A Study to Evaluate Efficacy and Safety of ASP015K in Patients With Rheumatoid Arthritis (RA) Who Had an Inadequate Response to Methotrexate (MTX) Treatment
- Conditions
- Rheumatoid Arthritis
- Interventions
- Registration Number
- NCT02305849
- Lead Sponsor
- Astellas Pharma Inc
- Brief Summary
The objective of this study was to verify the efficacy of ASP015K versus placebo administrated in combination with methotrexate (MTX) over placebo in terms of efficacy in participants with rheumatoid arthritis (RA) who had an inadequate response to MTX
- Detailed Description
This study was a multi-center, randomized, placebo-controlled, double-blind, parallel-group, confirmatory study to evaluate the efficacy and safety of ASP015K (100 and 150 mg/day) administered in combination with MTX in participants with RA who had an inadequate response to MTX.
Participants orally received ASP015K 100 mg, ASP015K 150 mg or placebo once daily (QD) in combination with MTX after breakfast for 52 weeks.
At Week 12, inadequate responders in the placebo group, as determined by a \< 20% improvement from baseline (i.e., treatment initiation day) in tender or painful joint count (TJC) and swollen joint count (SJC), were switched to either ASP015K 100 mg or ASP015K 150 mg, and the dosage was maintained until the end of treatment (EOT). In addition, participants who received placebo at Week 28 were switched to either ASP015K 100 mg or ASP015K 150 mg, and the dosage was maintained until the EOT.
The ASP015K dose that was started for placebo group participants at Week 12 or Week 28 was randomly chosen at baseline. The dose was switched under the blinded condition.
Participants who completed this study were eligible for participation in the open-label extension study (015K-CL-RAJ2). Participants made a follow-up visit after the week 52 visit if they did not enroll into the extension study on the day of the week 52 visit.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 519
-
Subject has RA of < 10 years duration at baseline that was diagnosed according to the 1987 American College of Rheumatology (ACR) criteria or the 2010 American College of Rheumatology/European League against Rheumatism (ACR/EULAR) criteria
-
Subject who did not receive the following drugs, or received the drugs with stable dosage for at least 28 days prior to the baseline (start of treatment) for RA treatment:
- Non-steroidal anti-inflammatory drugs (NSAIDs; excluding topical formulations with a local action), oral morphine or equivalent opioid analgesics (≤ 30 mg/day), acetaminophen, or oral corticosteroids (≤ 10 mg/day in prednisolone equivalent)
-
At screening subject has active RA as evidenced by both of the following:
- ≥ 6 tender/painful joints (using 68-joint assessment)
- ≥ 6 swollen joints (using 66-joint assessment)
-
CRP (latex agglutination test) of ≥ 1.00 mg/dL at screening.
-
Subject meets the ACR 1991 Revised Criteria for the Classification of Global Functional Status in RA Class I, II or, III at screening
-
Inadequate responders to MTX which was continuously administered for at least 90 days prior to screening and MTX ≥ 8 mg/week for at least 28 days prior to baseline. However, inadequate responder to MTX < 8 mg/week is eligible if intolerance precludes dose increase and defined as MTX-IR
-
Subject is able to continue stable dose of MTX (a maximum of 16 mg/week) from at least 28 days prior to screening until the end of treatment
-
Subject has bone erosion at the joint (as evidenced by x-rays of hands and feet) assessed in mTSS and any of the following apply at screening. Bone erosion may be evidenced by x-rays within 90 days prior to baseline.
- Positive anti-CCP antibody: ≥ 4.5 U/mL
- Positive rheumatoid factor: > 15 IU/mL
-
Subject has received a biologic DMARD within the specified period
-
Inadequate responders to biologic DMARD as determined by investigator/sub-investigator
-
Subject has received intra-articular, intravenous, intramuscular or endorectal (excluding suppositories for anal diseases) corticosteroid within 28 days prior to baseline
-
Subject has participated in any study of ASP015K and has received ASP015K or placebo
-
Subject has received other investigational drugs within 90 days or within 5 half-lives, whichever is longer, prior to baseline
-
Subject has received plasma exchange therapy within 60 days prior to baseline
-
Subject has undergone joint drainage, has received local anesthesia and nerve block, or has received articular cartilage protectant at the assessed joint within 28 days prior to baseline
-
Subject has undergone surgery and has residual effects in the assessed joints at the discretion of investigator/sub-investigator, or is scheduled to undergo surgery that may affect the study evaluation of the assessed joints at the discretion of investigator/sub-investigator
-
A diagnosis of inflammatory arthritis (psoriatic arthritis, ankylosing spondylitis, SLE, sarcoidosis, etc.) other than RA
-
Any of the following laboratory values at screening:
- Hemoglobin < 9.0 g/dL
- Absolute neutrophil count < 1000/μL
- Absolute lymphocyte count < 800/μL
- Platelet count < 75000/μL
- ALT ≥ 2 ×ULN
- AST ≥ 2 × ULN
- Total bilirubin (TBL) ≥ 1.5 × ULN
- Estimated GFR ≤ 40 mL/min as measured by the MDRD method
- β-D-glucan ≥ 11 pg/mL
- Positive HBs antigen, HBc antibody, HBs antibody or HBV-DNA quantitation (However, subject with negative HBs antigen and HBV-DNA quantitation, and positive HBc antibody and/or HBs antibody is eligible if HBV-DNA is monitored by HBV-DNA quantitation at every scheduled visit after initiation of study drug administration.)
- Positive HCV antibody
-
Subject has a history of or concurrent active tuberculosis (TB)
-
Subject has a history of or concurrent interstitial pneumonia and investigator/sub-investigator judges that it is inappropriate for the subject to participate in this study
-
Subject has a history of or concurrent malignant tumor (except for successfully treated basal cell carcinoma)
-
Subject has received live or live attenuated virus vaccination within 56 days prior to baseline. (Inactivated vaccines including influenza and pneumococcal vaccines are allowed.)
-
Subject has any ongoing severe, progressive, or uncontrolled renal, hepatic, hematological, gastrointestinal, metabolic, endocrine, pulmonary, cardiac, neurological, infectious, or autoimmune disease except for RA (excluding Sjogren's syndrome and chronic thyroiditis), or any ongoing illness which would make the subject unsuitable for the study as determined by the investigator/sub-investigator
-
Subject has a history of clinically significant allergy. (Clinically significant allergy includes allergies such as systemic urticaria induced by specific antigens and drugs, anaphylaxis, and allergy associated with shock necessitating hospitalized treatment.)
