Skip to main content
Top
Published in: Advances in Therapy 11/2020

01-11-2020 | Vulgar Psoriasis | Study Protocol

PSO-LONG: Design of a Novel, 12-Month Clinical Trial of Topical, Proactive Maintenance with Twice-Weekly Cal/BD Foam in Psoriasis

Authors: Linda Stein Gold, Javier Alonso-Llamazares, Jean-Philippe Lacour, Richard B. Warren, Stephen K. Tyring, Leon Kircik, Paul Yamauchi, Mark Lebwohl, for the PSO-LONG Trial Investigators

Published in: Advances in Therapy | Issue 11/2020

Login to get access

Abstract

Background

Psoriasis vulgaris is commonly treated with topical corticosteroids and vitamin D analogues. Although potent and super-potent topical corticosteroids are very effective at clearing psoriasis, with short-term reactive treatment durations, symptoms usually recur after treatment discontinuation, necessitating long-term disease management strategies. A foam formulation of calcipotriol and betamethasone dipropionate (Cal/BD foam), consisting of calcipotriol 50 μg/g and betamethasone dipropionate 0.5 mg/g, is approved for the daily treatment of psoriasis for up to 4 weeks. Here, we describe a clinical trial protocol for evaluating the long-term safety and efficacy of twice-weekly Cal/BD foam as a proactive topical maintenance therapy for plaque psoriasis for up to 52 weeks.

Objective

The aim of this trial was to evaluate the safety and efficacy of Cal/BD foam when applied twice weekly for up to 52 weeks as proactive maintenance therapy, with the goal of preventing or delaying disease relapse as long as possible while minimizing adverse effects.

Methods

Once-daily Cal/BD foam treatment responders from an initial 4-week open-label period were randomized to receive Cal/BD foam or foam vehicle applied to previously cleared plaques twice weekly for up to 52 weeks. In case of relapse, affected subjects in either group received rescue therapy with once-daily Cal/BD foam for 4 weeks on active areas. Thus, the trial (NCT02899962) compared the long-term use of Cal/BD foam in a proactive approach with a conventional, reactive approach.

Planned Outcomes

Efficacy endpoints included the time to first relapse, the number of relapse-free days, and the number of relapses during the maintenance phase. Safety assessments included adverse events, incidence of rebound, local safety and tolerability scores, and effects on calcium metabolism and hypothalamic–pituitary–adrenal axis function.

