A Study to Evaluate Efficacy and Safety of Anakinra in the Treatment of Still's Disease (SJIA and AOSD)

Phase 3

Terminated

Conditions: Still's Disease, Adult-Onset
Still's Disease, Juvenile-Onset

Interventions: Biological: anakinra
Drug: Placebo

Registration Number: NCT03265132

Lead Sponsor: Swedish Orphan Biovitrum

Brief Summary: The aim of this study is to demonstrate the efficacy and to evaluate the safety, pharmacokinetics (PK) and immunogenicity of anakinra in patients with newly diagnosed Still's disease, including SJIA (Systemic juvenile idiopathic arthritis) and AOSD (Adult-onset Still's disease).

Detailed Description: The study consists of a 12-week, randomized, double-blind, placebo controlled period with two dose levels of anakinra and a 4-week safety follow-up after last dose of investigational medicinal product (IMP). The primary endpoint will be evaluated at Week 2. Sustained efficacy and time to study drug discontinuation will be evaluated during the full study period.

A screening visit is optional and may be done to identify patients that could be suitable for the study. During the study 6 visits and 2 telephone contacts are scheduled i.e., Day 1 (baseline visit), Day 4Tel, Week 1, Week 2, Week 4, Week 8, Week 12 and Week 16Tel (End of Study).

Patients will be randomly assigned to study drug, after they meet all of the inclusion criteria and none of the exclusion criteria. Patients will receive treatment for 12 weeks, either anakinra or placebo. Patients will be randomized to anakinra in a dose of either 2 or 4 mg/kg/day, with a maximum dose of 100 or 200 mg once daily, respectively. Patients will be randomized to placebo with corresponding volumes for each of the two anakinra dose levels.

Recruitment & Eligibility

Status: TERMINATED

Sex: All

Target Recruitment: 13

Inclusion Criteria

Signed informed consent.
Male and female patients with a body weight ≥ 10 kg.
Diagnosis of Still's disease.
If currently on glucocorticoid treatment, a stable dose for at least 1 week prior to randomization.
If currently on methotrexate treatment, a stable dose for at least 8 weeks prior to randomization.
Active disease.
Female patients of childbearing potential must use an effective method of contraception during the study (abstinence being a possible option) as well as present a negative pregnancy test prior to randomization.
Negative interferon-gamma release assay or Purified protein derivative ( PPD) test within 2 months prior to randomization. If not available, a test should be performed at day of randomization.

Exclusion Criteria

Diagnosis of Still's disease more than 6 months prior to randomization.
Previous randomization into this study.
Participation in another concurrent clinical interventional study within 30 days of randomization.
Treatment with an investigational drug within 5 half-lives prior to randomization.
Previous or current treatment with anakinra, canakinumab or any other IL-1 inhibitor.
Use of the following therapies prior to randomization:
- Narcotic analgesics within 24 hours prior to randomization.
- Dapsone or etanercept within 3 weeks prior to randomization.
- Intraarticular, intramuscular or intravenous administration of glucocorticoids or intravenous immunoglobulin (Ig) within 4 weeks prior to randomization.
- Intravenous Ig with proven Still's disease modifying effect, leflunomide, infliximab or adalimumab within 8 weeks prior to randomization.
- Thalidomide, cyclosporine, mycophenolate mofetil, 6-mercaptopurine, azathioprine, cyclophosphamide, chlorambucil or any other immunosuppressant within 12 weeks prior to randomization.
- Tocilizumab within 12 weeks prior to randomization or any other immunomodulatory medication within 4 half-lives prior to randomization
- Rituximab within 26 weeks prior to randomization.
Live vaccines within 1 month prior to randomization.
Known presence or suspicion of active, chronic or recurrent bacterial, fungal or viral infections, including tuberculosis, HIV infection or hepatitis B or C infection.
Clinical evidence of liver disease or liver injury.
Presence of severe renal function impairment.
Presence of neutropenia.
Presence or suspicion of MAS at baseline.
A diagnosis of MAS within the last 2 months prior to randomization.
History of malignancy within 5 years.
Known hypersensitivity to E coli-derived proteins, or any components of Kineret® (anakinra).
Pregnant or lactating women.
Foreseeable inability to cooperate with given instructions or study procedures.
Presence of any medical or psychological condition or laboratory result that in the opinion of the investigator can interfere with the patient's ability to comply with the protocol requirements or makes the patient not appropriate for inclusion to the study and treatment with IMP.

