This is a multicenter, multinational (12 centers planned, in Germany 9 centers and in France, the Netherlands and the United Kingdom (UK) 1 center in each country respectively), randomized, double-blinded, placebo-controlled study. The primary objective is to evaluate the efficacy of methotrexate (MTX) in patients with moderate to severe Psoriasis compared to Placebo as assessed by the primary endpoint "75% reduction of Psoriasis Area Severity Index" (PASI 75 ) during a 16 week treatment phase. As secondary objectives the safety and efficacy of the optimized treatment schedule will be assessed using multiple methods (e.g. (Serious) Adverse Events ((S)AE) occurrence and questionnaires)
The present study was initiated to further increase the knowledge about the optimal dosing regimen and to thus optimize the efficacy and safety of MTX treatment for patients with moderate to severe psoriasis. In view of the described risk-benefit profile of MTX, an initial dose of at least 15 mg per week administered subcutaneously followed by 5 mg folic acid p.o. 24 hours after MTX application seems appropriate. Since 20 mg MTX per week has been proven to be beneficial in a considerable part of patients, who did not respond sufficiently to 15 mg MTX per week, in this study the dosing starts with a dose of 17.5 mg MTX per week, administered subcutaneously. At such a starting dose, it was expected to find the highest MTX efficacy possible, but with appropriate safety margins. If in a patient, a "50% reduction of Psoriasis Area Severity Index" PASI50 response is not achieved in week 8, the dose will be increased to 22.5 mg MTX per week. All dosages used in this study lay within the approved dosing range of MTX. The study will be conducted in a double-blind, placebo controlled manner. Placebo was chosen as control since only this comparator allows a reliable interpretation of safety and efficacy data.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Masking
DOUBLE
Enrollment
120
methotrexate 50 mg/ml in syringes for sub-cutaneous injection; Once weekly (every 7 days) s.c. administration of 17.5 mg MTX; If PASI50 is not reached after 8 weeks, the dosing will be increased to 22.5 mg
NaCl-Solution manufactured to mimic Methotrexate
Psoriasis-Zentrum, Universitäts-Hautklinik Kiel
Kiel, Schleswig-Holstein, Germany
Difference in 75% reduction of Psoriasis Area Severity Index (PASI75) responder rate between treatment arms
Time frame: week 16
Difference in PASI75 responder rate between treatment arms
Time frame: weeks 52
Difference in 50% reduction of Psoriasis Area Severity Index (PASI50)
Time frame: weeks 15 and 52
Difference in 90% reduction of Psoriasis Area Severity Index (PASI90)
Time frame: weeks 15 and 52
PASI75 in placebo arm (cross-over)
Time frame: weeks 32
Difference in Nail Psoriasis Severity Index (NAPSI)
Time frame: weeks 16 and 52
Difference in Body Surface Area Index (BSA)
Time frame: weeks 16 and 52
Difference in Physician's Global Assessment (PGA)
Time frame: weeks 16 and 52
Difference in Psoriatic Arthritis Index (PsA)
Time frame: weeks 16 and 52
Difference in Patient's satisfaction with metex® pre-filled syringe (PSAT metex®)
Time frame: weeks 16 and 52
Difference in Dermatology Life Quality Index (DLQI)
Time frame: weeks 16 and 52
Difference in European Qualification-5D-Questionnaire (EQ-5D)
Time frame: weeks 16 and 52
Safety and tolerability assessed by Adverse Events (AE)/ Serious Adverse Events (SAE) tolerability at the site of administration
Time frame: week 0 - week 51
Safety and tolerability assessed by laboratory values
Time frame: week 0 - week 51
local tolerability at the site of administration assessed by Erythema
Erythema (redness): diameter (mm) and severity from none to severe (0 = none, 1= mild, 2 = moderate 3 = severe)
Time frame: week 0 - week 51
local tolerability at the site of administration assessed by Swelling
Swelling/Induration: diameter (mm) and severity from none to severe (0 = none, 1= mild, 2 = moderate 3 = severe)
Time frame: week 0 - week 51
local tolerability at the site of administration assessed by Hematoma
Hematoma: yes/ no and if present diameter (mm)
Time frame: week 0 - week 51
local tolerability at the site of administration assessed by Local Pain
Local pain - assessed by the study subject on a visual analogue scale (1-10)
Time frame: week 0 - week 51
local tolerability at the site of administration assessed by Pruritus
Pruritus - assessed by the study subject on a visual analogue scale (1-10)
Time frame: week 0 - week 51
Changes of levels of molecular biologic analysis
Time frame: at baseline and 16 weeks
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