Safety and Efficacy Study of PEG-uricase in the Treatment of Hyperuricemic Patients With Symptomatic Gout

NCT ID: NCT00325195

Last Updated: 2011-02-28

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE3

Total Enrollment

225 participants

Study Classification

INTERVENTIONAL

Study Start Date

2006-05-31

Study Completion Date

2007-12-31

Brief Summary

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These are two replicate studies to evaluate the safety and efficacy of PEG (polyethylene glycol)-uricase in controlling the uric acid level in symptomatic gout patients with high uric acid levels who are unable to take standard gout therapies, or for whom those therapies have been unsuccessful in controlling their uric acid level.

Detailed Description

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The primary objective of each of the studies is to demonstrate superiority in the response rate (control of uric acid levels to below 6 mg/dL) in the PEG-uricase treatment groups compared to the placebo-control group.

While reduction or resolution of tophi have been reported in the setting of prolonged urate-lowering therapy, there is photographic and additional anecdotal evidence from the Phase 2 PEG-uricase study of resolution or significant reduction of tophi after 3 months of therapy. Therefore, an assessment of changes in tophi over time will be conducted through the use of digital photographs obtained in a standardized manner from all subjects during the study. The effect on other clinical outcomes, including quality of life, health-related disability measures, gout flares and the number of swollen and tender joints will also be compared between the treatment groups and control group. Subjects will be randomized to one of the three treatment arms in a 2:2:1 ratio: 8 mg PEG-uricase every 2 weeks; 8 mg PEG-uricase every 4 weeks; or placebo. All subjects will receive an intravenous infusion (PEG-uricase or placebo) every two weeks in order to maintain the blind throughout the study. Study duration is approximately 26 weeks, including two weeks for screening and 24 weeks (6 months) of treatment.

Conditions

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Gout

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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q2 wks

8 mg pegloticase every 2 weeks

Group Type EXPERIMENTAL

pegloticase

Intervention Type BIOLOGICAL

8 mg pegloticase by intravenous infusion

q4 wks

8 mg pegloticase every 4 weeks (alternating with placebo every 4 weeks)

Group Type EXPERIMENTAL

pegloticase

Intervention Type BIOLOGICAL

8 mg pegloticase by intravenous infusion

placebo

placebo every 2 weeks

Group Type PLACEBO_COMPARATOR

placebo

Intervention Type OTHER

placebo by intravenous infusion every 2 weeks

Interventions

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placebo

placebo by intravenous infusion every 2 weeks

Intervention Type OTHER

pegloticase

8 mg pegloticase by intravenous infusion

Intervention Type BIOLOGICAL

Other Intervention Names

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PEG-uricase Puricase

Eligibility Criteria

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Inclusion Criteria

1. Outpatients of either gender, age 18 or older ( no upper age limit).
2. Patient is hyperuricemic: screening serum uric acid must be ≥8 mg/dL.
3. Patient has symptomatic gout (presence of at least 3 gout flares in the 18 months prior to entry, or at least one gout tophus, or gouty arthritis).
4. Conventional therapy is contraindicated or has been ineffective in this patient, i.e., patient has a history (either by medical record or patient interview) of hypersensitivity or of failure to normalize SUA with at least 3 months treatment with allopurinol at the maximum labeled dose (800 mg/dL in the U.S.), or at a medically appropriate lower dose based on dose-limiting toxicity or dose-limiting co-morbidity.
5. Patient is willing and able to give informed consent and adhere to visit/protocol schedules (informed consent must be given before the first study procedure is performed, including washout).
6. If the patient is a woman of childbearing potential, she must have had a negative screening serum pregnancy test and must use a medically approved form of birth control during her participation in the protocol. Such methods include oral, injectable or implantable contraceptives; IUDs and barrier contraceptives in combination with spermicide. (If male or surgically sterile, check N/A.)

