | Percent of Participants Achieving ACR20 Response Rate at Week 24 | 57.1 percentage of participants |
| Clazakizumab (200mg) | Percent of Participants Achieving ACR20 Response Rate at Week 24 | 39.0 percentage of participants |
Percent of Participants Achieving ACR50 and ACR70 Response Rate
The ACR20/50/70 is a composite measure defined as both improvement of 20%, 50% or 70% in the number of tender and number of swollen joints, and a 20%, 50% or 70% improvement in three of the following five criteria: patient global assessment, physician global assessment, functional ability measure \[most often Health Assessment Questionnaire (HAQ)\], visual analog pain scale, and erythrocyte sedimentation rate or C-reactive protein (CRP).
Time frame: Week 16 and Week 24
Population: MITT
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Placebo | Percent of Participants Achieving ACR50 and ACR70 Response Rate | ACR50 (16 weeks) | 7.3 percentage of participants |
| Placebo | Percent of Participants Achieving ACR50 and ACR70 Response Rate | ACR50 (24 weeks) | 14.6 percentage of participants |
| Placebo | Percent of Participants Achieving ACR50 and ACR70 Response Rate | ACR70 (16 weeks) | 2.4 percentage of participants |
| Placebo | Percent of Participants Achieving ACR50 and ACR70 Response Rate | ACR70 (24 weeks) | 4.9 percentage of participants |
| Clazakizumab (25mg) | Percent of Participants Achieving ACR50 and ACR70 Response Rate | ACR50 (24 weeks) | 34.1 percentage of participants |
| Clazakizumab (25mg) | Percent of Participants Achieving ACR50 and ACR70 Response Rate | ACR70 (16 weeks) | 17.1 percentage of participants |
| Clazakizumab (25mg) | Percent of Participants Achieving ACR50 and ACR70 Response Rate | ACR70 (24 weeks) | 19.5 percentage of participants |
| Clazakizumab (25mg) | Percent of Participants Achieving ACR50 and ACR70 Response Rate | ACR50 (16 weeks) | 29.3 percentage of participants |
| Clazakizumab (100mg) | Percent of Participants Achieving ACR50 and ACR70 Response Rate | ACR70 (16 weeks) | 14.3 percentage of participants |
| Clazakizumab (100mg) | Percent of Participants Achieving ACR50 and ACR70 Response Rate | ACR50 (24 weeks) | 35.7 percentage of participants |
| Clazakizumab (100mg) | Percent of Participants Achieving ACR50 and ACR70 Response Rate | ACR70 (24 weeks) | 23.8 percentage of participants |
| Clazakizumab (100mg) | Percent of Participants Achieving ACR50 and ACR70 Response Rate | ACR50 (16 weeks) | 35.7 percentage of participants |
| Clazakizumab (200mg) | Percent of Participants Achieving ACR50 and ACR70 Response Rate | ACR70 (24 weeks) | 12.2 percentage of participants |
| Clazakizumab (200mg) | Percent of Participants Achieving ACR50 and ACR70 Response Rate | ACR50 (24 weeks) | 24.4 percentage of participants |
| Clazakizumab (200mg) | Percent of Participants Achieving ACR50 and ACR70 Response Rate | ACR50 (16 weeks) | 17.1 percentage of participants |
| Clazakizumab (200mg) | Percent of Participants Achieving ACR50 and ACR70 Response Rate | ACR70 (16 weeks) | 4.9 percentage of participants |
Percent of Participants Achieving a Health Assessment Questionnaire (HAQ) Response
For each item, there is a four-level difficulty scale that is scored from 0 to 3, representing normal (no difficulty) (0), some difficulty (1), much difficulty (2), and unable to do (3). There are 20 questions in eight categories of functioning - dressing, rising, eating, walking, hygiene, reach, grip, and usual activities. The highest component score in each category determines the score for the category, unless aids or devices are required. Dependence on equipment or physical assistance increases a lower score to the level of 2 to more accurately represent underlying disability. The eight category scores are averaged into an overall HAQ score on a scale from zero (no disability) to three (completely disabled). The scale is not truly continuous but has 25 possible values (i.e., 0, 0.125, 0.250, 0.375 … 3). Response is measured by a reduction of at least 0.3 unit from baseline in HAQ index.
