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A Study to Evaluate Pharmacokinetics and Safety of Tocilizumab (RoActemra/Actemra) in Participants Less Than 2 Years Old With Active Systemic Juvenile Idiopathic Arthritis (sJIA)

Primary Purpose

Juvenile Idiopathic Arthritis

Status
Completed
Phase
Phase 1
Locations
International
Study Type
Interventional
Intervention
Tocilizumab
Sponsored by
Hoffmann-La Roche
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Juvenile Idiopathic Arthritis

Eligibility Criteria

undefined - 24 Months (Child)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Fulfils international league of associations for rheumatology (ILAR) classification criteria for sJIA
  • Duration of sJIA symptoms lasting for at least 1 months subsequent to diagnosis of sJIA
  • Presence of active disease as determined by the presence of:

    1. Greater than or equal to (>=) 2 active joints at screening and baseline, with at least 14 consecutive days of temperature recordings, which may include the presence or absence of fever (>=38 degree Celsius) during the time between screening and baseline; or
    2. >=2 active joints at screening and baseline, with a fever >=38 degree Celsius for at least 5 consecutive days during the time between screening and baseline; under these circumstances a participant does not need to complete a full 14 days of temperature diary entries to meet this inclusion criteria
  • Not currently receiving corticosteroids (CS) or if taking oral CS like prednisone or equivalent, the dose should be less than or equal to (<=) 1 milligram per kilogram per day (mg/kg/day) and the dose has remained stable for at least 2 weeks prior to baseline
  • Not currently receiving methotrexate (MTX) or if taking MTX (together with either folic acid or folinic acid according to local standard-of-care), the dose has remained stable or has been discontinued for at least 4 weeks prior to baseline
  • Not currently receiving non-steroidal anti-inflammatory drugs (NSAIDs) or if taking NSAID, the dose has remained stable or has been discontinued for at least 2 weeks prior to baseline
  • If the participants has received previous treatment with any of the following biologic agents, these must have been discontinued according to the following timelines prior to the baseline visit and are not permitted during the study:

    1. Etanercept must have been discontinued within >= 2 weeks prior to baseline
    2. Anakinra must have been discontinued within >= 4 days prior to baseline
    3. Abatacept must have been discontinued within >= 12 weeks prior to baseline
    4. Infliximab or adalimumab must have been discontinued within >= 8 weeks prior to baseline
    5. Canakinumab must have been discontinued within >= 20 weeks prior to baseline
    6. Rilonacept must have been discontinued within >= 6 weeks prior to baseline
    7. Golimumab must have been discontinued within >= 10 weeks prior to baseline
    8. Certrolizumab pegol must have been discontinued within >= 10 weeks prior to baseline
  • History of inadequate clinical response (in the opinion of the treating physician) to NSAIDs and CS

Exclusion Criteria:

General Exclusion Criteria:

  • Any autoimmune, rheumatic disease or overlap syndrome other than sJIA
  • Not fully recovered from recent surgery or less than 6 weeks since surgery, at the time of screening visit; or planned surgery during the study (except for myringotomy surgery, which is permitted)

General Safety Exclusion Criteria:

  • Any significant concurrent medical or surgical condition which would jeopardize the participant's safety or ability to complete the trial
  • History of significant allergic or infusion reactions to prior biologic therapy or to any of the excipients listed in tocilizumab product labelling documents
  • Inborn conditions characterized by a compromised immune system
  • Known human immunodeficiency virus (HIV) infection or other acquired forms of immune compromise
  • Evidence of serious uncontrolled concomitant diseases including but not limited to the nervous system, renal, hepatic or endocrine systems
  • Asthma for which the participant has required the use of oral or parenteral corticosteroids for >=2 weeks within 6 months prior to baseline visit
  • Any active acute, subacute, chronic or recurrent bacterial, viral or systemic fungal infection
  • History of atypical tuberculosis (TB)
  • Active TB requiring treatment at any point prior to screening visit
  • Positive TB test result at screen, unless treated with anti-TB therapy for at least 4 weeks prior to receiving study medication and chest radiograph is negative for active TB within 6 months of screening visit consistent with local practice
  • Any major episode of infection requiring hospitalization or treatment during screening or treatment with IV antibiotics completing within 4 weeks of the screening visit or oral antibiotics completing within 2 weeks of the screening visit
  • History of reactivation or new onset of a systemic infection such as herpes zoster or Epstein Barr virus within 2 months of the screening visit
  • History of hepatitis B or hepatitis C infection
  • Chronic hepatitis - viral or autoimmune
  • Significant cardiac or pulmonary disease
  • History or concurrent serious gastrointestinal disorders such as ulcer or inflammatory bowel disease, ulcerative colitis or other symptomatic lower gastrointestinal conditions, including ulcer and perforation
  • History of or current cancer or lymphoma
  • History of macrophage activation syndrome (MAS) within 3 months prior to the screening visit
  • Uncontrolled diabetes mellitus with elevated hemoglobin A1c (HbA1c) as defined by age-specific standards

