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A Safety and Efficacy Study of Ustekinumab in Patients With Plaque Psoriasis Who Have Had an Inadequate Response to Methotrexate (TRANSIT)

13 de novembro de 2014 atualizado por: Janssen-Cilag International NV

An Exploratory Trial to Assess Naturalistic Safety and Efficacy Outcomes in Patients With Moderate to Severe Plaque Psoriasis Transitiioned to Ustekinumab From Previous Methotrexate Therapy (TRANSIT)

This purpose of this study is to assess the safety of ustekinumab in psoriasis patients who receive ustekinumab following an inadequate response to methotrexate therapy. The study will provide information for doctors on how to manage the transfer from methotrexate to the biologic agent ustekinumab. The study is designed to compare two methods of transferring patients from methotrexate to ustekinumab. The two methods being compared are discontinuation of methotrexate with immediate initiation of ustekinumab versus initiation of ustekinumab with overlap and gradual dose reduction of methotrexate over 4 weeks.

Visão geral do estudo

Status

Concluído

Condições

Intervenção / Tratamento

Descrição detalhada

Only limited data exist to guide physicians on transitioning patients onto biologic agents once conventional systemic agents have been found to be inadequate. Most Phase III regulatory studies for biologics, including ustekinumab, required washout periods of between one and three months between previous therapies and the start of study agent. Although advantageous from a methodological perspective, this approach does not appear to mirror real-world clinical practice, in which clinicians and patients are unwilling to go without treatment for extended periods. As a result, physicians appear to employ several arbitrary strategies when transitioning their patients. Two commonly used approaches are: Initiation of biologic therapy with immediate cessation of previous conventional systemic therapy or Initiation of biologic therapy with overlap and gradual reduction of previous conventional systemic therapy. Some physicians opt for the first strategy to minimise the risk of drug-drug interactions. Others opt for the second strategy to minimise the risk of symptomatic worsening between cessation of previous treatment and the onset of action of biologic agents. This study aims to compare safety, efficacy and quality of life outcomes associated with these two strategies, with follow-up for 52 weeks. The primary objective of this exploratory trial is to evaluate the comparative safety through week 12 of two treatment transition strategies in patients with inadequate response to methotrexate: discontinuation of methotrexate with immediate initiation of ustekinumab versus initiation of ustekinumab with overlap and gradual dose reduction of methotrexate over 4 weeks. Secondary objectives of the study include evaluating the safety, efficacy, and quality of life through Week 52. The focus of the trial is on estimation rather than on hypothesis testing and, therefore, no formal hypothesis testing is planned. The primary endpoint is the proportion of patients experiencing one or more treatment-emergent adverse events (AEs) through Week 12 within each treatment transition arm. All proportions will be accompanied by an estimated 95% confidence interval. This is a phase IIIB/IV multicentre, open label, two-arm, randomised study, lasting 56 weeks (including a screening period). The primary endpoint is assessed after 12 weeks of treatment (Week 12). All treated patients will be followed for safety and efficacy through Week 52. Patients will be stratified according to their body weight to ensure a similar distribution of patients >100 kg between the two treatment arms. Approximately 4 weeks prior to study start, all patients who provide consent for participation will be screened according to the requirements of the inclusion and exclusion criteria. Patients who meet all of the inclusion criteria and none of the exclusion criteria will enter the study. During the Screening Phase, patients will continue their current treatment schedule and dose for methotrexate, with folic acid if prescribed. At Week 0, prior to the first dose of ustekinumab, patients will be randomised 1:1 to one of the two treatment arms described below. Patients will be stratified according to their baseline body weight (=<100 kg or >100 kg) to ensure a similar distribution of patients >100 kg between the two treatment arms. Patients eligible for the study will be men and women aged 18 years or older with moderate to severe plaque psoriasis who have a Psoriasis Area and Severity Index (PASI) >=10, who have failed or are intolerant to methotrexate therapy. Patients entering the study must be receiving methotrexate at a dose of 10-25 mg/week, and should have been receiving methotrexate for at least 8 weeks prior to screening. Approximately 576 patients will be included in the study from approximately 100 sites in 20 countries. In both treatment arms, Patients weighing ≤ 100 kg will receive ustekinumab 45 mg at Weeks 0, 4 and 16. Patients who achieve a PASI 75 response at Week 28 and 40 will continue receiving ustekinumab 45 mg at Week 28 and 40. Patients who fail to achieve PASI 75 response at Week 28 will receive ustekinumab 90 mg at Week 28 and 40. Patients who achieve a PASI 75 response at Week 28, but fail to achieve PASI 75 response at Week 40 will receive ustekinumab 90 mg at Week 40. Patients > 100 kg will receive ustekinumab 90 mg at Weeks 0, 4, 16, 28 and 40, regardless of achievement of PASI 75 response. Consideration will be given to discontinuing treatment in these patients if they show no response at Week 28. At Week 0, all eligible patients will be randomised to one of the following treatment regimens. The methotrexate dose reduction regime will depend on the dose of methotrexate at screening. All patients will stop methotrexate regardless of the final dose after 4 overlapping weeks (Weeks 0, 1, 2 and 3). The last dose of methotrexate will be given within the 7 day period before the second dose of ustekinumab. Safety evaluations will include physical examination, body weight and waist circumference, pregnancy testing, vital signs, clinical laboratory testing with full blood analysis and biochemistry, skin assessment for suspicious malignant lesions, Tuberculosis (TB) assessment, adverse events review and collection. Efficacy evaluations, including Psoriasis Area Severity Index (PASI), Nail Psoriasis Severity Index (NAPSI) and Physician's Global Assessment (PGA), will be carried out. Evaluations to assess changes in quality of life, including the Dermatology Life Quality Index (DLQI), Hospital Anxiety Depression Score (HADS), EuroQol-5 dimensional questionnaire (EQ-5D) and Patient Benefit Index (PBI), will be carried out.

