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Efficacy and Safety of Subcutaneous Abatacept in Adults With Active Psoriatic Arthritis

A Phase 3 Randomized Placebo-Controlled Study to Evaluate the Efficacy and Safety of Abatacept Subcutaneous Injection in Adults With Active Psoriatic Arthritis

Status
Completed
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT01860976
Acronym
ASTRAEA
Enrollment
489
Registered
2013-05-23
Start date
2013-06-17
Completion date
2020-06-30
Last updated
2022-04-05

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

Conditions

Psoriatic Arthritis

Brief summary

The purpose of this study is to compare subcutaneous Abatacept to placebo in the treatment of psoriatic arthritis

Detailed description

ASTRAEA=Active PSoriaTic ARthritis RAndomizEd TriAl

Interventions

DRUGAbatacept
DRUGPlacebo

Sponsors

Bristol-Myers Squibb
Lead SponsorINDUSTRY

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
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

For more information regarding BMS clinical trial participation, please visit www.BMSStudyConnect.com Inclusion Criteria: * Subjects at least 18 years of age who have a diagnosis of PsA by Classification Criteria for Psoriatic Arthritis (CASPAR) * Subjects have active PsA as shown by a minimum of ≥3 swollen joints and ≥3 tender joints (66/68 joint counts) at screening and randomization/Day 1 (prior to study drug administration). At least one of the swollen joints must be in the digit of the hand or foot * Subjects with at least one confirmed ≥2 cm target lesion of plaque psoriasis in a region of the body that can be evaluated excluding the axilla, genitals, groin, palms, and soles * Subjects must have had an inadequate response or intolerance to at least one non-biologic disease-modifying anti-rheumatic drug (DMARD) * Subjects may have been exposed to TNFi therapy. Subjects may have discontinued for any reason (inadequate response, intolerance or other) * Subjects may enroll on certain concomitant non-biologic DMARDs (Methotrexate, Leflunomide, Sulfasalazine, or Hydroxychloroquine) provided the medication has been used for at least 3 months with a stable dose for at least 28 days prior to randomization (Day 1) * If using oral corticosteroids (≤10 mg mg/day Prednisone equivalent), dose must be stable ≥14 days prior to randomization (Day 1) * Subjects may enroll on systemic retinoids (eg: Acitretin) provided the medication has been used for at least 3 months with a stable dose for at least 28 days prior to randomization (Day 1)

Exclusion criteria

* Subjects with guttate, pustular, or erythrodermic psoriasis * Subjects who have had prior exposure to Abatacept (CTLA 4Ig) or other CTLA4 therapies * Subjects who have been exposed to any investigational drug within 4 weeks or 5 half lives, whichever is longer * Female subjects who had a breast cancer screening study that is suspicious for malignancy, and in whom the possibility of malignancy cannot be reasonably excluded following additional clinical, laboratory or other diagnostic evaluations * Subjects with a history of cancer within the last 5 years (other than non-melanoma skin cell cancers cured by local resection). Existing non-melanoma skin cell cancers must be removed prior to dosing. Subjects with carcinoma in situ, treated with definitive surgical intervention prior to study enrollment are allowed * Subjects with any bacterial infection within the last 60 days prior to screening (enrollment), unless treated and resolved with antibiotics, or any chronic bacterial infection (such as chronic pyelonephritis, osteomyelitis and bronchiectasis) * Subjects at risk for tuberculosis (TB). Specifically, subjects with: * Current clinical, radiographic or laboratory evidence of active TB * A history of active TB within the last 3 years even if it was treated * A history of active TB greater than 3 years ago unless there is documentation that the prior anti-TB treatment was appropriate in duration and type * Latent TB which was not successfully treated * Subjects with a positive TB screening test indicative of latent TB will not be eligible for the study unless they have no evidence of current TB on chest x-ray at screening and they are actively being treated for TB with isoniazid (INH) or other therapy for latent TB given according to local health authority guidelines (eg: Center for Disease Control). Treatment must have been given for at least 4 weeks prior to randomization (Day 1). These subjects should complete treatment according to local health authority guidelines * Subjects with herpes zoster that resolved less than 2 months prior to enrollment * Subjects with evidence (as measured by the investigator) of active or latent bacterial, active viral, or serious latent viral infections at the time of enrollment, including subjects with evidence of Immunodeficiency Virus (HIV) infection * Subjects who are not currently treated with a non-biologic DMARD and have clinical or radiographic evidence of arthritis mutilans (eg: digital telescoping or pencil-in-cup radiographic changes) * Subjects who have failed more than 2 TNFi due to inefficacy defined as inadequate response after 3 months treatment at a therapeutic dose * Subjects who have received TNFi therapy within 4 weeks for etanercept or within 8 weeks for adalimumab, certolizumab, infliximab, or golimumab * Subjects who have received prior use of apremilast within 4 weeks, ustekinumab within 20 weeks or briakinumab within 8 weeks * Subjects who have discontinued a non-biologic DMARD or systemic retinoid within four weeks or five half-lives, whichever is longer, prior to randomization (Day 1) * Use of any of the following within 28 days or five half lives whichever is longer prior to randomization (Day 1): Cyclosporine A, oral Tacrolimus, Mycophenolate Mofetil (MMF), Hydroxyurea, Fumaric Acid Esters, Paclitaxel, 6-Thioguanine, 6-Mercatopurine, or Tofacitinib

