Study of NDI-034858 in Participants With Moderate to Severe Plaque Psoriasis
Condition: Moderate to Severe Plaque Psoriasis
MeSH terms: Psoriasis
Intervention: NDI-034858 study drug; NDI-034858 study drug; NDI-034858 study drug; NDI-034858 study drug; Placebo
Intervention description: NDI-034858 2 mg oral capsules.; NDI-034858 5 mg oral capsules.; NDI-034858 15 mg oral capsules.; NDI-034858 30 mg (2*15 mg) oral capsules.; Placebo matched to NDI-034858 oral capsules.
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Enrollment: 259.0
Sex: All
Minimum age: 18 Years
Maximum age: 70 Years
Healthy volunteers: No

Summary:

      This is a Phase 2b, randomized, multicenter, double-blind, placebo-controlled, multiple-dose
      study designed to evaluate the efficacy, safety, and tolerability of NDI-034858 in
      participants with moderate to severe plaque psoriasis. This study will also evaluate the
      plasma concentrations of NDI-034858 and explore the immune response to NDI-034858 in
      participants with moderate to severe plaque psoriasis.
    

Eligibility criteria:

        Inclusion Criteria:

        In order to be eligible to participate in this study, a participant must meet all of the
        following criteria, either at the screening and Day 1 visits or only at one of the
        specified visits (screening or Day 1) as noted in the criterion:

          1. Male or female participant aged 18 to 70 years, inclusive, at the time of consent.

          2. Participant has a history of plaque psoriasis for at least 6 months prior to the
             screening visit.

          3. Participant had no significant flare in psoriasis for at least 3 months before
             screening (information obtained from medical chart or participant's physician, or
             directly from the participant).

          4. Participant has moderate to severe plaque psoriasis as defined by a PASI score ≥ 12
             and a PGA score ≥ 3 at screening and Day 1.

          5. Participant has plaque psoriasis covering ≥ 10% of his or her total BSA at screening
             and Day 1.

          6. Participant must be a candidate for phototherapy or systemic therapy.

          7. For female participants of childbearing potential involved in any sexual intercourse
             that could lead to pregnancy: the participant must agree to use a highly effective
             contraceptive method from at least 4 weeks prior to Day 1 until at least 4 weeks after
             the last study product administration. Highly effective contraceptive methods include
             hormonal contraceptives (eg, combined oral contraceptive, patch, vaginal ring,
             injectable, or implant), intrauterine devices or intrauterine systems, vasectomized
             partner(s) (provided vasectomy was performed ≥ 4 months prior to screening), bilateral
             tubal ligation or occlusion, or double barrier methods of contraception (eg, male
             condom with cervical cap, male condom with diaphragm, and male condom with
             contraceptive sponge) in conjunction with spermicide.

          8. Female participants of childbearing potential have had a negative serum pregnancy test
             at screening and negative urine pregnancy test at Day 1.

          9. For male participants involved in any sexual intercourse that could lead to pregnancy,
             participant must agree to use one of the highly effective contraceptive methods listed
             in Inclusion Criterion 6, from Day 1 until at least 12 weeks after the last study
             product administration. If the female partner of a male participant uses any of the
             hormonal contraceptive methods listed above, this contraceptive method should be used
             by the female partner from at least 4 weeks before Day 1 until at least 12 weeks after
             the last study product administration.

         10. Participant has a BMI within the range of 18 to 42 kg/m2, inclusive (BMI = weight
             [kg]/[height (m)]2), and total body weight >50 kg (110 lb).

         11. Participant is willing to participate and is capable of giving informed consent. Note:
             Consent must be obtained prior to any study-related procedures.

         12. Participant must be willing to comply with all study procedures and must be available
             for the duration of the study.

        Exclusion Criteria:

        A participant who meets any of the following criteria at the screening and/or Day 1 visits,
        as applicable, will be excluded from participation in this study:

          1. Participant is a female who is breastfeeding, pregnant, or who is planning to become
             pregnant during the study.

