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Clobetasol Versus Pimecrolimus for Vulvar Lichen Sclerosus

Primary Purpose

Lichen Sclerosus

Status

Completed

Phase

Phase 2

Locations

United States

Study Type

Interventional

Intervention

pimecrolimus and clobetasol

clobetasol 0.05% cream

About this trial

This is an interventional treatment trial for Lichen Sclerosus

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)FemaleAccepts Healthy Volunteers

Inclusion Criteria:

Female, 18 years or older.
With a diagnosis of biopsy proven active vulvar lichen sclerosus.
Signed written informed consent.
Willingness and ability to comply with the study requirements.
Negative urine pregnancy tests must be documented for all females of childbearing potential prior to enrollment.
Two forms of birth control will be required for women with childbearing potential.
IGA at baseline ≥1
Subjects must have ≥ 4 or greater (on a 0 to 10 point scale) on at least one of the two visual analog scales (pruritus or pain/burning).

Exclusion Criteria:

Who have received systemic immunosuppressants (e.g. corticosteroids) within 4 weeks prior to participation in the study.
Who have been treated with topical therapy (e.g., topical corticosteroids, pimecrolimus, and tacrolimus) at the affected area within two weeks prior to participation in the study.
Who are immunocompromised (e.g., lymphoma, AIDS, Wiskott-Aldrich Syndrome) or have an uncontrolled malignant disease.
Who have a history of lymphoma
Who have lympadenopathy
Who have active vulvar herpes, molluscum, or condyloma
Who suffer from systemic or generalized infections (bacterial, viral or fungal).
Who have been diagnosed with lichen planus, psoriasis, candidiasis, intraepithelial neoplasia, or carcinoma of the vulva.
Who have been diagnosed with diabetes mellitus or Netherton's syndrome.
Menstruating females of childbearing potential who are not using two medically accepted methods of contraception during the study. Medically approved contraception may, at the discretion of the investigator, include abstinence.
Women who are breastfeeding.
Who had received an investigational drug within four weeks prior to the study or who intend to use other investigational drugs during the course of this study.
Who are hypersensitive to pimecrolimus or clobetasol or any of the components of the creams.
Patients with severe medical condition(s) that in the view of the investigator prohibits participation in the study.
Who have a history of substance abuse or any factor, which limits the subject's ability to cooperate with the study procedures.
Who are uncooperative, known to miss appointments (according to subjects' records) and are unlikely to follow medical instructions or are not willing to attend regularly scheduled visits.

Sites / Locations

Center for VulvoVaginal Disorders

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

Arm Description

pimecrolimus

clobetasol

Outcomes

Primary Outcome Measures

Change in inflammation

Secondary Outcome Measures

Pruritus

Burning

Pain

Lichenification

Full Information

NCT ID

NCT00393263

First Posted

October 25, 2006

Last Updated

May 8, 2014

Sponsor

Center for Vulvovaginal Disorders

Collaborators

Novartis

1. Study Identification

Unique Protocol Identification Number

NCT00393263

Brief Title

Clobetasol Versus Pimecrolimus for Vulvar Lichen Sclerosus

Official Title

A Double-Blind, Parallel-group Trial of Topical Pimecrolimus Cream 1% (Elidel®) Versus Clobetasol 0.05% Cream for the Treatment of Vulvar Lichen Sclerosus

Study Type

Interventional

2. Study Status

Record Verification Date

May 2014

Overall Recruitment Status

Completed

Study Start Date

October 2006 (undefined)

Primary Completion Date

October 2009 (Actual)

Study Completion Date

October 2009 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title

Principal Investigator

Name of the Sponsor

Center for Vulvovaginal Disorders

Collaborators

Novartis

4. Oversight

5. Study Description

Brief Summary

Lichen sclerosus (LS) is a skin condition of the external genitals (vulva) of women. LS causes vulvar itching, pain, and burning. In addition, LS causes scarring of the vulva which may cause significant sexual dysfunction or pain. Lastly, 4-6% of women with LS will develop vulvar cancer. The current "gold standard" treatment for lichen sclerosus is ultra-potent topical corticosteroids. When properly administered, topical ultra-potent corticosteroids help to resolve the symptoms of itching and burning and can prevent further vulvar scarring. In addition, proper treatment reverses the underlying inflammation of LS, and preliminary data shows that the risk of cancer also declines. While effective, topical corticosteroids have serious local and systemic side effects that include thinning of the skin, superimposed fungal infections, and suppression of the adrenal gland. Elidel 1% cream is a new type of medication that has been approved by the FDA for the treatment of eczema. In theory, Elidel should also treat LS without the serious side effects that accompany corticosteroids. Therefore, this study is designed to compare the effectiveness and safety of a topical corticosteroid (clobetasol) versus Elidel 1% cream for the treatment of LS.