Excluded Previous or Concomitant Therapy:

  • Participation in another interventional clinical trial within the past 30 days or 5 serum half-lives of the investigative medication, whichever is longer
  • Previous treatment with tocilizumab
  • Administration of IV immunoglobulin within 4 weeks prior to the baseline visit
  • Previous treatment with any cell depleting therapies, including investigational agents
  • Prior stem cell transplant at any time
  • Live or attenuated vaccines within 4 weeks prior to the baseline visit, or intending to receive while on study medication or 8 weeks following the last dose of study medication
  • Serum creatinine >1.5 ULN (upper limit of normal for age and sex)
  • AST or ALT > 1.5 ULN (upper limit of normal for age and sex)
  • Total bilirubin > 1.3 mg/dL (> 23 umol/L)
  • Platelet count < 200 x103/μL (< 200,000/mm3)
  • Hemoglobin < 7.0 g/dL (< 4.3 mmol/L)
  • WBC count < 6,200/mm3 (< 6.2 x 109/L)
  • Neutrophil count < 2,500/ mm3 (< 2.5x 109/L)

Sites / Locations

  • Children's National Medical Center; Pediatric Rheumatology
  • The University of Chicago;Department of Pediatrics
  • University of Louisville Research Foundation, Inc; Kosair Charities Pediatric Clinical Research Unit
  • The Floating Hospital for Children at Tufts Medical Center
  • Children's Hospital Boston Pediatric Medicine
  • Children's Speciality Center of Nevada
  • Hackensack University Medical Center; Pediatric Rheumatology
  • Cincinnati Children'S Hospital Medical Center; Division of Rheumatology
  • Children's Hospital Of Pittsburgh
  • Hospital Gral de Niños Pedro Elizalde
  • UZ Gent
  • UZ Leuven Gasthuisberg
  • Alberta Children'S Hospital
  • Hospital For Sick Children
  • McGill University; Montreal Children's Hospital; Inflammatory, Autoimmune & Bone
  • Klinik Bremen-Mitte; Prof. Hess-Kinderklinik
  • Semmelweis University; 2nd Department of Paediatrics
  • Uniwersytecki Szpital Kliniczny Nr 4 im. M. Konopnickiej; Oddz. Kardiolog. i Reumatolog. dla Dzieci
  • Uniwersytecki Szpital Dzieciecy w Lublinie; Oddzial Pediatrii, Chorob Pluc i Reumatologii
  • Hospital Universitario la Fe: Servicio de Reumatologia Pediatrica

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Tocilizumab

Arm Description

Participants will receive tocilizumab intravenous (IV) infusion at a dose of 12 milligrams per kilogram (mg/kg) every two weeks (Q2W) during main evaluation period of 12 weeks (a total of 6 infusions including one at baseline visit). Participants will have the option to be treated in an optional extension period after completion of main evaluation period. In optional extension period, participants will receive tocilizumab 12 mg/kg IV infusion Q2W from Week 12 until the participant reaches 2 years of age or has been treated for one year from baseline, whichever is longer.

Outcomes

Primary Outcome Measures

Maximum Serum Concentration (Cmax) of Tocilizumab
Pharmacokinetic profile of tocilizumab is evaluated in terms of model predicted Cmax at steady state. Pharmacokinetic-evaluable population includes all participants who provided at least one serum pharmacokinetic sample with valid concentration data.
Minimum Serum Concentration (Cmin) of Tocilizumab
Pharmacokinetic profile of tocilizumab is evaluated in terms of observed Cmin at day 85. Pharmacokinetic-evaluable population.
Model predicted Area Under the Serum Concentration-Time Curve from Time Zero to End of Dosing (AUCtau) of Tocilizumab
AUCtau is the model-predicted area under the tocilizumab serum concentration versus time curve from time zero to the end of dosing interval (2 weeks). Pharmacokinetic-evaluable population.

