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CompletedNCT01951170Updated Sep 21, 2016Results posted

An Open-Label Study of RoActemra/Actemra (Tocilizumab) in Patients With Moderate to Severe Active Rheumatoid Arthritis

A Phase 3 interventional study of Tocilizumab in Rheumatoid Arthritis, sponsored by Hoffmann-La Roche. Completed at 10 sites in Australia. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2016-09-21.

Sponsored by Hoffmann-La Roche · Phase 3, Interventional, and Treatment

Phase
Phase 3
Study type
Interventional
Enrollment
52
Allocation
Not applicable
Ages
18 Years and older
Sex
All
01

Study summary

This open-label, single-arm study will evaluate the efficacy and safety of tocilizumab in patients with active moderate to severe rheumatoid arthritis. Participants will receive a subcutaneous dose of tocilizumab 162 mg once weekly. The anticipated time on study treatment is 24 weeks.

02

Conditions studied

  • Rheumatoid Arthritis
03

In context

Arthritis

3,554 studies on the registry are indexed under Arthritis; 317 are open to participants now.

This study's enrollment of 52 is below the median of 90 across 2,377 interventional studies indexed under Arthritis.

Browse Arthritis studies →

Lead sponsor

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.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  • Adult patients at least 18 years of age
  • Patients with a diagnosis of active moderate to severe rheumatoid arthritis (RA)
  • Oral corticosteroids and nonsteroidal anti-inflammatory are permitted if on a stable dose regimen for >/= 4 weeks prior baseline
  • Permitted non-biologic disease-modifying anti-rheumatic drugs (DMARDs) used alone or in combination are allowed if at a stable dose for at least 4 weeks prior to baseline
  • Receiving treatment on an outpatient basis, not including tocilizumab
  • Females of childbearing potential and males with female partners of childbearing potential may participate in this study only if using a reliable means of contraception for at least 5 months following the last dose tocilizumab
  • Previous or current treatment with methotrexate with an inadequate response to methotrexate, intolerance to methotrexate or treatment with methotrexate was considered as inappropriate
  • Evidence of one or more erosions in hands or feet assessed by X-ray attributable to RA or magnetic resonance imaging (MRI) of wrist of metacarpophalangeal (MCP) joints of dominant hand

Exclusion criteria

Exclusion Criteria:

  • Major surgery (including joint surgery) within 8 weeks prior to screening or planned major surgery within 6 months following baseline
  • Rheumatic autoimmune disease other than rheumatoid arthritis
  • Functional Class IV as defined by the American College of Rheumatology (ACR) Classification of Functional Status in Rheumatoid Arthritis
  • Diagnosis of juvenile idiopathic arthritis or juvenile RA and/or RA before the age of 16
  • Prior history of current inflammatory joint disease other than RA
  • Exposure to tocilizumab at any time prior to baseline
  • Treatment with any investigational agent within 4 weeks (or five half-lives of the investigational drug, whichever is longer) of screening
  • Previous treatment with any cell-depleting therapies
  • Treatment with intravenous (IV) gamma globulin, plasmapheresis within 6 months of baseline
  • Intraarticular (IA) or parenteral corticosteroids within 4 weeks prior to baseline
  • Any previous treatment with alkylating agents such as chlorambucil, or with total lymphoid irradiation
  • Treatment with 2 or more anti-tumor necrosis factor (TNF) agents or any other biologic agent at any time prior to screening
  • Evidence of serious uncontrolled concomitant disease (e.g., cardiovascular, nervous system, pulmonary)
  • History of diverticulitis, diverticulosis requiring antibiotic treatment, or chromic ulcerative lower gastrointestinal (GI) disease such as Crohn's disease, ulcerative colitis, or other symptomatic lower genitourinary (GU) conditions that might predispose to perforation
  • Known active current or history of recurrent infections
05

Study design

Phase
Phase 3
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrollment
52 participants (actual)

Study arms

  • Experimental
    Tocilizumab

    Participants were administered subcutaneous tocilizumab for the treatment of rheumatoid arthritis for 24 weeks.

    Drug: Tocilizumab

Interventions

  • DrugTocilizumab

    162 milligrams (mg) tocilizumab was administered subcutaneously once weekly for 24 weeks

    Also known as: RoActemra®/Actemra®

06

What researchers measure

Primary outcomes

  1. Change From Baseline in Genant-modified Total Sharp Score (mTSS)

    The mTSS is a measure of joint damage that combines scores for bone erosion and joint-space narrowing (JNS). Erosion score: A total of 14 locations in each hand and wrist and 6 joints in the foot were evaluated for erosion using an 8-point scale where 0=normal to 3.5=very severe erosion. JNS score: A total of 13 locations in each hand and wrist and 6 joints in the foot were evaluated for joint narrowing score using a 9-point scale where 0=normal to 4.0=definite ankylosis (stiffness or fixation of a joint). mTSS scores ranged from 0 (normal) to 292 (worst possible total score). Change from baseline = mTSS score at Week 24 minus score at baseline. An increase in mTSS from baseline represents disease progression and/or joint worsening, no change represents halting of disease progression, and a decrease represents improvement.

