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    Clinical Trial Results:
    A Phase 2 Multicenter, Randomized, Double-blind, Placebo-Controlled Trial to Evaluate Toreforant (JNJ-38518168) for the Treatment of Subjects with Moderate to Severe Plaque type Psoriasis

    Summary
    EudraCT number
    2015-000277-12
    Trial protocol
    PL  
    Global end of trial date
    11 Mar 2016

    Results information
    Results version number
    v1(current)
    This version publication date
    18 Feb 2017
    First version publication date
    18 Feb 2017
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    38518168PSO2001
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT02295865
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Janssen-Cilag International N.V.
    Sponsor organisation address
    Antwerpseweg 15-17, Beerse, Belgium, B-2340
    Public contact
    Clinical Registry group, Janssen-Cilag International N.V., ClinicalTrialsEU@its.jnj.com
    Scientific contact
    Clinical Registry group, Janssen-Cilag International N.V., ClinicalTrialsEU@its.jnj.com
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    11 Mar 2016
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    11 Mar 2016
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    The main objective was to evaluate the efficacy of JNJ-38518168 in subjects with moderate to severe plaque-type psoriasis and to assess the safety and tolerability of JNJ-38518168 in subjects with moderate to severe plaque-type psoriasis.
    Protection of trial subjects
    The safety assessments included vital signs, general physical examination,adverse events (AEs), concomitant medication review, electrocardiograms (ECGs), pregnancy testing,laboratory testing, urine testing.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    14 Dec 2014
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Poland: 41
    Country: Number of subjects enrolled
    United States: 20
    Worldwide total number of subjects
    61
    EEA total number of subjects
    41
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    55
    From 65 to 84 years
    6
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    The study was conducted at Poland (5 sites) and United States (9 sites) from 14 December 2014 to 11 March 2016.

    Pre-assignment
    Screening details
    A total of 80 subjects were screened, of which 62 subjects were randomized at Week 0. A total of 61 subjects were treated and enrolled in the study.

    Period 1
    Period 1 title
    Overall Study (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Placebo
    Arm description
    Subjects received 3*30 milligram(mg) placebo tablets and 1*3 mg placebo tablet orally at the same time each day upto week 12.
    Arm type
    Placebo

    Investigational medicinal product name
    Placebo
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Subjects received oral dose of 3*30 mg tablet of placebo along with 1*3 mg tablet of placebo at the same time each day upto week 12.

    Arm title
    JNJ-38518168 30 milligram (mg)
    Arm description
    Subjects in the JNJ-38518168 30 milligram (mg) group received 1*30 mg JNJ-38518168 tablet together with 2*30 mg placebo tablets and 1*3 mg placebo tablet at the same time each day upto week 12.
    Arm type
    Experimental

    Investigational medicinal product name
    JNJ-38518168
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Subjects received oral dose of JNJ-38518168 1*30 mg tablet each day upto week 12.

    Investigational medicinal product name
    Placebo
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Subjects received oral dose of 2*30 mg placebo and 1*3 mg placebo tablet each day upto week 12.

    Arm title
    JNJ-38518168 60 milligram (mg)
    Arm description
    Subjects in the JNJ-38518168 60 mg group received 2*30 mg JNJ-38518168 tablets, 1*30 mg placebo tablet and 1*3 mg placebo tablet orally at the same time each day upto week 12.
    Arm type
    Experimental

    Investigational medicinal product name
    JNJ-38518168
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Subjects received oral dose of JNJ-38518168, 2*30 mg tablet each day upto week 12.

    Investigational medicinal product name
    Placebo
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Subjects received oral dose of 1*30 mg placebo and 1*3 mg placebo tablet each day upto week 12.

    Number of subjects in period 1
    Placebo JNJ-38518168 30 milligram (mg) JNJ-38518168 60 milligram (mg)
    Started
    6
    29
    26
    Completed
    6
    25
    20
    Not completed
    0
    4
    6
         Adverse event, non-fatal
    -
    3
    -
         Other
    -
    -
    1
         Pregnancy
    -
    -
    1
         Adverse event, serious non-fatal
    -
    -
    1
         Lost to follow-up
    -
    -
    1
         Lack of efficacy
    -
    1
    2

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Placebo
    Reporting group description
    Subjects received 3*30 milligram(mg) placebo tablets and 1*3 mg placebo tablet orally at the same time each day upto week 12.

