Atopic Dermatitis
Conditions
Keywords
atopic dermatitis, adolescent, adults, in-home, telemedicine
Brief summary
This is a randomized, double blind, vehicle controlled Phase 2 study with a 4-week open label extension in adolescent and adult participants with atopic dermatitis and head and/or neck involvement. It is intended to compare the efficacy and safety of ruxolitinib cream 1.5% BID versus vehicle cream, then further evaluate ruxolitinib cream as maintenance during the open label extension period.
Interventions
Ruxolitinib cream 1.5% applied twice a day (BID)
Vehicle cream applied twice a day (BID) to affected areas
Sponsors
Study design
Masking description
4 week double-blind treatment
Intervention model description
This is 2:1 assignment to rux and vehicle creams.
Eligibility
Inclusion criteria
* Participants with diagnosis of AD for at least 6 months. * Participants with an overall and a face and/or neck IGA score of 2 or 3 at screening and baseline. * Participants with AD affecting the following at screening and baseline: 1. ≥ 0.5% of the total BSA on the face and/or neck 2. Up to a total of 20% BSA (face and/or neck plus other body areas) * Willingness to avoid pregnancy or fathering children based on the criteria outlined in the protocol. * Further inclusion criteria apply.
Exclusion criteria
* Participants who have an unstable course of AD (spontaneously improving or rapidly deteriorating) as determined by the investigator over the previous 4 weeks prior to baseline. * Participants with concurrent conditions and history of other diseases such as immunocompromised; chronic or acute infection requiring systemic treatments; active acute skin infection; other concomitant skin conditions that may interfere with the evaluation of AD or compromise participant safety; other types of eczema; chronic asthma requiring high dose of inhaled corticosteroids. * Any serious illness or medical, physical, or psychiatric condition(s) that, in the investigator's opinion, would interfere with full participation in the study, including administration of study drug and attending required study visits; pose a significant risk to the participant; or interfere with interpretation of study data. * Previous treatment with systemic or topical JAK inhibitors (eg, ruxolitinib, tofacitinib, baricitinib, filgotinib, lestaurtinib, pacritinib). * Participants who are pregnant (or who are considering pregnancy) or lactating. * Laboratory values outside of the protocol -defined criteria * Further
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants Who Achieve a ≥75% Improvement in the Eczema Area and Severity Index Score (EASI75) of the Head and Neck Region at Week 4 | Baseline; Week 4 | The EASI scoring system examines 4 areas of the body (head/neck, trunk, upper limbs, and lower limbs) and weights them for participants of at least 8 years of age. Each of the 4 body regions is assessed separately for erythema (E), induration/papulation/edema (I), excoriations (Ex), and lichenification (l) on a scale of 0 to 3 (0 = none, absent; 1 = mild; 2 = moderate; 3 = severe). Half scores are allowed between severities 1, 2, and 3. The final EASI score was obtained by weight-averaging these 4 scores and will range from 0 to 72; the severity strata are as follows: 0 = clear; 0.1 to 1.0 = almost clear; 1.1 to 7.0 = mild; 7.1 to 21.0 = moderate; 21.1 to 50.0 = severe; 50.1 to 72.0 = very severe. Specifically for the head and neck region, the EASI score ranges from 0 to 7.2 An EASI75 responder was defined as a participant achieving a 75% or greater improvement from Baseline in the EASI score for the head and neck. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants Who Achieve an Overall EASI75 at Weeks 2, 4, and 8 | Baseline; Weeks 2, 4, and 8 | The EASI scoring system examines 4 areas of the body (head/neck, trunk, upper limbs, and lower limbs) and weights them for participants of at least 8 years of age. Each of the 4 body regions is assessed separately for erythema (E), induration/papulation/edema (I), excoriations (Ex), and lichenification (l) on a scale of 0 to 3 (0 = none, absent; 1 = mild; 2 = moderate; 3 = severe). Half scores are allowed between severities 1, 2, and 3. The final EASI score was obtained by weight-averaging these 4 scores and will range from 0 to 72; the severity strata are as follows: 0 = clear; 0.1 to 1.0 = almost clear; 1.1 to 7.0 = mild; 7.1 to 21.0 = moderate; 21.1 to 50.0 = severe; 50.1 to 72.0 = very severe. An EASI75 responder was defined as a participant achieving 75% or greater improvement from Baseline in EASI score. |
