Evidence map›Paper›PMID 34411292›Full record

ArticleThe British journal of dermatology2021

Anakinra for palmoplantar pustulosis: results from a randomized, double-blind, multicentre, two-staged, adaptive placebo-controlled trial (APRICOT).

S Cro, V R Cornelius, A E Pink, R Wilson, A Pushpa-Rajah, P Patel, A Abdul-Wahab, S August, J Azad, G Becher and 29 more

Open access · hybridAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in The British journal of dermatology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
18citing papers in PubMed, 1 pooled it
5.1field-weighted citation impact, top 4% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

18 citing papers in PubMed, 1 synthesis or guideline pooled it, 31 citations in OpenAlex.

  1. Pooled it
  2. Trial
  3. Review
  4. Palmoplantar pustulosis: pathogenesis, differential diagnosis, and treatment.Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG · 2026
    Review
  5. Review
  6. Article
  7. Article
  8. Review
  9. Review
  10. Article
  11. Review
  12. Eliminating Ambiguous Treatment Effects Using Estimands.American journal of epidemiology · 2023
    Article
  13. Review
  14. Review
  15. Review
  16. Review
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  18. Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

39 authors at 20 institutions in 1 country.

S CroImperial Clinical Trials Unit, Imperial College London, London, W12 7RH, UK.ORCID https://orcid.org/0000-0002-6113-1173
V R CorneliusImperial Clinical Trials Unit, Imperial College London, London, W12 7RH, UK.
A E PinkSt John's Institute of Dermatology, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, UK.
R WilsonSt John's Institute of Dermatology, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, UK.
A Pushpa-RajahSt John's Institute of Dermatology, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, UK.
P PatelSt John's Institute of Dermatology, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, UK.
A Abdul-WahabSt George's University Hospitals NHS Foundation Trust, London, SW17 0QT, UK.
S AugustPoole Hospital NHS Foundation Trust University Hospitals Dorset, Poole, BH15 2JB, UK.
J AzadSouth Tees Hospitals NHS Foundation Trust, Middlesbrough, TS4 3BW, UK.
G BecherWest Glasgow Ambulatory Care Hospital, Glasgow, G3 8SJ, UK.
A ChapmanHomerton University Hospital, London, E9 6SR, UK.
G DunnilBristol Royal Infirmary, Bristol, BS2 8HW, UK.
A D FergusonUniversity Hospitals of Derby and Burton NHS Foundation Trust, Derby, DE22 3NE, UK.
A FogoKingston Hospital, Kingston upon Thames, KT2 7QB, UK.
S A GhaffarNinewells Hospital and Medical School, Dundee, DD1 9SY, UK.
J R IngramDivision of Infection and Immunity, School of Medicine, Cardiff University, University Hospital of Wales, Cardiff, CF14 4XN, UK.ORCID https://orcid.org/0000-0002-5257-1142
S KavakleivaRoyal Lancaster Infirmary, Lancaster, LA1 4RP, UK.
E LadoyanniRussells Hall Hospital, Dudley, DY1 2HQ, UK.
J A LemanKings Park Hospital, Stirling, FK7 9JH, UK.
A E MacbethNorfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, NR4 7UY, UK.
A MakrygeoegouWest Glasgow Ambulatory Care Hospital, Glasgow, G3 8SJ, UK.
R ParslewLiverpool University Hospitals NHS Foundation Trust, Liverpool, L9 7AL, UK.
A J RyanKing's College Hospital, London, SE5 9RS, UK.
A SharmaNottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK.
A R ShipmanPortsmouth Hospitals Universities NHS Trust, St Mary's Community Health Campus, Portsmouth, PO3 6AD, UK.ORCID https://orcid.org/0000-0001-5257-4418
C SinclairBroomfield Hospital, Chelmsford, CM1 7ET, UK.
R WachsmuthRoyal Devon and Exeter NHS Foundation Trust, Exeter, EX2 5DW, UK.
R T WoolfSt John's Institute of Dermatology, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, UK.
A WrightBradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ, UK.
H McAteerThe Psoriasis Association, Northampton, NN4 7BF, UK.
J N W N BarkerSt John's Institute of Dermatology, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King's College London, London, SE1 9RT, UK.
A D BurdenInstitute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, G12 8TA, UK.
C E M GriffithsDermatology Centre, Salford Royal NHS Foundation Trust, University of Manchester, NIHR Manchester Biomedical Research Centre, Manchester, M6 8HD, UK.ORCID https://orcid.org/0000-0001-5371-4427
N J ReynoldsInstitute of Translational and Clinical Medicine, Medical School, University of Newcastle, Department of Dermatology, Royal Victoria Infirmary and NIHR Newcastle Biomedical Research Centre, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE2 4HH, UK.
R B WarrenNational Amyloidosis Centre, University College London, London, NW3 2PF, UK.
H J LachmannNational Amyloidosis Centre, University College London, London, NW3 2PF, UK.
F CaponDepartment of Medical and Molecular Genetics, King's College London, London, SE1 9RT, UK.ORCID https://orcid.org/0000-0003-2432-5793
C H SmithSt John's Institute of Dermatology, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, UK.ORCID https://orcid.org/0000-0001-9918-1144
APRICOT Study Group
Guy's Hospital · GBImperial College London · GBKing's College London · GBUniversity College London · GBBradford Teaching Hospitals NHS Foundation Trust · GBBristol Royal Infirmary · GBBroomfield Hospital · GBHomerton University Hospital · GBKing's College Hospital · GBKings Park Hospital · GBKingston Hospital · GBNinewells Hospital · GBNorfolk and Norwich University Hospitals NHS Foundation Trust · GBNottingham University Hospitals NHS Trust · GBPoole Hospital · GBPortsmouth Hospitals NHS Trust · GBPsoriasis Association · GBRoyal Devon & Exeter NHS Foundation Trust · GBRoyal Lancaster Infirmary · GBRoyal Victoria Infirmary · GB

Funding

Efficacy and Mechanism Evaluation Programme NIHR EME 13/50/17 APRICOTNIHR BioResource Clinical Research Facility and comprehensive Biomedical Research Centre awards to Guy's and St Thomas' NHS Foundation Trust in partnership with King's College London and King's College Hospital NHS Foundation Trust guysbrc-2012-1Swedish Orphan BiovitrumThe Psoriasis Association RG2/10
6 · The paper itself

Abstract

backgroundPalmoplantar 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.

objectivesTo determine whether anakinra (an IL-1 receptor antagonist) delivers therapeutic benefit in PPP.

methodsThis 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.

resultsA 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.

conclusionsNo evidence for the superiority of anakinra was found. IL-1 blockade is not a useful intervention for the treatment of PPP.

Identifiers

PMID34411292
PMCPMC9255857
OpenAlexW3195538306

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.