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A Study to Investigate the Ability of GSK706769 to Maintain Clinical Remission After Withdrawal of Enbrel in Rheumatoid Arthritis Patients

Primary Purpose

Arthritis, Rheumatoid

Status
Withdrawn
Phase
Phase 2
Locations
Netherlands
Study Type
Interventional
Intervention
GSK706769
Placebo
Sponsored by
GlaxoSmithKline
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Arthritis, Rheumatoid focused on measuring GSK706769, Enbrel, Rheumatoid Arthritis

Eligibility Criteria

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

Inclusion Criteria:

  • Male or female over 18 years of age, at the time of signing the informed consent.
  • A female subject is eligible to participate if she is of child-bearing potential and agrees to use one of the contraception methods listed in the protocol for an appropriate period of time Female subjects must agree to use contraception until 4 days post-last dose.
  • Body weight greater than or equal to 50 kg and BMI within the range 19 - 32 kg/m2.
  • The subject has a diagnosis of RA according to the revised 1987 criteria of the American College of Rheumatology (ACR) and has been treated with an anti TNF-alpha agent for < 2 years.
  • The subject is taking Enbrel for at least 6 months prior to enrollment.
  • The subject is willing to stop taking Enbrel for 56 days.
  • The subject is in clinical remission, defined as DAS28 less than or equal to 2.6 and has been for the preceding 6 months.
  • Capable of giving written informed consent, which includes compliance with the requirements and restrictions listed in the consent form.
  • Average QTcB or QTcF < 450 msec; or QTc < 480 msec in subjects with Bundle Branch Block.
  • AST and ALT < 2xULN; alkaline phosphatase and bilirubin less than or equal to 1.5xULN (isolated bilirubin >1.5xULN is acceptable if bilirubin is fractionated and direct bilirubin <35%).

Exclusion Criteria:

  • The subject is using oral prednisolone at doses > 10mg/day.
  • The subject's NSAID or glucocorticoid dosing regimen has changed during the 4 weeks prior to randomisation.
  • The subject's receiving DMARDs other than Enbrel and methotrexate.
  • The subject's current methotrexate regimen has changed significantly (i.e. likely to impact disease activity during the study period) within the 3 months prior to dosing e.g. changes in dose of greater than 2.5mg.
  • Use of CYP3A4 inhibitors/inducers within 14 days prior to dosing and CYP3A4 substrates with a narrow therapeutic index within 7 days prior to dosing.
  • The subject has participated in a clinical trial and has received an investigational product within the following time period prior to the first dosing day in the current study: 30 days, 5 half-lives or twice the duration of the biological effect of the investigational product (whichever is longer).
  • Exposure to more than four new chemical entities within 12 months prior to the first dosing day.
  • Absolute neutrophil count < 1500/ul.
  • History of sensitivity to the study medication, or components thereof or a history of drug or other allergy that contraindicates their participation.
  • A positive pre-study Hepatitis B surface antigen or positive Hepatitis C antibody result within 3 months of screening.
  • Current or chronic history of liver disease, or known hepatic or biliary abnormalities (with the exception of Gilbert's syndrome or asymptomatic gallstones).
  • A positive pre-study drug screen, unless the subject is receiving a prescribed medication that could give a positive in the drug screen and prior to the screen being sent the medication has been discussed and pre-approved by the medical monitor.
  • A positive test for HIV antibody.
  • History of regular alcohol consumption within 6 months of the study defined by the protocol.
  • The subject has an acute infection or a history of repeated or chronic infections.
  • The subject has significant cardiac, pulmonary, metabolic, renal, hepatic or gastrointestinal conditions that in the opinion of the investigator and/or medical monitor, places the subject at an unacceptable risk as a participant in this trial.
  • Subjects with autoimmune hemolytic anemia or G6PD deficiency.
  • Malignancy in the past 2 years, except for adequately treated non-invasive cancers of the skin.
  • Where participation in the study would result in donation of blood or blood products in excess of 500 mL within a 56 day period.
  • Lactating females.
  • Unwillingness or inability to follow the procedures outlined in the protocol.
  • Subject is mentally or legally incapacitated.
  • Consumption of grapefruit, grapefruit juice or grapefruit hybrids within 7 days prior to the first dose of study medication.

Sites / Locations

  • GSK Investigational Site

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

GSK706769

Placebo

Arm Description

100 mg GSK706769 twice daily orally (BID) for 28 days

GSK706769 matched-placebo twice daily orally (BID) for 28 days

Outcomes

Primary Outcome Measures

Maintenance of clinical remission after withdrawal of Enbrel in patients with RA, as determined by DAS28 scores.

