Cro S, Cornelius V, Pink A, Wilson R, Pushpa‐Rajah A, Patel P, Abdul‐Wahab A, August S, Azad J, Becher G, Chapman A, Dunnill G, Ferguson A, Fogo A, Ghaffar S, Ingram J, Kavakleiva S, Ladoyanni E, Leman J, Macbeth A, Makrygeorgou A, Parslew R, Ryan A, Sharma A, Shipman A, Sinclair C, Wachsmuth R, Woolf R, Wright A, McAteer H, Barker J, Burden A, Griffiths C, Reynolds N, Warren R, Lachmann H, Capon F, Smith C. Anakinra for palmoplantar pustulosis: results from a randomized, double-blind, multicentre, two-staged, adaptive placebo-controlled trial (APRICOT).
Br J Dermatol 2021;
186:245-256. [PMID:
34411292 PMCID:
PMC9255857 DOI:
10.1111/bjd.20653]
[Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND
Palmoplantar pustulosis (PPP) is a rare, debilitating, chronic inflammatory skin disease that affects the hands and feet. Clinical, immunological and genetic findings suggest a pathogenic role for interleukin (IL)-1.
OBJECTIVES
To determine whether anakinra (an IL-1 receptor antagonist) delivers therapeutic benefit in PPP.
METHODS
This was a randomized (1 : 1), double-blind, two-staged, adaptive, UK multicentre, placebo-controlled trial [ISCRTN13127147 (registered 1 August 2016); EudraCT number: 2015-003600-23 (registered 1 April 2016)]. Participants had a diagnosis of PPP (> 6 months) requiring systemic therapy. Treatment was 8 weeks of anakinra or placebo via daily, self-administered subcutaneous injections. Primary outcome was the Palmoplantar Pustulosis Psoriasis Area and Severity Index (PPPASI) at 8 weeks.
RESULTS
A total of 374 patients were screened; 64 were enrolled (31 in the anakinra arm and 33 in the placebo arm) with a mean (SD) baseline PPPASI of 17·8 (10·5) and a PPP investigator's global assessment of severe (50%) or moderate (50%). The baseline adjusted mean difference in PPPASI favoured anakinra but did not demonstrate superiority in the intention-to-treat analysis [-1·65, 95% confidence interval (CI) -4·77 to 1·47; P = 0·30]. Similarly, secondary objective measures, including fresh pustule count (2·94, 95% CI -26·44 to 32·33; favouring anakinra), total pustule count (-30·08, 95% CI -83·20 to 23·05; favouring placebo) and patient-reported outcomes, did not show superiority of anakinra. When modelling the impact of adherence, the PPPASI complier average causal effect for an individual who received ≥ 90% of the total treatment (48% in the anakinra group) was -3·80 (95% CI -10·76 to 3·16; P = 0·285). No serious adverse events occurred.
CONCLUSIONS
No evidence for the superiority of anakinra was found. IL-1 blockade is not a useful intervention for the treatment of PPP.
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