Clinical trial NCT00358670: Long-Term Effects of Infliximab in the Treatment of Moderate to Severe Psoriasis [Extension of Study P04271, NCT00251641] (P04563)
Official title: A Long-Term Efficacy and Safety Study of Infliximab in the Treatment of Moderate to Severe Plaque-Type Psoriasis
Study type: INTERVENTIONAL
Overall status: TERMINATED
Phase: PHASE3
Conditions: Psoriasis
Lead sponsor: Merck Sharp & Dohme LLC
Sponsor class: INDUSTRY
First posted: 2006-08-01
Enrollment: 441
Sex: ALL
Minimum age (years): 18
Maximum age (years): 75
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: This is a long-term, randomized, multi-center, open-label study of infliximab treatment in adults with moderate to severe plaque-type psoriasis. This study is the long-term extension of Study P04271 (NCT00251641); Study P04271 is a Phase 3b, randomized, parallel-group, multicenter, open-label, 26-week study comparing the efficacy and safety of infliximab versus methotrexate in the treatment of adult subjects with moderate to severe plaque-type psoriasis. The objectives of this study are to assess the efficacy and safety of long-term maintenance therapy versus intermittent therapy with 5 mg/kg infliximab in a moderate to severe plaque-type psoriasis population.

During an interim safety evaluation of the trial, a higher incidence of serious and severe infusion reactions was observed in the intermittent treatment arm, consisting of a re-induction cycle (maximum of 4 infusions at 0, 2, 6 and 14 weeks) after a period of no treatment compared with the maintenance arm (infusions every 8 weeks without an interruption of treatment). Consequently, the sponsor has terminated the trial. The label will be updated to reflect this new information relating to the use of a re-induction regimen with infliximab.


Eligibility criteria: Inclusion Criteria:

* Subjects must have met all inclusion/exclusion criteria in Study P04271 (NCT00251641).
* Subjects must have been originally randomized to infliximab in Study P04271.
* Subjects must have completed the full 26 weeks of Study P04271.
* Subjects must have remained on infliximab for the full 22 weeks of treatment in Study P04271.
* Subjects must have achieved an improvement in Psoriasis Area and Severity Index (PASI) score \>=75% from Baseline of Study P04271 to Week 26 of Study P04271.
* Subjects must agree to avoid prolonged sun exposure and avoid use of tanning booths or other ultraviolet light sources during the study.
* Subjects are considered eligible according to the following tuberculosis (TB) criteria:

  * Have no signs or symptoms suggestive of active TB upon medical history and/or physical examination;
  * Have had no recent close contact with a person with active TB or, if there has been such contact, will be referred to a physician specializing in TB to undergo additional evaluation and, if warranted, receive appropriate treatment for latent TB prior to or simultaneously with the first administration of study medication.
* Subjects' Baseline (Visit 1) clinical laboratory tests (complete blood count, blood chemistry, and urinalysis) must be within the following parameters:

  * Hemoglobin \>=10 g/dL
  * White blood cells \>=3.5 x 10\^9/L
  * Neutrophils \>=1.5 x 10\^9/L
  * Platelets \>=100 x 10\^9/L
  * Serum creatinine \<1.5 mg/dL (or \<133 umol/L)
  * Aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and gamma-glutamyltransferase levels as outlined in Protocol P04563.
  * Total bilirubin \<2 x upper limit of normal \[Note: If Baseline laboratory tests are not yet available, then the previous laboratory tests from Week 22 of the parent study (Study P04271) should be used for enrollment. When the Baseline laboratory tests become available, the investigator must apply the above parameters to determine a subject's eligibility.\]
* Subjects must be free of any clinically significant disease (other than plaque-type psoriasis or psoriatic arthritis) that would interfere with the study evaluations.
* Subjects must be willing to give written informed consent and be able to adhere to dose and visit schedules.
* Women of childbearing potential and all men must be using adequate birth control measures (eg, abstinence, oral contraceptives, intrauterine device, barrier method with spermicide, or surgical sterilization) and must continue using such measures until 6 months after receiving the last infusion of study medication.
* Female subjects of childbearing potential must have a negative urine pregnancy test at Baseline.

Exclusion Criteria:

* Subjects who have any significant ongoing adverse events (AEs) or AEs from Study P04271 (NCT00251641) that would prohibit further treatment with infliximab at the time of entry.
* Subjects originally randomized to methotrexate or subjects who received methotrexate at any time during their participation in Study P04271.
* Subjects who have non-plaque forms of psoriasis (eg, erythrodermic, guttate, or pustular).
* Subjects who have current drug-induced psoriasis (eg, a new onset of psoriasis or an exacerbation of psoriasis from beta blockers, calcium channel blockers, or lithium).
* Female subjects who are pregnant, nursing, and both men and women who are planning pregnancy during the study period or during the 6 months after receiving of the last infusion of study medication.
* Subjects who are in a situation or have any condition that, in the opinion of the investigator, may interfere with optimal participation in the study.
* Subjects who are staff personnel directly involved with this study.
* Subjects who are family members of the investigational study staff.

Primary outcomes:
measure: Number of Participants Who Achieved Psoriasis Area and Severity Index 75 (PASI75) Response at Week 128
timeFrame: 128 weeks
Secondary outcomes:
measure: Number of Participants Who Achieved PASI75 Response at Week 52
timeFrame: 52 weeks
measure: Number of Participants Who Achieved PASI75 Response at Week 100
timeFrame: 100 Weeks
measure: PASI 6-month Area Under the Curve (AUC); (Time Adjusted Total PASI Score Over the 6 Month Period)
timeFrame: Day 0 to 180 days
measure: PASI 12-month AUC (Time Adjusted Total PASI Score Over the 12 Month Period)
timeFrame: Day 0 to 360 days
Other outcomes:
Locations:
Study officials:
References:
citation: Reich K, Wozel G, Zheng H, van Hoogstraten HJ, Flint L, Barker J. Efficacy and safety of infliximab as continuous or intermittent therapy in patients with moderate-to-severe plaque psoriasis: results of a randomized, long-term extension trial (RESTORE2). Br J Dermatol. 2013 Jun;168(6):1325-34. doi: 10.1111/bjd.12404.