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Multicenter Study to Evaluate CRx-102 vs. Each of Its Components to Treat Active Rheumatoid Arthritis (MARS-1)

Primary Purpose

Rheumatoid Arthritis

Status
Completed
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
CRx-102 (2.7/180)
prednisolone
dipyridamole
placebo
CRx-102 (2.7/360)
Sponsored by
Zalicus
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Rheumatoid Arthritis focused on measuring CombinatoRx, CRx-102, Rheumatoid Arthritis, Prednisolone, Dipyridamole, ACR20

Eligibility Criteria

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

Inclusion Criteria:

  • Subject must voluntarily give written informed consent
  • Subject must be ≥ 18 years of age
  • Subject must have RA (ACR criteria)
  • Subject must have at least 4 swollen joints and at least 6 tender joints at screening and baseline (28 joint count)
  • Subject must have a CRP > Upper Limit of Normal at screening
  • Subject must have been on DMARD or DMARD combination (e.g. MTX + hydroxychloroquine) for at least 3 months and be on a stable dose of DMARD(s) for at least 6 weeks prior to screening.
  • For MTX subjects: MTX ≥ 7.5 mg weekly (po/sc/im) and willing to take folic acid or folinic acid supplementation
  • Subject willing to take concomitant multivitamin or the equivalent of 400 I.U. vitamin D and the equivalent of 1000 mg of elemental calcium daily

Exclusion Criteria:

  • History of clinically significant (as determined by the Investigator) cardiac, endocrinologic, hematologic, hepatic, immunologic, metabolic, urologic, pulmonary, neurologic, dermatologic, psychiatric, renal, and/or other major disease
  • Wheelchair or bed bound
  • History of osteoporotic fracture
  • History of malignancy within the past 10 years. However, subjects with a history of treated or excised basal cell carcinoma or fewer than 3 squamous cell carcinomas are eligible to participate
  • History of lymphoma or chronic leukemia
  • Moles or lesions that are currently undiagnosed, but are suspicious for malignancy
  • Surgery within the previous 3 months (except for minor dental and cosmetic)
  • History of drug or alcohol abuse (as defined by the Investigator)
  • History of bleeding disorder
  • History of gastrointestinal bleeding within 5 years of screening
  • History of severe migraines or headaches
  • History of glaucoma
  • Active diabetic retinopathy
  • Visually compromising cataract
  • History of opportunistic infection within the previous 12 months
  • Active Tuberculosis (TB)
  • Serious local infection (e.g., cellulitis, abscess) or systemic infection (e.g., septicemia) within 3 months prior to screening
  • Fever or symptomatic viral or bacterial infection within 2 weeks prior to screening
  • Positive for Hepatitis C virus (HCV) antibody
  • Positive for HBsAg
  • Known positive HIV antibody
  • Has a history of hypersensitivity to glucocorticoids and/or dipyridamole
  • Treatment with oral, intra-articular, intramuscular, or intravenous glucocorticoids within 6 weeks prior to screening; inhaled glucocorticoid is permitted
  • Treatment with any tumor necrosis factor-alpha (TNFα) biologic, anakinra or abatacept within 2 months prior to screening
  • Treatment with rituximab
  • Treatment with another investigational drug 3 months prior to screening
  • Treatment with anticoagulants including: dipyridamole, warfarin, clopidogrel, ticlopidine; Acetylsalicylic acid > 150 mg per day
  • Treatment with any concomitant medications that have not been at a stable dose for at least 28 days prior to screening
  • Alanine Aminotransferase (ALT) or Aspartate Aminotransferase (AST) laboratory values that exceed 1.5 x ULN
  • HbA1C value of > 7.0%
  • Current enrollment in any other study with investigational drug or device
  • Female subject who is pregnant or lactating or of child bearing potential and not using acceptable methods of contraception (birth control pills, barriers or abstinence)
  • Unwilling or unable to comply with the requirements of this protocol, including the presence of any condition (physical, mental, or social) that is likely to affect the subject's return for follow-up visits on schedule
  • Other unspecified reasons that, in the opinion of the Investigator or sponsor make the subject unsuitable for enrollment

Sites / Locations

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm 5

Arm Type

Experimental

Experimental

Active Comparator

Active Comparator

Placebo Comparator

Arm Label

CRx-102 (2.7/180)

