Atopic Dermatitis
Conditions
Brief summary
The purpose of this study was to assess the safety of Dupilumab administered concomitantly with topical corticosteroids (TCS) in patients with moderate-to-severe atopic dermatitis (AD).
Interventions
Dupilumab 300 mg once weekly (QW) for 4 weeks
Placebo (for Dupilumab) once weekly (QW) for 4 weeks
TCS such as methylprednisolone aceponate 0.1%, mometasone furoate 0.1%, or betamethasone valerate 0.1%
Sponsors
Study design
Eligibility
Inclusion criteria
1. Male and female patients aged 18 years or older 2. Chronic AD that had been present for at least 2 years
Exclusion criteria
1. Prior treatment with Dupilumab 2. Hypersensitivity to corticosteroids or to any other ingredients contained by the TCS product used in the study 3. AD lesions located on face, flexural, and genital areas 4. Certain treatments and medical procedures, undertaken within a particular time frame prior to the baseline visit, preclude eligibility for participation in the study 5. Treatment with a live (attenuated) vaccine within 12 weeks before the baseline visit 6. Treatment with an investigational drug within 8 weeks 7. Known history of human immunodeficiency virus (HIV) infection 8. Presence of certain laboratory abnormalities at the screening visit 9. History of certain opportunistic infections or certain clinical parasite infections 10. History of malignancy within 5 years before the baseline visit, with certain exceptions 11. Pregnant or breast-feeding women 12. Travel within 12 months of study start to areas endemic for parasitic infections, such as developing countries in Africa and the tropical and subtropical regions of Asia 13. History of alcohol or drug abuse within 2 years of the screening visit 14. Any medical or psychiatric condition which, in the opinion of the investigator or the sponsor's medical monitor, would place the patient at risk, interfere with participation in the study, or interfere with the interpretation of study results
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants With Treatment Emergent Adverse Events (TEAEs) | Baseline up to the end of study (up to Day 78) | Any untoward medical occurrence in a subject who received investigational medicinal product (IMP) was considered an AE without regard to possibility of causal relationship with this treatment. Treatment-emergent adverse events (TEAEs) were defined as AEs that developed or worsened or became serious during on-treatment period (from start of administration of first dose of study drug to the end of study \[up to Day 78\]). A serious adverse event (SAE) was defined as any untoward medical occurrence that resulted in any of following outcomes: death, life-threatening, required initial or prolonged in-patient hospitalization, persistent or significant disability/incapacity, congenital anomaly/birth defect, or considered as medically important event. Any TEAE included participants with both serious and non-serious AEs. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants Achieving Eczema Area and Severity Index (EASI) Score: Reduction of ≥50 at Day 29 - Censored Last Observation Carried Forward (LOCF) | Day 29 | The EASI score was used to measure the severity and extent of atopic dermatitis (AD) and measures erythema, infiltration, excoriation and lichenification on 4 anatomic regions of the body: head, trunk, upper and lower extremities. The total EASI score range from 0 (minimum) to 72 (maximum) points, with the higher scores reflecting the worse severity of AD. The efficacy data were set to missing after prohibited medication was used or after the participant was discontinued from the study. Then, all missing values were imputed by simple LOCF. |
| Percent Change in Pruritus Numerical Rating Scale (NRS) From Day 1 (Baseline) to Day 29 (Week 4) | Baseline up to Day 29 | Pruritus NRS was an assessment tool that was used to report the intensity of participant's pruritus (itch), both maximum and average intensity, during a 24-hour recall period. Participants were asked the following question: how would a participant rate his itch at the worst moment during the previous 24 hours (for maximum itch intensity on a scale of 0 - 10 \[0 = no itch; 10 = worst itch imaginable\]). |
