<clinical_study>
  <!-- This xml conforms to an XML Schema at:
    https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
  <required_header>
    <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
    <link_text>Link to the current ClinicalTrials.gov record.</link_text>
    <url>https://clinicaltrials.gov/ct2/show/NCT02999776</url>
  </required_header>
  <id_info>
    <org_study_id>TopPso-2015</org_study_id>
    <nct_id>NCT02999776</nct_id>
  </id_info>
  <brief_title>Laser-assisted Topical Administration of Etanercept (Enbrel®) in Patients With Mild to Moderate Plaque-type Psoriasis</brief_title>
  <official_title>An Observer Partially-blinded, Lesion-randomized, Intra-patient Controlled, 3-arm, Phase I Study to Assess Safety and Efficacy of Laser-assisted Topical Etanercept Administration in Patients With Mild to Moderate Plaque Psoriasis</official_title>
  <sponsors>
    <lead_sponsor>
      <agency>Pantec Biosolutions AG</agency>
      <agency_class>Industry</agency_class>
    </lead_sponsor>
  </sponsors>
  <source>Pantec Biosolutions AG</source>
  <oversight_info>
    <has_dmc>Yes</has_dmc>
  </oversight_info>
  <brief_summary>
    <textblock>
      The purpose of this study is to assess the feasibility and safety of topical administration&#xD;
      of etanercept via AFL micropores to psoriatic plaques in patients with mild to moderate&#xD;
      plaque-type psoriasis.&#xD;
&#xD;
      While a wide variety of therapeutic innovations to treat moderate-to-severe psoriasis&#xD;
      (accounting for around 30% of the cases) become available each year, there are few&#xD;
      innovations for topical therapies to treat mild/localized psoriasis (accounting for around&#xD;
      70% of the cases). Given that only about half of the patients respond adequately to the&#xD;
      current standard of care, the topical application of a fixed combination of calcipotriole and&#xD;
      betamethasone, there is a medical need for better topical therapies.&#xD;
&#xD;
      Etanercept has been used successfully to treat moderate-to-severe plaque-type psoriasis in&#xD;
      children and adults for more than a decade. Its standard route of application is through&#xD;
      subcutaneous injections. Different dosing regimens have been used: 1 x 50 mg or 2 x 50 mg per&#xD;
      week as well as 1 x 25 mg or 2 x 25 mg per week. Under these regimens, etanercept has a&#xD;
      well-established favorable long-term safety record, with injection site reactions (pain,&#xD;
      swelling) the most frequently reported side effects. However, rare but serious side effects&#xD;
      such as serious opportunistic infections resulting from immune system inhibition common to&#xD;
      anti-TNF agents limit its systemic use to these patients. For this reason, a localized&#xD;
      topical alternative route of administration would be desirable. However, the large molecular&#xD;
      size and chemical nature of etanercept prevent it from crossing the epidermal barrier. A CE&#xD;
      certified ablative fractional laser (AFL) device with Er:YAG source will be used to create&#xD;
      micropores in plaques to allow local delivery of etanercept directly into psoriatic plaques.&#xD;
    </textblock>
  </brief_summary>
  <detailed_description>
    <textblock>
      Monocentric, observer partially-blinded Phase I study.&#xD;
&#xD;
      In this study, three similar plaques on each patient will be prospectively identified by the&#xD;
      blinded observer and then randomized by an unblinded investigator by using the eCRF to one of&#xD;
      the three study treatments:&#xD;
&#xD;
        1. Standard of care (daily administration of Daivobet® by the patient),&#xD;
&#xD;
        2. Ablative fractional laser microporation + topical application of etanercept&#xD;
&#xD;
        3. Ablative fractional laser microporation alone.&#xD;
&#xD;
      Over the treatment period of 8 weeks, patients will return to the clinic twice weekly for&#xD;
      assessment of the three study plaques by the blinded observer, followed by administration of&#xD;
      the treatment of plaques assigned to AFL microporation with or without etanercept. Patients&#xD;
      will treat the remaining plaque with Daivobet® themselves on a daily basis.&#xD;
&#xD;
      Although no incompatibilities of AFL and etanercept are anticipated, because this is the&#xD;
      first time etanercept is administered topically via AFL micropores and using a AFL&#xD;
      microporation device, the study will be conducted in two stages: a Safety Stage consisting of&#xD;
      the first five patients and the Study Stage with thirty patients.&#xD;
&#xD;
      In the Safety Stage of the study, three different plaques of the first 5 patients will be&#xD;
      randomized and administered the respective treatments only once. Enrollment will be suspended&#xD;