-
Subject has concurrent cardiac failure, defined as NYHA classification Class III or higher, or a history of it
-
Subject has concurrent prolonged QT syndrome or a history of it. Subject has prolonged QT interval (defined as QTc ≥ 500 msec. Subject has QTc ≥ 500 msec at retest will be excluded) at screening
-
Subject has a history of positive HIV infection
-
Subject has congenital short QT syndrome or a history of it. Subject has shortened QT interval (defined as QTc < 330 msec. Subject has QTc < 330 msec at retest will be excluded) at screening.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Placebo Placebo Participants who received placebo matching to peficitinib 100 mg or 150 mg orally once daily in combination with MTX until week 12 or 28 were switched to receive 100 mg or 150 mg tablet of peficitinib orally once daily in combination with MTX from week 12 or 28 to week 52. Peficitinib 150 mg Peficitinib Participants received 150 mg tablet of peficitinib orally once daily in combination with MTX for a period of 52 weeks. Peficitinib 100 mg Peficitinib Participants received 100 mg tablet of peficitinib orally once daily in combination with MTX for a period of 52 weeks. Peficitinib 100 mg Methotrexate Participants received 100 mg tablet of peficitinib orally once daily in combination with MTX for a period of 52 weeks. Placebo Methotrexate Participants who received placebo matching to peficitinib 100 mg or 150 mg orally once daily in combination with MTX until week 12 or 28 were switched to receive 100 mg or 150 mg tablet of peficitinib orally once daily in combination with MTX from week 12 or 28 to week 52. Peficitinib 150 mg Methotrexate Participants received 150 mg tablet of peficitinib orally once daily in combination with MTX for a period of 52 weeks.
- Primary Outcome Measures
Name Time Method Percentage of Participants With an American College of Rheumatology 20% (ACR20) C-Reactive Protein (CRP) Response at Week 12 Baseline and week 12/Early termination (ET) ACR20 response: greater than and equal to (≥) 20 percent (%) improvement in tender and swollen joint count; and ≥ 20% improvement in at least 3 of the following 5 criteria compared with baseline: 1) physician's global assessment of disease activity, 2) participant's assessment of disease activity, 3) participant's assessment of pain, 4) participant's assessment of functional disability via a health assessment questionnaire, and 5) C-reactive protein at each visit.
Change From Baseline in mTSS at Week 28 Baseline and week 28/ET mTSS was defined as the sum of joint erosion scores graded by assessing erosion severity in 44 joints (16 per hand and 6 per feet) and JSN scores graded by assessing narrowing of joint spaces in 42 joints (15 per hand and 6 per feet). Erosion score was scored from 0 (no erosion) to 5 (complete collapse of bone) and 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). 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. mTSS scores ranged from 0 (normal) to 448 (worst possible total score). Change from baseline was calculated as score at week 28 (ET) minus score at baseline. An increase in mTSS from baseline represented disease progression and/or joint worsening, no change represented halting of disease progression, and a decrease represented improvement.
- Secondary Outcome Measures
Name Time Method Percentage of Participants Achieving DAS28-CRP Score < 2.6 at Week 12 Week 12/ET DAS28-CRP response consisted of following parameters: TJC (28 joints), SJC (28 joints), CRP, SGA, and calculated according to description: DAS28 = 0.56√(TJC) + 0.28√(SJC) + 0.36 ln (CRP + 1) + 0.014 × SGA + 0.96. DAS28-CRP scores range from 0.96 to approximately 10. If the DAS28 score was less than 2.6, the participant was considered to be in DAS28 remission.
Percentage of Participants With a European League Against Rheumatism (EULAR) Good Response Using DAS28-CRP at Week 12 Week 12/ET The Disease Activity Score Based on 28-joints Count based EULAR response criteria were used to measure individual response as none, good, and moderate, depending on the extent of change from baseline and the level of disease activity reached. Good responders: change from baseline \>1.2 with DAS28 =\< 3.2; moderate responders: change from baseline \>1.2 with DAS28 \>3.2 to =\<5.1 or change from baseline \>0.6 to =\<1.2 with DAS28 =\<5.1; non-responders: change from baseline =\< 0.6 or change from baseline \>0.6 and =\<1.2 with DAS28 \>5.1. Percentage of participants with good response have been reported in this outcome measure.
Percentage of Participants With a EULAR Good Response Using DAS28-CRP Through Week 52 Weeks 4, 8, 12, 16, 20, 24, 28, 32, 36, 40, 44, 48, 52 and EOT The Disease Activity Score Based on 28-joints Count based EULAR response criteria were used to measure individual response as none, good, and moderate, depending on the extent of change from baseline and the level of disease activity reached. Good responders: change from baseline \>1.2 with DAS28 =\< 3.2; moderate responders: change from baseline \>1.2 with DAS28 \>3.2 to =\<5.1 or change from baseline \>0.6 to =\<1.2 with DAS28 =\<5.1; non-responders: change from baseline =\< 0.6 or change from baseline \>0.6 and =\<1.2 with DAS28 \>5.1. Percentage of participants with good response have been reported in this outcome measure.
Percentage of Participants Achieving DAS28-ESR Score <= 3.2 at Week 12 Week 12/ET DAS28-ESR response consisted of following parameters: TJC (28 joints), SJC (28 joints), ESR, SGA , and calculated according to description: DAS28 = 0.56√(TJC) + 0.28√(SJC) + 0.70 ln ESR + 0.014 × SGA. DAS28-ESR scores range from 0 to approximately 10. DAS28 score of less than or equal to 3.2 was considered to be low disease activity.
Percentage of Participants Achieving DAS28-ESR Score <= 3.2 Through Week 52 Weeks 4, 8, 12, 16, 20, 24, 28, 32, 36, 40, 44, 48, 52 and EOT DAS28-ESR response consisted of following parameters: TJC (28 joints), SJC (28 joints), ESR, SGA , and calculated according to description: DAS28 = 0.56√(TJC) + 0.28√(SJC) + 0.70 ln ESR + 0.014 × SGA. DAS28-ESR scores range from 0 to approximately 10. DAS28 score of less than or equal to 3.2 was considered to be low disease activity.
Change From Baseline in CRP at Week 12 Baseline and week 12/ET Higher CRP indicates greater disease activity.
Change From Baseline in CRP Through Week 52 Baseline, weeks 4, 8, 12, 16, 20, 24, 28, 32, 36, 40, 44, 48, 52 and EOT Higher CRP indicates greater disease activity.
Change From Baseline in ESR at Week 12 Baseline and week 12/ET Higher ESR indicates greater disease activity.
Change From Baseline in ESR Through Week 52 Baseline, weeks 4, 8, 12, 16, 20, 24, 28, 32, 36, 40, 44, 48, 52 and EOT Higher ESR indicates greater disease activity.
Percentage of Participants Achieving DAS28-CRP Score < 2.6 Through Week 52 Weeks 4, 8, 12, 16, 20, 24, 28, 32, 36, 40, 44, 48, 52 and EOT DAS28-CRP response consisted of following parameters: TJC (28 joints), SJC (28 joints), CRP, SGA, and calculated according to description: DAS28 = 0.56√(TJC) + 0.28√(SJC) + 0.36 ln (CRP + 1) + 0.014 × SGA + 0.96. DAS28-CRP scores range from 0.96 to approximately 10. If the DAS28 score was less than 2.6, the participant was considered to be in DAS28 remission.
