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Study for Treatment With Calcipotriol/Betamethasone Dipropionate Gel in Korean Patients With Psoriasis Vulgaris (TRIANGLE)

Primary Purpose

Psoriasis Vulgaris

Status
Completed
Phase
Phase 4
Locations
Korea, Republic of
Study Type
Interventional
Intervention
Calcipotriol/betamethasone dipropionate gel
Sponsored by
Jooheung Lee
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Psoriasis Vulgaris

Eligibility Criteria

19 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Male or female subjects aged 19 years and above
  2. Clinical diagnosis of stable psoriasis vulgaris of at least 4 weeks duration involving the non-scalp regions of the body (trunk and/or limbs) amenable to treatment with a maximum of 100 g of topical medication per week at screening
  3. An investigator's global assessment of disease severity(IGA) of at least mild on the body (trunk and/or limbs) at Day 0 (Baseline)
  4. Signed written informed consent prior to performance of any study-specific procedures or assessments, and must be willing to comply with treatment and follow up
  5. Able to communicate with the investigator and understand and comply with the requirements of the study
  6. Women of childbearing potential must have a negative pregnancy test and must use adequate contraception during the treatment phase of the study and for at least 1 week after the last application of study medication

Exclusion Criteria:

  1. Body surface area (BSA) > 10 % or Psoriasis Area and Severity Index (PASI) > 10 at baseline

    * The palm of one hand is approximately 1 percent of the body surface area

  2. Subjects with unstable forms of psoriasis including guttate, erythrodermic, exfoliative and pustular psoriasis, or psoriatic arthritis
  3. Subjects with known disorders of calcium metabolism/hypercalcemia
  4. Subjects with hypersensitivity to the active substances or to any of the excipients of the investigational products
  5. Systemic treatment with biological therapies with a possible effect on psoriasis vulgaris within the following time periods prior to baseline visit

    • etanercept - within 4 weeks prior to baseline
    • adalimumab, alefacept, infliximab - within 2 months prior to baseline
    • ustekinumab - within 4 months prior to baseline
    • investigational product - within 4 weeks/5 half-lives (whichever is longer) prior to baseline
  6. Systemic treatment with all other therapies with a possible effect on psoriasis vulgaris (e.g., corticosteroids, retinoids, methotrexate, cyclosporine and other immunosuppressants) within 4 weeks prior to baseline visit
  7. Phototherapy within the following time periods prior to baseline visit

    • PUVA or Grenz ray - within 4 weeks
    • UV-B - within 2 weeks
  8. Any topical treatment of the trunk and/or limbs (except for emollients) within 2 weeks prior to baseline visit
  9. Topical treatment for other relevant skin disorders on the face and flexures (e.g., facial and flexural psoriasis, eczema) with class 1- 5 corticosteroids or vitamin D analogues within 2 weeks prior to baseline visit
  10. Topical treatment for other relevant skin disorders on the scalp (e.g. scalp psoriasis) with class 1-5 corticosteroids, vitamin D analogues within 2 weeks prior to baseline visit
  11. Subjects with severe renal insufficiency
  12. Subjects with severe hepatic disorders
  13. Subjects with a confounding skin condition or disorders against psoriasis evaluation
  14. Subjects with viral (e.g. herpes or varicella) lesions of the skin, fungal or bacterial skin infections, parasitic infections on the treatment area
  15. Subjects with skin manifestations in relation to tuberculosis or syphilis on the treatment area
  16. Subjects with perioral dermatitis, atrophic skin, striae atrophicae on the treatment area
  17. Subjects with fragility of skin veins, ichthyosis on the treatment area
  18. Subjects with acne vulgaris, rosacea, wounds, ulcers, perianal and genital pruritus on the treatment area
  19. Planned initiation of, or changes to, concomitant medication that could affect psoriasis vulgaris (e.g. beta blockers, anti-malarials, lithium, ACE inhibitors) during the study
  20. Pregnant or lactating female subjects
  21. Subjects who are planning a pregnancy during the entire study period

Sites / Locations

  • Samsung Medical Center

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Experimental

Experimental

Arm Label

PRN treatment

Continuous treatment

Weekends treatment

Arm Description

Group 1: PRN treatment Apply Xamiol® gel (Calcipotriol/betamethasone dipropionate gel) once daily as needed (PRN)

Group 2: Continuous treatment Apply Xamiol® gel (Calcipotriol/betamethasone dipropionate gel)once daily

