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A Ph II/III Seamless, Multi-center, Randomized, Double-blind, Placebo-controlled Study of the Reduction in Signs and Symptoms and Inhibition of Structural Damage During Treatment With Tocilizumab Versus Placebo in Patients With Ankylosing Spondylitis Who Have Failed Non-steroidal Anti-inflammatory Drugs and Are naïve to TNF Antagonist Therapy NSAIDs


Phase 3
18 Years
N/A
Not Enrolling
Both
Spondylitis, Ankylosing

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Trial Information

A Ph II/III Seamless, Multi-center, Randomized, Double-blind, Placebo-controlled Study of the Reduction in Signs and Symptoms and Inhibition of Structural Damage During Treatment With Tocilizumab Versus Placebo in Patients With Ankylosing Spondylitis Who Have Failed Non-steroidal Anti-inflammatory Drugs and Are naïve to TNF Antagonist Therapy NSAIDs


This study was planned as a Phase II/III seamless, multicenter, randomized, double-blind,
placebo-controlled study in patients with AS who were naïve to TNF antagonist therapy. The
study consisted of 2 parts, each preceded by a screening visit and followed by a common
open-label extension phase. Recruitment into Part 2 commenced after completion of enrollment
for Part 1.

Part 1 was designed as a Phase II study exploring the efficacy and safety of tocilizumab
therapy versus placebo. Part 1 was intended to determine whether Part 2 of the study would
continue, based on a Week 12 analysis.

Part 2 was designed to provide pivotal Phase III efficacy and safety data for tocilizumab in
patients with AS. Approximately 400 patients were to be enrolled. Once randomization into
Part 1 was complete, randomization into Part 2 of the study was to be initiated.

Based on the results of the Week 12 Part 1 analyses of the primary endpoint (ASAS20) and
secondary endpoints, and in consideration of all available safety data, a benefit/risk
assessment was made and it was decided to halt the study because of lack of overall
efficacy. Most patients did not complete the 24-week double-blind treatment period in Part
2.

Inclusion Criteria


Inclusion Criteria

- Adult patients, ≥ 18 years of age

- Ankylosing Spondylitis as defined by the modified New York criteria for ≥ 3 months
prior to baseline

- Active disease at screening and baseline (Bath Ankylosing Spondylitis Disease
Activity Index [BASDAI] ≥4.0, spinal pain visual analog scale [VAS] ≥40)

- Inadequate response or intolerant to 1 or more previous non-steroidal
anti-inflammatory drugs (NSAIDs)

- Traditional disease-modifying anti-rheumatic drugs (DMARDs) must be withdrawn for at
least 4 weeks prior to baseline (methotrexate, sulfasalazine and hydroxychloroquine
or chloroquine may be allowed if at stable dose for at least 4 weeks prior to
baseline)

- Oral corticosteroids (≥ 10 mg/day prednisone or equivalent) and NSAIDs/COX-2
inhibitors must be at stable dose for at least 4 weeks prior to baseline

Exclusion Criteria:

- Major surgery (including joint surgery) within 8 weeks prior to screening or planned
major surgery within 6 months after randomization

- Total ankylosis of spine (as determined by investigator)

- Inflammatory rheumatic disease other than ankylosing spondylitis

- Active, acute uveitis at baseline

- Treatment with tumor necrosis factor (TNF) antagonist therapy at any time prior to
baseline

- Intra-articular or tendon injections or parenteral corticosteroids within 4 weeks
prior to screening

- History of severe allergic or anaphylactic reactions to humanized or murine
monoclonal antibodies

- Active current or history of recurrent bacterial, viral, fungal, mycobacterial or
other infection

- History of or currently active primary or secondary immunodeficiency

- Body weight > 150 kg

Type of Study:

Interventional

Study Design:

Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Investigator), Primary Purpose: Treatment

Outcome Measure:

Part 1: Percentage of Participants Achieving a 20% Improvement in Assessment in Ankylosing Spondylitis (ASAS20) at Week 12

Outcome Description:

ASAS is composed of four domains. To achieve an ASAS20 response required improvement of ≥20% and ≥ 1 unit (10 mm) in at least 3 domains and no worsening of ≥ 20 % and ≥ 1 unit (10 mm) in the remaining domain. The patient's global assessment of current disease status, measured on a 100 mm visual analog scale (VAS), from symptom-free / no AS symptoms (0) to maximum AS disease severity (100). The patient's overall assessment of the severity of spinal pain based on responses to 2 questions assessed on a 100 mm VAS, from no pain (0) to most severe pain (100). The spinal pain score is the mean of these 2 questions. The function component was measured by the Bath Ankylosing Spondylitis Functional Index (BASFI). The patient provides self-assessment of 10 questions on a 100 mm VAS. The BASFI score is the mean of these values. The inflammation component of the ASAS was determined by the mean of questions 5 and 6 of the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI).

Outcome Time Frame:

Baseline and Week 12

Safety Issue:

No

Principal Investigator

Clinical Trials

Investigator Role:

Study Director

Investigator Affiliation:

Hoffmann-La Roche

Authority:

United States: Food and Drug Administration

Study ID:

NA22823

NCT ID:

NCT01209702

Start Date:

September 2010

Completion Date:

December 2011

Related Keywords:

  • Spondylitis, Ankylosing
  • Spondylitis
  • Spondylitis, Ankylosing

Name

Location

Albany, Georgia  31701
Fountain Valley, California  92708
Miami, Florida  33176
Philadelphia, Pennsylvania  19104
Austin, Texas  78705
Flint, Michigan  48532
Kansas City, Kansas  66160
Baltimore, Maryland  21287
Charlotte, North Carolina  
Charleston, South Carolina  
Coeur D'alene, Idaho  83814