Ustekinumab for the Treatment of Patients With Active Ankylosing Spondylitis (TOPAS)

• ClinicalTrials.gov Identifier: NCT01330901
• Recruitment Status: Completed
• First Posted: April 7, 2011
• Last Update Posted: June 4, 2013
• Sponsor: Charite University, Berlin, Germany
• Information provided by (Responsible Party): J. Sieper, Charite University, Berlin, Germany

Study Description

Brief Summary:

This study is aimed at investigation of efficacy and safety of ustekinumab (monoclonal antibody against interleukin 12 and 23) treatment in patients with active ankylosing spondylitis (AS) fulfilling the modified New York criteria who have had an inadequate response to standard therapy with non-steroidal anti-inflammatory drugs (NSAIDs) or do not tolerate or have a contraindication for NSAIDs.

Condition or disease	Intervention/treatment	Phase
Ankylosing Spondylitis	Drug: Ustekinumab	Phase 2

Detailed Description:

This study is a prospective, open-label, proof-of-concept clinical trial that will be conducted in a referral center for patients with AS in Berlin. Eligible patients will be treated with ustekinumab 90 mg given subcutaneously at weeks 0, 4, and 16. The entire study period accounts 28 weeks. Assessment of the primary outcome parameter will be performed at week 24. The patients will be closely monitored throughout the study on a total of 9 visits.

Study Design

• Study Type: Interventional (Clinical Trial)
• Actual Enrollment: 22 participants
• Allocation: N/A
• Intervention Model: Single Group Assignment
• Masking: None (Open Label)
• Primary Purpose: Treatment
• Official Title: UsTekinumab for the Treatment Of Patients With Active Ankylosing Spondylitis (TOPAS) - a 28-week, Prospective, Open-label, Proof-of-concept Study
• Study Start Date: October 2011
• Actual Primary Completion Date: April 2013
• Actual Study Completion Date: May 2013

Arms and Interventions

Arm	Intervention/treatment
Experimental: Ustekinumab; Ustekinumab 90 mg subcutaneously at week 0, 4 and 16	Drug: Ustekinumab; Ustekinumab 90 mg given subcutaneously at weeks 0, 4, and 16; Other Name: Stelara

Outcome Measures

Primary Outcome Measures :

1. The Assessment of Spondyloarthritis International Society (ASAS)40 response [ Time Frame: week 24 ]

   The percentage of patients who achieved ASAS40 response defined as an improvement of ≥40% and ≥2 points in at least 3 out of four following domains (and no worsening in remaining domain):

   • Patient global
   • Pain
   • Function (as measured by the Bath Ankylosing Spondylitis Functional Index - BASFI)
   • Inflammation (mean of the Bath Ankylosing Spondylitis Disease Activity Index - BASDAI question 5 and 6)

Secondary Outcome Measures :

1. The Assessment of Spondyloarthritis International Society (ASAS)20 response at week 24 [ Time Frame: Week 24 ]

   The percentage of patients who achieved ASAS20 response defined as an improvement of ≥20% and ≥1 points in at least 3 out of four following domains (and no worsening of ≥20% and ≥1 points in remaining domain):

   • Patient global
   • Pain
   • Function (as measured by the Bath Ankylosing Spondylitis Functional Index - BASFI)
   • Inflammation (mean of the Bath Ankylosing Spondylitis Disease Activity Index - BASDAI question 5 and 6)
2. The Ankylosing Spondylitis Disease Activity Score (ASDAS) clinically important improvement [ Time Frame: Week 24 ]
   The percentage of patients who achieved the ASDAS clinically important improvement (≥1.1) at week 24
3. The Assessment of Spondyloarthritis International Society (ASAS) partial remission [ Time Frame: Week 24 ]
   The percentage of patients who achieved partial remission according to the ASAS definition at week 24
4. The Ankylosing Spondylitis Disease Activity Score (ASDAS) major improvement [ Time Frame: Week 24 ]
   The percentage of patients who achieved the ASDAS major improvement (≥2.0) at week 24
5. Number of participants with adverse events as a measure of safety and tolerability [ Time Frame: Week 28 ]
   Number of participants with adverse events as a measure of safety and tolerability up to week 28

Eligibility Criteria

• Ages Eligible for Study: 18 Years and older (Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

