Psoriasis Vulgaris
Conditions
Keywords
Psoriasis, Biomarker, Guselkumab
Brief summary
Plaque psoriasis may be an ideal model disease to explore potential therapeutic effects of immunosuppressive agents, given the easy accessibility of inflammatory lesions. In this study, the applicability of a systems dermatology approach is investigated in order to better assess the efficacy of psoriasis treatments at an early clinical stage. Up to this point, the clinical manifestation and regression of psoriasis is not yet sufficiently characterized with a multimodal state-of-the-art evaluation tool. The in-house developed 'DermaToolbox' enables the determination and subsequent integration of different diseaserelated biomarkers, including clinical, biophysical, molecular, cellular, and imaging markers as well as patient reported outcomes
Detailed description
Psoriasis is a common skin disorder affecting up to an estimated 3% of the world's population. The most prevalent form of psoriasis, called psoriasis vulgaris or plaque psoriasis, is characterized by the presence of sharply demarcated erythematous plaques covered with white scales. These lesions can occur all over the body, but are most often seen on the extensor surface of the joints, nether regions and on the scalp. Patients can experience excessive itch, pain and sometimes bleeding of the lesions. Moreover, the visual appearance of psoriatic lesions can severely impact the patients psychological state and quality of life. An abundancy of different factors contributes to the pathogenesis of psoriasis. However, aberrant inflammatory reactions in the skin are thought to be the underlying cause. Excessive infiltration of immune cells in the skin and their interactions with cutaneous resident cells results in the hyper proliferation of keratinocytes and subsequent thickening of the epidermis. Indeed, more and more immunosuppressive biologicals targeting specific components of the immune system, like tumor necrosis factor alpha (TNFα), interleukin (IL-)17 and IL-23, have shown excellent efficacy in treating psoriasis Plaque psoriasis may be an ideal model disease to explore potential therapeutic effects of immunosuppressive agents, given the easy accessibility of inflammatory lesions and the good willingness of patients to participate in clinical studies. In this study, the applicability of a systems dermatology approach is investigated in order to better assess the efficacy of psoriasis treatments at an early clinical stage. Up to this point, the clinical manifestation and regression of psoriasis is not yet sufficiently characterized with a multimodal state-of-the-art evaluation tool. The in-house developed 'DermaToolbox' enables the determination and subsequent integration of different disease-related biomarkers, including clinical, biophysical, molecular, cellular, and imaging markers as well as patient-reported outcomes
Interventions
DRUGGuselkumab
100 mg guselkumab administered subcutaneously
DRUGPlacebos
Sodiumchloride 0,9% solution for injection
Sponsors
Janssen Pharmaceuticals
Centre for Human Drug Research, Netherlands
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)
Intervention model description
This is an observational and interventional study in up to 40 patients with chronic plaque psoriasis and 10 healthy volunteers (observational only).
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
Yes
Inclusion criteria
Healthy volunteers Eligible healthy volunteers must meet all of the following inclusion criteria at screening: 1. Male or non-pregnant female subjects, 18 to 75 years of age (inclusive); 2. Healthy as defined by the absence of any uncontrolled active or uncontrolled chronic disease following a medical and surgical history, documentation of general symptoms, and a symptom-directed physical examination including vital signs; 3. Willing to give written informed consent and willing and able to comply with the study protocol; Psoriasis patients Eligible psoriasis patients must meet all of the following inclusion criteria at screening: 1. Male or non-pregnant female subjects, 18 to 75 years of age (inclusive); 2. Diagnosed with plaque psoriasis at least 6 months prior to study participation 3. Willing to discontinue any psoriasis therapy other than emollients. 4. Having mild (PASI ≥1 and ≤ 5) or moderate-to-severe (PASI ≥ 10) plaque psoriasis; 5. Currently not using psoriasis medication and ≥ 2 plaques suitable for repeated biopsies and target lesion assessments. At least one of these lesions must be located on the extremities, preferably on the elbow or knee, with a minimal target lesion score between 6 and 9. Or, when currently using psoriasis medication and insufficient lesional skin is present, willing to discontinue treatment awaiting rescreening (see also
Exclusion criteria
3 for psoriatic patients); 6. Willing to give written informed consent and willing and able to comply with the study protocol;
