Gülen Hatemi1, Alfred Mahr1, Yoshiaki Ishigatsubo1, Yeong-Wook Song1, Mitsuhiro Takeno1, Doyoung Kim1, Melike Melikoğlu1, Sue Cheng1, Shannon McCue1, Maria Paris1, Mindy Chen1, Yusuf Yazici1. 1. From Istanbul University-Cerrahpaşa, Cerrahpaşa Medical School and Behçet's Disease Research Center, Istanbul, Turkey (G.H., M.M.); Hospital Saint-Louis, University Paris Diderot, Paris (A.M.); Yokohama City University Graduate School of Medicine, Yokohama (Y.I.), and Nippon Medical School, Graduate School of Medicine, Tokyo (M.T.) - both in Japan; Seoul National University and Seoul National University Hospital (Y.-W.S.) and Yonsei University College of Medicine and Severance Hospital (D.K.), Seoul, South Korea; Celgene, Summit, NJ (S.C., S.M., M.P., M.C.); and New York University School of Medicine, New York (Y.Y.).
Abstract
BACKGROUND: The small-molecule phosphodiesterase 4 inhibitor apremilast modulates cytokines that are up-regulated in Behçet's syndrome. In a phase 2 trial involving patients with Behçet's syndrome, apremilast reduced the incidence and severity of oral ulcers. Data on the efficacy and safety of apremilast in patients with Behçet's syndrome who had active oral ulcers and had not previously received biologic agents are limited. METHODS: In a phase 3 trial, we randomly assigned, in a 1:1 ratio, patients who had Behçet's syndrome with active oral ulcers but no major organ involvement to receive eitherapremilast at a dose of 30 mg or placebo, administered orally, twice daily for 12 weeks, followed by a 52-week extension phase. The primary end point was the area under the curve (AUC) for the total number of oral ulcers during the 12-week placebo-controlled period (with lower values indicating fewer ulcers). There were 13 secondary end points, including complete response of oral ulcers, change from baseline in pain associated with oral ulcers, disease activity, and change from baseline in the Behçet's Disease Quality of Life score (range, 0 to 30, with higher scores indicating greater impairment in quality of life). Safety was also assessed. RESULTS: A total of 207 patients underwent randomization (104 patients to the apremilast group and 103 to the placebo group). The AUC for the number of oral ulcers was 129.5 for apremilast, as compared with 222.1 for placebo (least-squares mean difference, -92.6; 95% confidence interval [CI], -130.6 to -54.6; P<0.001). The change from baseline in the Behçet's Disease Quality of Life score was -4.3 points in the apremilast group, as compared with -1.2 points in the placebo group (least-squares mean difference, -3.1 points; 95% CI, -4.9 to -1.3). Adverse events with apremilast included diarrhea, nausea, and headache. CONCLUSIONS: In patients with oral ulcers associated with Behçet's syndrome, apremilast resulted in a greater reduction in the number of oral ulcers than placebo but was associated with adverse events, including diarrhea, nausea, and headache. (Funded by Celgene; ClinicalTrials.gov number, NCT02307513.).
RCT Entities:
BACKGROUND: The small-molecule phosphodiesterase 4 inhibitor apremilast modulates cytokines that are up-regulated in Behçet's syndrome. In a phase 2 trial involving patients with Behçet's syndrome, apremilast reduced the incidence and severity of oral ulcers. Data on the efficacy and safety of apremilast in patients with Behçet's syndrome who had active oral ulcers and had not previously received biologic agents are limited. METHODS: In a phase 3 trial, we randomly assigned, in a 1:1 ratio, patients who had Behçet's syndrome with active oral ulcers but no major organ involvement to receive either apremilast at a dose of 30 mg or placebo, administered orally, twice daily for 12 weeks, followed by a 52-week extension phase. The primary end point was the area under the curve (AUC) for the total number of oral ulcers during the 12-week placebo-controlled period (with lower values indicating fewer ulcers). There were 13 secondary end points, including complete response of oral ulcers, change from baseline in pain associated with oral ulcers, disease activity, and change from baseline in the Behçet's Disease Quality of Life score (range, 0 to 30, with higher scores indicating greater impairment in quality of life). Safety was also assessed. RESULTS: A total of 207 patients underwent randomization (104 patients to the apremilast group and 103 to the placebo group). The AUC for the number of oral ulcers was 129.5 for apremilast, as compared with 222.1 for placebo (least-squares mean difference, -92.6; 95% confidence interval [CI], -130.6 to -54.6; P<0.001). The change from baseline in the Behçet's Disease Quality of Life score was -4.3 points in the apremilast group, as compared with -1.2 points in the placebo group (least-squares mean difference, -3.1 points; 95% CI, -4.9 to -1.3). Adverse events with apremilast included diarrhea, nausea, and headache. CONCLUSIONS: In patients with oral ulcers associated with Behçet's syndrome, apremilast resulted in a greater reduction in the number of oral ulcers than placebo but was associated with adverse events, including diarrhea, nausea, and headache. (Funded by Celgene; ClinicalTrials.gov number, NCT02307513.).
Authors: Kristin Helene Skullerud; Petter Gjersvik; Are Hugo Pripp; Erik Qvigstad; Anne Lise Ording Helgesen Journal: Trials Date: 2021-07-20 Impact factor: 2.279
Authors: Kalpana Manthiram; Silvia Preite; Fatma Dedeoglu; Selcan Demir; Seza Ozen; Kathryn M Edwards; Sivia Lapidus; Alexander E Katz; Henry M Feder; Maranda Lawton; Greg R Licameli; Peter F Wright; Julie Le; Karyl S Barron; Amanda K Ombrello; Beverly Barham; Tina Romeo; Anne Jones; Hemalatha Srinivasalu; Pamela A Mudd; Roberta L DeBiasi; Ahmet Gül; Gary S Marshall; Olcay Y Jones; Settara C Chandrasekharappa; Yuriy Stepanovskiy; Polly J Ferguson; Pamela L Schwartzberg; Elaine F Remmers; Daniel L Kastner Journal: Proc Natl Acad Sci U S A Date: 2020-06-09 Impact factor: 11.205