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    Summary
    EudraCT Number:2010-019941-24
    Sponsor's Protocol Code Number:CC-10004-PSA-004
    National Competent Authority:Italy - Italian Medicines Agency
    Clinical Trial Type:EEA CTA
    Trial Status:Completed
    Date on which this record was first entered in the EudraCT database:2011-12-12
    Trial results View results
    Index
    A. PROTOCOL INFORMATION
    B. SPONSOR INFORMATION
    C. APPLICANT IDENTIFICATION
    D. IMP IDENTIFICATION
    D.8 INFORMATION ON PLACEBO
    E. GENERAL INFORMATION ON THE TRIAL
    F. POPULATION OF TRIAL SUBJECTS
    G. INVESTIGATOR NETWORKS TO BE INVOLVED IN THE TRIAL
    N. REVIEW BY THE COMPETENT AUTHORITY OR ETHICS COMMITTEE IN THE COUNTRY CONCERNED
    P. END OF TRIAL
    Expand All   Collapse All
    A. Protocol Information
    A.1Member State ConcernedItaly - Italian Medicines Agency
    A.2EudraCT number2010-019941-24
    A.3Full title of the trial
    A phase 3, multicenter, randomized, double-blind, placebo-controlled, parallel-group, efficacy and safety study of two doses of Apremilast (CC-10004) in subjects with active psoriatic arthritis and a qualifying psoriasis lesion
    Studio di fase 3, multicentrico, randomizzato, in doppio cieco, con controllo placebo, a gruppi paralleli, per valutare l'efficacia e la sicurezza di due dosi di Apremilast (CC-10004) in pazienti con Artrite Psoriasica Attiva e una lesione psoriasica qualificante
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    Phase 3 study to evaluate safety and effectiveness of oral Apremilast (CC-10004) in patients with Psoriatic Arthritis who have a qualifying psoriasis skin lesion
    Studio di fase 3 per valutare l`efficacia e la sicurezza di Apremilast (CC-10004) orale in pazienti con Artrite Psoriasica che presentano una lesione psoriasica della cute qualificante
    A.4.1Sponsor's protocol code numberCC-10004-PSA-004
    A.7Trial is part of a Paediatric Investigation Plan No
    A.8EMA Decision number of Paediatric Investigation Plan
    B. Sponsor Information
    B.Sponsor: 1
    B.1.1Name of SponsorCelgene Corporation
    B.1.3.4CountryUnited States
    B.3.1 and B.3.2Status of the sponsorCommercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportCelgene Corporation
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationCelgene Europe Ltd
    B.5.2Functional name of contact pointDagmar Gauweiler
    B.5.3 Address:
    B.5.3.1Street Address1 Longwalk road
    B.5.3.2Town/ cityStockley Park, Uxbridge
    B.5.3.3Post codeUB11 1DB
    B.5.3.4CountryUnited Kingdom
    B.5.4Telephone number+1 888 2601599
    B.5.5Fax number+1 913 4513459
    B.5.6E-mailClinicalTrialDisclosure@celgene.com
    D. IMP Identification
    D.IMP: 1
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameApremilast
    D.3.2Product code CC-10004
    D.3.4Pharmaceutical form Tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNApremilast
    D.3.9.1CAS number 608141-41-9
    D.3.9.2Current sponsor codeCC-10004
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number10
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 2
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameApremilast
    D.3.2Product code CC-10004
    D.3.4Pharmaceutical form Tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNApremilast
    D.3.9.1CAS number 608141-41-9
    D.3.9.2Current sponsor codeCC-10004
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number20
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 3
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameApremilast
    D.3.2Product code CC-10004
    D.3.4Pharmaceutical form Tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNApremilast
    D.3.9.1CAS number 608141-41-9
    D.3.9.2Current sponsor codeCC-10004
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number30
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.8 Information on Placebo
    D.8 Placebo: 1
    D.8.1Is a Placebo used in this Trial?Yes
    D.8.3Pharmaceutical form of the placeboTablet
    D.8.4Route of administration of the placeboOral use
    D.8 Placebo: 2
    D.8.1Is a Placebo used in this Trial?Yes
    D.8.3Pharmaceutical form of the placeboTablet
    D.8.4Route of administration of the placeboOral use
    D.8 Placebo: 3
    D.8.1Is a Placebo used in this Trial?Yes
    D.8.3Pharmaceutical form of the placeboTablet
    D.8.4Route of administration of the placeboOral use
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Psoriatic arthritis, an inflammatory arthritis that, depending on the method of ascertainment, occurs in 6 to 39% of patients with psoriasis.
