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Clinical Trial to Evaluate Efficacy and Safety of Dupilumab in Localized Scleroderma (DupiMorph)

Primary Purpose

Localized Scleroderma

Status
Recruiting
Phase
Phase 2
Locations
Germany
Study Type
Interventional
Intervention
Dupilumab 300Mg Solution for Injection
Placebo
Sponsored by
University of Cologne
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Localized Scleroderma focused on measuring Morphea

Eligibility Criteria

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

Inclusion Criteria:

  • Subject is a male or female ≥18 years of age on the day the study informed consent is signed
  • Out-patient status
  • Caucasian
  • Morphea (plaque type) or Generalized localized scleroderma (affecting at least three anatomic sites)
  • At least one lesions with lilac ring (active phase of the disease);
  • Activity of LS within the last 12 month (as defined by progression of size or new developing plaque)
  • For women of childbearing potential: negative pregnancy test at Visit 1
  • For women of childbearing potential: Use of effective method of contraception from 4 weeks prior to enrolment, throughout study treatment until 12 weeks after the last IMP dose.
  • Written informed consent signed

Exclusion Criteria:

  • Systemic immunosuppressive therapy or UV therapy less than 3 months before enrollment.
  • Participation in another trial of IMPs or devices parallel to, or less than 6 months before or previous participation in this trial
  • Pregnancy or breastfeeding mother
  • Diagnosis of other significant chronic inflammatory or autoimmune disorders. Patients with the following autoimmune disorders are excluded from the study: Multiple sclerosis, primary biliary cirrhosis, type I diabetes mellitus. Patients with the following autoimmune disorders are regarded as eligible: Lichen sclerosus, vitiligo, alopecia arthritis, thyroid diseases (e.g. Hashimoto disease). Patients with any autoimmune disorder not listed above should only be included after consultation with the principal coordinating investigator.
  • Topical immunosuppressive therapy less than 1 month before enrollment
  • Concurrent phototherapy
  • Known infection with helminths (helminthosis)
  • Any condition or laboratory abnormality that, in the judgment of the investigator, would put the subject at unacceptable risk for participation in the study or may interfere with the assessments included in the study. E.g. uncontrolled psychiatric illness or history of clinical relevant drug abuse.
  • Known hypersensitivity to any components of the IMP
  • Treatment with a live (attenuated) vaccine within 3 months prior to enrollment
  • History of malignancy (except patients with completely treated in situ carcinoma of the cervix, completely treated and resolved non-metastatic squamous or basal cell carcinoma of the skin)
  • Known diagnosis of active tuberculosis or non-tuberculous mycobacterial infection or latent untreated tuberculosis unless it is well documented by a specialist that the patient has been adequately treated
  • Known diagnosis of HIV, HBV or HCV infection
  • Regular use (more than 2 visits per week) of a tanning booth/parlor
  • Known diagnosis of asthma

Sites / Locations

  • Uniklinik Köln, Klinik für Dermatologie und VenerologieRecruiting
  • Helios St. Elisabeth Klinik Oberhausen, Klinik für Dermatologie, Venerologie und AllergologieRecruiting
  • Universitäts-Hautklinik TübingenRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Dupilumab

Placebo

Arm Description

30 patients; Dupilumab s.c. injection; 2 ready-to-use syringes (600 mg) initial (V1), 1 ready-to-use syringe (300 mg) every 14 days (V2- V13) Dupilumab s.c. injection in healthy skin, 24 weeks

15 patients; placebo s.c. injection; 2 ready-to-use syringes initial (V1), 1 ready-to-use syringe every 14 days (V2-V13) placebo s.c. injection in healthy skin, 24 weeks

Outcomes

Primary Outcome Measures

LoSCAT target lesion
Treatment response is assessed using the LoSCAT (Localized Scleroderma Cutaneous Assessment Tool). Target lesion will be assessed at Baseline and End of Treatment. Score reduction by 50% after 24 weeks (End of Treatment Visit V14) compared to Baseline Visit (V1) is defined as treatment response.