Design outcomes

Primary

MeasureTime frameDescription
Proportion of ACR 20 Responders at Day 169Day 169The American College of Rheumatology (ACR) 20 definition of improvement is a 20% improvement over baseline in tender and swollen joint counts and a 20% improvement in 3 of the 5 remaining core data set measures (participant global assessment of pain, participant global assessment of disease activity, physician global assessment of disease activity, participant assessment of physical function, acute phase reactant value). The number of ACR 20 responders was divided by the number of treated participants and expressed as a percentage. Early escape participants, and participants with missing data at day 169 were imputed as non-responders.

Secondary

MeasureTime frameDescription
Proportion of ACR 20 Responders at Day 169 in the TNFi-naïve SubpopulationDay 169The ACR 20 definition of improvement is a 20% improvement over baseline in tender and swollen joint counts and a 20% in 3 of the 5 remaining core data set measures (participant global assessment of pain, participant global assessment of disease activity, physician global assessment of disease activity, participant assessment of physical function, acute phase reactant value). The number of ACR 20 responders was divided by the number of treated, TNFi-naive participants and expressed as a percentage. Early escape participants, and participants with missing data at day 169 were imputed as non-responders.
Proportion of ACR 20 Responders at Day 169 in the TNFi-exposed SubpopulationDay 169The ACR 20 definition of improvement is a 20% improvement over baseline in tender and swollen joint counts and a 20% in 3 of the 5 remaining core data set measures (participant global assessment of pain, participant global assessment of disease activity, physician global assessment of disease activity, participant assessment of physical function, acute phase reactant value). The number of ACR 20 responders was divided by the number of treated, TNFi-exposed participants and expressed as a percentage. Early escape participants, and participants with missing data at day 169 were imputed as non-responders.
Proportion of Non-progressors in Total PsA-modified SHS at Day 169Baseline to Day 169The number of radiographic non-progressors in total PsA-Modified Sharp van der Heijde score (SHS) at Day 169 was divided by the number of treated participants and expressed as a percentage. Non-progression was defined as a change from baseline in total PsA modified SHS ≤0. Early escape participants, and participants with missing data at day 169 were imputed as non-progressors.
Proportion of Participants Achieving a PASI 50 at Day 169 in Participants With Baseline BSA >= 3%Baseline to Day 169The number of participants who achieved at least 50% improvement from baseline in Psoriasis Area and Severity Index Arthritis (PASI 50) at Day 169 was divided by the number of treated participants with BSA \>= 3% and expressed as a percentage. Only participants with \>= 3% body surface area (BSA) of psoriatic skin involvement at randomization were included in this analysis.
Proportions of ACR 50 and ACR 70 Responders at Day 169Day 169The ACR 50 and ACR 70 definition of improvement is a 50% or 70% improvement, respectively, over baseline in tender and swollen joint counts and a 50% or 70% improvement in 3 of the 5 remaining core data set measures (participant global assessment of pain, participant global assessment of disease activity, physician global assessment of disease activity, participant assessment of physical function, acute phase reactant value). The number of ACR 50 and ACR 70 responders was divided by the number of treated participants and expressed as a percentage. Early escape participants, and participants with missing data at day 169 were imputed as non-responders.