Group 3: Weekends treatment (twice weekly) Apply Xamiol® gel (Calcipotriol/betamethasone dipropionate gel) once daily at weekends (on Saturdays and Sundays)

Outcomes

Primary Outcome Measures

Percentage of "Responder" (subjects with a grade of "clear" or "almost clear") according to IGA at Week 16
The primary objective of this study is to evaluate the percentages of "Responder"* at week 16, as assessed by Investigator's Global Assessment of Disease Severity (IGA), in three different 8-week maintenance regimens of Xamiol® gel after 8-week induction treatment with Xamiol® gel in patients with psoriasis vulgaris.

Secondary Outcome Measures

Investigator's global assessment of disease severity
To evaluate the change of disease severity assessed by IGA in induction treatment phase and compare the IGA disease severity of three different maintenance regimens in the maintenance treatment phase.
Percentage of disease relapse
To evaluate descriptive statistics of three different regimens in the maintenance treatment phase and compare percentage of relapse in threee different regimens.
Patient's global assessment of disease severity
To evaluate the change of disease severity assessed by PGA in induction treatment phase and compare the PGA disease severity of three different maintenance regimens in the maintenance treatment phase.
Change in Psoriasis Area and Severity Index (PASI) score from Baseline to Week
To evaluate the change of PASI in induction treatment phase and compare the PASI of three different maintenance regimens in the maintenance treatment phase.
Percent of subjects achieving a 75% improvement in the Psoriasis Area and Severity Index (PASI) score
To evaluate the change of PASI75 from week 4 to week 8 in induction treatment phase and compare PASI75 in three different regimens in the maintenance treatment phase.
Time to relapse
To evaluate descriptive statistics of three different regimens in the maintenance treatment phase and compare the time to relapse in threee different regimens.

Full Information

First Posted
November 10, 2013
Last Updated
June 3, 2014
Sponsor
Jooheung Lee
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1. Study Identification

Unique Protocol Identification Number
NCT02004574
Brief Title
Study for Treatment With Calcipotriol/Betamethasone Dipropionate Gel in Korean Patients With Psoriasis Vulgaris
Acronym
TRIANGLE
Official Title
Investigator Initiated Study for Optimal Maintenance Treatment With Calcipotriol /Betamethasone Dipropionate Gel in Korean Patients With Psoriasis Vulgaris
Study Type
Interventional

2. Study Status

Record Verification Date
June 2014
Overall Recruitment Status
Completed
Study Start Date
October 2013 (undefined)
Primary Completion Date
June 2014 (Actual)
Study Completion Date
June 2014 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Jooheung Lee

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
The combination of calcipotriol and betamethasone dipropionate used in an ointment formulation (Daivobet® ointment) has shown to have an excellent efficacy and safety in the short-term and long-term management of psoriasis vulgaris. A newly developed gel formulation (Xamiol® gel) of calcipotriol and betamethasone dipropionate has recently been approved and marketed in Korea as a topical treatment of moderate to severe scalp psoriasis and non-scalp psoriasis vulgaris. Xamiol® gel, the investigational product (IP) used in this study, prevents keratinization by normalizing the reproduction cycle of skin cells. It also relieves itching associated with psoriasis. Xamiol® gel was initially approved for treatment of moderate to severe scalp psoriasis and its label was extended to non-scalp psoriasis vulgaris in October 2012. Since patient compliance is one of the important factors in achieving effective outcomes in the treatment of psoriasis, the once daily dosing of Xamiol® gel is expected to enhance compliance and treatment outcomes as well as to provide a safe and effective therapeutic option.
Detailed Description
Psoriasis is a disease difficult to cure and is usually recurrent and therefore, a continued management is crucial. An evidence-based approach is important for appropriate treatments of patient with psoriasis. However, there is a lack of response data for the topical treatments in Asian patients with psoriasis, and no treatment guidelines available. Therefore, routine topical treatments, instead of patient-specific treatments, are usually applied, which may result in treatment failure. In this regard, it is imperative to conduct a study to assess topical treatments in Korean patients with psoriasis vulgaris in terms of efficacy and side effects. Furthermore, psoriasis patients in Korea, mostly small plaque types, may exhibit different disease activities and response outcomes and accordingly require different treatment options as compared to Western populations whose dominant psoriasis type is large plaque type. Thus, a study in Korean patients with psoriasis may reveal an interesting finding. In order to investigate optimal maintenance regimens for the topical treatment of Korean patients with psoriasis vulgaris, we are planning this study which evaluates the efficacy of three 8-week maintenance regimens containing Xamiol® gel (PRN treatment group, Continuous treatment group and Twice weekly treatment group) in patients who have become "Responder" after 8-week induction therapy with Xamiol® gel ("Responder"). The primary objective of this study is to evaluate the percentages of "Responder"* at week 16, as assessed by Investigator's Global Assessment of Disease Severity (IGA), in three different 8-week maintenance regimens of Xamiol® gel after 8-week induction treatment with Xamiol® gel in patients with psoriasis vulgaris. * Responder is defined as subjects with "clear" or "almost clear" according to IGA. Secondary study objectives is to evaluate efficacy, % of Relapse and time to Relapse, PGA, Patient Compliance, Safety and Quality of Life (DLQI and TSQM) in three arms with calcipotriol/betamethasone dipropionate combination gel treatment in Korean patients with chronic plaque psoriasis of the body.