1. Age of ≥18 years.
2. Definite diagnosis of AS according to the modified New York criteria.
3. History of an inadequate response to ≥2 NSAIDs taken for at least 2 weeks each or NSAIDs intolerance/contraindication.
4. Active disease as defined by a BASDAI value of ≥4 at screening despite concomitant treatment with an NSAID or without NSAIDs in case of intolerance/contraindication.
5. Able and willing to give a written informed consent and comply with the requirements of the study protocol.
6. If female: either not of child-bearing potential (menopausal since 1 year or surgically sterile) or is willing and able to practice a reliable method of contraception.
7. If male: either not of child-bearing potential (surgically sterilized, e.g. vasectomy) or is willing and able to practice a reliable method of contraception.
8. If on NSAIDs: the dose must be stable for at least 2 weeks prior to baseline.
9. If on oral steroids: the dose must not exceed 10 mg (prednisolone equivalent) per day and must be stable for at least 4 weeks prior to baseline.
10. If on methotrexate: the dose must not exceed 25 mg per week and must be stable for at least 4 weeks prior to baseline, must be stable for 4 weeks prior to baseline.
11. If on analgesics: the dose must be stable for at least 2 weeks prior to baseline.

Exclusion Criteria:

1. The female subject is pregnant or lactating.
2. Patients with other chronic inflammatory articular disease or systemic autoimmune disease.
3. History of inadequate response to previous anti-tumor necrosis factor (TNF) α therapy.
4. Previous treatment with biologics other than TNF α blockers.
5. Treatment with any other investigational drug within 4 weeks of 5 half-life of the drug (whichever is longer) prior to baseline.
6. Treatments with disease modifying anti-rheumatic drugs (DMARDs) other than methotrexate within 4 weeks prior to screening (8 weeks for leflunomide or 4 weeks with a standard cholestyramine wash-out).
7. Treatment with intravenous, intramuscular or intraarticular/periarticular steroids within 4 weeks prior to screening.
8. Any active current infection, a history of recurrent clinically significant infection, infections requiring treatment with antibiotics within 4 weeks prior to baseline.
9. Current clinical signs and symptoms suggestive for tuberculosis.
10. Positive interferon gamma release assay (IGRA) test at screening and/or abnormal chest x-ray (performed at screening or within 3 months prior to screening) suggestive for past or present tuberculosis (positive x-ray). Patients with a positive IGRA test but negative chest x-ray and without clinical symptoms suggestive for tuberculosis may participate in the study after initiation of standard prophylactic antimycobacterial treatment.
11. Chronic infection with hepatitis B or C, history of human immunodeficiency virus infection.
12. Primary or secondary immunodeficiency.
13. Actual malignancies or history of malignancies with curative treatment within 5 years prior to screening, except successfully treated non-metastatic squamous-cell or basal-cell carcinoma or carcinoma in situ of the cervix.
14. Evidence of severe uncontrolled gastrointestinal, hepatic, renal, pulmonary, cardiovascular, nervous or endocrine disorders.
15. Any other conditions making the patient unsuitable in the opinion of the investigator for the participation in the current study.
16. Patients with a history of a severe psychiatric illness, which might interfere with the patient's ability to understand the requirements of the study and assessment.
17. Diagnosis of fibromyalgia.
18. Alcohol abuse or illegal drug consume in the last 12 months.
19. Vaccination with a live vaccine within 12 weeks prior to baseline.
20. Known hypersensitivity to any component of the study medication.
21. Clinically significant laboratory abnormalities
22. Patients who are institutionalised due to regulatory or juridical order.
23. Patients with contraindications for the magnetic resonance imaging (MRI)

Contacts and Locations

Locations

Germany

Department of Rheumatology, Charité - Campus Benjamin Franklin

Berlin, Germany, 12203

Sponsors and Collaborators

Charite University, Berlin, Germany

Investigators

• Principal Investigator: Joachim Sieper, MD; Charite University, Berlin, Germany

More Information

Additional Information:

Official web site of the study center 

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Poddubnyy D, Hermann KG, Callhoff J, Listing J, Sieper J. Ustekinumab for the treatment of patients with active ankylosing spondylitis: results of a 28-week, prospective, open-label, proof-of-concept study (TOPAS). Ann Rheum Dis. 2014 May;73(5):817-23. doi: 10.1136/annrheumdis-2013-204248. Epub 2014 Jan 3.

• Responsible Party: J. Sieper, Prof. Dr., Charite University, Berlin, Germany
• ClinicalTrials.gov Identifier: NCT01330901
• Other Study ID Numbers: TOPAS
• First Posted: April 7, 2011
• Last Update Posted: June 4, 2013
• Last Verified: June 2013

Additional relevant MeSH terms:

Spondylitis; Spondylarthritis; Spondylitis, Ankylosing; Bone Diseases, Infectious; Infections; Bone Diseases; Musculoskeletal Diseases; Spinal Diseases; Arthritis; Joint Diseases; Spondylarthropathies; Ankylosis; Ustekinumab; Dermatologic Agents