Effect of tofacitinib withdrawal and re-treatment on patient-reported outcomes: results from a Phase 3 study in patients with moderate to severe chronic plaque psoriasis

C E M Griffiths¹, R Vender², H Sofen³, L Kircik^{4 5 6}, H Tan⁷, S T Rottinghaus⁷, M Bachinsky⁷, L Mallbris⁸, C Mamolo⁷

Affiliations

¹ The Dermatology Centre, Salford Royal Hospital, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
² Dermatrials Research Inc, Hamilton, ON, Canada.
³ UCLA School of Medicine, Los Angeles, CA, USA.
⁴ Icahn School of Medicine at Mount Sinai, New York, NY, USA.
⁵ Indiana School of Medicine, Indianapolis, IN, USA.
⁶ DermResearch PLLC, Louisville, KY, USA.
⁷ Pfizer Inc, Global Innovative Pharmaceuticals, Groton, CT, USA.
⁸ Pfizer Inc, Collegeville, PA, USA.

PMID:27600367
PMCID: PMC5297866
DOI: 10.1111/jdv.13808

Clinical Trial

Effect of tofacitinib withdrawal and re-treatment on patient-reported outcomes: results from a Phase 3 study in patients with moderate to severe chronic plaque psoriasis

C E M Griffiths et al. J Eur Acad Dermatol Venereol.2017 Feb.

.2017 Feb;31(2):323-332.

doi: 10.1111/jdv.13808. Epub 2016 Sep 7.

Authors

C E M Griffiths¹, R Vender², H Sofen³, L Kircik^{4 5 6}, H Tan⁷, S T Rottinghaus⁷, M Bachinsky⁷, L Mallbris⁸, C Mamolo⁷

Affiliations

¹ The Dermatology Centre, Salford Royal Hospital, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
² Dermatrials Research Inc, Hamilton, ON, Canada.
³ UCLA School of Medicine, Los Angeles, CA, USA.
⁴ Icahn School of Medicine at Mount Sinai, New York, NY, USA.
⁵ Indiana School of Medicine, Indianapolis, IN, USA.
⁶ DermResearch PLLC, Louisville, KY, USA.
⁷ Pfizer Inc, Global Innovative Pharmaceuticals, Groton, CT, USA.
⁸ Pfizer Inc, Collegeville, PA, USA.

PMID:27600367
PMCID: PMC5297866
DOI: 10.1111/jdv.13808

Abstract

Background: Tofacitinib is an oral Janus kinase inhibitor being investigated for psoriasis. A Phase 3 withdrawal/re-treatment study (NCT01186744; OPT Retreatment) showed tofacitinib re-treatment was effective in patients with chronic plaque psoriasis.

Objectives: To describe the effects of tofacitinib withdrawal/re-treatment on health-related quality of life (HRQoL) and disease symptoms measured by patient-reported outcomes (PROs).

Methods: The study was divided into initial treatment, treatment withdrawal, and re-treatment periods. Initial treatment: patients were randomized to receive tofacitinib 5 (n = 331) or 10 mg (n = 335) BID for 24 weeks. Treatment withdrawal: patients who achieved both ≥ 75% reduction in Psoriasis Area and Severity Index (PASI) score from baseline and Physician's Global Assessment of 'clear'/'almost clear' at Week (W)24 received placebo (withdrawal) or the previous dose (continuous treatment). Re-treatment: at relapse (> 50% loss of W24 PASI response) or at W40, patients received their initial tofacitinib dose. PROs included: Dermatology Life Quality Index (DLQI), Itch Severity Item (ISI), Short Form-36 (SF-36) and Patient's Global Assessment (PtGA).

Results: After initial treatment with tofacitinib 5 and 10 mg BID, substantial and significant improvements were reported for mean DLQI (baseline: 12.6 and 12.6; W24: 5.1 and 2.6) and ISI (baseline: 6.7 and 6.9; W24: 2.9 and 1.6). Patients continuously treated with tofacitinib 5 and 10 mg BID maintained those improvements through Week 56 (DLQI: 3.0 and 2.1; ISI: 2.3 and 1.4). By W40, patients withdrawn from tofacitinib 5 and 10 mg BID showed worsening in DLQI (5.0 and 6.2) and ISI (3.7 and 4.0) scores; improvements were regained upon re-treatment (W56, DLQI: 3.4 and 2.4; ISI: 2.2 and 1.6). Similar results were reported for PtGA and SF-36.

Conclusion: Continuous tofacitinib treatment provided sustained improvement in HRQoL and disease symptoms. Patients randomized to treatment withdrawal lost initial improvements. Upon re-treatment, improvements were recaptured to levels comparable to those seen with continuous treatment.

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