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    Summary
    EudraCT Number:2018-002748-10
    Sponsor's Protocol Code Number:CC-10004-PSA-014
    National Competent Authority:Spain - AEMPS
    Clinical Trial Type:EEA CTA
    Trial Status:Completed
    Date on which this record was first entered in the EudraCT database:2019-01-18
    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 ConcernedSpain - AEMPS
    A.2EudraCT number2018-002748-10
    A.3Full title of the trial
    A Phase 4, Multicenter, Single-Arm, Open-Label Study to Evaluate the Impact of Apremilast (CC-10004) on MRI Outcomes in Subjects with Psoriatic Arthritis
    Estudio de fase 4, multicéntrico, abierto, de un solo grupo para evaluar el efecto de apremilast (CC-10004) sobre los resultados de la RM en pacientes con artritis psoriásica
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A clinical trial that will look at the effect of Apremilast on MRI Outcomes in Patients with Psoriatic Arthritis
    Ensayo clínico para evaluar el efecto de apremilast en los resultados de la RM en pacientes con artritis psoriásica.
    A.3.2Name or abbreviated title of the trial where available
    MOSAIC
    A.4.1Sponsor's protocol code numberCC-10004-PSA-014
    A.5.4Other Identifiers
    Name:INDNumber:101761
    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 Corporation
    B.5.2Functional name of contact pointClinicalTrialDisclosure
    B.5.3 Address:
    B.5.3.1Street Address9225 Indian Creek Parkway, Suite 900
    B.5.3.2Town/ cityOverland Park, Kansas
    B.5.3.3Post code66210
    B.5.3.4CountryUnited States
    B.5.4Telephone number+34914229000
    B.5.5Fax number+1913266 0394
    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 Yes
    D.2.1.1.1Trade name Otezla
    D.2.1.1.2Name of the Marketing Authorisation holderCelgene Europe BV
    D.2.1.2Country which granted the Marketing AuthorisationEuropean Union
    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 Film-coated 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 10 mg
    D.3.9.1CAS number 608141-41-9
    D.3.9.2Current sponsor codeCC-10004
    D.3.9.3Other descriptive nameAPREMILAST
    D.3.9.4EV Substance CodeSUB130837
    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 Yes
    D.2.1.1.1Trade name Otezla
    D.2.1.1.2Name of the Marketing Authorisation holderCelgene Europe BV
    D.2.1.2Country which granted the Marketing AuthorisationEuropean Union
    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 Film-coated 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 20 mg
    D.3.9.1CAS number 608141-41-9
    D.3.9.2Current sponsor codeCC-10004
    D.3.9.3Other descriptive nameAPREMILAST
    D.3.9.4EV Substance CodeSUB130837
    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 Yes
    D.2.1.1.1Trade name Otezla
    D.2.1.1.2Name of the Marketing Authorisation holderCelgene Europe BV
    D.2.1.2Country which granted the Marketing AuthorisationEuropean Union
    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 Film-coated 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 30 mg
    D.3.9.1CAS number 608141-41-9
    D.3.9.2Current sponsor codeCC-10004
    D.3.9.3Other descriptive nameAPREMILAST
    D.3.9.4EV Substance CodeSUB130837
    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
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Psoriatic arthritis
    Artritis psoriásica
    E.1.1.1Medical condition in easily understood language
    Psoriatic arthritis is a form of arthritis that affects some people who have psoriasis (scaly skin). Joint pain, stiffness and swelling are the main symptoms of psoriatic arthritis.
    La artritis psoriásica es una forma de artritis que afecta a algunas personas con psoriasis (piel con escamas). El dolor, la rigidez y la hinchazón de las articulaciones son sus principales síntomas.
    E.1.1.2Therapeutic area Diseases [C] - Immune System Diseases [C20]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.0
    E.1.2Level LLT
    E.1.2Classification code 10037160
    E.1.2Term Psoriatic arthritis
    E.1.2System Organ Class 100000004859
    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 efficacy of apremilast 30 mg twice a day (BID) on inflammation indices, assessed by magnetic resonance imaging (MRI) of the hand.
    El objetivo principal del estudio es evaluar la eficacia de apremilast 30 mg dos veces al día en los índices de inflamación, evaluados mediante RM de la mano.
