Methotrexate-Inadequate Response Study
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ClinicalTrials.gov Identifier: NCT00559585 |
Recruitment Status :
Completed
First Posted : November 16, 2007
Results First Posted : July 6, 2011
Last Update Posted : November 9, 2015
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Sponsor:
Bristol-Myers Squibb
Information provided by (Responsible Party):
Bristol-Myers Squibb
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Study Type | Interventional |
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Study Design | Allocation: Randomized; Intervention Model: Parallel Assignment; Masking: Double (Participant, Investigator); Primary Purpose: Treatment |
Condition |
Rheumatoid Arthritis (RA) |
Interventions |
Drug: Subcutaneous (SC) Abatacept Drug: Intravenous (IV) Abatacept |
Enrollment | 2492 |
Participant Flow
Recruitment Details | During the double blind short term (ST) period of the Main study, a sub-study in RA participants was initiated to evaluate anti-tumor necrosis factor (TNF) failure population. The sub-study was terminated early due to slow recruitment and participants from the sub-study were allowed to roll into the Main study during the LT Open Label Period. |
Pre-assignment Details | 2492 enrolled: 2472 in Main Study:1008 not randomized: 918 no longer met criteria, 61 withdrew consent, 7 lost to follow-up, 22 other reasons. Randomized, not treated: 4 no longer met criteria, 2 withdrew consent, and 1 randomization error; 20 enrolled in Anti-TNF sub-study; 2 not randomized as no longer met criteria; 18 randomized in substudy. |
Arm/Group Title | Subcutaneous (SC) Abatacept | Intravenous (IV) Abatacept |
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During the Main Study Double Blind ST Period, participants received 125 mg weekly SC abatacept injections for 6 months (with an IV abatacept loading dose on Day 1, based on weight). A double-dummy design was used to protect the blind, thus, participants also received IV injections of placebo (IV Placebo) with the exception that on Day 1 a loading dose of IV abatacept replaced the IV Placebo treatment. During the Open Label Long Term (LT) Period, participants in both the Main Study and the Anti-TNF Failure Sub-study switched to open-label SC abatacept. The study continued until SC formulation became commercially available on a country basis or the Sponsor terminated the study. | During the Main study Double Blind ST Period, participants received IV abatacept infusions on Days 1, 15, 29, and every 28 days, thereafter for 6 months. A double-dummy design was used to protect the blind, thus, participants also received SC injections of placebo (SC Placebo). During the Open Label LT Period, participants in both the Main Study and the Anti-TNF Failure Sub-study switched to open-label SC abatacept. The study continued until SC formulation became commercially available on a country basis or the Sponsor terminated the study. |
Period Title: Double Blind ST Period Main Study | ||
Started | 736 [1] | 721 [1] |
Completed | 693 | 676 |
Not Completed | 43 | 45 |
Reason Not Completed | ||
Adverse Event | 17 | 25 |
Withdrawal by Subject | 11 | 5 |
Lost to Follow-up | 0 | 6 |
Administrative Reason By Sponsor | 1 | 0 |
Death | 1 | 1 |
No Longer Meets Study Criteria | 2 | 1 |
Lack of Efficacy | 6 | 1 |
Poor/Non-Compliance | 3 | 0 |
Missed Doses | 0 | 1 |
Incomplete Breast Exam | 0 | 1 |
Suspended Drug Due To Surgery | 0 | 1 |
Early Discontinuation | 0 | 1 |
Participant Weight Gain | 1 | 0 |
Participant Withdrew-Recurrent Infection | 0 | 1 |
Investigator Decision | 0 | 1 |
Ongoing Infection Risk | 1 | 0 |
[1]
Randomized and treated
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Period Title: Anti-TNF Sub-Study in ST Period | ||
Started | 8 [1] | 10 [2] |
Completed | 7 | 9 |
Not Completed | 1 | 1 |
Reason Not Completed | ||
Lack of Efficacy | 1 | 1 |
[1]
7 completed Sub-Study ST period and 6 chose to roll over into LT Period.
[2]
9 completed Sub-Study ST Period and 9 chose to over into the LT Period.
