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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.

Terminated

Stopped early. The study ended before it was planned to and will not resume.

Official record
Search all trials

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

Other trials in Germany

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

Other trials in Spain

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

Other trials in France

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

Other trials in Greece

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

Other trials in Italy

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

Other trials in United Kingdom

Belgium3 sites
  • LEO Pharma Investigational Site

    Brussels, 1200

  • LEO Pharma Investigational Site

    Herstal, 4040

  • LEO Pharma Investigational Site

    Namur, 5000

Other trials in Belgium

Denmark3 sites
  • LEO Pharma Investigational Site

    Copenhagen, 2400

  • LEO Pharma Investigational Site

    Hellerup, 2900

  • LEO Pharma Investigational Site

    Roskilde, 4000

Other trials in Denmark

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

Other trials in Netherlands

Austria2 sites
  • LEO Pharma Investigational Site

    Graz, Styria, 8036

  • LEO Pharma Investigational Site

    Vienna, 1090

Other trials in Austria

Switzerland2 sites
  • LEO Pharma Investigational Site

    Sankt Gallen, 9007

  • LEO Pharma Investigational Site

    Zurich, 8091

Other trials in Switzerland

Sweden1 site
  • LEO Pharma Investigational Site

    Solna, Stockholm County, 171 76

Other trials in Sweden

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.

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 groups in NCT04533737
Study groupRoleWhat they receive
Arm 1 (brodalumab + dummy 1)ExperimentalParticipants 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 comparatorParticipants 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.

  1. 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)
  1. 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

  2. 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

  3. 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

  4. 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

  5. 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

  6. 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

  7. 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

  8. 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

  9. 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

  10. 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.

  1. First posted1 Sep 2020
  2. Study start17 Dec 2020
  3. Primary completion8 Sep 2022
  4. 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

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)
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
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

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.

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