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
anakinra	anakinra	2 mg/kg/day (max 100 mg/day) or 4 mg/kg/day (max 200 mg/day)
Placebo	Placebo	Corresponding volume to anakinra 2 mg/kg/day or 4 mg/kg/day

Primary Outcome Measures

Name	Time	Method
Proportion of ACR30 Responders With Absence of Fever Attributable to the Disease During the 7 Days Preceding Week 2.	Week 2	ACR30 response is defined as an improvement of ≥ 30% from baseline in at least 3 of any 6 variables listed below. Also no more than 1 of the 6 variables may worsen by \>30% from baseline. (ACR: American College of Rheumatology) 1. Physician global assessment of disease activity - Assessed on a Visual Analogue Scale (VAS) from no disease activity (0 mm) to very severe disease activity (100 mm). 2. Patient/parent global assessment of overall well-being - Assessed on a VAS from very well (0 mm) to very poor (100 mm). 3. Number of joints with active arthritis. 4. Number of joints with limitation of motion. 5. Assessment of physical function - Patient Reported Outcome instruments : Childhood Health Assessment Questionnaire (CHAQ) /Stanford Health Assessment Questionnaire (SHAQ). 6. C-Reactive Protein (CRP) (mg/L).

Secondary Outcome Measures

Name	Time	Method
Proportion of Patients With at Least One Serious Adverse Event Including Death.	From Informed consent to Week 16	Serious adverse events (SAEs) will be collected from informed consent up to 28 days after stopping study treatment.
Proportion of Patients With Antidrug Antibodies (ADA) Against Anakinra.	Week 2	Proportion of patients with antidrug antibodies (ADA) against anakinra.
Anakinra Serum Pre-dose Concentrations.	Week 2	Week 2 reported here.
Anakinra Serum Pharmacokinetic Parameters: Cmax,	Week 12	PK parameters only available for 2 patients.
Anakinra Serum Pharmacokinetic Parameters, Tmax and T½	Week 12	PK parameters only available for 2 patients
Anakinra Serum Pharmacokinetic Parameter: AUC 0-24 h	Week 12	PK parameters only available for 2 patients
Number of Days Off School or Work Due to Still's Disease.	Week 2	Number of days off school or work due to Still's disease week 1-2.
Percentage Decrease of the Glucocorticoid Dose From Baseline.	From Day 1 to Week12	Please note no patients were treated with any systemic glucocorticoids at randomization. Hence no results available
Time to Study Drug Discontinuation for Any Reason.	From Day 1 to Week12	Time to study drug discontinuation was analyzed using Kaplan-Meier curves. Number of patients with premature study drug discontinuation for any reason is reported here.
Proportion of ACR90 Responders With Absence of Fever During 7 Days Preceding Week 2.	Week 2	ACR90 response is defined as an improvement of ≥ 90% from baseline in at least 3 of any 6 variables listed in the description of the primary outcome . Also no more than 1 of the 6 variables may worsen by \>30% from baseline.
Proportion of Patients Who Have Initiated Tapering of Glucocorticoids.	From Week 2 to Week12	Please note no patients were treated with any systemic glucocorticoids at randomization. Hence no results available
Proportion of Patients That Have Decreased the Glucocorticoid Dose With at Least 50% From Baseline.	From Week 2 to Week12	Please note no patients were treated with any systemic glucocorticoids at randomization. Hence no results available
Proportion of Patients With Macrophage Activation Syndrome (MAS).	From Day 1 to Week 16	Proportion of patients with Macrophage Activation Syndrome (MAS).
Proportion of Patients With Neutralizing Antibodies.	Week 2	Confirmed ADA positive samples will be analyzed for the presence of neutralizing antibodies.
Proportion of ACR50 Responders With Absence of Fever During 24 Hours Preceding Week 1.	Week 1	ACR50 response is defined as an improvement of ≥ 50% from baseline in at least 3 of any 6 variables listed in the description of the primary outcome measure. Also no more than 1 of the 6 variables may worsen by \>30% from baseline.