Change From Baseline in SJC (66 Joints) at Week 12 Baseline and week 12/ET The participants were examined for the swollen joints and the location was confirmed by the investigator who assessed the following 66 joints which included temporomandibular joints (2), sternoclavicular joints (2), acromioclavicular joints (2), shoulder joints (2), elbow joints (2), wrist joints (2), distal interphalangeal joints (8), proximal interphalangeal joints of both hands (10), metacarpophalangeal joints (10), knee joints (2), ankle joints (2), tarsal bones (2), metatarsophalangeal joints (10), interphalangeal joint joints of toes (2), proximal interphalangeal joints of both feet (8). Higher SJC indicated greater disease activity.
Change From Baseline in SJC (66 Joints) Through Week 52 Baseline, weeks 4, 8, 12, 16, 20, 24, 28, 32, 36, 40, 44, 48, 52 and EOT The participants were examined for the swollen joints and the location was confirmed by the investigator who assessed the following 66 joints which included temporomandibular joints (2), sternoclavicular joints (2), acromioclavicular joints (2), shoulder joints (2), elbow joints (2), wrist joints (2), distal interphalangeal joints (8), proximal interphalangeal joints of both hands (10), metacarpophalangeal joints (10), knee joints (2), ankle joints (2), tarsal bones (2), metatarsophalangeal joints (10), interphalangeal joint joints of toes (2), proximal interphalangeal joints of both feet (8). Higher SJC indicated greater disease activity.
Percentage of Participants Achieving DAS28-CRP Score <= 3.2 Through Week 52 Weeks 4, 8, 12, 16, 20, 24, 28, 32, 36, 40, 44, 48, 52 and EOT DAS28-CRP response consisted of following parameters: TJC (28 joints), SJC (28 joints), CRP, SGA, and calculated according to description: DAS28 = 0.56√(TJC) + 0.28√(SJC) + 0.36 ln (CRP + 1) + 0.014 × SGA + 0.96. DAS28-CRP scores range from 0.96 to approximately 10. DAS28 score of less than or equal to 3.2 was considered to be low disease activity.
Percentage of Participants With a Good or Moderate EULAR Response Using DAS28-CRP Through Week 52 Weeks 4, 8, 12, 16, 20, 24, 28, 32, 36, 40, 44, 48, 52 and EOT The Disease Activity Score Based on 28-joints Count based EULAR response criteria were used to measure individual response as none, good, and moderate, depending on the extent of change from baseline and the level of disease activity reached. Good responders: change from baseline \>1.2 with DAS28 =\< 3.2; moderate responders: change from baseline \>1.2 with DAS28 \>3.2 to =\<5.1 or change from baseline \>0.6 to =\<1.2 with DAS28 =\<5.1; non-responders: change from baseline =\< 0.6 or change from baseline \>0.6 and =\<1.2 with DAS28 \>5.1. Percentage of participants with good or moderate response have been reported in this outcome measure.
Percentage of Participants With an ACR20-CRP Response Through Week 52 Baseline, weeks 4, 8, 12, 16, 20, 24, 28, 32, 36, 40, 44, 48, 52 and EOT ACR20 response:≥ 20% improvement in tender and swollen joint count; and ≥ 20% improvement in at least 3 of the following 5 criteria compared with baseline: 1) physician's global assessment of disease activity, 2) participant's assessment of disease activity, 3) participant's assessment of pain, 4) participant's assessment of functional disability via a health assessment questionnaire, and 5) C-reactive protein at each visit. EOT was defined as end of treatment i.e, either early termination or week 52.
Percentage of Participants With an ACR50-CRP Response at Week 12 Baseline and week 12/ET ACR50 response: ≥50% improvement in tender and swollen joint counts and 50% improvement in 3 of the following 5 criteria compared with baseline: 1) physician's global assessment of disease activity, 2) participant's assessment of disease activity, 3) participant's assessment of pain, 4) participant's assessment of functional ability via a health assessment questionnaire-Disability Index, and 5) C-reactive protein at each visit.
Percentage of Participants With an ACR50-CRP Response Through Week 52 Baseline, weeks 4, 8, 12, 16, 20, 24, 28, 32, 36, 40, 44, 48, 52 and EOT ACR50 response: ≥50% improvement in tender and swollen joint counts and 50% improvement in 3 of the following 5 criteria compared with baseline: 1) physician's global assessment of disease activity, 2) participant's assessment of disease activity, 3) participant's assessment of pain, 4) participant's assessment of functional ability via a health assessment questionnaire-Disability Index, and 5) C-reactive protein at each visit.
Percentage of Participants With an ACR70-CRP Response at Week 12 Baseline and week 12/ET ACR70 response: ≥ 70% improvement in tender and swollen joint counts and 70% improvement in 3 of the following 5 criteria compared with baseline: 1) physician's global assessment of disease activity, 2) participant's assessment of disease activity, 3) participant's assessment of pain, 4) participant's assessment of functional ability via a health assessment questionnaire-Disability Index, and 5) C-reactive protein at each visit.
Percentage of Participants With an ACR70-CRP Response Through Week 52 Baseline, weeks 4, 8, 12, 16, 20, 24, 28, 32, 36, 40, 44, 48, 52 and EOT ACR70 response: ≥ 70% improvement in tender and swollen joint counts and 70% improvement in 3 of the following 5 criteria compared with baseline: 1) physician's global assessment of disease activity, 2) participant's assessment of disease activity, 3) participant's assessment of pain, 4) participant's assessment of functional ability via a health assessment questionnaire-Disability Index, and 5) C-reactive protein at each visit.
Change From Baseline in mTSS at Week 52 Baseline and week 52/ET mTSS was defined as the sum of joint erosion scores graded by assessing erosion severity in 44 joints (16 per hand and 6 per feet) and JSN scores graded by assessing narrowing of joint spaces in 42 joints (15 per hand and 6 per feet). Erosion score was scored from 0 (no erosion) to 5 (complete collapse of bone) and 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). 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. mTSS scores ranged from 0 (normal) to 448 (worst possible total score). Change from baseline was calculated as score at week 52 (ET) minus score at baseline. An increase in mTSS from baseline represented disease progression and/or joint worsening, no change represented halting of disease progression, and a decrease represented improvement.
Change From Baseline in JSN Score at Week 28 and Week 52 Baseline and weeks 28/ET and 52/ET JSN was defined as narrowing in joint space width over the course of the study. 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. Higher scores indicate greater disease activity.
Change From Baseline in Erosion Score at Week 28 and Week 52 Baseline and weeks 28/ET and 52/ET The joint erosion score was a summary of erosion severity in 32 joints of the hands and 12 joints of the feet. Each joint in the hand is scored from 0-5 and each joint in the foot is scored from 0-10. The score for erosion ranges from 0 to 160 in the hands and from 0 to 120 in the feet. By summing these score, the range of total erosion score is 0-280. Higher erosion score indicates greater disease activity.
Percentage of Participants With a Good or Moderate EULAR Response Using DAS28-CRP at Week 12 Week 12/ET The Disease Activity Score Based on 28-joints Count based EULAR response criteria were used to measure individual response as none, good, and moderate, depending on the extent of change from baseline and the level of disease activity reached. Good responders: change from baseline \>1.2 with DAS28 =\< 3.2; moderate responders: change from baseline \>1.2 with DAS28 \>3.2 to =\<5.1 or change from baseline \>0.6 to =\<1.2 with DAS28 =\<5.1; non-responders: change from baseline =\< 0.6 or change from baseline \>0.6 and =\<1.2 with DAS28 \>5.1. Percentage of participants with good or moderate response have been reported in this outcome measure.