    Artrite psoriasica, un`artrite infiammatoria che si manifesta nel 6-39% dei pazienti affetti da psoriasi.
    E.1.1.1Medical condition in easily understood language
    Psoriatic arthritis
    Artrite psoriasica
    E.1.1.2Therapeutic area Diseases [C] - Musculoskeletal Diseases [C05]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 14.0
    E.1.2Level LLT
    E.1.2Classification code 10037160
    E.1.2Term Psoriatic arthritis
    E.1.2System Organ Class 10028395 - Musculoskeletal and connective tissue disorders
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    The primary objective of the study is to evaluate the clinical efficacy of 2 doses of apremilast (20 mg or 30 mg orally BID), compared with placebo, on the signs and symptoms of psoriatic arthritis (PsA) after 24 weeks`€™ administration.
    L`obiettivo primario di questo studio e` di valutare l`€™efficacia clinica di 2 dosi di apremilast (20 mg o 30 mg assunte per via orale due volte al giorno [BID]), confrontate con placebo, attraverso i segni e i sintomi dell`€™artrite psoriasica (AP) dopo la somministrazione per 24 settimane.
    E.2.2Secondary objectives of the trial
    To evaluate the following in subjects with active PsA who are treated with 2 doses of apremilast or placebo for up to 24 weeks: - Safety and tolerability - Physical function - Psoriatic skin lesions - Fatigue - Clinical disease activity. To evaluate the following in subjects with active PsA who are treated with 2 doses of apremilast for up to 52 weeks: - Safety and tolerability - Efficacy - Physical function - Psoriatic skin lesions - Fatigue - Clinical disease activity. To evaluate the efficacy, safety, and tolerability of 2 doses of apremilast during up to 5 years`€™ administration to subjects with active PsA.
    - Valutare gli aspetti seguenti in soggetti con AP attiva che vengono trattati con 2 dosi di apremilast o placebo per una durata massima di 24 settimane: -Sicurezza e tollerabilita` -Funzione fisica -Lesioni cutanee psoriasiche -Fatigue -Attivita` clinica della malattia. -Valutare gli elementi seguenti in soggetti con AP attiva che vengono trattati con 2 dosi di apremilast per una durata massima di 52 settimane: -Sicurezza e tollerabilita` -Efficacia -Funzione fisica -Lesioni cutanee psoriasiche -Fatigue -Attivita` clinica della malattia. -Valutare l`€™efficacia, la sicurezza e la tollerabilita` di 2 dosi di apremilast durante un periodo massimo di 5 anni di somministrazione in soggetti affetti da AP attiva.