    Time frame: From baseline to Week 24

Secondary outcomes

  1. Percentage of Participants With Disease Activity Score 28-Erythrocyte Sedimentation Rate (DAS28-ESR) Remission

    The DAS28 score is a measure of the patient's disease activity calculated using the tender joint count of 28 joints (TJC28), swollen joint count of 28 joints (SJC28), patient's global assessment of disease activity visual analog scale (PGA VAS) with 0=no disease activity to 100=maximum disease activity displayed on the 100-millimeter (mm) horizontal VAS and the erythrocyte sedimentation rate (ESR) for a total possible score of 0 to 10. Higher scores represent higher disease activity. DAS28-ESR remission is defined as a score \< 2.6.

    Time frame: At Week 24

  2. Percentage of Participants With Positive American College of Rheumatology 20/50/70 (ACR20/50/70) Responses

    A positive ACR20 response requires at least 20% improvement compared to baseline in SJC (66 joints) and TJC (68 joints) as well as at least 20% improvement in 3 of the following 5 assessments: 1) PGA pain VAS, 2) PGA VAS; 3) physician's global assessment of disease activity VAS, 4) Health Assessment Questionnaire-Disability Index (HAQ-DI) with 20 questions consisting of 8 components: dressing/grooming, arising, eating, walking, hygiene, reach, grip, and activities, 0=without difficulty to 3=unable to do; and 5) acute phase reactant (C-reactive protein \[CRP\] - if not available, ESR was used). ACR50 and ACR70 responses are defined in a similar way except that they required a 50% and 70% improvement from baseline, respectively. VAS range for all assessments was 0=no disease activity to 100=maximum disease activity.

    Time frame: From baseline to Week 24

  3. Percentage of Participants With European League Against Rheumatism (EULAR) Response

    EULAR response was calculated as the difference between DAS28-ESR scores at baseline and Week 24, and reported as the percentage of participants with good, moderate, or no response. Good responders = decrease from baseline \>1.2 with a DAS28 score of ≤3.2; moderate responders = decrease from baseline \>1.2 with a DAS28 score of \>3.2, or decrease from baseline \>0.6 to ≤1.2 with a DAS28 score of ≤5.1; non-responders = decrease from baseline ≤0.6 or decrease from baseline \>0.6 and ≤1.2 with a DAS28 score of \>5.1.

    Time frame: From baseline to Week 24

  4. Change From Baseline in Patient's Global Assessment of Disease Activity Visual Analog Scale (PGA VAS)

    PGA VAS is the participant's overall assessment of their current disease activity. The disease activity is displayed on a 100-mm horizontal VAS. The left-hand extreme (0 mm) of the line is described as "no disease activity" (symptom free and no arthritis symptoms) and the right-hand extreme (100 mm) is described as "maximum disease activity" (maximum arthritis disease activity). The change in PGA VAS is determined as the difference in values from baseline. A negative change from baseline indicates improvement.

    Time frame: From baseline to Week 24

  5. Change From Baseline in Patient's Global Assessment of Pain Using a Visual Analog Scale (PGA Pain VAS)

    The PGA pain VAS is the participant's overall assessment of pain. Pain is displayed on a 100-mm horizontal VAS. The left-hand extreme (0 mm) of the line is described as "no pain" and the right-hand extreme (100 mm) is described as "unbearable pain". The change in PGA VAS is determined as the difference in values from baseline. A negative change from baseline indicates improvement.

    Time frame: From baseline to Week 24

  6. Change From Baseline in Physician Global Assessment of Disease Activity

    The Physician Global Assessment of Disease Activity is the investigator's overall assessment of the participant's current disease activity. The disease activity is displayed on a 100-mm horizontal VAS. The left-hand extreme (0 mm) of the line is described as "no disease activity" (symptom free and no arthritis symptoms) and the right-hand extreme (100 mm) is described as "maximum disease activity" (maximum arthritis disease activity). The change in Physician Global Assessment of Disease Activity is determined as the difference in values from baseline. A negative change from baseline indicates improvement.

    Time frame: From baseline to Week 24

  7. Change From Baseline in Health Assessment Questionnaire-Disability Index (HAQ-DI)

    HAQ-DI is the 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. A negative change from baseline indicates improvement.