| Double-Blind Period: Number of Participants With Any Treatment-emergent Adverse Event (TEAE) | up to approximately 4 weeks plus 30 days | A TEAE was defined as any adverse event (AE) either reported for the first time or the worsening of a pre-existing event after the first application of the study drug. An AE was defined as any untoward medical occurrence associated with the use of a drug in humans, whether or not it was considered drug related. An AE could therefore have been any unfavorable or unintended sign (including an abnormal laboratory finding), symptom, or disease (new or exacerbated) temporally associated with the use of study drug. |
| Percentage of Participants Who Achieve an EASI75 of the Head and Neck Region at Weeks 2 and 8 | Baseline; Weeks 2 and 8 | The EASI scoring system examines 4 areas of the body (head/neck, trunk, upper limbs, and lower limbs) and weights them for participants of at least 8 years of age. Each of the 4 body regions is assessed separately for erythema (E), induration/papulation/edema (I), excoriations (Ex), and lichenification (l) on a scale of 0 to 3 (0 = none, absent; 1 = mild; 2 = moderate; 3 = severe). Half scores are allowed between severities 1, 2, and 3. The final EASI score was obtained by weight-averaging these 4 scores and will range from 0 to 72; the severity strata are as follows: 0 = clear; 0.1 to 1.0 = almost clear; 1.1 to 7.0 = mild; 7.1 to 21.0 = moderate; 21.1 to 50.0 = severe; 50.1 to 72.0 = very severe. Specifically for the head and neck region, the EASI score ranges from 0 to 7.2 An EASI75 responder was defined as a participant achieving a 75% or greater improvement from Baseline in the EASI score for the head and neck. |
| Double-Blind Period: Number of Participants With Any Grade 3 or Higher TEAE | up to approximately 4 weeks plus 30 days | A TEAE was defined as any AE either reported for the first time or the worsening of a pre-existing event after the first application of the study drug. An AE was defined as any untoward medical occurrence associated with the use of a drug in humans, whether or not it was considered drug related. The severity of AEs was graded using the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) version 5.0 (Grades 1 to 5). Grade 1: mild; asymptomatic or mild symptoms; clinical or diagnostic observations only; intervention not indicated. Grade 2: moderate; minimal, local or noninvasive intervention indicated; limiting age-appropriate instrumental activities of daily living (ADL). Grade 3: severe or medically significant but not immediately life threatening; hospitalization or prolongation of hospitalization indicated; disabling; limiting self-care ADL. Grade 4: life-threatening consequences; urgent intervention indicated. Grade 5: death related to AE. |
| Open-Label Period: Number of Participants With Any Grade 3 or Higher TEAE | from first dose date in Open-Label Period (start of Week 5) until last follow-up visit (up to approximately 4 weeks plus 30 days) | A TEAE was defined as any AE either reported for the first time or the worsening of a pre-existing event after the first application of the study drug. An AE was defined as any untoward medical occurrence associated with the use of a drug in humans, whether or not it was considered drug related. An AE could therefore have been any unfavorable or unintended sign (including an abnormal laboratory finding), symptom, or disease (new or exacerbated) temporally associated with the use of study drug. |
| Open-Label Period: Number of Participants With Any TEAE | from first dose date in Open-Label Period (start of Week 5) until last follow-up visit (up to approximately 4 weeks plus 30 days) | A TEAE was defined as any AE either reported for the first time or the worsening of a pre-existing event after the first application of the study drug. An AE was defined as any untoward medical occurrence associated with the use of a drug in humans, whether or not it was considered drug related. An AE could therefore have been any unfavorable or unintended sign (including an abnormal laboratory finding), symptom, or disease (new or exacerbated) temporally associated with the use of study drug. |
Countries
United States
Participant flow
Pre-assignment details
This decentralized clinical study was conducted through 1 virtual meta-site in the United States.
