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NCT03123471: STYLE

A Study of the Efficacy and Safety of Apremilast (CC-10004) in Subjects With Moderate to Severe Plaque Psoriasis of the Scalp

Completed Phase 3 Results posted Last updated 13 May 2020
What this trial tests

Phase 3 trial testing Apremilast in Psoriasis in 303 participants. Completed in 9 January 2019.

Timeline
16 May 2017
Primary endpoint
13 August 2018
9 January 2019

Quick facts

Lead sponsorAmgen
PhasePhase 3
StatusCompleted
Study typeINTERVENTIONAL
Allocationrandomized
Designparallel
Maskingquadruple
Primary purposetreatment
Enrollment303
Start date16 May 2017
Primary completion13 August 2018
Estimated completion9 January 2019
Sites45 locations across Canada, United States

Drugs / interventions tested

Conditions studied

Sponsor

Amgen — full company profile →

Who can join

18 and older, any sex, with Psoriasis. Patients with the condition only — healthy volunteers not accepted.

Results — posted to ClinicalTrials.gov

Per-arm endpoint measurements with 95% confidence intervals where reported. Source: trial results section.

Percentage of Participants With Scalp Physician Global Assessment (ScPGA) Score of Clear (0) or Almost Clear (1) With at Least a 2-Point Reduction From Baseline Primary · Baseline to Week 16

The ScPGA is a measurement of overall scalp involvement by the investigator at the time of evaluation. The ScPGA is a 5-point scale ranging from 0 (clear) to 4 (severe), incorporating an assessment of the severity of the 3 primary signs of the disease: erythema, scaling, and plaque elevation. When making the assessment of overall scalp severity, the investigator factored in areas that had already been cleared (ie, had scores of 0), not limited to the evaluation of remaining lesions for severity; consequently, the severity of each sign was averaged across all areas of involvement, including cle

GroupValue95% CI
Placebo/Apremilast13.76.6 – 20.8
Apremilast43.336.2 – 50.5
Percentage of Participants With ≥ 4-Point Reduction (Improvement) From Baseline in the Whole Body Itch Numeric Rating Score at Week 16 Secondary · Baseline to Week 16

The Whole Body Itch NRS scale is an 11-point scale to assess whole body itch. The scale ranges from 0-10, where "0" represents no itch, and "10" represents the worst imaginable itch, and a 4-point change from baseline was shown to be optimal for demonstrating a level of clinically meaningful improvement in itch severity. NRS response was defined as a ≥ 4-point reduction (improvement) from baseline.

GroupValue95% CI
Placebo/Apremilast22.513.7 – 31.3
Apremilast45.538.1 – 52.9
Percentage of Participants With ≥ 4-Point Reduction (Improvement) From Baseline in the Scalp Itch Numeric Rating Score (NRS) at Week 16 Secondary · Baseline to Week 16

The scalp itch NRS is a 11-point scale to assess scalp itch. The scale ranges from 0-10, where "0" represents no itch, and "10" represents the worst imaginable itch.

GroupValue95% CI
Placebo/Apremilast21.111.8 – 30.3
Apremilast47.139.5 – 54.7
Percentage of Participants With ≥ 4-Point Reduction (Improvement) From Baseline in the Whole Body Itch NRS Score by Visit in the Placebo-Controlled Phase Secondary · Baseline to Weeks 2, 4, 6, 8 and 12

The Whole Body Itch NRS scale is a 11-point scale to assess whole body itch. The scale ranges from 0-10, where "0" represents no itch, and "10" represents the worst imaginable itch, and a 4-point change from baseline was shown to be optimal for demonstrating a level of clinically meaningful improvement in itch severity.