Secondary Outcome Measures

Number of Participants With Adverse Events (AEs) and Serious AEs

Full Information

First Posted
October 18, 2011
Last Updated
October 31, 2019
Sponsor
Hoffmann-La Roche
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1. Study Identification

Unique Protocol Identification Number
NCT01455701
Brief Title
A Study to Evaluate Pharmacokinetics and Safety of Tocilizumab (RoActemra/Actemra) in Participants Less Than 2 Years Old With Active Systemic Juvenile Idiopathic Arthritis (sJIA)
Official Title
A Phase I Pharmacokinetic and Safety Study of Tocilizumab (TCZ) in Patients Less Than 2 Years Old With Active Systemic Juvenile Idiopathic Arthritis (sJIA)
Study Type
Interventional

2. Study Status

Record Verification Date
October 2019
Overall Recruitment Status
Completed
Study Start Date
October 26, 2012 (Actual)
Primary Completion Date
July 28, 2016 (Actual)
Study Completion Date
July 13, 2017 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Hoffmann-La Roche

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No

5. Study Description

Brief Summary
This is a multi-center, open-label single-arm study to investigate the pharmacokinetics and safety of tocilizumab (RoActemra/Actemra) in participants less than 2 years old with active sJIA. Participants will receive tocilizumab infusions every 2 weeks. The anticipated time on study treatment is 12 weeks (Main evaluation period). Participants will have the option to continue tocilizumab treatment until participant reaches 2 years of age or up to one year from baseline, whichever is longer. An optional extension period will follow the main evaluation period.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Juvenile Idiopathic Arthritis

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
11 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Tocilizumab
Arm Type
Experimental
Arm Description
Participants will receive tocilizumab intravenous (IV) infusion at a dose of 12 milligrams per kilogram (mg/kg) every two weeks (Q2W) during main evaluation period of 12 weeks (a total of 6 infusions including one at baseline visit). Participants will have the option to be treated in an optional extension period after completion of main evaluation period. In optional extension period, participants will receive tocilizumab 12 mg/kg IV infusion Q2W from Week 12 until the participant reaches 2 years of age or has been treated for one year from baseline, whichever is longer.
Intervention Type
Drug
Intervention Name(s)
Tocilizumab
Other Intervention Name(s)
RoActemra, Actemra, RO4877533
Intervention Description
Tocilizumab will be administered as indicated in the arm description.
Primary Outcome Measure Information:
Title
Maximum Serum Concentration (Cmax) of Tocilizumab
Description
Pharmacokinetic profile of tocilizumab is evaluated in terms of model predicted Cmax at steady state. Pharmacokinetic-evaluable population includes all participants who provided at least one serum pharmacokinetic sample with valid concentration data.
Time Frame
Pre-infusion (Hour 0) on Days 1, 15, 29, 43, 57, 71, and 85; at the end of infusion on Days 1, 29 and 71; and anytime on Days 8, 36, and 78 (infusion length = 1 hour)
Title
Minimum Serum Concentration (Cmin) of Tocilizumab
Description
Pharmacokinetic profile of tocilizumab is evaluated in terms of observed Cmin at day 85. Pharmacokinetic-evaluable population.
Time Frame
Pre-infusion (Hour 0) on Days 1, 15, 29, 43, 57, 71, and 85; at the end of infusion on Days 1, 29 and 71; and anytime on Days 8, 36, and 78 (infusion length = 1 hour)
Title
Model predicted Area Under the Serum Concentration-Time Curve from Time Zero to End of Dosing (AUCtau) of Tocilizumab
Description
AUCtau is the model-predicted area under the tocilizumab serum concentration versus time curve from time zero to the end of dosing interval (2 weeks). Pharmacokinetic-evaluable population.
Time Frame
Pre-infusion (Hour 0) on Days 1, 15, 29, 43, 57, 71, and 85; at the end of infusion on Days 1, 29 and 71; and anytime on Days 8, 36, and 78 (infusion length = 1 hour)
Secondary Outcome Measure Information:
Title
Number of Participants With Adverse Events (AEs) and Serious AEs
Time Frame
Baseline up to end of the study (up to approximately 60 weeks)