    E.2.2Secondary objectives of the trial
    - The efficacy of apremilast 30 mg BID on imaging outcomes associated with structural progression,
    assessed by MRI of the hand.
    - The efficacy of apremilast 30 mg BID on disease activity and functionality, assessed by clinical outcomes
    - The efficacy of apremilast 30 mg BID on inflammation indices of peripheral arthritis and enthesitis, total (sum of arthritis and enthesitis) and separately, assessed by whole-body MRI (WB-MRI)
    - The efficacy of apremilast 30 mg BID on The European League Against Rheumatism Psoriatic Arthritis Impact of Disease 12 domains (PsAID-12)
    - The safety and tolerability of apremilast 30 mg BID
    - Evaluar la eficacia de apremilast 30 mg dos veces al día en los resultados de imagen asociados a la progresión estructural, evaluada mediante RM de la mano.
    - Evaluar la eficacia de apremilast 30 mg dos veces al día sobre la actividad de la enfermedad y la funcionalidad, evaluada mediante resultados clínicos.
    - Evaluar la eficacia de apremilast 30 mg dos veces al día sobre los índices de inflamación de artritis periférica y entesitis, en total (suma de artritis y entesitis) y por separado, evaluado mediante RM de cuerpo entero (RM-CE).
    - Evaluar la eficacia de apremilast 30 mg dos veces al día en el PsAID-12.
    - Evaluar la seguridad y la tolerabilidad de apremilast 30 mg dos veces al día.
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1. Males or females, aged ≥ 18 years at time of consent
    2. For all regions, the local Regulatory Label for treatment with apremilast must be followed. For example, subjects in the EU must have had inadequate response or intolerance to a prior csDMARD.
    3. Must understand and voluntarily sign an informed consent document prior to any study related assessments/procedures being conducted
    4. Able to adhere to the study visit schedule and other protocol requirements
    5. Have a documented diagnosis of PsA of ≥ 3 months AND ≤ 5 years in duration, meeting the CASPAR criteria for PsA (Appendix B, Taylor, 2006) at the time of Screening Visit
    6. Have ≥ 3 swollen AND ≥ 3 tender joints, with hand involvement (defined as ≥ 1 swollen joint or dactylitis [each clinically active joint of a dactylitic digit is counted as one joint]).
    7. Have at least 1 active enthesitis site (one of the SPARCC or LEI sites)
    8. Must not have been treated previously with a TNF blocker or other biologic drug for PsA treatment
    9. Must not have been treated with more than 2 csDMARDs
    10. Subjects taking csDMARDs, with the exception of MTX, cyclosporine, or LEF (see Section 4.4, Exclusion Criterion 18, 19 and 20), do not require a washout period. However, they must discontinue the csDMARD treatment at least one day prior to their Baseline Visit (ie, Visit 2, Day 1)
    11. Subjects who have been previously treated with MTX for < 6 months and who are not on stable doses for at least 3 months will require a 28-day washout prior to the Baseline Visit (ie, Visit 2, Day 1) to participate in the study
    12. Subjects who have been previously treated with LEF will require a 12-week washout prior to the Baseline Visit (ie, Visit 2, Day 1), or treatment with cholestyramine, per LEF
    prescribing label (ie, 8 g cholestyramine 3 times daily for 11 days)
    13. Subjects who have been previously treated with cyclosporine will require a 28-day washout prior to the Baseline Visit (ie, Visit 2, Day 1) to participate in the study
    14. If taking MTX (≤ 25 mg/week), continuity of treatment will be allowed if duration of treatment is ≥ 6 months and on a stable dose for at least 3 months prior to the Baseline Visit (ie, Visit 2, Day 1)
    15. If taking oral glucocorticoids, must be on a stable dose of prednisone ≤ 10 mg/day or equivalent for at least 4 weeks prior to the Baseline Visit (ie, Visit 2, Day 1)
    16. If taking NSAIDs or narcotic analgesics, must be on stable dose for at least 4 weeks prior to Baseline Visit (ie, Visit 2, Day 1)
    17. A female of childbearing potential (FCBP)† must have a negative pregnancy test at screening and baseline. While on IP and for at least 28 days after taking the last dose of IP, a FCBP who engages in activity in which conception is possible must use one of the approved
    contraceptive§ options described below:
    Option 1: Any one of the following highly effective methods: hormonal contraception (oral, injection, implant, transdermal patch, vaginal ring); intrauterine device; tubal ligation; or partner’s vasectomy;
    OR
    Option 2: Male or female condom (latex condom or non-latex condom NOT made out of natural [animal] membrane [for example, polyurethane]); PLUS one additional barrier
    method: (a) diaphragm with spermicide; (b) cervical cap with spermicide; or (c) contraceptive sponge with spermicide.
