MPC-004 for the Treatment of an Acute Gout Flare
MPC-004 for the Treatment of an Acute Gout Flare
This study is a multicenter, randomized, double-blind, placebo-controlled, parallel group,
 dose-comparison to determine the efficacy and safety of a standard-dose of colchicine (4.8
 mg) versus low-dose colchicine (1.8 mg) or placebo for acute gout flares.
This study is a multi-center, randomized, double-blind, placebo-controlled, parallel group
 trial to compare the efficacy and safety of standard-dose colchicine (STD)(total dose = 4.8
 mg) versus low-dose colchicine (total dose 1.8 mg) or placebo for the treatment of acute gout
 flares. Eight hundred and thirteen patients with a confirmed diagnosis of gout were screened.
 238 of the screened patients failed screening; 235(98.7%) failed because they did not meet
 inclusion/exclusion criteria. The 575 eligible patients were randomly assigned (1:1:1) to one
 of three treatment groups . At the randomization visit the investigator dispensed a blister
 card containing eight identical looking capsules (in a combination of active drug and placebo
 capsules) in a double blind fashion for use during their next gout flare. Patients were
 instructed to self-initiate treatment with the study medication within 12 hours of a gout
 flare onset. Gout flares were determined by calling a Gout Flare Call Center established for
 this purpose. At Investigator discretion, rescue medication could also be provided, but
 patients were encouraged not to use rescue medication within the first 24 hours after
 starting treatment with study drug. Of the 575 study participants, 185 had a qualifying gout
 flare and 390 did not. Patients used a diary to record study drug administration, pain score,
 the presence or absence of gastrointestinal adverse events (nausea, vomiting, diarrhea, and
 abdominal pain) and the timing of any rescue medication use prior to beginning treatment and
 1, 2, 3, 4, 5, 6, 7, 8, 16, 24, 32, 40, 48, 56, 64, and 72 hours after the start of dosing.

 The pain score was based on a scale of 1 - 10 where 1 was no pain and 10 was the worst pain
 imaginable. Efficacy was defined as a 50% reduction in pain score in the target joint at 24
 hours in patients who did not use rescue medicine. The primary efficacy analysis was to be
 based on an Intent-to-Treat (ITT) population, defined as all patients who were randomized,
 contacted the Call Center, and were instructed to begin taking study drug. An otherwise
 qualified patient was excluded from the ITT population only if the patient returned a study
 drug blister pack completely unused.

 Secondary outcome measures compared the efficacy of STD dose colchicine to a low dose regimen
 and placebo using the same criteria for efficacy as for the primary outcome measure.

 Additional secondary outcome measures were time to 50% and 90% reduction in pain in the
 target joint analyzed by treatment group using Kaplan-Meier methods, and the change in mean
 pain intensity from 0 to 72 hours plotted by time point for each treatment group.

 All safety analyses were carried out using the safety population defined as all patients who
 received at least one dose of study medication regardless of authorization by the Call Center
 To determine the safety of colchicine when administered via two different dose regimens all
 patients who had a gout flare were seen by the investigator as soon as possible after onset
 and evaluated until the flare and any adverse events resolved. All adverse effects, whether
 recorded by the patient in the diary or obtained by systematic evaluation by the investigator
 were recorded and reported in tabular form. Treatment-emergent adverse events (TEAE) were
 summarized by MedDRA System Organ Class and preferred terms and tabulated according treatment
 arm, overall incidence, severity and relationship to study medication. Multiple events within
 a patient were counted once and at greatest severity and closest relationship to study
 medication.
Inclusion Criteria:

 1. Patients of either gender and of any race ≥18 years of age.

 2. If female, patients must be postmenopausal as evidenced by lack of menses for ≥12
 consecutive months.

 3. Patients must present with a confirmed diagnosis of gout.

 4. Patients must have experienced ≥2 acute gouty arthritic attacks in the 12 months prior
 to randomization.

 5. Patients on urate lowering therapy must be on a stable dose and schedule with no
 changes in therapy for 4 weeks prior to randomization and expected to remain on a
 stable regimen during study participation.

 6. Patients must be willing to adhere to the study schedule and the protocol
 requirements.

 7. Patients must be willing and able to give written informed consent. A HIPAA and/or
 state privacy consent must also be signed.

 Exclusion Criteria:

 1. Patients with acute polyarticular gout (>4 joints).

 2. Patients who have experienced >2 acute gouty arthritic attacks per month, or >12
 attacks overall, in the 6 months prior to randomization.

 3. Patients with arthritis due to any cause other than gout that may confound any study
 assessments per Investigator discretion.

 4. Patients with a history of myocardial infarction, unstable angina, cerebrovascular
 events, or coronary artery bypass grafting within the previous 6 months prior to
 screening.

 5. Patients with active myeloid leukemia, obstructive gastrointestinal cancer, or
 metastatic cancer.

 6. Patients with chronic renal dysfunction (creatinine clearance <60 mL/min as estimated
 with the Cockcroft Gault formula).

 7. Patients with chronic hepatic dysfunction.

 8. Patients with a history of alcohol or substance abuse within the 12 months prior to
 randomization.

 9. Patients who have any concomitant illness or other finding that, in the opinion of the
 Investigator, would confound the study data or place the patient at unacceptable risk
 if the patient were to participate in the study, or that would require frequent
 adjustments in concomitant medications during the course of the study.

 10. Patients using systemic corticosteroid, cyclosporine, adalimumab, etanercept,
 infliximab, anakinra, abatacept, mycophenolate, azathioprine, anticoagulants
 (warfarin, heparin, low molecular weight heparin [LMWH], antithrombin agents, thrombin
 inhibitors, or selective Factor Xa inhibitors [note, use of aspirin ≤325 mg/day is
 allowed]), or chronic use of non steroidal anti inflammatory drugs (NSAIDs),
 acetaminophen, tramadol, and other analgesics such as opiates at screening

 11. Use of any investigational drug within 30 days prior to randomization.

 12. Patients currently participating in another research study or anticipated to enroll in
 such during participation in this study.

 13. Patients for whom informed consent cannot be obtained.

 14. Patients who have previously been randomized into this study and begun ingestion of
 study drug.