Plaque PsoriasisPhase 4COBRANCT04533737
Efficacy and Safety of Brodalumab Compared With Guselkumab in the Treatment of Plaque Psoriasis After Inadequate Response to Ustekinumab
A Phase 4 study testing Brodalumab and Guselkumab in people with Plaque Psoriasis and Psoriasis Vulgaris, run by LEO Pharma at 65 sites in 12 countries.
Trial summary
The trial investigates the efficacy and safety of brodalumab against guselkumab in treatment for patients with moderate-to-severe plaque psoriasis who still have some remaining symptoms after ustekinumab treatment. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Plaque Psoriasis, Psoriasis Vulgaris, Psoriasis
- What is being tested?
- Brodalumab and Guselkumab
- Type of treatment
- Injection or infusion
- Could I receive a placebo?
- Yes, some participants may receive a placebo
- How many people
- 113 participants
- Where
- 65 sitesin 12 countries
- Study dates
- 17 Dec 2020to 7 Dec 2022
- Phase
- Phase 4
- Are there results?
- Yes, posted in the registrySummary in the doctors' view
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Participant has a diagnosis of plaque psoriasis for at least 6 months before the first administration of investigational medicinal product (IMP) as determined by the investigator.
- Participant has inadequately controlled plaque psoriasis currently treated with ustekinumab, and fulfils ALL of the following criteria:
- Ustekinumab administered at least 3 times at or higher than the approved dose or frequency before randomisation.
- IGA ≥2 at screening and baseline.
- Absolute PASI >3 at screening and baseline.
- Participant has no evidence of active tuberculosis according to local standard of care for patients requiring initiation of a biologic treatment. Participants with adequately treated latent tuberculosis, according to local guidelines, are eligible.
Who cannot join
- Participant was diagnosed with erythrodermic psoriasis, pustular psoriasis, guttate psoriasis, medication-induced psoriasis, or other skin conditions (e.g. eczema) that would interfere with evaluations of the effect of IMP on plaque psoriasis.
- Participant has clinically important active infections or infestations, chronic, recurrent, or latent infections or infestations, or is immunocompromised (e.g. human immunodeficiency virus).
- Participant has any systemic disease (e.g. renal failure, heart failure, hypertension, liver disease, diabetes, anaemia) considered by the investigator to be clinically significant and uncontrolled.
- Participant has a known history of Crohn's disease.
- Participant has any active malignancy, including evidence of cutaneous basal or squamous cell carcinoma or melanoma.
- Participant has a history of malignancy within 5 years, except for treated and considered cured cutaneous squamous or basal cell carcinoma, in situ cervical cancer, or in situ breast ductal carcinoma.
Show all 12Show fewer
- Participant has a known history of active tuberculosis.
- Participant has a history of suicidal behaviour (i.e. 'actual suicide attempt', 'interrupted attempt', 'aborted attempt', or 'preparatory acts or behaviour') based on the Columbia-Suicide Severity Rating Scale (C-SSRS) questionnaire at screening or baseline.
- Participant has any suicidal ideation of severity 4 or 5 ('some intent to act, no plan' or 'specific plan and intent') based on the C-SSRS questionnaire at screening or baseline.
- Participant has a Patient Health Questionnaire-8 (PHQ-8) score of ≥10, corresponding to moderate to severe depression at screening or baseline.
- Participant has previously been treated with any anti-interleukin (IL)-17A, anti-IL 17 receptor subunit A, or anti-IL-23 besides ustekinumab.
- Participant has known or suspected hypersensitivity to any component(s) of the IMPs.
Trial locations and contacts
65 sites in 12 countries.