Tipo de estudo

Intervencional

Inscrição (Real)

490

Estágio

  • Fase 4

Contactos e Locais

Esta seção fornece os detalhes de contato para aqueles que conduzem o estudo e informações sobre onde este estudo está sendo realizado.

Locais de estudo

  • Alemanha
      • Berlin, Alemanha
      • Dresden, Alemanha
      • Erlangen, Alemanha
      • Essen, Alemanha
      • Frankfurt, Alemanha
      • Gottingen, Alemanha
      • Hamburg, Alemanha
      • Kiel, Alemanha
      • Landau, Alemanha
      • Leipzig, Alemanha
      • Mahlow, Alemanha
      • Marburg, Alemanha
      • Munster, Alemanha
      • München, Alemanha
      • Tÿbingen, Alemanha
      • Witten, Alemanha
  • Bulgária
      • Pleven, Bulgária
      • Sofia, Bulgária
  • Bélgica
      • Brussels, Bélgica
      • Gent, Bélgica
      • Liège, Bélgica
  • Dinamarca
      • Aarhus, Dinamarca
      • Roskilde N/A, Dinamarca
  • Eslováquia
      • Bratislava, Eslováquia
  • Espanha
      • Alicante, Espanha
      • Badalona, Espanha
      • Barcelona, Espanha
      • Cordoba, Espanha
      • La Coruÿa N/A, Espanha
      • Madrid, Espanha
  • Finlândia
      • Tampere, Finlândia
      • Turku, Finlândia
  • França
      • Chambray-Lès-Tours, França
      • Creil, França
      • Jarez, França
      • Lille Cedex, França
      • Marseille, França
      • Montpellier N/A, França
      • Nantes Cedex 01 N/A, França
      • Nantes Cedex 1, França
      • Nice Cedex 3, França
      • Paris, França
      • Pessac, França
      • Pierre Benite, França
      • Poitiers, França
      • Rouen, França
      • Toulouse, França
  • Grécia
      • Athens, Grécia
      • Thessaloniki, Grécia
  • Holanda
      • Nijmegen, Holanda
      • Rotterdam, Holanda
  • Hungria
      • Debrecen, Hungria
      • Szeged, Hungria
  • Israel
      • Petah-Tikva, Israel
      • Tel-Aviv, Israel
  • Lituânia
      • Kaunas, Lituânia
      • Vilnius, Lituânia
  • Noruega
      • Oslo N/A, Noruega
      • Stavanger, Noruega
  • Polônia
      • Poznan, Polônia
      • Wrocław, Polônia
      • Łódź, Polônia
  • Portugal
      • Lisboa, Portugal
      • Porto, Portugal
  • Reino Unido
      • Aberdeen, Reino Unido
      • Cardiff, Reino Unido
      • Craigavon, Reino Unido
      • Glasgow, Reino Unido
      • London, Reino Unido
      • Nottingham, Reino Unido
      • Salford, Reino Unido
  • Suécia
      • Göteborg, Suécia
      • Malmö, Suécia
      • Solna, Suécia
      • Uppsala, Suécia
  • Áustria
      • Wien, Áustria

