Efficacy, Safety, and Immunogenicity of AVT04 With Moderate-to-Severe Chronic Plaque Psoriasis

Exclusion Criteria

• •1. Patient diagnosed with psoriatic arthritis, erythrodermic psoriasis, pustular psoriasis, guttate psoriasis, medication-induced psoriasis, other skin conditions (eg, eczema), or other systemic autoimmune disorder inflammatory disease at the time of the Screening Visit that would interfere with evaluations of the effect of the study drug on psoriasis.
• •2. Patient has prior use of any of the following medications within specified time periods or will require use during the study:
• •1. Topical medications within 2 weeks of BL visit (except low- to mid-potency topical corticosteroids on face, eyes, scalp, palms, soles, and genital area; only).
• •2. PUVA phototherapy and/or UVB phototherapy within 4 weeks prior to the BL visit.
• •3. Nonbiologic psoriasis systemic therapies (eg, cyclosporine, methotrexate, and acitretin) within 4 weeks prior to the BL visit.
• •4. Any systemic steroid in the 4 weeks prior to the BL visit.
• •5. Any oral traditional Chinese medicine (TCM) 4 weeks prior to the BL visit or any topical TCM 2 weeks prior to the BL visit.
• •6. Investigational agent(s) within 90 days or 5 half-lives (whichever is longer) before BL visit.
• •7. Other systemic biologics within 90 days or 5 half-lives (whichever is the longer) before BL visit.
• •8. Any therapeutic agent targeting IL-12, IL-17 or IL-23 at any time. Specified washout periods for approved/marketed products are provided in Table 5.1.
• •Table 5.1: Approved/Marketed Products Medication or Therapy Washout before BL Biologic Therapies, including but limited to: Adalimumab Etanercept Secukinumab Infliximab Certolizumab pegol Alefacept Briakinumab Guselkumab Brodalumab 12 weeks 8 weeks 12 weeks 12 weeks 24 weeks 24 weeks 24 weeks 13 weeks 13 weeks Any kinase inhibitor for any reason (eg, tofacitinib citrate) 1 day Any phosphodiesterase type 4 inhibitor (eg, apremilast \[Otezla\]) 4 weeks Cyclosporine 4 weeks Methotrexate 4 weeks PUVA-UVA/UVB 4 weeks Topical psoriasis treatments (examples include vitamin D analogs, topical steroids, polifenols, etc) (except low- to mid-potency topical corticosteroids on face, eyes, scalp, palms, soles, and genital area; only) 2 weeks Oral retinoids 4 weeks Corticosteroids IM - IV - oral - intraarticular 4 weeks Drugs that may cause new onset or exacerbation of psoriasis (including, but not limited to, beta blockers, lithium, and anti-malarials) 6 months1 TCM (oral) TCM (topical) 4 weeks 2 weeks Abbreviations: BL = Baseline; IM = intramuscular; IV = intravenous; PUVA = psoralen plus ultraviolet light A; TCM = traditional Chinese medicine; UVA = ultraviolet light A; UVB = ultraviolet light B. 1 Unless the patient has been on a stable dose for at least 6 months prior to BL Visit without exacerbation of psoriasis.
• •3. Patient has received live or attenuated vaccines during the 4 weeks prior to BL visit or has the intention of receiving a live or attenuated vaccine at any time during the study.
• •Note: Inactivated (non-live and non-attenuated) vaccines are allowed.
• •4. Patient has an underlying condition (including, but not limited to metabolic, hematologic, renal, hepatic, pulmonary, neurologic, endocrine, cardiac, infectious, or gastrointestinal) which, in the opinion of the investigator or designee, significantly immunocompromises the patient and/or places the patient at unacceptable risk for receiving an immunomodulatory therapy.
• •5. Patient has a planned surgical intervention during the duration of the study except those related to the underlying disease and which, in the opinion of the investigator or designee, will not put the patient at further risk or hinder the patient's ability to maintain compliance with study drug and the visit schedule.
• •6. Patient has an active and serious infection or history of infections as follows:
• •a. Any active infection (including Severe Acute Respiratory Syndrome-Coronavirus-2 \[SARS-CoV-2\] infection) i. For which non-systemic anti-infectives were used within 4 weeks prior to BL visit. Note: patients receiving topical antibiotics for facial acne do not need to be excluded.
• •ii. Which required hospitalization/quarantine or systemic anti-infective within 8 weeks prior to BL visit.
• •b. Recurrent or chronic infections or other active infection that, in the opinion of the investigator or designee, might cause this study to be detrimental to the patient.
• •c. Invasive fungal infection or mycobacterial infection. d. Opportunistic infections, such as listeriosis, legionellosis, or pneumocystis.
• •7. Patient is positive for human immunodeficiency virus (HIV), hepatitis C virus (HCV) antibody, hepatitis B surface antigen (HBsAg), or hepatitis B core antibody (HBcAb).
• •8. Patient has severe progressive or uncontrolled, clinically significant disease that in the judgment of the investigator or designee renders the patient unsuitable for the study.
• •9. Patient has a history of malignancy within 5 years except for adequately treated cutaneous squamous or basal cell carcinoma, in situ cervical cancer or in situ breast ductal carcinoma.
• •10. Patient has active neurological disease such as multiple sclerosis, Guillain-Barré syndrome, optic neuritis, transverse myelitis, or history of neurologic symptoms suggestive of central nervous system demyelinating disease.
• •11. Patient has moderate to severe heart failure (New York Heart Association class III/IV).
• •12. Patient has uncontrolled diabetes mellitus type 1 or 2.
• •13. Patient has a history of hypersensitivity to the active substance or to any of the excipients of Stelara or AVT04.
• •14. Patient is pregnant or nursing (lactating) women, where pregnancy is defined as the state of a female after conception and until the termination of gestation.
• •15. Patient has evidence (as assessed by the investigator or designee using good clinical judgment) of alcohol or drug abuse or dependency at the time of Screening, for the 5 years prior to Screening, or during the study.
• •16. Patient is unable to follow study instructions and comply with the protocol in the opinion of the investigator or designee.
• •17. Patient has a history of clinically significant hematological abnormalities, including cytopenia (eg, thrombocytopenia, leukopenia).
• •18. Patient has a laboratory abnormality that, in the opinion of the investigator or designee, could cause this study to be detrimental to the patient. The following laboratory abnormalities should be excluded:
• •1. Hemoglobin \<9 g/dL
• •2. Platelet count \<100,000/mm³
• •3. White blood cell count \<3000 cells/mm³
• •4. Aspartate aminotransferase and/or alanine aminotransferase that is persistently ≥2 × the upper limit of normal. (Persistently indicates at least on 2 occasions separated by a number of days, per the rescreening procedure)
• •5. Creatinine clearance \<50 mL/min (Cockcroft-Gault formula)