Efficacy of Ustekinumab Followed by Abatacept for the Treatment of Psoriasis Vulgaris (PAUSE)
2018年12月26日 更新者：National Institute of Allergy and Infectious Diseases (NIAID)
Efficacy of Ustekinumab (Anti-IL-12/23) Followed by Abatacept (CTLA4-Ig) for the Treatment of Psoriasis Vulgaris (ITN059AI)
The purpose of this study is to determine if the use of ustekinumab, followed by abatacept, will prevent relapse in people with moderate to severe plaque psoriasis.
調査の概要
詳細な説明
Psoriasis is a chronic immune disease of the skin and joints that affects about 2% of the population. The most common form of psoriasis is plaque psoriasis, also called psoriasis vulgaris. A variety of drugs, including biologics, are available for treatment of moderate to severe psoriasis. When biologic agents are stopped, psoriasis can return (relapse) and often requires the biologic to be restarted and continued. No treatment program has been identified to prevent relapse of psoriasis.
The study design has a lead-in period of weight-based ustekinumab treatment, with all participants receiving either 45 mg ustekinumab (<= 100 kg) or 90 mg ustekinumab (> 100 kg) administered subcutaneously at weeks 0 and 4. At week 12, participants will be assessed for a Psoriasis Area and Severity Index (PASI) 75 response to ustekinumab. Participants who do not achieve a PASI 75 score will be discontinued from the investigation and permitted to seek standard therapy.
研究の種類
介入
入学 (実際)
108
段階
- フェーズ2
連絡先と場所
このセクションには、調査を実施する担当者の連絡先の詳細と、この調査が実施されている場所に関する情報が記載されています。
研究場所
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California
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Los Angeles、California、アメリカ、90045
- Dermatology Research Associates
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Illinois
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Chicago、Illinois、アメリカ、60611
- Northwestern University
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Louisiana
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New Orleans、Louisiana、アメリカ、70112
- Tulane University School of Medicine: Dept. of Dermatology
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Michigan
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Ann Arbor、Michigan、アメリカ、48109
- University of Michigan
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New York
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New York、New York、アメリカ、10065
- The Rockefeller University
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North Carolina
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Winston-Salem、North Carolina、アメリカ、27104
- Wake Forest University
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Ohio
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Cleveland、Ohio、アメリカ、44106
- Case Western University
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Utah
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Salt Lake City、Utah、アメリカ、84132
- The University of Utah
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Alberta
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Calgary、Alberta、カナダ、T2G 1B1
- Kirk Barber Research
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Quebec
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Montreal、Quebec、カナダ、H2K 4L5
- Innovaderm Research Inc.
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参加基準
研究者は、適格基準と呼ばれる特定の説明に適合する人を探します。これらの基準のいくつかの例は、人の一般的な健康状態または以前の治療です。
適格基準
就学可能な年齢
18年～65年 (大人、高齢者)
健康ボランティアの受け入れ
いいえ
受講資格のある性別
全て
説明
Inclusion Criteria:
- A diagnosis of plaque psoriasis for at least 6 months
- Baseline Psoriasis Area and Severity Index (PASI) score >= 12
- >=10% body surface area psoriasis involvement
- Willingness to forgo other available psoriasis therapies, live vaccines, and pregnancy during the trial
- Ability and willingness to provide informed consent and comply with study requirements
Exclusion Criteria:
- Non-plaque forms of psoriasis
- Grade 2 or 3 moderate to severe psoriatic arthritis not adequately managed with non-steroidal anti-inflammatory drugs (NSAIDs)
- Myocardial infarction, unstable angina, cerebrovascular accident, or other significant cardiovascular event within the previous one year
- Chronic obstructive pulmonary disease (COPD)
- Comorbid condition that requires regular systemic corticosteroid treatment
- History of malignancy, except treated basal cell skin carcinoma
- Treated basal cell skin carcinoma within the previous 5 years
- Severe, progressive, or uncontrolled renal, hepatic, hematological, gastrointestinal, pulmonary, cardiac, or neurological disease, or any other medical condition that, in the investigator's opinion, places the participant at risk by participating in this study
- History of recent or ongoing uncontrolled bacterial, viral, fungal, or other opportunistic infections
- Evidence of infection with Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), or Human Immunodeficiency Virus (HIV)
- Positive QuantiFERON-TB Gold test. Purified Protein Derivative (PPD) tuberculin test may be substituted for QuantiFERON-TB Gold test.
