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    Clinical Trial Results:
    A 16-week randomized, open-label, multicenter study to assess the superiority of secukinumab over guselkumab in the complete treatment of ustekinumab-resistant psoriatic plaques – ARROW

    Summary
    EudraCT number
    2018-001048-70
    Trial protocol
    DE  
    Global end of trial date
    28 Jan 2020

    Results information
    Results version number
    v1(current)
    This version publication date
    06 Feb 2021
    First version publication date
    06 Feb 2021
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    CAIN457A2403
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT03553823
    WHO universal trial number (UTN)
    -
    Other trial identifiers
    EudraCT: 2018-001048-70
    Sponsors
    Sponsor organisation name
    Novartis Pharma AG
    Sponsor organisation address
    CH-4002, Basel, Switzerland,
    Public contact
    Clinical Disclosure Office, Novartis Pharma AG, 41 613241111, novartis.email@novartis.com
    Scientific contact
    Study Director, Novartis Pharma AG, 1 8627788300, novartis.email@novartis.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
    28 Jan 2020
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    28 Jan 2020
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    To assess the superiority of secukinumab over guselkumab in controlling clinical activity in psoriatic plaques resistant to treatment with ustekinumab
    Protection of trial subjects
    The study was in compliance with the ethical principles derived from the Declaration of Helsinki and the International Conference on Harmonization (ICH) Good Clinical Practice (GCP) guidelines. All the local regulatory requirements pertinent to safety of trial subjects were also followed during the conduct of the trial.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    14 Jan 2019
    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
    Canada: 4
    Country: Number of subjects enrolled
    Germany: 28
    Country: Number of subjects enrolled
    United States: 8
    Worldwide total number of subjects
    40
    EEA total number of subjects
    28
    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)
    36
    From 65 to 84 years
    4
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    The Screening Phase was completed by 40 (95.2%) of the 42 subjects screened. One (2.4%) subject was rescreened and 2 (4.8%) subjects failed screening

    Pre-assignment
    Screening details
    39 (97.5%) subjects completed this trial

    Period 1
    Period 1 title
    Overall Study (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Not blinded
    Blinding implementation details
    open-label

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    secukinumab
    Arm description
    20 subjects with plaque psoriasis with an inadequate response to ustekinumab self-administered 300 mg secukinumab as two 150-mg s.c. injections at Baseline, Weeks 1, 2, 3, 4 and then every 4 weeks until Week 12 inclusive
    Arm type
    Experimental

    Investigational medicinal product name
    secukinumab
    Investigational medicinal product code
    Other name
    AIN457
    Pharmaceutical forms
    Injection
    Routes of administration
    Subcutaneous use
    Dosage and administration details
    150 mg s.c.

    Arm title
    guselkumab
    Arm description
    20 subjects with plaque psoriasis with an inadequate response to ustekinumab self-administered guselkumab as 100 mg s.c. injections at Baseline, Weeks 4, and 12.
    Arm type
    Active comparator

    Investigational medicinal product name
    guselkumab
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Injection
    Routes of administration
    Subcutaneous use
    Dosage and administration details
    100 mg s.c.

    Number of subjects in period 1
    secukinumab guselkumab
    Started
    20
    20
    Completed
    20
    19
    Not completed
    0
    1
         Physician decision
    -
    1

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    secukinumab
    Reporting group description
    20 subjects with plaque psoriasis with an inadequate response to ustekinumab self-administered 300 mg secukinumab as two 150-mg s.c. injections at Baseline, Weeks 1, 2, 3, 4 and then every 4 weeks until Week 12 inclusive

    Reporting group title
    guselkumab
    Reporting group description
    20 subjects with plaque psoriasis with an inadequate response to ustekinumab self-administered guselkumab as 100 mg s.c. injections at Baseline, Weeks 4, and 12.

    Reporting group values
    secukinumab guselkumab Total
    Number of subjects
    20 20 40
    Age Categorical
    Units:
        <=18 years
    0 0 0
        Between 18 and 65 years
    17 19 36
        >=65 years
    3 1 4
    Age Continuous
    Units: Mean
        arithmetic mean (standard deviation)
    47.6 ± 15.10 48.5 ± 12.30 -
    Sex: Female, Male
    Units:
        Female
    6 5 11
        Male
    14 15 29
    Race/Ethnicity, Customized
    Units: Subjects
        White
    17 20 37
        Black or African American
    2 0 2
        Asian
    1 0 1

    End points

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    End points reporting groups
    Reporting group title
    secukinumab
    Reporting group description
    20 subjects with plaque psoriasis with an inadequate response to ustekinumab self-administered 300 mg secukinumab as two 150-mg s.c. injections at Baseline, Weeks 1, 2, 3, 4 and then every 4 weeks until Week 12 inclusive

    Reporting group title
    guselkumab
    Reporting group description
    20 subjects with plaque psoriasis with an inadequate response to ustekinumab self-administered guselkumab as 100 mg s.c. injections at Baseline, Weeks 4, and 12.

