The aim of the study is to evaluate the efficacy and safety of netakimab compared with placebo in a pediatric population of subjects over 6 years of age with moderate to severe plaque psoriasis. The study will have randomized, double-blind, placebo-controlled study with open-arm comparison.
Following screening, subjects will be randomized to receive either netakimab, placebo or adalimumab and enter the main study period. During the main study period, subjects will receive therapy with netakimab/placebo (double-blind arms) or adalimumab (open-label arm), which will be administered subcutaneously until week 12. At Week 12, after completion of all scheduled procedures subjects in groups netakimab/placebo will continue to receive open-label netakimab for up to week 58, subjects in group adalimumab will switch to open-label adalimumab after 8-week "washout" period. At Week 58, after completion of all scheduled procedures subjects with sPGA ≤1 will be re-randomised to recieve either netakimab or placebo in double-blind maner. The subjects with \>1 will continue to recieve open-label netakimab.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
140
netakimab will be administered subcutaneously with induction once a week for the first three weeks, then once every 4 weeks
placebo will be administered subcutaneously at a scheme masking netakimab treatment
adalimumab will be administered subcutaneously at weeks 1, 2, and then once every 2 weeks
Federal State Budgetary Educational Institution of Higher Education "Altai State Medical University" of the Ministry of Health of the Russian Federation
Barnaul, Russia
Proportion of subjects achieving PASI75
PASI combines assessments of the extent of body surface involvement in 4 regions (head \& neck(h), trunk(t), arms(u), legs(l)) \& severity of scaling (S), redness (R), \& plaque induration/infiltration (thickness, T) in each region. Severity is rated for each index (R, S, T) on a 0-4 scale (0 for no involvement up to 4 for severe involvement): 0 = none, 1 = slight, 2 = mild, 3 = moderate, 4 = severe Fraction of total body surface area (BSA) affected is graded on a 0-6 scale (0 for no involvement to 6 for 90% - 100% involvement): 0 = 0% (clear), 1 = \>0% to \<10%, 2 = 10% to \<30%, 3 = 30% to \<50%, 4 = 50% to \<70%, 5 = 70% to 90%, 6 = 90% to 100%. Overall score ranges from 0 (no psoriasis) to 72 (most severe disease).
Time frame: Week 12
Proportion of subjects achieving sPGA0/1
Static Physician Global Assessment (sPGA): The physician's global assessment of the Participant's psoriasis lesions at a given time point. Plaques are assessed for induration, erythema, and scaling, and an overall rating of psoriasis severity is given using the anchors of clear (0), minimal (1), mild (2), moderate (3), severe (4), or very severe (5). An sPGA assessed as either 0 or 1 represents a clinically meaningful response of minimal plaque severity or complete resolution of plaque psoriasis.
Time frame: Week 12
Proportion of subjects achieving PASI75
PASI combines assessments of the extent of body surface involvement in 4 regions (head \& neck(h), trunk(t), arms(u), legs(l)) \& severity of scaling (S), redness (R), \& plaque induration/infiltration (thickness, T) in each region. Severity is rated for each index (R, S, T) on a 0-4 scale (0 for no involvement up to 4 for severe involvement): 0 = none, 1 = slight, 2 = mild, 3 = moderate, 4 = severe Fraction of total BSA affected is graded on a 0-6 scale (0 for no involvement to 6 for 90% - 100% involvement): 0 = 0% (clear), 1 = \>0% to \<10%, 2 = 10% to \<30%, 3 = 30% to \<50%, 4 = 50% to \<70%, 5 = 70% to 90%, 6 = 90% to 100%. Overall score ranges from 0 (no psoriasis) to 72 (most severe disease).
