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Weinstein CLJ, Sliwinska-Stanczyk P, Hála T, Stanislav M, Tzontcheva A, Yao R, Berd Y, Curtis SP, Philip G. Efficacy and safety of golimumab in patients with non-radiographic axial spondyloarthritis: a withdrawal and retreatment study (GO-BACK). Rheumatology (Oxford) 2023; 62:3601-3609. [PMID: 36919768 PMCID: PMC10629786 DOI: 10.1093/rheumatology/kead112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/23/2023] [Accepted: 03/01/2023] [Indexed: 03/16/2023] Open
Abstract
OBJECTIVES The GO-BACK study was designed to evaluate the efficacy and safety of golimumab (GLM) treatment withdrawal in adults with non-radiographic axial spondyloarthritis (nr-axSpA) who demonstrate inactive disease during a 10-month open-label (OL) GLM run-in. METHODS Eligible participants received OL GLM in period 1. In period 2, participants who achieved inactive disease were randomized 1:1:1 to receive double-blind (DB) treatment with monthly placebo (PBO, treatment withdrawal) or continued GLM treatment given monthly (GLM QMT) or every 2 months (GLM Q2MT). Participants who did not have a disease flare continued DB treatment for ∼12 months. Participants with a disease flare discontinued DB treatment and resumed monthly OL GLM. Primary endpoint compared the proportion of participants without a disease flare in the continued GLM treatment groups (QMT or Q2MT) vs PBO in a multiplicity-controlled, step-down fashion. Safety follow-up continued for ∼3 months after last treatment. RESULTS A total of 188 patients, out of the 323 enrolled, were eligible for participation in period 2. Both GLM QMT and GLM Q2MT were superior to treatment withdrawal (PBO) in preventing disease flare (P < 0.001), with a treatment-difference vs PBO of 50.4% and 34.4% for the GLM QMT and GLM Q2MT groups, respectively. The time-to-first flare was significantly longer (log-rank P < 0.0001) with GLM treatment compared with PBO. Of 53 participants (in Q2MT or PBO) who had a confirmed disease flare, 51 (96.2%) attained a clinical response within 3 months of restarting OL GLM. Adverse events were consistent with the known GLM safety profile. CONCLUSION Among participants with active nr-axSpA who attained inactive disease after 10 months of GLM treatment, continued GLM treatment is well tolerated and provides superior protection against disease flares compared with GLM withdrawal. (EudraCT: 2015-004020-65, registered on 30 March 2022; NCT: 03253796, registered on 18 August 2017.).
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Affiliation(s)
| | | | - Tomas Hála
- CCR Czech a.s., Pardubice, Czech Republic
| | - Marina Stanislav
- Vladimirsky Moscow Regional Scientific Institution, Moscow, Russia
| | | | - Ruji Yao
- Merck & Co., Inc., Rahway, NJ, USA
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Fleischmann R, Genovese MC, Lin Y, St John G, van der Heijde D, Wang S, Gomez-Reino JJ, Maldonado-Cocco JA, Stanislav M, Kivitz AJ, Burmester GR. Long-term safety of sarilumab in rheumatoid arthritis: an integrated analysis with up to 7 years' follow-up. Rheumatology (Oxford) 2020; 59:292-302. [PMID: 31312844 PMCID: PMC7571482 DOI: 10.1093/rheumatology/kez265] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 05/26/2019] [Indexed: 12/16/2022] Open
Abstract
Objective Sarilumab is a human monoclonal antibody that blocks IL-6 from binding to membrane-bound and soluble IL-6 receptor-α. We assessed the long-term safety of sarilumab in patients from eight clinical trials and their open-label extensions. Methods Data were pooled from patients with rheumatoid arthritis who received at least one dose of sarilumab in combination with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs; combination group) or as monotherapy (monotherapy group). Treatment-emergent adverse events (AEs) and AEs and laboratory values of special interest were assessed. Results 2887 patients received sarilumab in combination with csDMARDs and 471 patients received sarilumab monotherapy, with mean exposure of 2.8 years and 1.7 years, maximum exposure 7.3 and 3.5 years, and cumulative AE observation period of 8188 and 812 patient-years, respectively. Incidence rates per 100 patient-years in the combination and monotherapy groups, respectively, were 9.4 and 6.7 for serious AEs, 3.7 and 1.0 for serious infections, 0.6 and 0.5 for herpes zoster (no cases were disseminated), 0.1 and 0 for gastrointestinal perforations, 0.5 and 0.2 for major adverse cardiovascular events, and 0.7 and 0.6 for malignancy. Absolute neutrophil counts <1000 cells/mm3 were recorded in 13% and 15% of patients, respectively. Neutropenia was not associated with increased risk of infection or serious infection. Analysis by 6-month interval showed no signal for increased rate of any AE over time. Conclusion The long-term safety profile of sarilumab, either in combination with csDMARDs or as monotherapy, remained stable and consistent with the anticipated profile of a molecule that inhibits IL6 signalling.
