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Development of Predictive Psoriasis Response Endotypes Using Single Cell Transcriptomics

Primary Purpose

Psoriasis

Status
Recruiting
Phase
Phase 4
Locations
United States
Study Type
Interventional
Intervention
Ustekinumab
Sponsored by
University Hospitals Cleveland Medical Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Psoriasis focused on measuring ustekinumab, guselkumab, risankizumab, psoriasis

Eligibility Criteria

18 Years - 89 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Diagnosed with plaque-type psoriasis defined by either:

    • A board-certified dermatologist, OR
    • Dermatology Nurse Practitioner, OR
    • Skin punch biopsy
  • Insurance that includes an anti-p40 biologic (ustekinumab/.Stelara) and at least one anti-p19 biologic (guselkumab/Tremfya or risankizumab/Skyrizi)
  • Must be naive to ustekinumab, guselkumab, and risankizumab.
  • Involvement of body surface area (BSA) of at least 10% at screening and baseline visit.
  • Able to give informed consent under IRB approval procedures

Exclusion Criteria:

  • Pregnant, breastfeeding, or planning to get pregnant 8 weeks before, during, and 8 weeks after the study.
  • Inability to provide informed consent
  • Inability to secure ustekinumab and either gusekumab or risankizumab for use while on trial
  • Use of tanning booths for at least 4 weeks prior to baseline visit
  • Current or recent use of topical steroid, tar, phototherapy, Vitamin D, or retinoid therapy to target lesions for at least 2 weeks prior to baseline visit and for duration of trial
  • Current or recent use of systemic or biologic therapy for at least 8 weeks prior to baseline visit
  • Patients with psoriatic arthritis or other rheumatologic diseases (e.g., Crohn's disease).

Sites / Locations

  • University Hospitals Cleveland Medical CenterRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Treatment

Arm Description

Patients will be treated with ustekinumab (90mg at week 0 and week 4 by subcutaneous injection) for 8 weeks followed by treatment with guselkumab (100mg at week 0 and week 4 by subcutaneous injection) or risankizumab (150mg at week 0 and week 4 by subcutaneous injection)

Outcomes

Primary Outcome Measures

Identification of a unique differentially expressed gene set in patients with psoriasis that may predict disease response following antagonism to IL-12 and/or IL-23.
Single-cell RNA transcriptomics from whole blood isolate from identify unique differentially expressed gene sets in patients following antagomism to IL-12 and/or IL-23.

Secondary Outcome Measures

Identification of a cell subset that is a modified and predictive of disease response following antagonism to IL-12 and/or IL-23
Single-cell RNA sequencing or flow cytometry to identify a cell subset that is a modified and predictive of disease response following antagonism to IL-12 and/or IL-23.

Full Information

First Posted
February 25, 2022
Last Updated
January 26, 2023
Sponsor
University Hospitals Cleveland Medical Center
Collaborators
LEO Foundation, Case Western Reserve University
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1. Study Identification

Unique Protocol Identification Number
NCT05270733
Brief Title
Development of Predictive Psoriasis Response Endotypes Using Single Cell Transcriptomics
Official Title
Development of Predictive Psoriasis Response Endotypes Using Single Cell Transcriptomics in Ustekinumab Responders Versus Non-responders
Study Type
Interventional

2. Study Status

Record Verification Date
January 2023
Overall Recruitment Status
Recruiting
Study Start Date
November 10, 2022 (Actual)
Primary Completion Date
December 31, 2024 (Anticipated)
Study Completion Date
December 31, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University Hospitals Cleveland Medical Center
Collaborators
LEO Foundation, Case Western Reserve University