    † An FCBP is defined as a sexually mature female who 1) has not undergone a hysterectomy (the surgical removal of the uterus) or bilateral oophorectomy (the surgical removal of both ovaries) or 2) has not been postmenopausal for at least 24 consecutive months (that is, has had menses at any time during the preceding 24
    consecutive months).
    § The female subject’s chosen form of contraception must be effective by the time the female subject is screened into the study (for example, hormonal contraception should be initiated at least 28 days before screening).
    18. Must be in general good health (except for PsA) as judged by the investigator, based on medical history, physical examination, and clinical laboratories. (Note: The definition of good health means a subject does not have uncontrolled significant comorbid conditions).
    1. Pacientes de ambos sexos, de edad ≥ 18 años en el momento del consentimiento.
    2. En todas las regiones deberán seguirse las directrices reglamentarias locales para el tratamiento con apremilast. Por ejemplo, los sujetos de la UE deben haber tenido una respuesta insuficiente o intolerancia a un FARMEsc previo.
    3. Deben comprender y firmar voluntariamente el documento de consentimiento informado antes de someterse a ninguna evaluación o procedimiento relacionado con el presente estudio.
    4. Deben ser capaces de cumplir el calendario de visitas del estudio y los demás requisitos del protocolo.
    5. Deben tener un diagnóstico documentado de APs de ≥ 3 meses Y ≤ 5 años de duración, que cumpla los criterios CASPAR de APs (Apéndice B, Taylor, 2006) en el momento de la visita de selección.
    6. Deben presentar ≥ 3 articulaciones hinchadas Y ≥ 3 articulaciones dolorosas, con afectación de las manos (lo que se define como ≥ 1 articulación hinchada o con dactilitis [cada articulación clínicamente activa de un dedo con dactilitis se contabiliza como una articulación]).
    7. Presentan al menos 1 foco activo de entesitis (uno de los focos SPARCC o LEI).
    8. No deben haber recibido tratamiento previo con un antagonista del TNF u otro fármaco biológico para la APs.
    9. No deben haber recibido más de 2 FARMEsc.
    10. Los sujetos que estén tomando FARMEsc, a excepción de MTX, ciclosporina o LEF (véase la sección 4.4, criterios de exclusión 18, 19 y 20), no precisan un período de lavado. Sin embargo, deberán haber suspendido el tratamiento con el FARMEsc al menos un día antes de la visita basal (es decir, visita 2, día 1).
    11. Los sujetos que hayan sido tratados previamente con MTX durante menos de 6 meses y que no hayan recibido dosis estables durante al menos 3 meses necesitarán un período de lavado de 28 días antes de la visita basal (es decir, visita 2, día 1) para participar en el estudio.
    12. Los sujetos tratados previamente con LEF necesitarán un período de lavado de 12 semanas antes de la visita basal (es decir, visita 2, día 1) o tratamiento con colestiramina según la ficha técnica de LEF (es decir, 8 g de colestiramina 3 veces al día durante 11 días).
    13. Los sujetos tratados previamente con ciclosporina necesitarán un período de lavado de 28 días antes de la visita basal (es decir, visita 2, día 1) para participar en el estudio.
    14. En caso de estar recibiendo MTX (≤ 25 mg/semana), se permitirá la continuidad del tratamiento si la duración del tratamiento es ≥ 6 meses y se ha mantenido con una dosis estable durante al menos 3 meses antes de la visita basal (es decir, visita 2, día 1).
    15. Si están tomando glucocorticosteroides orales, deberán haber recibido una dosis estable de prednisona ≤ 10 mg/día o equivalente durante al menos 4 semanas antes de la visita basal (es decir, visita 2, día 1).
    16. Si están tomando AINE o analgésicos narcóticos, deberán haber recibido una dosis estable durante al menos 4 semanas antes de la visita basal (es decir, visita 2, día 1).