65 sites in 12 countries
Germany20 sites
LEO Pharma Investigational Site
Aachen, 52074
LEO Pharma Investigational Site
Augsburg, 86163
LEO Pharma Investigational Site
Bad Bentheim, 48455
LEO Pharma Investigational Site
Bonn, 53127
LEO Pharma Investigational Site
Bramsche, 49565
LEO Pharma Investigational Site
Buxtehude, 21614
LEO Pharma Investigational Site
Cologne, 50937
LEO Pharma Investigational Site
Darmstadt, 64297
LEO Pharma Investigational Site
Erlangen, 91054
LEO Pharma Investigational Site
Frankfurt am Main, 60590
LEO Pharma Investigational Site
Freiburg im Breisgau, Baden-Wurttemberg, 79104
LEO Pharma Investigational Site
Hamburg, 20246
LEO Pharma Investigational Site
Hamburg, 20537
LEO Pharma Investigational Site
Kiel, 24105
LEO Pharma Investigational Site
Mainz, 55128
LEO Pharma Investigational Site
Mainz, 55131
LEO Pharma Investigational Site
Memmingen, 87700
LEO Pharma Investigational Site
Munich, 80802
LEO Pharma Investigational Site
Münster, 48149
LEO Pharma Investigational Site
Selters, 56242
Spain10 sites
LEO Pharma Investigational Site
Alicante, 03010
LEO Pharma Investigational Site
Barcelona, 08036
LEO Pharma Investigational Site
Barcelona, 08041
LEO Pharma Investigational Site
Bilbao, Vizcaya, 48013
LEO Pharma Investigational Site
Granada, 18016
LEO Pharma Investigational Site
Madrid, 28031
LEO Pharma Investigational Site
Madrid, 28041
LEO Pharma Investigational Site
Mieres, Principality of Asturias, 33611
LEO Pharma Investigational Site
Pontevedra, 36001
LEO Pharma Investigational Site
Valencia, 46026
France8 sites
LEO Pharma Investigational Site
Antony, 92160
LEO Pharma Investigational Site
Marseille, Bouches-du-Rhône, 13008
LEO Pharma Investigational Site
Martigues, Bouches-du-Rhône, 13500
LEO Pharma Investigational Site
Nice, 06000
LEO Pharma Investigational Site
Rouen, Seine-Maritime 10, 76031
LEO Pharma Investigational Site
Saint-Mandé, Val-de-Marne, 94160
LEO Pharma Investigational Site
Saint-Priest-en-Jarez, 42277
LEO Pharma Investigational Site
Toulouse, 31059
Greece5 sites
LEO Pharma Investigational Site 1
Athens, 16121
LEO Pharma Investigational Site 2
Athens, 16121
LEO Pharma Investigational Site 1
Thessaloniki, 54643
LEO Pharma Investigational Site 2
Thessaloniki, 54643
LEO Pharma Investigational Site
Thessaloniki, 54643
Italy4 sites
LEO Pharma Investigational Site
Naples, 80121
LEO Pharma Investigational Site
Pisa, 56126
LEO Pharma Investigational Site
Roma, 00133
LEO Pharma Investigational Site
Rozzano, 20089
United Kingdom4 sites
LEO Pharma Investigational Site
Bath, Avon, BA1 3NG
LEO Pharma Investigational Site
Dudley, West Midlands, DY1 2HQ
LEO Pharma investigational site
Leeds, West Yorkshire, LS7 4SA
LEO Pharma Investigational Site
London, SW17 0RE
Belgium3 sites
LEO Pharma Investigational Site
Brussels, 1200
LEO Pharma Investigational Site
Herstal, 4040
LEO Pharma Investigational Site
Namur, 5000
Denmark3 sites
LEO Pharma Investigational Site
Copenhagen, 2400
LEO Pharma Investigational Site
Hellerup, 2900
LEO Pharma Investigational Site
Roskilde, 4000
Netherlands3 sites
LEO Pharma Investigational Site
Almere Stad, RL Almere, 1311
LEO Pharma Investigational Site
Amsterdam, 1105 AZ
LEO Pharma Investigational Site
Bergen op Zoom, Bergen, 4614 VT
Austria2 sites
LEO Pharma Investigational Site
Graz, Styria, 8036
LEO Pharma Investigational Site
Vienna, 1090
Switzerland2 sites
LEO Pharma Investigational Site
Sankt Gallen, 9007
LEO Pharma Investigational Site
Zurich, 8091
About this study
Official title: Efficacy and Safety Comparison of Brodalumab Versus Guselkumab in Adult Subjects With Moderate-to-severe Plaque Psoriasis and Inadequate Response to Ustekinumab
The trial investigates the efficacy and safety of brodalumab against guselkumab in treatment for patients with moderate-to-severe plaque psoriasis who still have some remaining symptoms after ustekinumab treatment.
