A Phase 2 interventional study of Canakinumab and Canakinumab in Acute Gout, sponsored by Novartis. Completed at 75 sites in 11 countries. Open to participants aged 18 Years to 80 Years. Per ClinicalTrials.gov, last updated 2012-04-10.
Sponsored by Novartis · Phase 2, Interventional, and Treatment
This 8-week study is designed to determine the target dose of canakinumab (ACZ885) for the management of acute flare in gout patients who are contraindicated to Non-Steroidal anti-inflammatory drugs and/or colchicine. The efficacy of ACZ885 will be compared to the corticosteroid triamcinolone acetonide.
232 studies on the registry are indexed under Gout; 45 are open to participants now.
This study's enrollment of 200 is above the median of 121 across 202 interventional studies indexed under Gout.
Browse Gout studies →Novartis is the lead sponsor of 703 studies on the registry; none are open to participants now.
Counted across the registry records on this site, refreshed daily.
Exclusion Criteria:
Other protocol-defined inclusion/exclusion criteria applied
Canakinumab 10 mg subcutaneous (s.c) once. The s.c. injection could be administered into the arm or thigh. Randomized patients received one s.c. injection of canakinumab and placebo matching triamcinolone acetonide (0.9% sodium chloride) intramuscularly (i.m.) once, on Day 1. The i.m. injection was recommended to be administered deeply into the gluteal muscle.
Drug: Canakinumab
Canakinumab 25 mg subcutaneous (s.c) once. The s.c. injection could be administered into the arm or thigh. Randomized patients received one s.c. injection of canakinumab and placebo matching triamcinolone acetonide (0.9% sodium chloride) intramuscularly (i.m.) once, on Day 1. The i.m. injection was recommended to be administered deeply into the gluteal muscle.
Drug: Canakinumab
Canakinumab 50 mg subcutaneous (s.c) once. The s.c. injection could be administered into the arm or thigh. Randomized patients received one s.c. injection of canakinumab and placebo matching triamcinolone acetonide (0.9% sodium chloride) intramuscularly (i.m.) once, on Day 1. The i.m. injection was recommended to be administered deeply into the gluteal muscle.
Drug: Canakinumab
Canakinumab 90 mg subcutaneous (s.c) once. The s.c. injection could be administered into the arm or thigh. Randomized patients received one s.c. injection of canakinumab and placebo matching triamcinolone acetonide (0.9% sodium chloride) intramuscularly (i.m.) once, on Day 1. The i.m. injection was recommended to be administered deeply into the gluteal muscle.
Drug: Canakinumab
Canakinumab 150 mg subcutaneous (s.c) once. The s.c. injection could be administered into the arm or thigh. Randomized patients received one s.c. injection of canakinumab and placebo matching triamcinolone acetonide (0.9% sodium chloride) intramuscularly (i.m.) once, on Day 1. The i.m. injection was recommended to be administered deeply into the gluteal muscle.
Drug: Canakinumab
Triamcinolone acetonide 40 mg intramuscularly (i.m) once. The i.m. injection was recommended to be administered deeply into the gluteal muscle. Randomized patients received triamcinolone acetonide 40 mg i.m. once and placebo matching canakinumab s.c. once, on Day 1.
Drug: Triamcinolone acetonide
Randomized patients received one s.c. injection of canakinumab and placebo matching triamcinolone acetonide (0.9% sodium chloride) intramuscularly (i.m.) once, on Day 1. The i.m. injection was recommended to be administered deeply into the gluteal muscle.
Randomized patients received one s.c. injection of canakinumab and placebo matching triamcinolone acetonide (0.9% sodium chloride) intramuscularly (i.m.) once, on Day 1.
Randomized patients received one s.c. injection of canakinumab and placebo matching triamcinolone acetonide (0.9% sodium chloride) intramuscularly (i.m.) once, on Day 1.
Randomized patients received one s.c. injection of canakinumab and placebo matching triamcinolone acetonide (0.9% sodium chloride) intramuscularly (i.m.) once, on Day 1.
Randomized patients received one s.c. injection of canakinumab and placebo matching triamcinolone acetonide (0.9% sodium chloride) intramuscularly (i.m.) once, on Day 1.
Randomized patients received triamcinolone acetonide 40 mg i.m. once and placebo matching canakinumab s.c. once, on Day 1.
