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Efficacy and Safety of Tofacitinib in Subjects With Active Ankylosing Spondylitis (AS)

Primary Purpose

Ankylosing Spondylitis

Status
Completed
Phase
Phase 3
Locations
International
Study Type
Interventional
Intervention
Tofacitinib
Sponsored by
Pfizer
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Ankylosing Spondylitis

Eligibility Criteria

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

Inclusion Criteria:

  • Has a diagnosis of Ankylosing Spondylitis (AS) based on the Modified New York Criteria for AS (1984).
  • Must have a radiograph of SI joints (AP Pelvis) documenting diagnosis of AS.
  • Has active disease despite nonsteroidal anti-inflammatory drug (NSAID) therapy or intolerant to NSAIDs.

Exclusion Criteria:

  • History of known or suspected complete ankylosis of the spine.
  • History of allergies, intolerance or hypersensitivity to lactose or tofacitinib.
  • History of any other rheumatic disease.
  • Any subject with condition affecting oral drug absorption.

Sites / Locations

  • Rheumatology Associates of North Alabama, PC
  • Arizona Arthritis & Rheumatology Associates, P.C.
  • Medvin Clinical Research
  • Rheumatology Center of San Diego PC
  • University of California, San Francisco Medical Center
  • Robin K. Dore, MD, Inc.
  • New England Research Associates, LLC
  • Advanced Radiology
  • Stamford Therapeutics Consortium
  • Southcoast Research Center, Inc.
  • Millennium Research
  • Bluegrass Community Research, Inc
  • Center for Rheumatology and Bone Research
  • M3-Emerging Medical Research, LLC
  • Paramount Medical Research and Consulting, LLC
  • Oregon Health & Science University
  • Altoona Center For Clinical Research
  • Articularis Healthcare Group, Inc d/b/a Low Country Rheumatology
  • Precision Comprehensive Clinical Research Solutions
  • Adriana Pop-Moody MD - Clinic PA
  • Metroplex Clinical Research Center
  • Clinical Research Unit
  • Investigational Drug Services
  • Memorial Hermann Hospital Imaging
  • Southwest Rheumatology Research LLC
  • Trinity Universal Research Associates, Inc.
  • Advanced Rheumatology of Houston
  • Arthritis Northwest, PLLC
  • Pacific Radiology,
  • Rheumatology Research Unit Sunshine Coast
  • Emeritus Research Pty. Ltd.
  • Melbourne Radiology Clinic
  • SKG Radiology
  • Western Cardiology
  • RK Will Pty Ltd
  • Multiprofile Hospital for active treatment "Kaspela" EOOD
  • Diagnostic-Consulting Center XVII - Sofia
  • Medical Centre Synexus Sofia EOOD
  • Centre de Recherche Musculo-Squelettique
  • G.R.M.O. (Groupe de recherche en maladies osseuses) Inc.
  • Guangdong Provincial People's Hospital
  • The Third Affiliated Hospital, Sun Yat-Sen University
  • The Second Affiliated Hospital of Zhejiang University School of Medicine
  • The First Affiliated Hosptial of Wenzhou Medical University
  • Rheumatology and Immunology Department, Shanghai Changzheng Hospital
  • Lekarna Rezidence Nova Karolina
  • CCBR Ostrava s.r.o.
  • BENU Lekarna
  • CCR, Czech a.s.
  • Lekarna Hradebni, s.r.o.
  • Uherskohradistska nemocnice, a.s.
  • Medical Plus s.r.o.
  • CHRU de Tours, Hopital Trousseau
  • Qualiclinic K ft
  • Pest megyei Flór Ferenc Kórház, Reumatológia-és Fizioterápiás Osztály
  • VITAL MEDICAL CENTER (VITÁL-MEDICINA Kft.)
  • Barzilai Medical Center
  • Chonnam National University Hospital
  • Inha University Hospital
  • Hanyang University Seoul Hospital
  • Geo Medical Sp. z.o.o Szpital Geo Medical
  • Moja Przychodnia
  • C.M. Silmedic Sp. z o.o.
  • Malopolskie Badania Kliniczne Sp. z o.o. s.k.
  • Samodzielny Publiczny Zaklad Opieki Zdrowotnej MSWiA
  • Centrum Medyczne Plejady
  • Centrum Medyczne LUX MED
  • Malopolskie Centrum Medyczne S.C.
  • Szpital Uniwersytecki w Krakowie, Zaklad Radiologii
  • Top Medical
  • Zespol Poradni Specjalistycznych REUMED, Wallenroda Filia nr 1
  • NZOZ JAMED Pracownia Rentgenowska Jerema Antoszewski
  • Prywatna Praktyka Lekarska Prof. UM dr hab. med. Pawel Hrycaj
  • Klinika Alfa
  • RCMed Oddzial Sochaczew
  • Szpital Powiatowy w Sochaczewie
  • Szpital Sw. Elzbiety, Mokotowskie Centrum Medyczne, Zaklad Diagnostyki
  • "Reumatika - Centrum Reumatologii" NZOZ
  • Centrum Medyczne Oporow
  • Centrum Medyczne Medix
  • Limited Liability Company Medical Center "Rheuma-Med"
  • State Budgetary Healthcare Institution "Orenburg Regional Clinical Hospital"
  • Limited Liability Company "Sanavita"
  • State Healthcare Institution "Regional Clinical Hospital"
  • RSBHI "Smolensk Regional Clinical Hospital"
  • Limited Liability Company "BioMed"
  • Ankara Universitesi Tip Fakultesi Ibn-i Sina Hastanesi
  • Ankara Universitesi Tip Fakultesi, Ibn-i Sina Hastanesi
  • Hacettepe Universitesi Tip Fakultesi, Ic Hastaliklari Anabilim
  • Istanbul Universitesi Istanbul Tip Fakultesi, Ic Hastaliklari
  • Istanbul Universitesi Istanbul Tip Fakultesi
  • Marmara Univ. Istanbul Pendik Egitim ve Arastirma Hastanesi
  • Izmir Katip Celebi Univ Ataturk Egitim ve Arastirma Hastanesi
  • Izmir Katip Celebi Univ. Ataturk Egitim ve Arastirma Hastanesi
  • Kyiv City Clinical Hospital # 3, Rheumatology Department
  • Lviv Communal Clinical Hospital #4, Rheumatology department
  • Military-Medical Clinical Center (Clinical Hospital with 200 beds) of State Border Guard Service of
  • Ternopil University Hospital, Department of Rheumatology,
  • Vinnytsia Regional Clinical Hospital n.a. M.I.Pyrohov, rheumatology department,

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Tofacitinib

Placebo

Arm Description

Outcomes

Primary Outcome Measures

Percentage of Participants Achieving Assessment of SpondyloArthritis International Society (ASAS)20 Response at Week 16
ASAS20 assess 4 domains: Patient Global Assessment of Disease (PGA) (assess disease activity on a scale of 0 [not active] to 10 [very active], high score=more disease activity), total back pain (scale of 0 [no pain] to 10 [most severe pain], high score=more severity), Function (Bath Ankylosing Spondylitis Functional Index [BASFI]; participant's level of ability on scale of 0 [easy] to 10 [impossible], low score= better functional health) and Inflammation (morning stiffness, Mean of Question [Q]5 and Q6 of Bath Ankylosing Spondylitis Disease Activity Index [BASDAI] defined as 6-item questionnaire measure disease activity on a scale of 0 [none] to 10 [severe], high score=more disease activity). ASAS20 response: greater than or equal to (>=) 20 percent (%) improvement from baseline in disease activity and absolute change of >=1 unit in >=3 domains and no worsening of >=20% and an absolute change of >=1 unit in remaining domain.

