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    Clinical Trial Results:
    Treatment of Pustular Psoriasis with the IL-1 receptor antagonist anakinra: a randomised, placebo controlled trial and associated mechanistic studies

    Summary
    EudraCT number
    2015-003600-23
    Trial protocol
    GB  
    Global end of trial date
    10 Aug 2020

    Results information
    Results version number
    v1(current)
    This version publication date
    01 Oct 2023
    First version publication date
    01 Oct 2023
    Other versions
    Summary report(s)
    Report

    Trial information

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    Trial identification
    Sponsor protocol code
    APRICOT
    Additional study identifiers
    ISRCTN number
    ISRCTN13127147
    US NCT number
    -
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Guy's and St Thomas NHS Foundation Trust
    Sponsor organisation address
    Great Maze Pond, London, United Kingdom, SE1 9RT
    Public contact
    Prof. Catherine Smith, Guy's and St Thomas Foundation Trust, 40 207185 5375, catherine.smith@kcl.ac.uk
    Scientific contact
    Prof. Catherine Smith, Guy's and St Thomas Foundation Trust, 40 207185 5375, catherine.smith@kcl.ac.uk
    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
    23 Sep 2020
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    10 Aug 2020
    Global end of trial reached?
    Yes
    Global end of trial date
    10 Aug 2020
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    To determine the efficacy of anakinra in treatment of adults with PPP compared to placebo. The primary endpoint is change in disease activity over 8 weeks, adjusted for baseline (visit 1), measured using fresh pustule count, the default primary outcome, unless PPPASI is more discriminating (to be reviewed at the end of stage one). The Stage 1 review occurred on 22nd January 2018. As a result of this review the DMC recommended the primary outcome to be PPPASI and this was passed by the TSC. Fresh pustule count will be a secondary outcome.
    Protection of trial subjects
    Participants have the right to withdraw from the study at any time for any reason. The investigator also has the right to withdraw patients from the study drug in the event of inter-current illness, AEs, SAEs, SUSARs, protocol violations, administrative reasons or other reasons.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    08 Aug 2016
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    United Kingdom: 64
    Worldwide total number of subjects
    64
    EEA total number of subjects
    64
    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)
    60
    From 65 to 84 years
    4
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    -

    Pre-assignment
    Screening details
    -

    Pre-assignment period milestones
    Number of subjects started
    64
    Number of subjects completed
    64

    Period 1
    Period 1 title
    Overall Trial (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
    -
    Arm type
    Placebo

    Investigational medicinal product name
    Vehicle solution
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for solution for injection
    Routes of administration
    Subcutaneous use
    Dosage and administration details
    Placebo will be provided in identical, matched syringes, containing 0.67 ml vehicle solution only. Placebo formulation contains 140 mM Sodium Chloride, 10 mM Sodium Citrate, 0.5 mM EDTA, 0.1% (w/w) non-animal derived Polysorbate 80, pH 6.5.

    Arm title
    Anakinra
    Arm description
    -
    Arm type
    Experimental

    Investigational medicinal product name
    Anakinra
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for injection
    Routes of administration
    Subcutaneous use
    Dosage and administration details
    Anakinra: A pre-filled syringe (27G x 1/2in. Needle) will be supplied by SOBI i.e.: Kineret 100 mg/0.67 ml solution for injection in pre-filled syringe. Each pre-filled syringe contains 100 mg of anakinra* per 0.67 ml (150 mg/ml). It is a clear, colourless-to-white solution for injection that may contain some product-related translucent-to-white amorphous particles.

    Number of subjects in period 1
    Placebo Anakinra
    Started
    33
    31
    Completed
    27
    26
    Not completed
    6
    5
         Consent withdrawn by subject
    2
    1
         Physician decision
    1
    -
         Adverse event, non-fatal
    1
    4
         Lost to follow-up
    2
    -

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Placebo
    Reporting group description
    -

    Reporting group title
    Anakinra
    Reporting group description
    -

    Reporting group values
    Placebo Anakinra Total
    Number of subjects
    33 31 64
    Age categorical
    Units: Subjects
        In utero
    0
        Preterm newborn infants (gestational age < 37 wks)
    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)
    0
        From 65-84 years
    0
        85 years and over
    0
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    51.7 ( 13.6 ) 49.9 ( 11.9 ) -
    Gender categorical
    Units: Subjects
        Female
    27 27 54
        Male
    6 4 10

