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A Randomized Study to Evaluate the Efficacy of Herbal Ingredients Combined With a Carrier System (Phytonail) Compared With Amorolfine 5% Nail Lacquer (Loceryl) in the Treatment of Toenail Onychomycosis

Primary Purpose

Onycomycosis

Status
Unknown status
Phase
Not Applicable
Locations
Taiwan
Study Type
Interventional
Intervention
Phytonail
Loceryl
Sponsored by
National Taiwan University Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Onycomycosis focused on measuring Onychomycosis, BioEqual carrier system, amorolfine.

Eligibility Criteria

20 Years - 65 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

The subject must meet ALL the criteria listed below both at Screening and Baseline (Day 1)

  1. Subjects must be aged 20 to 65 years at Screening, and can be either sex.
  2. Subjects must have onychomycosis, that (a) involves at least one great toenail (if two great toenails are infected, the one with greater involvement will be selected as target nail), and (b) has been mycologically confirmed at Screening Phase (positive potassium hydroxide (KOH) preparation and culture positive for dermatophytes, Candida spp., or molds).
  3. Subjects must have the target great toenail capable of growing.
  4. Subjects must be able to apply the study drugs to their toenails.
  5. Subjects must be willing to sign the informed consent form and be able to adhere to dose and visit schedules during the study
  6. Subjects must agree to use no other products including nail polish applied to the toenails during the study.

Exclusion Criteria:

The subject will not be selected for the study if ANY of the criteria listed below are met at Screening and/or Baseline (Day 1)

  1. Subjects with a structural deformity of the target great toenail, including but not limited to genetic nail disorders, onychogryphosis, traumatic nail dystrophy, and/or any other abnormalities that in the investigator's judgment may interfere with efficacy assessments.
  2. Subjects with a current or past history of psoriasis and /or lichen planus.
  3. Subjects with a history of treatment failure (defined as no recognized increase in clean nail growth) after completion of ≧3 months of any oral antifungals.
  4. Subjects have controlled diabetes with HbA1C≧8%.
  5. Subjects with significant peripheral vascular disease or peripheral circulatory impairment, as evidenced by absence of dorsalis pedis or posterior tibial pulses.
  6. Subject with a history of immunosuppression or presence of a serious concurrent medical condition that might adversely affect the evaluation of treatment response.
  7. Subjects with chronic tinea pedis (eg, moccasin type) that in the investigator's judgment would require systemic treatment.
  8. Subjects who have received any treatment listed below more recently than the indicated washout period or who must continue to receive such treatments Systemic antifungal treatments (24 weeks prior to Screening) Topical antifungal agents applied to the toenails, excluding antifungal agents for the treatment of tinea pedis (4 weeks prior to Screening) Investigational drugs (4 weeks prior to Screening) Oral or intramuscular corticosteroid or immunosuppressive agents (2 weeks prior to Day 1) Topical antifungal agents for the treatment of tinea pedis (prior to Day 1) Topical anti-inflammatory, topical corticosteroids, and topical immunosuppressive agents applied to the feet (2 weeks prior to Day 1)
  9. Subject with a history of hypersensitivity to morpholine antifungal agents or essential herbal oil;
  10. Women who are breast-feeding, pregnant, or intended to become pregnant; and
  11. Subjects who are unable to comply with the treatment regimen.
  12. Subjects who are participating in any other clinical study.
  13. Subjects who are part of the staff personnel directly involved with the study.

Sites / Locations

  • National Taiwan University HospitalRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Active Comparator

Arm Label

Phytonail

amorolfine 5% nail lacquer

Arm Description

Phytonail is a mixture of herbal active ingredients including tea tree oil, lavender oil and Australian blue cypress (ABC) oil with BioEqual carrier system.

5% amorolfine

Outcomes

Primary Outcome Measures

Mycological cure
The primary efficacy endpoint of the study is the mycological cure rate of the target great toenail at Week 16. Mycological cure is defined as both negative KOH and negative fungal culture.

