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Skin bioMARkers for Atopic Eczema Therapy Evaluation (SMART)

Primary Purpose

Atopic Eczema/Dermatitis (Non-Specific)

Status
Completed
Phase
Phase 2
Locations
United Kingdom
Study Type
Interventional
Intervention
crisaborole (2%) ointment
betamethasone valerate 0.1% cream
Sponsored by
Sheffield Teaching Hospitals NHS Foundation Trust
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional other trial for Atopic Eczema/Dermatitis (Non-Specific)

Eligibility Criteria

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

Inclusion Criteria:

  • Volunteers with AD defined according to the UK working party diagnostic criteria
  • Male or female aged 18-65 years old at baseline (Visit 1)
  • Volunteer understands the purpose, modalities and potential risk of the trial
  • Participants able to read and understand English
  • Participants willing to sign the informed consent

Exclusion Criteria:

  • Participants with a known allergy/hypersensitivity to any of the excipients of the trial preparations.
  • Participants with acne, suntan, birth marks, multiple nevi, tattoos, blemishes or dense body hair that obstruct the test areas.
  • Investigator assessment of eczema severity at the treatment (anatomical) sites is almost clear or greater (score ≥1) based on the Investigators static global assessment scale at screening and baseline. At the start of the study the skin of the test sites (forearms) will therefore be clear (0) of the signs of eczema
  • Participants with a condition that in the opinion of the investigator contradicts participation in the study.
  • Pregnant female participants; breastfeeding female participants; and female participants of childbearing potential who are unwilling or unable to use a highly effective method of contraception as outlined in this protocol for the duration of the study and for at least 28 days after the last dose of investigational product.
  • Use of any topical product on the test areas within 7 days prior to Baseline/Day 1, including cosmetic moisturizers and sunscreen. Participants using any topical products on the test areas within 7 days at the screening visit will be eligible if they are willing and able to wash-out these products for 7 days in total and for the duration of the trial. Such participants will be potentially eligible at screening and will be confirmed as eligible if adequate washout is confirmed at visit 1. Use of moisturizers and/or sunscreen is permitted during the study to manage dry skin and sun exposure in areas surrounding but not on or overlapping the test areas.
  • Participants who have used a tanning bed within 28 days of baseline (visit 1). Participants who have used a sunbed within 28 days at the screening visit will be eligible if they are willing and able to wash-out for 28 days in total and for the duration of the trial. Such participants will be potentially eligible at screening and will be confirmed as eligible if adequate washout is confirmed at visit 1.
  • Participants who have used any medication that could interfere with the trial aim prior to the start of the study (baseline/visit 1). Participants using such medication at the screening visit will be eligible if they are willing and able to wash-out these treatments for the applicable washout period as defined by in section 8.8 'Prior and Concomitant Medication' and for the duration of the trial. Such participants will be potentially eligible at screening and will be confirmed as eligible if adequate washout is confirmed at visit 1.
  • Participants currently participating in another interventional clinical trial.
  • Volunteer is incapable of giving fully informed consent.
  • Participants judged by the PI to be inappropriate for the trial.

Sites / Locations

  • Sheffield Dermatology Research, University of Sheffield Medical School, The Royal Hallamshire Hospital

Arms of the Study

Arm 1

Arm Type

Other

Arm Label

crisaborole and topical Corticosteroid

Arm Description

crisaborole (2%) ointment on the other forearm, twice daily application for 4 weeks (randomised site allocation) betamethasone valerate (0.1%) cream on one forearm, twice daily application for 4 weeks (randomised site allocation)

Outcomes

Primary Outcome Measures

epidermal thickness (day 29 - day 1)
The difference in the change in epidermal thickness (day 29 - day 1), measured by structural OCT, between the sites treated with crisaborole (2%) ointment and betamethasone valerate (0.1%) cream.

Secondary Outcome Measures

epidermal thickness (on day 1, day 15, day 29 and day 57)
The difference in the change in epidermal thickness measured by structural OCT during and after 28 days treatment. OCT images of epidermal thickness taken on day 1, day 15, day 29 and day 57.
erythema
The difference in the change in skin redness/erythema (relating to tolerability) during and after 28 days treatment determined by: Visual redness/erythema score determined on day 1, day 15, day 29 and day 57 Objective redness assessed with the Mexameter measured on day 1, day 15, day 29 and day 57
TEWL - skin barrier function
The difference in the change in Trans-Epidermal Water Loss (TEWL, relates to skin barrier function) during and after treatment.17,18 TEWL measurements on day 1, day 15, day 29 and day 57.
TEWL - after tape-stripping
The difference in skin barrier integrity (TEWLts20) after 28 days treatment. TEWL measurements after tape-stripping (TEWLts20) on day 29
skin dryness
The difference in the change in visual skin dryness during and after treatment. Visual skin dryness scored on day 1, day 15, day 29 and day 57
Natural Moisturising Factor (NMF)
The difference in Natural Moisturising Factor (NMF, filaggrin breakdown products) levels at the end of treatment19 NMF will be quantified from superficial stratum corneum samples collected on day 29 using HPLC