CRx-102 (2.7/360)

Prednisolone

Dipyridamole

Placebo

Arm Description

CRx-102 dose 1 total daily dose during treatment period (days 14-98) 2.7 mg prednisolone plus 180 mg dipyridamole administered as 1.8 mg prednisolone plus 90 mg dipyridamole at 8 AM and 0.9 mg prednisolone plus 90 mg dipyridamole at 1 PM titration dose (days 0-13) 2.7 mg prednisolone plus 90 mg dipyridamole administered as 1.8 mg prednisolone plus 45 mg dipyridamole at 8 AM and 0.9 mg prednisolone plus 45 mg dipyridamole at 1 PM

CRx-102 Dose 2 total daily dose during treatment period (days 14-98) 2.7 mg prednisolone plus 360 mg dipyridamole administered as 1.8 mg prednisolone plus 180 mg dipyridamole at 8 AM and 0.9 mg prednisolone plus 180 mg dipyridamole at 1 PM titration dose 1 (days 0-6) 2.7 mg prednisolone plus 90 mg dipyridamole administered as 1.8 mg prednisolone plus 45 mg dipyridamole at 8 AM and 0.9 mg prednisolone plus 45 mg dipyridamole at 1 PM titration dose 2 (days 7-13) 2.7 mg prednisolone plus 180 mg dipyridamole administered as 1.8 mg prednisolone plus 90 mg dipyridamole at 8 AM and 0.9 mg prednisolone plus 90 mg dipyridamole at 1 PM

treatment dose ( days 0-98) total daily dose of 2.7 mg prednisolone administered as 1.8 mg prednisolone at 8 AM and 0.9 mg prednisolone at 1 PM

total daily dose during treatment period (days 14-98) 360 mg dipyridamole administered as 180 mg dipyridamole at 8 AM and and 180 mg dipyridamole at 1 PM titration dose 1 (days 0-6) 90 mg dipyridamole administered 45 mg dipyridamole at 8 AM and 45 mg dipyridamole at 1 PM titration dose 2 (days 7-13) 180 mg dipyridamole administered as 90 mg dipyridamole at 8 AM and 90 mg dipyridamole at 1 PM

placebo administered twice per day at 8 AM and 1 PM

Outcomes

Primary Outcome Measures

Absolute C-reactive Protein (CRP) Values at Day 98 - As Treated Population
Preliminary review of the efficacy dataset revealed that the efficacy dataset was not robust enough to support an extensive formal efficacy analysis as described in the SAP. Therefore, only the CRP values over time and the percent change in CRP values in the As-Treated population were calculated.

Secondary Outcome Measures

Percent Change From Baseline to Day 98 in C-reactive Protein (CRP) Values - As Treated Population
Preliminary review of the efficacy dataset revealed that the efficacy dataset was not robust enough to support an extensive formal efficacy analysis as described in the SAP. Therefore, only the CRP values over time and the percent change in CRP values in the As-Treated population were calculated.
To Assess the Superiority of CRx-102 Compared to Prednisolone and Dipyridamole Using American College of Rheumatology Rating Scale (20% or More Improvement; ACR20) Calculated From Baseline to Day 98 in Subjects With Active Rheumatoid Arthritis
Preliminary review of the efficacy dataset revealed that the efficacy dataset was not robust enough to support an extensive formal efficacy analysis as described in the SAP. Therefore, only the CRP values over time and the percent change in CRP values in the As-Treated population were calculated.
To Assess the Efficacy of CRx-102 Compared to Placebo Using ACR 20 Calculated From Baseline to Day 98
Preliminary review of the efficacy dataset revealed that the efficacy dataset was not robust enough to support an extensive formal efficacy analysis as described in the SAP. Therefore, only the CRP values over time and the percent change in CRP values in the As-Treated population were calculated.

