title: A phase III, multicenter, randomized, double-blind, placebo-controlled, parallel-group study of 2 dosing regimens of fostamatinib in patients with rheumatoid arthritis with an inadequate response to a tumor necrosis factor-α antagonist.
abstract: OBJECTIVE
  Our 24-week study (NCT01197755; OSKIRA-3) compared the efficacy and safety of fostamatinib versus placebo in patients taking background methotrexate treatment with active rheumatoid arthritis (RA) and an inadequate response to a single tumor necrosis factor-α antagonist.
  
  
  METHODS
  Adult patients were randomized (1:1:1) to fostamatinib [100 mg bid for 24 weeks (n=105; Group A)], or 100 mg bid for 4 weeks, then 150 mg qd (n=108; Group B), or to placebo (n=110; Group C) for 24 weeks. Nonresponders at Week 12 could enter a longterm extension study. The primary endpoint was the proportion of patients achieving an American College of Rheumatology 20% (ACR20) response at Week 24.
  
  
  RESULTS
  Baseline characteristics were well balanced. Significantly more patients in fostamatinib Group A (36.2%; p=0.004), but not B (27.8%; p=0.168), achieved ACR20 at Week 24 versus placebo (21.1%). Frequently reported adverse events were diarrhea, hypertension, and headache. Elevated blood pressure (≥140/90 mm Hg) at ≥1 visit was observed in 46.7%, 51.9%, and 26.6% of patients, respectively. There were 2 deaths in the study, 1 in Group B and 1 in the placebo group.
  
  
  CONCLUSIONS
  Fostamatinib 100 mg bid, but not fostamatinib 100 mg bid for 4 weeks then 150 mg qd, achieved statistical improvements in ACR20 at 24 weeks versus placebo. Because of efficacy and safety results from the phase III clinical program, the companies developing fostamatinib have decided not to study it further in RA at this time.
authors.affiliation: From Stanford University, Palo Alto, California, USA; Leiden University Medical Center, Leiden, The Netherlands; University of Toronto, Toronto, Ontario, Canada; Centro Medico Privado de Reumatologia, San Miguel de Tucuman, Argentina; Centre Hospitalier Régional, Orleans, France; University of California, San Diego, La Jolla, California; Austin Rheumatology Research PA, Austin, Texas; (formerly) AstraZeneca, Wilmington, Delaware, USA; AstraZeneca, Macclesfield, UK; Arthritis Associates, Orlando, Florida; Brigham and Women's Hospital, Boston, Massachusetts, USA.M.C. Genovese, MD, Stanford University; D.M. van der Heijde, MD, PhD, Leiden University Medical Center; E.C. Keystone, MD, University of Toronto; A.J. Spindler, MD, Centro Medico Privado de Reumatologia; C. Benhamou, MD, Centre Hospitalier Régional; A. Kavanaugh, MD, University of California, San Diego; E. Fudman, MD, Austin Rheumatology Research PA; K. Lampl, MD; C. O'Brien, MD, PhD, (formerly) AstraZeneca; E.L. Duffield, MSc, AstraZeneca, UK; J. Poiley, MD, Arthritis Associates; M.E. Weinblatt, MD, Brigham and Women's Hospital. genovese@stanford.edu.