Secondary Outcome Measures

The treatment success rate of the target toenail
Treatment success is defined as both almost clear nail (<10% nail involvement) after proper trimming, as determined by the investigator, and negative KOH and negative fungal culture.
The complete cure rate of the target toenail
Complete cure is defined as both completely clear nail (0% nail involvement) after proper trimming, as determined by the investigator, and negative KOH and negative fungal culture.
The CNG (clear nail growth) of the target great toenail
For other toenail excluding the target toenail, the proportion of nails that are completely clear (0% nail involvement) or almost clear (<10% nail involvement) at Baseline, Week 16 and Week 24.

Full Information

First Posted
August 22, 2013
Last Updated
August 22, 2013
Sponsor
National Taiwan University Hospital
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1. Study Identification

Unique Protocol Identification Number
NCT01929187
Brief Title
A Randomized Study to Evaluate the Efficacy of Herbal Ingredients Combined With a Carrier System (Phytonail) Compared With Amorolfine 5% Nail Lacquer (Loceryl) in the Treatment of Toenail Onychomycosis
Official Title
A Randomized Study to Evaluate the Efficacy of Herbal Ingredients Combined With a Carrier System (Phytonail) Compared With Amorolfine 5% Nail Lacquer (Loceryl) in the Treatment of Toenail Onychomycosis
Study Type
Interventional

2. Study Status

Record Verification Date
July 2013
Overall Recruitment Status
Unknown status
Study Start Date
February 2013 (undefined)
Primary Completion Date
December 2013 (Anticipated)
Study Completion Date
July 2014 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
National Taiwan University Hospital

