A Phase 3 Study Comparing 2 Doses Of CP-690,550 And The Active Comparator, Humira (Adalimumab) Vs. Placebo For Treatment Of Rheumatoid Arthritis

This study has been completed.
Sponsor:
Information provided by (Responsible Party):
Pfizer
ClinicalTrials.gov Identifier:
NCT00853385
First received: February 27, 2009
Last updated: January 10, 2013
Last verified: January 2013
Results First Received: December 4, 2012  
Study Type: Interventional
Study Design: Allocation: Randomized;   Endpoint Classification: Safety/Efficacy Study;   Intervention Model: Parallel Assignment;   Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor);   Primary Purpose: Treatment
Condition: Rheumatoid Arthritis
Interventions: Drug: CP 690,550
Drug: CP-690,550
Other: Placebo
Biological: Biologic TNFi

  Participant Flow
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Recruitment Details
Key information relevant to the recruitment process for the overall study, such as dates of the recruitment period and locations
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Pre-Assignment Details
Significant events and approaches for the overall study following participant enrollment, but prior to group assignment
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Reporting Groups
  Description
CP-690,550 5 mg CP-690,550 5 milligram (mg) tablet orally twice daily along with placebo matched to adalimumab 40 mg injection subcutaneously once every other week up to Month 12.
CP-690,550 10 mg CP-690,550 10 mg tablet orally twice daily along with placebo matched to adalimumab 40 mg injection subcutaneously once every other week up to Month 12.
Placebo, Then CP-690,550 5 mg Placebo matched to CP-690,550 5 mg tablet orally twice daily along with placebo matched to adalimumab 40 mg injection subcutaneously once every other week, for 3 to 6 months. Response was assessed at Month 3 and participants who failed to achieve a minimum improvement of at least 20 percent (%) reduction in both swollen and tender joint counts from baseline, received CP-690,550 5 mg tablet orally twice daily along with placebo matched to adalimumab 40 mg injection subcutaneously once every other week up to Month 12. At Month 6, remaining participants advanced to CP-690,550 5 mg tablet orally twice daily along with placebo matched to adalimumab 40 mg injection subcutaneously once every other week up to Month 12.
Placebo, Then CP-690,550 10 mg Placebo matched to CP-690,550 10 mg tablet orally twice daily along with placebo matched to adalimumab 40 mg injection subcutaneously once every other week, for 3 to 6 months. Response was assessed at Month 3 and participants who failed to achieve a minimum improvement of at least 20% reduction in both swollen and tender joint counts from baseline, received CP-690,550 10 mg tablet orally twice daily along with placebo matched to adalimumab 40 mg injection subcutaneously once every other week up to Month 12. At Month 6, remaining participants advanced to CP-690,550 10 mg tablet orally twice daily along with placebo matched to adalimumab 40 mg injection subcutaneously once every other week up to Month 12.
Adalimumab Adalimumab 40 mg injection subcutaneously once every other week along with placebo matched to CP-690,550 5 mg tablet orally twice daily up to Month 12.

Participant Flow:   Overall Study
    CP-690,550 5 mg     CP-690,550 10 mg     Placebo, Then CP-690,550 5 mg     Placebo, Then CP-690,550 10 mg     Adalimumab  
STARTED     204     201     56     52     204  
COMPLETED     150     158     47     39     162  
NOT COMPLETED     54     43     9     13     42  
Death                 0                 0                 0                 0                 1  
Adverse Event                 24                 24                 2                 5                 22  
Lack of Efficacy                 6                 7                 3                 3                 6  
Lost to Follow-up                 2                 1                 0                 0                 0  
Withdrawal by Subject                 4                 2                 0                 1                 1  
Unspecified                 18                 9                 4                 4                 12  



  Baseline Characteristics
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Population Description
Explanation of how the number of participants for analysis was determined. Includes whether analysis was per protocol, intention to treat, or another method. Also provides relevant details such as imputation technique, as appropriate.
No text entered.

