Comparative Effectiveness of Psoriasis Treatments on Systemic Inflammation

University Hospitals (UH)

Status: Completed

Conditions: Psoriasis; Inflammation

Treatments: Drug: Ustekinumab; Other: Narrowband UVB; Other: UVB Excimer Laser; Drug: Acitretin; Drug: Etanercept; Drug: Adalimumab; Drug: Methotrexate

Study type: Observational

Funder types: Other

Identifiers

NCT02330380

04-13-21

Details and patient eligibility

About

This is a prospective longitudinal observational pilot study of psoriasis patients on continuous standard-of-care systemic therapeutics to determine the level of change in established (plasma/serum) and investigative (cellular) biomarkers that are associated with increased risk of CVD events.

The final endpoint of the proposed study will be a ranking of the examined biomarkers based upon an integrated assessment of biomarker behavior over time.

Secondary outcomes will assess changes in coronary artery calcification scoring, PET-MRI, skin biopsies, and clinical improvement.

Enrollment: 26 patients

Sex: All

Ages: 18 to 65 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Subjects ages 18-65 years old

• Diagnosis of moderate-to-severe plaque psoriasis

• Plaque affects ≥ 10% of subject's body surface area (BSA)

• Subjects prescribed one of the following standard-of-care treatments for their psoriasis: Ustekinumab, Methotrexate, Etanercept, Adalimumab, Narrow Band UVB (311nm), Excimer Laser Treatment (308nm), or Acitretin

• Subjects willing to complete a Washout Period prior to Visit 1 (only for subjects currently on a psoriasis treatment):

  • Discontinue systemic therapies for at least 4 weeks
  • Discontinue topical therapies for at least 2 weeks
  • Discontinue phototherapies for at least 2 weeks

Exclusion criteria

• Subjects who are currently on a psoriasis treatment and unwilling to go through the washout-period

• Subjects with a critical illness or who are immunocompromised

• Weight is 400lbs or greater

• Subjects who are currently pregnant or breastfeeding

• Subjects who have metal implants

• Subjects who have a pacemaker, stent, or artificial heart valve

• History of clinically significant hematological, renal or liver disease

• Patients with known co-morbidities that raise biomarkers such as:

  • History of myocardial infarction (MI)
  • History of cerebrovascular accident (CVA)
  • Significant atherosclerosis (defined as the presence of any carotid plaque; or carotid intimal media thickness (cIMT) >75th percentile for age; or the presence of coronary artery calcium score>100)
  • Poorly controlled diabetes (elevated HbA1c > 8.5)

Trial design

26 participants in 7 patient groups

Methotrexate

Description:

Methotrexate will be dosed weekly. Methotrexate is given as a single, weekly dose and is will be started at 15mg after a first week test dose of 2.5 mg to minimize side effects and achieve efficacy. Weekly dosages will be 15mg.

Treatment:

Drug: Methotrexate

Ustekinumab

Description:

Ustekinumab is given as a subcutaneous injection of 45mg if the patient is \<100Kg or 90mg if the patient is \>100Kg at weeks 0, 4, 16, and every 12 weeks thereafter.

Treatment:

Drug: Ustekinumab

Etanercept

Description:

Etanercept will be given in the first 3 months of treatment as 50 mg twice a week (3 or 4 days apart). After 3 months, a reduced dose of 50 mg will be given once per week.

Treatment:

Drug: Etanercept

Adalimumab

Description:

Adalimumab will be given in a dose of 40 mg subcutaneously every other week.

Treatment:

Drug: Adalimumab

Acitretin

Description:

Acetretin will be prescribed as daily with 25mg if the patient is \<80Kg or 35mg if the patient is \>80Kg.

Treatment:

Drug: Acitretin

UVB Excimer Laser

Description:

Dose determination will be determined by a physician per standard-of-care by performing a Sunburn Test/Minimal Erythemal Dose Test, or by visually evaluating the patient's skin type and thickness of psoriasis plaque. Initial laser dose will be 1-4X the MED depending on the thickness of the plaque. Escalation will be 25-50% increase in dose per treatment if there is no residual erythema, 25% increase per treatment if there is mild residual erythema, and 0% increase per treatment if there is moderate residual erythema. Investigators also have the option to skip a treatment, if there is above moderate erythema, or significant patient discomfort. Patients will receive treatment twice a week.

Treatment:

Other: UVB Excimer Laser

Narrowband UVB

Description:

Narrowband UVB (311nm) will be used to treat patients 3X per week with 311nm of UVB light. Uninvolved areas of skin will be covered where possible to minimize excess sun exposure. Patients will be tested for their minimal erythemal dose (MED), after which, based upon Fitzpatrick Scale skin type, a patient will typically beginning with 1-2 minutes based on skin type and gradually increased by 10-15% per treatment dose as tolerated.

Treatment:

Other: Narrowband UVB