| Percentage of Participants Achieving an Investigator's Global Assessment (IGA) Score of 0 or 1 at Day 29 | Day 29 | IGA was an assessment scale used to determine severity of AD and clinical response to treatment on a 5-point scale (0 = clear; 1 = almost clear; 2 = mild; 3 = moderate; 4 = severe) based on erythema and papulation/infiltration. Therapeutic response was an IGA score of 0 (clear) or 1 (almost clear). |
| Percent Change in Investigator's Global Assessment (IGA) Score From Day 1 (Baseline) to Day 29 (Week 4) - Censored LOCF | Baseline up to Day 29 | IGA was an assessment scale used to determine severity of AD and clinical response to treatment on a 5-point scale (0 = clear; 1 = almost clear; 2 = mild; 3 = moderate; 4 = severe) based on erythema and papulation/infiltration. Therapeutic response was an IGA score of 0 (clear) or 1 (almost clear). The efficacy data were set to missing after prohibited medication was used or after the participant was discontinued from the study. Then, all missing values were imputed by simple LOCF. |
| Percent Change in Eczema Area and Severity Index (EASI) Score From Day 1 (Baseline) to Day 29 (Week 4) - Censored LOCF | Baseline up to Day 29 | EASI score was used to measure the severity and extent of atopic dermatitis (AD) and measures erythema, infiltration, excoriation and lichenification on 4 anatomic regions of the body: head, trunk, upper and lower extremities. The total EASI score ranges from 0 (minimum) to 72 (maximum) points, with the higher scores reflecting the worse severity of AD. The efficacy data were set to missing after prohibited medication was used or after the participant was discontinued from the study. Then, all missing values were imputed by simple LOCF. |
Countries
Germany, Hungary, Poland
Participant flow
Recruitment details
A total of 38 participants were screened in the study between 30 July 2012 and 20 December 2012.
Pre-assignment details
Out of 38 participants, 31 were randomized and treated in the study. Participants were randomized in 2:1 ratio to receive Dupilumab 300 mg or Placebo.
Participants by arm
| Arm | Count |
|---|---|
| Placebo Placebo (for REGN668) once weekly for 4 weeks by subcutaneous injection with the background therapy of potent TCS for up to 28 days. | 10 |
| REGN668 300 mg REGN668 300 mg once weekly for 4 weeks by subcutaneous injection with the background therapy of potent TCS for up to 28 days | 21 |
| Total | 31 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Adverse Event | 1 | 0 |
Baseline characteristics
| Characteristic | Total | Placebo | REGN668 300 mg |
|---|---|---|---|
| Age, Continuous | 36.6 years STANDARD_DEVIATION 13.01 | 37.8 years STANDARD_DEVIATION 16.73 | 36.0 years STANDARD_DEVIATION 11.26 |
| Eczema Area and Severity Index (EASI) Score | 23.4 units on a scale STANDARD_DEVIATION 12.26 | 24.1 units on a scale STANDARD_DEVIATION 12.7 | 23.1 units on a scale STANDARD_DEVIATION 12.35 |
| Investigator's Global Assessment (IGA) Score | 3.4 units on a scale STANDARD_DEVIATION 0.55 | 3.4 units on a scale STANDARD_DEVIATION 0.47 | 3.4 units on a scale STANDARD_DEVIATION 0.6 |
| Pruritus Numerical Rating Scale (NRS) score | 6.0 units on a scale STANDARD_DEVIATION 1.93 | 5.0 units on a scale STANDARD_DEVIATION 1.39 | 6.4 units on a scale STANDARD_DEVIATION 2 |
| Sex: Female, Male Female | 18 Participants | 5 Participants | 13 Participants |
| Sex: Female, Male Male | 13 Participants | 5 Participants | 8 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 7 / 10 | 8 / 21 |
| serious Total, serious adverse events | 1 / 10 | 0 / 21 |
Outcome results
Percentage of Participants With Treatment Emergent Adverse Events (TEAEs)
Any untoward medical occurrence in a subject who received investigational medicinal product (IMP) was considered an AE without regard to possibility of causal relationship with this treatment. Treatment-emergent adverse events (TEAEs) were defined as AEs that developed or worsened or became serious during on-treatment period (from start of administration of first dose of study drug to the end of study \[up to Day 78\]). A serious adverse event (SAE) was defined as any untoward medical occurrence that resulted in any of following outcomes: death, life-threatening, required initial or prolonged in-patient hospitalization, persistent or significant disability/incapacity, congenital anomaly/birth defect, or considered as medically important event. Any TEAE included participants with both serious and non-serious AEs.