Time frame: Week 58, Week 102
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State budgetary healthcare institution "Chelyabinsk Regional Clinical Dermatovenerological Dispensary"
Chelyabinsk, Russia
Limited Liability Company "Health Azbuka Medical Center"
Kazan', Russia
State Autonomous Healthcare Institution "Republic Clinical Dermatovenerologic Dispensary of the Ministry of Health of the Republic of Tatarstan named after Professor Ge"
Kazan', Russia
State Autonomous Healthcare Institution "Kuzbass Clinical Dermatovenerological Dispensary"
Kemerovo, Russia
Federal State Budgetary Educational Institution of Higher Education "Kirov State Medical University" of the Ministry of Health of the Russian Federation
Kirov, Russia
State budgetary healthcare institution "Clinical Dermatovenerologic Dispensary" of the Ministry of Health of the Krasnodar Territory
Krasnodar, Russia
Federal State Autonomous Institution "National Medical Research Center for Children's Health" of the Ministry of Health of the Russian Federation
Moscow, Russia
Federal State Budgetary Institution "State scientific centre of dermatovenerology and cosmetology" of the Ministry of health of Russian Federation, Nizhny Novgorod branch
Nizhny Novgorod, Russia
Federal State Budgetary Educational Institution of Higher Education "St. Petersburg State Pediatric Medical University" of the Ministry of Health of the Russian Federation
Saint Petersburg, Russia
...and 4 more locations
Proportion of subjects achieving sPGA0/1
Static Physician Global Assessment (sPGA): The physician's global assessment of the Participant's psoriasis lesions at a given time point. Plaques are assessed for induration, erythema, and scaling, and an overall rating of psoriasis severity is given using the anchors of clear (0), minimal (1), mild (2), moderate (3), severe (4), or very severe (5). An sPGA assessed as either 0 or 1 represents a clinically meaningful response of minimal plaque severity or complete resolution of plaque psoriasis.
Time frame: Week 58, Week 102
Proportion of subjects achieving IGA mod 2011 0/1
Investigator Global Assessment (IGA) mod 2011 provide the assessment of the disease severity from a score of 0 (clear skin) to 4 (severe disease)
Time frame: Week 12, Week 58, Week 102
Proportion of subjects achieving PASI90
PASI combines assessments of the extent of body surface involvement in 4 regions (head \& neck(h), trunk(t), arms(u), legs(l)) \& severity of scaling (S), redness (R), \& plaque induration/infiltration (thickness, T) in each region. Severity is rated for each index (R, S, T) on a 0-4 scale (0 for no involvement up to 4 for severe involvement): 0 = none, 1 = slight, 2 = mild, 3 = moderate, 4 = severe Fraction of total BSA affected is graded on a 0-6 scale (0 for no involvement to 6 for 90% - 100% involvement): 0 = 0% (clear), 1 = \>0% to \<10%, 2 = 10% to \<30%, 3 = 30% to \<50%, 4 = 50% to \<70%, 5 = 70% to 90%, 6 = 90% to 100%.Overall score ranges from 0 (no psoriasis) to 72 (most severe disease).
Time frame: Week 12, Week 58, Week 102
Proportion of subjects achieving PASI100
PASI combines assessments of the extent of body surface involvement in 4 regions (head \& neck(h), trunk(t), arms(u), legs(l)) \& severity of scaling (S), redness (R), \& plaque induration/infiltration (thickness, T) in each region. Severity is rated for each index (R, S, T) on a 0-4 scale (0 for no involvement up to 4 for severe involvement): 0 = none, 1 = slight, 2 = mild, 3 = moderate, 4 = severe Fraction of total BSA affected is graded on a 0-6 scale (0 for no involvement to 6 for 90% - 100% involvement): 0 = 0% (clear), 1 = \>0% to \<10%, 2 = 10% to \<30%, 3 = 30% to \<50%, 4 = 50% to \<70%, 5 = 70% to 90%, 6 = 90% to 100%. Overall score ranges from 0 (no psoriasis) to 72 (most severe disease).
Time frame: Week 12, Week 58, Week 102
Proportion of subjects achieving sPGA0
Static Physician Global Assessment (sPGA): The physician's global assessment of the Participant's psoriasis lesions at a given time point. Plaques are assessed for induration, erythema, and scaling, and an overall rating of psoriasis severity is given using the anchors of clear (0), minimal (1), mild (2), moderate (3), severe (4), or very severe (5). An sPGA assessed as either 0 or 1 represents a clinically meaningful response of minimal plaque severity or complete resolution of plaque psoriasis. An sPGA assessed as 0 represents a clinically important endpoint indicating complete resolution of plaque psoriasis.