10. Eligibility

Sex
All
Maximum Age & Unit of Time
24 Months
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Fulfils international league of associations for rheumatology (ILAR) classification criteria for sJIA Duration of sJIA symptoms lasting for at least 1 months subsequent to diagnosis of sJIA Presence of active disease as determined by the presence of: Greater than or equal to (>=) 2 active joints at screening and baseline, with at least 14 consecutive days of temperature recordings, which may include the presence or absence of fever (>=38 degree Celsius) during the time between screening and baseline; or >=2 active joints at screening and baseline, with a fever >=38 degree Celsius for at least 5 consecutive days during the time between screening and baseline; under these circumstances a participant does not need to complete a full 14 days of temperature diary entries to meet this inclusion criteria Not currently receiving corticosteroids (CS) or if taking oral CS like prednisone or equivalent, the dose should be less than or equal to (<=) 1 milligram per kilogram per day (mg/kg/day) and the dose has remained stable for at least 2 weeks prior to baseline Not currently receiving methotrexate (MTX) or if taking MTX (together with either folic acid or folinic acid according to local standard-of-care), the dose has remained stable or has been discontinued for at least 4 weeks prior to baseline Not currently receiving non-steroidal anti-inflammatory drugs (NSAIDs) or if taking NSAID, the dose has remained stable or has been discontinued for at least 2 weeks prior to baseline If the participants has received previous treatment with any of the following biologic agents, these must have been discontinued according to the following timelines prior to the baseline visit and are not permitted during the study: Etanercept must have been discontinued within >= 2 weeks prior to baseline Anakinra must have been discontinued within >= 4 days prior to baseline Abatacept must have been discontinued within >= 12 weeks prior to baseline Infliximab or adalimumab must have been discontinued within >= 8 weeks prior to baseline Canakinumab must have been discontinued within >= 20 weeks prior to baseline Rilonacept must have been discontinued within >= 6 weeks prior to baseline Golimumab must have been discontinued within >= 10 weeks prior to baseline Certrolizumab pegol must have been discontinued within >= 10 weeks prior to baseline History of inadequate clinical response (in the opinion of the treating physician) to NSAIDs and CS Exclusion Criteria: General Exclusion Criteria: Any autoimmune, rheumatic disease or overlap syndrome other than sJIA Not fully recovered from recent surgery or less than 6 weeks since surgery, at the time of screening visit; or planned surgery during the study (except for myringotomy surgery, which is permitted) General Safety Exclusion Criteria: Any significant concurrent medical or surgical condition which would jeopardize the participant's safety or ability to complete the trial History of significant allergic or infusion reactions to prior biologic therapy or to any of the excipients listed in tocilizumab product labelling documents Inborn conditions characterized by a compromised immune system Known human immunodeficiency virus (HIV) infection or other acquired forms of immune compromise Evidence of serious uncontrolled concomitant diseases including but not limited to the nervous system, renal, hepatic or endocrine systems Asthma for which the participant has required the use of oral or parenteral corticosteroids for >=2 weeks within 6 months prior to baseline visit Any active acute, subacute, chronic or recurrent bacterial, viral or systemic fungal infection History of atypical tuberculosis (TB) Active TB requiring treatment at any point prior to screening visit Positive TB test result at screen, unless treated with anti-TB therapy for at least 4 weeks prior to receiving study medication and chest radiograph is negative for active TB within 6 months of screening visit consistent with local practice Any major episode of infection requiring hospitalization or treatment during screening or treatment with IV antibiotics completing within 4 weeks of the screening visit or oral antibiotics completing within 2 weeks of the screening visit History of reactivation or new onset of a systemic infection such as herpes zoster or Epstein Barr virus within 2 months of the screening visit History of hepatitis B or hepatitis C infection Chronic hepatitis - viral or autoimmune Significant cardiac or pulmonary disease History or concurrent serious gastrointestinal disorders such as ulcer or inflammatory bowel disease, ulcerative colitis or other symptomatic lower gastrointestinal conditions, including ulcer and perforation History of or current cancer or lymphoma