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Open Label Study Etanercept's Maintenance Dose in Obese Patients With Moderate to Severe Plaque Type Psoriasis

Primary Purpose

Psoriasis

Status
Completed
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Narrow band (310-312 nm) ultraviolet light B phototherapy
etanercept
Sponsored by
University of California, San Francisco
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Psoriasis focused on measuring Obese patients (BMI>30), Patients with moderate to severe psoriasis

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  • Nonimmunocompromised males or females 18 years of age or older.
  • Must be able to read, understand, and speak basic English.
  • Body Surface Area (BSA) involvement of greater than 10%.
  • Psoriasis Area and Severity Index greater than 10.
  • Obese defined as having a Body Mass Index greater than 30.
  • Eligible for systemic therapy, particularly etanercept, and Narrow Band Ultraviolet B in the opinion of the investigator.
  • Sign and date the appropriate written informed consent and Health Insurance Portability and Accountability Act authorization
  • Negative urine pregnancy test within 7 days before the first dose of etanercept in all women (except those surgically sterile or at least 5 years postmenopausal).
  • No evidence of active or latent tuberculosis based on a negative Purified Protein Derivative skin test. Patients with documentation of adequately treated tuberculosis may be enrolled.
  • Sexually active subjects of childbearing potential must agree to use medically acceptable form of contraception during screening and throughout the study.
  • Willing and able to self-administer subcutaneous injections or to have a qualified person available to administer subcutaneous injections
  • Agrees to comply with protocol requirements, attend all regularly study visits and is considered to be a good study subject
  • Meets concomitant medication washout requirements

Exclusion Criteria:

  • Erythrodermic, pustular, or guttate psoriasis
  • Evidence of skin conditions other than psoriasis that would interfere with study-related evaluations of psoriasis.
  • Known sensitivity to any component of the study medications.
  • Evidence of active infections such as fevers, chills, sweats, or history of untreated Lyme disease and active severe infections within 4 weeks before screening visit, or between the screening and Week 0 visits.
  • Evidence of latent or active hepatitis B infection as indicated by positive HBsAg test during the screening visit.
  • Personal or first degree family history of neurologic disease.
  • Poorly controlled medical condition including, but not limited to, unstable cardiovascular disease, poorly controlled diabetes, recent stroke, history of recurrent infections, or any other condition for which, in the opinion of the investigator, participation in the study would place the subject at risk.
  • History of any Tumor Necrosis Factor-α inhibitor use including etanercept, infliximab, and adalimumab within 4 weeks of starting study drug.
  • History of non-cutaneous malignancy within the past 5 years.
  • History of drug or alcohol abuse. Substance abuse must clearly be documented so those patients with a remote and minor history of drug/alcohol use will still have an opportunity to participate in the study.
  • Female subjects who are not postmenopausal for at least 1 year, surgically sterile, or willing to practice effective contraception during the study. Nursing mothers, pregnant women and women planning to become pregnant while on study are to be excluded.
  • Plans to receive any live vaccines during the study.
  • Evidence of photosensitivity disorder (i.e. polymorphous light eruption).
  • Known photosensitivity or known sensitivity to any of the excipients or products to be administered during dosing.
  • Current enrollment in another clinical study and treatment with another experimental drug or approved therapy for experimental use within 30 days prior to Week 0
  • Cannot commit to all the assessments required by the protocol
  • Any disorder that compromises the ability of the subject to give written informed consent and/or to comply with study procedures
  • Considered by the investigator, for any reason, to be an unsuitable candidate for study participation.
  • Cannot or do not wish to comply with the protocol washout requirements (please see section below entitled "Washout Period Prior to Week 0).

Sites / Locations

  • UCSF Psoriasis and Skin Treatment Center

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Experimental

Arm Label

1 (Etanercept only)

2 (Etanercept + nb-UVB)

Arm Description

Subjects will only be treated with etanercept. This is given at the standard FDA approved dosage of 50 mg twice weekly x 3 months then 50 mg once weekly x 3 months. No UVB will be given. Sham UVB will not be used because the subjects are not blinded because they often know they are receiving sham UVB due to differences in light intensity and heat.

Subjects will receive etanercept. This is given at the standard FDA approved dosage of 50 mg twice weekly x 3 months then 50 mg once weekly x 3 months. In addition, for months 3-6, subjects will receive Narrow Band Ultraviolet B phototherapy three times a week for 12 weeks in addition to the etanercept maintenance dose. The safety and efficacy of the combination therapy will be evaluated by the registered phototherapy nurses at each phototherapy visit and by the study investigator at monthly visits. NB-UVB therapy will be adjusted according to the clinical judgment of the University of California San Francisco Psoriasis Treatment Center phototherapy staff.