Trial registration

ClinicalTrials.gov identifier, NCT02899962.
Appendix
Available only for authorised users
Literature
1.
go back to reference Langley RG, Krueger GG, Griffiths CE. Psoriasis: epidemiology, clinical features, and quality of life. Ann Rheum Dis. 2005;64(Suppl 2):ii18–23 (discussion ii4–5).PubMedPubMedCentral Langley RG, Krueger GG, Griffiths CE. Psoriasis: epidemiology, clinical features, and quality of life. Ann Rheum Dis. 2005;64(Suppl 2):ii18–23 (discussion ii4–5).PubMedPubMedCentral
2.
go back to reference Rachakonda TD, Schupp CW, Armstrong AW. Psoriasis prevalence among adults in the United States. J Am Acad Dermatol. 2014;70(3):512–6.PubMedCrossRef Rachakonda TD, Schupp CW, Armstrong AW. Psoriasis prevalence among adults in the United States. J Am Acad Dermatol. 2014;70(3):512–6.PubMedCrossRef
3.
go back to reference Griffiths CE, Christophers E, Barker JN, et al. A classification of psoriasis vulgaris according to phenotype. Br J Dermatol. 2007;156(2):258–62.PubMedCrossRef Griffiths CE, Christophers E, Barker JN, et al. A classification of psoriasis vulgaris according to phenotype. Br J Dermatol. 2007;156(2):258–62.PubMedCrossRef
4.
go back to reference Griffiths CEM, van der Walt JM, Ashcroft DM, et al. The global state of psoriasis disease epidemiology: a workshop report. Br J Dermatol. 2017;177(1):e4–e7.PubMedPubMedCentralCrossRef Griffiths CEM, van der Walt JM, Ashcroft DM, et al. The global state of psoriasis disease epidemiology: a workshop report. Br J Dermatol. 2017;177(1):e4–e7.PubMedPubMedCentralCrossRef
5.
go back to reference Strober BE, van der Walt JM, Armstrong AW, et al. Clinical goals and barriers to effective psoriasis care. Dermatol Ther (Heidelb). 2019;9(1):5–18.CrossRef Strober BE, van der Walt JM, Armstrong AW, et al. Clinical goals and barriers to effective psoriasis care. Dermatol Ther (Heidelb). 2019;9(1):5–18.CrossRef
6.
go back to reference Takeshita J, Gelfand JM, Li P, et al. Psoriasis in the US Medicare population: prevalence, treatment, and factors associated with biologic use. J Investig Dermatol. 2015;135(12):2955–63.PubMedCrossRef Takeshita J, Gelfand JM, Li P, et al. Psoriasis in the US Medicare population: prevalence, treatment, and factors associated with biologic use. J Investig Dermatol. 2015;135(12):2955–63.PubMedCrossRef
7.
go back to reference Bagel J, Gold LS. Combining topical psoriasis treatment to enhance systemic and phototherapy: a review of the literature. J Drugs Dermatol. 2017;16(12):1209–22.PubMed Bagel J, Gold LS. Combining topical psoriasis treatment to enhance systemic and phototherapy: a review of the literature. J Drugs Dermatol. 2017;16(12):1209–22.PubMed
8.
go back to reference Menter A, Korman NJ, Elmets CA, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis. Section 3. Guidelines of care for the management and treatment of psoriasis with topical therapies. J Am Acad Dermatol. 2009;60(4):643–59.PubMedCrossRef Menter A, Korman NJ, Elmets CA, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis. Section 3. Guidelines of care for the management and treatment of psoriasis with topical therapies. J Am Acad Dermatol. 2009;60(4):643–59.PubMedCrossRef
9.
go back to reference Stein Gold LF. Topical therapies for psoriasis: improving management strategies and patient adherence. Semin Cutan Med Surg. 2016;35(2 Suppl 2):S36–44 (quiz S5).PubMed Stein Gold LF. Topical therapies for psoriasis: improving management strategies and patient adherence. Semin Cutan Med Surg. 2016;35(2 Suppl 2):S36–44 (quiz S5).PubMed
10.
go back to reference Menter A, Strober BE, Kaplan DH, et al. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with biologics. J Am Acad Dermatol. 2019;80(4):1029–72.PubMedCrossRef Menter A, Strober BE, Kaplan DH, et al. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with biologics. J Am Acad Dermatol. 2019;80(4):1029–72.PubMedCrossRef
