An Open-Label Pilot Study to Evaluate the Safety and Efficacy of Apremilast (CC-10004) in the Treatment of Moderate to Severe Lichen Planus
Overview
- Phase
- Phase 2
- Intervention
- Apremilast (CC-10004)
- Conditions
- Lichen Planus
- Sponsor
- Virginia Clinical Research, Inc.
- Enrollment
- 10
- Locations
- 1
- Primary Endpoint
- Proportion of subjects achieving significant clinical response in cutaneous disease defined as a 2 or more grade improvement of the physician global assessment (PGA) after 12 weeks of treatment.
- Last Updated
- 16 years ago
Overview
Brief Summary
This study is designed to demonstrate to efficacy and safety of Apremilast 20mg oral administration twice daily over 12 weeks in subjects with moderate to severe lichen planus. The hypothesis is that the subjects will achieve a significant clinical improvement in their skin disease according to a specialized physician grading scale.
Detailed Description
This is a phase 2, single center, non-randomized, open label efficacy and safety study designed to characterize the response of Apremilast 20 mg oral administered twice daily over 12 weeks in subjects with moderate to severe lichen planus. The hypothesis and ideal primary end point will be that subjects achieve significant clinical response in cutaneous disease defined as a 2 or more grade improvement of the physician global assessment (PGA) after 12 weeks of treatment. Many various therapies have been used to treat LP including topical and oral corticosteroids, retinoids, cyclosporine, griseofulvin, dapsone and phototherapy, but often with disappointing response.4 It is an inflammatory condition whose pathogenesis involves damage to basal keratinocytes by alloreactive T cells through the release proinflammatory cytokines, such as TNF-α and IFN-γ.1 Significantly elevated levels of such inflammatory mediators are present in tissue from LP lesions compared to normal controls.5 Based on these observations, the investigation of Apremilast, due to its ability to inhibit multiple inflammatory cytokines, for the treatment of moderate to severe LP is warranted. The primary objective of this study is to evaluate the clinical efficacy of Apremilast in subjects with moderate to severe lichen planus after 12 weeks of treatment. Other objectives are to evaluate the safety and tolerability of Apremilast, effects on quality of life, and efficacy for mucosal disease if present.
Investigators
Eligibility Criteria
Inclusion Criteria
- •Must understand and voluntarily sign an informed consent form
- •Must be male or female and aged ≥ 18 years at time of consent
- •Must be able to adhere to the study visit schedule and other protocol requirements
- •Subjects must have stable cutaneous lichen planus appropriate for systemic therapy based on the following criteria:
- •Rated PGA of ≥ 3 (moderate or severe) AND
- •≥ 20 distinct lesions of lichen planus OR
- •Refractory to topical corticosteroid therapy (at least 4 weeks of high potency corticosteroid without significant improvement) OR
- •Severe itching/pain that significantly impairs activities of daily living (i.e. working, school, sleep, etc.)
- •Subjects using topical corticosteroids must be tapered and must undergo a washout period prior to initiation of the study. The washout period for topical corticosteroids is 2 weeks.
- •Must meet the following laboratory criteria:
Exclusion Criteria
- •Inability to provide voluntary consent
- •Any condition, including the presence of laboratory abnormalities, which places the subject at unacceptable risk if he/she were to participate in the study or confounds the ability to interpret data from the study
- •Pregnant or breastfeeding
- •Systemic fungal infection
- •History of active mycobacterial infection with any species (including Mycobacterium tuberculosis) within 3 years prior to screening visit. Subjects with Mycobacterium tuberculosis infection more than 3 years prior to screening visit are allowed if successful treatment was completed at least 3 years prior to randomization and is documented and available for verification.
- •Latent Mycobacterium tuberculosis infection as indicated by a positive Purified Protein Derivative \[PPD\] skin test. Subjects with a positive PPD skin test and documented completion of treatment for latent TB are eligible. Subjects with a positive PPD skin test and not treated or no documentation of completion of treatment are ineligible.
- •If QuantiFERON® test is performed instead of the PPD test, only those with a negative QuantiFERON® test are allowed in the study.
- •History of incompletely treated Mycobacterium tuberculosis infection as indicated by
- •Subject's medical records documenting incomplete treatment for Mycobacterium tuberculosis
- •Subject's self-reported history of incomplete treatment for Mycobacterium tuberculosis
Arms & Interventions
Apremilast
Apremilast 20 mg PO administered BID over 12 weeks
Intervention: Apremilast (CC-10004)
Outcomes
Primary Outcomes
Proportion of subjects achieving significant clinical response in cutaneous disease defined as a 2 or more grade improvement of the physician global assessment (PGA) after 12 weeks of treatment.
Time Frame: 12 weeks
Secondary Outcomes
- Proportion of subjects with mucosal involvement who achieve a significant clinical response in mucosal disease defined as physician global assessment of mucosal disease (PGAMD) of "complete resolution" or "marked improvement" after 12 weeks of treatment.(12 weeks)
- Change in the subjects' target area lesion count after 12 weeks of treatment relative to baseline.(12 weeks)
- Change in the subjects' target area lesion severity score (TALSS) after 12 weeks of treatment relative to baseline.(12 weeks)
- Proportion of subjects who achieve a subject global assessment of "complete resolution" or "marked improvement" after 12 weeks of treatment.(12 weeks)
- Change in the subjects' dermatology life quality index (DLQI) score after 12 weeks of treatment relative to baseline.(12 weeks)
- Change in the subjects' assessment of itching on a visual analogue scale (VAS) after 12 weeks of treatment relative to baseline.(12 weeks)
- Safety and tolerability of Apremilast (type, frequency, severity, and relationship of adverse events to study treatment)(16 weeks total (12 weeks treatment, 4 weeks observation))