Percentage of Participants Achieving Change From Baseline in mTSS <= 0.5 at Week 28 and Week 52 Baseline and week 28/ET and 52/ET mTSS was defined as the sum of joint erosion scores graded by assessing erosion severity in 44 joints (16 per hand and 6 per feet) and JSN scores graded by assessing narrowing of joint spaces in 42 joints (15 per hand and 6 per feet). Erosion score was scored from 0 (no erosion) to 5 (complete collapse of bone) and 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). 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. mTSS scores ranged from 0 (normal) to 448 (worst possible total score). An increase in mTSS from baseline represented disease progression and/or joint worsening, no change represented halting of disease progression, and a decrease represented improvement.
Change From Baseline in Disease Activity Score (DAS) 28-CRP at Week 12 Baseline and week 12/ET DAS28-CRP response consisted of following parameters: TJC (28 joints), SJC (28 joints), CRP, SGA, and calculated according to description: DAS28 = 0.56√(TJC) + 0.28√(SJC) + 0.36 ln (CRP + 1) + 0.014 × SGA + 0.96. DAS28-CRP scores range from 0.96 to approximately 10. Higher DAS28 score indicated greater disease activity.
Change From Baseline in DAS28-CRP Through Week 52 Baseline, weeks 4, 8, 12, 16, 20, 24, 28, 32, 36, 40, 44, 48, 52 and EOT DAS28-CRP response consisted of following parameters: TJC (28 joints), SJC (28 joints), CRP, SGA, and calculated according to description: DAS28 = 0.56√(TJC) + 0.28√(SJC) + 0.36 ln (CRP + 1) + 0.014 × SGA + 0.96. DAS28-CRP scores range from 0.96 to approximately 10. Higher DAS28 score indicated greater disease activity.
Change From Baseline in DAS28-ESR at Week 12 Baseline and week 12/ET DAS28-ESR response consisted of following parameters: TJC (28 joints), SJC (28 joints), ESR, SGA , and calculated according to description: DAS28 = 0.56√(TJC) + 0.28√(SJC) + 0.70 ln ESR + 0.014 × SGA. DAS28-ESR scores range from 0 to approximately 10. Higher DAS28 score indicated greater disease activity.
Change From Baseline in DAS28-ESR Score Through Week 52 Baseline, weeks 4, 8, 12, 16, 20, 24, 28, 32, 36, 40, 44, 48, 52 and EOT DAS28-ESR response consisted of following parameters: TJC (28 joints), SJC (28 joints), ESR, SGA , and calculated according to description: DAS28 = 0.56√(TJC) + 0.28√(SJC) + 0.70 ln ESR + 0.014 × SGA. DAS28-ESR scores range from 0 to approximately 10. Higher DAS28 score indicated greater disease activity.
Change From Baseline in TJC (68 Joints) at Week 12 Baseline and week 12/ET The participants were examined for the tender joints and the location was confirmed by the investigator who assessed the following 68 joints which included temporomandibular joints (2), sternoclavicular joints (2), acromioclavicular joints (2), shoulder joints (2), elbow joints (2), wrist joints (2), distal interphalangeal joints (8), proximal interphalangeal joints of both hands (10), metacarpophalangeal joints (10), knee joints (2), ankle joints (2), tarsal bones (2), metatarsophalangeal joints (10), interphalangeal joint joints of toes (2), proximal interphalangeal joints of both feet (8). Higher TJC indicated greater disease activity.
Change From Baseline in TJC (68 Joints) Through Week 52 Baseline, weeks 4, 8, 12, 16, 20, 24, 28, 32, 36, 40, 44, 48, 52 and EOT The participants were examined for the tender joints and the location was confirmed by the investigator who assessed the following 68 joints which included temporomandibular joints (2), sternoclavicular joints (2), acromioclavicular joints (2), shoulder joints (2), elbow joints (2), wrist joints (2), distal interphalangeal joints (8), proximal interphalangeal joints of both hands (10), metacarpophalangeal joints (10), knee joints (2), ankle joints (2), tarsal bones (2), metatarsophalangeal joints (10), interphalangeal joint joints of toes (2), proximal interphalangeal joints of both feet (8). Higher TJC indicated greater disease activity.
Percentage of Participants Achieving DAS28-ESR Score < 2.6 at Week 12 Week 12/ET DAS28-ESR response consisted of following parameters: TJC (28 joints), SJC (28 joints), ESR, SGA , and calculated according to description: DAS28 = 0.56√(TJC) + 0.28√(SJC) + 0.70 ln ESR + 0.014 × SGA. DAS28-ESR scores range from 0 to approximately 10. If the DAS28 score was less than 2.6, the participant was considered to be in DAS28 remission.
Percentage of Participants Achieving DAS28-ESR Score < 2.6 Through Week 52 Weeks 4, 8, 12, 16, 20, 24, 28, 32, 36, 40, 44, 48, 52 and EOT DAS28-ESR response consisted of following parameters: TJC (28 joints), SJC (28 joints), ESR, SGA , and calculated according to description: DAS28 = 0.56√(TJC) + 0.28√(SJC) + 0.70 ln ESR + 0.014 × SGA. DAS28-ESR scores range from 0 to approximately 10. If the DAS28 score was less than 2.6, the participant was considered to be in DAS28 remission.
Percentage of Participants Achieving DAS28-CRP Score <= 3.2 at Week 12 Week 12/ET DAS28-CRP response consisted of following parameters: TJC (28 joints), SJC (28 joints), CRP, SGA, and calculated according to description: DAS28 = 0.56√(TJC) + 0.28√(SJC) + 0.36 ln (CRP + 1) + 0.014 × SGA + 0.96. DAS28-CRP scores range from 0.96 to approximately 10. DAS28 score of less than or equal to 3.2 was considered to be low disease activity.
Percentage of Participants With a EULAR Good Response Using DAS28-ESR at Week 12 Week 12/ET The Disease Activity Score Based on 28-joints Count based EULAR response criteria were used to measure individual response as none, good, and moderate, depending on the extent of change from baseline and the level of disease activity reached. Good responders: change from baseline \>1.2 with DAS28 =\< 3.2; moderate responders: change from baseline \>1.2 with DAS28 \>3.2 to =\<5.1 or change from baseline \>0.6 to =\<1.2 with DAS28 =\<5.1; non-responders: change from baseline =\< 0.6 or change from baseline \>0.6 and =\<1.2 with DAS28 \>5.1. Percentage of participants with good response have been reported in the outcome measure.
Percentage of Participants With a EULAR Good Response Using DAS28-ESR Through Week 52 Weeks 4, 8, 12, 16, 20, 24, 28, 32, 36, 40, 44, 48, 52 and EOT The Disease Activity Score Based on 28-joints Count based EULAR response criteria were used to measure individual response as none, good, and moderate, depending on the extent of change from baseline and the level of disease activity reached. Good responders: change from baseline \>1.2 with DAS28 =\< 3.2; moderate responders: change from baseline \>1.2 with DAS28 \>3.2 to =\<5.1 or change from baseline \>0.6 to =\<1.2 with DAS28 =\<5.1; non-responders: change from baseline =\< 0.6 or change from baseline \>0.6 and =\<1.2 with DAS28 \>5.1. Percentage of participants with good response have been reported in this outcome measure.