The Dose of Canakinumab for Treatment of Acute Flares in Gout Patients That Leads to the Same Efficacy as Triamcinolone Acetonide With Respect to Pain Intensity on a 0-100 mm Visual Analog Scale (VAS)
Mean target dose at 24, 48 and 72 hours. Four models: Emax, Logistic, Linear in log-dose, Linear were selected to describe the potential dose-response curve and hence estimate the target dose of canakinumab using baseline Visual Analog Scale (VAS) and Body Mass Index (BMI) as covariates. Target dose was defined as the dose for which the efficacy is equivalent to the efficacy of triamcinolone acetonide 40 mg and was identified by assessing the dose response relationship with regards to the pain intensity in the target joint measured on a 0- 100 mm VAS (0= no pain and 100= unbearable pain).
Time frame: at 24,48 and 72 hours post-baseline
The Change in Pain Intensity in the Target Joint Following Canakinumab Administration Compared to Triamcinolone Acetonide
The change in pain intensity from baseline to 72 hours and 7 days post dose as measured on a 0-100 mm Visual Analog Scale(VAS): 0= no pain and 100= severe pain. Analysis of Covariance (ANCOVA) with treatment group, VAS at baseline and Body mass Index (BMI) at baseline as covariates. Change from baseline = (post-baseline measurement - baseline).
Time frame: Baseline,at 72 hrs post-dose and 7 days post-dose
Percentage of Participants With an Excellent or Good Response With Regards to the Patient's Global Assessment of Response to Treatment
Participants scored their global assessment of response to treatment using a 5-point Likert scale: Excellent, Good, Acceptable, Slight and Poor.
Time frame: at 72 hours post-baseline
The Time to 50% Reduction of Baseline Pain Intensity in the Target Joint
The median time in days to at least 50% reduction in Pain intensity from baseline as measured by Visual Analog Scale (VAS) for each treatment group. Participants scored their pain intensity in the target joint on a 0-100 mm VAS, ranging from no pain (0) to unbearable pain (100).
Time frame: Baseline, within 7 days after randomization
High Sensitivity C-reactive Protein (hsCRP) at 72 Hours, 7days, 4 Weeks and 8 Weeks Post Dose for Each Treatment Group
High sensitivity C-reactive protein (hsCRP) was determined in serum at all visits (Visits 1-5) in order to identify the presence of inflammation, to determine its severity, and to monitor response to treatment. ANCOVA with treatment group, protein level at baseline and BMI at baseline as covariates.
Time frame: at 72 hours and 7 days, 4 and 8 weeks post-dose
Serum Amyloid Protein (SAA) Levels at 72 Hours, 7days, 4 Weeks and 8 Weeks Post Dose for Each Treatment Group
Serum amyloid A (SAA) were determined in serum at all visits (Visits 1-5) in order to identify the presence of inflammation, to determine its severity, and to monitor response to treatment. ANCOVA with treatment group, protein level at baseline and BMI at baseline as covariates.
Time frame: at 72 hours and 7 days, 4 and 8 weeks post-dose
Amount of Rescue Medication Taken for Each Treatment Group
Participants who had difficulty in tolerating their pain after the 6-hour post-dose pain assessments and during the first 7 study days were allowed to take a maximum of 30 mg prednisolone (or equivalent dose of prednisone \[30 mg\]) orally once a day for a maximum of 5 days. In addition, participants could use 500 mg acetaminophen (paracetamol) and/or 30 mg codeine as needed during the first 7 study days. A maximum of 1 g/dose or 3 g/day of acetaminophen and 30 mg/dose or 180 mg/day of codeine was allowed during the first 7 days of the study.
