A Phase 4 interventional study of methotrexate and methotrexate in Rheumatoid Arthritis, sponsored by Hoffmann-La Roche. Completed at 54 sites in Spain. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2015-07-13.
Sponsored by Hoffmann-La Roche · Phase 4, Interventional, and Treatment
This randomized, double-blind, parallel-group study will evaluate the efficacy and safety of RoActemra/Actemra (tocilizumab) in combination with methotrexate versus RoActemra/Actemra monotherapy in patients with rheumatoid arthritis and an inadequate response to methotrexate. All patients will receive RoActemra/Actemra 8 mg/kg intravenously (iv) every 4 weeks plus oral methotrexate for 16 weeks. Patients achieving low disease activity at Week 16 will be randomized to receive a further 12 weeks of RoActemra/Actemra treatment plus either methotrexate or placebo. Anticipated time on study treatment is 28 weeks.
3,554 studies on the registry are indexed under Arthritis; 317 are open to participants now.
This study's enrollment of 261 is above the median of 90 across 2,377 interventional studies indexed under Arthritis.
Browse Arthritis studies →Hoffmann-La Roche is the lead sponsor of 2,061 studies on the registry; 85 are open to participants now.
Of its 319 completed or terminated interventional studies of FDA-regulated products, 239 (75%) have results posted.
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Exclusion Criteria:
Drug: methotrexate · Drug: tocilizumab [RoActemra/Actemra]
Drug: methotrexate · Drug: placebo · Drug: tocilizumab [RoActemra/Actemra]
orally, Week 1 - 16
orally, Week 17-28
methotrexate placebo orally, Week 17-28
8 mg/kg iv every 4 weeks, 28 weeks
Change in Disease Activity Score Based on 28-Joint Count (DAS28) From Week 16 to Week 28
The DAS28 is a combined index for measuring disease activity in rheumatoid arthritis (RA). The index includes swollen (range 0-28) and tender (range 0-28) joint counts, acute phase response (erythrocyte sedimentation rate \[ESR\] in millimeters per hour \[mm/hr\]), and general health status (participant global assessment of disease activity using visual analog scale \[VAS\], range 1-100 mm). DAS28, which uses a 28-joint count, is derived from the original DAS, which includes a 44-swollen joint count. The DAS28 scale ranges from 0 to 10, where higher scores represent higher disease activity.
Time frame: Baseline, Week 16, and Week 28
Percentage of Participants With DAS28 Score Less Than (<) 2.6 at Week 28
The DAS28 is a combined index for measuring disease activity in RA. The index includes swollen (range 0-28) and tender (range 0-28) joint counts, acute phase response (ESR in mm/hr), and general health status (participant global assessment of disease activity using VAS, range 1-100 mm). DAS28, which uses a 28-joint count, is derived from the original DAS, which includes a 44-swollen joint count. The DAS28 scale ranges from 0 to 10, where higher scores indicate worsening. DAS28 \<2.6 equals (=) remission.
Time frame: Week 28
Percentage of Participants With Clinical Disease Activity Index (CDAI) <2.8 at Week 28
CDAI is the sum of tender and swollen joint count based on 28 joints and the participant and physician global disease assessment (VAS 0-10 centimeters \[cm\]). CDAI total score 0-76; higher scores = greater affect due to disease activity. CDAI \<2.8 = clinical remission.
Time frame: Week 28
Percentage of Participants With Simplified Disease Activity Index (SDAI) <3.3 at Week 28
SDAI is calculated by a simple numerical sum of tender and swollen joint count (based on a 28-joint assessment), participant and physician global assessment of disease activity (VAS 0-10 cm), and level of C-reactive protein in milligram per deciliter (mg/dL). SDAI total score 0-86; higher scores = greater affect due to disease activity. SDAI \<3.3 = clinical remission.
Time frame: 28 weeks
Change in the Health Assessment Questionnaire Disability Index (HAQ-DI) From Week 16 to Week 28
HAQ-DI: participant-reported assessment of ability to perform tasks in 8 categories of daily living activities: dress/groom; arise; eat; walk; reach; grip; hygiene; and common activities over past week. Each item scored on 4-point scale from 0 to 3: 0 = no difficulty; 1 = some difficulty; 2 = much difficulty; 3 = unable to do. Overall score was computed as the sum of domain scores and divided by the number of domains answered. Total possible score range 0-3 where 0 = least difficulty and 3 = extreme difficulty.