Outcomes

Primary Outcome Measures

Psoriasis Area Severity Index. This Scale Ranges From 0-72, 0 Being no Disease, and 72 Being Most Severe. The Number of Patients Who Achieved 75% Improvement of Their Psoriasis at the End of 24 Weeks Are Indicated in the Outcomes Data Below.
Psoriasis area severity index was used to determine the number of patients in each treatment arm who had 75% improvement in their psoriasis. This scale uses the characteristics of the psoriasis, such as body surface area, redness, thickness, and scaling, to determine the severity score.

Secondary Outcome Measures

Full Information

First Posted
May 13, 2008
Last Updated
March 26, 2013
Sponsor
University of California, San Francisco
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1. Study Identification

Unique Protocol Identification Number
NCT00800982
Brief Title
Open Label Study Etanercept's Maintenance Dose in Obese Patients With Moderate to Severe Plaque Type Psoriasis
Official Title
A Single-Center, Open-Label, Pilot Study to Evaluate the Efficacy and Tolerability of Narrow Band UVB Phototherapy in Enhancing Etanercept's Maintenance Dose in Obese Patients With Moderate to Severe Plaque-Type Psoriasis
Study Type
Interventional

2. Study Status

Record Verification Date
March 2013
Overall Recruitment Status
Completed
Study Start Date
October 2008 (undefined)
Primary Completion Date
January 2012 (Actual)
Study Completion Date
March 2012 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University of California, San Francisco

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This is a single-center, open-label, pilot study. A total of 30 subjects (15 in each study arm) will be enrolled in this 6 month study to evaluate whether the addition of narrow band UVB (NB-UVB) phototherapy can enhance the efficacy of etanercept's maintenance dose, 50 mg once a week, in obese psoriasis patients.
Detailed Description
In Phase I, all subjects will receive etanercept's induction dose, 50 mg twice a week, for a total of 12 weeks. In Phase II, all subjects will receive etanercept's maintenance dose, 50 mg once a week, during Weeks 12-24. Those subjects randomized to the treatment arm will receive NB-UVB phototherapy 3 times a week during Phase II. In order to ensure homogeneity between the NB-UVB arm and non-NB-UVB arm, subjects will be randomized according to their Body Mass Index (BMI). The Psoriasis Area Severity Index (PASI) score and Physician Global Assessment (PGA) will be calculated at each visit to determine the effectiveness of the etanercept and NB-UVB treatment during both phases of the study. The hypothesis is that the combination of NB-UVB phototherapy three times a week and etanercept maintenance dose (50 mg once a week) will enhance the efficacy of the maintenance dose alone in obese patients (BMI >30) with moderate to severe psoriasis.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Psoriasis
Keywords
Obese patients (BMI>30), Patients with moderate to severe psoriasis

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
30 (Actual)

8. Arms, Groups, and Interventions

Arm Title
1 (Etanercept only)
Arm Type
Active Comparator
Arm Description
Subjects will only be treated with etanercept. This is given at the standard FDA approved dosage of 50 mg twice weekly x 3 months then 50 mg once weekly x 3 months. No UVB will be given. Sham UVB will not be used because the subjects are not blinded because they often know they are receiving sham UVB due to differences in light intensity and heat.
Arm Title
2 (Etanercept + nb-UVB)
Arm Type
Experimental
Arm Description
Subjects will receive etanercept. This is given at the standard FDA approved dosage of 50 mg twice weekly x 3 months then 50 mg once weekly x 3 months. In addition, for months 3-6, subjects will receive Narrow Band Ultraviolet B phototherapy three times a week for 12 weeks in addition to the etanercept maintenance dose. The safety and efficacy of the combination therapy will be evaluated by the registered phototherapy nurses at each phototherapy visit and by the study investigator at monthly visits. NB-UVB therapy will be adjusted according to the clinical judgment of the University of California San Francisco Psoriasis Treatment Center phototherapy staff.
Intervention Type
Procedure
Intervention Name(s)
Narrow band (310-312 nm) ultraviolet light B phototherapy
Other Intervention Name(s)
nb-UVB, nbUVB, narrowband UVB
Intervention Description
Narrow band (310-312 nm) ultraviolet light B phototherapy 3 times a week during Weeks 12-24. NB-UVB therapy will be adjusted according to the clinical judgment of the University of California San Francisco Psoriasis Treatment Center phototherapy staff
Intervention Type
Drug
Intervention Name(s)
etanercept
Other Intervention Name(s)
Enbrel
Intervention Description
Etanercept is given at the standard FDA approved dosage of 50 mg twice weekly x 3 months then 50 mg once weekly x 3 months.
Primary Outcome Measure Information:
Title
Psoriasis Area Severity Index. This Scale Ranges From 0-72, 0 Being no Disease, and 72 Being Most Severe. The Number of Patients Who Achieved 75% Improvement of Their Psoriasis at the End of 24 Weeks Are Indicated in the Outcomes Data Below.
Description
Psoriasis area severity index was used to determine the number of patients in each treatment arm who had 75% improvement in their psoriasis. This scale uses the characteristics of the psoriasis, such as body surface area, redness, thickness, and scaling, to determine the severity score.
Time Frame
Weeks 12-24

