A Phase IIIB Multicenter, Randomized, Double-Blind, Double-Dummy Study toCompare the Efficacy and Safety of Abatacept Administered Subcutaneously andIntravenously in Subjects with Rheumatoid Arthritis, Receiving BackgroundMethotrexate, and Experiencing an Inadequate Response to Methotrexate. (Short title: MTX-IR Study)Revised Protocol 01 incorporating Protocol amendment 02 (v2.0 date 19-dec-2007) and Protocol amendment 03 (v1.0, date 25-Apr-2008). And Pharmacogenetics Blood sample Amendment - Site Specific (v1.0, date 07-Sep-2007). - MTX-IR Study

Conditions: RHEUMATOID ARTHRITIS, NOS
MedDRA version: 9.1Level: LLTClassification code 10039073Term: Rheumatoid arthritis

Registration Number: EUCTR2007-005434-37-NL

Lead Sponsor: Bristol Myers Squibb International Corporation

Brief Summary: Not available

Detailed Description: Not available

Recruitment & Eligibility

Status: ot Recruiting

Sex: All

Target Recruitment: 2400

Inclusion Criteria

1) Signed Written Informed Consent
a) Subject is willing to participate in the study and signed the informed consent.

2) Target Population
a) Subjects must meet the criteria of the American Rheumatism Association (1987)
for the diagnosis of rheumatoid arthritis and the American College of Rheumatology (1991) functional Classes I, II, or III. (Protocol Appendices 3 and 4).
b) Subjects must have had rheumatoid arthritis for more than 1 year from the initial
diagnosis. Not Applicable per Amendment 03.
c) Subjects with stable renal, endocrine, hepatic, hematological, gastrointestinal,
pulmonary, cardiac, neurological or cerebral disease(s) (eg, diabetes mellitus,
congestive heart failure, chronic obstructive pulmonary disease) will be allowed
to participate in this study.
d) Subjects who are considered methotrexate inadequate responders by a treating
physician or investigator. Subjects must have been taking methotrexate for at least
3 months at a minimal weekly dose of 15 mg, and at a stable dose for 28 days
prior to randomization (Day 1). A methotrexate weekly dose as low as 10 mg is
permitted for subjects who can not tolerate higher doses. In this circumstance, the
10 mg weekly dose will be permitted if there is verifiable documentation in the
medical record prior to entry into the study that the subject could not tolerate
higher doses. Use of parenteral methotrexate is acceptable as clinically indicated.

3) Age and Sex
a) Men and women, ages = 18
Women of childbearing potential (WOCBP) must be using an adequate method of
contraception to avoid pregnancy throughout the study and for up to 10 weeks after the last dose of abatacept in such a manner that the risk of pregnancy is minimized.

4) Concomitant medication
Informed consent must be signed before making any changes in RA therapy, if those
are solely for the purpose of this study.
a) Drug stabilization requirements:
Oral corticosteriod treatment must have been reduced to the equivalent of = 10 mg
prednisone daily for 28 days and stabilized for at least 25 out of 28 days prior to treatment (Day 1). No intra-articular or IM injections of corticosteriods are permitted
within 28 days prior to treatment (Day 1).
b) Washout requirements:
Subjects receiving methotrexate monotherapy will not require a washout. Subjects
receiving combination RA therapy should discontinue their DMARDs (other than methotrexate) at least 28 days prior to treatment (Day 1).
Required washout periods (prior to Day 1):
At least 4 weeks for
- Gold
- Azathioprine
- Cyclosporin A and other Calcineurin inhibitors
- D-Penicillamine
- mycophenylate mofetil (CellCept®)
- Immunoadsorption columns
At least 8 weeks for
- Leflunomide (or perform active wash-out with cholestyramine according to
the manufacturer’s recommendations).

5) Disease Activity Requirements
The disease activity requirements will depend on whether the subject requires a
washout period (see Inclusion Criteria #4).
a) For subjects receiving methotrexate monotherapy (no washout):
At randomization (Day 1), subjects must have the following disease activity:
i) 10 or more swollen joints (66 joint count) and
ii) 12 or more tender joints (68 joint count) and
iii) C reactive protein (hsCRP) = 0.8 mg/dL (result used from screening visit).
b) For subjects receiving methotrexate plus other DMARDs (washout):
At screening visit, subjects must have the following disease activity:
i) 6 or more swollen joints (66 joint count) and
ii) 8 or more tender joint

Exclusion Criteria

1)Sex & Reproductive Status
a)WOCBP unwilling or unable to use an acceptable method to avoid
pregnancy for entire study period & up to 10 weeks after last dose of
investigational product
b)pregnant or breastfeeding Women
c)Women with positive pregnancy test on enrollment or prior to IMP administration

2)Target Disease Exceptions
a)Subjects who meet diagnostic criteria for any other rheumatic disease (eg, lupus
erythematous)
b)Subjects with active vasculitis of a major organ system (except for subcutaneous
rheumatoid nodules)

3)Medical History & Concurrent Diseases
a)Subjects who are impaired, incapacitated, or incapable of completing study
related assessments
b)Current symptoms of severe, progressive, or uncontrolled renal, hepatic,
hematological, gastrointestinal, pulmonary, cardiac, neurological, or cerebral
disease. Concomitant medical conditions that, in opinion of the investigator,
might place subject at unacceptable risk for participation in this study
c)Female subjects who have had breast cancer screening study that is suspicious
for malignancy & in whom the possibility of malignancy cannot be reasonably
excluded following additional clinical, laboratory or other diagnostic evaluations
(Protocol Section 6.3.6)
d)Subjects with history of cancer within the last 5 years (other than nonmelanoma skin cell cancers cured by local resection). Existing non-melanoma
skin cell cancers must be removed prior to dosing. Subjects with carcinoma in
situ, treated with definitive surgical intervention prior to study entry, are allowed
e)Subjects who have clinically significant drug or alcohol abuse
f)Subjects with serious acute bacterial infection (such as pneumonia or
pyelonephritis unless treated & completely resolved with antibiotics)
g)Subjects with severe chronic or recurrent bacterial infections (such as recurrent
pneumonia, chronic bronchiectasis)
h)Subjects at risk for TB. Specifically subjects with:
i)Current clinical, radiographic or laboratory evidence of active or latent TB
ii)A history of active TB within the last 3 years even if it was treated.
iii)A history of active TB > 3 years ago unless there is documentation
that prior anti-TB treatment was appropriate in duration & type
iv)Latent TB which was not successfully treated. Subjects with a positive TB
screening test indicative of latent TB will not be eligible for the study unless
active TB infection has been ruled out & they have initiated treatment for
latent TB with isoniazid (INH) for at least 4 weeks prior to dosing of study
drug and they have a negative chest X-ray at enrollment. Such subjects should
complete 9 months of INH treatment
i)Subjects with herpes zoster that resolved < 2 months prior to enrollment
j)Subjects with evidence (as assessed by investigator) of active or latent
bacterial or viral infections at time of potential enrollment, including subjects
with evidence of HIV infection

4)Physical & Laboratory Test Findings
a)Hepatitis B surface antigen-positive subjects
b)Hepatitis C antibody-positive subjects who are also RIBA-positive or PCR
positive
c)Subjects with any of following laboratory values:
i)Hgb <8.5 g/dL
ii)WBC <3,000/mm³
iii)Platelets <100,000/mm³
iv)Serum creatinine >2 x upper limit of normal
v)Serum ALT or AST >2 x upper limit of normal
vi)Any other laboratory test results that might place subject at unacceptable risk
for participation in this study