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
Background: Onychomycosis, the most common nail disorder, is a superficial fungal infection affecting toenails more than fingernails. Onychomycosis can cause pain and discomfort and has the potential to be a source of morbidity. Although oral antifungal agents achieve a better complete cure rate for onychomycosis, many patients are worried about the side effects and unwilling to take oral medications. Phytonail is a mixture of herbal active ingredients including tea tree oil, lavender oil and Australian blue cypress oil with BioEqual carrier system. A preliminary trial has shown a 100% KOH negative rate in 32 nails after 12 weeks of Phytonail therapy. Amorolfine 5% nail lacquer (Loceryl) is a broad-spectrum morpholine antifungal demonstrated 60-75% mycological cure rate in several randomized controlled trials for the treatment of toenail onychomycosis. Objective: To evaluate the efficacy and safety of Phytonail relative to amorolfine 5% nail lacquer in the treatment of toenail onychomycosis. Methods: This is a randomized, parallel-group, open-labeled study in adult subjects with toenail onychomycosis. In this study, 60 eligible patients will be randomized in a 1: 1 ratio to one of the two treatment groups: Phytonail or amorolfine 5% nail lacquer. Before randomization, patients are to have onychomycosis in at least one great toenail with positive KOH examination and positive fungal culture. During the treatment phase, Phytonail will be applied twice daily and amorolfine 5% nail lacquer once weekly for 16 weeks to all affected toenails. Physician's assessments and photographic analyses will be carried out at baseline, Week 4, 8, 16, and 24. Mycological evaluation including KOH examination will be performed at baseline, Week 4, 8, and 16. Fungal culture will be performed at baseline and for KOH negative patients.
Detailed Description
Subjects aged 20-65 years with toenail onychomychosis involved at least one great toenail will be recruited in the study. Approximately 200 subjects will be screened, in order to randomize 72 eligible subjects. Allowing for approximately 20% drop-outs, it is estimated that for completing 60 eligible subjects, approximately 72 subjects would be enrolled. Subjects must meet all the inclusion criteria and none of the exclusion criteria to receive treatment assignment. Procedures: Explain study and obtain written informed consent: Screening Review inclusion/exclusion criteria including prior and concomitant medications: Screening and Baseline (Day 1) Demographics: Screening Medical history (including prior onychomycosis): Screening Personal and family history as well as history of any prior treatment for onychomycosis and any symptoms attributed to onychomycosis Physical examination: Screening Selection of target great toenail: Screening Proper nail trimming of target great toenail (as needed): all visits The subject's target great toenail will be properly trimmed as needed by the investigator or a qualified designee. Proper nail trimming is defined as cutting the nail plate to within 1 mm of the hyponychium or distal groove. In case of onycholysis the nail is to be trimmed not to the proximal limit of the onycholysis. Percentage of nail involvement of the target great toenail based on signs of onychomycosis: all visits The percentage of involvement of the target great toenail will be determined by the investigator's visual estimate of the extent of the total nail area that shows signs of onychomycosis after proper trimming the nail. Assessment of other toenails: all visits (except screening) At baseline (Day 1) and all subsequent visits, the investigator will identify all other toenails (excluding the target great toenail) with signs of onychomycosis and determine the total number of toenails that are completely clear (0% involvement) or almost clear (<10% involvement). Marking the target great toenail: all visits The investigator will ink the distal groove, the 2-mm notch (except at Screening, when the notch will not have been made yet), and the healthy/involved limit of the target toenail with a supplied indelible marking pen. These markings on the target great toenail will be used to determine the CN, and will be used for the calculation of CNG and LNG. The initial photo of the unmarked nail must be taken before any marking is made. Two-millimeter notch for the target great toenail: Baseline (Day 1) At the Baseline (Day 1) visit, the investigator will make a superficial notch in the nail plate, approximately 2 mm distal from the proximal nail fold. The investigator will ink the notch with a marking pen at this and each subsequent visit. If, as the nail grows, the investigator feels that the original notch may be clipped off at the next visit, a new nail notch approximately 2 mm from the proximal nail fold will be made. KOH examination of the target great toenail: Screening, Week 4, 8, and 16. Fungal culture of the target great toenail: Screening, at Week 4, 8, and 16 only for KOH negative patients Digital photography: Baseline (Day 1); Week 4, 8, 16, and 24; early termination (if applicable) Digital photographs will be analyzed for the following measurements: Clear nail (CN) of the target great toenail: CN is defined as the distance (mm) between the PNF and the most proximal limit of the disease (as marked by the investigator). Clear nail growth (CNG) of the target great toenail: The CNG is a calculation and is defined as the difference (mm) between the CN at a given visit and the CN at Baseline (Day 1). For example, if the baseline CN is 2 mm and the Week 12 CN is 5 mm, the nail will have 3 mm of new clear nail growth. Linear nail growth (LNG) of the target great toenail: The LNG represents the growth of nail plate (normal and mycotic) over a period of time. LNG is defined as the distance at any given time point from the PNF to the nail notch, minus the distance of the notch from the PNF at Baseline (2 mm). For example, if at a post-Baseline visit the length from the proximal nail fold to the inked notch becomes 6 mm, then the nail will have growth 4 mm (6 mm- 2 mm= 4 mm). Randomization: Baseline (Day 1) Subject dosing diary dispensing: Baseline (Day 1) through Week 8 Subject dosing diary collection: Week 4 through Week 16, and early termination Study drug dispensing: Baseline (Day 1) through Week 8 Study drug self-administration: Baseline (Day 1) through Week 16 Study drug collection: Week 4 through Week 16, and early termination Prior and concomitant drugs: All visits Record adverse events: All visits (except screening)

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Onycomycosis
Keywords
Onychomycosis, BioEqual carrier system, amorolfine.

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
72 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Phytonail
Arm Type
Active Comparator
Arm Description
Phytonail is a mixture of herbal active ingredients including tea tree oil, lavender oil and Australian blue cypress (ABC) oil with BioEqual carrier system.
Arm Title
amorolfine 5% nail lacquer
Arm Type
Active Comparator
Arm Description
5% amorolfine
Intervention Type
Drug
Intervention Name(s)
Phytonail
Other Intervention Name(s)
herbal ingredients combined with a carrier system (Phytonail)
Intervention Type
Drug
Intervention Name(s)
Loceryl
Other Intervention Name(s)
amorolfine 5% nail lacquer (Loceryl)
Primary Outcome Measure Information:
Title
Mycological cure
Description
The primary efficacy endpoint of the study is the mycological cure rate of the target great toenail at Week 16. Mycological cure is defined as both negative KOH and negative fungal culture.
Time Frame
At week 16
Secondary Outcome Measure Information:
Title
The treatment success rate of the target toenail
Description
Treatment success is defined as both almost clear nail (<10% nail involvement) after proper trimming, as determined by the investigator, and negative KOH and negative fungal culture.
Time Frame
At Week16 and Week 24.
Title
The complete cure rate of the target toenail
Description
Complete cure is defined as both completely clear nail (0% nail involvement) after proper trimming, as determined by the investigator, and negative KOH and negative fungal culture.
Time Frame
At Week 16 and Week 24
Title
The CNG (clear nail growth) of the target great toenail
Description
For other toenail excluding the target toenail, the proportion of nails that are completely clear (0% nail involvement) or almost clear (<10% nail involvement) at Baseline, Week 16 and Week 24.
Time Frame
Week 16 and Week 24