- Severe reaction or anaphylaxis to any human monoclonal antibody
- Any previous treatment with agents targeting Interleukin (IL)-12 or IL-23, including ustekinumab
- Any previous treatment with abatacept
- Treatment with biologic agents within previous 3 months, including adalimumab, etanercept, and infliximab
- Treatment with immunosuppressive medications, including methotrexate, cyclosporine, oral retinoids, prednisone, or phototherapy within previous 4 weeks
- Topical psoriasis treatment within previous 2 weeks, including topical corticosteroids, vitamin D analogues, retinoids, calcineurin inhibitors, salicylic acid, and coal tar
- Investigational study medication within previous 6 months
- Liver function test (aspartate aminotransferase [AST], alanine aminotransferase [ALT], or alkaline phosphatase) results that are >/= 2x the upper limit of normal (ULN).
- Serum creatinine >= 2x the ULN.
Any of the following hematologic abnormalities, confirmed by repeat test at least 1 week apart:
- White blood count <3,000/μL or >14,000/μL;
- Lymphocyte count <1,000/μL;
- Neutrophil count <1,500/μL;
- Platelet count <150,000 /μL; or
- Hemoglobin <10 g/dL.
- Females who are pregnant, lactating, planning on pregnancy during the study period, or unwilling to use FDA-approved method of birth control
- Receipt of a live vaccine (e.g., varicella, measles, mumps, rubella, cold-attenuated intranasal influenza vaccine, and smallpox) in the 6 weeks before enrollment
- BCG (Bacillus Calmette-Guérin) vaccine one year prior to enrollment
研究計画
このセクションでは、研究がどのように設計され、研究が何を測定しているかなど、研究計画の詳細を提供します。
研究はどのように設計されていますか？
デザインの詳細
- 主な目的：処理
- 割り当て：ランダム化
- 介入モデル：並列代入
- マスキング：4倍
武器と介入
参加者グループ / アーム |
介入・治療 |
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実験的：UST, ABA/UST Placebo
Participants received 2 subcutaneous injections of open-label ustekinumab (UST) (45 mg for participants weighing <=100 kg at study entry or 90 mg for those weighing >100 kg at study entry), at Weeks 0 and 4 during the lead-in phase and were then randomized to receive blinded (masked) treatment of abatacept (ABA) (125 mg) subcutaneous injections weekly from Week 12 to 39, in addition to ustekinumab placebo subcutaneous injections at Weeks 16 and 28.
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Ustekinumab interferes with the actions of proteins, interleukin 12 (IL12) and interleukin 23 (IL23), which reduces inflammation (swelling) in the skin. Stelara™ is the trade name for ustekinumab and is approved by the U.S. Food and Drug Administration (FDA) to treat psoriasis. Dose: Participants who weigh <= 100 kg at study entry will receive 45 mg of ustekinumab. Participants who weigh > 100 kg at study entry will receive 90 mg of ustekinumab.
他の名前：
Abatacept (one form of the protein called CTLA4-Ig) interacts with the immune system, reducing the activity of T-cells and may prevent relapse. Orencia™ is the trade name for abatacept, and it is approved by the FDA to treat rheumatoid arthritis in adults. Dose: 125 mg sub-cutaneous injection
他の名前：
The abatacept treatment group will also receive subcutaneous placebo for ustekinumab (sterile normal saline) at week 16 and week 28, corresponding to the ustekinumab dosing regimen.
他の名前：
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アクティブコンパレータ：UST, UST/ABA Placebo
Participants received 2 subcutaneous injections of open-label ustekinumab (UST) (45 mg for participants weighing <=100 kg at study entry or 90 mg for those weighing >100 kg at study entry), at Weeks 0 and 4 during the lead-in phase and were then randomized to receive blinded (masked) treatment of ustekinumab (45 mg if <=100 kg or 90 mg if >100 kg at study entry) subcutaneous injections at Weeks 16 and 28, in addition to abatacept (ABA) placebo subcutaneous injections weekly from Week 12 to 39.
