SPROUT Data Show Otezla Resulted in Significant Improvements in Measures of Moderate to Severe Plaque Psoriasis at Week 16 Compared With Placebo in Children Ages 6-17 1
DISCREET 16-week Data Demonstrated Statistically Significant Improvements in Genital Psoriasis, Including Skin, Itch and Quality of Life, in Patients With Moderate to Severe Disease 2
Adverse Events Were Consistent With Known Safety Profile of Otezla in Both Studies
Amgen (NASDAQ:AMGN) today announced results from two significant Phase 3 clinical studies of oral Otezla ® (apremilast), demonstrating efficacy in pediatric patients with moderate to severe plaque psoriasis and in adults with moderate to severe genital psoriasis, at the 31 st European Academy of Dermatology and Venereology (EADV) Congress, taking place in Milan, Italy Sept. 7-10, 2022 .
SPROUT study in pediatric moderate to severe plaque psoriasis
The SPROUT study 1 investigated the efficacy and safety of Otezla in pediatric patients aged 6 to 17 years with moderate to severe plaque psoriasis inadequately controlled by or intolerant to topical therapy. The primary endpoint of the static Physician's Global Assessment (sPGA) response (defined as an sPGA score of clear  or almost clear  with at least a 2-point reduction from baseline) at week 16 was met with a 33.1% sPGA response for Otezla versus 11.5% for placebo (95% CI: 11.2%, 32.1%; P 0.0001). The major secondary endpoint was also met: a greater proportion of patients achieving a 75% or more reduction in the Psoriasis Area and Severity Index (PASI 75) score, with 45.4% for Otezla versus 16.1% for placebo (95% CI: 17.8%, 40.9%; P 0.0001).
The adverse events were consistent with the known safety profile of Otezla. The most commonly reported (in at least 5% of patients) adverse events were diarrhea (20.2%), nausea (19.6%), abdominal pain (19.6%), vomiting (17.8%), headache (10.4%), pyrexia (6.7%), nasopharyngitis (6.1%) and upper abdominal pain (5.5%).
"The SPROUT data are extremely encouraging and could provide a valuable new alternative option for children, who currently only have access to a few therapeutic options that have been studied and approved to treat moderate-to-severe pediatric plaque psoriasis," said Anna Belloni Fortina , MD, co-author of the study and Head of the Pediatric Dermatology Unit, Department of Medicine, University of Padua Medical School. "We are grateful to the patients, families and clinicians who have contributed to this study as we look to deliver a new therapeutic option for children with unmet need in moderate to severe plaque psoriasis."
DISCREET study in moderate to severe genital psoriasis
16-week data from the DISCREET study 2 in adult patients with moderate to severe genital psoriasis, demonstrated a clinically meaningful and statistically significant improvement in genital psoriasis, with twice as many patients achieving the primary endpoint of a clear (0) or almost clear (1) score on the Physician Global Assessment of Genitalia (sPGA-G) scale when receiving Otezla, when compared with placebo (38.7% for Otezla versus 19.1% for placebo; P = 0.0003).
The secondary endpoints of the study were also met. The data showed improvements in sPGA response, with 21.5% responding for Otezla versus 7.2% for placebo (95% CI: 6.0, 22.5; P = 0.0007), and Genital Psoriasis Itch Numeric Rating Scale response (GPI-NRS), at 46.0% for Otezla versus 19.6% for placebo (95% CI: 14.5, 38.0; P P = 0.0005); a Dermatology Life Quality Index (DLQI) burden score reduction of 5.3 for Otezla versus 2.6 for placebo (95% CI: -4.2, -1.1; P = 0.0008); a Genital Psoriasis Symptoms Scale (GPSS) reduction in mean score of 20.5 for Otezla versus 5.3 for placebo (95% CI: -20.3, -10.0; P
"With more than 700,000 patients treated worldwide, the data from SPROUT and DISCREET add to the robust safety and efficacy data on Otezla, and furthers our understanding of how Otezla works in patient populations where there remains a high unmet need. These data are greatly encouraging for those adults and children who currently have limited options," said David M. Reese , M.D., executive vice president of Research and Development at Amgen. "Based on these results, Amgen looks forward to discussions with regulatory authorities about the potential inclusion of data from these important trials in the Otezla prescribing information."
Amgen is committed to investigating the potential of Otezla in adults and children with plaque psoriasis, including underserved patients with genital psoriasis, juvenile psoriatic arthritis and other areas of high burden.