authors.forename: Mark C
authors.initials: MC
authors.lastname: Genovese
authors.affiliation: From Stanford University, Palo Alto, California, USA; Leiden University Medical Center, Leiden, The Netherlands; University of Toronto, Toronto, Ontario, Canada; Centro Medico Privado de Reumatologia, San Miguel de Tucuman, Argentina; Centre Hospitalier Régional, Orleans, France; University of California, San Diego, La Jolla, California; Austin Rheumatology Research PA, Austin, Texas; (formerly) AstraZeneca, Wilmington, Delaware, USA; AstraZeneca, Macclesfield, UK; Arthritis Associates, Orlando, Florida; Brigham and Women's Hospital, Boston, Massachusetts, USA.M.C. Genovese, MD, Stanford University; D.M. van der Heijde, MD, PhD, Leiden University Medical Center; E.C. Keystone, MD, University of Toronto; A.J. Spindler, MD, Centro Medico Privado de Reumatologia; C. Benhamou, MD, Centre Hospitalier Régional; A. Kavanaugh, MD, University of California, San Diego; E. Fudman, MD, Austin Rheumatology Research PA; K. Lampl, MD; C. O'Brien, MD, PhD, (formerly) AstraZeneca; E.L. Duffield, MSc, AstraZeneca, UK; J. Poiley, MD, Arthritis Associates; M.E. Weinblatt, MD, Brigham and Women's Hospital.
authors.forename: Désirée M
authors.initials: DM
authors.lastname: van der Heijde
authors.affiliation: From Stanford University, Palo Alto, California, USA; Leiden University Medical Center, Leiden, The Netherlands; University of Toronto, Toronto, Ontario, Canada; Centro Medico Privado de Reumatologia, San Miguel de Tucuman, Argentina; Centre Hospitalier Régional, Orleans, France; University of California, San Diego, La Jolla, California; Austin Rheumatology Research PA, Austin, Texas; (formerly) AstraZeneca, Wilmington, Delaware, USA; AstraZeneca, Macclesfield, UK; Arthritis Associates, Orlando, Florida; Brigham and Women's Hospital, Boston, Massachusetts, USA.M.C. Genovese, MD, Stanford University; D.M. van der Heijde, MD, PhD, Leiden University Medical Center; E.C. Keystone, MD, University of Toronto; A.J. Spindler, MD, Centro Medico Privado de Reumatologia; C. Benhamou, MD, Centre Hospitalier Régional; A. Kavanaugh, MD, University of California, San Diego; E. Fudman, MD, Austin Rheumatology Research PA; K. Lampl, MD; C. O'Brien, MD, PhD, (formerly) AstraZeneca; E.L. Duffield, MSc, AstraZeneca, UK; J. Poiley, MD, Arthritis Associates; M.E. Weinblatt, MD, Brigham and Women's Hospital.
authors.forename: Edward C
authors.initials: EC
authors.lastname: Keystone
authors.affiliation: From Stanford University, Palo Alto, California, USA; Leiden University Medical Center, Leiden, The Netherlands; University of Toronto, Toronto, Ontario, Canada; Centro Medico Privado de Reumatologia, San Miguel de Tucuman, Argentina; Centre Hospitalier Régional, Orleans, France; University of California, San Diego, La Jolla, California; Austin Rheumatology Research PA, Austin, Texas; (formerly) AstraZeneca, Wilmington, Delaware, USA; AstraZeneca, Macclesfield, UK; Arthritis Associates, Orlando, Florida; Brigham and Women's Hospital, Boston, Massachusetts, USA.M.C. Genovese, MD, Stanford University; D.M. van der Heijde, MD, PhD, Leiden University Medical Center; E.C. Keystone, MD, University of Toronto; A.J. Spindler, MD, Centro Medico Privado de Reumatologia; C. Benhamou, MD, Centre Hospitalier Régional; A. Kavanaugh, MD, University of California, San Diego; E. Fudman, MD, Austin Rheumatology Research PA; K. Lampl, MD; C. O'Brien, MD, PhD, (formerly) AstraZeneca; E.L. Duffield, MSc, AstraZeneca, UK; J. Poiley, MD, Arthritis Associates; M.E. Weinblatt, MD, Brigham and Women's Hospital.
