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Study to Evaluate Safety and Effectiveness of Oral Apremilast (CC-10004) in Patients With Moderate to Severe Plaque Psoriasis. (ESTEEM 2)

This study is ongoing, but not recruiting participants.
Sponsor:
Information provided by (Responsible Party):
Celgene Corporation
ClinicalTrials.gov Identifier:
NCT01232283
First received: October 29, 2010
Last updated: November 3, 2014
Last verified: November 2014
  Purpose

This study evaluated the effects of a study drug called apremilast. Apremilast works by lowering some of the chemicals that affect psoriasis and therefore improves the symptoms of psoriasis. The purpose of this study was to test apremilast and compare its effects to placebo (an inactive substance which contains no medicine but is in the same form as the drug).


Condition Intervention Phase
Plaque Psoriasis
Drug: Apremilast
Drug: Placebo
Other: Topical or Phototherapy Therapy
Phase 3

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: A Phase 3, Multicenter, Randomized, Double-Blind, Placebo-Controlled, Efficacy and Safety Study of Apremilast (CC-10004) in Subjects With Moderate to Severe Plaque Psoriasis

Resource links provided by NLM:


Further study details as provided by Celgene Corporation:

Primary Outcome Measures:
  • Percentage of Participants Who Achieved at Least a 75% Improvement (Response) in the Psoriasis Area Severity Index (PASI-75) at Week 16 From Baseline [ Time Frame: Baseline to Week 16 ] [ Designated as safety issue: No ]
    PASI-75 response is the percentage of participants who achieved at least a 75% reduction (improvement) from baseline in PASI score at week 16. The improvement in PASI score was used as a measure of efficacy. The PASI is a measure of psoriatic disease severity taking into account qualitative lesion characteristics (erythema, thickness, and scaling) and degree of skin surface area involvement on defined anatomical regions. PASI scores range from 0 to 72, with higher scores reflecting greater disease severity. Erythema, thickness, and scaling are scored on a scale of 0 (none) to 4 (very severe) on 4 anatomic regions of the body: head, trunk, upper limbs, and lower limbs. Degree of involvement on each of the 4 anatomic regions is scored on a scale of 0 (no involvement) to 6 (90% to 100% involvement). The PASI score was set to missing if any severity score or degree of involvement is missing.


Secondary Outcome Measures:
  • Percentage of Participants Who Achieved a Static Physician Global Assessment (sPGA) Score of Clear (0) or Almost Clear (1) With at Least 2 Points Reduction From Baseline [ Time Frame: Baseline to Week 16 ] [ Designated as safety issue: No ]
    The sPGA was a 5-point scale ranging from 0 (clear), 1 (almost clear), 2 (mild), 3 (moderate), to 4 (severe), incorporating an assessment of the severity of the three primary signs of the disease: erythema, scaling and plaque elevation. When making the assessment of overall severity, the Investigator must have factored in areas that have already been cleared (ie, have scores of 0) and not just evaluate remaining lesions for severity, ie, the severity of each sign was averaged across all areas of involvement, including cleared lesions. In the event of different severities across disease signs, the sign that is the predominant feature of the disease should be used to help determine the sPGA score.

  • Percent Change From Baseline in the Affected Body Surface Area (BSA) at Week 16 [ Time Frame: Baseline and Week 16 ] [ Designated as safety issue: No ]

    BSA was a measurement of involved skin. The overall BSA affected by psoriasis was estimated based on the palm area of the participant's hand (entire palmar surface or "handprint" including the fingers), which equates to approximately 1% of total body surface area.

    BSA percent change from baseline (Visit 2 Week 0) was determined at each visit of the study, which is calculated as 100*(visit BSA - baseline BSA) / baseline BSA (%).


  • Percent Change From Baseline in the Psoriasis Area Severity Index (PASI) Score at Week 16 [ Time Frame: Baseline and Week 16 ] [ Designated as safety issue: No ]
    Psoriasis Area Severity Index (PASI) scores range from 0 to 72, with higher scores reflecting greater disease severity. Erythema, thickness, and scaling are scored on a scale of 0 (none) to 4 (very severe) on 4 anatomic regions of the body: head, trunk, upper limbs, and lower limbs. Degree of involvement on each of the 4 anatomic regions is scored on a scale of 0 (no involvement) to 6 (90% to 100% involvement). The total qualitative score (sum of erythema, thickness, and scaling scores) is multiplied by the degree of involvement for each anatomic region and then multiplied by a constant. These values for each anatomic region are summed to yield the PASI score. The PASI score was set to missing if any severity score or degree of involvement is missing.