      after the 5th patient has been enrolled to permit the data monitoring committee (DMC) to&#xD;
      review of the initial safety data from these first 5 patients to reassess risk. Based on this&#xD;
      review, the DMC will make one of three recommendations:&#xD;
&#xD;
        1. to continue the study as planned,&#xD;
&#xD;
        2. to continue the study with adjustments to study procedures, such as changes to laser&#xD;
           parameters, frequency of treatments or concentration of etanercept or,&#xD;
&#xD;
        3. in the event of extreme safety concerns, to terminate the study.&#xD;
&#xD;
      If option 1 is recommended, the study will resume with the Study Stage (Stage 2), in which&#xD;
      the initial 5 patients will once again begin treatment, with their plaques receiving the same&#xD;
      treatments to which they were previously randomized. Their treatment will continue for 8&#xD;
      weeks. Enrollment will also resume and continue until an additional 25 patients have been&#xD;
      enrolled. If the DMC recommends option 2, treatment and enrollment will resume as just&#xD;
      described after an adapted protocol has been submitted to and approved by the relevant&#xD;
      authorities. If the DMC recommends option 3, then the study will terminate.&#xD;
&#xD;
      The Study Stage will consist of 2 periods: screening period (up to 2 weeks prior to baseline&#xD;
      assessments and randomization) and treatment period (for the first 5 patients: initially 1&#xD;
      set of treatments, followed by suspension of treatment until after DMC review, then 8 weeks&#xD;
      of treatment; for the remaining 25 patients: 8 weeks of treatment depending on plaque&#xD;
      randomization, either daily Daivobet® or biweekly AFL with or without etanercept).&#xD;
    </textblock>
  </detailed_description>
  <overall_status>Unknown status</overall_status>
  <last_known_status>Recruiting</last_known_status>
  <start_date>November 2016</start_date>
  <completion_date type="Anticipated">June 2018</completion_date>
  <primary_completion_date type="Anticipated">December 2017</primary_completion_date>
  <phase>Phase 1</phase>
  <study_type>Interventional</study_type>
  <has_expanded_access>No</has_expanded_access>
  <study_design_info>
    <allocation>Randomized</allocation>
    <intervention_model>Parallel Assignment</intervention_model>
    <primary_purpose>Treatment</primary_purpose>
    <masking>Single (Outcomes Assessor)</masking>
  </study_design_info>
  <primary_outcome>
    <measure>Administration site reactions (ASR)</measure>
    <time_frame>8 weeks</time_frame>
    <description>The investigator or qualified designee will assess ASRs such as itching, redness, swelling, pain, or ulceration at time points as indicated in Table 6-1. Whenever possible, the same evaluator should perform this assessment at all visits and document the result in the eCRF. An ASR that fulfills the criteria of an SAE should be documented and reported as such.</description>
  </primary_outcome>
  <secondary_outcome>
    <measure>Target Plaque Severity Score (TPSS)</measure>
    <time_frame>8 weeks</time_frame>
    <description>The blinded observer will perform the TPSS assessment at baseline (Visit 2) and at treatment visits 9 and 18. Whenever possible, the same evaluator should perform this assessment at all visits. For TPSS assessment, the target plaques will be evaluated separately for induration, scaling and erythema using a 5-point severity scale.</description>
  </secondary_outcome>
  <number_of_arms>3</number_of_arms>
  <enrollment type="Anticipated">30</enrollment>
  <condition>Psoriatic Plaque</condition>
  <arm_group>
    <arm_group_label>Standard of care</arm_group_label>
    <arm_group_type>Active Comparator</arm_group_type>
    <description>Daily self-administration of 1 to 5g Daivobet (Calcipotriol 50ug/g +Betamethasone, 0,5mg/g Gel) ointment, which is applied topically once per day for 8 weeks on one pre-selected randomized plaque.</description>
  </arm_group>
  <arm_group>
    <arm_group_label>Laser plus etanercept</arm_group_label>
    <arm_group_type>Experimental</arm_group_type>
    <description>Immediately following microporation of a 5 cm² area of the designated plaque with the P.L.E.A.S.E.® Professional laser, 0.0625 ml of Etanercept (50 mg/ml) solution for injection in pre-filled syringes will be applied to the microporated surface of the lesion. The treated area will then be covered with OpSiteTM Flexigrid Transparent Dressing for 4 hours. This treatment procedure will be repeated twice weekly for 8 weeks.</description>
  </arm_group>
  <arm_group>
    <arm_group_label>Laser alone</arm_group_label>
    <arm_group_type>Active Comparator</arm_group_type>
    <description>The Er:YAG laser induced microporation of 5 cm2 of a plaque surface, followed by application of an OpSiteTM Flexigrid Transparent Dressing for 4 hours. This treatment will also be repeated twice weekly for 8 weeks.</description>