6. Conditions and Keywords

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

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
201 (Actual)

8. Arms, Groups, and Interventions

Arm Title
PRN treatment
Arm Type
Experimental
Arm Description
Group 1: PRN treatment Apply Xamiol® gel (Calcipotriol/betamethasone dipropionate gel) once daily as needed (PRN)
Arm Title
Continuous treatment
Arm Type
Experimental
Arm Description
Group 2: Continuous treatment Apply Xamiol® gel (Calcipotriol/betamethasone dipropionate gel)once daily
Arm Title
Weekends treatment
Arm Type
Experimental
Arm Description
Group 3: Weekends treatment (twice weekly) Apply Xamiol® gel (Calcipotriol/betamethasone dipropionate gel) once daily at weekends (on Saturdays and Sundays)
Intervention Type
Drug
Intervention Name(s)
Calcipotriol/betamethasone dipropionate gel
Other Intervention Name(s)
Xamiol gel
Intervention Description
All enrolled subjects will receive Xamiol® gel once daily for 8 weeks during the induction period and then will be assessed according to IGA at the end of 8-week induction period. Those subjects determined to be "Responder" by IGA will be randomized to one of the following three treatment groups and they will continue their therapy with randomized maintenance regimens for the duration of additional 8 weeks.
Primary Outcome Measure Information:
Title
Percentage of "Responder" (subjects with a grade of "clear" or "almost clear") according to IGA at Week 16
Description
The primary objective of this study is to evaluate the percentages of "Responder"* at week 16, as assessed by Investigator's Global Assessment of Disease Severity (IGA), in three different 8-week maintenance regimens of Xamiol® gel after 8-week induction treatment with Xamiol® gel in patients with psoriasis vulgaris.
Time Frame
Week 16
Secondary Outcome Measure Information:
Title
Investigator's global assessment of disease severity
Description
To evaluate the change of disease severity assessed by IGA in induction treatment phase and compare the IGA disease severity of three different maintenance regimens in the maintenance treatment phase.
Time Frame
Week 0, 4, 8, 12 and 16
Title
Percentage of disease relapse
Description
To evaluate descriptive statistics of three different regimens in the maintenance treatment phase and compare percentage of relapse in threee different regimens.
Time Frame
Week 0, 4, 8, 12 and 16
Title
Patient's global assessment of disease severity
Description
To evaluate the change of disease severity assessed by PGA in induction treatment phase and compare the PGA disease severity of three different maintenance regimens in the maintenance treatment phase.
Time Frame
Week 0, 4, 8, 12 and 16
Title
Change in Psoriasis Area and Severity Index (PASI) score from Baseline to Week
Description
To evaluate the change of PASI in induction treatment phase and compare the PASI of three different maintenance regimens in the maintenance treatment phase.
Time Frame
Week 0, 4, 8, 12 and 16
Title
Percent of subjects achieving a 75% improvement in the Psoriasis Area and Severity Index (PASI) score
Description
To evaluate the change of PASI75 from week 4 to week 8 in induction treatment phase and compare PASI75 in three different regimens in the maintenance treatment phase.
Time Frame
Week 0, 4, 8, 12 and 16
Title
Time to relapse
Description
To evaluate descriptive statistics of three different regimens in the maintenance treatment phase and compare the time to relapse in threee different regimens.
Time Frame
Week 0, 4, 8, 12 and 16
Other Pre-specified Outcome Measures:
Title
Subject's Compliance
Description
To evaluate subject's compliance by subject's diary, interview, used IP dose and evaluate descriptive statistics for them.
Time Frame
Week 4, 8, 12 and 16
Title
Dermatology Life Quality Index
Description
To evaluate the change of DLQI score in induction treatment phase and evaluate change rate of week 8, week 12 and week 16 compared with baseline in the maintenance treatment phase.
Time Frame
Week 0, 4, 8, 12 and 16
Title
Treatment Satisfaction Questionnaire for Medication
Description
To evaluated descriptive statistics for TSQM score of week 8 in the induction treatment phase and evaluate change rate of week 8, week 16 and from week 8 to week 16 in the maintenance treatment phase.
Time Frame
Week 8 and 16
Title
Other treatment after completion of study
Description
To evaluate descriptive statistics for used other medication after study completion.
Time Frame
Week 16
Title
Laboratory assessment
Description
To evaluate the reported values(normal/abnormal) as follows. : To evaluate change of reported values from baseline to week 8 in induction treatment phase and compare reported values of week 8 and week 16 in three different regimens in the maintenance treatment phase.
Time Frame
Week 0, 8, 16 and 18
Title
SAEs
Description
To evaluate the number of occurrance(subject-based) in each treatment phase and regimen and compare the number of occurrance in three difference regimens in the maintenance treatment phase.
Time Frame
Week 0, 4, 8, 12, 16 and 18
Title
AEs
Description
To evaluate the number of occurrance(subject-based) in each treatment phase and regimen and compare the number of occurrance in three difference regimens in the maintenance treatment phase.
Time Frame
Week 0, 4, 8, 12, 16 and 18
Title
ADRs
Description
To evaluate the number of occurrance(subject-based) in each treatment phase and regimen and compare the number of occurrance in three difference regimens in the maintenance treatment phase.
Time Frame
Week 0, 4, 8, 12, 16 and 18

