Approval Probability
TA Base Rate
Adjusted LOA
ML Risk
sarilumab SAR153191 · 8 trials · 3 indications
Time to improvement of greater than or equal (\>=) 2 points in clinical status assessment was defined as time (in days) from first dose of study drug to the time of first occurrence of improvement of \>=2 points in clinical status of participants assessed using 7-point ordinal scale (calculated as: Date of first occurrence/episode of the event - date of first dose + 1). Seven-point ordinal scale for clinical assessment ranges from 1= death; 2= hospitalized, on invasive mechanical ventilation/ECMO; 3= hospitalized, on non-invasive ventilation/high flow oxygen devices; 4= hospitalized, requiring supplemental oxygen; 5= hospitalized, not requiring supplemental oxygen - requiring ongoing medical care (COVID-19 related/otherwise); 6= hospitalized, not requiring supplemental oxygen - no longer required ongoing medical care; 7= not hospitalized, higher score = less severity. Kaplan-Meier method was used for analysis.
American College of Rheumatology (ACR) response is a composite rating scale that includes 7 variables: tender joints count (TJC \[68 joints\]); Swollen joints count (SJC \[66 joints\]); levels of an acute phase reactant (high sensitivity C-reactive protein \[hs-CRP level\]); participant's assessment of pain (measured on 0 \[no pain\]-100 mm \[worst pain\] visual analog scale \[VAS\]); participant's global assessment of disease activity (measured on 0 \[no arthritis activity\]-100 mm \[maximal arthritis activity\] VAS); physician's global assessment of disease activity (measured on 0 \[no arthritis activity\]-100 mm \[maximal arthritis activity\] VAS); participant's assessment of physical function (measured by health assessment questionnaire disability index \[HAQ-DI\], with scoring range of 0 \[better health\] - 3 \[worst health\]). ACR20 response was defined as achieving at least 20% improvement in both TJC and SJC, and at least 20% improvement in at least 3 of the 5 other assessments.
ADA to sarilumab and anti-sarilumab neutralizing antibodies in serum samples were determined using a validated electrochemiluminescence immunoassay method. Percentage of participants with positive ADA during treatment emergent adverse event (TEAE) period (time from first dose of investigational medicinal product \[IMP\] to last dose of IMP + 60 days) was determined. Persistent ADA Response: treatment-emergent ADA detected at 2 or more consecutive sampling time points during the TEAE period, where the first and last ADA positive samples were separated by a period of at least 16 weeks or if the last measured sample was positive. ADA samples were collected prior to IMP administration at Week 0 (baseline), Week 2, 4, 12, 24 and 30.
Adverse event (AE) was defined as any untoward medical occurrence in a participant who received study drug and does not necessary have to have a causal relationship with treatment. All adverse events that occurred from the first dose of the study drug administration up to 60 days after the end of treatment visit were considered as TEAEs. Serious AE (SAE) was an AE resulting in any of the following outcomes or deemed significant for any other reason: death; initial or prolonged inpatient hospitalization; life-threatening experience (immediate risk of dying); persistent or significant disability/incapacity; congenital anomaly or a medically important event. A summary of SAEs, all other non-serious AEs, regardless of causality, are reported in AE section.
| Arm | Type | Description |
|---|---|---|
| Sarilumab 200 mg | EXPERIMENTAL | Sarilumab 200 milligrams (mg), single dose of intravenous (IV) injection on Day 1. Participants could receive a second dose of sarilumab 200 mg 24 to 48 hours after the first dose if first and any one of last three criteria was met as compared to Day 1 (as per following protocol amendment 2 \[dated 08-Apr-2020\]): * Benefit risk assessment by the investigator favored the administration of another dose of study drug without compromising safety and * Increase/recurrence of fever or * Increase/no change in fraction of inspired oxygen (FiO2) requirement or * Required vasopressors, extracorporeal membrane oxygenation (ECMO) or development of multi-organ dysfunction. |
| Sarilumab 400 mg | EXPERIMENTAL | Sarilumab 400 mg, single dose of IV injection on Day 1. Participants could receive a second dose of sarilumab 400 mg 24 to 48 hours after the first dose if first and any one of last three criteria was met as compared to Day 1 (as per following protocol amendment 2 \[dated 08-Apr-2020\]): * Benefit risk assessment by the investigator favored the administration of another dose of study drug without compromising safety and * Increase/recurrence of fever or * Increase/no change in FiO2 requirement or * Required vasopressors, ECMO or development of multi-organ dysfunction. |
| Placebo | PLACEBO_COMPARATOR | Placebo (for sarilumab), single dose of IV injection on Day 1. Participants could receive a second dose of placebo (for sarilumab) 24 to 48 hours after the first dose if first and any one of last three criteria was met as compared to Day 1 (as per following protocol amendment 2 \[dated 08-Apr-2020\]): * Benefit risk assessment by the investigator favored the administration of another dose of study drug without compromising safety and * Increase/recurrence of fever or * Increase/no change in FiO2 requirement or * Required vasopressors, ECMO or development of multi-organ dysfunction. |
| Sarilumab 150 mg/150 mg | EXPERIMENTAL | Sarilumab 150 mg subcutaneous (SC) injection once every 2 weeks (q2w) in combination with MTX and folic acid in double-blind period up to Week 24 followed by single-blind period in which participants continued with the same treatment up to Week 52. Participants with inadequate response (defined as less than 20% improvement from baseline on 2 consecutive visits \[at least 4 weeks apart\] in either tender joint count \[TJC\] or swollen joint count \[SJC\], or with any other clear lack of efficacy based on investigator's judgment) by Week 16, were rescued with open label sarilumab 200 mg q2w treatment. |