  </arm_group>
  <intervention>
    <intervention_type>Device</intervention_type>
    <intervention_name>Laser microporation alone</intervention_name>
    <description>The Er:YAG laser induced microporation of 5 cm2 of a plaque surface, followed by application of an OpSiteTM Flexigrid Transparent Dressing for 4 hours. This treatment will also be repeated twice weekly for 8 weeks.</description>
    <arm_group_label>Laser alone</arm_group_label>
    <other_name>P.L.E.A.S.E.</other_name>
  </intervention>
  <intervention>
    <intervention_type>Drug</intervention_type>
    <intervention_name>Standard of care-daily administration of Daivobet</intervention_name>
    <description>The other control treatment is Daivobet®, which is applied topically daily for 8 weeks on one pre-selected randomized plaque.</description>
    <arm_group_label>Standard of care</arm_group_label>
    <other_name>Daivobet</other_name>
  </intervention>
  <intervention>
    <intervention_type>Drug</intervention_type>
    <intervention_name>Laser microporation + topical application of Etanercept</intervention_name>
    <description>Immediately following microporation of a 5 cm² area of the designated plaque with the P.L.E.A.S.E.® Professional laser, 0.0625 ml of Etanercept (50 mg/ml) solution for injection in pre-filled syringes will be applied to the microporated surface of the lesion. The treated area will then be covered with OpSiteTM Flexigrid Transparent Dressing for 4 hours. This treatment procedure will be repeated twice weekly for 8 weeks.</description>
    <arm_group_label>Laser plus etanercept</arm_group_label>
    <other_name>Etanercept</other_name>
  </intervention>
  <eligibility>
    <criteria>
      <textblock>
        Inclusion Criteria:&#xD;
&#xD;
          1. Patients must be able to understand and communicate with the investigator and comply&#xD;
             with the requirements of the study and must give a written, signed and dated informed&#xD;
             consent before any study related activity is performed.&#xD;
&#xD;
          2. Men or women, non-pregnant and non-lactating, at least 18 years of age at time of&#xD;
             screening&#xD;
&#xD;
          3. Chronic mild to moderate plaque-type psoriasis diagnosed at least 6 months prior to&#xD;
             baseline. Chronic mild to moderate plaque-type psoriasis as defined at screening by:&#xD;
&#xD;
               -  BSA affected by plaque-type psoriasis of less than 10%&#xD;
&#xD;
          4. Eligible for topical therapy according to current psoriasis treatment guidelines (12).&#xD;
&#xD;
        Exclusion Criteria:&#xD;
&#xD;
          1. Forms of psoriasis other than mild to moderate plaque-type (e.g., pustular,&#xD;
             erythrodermic and guttate psoriasis)&#xD;
&#xD;
          2. Hyperpigmentation, e.g. birth marks, freckles, scar tissue at the psoriasis plaque&#xD;
             areas that are intended to be treated&#xD;
&#xD;
          3. Intertriginous plaques or plaques on the hands, feet, neck, face, elbows, knees, or on&#xD;
             the scalp will not be eligible as plaques for treatment.&#xD;
&#xD;
          4. Plaques on eyelids, lips or mucous membranes, open wounds, moles or birth marks, areas&#xD;
             at risk of developing post-inflammatory hypo- or hyperpigmentation due to high levels&#xD;
             of UV radiation subsequent to treatment will not be eligible for treatment.&#xD;
&#xD;
          5. Drug-induced psoriasis (i.e., new onset or current exacerbation from e.g.&#xD;
             beta-blockers, or lithium)&#xD;
&#xD;
          6. Ongoing use of prohibited psoriasis treatments (e.g., topical corticosteroids,&#xD;
             UV-therapy). Washout periods detailed in the protocol have to be adhered to (see Table&#xD;
             5-2)&#xD;
&#xD;
          7. Ongoing use of other non-psoriasis prohibited treatments. Washout periods detailed in&#xD;
             the protocol have to be adhered to (see Table 5-2). All other prior non-psoriasis&#xD;
             concomitant treatments must be on a stable dose for at least four weeks before&#xD;
             baseline&#xD;
&#xD;
          8. Use of any other investigational drugs within 30 days prior to screening (or within 5&#xD;
             half-lives or until the expected PD effect has returned to baseline, whichever is&#xD;
             longer).&#xD;
&#xD;
          9. Requiring treatment with any biological medicinal product during the study other than&#xD;
             the study medication.&#xD;
&#xD;
         10. Any contraindication to etanercept (Enbrel®) or calcipotriol/betamethasone&#xD;
             (Daivobet®).&#xD;
&#xD;
         11. Previous (last 12 months) and current exposure biologics, such as etanercept,&#xD;
