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A Study of the Safety, Tolerability and Efficacy of Treatment With AP1189 in Early RA Patients With Active Joint Disease (SynAct-CS002)

Primary Purpose

Rheumatoid Arthritis

Status
Completed
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
50 mg AP1189
AP1189
Placebo
Sponsored by
SynAct Pharma Aps
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Rheumatoid Arthritis

Eligibility Criteria

18 Years - 85 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Written informed consent has been obtained prior to initiating any study specific procedures
  • Male and female subjects, 18 to 85 years of age
  • Confirmed diagnosis of (RA) Rheumatoid Arthritis according to the 2010 ACR/EULAR RA classification criteria
  • Polyarthritis with joint swelling and tenderness of a minimum of three joints out of 68 joints tested
  • Candidate for Methotrexate treatment
  • Is about to begin treatment with MTX (Methotrexate)
  • Tested positive for anti-CCP Anti-cyclic citrullinated peptide) or RF (Rheumatoid Factor)
  • Severe active RA (CDAI > 22) at screening and baseline
  • Negative QFG-IT (QuantiFERON-in-Tube test)
  • Subjects should be able to complete the PRO (Patient Reported Outcome) questionnaires
  • Females of child-bearing potential may only participate if using reliable means of contraception or are post-menopausal. Surgically sterilized women at least 6 months prior to screening
  • Females of childbearing potential must have a negative pregnancy test at screening and baseline

Exclusion Criteria:

  • Participation in any other study involving investigational drug(s) within 4 weeks prior to study entry
  • Major surgery within 8 weeks prior to screening or planned surgery within 1 month following randomization
  • Rheumatic autoimmune disease other than RA, including SLE (systemic Lupus Erythematosus), MCTD (Mixed Connective Tissue Disease), scleroderma, polymyositis, or significant systemic involvement secondary to RA. Sjögren syndrome with RA is allowable
  • Functional class IV as defined by the ACR Criteria for Classification of Functional Status in RA or wheelchair/bedbound
  • Prior history of or current inflammatory joint disease other than RA
  • Subjects with fibromyalgia
  • Initiation or change in dose for NSAIDs within 2 weeks prior to dosing with the IMP (Investigational Medicinal Product)
  • Corticosteroids are prohibited within 2 weeks prior to screening (and during the entire treatment period and until the final visit
  • Evidence of serious uncontrolled concomitant cardiovascular, nervous system, pulmonary, renal, hepatic, endocrine, or gastrointestinal disease
  • Have prior renal transplant, current renal dialysis or severe renal insufficiency (determined by a derived glomerular filtration rate (GFR) using Cockcroft Gault Formula of ≤30 mL/min/1,73 m2 calculated by the local lab)
  • Uncontrolled disease states, such as asthma, psoriasis, or inflammatory bowel disease where flares are commonly treated with oral or parenteral corticosteroids
  • Evidence of active malignant disease
  • Pregnant women or nursing mothers
  • History of alcohol, drug, or chemical abuse within the 6 months prior to screening
  • Neuropathies or other painful conditions that might interfere with pain evaluation
  • Body weight of >150 kg

Exclusion criteria that only applies for Norway

  • Evidence of moderate and/or severe organ dysfunction
  • Abnormal chest x-ray (as per the discretion of the investigator
  • Evidence of positive hepatitis serology
  • Evidence of peptic ulcer disease

Sites / Locations

  • Aarhus Universitetshospital
  • Diakonhjemmet Sykehus

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Experimental

Placebo Comparator

Arm Label

50 mg AP1189

100 mg AP1189

Placebo

Arm Description

50 mg AP1189. The treatment is a 4 week treatment. Each daily dose will be administered as a suspension, i e. the powder will be added 50 ml water.

100 mg AP1189. The treatment is a 4 week treatment. Each daily dose will be administered as a suspension, i e. the powder will be added 50 ml water.

Placebo. The treatment is a 4 week treatment. Each daily dose will be administered as a suspension i e. the powder will be added 50 ml water.

Outcomes

Primary Outcome Measures

Change in CDAI
The change in CDAI score from severe (CDAI > 22) to moderate (CDAI <= 22) after 4 weeks treatment compared to baseline.

