A multicenter, randomised, double-blind, placebo-controlled Phase 2A/ proof-of-concept study to evaluate the efficacy and safety of an intravenous treatment regimen of 300 mg Anifrolumab versus placebo in patients with moderately to severely active RA who did not respond to biological disease-modifying anti-rheumatic drugs (bDMARDs) and who have a high type I IFN gene signature.
Background: Rheumatoid arthritis (RA) is the most common chronic inflammatory joint disorder with a prevalence of about 0.5-1% and results in joint inflammation and damage, which causes loss-of-function and disability, and ultimately results in loss of labour participation, loss of independence in daily life and high societal costs. Conventional synthetic DMARDs (csDMARDs), especially methotrexate, represent the first-line treatment in RA. If, however, the treatment target is not achieved with the first DMARD strategy escalation in the treatment regimen is needed. The current praxis is to add a biological (b) DMARD (e.g. TNF inhibitors, TNFi). With the growing evidence that type I IFNs play an important role in RA, inhibition of the biological activity of type I IFNs with anifrolumab may be a novel efficacious therapy for the treatment of RA and its significant unmet medical need. Objective: To evaluate the efficacy of Anifrolumab compared to placebo on RA disease activity in patients with an increased type I IFN gene signature Methods: This is a Phase 2A (proof-of-concept), multicenter, randomised, double-blind, placebo-controlled pilot study, to evaluate the efficacy and safety of an intravenous treatment regimen of 300 mg Anifrolumab versus placebo. Patients with moderately to severely active RA who did not respond to at least one TNFi but who had not more than three bDMARDs and who also have a high IFN- transcript score will be included. Expected Results: The hypothesis underlying this protocol is that blocking type I IFN signaling through the human type I IFN receptor with Anifrolumab will reduce the severity of disease in RA patients, who have an activated type I IFN response.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
24
IV Administration of Anifrolumab 300 mg every 4 weeks from week 0 to week 20 for a total of 6 doses. At week 24 patients will continue the current study for another 8 weeks to complete a 12-week safety follow-up after the last dose of investigational products (last dose of investigational product will be given at week 20). The total study duration could be up to approximately 36 weeks (including the screening period).
Placebo IV administration Q4W, a total of 6 doses At week 24 patients will continue the current study for another 8 weeks to complete a 12-week safety follow-up after the last dose of investigational products (last dose of investigational product will be given at week 20). The total study duration could be up to approximately 36 weeks (including the screening period).
Medizinische Universität Graz, Klinische Abteilung für Rheumatologie und Immunologie
Graz, Austria
RECRUITINGMedizinische Universität Wien, Innere Medizin III, Abteilung für Rheumatologie
Vienna, Austria
RECRUITINGKrankenhaus Hietzing, 2. Medizinische Abteilung
Vienna, Austria
RECRUITINGAchieving an ACR 20 response at week 24
To evaluate the efficacy of Anifrolumab compared to placebo on RA disease activity in patients with an increased type I IFN gene signature
Time frame: Week 24
Absolute and relative change in the Simplified Disease Activity Index (SDAI) after 24 weeks
To evaluate the effect of Anifrolumab compared to placebo
Time frame: Week 24
Absolute and relative change in Clinical Disease Activity Index (CDAI) at week 24 and at every visit before and after week 24
To evaluate the effect of Anifrolumab compared to placebo
Time frame: Week 24
Absolute and relative change in Disease Activity Score 28 (DAS28) after 24 weeks
To evaluate the effect of Anifrolumab compared to placebo
Time frame: Week 24
Achieving a EULAR response (good, moderate)
To evaluate the effect of Anifrolumab compared to placebo
Time frame: Week 24
Achieving a SDAI response (50%, 70%, 85%)
To evaluate the effect of Anifrolumab compared to placebo
Time frame: Week 24
Achieving a CDAI response (50%, 70%, 85%)
To evaluate the effect of Anifrolumab compared to placebo
Time frame: Week 24
Achieving an ACR response (20%, 50%, 70%)
To evaluate the effect of Anifrolumab compared to placebo
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Time frame: Week 24
Change in quality of life (SF-36)
To evaluate the effect of Anifrolumab compared to placebo
Time frame: Week 24
Change in physical function (HAQ)
To evaluate the effect of Anifrolumab compared to placebo
Time frame: Week 24
Change in pain (visual analog scale, VAS)
To evaluate the effect of Anifrolumab compared to placebo
Time frame: Week 24
Change in fatigue (visual analog scale, VAS)
To evaluate the effect of Anifrolumab compared to placebo
Time frame: Week 24
Change in sleep (visual analog scale, VAS)
To evaluate the effect of Anifrolumab compared to placebo
Time frame: Week 24
Proportion achieving a low disease activity state (CDAI≤10, SDAI≤11) after 24 weeks
To evaluate the effect of Anifrolumab compared to placebo
Time frame: Week 24
Proportion achieving a remission state (CDAI≤2.8; SDAI≤3.3; ACR/EULAR Boolean) after 24 weeks
To evaluate the effect of Anifrolumab compared to placebo
Time frame: Week 24
Proportion achieving DAS28≤3.2 after 24 weeks
To evaluate the effect of Anifrolumab compared to placebo
Time frame: Week 24
Change in Kessler Psychological Distress Scale (K10)
To evaluate the effect of Anifrolumab compared to placebo K10 is used as a simple measure of psychological distress, involves 10 questions about emotional states with a 5-level response scale and ranges from "all of the time" to "none of the time"
Time frame: Week 24