authors.forename: Alberto J
authors.initials: AJ
authors.lastname: Spindler
authors.affiliation: From Stanford University, Palo Alto, California, USA; Leiden University Medical Center, Leiden, The Netherlands; University of Toronto, Toronto, Ontario, Canada; Centro Medico Privado de Reumatologia, San Miguel de Tucuman, Argentina; Centre Hospitalier Régional, Orleans, France; University of California, San Diego, La Jolla, California; Austin Rheumatology Research PA, Austin, Texas; (formerly) AstraZeneca, Wilmington, Delaware, USA; AstraZeneca, Macclesfield, UK; Arthritis Associates, Orlando, Florida; Brigham and Women's Hospital, Boston, Massachusetts, USA.M.C. Genovese, MD, Stanford University; D.M. van der Heijde, MD, PhD, Leiden University Medical Center; E.C. Keystone, MD, University of Toronto; A.J. Spindler, MD, Centro Medico Privado de Reumatologia; C. Benhamou, MD, Centre Hospitalier Régional; A. Kavanaugh, MD, University of California, San Diego; E. Fudman, MD, Austin Rheumatology Research PA; K. Lampl, MD; C. O'Brien, MD, PhD, (formerly) AstraZeneca; E.L. Duffield, MSc, AstraZeneca, UK; J. Poiley, MD, Arthritis Associates; M.E. Weinblatt, MD, Brigham and Women's Hospital.
authors.forename: Claude
authors.initials: C
authors.lastname: Benhamou
authors.affiliation: From Stanford University, Palo Alto, California, USA; Leiden University Medical Center, Leiden, The Netherlands; University of Toronto, Toronto, Ontario, Canada; Centro Medico Privado de Reumatologia, San Miguel de Tucuman, Argentina; Centre Hospitalier Régional, Orleans, France; University of California, San Diego, La Jolla, California; Austin Rheumatology Research PA, Austin, Texas; (formerly) AstraZeneca, Wilmington, Delaware, USA; AstraZeneca, Macclesfield, UK; Arthritis Associates, Orlando, Florida; Brigham and Women's Hospital, Boston, Massachusetts, USA.M.C. Genovese, MD, Stanford University; D.M. van der Heijde, MD, PhD, Leiden University Medical Center; E.C. Keystone, MD, University of Toronto; A.J. Spindler, MD, Centro Medico Privado de Reumatologia; C. Benhamou, MD, Centre Hospitalier Régional; A. Kavanaugh, MD, University of California, San Diego; E. Fudman, MD, Austin Rheumatology Research PA; K. Lampl, MD; C. O'Brien, MD, PhD, (formerly) AstraZeneca; E.L. Duffield, MSc, AstraZeneca, UK; J. Poiley, MD, Arthritis Associates; M.E. Weinblatt, MD, Brigham and Women's Hospital.
authors.forename: Arthur
authors.initials: A
authors.lastname: Kavanaugh
authors.affiliation: From Stanford University, Palo Alto, California, USA; Leiden University Medical Center, Leiden, The Netherlands; University of Toronto, Toronto, Ontario, Canada; Centro Medico Privado de Reumatologia, San Miguel de Tucuman, Argentina; Centre Hospitalier Régional, Orleans, France; University of California, San Diego, La Jolla, California; Austin Rheumatology Research PA, Austin, Texas; (formerly) AstraZeneca, Wilmington, Delaware, USA; AstraZeneca, Macclesfield, UK; Arthritis Associates, Orlando, Florida; Brigham and Women's Hospital, Boston, Massachusetts, USA.M.C. Genovese, MD, Stanford University; D.M. van der Heijde, MD, PhD, Leiden University Medical Center; E.C. Keystone, MD, University of Toronto; A.J. Spindler, MD, Centro Medico Privado de Reumatologia; C. Benhamou, MD, Centre Hospitalier Régional; A. Kavanaugh, MD, University of California, San Diego; E. Fudman, MD, Austin Rheumatology Research PA; K. Lampl, MD; C. O'Brien, MD, PhD, (formerly) AstraZeneca; E.L. Duffield, MSc, AstraZeneca, UK; J. Poiley, MD, Arthritis Associates; M.E. Weinblatt, MD, Brigham and Women's Hospital.