10. Eligibility

Sex
All
Minimum Age & Unit of Time
19 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male or female subjects aged 19 years and above Clinical diagnosis of stable psoriasis vulgaris of at least 4 weeks duration involving the non-scalp regions of the body (trunk and/or limbs) amenable to treatment with a maximum of 100 g of topical medication per week at screening An investigator's global assessment of disease severity(IGA) of at least mild on the body (trunk and/or limbs) at Day 0 (Baseline) Signed written informed consent prior to performance of any study-specific procedures or assessments, and must be willing to comply with treatment and follow up Able to communicate with the investigator and understand and comply with the requirements of the study Women of childbearing potential must have a negative pregnancy test and must use adequate contraception during the treatment phase of the study and for at least 1 week after the last application of study medication Exclusion Criteria: Body surface area (BSA) > 10 % or Psoriasis Area and Severity Index (PASI) > 10 at baseline * The palm of one hand is approximately 1 percent of the body surface area Subjects with unstable forms of psoriasis including guttate, erythrodermic, exfoliative and pustular psoriasis, or psoriatic arthritis Subjects with known disorders of calcium metabolism/hypercalcemia Subjects with hypersensitivity to the active substances or to any of the excipients of the investigational products Systemic treatment with biological therapies with a possible effect on psoriasis vulgaris within the following time periods prior to baseline visit etanercept - within 4 weeks prior to baseline adalimumab, alefacept, infliximab - within 2 months prior to baseline ustekinumab - within 4 months prior to baseline investigational product - within 4 weeks/5 half-lives (whichever is longer) prior to baseline Systemic treatment with all other therapies with a possible effect on psoriasis vulgaris (e.g., corticosteroids, retinoids, methotrexate, cyclosporine and other immunosuppressants) within 4 weeks prior to baseline visit Phototherapy within the following time periods prior to baseline visit PUVA or Grenz ray - within 4 weeks UV-B - within 2 weeks Any topical treatment of the trunk and/or limbs (except for emollients) within 2 weeks prior to baseline visit Topical treatment for other relevant skin disorders on the face and flexures (e.g., facial and flexural psoriasis, eczema) with class 1- 5 corticosteroids or vitamin D analogues within 2 weeks prior to baseline visit Topical treatment for other relevant skin disorders on the scalp (e.g. scalp psoriasis) with class 1-5 corticosteroids, vitamin D analogues within 2 weeks prior to baseline visit Subjects with severe renal insufficiency Subjects with severe hepatic disorders Subjects with a confounding skin condition or disorders against psoriasis evaluation Subjects with viral (e.g. herpes or varicella) lesions of the skin, fungal or bacterial skin infections, parasitic infections on the treatment area Subjects with skin manifestations in relation to tuberculosis or syphilis on the treatment area Subjects with perioral dermatitis, atrophic skin, striae atrophicae on the treatment area Subjects with fragility of skin veins, ichthyosis on the treatment area Subjects with acne vulgaris, rosacea, wounds, ulcers, perianal and genital pruritus on the treatment area Planned initiation of, or changes to, concomitant medication that could affect psoriasis vulgaris (e.g. beta blockers, anti-malarials, lithium, ACE inhibitors) during the study Pregnant or lactating female subjects Subjects who are planning a pregnancy during the entire study period
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Joo-Heung Lee, MD
Organizational Affiliation
Samsung Medical Center
Official's Role
Study Chair
Facility Information:
Facility Name
Samsung Medical Center
City
Gangnam-gu
State/Province
Seoul
ZIP/Postal Code
135-710
Country
Korea, Republic of