Participants by arm
| Arm | Count |
|---|---|
| Double-Blind Period: Vehicle Cream BID Participants applied matching vehicle cream BID for 4 weeks. | 23 |
| Double-Blind Period: Ruxolitinib Cream 1.5% BID Participants applied ruxolitinib 1.5% cream twice daily (BID) for 4 weeks. | 54 |
| Total | 77 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 | FG003 |
|---|---|---|---|---|---|
| 4-Week Double-Blind Period | Lost to Follow-up | 1 | 0 | 0 | 0 |
| 4-Week Double-Blind Period | Physician Decision | 1 | 0 | 0 | 0 |
| 4-Week Double-Blind Period | Withdrawal by Subject | 3 | 1 | 0 | 0 |
| 4-Week Double-Blind Period | Withdrawn by Sponsor | 0 | 4 | 0 | 0 |
| 4-Week Double-Blind Period | Withdrawn Due to E-diary Compliance | 0 | 1 | 0 | 0 |
| 4-Week Open-Label Period | Lost to Follow-up | 0 | 0 | 0 | 1 |
| 4-Week Open-Label Period | Withdrawal by Subject | 0 | 0 | 1 | 1 |
| 4-Week Open-Label Period | Withdrawn by Sponsor | 0 | 0 | 0 | 1 |
Baseline characteristics
| Characteristic | Double-Blind Period: Vehicle Cream BID | Double-Blind Period: Ruxolitinib Cream 1.5% BID | Total |
|---|---|---|---|
| Age, Continuous | 41.0 years STANDARD_DEVIATION 13.44 | 37.9 years STANDARD_DEVIATION 14.37 | 38.8 years STANDARD_DEVIATION 14.08 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 1 Participants | 5 Participants | 6 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 22 Participants | 49 Participants | 71 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race/Ethnicity, Customized American-Indian/Alaska Native | 0 Participants | 1 Participants | 1 Participants |
| Race/Ethnicity, Customized Asian | 1 Participants | 4 Participants | 5 Participants |
| Race/Ethnicity, Customized Black/African-American | 10 Participants | 24 Participants | 34 Participants |
| Race/Ethnicity, Customized Black and Phillipino | 0 Participants | 1 Participants | 1 Participants |
| Race/Ethnicity, Customized Black, Asian | 1 Participants | 0 Participants | 1 Participants |
| Race/Ethnicity, Customized Captured as Hispanic in the Database | 0 Participants | 1 Participants | 1 Participants |
| Race/Ethnicity, Customized Indian | 0 Participants | 1 Participants | 1 Participants |
| Race/Ethnicity, Customized Mexican | 0 Participants | 1 Participants | 1 Participants |
| Race/Ethnicity, Customized Mexican and Spanish | 0 Participants | 1 Participants | 1 Participants |
| Race/Ethnicity, Customized White/Caucasian | 11 Participants | 20 Participants | 31 Participants |
| Sex: Female, Male Female | 16 Participants | 46 Participants | 62 Participants |
| Sex: Female, Male Male | 7 Participants | 8 Participants | 15 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 23 | 0 / 71 |
| other Total, other adverse events | 2 / 23 | 1 / 71 |
| serious Total, serious adverse events | 0 / 23 | 0 / 71 |
Outcome results
Percentage of Participants Who Achieve a ≥75% Improvement in the Eczema Area and Severity Index Score (EASI75) of the Head and Neck Region at Week 4
The EASI scoring system examines 4 areas of the body (head/neck, trunk, upper limbs, and lower limbs) and weights them for participants of at least 8 years of age. Each of the 4 body regions is assessed separately for erythema (E), induration/papulation/edema (I), excoriations (Ex), and lichenification (l) on a scale of 0 to 3 (0 = none, absent; 1 = mild; 2 = moderate; 3 = severe). Half scores are allowed between severities 1, 2, and 3. The final EASI score was obtained by weight-averaging these 4 scores and will range from 0 to 72; the severity strata are as follows: 0 = clear; 0.1 to 1.0 = almost clear; 1.1 to 7.0 = mild; 7.1 to 21.0 = moderate; 21.1 to 50.0 = severe; 50.1 to 72.0 = very severe. Specifically for the head and neck region, the EASI score ranges from 0 to 7.2 An EASI75 responder was defined as a participant achieving a 75% or greater improvement from Baseline in the EASI score for the head and neck.
