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

Inclusion Criteria:

1. Patient has signed the informed consent form (ICF) and documentation as required byrelevant competent authorities and is able to understand and adhere to the visitschedule and study requirements.
2. Chinese patients shall be recruited in Mainland China.
3. Patient is male or female, aged 18 to 75 years old, inclusive, at time of Screening.
4. Patient weighs ≤100 kg at Screening and at BL.
5. Patient has had moderate to severe chronic PsO for at least 6 months.
6. Patient has involved body surface area (BSA) ≥10%, PASI ≥12, and sPGA ≥3 (moderate) atScreening and at BL.
7. Patient has had stable psoriatic disease for at least 2 months (ie, withoutsignificant changes as defined by the investigator or designee) prior to Screening.
8. Patient is a candidate for systemic therapy because the patient has had a previousfailure, inadequate response, intolerance, or contraindication to at least 1 systemicantipsoriatic therapy including, but not limited to, methotrexate, cyclosporine,psoralen plus ultraviolet light A (PUVA), and ultraviolet light B (UVB).
9. Patient has a negative QuantiFERON test for tuberculosis (TB) during Screening. Note: Patients with an indeterminate QuantiFERON test are allowed if they have all ofthe following:
10. No evidence of active TB on chest radiograph within 3 months prior to the firstdose of study drug.
11. Documented history of adequate prophylaxis initiation prior to receiving studydrug in accordance with local recommendations.
12. No known exposure to active TB after most recent prophylaxis.
13. Asymptomatic at Screening and BL. Investigators should check with the medicalmonitor before enrolling such patients.
14. Patient is naïve to ustekinumab therapy, approved or investigational.
15. Women of childbearing potential (except those who are postmenopausal for more than 2years or if surgically sterile) must have a negative serum pregnancy test duringScreening and negative urine pregnancy test at BL. Sexually active women of childbearing potential must agree to use highly effectivecontraception (sterilization, hormonal contraception pills or injection or implants, andabstinence) for the duration of the study and until 4 months after the last dose of thestudy drug. Male patients must agree to use contraception for the duration of the study andagree not to donate sperm during and for 4 months after the last dose of study drug. Note: Male partners of female subjects should also use contraception and should not donatesperm until 4 months after the last dose of study drug.

Exclusion Criteria:

1. Patient diagnosed with psoriatic arthritis, erythrodermic psoriasis, pustularpsoriasis, guttate psoriasis, medication-induced psoriasis, other skin conditions (eg,eczema), or other systemic autoimmune disorder inflammatory disease at the time of theScreening Visit that would interfere with evaluations of the effect of the study drugon psoriasis.
2. Patient has prior use of any of the following medications within specified timeperiods or will require use during the study:
3. Topical medications within 2 weeks of BL visit (except low- to mid-potencytopical corticosteroids on face, eyes, scalp, palms, soles, and genital area;only).
4. PUVA phototherapy and/or UVB phototherapy within 4 weeks prior to the BL visit.
5. Nonbiologic psoriasis systemic therapies (eg, cyclosporine, methotrexate, andacitretin) within 4 weeks prior to the BL visit.
6. Any systemic steroid in the 4 weeks prior to the BL visit.
7. Any oral traditional Chinese medicine (TCM) 4 weeks prior to the BL visit or anytopical TCM 2 weeks prior to the BL visit.
8. Investigational agent(s) within 90 days or 5 half-lives (whichever is longer)before BL visit.
9. Other systemic biologics within 90 days or 5 half-lives (whichever is the longer)before BL visit.
10. Any therapeutic agent targeting IL-12, IL-17 or IL-23 at any time. Specifiedwashout periods for approved/marketed products are provided in Table 5.1. Table 5.1: Approved/Marketed Products Medication or Therapy Washout before BL BiologicTherapies, including but limited to: Adalimumab Etanercept Secukinumab InfliximabCertolizumab pegol Alefacept Briakinumab Guselkumab Brodalumab 12 weeks 8 weeks 12weeks 12 weeks 24 weeks 24 weeks 24 weeks 13 weeks 13 weeks Any kinase inhibitor forany 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 4weeks Topical psoriasis treatments (examples include vitamin D analogs, topicalsteroids, polifenols, etc) (except low- to mid-potency topical corticosteroids onface, eyes, scalp, palms, soles, and genital area; only) 2 weeks Oral retinoids 4weeks Corticosteroids IM - IV - oral - intraarticular 4 weeks Drugs that may cause newonset or exacerbation of psoriasis (including, but not limited to, beta blockers,lithium, and anti-malarials) 6 months1 TCM (oral) TCM (topical) 4 weeks 2 weeksAbbreviations: BL = Baseline; IM = intramuscular; IV = intravenous; PUVA = psoralenplus ultraviolet light A; TCM = traditional Chinese medicine; UVA = ultraviolet lightA; UVB = ultraviolet light B. 1 Unless the patient has been on a stable dose for atleast 6 months prior to BL Visit without exacerbation of psoriasis.
11. Patient has received live or attenuated vaccines during the 4 weeks prior to BL visitor has the intention of receiving a live or attenuated vaccine at any time during thestudy. Note: Inactivated (non-live and non-attenuated) vaccines are allowed.
12. Patient has an underlying condition (including, but not limited to metabolic,hematologic, renal, hepatic, pulmonary, neurologic, endocrine, cardiac, infectious, orgastrointestinal) which, in the opinion of the investigator or designee, significantlyimmunocompromises the patient and/or places the patient at unacceptable risk forreceiving an immunomodulatory therapy.
13. Patient has a planned surgical intervention during the duration of the study exceptthose related to the underlying disease and which, in the opinion of the investigatoror designee, will not put the patient at further risk or hinder the patient's abilityto maintain compliance with study drug and the visit schedule.
14. 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 4weeks prior to BL visit. Note: patients receiving topical antibiotics for facial acnedo not need to be excluded. ii. Which required hospitalization/quarantine or systemic anti-infective within 8weeks prior to BL visit. b. Recurrent or chronic infections or other active infection that, in the opinion ofthe 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.
15. Patient is positive for human immunodeficiency virus (HIV), hepatitis C virus (HCV)antibody, hepatitis B surface antigen (HBsAg), or hepatitis B core antibody (HBcAb).
16. Patient has severe progressive or uncontrolled, clinically significant disease that inthe judgment of the investigator or designee renders the patient unsuitable for thestudy.
17. Patient has a history of malignancy within 5 years except for adequately treatedcutaneous squamous or basal cell carcinoma, in situ cervical cancer or in situ breastductal carcinoma.
18. Patient has active neurological disease such as multiple sclerosis, Guillain-Barrésyndrome, optic neuritis, transverse myelitis, or history of neurologic symptomssuggestive of central nervous system demyelinating disease.
19. Patient has moderate to severe heart failure (New York Heart Association classIII/IV).
20. Patient has uncontrolled diabetes mellitus type 1 or 2.
21. Patient has a history of hypersensitivity to the active substance or to any of theexcipients of Stelara or AVT04.
22. Patient is pregnant or nursing (lactating) women, where pregnancy is defined as thestate of a female after conception and until the termination of gestation.
23. Patient has evidence (as assessed by the investigator or designee using good clinicaljudgment) of alcohol or drug abuse or dependency at the time of Screening, for the 5years prior to Screening, or during the study.
24. Patient is unable to follow study instructions and comply with the protocol in theopinion of the investigator or designee.
25. Patient has a history of clinically significant hematological abnormalities, includingcytopenia (eg, thrombocytopenia, leukopenia).
26. Patient has a laboratory abnormality that, in the opinion of the investigator ordesignee, could cause this study to be detrimental to the patient. The followinglaboratory abnormalities should be excluded:
27. Hemoglobin <9 g/dL
28. Platelet count <100,000/mm³
29. White blood cell count <3000 cells/mm³
30. Aspartate aminotransferase and/or alanine aminotransferase that is persistently ≥2 × the upper limit of normal. (Persistently indicates at least on 2 occasionsseparated by a number of days, per the rescreening procedure)
31. Creatinine clearance <50 mL/min (Cockcroft-Gault formula)