Critérios de participação

Os pesquisadores procuram pessoas que se encaixem em uma determinada descrição, chamada de critérios de elegibilidade. Alguns exemplos desses critérios são a condição geral de saúde de uma pessoa ou tratamentos anteriores.

Critérios de elegibilidade

Idades elegíveis para estudo

18 anos e mais velhos (Adulto, Adulto mais velho)

Aceita Voluntários Saudáveis

Não

Gêneros Elegíveis para o Estudo

Tudo

Descrição

Inclusion Criteria:

  • Patients should have diagnosis of plaque-type psoriasis for at least 6 months prior to first administration of study agent (patients with concurrent psoriatic arthritis may be enrolled)
  • Moderate-to-severe psoriasis scored as PASI >= 10 at screening and at the time of first administration of ustekinumab
  • Should currently receive (and have been receiving for at least 8 weeks directly prior to screening) systemic therapy with methotrexate at a dose of at least 10 mg/week but not exceeding 25 mg/week, with an inadequate response to this treatment (due to either efficacy or tolerability) and, in the judgment of the treating physician and patient, a treatment change is needed
  • Women should take adequate birth control measures throughout the study and must agree to continue to use such birth control measures and not to become pregnant or plan to become pregnant for at least 15 weeks after the last dose of ustekinumab and for at least 6 months after the last dose of methotrexate
  • Men must be using adequate birth control measures whilst receiving methotrexate and for 6 months after the last dose of methotrexate

Exclusion Criteria:

  • Patients should not have non-plaque forms of psoriasis (eg, erythrodermic, guttate, or pustular)
  • Should currently (and within 12 months) not receive ciclosporin, fumarates, PUVA, etanercept, efalizumab, infliximab, adalimumab or alefacept or other biologic or systemic therapy (and other therapy as indicated in the protocol)
  • Women who are pregnant, breastfeeding, or planning pregnancy (both men and women) while enrolled in the study
  • Have previously failed treatment with any therapeutic agent directly targeted at reducing IL-12 or IL-23, including, but not limited to, ustekinumab and ABT-874
  • Active or latent Tuberculosis or other chronic or recurrent infectious disease
  • Known history of lymphoproliferative disease
  • Known malignancy or history of malignancy

Plano de estudo

Esta seção fornece detalhes do plano de estudo, incluindo como o estudo é projetado e o que o estudo está medindo.

Como o estudo é projetado?

Detalhes do projeto

  • Finalidade Principal: Tratamento
  • Alocação: Randomizado
  • Modelo Intervencional: Atribuição Paralela
  • Mascaramento: Nenhum (rótulo aberto)