Read the detailed description
Brodalumab is an anti-interleukin 17 receptor A antibody (IL-17RA) and blocks the inflammatory effects of different IL-17 cytokines (IL-17A, IL-17C, IL-17F, IL-17A/F heterodimer, and IL-17E) in the skin. With increasing availability of novel biologics with new targets, the complexity of choosing the appropriate biologic treatment is ever more challenging for physicians. Therefore, the primary objective of this trial is to compare the efficacy of brodalumab versus guselkumab in adult participants with moderate to severe plaque psoriasis and inadequate response to ustekinumab, thereby providing new scientific information that could support decision making in the clinical setting. The study will run approximately 32 weeks for each participant (including a 2- to 4-weeks screening period and a 28-week treatment period), with the primary endpoint measurement at Week 16. Participants receive subcutaneous injections of brodalumab or guselkumab. Dummy injections are also given, so participants and assessors are unaware of which treatment is given.
- Conditions
- Plaque Psoriasis, Psoriasis Vulgaris, Psoriasis
- Being tested
- Brodalumab, Placebo, Guselkumab
- Medical subject headings
- Psoriasis
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
BrodalumabBiological
Also called Kyntheum®
Pre-filled syringe with 210 mg brodalumab in 1.5 ml solution for subcutaneous injection
PlaceboOther
Also called Dummy 1/Dummy 2
The placebo solution is similar to the active guselkumab (Dummy 1) or brodalumab (Dummy 2) solution except that it does not contain any active substance
GuselkumabBiological
Also called Tremfya®
Pre-filled syringe with 100 mg guselkumab in 1 ml solution for subcutaneous injection
| Study group | Role | What they receive |
|---|---|---|
| Arm 1 (brodalumab + dummy 1) | Experimental | Participants receive:
* Brodalumab 210 mg (1.5 ml) at Weeks 0, 1, 2, and then every 2 weeks.
* Dummy 1 (placebo 1.0 ml) at Weeks 0, 4, and then every 8 weeks. Receives: Biological: Brodalumab; Other: Placebo |
| Arm 2 (guselkumab + dummy 2) | Active comparator | Participants receive:
* Guselkumab 100 mg (1.0 ml) at Weeks 0, 4, and then every 8 weeks.
* Dummy 2 (placebo 1.5 ml) at Weeks 0, 1, 2, and then every 2 weeks. Receives: Other: Placebo; Biological: Guselkumab |
What is being measured
The primary outcome is the main question the study is designed to answer.
Having Psoriasis Area and Severity Index (PASI) 100 Response at Week 16
Having 100% improvement from baseline in PASI score. The outcome measure is summarized using the least squares mean percentage of subjects having PASI 100 response at Week 16, based on a logistic regression model adjusted for baseline body weight (<=100 kg,>100 kg) and baseline PASI score.
The PASI is the most widely used tool in clinical practice and clinical trials to assess psoriasis severity and extent. Assessment is done based on the condition of the disease at the time of evaluation, not in relation to the condition at a previous visit. The investigator assesses the severity of 3 psoriasis disease characteristics (redness, thickness, and scaliness) on each of the 4 body regions (head/neck, trunk, upper extremities, lower extremities) according to a severity scale. The investigator also assesses the extent of psoriasis within each of the 4 body regions. This gives a composite score ranging from 0 to 72, with higher values indicating a more severe/extensive condition.
Measured: Week 16
Secondary outcomes (10)
Time to PASI 100 Response (Summarized as the Cumulative Incidence for Achieving PASI 100 at Each Timepoint, Stratified by Weight)
Time to having 100% improvement from baseline in PASI score. The outcome measure summarizes the cumulative percentage of subjects with PASI 100 response (stratified by weight) over time, based on the Aalen-Johansen estimator.
The PASI is the most widely used tool in clinical practice and clinical trials to assess psoriasis severity and extent. Assessment is done based on the condition of the disease at the time of evaluation, not in relation to the condition at a previous visit. The investigator assesses the severity of 3 psoriasis disease characteristics (redness, thickness, and scaliness) on each of the 4 body regions (head/neck, trunk, upper extremities, lower extremities) according to a severity scale. The investigator also assesses the extent of psoriasis within each of the 4 body regions. This gives a composite score ranging from 0 to 72, with higher values indicating a more severe/extensive condition.
Measured: up to 28 weeks
Time to PASI 90 Response (Summarized as the Cumulative Incidence for Achieving PASI 90 at Each Timepoint, Stratified by Weight)
Time to having 90% improvement from baseline in PASI score. The outcome measure summarizes the cumulative percentage of subjects with PASI 90 response (stratified by weight) over time, based on the Aalen-Johansen estimator.
