Arthritis, Rheumatoid Clinical Trial
Official title:
A Phase II, Multi-center, Randomized, Double-blind, Methotrexate Controlled Study to Assess the Clinical Efficacy, Safety, and Tolerability of CH-1504 in Subjects With Active Rheumatoid Arthritis
The purpose of this trial is to assess the clinical effect of CH-1504 at doses of 0.25, 0.5 and 1.0 mg per day in patients with active rheumatoid arthritis by determining the proportion of patients achieving an American College of Rheumatology (ACR) 20% improvement response.
Rheumatoid Arthritis (RA) is a chronic inflammatory disease of unknown cause that leads to
pain, stiffness, swelling and limitation of joint function. If left untreated, RA produces
serious destruction of joints that frequently leads to permanent disability.
Methotrexate (MTX) is currently the most commonly prescribed first-line disease modifying
anti-rheumatic drug (DMARD) because of its early onset of action, good efficacy, and ease of
administration. In addition, MTX can be combined with other FDA approved DMARDs, including
gold compounds, sulfasalazine, hydroxychloroquine, TNF inhibitors, anakinra and leflunomide.
However, the administration of MTX has been associated with serious side effects such as
skin reactions, pneumonitis, gastrointestinal disturbances including diarrhea, ulcerative
stomatitis and hemorrhagic enteritis, hepatotoxicity and renal toxicity. Overall it is
estimated that up to 30% of all patients discontinue MTX therapy due to side effects.
MTX enters cells via the Reduced Folate Carrier (RFC) system. Once inside cells, it is
converted enzymatically to polyglutamylated derivatives. These metabolites cannot be readily
effluxed and are retained in tissues. The accumulation of polyglutamyl metabolites of MTX
for prolonged periods may play a significant role in both the efficacy and the toxicity of
this compound. Methotrexate in its parent form only has activity against dihydrofolate
reductase (DHFR). In order for it to have significant activity against other enzymes (i.e.
Thymidylate Synthase (TS)) it must be polyglutamylated. However by being polyglutamylated
the MTX metabolite is retained in the cell and may potentiate the cytotoxicity of MTX. In
addition to polyglutamylation metabolism, MTX is also hydroxylated in the liver to a
metabolite known as 7-hydroxymethotrexate, which is also subject to polyglutamylation and
cell retention. This metabolite has been implicated in liver and kidney toxicity of the
parent compound, while contributing no role in efficacy.
CH-1504 has been shown in vitro to be a nonpolyglutamylatable and nonhydroxylatable
antifolate that is more efficiently taken up into cells by the reduced folate carrier (RFC)
system than is MTX. CH-1504 has significant activity on both DHFR and TS enzymes without the
need for polyglutamylation. The lack of hydroxylation potentially leads to enhanced levels
of the active drug in the cell. Furthermore, the glutamyl moiety is not susceptible to being
cleaved by carboxypeptidase. Thus CH-1504 may be referred to as a metabolically stable
antifolate. It is our hypothesis that in the clinical setting CH-1504 will demonstrate the
efficacy of classical antifolates (via folate enzyme inhibition) but will be devoid of the
toxicity secondary to the formation of the polyglutamylated and hydroxylated metabolites,
providing a significantly improved therapeutic index compared to classical antifolates, such
as MTX.
This study is a randomized, double-blind, methotrexate controlled study to assess the
clinical effect of CH-1504 in patients with active rheumatoid arthritis by determining the
proportion of patients achieving an ACR20 response after 12 weeks of treatment.
Secondary objectives are:
- Assess the clinical efficacy of CH-1504 by proportion of patients achieving ACR50 and
ACR70 responses.
- Assess the clinical efficacy of CH-1504 using EULAR "good" and "moderate" response
criteria.
- Assess the clinical efficacy of CH-1504 using the difference from baseline of ACR core
set and DAS28 of measures.
- Evaluate the safety and tolerability of CH-1504 in RA patients as determined by the
frequency and severity of adverse events, laboratory abnormalities, and dropouts.
- Identify the dose response relationship of CH-1504
;
Allocation: Randomized, Endpoint Classification: Safety Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor), Primary Purpose: Treatment
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