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Period Title: Open Label LT Period Main + Sub-Study | ||
Started | 1373 [1] | 0 [2] |
Completed | 945 | 0 |
Not Completed | 428 | 0 |
Reason Not Completed | ||
Adverse Event | 100 | 0 |
Withdrawal by Subject | 81 | 0 |
Pregnancy | 16 | 0 |
Lost to Follow-up | 32 | 0 |
Administrative reason by Sponsor | 9 | 0 |
Death | 20 | 0 |
No longer met criteria | 1 | 0 |
Lack of Efficacy | 89 | 0 |
Poor/non-compliance | 8 | 0 |
non-specified | 71 | 0 |
no end of study status page | 1 | 0 |
[1]
1373 includes 15 participants from ST Period Sub-Study who rolled over into LT Period (6 SC + 9 IV).
[2]
IV administration was discontinued and abatacept was only administered SC during LT Period.
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Baseline Characteristics
Arm/Group Title | Subcutaneous (SC) Abatacept | Intravenous (IV) Abatacept | Total | |
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Participants received 125 mg weekly SC abatacept injections (with an intravenous [IV] abatacept loading dose on Day 1, based on weight). A double-dummy design was used to protect the blind, thus, participants also received IV injections of placebo (IV Placebo) with the exception that on Day 1 a loading dose of IV abatacept replaced the IV Placebo treatment. The Per Protocol (PP) Analysis Population (instead of the Intent-To-Treat Population) was used to perform primary and key secondary efficacy analyses as per regulatory guidelines for non-inferiority studies. | Participants received IV abatacept infusions on Days 1, 15, 29, and every 28 days, thereafter. A double-dummy design was used to protect the blind, thus, participants also received SC injections of placebo (SC Placebo). The Per Protocol (PP) Analysis Population (instead of the Intent-To-Treat Population) was used to perform primary and key secondary efficacy analyses as per regulatory guidelines for non-inferiority studies. | Total of all reporting groups | |
Overall Number of Baseline Participants | 696 | 683 | 1379 | |
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Per-protocol Population in ST Period.
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Age, Continuous
[1] Mean (Standard Deviation) Unit of measure: Years |
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Number Analyzed | 696 participants | 683 participants | 1379 participants | |
49.9 (13.0) | 49.9 (12.7) | 49.9 (12.8) | ||
[1]
Measure Description: Since regulatory guidelines indicate use of the Per Protocol (PP) Analysis Population (instead of the Intent-To-Treat Population) for non-inferiority studies, this population was used to perform primary and key secondary efficacy analyses. Thus, Baseline continuous age data are presented for the PP Analysis Population.
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Sex: Female, Male
Measure Type: Count of Participants Unit of measure: Participants |
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Number Analyzed | 696 participants | 683 participants | 1379 participants | |
Female |
586 84.2%
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549 80.4%
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1135 82.3%
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Male |
110 15.8%
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134 19.6%
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244 17.7%
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Race (NIH/OMB)
Measure Type: Count of Participants Unit of measure: Participants |
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Number Analyzed | 696 participants | 683 participants | 1379 participants | |
American Indian or Alaska Native |
5 0.7%
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1 0.1%
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6 0.4%
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Asian |
63 9.1%
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72 10.5%
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135 9.8%
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Native Hawaiian or Other Pacific Islander |
0 0.0%
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0 0.0%
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0 0.0%
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Black or African American |
26 3.7%
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24 3.5%
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50 3.6%
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White |
516 74.1%
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505 73.9%
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1021 74.0%
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More than one race |
0 0.0%
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0 0.0%
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0 0.0%
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Unknown or Not Reported |
86 12.4%
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81 11.9%
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167 12.1%
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Region Of Enrollment
Measure Type: Number Unit of measure: Participants |
Number Analyzed | 696 participants | 683 participants | 1379 participants |
North America | 129 | 111 | 240 | |
South America | 338 | 340 | 678 | |
Europe | 123 | 123 | 246 | |
Rest of the World | 106 | 109 | 215 | |
Baseline Weight Category
Measure Type: Number Unit of measure: Participants |
Number Analyzed | 696 participants | 683 participants | 1379 participants |
<60 kg | 175 | 171 | 346 | |
60 to 100 kg | 464 | 465 | 929 | |
>100 kg | 57 | 47 | 104 | |
Duration of RA Disease
Mean (Standard Deviation) Unit of measure: Years |
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Number Analyzed | 696 participants | 683 participants | 1379 participants | |
7.6 (8.0) | 7.7 (7.9) | 7.7 (7.9) | ||
Duration of Disease Category
Measure Type: Number Unit of measure: Participants |
Number Analyzed | 696 participants | 683 participants | 1379 participants |
≤2 Years | 229 | 206 | 435 | |
2 - ≤5 yrs | 144 | 145 | 289 | |
5 - ≤10 yrs | 134 | 155 | 289 | |
> 10 yrs | 189 | 177 | 366 | |
Number of Tender Joints
[1] Mean (Standard Deviation) Unit of measure: Tender joints |
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Number Analyzed | 696 participants | 683 participants | 1379 participants | |
30 (14.1) | 29.2 (13.1) | 29.6 (13.6) | ||
[1]
Measure Description: Tender joints are an indicator of Rheumatoid Arthritis. The number of tender joints in a standard 68 joint count was evaluated. The number of tender joints ranges from 0 tender joints to 68, where an increased number of tender joints indicates increasing level of disease severity.