          2. Participant has evidence of erythrodermic, pustular, predominantly guttate psoriasis,
             or drug induced psoriasis.

          3. Participant has a history of skin disease or presence of skin condition that, in the
             opinion of the investigator, would interfere with the study assessments.

          4. Participant has immune-mediated conditions commonly associated with psoriasis, such as
             psoriatic arthritis, uveitis, inflammatory bowel disease, that require systemic
             treatment (including corticosteroids, immunosuppressants, or biologics). Note:
             Participants with immune-mediated conditions that do not require systemic treatment
             may be included in the study. Certain therapies such as NSAIDs may be permitted, but
             should be discussed with the Medical Monitor prior to determination of participant
             eligibility.

          5. Participant has any clinically significant medical condition, evidence of an unstable
             clinical condition (eg, cardiovascular, renal, hepatic, hematologic, gastrointestinal,
             endocrine, pulmonary, immunologic, or local active infection/infectious illness),
             psychiatric condition, or vital signs/physical/laboratory/ECG abnormality that would,
             in the opinion of the investigator, put the participant at undue risk or interfere
             with interpretation of study results.

          6. Participant had a major surgery within 8 weeks prior to Day 1 or has a major surgery
             planned during the study.

          7. Participant has a history of Class III or IV congestive heart failure as defined by
             New York Heart Association Criteria.

          8. Participant has been hospitalized in the past 3 months for asthma, has ever required
             intubation for treatment of asthma, currently require oral corticosteroids for the
             treatment of asthma, or has required more than one short-term (≤ 2 weeks) course of
             oral corticosteroids for asthma within 6 months prior to Day 1.

          9. Participant has a history of cancer or lymphoproliferative disease within 5 years
             prior to Day 1. Participant with successfully treated non-metastatic cutaneous
             squamous cell or basal cell carcinoma and/or localized carcinoma in situ of the cervix
             are not to be excluded.

         10. Participant has a history of fever, inflammation, or systemic signs of illness
             suggestive of systemic or invasive infection within 4 weeks prior to Day 1.

         11. Participant has an active bacterial, viral, fungal, mycobacterial infection, or other
             infection (including TB or atypical mycobacterial disease), or any major episode of
             infection that required hospitalization or treatment with intravenous antibiotics
             within 12 weeks prior to Day 1, or oral antibiotics within 4 weeks prior to Day 1.

         12. Participant has a history of chronic or recurrent infectious disease, including but
             not limited to chronic renal infection, chronic chest infection, recurrent urinary
             tract infection, fungal infection (with the exception of superficial fungal infection
             of the nailbed), or infected skin wounds or ulcers.

         13. Participant has a history of an infected joint prosthesis or has received antibiotics
             for a suspected infection of a joint prosthesis, if that prosthesis has not been
             removed or replaced.

         14. Participant has active herpes infection, including herpes simplex 1 and 2 and herpes
             zoster (demonstrated on physical examination and/or medical history) within 8 weeks
             prior to Day 1.

         15. Participant has a history of known or suspected congenital or acquired
             immunodeficiency state or condition that would compromise the participant's immune
             status in the opinion of the investigator (eg, history of splenectomy, primary
             immunodeficiency).

         16. Participant has positive results for hepatitis B surface antigens (HBsAg), antibodies
             to hepatitis B core antigens (anti-HBc), hepatitis C virus (HCV), or human
             immunodeficiency virus (HIV).

         17. Participant has clinical or laboratory evidence of active or latent TB infection at
             screening.

         18. Participant with any of the following laboratory values at the screening visit:

               1. Alanine aminotransferase (ALT) or aspartate aminotransferase (AST) values ≥ 3
                  times the upper limit of normal (ULN);

               2. Hemoglobin < 11.0 g/dL (< 110.0 g/L);

               3. White blood cell count < 3.5 x 109/L (< 3500/mm3);

               4. Absolute neutrophil count of < 1.8 x 109/L (< 1800/mm3);

               5. Absolute lymphocyte count of < 1.0 x 109/L (< 1000/mm3);

               6. Platelet count < 100 x 109/L (< 100,000/mm3);

               7. Total bilirubin ˃ 2 times the ULN.

         19. Participant who have given > 50 ml of blood or plasma within 30 days of screening or >
             500 mL of blood or plasma within 56 days of screening (during a clinical study or at a
             blood bank donation).

