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The Effect of Riboflavin on Moderate to Severe Plaque Type Psoriasis

Primary Purpose

Psoriasis

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Riboflavin
Placebo
Sponsored by
University of Michigan
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Psoriasis focused on measuring Psoriasis

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  • 18 years of age or older
  • Good general health
  • Willingness and ability to follow the protocol
  • Signed Informed Consent Form, written and witnessed.
  • Stable moderate to severe chronic plaque psoriasis involving 8% or greater total body surface area (TBSA).
  • If subject is a woman of childbearing potential, she must have a negative pregnancy test at screening and agree to use a medically acceptable form of contraception during the screening and throughout the study.

Exclusion Criteria:

  • Started using a topical steroid stronger than moderate strength, vitamin A or D analog preparations, or anthralin within 14 days of study drug initiation.
  • Initiated a systemic medications, including biologic medication, or phototherapy within 180 days of study drug initiation.
  • Prior or concurrent use of cyclophosphamide.
  • Currently using sulfasalazine therapy.
  • Known hypersensitivity to riboflavin.
  • Enrolled in any other investigational device or investigational drug trial(s) or receipt of any other investigational agent(s) within 28 days of baseline visit.
  • Presence of severe comorbidities such as, diabetes mellitus requiring insulin; congestive heart failure (CHF) of any severity or myocardial infarction or cerebrovascular accident or transient ischemic attack within 3 months of screening visit; unstable angina pectoris, uncontrolled hypertension [sitting systolic BP <80 mm Hg or > 160 or diastolic BP > 100 mm Hg], oxygen-dependent severe pulmonary disease, history of cancer within 5 years [other than resected cutaneous basal or squamous cell carcinoma of the skin or in situ cervical cancer].
  • Any of the following hematologic abnormalities, confirmed by repeat test at least 1 week apart:

    1. White blood count <3,000/µL or >14,000/µL
    2. Lymphocyte count <1,000/µL
    3. Neutrophil count <1,5000/µL
    4. Platelet count <150,000/µL
    5. Hemoglobin<10 g/dL
  • Liver function test aspartate aminotransferase (AST), alanine aminotransferase (ALT) or alkaline phosphatase (AlkP) results that are greater than or equal to 2 times the upper limit of normal (ULN).
  • Serum creatinine ≥ to 2x the ULN.
  • Known HIV-positive status or known history of any other immune-suppressing disease.
  • Any current or past history of psychiatric disease that would interfere with ability to comply with study protocol or give informed consent.
  • Had grade 3 or 4 adverse events or infections within 28 days before screening, or between screening visit and drug initiation.
  • Evidence of any skin conditions other than psoriasis that would interfere with the evaluations of the effect of study medication on psoriasis.
  • Presence of any condition or circumstances judged by the patient's physician, the investigator, or medically qualified study staff to render this clinical trial detrimental or otherwise unsuitable for the patient's participation.
  • A history of non-compliance with other therapies.
  • Females who are pregnant, lactating, planning on pregnancy during the study period, or unwilling to use FDA-approved method of birth control.
  • A history of keloids or excessive scar formation or of healing poorly.
  • A history of allergic reaction to local anesthetics, including lidocaine and epinephrine

Sites / Locations

  • University of Michigan Department of Dermatology

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Riboflavin then Placebo

Placebo then Riboflavin

Arm Description

Riboflavin (Vitamin B2) 400 mg oral capsule taken once daily for 12 weeks, followed by 4 week washout period before crossover. At crossover, patients will no longer receive Riboflavin but matching placebo capsule for additional 12 weeks.

Placebo oral capsule taken once daily for 12 weeks, followed by 4 week washout period before crossover. At crossover, patients will no longer receive placebo but 400 mg Riboflavin (Vitamin B2) capsule for additional 12 weeks.

Outcomes

Primary Outcome Measures

Subjects Achieving 50% or Greater Psoriasis Area and Severity Index (PASI) Reduction
The number of subjects that achieve a 50 percent or greater reduction in their PASI with intervention as compared to placebo. The range of absolute PASI scores is 0-72, with higher scores indicating a greater severity of psoriasis. 0 to <5=Mild psoriasis; 5 to <10 = Moderate psoriasis; 10 to <72 = Severe psoriasis.

