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

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Protocol Version 3 14/01/2013 This trial may be audited by the Sponsor, or the Competent Authority. Investigators are obliged to cooperate in any inspection. 8.6 Serious Breaches in GCP or the Trial Protocol All investigators participating in the trial will promptly notify the Chief Investigator or Sponsor of a serious breach (as defined in Regulation 29A of the Medicines for Human Use (Clinical Trials) Regulations 2004 [Statutory Instrument 2004/1031], as amended by Statutory Instrument 2006/1928) that they become aware of. The CI is then responsible for notifying the sponsor within 24 hours of becoming aware of a serious breach. The Sponsor is responsible for notifying the licensing authority in writing of any serious breach of: (a) The conditions and principles of GCP in connection with that trial; or (b) The protocol relating to that trial, as amended from time to time in accordance with regulations 22 to 25, within 7 days of becoming aware of that breach. A “serious breach” is a breach which is likely to effect to a significant degree:- The safety or physical or mental integrity of the subjects of the trial; or the scientific value of the trial. Participating centres should contact the coordinating centre or CI for further information. 9 TRIAL COMMITTEES 9.1 Trial Management Group (TMG) The Trial Management Group normally includes those individuals responsible for the day-to-day management of the trial, such as the chief investigator, statistician, trial manager, research nurse, data manager. The role of the group is to monitor all aspects of the conduct and progress of the trial, ensure that the protocol is adhered To and take appropriate action to safeguard participants and the quality of the trial itself. The TMG will meet monthly. 9.2 Trial Steering Committee (TSC) The role of a Trial Steering Committee will be to provide overall supervision of the trial and ensure that it is being conducted in accordance with the principles of GCP and the relevant regulations. The Trial Steering Committee will be chaired by: Decisions about continuation or termination of the trial or substantial amendments to the protocol will be the responsibility of the Trial Steering Committee. The TSC will meet every 6 months and may take the form of a teleconference or face-to-face meetings. 9.3 Data Monitoring and Ethics Committee (DMC) The role of an Data Monitoring Committee will review the accruing trial data and assess whether there are any safety issues that should be brought to participants’ attention or any reasons for the trial not to continue. The Data Monitoring Committee is independent of both the investigators and the funder/sponsor. It will meet 6 monthly which may take the form of a teleconference or face-toface meetings. It will makes it recommendations to the Trial Steering Committee. The independent chair is: Dr. M. H. Buch, Section of Musculoskeletal Diseases, Leeds Institute of Molecular Medicine, University of Leeds, Leeds, UK 10 PUBLICATION POLICY This is an investigator led trial; sponsored by the CI’s substantive employers, QMUL. The data collected will not be used to license/ register any pharmaceuticals. Authorship of the final manuscript(s), interim publications, or abstracts will be decided according to active participation in the study design, trial management group and accrual of eligible patients. Contributing centres Study: R4RA EudraCT: 2012-002535-28 36 / 34
Protocol Version 3 14/01/2013 (and participating Investigators) will be acknowledged in the final manuscript. Representatives for the Sponsor will be added, as appropriate, as co-authors. No participant may present data from his/her centre separately from the rest of the trial results unless approved by the trial management group and the Sponsor. 11 REFERENCES 1. Silman AJ. Epidemiology of rheumatoid arthritis. Apmis 1994;102:721-8. 2. Scott DL, Symmons DP, Coulton BL, Popert AJ. Long-term outcome of treating rheumatoid arthritis: results after 20 years. Lancet 1987;1:1108-11. 3. Breedveld FC, Weisman MH, Kavanaugh AF, et al. The PREMIER study: A multicenter, randomized, double-blind clinical trial of combination therapy with adalimumab plus methotrexate versus methotrexate alone or adalimumab alone in patients with early, aggressive rheumatoid arthritis who had not had previous methotrexate treatment. Arthritis and rheumatism 2006;54:26-37. 4. Kristensen LE, Kapetanovic MC, Gulfe A, Soderlin M, Saxne T, Geborek P. Predictors of response to anti-TNF therapy according to ACR and EULAR criteria in patients with established RA: results from the South Swedish Arthritis Treatment Group Register. Rheumatology (Oxford, England) 2008;47:495-9. 5. Kramm H, Hansen KE, Gowing E, Bridges A. Successful therapy of rheumatoid arthritis with rituximab: renewed interest in the role of B cells in the pathogenesis of rheumatoid arthritis. J Clin Rheumatol 2004;10:28-32. 6. Rubbert-Roth A, Tak PP, Zerbini C, et al. Efficacy and safety of various repeat treatment dosing regimens of rituximab in patients with active rheumatoid arthritis: results of a Phase III randomized study (MIRROR). Rheumatology (Oxford, England) 2010;49:1683-93. 7. Khan A, Scott D. Rituximab after methotrexate failure in rheumatoid arthritis: evaluation of the SERENE trial. Expert Opin Biol Ther 2011;11:1515-8. 8. Dass S, Rawstron AC, Vital EM, Henshaw K, McGonagle D, Emery P. Highly sensitive B cell analysis predicts response to rituximab therapy in rheumatoid arthritis. Arthritis and rheumatism 2008;58:2993-9. 9. Leandro MJ, Cambridge G, Ehrenstein MR, Edwards JC. Reconstitution of peripheral blood B cells after depletion with rituximab in patients with rheumatoid arthritis. Arthritis and rheumatism 2006;54:613-20. 10. Thurlings RM, Vos K, Wijbrandts CA, Zwinderman AH, Gerlag DM, Tak PP. Synovial tissue response to rituximab: mechanism of action and identification of biomarkers of response. Annals of the rheumatic diseases 2008;67:917-25. 11. Taylor PC. Antibody therapy for rheumatoid arthritis. Curr Opin Pharmacol 2003;3:323-8. 12. Buch MH, Smolen JS, Betteridge N, et al. Updated consensus statement on the use of rituximab in patients with rheumatoid arthritis. Annals of the rheumatic diseases 2011;70:909- 20. 13. Boumans MJ, Vos K, Gerlag DM, Tak PP. Biological treatment of rheumatoid arthritis: towards a more cost-effective re-treatment regimen using rituximab? Annals of the rheumatic diseases 2011. 14. Humby F, Bombardieri M, Manzo A, et al. Ectopic lymphoid structures support ongoing production of class-switched autoantibodies in rheumatoid synovium. PLoS medicine 2009;6:e1. 15. Vos K, Thurlings RM, Wijbrandts CA, van Schaardenburg D, Gerlag DM, Tak PP. Early effects of rituximab on the synovial cell infiltrate in patients with rheumatoid arthritis. Arthritis and rheumatism 2007;56:772-8. 16. Lindberg J, af Klint E, Catrina AI, et al. Effect of infliximab on mRNA expression profiles in synovial tissue of rheumatoid arthritis patients. Arthritis research & therapy 2006;8:R179. 17. Wijbrandts CA, Dijkgraaf MG, Kraan MC, et al. The clinical response to infliximab in rheumatoid arthritis is in part dependent on pretreatment tumour necrosis factor alpha expression in the synovium. Annals of the rheumatic diseases 2008;67:1139-44. Study: R4RA EudraCT: 2012-002535-28 37 / 34
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Protocol Title : A Randomised, open labelled study in anti ... - EME

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