    End points

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    End points reporting groups
    Reporting group title
    Placebo
    Reporting group description
    -

    Reporting group title
    Anakinra
    Reporting group description
    -

    Primary: PalmoPlantarPustulosis Area and Severity Index (PPPASI) score

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    End point title
    PalmoPlantarPustulosis Area and Severity Index (PPPASI) score [1]
    End point description
    End point type
    Primary
    End point timeframe
    Baseline to Week 8
    Notes
    [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: Please see uploaded report
    End point values
    Placebo Anakinra
    Number of subjects analysed
    33
    31
    Units: score
    arithmetic mean (standard deviation)
        baseline
    18.0 ( 10.4 )
    17.5 ( 10.8 )
        Week 8
    15.4 ( 10.1 )
    13.9 ( 7.4 )
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Baseline to week 20
    Assessment type
    Non-systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    23
    Reporting groups
    Reporting group title
    Placebo
    Reporting group description
    -

    Reporting group title
    Anakinra
    Reporting group description
    -

    Serious adverse events
    Placebo Anakinra
    Total subjects affected by serious adverse events
         subjects affected / exposed
    0 / 33 (0.00%)
    0 / 31 (0.00%)
         number of deaths (all causes)
    0
    0
         number of deaths resulting from adverse events
    0
    0
    Frequency threshold for reporting non-serious adverse events: 0%
    Non-serious adverse events
    Placebo Anakinra
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    26 / 33 (78.79%)
    29 / 31 (93.55%)
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Synovial cyst
         subjects affected / exposed
    1 / 33 (3.03%)
    0 / 31 (0.00%)
         occurrences all number
    1
    0
    Vascular disorders
    Haematuria
         subjects affected / exposed
    1 / 33 (3.03%)
    2 / 31 (6.45%)
         occurrences all number
    1
    2
    Hypertension
         subjects affected / exposed
    0 / 33 (0.00%)
    1 / 31 (3.23%)
         occurrences all number
    0
    1
    Pregnancy, puerperium and perinatal conditions
    Gestational diabetes
         subjects affected / exposed
    0 / 33 (0.00%)
    1 / 31 (3.23%)
         occurrences all number
    0
    1
    Pregnancy
         subjects affected / exposed
    0 / 33 (0.00%)
    1 / 31 (3.23%)
         occurrences all number
    0
    1
    General disorders and administration site conditions
    constusion
         subjects affected / exposed
    2 / 33 (6.06%)
    1 / 31 (3.23%)
         occurrences all number
    2
    1
    Decreased appetite
         subjects affected / exposed
    1 / 33 (3.03%)
    0 / 31 (0.00%)
         occurrences all number
    1
    0
    Dizziness
         subjects affected / exposed
    0 / 33 (0.00%)
    1 / 31 (3.23%)
         occurrences all number
    0
    1
    Epistaxis
         subjects affected / exposed
    1 / 33 (3.03%)
    0 / 31 (0.00%)
         occurrences all number
    2
    0
    Flushing
         subjects affected / exposed
    1 / 33 (3.03%)
    0 / 31 (0.00%)
         occurrences all number
    1
    0
    Injection site discomfort
         subjects affected / exposed
    0 / 33 (0.00%)
    1 / 31 (3.23%)
         occurrences all number
    0
    1
    Injection site erythema
         subjects affected / exposed
    1 / 33 (3.03%)
    2 / 31 (6.45%)
         occurrences all number
    1
    2
    Injection site pain
         subjects affected / exposed
    0 / 33 (0.00%)
    1 / 31 (3.23%)
         occurrences all number
    0
    1
    Injection site pruritus
         subjects affected / exposed
    1 / 33 (3.03%)
    0 / 31 (0.00%)
         occurrences all number
    1
    0
    Injection site rash
         subjects affected / exposed
    0 / 33 (0.00%)
    1 / 31 (3.23%)
         occurrences all number
    0
    1