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Ustekinumab interferes with the actions of proteins, interleukin 12 (IL12) and interleukin 23 (IL23), which reduces inflammation (swelling) in the skin. Stelara™ is the trade name for ustekinumab and is approved by the U.S. Food and Drug Administration (FDA) to treat psoriasis. Dose: Participants who weigh <= 100 kg at study entry will receive 45 mg of ustekinumab. Participants who weigh > 100 kg at study entry will receive 90 mg of ustekinumab.
他の名前：
The ustekinumab treatment group will also receive weekly subcutaneous injections of placebo for abatacept from week 12 to week 39, corresponding to the abatacept dosing regimen.
他の名前：
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この研究は何を測定していますか？
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
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Percentage of Participants Who Experienced Psoriasis Relapse (Treating Drop-Outs as Relapse)
時間枠：Post-randomization (Week 12 to 88)
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The percentage of participants who experienced psoriasis relapse in the interval from Week 12 to 88. Psoriasis relapse is defined as loss of ≥ 50% of the initial Psoriasis Area and Severity Index (PASI) improvement measured at Week 12.
This occurs if the participant obtains a PASI score at any evaluation during the specified time interval that is ≥ Week 12 PASI + [(Baseline PASI -Week 12 PASI)/2]).
Participants who terminated early from the study (drop-outs) were considered to have experienced relapse at time of drop-out.
PASI is an assessment for psoriasis severity based on 4 body areas: Head and Neck, Upper Extremities, Trunk, and Lower Extremities.
Psoriasis severity within each body area is assessed for Redness (score 0-4), Thickness (score 0-4) and Scaling (score 0-4).
Scores for each body area are summed and weighted by the affected Body Surface Area (score 0-6) to produce the total score.
The score ranges from 0 (no psoriasis present) to 72 (very severe psoriasis).
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Post-randomization (Week 12 to 88)
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二次結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
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Percentage of Participants Who Experienced Psoriasis Relapse (Treating Drop-Outs as No Relapse)
時間枠：Post-randomization (Week 12 to 88)
|
The percentage of participants who experienced psoriasis relapse in the interval from Week 12 to 88. Psoriasis relapse is defined as loss of ≥ 50% of the initial Psoriasis Area and Severity Index (PASI) improvement measured at Week 12 (Baseline PASI -Week 12 PASI).
Participants who terminated early from the study due to reasons other than psoriasis relapse or worsening psoriasis (drop-outs) were considered to have not experienced relapse at time of drop-out.
PASI is an assessment for psoriasis severity based on 4 body areas: Head and Neck, Upper Extremities, Trunk, and Lower Extremities.
Psoriasis severity within each body area is assessed for Redness (score 0-4), Thickness (score 0-4) and Scaling (score 0-4).
Scores for each body area are summed and weighted by the affected Body Surface Area (score 0-6) to produce the total score.
The score ranges from 0 (no psoriasis present) to 72 (very severe psoriasis).
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Post-randomization (Week 12 to 88)
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Percentage of Participants Who Experienced Psoriasis Relapse (Treating Drop-Outs as Missing Relapse Status)
時間枠：Post-randomization (Week 12 to 88)
|
The percentage of participants who experienced psoriasis relapse in the interval from Week 12 to 88. Psoriasis relapse is defined as loss of ≥ 50% of the initial Psoriasis Area and Severity Index (PASI) improvement measured at Week 12 (Baseline PASI -Week 12 PASI).
Participants who terminated early due to reasons other than psoriasis relapse or worsening psoriasis were considered to have a missing relapse status at time of drop-out and were excluded from the analyses.
PASI is an assessment for psoriasis severity based on 4 body areas: Head and Neck, Upper Extremities, Trunk, and Lower Extremities.
Psoriasis severity within each body area is assessed for Redness (score 0-4), Thickness (score 0-4) and Scaling (score 0-4).
Scores for each body area are summed and weighted by the affected Body Surface Area (score 0-6) to produce the total score.
The score ranges from 0 (no psoriasis present) to 72 (very severe psoriasis).