Exclusion Criteria

1. The patient has unstable angina.
2. The patient has uncontrolled arrhythmia.
3. The patient has non-compensated congestive heart failure.
4. The patient has uncontrolled hypertension (above 150/95).
5. The patient has a history of end stage renal disease requiring dialysis.
6. The patient has hemoglobin \< 8 g/dL (males) or \< 7 g/dL (females).
7. The patient is an organ transplant recipient
8. The patient has had prior treatment with PEG-uricase, or other recombinant uricase, or any concomitant therapy with a PEG-conjugated drug.
9. The patient has had a gout flare at screening that is resolved for less than one week prior to first treatment with study drug (exclusive of chronic synovitis/ arthritis).
10. The patient has glucose-6-phosphate dehydrogenase (G6PD) deficiency.
11. The patient has a history of anaphylactic reaction to a recombinant protein or porcine product, or hypersensitivity to PEG.
12. The patient is pregnant or breast feeding.
13. The patient has taken an investigational drug within 4 weeks prior to study drug administration or plans to take an investigational agent during the study.
14. The patient has a known allergy to urate oxidase or PEGylated products.
15. The patient has any other medical or psychological condition which, in the opinion of the investigator, might create undue risk to the subject or interfere with the subject's ability to comply with the protocol requirements, or to complete the study.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Savient Pharmaceuticals

INDUSTRY

Sponsor Role lead

Responsible Party

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Savient Pharmaceuticals, Inc

Principal Investigators

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Medical Director, MD

Role: STUDY_DIRECTOR

Savient Pharmaceuticals, Inc.

Locations

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UAB Arthritis Clinical Intervention Program

Birmingham, Alabama, United States

Site Status

University of Arizona Arthritis Center

Tucson, Arizona, United States

Site Status

NEA Clinic

Jonesboro, Arkansas, United States

Site Status

UCSD Rheumatology Division

La Jolla, California, United States

Site Status

Kaiser Permanente Medical Center, Clinical Trials Unit

San Francisco, California, United States

Site Status

Pacific Arthritis Center Medical Group

Santa Maria, California, United States

Site Status

E. Robert Harris Medical Corporation

Whittier, California, United States

Site Status

Agilence Arthritis & Osteoporosis Medical Center

Whittier, California, United States

Site Status

Arthritis Associates & Osteoporosis Center of Colorado Springs

Colorado Springs, Colorado, United States

Site Status

Veterans Affairs Medical Center

Washington D.C., District of Columbia, United States

Site Status

Arthritis & Rheumatic Disease Specialties

Aventura, Florida, United States

Site Status

Malcom Randall VA Medical Center

Gainesville, Florida, United States

Site Status

Horizon Institute for Clinical Research

Hollywood, Florida, United States

Site Status

Ocala Rheumatology Research Center

Ocala, Florida, United States

Site Status

Arthritis & Osteoporosis Treatment Center, PA

Orange Park, Florida, United States

Site Status

St. Petersburg Arthritis Center

St. Petersburg, Florida, United States

Site Status

Idaho Arthritis & Osteoporosis Center

Boise, Idaho, United States

Site Status

Institute of Arthritis Research

Idaho Falls, Idaho, United States

Site Status

The University of Chicago

Chicago, Illinois, United States

Site Status

Graves Gilbert Clinic

Bowling Green, Kentucky, United States

Site Status

Peter A. Holt, M.D.

Baltimore, Maryland, United States

Site Status

Malamet & Klein, MD, PA

Hagerstown, Maryland, United States

Site Status

The Center for Rheumatology and Bone Research

Wheaton, Maryland, United States

Site Status

Fallon Clinic, Inc

Worcester, Massachusetts, United States

Site Status

Michigan Arthritis Research Center

Brighton, Michigan, United States

Site Status

Justus J. Fiechtner, MD, PC

Lansing, Michigan, United States

Site Status

Mayo Clinic

Rochester, Minnesota, United States

Site Status

CentraCare Clinic

Saint Cloud, Minnesota, United States

Site Status

Rheumatology Associates of North Jersey

Teaneck, New Jersey, United States

Site Status

Mount Sinai Medical Center

New York, New York, United States

Site Status

Duke University Medical Center

Durham, North Carolina, United States

Site Status

Brody School of Medicine, East Carolina University

Greenville, North Carolina, United States

Site Status

Physicians East, P.A.

Greenville, North Carolina, United States

Site Status

Carolina Atthritis Associates

Wilmington, North Carolina, United States

Site Status

New Horizons Clinical Research

Cincinnati, Ohio, United States

Site Status

The Cleveland Clinic Foundation

Cleveland, Ohio, United States

Site Status

The Ohio State University

Columbus, Ohio, United States

Site Status

STAT Research, Inc.

Dayton, Ohio, United States

Site Status

David R. Mandel, MD, Inc.