Secondary Outcome Measures

Swollen and tender joints
Proportion of subjects achieving a reduction of more than 10 swollen and/or tender joints compared to baseline
CDAI score
Proportion of subjects achieving a change in CDAI score compared to baseline
DAS28 score
Proportion of subjects achieving a change in DAS28 compared to baseline
HAQ-DI (Health Assessment Questionnaire-Disability Index) questionnaire
Proportion of subjects achieving a change in HAQ-DI
FACIT-Fatigue questionnaire
Proportion of subjects achieving a change in FACIT-Fatigue
ACR (American College of Rheumatology) response
Proportion of subjects achieving a response assessed by ACR20, ACR50 and ACR70

Full Information

First Posted
June 26, 2019
Last Updated
November 26, 2021
Sponsor
SynAct Pharma Aps
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1. Study Identification

Unique Protocol Identification Number
NCT04004429
Brief Title
A Study of the Safety, Tolerability and Efficacy of Treatment With AP1189 in Early RA Patients With Active Joint Disease
Acronym
SynAct-CS002
Official Title
A Double-blind, Multicenter, Two-part, Randomized, Placebo-controlled Study of the Safety, Tolerability, and Efficacy of 4 Weeks Treatment With AP1189 in Early Rheumatoid Arthritis (RA) Patients With Active Joint Disease
Study Type
Interventional

2. Study Status

Record Verification Date
November 2021
Overall Recruitment Status
Completed
Study Start Date
August 26, 2019 (Actual)
Primary Completion Date
November 16, 2021 (Actual)
Study Completion Date
November 16, 2021 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
SynAct Pharma Aps

4. Oversight

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

5. Study Description

Brief Summary
This is a multicenter, two-part, randomized, double-blind, placebo-kontrolled, 4-week study with repeated doses of AP1189. The study population will consist of newly diagnosed subjects with severe active Rheumatoid Arthritis, defined with a Clinical Disease Activity score (CDAI) > 22, who are to start up-titration with methotrexate.
Detailed Description
A multicenter, two-part, randomized, double-blind, placebo-kontrolled, 4-week study with repeated doses of AP1189. The study population will consist of newly diagnosed subjects with severe active Rheumatoid Arthritis, defined with a Clinical Disease Activity score (CDAI) > 22, who are to start up-titration with methotrexate. The study will be conducted in two parts separated by an interim analysis. Part 1: The subjects will be randomized in a 1:1:1 ratio into: . AP1189 dose 50 mg AP1189 dose 100 mg placebo INTERIM ANALYSIS Part 2: All subjects will be randomized into either design 1, 2 or 3 based on data from the interim analysis. Design 1: AP1189 dose 50 mg or placebo in a 2:1 ratio Design 2: AP1189 dose 100 mg or placebo in a 2:1 ratio Design 3: Continue with the same doses as in Part 1 The purpose of this study is to determine the safety and efficacy of 2 doses of AP1189 compared with placebo after 4 weeks of treatment.

6. Conditions and Keywords

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

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Model Description
Multicenter, two-part, randomized, double-blind, placebo-controlled 4-week study with repeated doses of AP1189
Masking
ParticipantInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
105 (Actual)