Percentage of Participants With a EULAR Good or Moderate Response Using DAS28-ESR at Week 12 Week 12/ET The Disease Activity Score Based on 28-joints Count based EULAR response criteria were used to measure individual response as none, good, and moderate, depending on the extent of change from baseline and the level of disease activity reached. Good responders: change from baseline \>1.2 with DAS28 =\< 3.2; moderate responders: change from baseline \>1.2 with DAS28 \>3.2 to =\<5.1 or change from baseline \>0.6 to =\<1.2 with DAS28 =\<5.1; non-responders: change from baseline =\< 0.6 or change from baseline \>0.6 and =\<1.2 with DAS28 \>5.1. Percentage of participants with good or moderate response have been reported in this outcome measure.
Percentage of Participants With a EULAR Good or Moderate Response Using DAS28-ESR Through Week 52 Weeks 4, 8, 12, 16, 20, 24, 28, 32, 36, 40, 44, 48, 52 and EOT The Disease Activity Score Based on 28-joints Count based EULAR response criteria were used to measure individual response as none, good, and moderate, depending on the extent of change from baseline and the level of disease activity reached. Good responders: change from baseline \>1.2 with DAS28 =\< 3.2; moderate responders: change from baseline \>1.2 with DAS28 \>3.2 to =\<5.1 or change from baseline \>0.6 to =\<1.2 with DAS28 =\<5.1; non-responders: change from baseline =\< 0.6 or change from baseline \>0.6 and =\<1.2 with DAS28 \>5.1. Percentage of participants with good or moderate response have been reported in this outcome measure.
Percentage of Participants Achieving ACR / EULAR Remission at Week 12 Week 12/ET ACR/EULAR Remission was defined as TJC (68 joints) ≤ 1, SJC (66 joints) ≤1, CRP ≤1 mg/dL, and participant's global assessment of arthritis ≤ 1 cm (on a visual analog scale (VAS) of 0 - 100 mm).
Percentage of Participants Achieving ACR / EULAR Remission Through Week 52 Weeks 4, 8, 12, 16, 20, 24, 28, 32, 36, 40, 44, 48, 52 and EOT ACR/EULAR Remission was defined as TJC (68 joints) ≤ 1, SJC (66 joints) ≤1, CRP ≤1 mg/dL, and participant's global assessment of arthritis ≤ 1 cm (on a visual analog scale (VAS) of 0 - 100 mm).
Percentage of Participants Achieving Simplified Disease Activity Index (SDAI) Remission <=3.3 at Week 12 Week 12/ET SDAI score consisted of following parameters: TJC (28 joints), SJC (28 joints), SGA, PGA, CRP (mg/dL), and calculated according to description. SDAI = TJC + SJC + SGA + PGA + CRP. SDAI Remission was defined as SDAI score ≤ 3.3.
Percentage of Participants Achieving SDAI Remission Score <=3.3 Through Week 52 Weeks 4, 8, 12, 16, 20, 24, 28, 32, 36, 40, 44, 48, 52 and EOT SDAI score consisted of following parameters: TJC (28 joints), SJC (28 joints), SGA, PGA, CRP (mg/dL), and calculated according to description. SDAI = TJC + SJC + SGA + PGA + CRP. SDAI Remission was defined as SDAI score ≤ 3.3.
Change From Baseline in SDAI Score at Week 12 Baseline and week 12/ET SDAI score consisted of following parameters: TJC (28 joints), SJC (28 joints), SGA, PGA, CRP (mg/dL), and calculated according to description: SDAI = TJC + SJC + SGA + PGA + CRP. The SDAI score ranges from 0 to approximately 86. Higher SDAI indicates greater disease activity.
Change From Baseline in SDAI Score Through Week 52 Baseline, weeks 4, 8, 12, 16, 20, 24, 28, 32, 36, 40, 44, 48, 52 and EOT SDAI score consisted of following parameters: TJC (28 joints), SJC (28 joints), SGA, PGA, CRP (mg/dL), and calculated according to description: SDAI = TJC + SJC + SGA + PGA + CRP. The SDAI score ranges from 0 to approximately 86. Higher SDAI indicates greater disease activity.
Change From Baseline in PGA at Week 12 Baseline and week 12/ET The investigator assessed the participants' disease activity on a VAS of 0-100 mm on the physician assessment table. Higher PGA (100 mm VAS) scores indicate greater activity impairment.
Change From Baseline in PGA Through Week 52 Baseline, weeks 4, 8, 12, 16, 20, 24, 28, 32, 36, 40, 44, 48, 52 and EOT The investigator assessed the participants disease activity on a VAS of 0-100 mm on the physician assessment table. Higher PGA (100 mm VAS) scores indicate greater activity impairment.
Change From Baseline in SGA at Week 12 Baseline and week 12/ET The participant assessed his/her own disease activity on a VAS of 0-100 mm on the questionnaire form. Higher SGA (100 mm VAS) scores indicate greater activity impairment.
Change From Baseline in SGA Through Week 52 Baseline, weeks 4, 8, 12, 16, 20, 24, 28, 32, 36, 40, 44, 48, 52 and EOT The participant assessed his/her own disease activity on a VAS of 0-100 mm on the questionnaire form. Higher SGA (100 mm VAS) scores indicate greater activity impairment.
Change From Baseline in SGAP at Week 12 Baseline and week 12/ET The participant assessed his/her own pain severity on a visual analog scale (VAS) of 0-100 mm on the questionnaire form. Higher SGA of pain (100 mm VAS) scores indicated greater activity pain.
Change From Baseline in SGAP Through Week 52 Baseline, weeks 4, 8, 12, 16, 20, 24, 28, 32, 36, 40, 44, 48, 52 and EOT The participant assessed his/her own pain severity on a visual analog scale (VAS) of 0-100 mm on the questionnaire form. Higher SGA of pain (100 mm VAS) scores indicated greater activity pain.
Number of Participants Who Withdrew Due to Lack of Efficacy Up to week 52 Participants who discontinued due to lack of efficacy have been reported.
Change From Baseline in HAQ-DI at Week 12 Baseline and week 12/ET Participant-reported assessment of ability to perform tasks in 8 categories of daily living activities: dress/groom; arise; eat; walk; reach; grip; hygiene; and common activities over past week. Each item was scored on 4-point scale from 0 to 3: 0=no difficulty; 1=some difficulty; 2=much difficulty; 3=unable to do. Overall score was computed as the sum of domain scores and divided by the number of domains answered. Total possible score range 0-3 where 0 = least difficulty and 3 = extreme difficulty.