Reporting Groups
  Description
CP-690,550 5 mg CP-690,550 5 mg tablet orally twice daily along with placebo matched to adalimumab 40 mg injection subcutaneously once every other week up to Month 12.
CP-690,550 10 mg CP-690,550 10 mg tablet orally twice daily along with placebo matched to adalimumab 40 mg injection subcutaneously once every other week up to Month 12.
Placebo, Then CP-690,550 5 mg Placebo matched to CP-690,550 5 mg tablet orally twice daily along with placebo matched to adalimumab 40 mg injection subcutaneously once every other week, for 3 to 6 months. Response was assessed at Month 3 and participants who failed to achieve a minimum improvement of at least 20% reduction in both swollen and tender joint counts from baseline, received CP-690,550 5 mg tablet orally twice daily along with placebo matched to adalimumab 40 mg injection subcutaneously once every other week up to Month 12. At Month 6, remaining participants advanced to CP-690,550 5 mg tablet orally twice daily along with placebo matched to adalimumab 40 mg injection subcutaneously once every other week up to Month 12.
Placebo, Then CP-690,550 10 mg Placebo matched to CP-690,550 10 mg tablet orally twice daily along with placebo matched to adalimumab 40 mg injection subcutaneously once every other week, for 3 to 6 months. Response was assessed at Month 3 and participants who failed to achieve a minimum improvement of at least 20% reduction in both swollen and tender joint counts from baseline, received CP-690,550 10 mg tablet orally twice daily along with placebo matched to adalimumab 40 mg injection subcutaneously once every other week up to Month 12. At Month 6, remaining participants advanced to CP-690,550 10 mg tablet orally twice daily along with placebo matched to adalimumab 40 mg injection subcutaneously once every other week up to Month 12.
Adalimumab Adalimumab 40 mg injection subcutaneously once every other week along with placebo matched to CP-690,550 5 mg tablet orally twice daily up to Month 12.
Total Total of all reporting groups

Baseline Measures
    CP-690,550 5 mg     CP-690,550 10 mg     Placebo, Then CP-690,550 5 mg     Placebo, Then CP-690,550 10 mg     Adalimumab     Total  
Number of Participants  
[units: participants]
  204     201     56     52     204     717  
Age  
[units: years]
Mean ± Standard Deviation
  53.0  ± 11.9     52.9  ± 11.8     55.5  ± 13.7     51.9  ± 13.7     52.5  ± 11.7     52.9  ± 12.1  
Gender  
[units: participants]
           
Female     174     168     43     39     162     586  
Male     30     33     13     13     42     131  



  Outcome Measures
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1.  Primary:   Percentage of Participants Achieving American College of Rheumatology 20% (ACR20) Response at Month 6   [ Time Frame: Month 6 ]

2.  Primary:   Change From Baseline in the Health Assessment Questionnaire-Disability Index (HAQ-DI) at Month 3   [ Time Frame: Baseline, Month 3 ]

3.  Primary:   Percentage of Participants With Disease Activity Score Using 28-Joint Count and Erythrocyte Sedimentation Rate (4 Variables) (DAS28-4 [ESR]) Less Than 2.6 at Month 6   [ Time Frame: Month 6 ]
  Hide Outcome Measure 3

Measure Type Primary
Measure Title Percentage of Participants With Disease Activity Score Using 28-Joint Count and Erythrocyte Sedimentation Rate (4 Variables) (DAS28-4 [ESR]) Less Than 2.6 at Month 6
Measure Description DAS28-4 (ESR) calculated from SJC and TJC using 28-joint count, erythrocyte sedimentation rate (ESR) (millimeters per hour [mm/hour]) and patient's global assessment (PtGA) of disease activity (transformed score ranging 0 to 10; higher score indicated greater affectation due to disease activity). Total score range: 0 to 9.4, higher score indicated more disease activity. DAS28-4 (ESR) less than or equal to (<=) 3.2 implied low disease activity and > 3.2 to 5.1 implied moderate to high disease activity, and < 2.6 = remission. For comparison of CP-690,550 with placebo, placebo sequences were combined into single reporting group for Month 6 analysis.
Time Frame Month 6  
Safety Issue No  

Population Description
Explanation of how the number of participants for analysis was determined. Includes whether analysis was per protocol, intention to treat, or another method. Also provides relevant details such as imputation technique, as appropriate.
FAS: all randomized participants who received at least 1 dose of study drug and had at least 1 post-baseline and baseline measurement (for change from baseline endpoint). N=participants evaluable for this measure. Missing values due to withdrawal advancement to active treatment before Month 6 were imputed using non-responder imputation (NRI).