Full Information

First Posted
December 9, 2019
Last Updated
December 13, 2021
Sponsor
Sheffield Teaching Hospitals NHS Foundation Trust
Collaborators
University of Sheffield
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1. Study Identification

Unique Protocol Identification Number
NCT04194814
Brief Title
Skin bioMARkers for Atopic Eczema Therapy Evaluation
Acronym
SMART
Official Title
Validation of a Novel Composite of Skin Biomarkers as a Primary Outcome Measure for Evaluating the Safety of Treatments for Atopic Dermatitis: a Randomized Controlled Trial (Phase 2) Comparing the Effects of Crisaborole 2% Ointment to Betamethasone Valerate 0.1% Cream on Skin Structure and Function in Participants With Atopic Dermatitis.
Study Type
Interventional

2. Study Status

Record Verification Date
November 2020
Overall Recruitment Status
Completed
Study Start Date
November 20, 2020 (Actual)
Primary Completion Date
September 30, 2021 (Actual)
Study Completion Date
September 30, 2021 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Sheffield Teaching Hospitals NHS Foundation Trust
Collaborators
University of Sheffield

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
The study aims to investigate two new non-invasive technologies for assessing skin properties to identify and validate a range of safety biomarkers that may be considered useful as primary outcome measures for evaluating the safety of topical treatments in atopic dermatitis. The method of assessing these biomarker technologies will be to determine whether twice daily treatment with crisaborole (2%) ointment, compared to betamethasone valerate (0.1%) cream, for up to 4 weeks, may cause skin structure or function changes, like skin atrophy, in patients with atopic dermatitis (AD).
Detailed Description
The first-line drug treatment for mild-moderate AD are currently topical corticosteroids (TCS) with recognized efficacy. However, their prolonged or inappropriate use, can lead to local adverse effects. Side-effects of topical corticosteroids comprise a variety of skin changes in the sense of skin atrophy thinning of the skin and in some cases development of telangiectasia, spontaneous scars, folliculitis, striae distensae (stretch marks), contact dermatitis, acne or rosacea depending on potency, galenic formulation, patient age and body area to which the medication will be applied, exposure time. Assessing the safety (local adverse effects) of current or new treatments and new treatment approaches using existing treatments through noninvasively monitor on possible early skin (subclinical) changes associated with the local clinical adverse effects of treatment may be an effective step for an enhanced AD treatment management. Primary Aim: To further develop and validate two new non-invasive technologies for the assessment of early sub-clinical skin changes associated with adverse effects and to derive an optimum panel of safety biomarkers for use in future clinical trials of topical anti-inflammatory treatments. The safety of two topical anti-inflammatory treatments for AD will be compared in this clinical trial, with a focus on early sub-clinical signs: crisaborole 2% ointment and betamethasone valerate 0,1% cream. Step 1 involves the collection of data on the early sub-clinical skin changes using the non-invasive technologies: OCT and FTIR spectroscopy. The data from this study will then be used to identify and refine biophysical biomarkers of skin atrophy and skin barrier disruption in steps 2 and 3. Secondary Aim: To determine the relative local skin effects of crisaborole (2%) ointment compared to a potent and moderately potent TCS in participants with mild to moderate AD. The focus is on 'early biomarkers' of 'local skin changes'and not clinical efficacy, which has been established in previous trials. Rationale for selecting the two comparators are related to prescription behaviors in UK (Betamethasone valerate 0,1% cream) and with no reported TCS-like local adverse effects profile (crisaborole 2% ointment)

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Atopic Eczema/Dermatitis (Non-Specific)

7. Study Design

Primary Purpose
Other
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Model Description
An observer-blind forearm-controlled clinical trial in 37 AD patients, wherein each participant will undergo 4 weeks treatment with crisaborole (2%) ointment on one forearm and betamethasone valerate (0.1%) cream on the other (twice daily application in each case and randomised site allocation). At the start of the study the skin of the test sites (forearms) will be clear of the signs of AD so that the investigation focuses on local adverse effects on the skin as opposed to anti-inflammatory effects (focus on local adverse effects and not clinical efficacy). The condition of the skin will be assessed before, during and after treatment.
Masking
None (Open Label)
Masking Description
Allocation of the treatments to the test sites (right/left forearm) will be randomised (to avoid site position-dependent artefacts) Observer-blind - The collection of study data will be conducted in a separate area (dedicated skin barrier research suite) by a separate team (comprising skilled dermatology researchers) who will be blind.
Allocation
N/A
Enrollment
37 (Actual)