Change From Baseline in HAQ-DI Through Week 52 Baseline, weeks 4, 8, 12, 16, 20, 24, 28, 32, 36, 40, 44, 48, 52 and EOT Participant-reported assessment of ability to perform tasks in 8 categories of daily living activities: dress/groom; arise; eat; walk; reach; grip; hygiene; and common activities over past week. Each item was scored on 4-point scale from 0 to 3: 0=no difficulty; 1=some difficulty; 2=much difficulty; 3=unable to do. Overall score was computed as the sum of domain scores and divided by the number of domains answered. Total possible score range 0-3 where 0 = least difficulty and 3 = extreme difficulty.
Change From Baseline in Short Form Health Survey - 36 Questions, Version 2 (SF-36v2) Physical Component Summary Score at Week 12 Baseline and week 12/ET The SF-36v2 was scored for the 8 subscales (each range: 0-100 scale): 1. physical functioning, 2. role physical, 3. bodily pain, 4. general health, 5. vitality, 6. social functioning, 7. role-emotional, and 8. mental health. Physical Component Summary Score, Mental Component Summary Score and Roll/Social Component Summary Score were calculated based on the 2007 General Japanese Population Means and Standard Deviations and coefficient. Component summary measures had means of 50 in 2007 General Japanese Population and deviation was expressed by the scale of 10. Higher score indicated better health state.
Change From Baseline in SF-36v2 Physical Component Summary Score Through Week 52 Baseline, weeks 4, 8, 12, 28, 52 and EOT The SF-36v2 was scored for the 8 subscales (each range: 0-100 scale): 1. physical functioning, 2. role physical, 3. bodily pain, 4. general health, 5. vitality, 6. social functioning, 7. role-emotional, and 8. mental health. Physical Component Summary Score, Mental Component Summary Score and Roll/Social Component Summary Score were calculated based on the 2007 General Japanese Population Means and Standard Deviations and coefficient. Component summary measures had means of 50 in 2007 General Japanese Population and deviation was expressed by the scale of 10. Higher score indicated better health state.
Change From Baseline in SF-36v2 Mental Component Summary Score at Week 12 Baseline and week 12/ET The SF-36v2 was scored for the 8 subscales (each range: 0-100 scale): 1. physical functioning, 2. role physical, 3. bodily pain, 4. general health, 5. vitality, 6. social functioning, 7. role-emotional, and 8. mental health. Physical Component Summary Score, Mental Component Summary Score and Roll/Social Component Summary Score were calculated based on the 2007 General Japanese Population Means and Standard Deviations and coefficient. Component summary measures had means of 50 in 2007 General Japanese Population and deviation was expressed by the scale of 10. Higher score indicated better health state.
Change From Baseline in SF-36v2 Mental Component Summary Score Through Week 52 Baseline, weeks 4, 8, 12, 28, 52 and EOT The SF-36v2 was scored for the 8 subscales (each range: 0-100 scale): 1. physical functioning, 2. role physical, 3. bodily pain, 4. general health, 5. vitality, 6. social functioning, 7. role-emotional, and 8. mental health. Physical Component Summary Score, Mental Component Summary Score and Roll/Social Component Summary Score were calculated based on the 2007 General Japanese Population Means and Standard Deviations and coefficient. Component summary measures had means of 50 in 2007 General Japanese Population and deviation was expressed by the scale of 10. Higher score indicated better health state.
Change From Baseline in SF-36v2 Role/Social Component Summary Score at Week 12 Baseline and week 12/ET The SF-36v2 was scored for the 8 subscales (each range: 0-100 scale): 1. physical functioning, 2. role physical, 3. bodily pain, 4. general health, 5. vitality, 6. social functioning, 7. role-emotional, and 8. mental health. Physical Component Summary Score, Mental Component Summary Score and Roll/Social Component Summary Score were calculated based on the 2007 General Japanese Population Means and Standard Deviations and coefficient. Component summary measures had means of 50 in 2007 General Japanese Population and deviation was expressed by the scale of 10. Higher score indicated better health state.
Change From Baseline in SF-36v2 Role/Social Component Summary Score Through Week 52 Baseline, weeks 4, 8, 12, 28, 52 and EOT The SF-36v2 was scored for the 8 subscales (each range: 0-100 scale): 1. physical functioning, 2. role physical, 3. bodily pain, 4. general health, 5. vitality, 6. social functioning, 7. role-emotional, and 8. mental health. Physical Component Summary Score, Mental Component Summary Score and Roll/Social Component Summary Score were calculated based on the 2007 General Japanese Population Means and Standard Deviations and coefficient. Component summary measures had means of 50 in 2007 General Japanese Population and deviation was expressed by the scale of 10. Higher score indicated better health state.
Change From Baseline in Work Productivity and Activity Impairment Questionnaire (WPAI) Percent Work Time Missed at Week 12 Baseline and week 12/ET WPAI consisted of 6 questions (Q1=Employment status; Q2=Hours absent from work due to the rheumatoid arthritis; Q3=Hours absent from work due to other reasons; Q4=Hours actually worked; Q5=Impact of the rheumatoid arthritis on productivity while working; Q6=Impact of the rheumatoid arthritis on productivity while doing regular daily activities other than work). Higher WPAI scores indicated greater activity impairment. The scores were multiplied by 100 to express in percentages. Percent work time missed due to problem was calculated as Q2/(Q2+Q4). Negative values indicate improvement from baseline.
Change From Baseline in WPAI Percent Work Time Missed Through Week 52 Baseline, weeks 4, 8, 12, 28, 52 and EOT WPAI consisted of 6 questions (Q1=Employment status; Q2=Hours absent from work due to the rheumatoid arthritis; Q3=Hours absent from work due to other reasons; Q4=Hours actually worked; Q5=Impact of the rheumatoid arthritis on productivity while working; Q6=Impact of the rheumatoid arthritis on productivity while doing regular daily activities other than work). Higher WPAI scores indicated greater activity impairment. The scores were multiplied by 100 to express in percentages. Percent work time missed due to problem was calculated as Q2/(Q2+Q4). Negative values indicate improvement from baseline.
Change From Baseline in WPAI Percent Impairment While Working at Week 12 Baseline and week 12/ET WPAI consisted of 6 questions (Q1=Employment status; Q2=Hours absent from work due to the rheumatoid arthritis; Q3=Hours absent from work due to other reasons; Q4=Hours actually worked; Q5=Impact of the rheumatoid arthritis on productivity while working; Q6=Impact of the rheumatoid arthritis on productivity while doing regular daily activities other than work). Higher WPAI scores indicated greater activity impairment. The scores were multiplied by 100 to express in percentages. Percent impairment while working due to problem was calculated as Q5/10. Negative values indicate improvement from baseline.
Change From Baseline in WPAI Percent Overall Work Impairment Through Week 52 Baseline, weeks 4, 8, 12, 28, 52 and EOT WPAI consisted of 6 questions (Q1=Employment status; Q2=Hours absent from work due to the rheumatoid arthritis; Q3=Hours absent from work due to other reasons; Q4=Hours actually worked; Q5=Impact of the rheumatoid arthritis on productivity while working; Q6=Impact of the rheumatoid arthritis on productivity while doing regular daily activities other than work). Higher WPAI scores indicated greater activity impairment. The scores were multiplied by 100 to express in percentages. Percent overall work impairment due to problem was calculated as Q2/(Q2+Q4)+\[(1-(Q2/(Q2+Q4))x(Q5/10)\]. Negative values indicate improvement from baseline.