12. IPD Sharing Statement

Citations:
PubMed Identifier
17314973
Citation
Lowes MA, Bowcock AM, Krueger JG. Pathogenesis and therapy of psoriasis. Nature. 2007 Feb 22;445(7130):866-73. doi: 10.1038/nature05663.
Results Reference
result
PubMed Identifier
15099362
Citation
Lew W, Lee E, Krueger JG. Psoriasis genomics: analysis of proinflammatory (type 1) gene expression in large plaque (Western) and small plaque (Asian) psoriasis vulgaris. Br J Dermatol. 2004 Apr;150(4):668-76. doi: 10.1111/j.0007-0963.2004.05891.x.
Results Reference
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PubMed Identifier
17310004
Citation
Pariser DM, Bagel J, Gelfand JM, Korman NJ, Ritchlin CT, Strober BE, Van Voorhees AS, Young M, Rittenberg S, Lebwohl MG, Horn EJ; National Psoriasis Foundation. National Psoriasis Foundation clinical consensus on disease severity. Arch Dermatol. 2007 Feb;143(2):239-42. doi: 10.1001/archderm.143.2.239.
Results Reference
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PubMed Identifier
17135738
Citation
Kragballe K, Austad J, Barnes L, Bibby A, de la Brassinne M, Cambazard F, Fleming C, Heikkila H, Williams Z, Peyri Rey J, Svensson A, Toole J, Wozel G. Efficacy results of a 52-week, randomised, double-blind, safety study of a calcipotriol/betamethasone dipropionate two-compound product (Daivobet/Dovobet/Taclonex) in the treatment of psoriasis vulgaris. Dermatology. 2006;213(4):319-26. doi: 10.1159/000096069.
Results Reference
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PubMed Identifier
15214905
Citation
Kragballe K, Noerrelund KL, Lui H, Ortonne JP, Wozel G, Uurasmaa T, Fleming C, Estebaranz JL, Hanssen LI, Persson LM. Efficacy of once-daily treatment regimens with calcipotriol/betamethasone dipropionate ointment and calcipotriol ointment in psoriasis vulgaris. Br J Dermatol. 2004 Jun;150(6):1167-73. doi: 10.1111/j.1365-2133.2004.05986.x.
Results Reference
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PubMed Identifier
21293107
Citation
Langley RG, Gupta A, Papp K, Wexler D, Osterdal ML, Curcic D. Calcipotriol plus betamethasone dipropionate gel compared with tacalcitol ointment and the gel vehicle alone in patients with psoriasis vulgaris: a randomized, controlled clinical trial. Dermatology. 2011;222(2):148-56. doi: 10.1159/000323408. Epub 2011 Feb 3.
Results Reference
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PubMed Identifier
23097521
Citation
Samarasekera E, Sawyer L, Parnham J, Smith CH; Guideline Development Group. Assessment and management of psoriasis: summary of NICE guidance. BMJ. 2012 Oct 24;345:e6712. doi: 10.1136/bmj.e6712. No abstract available.
Results Reference
result

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Study for Treatment With Calcipotriol/Betamethasone Dipropionate Gel in Korean Patients With Psoriasis Vulgaris

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