8. Arms, Groups, and Interventions

Arm Title
50 mg AP1189
Arm Type
Experimental
Arm Description
50 mg AP1189. The treatment is a 4 week treatment. Each daily dose will be administered as a suspension, i e. the powder will be added 50 ml water.
Arm Title
100 mg AP1189
Arm Type
Experimental
Arm Description
100 mg AP1189. The treatment is a 4 week treatment. Each daily dose will be administered as a suspension, i e. the powder will be added 50 ml water.
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Placebo. The treatment is a 4 week treatment. Each daily dose will be administered as a suspension i e. the powder will be added 50 ml water.
Intervention Type
Drug
Intervention Name(s)
50 mg AP1189
Other Intervention Name(s)
AP1189
Intervention Description
50 mg AP1189 powder in bottle
Intervention Type
Drug
Intervention Name(s)
AP1189
Intervention Description
100 mg AP1189 powder in bottle
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Placebo powder in bottle
Primary Outcome Measure Information:
Title
Change in CDAI
Description
The change in CDAI score from severe (CDAI > 22) to moderate (CDAI <= 22) after 4 weeks treatment compared to baseline.
Time Frame
4 weeks
Secondary Outcome Measure Information:
Title
Swollen and tender joints
Description
Proportion of subjects achieving a reduction of more than 10 swollen and/or tender joints compared to baseline
Time Frame
4 weeks
Title
CDAI score
Description
Proportion of subjects achieving a change in CDAI score compared to baseline
Time Frame
4 weeks
Title
DAS28 score
Description
Proportion of subjects achieving a change in DAS28 compared to baseline
Time Frame
4 weeks
Title
HAQ-DI (Health Assessment Questionnaire-Disability Index) questionnaire
Description
Proportion of subjects achieving a change in HAQ-DI
Time Frame
4 weeks
Title
FACIT-Fatigue questionnaire
Description
Proportion of subjects achieving a change in FACIT-Fatigue
Time Frame
4 weeks
Title
ACR (American College of Rheumatology) response
Description
Proportion of subjects achieving a response assessed by ACR20, ACR50 and ACR70
Time Frame
4 weeks
Other Pre-specified Outcome Measures:
Title
Effect of AP1189 as measured on the following biomarkers: CXCL13, IL-1β, IL-6, IL-10, and TNF-α
Description
Effect of AP1189, compared to placebo and by treatment group on inflammatory and collagen destructive biomarkers
Time Frame
4 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
85 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Written informed consent has been obtained prior to initiating any study specific procedures Male and female subjects, 18 to 85 years of age Confirmed diagnosis of (RA) Rheumatoid Arthritis according to the 2010 ACR/EULAR RA classification criteria Polyarthritis with joint swelling and tenderness of a minimum of three joints out of 68 joints tested Candidate for Methotrexate treatment Is about to begin treatment with MTX (Methotrexate) Tested positive for anti-CCP Anti-cyclic citrullinated peptide) or RF (Rheumatoid Factor) Severe active RA (CDAI > 22) at screening and baseline Negative QFG-IT (QuantiFERON-in-Tube test) Subjects should be able to complete the PRO (Patient Reported Outcome) questionnaires Females of child-bearing potential may only participate if using reliable means of contraception or are post-menopausal. Surgically sterilized women at least 6 months prior to screening Females of childbearing potential must have a negative pregnancy test at screening and baseline Exclusion Criteria: Participation in any other study involving investigational drug(s) within 4 weeks prior to study entry Major surgery within 8 weeks prior to screening or planned surgery within 1 month following randomization Rheumatic autoimmune disease other than RA, including SLE (systemic Lupus Erythematosus), MCTD (Mixed Connective Tissue Disease), scleroderma, polymyositis, or significant systemic involvement secondary to RA. Sjögren syndrome with RA is allowable Functional class IV as defined by the ACR Criteria for Classification of Functional Status in RA or wheelchair/bedbound Prior history of or current inflammatory joint disease other than RA Subjects with fibromyalgia Initiation or change in dose for NSAIDs within 2 weeks prior to dosing with the IMP (Investigational Medicinal Product) Corticosteroids are prohibited within 2 weeks prior to screening (and during the entire treatment period and until the final visit Evidence of serious uncontrolled concomitant cardiovascular, nervous system, pulmonary, renal, hepatic, endocrine, or gastrointestinal disease Have prior renal transplant, current renal dialysis or severe renal insufficiency (determined by a derived glomerular filtration rate (GFR) using Cockcroft Gault Formula of ≤30 mL/min/1,73 m2 calculated by the local lab) Uncontrolled disease states, such as asthma, psoriasis, or inflammatory bowel disease where flares are commonly treated with oral or parenteral corticosteroids Evidence of active malignant disease Pregnant women or nursing mothers History of alcohol, drug, or chemical abuse within the 6 months prior to screening Neuropathies or other painful conditions that might interfere with pain evaluation Body weight of >150 kg Exclusion criteria that only applies for Norway Evidence of moderate and/or severe organ dysfunction Abnormal chest x-ray (as per the discretion of the investigator Evidence of positive hepatitis serology Evidence of peptic ulcer disease
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Ellen-Margrethe Hauge, Professor
Organizational Affiliation
Aarhus Universitetshospital
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Espen A Haavardsholm, Concultant, PhD
Organizational Affiliation
Diakonhjemmet Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
Aarhus Universitetshospital
City
Aarhus
ZIP/Postal Code
8200
Country
Denmark
Facility Name
Diakonhjemmet Sykehus
City
Oslo
ZIP/Postal Code
0370
Country
Norway

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

A Study of the Safety, Tolerability and Efficacy of Treatment With AP1189 in Early RA Patients With Active Joint Disease

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