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Post-randomization (Week 12 to 88)
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Time to Psoriasis Relapse (Treating Drop-Outs as Relapse)
時間枠：Post-randomization (Week 12 to 88)
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Time in weeks from Week 12 to psoriasis relapse.
Psoriasis relapse is defined as loss of ≥ 50% of the initial Psoriasis Area and Severity Index (PASI) improvement measured at Week 12.
This occurs if the participant obtains a PASI score at any evaluation during the specified time interval that is ≥ Week 12 PASI + [(Baseline PASI -Week 12 PASI)/2]).
Participants who terminated early from the study (drop-outs) were considered to have experienced relapse at time of drop-out.
PASI is an assessment for psoriasis severity based on 4 body areas: Head and Neck, Upper Extremities, Trunk, and Lower Extremities.
Psoriasis severity within each body area is assessed for Redness (score 0-4), Thickness (score 0-4) and Scaling (score 0-4).
Scores for each body area are summed and weighted by the affected Body Surface Area (score 0-6) to produce the total score.
The score ranges from 0 (no psoriasis present) to 72 (very severe psoriasis).
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Post-randomization (Week 12 to 88)
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Time to Psoriasis Relapse (Treating Drop-Outs as Censored)
時間枠：Post-randomization (Week 12 to 88)
|
Time in weeks from Week 12 to psoriasis relapse.
Psoriasis relapse is defined as loss of ≥ 50% of the initial Psoriasis Area and Severity Index (PASI) improvement measured at Week 12.
This occurs if the participant obtains a PASI score at any evaluation during the specified time interval that is ≥ Week 12 PASI + [(Baseline PASI -Week 12 PASI)/2]).
Participants who terminated early from the study due to reasons other than psoriasis relapse or worsening psoriasis (drop-outs) were censored at the time of drop-out.
PASI is an assessment for psoriasis severity based on 4 body areas: Head and Neck, Upper Extremities, Trunk, and Lower Extremities.
Psoriasis severity within each body area is assessed for Redness (score 0-4), Thickness (score 0-4) and Scaling (score 0-4).
Scores for each body area are summed and weighted by the affected Body Surface Area (score 0-6) to produce the total score.
The score ranges from 0 (no psoriasis present) to 72 (very severe psoriasis).
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Post-randomization (Week 12 to 88)
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Percentage of Participants Who Were Cleared or Minimal in the Physician's Global Assessment (PGA)
時間枠：Week 40, Week 88
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Percentage of participants who were classified as cleared or minimal in the Physician's Global Assessment (PGA) average score at the specified post-randomization time point.
The PGA assesses the severity of the psoriasis in 3 components: induration, erythema and scaling.
Each component is given a score ranging from 0 to 5 based on the majority of the participant's psoriasis lesions, with higher scores indicating worse disease.
A PGA average score < 1.5 was classified as "cleared or minimal."
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Week 40, Week 88
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Change in Dermatology Life Quality Index (DLQI)
時間枠：Week 40, Week 88
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Change in the Dermatology Life Quality Index (DLQI) score from Week 12 to the specified post-randomization time point.
DLQI is a 10-question, participant-reported questionnaire that assesses quality of life with respect to skin conditions in the areas of symptoms and feelings, daily activities, leisure, work and school, personal relationships and treatment.
Each question measures the level of effect that the skin condition has on quality of life, and responses range from 'Not at all' (score = 0) to 'Very much' (score = 3).
The overall score is the sum of the scores for all 10 questions and ranges from 0-30, with higher scores indicating worse quality of life.
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Week 40, Week 88
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Frequency and Severity of Adverse Events and Serious Adverse Events (By Participant, Lead-in Phase)
時間枠：Lead-In Phase (Week 0 to 12)
|
Number of participants who experienced adverse events (AEs) during the lead-in phase (Week 0 to 12), classified by severity and type.
AEs were classified by grade according to the National Cancer Institute's (NCI's) Common Toxicity Criteria for Adverse Events (CTCAE) version 4.03, and all Grade 2 or greater AEs were collected in the database.
In addition, new onset or worsening psoriatic arthritis was separately collected and graded from 1 to 3 along a study-specific functional scale.
AEs were also classified based on relatedness to study drug, whether they led to study drug discontinuation, and whether they were AEs of special interest as specified in the protocol.