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Affiliation(s)
- Roy Fleischmann
- Metroplex Clinical Research Center and University of Texas Southwestern Medical Center, Dallas, TX
| | - Mark C Genovese
- Division of Immunology and Rheumatology, Stanford University, Palo Alto, CA
| | | | | | | | | | | | | | - Marina Stanislav
- Research Rheumatology Institute n. a. V.A. Nassonova, Moscow, Russia
| | - Alan J Kivitz
- Altoona Center for Clinical Research, Duncansville, PA, USA
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Genovese MC, van der Heijde D, Lin Y, St John G, Wang S, van Hoogstraten H, Gómez-Reino JJ, Kivitz A, Maldonado-Cocco JA, Seriolo B, Stanislav M, Burmester GR. Long-term safety and efficacy of sarilumab plus methotrexate on disease activity, physical function and radiographic progression: 5 years of sarilumab plus methotrexate treatment. RMD Open 2019; 5:e000887. [PMID: 31452928 PMCID: PMC6691511 DOI: 10.1136/rmdopen-2018-000887] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 06/05/2019] [Accepted: 06/06/2019] [Indexed: 01/12/2023] Open
Abstract
Objective In MOBILITY (NCT01061736), sarilumab significantly reduced disease activity, improved physical function and inhibited radiographic progression at week 52 versus placebo in patients with rheumatoid arthritis (RA) and an inadequate response to methotrexate. We report 5-year safety, efficacy and radiographic outcomes of sarilumab from NCT01061736 and the open-label extension (EXTEND; NCT01146652), in which patients received sarilumab 200 mg every 2 weeks (q2w) + methotrexate. Methods Patients (n=1197) with moderately to severely active RA were initially randomised to placebo, sarilumab 150 mg or sarilumab 200 mg subcutaneously q2w plus weekly methotrexate for 52 weeks. Completers were eligible to enrol in the open-label extension and receive sarilumab 200 mg q2w + methotrexate. Results Overall, 901 patients entered the open-label extension. The safety profile remained stable over 5-year follow-up and consistent with interleukin-6 receptor blockade. Absolute neutrophil count <1000 cells/mm3 was observed but not associated with increased infection rate. Initial treatment with sarilumab 200 mg + methotrexate was associated with reduced radiographic progression over 5 years versus sarilumab 150 mg + methotrexate or placebo + methotrexate (mean±SE change from baseline in van der Heijde-modified Total Sharp Score: 1.46±0.27, 2.35±0.28 and 3.68±0.27, respectively (p<0.001 for each sarilumab dose versus placebo)). Clinical efficacy was sustained through 5 years according to Disease Activity Score (28-joint count) using C reactive protein, Clinical Disease Activity Index (CDAI) and Health Assessment Questionnaire-Disability Index. The number of patients achieving CDAI ≤2.8 at 5 years was similar among initial randomisation groups (placebo, 76/398 (19%); sarilumab 150 mg, 68/400 (17%); sarilumab 200 mg, 84/399 (21%)). Conclusion Clinical efficacy, including inhibition of radiographic progression, reduction in disease activity and improvement in physical function, was sustained with sarilumab + methotrexate over 5 years. Safety appeared stable over the 5-year period.