About SPROUT (PPS0-003)
SPROUT (PPS0-003) is a Phase 3, multi-center, randomized, double-blind, placebo-controlled study to assess the efficacy and safety of OTEZLA ® (apremilast) in pediatric patients from 6 through 17 years of age with moderate to severe plaque psoriasis (defined as BSA involvement of ≥ 10, PASI score of ≥ 12, sPGA score of ≥ 3). A total of 245 patients were randomized 2:1 to receive Otezla 20 mg (patients 20kg to 50 kg) twice daily or Otezla 30 mg (patients ≥ 50 kg) twice daily or placebo for the first 16 weeks. All patients then received Otezla during an open-label extension phase through week 52. 1
The primary endpoint was the percentage of patients with sPGA response [defined as a sPGA score of clear (0) or almost clear (1) with ≥ 2-point reduction from baseline] at week 16.
About DISCREET (PSOR-025)
DISCREET (PSOR-025) is a Phase 3, multicenter, randomized, placebo-controlled, double-blind study evaluating the efficacy and safety of Otezla in patients with moderate to severe genital psoriasis (defined as modified sPGA-G score ≥ 3). Patients also had moderate to severe plaque psoriasis (sPGA score ≥ 3) with BSA involvement ≥ 1% in a non-genital area and had an inadequate response or intolerance to topical therapy for psoriasis affecting the genital area. The study randomized 289 patients 1:1 to receive Otezla 30 mg twice daily or placebo for the first 16 weeks. Following the 16-week placebo-controlled, double-blind phase of the trial, patients continued or switched to Otezla during the extension phase of the study and will be treated through week 32.
The primary endpoint was the proportion of patients who achieve modified sPGA-G response at week 16 (defined as modified sPGA-G score of clear (0) or almost clear (1) with at least a 2-point reduction from baseline at Week 16).
Psoriasis is a serious, chronic inflammatory disease that causes raised, red, scaly patches to appear on the skin, typically affecting the outside of the elbows, knees or scalp, though it can appear on any location. 3 Approximately 125 million people worldwide have psoriasis, including around 14 million people in Europe and more than 8 million people in the United States . 4,5 About 80% of those patients have plaque psoriasis. 6
About Otezla ® (apremilast)
Otezla ® (apremilast) is an oral small-molecule inhibitor of phosphodiesterase 4 (PDE4) specific for cyclic adenosine monophosphate (cAMP). PDE4 inhibition results in increased intracellular cAMP levels, which is thought to indirectly modulate the production of inflammatory mediators. The specific mechanism(s) by which Otezla exerts its therapeutic action in patients is not well defined.
Since its initial FDA approval in 2014, Otezla has been prescribed to more than 700,000 patients worldwide. 7
Otezla ® (apremilast) U.S. INDICATIONS
Otezla ® (apremilast) is indicated for the treatment of adult patients with plaque psoriasis who are candidates for phototherapy or systemic therapy.
Otezla is indicated for the treatment of adult patients with active psoriatic arthritis.
Otezla is indicated for the treatment of adult patients with oral ulcers associated with Behçet's Disease.
