The purpose of the following phase II clinical trial is to determine safety and effectiveness of Janus kinases and Rho-kinases inhibitor (JAK/ROCKi) in patients with Rheumatoid arthritis after oral administration of investigational medicinal product (IMP) called CPL409116. JAK inhibitors are a new class of small molecule drugs that modulate inflammatory pathways by blocking one or more JAK receptors. In recent years, JAK inhibitors have emerged as a new option for the treatment of various inflammatory diseases, including rheumatoid arthritis, psoriatic arthritis, skin disorders and others. CPL409116 inhibits JAK1 and JAK3 with less inhibitory activity against JAK2 and Tyk2. Inhibition of these kinases decreases inflammatory cytokine release which in turn decreases lymphocyte activation and proliferation. Moreover, CPL409116 blocks Rho-kinases (ROCKs), which are involved in diverse cellular processes including actin cytoskeleton organization, cell adhesion and motility, proliferation, apoptosis as well as smooth muscle contraction. ROCKs signalling is one of the major pathways implicated in the pathogenesis of cardiovascular, renal as well as fibrotic diseases. However recent data indicate their role in immune cell regulation and inflammatory disease development. CPL409116 was designed predominantly for the therapy of immune-related diseases: rheumatoid arthritis (RA) or psoriasis but the unique mode of action of this compound may be beneficial for patients suffering from fibrotic complications developing on the basis of autoimmune diseases. RA is a chronic systemic autoimmune disease characterised by persistent joint inflammation leading to loss of joint function as well as cartilage and bone damage. Chronic, progressive course of the disease results in disability, reduced quality of life, as well as higher comorbidity and mortality rates. It is well documented that JAK kinases play a pivotal role in cytokine receptor signalling to phosphorylate and activate signal transducer and activator of transcription (STAT) proteins. Several of these JAK-controlled cytokine receptor pathways are immediately involved in the initiation and progression of RA pathogenesis. After preclinical studies conducted by Celon Pharma, CPL409116 could have been classified as a good clinical candidate for the treatment of patients with RA and next, results obtained after the phase I clinical trial in healthy volunteers confirmed its safety and a good pharmacokinetic profile.
This is to be a 12-week, phase II, multicentre, randomised, double blind, efficacy and safety study of CPL409116 in participants with active rheumatoid arthritis who are taking methotrexate but have an inadequate response to this drug. Eligible subjects are to be randomised into one of the 4 treatment arms (60 mg BID, 120 mg BID, 240 mg BID of CPL409116 or palcebo) and approximately 100 male and female subjects are to be enrolled in the study (25 patients per arm). The study is to include the screening period, the treatment period and the follow-up period. In all treatment arms the investigated product/ placebo is to be administered orally for 12 weeks in a blinded fashion. In order to maintain the blind and minimize bias, all subjects will receive the same number and types of tablets each day of treatment. In the screening period, patients are to undergo screening assessments from Day -28 to Day 0. Rolling admission is to be employed in this study. Patients that fulfil all the inclusion criteria and none of the exclusion criteria will be considered eligible for this study. During the treatment period, patients are to be dosed with 60, 120, 240 mg CPL409116 administered twice a day or placebo administered twice a day for 85 consecutive days (Day 1 to Day 85). The MTX dosage which should be orally or parenterally administered by participants during the study and before the start of the study should be in the range of 15-25 mg/ week, which is typical of current clinical practice. MTX must be applied for at least 12 weeks prior to Screening, and with no change in dosage and route of administration for at least 8 weeks prior to Day 1/ baseline. Within the follow-up period patients are to undergo safety assessment for 4 weeks after the last dose of IMP.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
106
MICS Centrum Medyczne Bydgoszcz
Bydgoszcz, Poland
Centrum Nowoczesnych Terapii Sp. z o.o. "Dobry Lekarz"
Krakow, Poland
AMICARE Centrum Medyczne Sp. z o. o., Spółka Komandytowa
Lodz, Poland
Medyczne Centrum Hetmańska
Poznan, Poland
Samodzielny Publiczny Zespół Opieki Zdrowotnej w Tomaszowie Lubelskim
Tomaszów Lubelski, Poland
Wojskowy Instytut Medyczny
Warsaw, Poland
PCS Sp. z o. o.
