The purpose of this study was to determine how effective and safe the study drug Olokizumab was in patients with Rheumatoid Arthritis (RA) who had been already receiving, but not fully responding to treatment with methotrexate (MTX). The primary objective of this study was to evaluate the efficacy of olokizumab (OKZ) 64 mg administered subcutaneously (SC) once every 2 weeks (q2w) or once every 4 weeks (q4w) relative to placebo in subjects with moderately to severely active rheumatoid arthritis (RA) inadequately controlled by methotrexate (MTX) therapy.
The goal of this Phase III study was to assess the efficacy, tolerability, and safety of OKZ in subjects with moderately to severely active RA who had responded inadequately to MTX. The primary endpoint of the trial was at Week 12. Olokizumab was expected to reduce the disease activity and improve physical function. The study was expected to provide safety information in a large group of subjects over at least a 24 week period. The CREDO 1 study included a 4-week Screening Period, a double-blind Treatment Period from Week 0 to Week 24, and a Safety Follow-Up Period from Week 24 to Week 44. At randomization, a total of 428 eligible subjects were randomly assigned to 1 of 3 treatment groups in a 1:1:1 ratio: 1. OKZ 64 mg q4w: SC injection of OKZ 64 mg q4w (alternating with SC injection of placebo OKZ q4w to maintain blinding) + MTX. 2. OKZ 64 mg q2w: SC injection of OKZ 64 mg q2w + MTX. 3. Placebo: SC injection of placebo q2w + MTX Throughout the double-blind Treatment Period, all subjects were required to remain on a stable dose of background MTX at 15 to 25 mg/week (or ≥ 10 mg/week if there was documented intolerance to higher doses) with a stable route of administration, and concomitant treatment with folic acid ≥5 mg per week or equivalent is required for all subjects. The last dose of study treatment (OKZ or placebo) was at Week 22 in all groups. Following Visit 2 (randomization), subjects returned to the study site at least every other week through Week 24 for response and safety assessments as per the study Schedule of Events. Subjects were classified in terms of their response to study treatment at Week 14, with non-responders defined as subjects in any treatment group who had not improved by at least 20% in both swollen and tender joint counts (66-68 joint assessment). Starting at or as close as possible to Week 14, non-responders were administered sulfasalazine and/or hydroxychloroquine as rescue medication in addition to the assigned treatment. After completion of the 24-week double-blind Treatment Period, subjects either rolled over into the long-term open-label extension (OLE) study or entered the Safety Follow-Up Period. During the Safety Follow-Up Period, subjects returned for visits +4, +8, and +22 weeks after the last dose of study treatment. Subjects who discontinued the randomized treatment prematurely were required to come for the End of Treatment (EoT) Visit 2 weeks after the last study treatment administration and then continued with the scheduled study visits as per the Schedule of Events. The study was conducted at approximately 50 sites across 4 countries globally, which included Russia, Belarus, Turkey, and Bulgaria.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
428
160 mg/mL sterile solution for SC injection in a 2 mL clear Type I glass vial
sodium chloride 0.9% solution supplied in polypropylene plastic ampoules of 10 mL cartons to contain 10 ampoules
City Clinical Hospital #1
Minsk, Belarus
Vitebsk Regional Clinical Hospital
Vitebsk, Belarus
DCC 'Sv. Pantaleymon' OOD
Pleven, Bulgaria
UMHAT "Kaspela", EOOD
Plovdiv, Bulgaria
UMHAT "Sv. Ivan Rilski", EAD
Sofia, Bulgaria
MC "Synexus - Sofia", EOOD
Percentage of Subjects Achieving American College of Rheumatology 20% (ACR20) Response
A responder was defined as any subject satisfying ACR20 criteria and remaining on randomized treatment and in the study at Week 12. The calculations were based on a ≥ 20% improvement from baseline in the swollen joint count (SJC) assessed in 66 joints and in the tender joint count (TJC) assessed in 68 joints; and a ≥ 20% improvement from baseline in at least 3 of the 5 remaining core set measures: Patient Global Assessment of Disease Activity (Visual Analog Scale (VAS) assessment), Patient Assessment of Pain (VAS assessment), Health Assessment Questionnaire-Disability Index (HAQ-DI), Physician Global Assessment (VAS assessment), Level of acute phase reactant (CRP or ESR, using level of CRP in this study).
Time frame: at Week 12
Percentage of Subjects Achieving Low Disease Activity
Defined as Disease Activity Score 28 (DAS28) (CRP) \< 3.2, and remaining on randomized treatment and in the study at Week 12.
Time frame: at Week 12
Improvement of Physical Ability From Baseline to Week 12, as Measured by the Health Assessment Questionnaire Disability Index (HAQ-DI)
Change of physical ability from baseline (the last available assessment prior to the first dose of the study treatment) to week 12, as measured by HAQ-DI. The HAQ-DI total score ranges from 0 (the best outcome) to 3 (the worst outcome).The HAQ-DI assesses the degree of difficulty experienced in 8 domains (dressing and grooming, arising, eating, walking, hygiene, reach, grip, common daily activities) of daily living activities using 20 questions. Each domain consists of 2 or 3 items. For each question the level of difficulty is scored from 0 (without any difficulty, the best outcome) to 3 (unable to do, the worst outcome). Each category is given a score by taking the maximum score of each question. The HAQ-DI was calculated by dividing the sum of the category scores by the number of categories with at least 1 question answered. If fewer than 6 categories had responses, no disability score was calculated.
Time frame: Baseline to Week 12
Percentage of Subjects Achieving American College of Rheumatology 50% (ACR50) Response
A responder was defined as any subject satisfying ACR50 criteria and remaining on randomized treatment and in the study at Week 24. The calculations were based on a ≥ 50% improvement from baseline in the swollen joint count (SJC) assessed in 66 joints and in the tender joint count (TJC) assessed in 68 joints; and a ≥ 50% improvement from baseline in at least 3 of the 5 remaining core set measures: Patient Global Assessment of Disease Activity (Visual Analog Scale (VAS) assessment), Patient Assessment of Pain (VAS assessment), Health Assessment Questionnaire-Disability Index (HAQ-DI), Physician Global Assessment (VAS assessment), Level of acute phase reactant (CRP or ESR, using level of CRP in this study).
Time frame: at Week 24
Percentage of Subjects With Clinical Disease Activity Index (CDAI) ≤ 2.8 (Remission)
Percentage of subjects with Clinical Disease Activity Index (CDAI) ≤ 2.8 (remission) and remaining on randomized treatment and in the study at Week 24
Time frame: at Week 24
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