Proportion of ACR90 Responders With Absence of Fever During 24 Hours Preceding Week 1.	Week 1	ACR90 response is defined as an improvement of ≥ 90% from baseline in at least 3 of any 6 variables listed in the description of the primary outcome measure. Also no more than 1 of the 6 variables may worsen by \>30% from baseline.
Proportion of ACR50 Responders With Absence of Fever During 7 Days Preceding Week 2.	Week 2	ACR50 response is defined as an improvement of ≥ 50% from baseline in at least 3 of any 6 variables listed in the description of the primary outcome measure. Also no more than 1 of the 6 variables may worsen by \>30% from baseline.
Proportion of ACR70 Responders With Absence of Fever During 7 Days Preceding Week 2.	Week 2	ACR70 response is defined as an improvement of ≥ 70% from baseline in at least 3 of any 6 variables listed in the description of the primary outcome. Also no more than 1 of the 6 variables may worsen by \>30% from baseline.
Proportion of Responders in Physician Global Assessment of Disease Activity.	Week 2	Assessed on a VAS from no disease activity (0 mm) to very severe disease activity (100 mm). Response is defined as an improvement of ≥ 30%, 50%, 70% and 90% from baseline. Only improvement of ≥90% at Week 2 reported here.
Proportion of Responders in Patient/Parent Global Assessment of Overall Well-being.	Week 2	Assessed on a VAS from very well (0 mm) to very poor. (100 mm). Response is defined as an improvement of ≥ 30%, 50%, 70% and 90% from baseline.Only improvement of ≥90% at Week 2 reported here.
Proportion of Responders in Assessment of Physical Function (CHAQ/SHAQ).	Week 2	Childhood Health Assessment Questionnaire (CHAQ) and Stanford Health Assessment Questionnaire (SHAQ) assess physical and functional status (see Clinical protocol section 6.5.4.1.5). Response is defined as an improvement of ≥ 30%, 50%, 70% and 90% from baseline. Only improvement of ≥90% at Week 2 reported here.
Proportion of Patients With Sustained ACR30, ACR50, ACR70 and ACR90 Response in Relation to Glucocorticoid Tapering.	Week 2, Week 4, Week 8 and Week 12	Please note no patients were treated with any systemic glucocorticoids at randomization. Hence no results available.
Change From Baseline in Hemoglobin (Hb). Results at Week 2 Reported Here.	Week 2	Change from baseline in Hemoglobin (Hb). Results at Week 2 reported here.
Change From Baseline in Platelet Count.	Week 2	Change from baseline in platelet count. Results at Week 2 reported here.
Change From Baseline in Ferritin.	Week 2	Change from baseline in ferritin. Results at Week 2 reported here.
Time to Study Drug Discontinuation Due to Lack of Efficacy or Progressive Disease.	From Day 1 to Week12	Proportion of study drug discontinuation due to lack of efficacy or progressive disease was analyzed using Kaplan-Meier curves. Number of patients discontinuing study drug due to lack of efficacy or progressive disease is reported here.
Proportion of ACR70 Responders With Absence of Fever During 24 Hours Preceding Week 1.	Week 1	ACR70 response is defined as an improvement of ≥ 70% from baseline in at least 3 of any 6 variables listed in the description of the primary outcome measure. Also no more than 1 of the 6 variables may worsen by \>30% from baseline.
Change From Baseline in Patient/Parent Global Assessment of Overall Well-being at Week 1.	Day 1 and Week 1	Change from baseline in patient/parent global assessment of overall well-being measured on a VAS 0 (very well)-100 (very poor) at Week 1.
Proportion of ACR30 Responders With Absence of Fever During 24 Hours Preceding Week 1.	Week 1	ACR30 response is defined as an improvement of ≥ 30% from baseline in at least 3 of any 6 variables listed in the description of the primary outcome measure. Also no more than 1 of the 6 variables may worsen by \>30% from baseline.