8. Arms, Groups, and Interventions

Arm Title
crisaborole and topical Corticosteroid
Arm Type
Other
Arm Description
crisaborole (2%) ointment on the other forearm, twice daily application for 4 weeks (randomised site allocation) betamethasone valerate (0.1%) cream on one forearm, twice daily application for 4 weeks (randomised site allocation)
Intervention Type
Drug
Intervention Name(s)
crisaborole (2%) ointment
Other Intervention Name(s)
Eucrisa
Intervention Description
twice daily application on one forearm for 4 weeks (randomised site allocation)
Intervention Type
Drug
Intervention Name(s)
betamethasone valerate 0.1% cream
Other Intervention Name(s)
Betnovate cream
Intervention Description
twice daily application on one forearm for 4 weeks (randomised site allocation)
Primary Outcome Measure Information:
Title
epidermal thickness (day 29 - day 1)
Description
The difference in the change in epidermal thickness (day 29 - day 1), measured by structural OCT, between the sites treated with crisaborole (2%) ointment and betamethasone valerate (0.1%) cream.
Time Frame
day 29 - day 1
Secondary Outcome Measure Information:
Title
epidermal thickness (on day 1, day 15, day 29 and day 57)
Description
The difference in the change in epidermal thickness measured by structural OCT during and after 28 days treatment. OCT images of epidermal thickness taken on day 1, day 15, day 29 and day 57.
Time Frame
on day 1, day 15, day 29 and day 57
Title
erythema
Description
The difference in the change in skin redness/erythema (relating to tolerability) during and after 28 days treatment determined by: Visual redness/erythema score determined on day 1, day 15, day 29 and day 57 Objective redness assessed with the Mexameter measured on day 1, day 15, day 29 and day 57
Time Frame
during and after 28 days
Title
TEWL - skin barrier function
Description
The difference in the change in Trans-Epidermal Water Loss (TEWL, relates to skin barrier function) during and after treatment.17,18 TEWL measurements on day 1, day 15, day 29 and day 57.
Time Frame
day 1, day 15, day 29 and day 57
Title
TEWL - after tape-stripping
Description
The difference in skin barrier integrity (TEWLts20) after 28 days treatment. TEWL measurements after tape-stripping (TEWLts20) on day 29
Time Frame
on day 29, after 28 days treatment
Title
skin dryness
Description
The difference in the change in visual skin dryness during and after treatment. Visual skin dryness scored on day 1, day 15, day 29 and day 57
Time Frame
Visual skin dryness scored on day 1, day 15, day 29 and day 57
Title
Natural Moisturising Factor (NMF)
Description
The difference in Natural Moisturising Factor (NMF, filaggrin breakdown products) levels at the end of treatment19 NMF will be quantified from superficial stratum corneum samples collected on day 29 using HPLC
Time Frame
Day 1 - day 29
Other Pre-specified Outcome Measures:
Title
superficial plexus depth
Description
The difference in the change in superficial plexus depth (µm) measured by angiographic OCT
Time Frame
Angiographic OCT images taken on day 1, day 15, day 29 and day 57
Title
blood vessel diameter
Description
The difference in the change in mean blood vessel diameter (µm) measured by angiographic OCT
Time Frame
Angiographic OCT images taken on day 1, day 15, day 29 and day 57
Title
blood vessel density
Description
The difference in the change in blood vessel density (segments/mm2) measured by angiographic OCT
Time Frame
Angiographic OCT images taken on day 1, day 15, day 29 and day 57
Title
collagen matrix
Description
The difference in the change in collagen matrix index (an index derived from birefringence images of collagen density and arrangement) measured by polarisation sensitive (PS)-OCT
Time Frame
Polarisation sensitive (PS)-OCT images taken on day 1 and day 29.
Title
carboxylate levels
Description
The difference in the change in carboxylate levels (indirect measure of NMF levels, not to be confused with direct quantification from stratum corneum samples by HPLC) in the stratum corneum measured by FTIR spectroscopy
Time Frame
FTIR spectrum of the skin surface taken on day 1 day 15, day 29 and day 57
Title
stratum corneum lipid structure
Description
The difference in stratum corneum lipid structure measured by FTIR spectroscopy in conjunction with tape-stripping
Time Frame
FTIR spectra taken through the stratum corneum (during tape-stripping) on day 29
Title
FLG mutation carriers
Description
Number of FLG loss-of-function mutation carriers
Time Frame
Saliva sample at visit 1 for FLG genotyping
Title
Descriptive tabulations of TEWL by mutation status
Description
Descriptive tabulations of TEWL by mutation status, if sufficient participants with mutation are detected. All the above
Time Frame
TEWL measured at day 1, day 15 and day 29
Title
Descriptive tabulations of epidermal thickness by mutation status
Description
Descriptive tabulations of epidermal thickness (structural OCT derived) by mutation status , if sufficient participants with mutation are detected. All the above
Time Frame
Structural OCT derived epidermal thickness measured at day 1, day 15 and day 29