Mean Change From Baseline in SF-36 Physical and Mental Components at Day 169Baseline to Day 169Adjusted mean change in scores on the Short Form 36 physical and mental function assessment (SF-36) from baseline were analyzed from the physical component summary (PCS) mental component summary (MCS). The SF-36 is a participant questionnaire assessing 8 domains of health status: physical functioning, pain, vitality, social functioning, psychological functioning, general health perception, and role limitations due to physical and emotional problems. The instrument can be divided into two summary scores, physical and mental component score. The scores range from 0 to 100, with a higher score indicating better quality of life. The two summary scores (PCS and MCS) will be calculated by taking a weighted linear combination of the 8 individual subscales.
Proportion of Health Assessment Questionnaire (HAQ) Responders at Day 169Baseline to Day 169Participants were considered responders if their HAQ score decreased at least 0.35 from baseline. The number of HAQ responders was divided by the number of treated participants and expressed as a percentage. Scoring conventions are based on the Standard Disability Index of HAQ/HAQ-DI using the 20 response items. For each of the 8 disability categories there is an aids/devices companion variable that is used to record the type of assistance, if any, a participant uses for his/her usual activities. If either aids/devices and/or assistance from another person are checked for a disability category, the score for this category is set to 2 (much difficulty), if the original score was 0 (no difficulty) or 1 (some difficulty). The HAQ-DI is then calculated by summing the adjusted categories scores and dividing by the number of categories answered. Early escape participants, and participants with missing data at day 169 were imputed as non-responders.
Proportion of Participants With AEs at Day 169Day 169Proportion of participants with AEs at Day 169
Proportion of Participants With SAEs at Day 169Day 169Proportion of participants with SAEs at Day 169
Proportion of Participants With AEs Leading to Discontinuation at Day 169Day 169Proportion of participants with AEs leading to discontinuation at Day 169
Proportion of Participant Deaths at Day 169Day 169Proportion of participant deaths at Day 169
Proportion of Participants With Marked Laboratory Abnormalities at Day 169Day 169Proportion of participants with marked laboratory abnormalities at Day 169
Proportion of Participants With at Least One Positive Immunogenicity Response up to Day 169 Relative to BaselineBaseline to Day 169Blood samples were collected at Days 1, 85 and 169 and assayed for the presence of abatacept-specific antibodies. The number of participants with at least one positive immunogenicity response was divided by the number of treated participants and expressed as a percentage.

Countries

Argentina, Brazil, Canada, Chile, Colombia, Czechia, France, Germany, Greece, Israel, Italy, Mexico, Peru, Poland, South Africa, Spain, United States

Participant flow

Pre-assignment details

424 were Randomized and Treated

Participants by arm

ArmCount
Abatacept
Abatacept 125mg, self-administered subcutaneously, once weekly
213
Placebo
Placebo, self-administered subcutaneously, once weekly.
211
Total424

Withdrawals & dropouts

PeriodReasonFG000FG001
Blinded TreatmentAdverse Event13
Blinded TreatmentEarly Escape: Transitioned to OL period7689
Blinded TreatmentEntered Open-Label in error01
Blinded TreatmentLack of Efficacy512
Blinded TreatmentSubject no longer met criteria10
Blinded TreatmentSubject request to discontinue treatment23
Blinded TreatmentWithdrawal by Subject35
Long Term ExtensionAdverse Event40
Long Term ExtensionLack of Efficacy20
Long Term ExtensionLost to Follow-up20
Long Term ExtensionSubject request to discontinue treatment100
Long Term Extensionsubject withdrew consent70
Open-LabelAdverse Event24
Open-LabelLack of Efficacy168
Open-LabelLost to Follow-up12
Open-LabelOther Reasons11
Open-LabelSubject request discontinue treatment43
Open-LabelWithdrawal by Subject41