    Time frame: From baseline to Week 24

  8. Change From Baseline in Functional Assessment of Chronic Illness Therapy - Fatigue (FACIT-F)

    The FACIT measurement system is a collection of health-related quality of life questionnaires targeted to the management of chronic illness and includes questions on physical well-being, social/family well-being, emotional well-being and functional well-being. The FACIT-F Scale measures an individual's level of fatigue during their usual daily activities. Total scores range from 0 to 52 with lower scores representing greater fatigue, and scores below 30 representing severe fatigue. A positive change from baseline indicates improvement.

    Time frame: From baseline to Week 24

  9. Change From Baseline in Simplified Disease Activity Index (SDAI)

    The SDAI is a combined index for measuring disease activity in rheumatoid arthritis and calculated as SDAI = TJC28 + SJC28 + PGA VAS (in mm) + Physician Global Assessment of Disease Activity VAS (in mm) + C reactive protein (CRP) in milligrams/deciliter (mg/dL) with a total SDAI score ranging from 0 to 86. Higher scores indicate greater disease activity. The SDAI scale is divided into the following categories: Clinical remission = score ≤ 3.3; Low disease activity = score \> 3.3 and ≤ 11.0; Moderate disease activity = score \> 11.0 and ≤ 26.0; Severe disease = score \> 26.0. A negative change from baseline indicates improvement.

    Time frame: From baseline to Week 24

  10. Change From Baseline in Clinical Disease Activity Index (CDAI)

    The CDAI is a combined index for measuring disease activity in rheumatoid arthritis and calculated as CDAI = TJC28 + SJC28 + PGA VAS (in mm) + Physician Global Assessment of Disease Activity VAS (in mm) with a total CDAI score ranging from 0-76. Higher scores indicate greater disease activity. The SDAI scale is divided into the following categories: Clinical remission = score ≤ 2.8; Low disease activity = score \> 2.8 and ≤ 10.0; Moderate disease activity = score \> 10.0 and ≤ 22.0; Severe disease = score \> 22.0. A negative change from baseline indicates improvement.

    Time frame: From baseline to Week 24

  11. Change From Baseline in Total Tender Joint Count (TJC)

    TJC was counted based on 68 joints (TJC68) and based on 28 joints (TJC28). A negative change from baseline indicates improvement.

    Time frame: From baseline to Week 24

  12. Change From Baseline in Swollen Joint Count (SJC)

    SJC was counted based on 66 joints (SJC66) and based on 28 joints (SJC28). A negative change from baseline indicates improvement.

    Time frame: From baseline to Week 24

  13. Change From Baseline in Rheumatoid Arthritis Magnetic Resonance Imaging Scoring System (RAMRIS) Scoring of Bone Erosions

    Bone erosions were assessed by magnetic resonance imaging (MRI) at baseline and Week 24. Scans of 25 bone locations were read and scored in pairs for each participant by 2 assessors. Scores for each location ranged 0-10 on an 11-point scale with 0= no erosion, 1= 1-10% erosion, 2= 11-20% erosion, and up to 10= 91-100% erosion. Total score was the sum of the 25 individual scores and ranged 0-250 with 0= no erosion and 250= most severe erosion. A negative change from baseline indicates improvement.

    Time frame: From baseline to Week 24

  14. Change From Baseline in RAMRIS Scoring of Cartilage Loss

    Cartilage loss was assessed by MRI at baseline and Week 24. Scans of 25 joints were read and scored in pairs for each participant by 2 assessors. Scores for each location ranged 0-4 on a 9-point scale, with 0= no cartilage loss and 4= complete cartilage loss. Total score was the sum of the 25 individual scores and ranged 0-100 with 0= no cartilage loss and 100= most severe cartilage loss. A negative change from baseline indicates improvement.

    Time frame: From baseline to Week 24

  15. Change From Baseline in RAMRIS Scoring of Synovitis

    Synovitis (synovial membrane inflammation) was assessed by MRI at baseline and Week 24. Scans of 8 joint locations were read and scored in pairs for each participant by 2 assessors. Scores for each location ranged 0-3 on a 4-point scale, with 0= no synovitis, 1= 1-33% volume enhancement, 2= 34-67% volume enhancement and 3= 68-100% volume enhancement. Total score was the sum of the 8 individual scores and ranged 0-24 with 0= no synovitis and 24= most severe synovitis. A negative change from baseline indicates improvement.