Time frame: Week 16 and Week 28
Change in the Quality of Life Questionnaire (Short Form-12 [SF-12]) From Week 16 to Week 28 in Mental Health
Quality of life questionnaire (SF-12) scores were computed using the scores of 12 questions and ranged from 0 to 100, where a 0 score indicated the lowest level of health measured by the scales and 100 indicated the highest level of health. A negative change from baseline indicated decline in health and higher scores indicated improvement in health.
Time frame: Week 16 and Week 28
Change in the Quality of Life Questionnaire (SF-12) From Week 16 to Week 28 in Physical Health
Quality of life questionnaire (SF-12) scores were computed using the scores of 12 questions and ranged from 0 to 100, where a 0 score indicated the lowest level of health measured by the scales and 100 indicated the highest level of health. A negative change from baseline indicated a worsening of quality of life.
Time frame: Week 16 and Week 28
Change From Week 16 to Week 28 in Global Assessment of Disease Activity as Assessed With the Visual Analogue Scale (VAS) Performed by Participant
Participants were asked to rate their global assessment of disease activity on a scale ranging from 0=very good to 100=very bad. The scale was represented by a line with 0 at the left edge and 100 at the right edge. The participant was asked to mark the line corresponding to the assessment of their disease activity. The distance from the left edge was measured in mm.
Time frame: Week 16 and Week 28
Change From Week 16 to Week 28 in Global Assessment of Disease Activity Assessed Using the VAS Performed by the Investigator
Participants were asked to rate their global assessment of disease activity on a scale ranging from 0=very good to 100=very bad. The scale was represented by a line with 0 at the left edge and 100 at the right edge. The participant was asked to mark the line corresponding to the assessment of their disease activity. The distance from the left edge was measured in mm.
Time frame: Week 16 and Week 28
| Milestone | Tocilizumab (TCZ) Plus (+) Methotrexate (Not Randomized) | TCZ + MTX (Randomized) | TCZ + Placebo (Randomized) |
|---|---|---|---|
| Started | 96 | 83 | 82 |
| Completed | 55 | 80 | 78 |
| Not completed | 41 | 3 | 4 |
| Withdrew: Adverse event | 13 | 3 | 1 |
| Withdrew: Lost to follow-up | 2 | 0 | 0 |
| Withdrew: Withdrawal by subject | 8 | 0 | 0 |
| Withdrew: Investigator decisión | 1 | 0 | 2 |
| Withdrew: Lack of efficacy | 9 | 0 | 1 |
| Withdrew: Protocol violation | 2 | 0 | 0 |
| Withdrew: Non-compliant | 1 | 0 | 0 |
| Withdrew: Inclusion error | 2 | 0 | 0 |
| Withdrew: Positive result for hepatitis b | 1 | 0 | 0 |
| Withdrew: Clinical ra remission | 1 | 0 | 0 |
| Withdrew: Sponsor decision | 1 | 0 | 0 |
The DAS28 is a combined index for measuring disease activity in rheumatoid arthritis (RA). The index includes swollen (range 0-28) and tender (range 0-28) joint counts, acute phase response (erythrocyte sedimentation rate \[ESR\] in millimeters per hour \[mm/hr\]), and general health status (participant global assessment of disease activity using visual analog scale \[VAS\], range 1-100 mm). DAS28, which uses a 28-joint count, is derived from the original DAS, which includes a 44-swollen joint count. The DAS28 scale ranges from 0 to 10, where higher scores represent higher disease activity.
| units on a scale | TCZ + MTX (Randomized) | TCZ + Placebo (Randomized) |
|---|---|---|
| Baseline | 5.42 ± 1.01 | 5.29 ± 1.01 |
| Week 16 | 1.77 ± 0.77 | 1.96 ± 0.76 |
| Week 28 | 1.82 ± 1.18 | 1.98 ± 1.13 |
The DAS28 is a combined index for measuring disease activity in RA. The index includes swollen (range 0-28) and tender (range 0-28) joint counts, acute phase response (ESR in mm/hr), and general health status (participant global assessment of disease activity using VAS, range 1-100 mm). DAS28, which uses a 28-joint count, is derived from the original DAS, which includes a 44-swollen joint count. The DAS28 scale ranges from 0 to 10, where higher scores indicate worsening. DAS28 \<2.6 equals (=) remission.