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Affiliation(s)
- Mark C Genovese
- Stanford University Medical Center, Palo Alto, California, USA
| | | | - Yong Lin
- Sanofi Genzyme, Bridgewater, New Jersey, USA
| | | | | | | | - Juan José Gómez-Reino
- Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Alan Kivitz
- Altoona Center for Clinical Research, Duncansville, Pennsylvania, USA
| | | | - Bruno Seriolo
- Department of Internal Medicine, University of Genova, Genova, Italy
| | - Marina Stanislav
- Research Rheumatology Institute n. a. V.A. Nasonova, Moscow, Russia
| | - Gerd R Burmester
- Department of Rheumatology and Clinical Immunology, Charité - University Medicine Berlin, Berlin, Germany
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Curtis JR, John GS, Pannucci M, Lin Y, Maldonado-Cocco JA, Huizinga T, Stanislav M, Wilson E, Emery P. 078 Reductions in absolute neutrophil count with sarilumab resulting in dose delays or dose decreases: effects on efficacy and safety. Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez106.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jeffrey R Curtis
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL
| | - Gregory St John
- Medical Affairs, Regeneron Pharmaceuticals, Inc, Tarrytown, NY
| | - Michael Pannucci
- Medical Analytics, Regeneron Pharmaceuticals, Inc, Tarrytown, NY
| | - Yong Lin
- Clinical, Sanofi Genzyme, Bridgewater, NJ
| | - José A Maldonado-Cocco
- Buenos Aires University School of Medicine, Universidad de Buenos Aires, Buenos Aires, ARGENTINA
| | - Thomas Huizinga
- Rheumatology, Leiden University Medical Centre, Leiden, NETHERLANDS
| | - Marina Stanislav
- Rheumatology Research Institute, n. a. V.A. Nassonova, Moscow, RUSSIAN FEDERATION
| | - Elaine Wilson
- Rheumatology, Sanofi Genzyme, Oxford, UNITED KINGDOM
| | - Paul Emery
- Leeds Institute of Rheumatic & Musculoskeletal Medicine, University of Leeds, Leeds, UNITED KINGDOM
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Deodhar A, Gensler LS, Sieper J, Clark M, Calderon C, Wang Y, Zhou Y, Leu JH, Campbell K, Sweet K, Harrison DD, Hsia EC, Heijde D, Ariel F, Asnal CA, Berman A, Citera G, Rodriguez G, Savio VG, Bird P, Griffiths H, Nicholls D, Rischmueller M, Zochling J, De Vlam K, Malaise M, Toukap AN, Van den Bosch F, Vanhoof J, Bonfiglioli R, Keiserman M, Scotton AS, Xavier R, Ximenes AC, Atanasov A, Goranov I, Kazmin I, Licheva RN, Nikolov N, Oparanov B, Stoilov R, Bessette L, Rodrigues J, Bortilik L, Dokoupilova E, Dvoarak Z, Galatikova D, Nemec P, Podrazilova L, Simkova G, Stejfova Z, Moravcova R, Vitek P, Cantagrel A, Baillet A, Banneville B, Combe B, Breban M, Nguyen M, Goupille P, Braun J, Everding A, Kekow J, Koenig R, Rubbert‐Roth A, Witte T, Bartha A, Drescher E, Kerekes K, Kovacs A, Pulai J, Rojkovich B, Szanto S, Toth E, Avila H, Torre IG, Irazoque F, Maradiaga M, Pacheco C, Brzosko M, Dudek A, Jeka S, Krogulec M, Kwiatkowska B, Wiland P, Wojciechowski R, Zielinska A, Santos H, Bugrova O, Christyakov V, Gorbunov V, Ilivanova E, Zemerova E, Kamalova R, Kameneva T, Macievskaya G, Marusenko I, Maslyansky A, Myasoedova S, Myasoutova L, Nemtsov B, Nesmeyanova O, Plaksina T, Pokrovskaya T, Polyakova S, Rebrov A, Savina L, Smakotina S, Stanislav M, Ukhanova O, Vinogradova I, Zonova E, Baek HJ, Kim T, Lee C, Lee S, Lee S, Lee S, Park S, Song Y, Suh C, Ramos JA, Blanco FJ, Collantes E, Diaz MC, Vivar MLG, Gratacos J, Juanola X, Chen D, Chen H, Chen K, Chen Y, Chiu Y, Luo S, Tsai S, Tseng J, Wei C, Weng M, Abrahamovych O, Reshotko D, Golovchenko O, Hospodarsky I, Iaremenko O, Levchenko O, Dudnyk O, Garmish O, Grishyna O, Protsenko G, Rekalov D, Smiyan S, Stanislavchuk M, Trypilka S, Tseluyko V, Turianytsia S, Vasylets V, Virstyuk N, Kleban Y, Ciurtin C, Gaffney K, Gunasekera W, Mackay K, Packham J, Sengupta R, Tahir H, Aelion J, Bennett R, Deodhar A, Gonzalez‐Paoli J, Griffin RM, Grisanti M, Mallepalli J, Peters E, Schechtman J, Singhal A. Three Multicenter, Randomized, Double‐Blind, Placebo‐Controlled Studies Evaluating the Efficacy and Safety of Ustekinumab in Axial Spondyloarthritis. Arthritis Rheumatol 2018; 71:258-270. [DOI: 10.1002/art.40728] [Citation(s) in RCA: 173] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 09/13/2018] [Indexed: 12/12/2022]