    Injection site reaction
         subjects affected / exposed
    1 / 33 (3.03%)
    19 / 31 (61.29%)
         occurrences all number
    1
    20
    Injection site swelling
         subjects affected / exposed
    1 / 33 (3.03%)
    2 / 31 (6.45%)
         occurrences all number
    1
    2
    Lethargy
         subjects affected / exposed
    1 / 33 (3.03%)
    0 / 31 (0.00%)
         occurrences all number
    1
    0
    Malaise
         subjects affected / exposed
    1 / 33 (3.03%)
    0 / 31 (0.00%)
         occurrences all number
    2
    0
    Oedema peripheral
         subjects affected / exposed
    0 / 33 (0.00%)
    1 / 31 (3.23%)
         occurrences all number
    0
    1
    Immune system disorders
    Rhinitis allergic
         subjects affected / exposed
    0 / 33 (0.00%)
    1 / 31 (3.23%)
         occurrences all number
    0
    1
    Reproductive system and breast disorders
    Menorrhagia
         subjects affected / exposed
    0 / 33 (0.00%)
    1 / 31 (3.23%)
         occurrences all number
    0
    1
    metrorrhagia
         subjects affected / exposed
    0 / 33 (0.00%)
    1 / 31 (3.23%)
         occurrences all number
    0
    1
    Respiratory, thoracic and mediastinal disorders
    Catarrh
         subjects affected / exposed
    1 / 33 (3.03%)
    0 / 31 (0.00%)
         occurrences all number
    1
    0
    cough
         subjects affected / exposed
    2 / 33 (6.06%)
    4 / 31 (12.90%)
         occurrences all number
    2
    5
    Oropharyngeal pain
         subjects affected / exposed
    1 / 33 (3.03%)
    3 / 31 (9.68%)
         occurrences all number
    1
    3
    Pharyngeal oedema
         subjects affected / exposed
    1 / 33 (3.03%)
    0 / 31 (0.00%)
         occurrences all number
    1
    0
    Rhinorrhoea
         subjects affected / exposed
    0 / 33 (0.00%)
    1 / 31 (3.23%)
         occurrences all number
    0
    1
    Psychiatric disorders
    Depressed mood
         subjects affected / exposed
    0 / 33 (0.00%)
    3 / 31 (9.68%)
         occurrences all number
    0
    3
    Investigations
    Blood creatine increased
         subjects affected / exposed
    1 / 33 (3.03%)
    0 / 31 (0.00%)
         occurrences all number
    1
    0
    Blood pressure increased
         subjects affected / exposed
    0 / 33 (0.00%)
    1 / 31 (3.23%)
         occurrences all number
    0
    1
    C-reactive protein increased
         subjects affected / exposed
    1 / 33 (3.03%)
    1 / 31 (3.23%)
         occurrences all number
    1
    1
    DNA antibody positive
         subjects affected / exposed
    1 / 33 (3.03%)
    0 / 31 (0.00%)
         occurrences all number
    1
    0
    Glucose urine present
         subjects affected / exposed
    1 / 33 (3.03%)
    0 / 31 (0.00%)
         occurrences all number
    1
    0
    Hepatitis B antibody positive
         subjects affected / exposed
    0 / 33 (0.00%)
    1 / 31 (3.23%)
         occurrences all number
    0
    1
    Mean cell volume increased
         subjects affected / exposed
    1 / 33 (3.03%)
    0 / 31 (0.00%)
         occurrences all number
    1
    0
    Monocyte count increased
         subjects affected / exposed
    1 / 33 (3.03%)
    0 / 31 (0.00%)
         occurrences all number
    1
    0
    Neutrophil count increased
         subjects affected / exposed
    0 / 33 (0.00%)
    1 / 31 (3.23%)
         occurrences all number
    0
    1
    Transaminases increased
         subjects affected / exposed
    0 / 33 (0.00%)
    1 / 31 (3.23%)
         occurrences all number
    0
    1
    Urine analysis abnormal
         subjects affected / exposed
    1 / 33 (3.03%)
    2 / 31 (6.45%)
         occurrences all number
    1
    2
    White blood cell count increased
         subjects affected / exposed
    0 / 33 (0.00%)
    1 / 31 (3.23%)
         occurrences all number
    0
    1
    White blood cells urine positive
         subjects affected / exposed
    2 / 33 (6.06%)
    0 / 31 (0.00%)
         occurrences all number
    2
    0
