Phase 3
Completed N=401
A Study of Subcutaneous RoActemra/Actemra (Tocilizumab) as Monotherapy or in Combination With Methotrexate or Other Non-Biologic DMARDs in Patients With Active Rheumatoid Arthritis
Source: ClinicalTrials.gov NCT01995201 ↗Enrolled (actual)
401
Serious AEs
3.2%
Results posted
Jan 2018
Primary outcomePrimary: Percentage of Participants Achieving Sustained Clinical Remission, Disease Activity Scale 28 - Erythrocyte Sedimentation Rate <26 (DAS28-ESR <2.6) at Week 20 and Week 24 — 48.4; 52.9 Percentage of participants — p=0.5231
◆ Published Evidence
Established
37citations · ~5 / year
Subcutaneous tocilizumab in rheumatoid arthritis: findings from the common-framework phase 4 study programme TOZURA conducted in 22 countries.
Summary
This multicenter, open-label study will evaluate the efficacy and safety of subcutaneously administered RoActemra/Actemra (tocilizumab) as monotherapy or in combination with methotrexate or other non-biologic DMARDs in patients with active rheumatoid arthritis and an inadequate response to non-biologic DMARDs or to one anti-TNF. In Phase 1, all patients will receive RoActemra/Actemra 162 mg subcutaneously (sc) weekly for Weeks 1 to 24, with or without methotrexate or other non-biologic DMARDs. For Part 2, patients who achieve sustained clinical DAS28-ESR remission at Weeks 20 and 24 will be randomized to receive RoActemra/Actemra 162 mg sc either weekly or every 2 weeks for Weeks 24 to 48, with or without methotrexate or other non-biologic DMARDs. Patients who do not achieve sustained clinical remission but achieve low disease activity (DAS-ESR </= 3.2) will continue the initial treatment of RoActemra/Actemra 162 mg sc weekly for Weeks 24 to 48, with or without methotrexate or other non-biologic DMARDs.
Linked Publications (3)
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Subcutaneous tocilizumab in rheumatoid arthritis: findings from the common-framework phase 4 study programme TOZURA conducted in 22 countries.
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Reducing or Maintaining the Dose of Subcutaneous Tocilizumab in Patients With Rheumatoid Arthritis in Clinical Remission: A Randomized, Open-Label Trial.
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Effects of concomitant glucocorticoids in TOZURA, a common-framework study programme of subcutaneous tocilizumab in rheumatoid arthritis.
Outcome Measures
| Outcome | Result | p-value |
|---|---|---|
| PRIMARY Percentage of Participants Achieving Sustained Clinical Remission, Disease Activity Scale 28 - Erythrocyte Sedimentation Rate <26 (DAS28-ESR <2.6) at Week 20 and Week 24 |
48.4; 52.9 | 0.5231 |
| SECONDARY Mean Change in Disease Activity Score 28 - Erythrocyte Sedimentation Rate(DAS28-ESR) |
-4.07; -4.01; -3.94; -3.78; -3.97; -3.77 | — |
| SECONDARY Percentage of Patients Allocated in Groups A1 and A2 Who Remain With Clinical Remission Activity (DAS 28 ESR <2.6) up to Week 48 |
88.5; 84.1; 87.2; 81.1; 80.2; 86.4 | — |
| SECONDARY Percentage of Patients Reporting Change in DAS 28 ESR >1.2 Until Week 48 |
96.6; 96.6; 96.5; 95.6; 93.0; 97.7 | — |
| SECONDARY Percentage of Patients With American College of Rheumatology (ACR20, 50, 70, 90) Response Scores Until Week 24 |
27.0; 31.7; 50.7; 49.7; 67.1; 67.0 | — |
| SECONDARY Percentage of Patients With American College of Rheumatology (ACR20, 50, 70, 90) Response Scores Until Week 48 |
90.0; 92.2; 93.1; 94.4; 84.9; 91.0 | — |
| SECONDARY Number of Patients With Good and Moderate Clinical Response According to European League Against Rheumatism (EULAR) Response Scores up to Week 24 |
14; 61; 36; 196; 18; 109 | — |
| SECONDARY Number of Patients With Clinical Response According to European League Against Rheumatism (EULAR) Response Scores up to Week 48 |
82; 77; 5; 10; 79; 81 | — |
| SECONDARY Mean Change in Clinical Disease Activity Index (CDAI) From Baseline up to Week 24 |