             adalimumab.&#xD;
&#xD;
         12. Any contraindication to treatment with the P.L.E.A.S.E® device, including Fitzpatrick&#xD;
             skin types V or VI.&#xD;
&#xD;
         13. Current treatment or need for treatment with any prohibited medications (listed under&#xD;
             Section 5.9.6).&#xD;
&#xD;
         14. Any serious illness or uncontrolled medical condition, including but not limited to&#xD;
             severe infections, significant hepatic or renal disease, uncontrolled hypertension&#xD;
             (defined as blood pressure ≥160/95), congestive heart failure (NYHA class III or IV),&#xD;
             or other severe, uncontrolled cardiac disease.&#xD;
&#xD;
         15. Pregnant or nursing (lactating) women, where pregnancy is defined as the state of a&#xD;
             female after conception and until the termination of gestation, confirmed by a&#xD;
             positive human chorionic gonadotropin (hCG) laboratory test (cut-off as defined by&#xD;
             laboratory)&#xD;
&#xD;
         16. Women of child-bearing potential, defined as all women physiologically capable of&#xD;
             becoming pregnant, UNLESS they agree to use highly effective methods of contraception&#xD;
             (defined in Section 6.5.7) during the study and for 12 months after stopping&#xD;
             treatment. Women are considered not of child bearing potential if they have had 12&#xD;
             months of natural (spontaneous) amenorrhea with an appropriate clinical profile (e.g.&#xD;
             age appropriate, history of vasomotor symptoms) or have had surgical bilateral&#xD;
             oophorectomy (with or without hysterectomy) or tubal ligation at least six weeks ago.&#xD;
             In the case of oophorectomy alone, only when the reproductive status of the woman has&#xD;
             been confirmed by follow up hormone level assessment is she considered not of child&#xD;
             bearing potential&#xD;
&#xD;
         17. Active ongoing inflammatory diseases other than psoriasis that might confound the&#xD;
             evaluation of the benefit of treatment with etanercept&#xD;
&#xD;
         18. Underlying condition (including, but not limited to metabolic, hematologic, renal,&#xD;
             hepatic, pulmonary, neurologic, endocrine, cardiac, infectious or gastrointestinal)&#xD;
             which in the opinion of the investigator significantly immunocompromises the patient&#xD;
             and/or places the patient at unacceptable risk for receiving an immunomodulatory&#xD;
             therapy&#xD;
&#xD;
         19. History of clinically significant liver disease or liver injury as indicated by&#xD;
             abnormal liver function tests. Aspartate aminotransferase (AST), alanine&#xD;
             aminotransferase (ALT) or alkaline phosphatase may not exceed 2.5 x upper limit of&#xD;
             normal at screening.&#xD;
&#xD;
         20. Pre-existing or recent-onset central or peripheral nervous system demyelinating&#xD;
             disorders according to investigator's discretion and where necessary taking into&#xD;
             account a neurological assessment; patients who are considered to have an increased&#xD;
             risk of developing a demyelinating disease&#xD;
&#xD;
         21. Significant cardiovascular problems, including but not limited to the following:&#xD;
             uncontrolled hypertension (blood pressure ≥160 systolic/95 diastolic mmHg), congestive&#xD;
             heart failure with known decreased left ventricular ejection fraction&#xD;
&#xD;
         22. Patients with a serum creatinine level exceeding 176.8 μmol/L (2.0 mg/dL)&#xD;
&#xD;
         23. Any of the following laboratory values at screening: total WBC count &lt;3,500/μL, or&#xD;
             neutrophils &lt;2,000/μL or platelets &lt;125,000/μL or hemoglobin &lt;10.0 g/dL&#xD;
&#xD;
         24. Positive serology to hepatitis C infection (i.e. positive antibody against Hepatitis C&#xD;
             virus) or hepatitis B infection (i.e. positive hepatitis B surface antigen [HBsAg]).&#xD;
&#xD;
         25. Severely immunocompromised state, including but not limited to Felty's syndrome and&#xD;
             known human immunodeficiency virus (HIV) infection&#xD;
&#xD;
         26. Active tuberculosis. If a QuantiFERON®- Tuberculosis (TB) Gold test at screening is&#xD;
             positive, further work-up, according to local guidelines/practices needs to be&#xD;
             performed to conclusively establish that that the patient has no evidence of active&#xD;
             tuberculosis.&#xD;
&#xD;
         27. History of serious recurrent, chronic infectious disease (excluding fungal infections&#xD;
             of the nail beds) or active systemic infections during the last two weeks (exception:&#xD;