Armas e Intervenções

Grupo de Participantes / Braço
Intervenção / Tratamento
Experimental: Immediate Methotrexate Cessation
Patients will receive ustekinumab by SC injection at Weeks 0, 4, 16, 28 and 40. The last dose of methotrexate will be taken anytime in the week prior to baseline (week 0).
Medicamento: Ustekinumab
Patients weighting ≤ 100 kg will receive ustekinumab 45 mg at Weeks 0, 4 and 16. Patients who achieve a PASI 75 response at Week 28 and 40 will continue receiving ustekinumab 45 mg at Week 28 and 40. Patients who fail to achieve PASI 75 response at Week 28 will receive ustekinumab 90 mg at Week 28 and 40. Patients who achieve a PASI 75 response at Week 28, but fail to achieve PASI 75 response at Week 40 will receive ustekinumab 90 mg at Week 40. Patients > 100 kg will receive ustekinumab 90 mg at Weeks 0, 4, 16, 28 and 40, regardless of achievement of PASI 75 response. Consideration will be given to discontinuing treatment in these patients if they show no response at Week 28.
Comparador Ativo: Gradual Reduction of Methotrexate
Patients will receive ustekinumab by SC injection at Weeks 0, 4, 16, 28 and 40. Patients will gradually reduce the dose of methotrexate over the 4 week period after week 0.
Medicamento: Ustekinumab
Patients weighting ≤ 100 kg will receive ustekinumab 45 mg at Weeks 0, 4 and 16. Patients who achieve a PASI 75 response at Week 28 and 40 will continue receiving ustekinumab 45 mg at Week 28 and 40. Patients who fail to achieve PASI 75 response at Week 28 will receive ustekinumab 90 mg at Week 28 and 40. Patients who achieve a PASI 75 response at Week 28, but fail to achieve PASI 75 response at Week 40 will receive ustekinumab 90 mg at Week 40. Patients > 100 kg will receive ustekinumab 90 mg at Weeks 0, 4, 16, 28 and 40, regardless of achievement of PASI 75 response. Consideration will be given to discontinuing treatment in these patients if they show no response at Week 28.
Medicamento: Methotrexate
Gradual reduction of methotrexate therapy over the 4 week period after Week 0. The methotrexate dose reduction regime will depend on the dose of methotrexate at screening. All patients will stop methotrexate regardless of the final dose after 4 overlapping weeks. The last dose of methotrexate will be given within the 7 day period before the second dose of ustekinumab.

O que o estudo está medindo?

Medidas de resultados primários

Medida de resultado
Prazo
Number of Patients Experiencing One or More Adverse Events Occurring From Week 0 Through Week 12
Prazo: from week 0 to week 12
from week 0 to week 12