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1. Male or female, aged `‰¥ 18 years at time of consent. 2. Must understand and voluntarily sign an informed consent document prior to any study related assessments/procedures being conducted. 3. Able to adhere to the study visit schedule and other protocol requirements. 4. Have a documented diagnosis of PsA (by any criteria) of `‰¥ 6 months`€™ duration. 5. Meet the CASPAR criteria for PsA at time of screening. 6. Have `‰¥ 3 swollen AND `‰¥ 3 tender joints despite past or current use of DMARDs (inadequate control by DMARDs applies to therapeutic failure, loss of insurance, intolerance, adverse effects, or other reasons for discontinuation). 7. Have at least one `‰¥2 cm plaque psoriasis lesion. 8. Be receiving treatment on an outpatient basis. 9. If taking methotrexate, leflunomide, or sulfasalazine, must have been treated for at least 16 weeks and on a stable dose (oral or parenteral methotrexate `‰¤ 25 mg/week; leflunomide `‰¤ 20 mg/day; sulfasalazine `‰¤ 2 g/day) for at least 4 weeks prior to screening and through Week 24 of the study. One reduction in DMARD dose will be permitted after Week 24. 10. If taking oral corticosteroids, must be on a stable dose of prednisone `‰¤ 10 mg/day or equivalent for at least 1 month prior to screening.11. If taking NSAIDs or narcotic analgesics, must be on stable dose for at least 2 weeks prior to screening and until they have completed the Week 24 study visit.12. Low potency topical corticosteroids (Appendix M or locally available equivalent) will be allowed as background therapy for treatment of psoriasis on the face, axillae and groin in accordance with the manufacturers`€™ suggested usage during the course of the study. Subjects with scalp psoriasis will be permitted to use coal tar shampoo and/or salicylic acid scalp preparations on scalp lesions. A non-medicated skin emollient (eg, Eucerin cream) will also be permitted for body lesions only. Subjects must not use these treatments within 24 hours prior to the clinic visit. 13. Meet the following laboratory criteria: • White blood cell count `‰¥ 3000/mm3 (`‰¥ 3.0 x 109/L) and < 14,000/mm3 (< 14 x 109/L) • Platelet count `‰¥ 100,000/mm3 (`‰¥ 100 x 109/L) • Serum creatinine `‰¤ 1.5 mg/dL (`‰¤ 132.6 μmol/L) • AST (SGOT) and ALT (SGPT) `‰¤ 2 x upper limit of normal (ULN) • Total bilirubin `‰¤ 2 mg/dL (`‰¤ 34 μmol/L) • Hemoglobin `‰¥ 9 g/dL (`‰¥ 5.6 mmol/L)• Hemoglobin A1c `‰¤ 9.0% 14. Male subjects (including those who have had a vasectomy) who engage in activity in which conception is possible must use barrier contraception (male latex condom or nonlatex condom NOT made out of natural [animal] membrane [for example, polyurethane]) while on IP and for at least 28 days after the last dose of IP. 15. Females of childbearing potential (FCBP) must have a negative pregnancy test at Screening and Baseline. FCBP who engage in activity in which conception is possible must use contraception while on IP and for at least 28 days after taking the last dose of IP with either: 1) one highly effective form (non-oral hormonal, intrauterine device [IUD], tubal ligation, vasectomized partner); or 2) an oral hormonal contraceptive PLUS one additional form of barrier contraception (male or female latex condom or nonlatex condom NOT made out of natural [animal] membrane [for example, polyurethane], diaphragm with spermicide, cervical cap with spermicide, contraceptive sponge with spermicide); or 3) two forms of barrier contraception (male or female latex condom or nonlatex condom NOT made out of natural [animal] membrane [for example, polyurethane]) PLUS one of the following (diaphragm with spermicide, cervical cap with spermicide, contraceptive sponge with spermicide).