Proportion of Responders in Number of Joints With Active Arthritis.	Week 2	Response is defined as an improvement of ≥ 30%, 50%, 70% and 90% from baseline.Only improvement of ≥90% at Week 2 reported here.
Proportion of Responders in Number of Joints With Limitation of Motion.	Week 2	Response is defined as an improvement of ≥ 30%, 50%, 70% and 90% from baseline.Only improvement of ≥90% at Week 2 reported here.
Proportion of Responders in CRP (mg/L).	Week 2	Response is defined as an improvement of ≥ 30%, 50%, 70% and 90% from baseline. Only improvement of ≥90% at Week 2 reported here.
Proportion of Patients With Absence of Fever During the 7 Days Preceding Week 2.	Week 2	Proportion of patients with absence of fever during the 7 days preceding Week 2.
Proportion of Patients With Absence of Fever During the 24 Hours Preceding Week 1.	Week 1	Absence of fever during the 24 hours preceding week 1.
Change From Baseline in Physician Global Assessment of Disease Activity at Week 1.	Day 1 and Week 1	Change from baseline in Physician global assessment of disease activity measured on a VAS 0 (very well)-100 (very poor) at Week 1.
Change From Baseline in CRP.	Week 2	Change from baseline in CRP. Results at Week 2 reported here.
Proportion of Patients With Sustained ACR30, ACR50, ACR70 and ACR90 Response.	Week 12	Proportion of patients that still meet the corresponding week 2 response with absence of fever in the preceding 7 days. Only the strictest criteria, ACR90, is reported here.
Proportion of Patients With Absence of Rash.	Week 2	Absence of rash is evaluated 24 hours preceding Week 1 and 7 days preceding Week 2, Week 4, Week 8 and Week 12. Only data at Week 2 reported here.
Change From Baseline in Patient/Parent Global Assessment of Disease Related Pain.	Week 2	Assessed on a VAS from no pain (0 mm) to very severe pain (100 mm).
Change From Baseline in IL-18.	Week 2	Only results from Week 2 reported here
Change From Baseline in Serum Calprotectin.	Week 2	Change from baseline in serum calprotectin. Only results from Week 2 reported here
Change From Baseline in Neopterin.	Week 2	Only results from Week 2 reported here
Proportion of Patients With at Least One Adverse Event.	From Day 1 to Week 16	All adverse events collected from start of study treatment up to 28 days after stopping study treatment.
Anakinra Serum Pharmacokinetic Parameter: CL/F	Week 12	Pharmacokinetic parameters only available for 2 patients
Anakinra Serum Pharmacokinetic Parameter: Vd/F	Week 12	PK parameters only available for 2 patients
Change From Baseline in JADAS27.	Week 2	Juvenile Arthritis Disease Activity Score (JADAS) includes 4 measures: physician global assessment of disease activity, patient or parent global assessment of overall well-being, 27 active joint count, and CRP. The JADAS27 includes the 27 joints. JADAS27 is calculated as the sum of its four components, physician global assessment of disease activity converted to cm from the VAS (0=no activity, 10=maximum activity); patient global assessment of well-being converted to cm from the VAS (0=very well, 10=very poor); active joint count (0-27); and CRP. Prior to calculation CRP is truncated to a 0 - 10 scale according to the following formula: (CRP (mg/l) -10)/10. Before calculation, CRP values \<10 mg/l are converted to 10 and CRP values \>110 mg/l are converted to 110. The JADAS27 tool yields a global score of 0-57. Only results from Week 2 reported here.
Proportion of Patients With Inactive Disease.	Week 12	Inactive disease is a composite of the following parameters: no joints with active arthritis, no fever, no rash, no serositis, no splenomegaly, no generalized lymphadenopathy attributable to Still's disease, CRP level within normal limits, physician's global assessment of disease activity score below 10 mm on a 100 mm VAS and a documented morning stiffness ≤15 minutes.
Change From Baseline in IL-6.	Week 2	Only results from Week 2 reported here.