Time frame: Baseline; Week 4
Population: Full Analysis Population: all participants enrolled in the study who had at least 1 application of study drug. Missing post-Baseline values were imputed as Non-Responders at Week 4. The 95% confidence interval for the difference was computed based on a large-sample normal approximation with continuity correction.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Double-Blind Period: Vehicle Cream BID | Percentage of Participants Who Achieve a ≥75% Improvement in the Eczema Area and Severity Index Score (EASI75) of the Head and Neck Region at Week 4 | 17.4 percentage of participants |
| Double-Blind Period: Ruxolitinib Cream 1.5% BID | Percentage of Participants Who Achieve a ≥75% Improvement in the Eczema Area and Severity Index Score (EASI75) of the Head and Neck Region at Week 4 | 37.0 percentage of participants |
Double-Blind Period: Number of Participants With Any Grade 3 or Higher TEAE
A TEAE was defined as any AE either reported for the first time or the worsening of a pre-existing event after the first application of the study drug. An AE was defined as any untoward medical occurrence associated with the use of a drug in humans, whether or not it was considered drug related. The severity of AEs was graded using the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) version 5.0 (Grades 1 to 5). Grade 1: mild; asymptomatic or mild symptoms; clinical or diagnostic observations only; intervention not indicated. Grade 2: moderate; minimal, local or noninvasive intervention indicated; limiting age-appropriate instrumental activities of daily living (ADL). Grade 3: severe or medically significant but not immediately life threatening; hospitalization or prolongation of hospitalization indicated; disabling; limiting self-care ADL. Grade 4: life-threatening consequences; urgent intervention indicated. Grade 5: death related to AE.
Time frame: up to approximately 4 weeks plus 30 days
Population: Full Analysis Population
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Double-Blind Period: Vehicle Cream BID | Double-Blind Period: Number of Participants With Any Grade 3 or Higher TEAE | 0 Participants |
| Double-Blind Period: Ruxolitinib Cream 1.5% BID | Double-Blind Period: Number of Participants With Any Grade 3 or Higher TEAE | 1 Participants |
Double-Blind Period: Number of Participants With Any Treatment-emergent Adverse Event (TEAE)
A TEAE was defined as any adverse event (AE) either reported for the first time or the worsening of a pre-existing event after the first application of the study drug. An AE was defined as any untoward medical occurrence associated with the use of a drug in humans, whether or not it was considered drug related. An AE could therefore have been any unfavorable or unintended sign (including an abnormal laboratory finding), symptom, or disease (new or exacerbated) temporally associated with the use of study drug.
Time frame: up to approximately 4 weeks plus 30 days
Population: Full Analysis Population
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Double-Blind Period: Vehicle Cream BID | Double-Blind Period: Number of Participants With Any Treatment-emergent Adverse Event (TEAE) | 5 Participants |
| Double-Blind Period: Ruxolitinib Cream 1.5% BID | Double-Blind Period: Number of Participants With Any Treatment-emergent Adverse Event (TEAE) | 6 Participants |
Open-Label Period: Number of Participants With Any Grade 3 or Higher TEAE
A TEAE was defined as any AE either reported for the first time or the worsening of a pre-existing event after the first application of the study drug. An AE was defined as any untoward medical occurrence associated with the use of a drug in humans, whether or not it was considered drug related. An AE could therefore have been any unfavorable or unintended sign (including an abnormal laboratory finding), symptom, or disease (new or exacerbated) temporally associated with the use of study drug.
Time frame: from first dose date in Open-Label Period (start of Week 5) until last follow-up visit (up to approximately 4 weeks plus 30 days)
Population: Open-Label Evaluable Population
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Double-Blind Period: Vehicle Cream BID | Open-Label Period: Number of Participants With Any Grade 3 or Higher TEAE | 1 Participants |
| Double-Blind Period: Ruxolitinib Cream 1.5% BID | Open-Label Period: Number of Participants With Any Grade 3 or Higher TEAE | 1 Participants |
Open-Label Period: Number of Participants With Any TEAE
A TEAE was defined as any AE either reported for the first time or the worsening of a pre-existing event after the first application of the study drug. An AE was defined as any untoward medical occurrence associated with the use of a drug in humans, whether or not it was considered drug related. An AE could therefore have been any unfavorable or unintended sign (including an abnormal laboratory finding), symptom, or disease (new or exacerbated) temporally associated with the use of study drug.