33.06; 32.06; -7.54; -8.62; -13.03; -13.23 | — |
| SECONDARY Mean Change From Baseline in Clinical Disease Activity Index (CDAI) up to Week 48 |
29.27; 29.64; -25.54; -25.34; -24.75; -24.01 | — |
| SECONDARY Mean Change in Simplified Disease Activity Index (SDAI) From Baseline up to Week 24 |
48.66; 44.40; -20.45; -19.50; -27.86; -24.34 | — |
| SECONDARY Mean Change in Simplified Disease Activity Index (SDAI) From Week 24 up to Week 48 |
41.45; 40.92; -37.02; -35.88; -35.15; -34.50 | — |
| SECONDARY Mean Change From Baseline in Total Tender Joint Counts (TJC) Until Week 24 |
18.05; 19.12; -4.31; -5.00; -7.04; -7.96 | — |
| SECONDARY Mean Change From Baseline in Total Tender Joint Counts (TJC) Until Week 48 |
15.42; 15.97; -13.66; -12.88; -13.40; -13.88 | — |
| SECONDARY Mean Change in Total Swollen Joint Counts (SJC) From Baseline Until Week 24 |
10.05; 9.76; -3.22; -3.42; -5.07; -5.46 | — |
| SECONDARY Mean Change in Total Swollen Joint Counts (SJC) From Baseline Until Week 48 |
9.28; 9.23; -8.64; -8.14; -8.54; -8.62 | — |
| SECONDARY Percentages of Patients Who Achieve DAS28-ESR Remission (DAS28 < 2.6) up to Week 48 |
82.6; 90.6; 87.0; 83.1; 81.8; 89.1 | — |
| SECONDARY Percentages of Patients With Remission (CDAI<2.8) Until Week 24 |
0; 0; 2.7; 1.6; 2.7; 5.1 | — |
| SECONDARY Percentages of Patients With Remission (CDAI<2.8) Until Week 48 |
46.6; 48.3; 48.3; 45.6; 52.3; 46.6 | — |
| SECONDARY Percentages of Patients With Remission (SDAI<3.3) Until Week 24 |
0; 0; 1.4; 1.9; 2.9; 4.8 | — |
| SECONDARY Percentages of Patients With Remission (SDAI<3.3) Until Week 48 |
50.0; 46.0; 48.8; 45.6; 53.5; 47.7 | — |
| SECONDARY Percentage of Patients Who Achieve Low Disease Activity Based on DAS28-ESR Criteria (DAS28-ESR </=3.2) up to Week 24 |
21.6; 21.5; 26.0; 36.8; 50.7; 55.4 | — |
| SECONDARY Percentage of Patients Who Achieve Low Disease Activity Based on DAS28-ESR Criteria (DAS28-ESR </=3.2) up to Week 48 |
95.4; 88.6; 91.9; 92.2; 87.2; 92.0 | — |
| SECONDARY Percentage of Patients Who Achieve Low Disease Activity Based on CDAI Score (CDAI<10) Until Week 24 |
13.5; 16.9; 24.7; 26.9; 41.1; 47.5 | — |
| SECONDARY Percentage of Patients Who Achieve Low Disease Activity Based on CDAI Score (CDAI<10) Until Week 48 |
86.4; 85.4; 89.7; 86.7; 80.2; 89.8 | — |
| SECONDARY Percentage of Patients Who Achieved Low Disease Activity (LDA) Based on SDAI Score (SDAI<11) Until Week 24 |
16.7; 17.6; 27.1; 28.3; 41.7; 48.1 | — |
| SECONDARY Percentage of Patients Who Achieved Low Disease Activity (LDA) Based on SDAI Score (SDAI<11) Until Week 48 |
84.9; 83.89; 89.5; 85.6; 79.1; 87.5 | — |
| SECONDARY Safety: Number of Patients Reporting Adverse Events up to Week 24 |
52; 254; 2; 13; 3; 10 | — |
| SECONDARY Safety: Number of Patients Reporting Adverse Events up to Week 48 |
50; 63; 68; 46; 1; 1 | — |
| SECONDARY Immunogenicity: Number of Patients With Anti-tocilizumab Antibodies up to Week 24 |
6; 13; 1; 2; 3; 9 | — |
| SECONDARY Immunogenicity: Number of Patients With Anti-tocilizumab Antibodies up to Week 48 |
0; 0; 0; 2; 1; 3 | — |
| SECONDARY Immunogenicity: TCZ Levels up to Week 24 |
0.49; 0.67; 37.97; 41.23; 46.42; 46.87 | — |
| SECONDARY Immunogenicity: TCZ Levels at Week 36 and Early Withdrawal Visit |
48.47; 16.77; 41.89; 48.33; 36.45; 19.20 | — |
| SECONDARY Immunogenicity: SIL-6R Levels up to Week 24 |
42.85; 39.29; 566.47; 570.34; 570.49; 565.34 | — |
| SECONDARY Immunogenicity: SIL-6R Levels at Week 36 and Early Withdrawal Visit |
39.87; 39.70; 39.39; 43.11; 37.30; 539.89 | — |
| SECONDARY Patient Global Assessment of Disease Activity Visual Analogue Scale (VAS) up to Week 24 |
65.26; 59.40; 49.53; 44.16; 38.21; 35.19 | — |
| SECONDARY Patient Global Assessment of Disease Activity Visual Analogue Scale (VAS) up to Week 48 |
58.97; 60.96; 11.97; 12.74; 10.78; 10.80 | — |
| SECONDARY Assessment of Pain Reported by the Patient (VAS) Until Week 24 |
66.38; 58.59; 53.20; 47.46; 43.11; 42.88 | — |