Affiliation(s)
| | | | | | - Michael Clark
- Janssen Research & Development, LLC Spring House Pennsylvania
| | - Cesar Calderon
- Janssen Research & Development, LLC Spring House Pennsylvania
| | - Yuhua Wang
- Janssen Research & Development, LLC Spring House Pennsylvania
| | - Yiying Zhou
- Janssen Research & Development, LLC Spring House Pennsylvania
| | - Jocelyn H. Leu
- Janssen Research & Development, LLC Spring House Pennsylvania
| | - Kim Campbell
- Janssen Research & Development, LLC Spring House Pennsylvania
| | - Kristen Sweet
- Janssen Research & Development, LLC Spring House Pennsylvania
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Yoo DH, Suh CH, Shim SC, Jeka S, Molina FFC, Hrycaj P, Wiland P, Lee EY, Medina-Rodriguez FG, Shesternya P, Radominski S, Stanislav M, Kovalenko V, Sheen DH, Myasoutova L, Lim MJ, Choe JY, Lee SJ, Lee SY, Kim SH, Park W. Efficacy, Safety and Pharmacokinetics of Up to Two Courses of the Rituximab Biosimilar CT-P10 Versus Innovator Rituximab in Patients with Rheumatoid Arthritis: Results up to Week 72 of a Phase I Randomized Controlled Trial. BioDrugs 2018; 31:357-367. [PMID: 28612179 PMCID: PMC5548818 DOI: 10.1007/s40259-017-0232-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background CT-P10 is a biosimilar of innovator rituximab (RTX), a biological therapy used to treat patients with rheumatoid arthritis (RA) who have responded inadequately to anti-tumor necrosis factor agents. Objective Our objective was to compare the clinical profile of CT-P10 versus RTX in patients with RA who received up to two courses of treatment and were followed for up to 72 weeks. Methods In this multicenter double-blind phase I study, patients were randomized 2:1 to receive CT-P10 1000 mg or RTX 1000 mg at weeks 0 and 2. Based on disease activity, patients could receive a second course of treatment between weeks 24 and 48. Efficacy endpoints, including mean change from baseline in Disease Activity Score using 28 joints (DAS28), safety, immunogenicity, pharmacokinetics, and pharmacodynamics were evaluated. Results In total, 154 patients were randomized to CT-P10 or RTX (n = 103 and 51, respectively); 137 (n = 92 and 45) completed the first course of treatment, of whom 83 (n = 60 and 23) were re-treated. Improvements from baseline in all efficacy endpoints were highly similar between the CT-P10 and RTX groups over both treatment courses. At week 24 after the second course, mean change from week 0 of the first course in DAS28 erythrocyte sedimentation rate was −2.47 and −2.04 for CT-P10 and RTX, respectively, (p = 0.1866) and in DAS28 C-reactive protein was −2.32 and −2.00, respectively (p = 0.3268). The proportion of patients positive for antidrug antibodies at week 24 after the second treatment course was 20.0% and 21.7% in the CT-P10 and RTX groups, respectively. The safety profile of CT-P10 was comparable to that of RTX, and pharmacokinetic and pharmacodynamic properties were similar. Conclusions In patients with RA, efficacy, safety, and other clinical data were comparable between CT-P10 and RTX after up to two courses of treatment over 72 weeks. (ClinicalTrials.gov identifier NCT01534884). Electronic supplementary material The online version of this article (doi:10.1007/s40259-017-0232-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dae Hyun Yoo
- Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea
| | - Chang-Hee Suh
- Ajou University School of Medicine, Suwon, Republic of Korea
| | - Seung Cheol Shim
- Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Slawomir Jeka
- Collegium Medicum UMK, University Hospital No. 2, Bydgoszcz, Poland
| | | | - Pawel Hrycaj
- Poznań University of Medical Sciences, Poznań, Poland
| | | | - Eun Young Lee
- Seoul National University College of Medicine, Seoul, Republic of Korea
| | | | | | | | - Marina Stanislav
- Research Rheumatology Institute n. a. V.A. Nassonova, Moscow, Russia
| | | | | | | | - Mie Jin Lim
- School of Medicine, IN-HA University, Incheon, Republic of Korea
| | - Jung-Yoon Choe
- School of Medicine, Catholic University of Daegu, Daegu, Republic of Korea
| | | | | | | | - Won Park
- School of Medicine, IN-HA University, Incheon, Republic of Korea.