Secondary Outcome Measures

Percentage of Participants Achieving Ankylosing Spondylitis (ASAS)40 Response at Week 16
ASAS40 assessed 4 domains: the "PGA" (assess disease activity on a scale of 0 [not active] to 10 [very active], higher score=more disease activity), total back pain (on a scale of 0 [no pain] to 10 [most severe pain], higher score=more severity), Function (from BASFI: assess participant's level of ability on a scale of 0 [easy] to 10 [impossible], lower scores= better functional health) and Inflammation (morning stiffness, Mean of Q5 and Q6 of BASDAI defined as 6 item questionnaire: measures disease activity on a scale of 0 [none] to 10 [severe], higher score=more disease activity). ASAS40 response: >=40% and >=2 units improvement in >=3 domains and no worsening at all in the remaining domain.
Number of Participants With Treatment Emergent Adverse Events (AEs)
An AE: any untoward medical occurrence in a participant who received study drug without regard to possibility of causal relationship. As per National Cancer Institute - Common Terminology Criteria for Adverse Events (NCI-CTCAE) version 4.03, severity was graded as Grade 1: asymptomatic/mild symptoms, clinical or diagnostic observations only, intervention not indicated; Grade 2: moderate, minimal, local or noninvasive intervention indicated, limiting age-appropriate instrumental activities of daily living (ADL); Grade 3: severe or medically significant but not immediately life-threatening, hospitalization or prolongation of existing hospitalization indicated, disabling, limiting self-care ADL; Grade 4: life-threatening consequence, urgent intervention indicated; Grade 5: death related to AE. Treatment-emergent were events between first dose of study drug and up to 48 weeks that were absent before treatment or that worsened relative to pretreatment state.
Number of Participants With Treatment Emergent Adverse Events (AEs) by Severity
AE: any untoward medical occurrence in subject who receive study drug without regard to possibility of causal relationship. Treatment-emergent AEs were events that occurred between first dose of study drug and up to 48 weeks that were absent before treatment or that worsened relative to pretreatment state. The severity grades (mild, moderate and severe) were defined as - mild: did not interfere with participant's usual function, moderate: Interfered to some extent with participant's usual function and severe: Interfered significantly with participant's usual function.
Number of Participants With Laboratory Abnormalities (Without Regard to Baseline Abnormality)
Hematology (Hemoglobin, Hematocrit, Erythrocyte, Lymphocyte/Leukocyte, Neutrophil/Leukocyte <0.8*Lower limit of normal (LLN), Reticulocyte >1.5*Upper limit of normal (ULN), Erythrocyte Mean Corpuscular Volume, Erythrocyte Mean Corpuscular Hemoglobin, Erythrocyte Mean Corpuscular HGB Concentration <0.9*LLN, >1.1*ULN, Reticulocyte/Erythrocyte, Leukocyte >1.5*ULN, Lymphocyte, Neutrophil <0.8*LLN and >1.2*ULN, Basophil, Basophil/Leukocyte, Eosinophil, Eosinophil/Leukocyte, Monocyte, Monocyte/Leukocyte >1.2*ULN); Clinical Chemistry (Bilirubin, Glucose >1.5*ULN, AST, ALT, Gamma Glutamyl Transferase >3.0*ULN, Urea, Creatinine, Triglyceride, Cholesterol >1.3*ULN, LDL Cholesterol>1.2*ULN, Potassium, C Reactive Protein >1.1*ULN, Bicarbonate <0.9*LLN, Creatine Kinase >2.0*ULN, HDL Cholesterol <0.8*LLN), Urinalysis (Specific Gravity >1.035, pH >8, Glucose, Ketones, Protein, Hemoglobin >=1, Erythrocyte, Leukocyte >=20, Granular Cast, Hyaline Cast>1.
Number of Participants With Vital Signs Abnormalities
Criteria for abnormalities in vital signs: Pulse rate <40 beats per minute (bpm) to >120 bpm, Sitting Diastolic blood pressure < 50 millimeter of mercury (mmHg), increase and decrease in change from baseline of >= 20mmHg, sitting systolic blood pressure < 90 mmHg, increase and decrease in change from baseline of >= 30mmHg.
Number of Participants With Abnormalities in Physical Examination
Complete physical examination: included general appearance, skin (presence of rash), heent (head, eyes, ears, nose and throat), lungs (auscultation), heart (auscultation for presence of murmurs, gallops, rubs), lower extremities (presence of peripheral edema), abdominal (palpation and auscultation), neurologic (mental status, station, gait, reflexes, motor and sensory function, coordination) and lymph nodes. Abnormalities in physical examination was based on investigator's discretion/clinical judgement.
Number of Participants With Electrocardiogram (ECG) Abnormalities
Twelve-lead electrocardiograms (ECGs) were obtained for all participants. Criteria for ECG abnormality: PR interval >=300 and a percent change from baseline of >=25 or 50%; QRS duration >=140 and a percent change from baseline of >=50%; QT interval >=500; QTCB, QTCF interval <480 or >=450, <500 or >=480, >=500, change from baseline of <60 and >=30, and change from baseline of >=60.
Percentage of Participants Achieving ASAS20 Response at Weeks 2, 4, 8, 12, 24, 32, 40 and 48
ASAS20 assess 4 domains: PGA of Disease (assess disease activity on a scale of 0 [not active] to 10 [very active], high score=more disease activity), total back pain (scale of 0 [no pain] to 10 [most severe pain], high score=more severity), Function (BASFI; participant's level of ability on scale of 0 [easy] to 10 [impossible], low score= better functional health) and Inflammation (morning stiffness, Mean of Q5 and Q6 of BASDAI defined as 6-item questionnaire measure disease activity on a scale of 0 [none] to 10 [severe], high score=more disease activity). ASAS20 response: >= 20% improvement from baseline in disease activity and absolute change of >=1 unit in >=3 domains and no worsening of >=20% and an absolute change of >=1 unit in remaining domain.
Percentage of Participants Achieving ASAS40 Response at Weeks 2, 4, 8, 12, 24, 32, 40 and 48
ASAS40 assessed 4 domains: the "PGA" (assess disease activity on a scale of 0 [not active] to 10 [very active], higher score=more disease activity), total back pain (on a scale of 0 [no pain] to 10 [most severe pain], higher score=more severity), Function (from BASFI: assess participant's level of ability on a scale of 0 [easy] to 10 [impossible], lower scores= better functional health) and Inflammation (morning stiffness, Mean of Q5 and Q6 of BASDAI defined as 6 item questionnaire: measures disease activity on a scale of 0 [none] to 10 [severe], higher score=more disease activity). ASAS40 response: >=40% and >=2 units improvement in >=3 domains and no worsening at all in the remaining domain.
Change From Baseline in Ankylosing Spondylitis Disease Activity Score Using C-Reactive Protein (ASDAS[CRP]) at Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
ASDAS(CRP) was derived using BASDAI (6-item questionnaire measures disease activity on a scale of 0 [none] to 10 [severe], higher score=more disease activity) and PGA (measure disease activity on a scale of 0 [not active] to 10 [very active], high score=more disease activity) and calculated by using the following formula, 0.121 x Back Pain (Q2 of BASDAI) + 0.058 x Duration of Morning Stiffness (Q6 of BASDAI) + 0.110 x PGA + 0.073 x Peripheral Pain/Swelling (Q3 of BASDAI) + 0.579 x Ln(high sensitivity [hs] CRP mg/Liter [L] + 1). If hsCRP values were smaller than 2 mg/L, they were set to 2 mg/L in the formula. The range of score was >= 0.636 to no defined upper limit. A negative change from baseline value indicates decrease in disease activity; a positive change from baseline value indicates increase in disease activity.
Change From Baseline in High Sensitivity C-Reactive Protein (hsCRP) at Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
Blood samples were collected for analysis of hsCRP using an assay analyzed by central laboratory. hsCRP is an acute phase reactant, which was indicative of inflammation and of its severity.
Change From Baseline in Ankylosing Spondylitis Quality of Life (ASQoL) Score at Weeks 16 and 48
The ASQoL was an 18-item questionnaire assessed the amount of restriction participant experienced in daily activities, level of pain and fatigue, and the impact on the participant's emotional state. Each item was scored as 0 (no impact) or 1 (yes - impact). A total score was calculated by summing the items. The total score ranged from 0 (no impact) to 18 (yes-impact), with higher values indicated more impaired health-related quality of life.
Change From Baseline in Short-Form-36 Health Survey-Version 2 Acute (SF-36v2) Score at Weeks 16 and 48
SF-36 v.2 (Acute): 36-item generic health status measure. It measured 8 general health domains: physical functioning, role limitations due to physical health, bodily pain, general health perceptions, vitality, social functioning, role limitations due to emotional problems, mental health. These domains were aggregated into 2 summary scores - physical component summary (PCS), mental component summary (MCS). Four domains comprised PCS score (physical functioning, role-physical, bodily pain, general health) and remaining 4 domains comprised MCS score (vitality, social functioning, role-emotional, mental health). Normalized domain scores, PCS, MCS scores are used in analyses. Component and domain scores were scored by using United States 1998 general population norm. Resulting norm-based T-scores for both the SF36 version 2 and SF36 health domain scale and component summary measures had means of 50 and standard deviations of 10. Higher PCS/MCS/domain score represent better health status.
Change From Baseline in Bath Ankylosing Spondylitis Metrology Index (BASMI) Scores: Cervical Rotation Angle at Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
BASMI assess axial status and spinal mobility. It composed of 5 clinical measures: lateral spinal flexion, tragus-to-wall distance, lumbar flexion (modified Schober), maximal intermalleolar distance, cervical rotation. BASMI - Linear Method score was average of 5 individual component score mapped between 0 and 10, high score=more impairment of axial status, spinal mobility. For cervical rotation angle, participant sit straight on chair with chin level and hands on knees. Blinded assessor place goniometer at top of head in line with nose and ask participant to rotate neck maximally to left, follows with goniometer and record angle between sagittal plane and new plane after rotation. A second reading obtained and both readings recorded. Procedure repeated for right side. Better of two for each side was selected for scoring. Scoring done by calculating mean of left and right measurement and recorded in degrees (range: 0 to 90), higher cervical rotation value=better health status.
Change From Baseline in Bath Ankylosing Spondylitis Metrology Index (BASMI) Scores: Intermalleolar Distance at Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
BASMI assessed axial status and spinal mobility, using linear function. It composed of 5 clinical measures: lateral spinal flexion, tragus-to-wall distance, lumbar flexion (modified Schober), maximal intermalleolar distance, cervical rotation. BASMI - Linear Method score was average of 5 individual component scores mapped between 0 and 10, with higher scores indicating more impairment of axial status and spinal mobility. For the assessment of intermalleolar distances, participant should lie supine with the knees straight and feet/toes pointing straight up and asked to separate the legs as far as possible and the distance between the medial malleoli was measured (in Centimeters [cm] to the nearest 0.1 cm). Distance (in cm) was greater than or equal to 0, with no maximum defined range: higher intermalleolar distance value indicates better health status.
Change From Baseline in Bath Ankylosing Spondylitis Metrology Index (BASMI) Scores: Lateral Spinal Flexion at Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
BASMI assess axial status, spinal mobility, using linear function. It composed of 5 clinical measures. BASMI - Linear Method score-average of 5 component scores mapped between 0 and 10, with high scores =more impairment of axial status, spinal mobility. For assessment of lateral spinal flexion: participant stand upright with head and back rest against wall as close as possible with shoulders level and feet 30 cm apart and feet parallel. At tip of middle finger, place a mark on thigh. This neutral position recorded. Participant bend sideways without bending knees or lifting heels while attempting to keep shoulders in same position (flexion position). Second mark placed, lateral flexion recorded (left or right as appropriate) using cm tape measure. Two tries for left, two tries for right measured. Result of two tries recorded for left and right separately in cm to nearest 0.1 cm. Distance (in cm) should be >=0, with no maximum defined range: high value indicates better health status.
Change From Baseline in Bath Ankylosing Spondylitis Metrology Index (BASMI) Scores: Lumbar Flexion (Modified Schober) at Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
BASMI assessed axial status and spinal mobility. BASMI - Linear Method score was average of 5 individual component scores mapped between 0 and 10, with higher scores indicating more impairment of axial status and spinal mobility. For the assessment of lumbar flexion, With the participant standing erect and outer edges of feet 30 cm apart, a mark was placed in the midpoint of a line that joins the posterior superior iliac spines (baseline mark). A second mark (A) was placed 10 cm above the baseline mark and a third mark (B) 5 cm below the baseline mark. Then have the participant maximally bend forward, keeping the knees fully extended. With the participant's spine in full flexion, the distance between marks A and B (in cm to the nearest 0.1 cm) was re-measured. Distance (in cm) was greater than or equal to 0, with no maximum defined range. Higher value indicates better health status.
Change From Baseline in Bath Ankylosing Spondylitis Metrology Index (BASMI) Scores: Tragus-to-wall Distance at Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
BASMI assessed axial status and spinal mobility, using linear function. It composed of 5 clinical measures: lateral spinal flexion, tragus-to-wall distance, lumbar flexion (modified Schober), maximal intermalleolar distance, cervical rotation. BASMI - Linear Method score was average of 5 individual component scores mapped between 0 and 10, with higher scores indicating more impairment of axial status and spinal mobility. For the assessment of tragus-to-wall distance, participant was placed standing with his/her back against the wall; knees straight; scapulae, buttocks, and heels against wall; and head in as neutral position as possible. The distance between the tragus and wall in cm was measured (to the nearest 0.1 cm) from both the right side and left side at the maximum effort to touch the head against the wall. Distance should be greater than or equal to 0 cm with no defined maximum value, lower tragus-to-wall value indicates better health status.
Change From Baseline in Bath Ankylosing Spondylitis Metrology Index (BASMI) Linear Method Total Score at Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
The BASMI was used to assess the axial status and spinal mobility (cervical, dorsal and lumbar spine, hips and pelvic soft tissue) and was analyzed using the linear function method. BASMI score composed of five clinical measures: lateral spinal flexion, tragus-to-wall distance, lumbar flexion (modified Schober), maximal intermalleolar distance, and cervical rotation. BASMI - Linear Method score was the average of 5 individual component scores mapped between 0 and 10 and thus the BASMI - Linear Method total score ranged from 0 (very good) to 10 (very poor), wherein higher scores indicated more impairment of axial status and spinal mobility; lower scores indicated better health status.
Change From Baseline in Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) Total Scores at Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
FACIT-F is a 13-item questionnaire (felt fatigued, felt weak all over, felt listless ["washed out"],felt tired, had energy, had trouble starting things as tired, had trouble finishing things as tired, was able to do usual activities, needed to sleep during day, too tired to eat, needed help doing my usual activities, frustrated by being too tired to do things wanted to do, had to limit my social activity because tired), with each item scored on a 5-point scale ranging from 0 (not at all) to 4 (very much). Three type of scores were derived: change in FACIT-F total score, change in FACIT-F experience domain score, and change in FACIT-F impact domain score. FACIT-F total score was calculated by summing the 13 items (range 0 [not at all] to 52 [very much]); higher scores represent less fatigue status. In this outcome measure, change from baseline in FACIT-F total score was reported.
Change From Baseline in Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) Experience Domain Scores at Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
FACIT-F is a 13-item (felt fatigued, felt weak all over, felt listless ["washed out"],felt tired, had energy, had trouble starting things as tired, had trouble finishing things as tired, was able to do usual activities, needed to sleep during day, too tired to eat, needed help doing my usual activities, frustrated by being too tired to do things wanted to do, had to limit my social activity because tired) questionnaire, with each item scored on a 5-point scale ranging from 0 (not at all) to 4 (very much). FACIT-F experience domain score was calculated by summing 5 items: I feel fatigued, I feel weak all over, I feel listless ("washed out"), I feel tired, and I have energy. FACIT-F total experience domain score ranged from 0 (not at all) to 20 (very much), with higher scores represented better (less) fatigue impact on daily functioning. In this outcome measure, change from baseline in FACIT-F experience domain score was reported.