Time frame: Baseline up to the end of study (up to Day 78)
Population: Safety population included all randomized participants who received any study drug; based on the treatment received (as treated).
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Placebo QW | Percentage of Participants With Treatment Emergent Adverse Events (TEAEs) | With at least one TEAE | 70.0 percentage of participants |
| Placebo QW | Percentage of Participants With Treatment Emergent Adverse Events (TEAEs) | With serious TEAEs | 10.0 percentage of participants |
| Placebo QW | Percentage of Participants With Treatment Emergent Adverse Events (TEAEs) | With study drug related TEAEs | 40.0 percentage of participants |
| Placebo QW | Percentage of Participants With Treatment Emergent Adverse Events (TEAEs) | With TEAEs resulting in study discontinuation | 10.0 percentage of participants |
| Dupilumab 300 mg QW | Percentage of Participants With Treatment Emergent Adverse Events (TEAEs) | With study drug related TEAEs | 28.6 percentage of participants |
| Dupilumab 300 mg QW | Percentage of Participants With Treatment Emergent Adverse Events (TEAEs) | With at least one TEAE | 57.1 percentage of participants |
| Dupilumab 300 mg QW | Percentage of Participants With Treatment Emergent Adverse Events (TEAEs) | With TEAEs resulting in study discontinuation | 0 percentage of participants |
| Dupilumab 300 mg QW | Percentage of Participants With Treatment Emergent Adverse Events (TEAEs) | With serious TEAEs | 0 percentage of participants |
Percentage of Participants Achieving an Investigator's Global Assessment (IGA) Score of 0 or 1 at Day 29
IGA was an assessment scale used to determine severity of AD and clinical response to treatment on a 5-point scale (0 = clear; 1 = almost clear; 2 = mild; 3 = moderate; 4 = severe) based on erythema and papulation/infiltration. Therapeutic response was an IGA score of 0 (clear) or 1 (almost clear).
Time frame: Day 29
Population: FAS included all randomized participants who received at least 1 dose of study medication and had at least 1 post-baseline assessment; it was based on the treatment allocated (as randomized).
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo QW | Percentage of Participants Achieving an Investigator's Global Assessment (IGA) Score of 0 or 1 at Day 29 | 30.0 percentage of participants |
| Dupilumab 300 mg QW | Percentage of Participants Achieving an Investigator's Global Assessment (IGA) Score of 0 or 1 at Day 29 | 52.4 percentage of participants |
Percentage of Participants Achieving Eczema Area and Severity Index (EASI) Score: Reduction of ≥50 at Day 29 - Censored Last Observation Carried Forward (LOCF)
The EASI score was used to measure the severity and extent of atopic dermatitis (AD) and measures erythema, infiltration, excoriation and lichenification on 4 anatomic regions of the body: head, trunk, upper and lower extremities. The total EASI score range from 0 (minimum) to 72 (maximum) points, with the higher scores reflecting the worse severity of AD. The efficacy data were set to missing after prohibited medication was used or after the participant was discontinued from the study. Then, all missing values were imputed by simple LOCF.
Time frame: Day 29
Population: Full analysis set (FAS) included all randomized participants who received at least 1 dose of study medication and had at least 1 post-baseline assessment; it was based on the treatment allocated (as randomized).