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Park W, Suh CH, Shim SC, Molina FFC, Jeka S, Medina-Rodriguez FG, Hrycaj P, Wiland P, Lee EY, Shesternya P, Kovalenko V, Myasoutova L, Stanislav M, Radominski S, Lim MJ, Choe JY, Lee SJ, Lee SY, Kim SH, Yoo DH. Efficacy and Safety of Switching from Innovator Rituximab to Biosimilar CT-P10 Compared with Continued Treatment with CT-P10: Results of a 56-Week Open-Label Study in Patients with Rheumatoid Arthritis. BioDrugs 2018; 31:369-377. [PMID: 28600696 PMCID: PMC5548826 DOI: 10.1007/s40259-017-0233-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background CT-P10 is a biosimilar candidate of innovator rituximab (RTX) that demonstrated a comparable clinical profile to RTX in a phase I randomized controlled trial (RCT) in rheumatoid arthritis (RA) (ClinicalTrials.gov identifier: NCT01534884). Objective This open-label extension (OLE) study (NCT01873443) compared the efficacy and safety of CT-P10 in patients with RA who received CT-P10 from the outset (i.e., from the start of the RCT and also in the OLE; ‘maintenance group’) with those who received RTX during the RCT and switched to CT-P10 during the OLE (‘switch group’). Methods Patients who completed the RCT were recruited. Based on the Disease Activity Score using 28 joints (DAS28) and predefined safety criteria, patients could receive up to two courses of CT-P10 during the OLE. Efficacy [DAS28 and European League Against Rheumatism (EULAR) response], safety and immunogenicity were assessed. Results Eighty-seven patients were enrolled; 58 and 29 had previously received CT-P10 or RTX, respectively, in the RCT. Of these, 38 (65.5%) and 20 (69.0%) were treated with CT-P10 in the OLE and therefore comprised the maintenance and switch groups, respectively. The mean change in DAS28-erythrocyte sedimentation rate (ESR) from baseline (week 0 of RCT) at week 24 of the first OLE treatment course in the maintenance and switch groups was −2.7 and −2.4, respectively. The proportion of patients with good/moderate EULAR responses was also comparable between groups. Antidrug antibodies were detected in 13.2 and 15.0% of patients in the maintenance and switch groups, respectively, at week 24 of the first OLE course. CT-P10 treatment was well-tolerated when administered for up to 2 years or after switching from RTX. Conclusion In this study population, comparable efficacy and safety profiles were observed in patients who switched from RTX to CT-P10 and those maintained on CT-P10 throughout treatment. Electronic supplementary material The online version of this article (doi:10.1007/s40259-017-0233-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Won Park
- School of Medicine, IN-HA University, Incheon, Republic of Korea
| | - Chang-Hee Suh
- Ajou University School of Medicine, Suwon, Republic of Korea
| | - Seung Cheol Shim
- Chungnam National University Hospital, Daejeon, Republic of Korea
| | | | - Slawomir Jeka
- University Hospital No. 2, Collegium Medicum UMK, Bydgoszcz, Poland
| | | | - Pawel Hrycaj
- Poznań University of Medical Sciences, Poznań, Poland
| | | | - Eun Young Lee
- Seoul National University College of Medicine, Seoul, Republic of Korea
| | | | | | | | - Marina Stanislav
- Research Rheumatology Institute n. a. V.A. Nassonova, Moscow, Russia
| | | | - Mie Jin Lim
- School of Medicine, IN-HA University, Incheon, Republic of Korea
| | - Jung-Yoon Choe
- School of Medicine, Catholic University of Daegu, Daegu, Republic of Korea
| | | | | | | | - Dae Hyun Yoo
- Division of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, 222-1 Wangsimni-Ro, Seongdong-Gu, Seoul, 04763, Republic of Korea.