  • Percentage of Participants Who Achieved a 50% Improvement (Response) in the PASI Score (PASI-50) at Week 16 From Baseline [ Time Frame: Baseline and Week 16 ] [ Designated as safety issue: No ]
    PASI-50 response is the percentage of participants who achieved at least a 50% reduction (improvement) from baseline in PASI score at Week 16. The improvement in PASI score was used as a measure of efficacy. The PASI is a measure of psoriatic disease severity taking into account qualitative lesion characteristics (erythema, thickness, and scaling) and degree of skin surface area involvement on defined anatomical regions. PASI scores range from 0 to 72, with higher scores reflecting greater disease severity. Erythema, thickness, and scaling are scored on a scale of 0 (none) to 4 (very severe) on 4 anatomic regions of the body: head, trunk, upper limbs, and lower limbs. Degree of involvement on each of the 4 anatomic regions is scored on a scale of 0 (no involvement) to 6 (90% to 100% involvement). The PASI score was set to missing if any severity score or degree of involvement is missing.

  • Change From Baseline in Pruritus Visual Analog Scale (VAS) Score at Week 16 [ Time Frame: Baseline and Week 16 ] [ Designated as safety issue: No ]
    The Pruritus Visual Analog Scores (VAS) were used to measure the amount of itching and discomfort a participant experiences. Participant's Assessment of Pruritus (Itch) asked: On average, how much itch have you had because of your condition in the past week? All VAS values range from 0 to 100. Higher scores correspond to more severe symptom or disease. Change from baseline was calculated for the VAS scale, where change = visit value − baseline value.

  • Change From Baseline in Dermatology Life Quality Index (DLQI) Total Score at Week 16 [ Time Frame: Baseline and Week 16 ] [ Designated as safety issue: No ]
    DLQI is a simple, compact, and practical questionnaire for use in a dermatology clinical setting to assess limitations related to the impact of skin disease. The instrument contains ten items dealing with the participant's skin. With the exception of Item Number 7, the participant responds on a four-point scale, ranging from "Very Much" (score 3) to "Not at All" or "Not relevant" (score 0). Item Number 7 is a multi-part item, the first part of which ascertains whether the participant's skin prevented them from working or studying (Yes or No, scores 3 or 0 respectively), and if "No," then the subject is asked how much of a problem the skin has been at work or study over the past week, with response alternatives being "A lot," "A little," or "Not at all" (scores 2, 1, or 0 respectively). The DLQI total score was derived by summing all item scores, which has a possible range of 0 to 30, with 30 corresponding to the worst quality of life, and 0 corresponding to the best.

  • Change From Baseline in the Mental Component Summary (MSC) Score of the Medical Outcome Study Short Form 36-item (SF-36) Health Survey Version 2.0 at Week 16 [ Time Frame: Baseline to Week 16 ] [ Designated as safety issue: No ]

    The SF-36 was a 36-item general health instrument and consists of 8 scales: physical function (PF), role limitations-physical (RP), vitality (VT), general health perceptions (GH), bodily pain (BP), social function (SF), role limitations-emotional (RE), and mental health (MH). Scale scores range from 0 to 100, with higher scores indicating better health. Two overall summary scores were obtained − a Physical Component Summary score (PCS) and a Mental Component Summary score (MCS).

    Scores from the 8 scales, PCS and MCS were transformed to the norm-based scores using weights from U.S. general population, with 50 as the average and 10 as the standard deviation, higher scores indicating better health. For norm based scores, change from baseline were calculated for the 8 scales and the two summary scales, where change = visit value − baseline value.


  • Percentage of Participants Who Achieved Both a 75% Improvement (Response) in the PASI and sPGA Score of Clear (0) or Almost Clear (1) With at Least 2 Points Reduction at Week 16 From Baseline [ Time Frame: Baseline to Week 16 ] [ Designated as safety issue: No ]

    PASI-75 response is the percentage of participants who achieved at least a 75% reduction (improvement) from baseline in PASI score at Week 16. The improvement in PASI score was used as a measure of efficacy. See Outcome measure #1 for further description.

    sPGA is a 5-point scale ranging from 0 (clear), 1 (almost clear), 2 (mild), 3 (moderate), to 4 (severe), incorporating an assessment of the severity of the three primary signs of the disease: erythema, scaling and plaque elevation. See Outcome Measure #2 for further description.