    Time frame: From baseline to Week 24

  16. Change From Baseline in RAMRIS Scoring of Osteitis

    Osteitis (bone inflammation) was assessed by MRI at baseline and Week 24. Scans of 25 bone locations were read and scored in pairs for each participant by 2 assessors. Scores for each location ranged 0-3 on a 4-point scale, with 0= no osteitis, 1= 1-33% involvement of original articular bone, 2= 34-67% involvement of original articular bone and 3= 68-100% involvement of original articular bone. Total score was the sum of the 25 individual scores and ranged 0-75 with 0= no osteitis and 75= most severe osteitis. A negative change from baseline indicates improvement.

    Time frame: From baseline to Week 24

  17. Safety: Percentage of Participants With Adverse Events (AEs)

    An adverse event is any untoward medical occurrence in a participant administered a pharmaceutical product and which does not necessarily have to have a causal relationship with the treatment. An adverse event can therefore be any unfavorable and unintended sign (including an abnormal laboratory finding, for example), symptom, or disease temporally associated with the use of a pharmaceutical product, whether or not considered related to the pharmaceutical product. Preexisting conditions which worsen during a study are also considered as adverse events.

    Time frame: Up to Week 32 (end of follow up: 8 weeks after end of treatment)

  18. Safety: Number of AEs Leading to Tocilizumab Dose Modification or Study Treatment Withdrawal

    Time frame: Up to Week 32 (end of follow up: 8 weeks after end of treatment)

  19. Safety: Number of Participants With Confirmed Positive Assessment of Tocilizumab Immunogenicity

    A tocilizumab antibody screen was performed at baseline and at the end of follow up (8 weeks after end of treatment at Week 32). A confirmatory anti-tocilizumab antibody test was performed on positive screen samples. A confirmed positive test indicates the presence of tocilizumab antibodies.

    Time frame: At baseline, Week 32 (end of follow up: 8 weeks after end of treatment)

07

Results

Posted Sep 21, 2016

Participant flow

Participant flow — Overall Study
MilestoneTocilizumab
Started52
Completed51
Not completed1
Withdrew: Investigator decision1

Outcome measures

PrimaryChange From Baseline in Genant-modified Total Sharp Score (mTSS)

The mTSS is a measure of joint damage that combines scores for bone erosion and joint-space narrowing (JNS). Erosion score: A total of 14 locations in each hand and wrist and 6 joints in the foot were evaluated for erosion using an 8-point scale where 0=normal to 3.5=very severe erosion. JNS score: A total of 13 locations in each hand and wrist and 6 joints in the foot were evaluated for joint narrowing score using a 9-point scale where 0=normal to 4.0=definite ankylosis (stiffness or fixation of a joint). mTSS scores ranged from 0 (normal) to 292 (worst possible total score). Change from baseline = mTSS score at Week 24 minus score at baseline. An increase in mTSS from baseline represents disease progression and/or joint worsening, no change represents halting of disease progression, and a decrease represents improvement.

Time frame:
From baseline to Week 24
Reported as:
Median · units on a scale
Change From Baseline in Genant-modified Total Sharp Score (mTSS)
units on a scaleTocilizumab
Baseline7.00 (0 to 95.8)
Change from baseline at Week 240 (-1.5 to 5.5)
Statistical analysis
  • Tocilizumab · Wilcoxon signed rank test · p = 0.83 (Change in mTSS scores from baseline to Week 24.)
SecondaryPercentage of Participants With Disease Activity Score 28-Erythrocyte Sedimentation Rate (DAS28-ESR) Remission

The DAS28 score is a measure of the patient's disease activity calculated using the tender joint count of 28 joints (TJC28), swollen joint count of 28 joints (SJC28), patient's global assessment of disease activity visual analog scale (PGA VAS) with 0=no disease activity to 100=maximum disease activity displayed on the 100-millimeter (mm) horizontal VAS and the erythrocyte sedimentation rate (ESR) for a total possible score of 0 to 10. Higher scores represent higher disease activity. DAS28-ESR remission is defined as a score \< 2.6.

Time frame:
At Week 24
Reported as:
Number · percentage of participants
Percentage of Participants With Disease Activity Score 28-Erythrocyte Sedimentation Rate (DAS28-ESR) Remission
percentage of participantsTocilizumab
Percentage of Participants With Disease Activity Score 28-Erythrocyte Sedimentation Rate (DAS28-ESR) Remission76.60 (61.97 to 87.70)
SecondaryPercentage of Participants With Positive American College of Rheumatology 20/50/70 (ACR20/50/70) Responses

A positive ACR20 response requires at least 20% improvement compared to baseline in SJC (66 joints) and TJC (68 joints) as well as at least 20% improvement in 3 of the following 5 assessments: 1) PGA pain VAS, 2) PGA VAS; 3) physician's global assessment of disease activity VAS, 4) Health Assessment Questionnaire-Disability Index (HAQ-DI) with 20 questions consisting of 8 components: dressing/grooming, arising, eating, walking, hygiene, reach, grip, and activities, 0=without difficulty to 3=unable to do; and 5) acute phase reactant (C-reactive protein \[CRP\] - if not available, ESR was used). ACR50 and ACR70 responses are defined in a similar way except that they required a 50% and 70% improvement from baseline, respectively. VAS range for all assessments was 0=no disease activity to 100=maximum disease activity.

