Plaque Psoriasis, Psoriasis Guttate
Conditions
Brief summary
This is a two-arm open-label study to evaluate the clinical and immunogenetic responses of patients with plaque or guttate psoriasis to treatment with guselkumab.
Detailed description
Guselkumab (Tremfya®), an IL-23 inhibitor approved for the treatment of moderate-to-severe plaque psoriasis. Given the potential role of IL-23 in the pathogenesis of guttate psoriasis, guselkumab may be an effective option to treat the initial manifestation of guttate psoriasis. This is a two-arm open-label study to evaluate the clinical and immunogenetic responses of patients with plaque or guttate psoriasis to treatment with guselkumab. The primary objective of this study is to assess how treatment with guselkumab changes the immune milieu of the skin in patients with plaque or guttate psoriasis. The secondary objectives of this study are to assess how treatment with guselkumab affects the quality of life and extent of skin disease in patients with plaque or guttate psoriasis.
Interventions
DRUGGuselkumab
All subjects will initially be treated with guselkumab 100 mg SQ at weeks 0, 4, and then every 8 weeks thereafter until week 44
Sponsors
University of California, San Francisco
Janssen Biotech, Inc.
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
This is a single center, open-label study. Twenty-five subjects are planned (15 with new-onset guttate psoriasis and 10 with chronic plaque psoriasis). Screening data will be reviewed to determine subject eligibility. Subjects who meet all inclusion criteria and none of the exclusion criteria will be entered into the study. All subjects will initially be treated with guselkumab 100 mg SQ at weeks 0, 4, and then every 8 weeks thereafter until week 44.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
For subjects with guttate psoriasis: * Ability to provide written informed consent and comply with the protocol. * At least 18 years of age. * Diagnosis of guttate psoriasis. * Onset of guttate psoriasis within 12 months. * Body surface area (BSA) involvement greater than or equal to 5%. * PASI greater than or equal to 4. * Subject is considered a candidate for phototherapy or systemic therapy. * Subject is unlikely to conceive due to male, post-menopausal, or using adequate contraceptive (barrier, hormonal, implant, or permanent sterilization methods). Women of childbearing potential will be allowed to enroll provided they practice adequate forms of birth control. * Physical exam with no evidence of active skin infection and/or other findings that indicate chronic disease or concomitant inflammatory/immune-mediated skin disease other than psoriasis. For subjects with chronic plaque psoriasis (control): * Ability to provide written informed consent and comply with the protocol. * At least 18 years of age. * Diagnosis of plaque psoriasis. * Duration of plaque psoriasis \>5 years. * Body surface area (BSA) involvement greater than or equal to 5%. * Subject is considered a candidate for phototherapy or systemic therapy. * Subject is unlikely to conceive due to male, post-menopausal, or using adequate contraceptive (barrier, hormonal, implant, or permanent sterilization methods). Women of childbearing potential will be allowed to enroll provided they practice adequate forms of birth control. * Physical exam with no evidence of active skin infection and/or other findings that indicate chronic disease or concomitant inflammatory/immune-mediated skin disease other than psoriasis.