| Sarilumab 200 mg/200 mg | EXPERIMENTAL | Sarilumab 200 mg SC injection q2w in combination with MTX and folic acid in double-blind period up to Week 24 followed by single-blind period in which participants continued with the same treatment up to Week 52. Participants with inadequate response (defined as less than 20% improvement from baseline on 2 consecutive visits \[at least 4 weeks apart\] in either TJC or SJC, or with any other clear lack of efficacy based on investigator's judgment) by Week 16, were rescued with open label sarilumab 200 mg q2w treatment. |
| Placebo/Sarilumab 150 mg | PLACEBO_COMPARATOR | Placebo (for sarilumab) SC injection q2w in combination with MTX and folic acid in double-blind period up to Week 24 followed by a single-blind period in which participants were switched and received sarilumab 150 mg SC injection q2w in combination with MTX and folic acid up to Week 52. Participants with inadequate response (defined as less than 20% improvement from baseline on 2 consecutive visits \[at least 4 weeks apart\] in either TJC or SJC, or with any other clear lack of efficacy based on Investigator's judgment) by Week 16, were rescued with open label sarilumab 200 mg q2w treatment. |
| Placebo/Sarilumab 200 mg | PLACEBO_COMPARATOR | Placebo (for sarilumab) SC injection q2w in combination with MTX and folic acid in double-blind period up to Week 24 followed by a single-blind period in which participants were switched and received sarilumab 200 mg SC injection q2w in combination with MTX and folic acid up to Week 52. Participants with inadequate response (defined as less than 20% improvement from baseline on 2 consecutive visits \[at least 4 weeks apart\] in either TJC or SJC, or with any other clear lack of efficacy based on Investigator's judgment) by Week 16, were rescued with open label sarilumab 200 mg q2w treatment. |
| Sarilumab 150 mg q2w | EXPERIMENTAL | Sarilumab 150 mg subcutaneous (SC) injection every two weeks (q2w) for 24 weeks. |
| Sarilumab 200 mg q2w | EXPERIMENTAL | Sarilumab 200 mg SC injection q2w for 24 weeks. |
| Tocilizumab q4w | ACTIVE_COMPARATOR | Tocilizumab 4 mg/kg or 8 mg/kg IV infusion q4w and placebo SC injection q2w was added to one or a combination of the nonbiologic DMARD, hydroxychloroquine, methotrexate, sulfasalazine and/or leflunomide for 24 weeks, except for the simultaneous use of leflunomide and methotrexate. |
| Sarilumab | EXPERIMENTAL | Participants will receive one of two ascending doses (or an additional intermediate dose based on available data) of sarilumab by subcutaneous (SC) injection based on body weight. All the participants will receive the selected dose once the selected dose is identified. Sarilumab will be given during 12-week core treatment phase followed by a 144- week extension treatment phase. |
| Tocilizumab | ACTIVE_COMPARATOR | Single SC dose of tocilizumab |
| Sarilumab SAR153191 (REGN88) | EXPERIMENTAL | Single dose of simvastatin before and after sarilumab administration |
| Sarilumab (SAR153191, REGN88) Dose 1 | EXPERIMENTAL | First dose of Sarilumab in a single SC injection. Methotrexate (stable dose) and folic acid are continued as background therapy |
| Sarilumab (SAR153191, REGN88) Dose 2 | EXPERIMENTAL | Second dose of Sarilumab in a single SC injection. Methotrexate (stable dose) and folic acid are continued as background therapy |
| Sarilumab (SAR153191, REGN88) Dose 3 | EXPERIMENTAL | Third dose of Sarilumab in a single SC injection. Methotrexate (stable dose) and folic acid are continued as background therapy |
| Sarilumab (SAR153191, REGN88) Dose 4 | EXPERIMENTAL | Fourth dose of Sarilumab in a single SC injection. Methotrexate (stable dose) and folic acid are continued as background therapy |
| Placebo Dose 5 | PLACEBO_COMPARATOR | Placebo to match Sarilumab (SAR153191, REGN88) in a single SC injection. Methotrexate (stable dose) and folic acid are continued as background therapy |
| Name | Type | Description |
|---|---|---|
| Sarilumab SAR153191 | DRUG | Pharmaceutical form: Solution for injection Route of administration: Intravenous infusion |
| Placebo | DRUG | Pharmaceutical form: Solution for injection Route of administration: Intravenous infusion |
| Sarilumab SAR153191 (REGN88) | DRUG | Pharmaceutical form: solution for injection Route of administration: subcutaneous |
| Placebo (for sarilumab) | OTHER | Pharmaceutical form: solution for injection Route of administration: subcutaneous |
| Methotrexate | DRUG | Dispensed according to local practice. |
| Folic acid | DRUG | Dispensed according to local practice. |
| tocilizumab | DRUG | Pharmaceutical form: solution Route of administration: intravenous |
| hydroxychloroquine | DRUG | Dispensed according to local practice. |
| sulfasalazine | DRUG | Dispensed according to local practice. |
| leflunomide | DRUG | Dispensed according to local practice. |
| subcutaneous placebo | DRUG | Pharmaceutical form: solution Route of administration: subcutaneous |
| intravenous placebo | DRUG | Pharmaceutical form: solution Route of administration: intravenous |
| simvastatin | DRUG | Pharmaceutical form:Film-coated 20 mg Tablet Route of administration: oral |
Inclusion criteria : Participants must be \>=18 years of age. Participants must be hospitalized for less than or equal to 7 days with evidence of pneumonia and have one of the following disease categories: severe disease or critical disease. Laboratory-confirmed severe acute respiratory syndrome c...
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