Time frame:
From baseline to Week 24
Reported as:
Number · percentage of participants
Percentage of Participants With Positive American College of Rheumatology 20/50/70 (ACR20/50/70) Responses
percentage of participantsTocilizumab
ACR2091.49 (79.62 to 97.63)
ACR5076.60 (61.97 to 87.70)
ACR7053.19 (38.08 to 67.89)
SecondaryPercentage of Participants With European League Against Rheumatism (EULAR) Response

EULAR response was calculated as the difference between DAS28-ESR scores at baseline and Week 24, and reported as the percentage of participants with good, moderate, or no response. Good responders = decrease from baseline \>1.2 with a DAS28 score of ≤3.2; moderate responders = decrease from baseline \>1.2 with a DAS28 score of \>3.2, or decrease from baseline \>0.6 to ≤1.2 with a DAS28 score of ≤5.1; non-responders = decrease from baseline ≤0.6 or decrease from baseline \>0.6 and ≤1.2 with a DAS28 score of \>5.1.

Time frame:
From baseline to Week 24
Reported as:
Number · percentage of participants
Percentage of Participants With European League Against Rheumatism (EULAR) Response
percentage of participantsTocilizumab
No Response2.13 (0.05 to 11.29)
Moderate17.02 (7.65 to 30.81)
Good80.85 (66.74 to 90.85)
SecondaryChange From Baseline in Patient's Global Assessment of Disease Activity Visual Analog Scale (PGA VAS)

PGA VAS is the participant's overall assessment of their current disease activity. The disease activity is displayed on a 100-mm horizontal VAS. The left-hand extreme (0 mm) of the line is described as "no disease activity" (symptom free and no arthritis symptoms) and the right-hand extreme (100 mm) is described as "maximum disease activity" (maximum arthritis disease activity). The change in PGA VAS is determined as the difference in values from baseline. A negative change from baseline indicates improvement.

Time frame:
From baseline to Week 24
Reported as:
Mean · units on a scale
Change From Baseline in Patient's Global Assessment of Disease Activity Visual Analog Scale (PGA VAS)
units on a scaleTocilizumab
Baseline (n=52)67.26 ± 21.677
Change from baseline at Week 24 (n=47)-48.6 ± 25.934
SecondaryChange From Baseline in Patient's Global Assessment of Pain Using a Visual Analog Scale (PGA Pain VAS)

The PGA pain VAS is the participant's overall assessment of pain. Pain is displayed on a 100-mm horizontal VAS. The left-hand extreme (0 mm) of the line is described as "no pain" and the right-hand extreme (100 mm) is described as "unbearable pain". The change in PGA VAS is determined as the difference in values from baseline. A negative change from baseline indicates improvement.

Time frame:
From baseline to Week 24
Reported as:
Mean · units on a scale
Change From Baseline in Patient's Global Assessment of Pain Using a Visual Analog Scale (PGA Pain VAS)
units on a scaleTocilizumab
Baseline (n=52)59.55 ± 22.780
Change from baseline at Week 24 (n=47)-41.9 ± 26.980
SecondaryChange From Baseline in Physician Global Assessment of Disease Activity

The Physician Global Assessment of Disease Activity is the investigator's overall assessment of the participant's current disease activity. The disease activity is displayed on a 100-mm horizontal VAS. The left-hand extreme (0 mm) of the line is described as "no disease activity" (symptom free and no arthritis symptoms) and the right-hand extreme (100 mm) is described as "maximum disease activity" (maximum arthritis disease activity). The change in Physician Global Assessment of Disease Activity is determined as the difference in values from baseline. A negative change from baseline indicates improvement.

Time frame:
From baseline to Week 24
Reported as:
Mean · units on a scale
Change From Baseline in Physician Global Assessment of Disease Activity
units on a scaleTocilizumab
Baseline (n=51)64.63 ± 18.803
Change from baseline at Week 24 (n=46)-48.8 ± 21.342
SecondaryChange From Baseline in Health Assessment Questionnaire-Disability Index (HAQ-DI)

HAQ-DI is the 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. A negative change from baseline indicates improvement.