Full Information

First Posted
October 29, 2007
Last Updated
March 27, 2014
Sponsor
Zalicus
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1. Study Identification

Unique Protocol Identification Number
NCT00551707
Brief Title
Multicenter Study to Evaluate CRx-102 vs. Each of Its Components to Treat Active Rheumatoid Arthritis
Acronym
MARS-1
Official Title
A Randomized, Double-Blind, Placebo-Controlled, Multi-Center Study to Evaluate the Superiority of CRx-102 Over Each of Its Components When Given to Subjects With Active Rheumatoid Arthritis (RA)
Study Type
Interventional

2. Study Status

Record Verification Date
March 2014
Overall Recruitment Status
Completed
Study Start Date
October 2007 (undefined)
Primary Completion Date
November 2008 (Actual)
Study Completion Date
January 2009 (Actual)

3. Sponsor/Collaborators

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

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
CRx-102 is a synergistic combination drug candidate containing the cardiovascular drug dipyridamole and a very low dose of the glucocorticoid prednisolone. CRx-102 is believed to work through a novel mechanism of action in which dipyridamole selectively amplifies the anti-inflammatory and immunomodulatory activities of the glucocorticoid without replicating the dose-dependent adverse effects. CRx-102 has been associated with clinical benefit in proof of concept studies in subjects with hand Osteoarthritis (OA) and Rheumatoid Arthritis (RA). In this trial, CRx-102 will be given to subjects with active RA as an add-on therapy to existing stable doses of Disease Modifying Anti-Rheumatic Drugs (DMARDs) including methotrexate (MTX), sulfasalazine, hydroxychloroquine, leflunomide or azathioprine. MTX in combination with other DMARDs (e.g., sulfasalazine or hydroxychloroquine) will be permitted to reflect the current standard of care practices within rheumatology.
Detailed Description
The study was discontinued before the enrollment objective was met. Preliminary review of the efficacy dataset revealed that the efficacy dataset was not robust enough to support an extensive formal efficacy analysis as described in the SAP. Therefore, only the CRP values over time and the percent change in C-reactive protein (CRP) values in the As-Treated population were calculated.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Rheumatoid Arthritis
Keywords
CombinatoRx, CRx-102, Rheumatoid Arthritis, Prednisolone, Dipyridamole, ACR20