Change From Baseline in Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) Impact Domain Scores at Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
FACIT-F is a 13-item (felt fatigued, felt weak all over, felt listless ["washed out"],felt tired, had energy, had trouble starting things as tired, had trouble finishing things as tired, was able to do usual activities, needed to sleep during day, too tired to eat, needed help doing my usual activities, frustrated by being too tired to do things wanted to do, had to limit my social activity because tired) questionnaire, with each item scored on a 5-point scale ranging from 0 (not at all) to 4 (very much). FACIT-F experience domain score calculated by summing 5 items : I feel fatigued, I feel weak all over, I feel listless, I feel tired, and I have energy, while FACIT-F impact domain score was calculated by summing the remaining 8 items. FACIT-F impact domain score ranged from 0 (not at all) to 32 (very much), with higher scores represented better (less) fatigue impact on daily functioning. In this outcome measure, change from baseline in FACIT-F impact domain score was reported.
Change From Baseline in Patient's Global Assessment of Disease (PGA) at Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
Participants answered the question, "How active was your spondylitis on average during the last week?. Participant's response was recorded using a numerical rating scale ranged from 0 (Not Active) to 10 (Very Active), with higher scores indicated more severe disease.
Change From Baseline in Patient's Assessment of Spinal Pain: Total Back Pain at Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
Participants marked their level of total back pain on a numerical rating scale (NRS) ranged from 0 (no pain) to 10 (most severe pain), with higher scores indicated more severe pain.
Change From Baseline in Patient's Assessment of Spinal Pain: Nocturnal Spinal Pain at Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
Participants marked their level of nocturnal spinal pain on a NRS ranged from 0 (no pain) to 10 (most severe pain), with higher scores indicated more severe pain.
Change From Baseline in in Bath Ankylosing Spondylitis Functional Index (BASFI) at Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
BASFI was a functional index which included 10 items assessing ability of participants to perform normal daily activities. The first 8 questions/items consider activities related to functional anatomy. The final 2 questions/items assess the participants' ability to cope with everyday life. Each item was scored on a scale of 0=easy to 10=impossible. The BASFI total score was calculated as the average score of these 10 individual items. BASFI total score ranged from 0 (easy) to 10 (impossible), where higher scores indicated more severe disease activity.
Change From Baseline in the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) Inflammation (Morning Stiffness) Score at Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
The BASDAI was a validated questionnaire that consisted of 6 questions pertaining to the 5 major symptoms of AS: fatigue; spinal pain; peripheral arthritis; enthesitis, intensity of morning stiffness and duration of morning stiffness. Each question was rated using a numerical rating scale from 0 (none) to 10 (very severe), higher score=high disease activity. The BASDAI score was calculated by computing the mean of questions 5 and 6 and adding it to the sum of questions 1 to 4. This score was then divided by 5. The total BASDAI score was ranged from 0= none to 10= very severe, where higher score indicated high disease activity. BASDAI inflammation score was derived by taking mean of the responses of question 5 and 6 and ranged from 0 (none) to 10 (very severe), where higher score indicated more inflammation (morning stiffness).
Percentage of Participants Achieving ASAS 5/6 Response at Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
ASAS 5/6 consists of 6 domains: 4 used in ASAS20 - PGA (assess disease activity on a scale of 0 [not active] to 10 [very active], higher score=more disease activity), Spinal Pain (total back pain) (on a scale of 0 [no pain] to 10 [most severe pain], higher score=more severity), Function (using BASFI which assess participant's level of ability on a scale of 0 [easy] to 10 [impossible], lower scores= better functional health) and Inflammation (using BASDAI, mean of Q 5 and 6, which assess disease activity on a scale of 0 [none] to 10 [severe], higher score=more disease activity), CRP (was measured in mg per liter) and Spinal mobility was measured in centimeter and calculated as mean of right and left measurements of lateral spinal flexion from BASMI. ASAS 5/6: defined as >=20% improvement in at least 5 domains.
Percentage of Participants Achieving ASAS Partial Remission at Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
Partial remission was defined as a score of 2 or less (on a scale of 0-10, where 0=no disease activity and 10=high disease activity) in each of the 4 domains in ASAS. These 4 domains included: PGA (assess disease activity on a scale of 0 [not active] to 10 [very active], higher score=more disease activity), total back pain (on a scale of 0 [no pain] to 10 [most severe pain], higher score=more severity), Function (using BASFI which assess participant's level of ability on a scale of 0 [easy] to 10 [impossible], lower scores= better functional health) and Inflammation (using BASDAI, mean of Q 5 and 6, which assess disease activity on a scale of 0 [none] to 10 [severe], higher score=more disease activity).
Change From Baseline in the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) Total Score at Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
The BASDAI was a validated questionnaire that consisted of 6 questions pertaining to the 5 major symptoms of ankylosing spondylitis: fatigue; spinal pain; peripheral arthritis; enthesitis, intensity of morning stiffness and duration of morning stiffness. Each question was rated using a numerical rating scale from 0 (none) to 10 (very severe), higher score=high disease activity. The BASDAI score was calculated by computing the mean of questions 5 and 6 and adding it to the sum of questions 1 to 4. This score was then divided by 5. The total BASDAI score was ranged from 0= none to 10= very severe, where higher score indicated high disease activity.
Percentage of Participants Achieving Bath Ankylosing Spondylitis Disease Activity Index 50 (BASDAI50) Response at Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
BASDAI was a validated questionnaire that consisted of 6 questions pertaining to the 5 major symptoms of AS: fatigue; spinal pain; peripheral arthritis; enthesitis, intensity of morning stiffness and duration of morning stiffness. Each question was rated using a numerical rating scale from 0 (none) to 10 (very severe), higher score=high disease activity. BASDAI score was calculated by computing mean of questions 5 and 6 and adding it to sum of questions 1 to 4. This score was then divided by 5. The total BASDAI score was ranged from 0= none to 10= very severe, where higher score indicated high disease activity. BASDAI50 response was defined as decrease of >=50% from Baseline in BASDAI score at specified time points. Percentage of participants with BASDAI 50 response at specified weeks are reported.
Percentage of Participants With Ankylosing Spondylitis Disease Activity Score Using C-Reactive Protein (ASDAS[CRP]) Clinically Important Improvement Response at Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
ASDAS(CRP) was derived using BASDAI (6-item questionnaire measures disease activity on a scale of 0 [none] to 10 [severe], higher score=more disease activity) and PGA (measure disease activity on a scale of 0 [not active] to 10 [very active], high score=more disease activity) and by using the following formula, 0.121 x Back Pain (Q2 of BASDAI) + 0.058 x Duration of Morning Stiffness (Q6 of BASDAI) + 0.110 x PGA + 0.073 x Peripheral Pain/Swelling (Q3 of BASDAI) + 0.579 x Ln(hsCRP mg/L + 1). If hsCRP values were smaller than 2 mg/L, they were set to 2 mg/L in the formula. The range of score was >= 0.636 to no defined upper limit. A negative change from baseline value indicates decrease in disease activity; a positive change from baseline value indicates increase in disease activity. ASDAS(CRP) clinically important improvement was defined as decrease from Baseline of >=1.1 units in ASDAS(CRP) score.
Percentage of Participants Ankylosing Spondylitis Disease Activity Score Using C-Reactive Protein (ASDAS[CRP]) Major Improvement Response at Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
ASDAS(CRP) was derived using BASDAI (6-item questionnaire measures disease activity on a scale of 0 [none] to 10 [severe], higher score=more disease activity) and PGA (measure disease activity on a scale of 0 [not active] to 10 [very active], high score=more disease activity) and by using the following formula, 0.121 x Back Pain (Q2 of BASDAI) + 0.058 x Duration of Morning Stiffness (Q6 of BASDAI) + 0.110 x PGA + 0.073 x Peripheral Pain/Swelling (Q3 of BASDAI) + 0.579 x Ln(hsCRP mg/L + 1). If hsCRP values were smaller than 2 mg/L, they were set to 2 mg/L in the formula. The range of score was >= 0.636 to no defined upper limit. A negative change from baseline value indicates decrease in disease activity; a positive change from baseline value indicates increase in disease activity. ASDAS(CRP) major improvement was defined as a response if improvement (decrease) from Baseline in ASDAS(CRP) of >=2.0 units.
Percentage of Participants Ankylosing Spondylitis Disease Activity Score Using C-Reactive Protein (ASDAS[CRP]) Inactive Disease Response at Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
ASDAS(CRP) was derived using BASDAI (6-item questionnaire measures disease activity on a scale of 0 [none] to 10 [severe], higher score=more disease activity) and PGA (measure disease activity on a scale of 0 [not active] to 10 [very active], high score=more disease activity) and by using the following formula, 0.121 x Back Pain (Q2 of BASDAI) + 0.058 x Duration of Morning Stiffness (Q6 of BASDAI) + 0.110 x PGA + 0.073 x Peripheral Pain/Swelling (Q3 of BASDAI) + 0.579 x Ln(hsCRP mg/L + 1). If hsCRP values were smaller than 2 mg/L, they were set to 2 mg/L in the formula. The range of score was >= 0.636 to no defined upper limit. A negative change from baseline value indicates decrease in disease activity; a positive change from baseline value indicates increase in disease activity. ASDAS(CRP) inactive disease is defined as a response if actual ASDAS(CRP) was <1.3 units.
Change From Baseline in Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) at Weeks 4, 8, 12, 16, 24, 32, 40 and 48
The MASES is an index used to measure the severity of enthesitis. Enthesitis is the inflammation of enthuses (heels). The MASES assesses 13 sites for enthesitis. Sites assessed included 1st costochondral joint (left [l]/right [r]), 7th costochondral joint (l/r), posterior superior iliac spine (l/r), posterior anterior iliac spine (l/r), iliac crest (l/r), proximal insertion of Achilles tendon (l/r) and 5th lumbar spinous process. Each site was graded for the presence (1) and absence (0) of tenderness yielding total MASES score ranging from 0 (no tenderness) to 13 (worst possible score) with higher score indicated more severe tenderness.
Change From Baseline in Swollen Joint Count (SJC) at Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
Swollen joint count was an assessment on 44 joints (sternoclaviculars, acromioclaviculars, shoulders, elbows, wrists, metacarpophalangeals, thumb interphalangeal, proximal interphalangeals, knees, ankles, and metatarsophalangeals). Each joint was assessed for swelling as: Present or Absent. Artificial joints were not assessed
Change From Baseline in Spinal Mobility (Chest Expansion ) at Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
Chest expansion (measured in centimeters (cm), is defined as the difference in the thoracic circumference during full expiration versus full inspiration. This was measured at the 4th intercostal space. The difference between maximal inspiration and expiration of the two attempts was recorded. The better of the two attempts was used to calculate chest expansion which was defined to be greater than or equal to 0 cm with no defined maximum/upper limit. Greater chest circumference corresponds to higher score indicated more spinal mobility/better health status (measured as Chest Expansion in cm).
Change From Baseline in EuroQol 5 Dimensions 3 Levels (EQ-5D-3L) Score at Weeks 16 and 48
EQ-5D-3L, a health profile questionnaire was used to assess quality of life along 5 dimensions. Participants rated 5 aspects of health (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) by choosing from 3 answering options (1=no problems; 2=some problems; 3=extreme problems). The mean of the summed score ranged from 1 to 3 with "1" corresponding to no problems and "3" corresponding to severe problems in the 5 dimensions, where higher score indicates more severe problems.
Change From Baseline in EuroQol Visual Analogue Scale (EQ-VAS) Score (mm) at Weeks 16 and 48
EQ-5D-3L, a health profile questionnaire was used to assess quality of life along 5 dimensions. Its second part included EQ-VAS. EQ-VAS recorded the participant's self-rated health on a VAS ranging from 0 mm (worst imaginable health state) to 100 mm (best imaginable health state), with higher scores indicating better health state.
Change From Baseline in Work Productivity and Activity Impairment (WPAI): Percent Work Time Missed Due to Health Problem at Weeks 16 and 48
The WPAI assesses work productivity and impairment. It is a 6-item questionnaire used to assess the degree to which Ankylosing Spondylitis affected work productivity and regular activities over the past 7 days. The questions are as follows: Q1 = currently employed; Q2 = hours missed due to health problems; Q3 = hours missed due to other reasons; Q4 = hours actually worked; Q5 = degree health affected productivity while working (0-10 scale, with higher numbers indicating less productivity); Q6 = degree health affected regular activities (0-10 scale, with higher numbers indicating greater impairment of regular activities). Percent work time missed due to health problem was a subscale and calculated as: Q2/(Q2+Q4) for those who were currently employed. Subscale score was expressed as an impairment percentage (range: 0-100%) where higher numbers indicate greater impairment and less productivity.
Change From Baseline in Work Productivity and Activity Impairment (WPAI): Percent Impairment While Working Due to Health Problem at Weeks 16 and 48
The WPAI assesses work productivity and impairment. It is a 6-item questionnaire used to assess the degree to which Ankylosing Spondylitis affected work productivity and regular activities over the past 7 days. The questions are as follows: Q1 = currently employed; Q2 = hours missed due to health problems; Q3 = hours missed due to other reasons; Q4 = hours actually worked; Q5 = degree health affected productivity while working (0-10 scale, with higher numbers indicating less productivity); Q6 = degree health affected regular activities (0-10 scale, with higher numbers indicating greater impairment of regular activities). Percent Impairment while Working due to Health Problem was a subscale and calculated as: Q5/10 for those who were currently employed and actually worked in the past 7 days. Subscale score was expressed as an impairment percentage (range: 0-100%) where higher numbers indicate greater impairment and less productivity.
Change From Baseline in Work Productivity and Activity Impairment (WPAI): Percent Overall Work Impairment Due to Health Problem at Weeks 16 and 48
The WPAI assesses work productivity and impairment. It is a 6-item questionnaire used to assess the degree to which Ankylosing Spondylitis affected work productivity and regular activities over the past 7 days. The questions are as follows: Q1 = currently employed; Q2 = hours missed due to health problems; Q3 = hours missed due to other reasons; Q4 = hours actually worked; Q5 = degree health affected productivity while working (0-10 scale, with higher numbers indicating less productivity); Q6 = degree health affected regular activities (0-10 scale, with higher numbers indicating greater impairment of regular activities). Percent overall work impairment due to health problem was a subscale and calculated as: Q2/(Q2+Q4)+[(1- Q2/(Q2+Q4))×(Q5/10)] for those who were currently employed. Subscale score was expressed as an impairment percentage (range: 0-100%) where higher numbers indicate greater impairment.
Change From Baseline in Work Productivity and Activity Impairment (WPAI): Percent Activity Impairment Due to Health Problem at Weeks 16 and 48
The WPAI assesses work productivity and impairment. It is a 6-item questionnaire used to assess the degree to which Ankylosing Spondylitis affected work productivity and regular activities over the past 7 days. The questions are as follows: Q1 = currently employed; Q2 = hours missed due to health problems; Q3 = hours missed due to other reasons; Q4 = hours actually worked; Q5 = degree health affected productivity while working (0-10 scale, with higher numbers indicating less productivity); Q6 = degree health affected regular activities (0-10 scale, with higher numbers indicating greater impairment of regular activities). Percent activity impairment due to health problem was a subscale and calculated as: Q6/10 for all respondents. Subscale score was expressed as an impairment percentage (range: 0-100%) where higher numbers indicate greater impairment.

