Effect of Roflumilast Cream vs Vehicle Cream on Chronic Plaque Psoriasis: The DERMIS-1 and DERMIS-2 Randomized Clinical Trials


Mark G. Lebwohl, Icahn School of Medicine at Mount Sinai, New York, New York.
Leon H. Kircik, Icahn School of Medicine at Mount Sinai, New York, New York.
Angela Y. Moore, Arlington Research Center, Arlington, Texas.
Linda Stein Gold, Henry Ford Medical Center, Detroit, Michigan.
Zoe D. Draelos, Dermatology Consulting Services, High Point, North Carolina.
Melinda J. Gooderham, SkiN Centre for Dermatology, Peterborough, Ontario, Canada.
Kim A. Papp, Probity Medical Research, Waterloo, Ontario, Canada.
Jerry Bagel, Psoriasis Treatment Center of Central New Jersey, East Windsor.
Neal Bhatia, Therapeutics Clinical Research, San Diego, California.
James Q. Del Rosso, JDR Dermatology Research Center LLC, Las Vegas, Nevada.
Laura K. Ferris, University of Pittsburgh Clinical and Translational Science Institute, Pittsburgh, Pennsylvania.
Lawrence J. Green, George Washington University School of Medicine, Rockville, Maryland.
Adelaide A. Hebert, UT Health McGovern Medical School, Houston, Texas.
Terry Jones, US Dermatology Partners Bryan, Bryan, Texas.
Steven E. Kempers, Minnesota Clinical Study Center, Fridley.
David M. Pariser, Eastern Virginia Medical School, Norfolk.
Paul S. Yamauchi, David Geffen School of Medicine at UCLA, Los Angeles, California.
Matthew Zirwas, Dermatologists of the Central States, Bexley, Ohio.
Lorne Albrecht, Enverus Medical Research, Surrey, British Columbia, Canada.
Alim R. Devani, Dermatology Research Institute, Calgary, Alberta, Canada.
Mark Lomaga, DermEdge Research, Mississauga, Ontario, Canada.
Amy Feng, Arcutis Biotherapeutics Inc, Westlake Village, California.
Scott Snyder, Arcutis Biotherapeutics Inc, Westlake Village, California.
Patrick Burnett, Arcutis Biotherapeutics Inc, Westlake Village, California.
Robert C. Higham, Arcutis Biotherapeutics Inc, Westlake Village, California.
David R. Berk, Arcutis Biotherapeutics Inc, Westlake Village, California.

Document Type

Journal Article

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Importance: Once-daily roflumilast cream, 0.3%, a potent phosphodiesterase 4 inhibitor, demonstrated efficacy and was well tolerated in a phase 2b trial of patients with psoriasis. Objective: To evaluate the efficacy of roflumilast cream, 0.3%, applied once daily for 8 weeks in 2 trials of patients with plaque psoriasis. Design, Setting, and Participants: Two phase 3, randomized, double-blind, controlled, multicenter trials (DERMIS-1 [trial 1; n = 439] and DERMIS-2 [trial 2; n = 442]) were conducted at 40 centers (trial 1) and 39 centers (trial 2) in the US and Canada between December 9, 2019, and November 16, 2020, and between December 9, 2019, and November 23, 2020, respectively. Patients aged 2 years or older with plaque psoriasis involving 2% to 20% of body surface area were enrolled. The dates of final follow-up were November 20, 2020, and November 23, 2020, for trial 1 and trial 2, respectively. Interventions: Patients were randomized 2:1 to receive roflumilast cream, 0.3% (trial 1: n = 286; trial 2: n = 290), or vehicle cream (trial 1: n = 153; trial 2: n = 152) once daily for 8 weeks. Main Outcomes and Measures: The primary efficacy end point was Investigator Global Assessment (IGA) success (clear or almost clear status plus ≥2-grade improvement from baseline [score range, 0-4]) at week 8, analyzed using a Cochran-Mantel-Haenszel test stratified by site, baseline IGA score, and intertriginous involvement. There were 9 secondary outcomes, including intertriginous IGA success, 75% reduction in Psoriasis Area and Severity Index (PASI) score, and Worst Itch Numeric Rating Scale score of 4 or higher at baseline achieving 4-point reduction (WI-NRS success) at week 8 (scale: 0 [no itch] to 10 [worst imaginable itch]; minimum clinically important difference, 4 points). Results: Among 881 participants (mean age, 47.5 years; 320 [36.3%] female), mean IGA scores in trial 1 were 2.9 [SD, 0.52] for roflumilast and 2.9 [SD, 0.45] for vehicle and in trial 2 were 2.9 [SD, 0.48] for roflumilast and 2.9 [SD, 0.47]) for vehicle. Statistically significantly greater percentages of roflumilast-treated patients than vehicle-treated patients had IGA success at week 8 (trial 1: 42.4% vs 6.1%; difference, 39.6% [95% CI, 32.3%-46.9%]; trial 2: 37.5% vs 6.9%; difference, 28.9% [95% CI, 20.8%-36.9%]; P < .001 for both). Of 9 secondary end points, statistically significant differences favoring roflumilast vs vehicle were observed for 8 in trial 1 and 9 in trial 2, including intertriginous IGA success (71.2% vs 13.8%; difference, 66.5% [95% CI, 47.1%-85.8%] and 68.1% vs 18.5%; difference, 51.6% [95% CI, 29.3%-73.8%]; P < .001 for both), 75% reduction in PASI score (41.6% vs 7.6%; difference, 36.1% [95% CI, 28.5%-43.8%] and 39.0% vs 5.3%; difference, 32.4% [95% CI, 24.9%-39.8%]; P < .001 for both), WI-NRS success (67.5% vs 26.8%; difference, 42.6% [95% CI, 31.3%-53.8%] and 69.4% vs 35.6%; difference, 30.2% [95% CI, 18.2%-42.2%]; P < .001 for both). The incidence of treatment-emergent adverse events was 25.2% with roflumilast vs 23.5% with vehicle in trial 1 and 25.9% with roflumilast vs 18.4% with vehicle in trial 2. The incidence of serious adverse events was 0.7% with roflumilast vs 0.7% with vehicle in trial 1 and 0% with roflumilast vs 0.7% with vehicle in trial 2. Conclusions and Relevance: Among patients with chronic plaque psoriasis, treatment with roflumilast cream, 0.3%, compared with vehicle cream resulted in better clinical status at 8 weeks. Further research is needed to assess efficacy compared with other active treatments and to assess longer-term efficacy and safety. Trial Registration: ClinicalTrials.gov Identifiers: NCT04211363, NCT04211389.