Efficacy and safety of ustekinumab, a human interleukin-12/23 monoclonal antibody, in patients with psoriasis: 76-week results from a randomised, double-blind, placebo-controlled trial (PHOENIX 1)

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• 作者：Craig L Leonardi ; Alexa B Kimball ; Kim A Papp ; Newman Yeilding ; Cynthia Guzzo ; Yuhua Wang ; Shu Li ; Lisa T Dooley ; Kenneth B Gordon ; for the PHOENIX 1 study investigators
• 关键词：Trypanosoma brucei ; MicroRNA ; Host– ; parasite interaction ; Trypanosomiasis ; Antigenic variation ; Variant surface glycoprotein (VSG) ; miRNA cluster
• 刊名：The Lancet
• 出版年：2008
• 期刊代码：182_01406736
• 类别：med
• 出版时间：17 May 2008-23 May 2008
• 卷：371
• 期：9625
• 页码：1665-1674
• 文件大小：221 K

摘要

In this multicentre, phase III, double-blind, placebo-controlled study, 1230 patients with moderate-to-severe psoriasis (defined by a psoriasis area and severity index [PASI] score ≥12, and at least 10%total body surface area involvement) were randomly assigned to receive ustekinumab 45 mg (n=409) or 90 mg (n=411) at weeks 0 and 4, then every 12 weeks, or placebo (n=410). Partial responders (ie, patients achieving ≥50%but <75%improvement from baseline in PASI) were re-randomised at week 28 to continue dosing every 12 weeks or escalate to dosing every 8 weeks. Both randomisations were done with a minimisation method via a centralised interactive voice response. The primary endpoint was the proportion of patients achieving at least 75%improvement in PASI (PASI 75) at week 12. Analyses were by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00307437.

Findings

All randomised patients were included in the efficacy analysis. 273 (66·7%) patients receiving ustekinumab 45 mg, 311 (75·7%) receiving ustekinumab 90 mg, and 15 (3·7%) receiving placebo achieved the primary endpoint (difference in response rate 63·1%, 95%CI 58·2–68·0, p<0·0001 for the 45 mg group vs placebo and 72·0%, 67·5–76·5, p<0·0001 for the 90 mg group vs placebo). More partial responders at week 28 who received ustekinumab 90 mg every 8 weeks achieved PASI 75 at week 52 than did those who continued to receive the same dose every 12 weeks (22 [68·8%] vs 11 [33·3%]; difference in response rate 35·4%, 95%CI 12·7–58·1, p=0·004). There was no such response to changes in dosing intensity in partial responders treated with ustekinumab 45 mg. During the placebo-controlled phase, 217 (53·1%) patients in the 45 mg group, 197 (47·9%) in the 90 mg group, and 204 (49·8%) in the placebo group experienced adverse events; serious adverse events were seen in eight (2·0%) patients in the 45 mg group, five (1·2%) in the 90 mg group, and eight (2·0%) in the placebo group.

Interpretation

Although treatment with ustekinumab every 12 weeks is effective for most patients with moderate-to-severe psoriasis, intensification of dosing to once every 8 weeks with ustekinumab 90 mg might be necessary to elicit a full response in patients who only partially respond to the initial regimen.

Funding

Centocor Inc.