Time frame:
From baseline to Week 24
Reported as:
Mean · units on a scale
Change From Baseline in Health Assessment Questionnaire-Disability Index (HAQ-DI)
units on a scaleTocilizumab
Baseline (n=52)1.36 ± 0.639
Change from baseline at Week 24 (n=47)-0.78 ± 0.588
SecondaryChange From Baseline in Functional Assessment of Chronic Illness Therapy - Fatigue (FACIT-F)

The FACIT measurement system is a collection of health-related quality of life questionnaires targeted to the management of chronic illness and includes questions on physical well-being, social/family well-being, emotional well-being and functional well-being. The FACIT-F Scale measures an individual's level of fatigue during their usual daily activities. Total scores range from 0 to 52 with lower scores representing greater fatigue, and scores below 30 representing severe fatigue. A positive change from baseline indicates improvement.

Time frame:
From baseline to Week 24
Reported as:
Mean · units on a scale
Change From Baseline in Functional Assessment of Chronic Illness Therapy - Fatigue (FACIT-F)
units on a scaleTocilizumab
Baseline (n=52)27.42 ± 11.771
Change from baseline at Week 24 (n=47)12.62 ± 10.541
SecondaryChange From Baseline in Simplified Disease Activity Index (SDAI)

The SDAI is a combined index for measuring disease activity in rheumatoid arthritis and calculated as SDAI = TJC28 + SJC28 + PGA VAS (in mm) + Physician Global Assessment of Disease Activity VAS (in mm) + C reactive protein (CRP) in milligrams/deciliter (mg/dL) with a total SDAI score ranging from 0 to 86. Higher scores indicate greater disease activity. The SDAI scale is divided into the following categories: Clinical remission = score ≤ 3.3; Low disease activity = score \> 3.3 and ≤ 11.0; Moderate disease activity = score \> 11.0 and ≤ 26.0; Severe disease = score \> 26.0. A negative change from baseline indicates improvement.

Time frame:
From baseline to Week 24
Reported as:
Mean · units on a scale
Change From Baseline in Simplified Disease Activity Index (SDAI)
units on a scaleTocilizumab
Baseline (n=50)38.65 ± 14.656
Change from baseline at Week 24 (n=45)-31.6 ± 16.470
SecondaryChange From Baseline in Clinical Disease Activity Index (CDAI)

The CDAI is a combined index for measuring disease activity in rheumatoid arthritis and calculated as CDAI = TJC28 + SJC28 + PGA VAS (in mm) + Physician Global Assessment of Disease Activity VAS (in mm) with a total CDAI score ranging from 0-76. Higher scores indicate greater disease activity. The SDAI scale is divided into the following categories: Clinical remission = score ≤ 2.8; Low disease activity = score \> 2.8 and ≤ 10.0; Moderate disease activity = score \> 10.0 and ≤ 22.0; Severe disease = score \> 22.0. A negative change from baseline indicates improvement.

Time frame:
From baseline to Week 24
Reported as:
Mean · units on a scale
Change From Baseline in Clinical Disease Activity Index (CDAI)
units on a scaleTocilizumab
Baseline (n=51)36.91 ± 13.460
Change from baseline at Week 24 (n=46)-30.0 ± 15.138
SecondaryChange From Baseline in Total Tender Joint Count (TJC)

TJC was counted based on 68 joints (TJC68) and based on 28 joints (TJC28). A negative change from baseline indicates improvement.

Time frame:
From baseline to Week 24
Reported as:
Mean · tender joints
Change From Baseline in Total Tender Joint Count (TJC)
tender jointsTocilizumab
TJC68: Baseline (n=52)24.27 ± 12.550
TJC68: Change from baseline at Week 24 (n=47)-20.8 ± 13.622
TJC28: Baseline (n=52)13.19 ± 6.234
TJC28: Change from Baseline at Week 24 (n=47)-11.1 ± 7.568
SecondaryChange From Baseline in Swollen Joint Count (SJC)

SJC was counted based on 66 joints (SJC66) and based on 28 joints (SJC28). A negative change from baseline indicates improvement.

Time frame:
From baseline to Week 24
Reported as:
Mean · swollen joints
Change From Baseline in Swollen Joint Count (SJC)
swollen jointsTocilizumab
SJC66: Baseline (n=52)17.00 ± 11.068
SJC66: Change from baseline at Week 24 (n=47)-13.0 ± 8.745
SJC28: Baseline (n=52)10.71 ± 6.470
SJC28: Change from baseline at Week 24 (n=47)-8.77 ± 5.994
SecondaryChange From Baseline in Rheumatoid Arthritis Magnetic Resonance Imaging Scoring System (RAMRIS) Scoring of Bone Erosions

Bone erosions were assessed by magnetic resonance imaging (MRI) at baseline and Week 24. Scans of 25 bone locations were read and scored in pairs for each participant by 2 assessors. Scores for each location ranged 0-10 on an 11-point scale with 0= no erosion, 1= 1-10% erosion, 2= 11-20% erosion, and up to 10= 91-100% erosion. Total score was the sum of the 25 individual scores and ranged 0-250 with 0= no erosion and 250= most severe erosion. A negative change from baseline indicates improvement.