Secondary Outcome Measures

mLoSSI all lesions
Change in mLoSSI (Localized Scleroderma Skin Activity Index) of all existing lesions during treatment, at End of Treatment Visit and during follow-up
LoSDI all lesions
Change in LoSDI (Localized Scleroderma Skin Damage Index) of all existing lesions during treatment, at End of Treatment Visit and during follow-up
Number of lesions
Count of all existing non-target and new lesions on the entire integument during treatment, at End of Treatment Visit and during follow-up
DLQI
Change in DermatoLogy Quality of life Index (DLQI). The DLQI is calculated by summing the score of each question resulting in a maximum of 30 and a minimum of 0. The higher the score, the more quality of life is impaired.
RNAseq
Gene signature of localized scleroderma after Dupilumab treatment: RNA- seq of tissue biopsies obtained from the lesion (lilac ring, optional: center) before (baseline visit V1) and after treatment (EoT V14) and healthy skin before treatment
RT-qPCR
Quantification of change in gene expression of genes identified by RNAseq in tissue of localized scleroderma patients after Dupilumab treatment: RT-qPCR of tissue biopsies obtained from the lesion (lilac ring, optional: center) before (baseline visit V1) and after treatment (End of Treatment Visit V14) and healthy skin before treatment
Adverse events (AEs)
Adverse events will be documented throughout the study
Physical examination
Physical examination (general appearance including skin, head and throat (head, eyes, ears, nose, and throat), lymph nodes, respiratory, cardiovascular, musculoskeletal, and neurological systems) will be documented throughout the study.
Body weight
Body weight will be documented throughout the study.
Blood pressure
Blood pressure will be documented throughout the study.
Pulse rate
Pulse rate will be documented throughout the study.
Body temperature
Body temperature will be documented throughout the study.
Haematocrit (HcT)
Haematocrit (HcT) will be documented at End of Treatment Visit and during follow-up
Haemoglobin
Haemoglobin (Hgb) will be documented at End of Treatment Visit and during follow-up
Blood cell count
Platelet count and differential White blood cell count will be documented at End of Treatment Visit and during follow-up
Blood Enzymes
Clinical Chemistry parameters (Aspartate aminotransferase (AST), Alanine aminotransferase (ALT), Gamma-glutamyl transferase (GGT), Lactic dehydrogenase (LDH)) will be documented at End of Treatment Visit and during follow-up
Clinical Chemistry
Clinical Chemistry parameters (Creatinine) will be documented at End of Treatment Visit and during follow-up
Anti-nuclear antibodies (ANAs) levels
Change in anti-nuclear antibodies (ANAs) levels
Serum cytokine levels
Change in serum levels of IL-4, IL-5, IL-13, periostin, dipeptidyl peptidase-4

Full Information

First Posted
December 10, 2019
Last Updated
November 2, 2022
Sponsor
University of Cologne
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1. Study Identification

Unique Protocol Identification Number
NCT04200755
Brief Title
Clinical Trial to Evaluate Efficacy and Safety of Dupilumab in Localized Scleroderma
Acronym
DupiMorph
Official Title
A Randomized, Placebo-controlled Phase IIa Clinical Trial to Evaluate the Efficacy and Safety of Subcutaneous Dupilumab in Localized Scleroderma
Study Type
Interventional

2. Study Status

Record Verification Date
November 2022
Overall Recruitment Status
Recruiting
Study Start Date
May 19, 2020 (Actual)
Primary Completion Date
August 2024 (Anticipated)
Study Completion Date
June 2025 (Anticipated)