Detailed Description

Lichen sclerosus (LS) is a chronic cutaneous disorder affecting approximately one in seventy women. Presenting symptoms may include intense pruritis, pain, burning, and severe dyspareunia. The typical lesions of LS are white plaques and papules, often with areas of echymosis, excoriation, and ulceration. Often, LS causes destruction of the vulva architecture. In addition, 4-6% percent of women with LS will develop vulvar carcinoma. The histopathologic changes of LS are distinctive and make biopsy a very useful diagnostic tool. While there is no known cure for LS, the current gold standard treatment is ultra-potent corticosteroids. When properly administered, topical ultra-potent corticosteroids help to resolve the symptoms of pruritis and burning and can prevent further vulvar scarring. In addition, proper treatment reverses the underlying histopathologic changes of LS, and preliminary data shows that the risk of malignant transformation also declines. Although treatment with topical corticosteroids is effective, topical corticosteroids have serious local and systemic side effects, including dermal thinning, skin atrophy, superimposed fungal infections, rebound dermatitis, and adrenal insufficiency. Pimecrolimus cream 1% (Elidel®, Novartis Pharmaceutical) is a topical calcineurin inhibitor that binds to macrophilin-12 and inhibits cytokine synthesis by T lymphocytes. Elidel has been approved by the FDA for the treatment of mild to moderate atopic dermatitis. In theory, as Elidel inhibits T lymphocytes, it should effectively treat lichen sclerosus. In addition, as Elidel does not inhibit keratinocytes, or affect collagen synthesis, it does not cause dermal atrophy. Therefore, Elidel may be an effective and safer alternative treatment for LS. This study is designed to compare the effectiveness and safety of Elidel 1% cream versus an ultra-potent corticosteroid (clobetasol 0.05% cream) for the treatment for vulvar LS.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study

Lichen Sclerosus

7. Study Design

Primary Purpose

Treatment

Study Phase

Phase 2

Interventional Study Model

Parallel Assignment

Masking

ParticipantCare ProviderInvestigatorOutcomes Assessor

Allocation

Randomized

Enrollment

38 (Actual)

8. Arms, Groups, and Interventions

Arm Title

Arm Type

Experimental

Arm Description

pimecrolimus

Arm Title

Arm Type

Active Comparator

Arm Description

clobetasol

Intervention Type

Drug

Intervention Name(s)

pimecrolimus and clobetasol

Intervention Type

Drug

Intervention Name(s)

clobetasol 0.05% cream

Intervention Description

twice daily for three months

Primary Outcome Measure Information:

Title

Change in inflammation

Time Frame

3 months

Secondary Outcome Measure Information:

Title

Pruritus

Time Frame

3 months

Title

Burning

Time Frame

3 months

Title

Pain

Time Frame

3 months

Title

Lichenification

Time Frame

3 months

10. Eligibility

Sex

Female

Minimum Age & Unit of Time

18 Years

Accepts Healthy Volunteers

Eligibility Criteria

Inclusion Criteria: Female, 18 years or older. With a diagnosis of biopsy proven active vulvar lichen sclerosus. Signed written informed consent. Willingness and ability to comply with the study requirements. Negative urine pregnancy tests must be documented for all females of childbearing potential prior to enrollment. Two forms of birth control will be required for women with childbearing potential. IGA at baseline ≥1 Subjects must have ≥ 4 or greater (on a 0 to 10 point scale) on at least one of the two visual analog scales (pruritus or pain/burning). Exclusion Criteria: Who have received systemic immunosuppressants (e.g. corticosteroids) within 4 weeks prior to participation in the study. Who have been treated with topical therapy (e.g., topical corticosteroids, pimecrolimus, and tacrolimus) at the affected area within two weeks prior to participation in the study. Who are immunocompromised (e.g., lymphoma, AIDS, Wiskott-Aldrich Syndrome) or have an uncontrolled malignant disease. Who have a history of lymphoma Who have lympadenopathy Who have active vulvar herpes, molluscum, or condyloma Who suffer from systemic or generalized infections (bacterial, viral or fungal). Who have been diagnosed with lichen planus, psoriasis, candidiasis, intraepithelial neoplasia, or carcinoma of the vulva. Who have been diagnosed with diabetes mellitus or Netherton's syndrome. Menstruating females of childbearing potential who are not using two medically accepted methods of contraception during the study. Medically approved contraception may, at the discretion of the investigator, include abstinence. Women who are breastfeeding. Who had received an investigational drug within four weeks prior to the study or who intend to use other investigational drugs during the course of this study. Who are hypersensitive to pimecrolimus or clobetasol or any of the components of the creams. Patients with severe medical condition(s) that in the view of the investigator prohibits participation in the study. Who have a history of substance abuse or any factor, which limits the subject's ability to cooperate with the study procedures. Who are uncooperative, known to miss appointments (according to subjects' records) and are unlikely to follow medical instructions or are not willing to attend regularly scheduled visits.

Overall Study Officials:

First Name & Middle Initial & Last Name & Degree

Andrew T Goldstein, MD

Organizational Affiliation

Center for Vulvovaginal Disorders

Official's Role

Principal Investigator

Facility Information:

Facility Name

Center for VulvoVaginal Disorders

City

Washington

State/Province

District of Columbia

ZIP/Postal Code

21012

Country

United States

12. IPD Sharing Statement

Citations:

PubMed Identifier

15568399

Citation

Goldstein AT, Marinoff SC, Christopher K. Pimecrolimus for the treatment of vulvar lichen sclerosus: a report of 4 cases. J Reprod Med. 2004 Oct;49(10):778-80.

Results Reference

result

PubMed Identifier

21353334

Citation

Goldstein AT, Creasey A, Pfau R, Phillips D, Burrows LJ. A double-blind, randomized controlled trial of clobetasol versus pimecrolimus in patients with vulvar lichen sclerosus. J Am Acad Dermatol. 2011 Jun;64(6):e99-104. doi: 10.1016/j.jaad.2010.06.011. Epub 2011 Feb 25.

Results Reference

result

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Clobetasol Versus Pimecrolimus for Vulvar Lichen Sclerosus

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