Protocol Title : A Randomised, open labelled study in anti ... - EME

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Protocol Version 3 14/01/2013 2.2 Trial design This is a single-blinded, randomised clinical trial. Patients recruited to this study will undergo a synovial biopsy at baseline, prior to randomisation. Patients will subsequently be stratified in to 3 groups (B Cell Poor, B Cell Rich, Germinal Centres (GC) Rich)according to the following B-cell score prior to therapeutic intervention. 2.3 Study Scheme Diagram Study: R4RA EudraCT: 2012-002535-28 16 / 34
Protocol Version 3 14/01/2013 3 STUDY POPULATION 3.1 Number of Subjects and Subject Selection Number of subjects to be enrolled - 180 patients. Patients will be recruited from within the Rheumatology department who have been referred by their consultant Rheumatologists for a second line biological agent following failure of at least 1 anti-TNF agent. 3.2 Inclusion Criteria Patients will be recruited with active RA: 1. Patients who have failed anti-TNF therapy (inadequate responders – ir). 2. Who are eligible for Rituximab therapy according NICE guidelines 3. Patients should be receiving a stable dose Methotrexate for at least 4 weeks prior to screening. 4. 2010 ACR / EULAR Rheumatoid Arthritis classification criteria for a diagnosis of Rheumatoid Arthritis. 5. Over 18 years of age 6. Patient must be capable of giving informed consent 7. Willingness and ability to comply with scheduled visits, treatment plans and laboratory tests and other study procedures 3.3 Exclusion Criteria 1. Women who are pregnant or breast-feeding 2. Women of child-bearing potential, or males whose partners are women of child-bearing potential, unwilling to use effective contraception during the study and for at least 12 months after stopping study treatment. 3. History of or current inflammatory joint disease or autoimmune disease other than RA. 4. Treatment with any investigational agent ≤ 4 weeks prior to baseline (or < 5 half lives of the investigational drug, whichever is the longer). 5. Intra articular or parenteral corticosteroids ≤ 4 weeks prior to baseline. 6. Active infection. 7. Septic arthritis within a native joint within the last 12 months. 8. Sepsis of a prosthetic joint within 12 months or indefinitely if the joint remains in situ. 9. Known HIV or hepatitis B/C infection. 10. Latent TB infection unless they have completed adequate antibiotic prophylaxis. 11. Malignancy (other than basal cell carcinoma) within the last 10 years 12. New York Heart Association (NYHA) grade 3 or 4 congestive cardiac failure. 13. Demyelinating disease. 14. Latex allergy or allergy to any excipients of Rituximab 15. Any other contra-indication to the study medications as detailed in their summaries of product characteristics 16. Receipt of live vaccine 3 months prior to screening) 19. Known recent substance abuse (drug or alcohol) 20. Poor tolerability of venepuncture or lack of adequate venous access for required blood sampling during the study period. 21. Patients unable to tolerate synovial biopsy or in whom this is contraindicated (e.g. patients on anti-coagulants). 22. Patients current recruited to other clinical trials. 23. Other severe acute or chronic medical or psychiatric condition, or laboratory abnormality that would impart, in the judgment of the investigator, excess risk associated with study Study: R4RA EudraCT: 2012-002535-28 17 / 34
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Protocol Title : A Randomised, open labelled study in anti ... - EME

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