A Study of Guselkumab in Participants With Moderate to Severe Plaque-type Psoriasis and an Inadequate Response to Ustekinumab

Psoriasis Clinical Trial

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Official title:

A Phase 3, Multicenter, Randomized, Double-blind Study to Evaluate the Efficacy and Safety of Guselkumab for the Treatment of Subjects With Moderate to Severe Plaque-type Psoriasis and an Inadequate Response to Ustekinumab

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT02203032
• Other study ID #: CR104918
• Secondary ID: CNTO1959PSO30032
• Status: Completed
• Phase: Phase 3
• First received: July 25, 2014
• Last updated: July 12, 2016
• Start date: October 2014
• Est. completion date: May 2016

Study information

• Verified date: July 2016
• Source: Janssen Research & Development, LLC
• Contact: n/a
• Is FDA regulated: No
• Health authority: United States: Food and Drug AdministrationGermany: Ethics CommissionGermany: Institutional Review Board
• Study type: Interventional

Clinical Trial Summary

The purpose of this study is to evaluate the efficacy and safety of guselkumab (CNTO 1959) in the treatment of participants with moderate to severe plaque-type psoriasis (scaly skin rash) who had inadequate response to ustekinumab.

Description:

This is a randomized (assignment of study drug by chance), double-blind (participants nor study staff will know the identity of study drugs), multicenter study to evaluate efficacy and safety of guselkumab for the treatment of participants with moderate to severe plaque-type psoriasis who had an inadequate response to ustekinumab. The study will consist of a screening period, open-label and double-blind treatment periods, and a follow-up period. The treatment period will have 2 phases: an open-label treatment phase during which all participants will receive ustekinumab at Weeks 0 and 4 and a blinded treatment phase during which participants with an inadequate Investigator's Global Assessment response (IGA≥2) to ustekinumab at Week 16 will be randomized to receive either guselkumab or ustekinumab through Week 44. Participants with an IGA response of 0 or 1 (cleared or minimal disease) at Week 16 will continue to receive open-label treatment with ustekinumab every 12 weeks through Week 40. All participants will complete a follow-up phase through Week 52 for efficacy and through Week 60 for safety evaluations. The total duration of the study will be approximately 64 weeks (includes a 4-week screening period). Participants' safety will be monitored throughout the study.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 876
• Est. completion date: May 2016
• Est. primary completion date: December 2015
• Accepts healthy volunteers: No
• Gender: Both
• Age group: 18 Years to 99 Years

Eligibility

Inclusion Criteria:

• Have a diagnosis of plaque-type psoriasis (with or without psoriatic arthritis for at least 6 months before the first administration of study drug

• Have a Psoriasis Area and Severity Index (PASI) greater than or equal to (>=) 12 at Screening and at Baseline

• Have an Investigator's Global Assessment (IGA) >=3 at Screening and at Baseline

• Have an involved body surface area (BSA) >= 10 percent (%) at Screening and at Baseline

• Be a candidate for phototherapy or systemic treatment for psoriasis (either naïve or history of previous treatment)

Exclusion Criteria:

• Has a history or current signs or symptoms of severe, progressive, or uncontrolled renal, hepatic, cardiac, vascular, pulmonary, gastrointestinal, endocrine, neurologic, hematologic, rheumatologic, psychiatric, or metabolic disturbances

• Has unstable cardiovascular disease, defined as a recent clinical deterioration (example [eg], unstable angina, rapid atrial fibrillation) in the last 3 months or a cardiac hospitalization within the last 3 months

• Currently has a malignancy or has a history of malignancy within 5 years before Screening (with the exception of a nonmelanoma skin cancer that has been adequately treated with no evidence of recurrence for at least 3 months before the first study drug administration, or cervical carcinoma in situ that has been treated with no evidence of recurrence for at least 3 months before the first study drug administration)

• Has previously received guselkumab or ustekinumab

Study Design

Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Caregiver, Investigator), Primary Purpose: Treatment

Related Conditions & MeSH terms

• Psoriasis

Intervention

Drug:
• Ustekinumab
45 mg or 90 mg given by subcutaneous injection at Weeks 0 and 4 for all participants. Participants with an IGA score of 0 or 1 at Week 16 will also receive ustekinumab every 12 weeks (q12w) from Week 16 to Week 40.
• Guselkumab
100 mg given by subcutaneous injection at Weeks 16 and 20 and every 8 weeks (q8w) thereafter through Week 44.
• Placebo for ustekinumab
Subcutaneous injection at Weeks 16, 28, and 40 to maintain the blind for participants randomized to treatment with guselkumab.
• Placebo for guselkumab
Subcutaneous injection at Weeks 16 and 20 and q8w thereafter through Week 44 to maintain the blind for participants randomized to treatment with ustekinumab.

