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Uncontrolled GoutPhase 4NCT04772313

Pegloticase and Methotrexate Co-administered in Participants With Uncontrolled Gout Who Previously Failed Pegloticase Monotherapy

A Phase 4 study testing Pegloticase and Methotrexate (MTX) in people with Uncontrolled Gout, run by Amgen at 15 sites in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

This is a Phase 4, multicenter, open-label trial of pegloticase with methotrexate (MTX) in adult participants with uncontrolled gout who were previously treated with pegloticase without a concomitant immunomodulator and stopped pegloticase due to failure to maintain serum uric acid (sUA) response and/or a clinically… Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Uncontrolled Gout
What is being tested?
Pegloticase and Methotrexate (MTX)
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
11 participants
Where
15 sitesUnited States
Study dates
8 Mar 2021to 24 Apr 2023
Phase
Phase 4
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Willing and able to give informed consent.
  • Willing and able to comply with the prescribed treatment protocol and evaluations for the duration of the trial.
  • Adult men or women ≥18 years of age.
  • Uncontrolled gout, defined by the following criteria:
  • Hyperuricemia during the Screening Period, defined as sUA ≥6 mg/dL, and;
  • Failure to maintain normalization of sUA with xanthine oxidase inhibitors at the maximum medically appropriate dose or with a contraindication to xanthine oxidase inhibitor therapy based on medical record review or subject interview, and;
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  • Symptoms of gout, including at least 1 of the following:
  • Presence of at least 1 tophus
  • Recurrent flares, defined as 2 or more flares in the 12 months prior to Screening
  • Presence of chronic gouty arthritis
  • Subject was previously treated with pegloticase without concomitant immunomodulation and stopped pegloticase due to failure to maintain sUA reduction response (had ≥1 sUA >6 mg/dL within 2 weeks post pegloticase infusion) and did not experience an IR (Cohort 1) and/or stopped pegloticase treatment due to pegloticase-related clinically mild IR (Cohort 2).
  • Subject for whom the last pegloticase infusion occurred >6 months prior to Screening.
  • Willing to discontinue any oral urate-lowering therapy for at least 7 days prior to Day 1 and remain off other urate-lowering therapy during the Pegloticase + MTX Treatment Period.
  • Women of childbearing potential (including those with an onset of menopause <2 years prior to Screening, non-therapy-induced amenorrhea for <12 months prior to Screening or not surgically sterile [absence of ovaries and/or uterus]) must have negative serum pregnancy tests during Screening:
  • Subjects must agree to use 2 reliable forms of contraception during the trial, 1 of which is recommended to be hormonal, such as an oral contraceptive. Hormonal contraception must be started ≥1 full cycle prior to Week -6 (start of MTX) and continue for 30 days after the last dose of pegloticase, or at least 1 ovulatory cycle after the last dose of MTX (whichever is the longer duration after the last dose of pegloticase). Highly effective contraceptive methods (with a failure rate <1% per year), when used consistently and correctly, include implants, injectables, combined oral contraceptives, some intrauterine devices, sexual abstinence or vasectomized partner.
  • Men who are not vasectomized must agree to use appropriate contraception so as to not impregnate a female partner of reproductive potential during the trial, beginning with the initiation of MTX at Week -6 and continuing for at least 3 months after the last dose of MTX.
  • Able to tolerate MTX at SC doses of at least 15 mg during the MTX Run-in Period, regardless of estimated glomerular filtration rate (eGFR) status.

