The Immunological Basis for Treatment Resistance to Anti-TNF Treatments
试验速览
- 阶段
- 4 期
- 状态
- 已完成
- 入组人数
- 50
- 试验地点
- 1
- 主要终点
- Change in Psoriasis Area and Severity Index (PASI) Score
研究概览
简要总结
The purpose of this study is to determine the relationship between two types of cell signals, type I interferon (IFN) and tumor necrosis factor (TNF), in psoriatic skin prior to and during treatment with etanercept and correlate that information with the degree of the improvement in the psoriasis.
详细描述
Hypothesis: The balance between type I IFN and TNF determines the response to anti-TNF treatment. The goal of the proposed study is to address this hypothesis and demonstrate that the strength of the type I IFN signature in psoriatic skin is the major determinant of the clinical response to anti-TNF treatment.
Purpose: Determine the strength of the type I interferon and TNF signal in psoriatic skin prior to and during treatment with etanercept and correlate with degree of clinical improvement.
Study Population: up to 50 subjects, men or women over the age of 18 with clinically stable plaque psoriasis, who meet the wash out requirements and other exclusion criteria
Psoriatic patients will receive 100 mg etanercept per week (2 separate single-use pre-filled 50 mg subcutaneous injections taken on two separate days) for 3 months.
Procedures: Urine pregnancy test, TB test, photography, Physical Examinations, Skin Examinations, Study Drug, Peripheral blood and biopsies
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •At least 18 years of age at screening.
- •Clinically stable moderate to severe plaque psoriasis at screening and baseline.
- •Subject must be:
- •A woman who is surgically sterile or at least 3 years postmenopausal or
- •A woman of childbearing potential who has had a negative pregnancy test within 7 days before the first dose of study drug.
- •If the subject is sexually active, (s)he must agree to use a medically acceptable form of contraception during screening and throughout the study.
排除标准
- •Grade 3 or 4 adverse events or infections within 28 days before screening, or between the screening visit and drug initiation.
- •Active or chronic infection within 4 weeks before screening visit, or between the screening and baseline visits.
- •Evidence of skin conditions other than psoriasis that would interfere with the evaluations of the effect of study medication on psoriasis.
- •Use of oral psoralen with ultraviolet A (PUVA), oral retinoids, cyclosporine, alefacept, or any other systemic anti-psoriasis therapy within 28 days study drug initiation.
- •Use of ulltraviolet B (UVB) therapy, topical steroids at no higher than moderate strength, topical vitamin A or D analog preparations, or anthralin with 14 days of study initiation.
- •Prior or concurrent use of cyclophosphamide therapy
- •Concurrent sulfasalazine therapy.
- •Known hypersensitivity to Enbrel® (etanercept) or any of its components or known to have antibodies to etanercept.
- •Current enrollment in any other investigational device or investigational drug trial(s), or receipt of any other investigational agent(s) within 28 days before baseline visit.
- •Use of any biologic drugs within 28 days of study drug initiation.
- •Concurrent use of Anakinra.
- •Severe comorbidities (diabetes mellitus requiring insulin; congestive heart failure (CHF) of any severity or myocardial infarction or cerebrovascular accident or transient ischemic attack within 3 months of screening visit; unstable angina pectoris, uncontrolled hypertension (sitting systolic blood pressure (BP) <80 mm Hg or > 160 or diastolic BP > 100 mm Hg), oxygen-dependent severe pulmonary disease, history of cancer within 5 years (other than resected cutaneous basal or squamous cell carcinoma of the skin or in situ cervical cancer)
- •Known history of tuberculosis (TB), or previous positive purified protein derivative (PPD) test. Any mycobacterial disease or high risk factors for tuberculosis (TB), such as family member with TB, positive purified protein derivative (PPD) or taking anti-tuberculosis medication.
- •Known HIV-positive status or known history of any other immuno-suppressing disease.
- •Concurrent or history of psychiatric disease that would interfere with ability to comply with study protocol or give informed consent.
- •History of alcohol or drug abuse within 12 months of screening visit.
- •Latex sensitivity [Nota Bene: only applicable if they are using prefilled syringe or prefilled SureClick™ autoinjector presentations]
- •Exposure to hepatitis B or hepatitis C or to high risk factors for hepatitis B or C, such as intravenous drug use in patient.
- •Systemic lupus erythematosus, history of multiple sclerosis, transverse myelitis, optic neuritis or seizure disorder.
- •Use of a live vaccine 90 days prior to screening visit, or concurrent use of a live vaccine.
- •Any condition or circumstances judged by the patient's physician[or the investigator or medically qualified study staff] to render this clinical trial detrimental or otherwise unsuitable for the patient's participation.
- •History of non-compliance with other therapies.
- •Pregnant or nursing females.
- •Diagnosis of multiple sclerosis in first degree family relationship (parent, sibling or child)
研究组 & 干预措施
Etanercept
100 mg Etanercept injections per week for 3 months.
干预措施: etanercept (Drug)
结局指标
主要结局
Change in Psoriasis Area and Severity Index (PASI) Score
时间窗: Baseline, 12 weeks
A cumulative change in PASI score from baseline to week 12 will be calculated for each patient. The PASI is the industry standard to decrease/eliminate subjectivity in determining psoriasis severity. It is a quantitative rating scale for measuring the severity of psoriatic lesions based on area coverage and plaque appearance. The severity of plaque characteristics (erythema, thickness and scaling) for body regions (head, upper limbs, trunk and lower limbs) is combined with the degree of plaque involvement in each body region to determine a single PASI score in the range of 0 (no disease) and 72 (maximal disease).
次要结局
- Psoriasis Area and Severity Index (PASI) Response Profile(12 Weeks)
- Tumor Necrosis Factor (TNF)-Alpha Signal Strength(Baseline, Week 6, Week 12)
- Interferon (IFN)-Alpha Signal Strength(Baseline, Week 6, Week 12)
研究者
Johann E Gudjonsson MD, PhD
Assistant Professor of Dermatology, Medical School
University of Michigan