Otezla ® (apremilast) U.S. IMPORTANT SAFETY INFORMATION
- Otezla ® is contraindicated in patients with a known hypersensitivity to apremilast or to any of the excipients in the formulation
Warnings and Precautions
- Diarrhea, Nausea, and Vomiting: Cases of severe diarrhea, nausea, and vomiting were associated with the use of Otezla. Most events occurred within the first few weeks of treatment. In some cases, patients were hospitalized. Patients 65 years of age or older and patients taking medications that can lead to volume depletion or hypotension may be at a higher risk of complications from severe diarrhea, nausea, or vomiting. Monitor patients who are more susceptible to complications of diarrhea or vomiting; advise patients to contact their healthcare provider. Consider Otezla dose reduction or suspension if patients develop severe diarrhea, nausea, or vomiting
- Depression: Carefully weigh the risks and benefits of treatment with Otezla for patients with a history of depression and/or suicidal thoughts/behavior, or in patients who develop such symptoms while on Otezla. Patients, caregivers, and families should be advised of the need to be alert for the emergence or worsening of depression, suicidal thoughts or other mood changes, and they should contact their healthcare provider if such changes occur
- Plaque Psoriasis : Treatment with Otezla is associated with an increase in depression. During clinical trials in patients with moderate to severe plaque psoriasis, 1.3% (12/920) of patients reported depression compared to 0.4% (2/506) on placebo. Depression was reported as serious in 0.1% (1/1308) of patients exposed to Otezla, compared to none in placebo-treated patients (0/506). Suicidal behavior was observed in 0.1% (1/1308) of patients on Otezla, compared to 0.2% (1/506) on placebo. One patient treated with Otezla attempted suicide; one patient on placebo committed suicide
- Psoriatic Arthritis : Treatment with Otezla is associated with an increase in depression. During clinical trials, 1.0% (10/998) reported depression or depressed mood compared to 0.8% (4/495) treated with placebo. Suicidal ideation and behavior was observed in 0.2% (3/1441) of patients on Otezla, compared to none in placebo-treated patients. Depression was reported as serious in 0.2% (3/1441) of patients exposed to Otezla, compared to none in placebo-treated patients (0/495). Two patients who received placebo committed suicide compared to none on Otezla
- Behçet's Disease : Treatment with Otezla is associated with an increase in depression. During the clinical trial, 1% (1/104) reported depression or depressed mood compared to 1% (1/103) treated with placebo. No instances of suicidal ideation or behavior were reported in patients treated with Otezla or treated with placebo
- Weight Decrease: Monitor body weight regularly; evaluate unexplained or clinically significant weight loss, and consider discontinuation of Otezla
- Plaque Psoriasis : Body weight loss of 5-10% occurred in 12% (96/784) of patients with moderate to severe plaque psoriasis treated with Otezla and in 5% (19/382) of patients treated with placebo. Body weight loss of ≥10% occurred in 2% (16/784) of patients treated with Otezla compared to 1% (3/382) of patients treated with placebo
- Psoriatic Arthritis : Body weight loss of 5-10% was reported in 10% (49/497) of patients taking Otezla and in 3.3% (16/495) of patients taking placebo
- Behçet's Disease : Body weight loss of >5% was reported in 4.9% (5/103) of patients taking Otezla and in 3.9% (4/102) of patients taking placebo
- Drug Interactions: Apremilast exposure was decreased when Otezla was co-administered with rifampin, a strong CYP450 enzyme inducer; loss of Otezla efficacy may occur. Concomitant use of Otezla with CYP450 enzyme inducers (e.g., rifampin, phenobarbital, carbamazepine, phenytoin) is not recommended
- Plaque Psoriasis : The most common adverse reactions (≥ 5%) are diarrhea, nausea, upper respiratory tract infection, and headache, including tension headache. Overall, the safety profile of Otezla in patients with mild to moderate plaque psoriasis was consistent with the safety profile previously established in adult patients with moderate to severe plaque psoriasis
- Psoriatic Arthritis : The most common adverse reactions (≥ 5%) are diarrhea, nausea, and headache
- Behçet's Disease : The most common adverse reactions (≥ 10%) are diarrhea, nausea, headache, and upper respiratory tract infection.
Use in Specific Populations
- Otezla has not been studied in pregnant women. Advise pregnant women of the potential risk of fetal loss.
Please click here for Otezla ® Full Prescribing Information.
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1 Fiorillo L, et al. Efficacy and Safety of Apremilast in Pediatric Patients With Moderate to Severe Plaque Psoriasis: 16-Week Results From a Phase 3, Randomized, Double-Blind, Placebo-Controlled Study. 31 st EADV Congress, September 2022
2 Merola J F et al. Efficacy and Safety of Apremilast in Patients With Genital Psoriasis: Results From the Phase 3 Randomized, Placebo-Controlled, Double-Blind DISCREET Study. 31 st EADV Congress, September 2022
3 National Psoriasis Foundation. About Psoriasis. Available at: https://www.psoriasis.org/about-psoriasis . Accessed May 26, 2022 .
4 National Psoriasis Foundation. Statistics. Available at: https://www.psoriasis.org/content/statistics . Accessed May 26, 2022 .
5 Ortonne JP, Prinz JC. Alefacept: a novel and selective biologic agent for the treatment of chronic plaque psoriasis. Eur J Dermatol. 2004;14(1):41–45.
6 National Psoriasis Foundation. Plaque Psoriasis. Available at: https://www.psoriasis.org/about-psoriasis/types/plaque . Accessed May 26, 2022 .
7 Amgen Data on File.
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