Secondary Outcome Measures

The ability of GSK706769 to maintain clinical remission after withdrawal of Enbrel in patients with RA, as determined by the Patient Global Assessment scores and evidence of swollen or tender joints.
To investigate the time to relapse following withdrawal of Enbrel
Safety and tolerability of GSK706769 following repeat dosing in RA subjects for up to 28 days
Rheumatological assessments, pain, fatigue and physical functioning following repeat dosing with GSK706769 for up to 28 days
Pharmacokinetics (PK) of GSK706769, and its metabolite GSK1996847A
CCR5 receptor occupancy (RO) in peripheral blood following repeat dosing with GSK706769 for up to 28 days, as feasible

Full Information

First Posted
September 17, 2009
Last Updated
May 25, 2017
Sponsor
GlaxoSmithKline
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1. Study Identification

Unique Protocol Identification Number
NCT00979771
Brief Title
A Study to Investigate the Ability of GSK706769 to Maintain Clinical Remission After Withdrawal of Enbrel in Rheumatoid Arthritis Patients
Official Title
A Randomized, Double-blind, Placebo-controlled, Parallel Group Study to Investigate the Ability of GSK706769 to Maintain Clinical Remission After Withdrawal of Enbrel in Patients With Rheumatoid Arthritis
Study Type
Interventional

2. Study Status

Record Verification Date
May 2017
Overall Recruitment Status
Withdrawn
Why Stopped
internal decision
Study Start Date
February 2010 (undefined)
Primary Completion Date
June 2011 (Anticipated)
Study Completion Date
June 2011 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
GlaxoSmithKline

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
The purpose of this study is to determine if GSK706769 can maintain clinical remission established by Enbrel after withdrawal of Enbrel in rheumatoid arthritis patients.
Detailed Description
This study is a phase II, randomized, double-blind, placebo-controlled, parallel group study in subjects with rheumatoid arthritis (RA) on stable doses of Enbrel. Subjects with an adequate response to Enbrel will be enrolled into the study. Subjects will be withdrawn from their Enbrel and randomized to receive 28 days of dosing with either GSK706769 or placebo followed by 28 days off-drug. This study is exploring a novel therapeutic paradigm for RA, remission maintenance. In such an approach, remission is induced and then the inducing agent is stopped and a maintenance agent is added. The clinical benefit would be derived from the fact that the remission agent may be easier to take (e.g. oral rather than parenteral), more durable in its maintenance of remission, and/or safer (e.g. no TB reactivation). This study directly explores remission maintenance. Specifically, in a randomised, double blind, placebo controlled study, RA patients in remission through an adequate response to Enbrel will be recruited. Enbrel has been selected as it has a relatively short half life and therefore it is more likely patients treated with placebo may have a higher incidence of relapse after 28 days than with other anti-TNF treatments. After withdrawal of Enbrel (and possibly other oral DMARDs), subjects will be randomised to receive GSK706769 or placebo for 28 days followed by a period of 28 days off treatment. It is hypothesized that GSK706769 will prevent any CCR5+ cells from returning into the synovium, thereby resulting in maintenance of the efficacy induced by Enbrel. In the placebo group, CCR5 cells may re-populate the synovium resulting in increased inflammation. Patients experiencing increased disease activity will be able to withdraw from the study and resume standard of care.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Arthritis, Rheumatoid
Keywords
GSK706769, Enbrel, Rheumatoid Arthritis

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
0 (Actual)

8. Arms, Groups, and Interventions

Arm Title
GSK706769
Arm Type
Experimental
Arm Description
100 mg GSK706769 twice daily orally (BID) for 28 days
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
GSK706769 matched-placebo twice daily orally (BID) for 28 days
Intervention Type
Drug
Intervention Name(s)
GSK706769
Intervention Description
100 mg GSK706769 twice daily orally (BID) for 28 days
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
GSK706769 matched-placebo twice daily orally (BID) for 28 days
Primary Outcome Measure Information:
Title
Maintenance of clinical remission after withdrawal of Enbrel in patients with RA, as determined by DAS28 scores.
Time Frame
Day 28 after first dose administration
Secondary Outcome Measure Information:
Title
The ability of GSK706769 to maintain clinical remission after withdrawal of Enbrel in patients with RA, as determined by the Patient Global Assessment scores and evidence of swollen or tender joints.
Time Frame
Day 28 and 28 days after last dose of study medication
Title
To investigate the time to relapse following withdrawal of Enbrel
Time Frame
After first dose administration
Title
Safety and tolerability of GSK706769 following repeat dosing in RA subjects for up to 28 days
Time Frame
After first dose administration
Title
Rheumatological assessments, pain, fatigue and physical functioning following repeat dosing with GSK706769 for up to 28 days
Time Frame
Day 1, 14, 28, 56 after first dose administration
Title
Pharmacokinetics (PK) of GSK706769, and its metabolite GSK1996847A
Time Frame
Day 1, 14 and 28 after first dose administration
Title
CCR5 receptor occupancy (RO) in peripheral blood following repeat dosing with GSK706769 for up to 28 days, as feasible
Time Frame
Day 1, 14 and 28 after first dose administration