    1.Uomini e donne di eta' uguale o superiore ai 18 anni al momento del consenso. In grado di capire e firmare volontariamente un documento di consenso informato prima che siano condotte valutazioni/procedure connesse allo studio. 2.In grado di attenersi al programma di visite dello studio e agli altri requisiti del protocollo. 3.Con diagnosi documentata di PSA (mediante qualsiasi criterio) &gt;6 mesi. 4.Soddisfare i criteri CASPAR per il PsA al momento dello screening. 5.Avere &gt;3 articolazioni gonfie E &gt;3 articolazioni dolenti nonostante precedente o concomitante trattamento con DMARD (l`€™inadeguato controllo da DMARD si applica a inefficacia terapeutica, perdita della polizza di assicurazione, intolleranza, eventi avversi o altre ragioni che hanno portato all`€™interruzione) 6.Avere almeno una lesione della psoriasi a placche &gt;2cm. 7.Ricevere il trattamento in modalita' ambulatoriale. 8.Se assumono metotressato, leflunomide, o sulfasalazina, devono essere stati trattati per almeno 16 settimane e con una dose stabile (metotressato orale o parenterale &lt;25mg/sett; leflunomide &lt;20mg/die; sulfasalazina &lt;2g/die) per almeno 4 sett prima dello screening e fino alla sett 24 dello studio. Una riduzione della dose di DMARD sara' consentita dopo la sett 24. 9.Se assumono corticosteroidi per via orale, devono prendere una dose stabile di prednisone &lt;10mg/die o equivalente per almeno 1 mese prima dello screening. 10.Se stanno assumendo FANS o analgesici narcotici, devono prendere una dose stabile per almeno 2 sett prima dello screening e fino al completamento della visita dello studio della sett 24. 11.Corticosteroidi topici a bassa potenza saranno consentiti come terapia di fondo per il trattamento della psoriasi sul viso, sulle ascelle e all`inguine, conformemente agli usi suggeriti dai produttori durante il corso dello studio. Ai soggetti con psoriasi al cuoio capelluto sara' permesso di usare shampoo al catrame di carbone e/o preparati a base di acido salicilico per il cuoio capelluto sulle lesioni del cuoio capelluto. Sara' anche consentito un emolliente non medicato della pelle (ad es. crema Eucerin) solo per le lesioni del corpo. I soggetti non dovranno usare questi trattamenti nelle le 24h precedenti alla visita clinica. 12.Soddisfare i seguenti criteri di lab.: -Conteggio dei globuli bianchi &gt; 3000/mm3 (&gt; 3.0 X 109/L) e &lt; 14.000/mm3 (&lt; 14 X 109/L) ; -Conta piastrinica &gt; 100.000/mm3 (&gt; 100 X 109/L); -Creatinina nel siero &lt; 1.5 mg/dl (&lt; 132.6 µmol/L); -AST (SGOT) e ALT (SGPT) &lt; 2 volte il limite superiore del valore normale (ULN) ; -Bilirubina totale &lt; 2 mg/dL (&lt; 34 µmol/L) ; -Emoglobina &gt; 9 g/dL (&gt; 5.6 mmol/L) ; -Emoglobina Alc &lt; 9.0% 13.Soggetti di sesso maschile (compresi quelli che hanno avuto una vasectomia) che intraprendono attivita' in cui e' possibile il concepimento devono usare un metodo contraccettivo di barriera (preservativo maschile in lattice o preservativo non in lattice NON fatto di membrana naturale-animale [ad esempio poliuretano]) durante l`assunzione del farmaco sperimentale e per almeno 28 giorni dopo l`ultima dose del farmaco dello studio. 14. Le donne in eta' fertile dovranno sottoporsi a un test di gravidanza con esito negativo alla visita di screening ed a quella basale. Le donne in eta' fertile che partecipano ad attivita' in cui e' possibile il concepimento devono utilizzare contraccezione durante l`assunzione del IMP e per almeno 28gg dopo l`€™assunzione dell`ultima dose del IMP mediante uno dei seguenti metodi: 1) una forma altamente efficace; o 2) contraccezione ormonale orale PIU`€™ una forma addizionale di contraccezione di; o 3) due forme di contraccezione di barriera PIU`€™insieme ad uno dei seguenti: spugna, diaframma con spermicida, o cappuccio cervicale con spermicida. PER UNA VISIONE COMPLETA DEI CRITERI DI INCLUSIONE FARE RIFERIMENTO AL PROTOCOLLO DI STUDIO.