Full Information

First Posted
April 11, 2018
Last Updated
August 19, 2021
Sponsor
Pfizer
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1. Study Identification

Unique Protocol Identification Number
NCT03502616
Brief Title
Efficacy and Safety of Tofacitinib in Subjects With Active Ankylosing Spondylitis (AS)
Official Title
A PHASE 3, RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED, STUDY OF THE EFFICACY AND SAFETY OF TOFACITINIB IN SUBJECTS WITH ACTIVE ANKYLOSING SPONDYLITIS (AS)
Study Type
Interventional

2. Study Status

Record Verification Date
August 2021
Overall Recruitment Status
Completed
Study Start Date
June 7, 2018 (Actual)
Primary Completion Date
December 19, 2019 (Actual)
Study Completion Date
August 20, 2020 (Actual)

3. Sponsor/Collaborators

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

4. Oversight

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

5. Study Description

Brief Summary
The purpose of this study is to determine if tofacitinib is safe and effective in subjects with active ankylosing spondylitis.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Ankylosing Spondylitis

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
270 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Tofacitinib
Arm Type
Experimental
Arm Title
Placebo
Arm Type
Placebo Comparator
Intervention Type
Drug
Intervention Name(s)
Tofacitinib
Intervention Description
Oral administration twice per day
Primary Outcome Measure Information:
Title
Percentage of Participants Achieving Assessment of SpondyloArthritis International Society (ASAS)20 Response at Week 16
Description
ASAS20 assess 4 domains: Patient Global Assessment of Disease (PGA) (assess disease activity on a scale of 0 [not active] to 10 [very active], high score=more disease activity), total back pain (scale of 0 [no pain] to 10 [most severe pain], high score=more severity), Function (Bath Ankylosing Spondylitis Functional Index [BASFI]; participant's level of ability on scale of 0 [easy] to 10 [impossible], low score= better functional health) and Inflammation (morning stiffness, Mean of Question [Q]5 and Q6 of Bath Ankylosing Spondylitis Disease Activity Index [BASDAI] defined as 6-item questionnaire measure disease activity on a scale of 0 [none] to 10 [severe], high score=more disease activity). ASAS20 response: greater than or equal to (>=) 20 percent (%) improvement from baseline in disease activity and absolute change of >=1 unit in >=3 domains and no worsening of >=20% and an absolute change of >=1 unit in remaining domain.
Time Frame
Week 16
Secondary Outcome Measure Information:
Title
Percentage of Participants Achieving Ankylosing Spondylitis (ASAS)40 Response at Week 16
Description
ASAS40 assessed 4 domains: the "PGA" (assess disease activity on a scale of 0 [not active] to 10 [very active], higher score=more disease activity), total back pain (on a scale of 0 [no pain] to 10 [most severe pain], higher score=more severity), Function (from BASFI: assess participant's level of ability on a scale of 0 [easy] to 10 [impossible], lower scores= better functional health) and Inflammation (morning stiffness, Mean of Q5 and Q6 of BASDAI defined as 6 item questionnaire: measures disease activity on a scale of 0 [none] to 10 [severe], higher score=more disease activity). ASAS40 response: >=40% and >=2 units improvement in >=3 domains and no worsening at all in the remaining domain.
Time Frame
Week 16
Title
Number of Participants With Treatment Emergent Adverse Events (AEs)
Description
An AE: any untoward medical occurrence in a participant who received study drug without regard to possibility of causal relationship. As per National Cancer Institute - Common Terminology Criteria for Adverse Events (NCI-CTCAE) version 4.03, severity was graded as Grade 1: asymptomatic/mild symptoms, clinical or diagnostic observations only, intervention not indicated; Grade 2: moderate, minimal, local or noninvasive intervention indicated, limiting age-appropriate instrumental activities of daily living (ADL); Grade 3: severe or medically significant but not immediately life-threatening, hospitalization or prolongation of existing hospitalization indicated, disabling, limiting self-care ADL; Grade 4: life-threatening consequence, urgent intervention indicated; Grade 5: death related to AE. Treatment-emergent were events between first dose of study drug and up to 48 weeks that were absent before treatment or that worsened relative to pretreatment state.
Time Frame
Baseline up to Week 16 and Baseline up to Week 48
Title
Number of Participants With Treatment Emergent Adverse Events (AEs) by Severity
Description
AE: any untoward medical occurrence in subject who receive study drug without regard to possibility of causal relationship. Treatment-emergent AEs were events that occurred between first dose of study drug and up to 48 weeks that were absent before treatment or that worsened relative to pretreatment state. The severity grades (mild, moderate and severe) were defined as - mild: did not interfere with participant's usual function, moderate: Interfered to some extent with participant's usual function and severe: Interfered significantly with participant's usual function.
Time Frame
Baseline up to Week 16 and Baseline up to Week 48
Title
Number of Participants With Laboratory Abnormalities (Without Regard to Baseline Abnormality)
Description
Hematology (Hemoglobin, Hematocrit, Erythrocyte, Lymphocyte/Leukocyte, Neutrophil/Leukocyte <0.8*Lower limit of normal (LLN), Reticulocyte >1.5*Upper limit of normal (ULN), Erythrocyte Mean Corpuscular Volume, Erythrocyte Mean Corpuscular Hemoglobin, Erythrocyte Mean Corpuscular HGB Concentration <0.9*LLN, >1.1*ULN, Reticulocyte/Erythrocyte, Leukocyte >1.5*ULN, Lymphocyte, Neutrophil <0.8*LLN and >1.2*ULN, Basophil, Basophil/Leukocyte, Eosinophil, Eosinophil/Leukocyte, Monocyte, Monocyte/Leukocyte >1.2*ULN); Clinical Chemistry (Bilirubin, Glucose >1.5*ULN, AST, ALT, Gamma Glutamyl Transferase >3.0*ULN, Urea, Creatinine, Triglyceride, Cholesterol >1.3*ULN, LDL Cholesterol>1.2*ULN, Potassium, C Reactive Protein >1.1*ULN, Bicarbonate <0.9*LLN, Creatine Kinase >2.0*ULN, HDL Cholesterol <0.8*LLN), Urinalysis (Specific Gravity >1.035, pH >8, Glucose, Ketones, Protein, Hemoglobin >=1, Erythrocyte, Leukocyte >=20, Granular Cast, Hyaline Cast>1.
Time Frame
Baseline up to Week 16 and Baseline up to Week 48
Title
Number of Participants With Vital Signs Abnormalities
Description
Criteria for abnormalities in vital signs: Pulse rate <40 beats per minute (bpm) to >120 bpm, Sitting Diastolic blood pressure < 50 millimeter of mercury (mmHg), increase and decrease in change from baseline of >= 20mmHg, sitting systolic blood pressure < 90 mmHg, increase and decrease in change from baseline of >= 30mmHg.
Time Frame
Baseline up to Week 16 and Baseline up to Week 48
Title
Number of Participants With Abnormalities in Physical Examination
Description
Complete physical examination: included general appearance, skin (presence of rash), heent (head, eyes, ears, nose and throat), lungs (auscultation), heart (auscultation for presence of murmurs, gallops, rubs), lower extremities (presence of peripheral edema), abdominal (palpation and auscultation), neurologic (mental status, station, gait, reflexes, motor and sensory function, coordination) and lymph nodes. Abnormalities in physical examination was based on investigator's discretion/clinical judgement.
Time Frame
Screening, Week 16, and Week 48
Title
Number of Participants With Electrocardiogram (ECG) Abnormalities
Description
Twelve-lead electrocardiograms (ECGs) were obtained for all participants. Criteria for ECG abnormality: PR interval >=300 and a percent change from baseline of >=25 or 50%; QRS duration >=140 and a percent change from baseline of >=50%; QT interval >=500; QTCB, QTCF interval <480 or >=450, <500 or >=480, >=500, change from baseline of <60 and >=30, and change from baseline of >=60.
Time Frame
Baseline up to Week 16, Baseline up to Week 48
Title
Percentage of Participants Achieving ASAS20 Response at Weeks 2, 4, 8, 12, 24, 32, 40 and 48
Description
ASAS20 assess 4 domains: PGA of Disease (assess disease activity on a scale of 0 [not active] to 10 [very active], high score=more disease activity), total back pain (scale of 0 [no pain] to 10 [most severe pain], high score=more severity), Function (BASFI; participant's level of ability on scale of 0 [easy] to 10 [impossible], low score= better functional health) and Inflammation (morning stiffness, Mean of Q5 and Q6 of BASDAI defined as 6-item questionnaire measure disease activity on a scale of 0 [none] to 10 [severe], high score=more disease activity). ASAS20 response: >= 20% improvement from baseline in disease activity and absolute change of >=1 unit in >=3 domains and no worsening of >=20% and an absolute change of >=1 unit in remaining domain.
Time Frame
Weeks 2, 4, 8, 12, 24, 32, 40 and 48
Title
Percentage of Participants Achieving ASAS40 Response at Weeks 2, 4, 8, 12, 24, 32, 40 and 48
Description
ASAS40 assessed 4 domains: the "PGA" (assess disease activity on a scale of 0 [not active] to 10 [very active], higher score=more disease activity), total back pain (on a scale of 0 [no pain] to 10 [most severe pain], higher score=more severity), Function (from BASFI: assess participant's level of ability on a scale of 0 [easy] to 10 [impossible], lower scores= better functional health) and Inflammation (morning stiffness, Mean of Q5 and Q6 of BASDAI defined as 6 item questionnaire: measures disease activity on a scale of 0 [none] to 10 [severe], higher score=more disease activity). ASAS40 response: >=40% and >=2 units improvement in >=3 domains and no worsening at all in the remaining domain.
Time Frame
Weeks 2, 4, 8, 12, 24, 32, 40 and 48
Title
Change From Baseline in Ankylosing Spondylitis Disease Activity Score Using C-Reactive Protein (ASDAS[CRP]) at Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
Description
ASDAS(CRP) was derived using BASDAI (6-item questionnaire measures disease activity on a scale of 0 [none] to 10 [severe], higher score=more disease activity) and PGA (measure disease activity on a scale of 0 [not active] to 10 [very active], high score=more disease activity) and calculated by using the following formula, 0.121 x Back Pain (Q2 of BASDAI) + 0.058 x Duration of Morning Stiffness (Q6 of BASDAI) + 0.110 x PGA + 0.073 x Peripheral Pain/Swelling (Q3 of BASDAI) + 0.579 x Ln(high sensitivity [hs] CRP mg/Liter [L] + 1). If hsCRP values were smaller than 2 mg/L, they were set to 2 mg/L in the formula. The range of score was >= 0.636 to no defined upper limit. A negative change from baseline value indicates decrease in disease activity; a positive change from baseline value indicates increase in disease activity.
Time Frame
Baseline, Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
Title
Change From Baseline in High Sensitivity C-Reactive Protein (hsCRP) at Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
Description
Blood samples were collected for analysis of hsCRP using an assay analyzed by central laboratory. hsCRP is an acute phase reactant, which was indicative of inflammation and of its severity.
Time Frame
Baseline, Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
Title
Change From Baseline in Ankylosing Spondylitis Quality of Life (ASQoL) Score at Weeks 16 and 48
Description
The ASQoL was an 18-item questionnaire assessed the amount of restriction participant experienced in daily activities, level of pain and fatigue, and the impact on the participant's emotional state. Each item was scored as 0 (no impact) or 1 (yes - impact). A total score was calculated by summing the items. The total score ranged from 0 (no impact) to 18 (yes-impact), with higher values indicated more impaired health-related quality of life.
Time Frame
Baseline, Weeks 16 and 48
Title
Change From Baseline in Short-Form-36 Health Survey-Version 2 Acute (SF-36v2) Score at Weeks 16 and 48
Description
SF-36 v.2 (Acute): 36-item generic health status measure. It measured 8 general health domains: physical functioning, role limitations due to physical health, bodily pain, general health perceptions, vitality, social functioning, role limitations due to emotional problems, mental health. These domains were aggregated into 2 summary scores - physical component summary (PCS), mental component summary (MCS). Four domains comprised PCS score (physical functioning, role-physical, bodily pain, general health) and remaining 4 domains comprised MCS score (vitality, social functioning, role-emotional, mental health). Normalized domain scores, PCS, MCS scores are used in analyses. Component and domain scores were scored by using United States 1998 general population norm. Resulting norm-based T-scores for both the SF36 version 2 and SF36 health domain scale and component summary measures had means of 50 and standard deviations of 10. Higher PCS/MCS/domain score represent better health status.
Time Frame
Baseline, Weeks 16 and 48
Title
Change From Baseline in Bath Ankylosing Spondylitis Metrology Index (BASMI) Scores: Cervical Rotation Angle at Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
Description
BASMI assess axial status and spinal mobility. It composed of 5 clinical measures: lateral spinal flexion, tragus-to-wall distance, lumbar flexion (modified Schober), maximal intermalleolar distance, cervical rotation. BASMI - Linear Method score was average of 5 individual component score mapped between 0 and 10, high score=more impairment of axial status, spinal mobility. For cervical rotation angle, participant sit straight on chair with chin level and hands on knees. Blinded assessor place goniometer at top of head in line with nose and ask participant to rotate neck maximally to left, follows with goniometer and record angle between sagittal plane and new plane after rotation. A second reading obtained and both readings recorded. Procedure repeated for right side. Better of two for each side was selected for scoring. Scoring done by calculating mean of left and right measurement and recorded in degrees (range: 0 to 90), higher cervical rotation value=better health status.