Time frame: from first dose date in Open-Label Period (start of Week 5) until last follow-up visit (up to approximately 4 weeks plus 30 days)
Population: Open-Label Evaluable Population: all participants who applied at least 1 dose of ruxolitinib cream during the Open-Label Period
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Double-Blind Period: Vehicle Cream BID | Open-Label Period: Number of Participants With Any TEAE | 4 Participants |
| Double-Blind Period: Ruxolitinib Cream 1.5% BID | Open-Label Period: Number of Participants With Any TEAE | 9 Participants |
Percentage of Participants Who Achieve an EASI75 of the Head and Neck Region at Weeks 2 and 8
The EASI scoring system examines 4 areas of the body (head/neck, trunk, upper limbs, and lower limbs) and weights them for participants of at least 8 years of age. Each of the 4 body regions is assessed separately for erythema (E), induration/papulation/edema (I), excoriations (Ex), and lichenification (l) on a scale of 0 to 3 (0 = none, absent; 1 = mild; 2 = moderate; 3 = severe). Half scores are allowed between severities 1, 2, and 3. The final EASI score was obtained by weight-averaging these 4 scores and will range from 0 to 72; the severity strata are as follows: 0 = clear; 0.1 to 1.0 = almost clear; 1.1 to 7.0 = mild; 7.1 to 21.0 = moderate; 21.1 to 50.0 = severe; 50.1 to 72.0 = very severe. Specifically for the head and neck region, the EASI score ranges from 0 to 7.2 An EASI75 responder was defined as a participant achieving a 75% or greater improvement from Baseline in the EASI score for the head and neck.
Time frame: Baseline; Weeks 2 and 8
Population: Full Analysis Population. Only participants with available data were analyzed. The 95% confidence interval for the difference was computed based on a large-sample normal approximation with continuity correction.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Double-Blind Period: Vehicle Cream BID | Percentage of Participants Who Achieve an EASI75 of the Head and Neck Region at Weeks 2 and 8 | Week 2 | 16.7 percentage of participants |
| Double-Blind Period: Vehicle Cream BID | Percentage of Participants Who Achieve an EASI75 of the Head and Neck Region at Weeks 2 and 8 | Week 8 | 35.3 percentage of participants |
| Double-Blind Period: Ruxolitinib Cream 1.5% BID | Percentage of Participants Who Achieve an EASI75 of the Head and Neck Region at Weeks 2 and 8 | Week 2 | 14.6 percentage of participants |
| Double-Blind Period: Ruxolitinib Cream 1.5% BID | Percentage of Participants Who Achieve an EASI75 of the Head and Neck Region at Weeks 2 and 8 | Week 8 | 53.3 percentage of participants |
Percentage of Participants Who Achieve an Overall EASI75 at Weeks 2, 4, and 8
The EASI scoring system examines 4 areas of the body (head/neck, trunk, upper limbs, and lower limbs) and weights them for participants of at least 8 years of age. Each of the 4 body regions is assessed separately for erythema (E), induration/papulation/edema (I), excoriations (Ex), and lichenification (l) on a scale of 0 to 3 (0 = none, absent; 1 = mild; 2 = moderate; 3 = severe). Half scores are allowed between severities 1, 2, and 3. The final EASI score was obtained by weight-averaging these 4 scores and will range from 0 to 72; the severity strata are as follows: 0 = clear; 0.1 to 1.0 = almost clear; 1.1 to 7.0 = mild; 7.1 to 21.0 = moderate; 21.1 to 50.0 = severe; 50.1 to 72.0 = very severe. An EASI75 responder was defined as a participant achieving 75% or greater improvement from Baseline in EASI score.
Time frame: Baseline; Weeks 2, 4, and 8
Population: Full Analysis Population. Only participants with available data were analyzed. The 95% confidence interval for the difference was computed based on a large-sample normal approximation with continuity correction.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Double-Blind Period: Vehicle Cream BID | Percentage of Participants Who Achieve an Overall EASI75 at Weeks 2, 4, and 8 | Week 2 | 5.6 percentage of participants |
| Double-Blind Period: Vehicle Cream BID | Percentage of Participants Who Achieve an Overall EASI75 at Weeks 2, 4, and 8 | Week 4 | 33.3 percentage of participants |
| Double-Blind Period: Vehicle Cream BID | Percentage of Participants Who Achieve an Overall EASI75 at Weeks 2, 4, and 8 | Week 8 | 35.3 percentage of participants |
| Double-Blind Period: Ruxolitinib Cream 1.5% BID | Percentage of Participants Who Achieve an Overall EASI75 at Weeks 2, 4, and 8 | Week 2 | 10.4 percentage of participants |
| Double-Blind Period: Ruxolitinib Cream 1.5% BID | Percentage of Participants Who Achieve an Overall EASI75 at Weeks 2, 4, and 8 | Week 4 | 29.2 percentage of participants |
| Double-Blind Period: Ruxolitinib Cream 1.5% BID | Percentage of Participants Who Achieve an Overall EASI75 at Weeks 2, 4, and 8 | Week 8 | 33.3 percentage of participants |