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Volunteers with AD defined according to the UK working party diagnostic criteria Male or female aged 18-65 years old at baseline (Visit 1) Volunteer understands the purpose, modalities and potential risk of the trial Participants able to read and understand English Participants willing to sign the informed consent Exclusion Criteria: Participants with a known allergy/hypersensitivity to any of the excipients of the trial preparations. Participants with acne, suntan, birth marks, multiple nevi, tattoos, blemishes or dense body hair that obstruct the test areas. Investigator assessment of eczema severity at the treatment (anatomical) sites is almost clear or greater (score ≥1) based on the Investigators static global assessment scale at screening and baseline. At the start of the study the skin of the test sites (forearms) will therefore be clear (0) of the signs of eczema Participants with a condition that in the opinion of the investigator contradicts participation in the study. Pregnant female participants; breastfeeding female participants; and female participants of childbearing potential who are unwilling or unable to use a highly effective method of contraception as outlined in this protocol for the duration of the study and for at least 28 days after the last dose of investigational product. Use of any topical product on the test areas within 7 days prior to Baseline/Day 1, including cosmetic moisturizers and sunscreen. Participants using any topical products on the test areas within 7 days at the screening visit will be eligible if they are willing and able to wash-out these products for 7 days in total and for the duration of the trial. Such participants will be potentially eligible at screening and will be confirmed as eligible if adequate washout is confirmed at visit 1. Use of moisturizers and/or sunscreen is permitted during the study to manage dry skin and sun exposure in areas surrounding but not on or overlapping the test areas. Participants who have used a tanning bed within 28 days of baseline (visit 1). Participants who have used a sunbed within 28 days at the screening visit will be eligible if they are willing and able to wash-out for 28 days in total and for the duration of the trial. Such participants will be potentially eligible at screening and will be confirmed as eligible if adequate washout is confirmed at visit 1. Participants who have used any medication that could interfere with the trial aim prior to the start of the study (baseline/visit 1). Participants using such medication at the screening visit will be eligible if they are willing and able to wash-out these treatments for the applicable washout period as defined by in section 8.8 'Prior and Concomitant Medication' and for the duration of the trial. Such participants will be potentially eligible at screening and will be confirmed as eligible if adequate washout is confirmed at visit 1. Participants currently participating in another interventional clinical trial. Volunteer is incapable of giving fully informed consent. Participants judged by the PI to be inappropriate for the trial.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Michael J Cork, MB.ChB
Organizational Affiliation
The University of Sheffield & Sheffield Teaching Hospitals NHS FT
Official's Role
Principal Investigator
Facility Information:
Facility Name
Sheffield Dermatology Research, University of Sheffield Medical School, The Royal Hallamshire Hospital
City
Sheffield
State/Province
South Yorkshire
ZIP/Postal Code
S10 2JF
Country
United Kingdom

12. IPD Sharing Statement

Plan to Share IPD
No
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URL
https://www.spiedigitallibrary.org/conference-proceedings-of-spie/8565/1/Optical-coherence-tomography-demonstrates-differential-epidermalthinning-of-human-forearm-volar/10.1117/12.2006104.full
Description
Lu Z, et al. Optical coherence tomography demonstrates differential epidermal thinning of human forearm volar skin after 2 weeks application of a topical corticosteroid vs a non-steroidal anti-inflammatory alternative. Proc. SPIE 2013; 85
URL
https://www.osapublishing.org/as/abstract.cfm?uri=as-66-1-26
Description
Takada S, Naito S, Sonoda J et al. Noninvasive In Vivo Measurement of Natural Moisturizing Factor Content in Stratum Corneum of Human Skin by Attenuated Total Reflection Infrared Spectroscopy. Applied Spectroscopy 2012; 66: 26-32.

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Skin bioMARkers for Atopic Eczema Therapy Evaluation

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