12.
go back to reference El Hachem M, Gesualdo F, Ricci G, et al. Topical corticosteroid phobia in parents of pediatric patients with atopic dermatitis: a multicentre survey. Ital J Pediatr. 2017;43(1):22.PubMedPubMedCentralCrossRef El Hachem M, Gesualdo F, Ricci G, et al. Topical corticosteroid phobia in parents of pediatric patients with atopic dermatitis: a multicentre survey. Ital J Pediatr. 2017;43(1):22.PubMedPubMedCentralCrossRef
13.
go back to reference Abidi A, Ahmad F, Singh SK. A comparative clinical evaluation of once daily versus alternate day application of topical clobetasol propionate cream in psoriasis. J Clin Diagn Res. 2013;7(1):100–5.PubMed Abidi A, Ahmad F, Singh SK. A comparative clinical evaluation of once daily versus alternate day application of topical clobetasol propionate cream in psoriasis. J Clin Diagn Res. 2013;7(1):100–5.PubMed
14.
go back to reference Emer JJ, Frankel A, Sohn A, Lebwohl M. A randomized, double-blind, placebo-controlled study to evaluate the safety and efficacy of ammonium lactate lotion 12% and halobetasol propionate ointment 0.05% in the treatment and maintenance of psoriasis. J Clin Aesthetic Dermatol. 2011;4(2):28–39. Emer JJ, Frankel A, Sohn A, Lebwohl M. A randomized, double-blind, placebo-controlled study to evaluate the safety and efficacy of ammonium lactate lotion 12% and halobetasol propionate ointment 0.05% in the treatment and maintenance of psoriasis. J Clin Aesthetic Dermatol. 2011;4(2):28–39.
15.
go back to reference Koo J, Blum RR, Lebwohl M. A randomized, multicenter study of calcipotriene ointment and clobetasol propionate foam in the sequential treatment of localized plaque-type psoriasis: short- and long-term outcomes. J Am Acad Dermatol. 2006;55(4):637–41.PubMedCrossRef Koo J, Blum RR, Lebwohl M. A randomized, multicenter study of calcipotriene ointment and clobetasol propionate foam in the sequential treatment of localized plaque-type psoriasis: short- and long-term outcomes. J Am Acad Dermatol. 2006;55(4):637–41.PubMedCrossRef
16.
go back to reference Lebwohl M, Yoles A, Lombardi K, Lou W. Calcipotriene ointment and halobetasol ointment in the long-term treatment of psoriasis: effects on the duration of improvement. J Am Acad Dermatol. 1998;39(3):447–50.PubMedCrossRef Lebwohl M, Yoles A, Lombardi K, Lou W. Calcipotriene ointment and halobetasol ointment in the long-term treatment of psoriasis: effects on the duration of improvement. J Am Acad Dermatol. 1998;39(3):447–50.PubMedCrossRef
17.
go back to reference Zampetti A, Barone A, Antuzzi D, et al. Topical preparations for the treatment of psoriasis: results of a retrospective study over 15 years. J Dermatol Treat. 2008;19(3):134–40.CrossRef Zampetti A, Barone A, Antuzzi D, et al. Topical preparations for the treatment of psoriasis: results of a retrospective study over 15 years. J Dermatol Treat. 2008;19(3):134–40.CrossRef
18.
go back to reference Gupta R, Koo J. Topical sequential therapy. In: Koo J, Levin E, Leon A, Wu J, Lebwohl M, editors. Mild to moderate psoriasis. 3rd ed. Boca Raton: CRC; 2014. Gupta R, Koo J. Topical sequential therapy. In: Koo J, Levin E, Leon A, Wu J, Lebwohl M, editors. Mild to moderate psoriasis. 3rd ed. Boca Raton: CRC; 2014.
19.
go back to reference Brodell RT, Bruce S, Hudson CP, et al. A multi-center, open-label study to evaluate the safety and efficacy of a sequential treatment regimen of clobetasol propionate 0.05% spray followed by calcitriol 3 mg/g ointment in the management of plaque psoriasis. J Drugs Dermatol. 2011;10(2):158–64.PubMed Brodell RT, Bruce S, Hudson CP, et al. A multi-center, open-label study to evaluate the safety and efficacy of a sequential treatment regimen of clobetasol propionate 0.05% spray followed by calcitriol 3 mg/g ointment in the management of plaque psoriasis. J Drugs Dermatol. 2011;10(2):158–64.PubMed