Reporting Groups
  Description
CP-690,550 5 mg CP-690,550 5 mg tablet orally twice daily along with placebo matched to adalimumab 40 mg injection subcutaneously once every other week up to Month 12.
CP-690,550 10 mg CP-690,550 10 mg tablet orally twice daily along with placebo matched to adalimumab 40 mg injection subcutaneously once every other week up to Month 12.
Placebo Placebo matched to CP-690,550 tablet orally twice daily along with placebo matched to adalimumab 40 mg injection subcutaneously once every other week for 3 to 6 months. Response was assessed at Month 3 and participants who failed to achieve at least 20% reduction from baseline in both swollen and tender joint counts, received CP-690,550 5 mg or 10 mg tablet orally twice daily along with placebo matched to adalimumab 40 mg injection subcutaneously once every other week up to Month 12. At Month 6, remaining participants received CP-690,550 5 mg or 10 mg tablet orally twice daily along with placebo matched to adalimumab 40 mg injection subcutaneously once every other week up to Month 12.
Adalimumab Adalimumab 40 mg injection subcutaneously once every other week along with placebo matched to CP-690,550 5 mg tablet orally twice daily up to Month 12.

Measured Values
    CP-690,550 5 mg     CP-690,550 10 mg     Placebo     Adalimumab  
Number of Participants Analyzed  
[units: participants]
  177     176     92     178  
Percentage of Participants With Disease Activity Score Using 28-Joint Count and Erythrocyte Sedimentation Rate (4 Variables) (DAS28-4 [ESR]) Less Than 2.6 at Month 6  
[units: percentage¬†of¬†participants]
  6.21     12.50     1.09     6.74  


Statistical Analysis 1 for Percentage of Participants With Disease Activity Score Using 28-Joint Count and Erythrocyte Sedimentation Rate (4 Variables) (DAS28-4 [ESR]) Less Than 2.6 at Month 6
Groups [1] CP-690,550 10 mg vs. Placebo
Method [2] Normal approximation
P Value [3] <0.0001
Percent difference [4] 11.41
95% Confidence Interval ( 6.08 to 16.73 )
[1] Additional details about the analysis, such as null hypothesis and power calculation:
  Normal approximation to the binomial distribution was used to test the superiority of CP-690,550 10 mg to placebo and two-sided 95% CI was evaluated for the difference in percentages.
[2] Other relevant method information, such as adjustments or degrees of freedom:
  No text entered.
[3] Additional information, such as whether or not the p-value is adjusted for multiple comparisons and the a priori threshold for statistical significance:
  A step-down procedure was used to control for multiple comparisons. For comparison of 10 mg to placebo to be statistically significant in this measure, comparison of 10 mg to placebo in HAQ-DI had to be significant.
[4] Other relevant estimation information:
  No text entered.

Statistical Analysis 2 for Percentage of Participants With Disease Activity Score Using 28-Joint Count and Erythrocyte Sedimentation Rate (4 Variables) (DAS28-4 [ESR]) Less Than 2.6 at Month 6
Groups [1] CP-690,550 5 mg vs. Placebo
Method [2] Normal approximation
P Value [3] 0.0151
Percent difference [4] 5.12
95% Confidence Interval ( 0.98 to 9.26 )
[1] Additional details about the analysis, such as null hypothesis and power calculation:
  Normal approximation for the difference in binomial proportions was used to test the superiority of CP-690,550 5 mg to placebo and 2-sided 95% CI was evaluated for the difference in percentages.
[2] Other relevant method information, such as adjustments or degrees of freedom:
  No text entered.
[3] Additional information, such as whether or not the p-value is adjusted for multiple comparisons and the a priori threshold for statistical significance:
  Step-down procedure: For the comparison of 5 mg to placebo to be statistically significant in this measure, the comparison of 10 mg to placebo as well as comparison of 5 mg to placebo in HAQ-DI had to be statistically significant.
[4] Other relevant estimation information:
  No text entered.

