The purpose of this study is to assess the effect of adalimumab (Humira), when compared to NB-UVB (narrow-band ultraviolet B) phototherapy or placebo (an inactive substance that may resemble an active substance but has no medical value) injection. The study will compare the effects of each on systemic inflammation and cardiovascular disease risk factors in subjects diagnosed with moderate to severe psoriasis. This study will look for systemic vascular inflammation in subjects with a test called FDG-PET/CT (Fluorodeoxyglucose-positron emission tomography/computed tomography). The study will also look for cardio metabolic (heart disease and metabolic factors such as diabetes) identifiers in the blood. A blood sample will be taken that will look for these markers identifying high cholesterol, cholesterol efflux function (the ability of cholesterol to move in the body), metabolic factors, and inflammation. This study will also assess the effect of adalimumab (Humira), when compared to NB-UVB phototherapy or placebo injection on psoriasis activity and severity. The study will also compare the safety of adalimumab (Humira) to NB-UVB phototherapy or placebo injection. This study will also evaluate subjects' reported outcomes through a questionnaire that will assess quality-of-life in subjects living with psoriasis.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
97
Humira will be given at an initial dose of 80mg followed by 40 mg the second week, subsequent doses will be given at 40mg and follow FDA dosing schedule.
Placebo injection will be given according to the same dose and schedule as the active comparator.
Phototherapy will be given 3 times per week according to the Fitzpatrick scale for skin types.
University of California, Davis Health System
Sacramento, California, United States
The University of Colorado
Denver, Colorado, United States
National Heart, Lung, and Blood Institute
Bethesda, Maryland, United States
Buffalo Medical Group
Buffalo, New York, United States
Oregon Health & Science University
Portland, Oregon, United States
The University of Pennsylvania
Philadelphia, Pennsylvania, United States
Menter Dermatology Research Institute
Dallas, Texas, United States
Center for Clinical Studies
Houston, Texas, United States
University of Utah
Salt Lake City, Utah, United States
Change in Vascular Inflammation
Change in total vascular inflammation of five aortic segments as assessed on FDG-PET/CT between baseline and week 12. The arterial uptake of FDG is measured by the standardized uptake value (SUV) max divided by the venous SUV mean yielding a target to background ratio (TBR).
Time frame: Baseline - Week 12
Change in Cardiometabolic Biomarkers: Total Cholesterol
To assess the effects of adalimumab, as compared to NB-UVB phototherapy or placebo, in patients with moderate to severe psoriasis on total cholesterol.
Time frame: Baseline - Week 12
Change in Cardiometabolic Biomarkers: Cholesterol Efflux
To assess the effects of adalimumab, as compared to NB-UVB phototherapy or placebo, in patients with moderate to severe psoriasis on cholesterol efflux capacity. The ability to promote cholesterol efflux from macrophages is a classic function of HDL that is thought to be an important mechanism by which HDL protects against atherosclerosis. HDL cholesterol efflux capacity assays are performed based on published methods using J774 cells derived from a murine macrophage cell line (Mehta NN Atherosclerosis 2012). Efflux is calculated as a unitless measure by using the following formula: \[(µCi of 3H-cholesterol in media containing apoB-depleted subject plasma - µCi of 3H-cholesterol in plasma-free media) / (µCi of 3H-cholesterol in media containing apoB-depleted pooled control plasma-µCi of 3H-cholesterol in pooled control plasma-free media)\]. The pooled plasma was obtained from five healthy volunteers.
Time frame: Baseline - Week 12
Change in Cardiometabolic Biomarkers: Low Density Lipoprotein Particle Total
To assess the effects of adalimumab, as compared to NB-UVB phototherapy or placebo, in patients with moderate to severe psoriasis on low density lipoprotein particle total.
Time frame: Baseline - Week 12
Change in Cardiometabolic Biomarkers: High Density Lipoprotein Particle Total
To assess the effects of adalimumab, as compared to NB-UVB phototherapy or placebo, in patients with moderate to severe psoriasis on high density lipoprotein particle total.
Time frame: Baseline - Week 12
Change in Cardiometabolic Biomarkers: Log Insulin
To assess the effects of adalimumab, as compared to NB-UVB phototherapy or placebo, in patients with moderate to severe psoriasis on log insulin.
