The Maintenance Effect of Enstilar Foam in Combination With Otezla

Study Overview
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Brief Summary
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This is a single-center, open-label study. Approximately 30 qualified subjects will be enrolled in a study lasting 20 weeks which investigates the effect of Enstilar used in combination with Otezla to treat psoriasis.

Detailed Description
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Approximately 30 subjects will be enrolled in a single-center, open-label study of the treatment of psoriasis. There will be a screening/baseline, week 4, week 16 and week 20 visits. Subjects will include those who have been started on commercial Otezla within the last 10 days of baseline. We will add Enstilar foam QD at baseline visit for 4 weeks. Those subjects who achieve clear or almost clear on PGA scale at week 4 will continue on maintenance dose of Enstilar twice weekly on Mondays and Thursdays QD for the next 12 weeks and they will also continue on Otezla. Subjects will continue to week 20 after stopping Enstilar at week 16..

Official Title
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The Maintenance Effect of Enstilar Foam in Combination With Otezla

Conditions
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Psoriasis

Intervention / Treatment
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* Drug: Apremilast 30mg
* Drug: calcipotriene and betamethasone dipropionate


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Outpatient, male or female subjects of any race, 18 years of age or higher. Female subjects of childbearing potential must have a (-)UPT result at within 7 days of the first dose of study drug and practice a reliable method of contraception throughout the study; A female is considered of childbearing potential unless she is: - postmenopausal > 5Y, without a uterus and/or both ovaries; or has been surgically sterile for > 6M. Reliable methods of contraception are: - hormonal methods or IUD in use > 90d prior to study drug administration, barrier methods plus spermicide in use > 14d prior, or vasectomized partner. [Exception: Female subjects of CBP who are not sexually active are not required to practice a reliable method of contraception and may be enrolled at the Investigator's discretion provided they are counseled to remain sexually inactive for the duration of the study and understand the risks involved in getting pregnant during the study.] Subjects with moderate plaque type psoriasis who have been started on commercial Otezla within the last 10 days Physician Global Assessment (PGA) score of 3 Able to understand study requirements and sign Informed Consent/HIPAA forms Exclusion Criteria: Female subjects who are pregnant, breast-feeding, or who are of childbearing potential and not practicing a reliable method of birth control, or male subjects planning a pregnancy with their spouse or partner while in the study History of hypercalcemia or Vitamin D toxicity or history of significant renal or hepatic disease Patients with guttate, erythrodermic, or pustular psoriasis Serious skin condition (other than psoriasis) or uncontrolled medical condition (in the opinion of the investigator.) Skin conditions (e.g. eczema) that may interfere with evaluations of psoriasis Known hypersensitivity to Enstilar Foam or any of its components Current drug or alcohol abuse (Investigator opinion.) Subject unable to commit to all the assessments required by the protocol Current enrollment in another clinical study and treatment with another experimental drug or approved therapy for experimental use within 30 days prior to the Screening Visit.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Otezla + Enstilar<br> | Drug: Apremilast 30mg<br>* 30mg PO BID started within 10 days of baseline<br>* Other names: Otezla;Drug: calcipotriene and betamethasone dipropionate<br>* 1 application daily starting at baseline and continuing for 4 weeks; those achieving clear or almost clear PGA at week 4 will continue application twice weekly on Monday and Thursday in combination with Otezla. Enstilar application is discontinued at week 16 and study participation continues until week 20.<br>* Other names: Enstilar;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percent of subjects who are clear or almost clear on Physicians Global Assessment at Week 4 | Physician assessment of disease severity. 0=Clear, 1=Almost Clear, 2=Mild, 3=Moderate | 4 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percent of subjects who are clear or almost clear at week 4, 16 and week 20 on Physicians Global Assessment | Physician assessment of disease severity. 0=Clear, 1=Almost Clear, 2=Mild, 3=Moderate | week 4, week 16, week 20 | 
| The percent of subjects who are clear or almost clear at week 4, 16 and week 20 on Patient Global Assessment | Patient's Global Assessment of Disease Severity. 0=Clear, 1=Very mild, 2=Mild, 3=Moderate, 4=Severe | week 4, week 16, week 20 | 
| Percent of subjects who achieve PASI (psoriasis area and severity index) 75 at week 4 | The Psoriasis Area and Severity Index (PASI) is a quantitative rating score for measuring the severity of psoriatic lesions based on area coverage and plaque appearance. PASI 75 evaluates if the subject had a 75% or more reduction in their PASI score from baseline. | 4 weeks | 
| Percent of subjects who achieve PASI 75 at week 16 | The Psoriasis Area and Severity Index (PASI) is a quantitative rating score for measuring the severity of psoriatic lesions based on area coverage and plaque appearance. PASI 75 evaluates if the subject had a 75% or more reduction in their PASI score from baseline. | 16 weeks | 
| DLQI (dermatology life quality index) at week 4 | The Dermatology Life Quality Index (DLQI) is a ten-question questionnaire used to measure the impact of skin disease on the quality of life of an affected person. Each question is scored on a four-point Likert scale: Very much = 3, A lot = 2, A little = 1, Not at all = 0, Not relevant = 0, Question unanswered = 0. The DLQI is calculated by adding the score of each question, resulting in a maximum of 30 and a minimum of 0. The higher the score, the more quality of life is impaired. A score higher than 10 indicates that the patient's life is being severely affected by their skin disease. | 4 weeks | 
| DLQI at week 16 | The Dermatology Life Quality Index (DLQI) is a ten-question questionnaire used to measure the impact of skin disease on the quality of life of an affected person. Each question is scored on a four-point Likert scale: Very much = 3, A lot = 2, A little = 1, Not at all = 0, Not relevant = 0, Question unanswered = 0. The DLQI is calculated by adding the score of each question, resulting in a maximum of 30 and a minimum of 0. The higher the score, the more quality of life is impaired. A score higher than 10 indicates that the patient's life is being severely affected by their skin disease. | 16 weeks | 
| Itch VAS (visual analogue scale) at week 4 and week 16 | The VAS is a scale consisting of a 10cm long line and a single question used for measuring itch intensity. The left end point represents no itch and the right end point the worst imaginable itch. | 4 week, 16 weeks |