Baseline characteristics

CharacteristicPlaceboTotalAbatacept
Age, Continuous49.8 years
STANDARD_DEVIATION 11.26
50.4 years
STANDARD_DEVIATION 10.97
51.0 years
STANDARD_DEVIATION 10.67
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Asian
1 Participants1 Participants0 Participants
Race (NIH/OMB)
Black or African American
0 Participants0 Participants0 Participants
Race (NIH/OMB)
More than one race
11 Participants29 Participants18 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Unknown or Not Reported
1 Participants1 Participants0 Participants
Race (NIH/OMB)
White
198 Participants393 Participants195 Participants
Sex: Female, Male
Female
112 Participants233 Participants121 Participants
Sex: Female, Male
Male
99 Participants191 Participants92 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
0 / 2130 / 2110 / 3820 / 3220 / 106
other
Total, other adverse events
39 / 21343 / 21192 / 382103 / 32256 / 106
serious
Total, serious adverse events
6 / 2139 / 21129 / 38220 / 32217 / 106

Outcome results

Primary

Proportion of ACR 20 Responders at Day 169

The American College of Rheumatology (ACR) 20 definition of improvement is a 20% improvement over baseline in tender and swollen joint counts and a 20% improvement in 3 of the 5 remaining core data set measures (participant global assessment of pain, participant global assessment of disease activity, physician global assessment of disease activity, participant assessment of physical function, acute phase reactant value). The number of ACR 20 responders was divided by the number of treated participants and expressed as a percentage. Early escape participants, and participants with missing data at day 169 were imputed as non-responders.

Time frame: Day 169

Population: All treated participants

ArmMeasureValue (NUMBER)
AbataceptProportion of ACR 20 Responders at Day 16939.4 Percentage of participants
PlaceboProportion of ACR 20 Responders at Day 16922.3 Percentage of participants
p-value: <0.00195% CI: [8.7, 25.6]Cochran-Mantel-Haenszel
Secondary

Mean Change From Baseline in SF-36 Physical and Mental Components at Day 169

Adjusted mean change in scores on the Short Form 36 physical and mental function assessment (SF-36) from baseline were analyzed from the physical component summary (PCS) mental component summary (MCS). The SF-36 is a participant questionnaire assessing 8 domains of health status: physical functioning, pain, vitality, social functioning, psychological functioning, general health perception, and role limitations due to physical and emotional problems. The instrument can be divided into two summary scores, physical and mental component score. The scores range from 0 to 100, with a higher score indicating better quality of life. The two summary scores (PCS and MCS) will be calculated by taking a weighted linear combination of the 8 individual subscales.

Time frame: Baseline to Day 169

Population: All treated participants

ArmMeasureGroupValue (MEAN)Dispersion
AbataceptMean Change From Baseline in SF-36 Physical and Mental Components at Day 169PCS5.11 SF-36 pointsStandard Error 0.637
AbataceptMean Change From Baseline in SF-36 Physical and Mental Components at Day 169MCS2.56 SF-36 pointsStandard Error 0.826
PlaceboMean Change From Baseline in SF-36 Physical and Mental Components at Day 169PCS3.69 SF-36 pointsStandard Error 0.707
PlaceboMean Change From Baseline in SF-36 Physical and Mental Components at Day 169MCS2.62 SF-36 pointsStandard Error 0.924
Secondary

Proportion of ACR 20 Responders at Day 169 in the TNFi-exposed Subpopulation

The ACR 20 definition of improvement is a 20% improvement over baseline in tender and swollen joint counts and a 20% in 3 of the 5 remaining core data set measures (participant global assessment of pain, participant global assessment of disease activity, physician global assessment of disease activity, participant assessment of physical function, acute phase reactant value). The number of ACR 20 responders was divided by the number of treated, TNFi-exposed participants and expressed as a percentage. Early escape participants, and participants with missing data at day 169 were imputed as non-responders.