Time frame:
From baseline to Week 24
Reported as:
Mean · units on a scale
Change From Baseline in Rheumatoid Arthritis Magnetic Resonance Imaging Scoring System (RAMRIS) Scoring of Bone Erosions
units on a scaleTocilizumab
Baseline8.88 ± 6.70
Change from baseline at Week 240.9 ± 1.66
SecondaryChange From Baseline in RAMRIS Scoring of Cartilage Loss

Cartilage loss was assessed by MRI at baseline and Week 24. Scans of 25 joints were read and scored in pairs for each participant by 2 assessors. Scores for each location ranged 0-4 on a 9-point scale, with 0= no cartilage loss and 4= complete cartilage loss. Total score was the sum of the 25 individual scores and ranged 0-100 with 0= no cartilage loss and 100= most severe cartilage loss. A negative change from baseline indicates improvement.

Time frame:
From baseline to Week 24
Reported as:
Mean · units on a scale
Change From Baseline in RAMRIS Scoring of Cartilage Loss
units on a scaleTocilizumab
Baseline6.29 ± 9.46
Change from baseline at Week 240.12 ± 0.59
SecondaryChange From Baseline in RAMRIS Scoring of Synovitis

Synovitis (synovial membrane inflammation) was assessed by MRI at baseline and Week 24. Scans of 8 joint locations were read and scored in pairs for each participant by 2 assessors. Scores for each location ranged 0-3 on a 4-point scale, with 0= no synovitis, 1= 1-33% volume enhancement, 2= 34-67% volume enhancement and 3= 68-100% volume enhancement. Total score was the sum of the 8 individual scores and ranged 0-24 with 0= no synovitis and 24= most severe synovitis. A negative change from baseline indicates improvement.

Time frame:
From baseline to Week 24
Reported as:
Mean · units on a scale
Change From Baseline in RAMRIS Scoring of Synovitis
units on a scaleTocilizumab
Baseline4.5 ± 4.01
Change from baseline at Week 24-1.7 ± 2.67
SecondaryChange From Baseline in RAMRIS Scoring of Osteitis

Osteitis (bone inflammation) was assessed by MRI at baseline and Week 24. Scans of 25 bone locations were read and scored in pairs for each participant by 2 assessors. Scores for each location ranged 0-3 on a 4-point scale, with 0= no osteitis, 1= 1-33% involvement of original articular bone, 2= 34-67% involvement of original articular bone and 3= 68-100% involvement of original articular bone. Total score was the sum of the 25 individual scores and ranged 0-75 with 0= no osteitis and 75= most severe osteitis. A negative change from baseline indicates improvement.

Time frame:
From baseline to Week 24
Reported as:
Mean · units on a scale
Change From Baseline in RAMRIS Scoring of Osteitis
units on a scaleTocilizumab
Baseline6.63 ± 10.26
Change from baseline at Week 24-4 ± 9.58
SecondarySafety: Percentage of Participants With Adverse Events (AEs)

An adverse event is any untoward medical occurrence in a participant administered a pharmaceutical product and which does not necessarily have to have a causal relationship with the treatment. An adverse event can therefore be any unfavorable and unintended sign (including an abnormal laboratory finding, for example), symptom, or disease temporally associated with the use of a pharmaceutical product, whether or not considered related to the pharmaceutical product. Preexisting conditions which worsen during a study are also considered as adverse events.

Time frame:
Up to Week 32 (end of follow up: 8 weeks after end of treatment)
Reported as:
Number · percentage of participants
Safety: Percentage of Participants With Adverse Events (AEs)
percentage of participantsTocilizumab
Safety: Percentage of Participants With Adverse Events (AEs)92.31
SecondarySafety: Number of AEs Leading to Tocilizumab Dose Modification or Study Treatment Withdrawal
Time frame:
Up to Week 32 (end of follow up: 8 weeks after end of treatment)
Reported as:
Number · adverse events
Safety: Number of AEs Leading to Tocilizumab Dose Modification or Study Treatment Withdrawal
adverse eventsTocilizumab
Leading to withdrawal of study treatment2
Leading to dose modification3
SecondarySafety: Number of Participants With Confirmed Positive Assessment of Tocilizumab Immunogenicity

A tocilizumab antibody screen was performed at baseline and at the end of follow up (8 weeks after end of treatment at Week 32). A confirmatory anti-tocilizumab antibody test was performed on positive screen samples. A confirmed positive test indicates the presence of tocilizumab antibodies.