10. Eligibility

Sex
All
Minimum Age & Unit of Time
20 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: The subject must meet ALL the criteria listed below both at Screening and Baseline (Day 1) Subjects must be aged 20 to 65 years at Screening, and can be either sex. Subjects must have onychomycosis, that (a) involves at least one great toenail (if two great toenails are infected, the one with greater involvement will be selected as target nail), and (b) has been mycologically confirmed at Screening Phase (positive potassium hydroxide (KOH) preparation and culture positive for dermatophytes, Candida spp., or molds). Subjects must have the target great toenail capable of growing. Subjects must be able to apply the study drugs to their toenails. Subjects must be willing to sign the informed consent form and be able to adhere to dose and visit schedules during the study Subjects must agree to use no other products including nail polish applied to the toenails during the study. Exclusion Criteria: The subject will not be selected for the study if ANY of the criteria listed below are met at Screening and/or Baseline (Day 1) Subjects with a structural deformity of the target great toenail, including but not limited to genetic nail disorders, onychogryphosis, traumatic nail dystrophy, and/or any other abnormalities that in the investigator's judgment may interfere with efficacy assessments. Subjects with a current or past history of psoriasis and /or lichen planus. Subjects with a history of treatment failure (defined as no recognized increase in clean nail growth) after completion of ≧3 months of any oral antifungals. Subjects have controlled diabetes with HbA1C≧8%. Subjects with significant peripheral vascular disease or peripheral circulatory impairment, as evidenced by absence of dorsalis pedis or posterior tibial pulses. Subject with a history of immunosuppression or presence of a serious concurrent medical condition that might adversely affect the evaluation of treatment response. Subjects with chronic tinea pedis (eg, moccasin type) that in the investigator's judgment would require systemic treatment. Subjects who have received any treatment listed below more recently than the indicated washout period or who must continue to receive such treatments Systemic antifungal treatments (24 weeks prior to Screening) Topical antifungal agents applied to the toenails, excluding antifungal agents for the treatment of tinea pedis (4 weeks prior to Screening) Investigational drugs (4 weeks prior to Screening) Oral or intramuscular corticosteroid or immunosuppressive agents (2 weeks prior to Day 1) Topical antifungal agents for the treatment of tinea pedis (prior to Day 1) Topical anti-inflammatory, topical corticosteroids, and topical immunosuppressive agents applied to the feet (2 weeks prior to Day 1) Subject with a history of hypersensitivity to morpholine antifungal agents or essential herbal oil; Women who are breast-feeding, pregnant, or intended to become pregnant; and Subjects who are unable to comply with the treatment regimen. Subjects who are participating in any other clinical study. Subjects who are part of the staff personnel directly involved with the study.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
shiu-lan Wang, Master
Phone
+886+975212275
Email
belle896106@yahoo.com.tw
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Jin-Bon Hong, MD
Organizational Affiliation
Department of Dermatology, National Taiwan University Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
National Taiwan University Hospital
City
Taipei
ZIP/Postal Code
100
Country
Taiwan
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Chiu-Nun Chen
Phone
+886+2-23562141
Email
derm@ntuh.gov.tw
First Name & Middle Initial & Last Name & Degree
Jin-Bon Hong, MD

12. IPD Sharing Statement

Learn more about this trial

A Randomized Study to Evaluate the Efficacy of Herbal Ingredients Combined With a Carrier System (Phytonail) Compared With Amorolfine 5% Nail Lacquer (Loceryl) in the Treatment of Toenail Onychomycosis

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