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
CRx-102 (2.7/180)
Arm Type
Experimental
Arm Description
CRx-102 dose 1 total daily dose during treatment period (days 14-98) 2.7 mg prednisolone plus 180 mg dipyridamole administered as 1.8 mg prednisolone plus 90 mg dipyridamole at 8 AM and 0.9 mg prednisolone plus 90 mg dipyridamole at 1 PM titration dose (days 0-13) 2.7 mg prednisolone plus 90 mg dipyridamole administered as 1.8 mg prednisolone plus 45 mg dipyridamole at 8 AM and 0.9 mg prednisolone plus 45 mg dipyridamole at 1 PM
Arm Title
CRx-102 (2.7/360)
Arm Type
Experimental
Arm Description
CRx-102 Dose 2 total daily dose during treatment period (days 14-98) 2.7 mg prednisolone plus 360 mg dipyridamole administered as 1.8 mg prednisolone plus 180 mg dipyridamole at 8 AM and 0.9 mg prednisolone plus 180 mg dipyridamole at 1 PM titration dose 1 (days 0-6) 2.7 mg prednisolone plus 90 mg dipyridamole administered as 1.8 mg prednisolone plus 45 mg dipyridamole at 8 AM and 0.9 mg prednisolone plus 45 mg dipyridamole at 1 PM titration dose 2 (days 7-13) 2.7 mg prednisolone plus 180 mg dipyridamole administered as 1.8 mg prednisolone plus 90 mg dipyridamole at 8 AM and 0.9 mg prednisolone plus 90 mg dipyridamole at 1 PM
Arm Title
Prednisolone
Arm Type
Active Comparator
Arm Description
treatment dose ( days 0-98) total daily dose of 2.7 mg prednisolone administered as 1.8 mg prednisolone at 8 AM and 0.9 mg prednisolone at 1 PM
Arm Title
Dipyridamole
Arm Type
Active Comparator
Arm Description
total daily dose during treatment period (days 14-98) 360 mg dipyridamole administered as 180 mg dipyridamole at 8 AM and and 180 mg dipyridamole at 1 PM titration dose 1 (days 0-6) 90 mg dipyridamole administered 45 mg dipyridamole at 8 AM and 45 mg dipyridamole at 1 PM titration dose 2 (days 7-13) 180 mg dipyridamole administered as 90 mg dipyridamole at 8 AM and 90 mg dipyridamole at 1 PM
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
placebo administered twice per day at 8 AM and 1 PM
Intervention Type
Drug
Intervention Name(s)
CRx-102 (2.7/180)
Other Intervention Name(s)
prednisolone 2.7 mg plus dipyridamole 180 mg
Intervention Description
prednisolone 2.7 mg plus dipyridamole 180 mg
Intervention Type
Drug
Intervention Name(s)
prednisolone
Intervention Description
prednisolone (2.7 mg)
Intervention Type
Drug
Intervention Name(s)
dipyridamole
Other Intervention Name(s)
dipyridamole 360 mg
Intervention Description
dipyridamole 360 mg
Intervention Type
Drug
Intervention Name(s)
placebo
Intervention Description
placebo
Intervention Type
Drug
Intervention Name(s)
CRx-102 (2.7/360)
Other Intervention Name(s)
Prednisolone 2.7 mg plus Dipyridamole 360 mg
Intervention Description
Prednisolone 2.7 mg plus Dipyridamole 360 mg
Primary Outcome Measure Information:
Title
Absolute C-reactive Protein (CRP) Values at Day 98 - As Treated Population
Description
Preliminary review of the efficacy dataset revealed that the efficacy dataset was not robust enough to support an extensive formal efficacy analysis as described in the SAP. Therefore, only the CRP values over time and the percent change in CRP values in the As-Treated population were calculated.
Time Frame
Day 98
Secondary Outcome Measure Information:
Title
Percent Change From Baseline to Day 98 in C-reactive Protein (CRP) Values - As Treated Population
Description
Preliminary review of the efficacy dataset revealed that the efficacy dataset was not robust enough to support an extensive formal efficacy analysis as described in the SAP. Therefore, only the CRP values over time and the percent change in CRP values in the As-Treated population were calculated.
Time Frame
baseline to day 98
Title
To Assess the Superiority of CRx-102 Compared to Prednisolone and Dipyridamole Using American College of Rheumatology Rating Scale (20% or More Improvement; ACR20) Calculated From Baseline to Day 98 in Subjects With Active Rheumatoid Arthritis
Description
Preliminary review of the efficacy dataset revealed that the efficacy dataset was not robust enough to support an extensive formal efficacy analysis as described in the SAP. Therefore, only the CRP values over time and the percent change in CRP values in the As-Treated population were calculated.
Time Frame
baseline to day 98
Title
To Assess the Efficacy of CRx-102 Compared to Placebo Using ACR 20 Calculated From Baseline to Day 98
Description
Preliminary review of the efficacy dataset revealed that the efficacy dataset was not robust enough to support an extensive formal efficacy analysis as described in the SAP. Therefore, only the CRP values over time and the percent change in CRP values in the As-Treated population were calculated.
Time Frame
baseline to 98 Days

