Juvenile Idiopathic Arthritis
Conditions
Brief summary
This Phase IV, multicenter, single-arm, open-label study will evaluate the efficacy and safety of tocilizumab in Chinese participants with sJIA with persistent activity and an inadequate response to non-steroidal anti-inflammatory drugs (NSAIDs) and steroid therapy.
Interventions
DRUGTocilizumab
Tocilizumab will be administered as per the schedule specified in the arm description.
DRUGNSAIDs
Participants may receive NSAIDs up to the maximum recommended stable daily dose. Study protocol does not enforce any particular NSAID.
DRUGCSs
Participants may receive CSs at a stable dose of 30 milligrams per day (mg/day) or 0.5 milligrams per kilogram per day (mg/kg/day), whichever is less. Study protocol does not enforce any particular CS.
DRUGMTX
Participants may receive MTX at a stable dose of less than or equal to (\</=) 20 milligrams per square meter (mg/m\^2).
Sponsors
Hoffmann-La Roche
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
2 Years to 17 Years
Healthy volunteers
No
Inclusion criteria
* Participants meeting International League of Associations for Rheumatology (ILAR) classification for sJIA * Greater than (\>) 6 months of documented persistent sJIA activity prior to screening * Active disease * hsCRP \>4.3 milligrams per liter (mg/L) or 0.43 milligrams per deciliter (mg/dL) * Participant who has recovered from any symptomatic serositis for at least 30 days prior to the screening visit, and requires a dose of CSs at baseline of \</=30 mg/day or \</=0.5 mg/kg/day, whichever is less * Participants meeting one of the following: Participant who is not receiving MTX or discontinued MTX \>/=4 weeks prior to baseline visit; participant who has been taking MTX \>/=12 weeks immediately prior to the baseline visit and on a stable dose of \</=20 mg/m\^2 for \>/=8 weeks prior to the baseline visit, together with either folic acid or folinic acid according to local standard of care * Participant who was never treated with biologics or, if was previously treated with biologics, discontinued etanercept (or Yisaipu, Qiangke, or Anbainuo) \>/=2 weeks, infliximab or adalimumab \>/=8 weeks, anakinra \>/=1 week, or abatacept \>/=12 weeks prior to the baseline visit * Participant who is not currently receiving oral CSs, or is taking oral CSs at a stable dose for \>/=2 weeks prior to the baseline visit at \</=30 mg/day or \</=0.5 mg/kg/day, whichever is less * Participant who is not taking NSAIDs, or taking \</=1 type of NSAID at a stable dose for \>/=2 weeks prior to the baseline visit and is less than or equal to the maximum recommended daily dose
Exclusion criteria
* Wheelchair bound or bedridden participant * Any other autoimmune, rheumatic disease, or overlap syndrome other than sJIA * Participant who is not fully recovered from recent surgery or \<6 weeks since surgery at the time of screening visit; or planned surgery during the initial 12 weeks of the study * Lack of peripheral venous access * Any significant concurrent medical or surgical condition that would jeopardize the participant's safety or ability to complete the trial * Evidence of serious uncontrolled concomitant diseases * Asthma for which the participant has required the use of oral or parenteral CSs for \>/=2 weeks within 6 months prior to the baseline visit * Known human immunodeficiency (HIV) infection or other acquired forms of immune compromise or congenital conditions characterized by a compromised immune system * Any active acute, subacute, chronic, or recurrent bacterial, mycobacterial, viral, or systemic fungal infection or opportunistic infection * Any major episode of infection requiring hospitalization or treatment during screening, treatment with IV antibiotics completing within 4 weeks of the screening visit, or oral antibiotics completing within 2 weeks of the screening visit * History of atypical tuberculosis (TB) * Active TB requiring treatment within 2 years prior to screening visit * Positive purified protein derivative (PPD) or T-spot test (interferon-gamma \[IFN-γ\]-based test) at screen * Positive for latent TB * History of reactivation or new onset of a systemic infection such as herpes zoster or Epstein-Barr virus (EBV) within 2 months of the screening visit * Hepatitis B surface antigen (Ag)- or hepatitis C antibody (Ab)-positive * History of macrophage activation syndrome (MAS) within 3 months prior to the screening visit * Evidence of active malignant disease or diagnosed malignancies * Uncontrolled diabetes mellitus * Previous treatment with tocilizumab * Intra-articular, intramuscular, IV, or long-acting CSs administration within 28 days prior to the baseline visit * Treatment with non-biologic disease-modifying antirheumatic drugs (DMARDs; other than MTX) within 6 weeks prior to the baseline visit * Treatment with leflunomide that was not followed by standardized cholestyramine washout and documented to be below the limit of detection prior to the baseline visit * Treatment with cyclophosphamide, etoposide (VP16) and statins within 90 days prior to the baseline visit * Treatment with growth hormone and androgens within 4 weeks prior to the baseline visit * Administration of IV immunoglobulin within 28 days prior to the baseline visit * Treatment with any cell-depleting therapies * Stem cell transplant at any time * Participant who has received live or attenuated vaccines within 4 weeks prior to the baseline visit, or intending to receive while on study drug or 3 months following the last dose of study drug
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Percentage of Participants Achieving Juvenile Idiopathic Arthritis (JIA) American College of Rheumatology (ACR) 30 (JIA ACR30) Response With Absence of Fever, at Week 12 | Week 12 |
Secondary
| Measure | Time frame |
|---|---|
| Percentage of Participants Achieving JIA ACR30 Response With Absence of Fever, at Week 52 | Week 52 |
| Percentage of Participants With 30 Percent (%), 50%, 70%, and 90% Improvement From Baseline in JIA Core Set Parameters | Baseline, Weeks 12, 24, and 52 |
| Percentage of Participants With Inactive Disease Assessed According to Criteria for Inactive Disease and Clinical Remission of sJIA (Wallace et. al. 2011 Criteria) | Weeks 24 and 52 |
| Percentage of Participants With Clinical Remission Assessed According to Criteria for Inactive Disease and Clinical Remission of sJIA (Wallace et. al. 2011 Criteria) | Week 52 |
| Percentage of Participants With an Elevated High-Sensitivity C-Reactive Protein (hsCRP) Levels at Baseline Who Have Normal hsCRP Levels at Weeks 12, 24, and 52 | Baseline, Weeks 12, 24, and 52 |
| Mean Glucocorticoid Dose | Baseline up to Week 52 |
| Mean Methotrexate (MTX) Dose | Baseline up to Week 52 |
| Change From Baseline in Glucocorticoid Dose | From Baseline to Week 52 |
| Change From Baseline in MTX Dose | From Baseline to Week 52 |
| Pain Visual Analog Scale (VAS) Score | Baseline, Weeks 4, 8, 12, 16, 20, 24, 28, 32, 36, 40, 44, 48, and 52 |
| Change From Baseline in Pain VAS Score | Baseline, Weeks 4, 8, 12, 16, 20, 24, 28, 32, 36, 40, 44, 48, and 52 |
| Percentage of Participants Who Discontinue Permitted Concomitant Medication for sJIA | Baseline up to Week 52 |
| Percentage of Participants With Adverse Events (AEs) | Baseline up to end of study (up to Week 60) |
Countries
China
Outcome results
None listed