    17. Las mujeres en edad fértil (MEF)† deberán tener un resultado negativo en una prueba de embarazo realizada en las visitas de selección y basal. Mientras reciban el PEI y durante al menos 28 días después de la última dosis, las MEF que mantengan relaciones sexuales con riesgo de embarazo deberán utilizar uno de los métodos anticonceptivos aprobados§ que se describen a continuación:
    Opción 1: cualquiera de los siguientes métodos de gran eficacia: anticonceptivos hormonales (orales, inyectables, implantes, parche transdérmico, anillo vaginal), dispositivo intrauterino, ligadura de trompas o vasectomía de la pareja.
    O
    Opción 2: preservativo masculino o femenino (preservativo de látex o preservativo sin látex NO fabricado con membranas naturales [animales] [por ejemplo, de poliuretano]) MÁS un método de barrera adicional: (a) diafragma con espermicida, (b) capuchón cervical con espermicida o (c) esponja anticonceptiva con espermicida.
    † Una MEF es una mujer sexualmente madura que 1) no se ha sometido a una histerectomía (extirpación quirúrgica del útero) ni a una ovariectomía bilateral (extirpación quirúrgica de ambos ovarios) o 2) no ha presentado un estado posmenopáusico durante al menos 24 meses consecutivos (es decir, ha tenido la menstruación en algún momento durante los 24 meses consecutivos precedentes).
    § El método anticonceptivo escogido por la paciente debe ser completamente eficaz cuando comience la fase de selección para el estudio (es decir, los anticonceptivos hormonales deberán empezar a administrarse al menos 28 días antes de la selección).
    18. Buen estado general de salud (excepto por la artritis psoriásica) según el criterio del investigador, basándose en la historia clínica, la exploración física y los análisis clínicos. (Nota: por buena salud se entiende que el sujeto no tiene enfermedades concomitantes importantes no controladas).
    E.4Principal exclusion criteria
    1. Contraindication to MRI examination including, but not limited to, intracranial metal clips, heart pacemakers, insulin pumps, implanted hearing aids, neurostimulators, metal hip replacements, profound claustrophobia or inability to lie in the MRI machine in an appropriate position to obtain quality images
    2. Severe renal impairment (creatinine clearance of less than 30 mL per minute estimated by the Cockroft–Gault equation), which would prevent the use of gadolinium enhancement
    3. History of clinically significant (as determined by the investigator) cardiac, endocrine, pulmonary, neurologic, psychiatric, hepatic, renal, hematologic, immunologic disease, or other major uncontrolled disease
    4. Any condition, including the presence of laboratory abnormalities, which places the subject at unacceptable risk if he/she were to participate in the study
    5. Prior history of suicide attempt at any time in the subject’s lifetime prior to signing the informed consent, or major psychiatric illness requiring hospitalization within the last 3 years prior to signing the informed consent.
    6. Pregnant or breast feeding
    7. Active substance abuse or a history of substance abuse within 6 months prior to screening
    8. History of allergy to any component of the IP
    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. 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 and the infection cured, at least 4 weeks prior to screening and no new or recurrent infections prior to the Baseline Visit
    12. Malignancy or history of malignancy or myeloproliferative or lymphoproliferative disease within the past 3 years, except for treated (ie, cured) basal cell or squamous cell in situ skin carcinomas;
    13. Major surgery (including joint surgery) within 8 weeks prior to screening or planned major surgery within 6 months following Baseline Visit
    14. Rheumatic autoimmune disease other than PsA, including, but not limited to: systemic lupus erythematosus, mixed connective tissue disease, scleroderma, polymyositis, or fibromyalgia
    15. Prior history of or current inflammatory joint disease other than PsA (eg, gout, reactive arthritis, RA, ankylosing spondylitis, Lyme disease), which confounds the ability to interpret data from the study
    16. Prior treatment with any biologic DMARD
    17. Prior treatment with more than 2 csDMARDs
    18. Use of the following systemic therapy(ies) within 28 days of the Baseline Visit (ie, Visit 2, Day 1): cyclosporine or other calcineurin inhibitors, glucocorticoids exceeding 10 mg daily prednisone equivalent, as well as mycophenolate.
