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An Investigator-Initiated, Assessor Blinded, Randomized Study Comparing the Mechanism of Action of Adalimumab to Methotrexate in Subjects With Moderate to Severe Chronic Plaque Psoriasis.

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Conditions:		Psoriasis
Purpose:		The objective of this study is to compare the mechanism of action between adalimumab and methotrexate in subjects with psoriasis.
Study Summary:		Both methotrexate and adalimumab are FDA-approved drugs for the treatment of moderate to severe psoriasis. The two treatments, methotrexate and adalimumab, both show efficacy for psoriasis, however their profiles differ. In the CHAMPION Study, more adalimumab-treated, moderate to severe psoriasis patients achieved a PASI 75 after 16 weeks compared to those treated with methotrexate (80% vs. 36%). The reason for this difference is poorly understood. No direct comparative mechanism of action studies in psoriasis patients between methotrexate and adalimumab (or any TNF blocker) has been reported. With etanercept, another TNF blocker, the in vivo mechanism has been studied with some scientific rigor. These studies demonstrate that etanercept down regulates multiple pro-inflammatory pathways (as shown in Table 1 of the protocol). To date, there are no similar studies with adalimumab or methotrexate. In order to understand the molecular and cellular basis for the differential clinical efficacy of adalimumab and methotrexate, it is essential to compare their mechanisms of action in psoriatic plaques. Biopsies will be performed, and we will study biomarkers in this proposal with immunohistochemistry, real-time PCR, and gene arrays.
Criteria:		Inclusion Criteria: - Adults 18 to 85 years of age with moderate to severe psoriasis, in general good health as determined by the Principal Investigator based upon the results of medical history, laboratory profile, and physical examination, and who are candidates for systemic or photo- therapy - Presence of a psoriatic plaque of 2 cm or greater in an area which can be biopsied repeatedly. - Men must agree to avoid impregnating a woman while on this study. - Women are eligible to participate in the study if they meet one of the following criteria: - Women who are postmenopausal (for at least one year), sterile, or hysterectomized - Women of childbearing potential must undergo monthly pregnancy testing during the study and agree to use two of the following methods of contraception throughout the study and for 60 days after the last dose of study drug: - Oral contraceptives - Transdermal contraceptives - Injectable or implantable methods - Intrauterine devices - Barrier methods (diaphragm with spermicide, condom with spermicide) - Abstinence and Tubal Ligation are also considered a form of Birth control Exclusion Criteria: - Patients < 18 years old or > 85 years old - Absence of a psoriatic plaque at least 2 cm in diameter - Active guttate, erythrodermic, or pustular psoriasis at the time of the screening visit - Evidence of skin conditions at the time of the screening visit (e.g. eczema) other than psoriasis that would interfere with evaluations of the effect of study medication on psoriasis - Inability to understand the consent process - Receipt of any investigational drugs or biologics within 4 weeks of study drug initiation - PUVA or oral systemic treatments within 4 weeks of study drug initiation - Biologics within 3 months of study initiation - UVB therapy within 2 weeks of study drug initiation - Topical steroids, topical vitamin A or D analog preparations or anthralin within 2 weeks of study drug initiation. (Exception - topical steroids at no higher than moderate strength, are permitted on scalp, axillae, and groin but dose and formulation must be kept stable throughout trial.) - Methotrexate within 6 weeks of study initiation - History of prior treatment with adalimumab - History of primary non-response to methotrexate, infliximab or etanercept - History of prior discontinuation of methotrexate or a TNF antagonist for a safety-related reason that makes it unwise to restart either type of drug - Any internal malignancy within 5 years (fully excised cutaneous, basal cell carcinoma or squamous cell carcinoma are exceptions) - Pregnancy, not practicing effective birth control, or inability to practice safe sex during the length of the study - Lactation - Subjects who have known hypersensitivity to adalimumab or methotrexate or any of its components or who is known to have antibodies to etanercept - History of alcohol or drug abuse one year before and during the study - Known HIV-positive status or any other immune-suppressing disease - Presence of a grade 3 or 4 infection < 30 days prior to the screening visit, between the screening visit and the first day of treatment on study, or any time during the study that in the opinion of the Investigator would preclude participation in the study - Any grade 3 or 4 adverse event, or laboratory toxicity, at the time of the screening visit or at any time during the study, which in the opinion of the Investigator would, preclude participation in the study - Serum creatinine > 3.0 mg/dL (265 micromoles/L) - Serum potassium < 3.5 mmol/L or > 5.5 mmol/L - Serum ALT or AST > 3 times the upper limit of normal for the Lab - Platelet count < 100,000/mm3 - WBC count < 3,000 cells/mm3 - Hemoglobin, hematocrit, or red blood cell count outside 30% of the upper or lower limits of normal for the Lab - Receipt of live vaccines 1 month prior to or while on study - A prior history of tuberculosis, and/or a positive PPD skin test/CXR at screening without appropriate treatment - treatment of latent TB infections (for those with positive PPD tests) must be initiated prior to therapy with adalimumab or methotrexate - Chronic hepatitis B or hepatitis C infection, history of multiple sclerosis, transverse myelitis, optic neuritis or epilepsy
NCT ID:		NCT00932113
Primary Contact:		Principal Investigator Alice B. Gottlieb, M.D., PhD. Tufts Medical Center, Department of Dermatology
Backup Contact:		N/A
Location Contact:		Boston, Massachusetts 02111 United States There is no listed contact information for this specific location. Site Status: N/A

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