Time Frame
Baseline, Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
Title
Change From Baseline in Bath Ankylosing Spondylitis Metrology Index (BASMI) Scores: Intermalleolar Distance at Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
Description
BASMI assessed axial status and spinal mobility, using linear function. It composed of 5 clinical measures: lateral spinal flexion, tragus-to-wall distance, lumbar flexion (modified Schober), maximal intermalleolar distance, cervical rotation. BASMI - Linear Method score was average of 5 individual component scores mapped between 0 and 10, with higher scores indicating more impairment of axial status and spinal mobility. For the assessment of intermalleolar distances, participant should lie supine with the knees straight and feet/toes pointing straight up and asked to separate the legs as far as possible and the distance between the medial malleoli was measured (in Centimeters [cm] to the nearest 0.1 cm). Distance (in cm) was greater than or equal to 0, with no maximum defined range: higher intermalleolar distance value indicates better health status.
Time Frame
Baseline, Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
Title
Change From Baseline in Bath Ankylosing Spondylitis Metrology Index (BASMI) Scores: Lateral Spinal Flexion at Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
Description
BASMI assess axial status, spinal mobility, using linear function. It composed of 5 clinical measures. BASMI - Linear Method score-average of 5 component scores mapped between 0 and 10, with high scores =more impairment of axial status, spinal mobility. For assessment of lateral spinal flexion: participant stand upright with head and back rest against wall as close as possible with shoulders level and feet 30 cm apart and feet parallel. At tip of middle finger, place a mark on thigh. This neutral position recorded. Participant bend sideways without bending knees or lifting heels while attempting to keep shoulders in same position (flexion position). Second mark placed, lateral flexion recorded (left or right as appropriate) using cm tape measure. Two tries for left, two tries for right measured. Result of two tries recorded for left and right separately in cm to nearest 0.1 cm. Distance (in cm) should be >=0, with no maximum defined range: high value indicates better health status.
Time Frame
Baseline, Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
Title
Change From Baseline in Bath Ankylosing Spondylitis Metrology Index (BASMI) Scores: Lumbar Flexion (Modified Schober) at Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
Description
BASMI assessed axial status and spinal mobility. BASMI - Linear Method score was average of 5 individual component scores mapped between 0 and 10, with higher scores indicating more impairment of axial status and spinal mobility. For the assessment of lumbar flexion, With the participant standing erect and outer edges of feet 30 cm apart, a mark was placed in the midpoint of a line that joins the posterior superior iliac spines (baseline mark). A second mark (A) was placed 10 cm above the baseline mark and a third mark (B) 5 cm below the baseline mark. Then have the participant maximally bend forward, keeping the knees fully extended. With the participant's spine in full flexion, the distance between marks A and B (in cm to the nearest 0.1 cm) was re-measured. Distance (in cm) was greater than or equal to 0, with no maximum defined range. Higher value indicates better health status.
Time Frame
Baseline, Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
Title
Change From Baseline in Bath Ankylosing Spondylitis Metrology Index (BASMI) Scores: Tragus-to-wall Distance at Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
Description
BASMI assessed axial status and spinal mobility, using linear function. It composed of 5 clinical measures: lateral spinal flexion, tragus-to-wall distance, lumbar flexion (modified Schober), maximal intermalleolar distance, cervical rotation. BASMI - Linear Method score was average of 5 individual component scores mapped between 0 and 10, with higher scores indicating more impairment of axial status and spinal mobility. For the assessment of tragus-to-wall distance, participant was placed standing with his/her back against the wall; knees straight; scapulae, buttocks, and heels against wall; and head in as neutral position as possible. The distance between the tragus and wall in cm was measured (to the nearest 0.1 cm) from both the right side and left side at the maximum effort to touch the head against the wall. Distance should be greater than or equal to 0 cm with no defined maximum value, lower tragus-to-wall value indicates better health status.
Time Frame
Baseline, Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
Title
Change From Baseline in Bath Ankylosing Spondylitis Metrology Index (BASMI) Linear Method Total Score at Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
Description
The BASMI was used to assess the axial status and spinal mobility (cervical, dorsal and lumbar spine, hips and pelvic soft tissue) and was analyzed using the linear function method. BASMI score composed of five clinical measures: lateral spinal flexion, tragus-to-wall distance, lumbar flexion (modified Schober), maximal intermalleolar distance, and cervical rotation. BASMI - Linear Method score was the average of 5 individual component scores mapped between 0 and 10 and thus the BASMI - Linear Method total score ranged from 0 (very good) to 10 (very poor), wherein higher scores indicated more impairment of axial status and spinal mobility; lower scores indicated better health status.
Time Frame
Baseline, Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
Title
Change From Baseline in Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) Total Scores at Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
Description
FACIT-F is a 13-item questionnaire (felt fatigued, felt weak all over, felt listless ["washed out"],felt tired, had energy, had trouble starting things as tired, had trouble finishing things as tired, was able to do usual activities, needed to sleep during day, too tired to eat, needed help doing my usual activities, frustrated by being too tired to do things wanted to do, had to limit my social activity because tired), with each item scored on a 5-point scale ranging from 0 (not at all) to 4 (very much). Three type of scores were derived: change in FACIT-F total score, change in FACIT-F experience domain score, and change in FACIT-F impact domain score. FACIT-F total score was calculated by summing the 13 items (range 0 [not at all] to 52 [very much]); higher scores represent less fatigue status. In this outcome measure, change from baseline in FACIT-F total score was reported.
Time Frame
Baseline, Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
Title
Change From Baseline in Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) Experience Domain Scores at Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
Description
FACIT-F is a 13-item (felt fatigued, felt weak all over, felt listless ["washed out"],felt tired, had energy, had trouble starting things as tired, had trouble finishing things as tired, was able to do usual activities, needed to sleep during day, too tired to eat, needed help doing my usual activities, frustrated by being too tired to do things wanted to do, had to limit my social activity because tired) questionnaire, with each item scored on a 5-point scale ranging from 0 (not at all) to 4 (very much). FACIT-F experience domain score was calculated by summing 5 items: I feel fatigued, I feel weak all over, I feel listless ("washed out"), I feel tired, and I have energy. FACIT-F total experience domain score ranged from 0 (not at all) to 20 (very much), with higher scores represented better (less) fatigue impact on daily functioning. In this outcome measure, change from baseline in FACIT-F experience domain score was reported.
Time Frame
Baseline, Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
Title
Change From Baseline in Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) Impact Domain Scores at Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
Description
FACIT-F is a 13-item (felt fatigued, felt weak all over, felt listless ["washed out"],felt tired, had energy, had trouble starting things as tired, had trouble finishing things as tired, was able to do usual activities, needed to sleep during day, too tired to eat, needed help doing my usual activities, frustrated by being too tired to do things wanted to do, had to limit my social activity because tired) questionnaire, with each item scored on a 5-point scale ranging from 0 (not at all) to 4 (very much). FACIT-F experience domain score calculated by summing 5 items : I feel fatigued, I feel weak all over, I feel listless, I feel tired, and I have energy, while FACIT-F impact domain score was calculated by summing the remaining 8 items. FACIT-F impact domain score ranged from 0 (not at all) to 32 (very much), with higher scores represented better (less) fatigue impact on daily functioning. In this outcome measure, change from baseline in FACIT-F impact domain score was reported.
Time Frame
Baseline, Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
Title
Change From Baseline in Patient's Global Assessment of Disease (PGA) at Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
Description
Participants answered the question, "How active was your spondylitis on average during the last week?. Participant's response was recorded using a numerical rating scale ranged from 0 (Not Active) to 10 (Very Active), with higher scores indicated more severe disease.
Time Frame
Baseline, Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
Title
Change From Baseline in Patient's Assessment of Spinal Pain: Total Back Pain at Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
Description
Participants marked their level of total back pain on a numerical rating scale (NRS) ranged from 0 (no pain) to 10 (most severe pain), with higher scores indicated more severe pain.
Time Frame
Baseline, Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
Title
Change From Baseline in Patient's Assessment of Spinal Pain: Nocturnal Spinal Pain at Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
Description
Participants marked their level of nocturnal spinal pain on a NRS ranged from 0 (no pain) to 10 (most severe pain), with higher scores indicated more severe pain.
Time Frame
Baseline, Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
Title
Change From Baseline in in Bath Ankylosing Spondylitis Functional Index (BASFI) at Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
Description
BASFI was a functional index which included 10 items assessing ability of participants to perform normal daily activities. The first 8 questions/items consider activities related to functional anatomy. The final 2 questions/items assess the participants' ability to cope with everyday life. Each item was scored on a scale of 0=easy to 10=impossible. The BASFI total score was calculated as the average score of these 10 individual items. BASFI total score ranged from 0 (easy) to 10 (impossible), where higher scores indicated more severe disease activity.
Time Frame
Baseline, Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
Title
Change From Baseline in the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) Inflammation (Morning Stiffness) Score at Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
Description
The BASDAI was a validated questionnaire that consisted of 6 questions pertaining to the 5 major symptoms of AS: fatigue; spinal pain; peripheral arthritis; enthesitis, intensity of morning stiffness and duration of morning stiffness. Each question was rated using a numerical rating scale from 0 (none) to 10 (very severe), higher score=high disease activity. The BASDAI score was calculated by computing the mean of questions 5 and 6 and adding it to the sum of questions 1 to 4. This score was then divided by 5. The total BASDAI score was ranged from 0= none to 10= very severe, where higher score indicated high disease activity. BASDAI inflammation score was derived by taking mean of the responses of question 5 and 6 and ranged from 0 (none) to 10 (very severe), where higher score indicated more inflammation (morning stiffness).
Time Frame
Baseline, Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
Title
Percentage of Participants Achieving ASAS 5/6 Response at Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
Description
ASAS 5/6 consists of 6 domains: 4 used in ASAS20 - PGA (assess disease activity on a scale of 0 [not active] to 10 [very active], higher score=more disease activity), Spinal Pain (total back pain) (on a scale of 0 [no pain] to 10 [most severe pain], higher score=more severity), Function (using BASFI which assess participant's level of ability on a scale of 0 [easy] to 10 [impossible], lower scores= better functional health) and Inflammation (using BASDAI, mean of Q 5 and 6, which assess disease activity on a scale of 0 [none] to 10 [severe], higher score=more disease activity), CRP (was measured in mg per liter) and Spinal mobility was measured in centimeter and calculated as mean of right and left measurements of lateral spinal flexion from BASMI. ASAS 5/6: defined as >=20% improvement in at least 5 domains.
Time Frame
Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
Title
Percentage of Participants Achieving ASAS Partial Remission at Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
Description