Secondary Outcome Measures

Subjects Achieving PASI 75, 90, 100 Response
The number of subjects that achieve a PASI 75, 90, 100 response with intervention as compared to placebo.
Subjects Achieving Physician Global Assessment (PGA) Score 0/1
The number of subjects that achieve a PGA score of 0/1 with intervention as compared to placebo. The Global Assessment Scale is a simple instrument with a 9 point ordinal scoring system ranging from -4 indicating very marked worsening to +4 very marked improvement. This scale provides a subjective overall evaluation of treatment response by the patients/caregivers or physicians/health care providers.
Subjects Reporting Pruritus Score 0/1
The number of subjects that report a pruritus score of 0/1 with intervention as compared to placebo. The pruritis scores can range from 0 to 10; where 0 means no itching and 10 means the worst itching.
Subjects Reporting Dermatology Life Quality Index (DLQI) Score 0/1
The number of subjects treated that report a DLQI score of 0/1 with intervention as compared to placebo. Minimum score 0, maximum score of 30, where 0 means dermatological problems are not causing impairment on their quality of life and 30 means extreme negative impact of dermatological conditions. 0-1 = no effect at all on patient's life; 2-5 = small effect on patient's life; 6-10 = moderate effect on patient's life; 11-20 = very large effect on patient's life; 21-30 = extremely large effect on patient's life.
Difference in Riboflavin Serum Plasma Levels and Flavin-adenine Dinucleotide (FAD)
The difference in serum plasma levels of riboflavin and FAD in subjects treated with intervention as compared to placebo.

Full Information

First Posted
December 2, 2015
Last Updated
July 5, 2022
Sponsor
University of Michigan
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1. Study Identification

Unique Protocol Identification Number
NCT02622386
Brief Title
The Effect of Riboflavin on Moderate to Severe Plaque Type Psoriasis
Official Title
The Effect of Riboflavin on Moderate to Severe Plaque Type Psoriasis
Study Type
Interventional

2. Study Status

Record Verification Date
July 2022
Overall Recruitment Status
Completed
Study Start Date
August 11, 2016 (Actual)
Primary Completion Date
April 6, 2020 (Actual)
Study Completion Date
April 6, 2020 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of Michigan

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
The purpose of this study is to determine the anti-inflammatory effect of high-dose riboflavin supplementation on chronic plaque psoriasis. Psoriasis is a common chronic skin disorder that affects over 4 million people. There is no cure for psoriasis and treatment is directed at controlling patients' symptoms. Amongst patients with skin disease, there is significant interest in using complementary alternative medicine and vitamins to treat their disease. Previous human case reports suggest that riboflavin, commonly known as Vitamin B2, is clinically effective for the treatment of psoriasis; however, they were not conclusive. More recent human trials have shown that 400 mg of daily oral riboflavin is a safe and well-tolerated medication to administer to humans. For the purpose of this study, the riboflavin is used as an investigational drug.
Detailed Description
The purpose of this investigation is to determine the anti-inflammatory effect of high-dose riboflavin supplementation on chronic plaque psoriasis. Up to fifty volunteers with chronic plaque psoriasis will be recruited for a double-blind, placebo-controlled 28 week prospective study with cross-over of both the intervention and control groups at the 12 week time mark. There will be a 4 week washout period when subjects crossover. Riboflavin will be dosed 400 mg by mouth daily versus placebo. Throughout the study the investigators will perform both clinical and laboratory assessments to measure response.