    19. Use of MTX within 4 weeks of the Baseline Visit (ie, Visit 2, Day 1), unless subject is on stable doses for at least 3 months and total treatment duration with MTX is ≥ 6 months
    20. Use of LEF within 12 weeks of the Baseline Visit (ie, Visit 2, Day 1), unless subject has taken cholestyramine, 8 g three times daily X 11 days after stopping LEF
    21. Previous treatment with a JAK inhibitor
    22. Prior treatment with apremilast, or participation in a clinical study involving apremilast
    23. Use of intra-articular (IA) glucocorticoid injection within 8 weeks before the Baseline Visit (ie, Visit 2, Day 1).
    24. Use of any investigational drug within 4 weeks of the Baseline Visit, or 5 pharmacokinetic/pharmacodynamic half-lives, if known (whichever is longer)
    1. Contraindicación para la RM, entre otras, grapas metálicas intracraneales, marcapasos cardíacos, bombas de insulina, audífonos implantados, neuroestimuladores, prótesis de cadera metálicas, claustrofobia profunda o incapacidad para permanecer tumbado en el aparato de RM en una posición adecuada para obtener imágenes de calidad.
    2. Insuficiencia renal grave (aclaramiento de creatinina inferior a 30 ml por minuto calculado con la ecuación de Cockroft–Gault), que impediría el uso de realce con gadolinio.
    3. Antecedentes cardíacos, endocrinos, respiratorios, neurológicos, psiquiátricos, hepáticos, renales o hematológicos clínicamente significativos (en opinión del investigador), enfermedad inmunitarias u otras enfermedades importantes no controladas.
    4. Cualquier situación, incluida la presencia de anomalías analíticas, que entrañe un riesgo inaceptable para el sujeto en caso de participar en el estudio.
    5. Antecedentes de intento de suicidio en cualquier momento de la vida del sujeto antes de la firma del consentimiento informado o enfermedad psiquiátrica importante con necesidad de hospitalización en los 3 años anteriores a la firma del consentimiento informado.
    6. Embarazo o lactancia materna.
    7. Abuso actual de sustancias o antecedentes de abuso de sustancias en los seis meses previos a la selección.
    8. Antecedentes de alergia a alguno de los componentes del PEI.
    9. Antecedentes de seropositividad para el virus de la inmunodeficiencia humana (VIH) o inmunodeficiencia congénita o adquirida (por ejemplo, inmunodeficiencia variable común).
    10. Tuberculosis activa o antecedentes de tuberculosis tratada de forma incompleta.
    11. Infecciones bacterianas con necesidad de tratamiento con antibióticos orales o inyectables, o infecciones virales o fúngicas importantes, en las 4 semanas previas a la selección. El tratamiento de estas infecciones debe haber finalizado y la infección debe estar curada como mínimo 4 semanas antes de la selección, y no deben haberse producido infecciones nuevas ni recurrentes antes de la visita basal.
    12. Neoplasia maligna o antecedentes de neoplasia maligna o enfermedad mieloproliferativa o linfoproliferativa en los 3 últimos años, excepto carcinoma de piel basocelular o espinocelular in situ tratado (es decir, curado).
    13. Intervención de cirugía mayor (incluida la cirugía articular) en las 8 semanas previas a la selección o intervención de cirugía mayor programada en los 6 meses siguientes a la visita basal.
    14. Enfermedad autoinmunitaria reumática distinta de la APs, incluidas, entre otras: lupus eritematoso sistémico, enfermedad mixta del tejido conjuntivo, esclerodermia, polimiositis o fibromialgia.
    15. Antecedentes o presencia de artropatía inflamatoria distinta de la APs (por ejemplo, gota, artritis reactiva, AR, espondilitis anquilosante o enfermedad de Lyme), que dificulte la capacidad de interpretar los datos del estudio.
    16. Tratamiento previo con cualquier FARME biológico.
    17. Tratamiento previo con más de 2 FARMEsc.
    18. Uso de los siguientes tratamientos sistémicos en los 28 días previos a la visita basal (es decir, visita 2, día 1): ciclosporina u otros inhibidores de la calcineurina, glucocorticoides en dosis superiores a un equivalente a 10 mg diarios de prednisona, así como micofenolato.