Medidas de resultados secundários

Medida de resultado
Descrição da medida
Prazo
Rate of Adverse Events (AEs), Serious AEs (SAEs) and Deaths During the Study Period
Prazo: at week 12, 16, 28 40 and 52
The number of patients with any of the following Treatment Emergent AEs (TEAEs) were summarized through Week 12 and through Week 52, by treatment arm and body weight category (≤100 kg and >100 kg): AE; SAE and Death.
at week 12, 16, 28 40 and 52
Rate of Severe AEs, Reasonably Related AEs, and AEs Leading to Discontination During the Study Period
Prazo: at week 12, 16, 28 40 and 52
The number of patients with any of the following TEAEs were summarized through Week 12 and through Week 52, by treatment arm and body weight category (≤100 kg and >100 kg): AE with severe intensity; AE or SAE reasonably related to ustekinumab (i.e., AEs classified by the investigator as 'possibly', 'probably', or 'very likely' related to study agent); AE or SAE leading to permanent discontinuation of ustekinumab.
at week 12, 16, 28 40 and 52
Rate of Infections, Severe Infections and Infections Requiring Oral or Parenteral Antimicrobial Treatment During the Study Period
Prazo: at week 12, 16, 28 40 and 52
The number of patients with any of the following TEAEs were summarized through Week 12 and through Week 52, by treatment arm and body weight category (≤100 kg and >100 kg): infections, serious infections, and infections requiring oral or parenteral antimicrobial treatment (infections being considered any event that by the investigator was indicated as infection on the CRF).
at week 12, 16, 28 40 and 52
Rate of Malignancies and Other Events of Clinical Interest (Tuberculosis, Serious Cardiovascular Events, Anaphylactic/Serum Sickness Reaction)
Prazo: at week 12, 16, 28 40 and 52
The number of patients with a malignancy and other event of clinical interest (tuberculosis, serious cardiovascular events, anaphylactic/serum sickness reaction) were summarized through Week 12 and through Week 52, by treatment arm and body weight category (≤100 kg and >100 kg)
at week 12, 16, 28 40 and 52
Change in Mean Psoriasis Area-and-severity Index (PASI) Score Compared to Baseline
Prazo: at Weeks 0, 2, 4, 12, 16, 28, 40 and 52
Change from baseline in Psoriasis Area and Severity Index (PASI) (0 [best] - 72 [worst]). The PASI is a test of how bad a person's psoriasis is. The combination of redness, scaling, and thickness, as well as overall body involvement determine the PASI score.
at Weeks 0, 2, 4, 12, 16, 28, 40 and 52
Proportion of Patients Achieving PASI 50 Response
Prazo: at Weeks 2, 4, 12, 16, 28, 40 and 52
This is based on the number of participants achieving at least 50% improvement from baseline in Psoriasis Area and Severity Index (PASI) (0 [best] - 72 [worst]). The PASI is a test of how bad a person's psoriasis is. The combination of redness, scaling, and thickness, as well as overall body involvement determine the PASI score.
at Weeks 2, 4, 12, 16, 28, 40 and 52
Proportion of Patients Achieving PASI 75 Response
Prazo: at Weeks 2, 4, 12, 16, 28, 40 and 52
This is based on the number of participants achieving at least 75% improvement from baseline in Psoriasis Area and Severity Index (PASI) (0 [best] - 72 [worst]). The PASI is a test of how bad a person's psoriasis is. The combination of redness, scaling, and thickness, as well as overall body involvement determine the PASI score.
at Weeks 2, 4, 12, 16, 28, 40 and 52
Proportion of Patients Achieving PASI 90 Response
Prazo: at Weeks 2, 4, 12, 16, 28, 40 and 52
This is based on the number of participants achieving at least 90% improvement from baseline in Psoriasis Area and Severity Index (PASI) (0 [best] - 72 [worst]). The PASI is a test of how bad a person's psoriasis is. The combination of redness, scaling, and thickness, as well as overall body involvement determine the PASI score.
at Weeks 2, 4, 12, 16, 28, 40 and 52

Colaboradores e Investigadores

É aqui que você encontrará pessoas e organizações envolvidas com este estudo.

Patrocinador

Janssen-Cilag International NV

Datas de registro do estudo

Essas datas acompanham o progresso do registro do estudo e os envios de resumo dos resultados para ClinicalTrials.gov. Os registros do estudo e os resultados relatados são revisados ​​pela National Library of Medicine (NLM) para garantir que atendam aos padrões específicos de controle de qualidade antes de serem publicados no site público.

Datas Principais do Estudo

Início do estudo

1 de outubro de 2009

Conclusão Primária (Real)

1 de novembro de 2010

Conclusão do estudo (Real)

1 de agosto de 2011

Datas de inscrição no estudo

Enviado pela primeira vez

28 de janeiro de 2010

Enviado pela primeira vez que atendeu aos critérios de CQ

28 de janeiro de 2010

Primeira postagem (Estimativa)

1 de fevereiro de 2010

Atualizações de registro de estudo

Última Atualização Postada (Estimativa)

24 de novembro de 2014

Última atualização enviada que atendeu aos critérios de controle de qualidade

13 de novembro de 2014

Última verificação

1 de novembro de 2014

Mais Informações

Termos relacionados a este estudo

Palavras-chave

Termos MeSH relevantes adicionais

Outros números de identificação do estudo

  • CR016639 (Identificador de registro: ClinicalTrials.gov)
  • CNTO1275PSO4004 (Outro identificador: Janssen CTMS ID)

Essas informações foram obtidas diretamente do site clinicaltrials.gov sem nenhuma alteração. Se você tiver alguma solicitação para alterar, remover ou atualizar os detalhes do seu estudo, entre em contato com register@clinicaltrials.gov. Assim que uma alteração for implementada em clinicaltrials.gov, ela também será atualizada automaticamente em nosso site .

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