Łady, Poland
Medical center of the limited liability company "Medical center "Consilium Medical"
Kyiv, Ukraine
Polyclinic of the center of medical services and rehabilitation JSC "Company of aviation and rocket technology manufacture"
Kyiv, Ukraine
Communal enterprise "Hospital No. 1" of the Zhytomyr City Council, consulting and treatment department "Research Center"
Zhytomyr, Ukraine
Change in Disease Activity Score 28 joint count C reactive protein (DAS28(CRP)).
Change from baseline in Disease Activity Score 28 joint count C reactive protein (DAS28(CRP)) score at Week 12 DAS28 is a measure of disease activity in participants with rheumatoid arthritis. DAS28- (CRP) will be calculated from swollen joint count (SJC) and tender/painful joint count (TJC) using 28 joints count, CRP \[mg/L\] and patient global assessment of disease activity on a 100 millimeter (mm) visual analog scale (VAS: scores ranging from 0 mm \[very well\] to 100 mm \[extremely bad\], higher scores indicate worse health condition). Score interpretation: \<2.6 suggests disease remission. 2.6-3.2 suggests low disease activity \>3.2-5.1 suggests moderate disease activity \>5.1 suggest high disease activity
Time frame: Baseline to Week 12
Proportion of patients with remission over time assessed by Disease Activity Score 28 joint count C reactive protein (DAS28(CRP)).
Proportion of patients with Disease Activity Score 28 joint count C reactive protein (DAS28(CRP)). score\< 2.6 DAS28 is a measure of disease activity in participants with rheumatoid arthritis. DAS28- (CRP) will be calculated from swollen joint count (SJC) and tender/painful joint count (TJC) using 28 joints count, CRP \[mg/L\] and patient global assessment of disease activity on a 100 millimeter (mm) visual analog scale (VAS: scores ranging from 0 mm \[very well\] to 100 mm \[extremely bad\], higher scores indicate worse health condition). Score interpretation: \<2.6 suggests disease remission. 2.6-3.2 suggests low disease activity \>3.2-5.1 suggests moderate disease activity \>5.1 suggest high disease activity
Time frame: Baseline through Week 12
Proportion of patients achieving American College of Rheumatology (ACR) ACR20/50/70/90 response over time
Proportion of patients achieving American College of Rheumatology (ACR) ACR20/50/70/90 response over time. The specific components of the ACR Assessments (ACR Core Dataset) that are to be used in this study are: 1. Tender/Painful Joint count (TJC) (68); 2. Swollen Joint Count (SJC) (66); 3. Patient's Assessment of Arthritis Pain; 4. Patient's Global Assessment of Arthritis; 5. Physician's Global Assessment of Arthritis; 6. C-Reactive Protein (CRP); 7. Erythrocyte Sedimentation Rate (ESR); 8. Health Assessment Questionnaire - Disability Index (HAQ-DI). Participants with 20/50/70 and 90% improvement in 68-tender and 66-swollen joint counts and 20/50/70 and 90% improvement respectively in at least 3 of the 5 measures: patient's global assessment of arthritis, physician global assessment of arthritis, patient's assessment of arthritis pain, health assessment questionnaire-disability index(HAQ-DI) and CRP.
Time frame: Baseline through Week 12
Change in the Tender/Painful and Swollen Joint Count
Change from baseline in the Tender/Painful and Swollen Joint Count Sixty-eight (68) joints will be assessed to determine the number of joints that are considered tender or painful. The response to pressure/motion on each joint will be assessed using the following scale: Present/Absent/Not Done/Not Applicable- artificial joints will not be assessed.
Time frame: Baseline through Week 12
Change in the Physician's Global Assessment (PhGA) of Arthritis
Change from baseline in the Physician's Global Assessment (PhGA) of Arthritis The investigator will assess how the patient's overall arthritis appears at the time of the visit. This is an evaluation based on the patient's disease signs, functional capacity and physical examination, and should be independent of the Patient's Global Assessment of Arthritis. The investigator's response will be recorded using a 100 mm visual analogue scale (VAS). VAS measures pain intensity. The VAS consists of a 10cm line, with two end points representing 0 ('no pain') and 10 ('pain as bad as it could possibly be')
Time frame: Baseline through Week 12
Incidence and severity of adverse events, serious adverse events, and withdrawals due to adverse events
Incidence and severity of adverse events, serious adverse events, and withdrawals due to adverse events
Time frame: Baseline through Week 16
Incidence of abnormality in clinical chemistry parameters
Incidence of abnormality in clinical chemistry parameters
Time frame: Baseline through Week 16
Incidence of abnormality in hematological parameters
Incidence of abnormality in hematological parameters
Time frame: Baseline through Week 16
Change in blood pressure measurement
Change from baseline in blood pressure measurement Number of Participants with Change in blood pressure measurement
Time frame: Baseline through Week 16
Change in pulse rate measurement
Change from baseline in pulse rate Number of Participants with Change in pulse rate measurements
Time frame: Baseline through Week 16
Change in temperature measurement
Change from baseline in temperature Number of Participants with Change in temperature measurements
Time frame: Baseline through Week 16
Change in the Patient's Assessment of Arthritis Pain (PAAP;visual analogue scale [VAS]
Change from baseline in the Patient's Assessment of Arthritis Pain (PAAP) visual analogue scale (VAS) Patients will assess the severity of their arthritis pain using a 100 mm visual analogue scale (VAS) by placing a mark on the scale between 0 (no pain) and 100 (most severe pain), which corresponds to the magnitude of their pain.