Time frame: Day 169

Population: All treated TNFi-exposed participants

ArmMeasureValue (NUMBER)
AbataceptProportion of ACR 20 Responders at Day 169 in the TNFi-exposed Subpopulation36.4 Percentage of participants
PlaceboProportion of ACR 20 Responders at Day 169 in the TNFi-exposed Subpopulation22.3 Percentage of participants
Secondary

Proportion of ACR 20 Responders at Day 169 in the TNFi-naïve Subpopulation

The ACR 20 definition of improvement is a 20% improvement over baseline in tender and swollen joint counts and a 20% in 3 of the 5 remaining core data set measures (participant global assessment of pain, participant global assessment of disease activity, physician global assessment of disease activity, participant assessment of physical function, acute phase reactant value). The number of ACR 20 responders was divided by the number of treated, TNFi-naive participants and expressed as a percentage. Early escape participants, and participants with missing data at day 169 were imputed as non-responders.

Time frame: Day 169

Population: All treated TNFi-naïve participants

ArmMeasureValue (NUMBER)
AbataceptProportion of ACR 20 Responders at Day 169 in the TNFi-naïve Subpopulation44.0 Percentage of participants
PlaceboProportion of ACR 20 Responders at Day 169 in the TNFi-naïve Subpopulation22.2 Percentage of participants
Secondary

Proportion of Health Assessment Questionnaire (HAQ) Responders at Day 169

Participants were considered responders if their HAQ score decreased at least 0.35 from baseline. The number of HAQ responders was divided by the number of treated participants and expressed as a percentage. Scoring conventions are based on the Standard Disability Index of HAQ/HAQ-DI using the 20 response items. For each of the 8 disability categories there is an aids/devices companion variable that is used to record the type of assistance, if any, a participant uses for his/her usual activities. If either aids/devices and/or assistance from another person are checked for a disability category, the score for this category is set to 2 (much difficulty), if the original score was 0 (no difficulty) or 1 (some difficulty). The HAQ-DI is then calculated by summing the adjusted categories scores and dividing by the number of categories answered. Early escape participants, and participants with missing data at day 169 were imputed as non-responders.

Time frame: Baseline to Day 169

Population: All treated participants

ArmMeasureValue (NUMBER)
AbataceptProportion of Health Assessment Questionnaire (HAQ) Responders at Day 16931.0 percentage of participants
PlaceboProportion of Health Assessment Questionnaire (HAQ) Responders at Day 16923.7 percentage of participants
Secondary

Proportion of Non-progressors in Total PsA-modified SHS at Day 169

The number of radiographic non-progressors in total PsA-Modified Sharp van der Heijde score (SHS) at Day 169 was divided by the number of treated participants and expressed as a percentage. Non-progression was defined as a change from baseline in total PsA modified SHS ≤0. Early escape participants, and participants with missing data at day 169 were imputed as non-progressors.

Time frame: Baseline to Day 169

Population: All treated participants

ArmMeasureValue (NUMBER)
AbataceptProportion of Non-progressors in Total PsA-modified SHS at Day 16942.7 Percentage of participants
PlaceboProportion of Non-progressors in Total PsA-modified SHS at Day 16932.7 Percentage of participants
Secondary

Proportion of Participant Deaths at Day 169

Proportion of participant deaths at Day 169

Time frame: Day 169

Population: All Treated Participants

ArmMeasureValue (NUMBER)
AbataceptProportion of Participant Deaths at Day 1690 Percentage of participants
PlaceboProportion of Participant Deaths at Day 1690 Percentage of participants
Secondary

Proportion of Participants Achieving a PASI 50 at Day 169 in Participants With Baseline BSA >= 3%

The number of participants who achieved at least 50% improvement from baseline in Psoriasis Area and Severity Index Arthritis (PASI 50) at Day 169 was divided by the number of treated participants with BSA \>= 3% and expressed as a percentage. Only participants with \>= 3% body surface area (BSA) of psoriatic skin involvement at randomization were included in this analysis.