Who cannot join

  • Known history of medically confirmed prior anaphylactic reaction.
  • Known history of moderate or severe IR (including but not limited to difficulty in breathing, hypotension, generalized urticaria, generalized erythema, angioedema and/or required treatment with IV steroids or epinephrine; or other serious adverse events (SAEs) related to pegloticase or any other pegylated product treatment.
  • Weight >160 kg (352 pounds) at Screening.
  • Any serious acute bacterial infection, unless treated and completely resolved with antibiotics at least 2 weeks prior to the Week 6 Visit.
  • Severe chronic or recurrent bacterial infections, such as recurrent pneumonia or chronic bronchiectasis.
  • Current or chronic treatment with systemic immunosuppressive agents, such as MTX, azathioprine, cyclosporine, leflunomide, cyclophosphamide or mycophenolate mofetil.
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  • Current treatment with prednisone >10 mg/day or equivalent dose of another corticosteroid on a chronic basis (defined as 3 months or longer).
  • Known history of any solid organ transplant surgery requiring maintenance immunosuppressive therapy.
  • Known history of hepatitis B virus surface antigen positivity or hepatitis B DNA positivity, unless treated, viral load is negative and no chronic or active infection confirmed by hepatitis B virus serology.
  • Known history of hepatitis C virus RNA positivity, unless treated and viral load is negative.
  • Known history of human immunodeficiency virus positivity.
  • glucose-6-phosphate dehydrogenase (G6PD) deficiency (tested at the Screening Visit).
  • Severe chronic renal impairment (eGFR <30 mL/min/1.73 m^2) at the Screening Visit based on 4 variable Modification of Diet in Renal Disease [MDRD] formula or currently on dialysis.
  • Non-compensated congestive heart failure, hospitalization for congestive heart failure or treatment for acute coronary syndrome (myocardial infarction or unstable angina) within 3 months of the Screening Visit, current uncontrolled arrhythmia or current uncontrolled blood pressure (>160/100 mm Hg) prior to Week -6.
  • Pregnant, planning to become pregnant, breastfeeding, planning to impregnate female partner, or not on an effective form of birth control, as determined by the Investigator.
  • Prior treatment with another recombinant uricase (rasburicase) or concomitant therapy with a PEG-conjugated drug.
  • Known allergy to pegylated products or history of anaphylactic reaction to a recombinant protein or porcine product.
  • Contraindication to MTX treatment or MTX treatment considered inappropriate.
  • Known intolerance to MTX.
  • Receipt of an investigational drug within 4 weeks or 5 half-lives, whichever is longer, prior to MTX administration at Week -6 or plan to take an investigational drug during the trial.
  • Current liver disease, as determined by alanine transaminase (ALT) or aspartate transaminase (AST) >1.25 × upper limit of normal (ULN) or albumin <lower limit of normal at the Screening Visit.
  • Currently receiving systemic or radiologic treatment for ongoing cancer, excluding nonmelanoma skin cancer.
  • History of malignancy within 5 years other than non-melanoma skin cancer or in situ carcinoma of cervix.
  • White blood cell count <4.0 × 10^9/L, hematocrit <32% or platelet count <75 × 10^9/L.
  • Diagnosis of osteomyelitis.
  • Known history of hypoxanthine-guanine phosphoribosyl-transferase deficiency, such as Lesch-Nyhan and Kelley-Seegmiller syndrome.
  • Unsuitable candidate for the trial (e.g., cognitive impairment), based on the opinion of the Investigator, such that participation might create undue risk to the subject or interfere with the subject's ability to comply with the protocol requirements or complete the trial.
  • Alcohol use in excess of 3 alcoholic beverages per week.
  • A known intolerance to all protocol standard gout flare prophylaxis regimen (i.e., unable to tolerate any of the following 3 agents: colchicine,nonsteroidal anti-inflammatory drugs (NSAIDs) or low- dose prednisone (≤10 mg/day).
  • Current pulmonary fibrosis, bronchiectasis or interstitial pneumonitis. If deemed necessary by the Investigator, a chest x-ray may be performed during Screening.

Trial locations and contacts

15 sites in 1 country.