3. Sponsor/Collaborators

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

4. Oversight

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

5. Study Description

Brief Summary
The DupiMorph study evaluates the efficacy of Dupilumab in localized scleroderma patients. Dupilumab is approved in the US and EU for the treatment of moderate/severe atopic dermatitis and since 2018 in the US for severe asthma therapy.
Detailed Description
Localized scleroderma (LS) comprises a heterogenous group of sclerotic skin disorders. The incidence of LS is reported to be approximately 27 cases/ 1x106 and is hence approximately 2-3-fold higher compared to systemic scleroderma. Although in most cases not lethal the disease can significantly impact quality of life. Depending on the location of fibrosis, the disorder can cause bone deformities, alopecia, skin atrophy or lesions with severe hypo-/hyperpigmentation. The disease is pathomechanistically poorly understood and no effective therapy is currently approved. The most promising treatments up to date include methotrexate ± pulsed corticosteroids or phototherapy with PUVA or UVA1. Yet, the number of treated patients in these studies is low. The response rates are low and inconsistent with approximately 50% of patients treated with UVA1 experience a recurrence within three years. There are no studies on efficacy of topical corticosteroids in LS. Small pilot studies and few case reports describe regression of lesions after topical calcineurin inhibitors. In addition, current therapies can only be applied for a short time during the acute phase due to the side effect profile after long-term use (e.g. skin atrophy in response to topical steroids, skin cancer in response to long term UV therapy, multiple side effects by long- term use of methotrexate and/or corticosteroids). Hence, this study evaluates, in comparison with placebo, the efficacy of Dupilumab administered subcutaneously every 14 days in patients with Morphea (plaque type) or generalized localized scleroderma (affecting at least three anatomic sites).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Localized Scleroderma
Keywords
Morphea

