Phase 3
N=250
An Efficacy and Safety Study of Tocilizumab (RoActemra/Actemra) in Participants With Giant Cell Arteritis (GCA)
Giant Cell Arteritis
Bottom Line
View on ClinicalTrials.gov: NCT01791153 ↗Enrolled (actual)
250
Serious AEs
22.6%
Results posted
May 2017
Primary outcome: Primary: Percentage of Participants in Sustained Remission at Week 52 (Tocilizumab + 26 Weeks Prednisone Taper Versus Placebo + 26 Weeks Prednisone Taper) — 56.0; 53.1; 14.0 percentage of participants — p=<0.0001
Study Design & Population
- Study type
- Interventional
- Phase
- Phase 3
- Interventions
- Tocilizumab (Drug); Prednisone (Drug); Tocilizumab Placebo (Drug); Prednisone Placebo (Drug); Corticosteroids (Drug); Methotrexate (Drug)
- Age
- Adult, Older Adult · 50+ yrs
- Sex
- All
- Sponsor
- Hoffmann-La Roche
- Primary completion
- Apr 2016
Outcome Measures
| Outcome | Result | p-value |
|---|---|---|
| PRIMARY Percentage of Participants in Sustained Remission at Week 52 (Tocilizumab + 26 Weeks Prednisone Taper Versus Placebo + 26 Weeks Prednisone Taper) |
56.0; 53.1; 14.0 | <0.0001 sig |
| SECONDARY Percentage of Participants in Sustained Remission at Week 52 (Tocilizumab + 26 Weeks Prednisone Taper Versus Placebo + 52 Weeks Prednisone Taper) |
56.0; 53.1; 17.6 | < 0.0001 sig |
| SECONDARY Time to First GCA Disease Flare |
NA; NA; 165.0; 295.0 | <0.0001 sig |
| SECONDARY Total Cumulative Prednisone Dose |
1862.00; 1862.00; 3296.00; 3817.50 | <0.0001 sig |
| SECONDARY Change From Baseline in Short Form (SF)-36 Questionnaire Score at Week 52 |
43.10; 40.62; 42.65; 41.12; 5.37; 2.71 | 0.8067 |
| SECONDARY Change From Baseline in Patient Global Assessment (PGA) of Disease Activity Assessed Using Visual Analogue Scale (VAS) at Week 52 |
43.61; 46.65; 35.73; 47.78; -19.68; -22.69 | 0.0312 sig |
| SECONDARY Area Under the Curve From Time Zero to End of Dosing Interval (AUCtau) at Steady State of Tocilizumab |
499.2; 227.2 | — |
| SECONDARY Maximum Serum Concentration at Steady State (Cmax,ss) of Tocilizumab |
73; 19.3 | — |
| SECONDARY Minimum Serum Concentration at Steady State (Cmin,ss) of Tocilizumab |
68.1; 11.1 | — |
| SECONDARY Minimum Observed Serum Concentration (Ctrough) of Tocilizumab |
0.07; 0.00; 67.93; 12.22 | — |
| SECONDARY Serum Interleukin-6 (IL-6) Level |
8.79; 16.29; 12.73; 8.31; 65.99; 52.70 | — |
| SECONDARY Serum Soluble IL-6 Receptor (sIL-6R) Level |
51.34; 50.82; 42.07; 40.37; 600.53; 464.30 | — |
| SECONDARY Erythrocyte Sedimentation Rate (ESR) |
19.00; 15.00; 23.00; 20.00; 3.00; 5.00 | — |
| SECONDARY C-Reactive Protein (CRP) Level |
3.67; 4.52; 3.64; 3.56; 0.30; 0.33 | — |
| SECONDARY Percentage of Participants With Anti-Tocilizumab Antibodies |
1.1; 6.5; 2.0; 2.1 | — |
Summary
This multicenter, randomized, double-blind, placebo-controlled, parallel-group study will evaluate the efficacy and safety of tocilizumab in participants with GCA. The study will consist of 2 parts: a 52-week double-blind treatment period (Part 1) followed by a 104-week open label long-term follow-up period (Part 2). In Part 1 of the study eligible participants will be randomized to receive either tocilizumab every week (qw) or every 2 weeks (q2w) or placebo for 52 weeks, with tapering oral daily doses of prednisone. After Week 52, participants in remission will stop study treatment and enter long-term follow-up, whereas participants with disease activity or flares will receive open-label tocilizumab or other treatment at the discretion of the investigator for a maximum period of 104 weeks.
Eligibility Criteria
Inclusion Criteria
- Diagnosis of GCA classified according to age >/=50 years; history of ESR >/=50 mm/hr or history of CRP >/=2.45 mg/dL; and at least one of the following: unequivocal cranial symptoms of GCA or symptoms of polymyalgia rheumatica [PMR]; and at least one of the following: temporal artery biopsy revealing features of GCA or evidence of large-vessel vasculitis by angiography or cross-sectional imaging
- New onset (diagnosis within 6 weeks of baseline) or refractory (diagnosis greater than [>] 6 weeks before baseline and previous treatment with >/= 40 milligrams per day prednisone [or equivalent] for at least 2 consecutive weeks at any time) GCA
- Active disease (presence of clinical signs and symptoms [cranial or PMR] and ESR >/=30 mm/hour or CRP >/=1 mg/dL) within 6 weeks of baseline visit
Exclusion Criteria
- Major surgery within 8 weeks prior to screening or planned within 12 months after randomization
- Transplanted organs (except corneas with transplant performed >3 months prior to screening)
- Major ischemic event, unrelated to GCA, within 12 weeks of screening
- Prior treatment with any of the following: investigational agent within 12 weeks (or 5 half-lives of the investigational drug, whichever is longer) of screening; cell-depleting therapies including investigational agent; intravenous (IV) gamma globulin or plasmapheresis within 6 months of baseline; alkylating agents or with total lymphoid irradiation; tocilizumab; hydroxychloroquine, cyclosporine A, azathioprine, or mycophenolate mofetil within 4 weeks of baseline; etanercept within 2 weeks of baseline; infliximab, certolizumab, golimumab, abatacept, or adalimumab within 8 weeks of baseline; anakinra within 1 week of baseline; tofacitinib; cyclophosphamide within 6 months of baseline; >100 milligrams of daily IV methylprednisolone within 6 weeks of baseline
- Participants requiring systemic glucocorticoids for conditions other than GCA, which, in the opinion of the investigator, would interfere with adherence to the fixed glucocorticoid taper regimen and/or to assessment of efficacy in response to the test article
- History of severe allergic reactions to monoclonal antibodies or to prednisone
- Evidence of serious uncontrolled concomitant disease (for example, cardiovascular, respiratory, renal, endocrine, psychiatric, corneal ulcers/injuries, or gastrointestinal [GI] disease)
- Current liver disease, as determined by the investigator
- History of diverticulitis, inflammatory bowel disease, or other symptomatic GI tract condition that might predispose to bowel perforation
- Known active or history of recurrent bacterial, viral fungal, mycobacterial, or other infection
- Primary or secondary immunodeficiency
- Evidence of malignancies diagnosed within previous 5 years (except basal and squamous cell carcinoma of the skin or carcinoma in situ of the cervix uteri that have been excised and cured)
- Inadequate hematologic, renal or liver function
- Positive for hepatitis B or hepatitis C infection
Data sourced from ClinicalTrials.gov (NCT01791153). Outcome figures and adverse-event rates are extracted automatically from the registry's posted results and are provided for clinician reference, not as a substitute for the primary publication.