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male or female over 18 years of age, at the time of signing the informed consent. A female subject is eligible to participate if she is of child-bearing potential and agrees to use one of the contraception methods listed in the protocol for an appropriate period of time Female subjects must agree to use contraception until 4 days post-last dose. Body weight greater than or equal to 50 kg and BMI within the range 19 - 32 kg/m2. The subject has a diagnosis of RA according to the revised 1987 criteria of the American College of Rheumatology (ACR) and has been treated with an anti TNF-alpha agent for < 2 years. The subject is taking Enbrel for at least 6 months prior to enrollment. The subject is willing to stop taking Enbrel for 56 days. The subject is in clinical remission, defined as DAS28 less than or equal to 2.6 and has been for the preceding 6 months. Capable of giving written informed consent, which includes compliance with the requirements and restrictions listed in the consent form. Average QTcB or QTcF < 450 msec; or QTc < 480 msec in subjects with Bundle Branch Block. AST and ALT < 2xULN; alkaline phosphatase and bilirubin less than or equal to 1.5xULN (isolated bilirubin >1.5xULN is acceptable if bilirubin is fractionated and direct bilirubin <35%). Exclusion Criteria: The subject is using oral prednisolone at doses > 10mg/day. The subject's NSAID or glucocorticoid dosing regimen has changed during the 4 weeks prior to randomisation. The subject's receiving DMARDs other than Enbrel and methotrexate. The subject's current methotrexate regimen has changed significantly (i.e. likely to impact disease activity during the study period) within the 3 months prior to dosing e.g. changes in dose of greater than 2.5mg. Use of CYP3A4 inhibitors/inducers within 14 days prior to dosing and CYP3A4 substrates with a narrow therapeutic index within 7 days prior to dosing. The subject has participated in a clinical trial and has received an investigational product within the following time period prior to the first dosing day in the current study: 30 days, 5 half-lives or twice the duration of the biological effect of the investigational product (whichever is longer). Exposure to more than four new chemical entities within 12 months prior to the first dosing day. Absolute neutrophil count < 1500/ul. History of sensitivity to the study medication, or components thereof or a history of drug or other allergy that contraindicates their participation. A positive pre-study Hepatitis B surface antigen or positive Hepatitis C antibody result within 3 months of screening. Current or chronic history of liver disease, or known hepatic or biliary abnormalities (with the exception of Gilbert's syndrome or asymptomatic gallstones). A positive pre-study drug screen, unless the subject is receiving a prescribed medication that could give a positive in the drug screen and prior to the screen being sent the medication has been discussed and pre-approved by the medical monitor. A positive test for HIV antibody. History of regular alcohol consumption within 6 months of the study defined by the protocol. The subject has an acute infection or a history of repeated or chronic infections. The subject has significant cardiac, pulmonary, metabolic, renal, hepatic or gastrointestinal conditions that in the opinion of the investigator and/or medical monitor, places the subject at an unacceptable risk as a participant in this trial. Subjects with autoimmune hemolytic anemia or G6PD deficiency. Malignancy in the past 2 years, except for adequately treated non-invasive cancers of the skin. Where participation in the study would result in donation of blood or blood products in excess of 500 mL within a 56 day period. Lactating females. Unwillingness or inability to follow the procedures outlined in the protocol. Subject is mentally or legally incapacitated. Consumption of grapefruit, grapefruit juice or grapefruit hybrids within 7 days prior to the first dose of study medication.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
GSK Clinical Trials
Organizational Affiliation
GlaxoSmithKline
Official's Role
Study Director
Facility Information:
Facility Name
GSK Investigational Site
City
Amsterdam
ZIP/Postal Code
1105 AZ
Country
Netherlands

12. IPD Sharing Statement

Learn more about this trial

A Study to Investigate the Ability of GSK706769 to Maintain Clinical Remission After Withdrawal of Enbrel in Rheumatoid Arthritis Patients

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