Time frame: Weeks 16 and Week 24
Population: MITT
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Placebo | Percent of Participants Achieving a Health Assessment Questionnaire (HAQ) Response | week 16 | 36.6 percentage of participants |
| Placebo | Percent of Participants Achieving a Health Assessment Questionnaire (HAQ) Response | week 24 | 26.8 percentage of participants |
| Clazakizumab (25mg) | Percent of Participants Achieving a Health Assessment Questionnaire (HAQ) Response | week 24 | 51.2 percentage of participants |
| Clazakizumab (25mg) | Percent of Participants Achieving a Health Assessment Questionnaire (HAQ) Response | week 16 | 48.8 percentage of participants |
| Clazakizumab (100mg) | Percent of Participants Achieving a Health Assessment Questionnaire (HAQ) Response | week 16 | 45.2 percentage of participants |
| Clazakizumab (100mg) | Percent of Participants Achieving a Health Assessment Questionnaire (HAQ) Response | week 24 | 47.6 percentage of participants |
| Clazakizumab (200mg) | Percent of Participants Achieving a Health Assessment Questionnaire (HAQ) Response | week 16 | 39.0 percentage of participants |
| Clazakizumab (200mg) | Percent of Participants Achieving a Health Assessment Questionnaire (HAQ) Response | week 24 | 36.6 percentage of participants |
Percent of Participants Achieving Psoriasis Area Severity Index (PASI) 75 Response Rate
To calculate the PASI score, the psoriasis plaques found on each body region are graded for their combined redness, thickness, and scaliness. The severity of the plaques in each region is graded on a 0 to 4 scale, with 0 meaning no involvement and 4 meaning severe involvement. Next, the amount of surface area on each body region that is covered by the plaques is calculated. The total surface area affected by psoriasis is graded from 0 to 6, with 0 meaning no involvement and 6 meaning greater than 90 percent of the region covered in plaques. These grades are then fed into an equation to determine the patient's PASI score. The PASI score then is used as a clinical assessment of the patient's psoriasis involvement. A person free of psoriasis has a score of 0 and the score could be as high as 72. PASI 75 means that the person's PASI score dropped by 75 percent as a result of the psoriasis treatment.
Time frame: Week 16 and Week 24
Population: MITT
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Placebo | Percent of Participants Achieving Psoriasis Area Severity Index (PASI) 75 Response Rate | week 16 | 14.6 percentage of participants |
| Placebo | Percent of Participants Achieving Psoriasis Area Severity Index (PASI) 75 Response Rate | week 24 | 12.2 percentage of participants |
| Clazakizumab (25mg) | Percent of Participants Achieving Psoriasis Area Severity Index (PASI) 75 Response Rate | week 24 | 19.5 percentage of participants |
| Clazakizumab (25mg) | Percent of Participants Achieving Psoriasis Area Severity Index (PASI) 75 Response Rate | week 16 | 12.2 percentage of participants |
| Clazakizumab (100mg) | Percent of Participants Achieving Psoriasis Area Severity Index (PASI) 75 Response Rate | week 16 | 16.7 percentage of participants |
| Clazakizumab (100mg) | Percent of Participants Achieving Psoriasis Area Severity Index (PASI) 75 Response Rate | week 24 | 28.6 percentage of participants |
| Clazakizumab (200mg) | Percent of Participants Achieving Psoriasis Area Severity Index (PASI) 75 Response Rate | week 16 | 4.9 percentage of participants |
| Clazakizumab (200mg) | Percent of Participants Achieving Psoriasis Area Severity Index (PASI) 75 Response Rate | week 24 | 12.2 percentage of participants |