Partial remission was defined as a score of 2 or less (on a scale of 0-10, where 0=no disease activity and 10=high disease activity) in each of the 4 domains in ASAS. These 4 domains included: PGA (assess disease activity on a scale of 0 [not active] to 10 [very active], higher score=more disease activity), total back pain (on a scale of 0 [no pain] to 10 [most severe pain], higher score=more severity), Function (using BASFI which assess participant's level of ability on a scale of 0 [easy] to 10 [impossible], lower scores= better functional health) and Inflammation (using BASDAI, mean of Q 5 and 6, which assess disease activity on a scale of 0 [none] to 10 [severe], higher score=more disease activity).
Time Frame
Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
Title
Change From Baseline in the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) Total Score at Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
Description
The BASDAI was a validated questionnaire that consisted of 6 questions pertaining to the 5 major symptoms of ankylosing spondylitis: fatigue; spinal pain; peripheral arthritis; enthesitis, intensity of morning stiffness and duration of morning stiffness. Each question was rated using a numerical rating scale from 0 (none) to 10 (very severe), higher score=high disease activity. The BASDAI score was calculated by computing the mean of questions 5 and 6 and adding it to the sum of questions 1 to 4. This score was then divided by 5. The total BASDAI score was ranged from 0= none to 10= very severe, where higher score indicated high disease activity.
Time Frame
Baseline, Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
Title
Percentage of Participants Achieving Bath Ankylosing Spondylitis Disease Activity Index 50 (BASDAI50) Response at Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
Description
BASDAI was a validated questionnaire that consisted of 6 questions pertaining to the 5 major symptoms of AS: fatigue; spinal pain; peripheral arthritis; enthesitis, intensity of morning stiffness and duration of morning stiffness. Each question was rated using a numerical rating scale from 0 (none) to 10 (very severe), higher score=high disease activity. BASDAI score was calculated by computing mean of questions 5 and 6 and adding it to sum of questions 1 to 4. This score was then divided by 5. The total BASDAI score was ranged from 0= none to 10= very severe, where higher score indicated high disease activity. BASDAI50 response was defined as decrease of >=50% from Baseline in BASDAI score at specified time points. Percentage of participants with BASDAI 50 response at specified weeks are reported.
Time Frame
Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
Title
Percentage of Participants With Ankylosing Spondylitis Disease Activity Score Using C-Reactive Protein (ASDAS[CRP]) Clinically Important Improvement Response at Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
Description
ASDAS(CRP) was derived using BASDAI (6-item questionnaire measures disease activity on a scale of 0 [none] to 10 [severe], higher score=more disease activity) and PGA (measure disease activity on a scale of 0 [not active] to 10 [very active], high score=more disease activity) and by using the following formula, 0.121 x Back Pain (Q2 of BASDAI) + 0.058 x Duration of Morning Stiffness (Q6 of BASDAI) + 0.110 x PGA + 0.073 x Peripheral Pain/Swelling (Q3 of BASDAI) + 0.579 x Ln(hsCRP mg/L + 1). If hsCRP values were smaller than 2 mg/L, they were set to 2 mg/L in the formula. The range of score was >= 0.636 to no defined upper limit. A negative change from baseline value indicates decrease in disease activity; a positive change from baseline value indicates increase in disease activity. ASDAS(CRP) clinically important improvement was defined as decrease from Baseline of >=1.1 units in ASDAS(CRP) score.
Time Frame
Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
Title
Percentage of Participants Ankylosing Spondylitis Disease Activity Score Using C-Reactive Protein (ASDAS[CRP]) Major Improvement Response at Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
Description
ASDAS(CRP) was derived using BASDAI (6-item questionnaire measures disease activity on a scale of 0 [none] to 10 [severe], higher score=more disease activity) and PGA (measure disease activity on a scale of 0 [not active] to 10 [very active], high score=more disease activity) and by using the following formula, 0.121 x Back Pain (Q2 of BASDAI) + 0.058 x Duration of Morning Stiffness (Q6 of BASDAI) + 0.110 x PGA + 0.073 x Peripheral Pain/Swelling (Q3 of BASDAI) + 0.579 x Ln(hsCRP mg/L + 1). If hsCRP values were smaller than 2 mg/L, they were set to 2 mg/L in the formula. The range of score was >= 0.636 to no defined upper limit. A negative change from baseline value indicates decrease in disease activity; a positive change from baseline value indicates increase in disease activity. ASDAS(CRP) major improvement was defined as a response if improvement (decrease) from Baseline in ASDAS(CRP) of >=2.0 units.
Time Frame
Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
Title
Percentage of Participants Ankylosing Spondylitis Disease Activity Score Using C-Reactive Protein (ASDAS[CRP]) Inactive Disease Response at Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
Description
ASDAS(CRP) was derived using BASDAI (6-item questionnaire measures disease activity on a scale of 0 [none] to 10 [severe], higher score=more disease activity) and PGA (measure disease activity on a scale of 0 [not active] to 10 [very active], high score=more disease activity) and by using the following formula, 0.121 x Back Pain (Q2 of BASDAI) + 0.058 x Duration of Morning Stiffness (Q6 of BASDAI) + 0.110 x PGA + 0.073 x Peripheral Pain/Swelling (Q3 of BASDAI) + 0.579 x Ln(hsCRP mg/L + 1). If hsCRP values were smaller than 2 mg/L, they were set to 2 mg/L in the formula. The range of score was >= 0.636 to no defined upper limit. A negative change from baseline value indicates decrease in disease activity; a positive change from baseline value indicates increase in disease activity. ASDAS(CRP) inactive disease is defined as a response if actual ASDAS(CRP) was <1.3 units.
Time Frame
Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
Title
Change From Baseline in Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) at Weeks 4, 8, 12, 16, 24, 32, 40 and 48
Description
The MASES is an index used to measure the severity of enthesitis. Enthesitis is the inflammation of enthuses (heels). The MASES assesses 13 sites for enthesitis. Sites assessed included 1st costochondral joint (left [l]/right [r]), 7th costochondral joint (l/r), posterior superior iliac spine (l/r), posterior anterior iliac spine (l/r), iliac crest (l/r), proximal insertion of Achilles tendon (l/r) and 5th lumbar spinous process. Each site was graded for the presence (1) and absence (0) of tenderness yielding total MASES score ranging from 0 (no tenderness) to 13 (worst possible score) with higher score indicated more severe tenderness.
Time Frame
Baseline, Weeks 4, 8, 12, 16, 24, 32, 40 and 48
Title
Change From Baseline in Swollen Joint Count (SJC) at Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
Description
Swollen joint count was an assessment on 44 joints (sternoclaviculars, acromioclaviculars, shoulders, elbows, wrists, metacarpophalangeals, thumb interphalangeal, proximal interphalangeals, knees, ankles, and metatarsophalangeals). Each joint was assessed for swelling as: Present or Absent. Artificial joints were not assessed
Time Frame
Baseline, Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
Title
Change From Baseline in Spinal Mobility (Chest Expansion ) at Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
Description
Chest expansion (measured in centimeters (cm), is defined as the difference in the thoracic circumference during full expiration versus full inspiration. This was measured at the 4th intercostal space. The difference between maximal inspiration and expiration of the two attempts was recorded. The better of the two attempts was used to calculate chest expansion which was defined to be greater than or equal to 0 cm with no defined maximum/upper limit. Greater chest circumference corresponds to higher score indicated more spinal mobility/better health status (measured as Chest Expansion in cm).
Time Frame
Baseline, Weeks 2, 4, 8, 12, 16, 24, 32, 40 and 48
Title
Change From Baseline in EuroQol 5 Dimensions 3 Levels (EQ-5D-3L) Score at Weeks 16 and 48
Description
EQ-5D-3L, a health profile questionnaire was used to assess quality of life along 5 dimensions. Participants rated 5 aspects of health (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) by choosing from 3 answering options (1=no problems; 2=some problems; 3=extreme problems). The mean of the summed score ranged from 1 to 3 with "1" corresponding to no problems and "3" corresponding to severe problems in the 5 dimensions, where higher score indicates more severe problems.
Time Frame
Baseline, Weeks 16 and 48
Title
Change From Baseline in EuroQol Visual Analogue Scale (EQ-VAS) Score (mm) at Weeks 16 and 48
Description
EQ-5D-3L, a health profile questionnaire was used to assess quality of life along 5 dimensions. Its second part included EQ-VAS. EQ-VAS recorded the participant's self-rated health on a VAS ranging from 0 mm (worst imaginable health state) to 100 mm (best imaginable health state), with higher scores indicating better health state.
Time Frame
Baseline, Weeks 16 and 48
Title
Change From Baseline in Work Productivity and Activity Impairment (WPAI): Percent Work Time Missed Due to Health Problem at Weeks 16 and 48
Description
The WPAI assesses work productivity and impairment. It is a 6-item questionnaire used to assess the degree to which Ankylosing Spondylitis affected work productivity and regular activities over the past 7 days. The questions are as follows: Q1 = currently employed; Q2 = hours missed due to health problems; Q3 = hours missed due to other reasons; Q4 = hours actually worked; Q5 = degree health affected productivity while working (0-10 scale, with higher numbers indicating less productivity); Q6 = degree health affected regular activities (0-10 scale, with higher numbers indicating greater impairment of regular activities). Percent work time missed due to health problem was a subscale and calculated as: Q2/(Q2+Q4) for those who were currently employed. Subscale score was expressed as an impairment percentage (range: 0-100%) where higher numbers indicate greater impairment and less productivity.
Time Frame
Baseline, Weeks 16 and 48
Title
Change From Baseline in Work Productivity and Activity Impairment (WPAI): Percent Impairment While Working Due to Health Problem at Weeks 16 and 48
Description
The WPAI assesses work productivity and impairment. It is a 6-item questionnaire used to assess the degree to which Ankylosing Spondylitis affected work productivity and regular activities over the past 7 days. The questions are as follows: Q1 = currently employed; Q2 = hours missed due to health problems; Q3 = hours missed due to other reasons; Q4 = hours actually worked; Q5 = degree health affected productivity while working (0-10 scale, with higher numbers indicating less productivity); Q6 = degree health affected regular activities (0-10 scale, with higher numbers indicating greater impairment of regular activities). Percent Impairment while Working due to Health Problem was a subscale and calculated as: Q5/10 for those who were currently employed and actually worked in the past 7 days. Subscale score was expressed as an impairment percentage (range: 0-100%) where higher numbers indicate greater impairment and less productivity.
Time Frame
Baseline, Weeks 16 and 48
Title
Change From Baseline in Work Productivity and Activity Impairment (WPAI): Percent Overall Work Impairment Due to Health Problem at Weeks 16 and 48
Description
The WPAI assesses work productivity and impairment. It is a 6-item questionnaire used to assess the degree to which Ankylosing Spondylitis affected work productivity and regular activities over the past 7 days. The questions are as follows: Q1 = currently employed; Q2 = hours missed due to health problems; Q3 = hours missed due to other reasons; Q4 = hours actually worked; Q5 = degree health affected productivity while working (0-10 scale, with higher numbers indicating less productivity); Q6 = degree health affected regular activities (0-10 scale, with higher numbers indicating greater impairment of regular activities). Percent overall work impairment due to health problem was a subscale and calculated as: Q2/(Q2+Q4)+[(1- Q2/(Q2+Q4))×(Q5/10)] for those who were currently employed. Subscale score was expressed as an impairment percentage (range: 0-100%) where higher numbers indicate greater impairment.
Time Frame
Baseline, Weeks 16 and 48
Title
Change From Baseline in Work Productivity and Activity Impairment (WPAI): Percent Activity Impairment Due to Health Problem at Weeks 16 and 48
Description
The WPAI assesses work productivity and impairment. It is a 6-item questionnaire used to assess the degree to which Ankylosing Spondylitis affected work productivity and regular activities over the past 7 days. The questions are as follows: Q1 = currently employed; Q2 = hours missed due to health problems; Q3 = hours missed due to other reasons; Q4 = hours actually worked; Q5 = degree health affected productivity while working (0-10 scale, with higher numbers indicating less productivity); Q6 = degree health affected regular activities (0-10 scale, with higher numbers indicating greater impairment of regular activities). Percent activity impairment due to health problem was a subscale and calculated as: Q6/10 for all respondents. Subscale score was expressed as an impairment percentage (range: 0-100%) where higher numbers indicate greater impairment.
Time Frame
Baseline, Weeks 16 and 48