             common cold) prior to baseline and any infections that reoccur on a regular basis;&#xD;
             patients with a history or evidence of opportunistic infections including specific&#xD;
             pathogens such as listeria, legionella and parasitic infections. Investigator&#xD;
             discretion should be used regarding patients who have traveled or resided in areas of&#xD;
             endemic mycoses, such as histoplasmosis, coccidioidomycosis or blastomycosis and for&#xD;
             patients with underlying conditions that may predispose them to infection, such as&#xD;
             advanced or poorly controlled diabetes&#xD;
&#xD;
         28. Known infection with human immunodeficiency virus (HIV), hepatitis B or hepatitis C at&#xD;
             screening or baseline&#xD;
&#xD;
         29. History of lymphoproliferative disease or any known malignancy or history of&#xD;
             malignancy of any organ system (except for basal cell carcinoma or actinic keratoses&#xD;
             that have been treated with no evidence of recurrence in the past 3 months, and except&#xD;
             for carcinoma in situ of the cervix or non-invasive malignant colon polyps that have&#xD;
             been removed)&#xD;
&#xD;
         30. Current severe progressive or uncontrolled disease which in the judgment of the&#xD;
             clinical investigator renders the patient unsuitable for the trial&#xD;
&#xD;
         31. Inability or unwillingness to undergo repeated venipuncture (poor tolerability or lack&#xD;
             of access to veins)&#xD;
&#xD;
         32. Blood donation or blood loss of &gt;400 ml in the 8 weeks prior to randomization.&#xD;
&#xD;
         33. History of hypersensitivity to any recombinant protein drugs or any of the excipients&#xD;
             used in Enbrel® (see list of excipients in Table 5-1)&#xD;
&#xD;
         34. Patients who are allergic to rubber or latex (the needle cover on the prefilled&#xD;
             syringes for Enbrel® contain dry natural rubber)&#xD;
&#xD;
         35. Any medical or psychiatric condition which, in the Investigator's opinion, would&#xD;
             preclude the participant from adhering to the protocol or completing the study per&#xD;
             protocol&#xD;
&#xD;
         36. History or evidence of ongoing alcohol or drug abuse, within the last six months&#xD;
             before baseline&#xD;
&#xD;
         37. Plans for administration of live vaccines during the study period or live vaccination&#xD;
             within 6 weeks prior to baseline&#xD;
&#xD;
         38. Patients not willing to limit UV light exposure (e.g., sunbathing and/or the use of&#xD;
             tanning devices) during the course of the study.&#xD;
      </textblock>
    </criteria>
    <gender>All</gender>
    <minimum_age>18 Years</minimum_age>
    <maximum_age>N/A</maximum_age>
    <healthy_volunteers>No</healthy_volunteers>
  </eligibility>
  <overall_official>
    <last_name>Wolf-Henning Boehncke, Prof.</last_name>
    <role>Principal Investigator</role>
    <affiliation>HUG</affiliation>
  </overall_official>
  <overall_contact>
    <last_name>Wolf-Henning Boehncke, Prof.</last_name>
    <phone>+41(0)22 372 94 22</phone>
    <email>wolf-henning.boehncke@hcuge.ch</email>
  </overall_contact>
  <location>
    <facility>
      <name>University Hospital Geneva</name>
      <address>
        <city>Geneva</city>
        <zip>41205</zip>
        <country>Switzerland</country>
      </address>
    </facility>
    <status>Recruiting</status>
    <contact>
      <last_name>Wolf-Henning Boehncke, Professor</last_name>
      <phone>+41 (0)22 372 94 23</phone>
    </contact>
  </location>
  <location_countries>
    <country>Switzerland</country>
  </location_countries>
  <verification_date>December 2016</verification_date>
  <study_first_submitted>November 28, 2016</study_first_submitted>
  <study_first_submitted_qc>December 16, 2016</study_first_submitted_qc>
  <study_first_posted type="Estimate">December 21, 2016</study_first_posted>
  <last_update_submitted>December 16, 2016</last_update_submitted>
  <last_update_submitted_qc>December 16, 2016</last_update_submitted_qc>
  <last_update_posted type="Estimate">December 21, 2016</last_update_posted>
  <responsible_party>
    <responsible_party_type>Sponsor</responsible_party_type>
  </responsible_party>
  <keyword>Plaques Psoriasis</keyword>
  <keyword>Topical</keyword>
  <keyword>Laser microporation</keyword>
  <condition_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>Psoriasis</mesh_term>
  </condition_browse>
  <intervention_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>Etanercept</mesh_term>
  </intervention_browse>
  <patient_data>
    <sharing_ipd>No</sharing_ipd>
  </patient_data>
  <!-- Results have not yet been posted for this study                                          -->
</clinical_study>