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Model Description
Randomized, multi-center, double-blind, placebo controlled, parallel group, multiple dose, phase IIa trial
Masking
ParticipantInvestigator
Masking Description
Permuted blocks of varying length with allocation ratio (verum:placebo = 2:1); double-blind, i.e. patients and investigators are masked
Allocation
Randomized
Enrollment
45 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Dupilumab
Arm Type
Experimental
Arm Description
30 patients; Dupilumab s.c. injection; 2 ready-to-use syringes (600 mg) initial (V1), 1 ready-to-use syringe (300 mg) every 14 days (V2- V13) Dupilumab s.c. injection in healthy skin, 24 weeks
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
15 patients; placebo s.c. injection; 2 ready-to-use syringes initial (V1), 1 ready-to-use syringe every 14 days (V2-V13) placebo s.c. injection in healthy skin, 24 weeks
Intervention Type
Drug
Intervention Name(s)
Dupilumab 300Mg Solution for Injection
Other Intervention Name(s)
Dupixent
Intervention Description
First dose: 600 mg (2 syringes); subsequent doses: 300 mg (1 syringe)
Intervention Type
Other
Intervention Name(s)
Placebo
Intervention Description
First dose: 2 syringes, no active substance; subsequent doses: 1 syringe, no active substance
Primary Outcome Measure Information:
Title
LoSCAT target lesion
Description
Treatment response is assessed using the LoSCAT (Localized Scleroderma Cutaneous Assessment Tool). Target lesion will be assessed at Baseline and End of Treatment. Score reduction by 50% after 24 weeks (End of Treatment Visit V14) compared to Baseline Visit (V1) is defined as treatment response.
Time Frame
Baseline to End of Treatment Visit, 24 weeks
Secondary Outcome Measure Information:
Title
mLoSSI all lesions
Description
Change in mLoSSI (Localized Scleroderma Skin Activity Index) of all existing lesions during treatment, at End of Treatment Visit and during follow-up
Time Frame
Baseline to Follow-Up Visit, 48 weeks
Title
LoSDI all lesions
Description
Change in LoSDI (Localized Scleroderma Skin Damage Index) of all existing lesions during treatment, at End of Treatment Visit and during follow-up
Time Frame
Baseline to Follow-Up Visit, 48 weeks
Title
Number of lesions
Description
Count of all existing non-target and new lesions on the entire integument during treatment, at End of Treatment Visit and during follow-up
Time Frame
Baseline to Follow-Up Visit, 48 weeks
Title
DLQI
Description
Change in DermatoLogy Quality of life Index (DLQI). The DLQI is calculated by summing the score of each question resulting in a maximum of 30 and a minimum of 0. The higher the score, the more quality of life is impaired.
Time Frame
Baseline to Follow-Up Visit, 48 weeks
Title
RNAseq
Description
Gene signature of localized scleroderma after Dupilumab treatment: RNA- seq of tissue biopsies obtained from the lesion (lilac ring, optional: center) before (baseline visit V1) and after treatment (EoT V14) and healthy skin before treatment
Time Frame
Baseline to End of Treatment Visit, 24 weeks
Title
RT-qPCR
Description
Quantification of change in gene expression of genes identified by RNAseq in tissue of localized scleroderma patients after Dupilumab treatment: RT-qPCR of tissue biopsies obtained from the lesion (lilac ring, optional: center) before (baseline visit V1) and after treatment (End of Treatment Visit V14) and healthy skin before treatment
Time Frame
Baseline to End of Treatment Visit, 24 weeks
Title
Adverse events (AEs)
Description
Adverse events will be documented throughout the study
Time Frame
Baseline to Follow-Up Visit, 48 weeks
Title
Physical examination
Description
Physical examination (general appearance including skin, head and throat (head, eyes, ears, nose, and throat), lymph nodes, respiratory, cardiovascular, musculoskeletal, and neurological systems) will be documented throughout the study.
Time Frame
Baseline to Follow-Up Visit, 48 weeks
Title
Body weight
Description
Body weight will be documented throughout the study.
Time Frame
Baseline to Follow-Up Visit, 48 weeks
Title
Blood pressure
Description
Blood pressure will be documented throughout the study.
Time Frame
Baseline to Follow-Up Visit, 48 weeks
Title
Pulse rate
Description
Pulse rate will be documented throughout the study.
Time Frame
Baseline to Follow-Up Visit, 48 weeks
Title
Body temperature
Description
Body temperature will be documented throughout the study.
Time Frame
Baseline to Follow-Up Visit, 48 weeks
Title
Haematocrit (HcT)
Description
Haematocrit (HcT) will be documented at End of Treatment Visit and during follow-up
Time Frame
Baseline to Follow-Up Visit, 48 weeks
Title
Haemoglobin
Description
Haemoglobin (Hgb) will be documented at End of Treatment Visit and during follow-up
Time Frame
Baseline to Follow-Up Visit, 48 weeks
Title
Blood cell count
Description
Platelet count and differential White blood cell count will be documented at End of Treatment Visit and during follow-up
Time Frame
Baseline to Follow-Up Visit, 48 weeks
Title
Blood Enzymes
Description
Clinical Chemistry parameters (Aspartate aminotransferase (AST), Alanine aminotransferase (ALT), Gamma-glutamyl transferase (GGT), Lactic dehydrogenase (LDH)) will be documented at End of Treatment Visit and during follow-up
Time Frame
Baseline to Follow-Up Visit, 48 weeks
Title
Clinical Chemistry
Description
Clinical Chemistry parameters (Creatinine) will be documented at End of Treatment Visit and during follow-up
Time Frame
Baseline to Follow-Up Visit, 48 weeks
Title
Anti-nuclear antibodies (ANAs) levels
Description
Change in anti-nuclear antibodies (ANAs) levels