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Has a diagnosis of Ankylosing Spondylitis (AS) based on the Modified New York Criteria for AS (1984). Must have a radiograph of SI joints (AP Pelvis) documenting diagnosis of AS. Has active disease despite nonsteroidal anti-inflammatory drug (NSAID) therapy or intolerant to NSAIDs. Exclusion Criteria: History of known or suspected complete ankylosis of the spine. History of allergies, intolerance or hypersensitivity to lactose or tofacitinib. History of any other rheumatic disease. Any subject with condition affecting oral drug absorption.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Pfizer CT.gov Call Center
Organizational Affiliation
Pfizer
Official's Role
Study Director
Facility Information:
Facility Name
Rheumatology Associates of North Alabama, PC
City
Huntsville
State/Province
Alabama
ZIP/Postal Code
35801
Country
United States
Facility Name
Arizona Arthritis & Rheumatology Associates, P.C.
City
Gilbert
State/Province
Arizona
ZIP/Postal Code
85297
Country
United States
Facility Name
Medvin Clinical Research
City
Covina
State/Province
California
ZIP/Postal Code
91722
Country
United States
Facility Name
Rheumatology Center of San Diego PC
City
San Diego
State/Province
California
ZIP/Postal Code
92128
Country
United States
Facility Name
University of California, San Francisco Medical Center
City
San Francisco
State/Province
California
ZIP/Postal Code
94143
Country
United States
Facility Name
Robin K. Dore, MD, Inc.
City
Tustin
State/Province
California
ZIP/Postal Code
92780
Country
United States
Facility Name
New England Research Associates, LLC
City
Bridgeport
State/Province
Connecticut
ZIP/Postal Code
06606
Country
United States
Facility Name
Advanced Radiology
City
Stamford
State/Province
Connecticut
ZIP/Postal Code
06902
Country
United States
Facility Name
Stamford Therapeutics Consortium
City
Stamford
State/Province
Connecticut
ZIP/Postal Code
06905
Country
United States
Facility Name
Southcoast Research Center, Inc.
City
Miami
State/Province
Florida
ZIP/Postal Code
33136
Country
United States
Facility Name
Millennium Research
City
Ormond Beach
State/Province
Florida
ZIP/Postal Code
32174
Country
United States
Facility Name
Bluegrass Community Research, Inc
City
Lexington
State/Province
Kentucky
ZIP/Postal Code
40504
Country
United States
Facility Name
Center for Rheumatology and Bone Research
City
Wheaton
State/Province
Maryland
ZIP/Postal Code
20902
Country
United States
Facility Name
M3-Emerging Medical Research, LLC
City
Durham
State/Province
North Carolina
ZIP/Postal Code
27704
Country
United States
Facility Name
Paramount Medical Research and Consulting, LLC
City
Middleburg Heights
State/Province
Ohio
ZIP/Postal Code
44130
Country
United States
Facility Name
Oregon Health & Science University
City
Portland
State/Province
Oregon
ZIP/Postal Code
97239
Country
United States
Facility Name
Altoona Center For Clinical Research
City
Duncansville
State/Province
Pennsylvania
ZIP/Postal Code
16635
Country
United States
Facility Name
Articularis Healthcare Group, Inc d/b/a Low Country Rheumatology
City
Summerville
State/Province
South Carolina
ZIP/Postal Code
29486
Country
United States
Facility Name
Precision Comprehensive Clinical Research Solutions
City
Colleyville
State/Province
Texas
ZIP/Postal Code
76034
Country
United States
Facility Name
Adriana Pop-Moody MD - Clinic PA
City
Corpus Christi
State/Province
Texas
ZIP/Postal Code
78404
Country
United States
Facility Name
Metroplex Clinical Research Center
City
Dallas
State/Province
Texas
ZIP/Postal Code
75231
Country
United States
Facility Name
Clinical Research Unit
City
Houston
State/Province
Texas
ZIP/Postal Code
77030
Country
United States
Facility Name
Investigational Drug Services
City
Houston
State/Province
Texas
ZIP/Postal Code
77030
Country
United States
Facility Name
Memorial Hermann Hospital Imaging
City
Houston
State/Province
Texas
ZIP/Postal Code
77030
Country
United States
Facility Name
Southwest Rheumatology Research LLC
City
Mesquite
State/Province
Texas
ZIP/Postal Code
75150
Country
United States
Facility Name
Trinity Universal Research Associates, Inc.
City
Plano
State/Province
Texas
ZIP/Postal Code
75024
Country
United States
Facility Name
Advanced Rheumatology of Houston
City
The Woodlands
State/Province
Texas
ZIP/Postal Code
77382
Country
United States
Facility Name
Arthritis Northwest, PLLC
City
Spokane
State/Province
Washington
ZIP/Postal Code
99204
Country
United States
Facility Name
Pacific Radiology,
City
Maroochydore
State/Province
Queensland
ZIP/Postal Code
4558
Country
Australia
Facility Name
Rheumatology Research Unit Sunshine Coast
City
Maroochydore
State/Province
Queensland
ZIP/Postal Code
4558
Country
Australia
Facility Name
Emeritus Research Pty. Ltd.
City
Camberwell
State/Province
Victoria
ZIP/Postal Code
3124
Country
Australia
Facility Name
Melbourne Radiology Clinic
City
East Melbourne
State/Province
Victoria
ZIP/Postal Code
3002
Country
Australia
Facility Name
SKG Radiology
City
Subiaco
State/Province
Western Australia
ZIP/Postal Code
6008
Country
Australia
Facility Name
Western Cardiology
City
Subiaco
State/Province
Western Australia
ZIP/Postal Code
6008
Country
Australia
Facility Name
RK Will Pty Ltd
City
Victoria Park
State/Province
Western Australia
ZIP/Postal Code
6100
Country
Australia
Facility Name
Multiprofile Hospital for active treatment "Kaspela" EOOD
City
Plovdiv
ZIP/Postal Code
4002
Country
Bulgaria
Facility Name
Diagnostic-Consulting Center XVII - Sofia
City
Sofia
ZIP/Postal Code
1505
Country
Bulgaria
Facility Name
Medical Centre Synexus Sofia EOOD
City
Sofia
ZIP/Postal Code
1784
Country
Bulgaria
Facility Name
Centre de Recherche Musculo-Squelettique
City
Trois-Rivieres
State/Province
Quebec
ZIP/Postal Code
G8Z 1Y2
Country
Canada
Facility Name
G.R.M.O. (Groupe de recherche en maladies osseuses) Inc.
City
Quebec
ZIP/Postal Code
G1V 3M7
Country
Canada
Facility Name
Guangdong Provincial People's Hospital
City
Guangzhou
State/Province
Guangdong
ZIP/Postal Code
510080
Country
China
Facility Name
The Third Affiliated Hospital, Sun Yat-Sen University
City
Guangzhou
State/Province
Guangdong
ZIP/Postal Code
510630
Country
China
Facility Name
The Second Affiliated Hospital of Zhejiang University School of Medicine
City
Hangzhou
State/Province
Zhejiang
ZIP/Postal Code
310009
Country
China
Facility Name
The First Affiliated Hosptial of Wenzhou Medical University
City
Wenzhou
State/Province
Zhejiang
ZIP/Postal Code
325000
Country
China
Facility Name
Rheumatology and Immunology Department, Shanghai Changzheng Hospital
City
Shanghai
ZIP/Postal Code
200003
Country
China
Facility Name
Lekarna Rezidence Nova Karolina
City
Ostrava
ZIP/Postal Code
702 00
Country
Czechia
Facility Name
CCBR Ostrava s.r.o.
City
Ostrava
ZIP/Postal Code
70200
Country
Czechia
Facility Name
BENU Lekarna
City
Pardubice
ZIP/Postal Code
530 02
Country
Czechia
Facility Name
CCR, Czech a.s.
City
Pardubice
ZIP/Postal Code
530 02
Country
Czechia
Facility Name
Lekarna Hradebni, s.r.o.
City
Uherske Hradiste
ZIP/Postal Code
686 01
Country
Czechia
Facility Name
Uherskohradistska nemocnice, a.s.
City
Uherske Hradiste
ZIP/Postal Code
686 06
Country
Czechia
Facility Name
Medical Plus s.r.o.
City
Uherske Hradiste
ZIP/Postal Code
68601
Country
Czechia
Facility Name
CHRU de Tours, Hopital Trousseau
City
TOURS Cedex 9
ZIP/Postal Code
37044
Country
France
Facility Name
Qualiclinic K ft
City
Budapest
ZIP/Postal Code
1036
Country
Hungary
Facility Name
Pest megyei Flór Ferenc Kórház, Reumatológia-és Fizioterápiás Osztály
City
Kistarcsa
ZIP/Postal Code
2143
Country
Hungary
Facility Name
VITAL MEDICAL CENTER (VITÁL-MEDICINA Kft.)
City
Veszprém
ZIP/Postal Code
8200
Country
Hungary
Facility Name
Barzilai Medical Center
City
Ashkelon
ZIP/Postal Code
7830604
Country
Israel
Facility Name
Chonnam National University Hospital
City
Gwangju
ZIP/Postal Code
61469
Country
Korea, Republic of
Facility Name
Inha University Hospital
City
Incheon
ZIP/Postal Code
22332
Country
Korea, Republic of
Facility Name
Hanyang University Seoul Hospital
City
Seoul
ZIP/Postal Code
04763
Country
Korea, Republic of
Facility Name
Geo Medical Sp. z.o.o Szpital Geo Medical
City
Katowice
ZIP/Postal Code
40-042
Country
Poland
Facility Name
Moja Przychodnia
City
Katowice
ZIP/Postal Code
40-057
Country
Poland
Facility Name
C.M. Silmedic Sp. z o.o.
City
Katowice
ZIP/Postal Code
40-282
Country
Poland
Facility Name
Malopolskie Badania Kliniczne Sp. z o.o. s.k.
City
Krakow
ZIP/Postal Code
30-040
Country
Poland
Facility Name
Samodzielny Publiczny Zaklad Opieki Zdrowotnej MSWiA
City
Krakow
ZIP/Postal Code
30-053
Country
Poland
Facility Name
Centrum Medyczne Plejady
City
Krakow
ZIP/Postal Code
30-363
Country
Poland
Facility Name
Centrum Medyczne LUX MED
City
Krakow
ZIP/Postal Code
30-415
Country
Poland
Facility Name
Malopolskie Centrum Medyczne S.C.
City
Krakow
ZIP/Postal Code
30-510
Country
Poland
Facility Name
Szpital Uniwersytecki w Krakowie, Zaklad Radiologii
City
Krakow
ZIP/Postal Code
31-066
Country
Poland
Facility Name
Top Medical
City
Lublin
ZIP/Postal Code
20-601
Country
Poland
Facility Name
Zespol Poradni Specjalistycznych REUMED, Wallenroda Filia nr 1
City
Lublin
ZIP/Postal Code
20-607
Country
Poland
Facility Name
NZOZ JAMED Pracownia Rentgenowska Jerema Antoszewski
City
Poznan
ZIP/Postal Code
61-397
Country
Poland
Facility Name
Prywatna Praktyka Lekarska Prof. UM dr hab. med. Pawel Hrycaj
City
Poznan
ZIP/Postal Code
61-397
Country
Poland
Facility Name
Klinika Alfa
City
Sochaczew
ZIP/Postal Code
96-500
Country
Poland
Facility Name
RCMed Oddzial Sochaczew
City
Sochaczew
ZIP/Postal Code
96-500
Country
Poland
Facility Name
Szpital Powiatowy w Sochaczewie
City
Sochaczew
ZIP/Postal Code
96-500
Country
Poland
Facility Name
Szpital Sw. Elzbiety, Mokotowskie Centrum Medyczne, Zaklad Diagnostyki
City
Warszawa
ZIP/Postal Code
02-616
Country
Poland
Facility Name
"Reumatika - Centrum Reumatologii" NZOZ
City
Warszawa
ZIP/Postal Code
02-691
Country
Poland
Facility Name
Centrum Medyczne Oporow
City
Wroclaw
ZIP/Postal Code
52-416
Country
Poland
Facility Name
Centrum Medyczne Medix
City
Wroclaw
ZIP/Postal Code
53-413
Country
Poland
Facility Name
Limited Liability Company Medical Center "Rheuma-Med"
City
Kemerovo
ZIP/Postal Code
650070
Country
Russian Federation
Facility Name
State Budgetary Healthcare Institution "Orenburg Regional Clinical Hospital"
City
Orenburg
ZIP/Postal Code
460018
Country
Russian Federation
Facility Name
Limited Liability Company "Sanavita"
City
Saint-Petersburg
ZIP/Postal Code
195257
Country
Russian Federation
Facility Name
State Healthcare Institution "Regional Clinical Hospital"
City
Saratov
ZIP/Postal Code
410053
Country
Russian Federation
Facility Name
RSBHI "Smolensk Regional Clinical Hospital"
City
Smolensk
ZIP/Postal Code
214018
Country
Russian Federation
Facility Name
Limited Liability Company "BioMed"
City
Vladimir
ZIP/Postal Code
600005
Country
Russian Federation
Facility Name
Ankara Universitesi Tip Fakultesi Ibn-i Sina Hastanesi
City
Ankara
ZIP/Postal Code
06100
Country
Turkey
Facility Name
Ankara Universitesi Tip Fakultesi, Ibn-i Sina Hastanesi
City
Ankara
ZIP/Postal Code
06100
Country
Turkey
Facility Name
Hacettepe Universitesi Tip Fakultesi, Ic Hastaliklari Anabilim
City
Ankara
ZIP/Postal Code
06230
Country
Turkey
Facility Name
Istanbul Universitesi Istanbul Tip Fakultesi, Ic Hastaliklari
City
Istanbul
ZIP/Postal Code
34093
Country
Turkey
Facility Name
Istanbul Universitesi Istanbul Tip Fakultesi
City
Istanbul
ZIP/Postal Code
34093
Country
Turkey
Facility Name
Marmara Univ. Istanbul Pendik Egitim ve Arastirma Hastanesi
City
Istanbul
ZIP/Postal Code
34899
Country
Turkey
Facility Name
Izmir Katip Celebi Univ Ataturk Egitim ve Arastirma Hastanesi
City
Izmir
ZIP/Postal Code
35360
Country
Turkey
Facility Name
Izmir Katip Celebi Univ. Ataturk Egitim ve Arastirma Hastanesi
City
Izmir
ZIP/Postal Code
35360
Country
Turkey
Facility Name
Kyiv City Clinical Hospital # 3, Rheumatology Department
City
Kyiv
ZIP/Postal Code
02125
Country
Ukraine
Facility Name
Lviv Communal Clinical Hospital #4, Rheumatology department
City
Lviv
ZIP/Postal Code
79011
Country
Ukraine
Facility Name
Military-Medical Clinical Center (Clinical Hospital with 200 beds) of State Border Guard Service of
City
Lviv
ZIP/Postal Code
79014
Country
Ukraine
Facility Name
Ternopil University Hospital, Department of Rheumatology,
City
Ternopil
ZIP/Postal Code
46002
Country
Ukraine
Facility Name
Vinnytsia Regional Clinical Hospital n.a. M.I.Pyrohov, rheumatology department,
City
Vinnytsia
ZIP/Postal Code
21018
Country
Ukraine