download date: ClinicalTrials.gov processed this data on September 20, 2023
link text: Link to the current ClinicalTrials.gov record.
url: https://clinicaltrials.gov/ct2/show/NCT02999776
org study id: TopPso-2015
nct id: NCT02999776
lead sponsor: 
has dmc: Yes
The purpose of this study is to assess the feasibility and safety of topical administration
      of etanercept via AFL micropores to psoriatic plaques in patients with mild to moderate
      plaque-type psoriasis.

      While a wide variety of therapeutic innovations to treat moderate-to-severe psoriasis
      (accounting for around 30% of the cases) become available each year, there are few
      innovations for topical therapies to treat mild/localized psoriasis (accounting for around
      70% of the cases). Given that only about half of the patients respond adequately to the
      current standard of care, the topical application of a fixed combination of calcipotriole and
      betamethasone, there is a medical need for better topical therapies.

      Etanercept has been used successfully to treat moderate-to-severe plaque-type psoriasis in
      children and adults for more than a decade. Its standard route of application is through
      subcutaneous injections. Different dosing regimens have been used: 1 x 50 mg or 2 x 50 mg per
      week as well as 1 x 25 mg or 2 x 25 mg per week. Under these regimens, etanercept has a
      well-established favorable long-term safety record, with injection site reactions (pain,
      swelling) the most frequently reported side effects. However, rare but serious side effects
      such as serious opportunistic infections resulting from immune system inhibition common to
      anti-TNF agents limit its systemic use to these patients. For this reason, a localized
      topical alternative route of administration would be desirable. However, the large molecular
      size and chemical nature of etanercept prevent it from crossing the epidermal barrier. A CE
      certified ablative fractional laser (AFL) device with Er:YAG source will be used to create
      micropores in plaques to allow local delivery of etanercept directly into psoriatic plaques.
Monocentric, observer partially-blinded Phase I study.