The PASI is the most widely used tool in clinical practice and clinical trials to assess psoriasis severity and extent. Assessment is done based on the condition of the disease at the time of evaluation, not in relation to the condition at a previous visit. The investigator assesses the severity of 3 psoriasis disease characteristics (redness, thickness, and scaliness) on each of the 4 body regions (head/neck, trunk, upper extremities, lower extremities) according to a severity scale. The investigator also assesses the extent of psoriasis within each of the 4 body regions. This gives a composite score ranging from 0 to 72, with higher values indicating a more severe/extensive condition.
Measured: up to 28 weeks
Having PASI 100 Response, Assessed Separately at Weeks 4, 8, and 28.
Having 100% improvement from baseline in PASI score. The outcome measure is summarized using the least squares mean percentage of subjects having PASI 100 response at Weeks 4, 8, and 28, based on a logistic regression model adjusted for baseline body weight (<=100 kg,>100 kg) and baseline PASI score.
The PASI is the most widely used tool in clinical practice and clinical trials to assess psoriasis severity and extent. Assessment is done based on the condition of the disease at the time of evaluation, not in relation to the condition at a previous visit. The investigator assesses the severity of 3 psoriasis disease characteristics (redness, thickness, and scaliness) on each of the 4 body regions (head/neck, trunk, upper extremities, lower extremities) according to a severity scale. The investigator also assesses the extent of psoriasis within each of the 4 body regions. This gives a composite score ranging from 0 to 72, with higher values indicating a more severe/extensive condition.
Measured: Weeks 4, 8, and 28
Having PASI 90 Response, Assessed Separately at Weeks 4, 8, 16, and 28.
Having 90% improvement from baseline in PASI score. The outcome measure is summarized using the least squares mean percentage of subjects having PASI 90 response at Weeks 4, 8, 16, and 28, based on a logistic regression model adjusted for baseline body weight (<=100 kg,>100 kg) and baseline PASI score.
The PASI is the most widely used tool in clinical practice and clinical trials to assess psoriasis severity and extent. Assessment is done based on the condition of the disease at the time of evaluation, not in relation to the condition at a previous visit. The investigator assesses the severity of 3 psoriasis disease characteristics (redness, thickness, and scaliness) on each of the 4 body regions (head/neck, trunk, upper extremities, lower extremities) according to a severity scale. The investigator also assesses extent of psoriasis within each of the 4 body regions. This gives a composite score ranging from 0 to 72, with higher values indicating a more severe/extensive condition.
Measured: Weeks 4, 8, 16, and 28
Having Investigator's Global Assessment (IGA) of 0, Assessed Separately at Weeks 16 and 28.
Having a score of 0 (clear) in IGA. The outcome measure is summarized using the least squares mean percentage of subjects having an IGA score of 0 at Weeks 16 and 28, based on a logistic regression model adjusted for baseline body weight (<=100 kg,>100 kg) and baseline IGA score.
The IGA is an instrument used in clinical trials to rate the severity of psoriasis and is based on a 5-point scale ranging from 0 (clear) to 4 (severe).
Measured: Weeks 16 and 28
Having IGA of 0 or 1, Assessed Separately at Weeks 16 and 28.
Having a score of 0 (clear) or 1 (almost clear) in IGA. The outcome measure is summarized using the least squares mean percentage of subjects having an IGA score of 0 or 1 at Weeks 16 and 28, based on a logistic regression model adjusted for baseline body weight (<=100 kg,>100 kg) and baseline IGA score.
The IGA is an instrument used in clinical trials to rate the severity of psoriasis and is based on a 5-point scale ranging from 0 (clear) to 4 (severe).
Measured: Weeks 16 and 28
Having Dermatology Life Quality Index (DLQI) Total Score of 0 or 1, Assessed Separately at Weeks 4, 8, 12, 16, 20, 24, and 28.
The outcome measure is summarized using the least squares mean percentage of subjects having a DLQI score of 0 or 1 at Weeks 4, 8, 12, 16, 20, 24, and 28, based on a logistic regression model adjusted for baseline body weight (<=100 kg,>100 kg) and baseline DLQI score.