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Lead-In Phase (Week 0 to 12)
|
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Frequency and Severity of Adverse Events and Serious Adverse Events (By Event, Lead-in Phase)
時間枠：Lead-In Phase (Week 0 to 12)
|
Number of adverse events (AEs) that occurred during the lead-in phase (Week 0 to 12), classified by severity and type.
AEs were classified by grade according to the National Cancer Institute's (NCI's) Common Toxicity Criteria for Adverse Events (CTCAE) version 4.03, and all Grade 2 or greater AEs were collected in the database.
In addition, new onset or worsening psoriatic arthritis was separately collected and graded from 1 to 3 along a study-specific functional scale.
AEs were also classified based on relatedness to study drug, whether they led to study drug discontinuation, and whether they were AEs of special interest as specified in the protocol.
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Lead-In Phase (Week 0 to 12)
|
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Frequency and Severity of Adverse Events and Serious Adverse Events (By Participant, Post-Randomization)
時間枠：From randomization (Week 12) to last safety follow-up visit (up to Week 100)
|
Number of participants who experienced adverse events (AEs) during the post-randomization phase (Week 12 to 100), classified by severity and type.
AEs were classified by grade according to the National Cancer Institute's (NCI's) Common Toxicity Criteria for Adverse Events (CTCAE) version 4.03, and all Grade 2 or greater AEs were collected in the database.
In addition, new onset or worsening psoriatic arthritis was separately collected and graded from 1 to 3 along a study-specific functional scale.
AEs were also classified based on relatedness to study drug, whether they led to study drug discontinuation, and whether they were AEs of special interest as specified in the protocol.
AEs that started prior to randomization but became serious after randomization were included in the counts for the post-randomization time period.
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From randomization (Week 12) to last safety follow-up visit (up to Week 100)
|
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Frequency and Severity of Adverse Events and Serious Adverse Events (By Event, Post-Randomization)
時間枠：From randomization (Week 12) to last safety follow-up visit (up to Week 100)
|
Number of adverse events (AEs) that occurred during the post-randomization phase (Week 12 to 100), classified by severity and type.
AEs were classified by grade according to the National Cancer Institute's (NCI's) Common Toxicity Criteria for Adverse Events (CTCAE) version 4.03, and all Grade 2 or greater AEs were collected in the database.
In addition, new onset or worsening psoriatic arthritis was separately collected and graded from 1 to 3 along a study-specific functional scale.
AEs were also classified based on relatedness to study drug, whether they led to study drug discontinuation, and whether they were AEs of special interest as specified in the protocol.
AEs that started prior to randomization but became serious after randomization were included in the counts for the post-randomization time period.
|
From randomization (Week 12) to last safety follow-up visit (up to Week 100)
|
協力者と研究者
ここでは、この調査に関係する人々や組織を見つけることができます。
出版物と役立つリンク
研究に関する情報を入力する責任者は、自発的にこれらの出版物を提供します。これらは、研究に関連するあらゆるものに関するものである可能性があります。
研究記録日
これらの日付は、ClinicalTrials.gov への研究記録と要約結果の提出の進捗状況を追跡します。研究記録と報告された結果は、国立医学図書館 (NLM) によって審査され、公開 Web サイトに掲載される前に、特定の品質管理基準を満たしていることが確認されます。
主要日程の研究
研究開始 (実際)
2014年3月19日
一次修了 (実際)
2017年12月7日
研究の完了 (実際)
2018年3月1日
試験登録日
最初に提出
2013年11月26日
QC基準を満たした最初の提出物
2013年11月26日
最初の投稿 (見積もり)
2013年12月3日
学習記録の更新
投稿された最後の更新 (実際)
2019年1月15日
QC基準を満たした最後の更新が送信されました
2018年12月26日
最終確認日
2018年12月1日
詳しくは
この情報は、Web サイト clinicaltrials.gov から変更なしで直接取得したものです。研究の詳細を変更、削除、または更新するリクエストがある場合は、register@clinicaltrials.gov。 までご連絡ください。 clinicaltrials.gov に変更が加えられるとすぐに、ウェブサイトでも自動的に更新されます。