6. Conditions and Keywords

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

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Crossover Assignment
Masking
ParticipantInvestigator
Allocation
Randomized
Enrollment
23 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Riboflavin then Placebo
Arm Type
Experimental
Arm Description
Riboflavin (Vitamin B2) 400 mg oral capsule taken once daily for 12 weeks, followed by 4 week washout period before crossover. At crossover, patients will no longer receive Riboflavin but matching placebo capsule for additional 12 weeks.
Arm Title
Placebo then Riboflavin
Arm Type
Placebo Comparator
Arm Description
Placebo oral capsule taken once daily for 12 weeks, followed by 4 week washout period before crossover. At crossover, patients will no longer receive placebo but 400 mg Riboflavin (Vitamin B2) capsule for additional 12 weeks.
Intervention Type
Drug
Intervention Name(s)
Riboflavin
Other Intervention Name(s)
Vitamin B2
Intervention Description
Riboflavin (Vitamin B2) 400 mg capsule taken daily for 12 weeks.
Intervention Type
Other
Intervention Name(s)
Placebo
Intervention Description
Matching placebo capsule taken daily for 12 weeks.
Primary Outcome Measure Information:
Title
Subjects Achieving 50% or Greater Psoriasis Area and Severity Index (PASI) Reduction
Description
The number of subjects that achieve a 50 percent or greater reduction in their PASI with intervention as compared to placebo. The range of absolute PASI scores is 0-72, with higher scores indicating a greater severity of psoriasis. 0 to <5=Mild psoriasis; 5 to <10 = Moderate psoriasis; 10 to <72 = Severe psoriasis.
Time Frame
12 weeks
Secondary Outcome Measure Information:
Title
Subjects Achieving PASI 75, 90, 100 Response
Description
The number of subjects that achieve a PASI 75, 90, 100 response with intervention as compared to placebo.
Time Frame
12 weeks
Title
Subjects Achieving Physician Global Assessment (PGA) Score 0/1
Description
The number of subjects that achieve a PGA score of 0/1 with intervention as compared to placebo. The Global Assessment Scale is a simple instrument with a 9 point ordinal scoring system ranging from -4 indicating very marked worsening to +4 very marked improvement. This scale provides a subjective overall evaluation of treatment response by the patients/caregivers or physicians/health care providers.
Time Frame
12 weeks
Title
Subjects Reporting Pruritus Score 0/1
Description
The number of subjects that report a pruritus score of 0/1 with intervention as compared to placebo. The pruritis scores can range from 0 to 10; where 0 means no itching and 10 means the worst itching.
Time Frame
12 weeks
Title
Subjects Reporting Dermatology Life Quality Index (DLQI) Score 0/1
Description
The number of subjects treated that report a DLQI score of 0/1 with intervention as compared to placebo. Minimum score 0, maximum score of 30, where 0 means dermatological problems are not causing impairment on their quality of life and 30 means extreme negative impact of dermatological conditions. 0-1 = no effect at all on patient's life; 2-5 = small effect on patient's life; 6-10 = moderate effect on patient's life; 11-20 = very large effect on patient's life; 21-30 = extremely large effect on patient's life.
Time Frame
12 weeks
Title
Difference in Riboflavin Serum Plasma Levels and Flavin-adenine Dinucleotide (FAD)
Description
The difference in serum plasma levels of riboflavin and FAD in subjects treated with intervention as compared to placebo.
Time Frame
12 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: 18 years of age or older Good general health Willingness and ability to follow the protocol Signed Informed Consent Form, written and witnessed. Stable moderate to severe chronic plaque psoriasis involving 8% or greater total body surface area (TBSA). If subject is a woman of childbearing potential, she must have a negative pregnancy test at screening and agree to use a medically acceptable form of contraception during the screening and throughout the study. Exclusion Criteria: Started using a topical steroid stronger than moderate strength, vitamin A or D analog preparations, or anthralin within 14 days of study drug initiation. Initiated a systemic medications, including biologic medication, or phototherapy within 180 days of study drug initiation. Prior or concurrent use of cyclophosphamide. Currently using sulfasalazine therapy. Known hypersensitivity to riboflavin. Enrolled in any other investigational device or investigational drug trial(s) or receipt of any other investigational agent(s) within 28 days of baseline visit. Presence of severe comorbidities such as, diabetes mellitus requiring insulin; congestive heart failure (CHF) of any severity or myocardial infarction or cerebrovascular accident or transient ischemic attack within 3 months of screening visit; unstable angina pectoris, uncontrolled hypertension [sitting systolic BP <80 mm Hg or > 160 or diastolic BP > 100 mm Hg], oxygen-dependent severe pulmonary disease, history of cancer within 5 years [other than resected cutaneous basal or squamous cell carcinoma of the skin or in situ cervical cancer]. Any of the following hematologic abnormalities, confirmed by repeat test at least 1 week apart: White blood count <3,000/µL or >14,000/µL Lymphocyte count <1,000/µL Neutrophil count <1,5000/µL Platelet count <150,000/µL Hemoglobin<10 g/dL Liver function test aspartate aminotransferase (AST), alanine aminotransferase (ALT) or alkaline phosphatase (AlkP) results that are greater than or equal to 2 times the upper limit of normal (ULN). Serum creatinine ≥ to 2x the ULN. Known HIV-positive status or known history of any other immune-suppressing disease. Any current or past history of psychiatric disease that would interfere with ability to comply with study protocol or give informed consent. Had grade 3 or 4 adverse events or infections within 28 days before screening, or between screening visit and drug initiation. Evidence of any skin conditions other than psoriasis that would interfere with the evaluations of the effect of study medication on psoriasis. Presence of any condition or circumstances judged by the patient's physician, the investigator, or medically qualified study staff to render this clinical trial detrimental or otherwise unsuitable for the patient's participation. A history of non-compliance with other therapies. Females who are pregnant, lactating, planning on pregnancy during the study period, or unwilling to use FDA-approved method of birth control. A history of keloids or excessive scar formation or of healing poorly. A history of allergic reaction to local anesthetics, including lidocaine and epinephrine
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Johann Gudjonsson, MD
Organizational Affiliation
University of Michigan
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Michigan Department of Dermatology
City
Ann Arbor
State/Province
Michigan
ZIP/Postal Code
48109
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

The Effect of Riboflavin on Moderate to Severe Plaque Type Psoriasis

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