15 sites in 1 country

United States15 sites

  • University of Colorado Anschutz Medical Campus

    Aurora, Colorado, 80045-2536

  • University of Alabama at Birmingham (UAB) - Center for Education & Research on Therapeutics of Musculoskeletal Disorders

    Birmingham, Alabama, 35294-0002

  • Western Washington Arthritis Clinic

    Bothell, Washington, 98021

  • Altoona Center for Clinical Research

    Duncansville, Pennsylvania, 16635

  • Arizona Arthritis and Rheumatology Associates

    Flagstaff, Arizona, 86001

  • Arizona Arthritis and Rheumatology Associates

    Glendale, Arizona, 85306

  • Biopharma Informatic, LLC

    Houston, Texas, 77043

  • Life Clinical Trials

    Margate, Florida, 33063

  • Arizona Arthritis and Rheumatology Associates

    Mesa, Arizona, 85210

  • IRIS Research and Development, LLC

    Plantation, Florida, 33324

  • Napa Research

    Pompano Beach, Florida, 33046

  • East Bay Rheumatology Medical Group

    San Leandro, California, 94578

  • Providence St. John's Health Clinic

    Santa Monica, California, 90404

  • GCP Clinical Research, LLC

    Tampa, Florida, 33609

  • The Center for Rheumatology and Bone Research

    Wheaton, Maryland, 20902

Other trials in United States

About this study

Official title: A Phase 4, Multicenter, Open-label, Efficacy and Safety Trial of Pegloticase and Methotrexate Co-administered in Patients With Uncontrolled Gout Who Have Previously Received Pegloticase Monotherapy But Did Not Maintain a Serum Uric Acid Response

This is a Phase 4, multicenter, open-label trial of pegloticase with methotrexate (MTX) in adult participants with uncontrolled gout who were previously treated with pegloticase without a concomitant immunomodulator and stopped pegloticase due to failure to maintain serum uric acid (sUA) response and/or a clinically mild infusion reaction (IR). Approximately 30 participants will be enrolled. Pegloticase + MTX will be administered for approximately 24 weeks, with an optional extension up to 48 weeks.

The trial design will include 5 distinct components:

  1. Screening Period, lasting up to 42 days;
  2. 6-week MTX Tolerability Assessment Period (hereafter referred to as the MTX Run-in Period);
  3. 24-week Pegloticase + MTX Treatment Period, which will include a Week 24/End of Trial/Early Termination Visit (subjects that end MTX and pegloticase treatment prior to the Week 24 will remain on trial for follow up until the Week 24 visit)
  4. Optional Pegloticase + MTX Extension Period up to 24 weeks
  5. 30-Day Post Treatment Follow -up
Read the detailed description

All participants who meet eligibility criteria at Screening will begin once-weekly subcutaneous (SC) MTX Run-in period. Participants must be able to tolerate MTX at a minimum dose of 15 mg during the 6-week MTX Run-in Period to be eligible to participate in the Pegloticase + MTX Treatment Period.

All participants who meet the inclusion/exclusion criteria and complete the MTX Run-in Period will be considered enrolled participants. During the Pegloticase + MTX Treatment Period, pegloticase 8 mg will be administered IV every 2 weeks and MTX SC weekly.

Two sequential cohorts of participants will be enrolled in this trial. Cohort 1 is targeted to enroll 10 participants who previously failed to maintain sUA response with pegloticase monotherapy and stopped pegloticase treatment without a history of pegloticase-related infusion reaction.

If the safety assessment during Cohort 1 indicates that the pegloticase infusions are well tolerated, then the trial can begin enrolling Cohort 2 for 20 participants who failed to maintain sUA response with pegloticase monotherapy with or without a history of pegloticase-related clinically mild IRs.

Study acquired from Horizon in 2024.

Being tested
Pegloticase, Methotrexate (MTX)
Keywords
Gout
Medical subject headings
Gout

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • PegloticaseBiological

    Participants will receive pegloticase with MTX for up to 24 weeks during the treatment period. Participants may opt to receive pegloticase with MTX for an additional 24 weeks.

  • Methotrexate (MTX)Drug

    Participants will receive MTX during the run-in period then pegloticase with MTX for up to 24 weeks during the treatment period. Participants may opt to receive pegloticase with MTX for an additional 24 weeks.