The DLQI is a validated questionnaire with content specific to those with dermatology conditions. It consists of 10 items addressing the participant's perception of the impact of their skin disease on different aspects of their quality of life over the last week such as dermatology-related symptoms and feelings, daily activities, leisure, work or school, personal relationships, and the treatment. Each item is scored on a 4-point Likert scale (0 = 'not at all/not relevant'; 1 = 'a little'; 2 = 'a lot'; 3 = 'very much'). The total score is the sum of the 10 items (0 to 30); a high score is indicative of a poor quality of life.
Measured: Weeks 4, 8, 12, 16, 20, 24, and 28
Change in 36-Item Short Form Health Survey Version 2 (SF-36v2) Physical Component Score From Baseline, Assessed Separately at Weeks 4, 8, 16, and 28.
The SF-36v2 is a 36-item general health status assessment. Participants answer each question by selecting 1 of 3 to 6 categorical response options. The SF-36v2 yields scores for 8 health domains (physical functioning, role physical, bodily pain, general health, vitality, social functioning, role emotional, and mental health) and 2 psychometrically derived summary scores (a physical component summary and a mental component summary). The physical component summary score ranges from 5.1 to 79.7. Higher scores indicate better outcome.
Measured: Weeks 4, 8, 16, and 28
Change in 36-Item Short Form Health Survey Version 2 (SF-36v2) Mental Component Score From Baseline, Assessed Separately at Weeks 4, 8, 16, and 28.
The SF-36v2 is a 36-item general health status assessment. Participants answer each question by selecting 1 of 3 to 6 categorical response options. The SF-36v2 yields scores for 8 health domains (physical functioning, role physical, bodily pain, general health, vitality, social functioning, role emotional, and mental health) and 2 psychometrically derived summary scores (a physical component summary and a mental component summary). The mental component summary score ranges from -4.0 to 79.7. Higher scores indicate better outcome.
Measured: Weeks 4, 8, 16, and 28
Occurrence of Treatment-emergent Adverse Events (AEs) From Baseline to Week 28.
An adverse event is considered treatment-emergent if the onset occurred after the first administration of IMP or if the event started prior to the first administration of IMP and worsened in severity after the first administration of IMP.
Measured: From baseline to Week 28
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted1 Sep 2020
- Study start17 Dec 2020
- Primary completion8 Sep 2022
- Study completion7 Dec 2022
Why it stopped: The recruitment was terminated early due to delays and slow recruitment that significantly jeopardized the trial timelines. There were no safety concerns related to the early termination of the trial.
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Posted resultsParticipant flow, outcome measures and adverse events reported by the sponsor.
- Publications (1)Papers the sponsor has linked to this study.
- Other trials for Plaque PsoriasisStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 4
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Double blind
- Who is masked
- Participant, Outcomes assessor
- Enrolment
- 113 participants (actual)
Sponsor and investigators
- Lead sponsor
- LEO Pharma
- Sponsor type
- Industry (pharma, biotech, devices)
- Responsible party
- Sponsor
- Investigators
- Medical Expert, Study director, LEO Pharma
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT04533737
- Sponsor's protocol ID
- LP0160-1510
- Other IDs
- 2019-004099-20, U1111-1283-7584, 2019
- Acronym
- COBRA
- Status last verified
- Feb 2024
- First submitted
- 26 Aug 2020
- Last updated
- 14 Mar 2025
- Results posted
- Yes, on ClinicalTrials.gov
- Data monitoring committee
- No
- FDA-regulated drug
- Yes
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Reich K, Bianchi L, Khemis A, Maul JT, Tsianakas A, Schempp CM, Petersen K, Noergaard MM, Puig L. Brodalumab Versus Guselkumab in Patients with Moderate-to-Severe Psoriasis with an Inadequate Response to Ustekinumab: A Randomized, Multicenter, Double-Blind Phase 4 Trial (COBRA). Dermatol Ther (Heidelb). 2024 Feb;14(2):453-468. doi: 10.1007/s13555-023-01092-x. Epub 2024 Feb 1.
PubMed 38300408
Study at a glance
From the registry record, last updated by the sponsor on 14 Mar 2025. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Efficacy and Safety Comparison of Brodalumab Versus Guselkumab in Adult Subjects With Moderate-to-severe Plaque Psoriasis and Inadequate Response to Ustekinumab
- ClinicalTrials.gov ID
- NCT04533737
- Acronym / sponsor ID
- COBRA / LP0160-1510
- Conditions
- Plaque Psoriasis, Psoriasis Vulgaris, Psoriasis
- Phase
- Phase 4
- Study type
- Interventional
- Recruitment status
- TerminatedReason stopped: The recruitment was terminated early due to delays and slow recruitment that significantly jeopardized the trial timelines. There were no safety concerns related to the early termination of the trial.