         20. Participant has used any topical medication that could affect psoriasis (including
             corticosteroids, retinoids, vitamin D analogues [such as calcipotriol], JAK
             inhibitors, or tar) within 2 weeks prior to Day 1.

         21. Participant has used any systemic treatment that could affect psoriasis (including
             oral, intravenous, intraarticular, intrathecal, intramuscular, or intralesional
             corticosteroids, oral retinoids, immunosuppressive/immunomodulating medication,
             methotrexate, cyclosporine, oral JAK inhibitors, or apremilast) within 4 weeks prior
             to Day 1.

         22. Participant has received any UV-B phototherapy (including tanning beds) or excimer
             laser within 4 weeks prior to Day 1.

         23. Participant has had PUVA treatment within 4 weeks prior to Day 1.

         24. Participant has received any live-attenuated vaccine within 4 weeks prior to Day 1 or
             plans to receive a live-attenuated vaccine during the study and up to 4 weeks or 5
             half lives of the study product, whichever is longer, after the last study product
             administration. Note: Nonlive-attenuated vaccines or boosters for Coronavirus Disease
             2019 (COVID-19) (eg, RNA-based vaccines, inactivated adenovirus-based vaccines,
             protein-based vaccines) are allowed during the study. The study site should follow
             local guidelines related to COVID-19.

         25. Participant is currently receiving a nonbiological investigational product or device
             or has received one within 4 weeks prior to Day 1.

         26. Participant has received any marketed or investigational biological agent within 12
             weeks or 5 half-lives (whichever is longer) prior to Day 1 (except those listed in
             Exclusion Criterion 27 and 28 that are to be excluded for 6 months).

         27. Participant was previously enrolled in any study with NDI-034858.

         28. Participant has a history of lack of response to any therapeutic agent targeting
             IL-12, IL-17, and/or IL 23 (eg, ustekinumab, secukinumab, ixekizumab, brodalumab,
             guselkumab, tildrakizumab, risankizumab) at approved doses after at least 12 weeks of
             therapy, and/or received one of these therapies within 6 months prior to Day 1.

         29. Participant has received rituximab or other immune-cell depleting therapy within 6
             months.

         30. Participant is currently being treated with strong or moderate cytochrome P450 3A
             (CYP3A4) inhibitors (such as itraconazole), or has received moderate or strong CYP3A4
             inhibitors within 4 weeks prior to Day 1.

         31. Participant is currently being treated with terbinafine, or has received terbinafine
             within 4 weeks prior to Day 1.

         32. Participant has consumed grapefruit within 1 week prior to Day 1.

         33. Participant has used tanning booths within 4 weeks prior to Day 1, has had excessive
             sun exposure, or is not willing to minimize natural and artificial sunlight exposure
             during the study.

         34. Participant has a known or suspected allergy to NDI-034858 or any component of the
             investigational product, or any other significant drug allergy (such as anaphylaxis or
             hepatotoxicity).

         35. Participant has a known history of clinically significant drug or alcohol abuse in the
             last year prior to Day 1.

         36. For participant consenting to biopsy collection only:

               -  Participant has a history of an allergic reaction or significant sensitivity to
                  lidocaine or other local anesthetics.

               -  Participant has a history of hypertrophic scarring or keloid formation in scars
                  or suture sites.

               -  Participant has taken anticoagulant medication, such as heparin, low molecular
                  weight (LMW)-heparin, warfarin, or antiplatelet agents (except low-dose aspirin ≤
                  81 mg which will be allowed), within 2 weeks prior to Day 1, or has a
                  contraindication to skin biopsies. Nonsteroidal anti-inflammatory drugs will not
                  be considered antiplatelet agents and will be allowed.