Change From Baseline in WPAI Percent Activity Impairment at Week 12 Baseline and week 12/ET WPAI consisted of 6 questions (Q1=Employment status; Q2=Hours absent from work due to the rheumatoid arthritis; Q3=Hours absent from work due to other reasons; Q4=Hours actually worked; Q5=Impact of the rheumatoid arthritis on productivity while working; Q6=Impact of the rheumatoid arthritis on productivity while doing regular daily activities other than work) and a 1-week recall period. Higher WPAI scores indicated greater activity impairment. The scores were multiplied by 100 to express in percentages. Percent activity impairment due to problem was calculated as Q6/10. Negative values indicate improvement from baseline.
Change From Baseline in WPAI Percent Activity Impairment Through Week 52 Baseline, weeks 4, 8, 12, 28, 52 and EOT WPAI consisted of 6 questions (Q1=Employment status; Q2=Hours absent from work due to the rheumatoid arthritis; Q3=Hours absent from work due to other reasons; Q4=Hours actually worked; Q5=Impact of the rheumatoid arthritis on productivity while working; Q6=Impact of the rheumatoid arthritis on productivity while doing regular daily activities other than work) and a 1-week recall period. Higher WPAI scores indicated greater activity impairment. The scores were multiplied by 100 to express in percentages. Percent activity impairment due to problem was calculated as Q6/10. Negative values indicate improvement from baseline.
Number of Participants With Treatment-Emergent Adverse Events (TEAEs) During the First 12 Weeks Week 0 to week 12 TEAEs were defined as any AE that started or worsened in severity after initial dose of study drug or reference drug through week 52 or withdrawal. TEAEs were summarized using MedDRA (Version 11.1) by System Organ Class (SOC) and Preferred Term (PT). Participants reporting more than 1 AE for a given MedDRA PT were counted only once for that term. Participants reporting more than 1 AE within a SOC were counted only once for the SOC total. Based on National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE), AEs were graded as grade 1=mild; grade 2=moderate: grade 3 = severe or medically significant, grade 4 = life threatening, grade 5 = death related to AE.
Number of Participants With TEAEs From Week 12 to Week 28 Week 12 to week 28 TEAEs were defined as any AE that started or worsened in severity after initial dose of study drug or reference drug through week 52 or withdrawal. TEAEs were summarized using MedDRA (Version 11.1) by SOC and PT. Participants reporting more than 1 AE for a given MedDRA PT were counted only once for that term. Participants reporting more than 1 AE within a SOC were counted only once for the SOC total. Based on NCI-CTCAE, AEs were graded as grade 1=mild; grade 2=moderate: grade 3 = severe or medically significant, grade 4 = life threatening, grade 5 = death related to AE
Number of Participants With TEAEs From Week 28 to Week 52 Week 28 to week 52, plus 28 days after the week 52 visit for participants who did not enroll in the extension study TEAEs were defined as any AE that started or worsened in severity after initial dose of study drug or reference drug through week 52 or withdrawal. TEAEs were summarized using MedDRA (Version 11.1) by SOC and PT. Participants reporting more than 1 AE for a given MedDRA PT were counted only once for that term. Participants reporting more than 1 AE within a SOC were counted only once for the SOC total. Based on National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE), AEs were graded as grade 1=mild; grade 2=moderate: grade 3 = severe or medically significant, grade 4 = life threatening, grade 5 = death related to AE.
Change From Baseline in WPAI Percent Impairment While Working Through Week 52 Baseline, weeks 4, 8, 12, 28, 52 and EOT WPAI consisted of 6 questions (Q1=Employment status; Q2=Hours absent from work due to the rheumatoid arthritis; Q3=Hours absent from work due to other reasons; Q4=Hours actually worked; Q5=Impact of the rheumatoid arthritis on productivity while working; Q6=Impact of the rheumatoid arthritis on productivity while doing regular daily activities other than work). Higher WPAI scores indicated greater activity impairment. The scores were multiplied by 100 to express in percentages. Percent impairment while working due to problem was calculates as Q5/10. Negative values indicate improvement from baseline.
Change From Baseline in Percent Overall Work Impairment at Week 12 Baseline and week 12/ET WPAI consisted of 6 questions (Q1=Employment status; Q2=Hours absent from work due to the rheumatoid arthritis; Q3=Hours absent from work due to other reasons; Q4=Hours actually worked; Q5=Impact of the rheumatoid arthritis on productivity while working; Q6=Impact of the rheumatoid arthritis on productivity while doing regular daily activities other than work). Higher WPAI scores indicated greater activity impairment. The scores were multiplied by 100 to express in percentages. Percent overall work impairment due to problem was calculated as Q2/(Q2+Q4)+\[(1-(Q2/(Q2+Q4))x(Q5/10)\]. Negative values indicate improvement from baseline.