Study groups in NCT04772313
Study groupRoleWhat they receive
Pegloticase plus Methotrexate (MTX)ExperimentalPegloticase (8 mg) intravenous (IV) every two weeks. Methotrexate (15 or 25 mg weekly) SC.
Receives: Biological: Pegloticase; Drug: Methotrexate (MTX)

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Percentage of Serum Uric Acid (sUA) Responders (sUA < 6 mg/dL) During Month 6

    An sUA responder is defined as a participant achieving and maintaining sUA <6 mg/dL for at least 80% of the time during Month 6 (Weeks 20, 21, 22, 23 and 24).

    Measured: Month 6

Secondary outcomes (6)

  1. Percentage of sUA Responders (sUA < 6 mg/dL) During Month 3

    An sUA responder is defined as a participant achieving and maintaining sUA <6 mg/dL for at least 80% of the time during Month 3 (Weeks 10 to 14).

    Measured: Month 3

  2. Percentage of Participants Who Experienced Any of the Following Events From Day 1 to Week 24: Infusion Reaction (IR) Leading to Discontinuation of Treatment, Anaphylaxis or Meeting Individual Participant sUA Discontinuation Criteria

    Individual participant sUA discontinuation criteria are met when the lowest available interim sUA value after the pegloticase infusion at Week 2, 4, 6, 8, 10 or 12 is less than a 50% reduction from the highest sUA value measured between Screening and pre-infusion on Day 1.

    Measured: Day1 to Week 24

  3. Mean Change From Baseline in Urate Deposition Volume Measured by Dual Energy Computed Tomography (DECT) to Week 24

    DECT scans measure urate deposition volume. DECT scans at Week 24 were taken for hands, foot/ankle, and knees.

    Measured: Baseline to Week 24

  4. Mean Change From Baseline in Health Assessment Questionnaire - Disability Index (HAQ-DI) Score at Weeks 14 and 24

    HAQ-DI is a self-report functional status instrument that is filled out by the participant and measures disability over the past week via 20 questions relating to 8 domains of function: dressing grooming, arising, eating, walking, hygiene, reach, grip, usual activities. For each of the categories, participants reported the amount of difficulty they had in performing 2 or 3 specific subcategory items. The standard disability score is calculated from the 8 categories by dividing the sum of the individual categories by the number of categories answered, yielding a score from 0 (without any difficulty) to 3 (unable to do), with higher values indicating higher disability.

    Measured: Baseline, Week 14, Week 24

  5. Mean Change From Baseline in Health Assessment Questionnaire (HAQ) Pain Score at Weeks 14 and 24

    The HAQ pain scale asks participants to record how much pain they have had in the past week on a scale of 0-100 where zero represents no pain and 100 represents severe pain.

    Measured: Baseline, Week 14, Week 24

  6. Mean Change From Baseline in HAQ Health Score at Weeks 14 and 24

    The HAQ health scale is a measure of overall health. Participants are asked to rate how well they are doing on a scale of 0 to 100, where zero represents very well and 100 represents very poor health.

    Measured: Baseline, Week 14, Week 24

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted26 Feb 2021
  2. Study start8 Mar 2021
  3. Primary completion23 Aug 2022
  4. Study completion24 Apr 2023

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 4
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrolment
11 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04772313
Sponsor's protocol ID
HZNP-KRY-407
Status last verified
Jun 2024
First submitted
24 Feb 2021
Last updated
27 Jun 2024
Data monitoring committee
No
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
Yes: De-identified individual patient data for variables necessary to address the specific research question in an approved data sharing request.

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing Pegloticase and Methotrexate (MTX) in people with Uncontrolled Gout, run by Amgen at 15 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 17 inclusion and 30 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 27 Jun 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 15 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 10 Oct 2023). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Percentage of Serum Uric Acid (sUA) Responders (sUA < 6 mg/dL) During Month 6 (time frame: Month 6). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04772313.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 27 Jun 2024.

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