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Number of Swollen Joints
[1] Mean (Standard Deviation) Unit of measure: Swollen joints |
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Number Analyzed | 696 participants | 683 participants | 1379 participants | |
20.5 (9.4) | 19.6 (8.5) | 20.0 (9.0) | ||
[1]
Measure Description: Swollen joints are an indicator of Rheumatoid Arthritis. The number of swollen joints in a standard 66 joint count was evaluated. The number of swollen joints ranges from 0 swollen joints to 66, where an increased number of swollen joints indicates increasing level of disease severity.
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Participant Pain Assessment
[1] Mean (Standard Deviation) Unit of measure: Units on a scale |
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Number Analyzed | 696 participants | 683 participants | 1379 participants | |
68.0 (20.0) | 66.9 (20.5) | 67.5 (20.3) | ||
[1]
Measure Description: The participant self-reported pain assessment is a core component of the ACR scoring system where increasing score indicates increasing level of severity as indicated on a 100 mm Visual Analog Scale (VAS) with 0 mm representing no pain and 100 mm representing the most pain possible. For each post-baseline visit in the DB, time-matched baseline Participant Pain Assessment values were presented and represent the mean baseline value for only that cohort of participants with assessments available at that visit.
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Physical Function (Health Assessment Questionnaire Disability Index [HAQ-DI])
[1] Mean (Standard Deviation) Unit of measure: Units on a scale |
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Number Analyzed | 696 participants | 683 participants | 1379 participants | |
1.73 (0.68) | 1.69 (0.67) | 1.71 (0.67) | ||
[1]
Measure Description: The disability section of the full HAQ includes 20 questions to assess physical The HAQ-DI includes 20 questions to assess physical function in 8 domains: dressing, arising, eating, walking, hygiene, reach, grip, and common activities. The domain questions are evaluated on a 4-point scale: 0=without any difficulty, 1=with some difficulty, 2=with much difficulty, 3=unable to do. HAQ-DI=sum of worst scores in each domain divided by the number of domains answered. HAQ-DI overall score ranges from a minimum of 0 to a maximum of 3.0.
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Participant Global Assessment
[1] Mean (Standard Deviation) Unit of measure: Units on a scale |
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Number Analyzed | 696 participants | 683 participants | 1379 participants | |
67.2 (20.1) | 65.2 (19.9) | 66.2 (20.0) | ||
[1]
Measure Description: Participants used a horizontal VAS of 100 mm for overall assessment of rheumatoid arthritis. Scale ranged from 0 (very well) to 100 (very poor). Participants were instructed to draw a vertical through a horizontal line to indicate state of rheumatoid arthritis. Distance from the "very well" end of the horizontal line to the vertical line drawn by the participant was the global disease assessment score on a scale of 1-10, where 1=controlled or equivocal rheumatoid arthritis activity, 1.1-4=mild activity, 4-8=moderate activity, and 8.1-10=high activity.