| SECONDARY Assessment of Pain Reported by the Patient (VAS) Until Week 48 |
55.73; 56.00; 17.33; 15.67; 17.08; 17.27 | — |
| SECONDARY Health Assessment Questionnaire-Disability Index (HAQ-DI) up to Week 24 |
1.49; 1.36; 1.39; 1.18; 1.20; 1.05 | — |
| SECONDARY Health Assessment Questionnaire-Disability Index (HAQ-DI) up to Week 48 |
1.21; 1.20; 0.58; 0.57; 0.55; 0.57 | — |
| SECONDARY Functional Assessment of Chronic Illness Therapy - Fatigue (FACIT-F) up to Week 24 |
81.72; 89.16; 86.64; 95.82; 92.26; 99.54 | — |
| SECONDARY Functional Assessment of Chronic Illness Therapy - Fatigue (FACIT-F) up to Week 48 |
17.36; 17.13; 23.50; 23.12; 23.62; 22.98 | — |
Eligibility Criteria
Inclusion Criteria
- Adult patients, >/= 18 years of age
- Active rheumatoid arthritis (DAS28-ESR > 3.2), according to the revised (1987) ACR criteria or EULAR/ACR (2010) criteria of > 6 months duration
- Patients with intolerance or inadequate response to methotrexate or other non-biologic DMRADs or inadequate response to a first ant-TNF agent
- Oral corticosteroids ( /= 4 weeks prior to baseline
- Permitted non-biologic DMRAD is allowed if at stable dose for at least 4 weeks prior to baseline
- Females of childbearing potential and males with female partners of childbearing potential must be using a reliable means of contraception as defined by protocol during the study and for at least 3 months following the last dose of RoActemra/Actemra
- Patients with intolerance or inadequate response to methotrexate or other non-biologic DMARDs or inadequate response to first anti-TNF agent
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 RA or significant systemic involvement secondary to RA; secondary Sjögren's syndrome with RA is permitted
- Functional Class IV as defined by the 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 (either intravenous [IV] or SC) at any time prior to baseline
- Treatment with any investigational agent with four weeks (or five-half lives of the investigational drug, whichever is longer) of screening
- Intra-articular or parenteral corticosteroids within 4 weeks prior to baseline
- Previous treatment with Abatacept
- History of severe allergic of anaphylactic reactions to human, humanized, or murine monoclonal antibodies
- Evidence of serious uncontrolled concomitant cardiovascular, nervous system, pulmonary, renal, hepatic, endocrine, or gastrointestinal (GI) disease
- History of diverticulitis, diverticulitis requiring antibiotic treatment, or chronic ulcerative lower GI disease such as Crohn's disease, ulcerative colitis, or other symptomatic lower GI conditions that might predispose to perforation
- Known active current or history of recurrent bacterial, viral, fungal, mycobacterial, or other infections (including but not limited to tuberculosis [TB] and atypical mycobacterial disease, hepatitis B and C, and herpes zoster, but excluding fungal infections or nail beds)
- Any major episode of infection requiring hospitalization or treatment with IV antibiotics within 4 weeks of screening or oral antibiotics within 2 weeks of screening
- Active TB requiring treatment within the previous 3 years
- Positive hepatitis B or hepatitis C
- Primary or secondary immunodeficiency (history of or currently active)
- Evidence of active malignant disease, malignancies diagnosed with the previous 10 years (including hematological malignancies and solid tumors, except basal of squamous cell carcinoma of the skin diagnosed within the previous 20 years
- Pregnant and lactating women
- History of alcohol, drug, or chemical abuse within 1 year prior to screening
- Neuropathies or other conditions that might interfere with pain evaluation
- Inadequate hematological, real of liver function
Data sourced from ClinicalTrials.gov (NCT01995201) and the linked publication. 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. Informational only — not medical advice.