Exclusion criteria
For subjects with guttate psoriasis: * Subject is unable to provide written informed consent or comply with the protocol. * Subject is younger than 18 years of age or older than 70 years. * Have a history of active, chronic or recurrent infectious disease including HIV, hepatitis B, or hepatitis C. * Have active tuberculosis or latent tuberculosis without at least 4 weeks of treatment with isoniazid. * Have current signs or symptoms of severe, progressive, or uncontrolled medical disease. * Known allergies, hypersensitivity, or intolerance to guselkumab (TremfyaTM) excipients. * Have a known history of lymphoproliferative disease, including lymphoma, or signs and symptoms suggestive of possible lymphoproliferative disease, such as lymphadenopathy and/or splenomegaly. * Have any known malignancy or have a history of malignancy (with the exception of basal cell carcinoma, squamous cell carcinoma in situ of the skin, or cervical carcinoma in situ that has been treated with no evidence of recurrence, or squamous cell carcinoma of the skin that has been treated with no evidence of recurrence within 5 years prior to screening) * Are pregnant, nursing, or planning a pregnancy while enrolled in the study or for 12 weeks after the study agent injection for women or are planning to father a child while enrolled in the study or for 12 weeks after the last study agent injection. * Are participating in another study using an investigational agent or procedure during participation in this study. * Have any condition that, in the opinion of the investigator, would compromise the well-being of the subject or the study or prevent the subject from meeting or performing study requirements. * Subjects possess other diagnoses that, in the investigator's opinion interfere with the evaluation of the subject's guttate psoriasis. * Pre-existing psoriasis of any type for longer than 6 months. (i.e. plaque, guttate, palmoplantar, pustular, erythrodermic) * Previous treatment for psoriasis with phototherapy (narrowband ultraviolet (UV) B, broadband UVB, or UVA), systemic agents (methotrexate, acitretin, cyclosporine, apremilast), or biologic agents (etanercept, adalimumab, ustekinumab, secukinumab, etc.) For subjects with chronic plaque psoriasis: * Subject is unable to provide written informed consent or comply with the protocol. * Subject is younger than 18 years of age or older than 70 years. * Have a history of active, chronic or recurrent infectious disease, including HIV, hepatitis B, or hepatitis C. * Have active tuberculosis or latent tuberculosis without at least 4 weeks of treatment with isoniazid. * Have current signs or symptoms of severe, progressive, or uncontrolled medical disease. * Known allergies, hypersensitivity, or intolerance to guselkumab (TremfyaTM) excipients. * Have a known history of lymphoproliferative disease, including lymphoma, or signs and symptoms suggestive of possible lymphoproliferative disease, such as lymphadenopathy and/or splenomegaly. * Have any known malignancy or have a history of malignancy (with the exception of basal cell carcinoma, squamous cell carcinoma in situ of the skin, or cervical carcinoma in situ that has been treated with no evidence of recurrence, or squamous cell carcinoma of the skin that has been treated with no evidence of recurrence within 5 years prior to screening) * Are pregnant, nursing, or planning a pregnancy while enrolled in the study or for 12 weeks after the study agent injection for women or are planning to father a child while enrolled in the study or for 12 weeks after the last study agent injection. * Are participating in another study using an investigational agent or procedure during participation in this study. * Have any condition that, in the opinion of the investigator, would compromise the well-being of the subject or the study or prevent the subject from meeting or performing study requirements. * Subjects possess other diagnoses that, in the investigator's opinion, interfere with the evaluation of the subject's plaque psoriasis. * Prior history of guttate psoriasis.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Lesional CD4+ T Effector Cells | baseline and week 12 | Mean change from baseline in percent of lesional CD4+ T effector cells producing IL-17 between baseline and week 12 |
| Lesional CD8+ T Effector Cells | baseline and week 12 | Mean change from baseline in percent of lesional CD8+ T effector cells producing IL-17 between baseline and week 12 |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORWilson Liao, MD
University of California, San Francisco
Participant flow
Recruitment details
We recruited by recontact participants from prior studies who had previously consented, used referrals from colleagues with approved language, flyers, and directly from clinic. Recruitment ran from February 2021 until May 2023
Pre-assignment details
Actual enrollment of a total of 17 patients, as detailed in the periods section. 3 additional screened but not enrolled as not eligible.
Baseline characteristics
| Characteristic | — |
|---|---|
| Age, Continuous | 45.3 years STANDARD_DEVIATION 8.47283 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 1 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 6 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants |
| Lesional CD4+ effector cells | 31.8 Percentage of IL17+ CD4 T cells STANDARD_DEVIATION 10.2 |
| Lesional CD8+ T effector cells | 11.5 Percentage of IL17+ CD8 T cells STANDARD_DEVIATION 7.9 |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants |
| Race (NIH/OMB) Asian | 1 Participants |
| Race (NIH/OMB) Black or African American | 1 Participants |
| Race (NIH/OMB) More than one race | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 4 Participants |
| Race (NIH/OMB) White | 9 Participants |
| Sex: Female, Male Female | 5 Participants |
| Sex: Female, Male Male | 2 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 7 | 0 / 10 |
| other Total, other adverse events | 1 / 7 | 2 / 10 |
| serious Total, serious adverse events | 0 / 7 | 0 / 10 |
Outcome results
None listed