Time frame: Baseline - Week 12
Change in Cardiometabolic Biomarkers: Log Adiponectin
To assess the effects of adalimumab, as compared to NB-UVB phototherapy or placebo, in patients with moderate to severe psoriasis on log adiponectin.
Time frame: Baseline - Week 12
Change in Cardiometabolic Biomarkers: Log Leptin
To assess the effects of adalimumab, as compared to NB-UVB phototherapy or placebo, in patients with moderate to severe psoriasis on log leptin.
Time frame: Baseline - Week 12
Change in Cardiometabolic Biomarkers: Log C-reactive Protein
To assess the effects of adalimumab, as compared to NB-UVB phototherapy or placebo, in patients with moderate to severe psoriasis on log C-reactive protein (CRP).
Time frame: Baseline - Week 12
Change in Cardiometabolic Biomarkers: Log Tumor Necrosis Factor-alpha
To assess the effects of adalimumab, as compared to NB-UVB phototherapy or placebo, in patients with moderate to severe psoriasis on log Tumor necrosis factor-alpha.
Time frame: Baseline - Week 12
Change in Cardiometabolic Biomarkers: Log Interleukin 6
To assess the effects of adalimumab, as compared to NB-UVB phototherapy or placebo, in patients with moderate to severe psoriasis on log interleukin 6.
Time frame: Baseline - Week 12
Change in Cardiometabolic Biomarkers: GlycA
To assess the effects of adalimumab, as compared to NB-UVB phototherapy or placebo, in patients with moderate to severe psoriasis on GlycA
Time frame: Baseline - Week 12
Change in Psoriasis Activity (PASI-75 and PGA)
Psoriasis activity will be assessed using standard psoriasis measurements, PASI75 and PGA Clear/Almost Clear
Time frame: Baseline - Week 12
Change in Patient-reported Outcomes-EuroQol EQ-5D
EQ-5D is a standardized instrument developed by the EuroQol Group as a measure of health-related quality of life that can be used in a wide range of health conditions and treatments. The EQ-5D consists of a descriptive system and the EQ VAS. The descriptive system comprises five dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression on a scale ranging from 1 (no health state problem) to 3 (extreme health state problems). The EQ VAS records the patient's self-rated health on a vertical visual analogue scale ranging from 0, worst health state, to 100, best health state. A scoring function is used to assign a value (i.e., EQ-5D™ index score) to self-reported health states from a set of population-based preference weights. For the U.S. general population, the possible EQ-5D index scores range from -0.11 to 1.0 where 0.0 = death and 1.0 = perfect health.
Time frame: Baseline -Week 12
Change in Patient-reported Outcomes-Dermatology Life Quality Index (DLQI)
Patient reported quality of life outcomes will be assessed using DLQI. The DLQI is calculated by summing the score of 10 questions regarding impact of skin condition on daily life resulting in a maximum of 30 and a minimum of 0. The higher the score, the more quality of life is impaired.
Time frame: Baseline - Week 12
Change in Patient-reported Outcomes-MEDFICTS Dietary Assessment)
Patient reported dietary outcomes will be assessed using MEDFICTS (Meats, Eggs, Dairy, Fried foods, fat In baked goods, Convenience foods, fats added at the Table, and Snacks), a brief dietary assessment instrument for properly assessing cardiovascular diet. The questionnaire yields a continuous score (ranging from 0 to 216), with a score of \<40 indicating adherence to the Therapeutic Lifestyle Changes (TLC) diet (intake of \<7% of energy from saturated fat, \<30% of energy from total fat, and \<200 mg dietary cholesterol/day).
Time frame: Baseline to Week 12
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Change in Patient-reported Outcomes-International Physical Activity Questionnaire (IPAQ)
Patient reported physical activity will be assessed using IPAQ. IPAQ is an instrument designed primarily for population surveillance of physical activity among adults with activity measured in metabolic equivalent (MET)-minutes per week.
Time frame: Baseline week 4, 8 and 12
Number of Patients With Adverse Events.
Safety will be assessed by comparing how many patients have adverse events depending on whether they are on adalimumab, as compared to NB-UVB phototherapy or placebo.
Time frame: Baseline - Week 12