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
Pfizer will provide access to individual de-identified participant data and related study documents (e.g. protocol, Statistical Analysis Plan (SAP), Clinical Study Report (CSR)) upon request from qualified researchers, and subject to certain criteria, conditions, and exceptions. Further details on Pfizer's data sharing criteria and process for requesting access can be found at: https://www.pfizer.com/science/clinical_trials/trial_data_and_results/data_requests.
IPD Sharing URL
https://www.pfizer.com/science/clinical_trials/trial_data_and_results/data_requests
Citations:
PubMed Identifier
36138330
Citation
Cella D, Lenderking WR, Chongpinitchai P, Bushmakin AG, Dina O, Wang L, Cappelleri JC, Navarro-Compan V. Functional Assessment of Chronic Illness Therapy-Fatigue is a reliable and valid measure in patients with active ankylosing spondylitis. J Patient Rep Outcomes. 2022 Sep 23;6(1):100. doi: 10.1186/s41687-022-00508-0.
Results Reference
derived
PubMed Identifier
35654457
Citation
Navarro-Compan V, Wei JC, Van den Bosch F, Magrey M, Wang L, Fleishaker D, Cappelleri JC, Wang C, Wu J, Dina O, Fallon L, Strand V. Effect of tofacitinib on pain, fatigue, health-related quality of life and work productivity in patients with active ankylosing spondylitis: results from a phase III, randomised, double-blind, placebo-controlled trial. RMD Open. 2022 Jun;8(2):e002253. doi: 10.1136/rmdopen-2022-002253.
Results Reference
derived
PubMed Identifier
33906853
Citation
Deodhar A, Sliwinska-Stanczyk P, Xu H, Baraliakos X, Gensler LS, Fleishaker D, Wang L, Wu J, Menon S, Wang C, Dina O, Fallon L, Kanik KS, van der Heijde D. Tofacitinib for the treatment of ankylosing spondylitis: a phase III, randomised, double-blind, placebo-controlled study. Ann Rheum Dis. 2021 Aug;80(8):1004-1013. doi: 10.1136/annrheumdis-2020-219601. Epub 2021 Apr 27.
Results Reference
derived
Links:
URL
https://pmiform.com/clinical-trial-info-request?StudyID=A3921120
Description
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Learn more about this trial

Efficacy and Safety of Tofacitinib in Subjects With Active Ankylosing Spondylitis (AS)

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