Time frame: Baseline to Day 169

Population: All treated participants with \>= 3% BSA of psoriatic skin involvement at randomization

ArmMeasureValue (NUMBER)
AbataceptProportion of Participants Achieving a PASI 50 at Day 169 in Participants With Baseline BSA >= 3%26.7 Percentage of participants
PlaceboProportion of Participants Achieving a PASI 50 at Day 169 in Participants With Baseline BSA >= 3%19.6 Percentage of participants
Secondary

Proportion of Participants With AEs at Day 169

Proportion of participants with AEs at Day 169

Time frame: Day 169

Population: All Treated Participants

ArmMeasureValue (NUMBER)
AbataceptProportion of Participants With AEs at Day 16954.5 Percentage of participants
PlaceboProportion of Participants With AEs at Day 16953.1 Percentage of participants
Secondary

Proportion of Participants With AEs Leading to Discontinuation at Day 169

Proportion of participants with AEs leading to discontinuation at Day 169

Time frame: Day 169

Population: All Treated Participants

ArmMeasureValue (NUMBER)
AbataceptProportion of Participants With AEs Leading to Discontinuation at Day 1691.4 Percentage of participants
PlaceboProportion of Participants With AEs Leading to Discontinuation at Day 1691.9 Percentage of participants
Secondary

Proportion of Participants With at Least One Positive Immunogenicity Response up to Day 169 Relative to Baseline

Blood samples were collected at Days 1, 85 and 169 and assayed for the presence of abatacept-specific antibodies. The number of participants with at least one positive immunogenicity response was divided by the number of treated participants and expressed as a percentage.

Time frame: Baseline to Day 169

Population: All treated participants

ArmMeasureValue (NUMBER)
AbataceptProportion of Participants With at Least One Positive Immunogenicity Response up to Day 169 Relative to Baseline3.9 Percentage of participants
PlaceboProportion of Participants With at Least One Positive Immunogenicity Response up to Day 169 Relative to Baseline8.6 Percentage of participants
Secondary

Proportion of Participants With Marked Laboratory Abnormalities at Day 169

Proportion of participants with marked laboratory abnormalities at Day 169

Time frame: Day 169

Population: All Treated Participants

ArmMeasureValue (NUMBER)
AbataceptProportion of Participants With Marked Laboratory Abnormalities at Day 1693.2 Percentage of participants
PlaceboProportion of Participants With Marked Laboratory Abnormalities at Day 1695.4 Percentage of participants
Secondary

Proportion of Participants With SAEs at Day 169

Proportion of participants with SAEs at Day 169

Time frame: Day 169

Population: All Treated Participants

ArmMeasureValue (NUMBER)
AbataceptProportion of Participants With SAEs at Day 1692.8 Percentage of participants
PlaceboProportion of Participants With SAEs at Day 1694.3 Percentage of participants
Secondary

Proportions of ACR 50 and ACR 70 Responders at Day 169

The ACR 50 and ACR 70 definition of improvement is a 50% or 70% improvement, respectively, over baseline in tender and swollen joint counts and a 50% or 70% improvement in 3 of the 5 remaining core data set measures (participant global assessment of pain, participant global assessment of disease activity, physician global assessment of disease activity, participant assessment of physical function, acute phase reactant value). The number of ACR 50 and ACR 70 responders was divided by the number of treated participants and expressed as a percentage. Early escape participants, and participants with missing data at day 169 were imputed as non-responders.

Time frame: Day 169

Population: All treated participants

ArmMeasureGroupValue (NUMBER)
AbataceptProportions of ACR 50 and ACR 70 Responders at Day 169ACR 5019.2 Percentage of participants
AbataceptProportions of ACR 50 and ACR 70 Responders at Day 169ACR 7010.3 Percentage of participants
PlaceboProportions of ACR 50 and ACR 70 Responders at Day 169ACR 5012.3 Percentage of participants
PlaceboProportions of ACR 50 and ACR 70 Responders at Day 169ACR 706.6 Percentage of participants

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