    Injury, poisoning and procedural complications
    Head injury
         subjects affected / exposed
    0 / 33 (0.00%)
    1 / 31 (3.23%)
         occurrences all number
    0
    1
    Post procedural infection
         subjects affected / exposed
    1 / 33 (3.03%)
    0 / 31 (0.00%)
         occurrences all number
    1
    0
    Nervous system disorders
    Headache
         subjects affected / exposed
    2 / 33 (6.06%)
    6 / 31 (19.35%)
         occurrences all number
    4
    6
    Migraine
         subjects affected / exposed
    2 / 33 (6.06%)
    0 / 31 (0.00%)
         occurrences all number
    2
    0
    Neuralgia
         subjects affected / exposed
    0 / 33 (0.00%)
    1 / 31 (3.23%)
         occurrences all number
    0
    1
    Blood and lymphatic system disorders
    Eosinophilia
         subjects affected / exposed
    0 / 33 (0.00%)
    1 / 31 (3.23%)
         occurrences all number
    0
    1
    Lymphadenopathy
         subjects affected / exposed
    1 / 33 (3.03%)
    0 / 31 (0.00%)
         occurrences all number
    1
    0
    Ear and labyrinth disorders
    Ear pain
         subjects affected / exposed
    1 / 33 (3.03%)
    0 / 31 (0.00%)
         occurrences all number
    1
    0
    Eye disorders
    Visual acuity reduced
         subjects affected / exposed
    1 / 33 (3.03%)
    0 / 31 (0.00%)
         occurrences all number
    1
    0
    Gastrointestinal disorders
    Constipation
         subjects affected / exposed
    0 / 33 (0.00%)
    1 / 31 (3.23%)
         occurrences all number
    0
    1
    Diarrhoea
         subjects affected / exposed
    0 / 33 (0.00%)
    5 / 31 (16.13%)
         occurrences all number
    0
    5
    Nausea
         subjects affected / exposed
    2 / 33 (6.06%)
    2 / 31 (6.45%)
         occurrences all number
    2
    2
    Toothache
         subjects affected / exposed
    1 / 33 (3.03%)
    0 / 31 (0.00%)
         occurrences all number
    1
    0
    Vomiting
         subjects affected / exposed
    0 / 33 (0.00%)
    2 / 31 (6.45%)
         occurrences all number
    0
    2
    Hepatobiliary disorders
    Hepatotoxicity
         subjects affected / exposed
    1 / 33 (3.03%)
    4 / 31 (12.90%)
         occurrences all number
    1
    4
    Skin and subcutaneous tissue disorders
    Biopsy skin
         subjects affected / exposed
    0 / 33 (0.00%)
    1 / 31 (3.23%)
         occurrences all number
    1
    0
    Dermatitis
         subjects affected / exposed
    1 / 33 (3.03%)
    0 / 31 (0.00%)
         occurrences all number
    1
    0
    Folliculitis
         subjects affected / exposed
    1 / 33 (3.03%)
    1 / 31 (3.23%)
         occurrences all number
    1
    2
    Pain of skin
         subjects affected / exposed
    0 / 33 (0.00%)
    1 / 31 (3.23%)
         occurrences all number
    0
    1
    Pruritus
         subjects affected / exposed
    0 / 33 (0.00%)
    1 / 31 (3.23%)
         occurrences all number
    0
    1
    Psoriasis
         subjects affected / exposed
    2 / 33 (6.06%)
    3 / 31 (9.68%)
         occurrences all number
    2
    3
    Psoriatic arthropathy
         subjects affected / exposed
    1 / 33 (3.03%)
    0 / 31 (0.00%)
         occurrences all number
    1
    0
    Pustular psoriasis
         subjects affected / exposed
    2 / 33 (6.06%)
    2 / 31 (6.45%)
         occurrences all number
    2
    2
    Rash macular
         subjects affected / exposed
    1 / 33 (3.03%)
    0 / 31 (0.00%)
         occurrences all number
    1
    0
    Rash papular
         subjects affected / exposed
    1 / 33 (3.03%)
    0 / 31 (0.00%)
         occurrences all number
    1
    0
    Skin irritation
         subjects affected / exposed
    1 / 33 (3.03%)
    0 / 31 (0.00%)
         occurrences all number
    1
    0
    Skin lesion
         subjects affected / exposed
    1 / 33 (3.03%)
    0 / 31 (0.00%)
         occurrences all number
    1
    0
    Renal and urinary disorders
    Glomerular filtration rate decreased
         subjects affected / exposed
    1 / 33 (3.03%)