      In this study, three similar plaques on each patient will be prospectively identified by the
      blinded observer and then randomized by an unblinded investigator by using the eCRF to one of
      the three study treatments:

        1. Standard of care (daily administration of Daivobet® by the patient),

        2. Ablative fractional laser microporation + topical application of etanercept

        3. Ablative fractional laser microporation alone.

      Over the treatment period of 8 weeks, patients will return to the clinic twice weekly for
      assessment of the three study plaques by the blinded observer, followed by administration of
      the treatment of plaques assigned to AFL microporation with or without etanercept. Patients
      will treat the remaining plaque with Daivobet® themselves on a daily basis.

      Although no incompatibilities of AFL and etanercept are anticipated, because this is the
      first time etanercept is administered topically via AFL micropores and using a AFL
      microporation device, the study will be conducted in two stages: a Safety Stage consisting of
      the first five patients and the Study Stage with thirty patients.

      In the Safety Stage of the study, three different plaques of the first 5 patients will be
      randomized and administered the respective treatments only once. Enrollment will be suspended
      after the 5th patient has been enrolled to permit the data monitoring committee (DMC) to
      review of the initial safety data from these first 5 patients to reassess risk. Based on this
      review, the DMC will make one of three recommendations:

        1. to continue the study as planned,

        2. to continue the study with adjustments to study procedures, such as changes to laser
           parameters, frequency of treatments or concentration of etanercept or,

        3. in the event of extreme safety concerns, to terminate the study.

      If option 1 is recommended, the study will resume with the Study Stage (Stage 2), in which
      the initial 5 patients will once again begin treatment, with their plaques receiving the same
      treatments to which they were previously randomized. Their treatment will continue for 8
      weeks. Enrollment will also resume and continue until an additional 25 patients have been
      enrolled. If the DMC recommends option 2, treatment and enrollment will resume as just
      described after an adapted protocol has been submitted to and approved by the relevant
      authorities. If the DMC recommends option 3, then the study will terminate.