  • Time to Loss of Effect (Loss of 50% Improvement in PASI Score Obtained at Week 32 Compared to Baseline) During the Randomized Treatment Withdrawal Phase [ Time Frame: Weeks 32 to Week 52 ] [ Designated as safety issue: No ]
    Time to loss was the time between the re-randomization date and the date of the first assessment with loss of 50% PASI improvement (event), or the time between the re-randomization date and the date of the last PASI assessment in the randomized withdrawal phase prior to addition of topical/phototherapy or other effective psoriasis therapies, or resumption of apremilast 30 mg BID, or discontinuation, or Week 52 if no loss (censored), whichever was earlier

  • Number of Participants With Adverse Events (AE) in the Placebo Controlled Phase [ Time Frame: Baseline to Week 16 ] [ Designated as safety issue: Yes ]
    An AE was any noxious, unintended, or untoward medical occurrence, that may appear or worsen in a participant during the course of study. It may be a new intercurrent illness, a worsening concomitant illness, an injury, or any concomitant impairment of the participant's health, including laboratory test values regardless of etiology. Any worsening (ie, any clinically significant adverse change in the frequency or intensity of a preexisting condition) was considered an AE. A serious AE (SAE) is any untoward adverse event that is fatal, life-threatening, results in persistent or significant disability or incapacity, requires or prolongs existing in-patient hospitalization, is a congenital anomaly/birth defect, or is a condition that may jeopardize the patient or may require intervention to prevent one of the outcomes listed above. An AE is a treatment emergent AE if the AE start date is on or after the date of the first dose of study drug and no later than 28 days after the last dose.

  • Number of Participants With Psoriasis Flare or Rebound in the Placebo Controlled Phase [ Time Frame: Week 0 to Week 16 ] [ Designated as safety issue: Yes ]
    Psoriasis flare was defined as a sudden intensification of psoriasis requiring medical intervention, or a diagnosis of new generalized erythrodermic, inflammatory, or pustular psoriasis. Rebound is defined as a severe and sudden worsening of disease that occurs after treatment has been discontinued. Note categories below. [1] Psoriasis adverse events (ie, preferred term as Guttate psoriasis, Psoriasis, Pustular psoriasis) started on or after the first dose date and on or before the last dose date within the phase. [2] Psoriasis adverse events (ie, preferred term as Guttate psoriasis, Psoriasis, Pustular psoriasis, Rebound psoriasis) started after the last dose date for participants who discontinued within the phase. [3] PASI >= 125% of baseline score at any visit after the last dose date for participants who discontinued within the phase and were not included in [1] and/or [2].


Enrollment: 413
Study Start Date: November 2010
Estimated Study Completion Date: December 2016
Primary Completion Date: December 2012 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Apremilast
Participants were initially randomized 1:1 and received apremilast 30 mg twice a day (BID).Participants maintained dosing through Week 32. At Week 32, responders, those with a Psoriasis Area Severity Index response -≥75 (PASI-75) and partial responders (≥PASI-50) were re-randomized 1:1 to apremilast 30 mg BID or matching placebo (treatment withdrawal). Participants could resume apremilast 30mg BID at the time of loss of response compared to baseline), and no later than Week 52. At Week 32, the non-responders (< PASI-50) had the option of adding topical therapies and/or phototherapy to their treatment regimen. Those re-randomized to apremilast 30mg BID continued dosing through week 52. At Week 52, participants continued treatment with apremilast 30 mg BID.
Drug: Apremilast
Other Names:
  • CC-10004
  • Otezla
Drug: Placebo Other: Topical or Phototherapy Therapy
Topical therapies were low-potency or weak corticosteroids or phototherapies such as light therapy were added for non-responders at Week 32, (< PASI-50) and added to their treatment regimen.
Other Names:
  • Ultraviolet B
  • Light Therapy
Placebo Comparator: Placebo
Participants were initially randomized to placebo, identically matching during Weeks 0-16. At Week 16, participants were switched and received apremilast 30 mg BID through Week 32. At Week 32, participants considered non-responders (< PASI-50) had the option of adding topical therapies and/or phototherapy to their apremilast treatment regimen. At Week 52, participants continued treatment with apremilast 30 mg BID.
Drug: Apremilast
Other Names:
  • CC-10004
  • Otezla
Drug: Placebo Other: Topical or Phototherapy Therapy
Topical therapies were low-potency or weak corticosteroids or phototherapies such as light therapy were added for non-responders at Week 32, (< PASI-50) and added to their treatment regimen.
Other Names:
  • Ultraviolet B
  • Light Therapy