Trial Locations
- Locations (146)
JP00109
🇯🇵Nagoya, Aichi, Japan
JP00068
🇯🇵Yatomi, Aichi, Japan
JP00106
🇯🇵Kurume, Fukuoka, Japan
JP00003
🇯🇵Sapporo, Hokkaido, Japan
JP00180
🇯🇵Asahi, Chiba, Japan
JP00071
🇯🇵Kurume, Fukuoka, Japan
JP00026
🇯🇵Asahikawa, Hokkaido, Japan
JP00001
🇯🇵Sapporo, Hokkaido, Japan
JP00136
🇯🇵Itami, Hyogo, Japan
JP00038
🇯🇵Sapporo, Hokkaido, Japan
JP00181
🇯🇵Hitachinaka, Ibaraki, Japan
JP00073
🇯🇵Koga, Ibaraki, Japan
JP00113
🇯🇵Kakogawa, Hyogo, Japan
JP00058
🇯🇵Kawasaki, Kanagawa, Japan
JP00054
🇯🇵Mito, Ibaraki, Japan
JP00039
🇯🇵Tsukuba, Ibaraki, Japan
JP00050
🇯🇵Hyuga, Miyazaki, Japan
JP00151
🇯🇵Sendai, Miyagi, Japan
JP00153
🇯🇵Sasebo, Nagasaki, Japan
JP00051
🇯🇵Setouchi, Okayama, Japan
JP00078
🇯🇵Kawachinagano, Osaka, Japan
JP00075
🇯🇵Ureshino, Saga, Japan
JP00126
🇯🇵Gyoda, Saitama, Japan
JP00077
🇯🇵Kanuma, Tochigi, Japan
JP00137
🇯🇵Sakai, Osaka, Japan
JP00062
🇯🇵Kawaguchi, Saitama, Japan
JP00052
🇯🇵Sayama, Saitama, Japan
JP00024
🇯🇵Bunkyo, Tokyo, Japan
JP00081
🇯🇵Shibuya, Tokyo, Japan
JP00089
🇯🇵Shizuoka, Japan
JP00139
🇯🇵Toyama, Japan
JP00166
🇯🇵Funabashi, Chiba, Japan
JP00115
🇯🇵Narashino, Chiba, Japan
JP00138
🇯🇵Yotsukaido, Chiba, Japan
JP00110
🇯🇵Kasuga, Fukuoka, Japan
JP00040
🇯🇵Kitakyushu, Fukuoka, Japan
JP00120
🇯🇵Iizuka, Fukuoka, Japan
JP00119
🇯🇵Kitakyushu, Fukuoka, Japan
JP00033
🇯🇵Takasaki, Gunma, Japan
JP00163
🇯🇵Higashihiroshima, Hiroshima, Japan
JP00124
🇯🇵Tomakomai, Hokaido, Japan
JP00172
🇯🇵Kitami, Hokkaido, Japan
JP00002
🇯🇵Sapporo, Hokkaido, Japan
JP00125
🇯🇵Kushiro, Hokkaido, Japan
JP00114
🇯🇵Sapporo, Hokkaido, Japan
JP00069
🇯🇵Himeji, Hyogo, Japan
JP00056
🇯🇵Akashi, Hyogo, Japan
JP00042
🇯🇵Kobe, Hyogo, Japan
JP00117
🇯🇵Nishinomiya, Hyogo, Japan
JP00154
🇯🇵Kobe, Hyogo, Japan
JP00171
🇯🇵Kobe, Hyogo, Japan
JP00092
🇯🇵Kobe, Hyogo, Japan
JP00179
🇯🇵Komatsu, Ishikawa, Japan
JP00107
🇯🇵Hitachi, Ibaraki, Japan
JP00049
🇯🇵Morioka, Iwate, Japan
JP00088
🇯🇵Kida, Kagawa, Japan
JP00084
🇯🇵Isehara, Kanagawa, Japan
JP00048
🇯🇵Kawasaki, Kanagawa, Japan
JP00162
🇯🇵Isehaya, Nagasaki, Japan
JP00025
🇯🇵Nagaoka, Niigata, Japan
JP00011
🇯🇵Hannan, Osaka, Japan
JP00134
🇯🇵Higashiosaka, Osaka, Japan
JP00178
🇯🇵Hirakata, Osaka, Japan
JP00146
🇯🇵Suita, Osaka, Japan
JP00070
🇯🇵Suita, Osaka, Japan
JP00061
🇯🇵Toyonaka, Osaka, Japan
JP00007
🇯🇵Hiki, Saitama, Japan
JP00060
🇯🇵Kawagoe, Saitama, Japan
JP00133
🇯🇵Kakegawa, Shizuoka, Japan
JP00143
🇯🇵Bunkyo, Tokyo, Japan
JP00145
🇯🇵Shimotsuke, Tochigi, Japan
JP00148
🇯🇵Ota, Tokyo, Japan
JP00142
🇯🇵Chuo, Tokyo, Japan
JP00053
🇯🇵Kiyose, Tokyo, Japan
JP00072
🇯🇵Meguro, Tokyo, Japan
JP00093
🇯🇵Kochi, Japan
JP00096
🇯🇵Yokohama, Kanagawa, Japan
JP00019
🇯🇵Koshi, Kumamoto, Japan
JP00168
🇯🇵Yokkaichi, Mie, Japan
JP00144
🇯🇵Shibata, Niigata, Japan
JP00156
🇯🇵Toyota, Aichi, Japan
JP00037
🇯🇵Nagoya, Aichi, Japan
JP00175
🇯🇵Nagoya, Aichi, Japan
JP00170
🇯🇵Toyohashi, Aichi, Japan
JP00066
🇯🇵Okazaki, Aichi, Japan
JP00141
🇯🇵Sagamihara, Kanagawa, Japan
JP00169
🇯🇵Osaki, Miyagi, Japan
JP00129
🇯🇵Matsumoto, Nagano, Japan
JP00064
🇯🇵Beppu, Oita, Japan
JP00130
🇯🇵Nagoya, Aichi, Japan
JP00108
🇯🇵Toyohashi, Aichi, Japan
JP00090
🇯🇵Hakodate, Hokkaido, Japan
JP00041
🇯🇵Kato, Hyogo, Japan
JP00045
🇯🇵Zushi, Kanagawa, Japan
JP00004
🇯🇵Sendai, Miyagi, Japan
JP00036
🇯🇵Sendai, Miyagi, Japan
JP00057
🇯🇵Tamana, Kumamoto, Japan
JP00105
🇯🇵Sendai, Miyagi, Japan
JP00101
🇯🇵Omura, Nagasaki, Japan
JP00103
🇯🇵Omura, Nagasaki, Japan
JP00094
🇯🇵Kashihara, Nara, Japan
JP00161
🇯🇵Kawagoe, Saitama, Japan
JP00008
🇯🇵Tokorozawa, Saitama, Japan
JP00149
🇯🇵Bunkyo, Tokyo, Japan
JP00152
🇯🇵Bunkyo, Tokyo, Japan
JP00099
🇯🇵Chiyoda, Tokyo, Japan
JP00063
🇯🇵Hachioji, Tokyo, Japan
JP00155
🇯🇵Nishimuro, Wakayama, Japan
JP00047
🇯🇵Shunan, Yamaguchi, Japan
JP00035
🇯🇵Fukuoka, Japan
JP00164
🇯🇵Fukuoka, Japan
JP00013
🇯🇵Hiroshima, Japan
JP00074
🇯🇵Kagoshima, Japan
JP00010
🇯🇵Takaoka, Toyama, Japan
JP00104
🇯🇵Shimonoseki, Yamaguchi, Japan
JP00176
🇯🇵Fukui, Japan
JP00167
🇯🇵Kagoshima, Japan
JP00123
🇯🇵Kyoto, Japan
JP00023
🇯🇵Miyagi, Japan
JP00018
🇯🇵Fukuoka, Japan
JP00020
🇯🇵Fukuoka, Japan
JP00059
🇯🇵Fukuoka, Japan
JP00067
🇯🇵Fukuoka, Japan
JP00076
🇯🇵Fukuoka, Japan
JP00131
🇯🇵Fukuoka, Japan
JP00165
🇯🇵Fukushima, Japan
JP00014
🇯🇵Hiroshima, Japan
JP00016
🇯🇵Hiroshima, Japan
JP00055
🇯🇵Hiroshima, Japan
JP00022
🇯🇵Kumamoto, Japan
JP00017
🇯🇵Oita, Japan
JP00177
🇯🇵Osaka, Japan
JP00044
🇯🇵Shizuoka, Japan
JP00046
🇯🇵Kumamoto, Japan
JP00085
🇯🇵Kyoto, Japan
JP00160
🇯🇵Kyoto, Japan
JP00122
🇯🇵Miyazaki, Japan
JP00118
🇯🇵Okayama, Japan
JP00150
🇯🇵Osaka, Japan
JP00135
🇯🇵Shizuoka, Japan
JP00080
🇯🇵Nagano, Japan
JP00174
🇯🇵Nagano, Japan
JP00098
🇯🇵Nagasaki, Japan
JP00112
🇯🇵Nagasaki, Japan
JP00147
🇯🇵Nagasaki, Japan
JP00157
🇯🇵Osaka, Japan