    E.4Principal exclusion criteria
    1. History of clinically significant (as determined by the Investigator) cardiac, endocrinologic, pulmonary, neurologic, psychiatric, hepatic, renal, hematologic, immunologic disease, or other major uncontrolled disease. 2. Any condition, including the presence of laboratory abnormalities that places the subject at unacceptable risk if he/she were to participate in the study or confounds the ability to interpret data from the study. 3. Clinically significant abnormality on 12-lead ECG at Screening. 4. Pregnant or breast feeding. 5. History of allergy to any component of the IP. 6. Hepatitis B surface antigen positive at screening. 7. Hepatitis C antibody positive at screening. 8. AST (SGOT) and/or ALT (SGPT) > 1.5 x ULN and total bilirubin > ULN or albumin < lower limit of normal (LLN). 9. History of positive Human Immunodeficiency Virus (HIV), or congenital or acquired immunodeficiency (eg, Common Variable Immunodeficiency Disease). 10. Active tuberculosis or a history of incompletely treated tuberculosis. 11. Clinically significant abnormality based upon chest radiograph with at least PA view (radiograph must be taken within 12 weeks prior to Screening or during the Screening visit). An additional lateral view is strongly recommended but not required. 12. Active substance abuse or a history of substance abuse within 6 months prior to Screening. 13. Bacterial infections requiring treatment with oral or injectable antibiotics, or significant viral or fungal infections, within 4 weeks of Screening. Any treatment for such infections must have been completed at least 4 weeks prior to Screening. 14. Malignancy or history of malignancy (except for treated [ie, cured] basal-cell or squamous cell in situ skin carcinomas and treated [ie, cured] cervical intraepithelial neoplasia [CIN] or carcinoma in situ of the cervix. 15. Major surgery (including joint surgery) within 8 weeks prior to screening or planned major surgery within 6 months following randomization. 16. Erythrodermic, guttate, or generalized pustular psoriasis at randomization. 17. Topical therapy for psoriasis, except as noted in the Inclusion Criteria, within 2 weeks of randomization (including but not limited to topical corticosteroids, topical retinoids or vitamin D analog preparations, tacrolimus, pimecrolimus, or anthralin). 18. Rheumatic autoimmune disease other than PsA, including systemic lupus erythematosis (SLE), mixed connective tissue disease (MCTD), scleroderma, polymyositis, or fibromyalgia. 19. Functional Class IV as defined by the ACR Classification of Functional Status in Rheumatoid Arthritis (Appendix Q). 20. Prior history of or current inflammatory joint disease other than PsA (eg, gout, reactive arthritis, RA, ankylosing spondylitis, Lyme disease). 21. Use of the following systemic therapy(ies) within 4 weeks of randomization, including but not limited to cyclosporine or other calcineurin inhibitors, corticosteroids and small molecule DMARDs (except as noted in inclusion criteria), oral retinoids, mycophenolate, thioguanine, hydroxyurea, sirolimus, tacrolimus, azathioprine, fumaric acid esters. 22. Use of phototherapy within 4 weeks of randomization (ie, UVB, PUVA). 23. Use of adalimumab, etanercept, golimumab, infliximab, certolizumab pegol, or tocilizumab within 12 weeks of randomization. 24. Use of alefacept or ustekinumab within 24 weeks of randomization. 25. Previous treatment with any cell depleting therapies, including investigational agents (eg, rituximab, CAMPATH, anti-CD4, anti-CD5, anti-CD3, anti-CD19, and anti-CD20). 26. Treatment with intravenous gamma globulin, plasmapheresis, or Prosorba column within 6 months of baseline.27. Any previous treatment with alkylating agents such as cyclophosphamide or chlorambucil, or with total lymphoid irradiation. 28. Prior treatment with apremilast. FOR A COMPLETE LIST REFER TO THE STUDY PROTOCOL.