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Males or females, ≥ 18 years of age at the time of signing the informed consent document
  2. Diagnosis of chronic plaque psoriasis for at least 12 months prior to Screening

    • Have moderate to severe plaque psoriasis at Screening and Baseline
  3. Must meet all laboratory criteria
  4. Females of childbearing potential (FCBP) must have a negative pregnancy test at Screening and Baseline. FCBP who engage in activity in which conception is possible must use 2 forms of contraception as described by the Study Doctor while on study medication and for at least 28 days after taking the last dose of study medication
  5. Male subjects (including those who have had a vasectomy) who engage in activity in which conception is possible must use barrier contraception (latex condom or any nonlatex condom NOT made out of natural [animal] membrane [eg, polyurethane]) while on study medication and for a least 28 days after the last dose of study medication.

Exclusion Criteria:

  1. Other than psoriasis, history of any clinically significant (as determined by the Investigator) or other major uncontrolled disease.
  2. Pregnant or breast feeding
  3. History of allergy to any component of the study drug
  4. Hepatitis B surface antigen positive at Screening
  5. Anti-hepatitis C antibody positive at Screening
  6. Active tuberculosis (TB) or a history of incompletely treated TB
  7. Clinically significant abnormality on 12-Lead electrocardiogram (ECG) at Screening
  8. Clinically significant abnormal chest x-ray
  9. History of positive human immunodeficiency virus (HIV), or have congenital or acquired immunodeficiency
  10. Active substance abuse or a history of substance abuse within 6 months prior to Screening
  11. Bacterial infections requiring treatment with oral or injectable antibiotics, or significant viral or fungal infections, within 4 weeks of Screening
  12. Malignancy or history of malignancy (except for treated [ie, cured] basal cell or squamous cell in situ skin carcinomas and treated [ie, cured] cervical intraepithelial neoplasia [CIN] or carcinoma in situ of the cervix with no evidence of recurrence within the previous 5 years)
  13. Psoriasis flare or rebound within 4 weeks prior to Screening
  14. Evidence of skin conditions that would interfere with clinical assessments
  15. Topical therapy within 2 weeks of randomization
  16. Systemic therapy for psoriasis within 4 weeks prior to randomization
  17. Use of phototherapy within 4 weeks prior to randomization (ie, UVB, PUVA)
  18. Adalimumab, etanercept, infliximab, or certolizumab pegol within 12 weeks prior to randomization
  19. Alefacept, briakinumab, or ustekinumab within 24 weeks prior to randomization
  20. Use of any investigational drug within 4 weeks prior to randomization
  21. Prolonged sun exposure or use of tanning booths or other ultraviolet (UV) light sources
  22. Prior treatment with apremilast
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01232283