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Kivitz A, Baret-Cormel L, van Hoogstraten H, Wang S, Parrino J, Xu C, Stanislav M. Usability and Patient Preference Phase 3 Study of the Sarilumab Pen in Patients with Active Moderate-to-Severe Rheumatoid Arthritis. Rheumatol Ther 2017; 5:231-242. [PMID: 29209946 DOI: 10.1007/s40744-017-0090-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Sarilumab is a human monoclonal antibody that blocks the interleukin-6 receptor alpha (IL-6Rα). The phase 3 SARIL-RA-EASY study (EASY) assessed the robustness of an autoinjector (pen) for administering sarilumab when used by adults with active moderate-to-severe rheumatoid arthritis (RA) who are candidates for anti-IL-6R therapy in an unsupervised real-world setting. METHODS EASY was a 12-week, multicenter, randomized, open-label, parallel-group usability study of the sarilumab pen and prefilled syringe. Patients were randomized 1:1:1:1 to sarilumab 150 or 200 mg every 2 weeks (q2w) administered via pen or syringe, plus background disease-modifying antirheumatic drugs. Patients reported their ability to remove the pen cap and initiate and complete injections; negative responses were defined as product technical complaints (PTCs). The primary endpoint was the number of validated product technical failures (PTFs; PTC with a validated technical cause). This study was not powered to demonstrate bioequivalence or differences in efficacy among groups. RESULTS A total of 217 patients were randomized. There were 600 successful injections with the sarilumab pen in 108 patients and no pen-associated PTFs. One PTC was observed (the pen was mistakenly activated before injection). At week 12, 88% of patients indicated the pen was "easy" to use, and 98% reported they were "satisfied" with the pen. Proportions of patients achieving an American College of Rheumatology 20/50/70 response and a 28-joint disease activity score by C-reactive protein < 2.6 were similar at each dose between the pen and syringe groups, as were the pharmacokinetics. There were no clinically meaningful differences in adverse events (AEs), serious AEs, and AEs leading to discontinuation in the pen and syringe groups. The most common treatment-emergent AEs were infections and neutropenia. CONCLUSION This study demonstrated the ease of use and robustness of the sarilumab pen when used by patients with RA in an unsupervised setting. Pharmacokinetics, safety, and efficacy were generally similar for the pen and syringe groups (NCT02057250). FUNDING Sanofi Genzyme and Regeneron Pharmaceuticals, Inc. TRIAL REGISTRATION Clinicaltrials.gov identifier, NCT02057250.
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Affiliation(s)
- Alan Kivitz
- Altoona Center for Clinical Research, Duncansville, PA, USA.
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Hsu VM, Denton CP, Domsic RT, Furst DE, Rischmueller M, Stanislav M, Steen VD, Distler JH, Korish S, Cooper A, Choi S, Schafer PH, Horan G, Hough DR. Pomalidomide in Patients with Interstitial Lung Disease due to Systemic Sclerosis: A Phase II, Multicenter, Randomized, Double-blind, Placebo-controlled, Parallel-group Study. J Rheumatol 2017; 45:405-410. [DOI: 10.3899/jrheum.161040] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2017] [Indexed: 11/22/2022]
Abstract
Objective.To evaluate the safety and efficacy of pomalidomide (POM) on forced vital capacity (FVC), modified Rodnan skin score (mRSS), and gastrointestinal (GI) symptomatology over 52 weeks of treatment in patients with interstitial lung disease due to systemic sclerosis (SSc).Methods.Twenty-three adult patients diagnosed with SSc were randomized 1:1 POM:placebo (PBO).Results.Mean change at Week 52 from baseline in predicted FVC% −5.2 and −2.8; mRSS −2.7 and −3.7; and UCLA Scleroderma Clinical Trial Consortium Gastrointestinal Tract (SCTC GIT 2.0) score 0.1 and 0.0, with POM and PBO, respectively. Statistical significance was not achieved for any of these 3 primary endpoints at 52 weeks.Conclusion.Because of recruitment challenges, subject enrollment was discontinued early. In an interim analysis, the study did not meet its Week 52 primary endpoints. Therefore, a decision was made to terminate all study phases. POM was generally well tolerated, with an adverse event profile consistent with the known safety and tolerability profile of POM in other diseases. Study results were neither positive nor negative because too few subjects were enrolled to make meaningful conclusions. Clinical Trials number: NCT01559129.