    1. Anamnesi di malattie clinicamente significative (secondo il ricercatore) di tipo cardiaco, endocrino, polmonare, neurologico, psichiatrico, epatico, renale, ematologico, immunologico, o altre patologie gravi non controllate. 2. Qualunque condizione, inclusa la presenza di anomalie di laboratorio, che possa porre il soggetto a un livello di rischio inaccettabile in caso di partecipazione allo studio, o alterare la capacita' di interpretazione dei dati dello studio. 3. Anormalita' clinicamente significative sul tracciato ECG a 12 derivazioni allo screening. 4. Gravidanza o allattamento. 5. Anamnesi di allergia a qualsiasi componente del prodotto sperimentale (IP). 6. Antigene di superficie dell`epatite B positivo allo screening. 7. Positivita' all`anticorpo dell`epatite C allo screening. 8. AST (SGOT) e/o ALT (SGPT) &gt; 1,5X ULN e bilirubina totale &gt; ULN o albumina &lt; LLN limite minimo di normalita'. 9. Anamnesi di virus dell`€™immunodeficienza umana (HIV), o di immunodeficienza congenita o acquisita (ad esempio, Immunodeficienza Primitiva ). 10. Tubercolosi attiva o anamnesi di tubercolosi non completamente trattata. 11. Anormalita' clinicamente significative sulla base di radiografia del torace con almeno una veduta postero-anteriore (la radiografia deve essere fatta entro 12 settimane prima dello screening o durante la visita di screening). Una vista laterale supplementare e' fortemente raccomandata, ma non obbligatoria. 12. Il soggetto ha un`anamnesi di utilizzo di sostanze di abusonei 6 mesi precedenti alla visita di screening. 13. Infezioni batteriche che richiedono un trattamento con antibiotici orali o iniettabili, o significative infezioni virali o fungine, nelle 4 settimane antecedentilo screening. Ogni trattamento per queste infezioni deve essere stato concluso almeno 4 settimane prima dello screening 14. Malignita' o anamnesi di tumore maligno (ad eccezione del carcinoma delle cellule basali o squamose della pelle trattato [cioe', risolto] e della neoplasia intraepiteliale cervicale [CIN] trattata [cioe', risolta] o carcinoma in situ della cervice). 15. Importante intervento chirurgico (compreso intervento chirurgico alle articolazioni) nelle 8 settimane precedenti lo screening, o importante intervento chirurgico programmato nei 6 mesi successivi alla randomizzazione. 16. Psoriasi eritrodermica, guttata , o pustolosa generalizzata alla randomizzazione. 17. Terapia topica per la psoriasi, ad eccezione di quanto e' indicato nei criteri d`inclusione, nelle 2 settimane precedenti la randomizzazione (compresi ma non esclusivamente i corticosteroidi topici, i retinoidi per uso topico o preparati a base di analoghi della vitamina D, tacrolimus, pimecrolimus, o antralina). 18. Malattie autoimmuni reumatiche diverse da PsA, compreso il lupus eritematoso sistemico (LES), la malattia mista del tessuto connettivo (MMTC), la sclerodermia, o la polimiosite o fibromialgia. 19. Classe funzionale IV secondo la classificazione ACR di Stato funzionale nell`artrite reumatoide (Appendice R). 20. Anamnesi precedente o attuale di malattia infiammatoria delle articolazioni diversa da PSA (per esempio, gotta, artrite reattiva, RA, spondilite anchilosante, malattia di Lyme). 21. L`uso della/e terapia/e sistemica/che seguente/i nelle 4 settimane precedenti la randomizzazione, compresi ma non esclusivamente la ciclosporina o altri inibitori della calcineurina, corticosteroidi (ad eccezione di quanto osservato nei criteri di inclusione ), retinoidi per via orale, il micofenolato, la tioguanina, l`idrossiurea, il sirolimus, il tacrolimus, l`azatioprina , gli esteri dell`acido fumarico. 22. Uso della fototerapia nelle 4 settimane precedenti la randomizzazione (cioe', UVB, PUVA). PER UNA LISTA COMPLETA FARE RIFERIMENTO AL PROTOCOLLO DI STUDIO.
