CR6086 is a new, potent and selective, orally available, small molecule prostaglandin EP4 receptor antagonist, endowed with immunomodulatory properties. The pharmacological properties of CR6086, along with its oral bioavailability, predictable pharmacokinetics and good safety, make it the ideal candidate to be tested alone or in combination with methotrexate (MTX) in patients with early Rheumatoid Arthritis who are naïve to Disease-Modifying Antirheumatic Drugs (DMARDs). The compound has indeed the potential to provide a safer and more effective treatment than MTX (or other conventional synthetic DMARDs - csDMARDs), and could significantly improve the proportion of responder patients and avoid/delay the recourse to biological DMARDs (bDMARDs) or targeted synthetic DMARDs (tsDMARDs).
There is growing evidence that EP4 receptors play an important role in the altered immune response observed in autoimmune diseases. These findings point to the EP4 receptor as a rational target for the development of novel Disease-Modifying Antirheumatic Drugs (DMARDs)/immunomodulators which, in addition, have direct anti-inflammatory properties. The potential for CR6086 to act as a DMARD was extensively demonstrated in a series of widely accepted models of arthritis in rodents, where oral CR6086 was effective in all the parameters examined, including oedema, clinical arthritis score, and histology. CR6086 performed much better than nonsteroidal anti-inflammatory drugs (NSAIDs, that lack the immunomodulatory properties of an EP4 receptor antagonist and are scarcely effective), better than first-line csDMARDs such as MTX, and similarly to immunosuppressive bDMARDs such as TNF-blockers, or tsDMARDs such as JAK inhibitors. In the present study, CR6086 (or placebo) will be administered in a dose-response fashion for 12 weeks to DMARD-naïve patients with early Rheumatoid Arthritis, in combination with oral MTX. The treatment duration and study design will allow to test the effects of the new treatment on clinical outcomes of disease activity, laboratory biomarkers and imaging parameters.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
248
oral CR6086 capsules
oral Methotrexate tablets
oral CR6086 Placebo capsules
Institute of Rheumatology
Prague, Czechia
American College of Rheumatology 20% improvement (ACR20) responder rate
Time frame: 12 weeks
ACR50 responder rate
Time frame: 12 weeks
ACR70 responder rate
Time frame: 12 weeks
Disease Activity Score on 28-joint count (DAS28)
Time frame: 12 weeks
Clinical Disease Activity Index (CDAI)
Time frame: 12 weeks
Simplified Disease Activity Index (SDAI)
Time frame: 12 weeks
ACR/EULAR remission criteria
Time frame: 12 weeks
Adverse Events
number of patients with Adverse Events
Time frame: 12 weeks
Routine Laboratory determinations
Time frame: 12 weeks
Pharmacokinetics (PK) of Methotrexate and CR6086 in combination
Main PK endpoint: AUCinf (ng.h/mL). Area under the plasma concentration vs time curve extrapolated to infinity
Time frame: 12 weeks
Biochemical markers
Serum biomarkers of disease activity
Time frame: 12 weeks
Imaging biomarkers
Dynamic Contrast-Enhanced MRI (DCE-MRI)
Time frame: 12 weeks
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