- Enrolment
- 113 participants (actual)
- Lead sponsor
- LEO PharmaIndustry (pharma, biotech, devices)
- Study start
- 17 Dec 2020 (actual)
- Primary completion
- 8 Sep 2022 (actual)
- Study completion
- 7 Dec 2022 (actual)
- First posted
- 1 Sep 2020 (actual)
- Results
- Posted 9 Jan 2024
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The trial investigates the efficacy and safety of brodalumab against guselkumab in treatment for patients with moderate-to-severe plaque psoriasis who still have some remaining symptoms after ustekinumab treatment.
Detailed description
Brodalumab is an anti-interleukin 17 receptor A antibody (IL-17RA) and blocks the inflammatory effects of different IL-17 cytokines (IL-17A, IL-17C, IL-17F, IL-17A/F heterodimer, and IL-17E) in the skin. With increasing availability of novel biologics with new targets, the complexity of choosing the appropriate biologic treatment is ever more challenging for physicians. Therefore, the primary objective of this trial is to compare the efficacy of brodalumab versus guselkumab in adult participants with moderate to severe plaque psoriasis and inadequate response to ustekinumab, thereby providing new scientific information that could support decision making in the clinical setting. The study will run approximately 32 weeks for each participant (including a 2- to 4-weeks screening period and a 28-week treatment period), with the primary endpoint measurement at Week 16. Participants receive subcutaneous injections of brodalumab or guselkumab. Dummy injections are also given, so participants and assessors are unaware of which treatment is given.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Double blind (participant, outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Arm 1 (brodalumab + dummy 1) | Experimental | Biological: Brodalumab, Other: PlaceboParticipants receive: * Brodalumab 210 mg (1.5 ml) at Weeks 0, 1, 2, and then every 2 weeks. * Dummy 1 (placebo 1.0 ml) at Weeks 0, 4, and then every 8 weeks. |
| Arm 2 (guselkumab + dummy 2) | Active comparator | Other: Placebo, Biological: GuselkumabParticipants receive: * Guselkumab 100 mg (1.0 ml) at Weeks 0, 4, and then every 8 weeks. * Dummy 2 (placebo 1.5 ml) at Weeks 0, 1, 2, and then every 2 weeks. |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (6 listed)
- Participant has a diagnosis of plaque psoriasis for at least 6 months before the first administration of investigational medicinal product (IMP) as determined by the investigator.
- Participant has inadequately controlled plaque psoriasis currently treated with ustekinumab, and fulfils ALL of the following criteria:
- Participant has no evidence of active tuberculosis according to local standard of care for patients requiring initiation of a biologic treatment. Participants with adequately treated latent tuberculosis, according to local guidelines, are eligible.
Key exclusion criteria (12 listed)
- Participant was diagnosed with erythrodermic psoriasis, pustular psoriasis, guttate psoriasis, medication-induced psoriasis, or other skin conditions (e.g. eczema) that would interfere with evaluations of the effect of IMP on plaque psoriasis.
- Participant has clinically important active infections or infestations, chronic, recurrent, or latent infections or infestations, or is immunocompromised (e.g. human immunodeficiency virus).
- Participant has any systemic disease (e.g. renal failure, heart failure, hypertension, liver disease, diabetes, anaemia) considered by the investigator to be clinically significant and uncontrolled.
- Participant has a known history of Crohn's disease.