21.
go back to reference Kubota Y, Yoneda K, Nakai K, et al. Effect of sequential applications of topical tacrolimus and topical corticosteroids in the treatment of pediatric atopic dermatitis: an open-label pilot study. J Am Acad Dermatol. 2009;60(2):212–7.PubMedCrossRef Kubota Y, Yoneda K, Nakai K, et al. Effect of sequential applications of topical tacrolimus and topical corticosteroids in the treatment of pediatric atopic dermatitis: an open-label pilot study. J Am Acad Dermatol. 2009;60(2):212–7.PubMedCrossRef
22.
go back to reference Girolomoni G, Calzavara Pinton P, Cristaudo A, Cicchetti A. Back to the future: a new topical approach for mild-to-moderate psoriasis. G Ital Dermatol Venereol. 2018;153(3):375–82.PubMed Girolomoni G, Calzavara Pinton P, Cristaudo A, Cicchetti A. Back to the future: a new topical approach for mild-to-moderate psoriasis. G Ital Dermatol Venereol. 2018;153(3):375–82.PubMed
23.
go back to reference Leonardi C, Bagel J, Yamauchi P, et al. Efficacy and safety of calcipotriene plus betamethasone dipropionate aerosol foam in patients with psoriasis vulgaris–a randomized phase III study (PSO-FAST). J Drugs Dermatol. 2015;14(12):1468–77.PubMed Leonardi C, Bagel J, Yamauchi P, et al. Efficacy and safety of calcipotriene plus betamethasone dipropionate aerosol foam in patients with psoriasis vulgaris–a randomized phase III study (PSO-FAST). J Drugs Dermatol. 2015;14(12):1468–77.PubMed
24.
go back to reference Zaghloul SS, Goodfield MJ. Objective assessment of compliance with psoriasis treatment. Arch Dermatol. 2004;140(4):408–14.PubMedCrossRef Zaghloul SS, Goodfield MJ. Objective assessment of compliance with psoriasis treatment. Arch Dermatol. 2004;140(4):408–14.PubMedCrossRef
25.
go back to reference Lavaud J, Mahe E. Proactive treatment in childhood psoriasis. Ann Dermatol Venereol. 2020;147(1):29–35.PubMedCrossRef Lavaud J, Mahe E. Proactive treatment in childhood psoriasis. Ann Dermatol Venereol. 2020;147(1):29–35.PubMedCrossRef
26.
go back to reference Poulin Y, Papp K, Bissonnette R, et al. Clobetasol propionate shampoo 0.05% is efficacious and safe for long-term control of moderate scalp psoriasis. J Dermatol Treat. 2010;21(3):185–92.PubMedCrossRef Poulin Y, Papp K, Bissonnette R, et al. Clobetasol propionate shampoo 0.05% is efficacious and safe for long-term control of moderate scalp psoriasis. J Dermatol Treat. 2010;21(3):185–92.PubMedCrossRef
28.
go back to reference Saraceno R, Camplone G, D'Agostino M, et al. Efficacy and maintenance strategies of two-compound formulation calcipotriol and betamethasone dipropionate gel (Xamiol® gel) in the treatment of scalp psoriasis: results from a study in 885 patients. J Dermatol Treat. 2014;25(1):30–3.CrossRef Saraceno R, Camplone G, D'Agostino M, et al. Efficacy and maintenance strategies of two-compound formulation calcipotriol and betamethasone dipropionate gel (Xamiol® gel) in the treatment of scalp psoriasis: results from a study in 885 patients. J Dermatol Treat. 2014;25(1):30–3.CrossRef
29.
go back to reference Ito K, Koga M, Shibayama Y, Tatematsu S, Nakayama J, Imafuku S. Proactive treatment with calcipotriol reduces recurrence of plaque psoriasis. J Dermatol. 2016;43(4):402–5.PubMedCrossRef Ito K, Koga M, Shibayama Y, Tatematsu S, Nakayama J, Imafuku S. Proactive treatment with calcipotriol reduces recurrence of plaque psoriasis. J Dermatol. 2016;43(4):402–5.PubMedCrossRef
30.
go back to reference Augustin M, Mrowietz U, Bonnekoh B, et al. Topical long-term therapy of psoriasis with vitamin D(3) analogues, corticosteroids and their two compound formulations: position paper on evidence and use in daily practice. J Dtsch Dermatol Ges. 2014;12(8):667–82.PubMed Augustin M, Mrowietz U, Bonnekoh B, et al. Topical long-term therapy of psoriasis with vitamin D(3) analogues, corticosteroids and their two compound formulations: position paper on evidence and use in daily practice. J Dtsch Dermatol Ges. 2014;12(8):667–82.PubMed