Week 2
GroupValue95% CI
Placebo/Apremilast3.5-0.4 – 7.4
Apremilast20.514.6 – 26.4
Week 4
GroupValue95% CI
Placebo/Apremilast10.13.9 – 16.3
Apremilast32.325.4 – 39.1
Week 8
GroupValue95% CI
Placebo/Apremilast19.711.4 – 27.9
Apremilast39.832.6 – 47.1
Week 12
GroupValue95% CI
Placebo/Apremilast26.317.0 – 35.7
Apremilast47.039.6 – 54.3
Percentage of Participants With ≥ 4-Point Reduction (Improvement) From Baseline in the Scalp Itch NRS Score by Visit in the Placebo-Controlled Phase Secondary · Baseline to Weeks 2, 4, 8 and 12

The scalp itch NRS is a 11-point scale to assess scalp itch. The scale ranges from 0-10, where "0" represents no itch, and "10" represents the worst imaginable itch.

Week 2
GroupValue95% CI
Placebo/Apremilast11.54.8 – 18.2
Apremilast26.119.5 – 32.7
Week 4
GroupValue95% CI
Placebo/Apremilast16.58.7 – 24.4
Apremilast37.830.5 – 45.0
Week 8
GroupValue95% CI
Placebo/Apremilast23.714.6 – 32.9
Apremilast45.638.1 – 53.2
Week 12
GroupValue95% CI
Placebo/Apremilast19.610.6 – 28.5
Apremilast46.538.9 – 54.1
Change From Baseline in Dermatological Life Quality Index (DLQI) Total Score at Week 16 Secondary · Baseline to Week 16

DLQI is questionnaire for use in a dermatology clinical setting to assess limitations related to the impact of skin disease. The instrument contains ten items dealing with the participant's skin. With the exception of Item Number 7, the participant responds on a four-point scale, ranging from "Very Much" (score 3) to "Not at All" or "Not relevant" (score 0). Item Number 7 is a multi-part item, the first part of which ascertains whether the participant's skin prevented them from working or studying (Yes or No, scores 3 or 0 respectively), and if "No," then the subject is asked how much of a pro

GroupValue95% CI
Placebo/Apremilast-3.8± 0.56
Apremilast-6.7± 0.41
Number of Participants With Treatment Emergent Adverse Events (TEAE) During the Placebo-Controlled Phase Secondary · Week 0 to Week 16; mean duration of exposure was 14.5 weeks and 14.6 weeks for participants randomized to placebo and apremilast respectively.

A TEAE is an AE with a start date on or after the date of the first dose of study drug and no later than 28 days after the last dose of study drug. A serious AE (SAE) is any untoward AE that is fatal, life-threatening, results in persistent or significant disability or incapacity, requires or prolongs existing in-patient hospitalization, is a congenital anomaly/birth defect, or is a condition that may jeopardize or may require intervention to prevent one of the outcomes above. The severity of AEs was assessed based on the following scale: Mild = asymptomatic or mild symptoms, clinical or diagn

Any TEAE
GroupValue95% CI
Apremilast135
Placebo/Apremilast52
Any Drug-related TEAE
GroupValue95% CI
Apremilast99
Placebo/Apremilast22
Any Severe TEAE
GroupValue95% CI
Apremilast5
Placebo/Apremilast2
Any Serious TEAE
GroupValue95% CI
Apremilast2
Placebo/Apremilast1
Any TEAE Leading to Drug Interruption
GroupValue95% CI
Apremilast9
Placebo/Apremilast4
Any TEAE Leading to Drug Withdrawal
GroupValue95% CI
Apremilast11
Placebo/Apremilast3
Number of Participants With Treatment Emergent Adverse Events During the Apremilast-Extension Phase Secondary · Weeks 16 to Week 32; the mean treatment duration was 14.6 weeks and 15.3 weeks in the APR 30/APR 30 BID and placebo/APR 30 BID arms, respectively

A TEAE is an AE with a start date on or after the date of the first dose of study drug and no later than 28 days after the last dose of study drug. A serious AE (SAE) is any untoward AE that is fatal, life-threatening, results in persistent or significant disability or incapacity, requires or prolongs existing in-patient hospitalization, is a congenital anomaly/birth defect, or is a condition that may jeopardize or may require intervention to prevent one of the outcomes above. The severity of AEs was assessed based on the following scale: Mild = asymptomatic or mild symptoms, clinical or diagn