    E.5 End points
    E.5.1Primary end point(s)
    Proportion of subjects in each treatment group who achieve the American College of Rheumatology criteria for a 20% improvement (ACR 20), compared with baseline, after 24 weeks`€™ treatment
    Proporzione di soggetti che, in ciascun gruppo di trattamento, raggiungono il 20% di miglioramento secondo i criteri dell'American College of Rheumatology (ACR20), rispetto al baseline, dopo 24 settimane di trattamento
    E.5.1.1Timepoint(s) of evaluation of this end point
    24 weeks` treatment
    24 settimane di trattamento
    E.5.2Secondary end point(s)
    Safety of up to 5 years` administration as defined by - Type, frequency, severity, and relationship of adverse events to apremilast -Number of subjects who prematurely discontinue Investigational Product (IP) due to any adverse event -Frequency of clinically significant changes in physical examination, vital signs, electrocardiogram, and/or laboratory findings Efficacy as defined by: - Change from baseline in physical function (Health Assessment Questionnaire-Disability Index [HAQ-DI]) in each treatment group after 24 weeks`treatment - Proportion of subjects in each treatment group, whose psoriasis body surface area (BSA) at baseline was ≥ 3%, that achieves PASI-75 after 24 weeks` treatment - Change from baseline in the physical function domain score of the Medical Outcome Study Short Form 36-Item Health Survey, Version 2 (SF-36) in each treatment group after 24 weeks` treatment - Change from baseline in the Clinical Disease Activity Index (CDAI) in each treatment group after 24 weeks` treatment - Change from baseline in the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue) score in each treatment group after 24 weeks` treatment - Proportion of subjects in each treatment group who achieve an ACR 50, compared with baseline, after 24 weeks` treatment - Proportion of subjects in each treatment group who achieve an ACR 70, compared with baseline, after 24 weeks` treatment - Change from baseline in the Disease Activity Score (DAS-28) in each treatment group after 24 weeks` treatment - Proportion of subjects in each treatment group who achieve ACR 20after 52 weeks` treatment - Change in HAQ-DI in each treatment group after 52 weeks` treatment - Proportion of subjects in each treatment group, whose psoriasis body surface area (BSA) at baseline was ≥ 3%, that achieves PASI-75 after 52 weeks` treatment - Change from baseline in the physical function domain score of the SF- 36 questionnaire in each treatment group after 52 weeks` treatment - Change in the CDAI in each treatment group after 52 weeks` treatment - Change in the FACIT-Fatigue score in each treatment group after 52 weeks` treatment - Proportion of subjects in each treatment group who achieve ACR 50 after 52 weeks` treatment - Proportion of subjects in each treatment group who achieve ACR 70 after 52 weeks` treatment - Change from baseline in the DAS-28 in each treatment group after 52 weeks` treatment
    Sicurezza della somministrazione fino a 2 anni definita da: - Tipo, frequenza, gravita' e relazione degli eventi avversi con premilast - Numero di soggetti che hanno interrotto anticipatamente l’assunzione del Prodotto sperimentale a causa di un qualsiasi evento avverso - Frequenza di variazioni clinicamente significative relativamente a esame fisico, segni vitali, elettrocardiogramma e/o risultati di laboratorio Efficacia definita da: - Variazione dalla baseline della funzione fisica (Questionario sulla valutazione dello stato di salute – Indice di disabilita' [HAQ-DI]) in ciascun gruppo di trattamento dopo un trattamento di 24 settimane - Percentuale di soggetti in ciascun gruppo di trattamento, la cui area del corpo affetta da psoriasi alla baseline sia ≥ 3, che raggiunge PASI-75 dopo 24 settimane di trattamento - Variazione dalla baseline del punteggio sulla funzione fisica del Questionario breve per lo studio dei risultati medici, valutazione dello stato di salute, versione 2 (SF-36) in ciascun gruppo di trattamento dopo un trattamento di 24 settimane - Variazione dalla baseline dell’indice clinico di attivita' della malattia (CDAI) in ciascun gruppo di trattamento dopo un trattamento di 24 settimane - Variazione dalla baseline del punteggio della Valutazione funzionale della terapia per patologie croniche – Affaticamento (FACIT-Fatigue) in ciascun gruppo di trattamento dopo un trattamento di 24 settimane - Percentuale di soggetti in ciascun gruppo di trattamento che raggiungono un ACR 50, rispetto alla baseline, dopo un trattamento di 24 settimane - Percentuale di soggetti in ciascun gruppo di trattamento che raggiungono un ACR 70, rispetto alla baseline, dopo un trattamento di 24 settimane - Variazione dalla baseline dell’Indice di