Time frame: Week 12, Week 58, Week 102
Mean change in the PASI score from baseline
PASI combines assessments of the extent of body surface involvement in 4 regions (head \& neck(h), trunk(t), arms(u), legs(l)) \& severity of scaling (S), redness (R), \& plaque induration/infiltration (thickness, T) in each region. Severity is rated for each index (R, S, T) on a 0-4 scale (0 for no involvement up to 4 for severe involvement): 0 = none, 1 = slight, 2 = mild, 3 = moderate, 4 = severe Fraction of total BSA affected is graded on a 0-6 scale (0 for no involvement to 6 for 90% - 100% involvement): 0 = 0% (clear), 1 = \>0% to \<10%, 2 = 10% to \<30%, 3 = 30% to \<50%, 4 = 50% to \<70%, 5 = 70% to 90%, 6 = 90% to 100%. Overall score ranges from 0 (no psoriasis) to 72 (most severe disease).
Time frame: Week 12, Week 58, Week 102
Mean change in the Nail Psoriasis Severity Index NAPSI from baseline (for subjects with NAPSI>0 at baseline)
NAPSI is a numeric, reproducible, objective tool for evaluation of nail psoriasis. This scale was used to evaluate the severity of nail bed psoriasis \& nail matrix psoriasis by area of involvement in the nail unit. Both fingernail \& toenail involvement were assessed.The nail is divided with imaginary horizontal \& longitudinal lines into quadrants. Each nail is given a score for nail bed psoriasis (0 to 4) \& nail matrix psoriasis (0 to 4), depending on the presence (score of 1) or absence (score of 0) of any of the features of nail bed \& nail matrix psoriasis in each quadrant: 0 = None 1. = present in one quadrant of nail 2. = present in two quadrants of nail 3. = present in three quadrants of nail 4. = present in four quadrants of nail NAPSI score of a nail is the sum of scores in nail bed \& nail matrix from each quadrant (maximum of 8). Each nail is evaluated, \& the sum of all the fingernails and toenails is the total NAPSI score ranging from 0 to 160 (No to Severe nail Psoriasis)
Time frame: Week 12, Week 58, Week 102
Mean change in the pruritus severity score on the numerical rating scale (NRS) from baseline.
Itch Numeric Rating Scale (NRS): is a single-item, patient-reported outcome (PRO) measure designed to capture the overall severity of a participant's itching due to his/her psoriasis by having the patient circle the integer that describes the worst level of itching in the past 24 hours on an 11-point NRS anchored at 0 representing "no itching" and 10 representing "worst itch imaginable.
Time frame: Week 12, Week 58, Week 102
Time to relapse defined as sPGA≥2 during the treatment discontinuation period
Static Physician Global Assessment (sPGA): The physician's global assessment of the Participant's psoriasis lesions at a given time point. Plaques are assessed for induration, erythema, and scaling, and an overall rating of psoriasis severity is given using the anchors of clear (0), minimal (1), mild (2), moderate (3), severe (4), or very severe (5). An sPGA assessed as either 0 or 1 represents a clinically meaningful response of minimal plaque severity or complete resolution of plaque psoriasis.
Time frame: Week 58 through Week 102
Safety assessment
The subjects will be examined for vital signs (blood pressure (BP), wrist pulse rate, axial body temperature) and undergo a physical and instrumental examination, complete blood count, blood chemistry, and urinalysis; the presence and characteristics of adverse events will also be determined. Body weight, height and body mass index will be compared with the World Health Organization's reference values for the physical development of children and adolescents
Time frame: Through Week 124
Immunogenicity assessment
Proportion of subjects with detected binding and/or neutralizing antibodies to netakimab.
Time frame: Through Week 102
Pharmacokinetics assessment
Multiple dosing pharmacokinetics will be assessed via Ctrough calculation
Time frame: Through Week 102