| percentage of participants | TCZ + MTX (Randomized) | TCZ + Placebo (Randomized) |
|---|---|---|
| Percentage of Participants With DAS28 Score Less Than (<) 2.6 at Week 28 | 82.3 | 75.9 |
CDAI is the sum of tender and swollen joint count based on 28 joints and the participant and physician global disease assessment (VAS 0-10 centimeters \[cm\]). CDAI total score 0-76; higher scores = greater affect due to disease activity. CDAI \<2.8 = clinical remission.
| percentage of participants | Tocilizumab + Methotrexate (Randomized) | Tocilizumab + Placebo (Randomized) |
|---|---|---|
| Percentage of Participants With Clinical Disease Activity Index (CDAI) <2.8 at Week 28 | 40.7 | 35.8 |
SDAI is calculated by a simple numerical sum of tender and swollen joint count (based on a 28-joint assessment), participant and physician global assessment of disease activity (VAS 0-10 cm), and level of C-reactive protein in milligram per deciliter (mg/dL). SDAI total score 0-86; higher scores = greater affect due to disease activity. SDAI \<3.3 = clinical remission.
| percentage of participants | TCZ + MTX (Randomized) | TCZ + Placebo (Randomized) |
|---|---|---|
| Percentage of Participants With Simplified Disease Activity Index (SDAI) <3.3 at Week 28 | 35.1 | 28.2 |
HAQ-DI: participant-reported assessment of ability to perform tasks in 8 categories of daily living activities: dress/groom; arise; eat; walk; reach; grip; hygiene; and common activities over past week. Each item scored on 4-point scale from 0 to 3: 0 = no difficulty; 1 = some difficulty; 2 = much difficulty; 3 = unable to do. Overall score was computed as the sum of domain scores and divided by the number of domains answered. Total possible score range 0-3 where 0 = least difficulty and 3 = extreme difficulty.
| units on a scale | TCZ + MTX (Randomized) | TCZ + Placebo (Randomized) |
|---|---|---|
| Change in the Health Assessment Questionnaire Disability Index (HAQ-DI) From Week 16 to Week 28 | 0.08 ± 0.47 | 0.00 ± 0.52 |
Quality of life questionnaire (SF-12) scores were computed using the scores of 12 questions and ranged from 0 to 100, where a 0 score indicated the lowest level of health measured by the scales and 100 indicated the highest level of health. A negative change from baseline indicated decline in health and higher scores indicated improvement in health.
| units on a scale | TCZ + MTX (Randomized) | TCZ + Placebo (Randomized) |
|---|---|---|
| Change in the Quality of Life Questionnaire (Short Form-12 [SF-12]) From Week 16 to Week 28 in Mental Health | -2.36 ± 10.22 | -0.38 ± 9.25 |
Quality of life questionnaire (SF-12) scores were computed using the scores of 12 questions and ranged from 0 to 100, where a 0 score indicated the lowest level of health measured by the scales and 100 indicated the highest level of health. A negative change from baseline indicated a worsening of quality of life.
| units on a scale | TCZ + MTX (Randomized) | TCZ + Placebo (Randomized) |
|---|---|---|
| Change in the Quality of Life Questionnaire (SF-12) From Week 16 to Week 28 in Physical Health | 0.48 ± 9.49 | -2.26 ± 8.82 |
Participants were asked to rate their global assessment of disease activity on a scale ranging from 0=very good to 100=very bad. The scale was represented by a line with 0 at the left edge and 100 at the right edge. The participant was asked to mark the line corresponding to the assessment of their disease activity. The distance from the left edge was measured in mm.
| units on a scale | TCZ + MTX (Randomized) | Tocilizumab + Placebo (Randomized) |
|---|---|---|
| Change From Week 16 to Week 28 in Global Assessment of Disease Activity as Assessed With the Visual Analogue Scale (VAS) Performed by Participant | 1.68 ± 23.80 | 0.56 ± 20.42 |
Participants were asked to rate their global assessment of disease activity on a scale ranging from 0=very good to 100=very bad. The scale was represented by a line with 0 at the left edge and 100 at the right edge. The participant was asked to mark the line corresponding to the assessment of their disease activity. The distance from the left edge was measured in mm.