      The Study Stage will consist of 2 periods: screening period (up to 2 weeks prior to baseline
      assessments and randomization) and treatment period (for the first 5 patients: initially 1
      set of treatments, followed by suspension of treatment until after DMC review, then 8 weeks
      of treatment; for the remaining 25 patients: 8 weeks of treatment depending on plaque
      randomization, either daily Daivobet® or biweekly AFL with or without etanercept).
allocation: Randomized
intervention model: Parallel Assignment
primary purpose: Treatment
masking: Single (Outcomes Assessor)
measure: Administration site reactions (ASR)
time frame: 8 weeks
description: The investigator or qualified designee will assess ASRs such as itching, redness, swelling, pain, or ulceration at time points as indicated in Table 6-1. Whenever possible, the same evaluator should perform this assessment at all visits and document the result in the eCRF. An ASR that fulfills the criteria of an SAE should be documented and reported as such.
measure: Target Plaque Severity Score (TPSS)
time frame: 8 weeks
description: The blinded observer will perform the TPSS assessment at baseline (Visit 2) and at treatment visits 9 and 18. Whenever possible, the same evaluator should perform this assessment at all visits. For TPSS assessment, the target plaques will be evaluated separately for induration, scaling and erythema using a 5-point severity scale.
arm group label: Standard of care
arm group type: Active Comparator
description: Daily self-administration of 1 to 5g Daivobet (Calcipotriol 50ug/g +Betamethasone, 0,5mg/g Gel) ointment, which is applied topically once per day for 8 weeks on one pre-selected randomized plaque.
arm group label: Laser plus etanercept
arm group type: Experimental
description: Immediately following microporation of a 5 cm² area of the designated plaque with the P.L.E.A.S.E.® Professional laser, 0.0625 ml of Etanercept (50 mg/ml) solution for injection in pre-filled syringes will be applied to the microporated surface of the lesion. The treated area will then be covered with OpSiteTM Flexigrid Transparent Dressing for 4 hours. This treatment procedure will be repeated twice weekly for 8 weeks.
arm group label: Laser alone
arm group type: Active Comparator
description: The Er:YAG laser induced microporation of 5 cm2 of a plaque surface, followed by application of an OpSiteTM Flexigrid Transparent Dressing for 4 hours. This treatment will also be repeated twice weekly for 8 weeks.
intervention type: Device
intervention name: Laser microporation alone
description: The Er:YAG laser induced microporation of 5 cm2 of a plaque surface, followed by application of an OpSiteTM Flexigrid Transparent Dressing for 4 hours. This treatment will also be repeated twice weekly for 8 weeks.
arm group label: Laser alone
other name: P.L.E.A.S.E.
intervention type: Drug
intervention name: Standard of care-daily administration of Daivobet
description: The other control treatment is Daivobet®, which is applied topically daily for 8 weeks on one pre-selected randomized plaque.
arm group label: Standard of care
other name: Daivobet
intervention type: Drug
intervention name: Laser microporation + topical application of Etanercept
description: Immediately following microporation of a 5 cm² area of the designated plaque with the P.L.E.A.S.E.® Professional laser, 0.0625 ml of Etanercept (50 mg/ml) solution for injection in pre-filled syringes will be applied to the microporated surface of the lesion. The treated area will then be covered with OpSiteTM Flexigrid Transparent Dressing for 4 hours. This treatment procedure will be repeated twice weekly for 8 weeks.
arm group label: Laser plus etanercept
other name: Etanercept
criteria: 
gender: All
minimum age: 18 Years
maximum age: N/A
healthy volunteers: No
last name: Wolf-Henning Boehncke, Prof.
role: Principal Investigator
affiliation: HUG
last name: Wolf-Henning Boehncke, Prof.
phone: +41(0)22 372 94 22
email: wolf-henning.boehncke@hcuge.ch
facility: 
status: Recruiting
contact: 
country: Switzerland
responsible party type: Sponsor
mesh term: Psoriasis
mesh term: Etanercept
sharing ipd: No