Time frame:
At baseline, Week 32 (end of follow up: 8 weeks after end of treatment)
Reported as:
Number · participants
Safety: Number of Participants With Confirmed Positive Assessment of Tocilizumab Immunogenicity
participantsTocilizumab
Baseline0
Week 320

Adverse events

Collected over Up to Week 32 (end of follow up: 8 weeks after end of treatment). Non-serious events are listed at a 5% frequency threshold.

Adverse event summary by group
GroupDeathsSeriousOther
Tocilizumab—3/52 (5.8%)35/52 (67.3%)
Most frequent serious events
Most frequent serious events
EventTocilizumab
AnaemiaBlood and lymphatic system disorders1/52
Ankle fractureInjury, poisoning and procedural complications1/52
AsthmaRespiratory, thoracic and mediastinal disorders1/52
Most frequent other events
Showing 10 of 15
Most frequent other events
EventTocilizumab
Upper respiratory tract infectionInfections and infestations15/52
Rheumatoid arthritisMusculoskeletal and connective tissue disorders11/52
NeutropeniaBlood and lymphatic system disorders6/52
DiarrhoeaGastrointestinal disorders5/52
Mouth ulcerationGastrointestinal disorders4/52
ArthralgiaMusculoskeletal and connective tissue disorders4/52
ParaesthesiaNervous system disorders4/52
NauseaGastrointestinal disorders3/52
ContusionInjury, poisoning and procedural complications3/52
LacerationInjury, poisoning and procedural complications3/52

Baseline characteristics

Full Analysis Set (FAS) included all enrolled participants who received at least one dose of subcutaneous tocilizumab.

Age, Continuous
Age, Continuous(years)Tocilizumab
Mean56.87 ± 11.525
Sex: Female, Male
Sex: Female, Male(Participants)Tocilizumab
Female41
Male11
08

Study locations

10 sites
  • Camperdown, New South Wales 2050, Australia
  • Coffs Harbour, New South Wales 2450, Australia
  • Kogarah, New South Wales 2217, Australia
  • Southport, Queensland 4215, Australia
  • Adelaide, South Australia 5000, Australia
  • Hobart, Tasmania 7000, Australia
  • Geelong, Victoria 3220, Australia
  • Ivanhoe, Victoria 3079, Australia
  • Malvern East, Victoria 3145, Australia
  • Morwell, Victoria 3842, Australia
09

References and documents

Publications

  • Choy E, Caporali R, Xavier R, Fautrel B, Sanmarti R, Bao M, Devenport J, Petho-Schramm A. Effects of concomitant glucocorticoids in TOZURA, a common-framework study programme of subcutaneous tocilizumab in rheumatoid arthritis. Rheumatology (Oxford). 2019 Jun 1;58(6):1056-1064. doi: 10.1093/rheumatology/key393. PubMed 30649524 ↗
  • Bird P, Peterfy C, Countryman P, Griffiths H, Barrett R, Youssef P, Joshua F, Hall S. AC-CUTE: An Open-Label Study to Evaluate Progression of Structural Joint Damage and Inflammation in Subjects with Moderate to Severe Rheumatoid Arthritis. Int J Rheumatol. 2018 Apr 12;2018:8721753. doi: 10.1155/2018/8721753. eCollection 2018. PubMed 29849651 ↗
  • Choy E, Caporali R, Xavier R, Fautrel B, Sanmarti R, Bao M, Bernasconi C, Petho-Schramm A. Subcutaneous tocilizumab in rheumatoid arthritis: findings from the common-framework phase 4 study programme TOZURA conducted in 22 countries. Rheumatology (Oxford). 2018 Mar 1;57(3):499-507. doi: 10.1093/rheumatology/kex443. Erratum In: Rheumatology (Oxford). 2018 Jun 1;57(6):1129. doi: 10.1093/rheumatology/key116. PubMed 29244149 ↗
10

Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Sep 21, 2016, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
11

Registry details

Key details

Study ID
NCT01951170
Lead sponsor
Hoffmann-La Roche
Responsible party
Sponsor
First posted
Sep 26, 2013
Start date
Nov 2013
Primary completion
Aug 2015
Completion
Aug 2015
Results posted
Sep 21, 2016
Last update
Sep 21, 2016

Study contacts

Clinical Trials
study director · Hoffmann-La Roche
View the source record on ClinicalTrials.gov ↗

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