authors.forename: Edward
authors.initials: E
authors.lastname: Fudman
authors.affiliation: From Stanford University, Palo Alto, California, USA; Leiden University Medical Center, Leiden, The Netherlands; University of Toronto, Toronto, Ontario, Canada; Centro Medico Privado de Reumatologia, San Miguel de Tucuman, Argentina; Centre Hospitalier Régional, Orleans, France; University of California, San Diego, La Jolla, California; Austin Rheumatology Research PA, Austin, Texas; (formerly) AstraZeneca, Wilmington, Delaware, USA; AstraZeneca, Macclesfield, UK; Arthritis Associates, Orlando, Florida; Brigham and Women's Hospital, Boston, Massachusetts, USA.M.C. Genovese, MD, Stanford University; D.M. van der Heijde, MD, PhD, Leiden University Medical Center; E.C. Keystone, MD, University of Toronto; A.J. Spindler, MD, Centro Medico Privado de Reumatologia; C. Benhamou, MD, Centre Hospitalier Régional; A. Kavanaugh, MD, University of California, San Diego; E. Fudman, MD, Austin Rheumatology Research PA; K. Lampl, MD; C. O'Brien, MD, PhD, (formerly) AstraZeneca; E.L. Duffield, MSc, AstraZeneca, UK; J. Poiley, MD, Arthritis Associates; M.E. Weinblatt, MD, Brigham and Women's Hospital.
authors.forename: Kathy
authors.initials: K
authors.lastname: Lampl
authors.affiliation: From Stanford University, Palo Alto, California, USA; Leiden University Medical Center, Leiden, The Netherlands; University of Toronto, Toronto, Ontario, Canada; Centro Medico Privado de Reumatologia, San Miguel de Tucuman, Argentina; Centre Hospitalier Régional, Orleans, France; University of California, San Diego, La Jolla, California; Austin Rheumatology Research PA, Austin, Texas; (formerly) AstraZeneca, Wilmington, Delaware, USA; AstraZeneca, Macclesfield, UK; Arthritis Associates, Orlando, Florida; Brigham and Women's Hospital, Boston, Massachusetts, USA.M.C. Genovese, MD, Stanford University; D.M. van der Heijde, MD, PhD, Leiden University Medical Center; E.C. Keystone, MD, University of Toronto; A.J. Spindler, MD, Centro Medico Privado de Reumatologia; C. Benhamou, MD, Centre Hospitalier Régional; A. Kavanaugh, MD, University of California, San Diego; E. Fudman, MD, Austin Rheumatology Research PA; K. Lampl, MD; C. O'Brien, MD, PhD, (formerly) AstraZeneca; E.L. Duffield, MSc, AstraZeneca, UK; J. Poiley, MD, Arthritis Associates; M.E. Weinblatt, MD, Brigham and Women's Hospital.
authors.forename: Chris
authors.initials: C
authors.lastname: O'Brien
authors.affiliation: From Stanford University, Palo Alto, California, USA; Leiden University Medical Center, Leiden, The Netherlands; University of Toronto, Toronto, Ontario, Canada; Centro Medico Privado de Reumatologia, San Miguel de Tucuman, Argentina; Centre Hospitalier Régional, Orleans, France; University of California, San Diego, La Jolla, California; Austin Rheumatology Research PA, Austin, Texas; (formerly) AstraZeneca, Wilmington, Delaware, USA; AstraZeneca, Macclesfield, UK; Arthritis Associates, Orlando, Florida; Brigham and Women's Hospital, Boston, Massachusetts, USA.M.C. Genovese, MD, Stanford University; D.M. van der Heijde, MD, PhD, Leiden University Medical Center; E.C. Keystone, MD, University of Toronto; A.J. Spindler, MD, Centro Medico Privado de Reumatologia; C. Benhamou, MD, Centre Hospitalier Régional; A. Kavanaugh, MD, University of California, San Diego; E. Fudman, MD, Austin Rheumatology Research PA; K. Lampl, MD; C. O'Brien, MD, PhD, (formerly) AstraZeneca; E.L. Duffield, MSc, AstraZeneca, UK; J. Poiley, MD, Arthritis Associates; M.E. Weinblatt, MD, Brigham and Women's Hospital.