Statistical Analysis 3 for Percentage of Participants With Disease Activity Score Using 28-Joint Count and Erythrocyte Sedimentation Rate (4 Variables) (DAS28-4 [ESR]) Less Than 2.6 at Month 6
Groups [1] Placebo vs. Adalimumab
Method [2] Normal approximation
P Value [3] 0.0091
Percent difference [4] 5.65
95% Confidence Interval ( 1.40 to 9.90 )
[1] Additional details about the analysis, such as null hypothesis and power calculation:
  Normal approximation for the difference in binomial proportions was used to test the superiority of adalimumab to placebo and 2-sided 95% CI was evaluated for the difference in percentages.
[2] Other relevant method information, such as adjustments or degrees of freedom:
  No text entered.
[3] Additional information, such as whether or not the p-value is adjusted for multiple comparisons and the a priori threshold for statistical significance:
  Statistical testing was done at 5% significance level (2-sided).
[4] Other relevant estimation information:
  No text entered.



4.  Secondary:   Percentage of Participants Achieving American College of Rheumatology 20% (ACR20) Response at Month 1 and 3   [ Time Frame: Month 1, 3 ]

5.  Secondary:   Percentage of Participants Achieving American College of Rheumatology 20% (ACR20) Response at Month 9 and 12   [ Time Frame: Month 9, 12 ]

6.  Secondary:   Percentage of Participants Achieving American College of Rheumatology 50% (ACR50) Response at Month 1, 3 and 6   [ Time Frame: Month 1, 3, 6 ]

7.  Secondary:   Percentage of Participants Achieving American College of Rheumatology 50% (ACR50) Response at Month 9 and 12   [ Time Frame: Month 9, 12 ]

8.  Secondary:   Percentage of Participants Achieving American College of Rheumatology 70% (ACR70) Response at Month 1, 3 and 6   [ Time Frame: Month 1, 3, 6 ]

9.  Secondary:   Percentage of Participants Achieving American College of Rheumatology 70% (ACR70) Response at Month 9 and 12   [ Time Frame: Month 9, 12 ]

10.  Secondary:   Disease Activity Score Using 28-Joint Count and C-Reactive Protein (3 Variables) (DAS28-3 [CRP]) at Baseline, Month 1, 3 and 6   [ Time Frame: Baseline, Month 1, 3, 6 ]

11.  Secondary:   Disease Activity Score Using 28-Joint Count and C-Reactive Protein (3 Variables) (DAS28-3 [CRP]) at Month 9 and 12   [ Time Frame: Month 9, 12 ]

12.  Secondary:   Disease Activity Score Using 28-Joint Count and Erythrocyte Sedimentation Rate (4 Variables) (DAS28-4 [ESR]) at Baseline, Month 1, 3 and 6   [ Time Frame: Baseline, Month 1, 3, 6 ]

13.  Secondary:   Disease Activity Score Using 28-Joint Count and Erythrocyte Sedimentation Rate (4 Variables) (DAS28-4 [ESR]) at Month 9 and 12   [ Time Frame: Month 9, 12 ]

14.  Secondary:   Disease Activity Score Using 28-Joint Count and C-Reactive Protein (4 Variables) (DAS28-4 [CRP])   [ Time Frame: Baseline, Month 1, 3, 6, 9, 12 ]

15.  Secondary:   Disease Activity Score Using 28-Joint Count and Erythrocyte Sedimentation Rate (3 Variables) (DAS28-3 [ESR])   [ Time Frame: Baseline, Month 1, 3, 6, 9, 12 ]

16.  Secondary:   Health Assessment Questionnaire-Disability Index (HAQ-DI) at Month 1, 3 and 6   [ Time Frame: Month 1, 3, 6 ]

17.  Secondary:   Health Assessment Questionnaire-Disability Index (HAQ-DI) at Month 9 and 12   [ Time Frame: Month 9, 12 ]

18.  Secondary:   Patient Assessment of Arthritis Pain at Baseline, Month 1, 3 and 6   [ Time Frame: Baseline, Month 1, 3, 6 ]

19.  Secondary:   Patient Assessment of Arthritis Pain at Month 9 and 12   [ Time Frame: Month 9, 12 ]

20.  Secondary:   Patient Global Assessment (PtGA) of Arthritis Pain at Baseline, Month 1, 3 and 6   [ Time Frame: Baseline, Month 1, 3, 6 ]

21.  Secondary:   Patient Global Assessment (PtGA) of Arthritis Pain at Month 9 and 12   [ Time Frame: Month 9, 12 ]

22.  Secondary:   Physician Global Assessment (PGA) of Arthritis Pain at Baseline, Month 1, 3 and 6   [ Time Frame: Baseline, Month 1, 3, 6 ]