  Hide Study Locations
Locations
United States, Arizona
Arizona Research Center
Phoenix, Arizona, United States, 85023
United States, Arkansas
Burke Pahrmaceutical Research
Hot Springs, Arkansas, United States, 71913
United States, California
Bakersfield Dermatology and Skin Cancer Medical Center
Bakersfield, California, United States, 93309
Dermatology Research Associates
Los Angeles, California, United States, 90045
Clinical Science Institute
Santa Monica, California, United States, 90404
United States, Florida
Florida Academic Dermatology Centers
Miami, Florida, United States, 33136
United States, Georgia
Peachtree Dermatology Associates, PC
Atlanta, Georgia, United States, 30327
MedaPhase, Inc
Newnan, Georgia, United States, 30263
United States, Illinois
Northwestern University
Chicago, Illinois, United States, 60611
United States, Massachusetts
Tufts-New England Medical Center Hospitals
Boston, Massachusetts, United States, 02111
United States, North Carolina
Piedmont Medical Research Associates
Winstom-Salem, North Carolina, United States, 27103
Wake Forest University Health Sciences
Winston-Salem, North Carolina, United States, 27104
United States, Rhode Island
Clinical Partners, LLC
Johnston, Rhode Island, United States, 02919
United States, South Carolina
Radiant Research
Anderson, South Carolina, United States, 29621
United States, Texas
Austin Dermatology Associates
Austin, Texas, United States, 78705
Modern Research Associates
Dallas, Texas, United States, 75231
Center for Clinical Studies
Houston, Texas, United States, 77030
Center for Clinical Studies
Webster, Texas, United States, 77598
United States, Virginia
Virginia Clinical Research, Inc.
Norfolk, Virginia, United States, 23507
Austria
Medical University Vienna
Vienna, Austria, 1090
Canada, Alberta
North West Dermatology & Laser Centre
Calgary, Alberta, Canada, T3G 0B4
Stratica Medical
Edmonton, Alberta, Canada, T5k 1X3
Canada, Newfoundland and Labrador
New Lab Clinical Research
St. Johns, Newfoundland and Labrador, Canada, A1C 2H5
Canada, Ontario
Skin Care Centre for Dermatology
Peterborough, Ontario, Canada, K9J 1Z2
Windsor Clinical Research Inc.
Windsor, Ontario, Canada, N8W5L7
Canada, Quebec
Q&T Research
Sherbrooke, Quebec, Canada, J1H4J6
Canada
CRDQ Chemin des Quatre-Bourgeo
Quebec, Canada, G1V4X7
Denmark
Bispebjerg Hospital
Copenhagen, Denmark, 2400
France
Hopital Saint Jacques, Departement of Dermatology
Besancon, France, 25030
Hopital Haut Leveque service de dermatologie
Pessac, France, 33604
CHU Larrey/Department of Dermatology
Toulouse, France, 31000
Germany
Hautarztpraxis Dr. med. Beatrice Gerlach
Dresden, Germany, 01079
Universitatsklinikum Hamburg Eppendorf
Hamburg, Germany, 20246
University Hospital Schleswig-Holstein, Campus Kiel, Dep. Of Dermatology
Kiel, Germany, 24105
Clinic of Dermatology
Leipzig, Germany, 04103
Gemeinschaftspraxis Mahlow
Mahlow, Germany, 15831
Italy
Universita degli Studi di Napoli Federico II
Napoli, Italy, 80131
San Galliano Dermatolgoical Institute
Rome, Italy, 00144
Clinica Dermatologica
Verona, Italy, 37136
Spain
Fundacion Hospital Alcorcon
Alcorcon, Spain, 28922
Hospital Germans Trias I Pujol
Barcelona, Spain, 8006
University Hospital La Coruna
La Coruna, Spain, 15006
Hospital de Alcorcon
Madrid, Spain, 28922
Hospital Universitario 12 de Octubre
Madrid, Spain, 28041
Hospital Universitario La Princesa
Madrid, Spain, 28006
Switzerland
Dermatology, Hopitaux Universitaires de Geneve
Geneva, Switzerland, 1211
Universitaetsspital Zuerich Department of Dermatology
Zurich, Switzerland, 8091
Sponsors and Collaborators
Celgene Corporation
Investigators
Study Director: Irina Khanskaya, MD Celgene Corporation
  More Information

No publications provided

Responsible Party: Celgene Corporation
ClinicalTrials.gov Identifier: NCT01232283     History of Changes
Other Study ID Numbers: CC-10004-PSOR-009
Study First Received: October 29, 2010
Results First Received: October 22, 2014
Last Updated: November 3, 2014
Health Authority: Canada: Health Canada
United States: Food and Drug Administration
Spain: Agencia Española de Medicamentos y Productos Sanitarios
France: Afssaps - Agence française de sécurité sanitaire des produits de santé (Saint-Denis)
Germany: Federal Institute for Drugs and Medical Devices
Italy: National Monitoring Centre for Clinical Trials - Ministry of Health
Denmark: Danish Medicines Agency
Switzerland: Swissmedic
Austria: Agency for Health and Food Safety

Additional relevant MeSH terms:
Psoriasis
Skin Diseases
Skin Diseases, Papulosquamous
Apremilast
Analgesics
Analgesics, Non-Narcotic
Anti-Inflammatory Agents
Anti-Inflammatory Agents, Non-Steroidal
Antirheumatic Agents
Central Nervous System Agents
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Peripheral Nervous System Agents
Pharmacologic Actions
Phosphodiesterase Inhibitors
Physiological Effects of Drugs
Sensory System Agents
Therapeutic Uses

ClinicalTrials.gov processed this record on November 23, 2014