Efficacy and safety of monotherapy with sirukumab compared with adalimumab monotherapy in biologic-naïve patients with active rheumatoid arthritis (SIRROUND-H): a randomised, double-blind, parallel-group, multinational, 52-week, phase 3 study

• Published in: Annals of the rheumatic diseases Vol. 77; no. 5; pp. 658 - 666
• Main Authors: Taylor, Peter C, Schiff, Michael H, Wang, Qingmin, Jiang, Yusang, Zhuang, Yanli, Kurrasch, Regina, Daga, Shruti, Rao, Ravi, Tak, Paul P, Hsu, Benjamin
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.05.2018
• Subjects: Adalimumab - administration & dosage; Adult; Antibodies, Monoclonal - administration & dosage; Antirheumatic Agents - administration & dosage; Arthritis, Rheumatoid - blood; Arthritis, Rheumatoid - drug therapy; Biological Products - administration & dosage; Blood Sedimentation; Cytokines; Double-Blind Method; Double-blind studies; Drug dosages; Erythrocyte sedimentation rate; Failure; Female; Health risk assessment; Humans; Immunoglobulins; Immunotherapy; Interleukin 6; Joint diseases; Male; Methotrexate; Middle Aged; Monoclonal antibodies; Rheumatoid arthritis; Severity of Illness Index; Statistical methods; TNF inhibitors; Treatment Outcome; Tumor necrosis factor-TNF; DMARDs (biologic); rheumatoid arthritis; anti-TNF
• DOI: 10.1136/annrheumdis-2017-212496
• ISSN: 0003-4967

ObjectiveThis randomised, double-blind, parallel-group, phase 3 study compared monotherapy with sirukumab, an anti–interleukin-6 cytokine monoclonal antibody, with adalimumab monotherapy in patients with rheumatoid arthritis (RA).MethodsBiologic-naïve patients with active RA who were inadequate responders or were intolerant to, or inappropriate for, methotrexate were randomised to subcutaneous sirukumab 100 mg every 2 weeks (n=187), sirukumab 50 mg every 4 weeks (n=186) or adalimumab 40 mg every 2 weeks (n=186). Primary endpoints at week 24 were change from baseline in Disease Activity Score in 28 joints (DAS28) using erythrocyte sedimentation rate (ESR) and proportion of patients achieving an American College of Rheumatology (ACR) 50 response; these endpoints were tested in sequential order. This study is registered at EudraCT (number: 2013-001417-32) and ClinicalTrials.gov (number: NCT02019472).ResultsSignificantly greater improvements from baseline in mean (SD) DAS28 (ESR) were observed at week 24 with sirukumab 100 mg every 2 weeks (−2.96 (1.580)) versus adalimumab 40 mg every 2 weeks (−2.19 (1.437); P<0.001). Sirukumab 50 mg every 4 weeks also showed significantly greater improvement from baseline at week 24 in DAS28 (ESR) (−2.58 (1.524)) compared with adalimumab (P=0.013). The ACR50 response rates with the 100 mg (35.3%) and 50 mg (26.9%) doses of sirukumab were comparable to that with adalimumab (31.7%) at week 24. The safety profile of sirukumab was consistent with that observed with anti–interleukin-6 receptor antibodies. A dose-related effect on the incidence of injection-site reactions was observed with sirukumab.ConclusionSirukumab monotherapy showed greater improvements in DAS28 (ESR), but similar ACR50 response rates, versus adalimumab monotherapy.