23.  Secondary:   Physician Global Assessment (PGA) of Arthritis Pain at Month 9 and 12   [ Time Frame: Month 9, 12 ]

24.  Secondary:   36-Item Short-Form Health Survey (SF-36) at Baseline, Month 1, 3 and 6   [ Time Frame: Baseline, Month 1, 3, 6 ]

25.  Secondary:   36-Item Short-Form Health Survey (SF-36) at Month 9 and 12   [ Time Frame: Month 9, 12 ]

26.  Secondary:   Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT)-Fatigue Scale at Baseline, Month 1, 3 and 6   [ Time Frame: Baseline, Month 1, 3, 6 ]

27.  Secondary:   Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT)-Fatigue Scale at Month 12   [ Time Frame: Month 12 ]

28.  Secondary:   Medical Outcomes Study-Sleep Scale (MOS-SS) at Baseline, Month 1, 3 and 6   [ Time Frame: Baseline, Month 1, 3, 6 ]

29.  Secondary:   Medical Outcomes Study-Sleep Scale (MOS-SS) at Month 12   [ Time Frame: Month 12 ]

30.  Secondary:   Number of Participants With Optimal Sleep Assessed Using Medical Outcomes Study-Sleep Scale (MOS-SS) at Baseline, Month 1, 3 and 6   [ Time Frame: Baseline, Month 1, 3, 6 ]

31.  Secondary:   Number of Participants With Optimal Sleep Assessed Using Medical Outcomes Study-Sleep Scale (MOS-SS) at Month 12   [ Time Frame: Month 12 ]

32.  Secondary:   Euro Quality of Life-5 Dimension (EQ-5D) Health State Profile Utility Score at Baseline, Month 1, 3 and 6   [ Time Frame: Baseline, Month 1, 3, 6 ]

33.  Secondary:   Euro Quality of Life-5 Dimension (EQ-5D) Health State Profile Utility Score at Month 12   [ Time Frame: Month 12 ]

34.  Secondary:   Work Limitations Questionnaire (WLQ) Score at Month 3 and 6   [ Time Frame: Month 3, 6 ]

35.  Secondary:   Work Limitations Questionnaire (WLQ) Score at Baseline and Month 12   [ Time Frame: Baseline, Month 12 ]

36.  Secondary:   Work Productivity and Healthcare Resource Utilization (HCRU) at Baseline, Month 3 and 6   [ Time Frame: Baseline, Month 3, 6 ]

37.  Secondary:   Work Productivity and Healthcare Resource Utilization (HCRU) at Month 12   [ Time Frame: Month 12 ]

38.  Secondary:   Number of Events Including Visits, Surgeries, Tests or Devices as Assessed Using RA-HCRU at Baseline, Month 3 and 6   [ Time Frame: Baseline, Month 3, 6 ]

39.  Secondary:   Number of Events Including Visits, Surgeries, Tests or Devices as Assessed Using RA-HCRU at Month 12   [ Time Frame: Month 12 ]

40.  Secondary:   Number of Days as Assessed Using RA-HCRU at Baseline, Month 3 and 6   [ Time Frame: Baseline, Month 3, 6 ]

41.  Secondary:   Number of Days as Assessed Using RA-HCRU at Month 12   [ Time Frame: Month 12 ]

42.  Secondary:   Number of Hours Per Day as Assessed RA-HCRU at Baseline, Month 3 and 6   [ Time Frame: Baseline, Month 3, 6 ]

43.  Secondary:   Number of Hours Per Day as Assessed RA-HCRU at Month 12   [ Time Frame: Month 12 ]

44.  Secondary:   Work Performance in Past 3 Months on Days Bothered as Assessed Using RA-HCRU at Baseline, Month 3 and 6   [ Time Frame: Baseline, Month 3, 6 ]

45.  Secondary:   Work Performance in Past 3 Months on Days Bothered as Assessed Using RA-HCRU at Month 12   [ Time Frame: Month 12 ]


  Serious Adverse Events


  Other Adverse Events


  Limitations and Caveats
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Limitations of the study, such as early termination leading to small numbers of participants analyzed and technical problems with measurement leading to unreliable or uninterpretable data
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