    Reporting group title
    JNJ-38518168 30 milligram (mg)
    Reporting group description
    Subjects in the JNJ-38518168 30 milligram (mg) group received 1*30 mg JNJ-38518168 tablet together with 2*30 mg placebo tablets and 1*3 mg placebo tablet at the same time each day upto week 12.

    Reporting group title
    JNJ-38518168 60 milligram (mg)
    Reporting group description
    Subjects in the JNJ-38518168 60 mg group received 2*30 mg JNJ-38518168 tablets, 1*30 mg placebo tablet and 1*3 mg placebo tablet orally at the same time each day upto week 12.

    Reporting group values
    Placebo JNJ-38518168 30 milligram (mg) JNJ-38518168 60 milligram (mg) Total
    Number of subjects
    6 29 26 61
    Title for AgeCategorical
    Units: subjects
        Children (2-11 years)
    0 0 0 0
        Adolescents (12-17 years)
    0 0 0 0
        Adults (18-64 years)
    5 27 23 55
        From 65 to 84 years
    1 2 3 6
        85 years and over
    0 0 0 0
    Title for AgeContinuous
    Units: years
        arithmetic mean (standard deviation)
    46.8 ± 18.95 42.2 ± 14.06 41.4 ± 18.25 -
    Title for Gender
    Units: subjects
        Female
    0 11 5 16
        Male
    6 18 21 45

    End points

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    End points reporting groups
    Reporting group title
    Placebo
    Reporting group description
    Subjects received 3*30 milligram(mg) placebo tablets and 1*3 mg placebo tablet orally at the same time each day upto week 12.

    Reporting group title
    JNJ-38518168 30 milligram (mg)
    Reporting group description
    Subjects in the JNJ-38518168 30 milligram (mg) group received 1*30 mg JNJ-38518168 tablet together with 2*30 mg placebo tablets and 1*3 mg placebo tablet at the same time each day upto week 12.

    Reporting group title
    JNJ-38518168 60 milligram (mg)
    Reporting group description
    Subjects in the JNJ-38518168 60 mg group received 2*30 mg JNJ-38518168 tablets, 1*30 mg placebo tablet and 1*3 mg placebo tablet orally at the same time each day upto week 12.

    Primary: Percentage of Subjects who Achieved Psoriasis Area and Severity Index (PASI) 75 Response at Week 12

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    End point title
    Percentage of Subjects who Achieved Psoriasis Area and Severity Index (PASI) 75 Response at Week 12
    End point description
    The PASI score is a combined assessment of lesion severity and area affected into a single score. Body is divided into 4 regions:head, arms, trunk, and legs. For each region, percent (%) area of skin involved is estimated:0=0%, 1=less than (<) 10%, 2=10 to <30%, 3=30 to <50%, 4=50 to <70%, 5=70 to <90%, 6=90 to 100%. Severity is estimated by clinical symptoms: erythema, induration, scaling; scale:0= none to 4=maximum. Final PASI=sum of severity parameters for each region*area score*weight of region (head:0.1,arms:0.2,body:0.3,legs:0.4);total possible score range: 0=no disease to 72=maximal disease. A PASI 75 response is defined as greater than or equal to (>=) 75 % improvement in PASI score from baseline.The efficacy analyses included all randomized and treated subjects.
    End point type
    Primary
    End point timeframe
    Week 12
    End point values
    Placebo JNJ-38518168 30 milligram (mg) JNJ-38518168 60 milligram (mg)
    Number of subjects analysed
    6
    29
    26
    Units: percentage of responders
        number (not applicable)
    16.7
    20.7
    19.2
    Statistical analysis title
    Statistical analysis 1
    Statistical analysis description
    Bayesian analyses with credible interval were reported.
    Comparison groups
    JNJ-38518168 30 milligram (mg) v Placebo
    Number of subjects included in analysis
    35
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    Method
    Parameter type
    Difference
    Point estimate
    14.1
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -0.1
         upper limit
    30.9
    Statistical analysis title
    Statistical analysis 2
    Statistical analysis description
    Bayesian analyses with credible interval were reported.
    Comparison groups
    Placebo v JNJ-38518168 60 milligram (mg)
    Number of subjects included in analysis
    32
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    Method
    Parameter type
    Difference
    Point estimate
    8.9
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -5
         upper limit
    24.3