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Fleischmann R, Schiff M, van der Heijde D, Ramos-Remus C, Spindler A, Stanislav M, Zerbini CAF, Gurbuz S, Dickson C, de Bono S, Schlichting D, Beattie S, Kuo WL, Rooney T, Macias W, Takeuchi T. Baricitinib, Methotrexate, or Combination in Patients With Rheumatoid Arthritis and No or Limited Prior Disease-Modifying Antirheumatic Drug Treatment. Arthritis Rheumatol 2017; 69:506-517. [PMID: 27723271 PMCID: PMC5347954 DOI: 10.1002/art.39953] [Citation(s) in RCA: 272] [Impact Index Per Article: 38.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 10/05/2016] [Indexed: 12/14/2022]
Abstract
Objective We undertook this phase III study to evaluate baricitinib, an orally administered JAK‐1/JAK‐2 inhibitor, as monotherapy or combined with methotrexate (MTX) compared to MTX monotherapy in patients with active rheumatoid arthritis (RA) who had received no or minimal conventional synthetic disease‐modifying antirheumatic drugs (DMARDs) and who were naive to biologic DMARDs. Methods A total of 588 patients were randomized 4:3:4 to receive MTX monotherapy (once weekly), baricitinib monotherapy (4 mg once daily), or the combination of baricitinib and MTX for 52 weeks. The primary end point assessment was a noninferiority comparison of baricitinib monotherapy to MTX monotherapy based on the proportion of patients meeting the American College of Rheumatology 20% improvement criteria (achieving an ACR20 response) at week 24. Results The study met its primary objective. Moreover, baricitinib monotherapy was found to be superior to MTX monotherapy at week 24, with a higher ACR20 response rate (77% versus 62%; P ≤ 0.01). Similar results were observed for combination therapy. Compared to MTX monotherapy, significant improvements in disease activity and physical function were observed for both baricitinib groups as early as week 1. Radiographic progression was reduced in both baricitinib groups compared to MTX monotherapy; the difference was statistically significant for baricitinib plus MTX. The rates of serious adverse events (AEs) were similar across treatment groups, while rates of some treatment‐emergent AEs, including infections, were increased with baricitinib plus MTX. Three deaths were reported, all occurring in the MTX monotherapy group. Malignancies, including nonmelanoma skin cancer, were reported in 1 patient receiving MTX monotherapy, 1 receiving baricitinib monotherapy, and 4 receiving baricitinib plus MTX. Conclusion Baricitinib alone or in combination with MTX demonstrated superior efficacy with acceptable safety compared to MTX monotherapy as initial therapy for patients with active RA.