31.
go back to reference Bagel J, Zapata J, Nelson E. A prospective, open-label study evaluating adjunctive calcipotriene 0.005%/betamethasone dipropionate 0.064% foam in psoriasis patients with inadequate response to biologic therapy. J Drugs Dermatol. 2018;17(8):845–50.PubMed Bagel J, Zapata J, Nelson E. A prospective, open-label study evaluating adjunctive calcipotriene 0.005%/betamethasone dipropionate 0.064% foam in psoriasis patients with inadequate response to biologic therapy. J Drugs Dermatol. 2018;17(8):845–50.PubMed
32.
go back to reference Lambert J, Hol CW, Vink J. Real-life effectiveness of once-daily calcipotriol and betamethasone dipropionate gel vs. ointment formulations in psoriasis vulgaris: final analysis of the 52-week PRO-LONG study. J Eur Acad Dermatol Venereol. 2015;29(12):2349–55.PubMedPubMedCentralCrossRef Lambert J, Hol CW, Vink J. Real-life effectiveness of once-daily calcipotriol and betamethasone dipropionate gel vs. ointment formulations in psoriasis vulgaris: final analysis of the 52-week PRO-LONG study. J Eur Acad Dermatol Venereol. 2015;29(12):2349–55.PubMedPubMedCentralCrossRef
33.
go back to reference Kragballe K, Austad J, Barnes L, et al. A 52-week randomized safety study of a calcipotriol/betamethasone dipropionate two-compound product (Dovobet/Daivobet/Taclonex) in the treatment of psoriasis vulgaris. Br J Dermatol. 2006;154(6):1155–60.PubMedCrossRef Kragballe K, Austad J, Barnes L, et al. A 52-week randomized safety study of a calcipotriol/betamethasone dipropionate two-compound product (Dovobet/Daivobet/Taclonex) in the treatment of psoriasis vulgaris. Br J Dermatol. 2006;154(6):1155–60.PubMedCrossRef
34.
go back to reference Fleming C, Ganslandt C, Leese GP. Short- and long-term safety assessment of a two-compound ointment containing calcipotriene/betamethasone dipropionate (Taclonex/Daivobet/Dovobet ointment): hypothalamic–pituitary–adrenal axis function in patients with psoriasis vulgaris. J Drugs Dermatol. 2010;9(8):969–74.PubMed Fleming C, Ganslandt C, Leese GP. Short- and long-term safety assessment of a two-compound ointment containing calcipotriene/betamethasone dipropionate (Taclonex/Daivobet/Dovobet ointment): hypothalamic–pituitary–adrenal axis function in patients with psoriasis vulgaris. J Drugs Dermatol. 2010;9(8):969–74.PubMed
35.
go back to reference Kragballe K, Austad J, Barnes L, et al. Efficacy results of a 52-week, randomised, double-blind, safety study of a calcipotriol/betamethasone dipropionate two-compound product (Daivobet/Dovobet/Taclonex) in the treatment of psoriasis vulgaris. Dermatology. 2006;213(4):319–26.PubMedCrossRef Kragballe K, Austad J, Barnes L, et al. Efficacy results of a 52-week, randomised, double-blind, safety study of a calcipotriol/betamethasone dipropionate two-compound product (Daivobet/Dovobet/Taclonex) in the treatment of psoriasis vulgaris. Dermatology. 2006;213(4):319–26.PubMedCrossRef
36.
go back to reference Luger TA, Cambazard F, Larsen FG, et al. A study of the safety and efficacy of calcipotriol and betamethasone dipropionate scalp formulation in the long-term management of scalp psoriasis. Dermatology. 2008;217(4):321–8.PubMedPubMedCentralCrossRef Luger TA, Cambazard F, Larsen FG, et al. A study of the safety and efficacy of calcipotriol and betamethasone dipropionate scalp formulation in the long-term management of scalp psoriasis. Dermatology. 2008;217(4):321–8.PubMedPubMedCentralCrossRef
37.