Any TEAE
GroupValue95% CI
Placebo/Apremilast35
Apremilast66
Any Drug-related TEAE
GroupValue95% CI
Placebo/Apremilast17
Apremilast17
Any Severe TEAE
GroupValue95% CI
Placebo/Apremilast2
Apremilast4
Any Serious TEAE
GroupValue95% CI
Placebo/Apremilast1
Apremilast5
Any TEAE Leading to Drug Interruption
GroupValue95% CI
Placebo/Apremilast2
Apremilast4
Any TEAE Leading to Drug Withdrawal
GroupValue95% CI
Placebo/Apremilast1
Apremilast4
Deaths
GroupValue95% CI
Placebo/Apremilast0
Apremilast0
Number of Participants With Treatment Emergent Adverse Events During the Apremilast-Exposure Period Secondary · Week 0 to 32;

The apremilast-exposure period started on the date of the first dose of apremilast (Week 0 for participants originally randomized to apremilast or Week 16 for participants originally randomized to placebo) to the last dose of apremilast. A TEAE is an AE with a start date on or after the date of the first dose of study drug and no later than 28 days after the last dose of study drug. A serious AE (SAE) is any untoward AE that is fatal, life-threatening, results in persistent or significant disability or incapacity, requires or prolongs existing in-patient hospitalization, is a congenital anomal

Any TEAE
GroupValue95% CI
Placebo/Apremilast35
Apremilast144
Any Drug-related TEAE
GroupValue95% CI
Placebo/Apremilast17
Apremilast103
Any Severe TEAE
GroupValue95% CI
Placebo/Apremilast2
Apremilast8
Any Serious TEAE
GroupValue95% CI
Placebo/Apremilast1
Apremilast6
Any Serious TEAE Drug Related TEAE
GroupValue95% CI
Placebo/Apremilast0
Apremilast3
Any TEAE Leading to Drug Interruption
GroupValue95% CI
Placebo/Apremilast2
Apremilast13
Any TEAE Leading to Drug Withdrawal
GroupValue95% CI
Placebo/Apremilast1
Apremilast15
Deaths
GroupValue95% CI
Placebo/Apremilast0
Apremilast0

Adverse events — posted to ClinicalTrials.gov

Time frame: From the date of randomization to 28 days after the last dose of study drug. AEs are reported for the placebo-controlled phase from Week 0 to Week 16 and for the apremilast extension phase from Week 16 to Week 32;. Reporting threshold: 5%. Adverse-event reports describe events observed during the trial — not all are caused by the drug.

Placebo (Weeks 0-16)
Serious: 1/102 (1%)
Deaths: 0/102
Apremilast 30 mg (Weeks 0-16)
Serious: 2/200 (1%)
Deaths: 0/200
Placebo/Apremilast (APR Extension Phase Weeks 16-32)
Serious: 1/84 (1%)
Deaths: 0/84
Apremilast /Apremilast (APR Exposure Period, Weeks 0-32)
Serious: 6/200 (3%)
Deaths: 0/200
Apremilast Total (APR Exposure Period, Weeks 0-32)
Serious: 7/284 (2%)
Deaths: 0/284

Serious adverse events (11 terms)

ReactionSystemPlacebo (Weeks 0-16)Apremilast 30 mg (Weeks 0-…Placebo/Apremilast (APR Ex…Apremilast /Apremilast (AP…Apremilast Total (APR Expo…
Acute myocardial infarctionCardiac disorders
Coronary artery diseaseCardiac disorders
Non-cardiac chest painGeneral disorders
BacteraemiaInfections and infestations
CellulitisInfections and infestations
Herpes zosterInfections and infestations
Postoperative wound infectionInfections and infestations
Hip fractureInjury, poisoning and procedural complications
Suicidal ideationPsychiatric disorders
Chronic kidney diseaseRenal and urinary disorders
AsthmaRespiratory, thoracic and mediastinal disorders
Other adverse events (6 terms — click to expand)