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Psoriasis Area and Severity Index (PASI) Assessment | from day -14 to day 168 | Psoriasis Area and Severity Index (PASI) combines the assessment of the severity of lesions and the area affected into a single score in the range 0 (no disease) to 72 (maximal disease). |
| Physicians Global Assesment (PGA) Assessment | from day -14 to day 168 | Physicians Global Assesment (PGA) is a 4-point scale ranging from 0 (no disease) to 4 (maximal disease). |
| Percentage body surface affected (%BSA) Assessment | from day -14 to day 168 | Percentage body surface affected (%BSA) is the area of lesional skin as a percentage of the total body surface |
| digital PASI | from day -14 to day 168 | Digital Psoriasis Area and Severity Index (dPASI) calculated from standardized total body photography |
| Erythema measurement of the skin | from day -14 to day 168 | Redness of the skin will be determined using a colorimeter |
| Anti-drug antibodies | from day 0 to day 168 | The occurrence of antibodies directed against guselkumab will be monitored during the treatment period (ng/ml) |
| Multispectral imaging | from day -14 to day 168 | The redness and superficial morphology of (non-)lesional skin sites will be determined using a multispectral imaging system |
| Laser Speckle Contrast imaging | from day -14 to day 168 | The cutaneous microcirculation of (non-)lesional skin sites will be monitored over a 30 second timespan with a laser speckle contrast imager |
| Thermography | from day -14 to day 168 | Body surface temperature of (non-)lesional skin will be determined using a thermal imaging infrared camera |
| Patient reported outcomes | from day -14 to day 168 | Patients will be asked to report on their condition through an NRS scale (0 (better)- 10 (worse)) for sleeplessness, itch and quality of life. Additionally, patients image their lesions on a daily basis using a mobile device. |
| Activity Tracking Heartrate | from day -14 to day 168 | Subjects are requested to wear a smartwatch at all times which heart rate (beats per minute) |
| Activity Tracking Steps | from day -14 to day 168 | Subjects are requested to wear a smartwatch at all times which register steps (amount of steps taken) |
| Activity Tracking Sleep | from day -14 to day 168 | Subjects are requested to wear a smartwatch at all times which register sleep (hrs, minutes, seconds of rest) |
| Cells/ml; Circulating immune cell subsets | from day -14 to day 168 | Blood be drawn during using a venipuncture during visits and analyzed for the presence of immune cells (e.g. CD4+ and CD8+ T-Cells) using flow cytometry |
| Circulating protein biomarkers | from day -14 to day 168 | Blood be drawn during using a venipuncture during visits and analyzed for the presence of various chemokines and cytokines (e.g. CCL20, CCL17, CXCL8) |
| Blister immune cell subsets | from day 0 to day 112 | Blisters will be induced on the non-lesional skin and the blister exudate aspirated. Blister exudate will be analyzed for the presence of immune cells (e.g. CD4+ and CD8+ T-Cells) using flow cytometry |
| Blister protein biomarkers | from day 0 to day 112 | Blisters will be induced on the non-lesional skin and blister fluid aspirated. Blister fluid will be analyzed for the presence of various chemokines and cytokines (e.g. CCL20, CCL17, CXCL8) (ng/ml) |
| Immunohistochemistry of biopsies | day 0 to day 112 | Biopsies will be sectioned and stained for the determination of the epidermal homeostasis (proliferation, differentiation and thickness) and infiltration of cellular immune subsets (e.g. presence of CD4 and CD8). |
| Transcriptome of biopsies | day 0 to day 112 | Biopsies will be analyzed with an untargeted next-generation sequencing approach. |
| Cutaneous microbiome | from day -14 to day 112 | The microbiome is collected by swabbing. The abundance of bacteria is thereafter determined using next-generation sequencing. |
| Fecal microbiome | from day 0 to day 112 | The bacterial composition of stool samples is determined using next-generation sequencing. |
| Skin surface biomarkers | from day -14 to day 112 | Superficial protein biomarkers are samples using a FibroTx Patch. Afterwards, these patches are extracted and the presence of protein biomarkers (e.g. HBD-3) determined using ELISA. |
| Lipidomics of the stratum corneum | from day -14 to day 112 | Tape stripping will be performed on (non-)lesional skin and lipids are subsequently extracted from the tape and analyzed using Liquid Chromatogrpahy-Mass Spectormetry. (ng/cm2) |
| Skin barrier function | from day -14 to day 168 | The trans epidermal water loss of (non-)lesional skin will be determined as function of the inside-out barrier function of the skin. (g/m2/h) |
| Patient genotyping | day -14 | A whole blood sample will be used to scan for common mutations in genes implicated in psoriasis using next-generation sequencing. |
Countries
Netherlands
Outcome results
None listed