Time frame: 7 days after study drug administration
| Milestone | Canakinumab 10 mg | Canakinumab 25 mg | Canakinumab 50 mg | Canakinumab 90 mg | Canakinumab 150 mg | Triamcinolone Acetonide 40 mg |
|---|---|---|---|---|---|---|
| Started | 28 | 29 | 29 | 29 | 28 | 57 |
| Completed | 27 | 28 | 27 | 28 | 27 | 54 |
| Not completed | 1 | 1 | 2 | 1 | 1 | 3 |
| Withdrew: Subject withdrew consent | 0 | 0 | 1 | 1 | 0 | 2 |
| Withdrew: Lost to follow-up | 1 | 1 | 1 | 0 | 1 | 0 |
| Withdrew: Adminstrative problems | 0 | 0 | 0 | 0 | 0 | 1 |
The change in pain intensity from baseline to 72 hours and 7 days post dose as measured on a 0-100 mm Visual Analog Scale(VAS): 0= no pain and 100= severe pain. Analysis of Covariance (ANCOVA) with treatment group, VAS at baseline and Body mass Index (BMI) at baseline as covariates. Change from baseline = (post-baseline measurement - baseline).
| Units on a scale | Canakinumab 10 mg | Canakinumab 25 mg | Canakinumab 50 mg | Canakinumab 90 mg | Canakinumab 150 mg | Triamcinolone Acetonide 40 mg |
|---|---|---|---|---|---|---|
| 72 hrs post-dose (n= 28, 28, 26, 28, 27, 53) | -48.6 ± 4.36 | -46.6 ± 4.39 | -48.6 ± 4.56 | -52.7 ± 4.35 | -62.5 ± 4.58 | -43.3 ± 3.16 |
| 7 days post-dose (n= 26, 28, 27, 27, 26, 51) | -57.6 ± 4.06 | -53.9 ± 3.93 | -63.4 ± 4.00 | -61.2 ± 3.96 | -66.4 ± 4.19 | -56.0 ± 2.88 |
Participants scored their global assessment of response to treatment using a 5-point Likert scale: Excellent, Good, Acceptable, Slight and Poor.
| Percentage of Participants | Canakinumab 10 mg | Canakinumab 25 mg | Canakinumab 50 mg | Canakinumab 90 mg | Canakinumab 150 mg | Triamcinolone Acetonide 40 mg |
|---|---|---|---|---|---|---|
| Percentage of Participants With an Excellent or Good Response With Regards to the Patient's Global Assessment of Response to Treatment | 64 | 62 | 71 | 66 | 89 | 54 |
The median time in days to at least 50% reduction in Pain intensity from baseline as measured by Visual Analog Scale (VAS) for each treatment group. Participants scored their pain intensity in the target joint on a 0-100 mm VAS, ranging from no pain (0) to unbearable pain (100).
| Days | Canakinumab 10 mg | Canakinumab 25 mg | Canakinumab 50 mg | Canakinumab 90 mg | Canakinumab 150 mg | Triamcinolone Acetonide 40 mg |
|---|---|---|---|---|---|---|
| The Time to 50% Reduction of Baseline Pain Intensity in the Target Joint | 2.9 (1.0 to 4.0) | 2.9 (2.0 to 3.0) | 1.0 (1.0 to 2.9) | 1.0 (1.0 to 2.0) | 1.0 (0.5 to 2.0) | 2.0 (1.0 to 3.6) |
High sensitivity C-reactive protein (hsCRP) was determined in serum at all visits (Visits 1-5) in order to identify the presence of inflammation, to determine its severity, and to monitor response to treatment. ANCOVA with treatment group, protein level at baseline and BMI at baseline as covariates.
| mg/L | Canakinumab 10 mg | Canakinumab 25 mg | Canakinumab 50 mg | Canakinumab 90 mg | Canakinumab 150 mg | Triamcinolone Acetonide 40 mg |
|---|---|---|---|---|---|---|
| 72 hrs post-dose (n= 27, 28, 26, 28, 25, 53) | 16.7 ± 3.41 | 7.9 ± 3.34 | 11.7 ± 3.49 | 13.4 ± 3.34 | 9.2 ± 3.53 | 13.4 ± 2.43 |
| 7 days post-dose (n= 28, 29, 28, 28, 27, 55) | 8.0 ± 3.30 | 2.5 ± 3.23 | 4.3 ± 3.31 | 6.3 ± 3.29 | 3.7 ± 3.36 | 13.7 ± 2.35 |
| 4 week post-dose (n= 27, 28, 27, 28, 27, 55) | 3.0 ± 3.13 | 2.9 ± 3.08 | 2.9 ± 3.14 | 4.8 ± 3.08 | 4.8 ± 3.13 | 9.2 ± 2.20 |
| 8 weeks post-dose (n= 26, 28, 27, 28, 27, 54) | 3.8 ± 1.79 | 2.0 ± 1.72 | 2.6 ± 1.75 | 5.2 ± 1.72 | 2.9 ± 1.75 | 8.6 ± 1.24 |
Serum amyloid A (SAA) were determined in serum at all visits (Visits 1-5) in order to identify the presence of inflammation, to determine its severity, and to monitor response to treatment. ANCOVA with treatment group, protein level at baseline and BMI at baseline as covariates.