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Affiliation(s)
| | | | - Désirée van der Heijde
- Leiden University Medical Center, Leiden, The Netherlands, and Imaging Rheumatology BV, Meerssen, The Netherlands
| | - Cesar Ramos-Remus
- Unidad de Investigacion en Enfermedades Cronico-Degenerativas, Guadalajara, Mexico
| | | | - Marina Stanislav
- Scientific Research Institute of Rheumatology, Russian Academy of Medical Sciences, Moscow, Russia
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Yoo DH, Suh CH, Shim SC, Jeka S, Cons-Molina FF, Hrycaj P, Wiland P, Lee EY, Medina-Rodriguez FG, Shesternya P, Radominski S, Stanislav M, Kovalenko V, Sheen DH, Myasoutova L, Lim MJ, Choe JY, Lee SJ, Lee SY, Kwon TS, Park W. A multicentre randomised controlled trial to compare the pharmacokinetics, efficacy and safety of CT-P10 and innovator rituximab in patients with rheumatoid arthritis. Ann Rheum Dis 2016; 76:566-570. [PMID: 27624791 PMCID: PMC5446025 DOI: 10.1136/annrheumdis-2016-209540] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 08/05/2016] [Accepted: 08/09/2016] [Indexed: 02/01/2023]
Abstract
Objective To demonstrate pharmacokinetic equivalence of CT-P10 and innovator rituximab (RTX) in patients with rheumatoid arthritis (RA) with inadequate responses or intolerances to antitumour necrosis factor agents. Methods In this randomised phase I trial, patients with active RA were randomly assigned (2:1) to receive 1000 mg CT-P10 or RTX at weeks 0 and 2 (alongside continued methotrexate therapy). Primary endpoints were area under the serum concentration–time curve from time zero to last quantifiable concentration (AUC0–last) and maximum serum concentration after second infusion (Cmax). Additional pharmacokinetic parameters, efficacy, pharmacodynamics, immunogenicity and safety were also assessed. Data are reported up to week 24. Results 103 patients were assigned to CT-P10 and 51 to RTX. The 90% CIs for the ratio of geometric means (CT-P10/RTX) for both primary endpoints were within the bioequivalence range of 80%–125% (AUC0–last: 97.7% (90% CI 89.2% to 107.0%); Cmax: 97.6% (90% CI 92.0% to 103.5%)). Pharmacodynamics and efficacy were comparable between groups. Antidrug antibodies were detected in 17.6% of patients in each group at week 24. CT-P10 and RTX displayed similar safety profiles. Conclusions CT-P10 and RTX demonstrated equivalent pharmacokinetics and comparable efficacy, pharmacodynamics, immunogenicity and safety. Trial registration number NCT01534884.
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Affiliation(s)
- Dae Hyun Yoo
- Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | | | | | - Slawomir Jeka
- University Hospital No. 2, Collegium Medicum in Bydgoszcz, UMK in Toruń, Poland
| | | | - Pawel Hrycaj
- Poznań University of Medical Sciences, Poznań, Poland
| | | | - Eun Young Lee
- Seoul National University College of Medicine, Seoul, Korea
| | | | | | | | - Marina Stanislav
- Research Rheumatology Institute n. a. V.A. Nassonova, Moscow, Russia
| | | | | | | | - Mie Jin Lim
- IN-HA University, School of Medicine, Incheon, Korea
| | - Jung-Yoon Choe
- Catholic University of Daegu, School of Medicine, Daegu, Korea
| | | | | | | | - Won Park
- IN-HA University, School of Medicine, Incheon, Korea
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12
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Pena-Rossi C, Nasonov E, Stanislav M, Yakusevich V, Ershova O, Lomareva N, Saunders H, Hill J, Nestorov I. An exploratory dose-escalating study investigating the safety, tolerability, pharmacokinetics and pharmacodynamics of intravenous atacicept in patients with systemic lupus erythematosus. Lupus 2009; 18:547-55. [PMID: 19395457 PMCID: PMC3835146 DOI: 10.1177/0961203309102803] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Atacicept, a recombinant fusion protein containing the extracellular, ligand-binding portion of the transmembrane activator and calcium modulator and cyclophilin-ligand interactor receptor, and the Fc portion of human immunoglobulin (Ig) G, is designed to block the activity of B-lymphocyte stimulator and a proliferation-inducing ligand, and may have utility as a treatment for B-cellmediated diseases, such as systemic lupus erythematosus (SLE). This Phase Ib study investigated the safety, tolerability, pharmacokinetics (PK) and pharmacodynamics of intravenous (i.v.) atacicept in patients with mild-to-moderate SLE. Patients (n = 24) were randomised (5:1) to receive atacicept (single dose: 3, 9 or 18 mg/kg; or multiple dose: 2 × 9 mg/kg) or matching placebo. Patients were followed for 6 weeks after dosing (9 weeks in the 2 × 9 mg/kg cohort). Local tolerability of atacicept was comparable with that of placebo, with only mild injection-site reactions reported with atacicept. Atacicept i.v. was generally well tolerated, both systemically and locally, in patients with mild-to-moderate SLE. Atacicept displayed non-linear PK, which was predictable across doses and between single and repeat doses. The biological activity of atacicept was demonstrated by its marked effect in reducing B-cells and Ig levels in patients with SLE. This supports the utility of this therapeutic approach in the treatment of autoimmune diseases, such as SLE.
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