    Primary: Proportion of subjects whose plaque achieves “clear” or “almost clear” status (TCS = 0-2)

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    End point title
    Proportion of subjects whose plaque achieves “clear” or “almost clear” status (TCS = 0-2)
    End point description
    Total clinical score: number (%) of subjects who responded at Week 16 (FAS)
    End point type
    Primary
    End point timeframe
    16 week
    End point values
    secukinumab guselkumab
    Number of subjects analysed
    20
    20
    Units: participants
    12
    8
    Statistical analysis title
    Subjects with “clear” or “almost clear”(TCS = 0-2)
    Statistical analysis description
    Proportion of Subjects whose plaque achieves “clear” or “almost clear” status (TCS = 0-2)
    Comparison groups
    secukinumab v guselkumab
    Number of subjects included in analysis
    40
    Analysis specification
    Pre-specified
    Analysis type
    P-value
    = 0.1715
    Method
    Fisher exact
    Parameter type
    Difference secukinumab vs guselkumab
    Point estimate
    20
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -13.3
         upper limit
    50.3

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Adverse Events (AEs) were collected for duration of study to week 16
    Adverse event reporting additional description
    Adverse Events are any untoward sign or symptom that occurs during the study treatment period
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    20.1
    Reporting groups
    Reporting group title
    Secukinumab
    Reporting group description
    Secukinumab

    Reporting group title
    Guselkumab
    Reporting group description
    Guselkumab

    Serious adverse events
    Secukinumab Guselkumab
    Total subjects affected by serious adverse events
         subjects affected / exposed
    2 / 20 (10.00%)
    1 / 20 (5.00%)
         number of deaths (all causes)
    0
    0
         number of deaths resulting from adverse events
    0
    0
    Gastrointestinal disorders
    Gastritis
         subjects affected / exposed
    1 / 20 (5.00%)
    0 / 20 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Hepatobiliary disorders
    Cholelithiasis
         subjects affected / exposed
    0 / 20 (0.00%)
    1 / 20 (5.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Infections and infestations
    Pneumonia
         subjects affected / exposed
    1 / 20 (5.00%)
    0 / 20 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 2%
    Non-serious adverse events
    Secukinumab Guselkumab
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    11 / 20 (55.00%)
    5 / 20 (25.00%)
    Investigations
    Blood bilirubin increased
         subjects affected / exposed
    1 / 20 (5.00%)
    0 / 20 (0.00%)
         occurrences all number
    1
    0
    Injury, poisoning and procedural complications
    Wound dehiscence
         subjects affected / exposed
    1 / 20 (5.00%)
    0 / 20 (0.00%)
         occurrences all number
    1
    0
    Eye disorders
    Dacryostenosis acquired
         subjects affected / exposed
    1 / 20 (5.00%)
    0 / 20 (0.00%)
         occurrences all number
    1
    0
    Reproductive system and breast disorders
    Balanoposthitis
         subjects affected / exposed
    1 / 20 (5.00%)
    0 / 20 (0.00%)
         occurrences all number
    1
    0
    Respiratory, thoracic and mediastinal disorders
    Asthma
         subjects affected / exposed
    1 / 20 (5.00%)
    0 / 20 (0.00%)
         occurrences all number
    1
    0
    Skin and subcutaneous tissue disorders
    Dyshidrotic eczema
         subjects affected / exposed
    0 / 20 (0.00%)
    1 / 20 (5.00%)
         occurrences all number
    0
    1
    Eczema
         subjects affected / exposed
    0 / 20 (0.00%)
    1 / 20 (5.00%)
         occurrences all number
    0
    1
    Hyperhidrosis
         subjects affected / exposed
    0 / 20 (0.00%)
    1 / 20 (5.00%)
         occurrences all number
    0
    1
    Miliaria
         subjects affected / exposed
    1 / 20 (5.00%)
    0 / 20 (0.00%)
         occurrences all number
    1
    0
    Renal and urinary disorders
    Acute kidney injury
         subjects affected / exposed
    1 / 20 (5.00%)
    0 / 20 (0.00%)
         occurrences all number
    1
    0
    Musculoskeletal and connective tissue disorders
    Back pain
         subjects affected / exposed
    0 / 20 (0.00%)
    1 / 20 (5.00%)
         occurrences all number
    0
    1
    Infections and infestations
    Bronchitis
         subjects affected / exposed
    0 / 20 (0.00%)
    1 / 20 (5.00%)
         occurrences all number
    0
    1
    Erysipelas
         subjects affected / exposed
    1 / 20 (5.00%)
    0 / 20 (0.00%)
         occurrences all number
    1
    0
    Herpes zoster
         subjects affected / exposed
    1 / 20 (5.00%)
    0 / 20 (0.00%)
         occurrences all number
    1
    0
    Nasopharyngitis
         subjects affected / exposed
    2 / 20 (10.00%)
    1 / 20 (5.00%)
         occurrences all number
    3
    1
    Postoperative wound infection
         subjects affected / exposed
    1 / 20 (5.00%)
    0 / 20 (0.00%)
         occurrences all number
    1
    0
    Sepsis
         subjects affected / exposed
    1 / 20 (5.00%)
    0 / 20 (0.00%)
         occurrences all number
    1
    0
    Vulvovaginal mycotic infection
         subjects affected / exposed
    1 / 20 (5.00%)
    0 / 20 (0.00%)
         occurrences all number
    1
    0
    Metabolism and nutrition disorders
    Gout
         subjects affected / exposed
    2 / 20 (10.00%)
    0 / 20 (0.00%)
         occurrences all number
    2
    0
    Hyperglycaemia
         subjects affected / exposed
    1 / 20 (5.00%)
    0 / 20 (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? No

    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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    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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