    19. Uso de MTX en las 4 semanas previas a la visita basal (es decir, visita 2, día 1), a menos que el sujeto reciba dosis estables durante al menos 3 meses y la duración total del tratamiento con MTX sea ≥ 6 meses.
    20. Uso de LEF en las 12 semanas previas a la visita basal (es decir, visita 2, día 1), a menos que el sujeto haya tomado colestiramina, 8 g tres veces al día durante 11 días después de suspender LEF.
    21. Tratamiento previo con un inhibidor de JAK.
    22. Tratamiento previo con apremilast o participación en un estudio clínico de apremilast.
    23. Uso de glucocorticoides en inyección intraarticular (IA) en las 8 semanas previas a la visita basal (es decir, visita 2, día 1).
    24. Uso de cualquier fármaco en investigación en las 4 semanas anteriores a la visita basal o el periodo correspondiente a 5 semividas farmacocinéticas/farmacodinámicas, si se conoce (lo que suponga más tiempo).
    E.5 End points
    E.5.1Primary end point(s)
    Psoriatic Arthritis Magnetic Resonance Imaging Score (PsAMRIS) Inflammation Score of bone marrow edema [BME] + synovitis + tenosynovitis
    Puntuación de inflamación del edema de la médula ósea [BME] + sinovitis + tenosinovitis basada en la PsAMRIS (Puntuación de la artritis psoriásica mediante resonancia magnética).
    E.5.1.1Timepoint(s) of evaluation of this end point
    Week 24
    Semana 24
    E.5.2Secondary end point(s)
    EFFICACY ENDPOINTS
    1. PsAMRIS Inflammation Score of BME + Synovitis + Tenosynovitis
    2. PsAMRIS BME + Synovitis
    3. PsAMRIS Total Inflammation Score (BME + Synovitis + Tenosynovitis + Periarticular Inflammation)
    4. PsAMRIS BME
    5. PsAMRIS Synovitis
    6. PsAMRIS Tenosynovitis
    7. PsAMRIS Periarticular Inflammation
    8. PsAMRIS Total Damage Score (erosion + bone proliferation)
    9. PsAMRIS Erosion
    10. PsAMRIS Bone Proliferation
    11. Swollen Joint Count (SJC)
    12. Tender Joint Count (TJC)
    13. Clinical Disease Activity Index for Psoriatic Arthritis (c-DAPSA)
    14. Spondyloarthritis Research Consortium of Canada (SPARCC)
    15. Leeds Enthesitis Index (LEI)
    16. Enthesitis improvement to 0
    17. Leeds Dactylitis Index (LDI)
    18. Dactylitis improvement to 0
    19. Psoriatic Arthritis Disease Activity Score (PASDAS)
    20. Evaluator’s Global Assessment of Disease Activity
    21. Subject’s Global Assessment of Disease Activity
    22. Subject's Assessment of Pain
    23. Health Assessment Questionnaire-Disability Index (HAQ-DI)
    24. WB-MRI Peripheral Enthesitis Inflammation Index
    25. WB-MRI Peripheral Joints Inflammation Index
    26. WB-MRI Total Peripheral Inflammation Index
    27. BASDAI
    28. The European League Against Rheumatism Psoriatic Arthritis Impact of Disease 12 domains (PsAID-12)
    SAFETY ENDPOINTS
    29. Adverse events (AEs)
    30. Discontinuation due to AEs
    31. Clinically significant changes in physical examination, vital signs, and/or laboratory findings
    CRITERIOS DE VALORACIÓN DE LA EFICACIA
    1. Puntuación de inflamación BME + sinovitis + tenosinovitis basada en la PsAMRIS.
    2. BME + sinovitis basada en la PsAMRIS.
    3. Puntuación total de la inflamación (BME + sinovitis + tenosinovitis + inflamación periarticular) basada en la PsAMRIS.
    4. BME basada en la PsAMRIS.
    5. Sinovitis basada en la PsAMRIS.
    6. Tenosinovitis basada en la PsAMRIS.
    7. Inflamación periarticular basada en la PsAMRIS.
    8. Puntuación total del daño (erosión + proliferación ósea) basada en la PsAMRIS.
    9. Erosión basada en la PsAMRIS.
    10. Proliferación ósea basada en la PsAMRIS.
    11. Recuento de articulaciones hinchadas (RAH).
    12. Recuento de articulaciones dolorosas (RAD).
    13. Índice de actividad clínica de la enfermedad en la artritis psoriásica (c-DAPSA).