- Participant has any active malignancy, including evidence of cutaneous basal or squamous cell carcinoma or melanoma.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| BrodalumabAlso: Kyntheum®Pre-filled syringe with 210 mg brodalumab in 1.5 ml solution for subcutaneous injection | Biological | Arm 1 (brodalumab + dummy 1) |
| PlaceboAlso: Dummy 1/Dummy 2The placebo solution is similar to the active guselkumab (Dummy 1) or brodalumab (Dummy 2) solution except that it does not contain any active substance | Other | Arm 1 (brodalumab + dummy 1), Arm 2 (guselkumab + dummy 2) |
| GuselkumabAlso: Tremfya®Pre-filled syringe with 100 mg guselkumab in 1 ml solution for subcutaneous injection | Biological | Arm 2 (guselkumab + dummy 2) |
Primary outcome
Having Psoriasis Area and Severity Index (PASI) 100 Response at Week 16
Time frame: Week 16
Having 100% improvement from baseline in PASI score. The outcome measure is summarized using the least squares mean percentage of subjects having PASI 100 response at Week 16, based on a logistic regression model adjusted for baseline body weight (<=100 kg,>100 kg) and baseline PASI score. The PASI is the most widely used tool in clinical practice and clinical trials to assess psoriasis severity and extent. Assessment is done based on the condition of the disease at the time of evaluation, not in relation to the condition at a previous visit. The investigator assesses the severity of 3 psoriasis disease characteristics (redness, thickness, and scaliness) on each of the 4 body regions (head/neck, trunk, upper extremities, lower extremities) according to a severity scale. The investigator also assesses the extent of psoriasis within each of the 4 body regions. This gives a composite score ranging from 0 to 72, with higher values indicating a more severe/extensive condition.
10 secondary outcomes
Time to PASI 100 Response (Summarized as the Cumulative Incidence for Achieving PASI 100 at Each Timepoint, Stratified by Weight)
Time frame: up to 28 weeks
Time to PASI 90 Response (Summarized as the Cumulative Incidence for Achieving PASI 90 at Each Timepoint, Stratified by Weight)
Time frame: up to 28 weeks
Having PASI 100 Response, Assessed Separately at Weeks 4, 8, and 28.
Time frame: Weeks 4, 8, and 28
Having PASI 90 Response, Assessed Separately at Weeks 4, 8, 16, and 28.
Time frame: Weeks 4, 8, 16, and 28
Having Investigator's Global Assessment (IGA) of 0, Assessed Separately at Weeks 16 and 28.
Time frame: Weeks 16 and 28
Having IGA of 0 or 1, Assessed Separately at Weeks 16 and 28.
Time frame: Weeks 16 and 28
Having Dermatology Life Quality Index (DLQI) Total Score of 0 or 1, Assessed Separately at Weeks 4, 8, 12, 16, 20, 24, and 28.
Time frame: Weeks 4, 8, 12, 16, 20, 24, and 28
Change in 36-Item Short Form Health Survey Version 2 (SF-36v2) Physical Component Score From Baseline, Assessed Separately at Weeks 4, 8, 16, and 28.
Time frame: Weeks 4, 8, 16, and 28
Change in 36-Item Short Form Health Survey Version 2 (SF-36v2) Mental Component Score From Baseline, Assessed Separately at Weeks 4, 8, 16, and 28.
Time frame: Weeks 4, 8, 16, and 28
Occurrence of Treatment-emergent Adverse Events (AEs) From Baseline to Week 28.
Time frame: From baseline to Week 28
Results and safety
Loading the posted results from ClinicalTrials.gov…
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 14 Mar 2025.
- Posted resultsParticipant flow, baseline, all outcome measures and adverse events.
- Results publication: PubMed 38300408Reich K, Bianchi L, Khemis A, Maul JT, Tsianakas A, Schempp CM, Petersen K, Noergaard MM, Puig L. Brodalumab Versus Guselkumab in Patients with Moderate-to-Severe Psoriasis with an Inadequate Response to Ustekinumab: A Randomized, Multicenter, Double-Blind Phase 4 Trial (COBRA). Dermatol Ther (Heidelb). 2024 Feb;14(2):453-468. doi: 10.1007/s13555-023-01092-x. Epub 2024 Feb 1.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Medical Expert study director
LEO Pharma
65 sites in 12 countries: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 4 study testing Brodalumab and Guselkumab in people with Plaque Psoriasis and Psoriasis Vulgaris, run by LEO Pharma at 65 sites in 12 countries.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 6 inclusion and 12 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: stopped early, as of the sponsor's last update on 14 Mar 2025. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 65 sites in Germany, Spain, France, Greece, Italy and 7 more countries. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this phase mean?
Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
Yes. Results are posted in the registry (first posted 9 Jan 2024). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Having Psoriasis Area and Severity Index (PASI) 100 Response at Week 16 (time frame: Week 16). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT04533737, which also lists 1 linked publication.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 14 Mar 2025.