Long-term Treatment Study of Certolizumab Pegol Without Coadministration of Methotrexate in Japanese Rheumatoid Arthritis (RA) Patients

• Percentage of Participants With American College of Rheumatology 20% (ACR20) Response [ Time Frame: Baseline (of Study 275-08-003), Week 24, Week 52 and at the final assessment (maximum was 208 weeks) ] [ Designated as safety issue: No ]

  A participant was an ACR20 responder if the following 3 criteria for improvement from Baseline (before study drug administration in Study 275-08-003) were met:

  • ≥ 20% improvement in 68 tender joint count;
  • ≥ 20% improvement in 66 swollen joint count; and

  • ≥ 20% improvement in at least 3 of the 5 following parameters:

    • Patient's assessment of arthritis pain (measured on a 100 mm visual analog scale [VAS]);
    • Patient's global assessment of disease activity (measured on a 100 mm VAS);
    • Physician's global assessment of disease activity (measured on a 100 mm VAS);
    • Patient's self-assessment of physical function (Health Assessment Questionnaire - Disability Index (HAQ-DI));
    • C-Reactive Protein (CRP).
• Percentage of Participants With American College of Rheumatology 50% (ACR50) Response [ Time Frame: Baseline (of Study 275-08-003), Week 24, Week 52 and at the final assessment (maximum was 208 weeks) ] [ Designated as safety issue: No ]

  A participant was an ACR50 responder if the following 3 criteria for improvement from Baseline (before study drug administration in Study 275-08-003) were met:

  • ≥ 50% improvement in 68 tender joint count;
  • ≥ 50% improvement in 66 swollen joint count; and

  • ≥ 50% improvement in at least 3 of the 5 following parameters:

    • Patient's assessment of arthritis pain (measured on a 100 mm visual analog scale [VAS]);
    • Patient's global assessment of disease activity (measured on a 100 mm VAS);
    • Physician's global assessment of disease activity (measured on a 100 mm VAS);
    • Patient's self-assessment of physical function (Health Assessment Questionnaire - Disability Index (HAQ-DI));
    • C-Reactive Protein (CRP).
• Percentage of Participants With American College of Rheumatology 70% (ACR70) Response [ Time Frame: Baseline (of Study 275-08-003), Week 24, Week 52 and at the final assessment (maximum was 208 weeks) ] [ Designated as safety issue: No ]

  A participant was an ACR70 responder if the following 3 criteria for improvement from Baseline (before study drug administration in Study 275-08-003) were met:

  • ≥ 70% improvement in 68 tender joint count;
  • ≥ 70% improvement in 66 swollen joint count; and

  • ≥ 70% improvement in at least 3 of the 5 following parameters:

    • Patient's assessment of arthritis pain (measured on a 100 mm visual analog scale [VAS]);
    • Patient's global assessment of disease activity (measured on a 100 mm VAS);
    • Physician's global assessment of disease activity (measured on a 100 mm VAS);
    • Patient's self-assessment of physical function (Health Assessment Questionnaire - Disability Index (HAQ-DI));
    • C-Reactive Protein (CRP).
• Change From Baseline in Disease Activity Score (DAS) 28 [ Time Frame: Baseline (of Study 275-08-003), Week 24, Week 52 and at the final assessment (maximum was 208 weeks) ] [ Designated as safety issue: No ]

  The DAS28 measures the severity of disease at a specific time and is derived from the following variables:

  • 28 tender joint count;
  • 28 swollen joint count;
  • Erythrocyte sedimentation rate (ESR);
  • Patient's global assessment of disease activity.

  To obtain the tender joint count and swollen joint count, 28 joints of the shoulder, elbow, wrist, metacarpophalangeal joints, thumb interphalangeal joints, proximal interphalangeal joints, and knee joints were examined.

  The data before study drug administration of 275-08-003 Study was utilized for Baseline.

  DAS28(ESR) scores range from 0 to approximately 10, with the upper bound dependent on the highest possible ESR. A DAS28 score higher than 5.1 indicates high disease activity, a DAS28 score of 3.2 or less indicates low disease activity, and a DAS28 score less than 2.6 indicates clinical remission.

• Change From Baseline in Modified Total Sharp Score (mTSS) [ Time Frame: Baseline (of Study 275-08-003), Week 0 (of this study) and Week 100 ] [ Designated as safety issue: No ]

  X-ray images of extremities (posteroanterior views of both hands and dorsoplantar views of both feet) were independently assessed by at least two radiographic readers.

  The degree of joint destruction was graded by assessing bone erosion in 44 joints and joint space narrowing (JSN) in 42 joints.

  The joint erosion score is a summary of erosion severity in 32 joints of the hands and 12 joints in the feet. Each joint was scored, according to the surface area involved, from 0 (no erosion) to 5 (complete collapse of bone). The score for erosion ranges from 0 to 160 in the hands and from 0 to 120 in the feet (the maximum erosion score for a joint in the foot is 10). The JSN score summarizes the severity of JSN in 30 joints of the hands and 12 joints of the feet. JSN, including subluxation, was scored from 0 (normal) to 4 (complete loss of joint space, bony ankylosis, or luxation), with a maximum JSN score of 168. The mTSS ranges from 0 (normal) to 448 (worst).

• ACR20/50/70 responder rate [ Time Frame: Week 24, 52 ] [ Designated as safety issue: Yes ]
• DAS28(ESR) [ Time Frame: Week 24, 52 ] [ Designated as safety issue: Yes ]
• Modified Total Sharp Score [ Time Frame: Week 24 ] [ Designated as safety issue: Yes ]

The objectives of this study are to evaluate the safety and efficacy of certolizumab pegol when administered without coadministration of methotrexate over the long term in Japanese RA patients who transferred from Study 275-08-003 (NCT00791921), and to evaluate the effects of different dosing regimens on the safety and efficacy of certolizumab pegol in American College of Rheumatology 20% (ACR20) responders who completed Study 275-08-003.

This study was initiated by Otsuka Pharmaceutical Co., Ltd and transferred to Astellas on 12/04/2012.

• Experimental: Certolizumab pegol 200 mg
  Participants received 200 mg certolizumab pegol by subcutaneous injection once every 2 weeks for up to 52 weeks or until approval of certolizumab pegol for rheumatoid arthritis in Japan.
  Intervention: Drug: Certolizumab pegol
• Experimental: Certolizumab pegol 400 mg
  Participants received 400 mg certolizumab pegol by subcutaneous injection once every 4 weeks for up to 52 weeks or until approval of certolizumab pegol for rheumatoid arthritis in Japan.
  Intervention: Drug: Certolizumab pegol

Inclusion Criteria:

• Subjects who participated in Study 275-08-003 and meet all of the criteria described below.

  • Patients who did not reach ACR20, and prematurely discontinued Study 275-08-003 at Week 16 or completed Study 275-08-003 by Week 24.

Exclusion Criteria:

• Patients who experienced an important protocol deviation as mentioned below during Study 275-08-003.
• Patients who received live or attenuated vaccines during Study 275-08-003 (Except for influenza or pneumococcal vaccines).
• Patients who were found to have tuberculosis on a chest X-ray during Study 275-08-003.
• Patients who required treatment for the same infection at two or more different times during Study 275-08-003
• Women who are pregnant, are lactating, of childbearing potential and wish to conceive during the study and post-study 3 months.
• Patients whom the investigator has decided to be inappropriate for participation in the study