• Mark G Lebwohl, Linda Stein Gold, Bruce Strober, Kim A Papp, April W Armstrong, Jerry Bagel, Leon Kircik, Benjamin Ehst, H Chih-Ho Hong, Jennifer Soung, Jeff Fromowitz, Scott Guenthner, Stephen C Piscitelli, David S Rubenstein, Philip M Brown, Anna M Tallman, and Robert Bissonnette.
• From the Icahn School of Medicine at Mount Sinai, New York (M.G.L., L.K.); Henry Ford Health System, Detroit (L.S.G.); Yale University, New Haven, and Central Connecticut Dermatology Research, Cromwell - both in Connecticut (B.S.); Probity Medical Research, Waterloo, ON (K.A.P.), the University of British Columbia and Probity Medical Research, Surrey (H.C.H.), and Innovaderm Research, Montreal (R.B.) - all in Canada; Keck School of Medicine, University of Southern California, Los Angeles (A.W.A.), and Southern California Dermatology, Santa Ana (J.S.) - both in California; the Psoriasis Treatment Center of Central New Jersey, East Windsor (J.B.); Skin Sciences, Louisville, KY (L.K.); Oregon Medical Research Center, Portland (B.E.); Dermatology of Boca, Boca Raton, FL (J.F.); the Indiana Clinical Trials Center, Plainfield (S.G.); and Dermavant Sciences, Morrisville, NC (S.C.P., D.S.R., P.M.B., A.M.T.).
• N. Engl. J. Med. 2021 Dec 9; 385 (24): 2219-2229.

BackgroundTapinarof cream is a topical aryl hydrocarbon receptor-modulating agent under investigation for the treatment of psoriasis. Tapinarof modulates the expression of interleukin-17 and the skin-barrier proteins filaggrin and loricrin.MethodsWe conducted two identical phase 3 randomized trials of tapinarof in patients with mild-to-severe plaque psoriasis. Adults with a baseline Physician's Global Assessment (PGA) score of 2 (mild) to 4 (severe) (on a scale from 0 to 4, with higher scores indicating more severe psoriasis) and a percent of total body-surface area affected of 3 to 20% were randomly assigned in a 2:1 ratio to use tapinarof 1% cream or vehicle cream once daily for 12 weeks. The primary end point, PGA response, was a PGA score of 0 (clear) or 1 (almost clear) and a decrease from baseline of at least 2 points at week 12. Secondary efficacy end points at week 12 were a reduction of at least 75% in the Psoriasis Area and Severity Index (PASI) score, a PGA score of 0 or 1, the mean change from baseline in the percent of body-surface area affected, and a reduction of at least 90% in the PASI score. Patient-reported outcomes were the mean changes from baseline to week 12 in the proportion of patients who had a decrease of at least 4 points in the Peak Pruritus Numeric Rating Scale (PP-NRS) score (range, 0 [no itch] to 10 [worst imaginable itch]), the PP-NRS total score, the Dermatology Life Quality Index total score, and the Psoriasis Symptom Diary score.ResultsIn trials 1 and 2, a total of 692 and 674 patients, respectively, were screened, with 510 and 515 patients being enrolled. A PGA response occurred in 35.4% of the patients in the tapinarof group and in 6.0% of those in the vehicle group in trial 1 and in 40.2% and 6.3%, respectively, in trial 2 (P<0.001 for both comparisons). Results for secondary end points and patient-reported outcomes were generally in the same direction as those for the primary end point. Adverse events with tapinarof cream included folliculitis, nasopharyngitis, contact dermatitis, headache, upper respiratory tract infection, and pruritus.ConclusionsTapinarof 1% cream once daily was superior to vehicle control in reducing the severity of plaque psoriasis over a period of 12 weeks but was associated with local adverse events and headache. Larger and longer trials are needed to evaluate the efficacy and safety of tapinarof cream as compared with existing treatments for psoriasis. (Funded by Dermavant Sciences; PSOARING 1 and 2 ClinicalTrials.gov numbers, NCT03956355 and NCT03983980, respectively.).Copyright © 2021 Massachusetts Medical Society.

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