2. Academic Validation
  3. Spesolimab, an Anti-Interleukin-36 Receptor Antibody, in Patients with Palmoplantar Pustulosis: Results of a Phase IIa, Multicenter, Double-Blind, Randomized, Placebo-Controlled Pilot Study

Spesolimab, an Anti-Interleukin-36 Receptor Antibody, in Patients with Palmoplantar Pustulosis: Results of a Phase IIa, Multicenter, Double-Blind, Randomized, Placebo-Controlled Pilot Study

  • Dermatol Ther (Heidelb). 2021 Apr;11(2):571-585. doi: 10.1007/s13555-021-00504-0.
Ulrich Mrowietz 1,  A David Burden 2,  Andreas Pinter 3,  Kristian Reich 4,  Knut Schäkel 5,  Patrick Baum 6,  Yakov Datsenko 6,  Hongjie Deng 7,  Steven J Padula 8,  Christian Thoma 6,  Robert Bissonnette 9
Affiliations

Affiliations

  • 1 Psoriasis-Center at the Department of Dermatology, University Medical Center, Schleswig-Holstein, Campus Kiel, Kiel, Germany. umrowietz@dermatology.uni-kiel.de.
  • 2 Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK.
  • 3 Department of Dermatology, Venereology and Allergology, University Clinic Frankfurt Am Main, Frankfurt am Main, Germany.
  • 4 Center of Translational Research in Inflammatory Skin Diseases, Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
  • 5 Department of Dermatology, Universitätsklinikum Heidelberg, Heidelberg, Germany.
  • 6 Boehringer Ingelheim International GmbH, Biberach, Germany.
  • 7 Boehringer Ingelheim (China) Investment Co. Ltd, Shanghai, China.
  • 8 Boehringer Ingelheim International GmbH, Ingelheim, Germany.
  • 9 Innovaderm Research Inc., Montreal, Quebec, Canada.
PMID: 33661508 DOI: 10.1007/s13555-021-00504-0
Abstract

Introduction: Palmoplantar pustulosis (PPP) is a chronic, inflammatory skin disease, with high disease burden, that is often refractory to treatment. There is a high unmet clinical need for the treatment of patients with PPP. The objectives of this study were to evaluate the safety and efficacy of spesolimab, a novel anti-interleukin-36 receptor antibody, in patients with PPP.

Methods: This was a phase IIa, multicenter, double-blind, randomized, placebo-controlled pilot study comparing 900 mg spesolimab (n = 19), 300 mg spesolimab (n = 19), and placebo (n = 21) administered intravenously every 4 weeks until week 12 in patients with PPP. The primary efficacy endpoint was the achievement of Palmoplantar Pustulosis Area and Severity Index 50 (PPP ASI50) at week 16, defined as achieving an ≥ 50% decrease from baseline PPP ASI.

Results: At week 16, 31.6% of patients in both spesolimab dose groups achieved PPP ASI50 versus 23.8% receiving placebo (risk difference 0.078; 95% confidence interval -0.190, 0.338). Thus, the primary endpoint was not met. Spesolimab was well tolerated with no clinically relevant treatment-emergent safety signals observed.

Conclusions: PPP severity declined over time in all treatment groups after the start of treatment, with a faster decline in the spesolimab arms than in the placebo arm, indicating a potential treatment effect for spesolimab. Limitations to the study included a small sample size and lower overall disease severity than expected at baseline. It is possible that the primary efficacy endpoint may have coincided with natural disease resolution in some patients. Further effects of the efficacy of spesolimab in PPP are being explored in a phase IIb trial.

Keywords

BI 655130; IL-36; IL-36R; PPP; biomarkers; palmoplantar pustular psoriasis; palmoplantar pustulosis; randomized controlled trial; spesolimab.

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