    Secondary: Percentage of Subjects Who Achieved a Score of 0 or 1 on the Investigator's Global Assessment (IGA) at Week 12

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    End point title
    Percentage of Subjects Who Achieved a Score of 0 or 1 on the Investigator's Global Assessment (IGA) at Week 12
    End point description
    The IGA documents the investigator's assessment of the participants psoriasis at a given time point. Overall lesions are graded for induration, erythema, and scaling on a scale of 0 to 4 (higher score = more severe). The participant's psoriasis is assessed as 5-point scale as follows: 0=cleared, 1=minimal, 2=mild, 3=moderate, 4=severe.The efficacy analyses included all randomized and treated subjects.
    End point type
    Secondary
    End point timeframe
    Week 12
    End point values
    Placebo JNJ-38518168 30 milligram (mg) JNJ-38518168 60 milligram (mg)
    Number of subjects analysed
    6
    29
    26
    Units: percentage of responders
        number (not applicable)
    16.7
    20.7
    19.2
    Statistical analysis title
    Statistical analysis 1
    Statistical analysis description
    Bayesian analyses with credible interval were reported.
    Comparison groups
    Placebo v JNJ-38518168 30 milligram (mg)
    Number of subjects included in analysis
    35
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    Method
    Parameter type
    Difference
    Point estimate
    14.4
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -3.6
         upper limit
    33.2
    Statistical analysis title
    Statistical analysis 2
    Statistical analysis description
    Bayesian analyses with credible interval were reported.
    Comparison groups
    Placebo v JNJ-38518168 60 milligram (mg)
    Number of subjects included in analysis
    32
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    Method
    Parameter type
    Difference
    Point estimate
    13.4
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -3.6
         upper limit
    32.1

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Upto Week 16
    Assessment type
    Non-systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    18.1
    Reporting groups
    Reporting group title
    Placebo
    Reporting group description
    Subjects received 3*30 milligram(mg) placebo tablets and 1*3 mg placebo tablet orally at the same time each day upto week 12.

    Reporting group title
    JNJ-38518168 30 mg
    Reporting group description
    Subjects in the JNJ-38518168 30 milligram (mg) group received 1*30 mg JNJ-38518168 tablet together with 2*30 mg placebo tablets and 1*3 mg placebo tablet at the same time each day upto week 12.

    Reporting group title
    JNJ-38518168 60 mg
    Reporting group description
    Subjects in the JNJ-38518168 60 mg group received 2*30 mg JNJ-38518168 tablets, 1 x 30 mg placebo tablet and 1*3 mg placebo tablet orally at the same time each day upto week 12.