    14. Spondyloarthritis Research Consortium of Canada (SPARCC).
    15. Índice de entesitis de Leeds (LEI).
    16. Mejoría de la entesitis a 0.
    17. Índice de dactilitis de Leeds (LDI).
    18. Mejoría de la dactilitis a 0.
    19. Puntuación de actividad de la artritis psoriásica (PASDAS).
    20. Evaluación global de la actividad de la enfermedad por el evaluador.
    21. Evaluación global de la actividad de la enfermedad por el sujeto.
    22. Evaluación del dolor por el sujeto.
    23. Cuestionario de evaluación de la salud - Índice de discapacidad (HAQ-DI).
    24. WB-MRI Índice de inflamación de la entesitis periférica.
    25. WB-MRI Índice de inflamación de articulaciones periféricas.
    26. WB-MRI Índice de inflamación periférica total.
    27. BASDAI.
    28. Cuestionario de 12 dominios sobre el impacto de la artritis psoriásica de la European League Against Rheumatism (PsAID-12).
    CRITERIOS DE VALORACIÓN DE LA SEGURIDAD
    29. Acontecimientos adversos (AA).
    30. Retirada por AA.
    31. Variaciones clínicamente significativas en la exploración física, las constantes vitales o los resultados analíticos.
    E.5.2.1Timepoint(s) of evaluation of this end point
    #1: Week 48.
    #2 - #28: Week 24 & 48
    #29 - #31: throughout the study
    #1: Semana 48.
    #2 - #28: Semana 24 y 48
    #29 - #31: a lo largo del estudio
    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 No
    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) No
    E.7.4Therapeutic use (Phase IV) Yes
    E.8 Design of the trial
    E.8.1Controlled No
    E.8.1.1Randomised No
    E.8.1.2Open Yes
    E.8.1.3Single blind No
    E.8.1.4Double blind No
    E.8.1.5Parallel group No
    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 No
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial1
    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 concerned3
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA24
    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
    Austria
    Belgium
    Canada
    Denmark
    France
    Germany
    Italy
    Russian Federation
    Spain
    Switzerland
    United Kingdom
    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
    The End of Trial is defined as either the date of the last visit of the last subject to complete the post-treatment follow-up, or the date of receipt of the last data point from the last subject that is required for primary, secondary and/or exploratory analysis, as prespecified in the protocol, whichever is the later date.
    El final del ensayo se define como la fecha de la última visita del último sujeto que complete el seguimiento posterior al tratamiento, o la fecha de recepción de los últimos datos correspondientes al último sujeto que sean necesarios para los análisis principales, secundarios o exploratorios, tal como se especifique en el protocolo, lo que ocurra más tarde.
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years2
    E.8.9.1In the Member State concerned months2
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years2
    E.8.9.2In all countries concerned by the trial months2
    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.1.1.1In 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.1.2.1Number of subjects for this age range: 105
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 15
    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 state15
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 80
    F.4.2.2In the whole clinical trial 120
    F.5 Plans for treatment or care after the subject has ended the participation in the trial (if it is different from the expected normal treatment of that condition)
    This is left at the discretion of the treating physician. As Otezla (apremilast) is an approved, marketed product, subjects who benefit from treatment with apremilast during the CC-10004-PSA-014 study will have the option to receive Otezla in accordance with the marketing authorization in their respective country. Subjects are also required to meet a specific Inclusion Criterion to support compliance with the local marketing authorization.
    Esto quedará a criterio del médico responsable del tratamiento. Dado que Otezla (apremilast) es un producto aprobado y comercializado, los sujetos que se beneficien del tratamiento con apremilast durante el estudio CC-10004-PSA-014 tendrán la opción de recibir Otezla de acuerdo con la autorización de comercialización en su país. Los sujetos también deberán cumplir un criterio de inclusión específico para asegurar el cumplimiento de la autorización de comercialización local.
    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 Decision2019-03-25
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2019-02-27
    P. End of Trial
    P.End of Trial StatusCompleted
    P.Date of the global end of the trial2022-05-11
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