attivita' della malattia (DAS-28) in ciascun gruppo di trattamento dopo un trattamento di 24 settimane - Percentuale di soggetti in ciascun gruppo di trattamento che raggiungono un ACR 20 dopo un trattamento di 52 settimane - Variazione dell`HAQ-DI in ciascun gruppo di trattamento dopo un trattamento di 52 settimane - Percentuale di soggetti in ciascun gruppo di trattamento, la cui area del corpo affetta da psoriasi alla baseline sia ≥ 3, che raggiunge PASI-75 dopo 52 settimane di trattamento - Variazione dalla baseline del punteggio sulla funzione fisica del questionario SF-36 in ciascun gruppo di trattamento dopo un trattamento di 52 settimane - Variazione del CDAI in ciascun gruppo di trattamento dopo un trattamento di 52 settimane - Variazione del FACIT-Fatigue in ciascun gruppo di trattamento dopo un trattamento di 52 settimane - Percentuale di soggetti in ciascun gruppo di trattamento che raggiungono un ACR 50 dopo un trattamento di 52 settimane - Percentuale di soggetti in ciascun gruppo di trattamento che raggiungono un ACR 70 dopo un trattamento di 52 settimane - Variazione dalla baseline del DAS-28 in ciascun gruppo di trattamento dopo un trattamento di 52 settimane
    E.5.2.1Timepoint(s) of evaluation of this end point
    See E.5.2
    Fare riferimento alla sezione precedente
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy No
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic No
    E.6.7Pharmacodynamic No
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others No
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) No
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other No
    E.7.1.3.1Other trial type description
    E.7.2Therapeutic exploratory (Phase II) No
    E.7.3Therapeutic confirmatory (Phase III) Yes
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled Yes
    E.8.1.1Randomised Yes
    E.8.1.2Open No
    E.8.1.3Single blind No
    E.8.1.4Double blind Yes
    E.8.1.5Parallel group Yes
    E.8.1.6Cross over No
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) No
    E.8.2.2Placebo Yes
    E.8.2.3Other Yes
    E.8.2.3.1Comparator description
    - Stesso farmaco ad altro dosaggio
    - same IMP used at different dosage
    E.8.2.4Number of treatment arms in the trial3
    E.8.3 The trial involves single site in the Member State concerned No
    E.8.4 The trial involves multiple sites in the Member State concerned Yes
    E.8.4.1Number of sites anticipated in Member State concerned4
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA60
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA Yes
    E.8.6.2Trial being conducted completely outside of the EEA No
    E.8.6.3If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned
    Australia
    Canada
    Korea, Republic of
    Russian Federation
    Switzerland
    United States
    E.8.7Trial has a data monitoring committee No
    E.8.8 Definition of the end of the trial and justification where it is not the last visit of the last subject undergoing the trial
    See protocol
    Fare riferimento al protocollo di studio
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years0
    E.8.9.1In the Member State concerned months67
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years0
    E.8.9.2In all countries concerned by the trial months67
    E.8.9.2In all countries concerned by the trial days0
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 No
    F.1.1Number of subjects for this age range: 0
    F.1.1.1In Utero No
    F.1.1.2Preterm newborn infants (up to gestational age < 37 weeks) No
    F.1.1.3Newborns (0-27 days) No
    F.1.1.4Infants and toddlers (28 days-23 months) No
    F.1.1.5Children (2-11years) No
    F.1.1.6Adolescents (12-17 years) No
    F.1.2Adults (18-64 years) Yes
    F.1.3Elderly (>=65 years) Yes
    F.2 Gender
    F.2.1Female Yes
    F.2.2Male Yes
    F.3 Group of trial subjects
    F.3.1Healthy volunteers No
    F.3.2Patients Yes
    F.3.3Specific vulnerable populations Yes
    F.3.3.1Women of childbearing potential not using contraception No
    F.3.3.2Women of child-bearing potential using contraception Yes
    F.3.3.3Pregnant women No
    F.3.3.4Nursing women No
    F.3.3.5Emergency situation No
    F.3.3.6Subjects incapable of giving consent personally No
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state20
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 304
    F.4.2.2In the whole clinical trial 495
    G. Investigator Networks to be involved in the Trial
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2011-05-19
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2011-05-10
    P. End of Trial
    P.End of Trial StatusCompleted
    P.Date of the global end of the trial2016-04-20
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