Trial Locations

Locations (39): MetroHealth System
🇺🇸
Cleveland, Ohio, United States
Children's Hospital of Pittsburgh of UPMC
🇺🇸
Pittsburgh, Pennsylvania, United States
University of Vermont Medical Center
🇺🇸
Burlington, Vermont, United States
Baylor Research Institute
🇺🇸
Dallas, Texas, United States
Attune Health
🇺🇸
Beverly Hills, California, United States
Beth Israel Deaconess Medical Center
🇺🇸
Boston, Massachusetts, United States
Nicklaus Children's Hospital
🇺🇸
Miami, Florida, United States
Texas Children's Hospital
🇺🇸
Houston, Texas, United States
University of Washington
🇺🇸
Seattle, Washington, United States
Rady Children's Hospital & Health Center
🇺🇸
San Diego, California, United States
University of Minnesota
🇺🇸
Minneapolis, Minnesota, United States
Duke Children's Hospital and Health Center
🇺🇸
Durham, North Carolina, United States
University of Texas Health Science Center at San Antonio
🇺🇸
San Antonio, Texas, United States
Monroe Carell Jr. Children's Hospital at Vanderbilt
🇺🇸
Nashville, Tennessee, United States
University of Utah Hospitals and Clinics
🇺🇸
Salt Lake City, Utah, United States
University of Calgary - Alberta Children's Hospital
🇨🇦
Calgary, Canada
Saint Louis University
🇺🇸
Saint Louis, Missouri, United States
Saint Paul Rheumatology
🇺🇸
Eagan, Minnesota, United States
Hospital for Special Surgery
🇺🇸
New York, New York, United States
Columbia University Medical Center
🇺🇸
New York, New York, United States
Institute for Rheumatic and Autoimmune Diseases
🇺🇸
Summit, New Jersey, United States
Univ of TX Southwestern Medical Center Dallas - Texas Scottish Rite Hospital for Children
🇺🇸
Dallas, Texas, United States
University of Calgary
🇨🇦
Calgary, Canada
The Hospital for Sick Children
🇨🇦
Toronto, Canada
Boston Children's Hospital
🇺🇸
Boston, Massachusetts, United States
Hackensack University Medical Center
🇺🇸
Hackensack, New Jersey, United States
University of Iowa Hospitals and Clinics
🇺🇸
Iowa City, Iowa, United States
University of Miami
🇺🇸
Miami, Florida, United States
Children's Mercy Hospital and Clinics
🇺🇸
Kansas City, Kansas, United States
Nationwide Children's Hospital
🇺🇸
Columbus, Ohio, United States
University of Alabama Birmingham
🇺🇸
Birmingham, Alabama, United States
The Children's Hospital Colorado
🇺🇸
Aurora, Colorado, United States
University of Florida
🇺🇸
Gainesville, Florida, United States
University of Louisville School of Medicine Research Foundation
🇺🇸
Louisville, Kentucky, United States
University of Michigan
🇺🇸
Ann Arbor, Michigan, United States
UNC Hospitals
🇺🇸
Chapel Hill, North Carolina, United States
Wake Forest Baptist Brenner Medical Center
🇺🇸
Winston-Salem, North Carolina, United States
Virginia Commonwealth University
🇺🇸
Richmond, Virginia, United States
Medical College of Wisconsin
🇺🇸
Milwaukee, Wisconsin, United States