A Long-term Extension Study of Apremilast (CC-10004) in Pediatric Subjects From 6 Through 17 Years of Age With Moderate to Severe Plaque Psoriasis

Study Overview
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Brief Summary
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This study was created to provide subjects who complete Week 52 (end of Apremilast Extension Phase) of study CC-10004-PPSO-003 the option to continue to receive open-label apremilast therapy. The study will consist of up to 208 weeks of long-term treatment followed by an 8-week observational follow-up phase.

Official Title
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A Phase 3b, Multi Center, Open-label, Long-term Extension Study of Apremilast (CC-10004) in Pediatric Subjects From 6 Through 17 Years of Age With Moderate to Severe Plaque Psoriasis

Conditions
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Psoriasis

Intervention / Treatment
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* Drug: Apremilast


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Subject must satisfy the following criteria to be enrolled in the study: Subject is male or female 6 to 17 years of age, inclusive, at the time the informed consent document is signed by the legal guardian. Subject must have a weight of ≥ 20 kg. Subjects must have an age and sex specific BMI value no lower in range than the 5th percentile on the Centers for Disease Control (CDC) growth chart for children and adolescents. Subject must have completed Week 52 (Apremilast Extension Phase) of Study CC-10004-PPSO-003. Subject is able to sign an assent with a legal guardian/s who understand/s and voluntarily sign/s an informed consent prior to any study-related assessments/procedures being conducted. Subject is willing and able to adhere to the study visit schedule and other protocol requirements. All female subjects of childbearing potential (FCBP) must either practice abstinence from heterosexual contact or use one of the approved contraceptive options as described below while on apremilast and for at least 28 days after administration of the last dose of apremilast. For the purpose of this study, a female subject is considered of childbearing potential if she is ≥ 12 years old or has reached menarche, whichever occurred first. At the time of study entry, and at any time during the study when a female subject of childbearing potential's contraceptive measures or ability to become pregnant changes, the Investigator will educate the subject regarding abstinence or contraception options and the correct and consistent use of effective contraceptive methods in order to successfully prevent pregnancy. Females of childbearing potential must have a negative pregnancy test at each visit. All FCBP who engage in activity in which conception is possible must use one of the approved contraceptive options described below: Option 1: Any one of the following effective methods: hormonal contraception (oral, injection, implant, transdermal patch, vaginal ring); intrauterine device (IUD); tubal ligation; or partner's vasectomy; OR Option 2: Male or female condom or nonlatex condom NOT made out of natural [animal] membrane [for example, polyurethane]; PLUS one additional barrier method: (a) diaphragm with spermicide; (b) cervical cap with spermicide; or (c) contraceptive sponge with spermicide. NOTE: Option 2 may not be acceptable as a contraception option in all countries per local guidelines/regulations. Exclusion Criteria: The presence of any of the following will exclude a subject from enrollment: Subject has a condition, including the presence of laboratory abnormalities, or psychiatric illness, that would place the subject at unacceptable risk if he/she were to participate in the study. Subject has a condition that confounds the ability to interpret data from the study. Subject has evidence of skin conditions, other than psoriasis, that would interfere with clinical assessments. Subject is pregnant or breastfeeding. Subject has guttate, erythrodermic, or pustular psoriasis. Subject has active tuberculosis (TB) or a history of incompletely treated TB. Subject answers Yes to any question on the Columbia-Suicide Severity Rating Scale at Visit 16 of study CC-10004-PPSO-003. Subject plans concurrent use of the following therapies that may have a possible effect on psoriasis. Conventional systemic therapy for psoriasis (including but not limited to cyclosporine, corticosteroids, methotrexate, oral retinoids, mycophenolate, thioguanine, hydroxyurea, sirolimus, sulfasalazine, azathioprine, and fumaric acid esters) Biologic therapy: i. Etanercept (or biosimilar) treatment ii. Adalimumab (or biosimilar) treatment iii. Other TNF or interleukin (IL)-17 blockers (such as infliximab, certolizumab pegol, secukinumab, ixekizumab, brodalumab, or their biosimilars) iv. Anti-IL-12 or anti-IL-23 treatment (such as ustekinumab, guselkumab, or tildrakizumab) c) Use of any investigational drug other than apremilast Subject has prolonged sun exposure or use of tanning booths or other ultraviolet (UV) light sources. Children in Care: a child who has been placed under the control or protection of an agency, organization, institution or entity by the courts, the government or a government body, acting in accordance with powers conferred on them by law or regulation.

Ages Eligible for Study
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Minimum Age: 6 Years
Maximum Age: 17 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: Patients treated with Apremilast<br>Subjects with a weight between 20 kg to < 50 kg will receive apremilast 20 mg BID and subjects with weight ≥ 50 kg at Visit 1 will receive apremilast 30 mg BID. Subjects that begin the study receiving apremilast 20 mg BID and later record a body weight ≥ 50 kg, will be switched to apremilast 30 mg BID. | Drug: Apremilast<br>* Apremilast dose will be increased from 20 mg BID to 30 mg BID for those subjects that reach a weight of 50 kg or more during the study<br>* Other names: CC-10004, Otezla;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Adverse Events (AEs) | An AE is any noxious, unintended, or untoward medical occurrence that may appear or worsen in a subject during the course of a study. It may be a new intercurrent illness, a worsening concomitant illness, an injury, or any concomitant impairment of the subject's health, including laboratory test values, regardless of etiology. Any worsening (ie, any clinically significant adverse change in the frequency or intensity of a preexisting condition) should be considered an AE. | Up to approximately 4 years | 
| Columbia-Suicide Severity Rating Scale (C-SSRS) | Questionnaire to monitor depression, suicidal thoughts and behavior | Collected at each study visit throughout the life of the study - up to 4 years | 
| Weight of patients treated with Apremilast | Body weight in kg | Collected at each study visit throughout the life of the study - up to 4 years | 
| Mean body mass index of the patient treated with Apremilast | BMI (combined outcome of weight and height in the form of kg/m^2) | Collected at each study visit throughout the life of the study - up to 4 years | 
| Height patients treated with Apremilast | Height (inches or centimeters) will be collected for all pediatric subjects and descriptively summarized | Collected at each study visit throughout the life of the study - up to 4 years | 
| Assessment of sexual maturity | Sexual maturation, assessed by Tanner staging system, will be conducted for all pediatric subjects and descriptively summarized | Collected every 52 weeks throughout the life of the study - up to 4 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Static Physician Global Assessment (sPGA) | is the assessment by the Investigator of the overall disease severity at the time of evaluation. The sPGA is a 5-point scale ranging from 0 (clear) to 4 (severe), incorporating an assessment of the severity of the three primary signs of the disease: erythema, scaling and plaque elevation. | Collected at each study visit throughout the life of the study - up to 4 years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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CC-10004, Apremilast, Pediatric, Age 6 - 17 years, Plaque Psoriasis