    Serious adverse events
    Placebo JNJ-38518168 30 mg JNJ-38518168 60 mg
    Total subjects affected by serious adverse events
         subjects affected / exposed
    0 / 5 (0.00%)
    0 / 30 (0.00%)
    1 / 26 (3.85%)
         number of deaths (all causes)
    0
    0
    0
         number of deaths resulting from adverse events
    Blood and lymphatic system disorders
    Leukopenia
         subjects affected / exposed
    0 / 5 (0.00%)
    0 / 30 (0.00%)
    1 / 26 (3.85%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 0%
    Non-serious adverse events
    Placebo JNJ-38518168 30 mg JNJ-38518168 60 mg
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    2 / 5 (40.00%)
    15 / 30 (50.00%)
    14 / 26 (53.85%)
    Vascular disorders
    Hypertension
         subjects affected / exposed
    0 / 5 (0.00%)
    0 / 30 (0.00%)
    1 / 26 (3.85%)
         occurrences all number
    0
    0
    1
    Pregnancy, puerperium and perinatal conditions
    Pregnancy
         subjects affected / exposed
    0 / 5 (0.00%)
    0 / 30 (0.00%)
    1 / 26 (3.85%)
         occurrences all number
    0
    0
    1
    General disorders and administration site conditions
    Fatigue
         subjects affected / exposed
    0 / 5 (0.00%)
    1 / 30 (3.33%)
    1 / 26 (3.85%)
         occurrences all number
    0
    1
    1
    Pain
         subjects affected / exposed
    0 / 5 (0.00%)
    1 / 30 (3.33%)
    0 / 26 (0.00%)
         occurrences all number
    0
    1
    0
    Pyrexia
         subjects affected / exposed
    0 / 5 (0.00%)
    0 / 30 (0.00%)
    1 / 26 (3.85%)
         occurrences all number
    0
    0
    1
    Reproductive system and breast disorders
    Dysmenorrhoea
         subjects affected / exposed
    0 / 5 (0.00%)
    1 / 30 (3.33%)
    0 / 26 (0.00%)
         occurrences all number
    0
    1
    0
    Genital Tract Inflammation
         subjects affected / exposed
    0 / 5 (0.00%)
    1 / 30 (3.33%)
    0 / 26 (0.00%)
         occurrences all number
    0
    1
    0
    Respiratory, thoracic and mediastinal disorders
    Cough
         subjects affected / exposed
    0 / 5 (0.00%)
    2 / 30 (6.67%)
    1 / 26 (3.85%)
         occurrences all number
    0
    2
    1
    Oropharyngeal Pain
         subjects affected / exposed
    0 / 5 (0.00%)
    1 / 30 (3.33%)
    0 / 26 (0.00%)
         occurrences all number
    0
    1
    0
    Productive Cough
         subjects affected / exposed
    0 / 5 (0.00%)
    1 / 30 (3.33%)
    0 / 26 (0.00%)
         occurrences all number
    0
    1
    0
    Respiratory Tract Congestion
         subjects affected / exposed
    0 / 5 (0.00%)
    1 / 30 (3.33%)
    0 / 26 (0.00%)
         occurrences all number
    0
    1
    0
    Rhinorrhoea
         subjects affected / exposed
    0 / 5 (0.00%)
    2 / 30 (6.67%)
    0 / 26 (0.00%)
         occurrences all number
    0
    2
    0
    Sinus Congestion
         subjects affected / exposed
    0 / 5 (0.00%)
    1 / 30 (3.33%)
    0 / 26 (0.00%)
         occurrences all number
    0
    2
    0
    Investigations
    Alanine Aminotransferase Increased
         subjects affected / exposed
    0 / 5 (0.00%)
    2 / 30 (6.67%)
    0 / 26 (0.00%)
         occurrences all number
    0
    2
    0
    Aspartate Aminotransferase Increased
         subjects affected / exposed
    0 / 5 (0.00%)
    1 / 30 (3.33%)
    0 / 26 (0.00%)
         occurrences all number
    0
    1
    0
    Blood Creatine Phosphokinase Increased
         subjects affected / exposed
    0 / 5 (0.00%)
    1 / 30 (3.33%)
    0 / 26 (0.00%)
         occurrences all number
    0
    1
    0
    Blood Creatinine Increased
         subjects affected / exposed
    0 / 5 (0.00%)
    1 / 30 (3.33%)
    0 / 26 (0.00%)
         occurrences all number
    0
    1
    0
    Serum Ferritin Increased
         subjects affected / exposed
    0 / 5 (0.00%)
    0 / 30 (0.00%)
    1 / 26 (3.85%)
         occurrences all number
    0
    0
    1
    Injury, poisoning and procedural complications
    Meniscus Injury
         subjects affected / exposed
    0 / 5 (0.00%)
    0 / 30 (0.00%)
    1 / 26 (3.85%)
         occurrences all number
    0
    0
    1
    Skin Abrasion
         subjects affected / exposed
    0 / 5 (0.00%)
    0 / 30 (0.00%)
    1 / 26 (3.85%)
         occurrences all number
    0
    0
    1
    Cardiac disorders
    Atrial Fibrillation
         subjects affected / exposed
    0 / 5 (0.00%)
    1 / 30 (3.33%)