go back to reference Reich K, Zschocke I, Bachelez H, et al. A Topical Treatment Optimization Programme (TTOP) improves clinical outcome for calcipotriol/betamethasone gel in psoriasis: results of a 64-week multinational randomized phase IV study in 1790 patients (PSO-TOP). Br J Dermatol. 2017;177(1):197–205.PubMedCrossRef Reich K, Zschocke I, Bachelez H, et al. A Topical Treatment Optimization Programme (TTOP) improves clinical outcome for calcipotriol/betamethasone gel in psoriasis: results of a 64-week multinational randomized phase IV study in 1790 patients (PSO-TOP). Br J Dermatol. 2017;177(1):197–205.PubMedCrossRef
38.
go back to reference Lebwohl MG, Sugarman JL, Gold LS, et al. Long-term safety results from a phase 3 open-label study of a fixed combination halobetasol propionate 0.01% and tazarotene 0.045% lotion in moderate-to-severe plaque psoriasis. J Am Acad Dermatol. 2019;80(1):282–5.PubMedCrossRef Lebwohl MG, Sugarman JL, Gold LS, et al. Long-term safety results from a phase 3 open-label study of a fixed combination halobetasol propionate 0.01% and tazarotene 0.045% lotion in moderate-to-severe plaque psoriasis. J Am Acad Dermatol. 2019;80(1):282–5.PubMedCrossRef
39.
go back to reference LEO pharma. Enstilar® [package insert]. Madison: LEO Pharma; 2017. LEO pharma. Enstilar® [package insert]. Madison: LEO Pharma; 2017.
40.
go back to reference Koo J, Tyring S, Werschler WP, et al. Superior efficacy of calcipotriene and betamethasone dipropionate aerosol foam versus ointment in patients with psoriasis vulgaris—a randomized phase II study. J Dermatol Treat. 2016;27(2):120–7.CrossRef Koo J, Tyring S, Werschler WP, et al. Superior efficacy of calcipotriene and betamethasone dipropionate aerosol foam versus ointment in patients with psoriasis vulgaris—a randomized phase II study. J Dermatol Treat. 2016;27(2):120–7.CrossRef
41.
go back to reference Lebwohl M, Tyring S, Bukhalo M, et al. Fixed combination aerosol foam calcipotriene 0.005% (Cal) plus betamethasone dipropionate 0.064% (BD) is more efficacious than Cal or BD aerosol foam alone for psoriasis vulgaris: a randomized, double-blind, multicenter, three-arm, phase 2 study. J Clin Aesthetic Dermatol. 2016;9(2):34–41. Lebwohl M, Tyring S, Bukhalo M, et al. Fixed combination aerosol foam calcipotriene 0.005% (Cal) plus betamethasone dipropionate 0.064% (BD) is more efficacious than Cal or BD aerosol foam alone for psoriasis vulgaris: a randomized, double-blind, multicenter, three-arm, phase 2 study. J Clin Aesthetic Dermatol. 2016;9(2):34–41.
42.
go back to reference Paul C, Stein Gold L, Cambazard F, et al. Calcipotriol plus betamethasone dipropionate aerosol foam provides superior efficacy vs. gel in patients with psoriasis vulgaris: randomized, controlled PSO-ABLE study. J Eur Acad Dermatol Venereol. 2017;31(1):119–26.PubMedCrossRef Paul C, Stein Gold L, Cambazard F, et al. Calcipotriol plus betamethasone dipropionate aerosol foam provides superior efficacy vs. gel in patients with psoriasis vulgaris: randomized, controlled PSO-ABLE study. J Eur Acad Dermatol Venereol. 2017;31(1):119–26.PubMedCrossRef
43.
go back to reference Levin E, Gupta R, Butler D, Chiang C, Koo JY. Topical steroid risk analysis: differentiating between physiologic and pathologic adrenal suppression. J Dermatol Treat. 2014;25(6):501–6.CrossRef Levin E, Gupta R, Butler D, Chiang C, Koo JY. Topical steroid risk analysis: differentiating between physiologic and pathologic adrenal suppression. J Dermatol Treat. 2014;25(6):501–6.CrossRef
Metadata
Title
PSO-LONG: Design of a Novel, 12-Month Clinical Trial of Topical, Proactive Maintenance with Twice-Weekly Cal/BD Foam in Psoriasis
Authors
Linda Stein Gold
Javier Alonso-Llamazares
Jean-Philippe Lacour
Richard B. Warren
Stephen K. Tyring
Leon Kircik
Paul Yamauchi
Mark Lebwohl
for the PSO-LONG Trial Investigators
Publication date
01-11-2020
Publisher
Springer Healthcare
Published in
Advances in Therapy / Issue 11/2020
Print ISSN: 0741-238X
Electronic ISSN: 1865-8652
DOI
https://doi.org/10.1007/s12325-020-01497-6

Other articles of this Issue 11/2020

Advances in Therapy 11/2020 Go to the issue