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Subject must voluntarily give written informed consent Subject must be ≥ 18 years of age Subject must have RA (ACR criteria) Subject must have at least 4 swollen joints and at least 6 tender joints at screening and baseline (28 joint count) Subject must have a CRP > Upper Limit of Normal at screening Subject must have been on DMARD or DMARD combination (e.g. MTX + hydroxychloroquine) for at least 3 months and be on a stable dose of DMARD(s) for at least 6 weeks prior to screening. For MTX subjects: MTX ≥ 7.5 mg weekly (po/sc/im) and willing to take folic acid or folinic acid supplementation Subject willing to take concomitant multivitamin or the equivalent of 400 I.U. vitamin D and the equivalent of 1000 mg of elemental calcium daily Exclusion Criteria: History of clinically significant (as determined by the Investigator) cardiac, endocrinologic, hematologic, hepatic, immunologic, metabolic, urologic, pulmonary, neurologic, dermatologic, psychiatric, renal, and/or other major disease Wheelchair or bed bound History of osteoporotic fracture History of malignancy within the past 10 years. However, subjects with a history of treated or excised basal cell carcinoma or fewer than 3 squamous cell carcinomas are eligible to participate History of lymphoma or chronic leukemia Moles or lesions that are currently undiagnosed, but are suspicious for malignancy Surgery within the previous 3 months (except for minor dental and cosmetic) History of drug or alcohol abuse (as defined by the Investigator) History of bleeding disorder History of gastrointestinal bleeding within 5 years of screening History of severe migraines or headaches History of glaucoma Active diabetic retinopathy Visually compromising cataract History of opportunistic infection within the previous 12 months Active Tuberculosis (TB) Serious local infection (e.g., cellulitis, abscess) or systemic infection (e.g., septicemia) within 3 months prior to screening Fever or symptomatic viral or bacterial infection within 2 weeks prior to screening Positive for Hepatitis C virus (HCV) antibody Positive for HBsAg Known positive HIV antibody Has a history of hypersensitivity to glucocorticoids and/or dipyridamole Treatment with oral, intra-articular, intramuscular, or intravenous glucocorticoids within 6 weeks prior to screening; inhaled glucocorticoid is permitted Treatment with any tumor necrosis factor-alpha (TNFα) biologic, anakinra or abatacept within 2 months prior to screening Treatment with rituximab Treatment with another investigational drug 3 months prior to screening Treatment with anticoagulants including: dipyridamole, warfarin, clopidogrel, ticlopidine; Acetylsalicylic acid > 150 mg per day Treatment with any concomitant medications that have not been at a stable dose for at least 28 days prior to screening Alanine Aminotransferase (ALT) or Aspartate Aminotransferase (AST) laboratory values that exceed 1.5 x ULN HbA1C value of > 7.0% Current enrollment in any other study with investigational drug or device Female subject who is pregnant or lactating or of child bearing potential and not using acceptable methods of contraception (birth control pills, barriers or abstinence) Unwilling or unable to comply with the requirements of this protocol, including the presence of any condition (physical, mental, or social) that is likely to affect the subject's return for follow-up visits on schedule Other unspecified reasons that, in the opinion of the Investigator or sponsor make the subject unsuitable for enrollment
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Margaret Lee, PhD
Organizational Affiliation
Zalicus
Official's Role
Study Director
Facility Information:
City
Birmingham
State/Province
Alabama
Country
United States
City
Huntsville
State/Province
Alabama
Country
United States
City
Phoenix
State/Province
Arizona
Country
United States
City
Little Rock
State/Province
Arkansas
Country
United States
City
Anaheim
State/Province
California
Country
United States
City
La Jolla
State/Province
California
Country
United States
City
Westlake Village
State/Province
California
Country
United States
City
Palm Harbor
State/Province
Florida
Country
United States
City
Elizabethtown
State/Province
Kentucky
Country
United States
City
Haddon Heights
State/Province
New Jersey
Country
United States
City
Mayfield Village
State/Province
Ohio
Country
United States
City
Oklahoma City
State/Province
Oklahoma
Country
United States
City
Dallas
State/Province
Texas
Country
United States
City
Rosario
State/Province
Santa Fe
Country
Argentina
City
Buenos Aires
Country
Argentina
City
San Jan
Country
Argentina
City
San Miguel de Tucuman
Country
Argentina
City
Winnipeg
State/Province
Manitoba
Country
Canada
City
St. John's
State/Province
Newfoundland and Labrador
Country
Canada
City
Hamilton
State/Province
Ontario
Country
Canada
City
Windsor
State/Province
Ontario
Country
Canada
City
Tallinn
Country
Estonia
City
Tartu
Country
Estonia
City
Bekescsaba
Country
Hungary
City
Esztergom
Country
Hungary
City
Szolnok
Country
Hungary
City
Kaunas
Country
Lithuania
City
Vilnius
Country
Lithuania
City
Aguas Calientes
State/Province
Aguascalientes
Country
Mexico
City
Vallarta Norte
State/Province
Guadalajara
Country
Mexico
City
Bialystok
Country
Poland
City
Elblag
Country
Poland
City
Katowice
Country
Poland
City
Krakow
Country
Poland
City
Lublin
Country
Poland
City
Poznan
Country
Poland
City
Torun
Country
Poland
City
Warszawa
Country
Poland
City
Bucuresti
Country
Romania
City
Cluj Napoca
Country
Romania
City
Timisoara
Country
Romania
City
Moscow
Country
Russian Federation
City
St. Petersburg
Country
Russian Federation
City
Belgrade
Country
Serbia
City
Niska Banja
Country
Serbia
City
Pretoria
State/Province
Gauteng
Country
South Africa
City
Cape Town
State/Province
Western Cape
Country
South Africa
City
Worcester
State/Province
Western Cape
Country
South Africa

12. IPD Sharing Statement

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Multicenter Study to Evaluate CRx-102 vs. Each of Its Components to Treat Active Rheumatoid Arthritis

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