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo QW | Percentage of Participants Achieving Eczema Area and Severity Index (EASI) Score: Reduction of ≥50 at Day 29 - Censored Last Observation Carried Forward (LOCF) | 50.0 percentage of participants |
| Dupilumab 300 mg QW | Percentage of Participants Achieving Eczema Area and Severity Index (EASI) Score: Reduction of ≥50 at Day 29 - Censored Last Observation Carried Forward (LOCF) | 100.0 percentage of participants |
Percent Change in Eczema Area and Severity Index (EASI) Score From Day 1 (Baseline) to Day 29 (Week 4) - Censored LOCF
EASI score was used to measure the severity and extent of atopic dermatitis (AD) and measures erythema, infiltration, excoriation and lichenification on 4 anatomic regions of the body: head, trunk, upper and lower extremities. The total EASI score ranges from 0 (minimum) to 72 (maximum) points, with the higher scores reflecting the worse severity of AD. The efficacy data were set to missing after prohibited medication was used or after the participant was discontinued from the study. Then, all missing values were imputed by simple LOCF.
Time frame: Baseline up to Day 29
Population: FAS included all randomized participants who received at least 1 dose of study medication and had at least 1 post-baseline assessment; it was based on the treatment allocated (as randomized).
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Placebo QW | Percent Change in Eczema Area and Severity Index (EASI) Score From Day 1 (Baseline) to Day 29 (Week 4) - Censored LOCF | -52.5 percent Change | Standard Deviation 39.53 |
| Dupilumab 300 mg QW | Percent Change in Eczema Area and Severity Index (EASI) Score From Day 1 (Baseline) to Day 29 (Week 4) - Censored LOCF | -75.6 percent Change | Standard Deviation 13.29 |
Percent Change in Investigator's Global Assessment (IGA) Score From Day 1 (Baseline) to Day 29 (Week 4) - Censored LOCF
IGA was an assessment scale used to determine severity of AD and clinical response to treatment on a 5-point scale (0 = clear; 1 = almost clear; 2 = mild; 3 = moderate; 4 = severe) based on erythema and papulation/infiltration. Therapeutic response was an IGA score of 0 (clear) or 1 (almost clear). The efficacy data were set to missing after prohibited medication was used or after the participant was discontinued from the study. Then, all missing values were imputed by simple LOCF.
Time frame: Baseline up to Day 29
Population: FAS included all randomized participants who received at least 1 dose of study medication and had at least 1 post-baseline assessment; it was based on the treatment allocated (as randomized).
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Placebo QW | Percent Change in Investigator's Global Assessment (IGA) Score From Day 1 (Baseline) to Day 29 (Week 4) - Censored LOCF | -30.6 percent change | Standard Deviation 39 |
| Dupilumab 300 mg QW | Percent Change in Investigator's Global Assessment (IGA) Score From Day 1 (Baseline) to Day 29 (Week 4) - Censored LOCF | -52.5 percent change | Standard Deviation 21.44 |
Percent Change in Pruritus Numerical Rating Scale (NRS) From Day 1 (Baseline) to Day 29 (Week 4)
Pruritus NRS was an assessment tool that was used to report the intensity of participant's pruritus (itch), both maximum and average intensity, during a 24-hour recall period. Participants were asked the following question: how would a participant rate his itch at the worst moment during the previous 24 hours (for maximum itch intensity on a scale of 0 - 10 \[0 = no itch; 10 = worst itch imaginable\]).
Time frame: Baseline up to Day 29
Population: FAS included all randomized participants who received at least 1 dose of study medication and had at least 1 post-baseline assessment; it was based on the treatment allocated (as randomized).
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Placebo QW | Percent Change in Pruritus Numerical Rating Scale (NRS) From Day 1 (Baseline) to Day 29 (Week 4) | -24.7 percent change | Standard Deviation 47.3 |
| Dupilumab 300 mg QW | Percent Change in Pruritus Numerical Rating Scale (NRS) From Day 1 (Baseline) to Day 29 (Week 4) | -70.7 percent change | Standard Deviation 21.45 |