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No

5. Study Description

Brief Summary
The investigators propose to improve the possibility of reaching skin resolution by identifying certain markers or gene patterns that may predict patient response to certain psoriasis drugs ahead of time, thus eliminating or reducing the trial-and-error approach often employed. The ability to rule out (or in) specific therapeutics based on predictive efficacy would lead to a more personalized approach for psoriasis treatment. To do this, the investigators will be asking participants to try two different already on the market FDA-approved psoriasis drugs for 8 weeks at a time. The investigators will be monitoring participants skin for improvements as well as taking blood and skin samples at least three times. Investigators may also ask to take stool samples and/or skin swabs.
Detailed Description
Psoriasis is a chronic systemic skin disease in which pro-inflammatory molecules contribute to the development of scaled inflamed skin and other disease-associated comorbidities such as increased risk of depression, heart attack, stroke, and metabolic syndrome. Some lesion-derived cytokines/chemokines are released into systemic circulation and increase lesional severity. Given their importance in the pathogenesis of psoriasis, the interleukins 12 (IL-12) and 23 (IL-23) are significant targets of biologic therapies. Importantly, psoriasis patients exhibit variable responses to treatments targeting interleukins; one size does not fit all for these therapeutics. Our preliminary data demonstrates individual skin improvement (Responders) as well as lack of skin improvement (Non-Responders) in patients treated with monoclonal antibody therapy specifically targeting the shared (p40) subunit common to IL-12 and IL-23 (ustekinumab/Stelara). Interestingly, some Non-Responders to ustekinumab respond well to inhibition of the IL-23 pathway via the unique p19 subunit. We hypothesize that the pattern of differentially expressed genes (DEGs) among Responders and Non-Responders following anti-IL-12 and anti-IL-23 therapy may enable us to predict the likelihood of patient response to p40 antagonism as well as antagonism of the p19 subunit of IL-23. Single cell transcriptome analysis will be used to generate gene expression patterns that identify variable patient response patterns (endotypes).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Psoriasis
Keywords
ustekinumab, guselkumab, risankizumab, psoriasis

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
56 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Treatment
Arm Type
Experimental
Arm Description
Patients will be treated with ustekinumab (90mg at week 0 and week 4 by subcutaneous injection) for 8 weeks followed by treatment with guselkumab (100mg at week 0 and week 4 by subcutaneous injection) or risankizumab (150mg at week 0 and week 4 by subcutaneous injection)
Intervention Type
Drug
Intervention Name(s)
Ustekinumab
Other Intervention Name(s)
Guselkumab, Risankizumab
Intervention Description
Subjects will receive ustekinumab for 8 weeks followed by guselkumab or risankizumab for 8 weeks.
Primary Outcome Measure Information:
Title
Identification of a unique differentially expressed gene set in patients with psoriasis that may predict disease response following antagonism to IL-12 and/or IL-23.
Description
Single-cell RNA transcriptomics from whole blood isolate from identify unique differentially expressed gene sets in patients following antagomism to IL-12 and/or IL-23.
Time Frame
24 weeks
Secondary Outcome Measure Information:
Title
Identification of a cell subset that is a modified and predictive of disease response following antagonism to IL-12 and/or IL-23
Description
Single-cell RNA sequencing or flow cytometry to identify a cell subset that is a modified and predictive of disease response following antagonism to IL-12 and/or IL-23.
Time Frame
24 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
89 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Diagnosed with plaque-type psoriasis defined by either: A board-certified dermatologist, OR Dermatology Nurse Practitioner, OR Skin punch biopsy Insurance that includes an anti-p40 biologic (ustekinumab/.Stelara) and at least one anti-p19 biologic (guselkumab/Tremfya or risankizumab/Skyrizi) Must be naive to ustekinumab, guselkumab, and risankizumab. Involvement of body surface area (BSA) of at least 10% at screening and baseline visit. Able to give informed consent under IRB approval procedures Exclusion Criteria: Pregnant, breastfeeding, or planning to get pregnant 8 weeks before, during, and 8 weeks after the study. Inability to provide informed consent Inability to secure ustekinumab and either gusekumab or risankizumab for use while on trial Use of tanning booths for at least 4 weeks prior to baseline visit Current or recent use of topical steroid, tar, phototherapy, Vitamin D, or retinoid therapy to target lesions for at least 2 weeks prior to baseline visit and for duration of trial Current or recent use of systemic or biologic therapy for at least 8 weeks prior to baseline visit Patients with psoriatic arthritis or other rheumatologic diseases (e.g., Crohn's disease).
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Amy Johnson, MD
Phone
216-286-7369
Email
Amy.Johnson@UHhospitals.org
First Name & Middle Initial & Last Name or Official Title & Degree
Amanda Davies, MBA
Phone
216-844-7834
Email
Amanda.Davies@UHhospitals.org
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Kevin Cooper, MD
Organizational Affiliation
University Hospitals Cleveland Medical Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
University Hospitals Cleveland Medical Center
City
Cleveland
State/Province
Ohio
ZIP/Postal Code
44106
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Kevin Cooper, MD
Phone
216-844-7834
First Name & Middle Initial & Last Name & Degree
Amy Johnson, MD
Phone
216-286-7369
Email
Amy.Johnson@UHhospitals.org
First Name & Middle Initial & Last Name & Degree
Neil Korman, MD
First Name & Middle Initial & Last Name & Degree
Amy Johnson, MD

12. IPD Sharing Statement

Plan to Share IPD
No

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Development of Predictive Psoriasis Response Endotypes Using Single Cell Transcriptomics

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