History of macrophage activation syndrome (MAS) within 3 months prior to the screening visit Uncontrolled diabetes mellitus with elevated hemoglobin A1c (HbA1c) as defined by age-specific standards Excluded Previous or Concomitant Therapy: Participation in another interventional clinical trial within the past 30 days or 5 serum half-lives of the investigative medication, whichever is longer Previous treatment with tocilizumab Administration of IV immunoglobulin within 4 weeks prior to the baseline visit Previous treatment with any cell depleting therapies, including investigational agents Prior stem cell transplant at any time Live or attenuated vaccines within 4 weeks prior to the baseline visit, or intending to receive while on study medication or 8 weeks following the last dose of study medication Serum creatinine >1.5 ULN (upper limit of normal for age and sex) AST or ALT > 1.5 ULN (upper limit of normal for age and sex) Total bilirubin > 1.3 mg/dL (> 23 umol/L) Platelet count < 200 x103/μL (< 200,000/mm3) Hemoglobin < 7.0 g/dL (< 4.3 mmol/L) WBC count < 6,200/mm3 (< 6.2 x 109/L) Neutrophil count < 2,500/ mm3 (< 2.5x 109/L)
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Clinical Trials
Organizational Affiliation
Hoffmann-La Roche
Official's Role
Study Director
Facility Information:
Facility Name
Children's National Medical Center; Pediatric Rheumatology
City
Washington
State/Province
District of Columbia
ZIP/Postal Code
20010-2970
Country
United States
Facility Name
The University of Chicago;Department of Pediatrics
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60649
Country
United States
Facility Name
University of Louisville Research Foundation, Inc; Kosair Charities Pediatric Clinical Research Unit
City
Louisville
State/Province
Kentucky
ZIP/Postal Code
40202
Country
United States
Facility Name
The Floating Hospital for Children at Tufts Medical Center
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02111
Country
United States
Facility Name
Children's Hospital Boston Pediatric Medicine
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02115
Country
United States
Facility Name
Children's Speciality Center of Nevada
City
Las Vegas
State/Province
Nevada
ZIP/Postal Code
89109
Country
United States
Facility Name
Hackensack University Medical Center; Pediatric Rheumatology
City
Hackensack
State/Province
New Jersey
ZIP/Postal Code
07601
Country
United States
Facility Name
Cincinnati Children'S Hospital Medical Center; Division of Rheumatology
City
Cincinnati
State/Province
Ohio
ZIP/Postal Code
45229-3039
Country
United States
Facility Name
Children's Hospital Of Pittsburgh
City
Pittsburgh
State/Province
Pennsylvania
ZIP/Postal Code
15224
Country
United States
Facility Name
Hospital Gral de Niños Pedro Elizalde
City
Buenos Aires
ZIP/Postal Code
1270
Country
Argentina
Facility Name
UZ Gent
City
Gent
ZIP/Postal Code
9000
Country
Belgium
Facility Name
UZ Leuven Gasthuisberg
City
Leuven
ZIP/Postal Code
3000
Country
Belgium
Facility Name
Alberta Children'S Hospital
City
Calgary
State/Province
Alberta
ZIP/Postal Code
T3B 6A8
Country
Canada
Facility Name
Hospital For Sick Children
City
Toronto
State/Province
Ontario
ZIP/Postal Code
M5G 1X8
Country
Canada
Facility Name
McGill University; Montreal Children's Hospital; Inflammatory, Autoimmune & Bone
City
Montreal
State/Province
Quebec
ZIP/Postal Code
H4A 3J1
Country
Canada
Facility Name
Klinik Bremen-Mitte; Prof. Hess-Kinderklinik
City
Bremen
ZIP/Postal Code
28177
Country
Germany
Facility Name
Semmelweis University; 2nd Department of Paediatrics
City
Budapest
ZIP/Postal Code
1094
Country
Hungary
Facility Name
Uniwersytecki Szpital Kliniczny Nr 4 im. M. Konopnickiej; Oddz. Kardiolog. i Reumatolog. dla Dzieci
City
Lodz
ZIP/Postal Code
91-738
Country
Poland
Facility Name
Uniwersytecki Szpital Dzieciecy w Lublinie; Oddzial Pediatrii, Chorob Pluc i Reumatologii
City
Lublin
ZIP/Postal Code
20-093
Country
Poland
Facility Name
Hospital Universitario la Fe: Servicio de Reumatologia Pediatrica
City
Valencia
ZIP/Postal Code
46026
Country
Spain

12. IPD Sharing Statement

Citations:
PubMed Identifier
31438986
Citation
Mallalieu NL, Wimalasundera S, Hsu JC, Douglass W, Wells C, Penades IC, Cuttica R, Huppertz HI, Joos R, Kimura Y, Milojevic D, Rosenkranz M, Schikler K, Constantin T, Wouters C. Intravenous dosing of tocilizumab in patients younger than two years of age with systemic juvenile idiopathic arthritis: results from an open-label phase 1 clinical trial. Pediatr Rheumatol Online J. 2019 Aug 22;17(1):57. doi: 10.1186/s12969-019-0364-z.
Results Reference
derived

Learn more about this trial

A Study to Evaluate Pharmacokinetics and Safety of Tocilizumab (RoActemra/Actemra) in Participants Less Than 2 Years Old With Active Systemic Juvenile Idiopathic Arthritis (sJIA)

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