| mg/L | Canakinumab 10 mg | Canakinumab 25 mg | Canakinumab 50 mg | Canakinumab 90 mg | Canakinumab 150 mg | Triamcinolone Acetonide 40 mg |
|---|---|---|---|---|---|---|
| 72 hrs post-dose (n= 26, 28, 28, 28, 27, 50) | 50.1 ± 20.05 | 27.6 ± 19.32 | 70.7 ± 19.37 | 29.4 ± 19.28 | 26.9 ± 19.69 | 52.5 ± 14.48 |
| 7 days post-dose (n= 28, 28, 28, 28, 26, 49) | 10.6 ± 10.92 | 5.4 ± 10.91 | 11.9 ± 10.94 | 10.5 ± 10.89 | 10.3 ± 11.33 | 39.4 ± 8.26 |
| 4 week post-dose (n= 27, 28, 27, 28, 27, 50) | 4.4 ± 3.53 | 4.2 ± 3.46 | 4.9 ± 3.53 | 14.3 ± 3.45 | 6.2 ± 3.53 | 12.9 ± 2.59 |
| 8 weeks post-dose (n= 26, 26, 26, 27, 27, 48) | 5.5 ± 3.64 | 4.6 ± 3.64 | 5.7 ± 3.64 | 8.2 ± 3.56 | 4.1 ± 3.57 | 18.0 ± 2.68 |
Mean target dose at 24, 48 and 72 hours. Four models: Emax, Logistic, Linear in log-dose, Linear were selected to describe the potential dose-response curve and hence estimate the target dose of canakinumab using baseline Visual Analog Scale (VAS) and Body Mass Index (BMI) as covariates. Target dose was defined as the dose for which the efficacy is equivalent to the efficacy of triamcinolone acetonide 40 mg and was identified by assessing the dose response relationship with regards to the pain intensity in the target joint measured on a 0- 100 mm VAS (0= no pain and 100= unbearable pain).
| mg | Linear Model |
|---|---|
| Target dose at 24 hrs post-baseline | 37 (5.94 to 103.37) |
| Target dose at 48 hrs post-baseline | 23 (2.87 to 96.31) |
| Target dose at 72 hrs post-baseline | NA (NA to NA) |
Participants who had difficulty in tolerating their pain after the 6-hour post-dose pain assessments and during the first 7 study days were allowed to take a maximum of 30 mg prednisolone (or equivalent dose of prednisone \[30 mg\]) orally once a day for a maximum of 5 days. In addition, participants could use 500 mg acetaminophen (paracetamol) and/or 30 mg codeine as needed during the first 7 study days. A maximum of 1 g/dose or 3 g/day of acetaminophen and 30 mg/dose or 180 mg/day of codeine was allowed during the first 7 days of the study.