ReactionSystemPlacebo (Weeks 0-16)Apremilast 30 mg (Weeks 0-…Placebo/Apremilast (APR Ex…Apremilast /Apremilast (AP…Apremilast Total (APR Expo…
DiarrhoeaGastrointestinal disorders
NauseaGastrointestinal disorders
HeadacheNervous system disorders
VomitingGastrointestinal disorders
FatigueGeneral disorders
InfluenzaInfections and infestations

Most-reported serious reactions: Acute myocardial infarction, Coronary artery disease, Non-cardiac chest pain, Bacteraemia, Cellulitis, Herpes zoster, Postoperative wound infection, Hip fracture.

Data from ClinicalTrials.gov NCT03123471 adverse events section.

Sponsor's own description

This is a Phase 3, multicenter, randomized, placebo-controlled, double-blind study of the efficacy and safety of apremilast (CC-10004) in subjects with moderate to severe plaque psoriasis of the scalp. Approximately 300 subjects with moderate to severe plaque psoriasis of the scalp will be randomized 2:1 to receive either apremilast 30 mg twice daily (BID) or placebo for the first 16 weeks.

Publications & conference data

8 peer-reviewed publications reference this trial (live from Europe PMC):

  1. Systemic pharmacological treatments for chronic plaque psoriasis: a network meta-analysis.
    Sbidian E, Chaimani A, Garcia-Doval I, Doney L, et al · · 2022 · cited 84× · PMID 35603936 · DOI 10.1002/14651858.cd011535.pub5
  2. Systemic pharmacological treatments for chronic plaque psoriasis: a network meta-analysis.
    Sbidian E, Chaimani A, Guelimi R, Garcia-Doval I, et al · · 2023 · cited 67× · PMID 37436070 · DOI 10.1002/14651858.cd011535.pub6
  3. Systemic pharmacological treatments for chronic plaque psoriasis: a network meta-analysis.
    Sbidian E, Chaimani A, Garcia-Doval I, Doney L, et al · · 2021 · cited 54× · PMID 33871055 · DOI 10.1002/14651858.cd011535.pub4
  4. Efficacy and safety of apremilast in patients with moderate to severe plaque psoriasis of the scalp: Results of a phase 3b, multicenter, randomized, placebo-controlled, double-blind study.
    Van Voorhees AS, Stein Gold L, Lebwohl M, Strober B, et al · · 2020 · cited 48× · PMID 32032692 · DOI 10.1016/j.jaad.2020.01.072
  5. Apremilast Long-Term Safety Up to 5 Years from 15 Pooled Randomized, Placebo-Controlled Studies of Psoriasis, Psoriatic Arthritis, and Behçet's Syndrome.
    Mease PJ, Hatemi G, Paris M, Cheng S, et al · · 2023 · cited 31× · PMID 37316690 · DOI 10.1007/s40257-023-00783-7
  6. Off-label studies on apremilast in dermatology: a review.
    Maloney NJ, Zhao J, Tegtmeyer K, Lee EY, et al · · 2020 · cited 26× · PMID 30935262 · DOI 10.1080/09546634.2019.1589641
  7. Phosphodiesterase-4 Inhibition in the Management of Psoriasis.
    Crowley EL, Gooderham MJ. · · 2023 · cited 24× · PMID 38258034 · DOI 10.3390/pharmaceutics16010023
  8. Qualitative analysis and reproducibility assessment of the Scalp Itch Numeric Rating Scale among patients with moderate to severe plaque psoriasis of the scalp.
    Wang Y, Coyne K, Sofen H, Santanello N, et al · · 2019 · cited 10× · PMID 30747550 · DOI 10.1080/09546634.2019.1577546

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