Time Frame
Baseline to Follow-Up Visit, 48 weeks
Title
Serum cytokine levels
Description
Change in serum levels of IL-4, IL-5, IL-13, periostin, dipeptidyl peptidase-4
Time Frame
Baseline to Follow-Up Visit, 48 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Subject is a male or female ≥18 years of age on the day the study informed consent is signed Out-patient status Caucasian Morphea (plaque type) or Generalized localized scleroderma (affecting at least three anatomic sites) At least one lesions with lilac ring (active phase of the disease); Activity of LS within the last 12 month (as defined by progression of size or new developing plaque) For women of childbearing potential: negative pregnancy test at Visit 1 For women of childbearing potential: Use of effective method of contraception from 4 weeks prior to enrolment, throughout study treatment until 12 weeks after the last IMP dose. Written informed consent signed Exclusion Criteria: Systemic immunosuppressive therapy or UV therapy less than 3 months before enrollment. Participation in another trial of IMPs or devices parallel to, or less than 6 months before or previous participation in this trial Pregnancy or breastfeeding mother Diagnosis of other significant chronic inflammatory or autoimmune disorders. Patients with the following autoimmune disorders are excluded from the study: Multiple sclerosis, primary biliary cirrhosis, type I diabetes mellitus. Patients with the following autoimmune disorders are regarded as eligible: Lichen sclerosus, vitiligo, alopecia arthritis, thyroid diseases (e.g. Hashimoto disease). Patients with any autoimmune disorder not listed above should only be included after consultation with the principal coordinating investigator. Topical immunosuppressive therapy less than 1 month before enrollment Concurrent phototherapy Known infection with helminths (helminthosis) Any condition or laboratory abnormality that, in the judgment of the investigator, would put the subject at unacceptable risk for participation in the study or may interfere with the assessments included in the study. E.g. uncontrolled psychiatric illness or history of clinical relevant drug abuse. Known hypersensitivity to any components of the IMP Treatment with a live (attenuated) vaccine within 3 months prior to enrollment History of malignancy (except patients with completely treated in situ carcinoma of the cervix, completely treated and resolved non-metastatic squamous or basal cell carcinoma of the skin) Known diagnosis of active tuberculosis or non-tuberculous mycobacterial infection or latent untreated tuberculosis unless it is well documented by a specialist that the patient has been adequately treated Known diagnosis of HIV, HBV or HCV infection Regular use (more than 2 visits per week) of a tanning booth/parlor Known diagnosis of asthma
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Sabine Schleicher, Dr.
Phone
0049 221 478
Ext
88793
Email
sabine.schleicher1@uk-koeln.de
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Sabine Eming, Prof. Dr.
Organizational Affiliation
University of Cologne
Official's Role
Principal Investigator
Facility Information:
Facility Name
Uniklinik Köln, Klinik für Dermatologie und Venerologie
City
Köln
ZIP/Postal Code
50924
Country
Germany
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Sabine Eming, Prof. Dr.
Phone
0049 221 478
Ext
3196
Email
sabine.eming@uni-koeln.de
First Name & Middle Initial & Last Name & Degree
Nicolas Hunzelmann, Prof. Dr.
Phone
0049 221 478
Ext
4517
Email
nico.hunzelmann@uni-koeln.de
First Name & Middle Initial & Last Name & Degree
Sabine Eming, Prof. Dr.
First Name & Middle Initial & Last Name & Degree
Nicolas Hunzelmann, Prof. Dr.
First Name & Middle Initial & Last Name & Degree
Pia Moinzadeh, PD Dr.
First Name & Middle Initial & Last Name & Degree
Judith Kästle
First Name & Middle Initial & Last Name & Degree
Phillip Szudybill
Facility Name
Helios St. Elisabeth Klinik Oberhausen, Klinik für Dermatologie, Venerologie und Allergologie
City
Oberhausen
ZIP/Postal Code
46045
Country
Germany
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Alexander Kreuter, Prof. Dr.
Phone
0049 208 8508
Ext
8002
Email
alexander.kreuter@helios-gesundheit.de
First Name & Middle Initial & Last Name & Degree
Christian Tigges, Dr.
Phone
0049 208 8508
Ext
8016
Email
christian.tigges@helios-gesundheit.de
First Name & Middle Initial & Last Name & Degree
Alexander Kreuter, Prof. Dr.
First Name & Middle Initial & Last Name & Degree
Christian Tigges, Dr.
First Name & Middle Initial & Last Name & Degree
Alena-Lioba Michalowitz
First Name & Middle Initial & Last Name & Degree
Bijan Koushk, Dr.
Facility Name
Universitäts-Hautklinik Tübingen
City
Tübingen
ZIP/Postal Code
72076
Country
Germany
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Matthias Hahn, Dr.
Phone
0049 7071 29
Email
matthias.hahn@med.uni-tuebingen.de
First Name & Middle Initial & Last Name & Degree
Thomas Eigentler, Prof. Dr.
Phone
0049 7071 29
Ext
85748
Email
thomas.eigentler@med.uni-tuebingen.de
First Name & Middle Initial & Last Name & Degree
Matthias Hahn, Dr.
First Name & Middle Initial & Last Name & Degree
Thomas Eigentler, Prof. Dr.
First Name & Middle Initial & Last Name & Degree
Martin Röcken, Prof. Dr.
First Name & Middle Initial & Last Name & Degree
Benjamin Walz, Dr.
First Name & Middle Initial & Last Name & Degree
Isabel Grethel

12. IPD Sharing Statement

Plan to Share IPD
No

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Clinical Trial to Evaluate Efficacy and Safety of Dupilumab in Localized Scleroderma

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