authors.forename: Emma L
authors.initials: EL
authors.lastname: Duffield
authors.affiliation: From Stanford University, Palo Alto, California, USA; Leiden University Medical Center, Leiden, The Netherlands; University of Toronto, Toronto, Ontario, Canada; Centro Medico Privado de Reumatologia, San Miguel de Tucuman, Argentina; Centre Hospitalier Régional, Orleans, France; University of California, San Diego, La Jolla, California; Austin Rheumatology Research PA, Austin, Texas; (formerly) AstraZeneca, Wilmington, Delaware, USA; AstraZeneca, Macclesfield, UK; Arthritis Associates, Orlando, Florida; Brigham and Women's Hospital, Boston, Massachusetts, USA.M.C. Genovese, MD, Stanford University; D.M. van der Heijde, MD, PhD, Leiden University Medical Center; E.C. Keystone, MD, University of Toronto; A.J. Spindler, MD, Centro Medico Privado de Reumatologia; C. Benhamou, MD, Centre Hospitalier Régional; A. Kavanaugh, MD, University of California, San Diego; E. Fudman, MD, Austin Rheumatology Research PA; K. Lampl, MD; C. O'Brien, MD, PhD, (formerly) AstraZeneca; E.L. Duffield, MSc, AstraZeneca, UK; J. Poiley, MD, Arthritis Associates; M.E. Weinblatt, MD, Brigham and Women's Hospital.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Poiley
authors.affiliation: From Stanford University, Palo Alto, California, USA; Leiden University Medical Center, Leiden, The Netherlands; University of Toronto, Toronto, Ontario, Canada; Centro Medico Privado de Reumatologia, San Miguel de Tucuman, Argentina; Centre Hospitalier Régional, Orleans, France; University of California, San Diego, La Jolla, California; Austin Rheumatology Research PA, Austin, Texas; (formerly) AstraZeneca, Wilmington, Delaware, USA; AstraZeneca, Macclesfield, UK; Arthritis Associates, Orlando, Florida; Brigham and Women's Hospital, Boston, Massachusetts, USA.M.C. Genovese, MD, Stanford University; D.M. van der Heijde, MD, PhD, Leiden University Medical Center; E.C. Keystone, MD, University of Toronto; A.J. Spindler, MD, Centro Medico Privado de Reumatologia; C. Benhamou, MD, Centre Hospitalier Régional; A. Kavanaugh, MD, University of California, San Diego; E. Fudman, MD, Austin Rheumatology Research PA; K. Lampl, MD; C. O'Brien, MD, PhD, (formerly) AstraZeneca; E.L. Duffield, MSc, AstraZeneca, UK; J. Poiley, MD, Arthritis Associates; M.E. Weinblatt, MD, Brigham and Women's Hospital.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Weinblatt
mesh_terms: D000328:Adult; D000631:Aminopyridines; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy*; D018450:Disease Progression; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D006801:Humans; D020714:Maximum Tolerated Dose; D008727:Methotrexate / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D009025:Morpholines; D010078:Oxazines / Q000009:adverse effects / Q000627:therapeutic use*; D061214:Patient Safety; D011379:Prognosis; D011725:Pyridines / Q000009:adverse effects / Q000627:therapeutic use*; D011743:Pyrimidines; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000631:Aminopyridines; D009025:Morpholines; D010078:Oxazines; D011725:Pyridines; D011743:Pyrimidines; D014409:Tumor Necrosis Factor-alpha; C523665:fostamatinib; D008727:Methotrexate
keywords: EFFICACY; FOSTAMATINIB; METHOTREXATE; OSKIRA; RHEUMATOID ARTHRITIS