Mayfield Village, Ohio, United States

Site Status

Health Research of Oklahoma

Oklahoma City, Oklahoma, United States

Site Status

Portland Medical Associates

Portland, Oregon, United States

Site Status

Altoona Center for Clinical Research

Duncansville, Pennsylvania, United States

Site Status

Mid Atlantic Research Assoc.

Philadelphia, Pennsylvania, United States

Site Status

Rheumatology Associates

Charleston, South Carolina, United States

Site Status

Piedmont Arthritis, PA

Greenville, South Carolina, United States

Site Status

AAMR Research Clinic

Amarillo, Texas, United States

Site Status

Arthritis & Osteoporosis Center of South Texas

San Antonio, Texas, United States

Site Status

Arthritis & Osteoporosis Clinic Research Center of Central Texas

Waco, Texas, United States

Site Status

Arthritis Northwest, PLLC

Spokane, Washington, United States

Site Status

Rheumatic Disease Center

Glendale, Wisconsin, United States

Site Status

Manitoba Clinic

Winnipeg, Manitoba, Canada

Site Status

St. Joseph's Health Care

London, Ontario, Canada

Site Status

Clinica para el Diagnostico y Tratamiento de las Enfermedades Rheumaticas

México, D.f., Mexico

Site Status

Hospital General de mexico

México, D.f., Mexico

Site Status

Antiguo Hospital Civil de Guadalajara

Guadalajara, Jalisco, Mexico

Site Status

Hospital Civil de Guadalajara

Guadalajara, Jalisco, Mexico

Site Status

Countries

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United States Canada Mexico

References

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Pillinger MH, Fields TR, Yeo AE, Lipsky PE. Dissociation Between Clinical Benefit and Persistent Urate Lowering in Patients with Chronic Refractory Gout Treated with Pegloticase. J Rheumatol. 2020 Apr;47(4):605-612. doi: 10.3899/jrheum.190161. Epub 2019 Jun 15.

Reference Type DERIVED
PMID: 31203212 (View on PubMed)

Johnson RJ, Choi HK, Yeo AE, Lipsky PE. Pegloticase Treatment Significantly Decreases Blood Pressure in Patients With Chronic Gout. Hypertension. 2019 Jul;74(1):95-101. doi: 10.1161/HYPERTENSIONAHA.119.12727. Epub 2019 May 13.

Reference Type DERIVED
PMID: 31079535 (View on PubMed)

Lipsky PE, Calabrese LH, Kavanaugh A, Sundy JS, Wright D, Wolfson M, Becker MA. Pegloticase immunogenicity: the relationship between efficacy and antibody development in patients treated for refractory chronic gout. Arthritis Res Ther. 2014 Mar 4;16(2):R60. doi: 10.1186/ar4497.

Reference Type DERIVED
PMID: 24588936 (View on PubMed)

Yood RA, Ottery FD, Irish W, Wolfson M. Effect of pegloticase on renal function in patients with chronic kidney disease: a post hoc subgroup analysis of 2 randomized, placebo-controlled, phase 3 clinical trials. BMC Res Notes. 2014 Jan 21;7:54. doi: 10.1186/1756-0500-7-54.

Reference Type DERIVED
PMID: 24447425 (View on PubMed)

Baraf HS, Becker MA, Gutierrez-Urena SR, Treadwell EL, Vazquez-Mellado J, Rehrig CD, Ottery FD, Sundy JS, Yood RA. Tophus burden reduction with pegloticase: results from phase 3 randomized trials and open-label extension in patients with chronic gout refractory to conventional therapy. Arthritis Res Ther. 2013 Sep 26;15(5):R137. doi: 10.1186/ar4318.

Reference Type DERIVED
PMID: 24286509 (View on PubMed)

Sundy JS, Baraf HS, Yood RA, Edwards NL, Gutierrez-Urena SR, Treadwell EL, Vazquez-Mellado J, White WB, Lipsky PE, Horowitz Z, Huang W, Maroli AN, Waltrip RW 2nd, Hamburger SA, Becker MA. Efficacy and tolerability of pegloticase for the treatment of chronic gout in patients refractory to conventional treatment: two randomized controlled trials. JAMA. 2011 Aug 17;306(7):711-20. doi: 10.1001/jama.2011.1169.

Reference Type DERIVED
PMID: 21846852 (View on PubMed)

Other Identifiers

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C0405 & C0406

Identifier Type: -

Identifier Source: org_study_id