    0 / 31 (0.00%)
         occurrences all number
    1
    0
    Proteinuria
         subjects affected / exposed
    0 / 33 (0.00%)
    1 / 31 (3.23%)
         occurrences all number
    0
    1
    Pyuria
         subjects affected / exposed
    0 / 33 (0.00%)
    1 / 31 (3.23%)
         occurrences all number
    0
    1
    Endocrine disorders
    Diabetes mellitus
         subjects affected / exposed
    1 / 33 (3.03%)
    0 / 31 (0.00%)
         occurrences all number
    1
    0
    Musculoskeletal and connective tissue disorders
    Back injury
         subjects affected / exposed
    1 / 33 (3.03%)
    0 / 31 (0.00%)
         occurrences all number
    1
    0
    Myalgia
         subjects affected / exposed
    1 / 33 (3.03%)
    0 / 31 (0.00%)
         occurrences all number
    1
    0
    Osteoporosis
         subjects affected / exposed
    1 / 33 (3.03%)
    0 / 31 (0.00%)
         occurrences all number
    1
    0
    Pain in extremity
         subjects affected / exposed
    1 / 33 (3.03%)
    1 / 31 (3.23%)
         occurrences all number
    1
    1
    Infections and infestations
    Cellulitis
         subjects affected / exposed
    1 / 33 (3.03%)
    0 / 31 (0.00%)
         occurrences all number
    1
    0
    Cystitis
         subjects affected / exposed
    1 / 33 (3.03%)
    0 / 31 (0.00%)
         occurrences all number
    1
    0
    Influenza
         subjects affected / exposed
    1 / 33 (3.03%)
    0 / 31 (0.00%)
         occurrences all number
    1
    0
    Influenza like illness
         subjects affected / exposed
    1 / 33 (3.03%)
    0 / 31 (0.00%)
         occurrences all number
    1
    0
    Lower respiratory tract infection
         subjects affected / exposed
    3 / 33 (9.09%)
    3 / 31 (9.68%)
         occurrences all number
    3
    3
    Nasopharyngitis
         subjects affected / exposed
    3 / 33 (9.09%)
    4 / 31 (12.90%)
         occurrences all number
    3
    5
    Rhinitis
         subjects affected / exposed
    1 / 33 (3.03%)
    1 / 31 (3.23%)
         occurrences all number
    1
    1
    Sinusitis
         subjects affected / exposed
    1 / 33 (3.03%)
    2 / 31 (6.45%)
         occurrences all number
    1
    2
    Skin infection
         subjects affected / exposed
    2 / 33 (6.06%)
    1 / 31 (3.23%)
         occurrences all number
    2
    1
    Synovitis
         subjects affected / exposed
    1 / 33 (3.03%)
    0 / 31 (0.00%)
         occurrences all number
    1
    0
    Tonsillitis
         subjects affected / exposed
    0 / 33 (0.00%)
    1 / 31 (3.23%)
         occurrences all number
    0
    1
    Upper respiratory tract infection
         subjects affected / exposed
    3 / 33 (9.09%)
    4 / 31 (12.90%)
         occurrences all number
    3
    4
    Viral infection
         subjects affected / exposed
    2 / 33 (6.06%)
    0 / 31 (0.00%)
         occurrences all number
    2
    0
    Metabolism and nutrition disorders
    Hyperkalaemia
         subjects affected / exposed
    1 / 33 (3.03%)
    0 / 31 (0.00%)
         occurrences all number
    1
    0

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    13 Sep 2016
    Protocol v2
    27 Sep 2016
    Protocol v3
    15 Jun 2017
    Protocol v4
    16 May 2018
    Protocol v5
    23 May 2019
    Protocol v6
    14 Oct 2019
    protocol v6.1

    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
    For support, Contact us.
    The status and protocol content of GB trials is no longer updated since 1 January 2021. For the UK, as of 31 January 2021, EU Law applies only to the territory of Northern Ireland (NI) to the extent foreseen in the Protocol on Ireland/NI. Legal notice
    As of 31 January 2023, all EU/EEA initial clinical trial applications must be submitted through CTIS . Updated EudraCT trials information and information on PIP/Art 46 trials conducted exclusively in third countries continues to be submitted through EudraCT and published on this website.

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