| mg | Canakinumab 10 mg | Canakinumab 25 mg | Canakinumab 50 mg | Canakinumab 90 mg | Canakinumab 150 mg | Triamcinolone Acetonide 40 mg |
|---|---|---|---|---|---|---|
| Acetaminophen | 1414.3 ± 2628.58 | 1656.9 ± 4437.26 | 2178.6 ± 2925.67 | 1646.6 ± 3161.20 | 607.4 ± 2250.12 | 1614.3 ± 2958.51 |
| Codeine | 42.9 ± 138.19 | 78.6 ± 164.20 | 49.3 ± 139.57 | 27.9 ± 87.07 | 4.4 ± 23.09 | 52.0 ± 158.28 |
| Prednisolone/Prednisone | 13.4 ± 36.82 | 23.8 ± 44.03 | 24.1 ± 59.36 | 13.1 ± 35.37 | 6.2 ± 24.54 | 13.3 ± 26.13 |
Collected over End of study (8 weeks). Non-serious events are listed at a 5% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Canakinumab 10 mg | — | 0/28 (0%) | 2/28 (7.1%) |
| Canakinumab 25 mg | — | 2/29 (6.9%) | 7/29 (24.1%) |
| Canakinumab 50 mg | — | 2/29 (6.9%) | 5/29 (17.2%) |
| Canakinumab 90 mg | — | 0/29 (0%) | 8/29 (27.6%) |
| Canakinumab 150 mg | — | 0/28 (0%) | 5/28 (17.9%) |
| Triamcinolone Acetonide 40 mg | — | 1/57 (1.8%) | 8/57 (14%) |
| Event | Canakinumab 10 mg | Canakinumab 25 mg | Canakinumab 50 mg | Canakinumab 90 mg | Canakinumab 150 mg | Triamcinolone Acetonide 40 mg |
|---|---|---|---|---|---|---|
| AppendicitisInfections and infestations | 0/28 | 1/29 | 1/29 | 0/29 | 0/28 | 0/57 |
| BronchitisInfections and infestations | 0/28 | 1/29 | 0/29 | 0/29 | 0/28 | 0/57 |
| Carotid artery stenosisNervous system disorders | 0/28 | 0/29 | 1/29 | 0/29 | 0/28 | 0/57 |
| Cerebrovascular disorderNervous system disorders | 0/28 | 0/29 | 0/29 | 0/29 | 0/28 | 1/57 |
| Event | Canakinumab 10 mg | Canakinumab 25 mg | Canakinumab 50 mg | Canakinumab 90 mg | Canakinumab 150 mg | Triamcinolone Acetonide 40 mg |
|---|---|---|---|---|---|---|
| HeadacheNervous system disorders | 1/28 | 3/29 | 1/29 | 2/29 | 1/28 | 4/57 |
| NasopharyngitisInfections and infestations | 1/28 | 1/29 | 2/29 | 0/29 | 1/28 | 2/57 |
| Alanine aminotransferase increasedInvestigations | 0/28 | 0/29 | 0/29 | 2/29 | 0/28 | 0/57 |
| Aspartate aminotransferase increasedInvestigations | 0/28 | 0/29 | 0/29 | 2/29 | 1/28 | 0/57 |
| Blood uric acid increasedInvestigations | 0/28 | 0/29 | 0/29 | 2/29 | 1/28 | 0/57 |
| Bone painMusculoskeletal and connective tissue disorders | 0/28 | 0/29 | 2/29 | 0/29 | 0/28 | 0/57 |
| Oropharyngeal painRespiratory, thoracic and mediastinal disorders | 0/28 | 0/29 | 0/29 | 2/29 | 1/28 | 0/57 |
| HyperhidrosisSkin and subcutaneous tissue disorders | 0/28 | 2/29 | 0/29 | 0/29 | 0/28 | 0/57 |
| Urinary tract infectionInfections and infestations | 0/28 | 0/29 | 0/29 | 1/29 | 0/28 | 3/57 |
| Pain in extremityMusculoskeletal and connective tissue disorders | 0/28 | 1/29 | 1/29 | 0/29 | 0/28 | 3/57 |
| Age, Customized(participants) | Canakinumab 10 mg | Canakinumab 25 mg | Canakinumab 50 mg | Canakinumab 90 mg | Canakinumab 150 mg | Triamcinolone Acetonide 40 mg | Total |
|---|---|---|---|---|---|---|---|
| ≥18 years - 40 years | 6 | 4 | 3 | 5 | 8 | 7 | 33 |
| ≥ 41 - 64 years | 21 | 21 | 19 | 20 | 15 | 39 | 135 |
| ≥ 65 - 74 years | 0 | 3 | 6 | 2 | 3 | 10 | 24 |
| ≥ 75 years | 1 | 1 | 1 | 2 | 2 | 1 | 8 |
| Sex: Female, Male(Participants) | Canakinumab 10 mg | Canakinumab 25 mg | Canakinumab 50 mg | Canakinumab 90 mg | Canakinumab 150 mg | Triamcinolone Acetonide 40 mg | Total |
|---|---|---|---|---|---|---|---|
| Female | 2 | 3 | 2 | 5 | 0 | 2 | 14 |
| Male | 26 | 26 | 27 | 24 | 28 | 55 | 186 |
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