    0 / 26 (0.00%)
         occurrences all number
    0
    1
    0
    Nervous system disorders
    Headache
         subjects affected / exposed
    0 / 5 (0.00%)
    2 / 30 (6.67%)
    0 / 26 (0.00%)
         occurrences all number
    0
    2
    0
    Somnolence
         subjects affected / exposed
    0 / 5 (0.00%)
    1 / 30 (3.33%)
    0 / 26 (0.00%)
         occurrences all number
    0
    1
    0
    Syncope
         subjects affected / exposed
    0 / 5 (0.00%)
    1 / 30 (3.33%)
    0 / 26 (0.00%)
         occurrences all number
    0
    1
    0
    Gastrointestinal disorders
    Diarrhoea
         subjects affected / exposed
    1 / 5 (20.00%)
    0 / 30 (0.00%)
    1 / 26 (3.85%)
         occurrences all number
    1
    0
    1
    Toothache
         subjects affected / exposed
    0 / 5 (0.00%)
    0 / 30 (0.00%)
    1 / 26 (3.85%)
         occurrences all number
    0
    0
    1
    Skin and subcutaneous tissue disorders
    Psoriasis
         subjects affected / exposed
    0 / 5 (0.00%)
    1 / 30 (3.33%)
    0 / 26 (0.00%)
         occurrences all number
    0
    1
    0
    Rash
         subjects affected / exposed
    0 / 5 (0.00%)
    1 / 30 (3.33%)
    0 / 26 (0.00%)
         occurrences all number
    0
    1
    0
    Skin Lesion
         subjects affected / exposed
    0 / 5 (0.00%)
    0 / 30 (0.00%)
    1 / 26 (3.85%)
         occurrences all number
    0
    0
    1
    Renal and urinary disorders
    Nephrolithiasis
         subjects affected / exposed
    1 / 5 (20.00%)
    0 / 30 (0.00%)
    0 / 26 (0.00%)
         occurrences all number
    1
    0
    0
    Musculoskeletal and connective tissue disorders
    Back Pain
         subjects affected / exposed
    1 / 5 (20.00%)
    0 / 30 (0.00%)
    0 / 26 (0.00%)
         occurrences all number
    1
    0
    0
    Infections and infestations
    Bronchitis
         subjects affected / exposed
    0 / 5 (0.00%)
    0 / 30 (0.00%)
    1 / 26 (3.85%)
         occurrences all number
    0
    0
    1
    Gastroenteritis
         subjects affected / exposed
    0 / 5 (0.00%)
    0 / 30 (0.00%)
    1 / 26 (3.85%)
         occurrences all number
    0
    0
    1
    Nasopharyngitis
         subjects affected / exposed
    1 / 5 (20.00%)
    1 / 30 (3.33%)
    3 / 26 (11.54%)
         occurrences all number
    1
    1
    4
    Oral Herpes
         subjects affected / exposed
    0 / 5 (0.00%)
    1 / 30 (3.33%)
    0 / 26 (0.00%)
         occurrences all number
    0
    1
    0
    Pulpitis Dental
         subjects affected / exposed
    0 / 5 (0.00%)
    0 / 30 (0.00%)
    1 / 26 (3.85%)
         occurrences all number
    0
    0
    1
    Rotavirus Infection
         subjects affected / exposed
    0 / 5 (0.00%)
    0 / 30 (0.00%)
    1 / 26 (3.85%)
         occurrences all number
    0
    0
    1
    Sinusitis
         subjects affected / exposed
    0 / 5 (0.00%)
    0 / 30 (0.00%)
    1 / 26 (3.85%)
         occurrences all number
    0
    0
    1
    Metabolism and nutrition disorders
    Decreased Appetite
         subjects affected / exposed
    0 / 5 (0.00%)
    0 / 30 (0.00%)
    1 / 26 (3.85%)
         occurrences all number
    0
    0
    1

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    19 Sep 2014
    The highest dose of study agent to be tested was reduced from 90 mg once daily to 60 mg once daily based upon feedback from the FDA; Text on safety margins and adjusted values based upon the change in dose was clarified as appropriate; Screening period expanded to no more than 42 days prior to the first administration of study agent to allow more flexibility for subject screening; To ensure patient safety, a new discontinuation of treatment criterion was added. This criterion stated that all subjects whose postbaseline serum creatinine increase met toxicity Grade 3 and higher based on the Common Terminology Criteria for Adverse Events(CTCAE), version 4.0, were to be discontinued from further study treatment; To establish a baseline triglyceride value, a baseline fasting lipid panel test was added to further assess the risk of increase in triglyceride levels from baseline if needed; Corrections were made to the safety analysis section in statistical methods to summarize number and percentage of subjects by maximum CTCAE grade for each treatment group for each laboratory parameter.

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported
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