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Physician Global Assessment
[1] Mean (Standard Deviation) Unit of measure: Units on a scale |
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Number Analyzed | 696 participants | 683 participants | 1379 participants | |
64.3 (16.5) | 63.4 (16.3) | 63.9 (16.4) | ||
[1]
Measure Description: Physician global rheumatoid arthritis assessment core component of the ACR scoring system where increasing score indicates increasing level of severity as indicated on a 100 mm Visual Analog Scale, with 0 mm representing no pain and 100 mm representing the most pain possible.
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High Sensitivity C-Reactive Protein (hsCRP) Level
[1] Mean (Standard Deviation) Unit of measure: mg/dL |
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Number Analyzed | 696 participants | 683 participants | 1379 participants | |
2.65 (2.91) | 2.72 (2.91) | 2.69 (2.91) | ||
[1]
Measure Description: hs-CRP is a acute phase reactant protein that is a clinical marker for Rheumatoid Arthritis (RA). Levels of hs-CRP can be used to determine DAS28.
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Disease Activity Score (CRP)
[1] Mean (Standard Deviation) Unit of measure: Units on a scale |
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Number Analyzed | 696 participants | 683 participants | 1379 participants | |
6.25 (0.84) | 6.22 (0.83) | 6.24 (0.83) | ||
[1]
Measure Description: The DAS28 index measures disease activity in rheumatoid arthritis and is a composite derived from the number of swollen/tender joints, laboratory tests of inflammation (C-reactive protein measured in mg/L), and participant assessment of global health (by marking a 100 mm line from "very good" to "very bad"). A higher DAS28 score indicates worse control of disease. High disease activity is > 5.1, low disease activity is < 3.2 and remission is < 2.6.
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Rheumatoid Factor Status
[1] Measure Type: Number Unit of measure: Participants |
Number Analyzed | 696 participants | 683 participants | 1379 participants |
Negative | 102 | 91 | 193 | |
Positive | 582 | 583 | 1165 | |
Unknown | 12 | 9 | 21 | |
[1]
Measure Description: Rheumatoid factor (RF or RhF) is an autoantibody (antibody directed against an organism's own tissues) most relevant in rheumatoid arthritis. It is an antibody against the Fc portion of Immunoglobulin (Ig)G, which is itself an antibody. RF and IgG join to form immune complexes which contribute to the disease process. A positive value for RF was >20 IU/mL; a negative value for RF was ≤ 20 IU/mL.
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Baseline Methotrexate (MTX) Dose
Mean (Standard Deviation) Unit of measure: Mg/wk |
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Number Analyzed | 696 participants | 683 participants | 1379 participants | |
16.3 (3.6) | 16.5 (3.7) | 16.4 (3.6) | ||
Weight
Mean (Standard Deviation) Unit of measure: Kg |
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Number Analyzed | 696 participants | 683 participants | 1379 participants | |
72.1 (18.1) | 71.5 (17.5) | 71.8 (17.8) |
Outcome Measures
Adverse Events
Limitations and Caveats
[Not Specified]
More Information
Principal Investigators are NOT employed by the organization sponsoring the study.
There IS an agreement between Principal Investigators and the Sponsor (or its agents) that restricts
the PI's rights to discuss or publish trial results after the trial is completed.
Bristol-Myers Squibb Co. agreements with investigators vary; constant is our right to embargo communications regarding trial results prior to public release for a period ≤60 days from submittal for review. We will not prohibit investigators from publishing, but will prohibit the disclosure of previously undisclosed confidential information other than study results, and request postponement of single-center publications until after disclosure of the clinical trial's primary publication.
Results Point of Contact
Name/Title: | BMS Study Director |
Organization: | Bristol-Myers Squibb |
EMail: | Clinical.Trials@bms.com |
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: | Bristol-Myers Squibb |
ClinicalTrials.gov Identifier: | NCT00559585 |
Other Study ID Numbers: |
IM101-174 EUDRACT # 2007-005434-37 |
First Submitted: | November 15, 2007 |
First Posted: | November 16, 2007 |
Results First Submitted: | April 29, 2011 |
Results First Posted: | July 6, 2011 |
Last Update Posted: | November 9, 2015 |