Locations

Country	Name	City	State
n/a

Sponsors (1)

Lead Sponsor	Collaborator
Janssen Research & Development, LLC

Countries where clinical trial is conducted

United States,  Australia,  Canada,  Germany,  Korea, Republic of,  Poland,  Russian Federation,  Spain,  Taiwan,  United Kingdom, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	The number of visits at which participants achieve an Investigator's Global Assessment (IGA) response of 0 or 1 and at least a 2 grade improvement (from Week 16) among randomized participants with an inadequate (IGA=2) response to ustekinumab at Week 16	The IGA documents the investigator's assessment of the participants psoriasis at a given time point. Overall lesions are graded for induration, erythema, and scaling on a scale of 0 to 4 (higher score = more severe). The participant's psoriasis is assessed as cleared (0), minimal (1), mild (2), moderate (3), or severe (4).	Week 28 through Week 40	No
Secondary	The number of visits at which participants achieve a Psoriasis Area and Severity Index (PASI) 90 response from Week 28 through Week 40 among randomized participants with an inadequate (IGA=2) response to ustekinumab at Week 16	The PASI is a system used for assessing and grading the severity of psoriatic lesions and their response to therapy. In the PASI system, the body is divided into 4 regions: the head, trunk, upper extremities, and lower extremities. Each of these areas is assessed separately for erythema, induration, and scaling, which are each rated on a scale of 0 to 4. The PASI produces a numeric score that can range from 0 to 72. A higher score indicates more severe disease. A PASI 90 response represents participants achieving at least a 90% improvement from baseline in the PASI score.	Week 28 through Week 40	No
Secondary	The number of visits at which participants achieve an IGA response of cleared (0) from Week 28 through Week 40 among randomized participants with an inadequate (IGA=2) response to ustekinumab at Week 16		Week 28 through Week 40	No
Secondary	The percentage of participants who achieve an IGA of 0 or 1 and at least a 2-grade improvement (from Week 16) at Week 28		Week 28	No
Secondary	The number of visits at which participants achieve a PASI 100 response from Week 28 through Week 40 among randomized participants with an inadequate (IGA=2) response to ustekinumab at Week 16	A PASI 100 response represents participants achieving 100% improvement from baseline in the PASI score.	Week 28 through Week 40	No
Secondary	The number of visits at which participants achieve a PASI 75 response from Week 28 through Week 40 among randomized participants with an inadequate (IGA=2) response to ustekinumab at Week 16	A PASI 75 response represents participants achieving at least a 75% improvement from baseline in the PASI score.	Week 28 through Week 40	No
Secondary	The average percent improvement from baseline in PASI response between Week 28 and Week 40 among randomized participants with an inadequate (IGA=2) response to ustekinumab at Week 16		Week 28 through Week 40	No
Secondary	The number of visits at which participants with an inadequate IGA response (IGA=2) to ustekinumab at Week 16 who achieve a Dermatology Life Quality Index (DLQI) of 0 or 1 among randomized participants with DLQI >1 at Week 16	The DLQI is a dermatology-specific quality of life instrument designed to assess the impact of the disease on a participant's quality of life. It is a 10-item PRO questionnaire that, in addition to evaluating overall quality of life, can be used to assess 6 different aspects that may affect quality of life: symptoms and feelings, daily activities, leisure, work or school performance, personal relationships, and treatment. The DLQI produces a numeric score that can range from 0 to 30. A higher score indicates more severe disease.	Week 28 through Week 40	No
Secondary	The number of visits at which participants with an inadequate IGA response (IGA=2) to ustekinumab at Week 16 who achieve a Psoriasis Symptom and Sign Diary (PSSD) symptom score of 0 among randomized participants with a PSSD symptom score =1 at Week 16	The PSSD is a questionnaire designed to measure the severity of psoriasis symptoms and signs over the previous 7 days for the assessment of treatment benefit. The PSSD questionnaire includes 11 items covering symptoms (itch, pain, stinging, burning, and skin tightness) and patient-observable signs (skin dryness, cracking, scaling, shedding or flaking, redness and bleeding) using 0 to 10 numerical rating scales for severity. Two subscores will be derived: the psoriasis symptom score and the psoriasis sign score. A higher score indicates more severe disease.	Week 28 through Week 40	No
Secondary	The number of visits at which participants with an inadequate IGA response (IGA=2) to ustekinumab at Week 16 who achieve a PSSD sign score of 0 among randomized participants with a PSSD sign score =1 at Week 16	See PSSD sign score described above.	Week 28 through Week 40	No
Secondary	The number of visits at which participants with an inadequate (IGA=2) response to ustekinumab at Week 16 who achieve a score of 0 for each PSSD individual scale from Week 28 through 40 among randomized participants with PSSD scale score =1 at Week 16		Week 28 through Week 40	No
Secondary	The percentage of participants with an inadequate (IGA=2) response to ustekinumab at Week 16 who achieve a PASI 90 response at Week 28		Week 28	No
Secondary	The percentage of participants with an inadequate (IGA=2) response to ustekinumab at Week 16 who achieve an IGA of 0 or 1 and at least a 2-grade improvement (from Week 16) at Week 52		Week 52	No
Secondary	The percentage of participants with an inadequate (IGA=2) response to ustekinumab at Week 16 who achieve a PASI 90 response at Week 52		Week 52	No
Secondary	The percentage of participants with an inadequate (IGA=2) response to ustekinumab at Week 16 who achieve a PSSD symptom score of 0 at Week 52 among randomized participants with a PSSD symptom score =1 at Week 16		Week 52	No
Secondary	The percentage of participants with an inadequate (IGA=2) response to ustekinumab at Week 16 who achieve a PSSD sign score of 0 at Week 52 among randomized participants with a PSSD sign score =1 at Week 16		Week 52	No
Secondary	The percentage of participants with an inadequate (IGA=2) response to ustekinumab at Week 16 who achieve DLQI of 0 and 1 at Week 52 among randomized participants with DLQI >1 at Week 16		Week 52	No
Secondary	The percentage of participants with an inadequate (IGA=2) response to ustekinumab at Week 16 who achieve each PSSD individual score of 0 at Week 52 among randomized participants with PSSD scale score =1 at Week 16		Week 52	No