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Nonimmunocompromised males or females 18 years of age or older. Must be able to read, understand, and speak basic English. Body Surface Area (BSA) involvement of greater than 10%. Psoriasis Area and Severity Index greater than 10. Obese defined as having a Body Mass Index greater than 30. Eligible for systemic therapy, particularly etanercept, and Narrow Band Ultraviolet B in the opinion of the investigator. Sign and date the appropriate written informed consent and Health Insurance Portability and Accountability Act authorization Negative urine pregnancy test within 7 days before the first dose of etanercept in all women (except those surgically sterile or at least 5 years postmenopausal). No evidence of active or latent tuberculosis based on a negative Purified Protein Derivative skin test. Patients with documentation of adequately treated tuberculosis may be enrolled. Sexually active subjects of childbearing potential must agree to use medically acceptable form of contraception during screening and throughout the study. Willing and able to self-administer subcutaneous injections or to have a qualified person available to administer subcutaneous injections Agrees to comply with protocol requirements, attend all regularly study visits and is considered to be a good study subject Meets concomitant medication washout requirements Exclusion Criteria: Erythrodermic, pustular, or guttate psoriasis Evidence of skin conditions other than psoriasis that would interfere with study-related evaluations of psoriasis. Known sensitivity to any component of the study medications. Evidence of active infections such as fevers, chills, sweats, or history of untreated Lyme disease and active severe infections within 4 weeks before screening visit, or between the screening and Week 0 visits. Evidence of latent or active hepatitis B infection as indicated by positive HBsAg test during the screening visit. Personal or first degree family history of neurologic disease. Poorly controlled medical condition including, but not limited to, unstable cardiovascular disease, poorly controlled diabetes, recent stroke, history of recurrent infections, or any other condition for which, in the opinion of the investigator, participation in the study would place the subject at risk. History of any Tumor Necrosis Factor-α inhibitor use including etanercept, infliximab, and adalimumab within 4 weeks of starting study drug. History of non-cutaneous malignancy within the past 5 years. History of drug or alcohol abuse. Substance abuse must clearly be documented so those patients with a remote and minor history of drug/alcohol use will still have an opportunity to participate in the study. Female subjects who are not postmenopausal for at least 1 year, surgically sterile, or willing to practice effective contraception during the study. Nursing mothers, pregnant women and women planning to become pregnant while on study are to be excluded. Plans to receive any live vaccines during the study. Evidence of photosensitivity disorder (i.e. polymorphous light eruption). Known photosensitivity or known sensitivity to any of the excipients or products to be administered during dosing. Current enrollment in another clinical study and treatment with another experimental drug or approved therapy for experimental use within 30 days prior to Week 0 Cannot commit to all the assessments required by the protocol Any disorder that compromises the ability of the subject to give written informed consent and/or to comply with study procedures Considered by the investigator, for any reason, to be an unsuitable candidate for study participation. Cannot or do not wish to comply with the protocol washout requirements (please see section below entitled "Washout Period Prior to Week 0).
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
John Koo, MD
Organizational Affiliation
UCSF Psoriasis and Skin Treatment Center, Department of Dermatology, University of California, San Francisco
Official's Role
Principal Investigator
Facility Information:
Facility Name
UCSF Psoriasis and Skin Treatment Center
City
San Francisco
State/Province
California
ZIP/Postal Code
94118
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
22702846
Citation
Park KK, Wu JJ, Koo J. A randomized, 'head-to-head' pilot study comparing the effects of etanercept monotherapy vs. etanercept and narrowband ultraviolet B (NB-UVB) phototherapy in obese psoriasis patients. J Eur Acad Dermatol Venereol. 2013 Jul;27(7):899-906. doi: 10.1111/j.1468-3083.2012.04611.x. Epub 2012 Jun 15.
Results Reference
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Open Label Study Etanercept's Maintenance Dose in Obese Patients With Moderate to Severe Plaque Type Psoriasis

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