Time frame: Baseline through Week 12
Change in the Patient Global Assessment of Arthritis (PtGA, VAS-visual analogue scale )
Change from baseline in the Patient Global Assessment of Arthritis (PtGA, visual analogue scale, VAS) Patients will answer the following question, "Considering all the ways in which your rheumatoid arthritis affected you, how do you feel about your arthritis today?" VAS measures pain intensity. The VAS consists of a 10cm line, with two end points representing 0 ('no pain') and 10 ('pain as bad as it could possibly be')
Time frame: Baseline through Week 12
Change from baseline in the Health Assessment Questionnaire - Disability Index (HAQ-DI)
HAQ-DI evaluate the degree of difficulty a participant has experienced during the past week in 8 categories of daily living activities: dressing/grooming; arising; eating; walking; reach; grip; hygiene; and other activities over past week. Scoring is from 0 (without any difficulty) to 3 (unable to do).
Time frame: Baseline through Week 12
Change in the Short Form Survey (SF-36 RAND)
Change from baseline in the Short Form Survey (SF-36 RAND) 8 domain scores and physical component score (PCS) and mental component score (MCS). Short Form Survey (SF-36 RAND) is a 36-item generic health status measure.
Time frame: Baseline to Week 12
Change in the Functional Assessment of Chronic Illness Therapy Fatigue (FACIT-F) total score
Change from baseline in the Functional Assessment of Chronic Illness Therapy Fatigue (FACIT-F) total score. The FACIT Fatigue Scale is a short, 13-item, easy to administer tool that measures an individual's level of fatigue during their usual daily activities over the past week.Instrument scoring yields a range from 0 to 52, with higher scores representing better patient status (less fatigue).
Time frame: Baseline to Week 12
CPL409116 and metabolite M3 pharmacokinetic variable: AUC(0-6h)
Pharmacokinetic Endpoint: area under the plasma concentration - time curve from time 0 to 6 hours after IMP administration
Time frame: up to 6 hours after administration of IMP on Day 1, 8, 57 and 85
CPL409116 and metabolite M3 pharmacokinetic variable: Cmax
Pharmacokinetic Endpoint: The maximum concentration of the CPL409116 compound in plasma after IMP administration, obtained directly from the measured concentrations
Time frame: up to 6 hours after IMP administration on Day 1, 8, 57 and up to 24 hours after IMP administration on Day 85
CPL409116 and metabolite M3 pharmacokinetic variable: Tmax
Pharmacokinetic Endpoint: The time to reach the maximum plasma concentration (Cmax), obtained directly from the actual sampling times
Time frame: up to 6 hours after administration of IMP on Day 1, 8, 57 andand up to 24 hours after IMP administration on Day 85
CPL409116 and metabolite M3 pharmacokinetic variable: T1/2 (if possible)
Pharmacokinetic Endpoint: The plasma elimination half-life
Time frame: up to 6 hours after IMP administration on Day 1, 8, 57 and up to 24 hours after IMP administration on Day 85
CPL409116 and metabolite M3 pharmacokinetic variable: Kel (if possible)
Pharmacokinetic Endpoint: Kel is to be estimated via linear regression of time versus log of concentration
Time frame: up to 6 hours after IMP administration on Day 1, 8, 57 and up to 24 hours after IMP administration on Day 85
CPL409116 pharmacokinetic variables: C0 and C2.5h
Pharmacokinetic Endpoint: the concentration pre-dose and 2.5 hours after IMP administration.
Time frame: 5 minutes before IMP administration and up to 2.5 hours after IMP administration on Day 29
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.