| units on a scale | TCZ + MTX (Randomized) | TCZ + Placebo (Randomized) |
|---|---|---|
| Change From Week 16 to Week 28 in Global Assessment of Disease Activity Assessed Using the VAS Performed by the Investigator | 2.71 ± 16.96 | 2.85 ± 18.48 |
Collected over From Day 1 up to Week 36. Non-serious events are listed at a 5% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| TCZ + MTX (Not Randomized) | — | 11/96 (11.5%) | 28/96 (29.2%) |
| TCZ + MTX (Pre-randomization) | — | 0/83 (0%) | 20/83 (24.1%) |
| TCZ + Placebo (Pre-randomization) | — | 1/82 (1.2%) | 24/82 (29.3%) |
| TCZ + MTX (Post-randomization) | — | 1/83 (1.2%) | 8/83 (9.6%) |
| TCZ + Placebo (Post-randomization) | — | 4/82 (4.9%) | 4/82 (4.9%) |
| Event | TCZ + MTX (Not Randomized) | TCZ + MTX (Pre-randomization) | TCZ + Placebo (Pre-randomization) | TCZ + MTX (Post-randomization) | TCZ + Placebo (Post-randomization) |
|---|---|---|---|---|---|
| HypertransaminasaemiaHepatobiliary disorders | 3/96 | 0/83 | 0/82 | 0/83 | 0/82 |
| Deep vein thrombosisVascular disorders | 2/96 | 0/83 | 0/82 | 0/83 | 0/82 |
| VertigoEar and labyrinth disorders | 0/96 | 0/83 | 0/82 | 0/83 | 1/82 |
| Bursitis infectiveInfections and infestations | 0/96 | 0/83 | 0/82 | 0/83 | 1/82 |
| PneumoniaInfections and infestations | 1/96 | 0/83 | 0/82 | 0/83 | 1/82 |
| Staphylococcal skin infectionInfections and infestations | 0/96 | 0/83 | 0/82 | 0/83 | 1/82 |
| Respiratory tract infectionInfections and infestations | 0/96 | 0/83 | 1/82 | 0/83 | 0/82 |
| Endocarditis bacterialInfections and infestations | 0/96 | 0/83 | 0/82 | 1/83 | 0/82 |
| Chest PainGeneral disorders | 1/96 | 0/83 | 0/82 | 0/83 | 0/82 |
| Cytomegalovirus infectionInfections and infestations | 1/96 | 0/83 | 0/82 | 0/83 | 0/82 |
| Event | TCZ + MTX (Not Randomized) | TCZ + MTX (Pre-randomization) | TCZ + Placebo (Pre-randomization) | TCZ + MTX (Post-randomization) | TCZ + Placebo (Post-randomization) |
|---|---|---|---|---|---|
| HypertransaminasaemiaHepatobiliary disorders | 15/96 | 12/83 | 10/82 | 8/83 | 4/82 |
| HypercholesterolaemiaMetabolism and nutrition disorders | 9/96 | 2/83 | 6/82 | 0/83 | 0/82 |
| Aphthous stomatitisGastrointestinal disorders | 0/96 | 3/83 | 6/82 | 0/83 | 0/82 |
| LeukopeniaBlood and lymphatic system disorders | 7/96 | 0/83 | 0/82 | 0/83 | 0/82 |
| NeutropeniaBlood and lymphatic system disorders | 7/96 | 0/83 | 0/82 | 0/83 | 0/82 |
| Urinary tract infectionInfections and infestations | 0/96 | 3/83 | 5/82 | 0/83 | 0/82 |
| Respiratory tract infectionInfections and infestations | 5/96 | 0/83 | 0/82 | 0/83 | 0/82 |
All treated population
| Age, Continuous(years) | TCZ + MTX (Not Randomized) | TCZ + MTX (Randomized) | TCZ + Placebo (Randomized) | Total |
|---|---|---|---|---|
| Mean | 52.3 ± 13.2 | 50.2 ± 12.5 | 51.0 ± 12.2 | 51.2 ± 12.6 |
| Sex: Female, Male(Participants) | TCZ + MTX (Not Randomized) | TCZ + MTX (Randomized) | TCZ + Placebo (Randomized) | Total |
|---|---|---|---|---|
| Female | 76 | 62 | 65 | 203 |
| Male | 20 | 21 | 17 | 58 |
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