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Secukinumab for the Inflammatory Phase of Pyoderma Gangrenosum

Primary Purpose

Pyoderma Gangrenosum

Status
Withdrawn
Phase
Phase 2
Locations
Study Type
Interventional
Intervention
secukinumab 150 mg (2 injections per dose
Sponsored by
Wake Forest University Health Sciences
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Pyoderma Gangrenosum

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

1. Must give written informed consent. 2. Has a diagnosis of pyoderma gangrenosum, as determined by the investigator based on the following diagnostic criteria4:

a. Diagnosis requires both major criteria and at least two minor criteria i. Major criteria

  1. Rapid progression of a painful, necrolytic cutaneous ulcer with an irregular, violaceous, and undermined border
  2. Other causes of cutaneous ulceration have been excluded ii. Minor criteria

1. History suggestive of pathergy or clinical finding of cribriform scarring 2. Systemic diseases associated with PG 3. Histopathologic findings (sterile dermal neutrophilia, ± mixed inflammation, ± lymphocytic vasculitis) 4. Treatment response (rapid response to systemic steroid treatment)

3. PG global assessment of moderate to severe, with at least one ulcer measuring at least 3 cm in diameter.

4. 18 years of age or greater. 5. Must require systemic therapy for their pyoderma gangrenosum, as determined by the investigator prior to Baseline. Currently prescribed low-dose corticosteroids (≤ 10 mg/day), and other medications within one week prior to investigational drug administration, may be continued with no change in dose or frequency during the study.

Exclusion Criteria:

  1. Female subjects who are not postmenopausal for at least 1 year, surgically sterile, or willing to practice effective contraception during the study. Nursing mothers, pregnant women and women planning to become pregnant while on study are to be excluded.
  2. Current enrollment in any investigational study in which the subject is receiving any type of drug, biologic, or non-drug therapy (participation in registry-type studies is allowed).
  3. Serious local infection (e.g., cellulitis, abscess) or systemic infection (e.g., pneumonia, septicemia) within the 3 months prior to the first dose of investigational drug.
  4. Treatment with another investigational drug or approved therapy for investigational use within 28 days prior to investigational drug administration.
  5. Treatment with high dose (>10 mg/day) systemic steroids (prednisone) within one week prior to investigational drug administration. Treatment with cyclosporine, thalidomide, methotrexate, mycophenolate mofetil, azathioprine, or other systemic immunosuppressant agents within the 14 days prior to investigational drug administration (requirement of a 2-week washout).
  6. Known HIV+, known viral hepatitis infection, known tuberculosis infection.
  7. Any subject with a current or history of a malignancy in the last five years (excluding treated basal cell carcinoma).
  8. Clinically significant abnormal laboratory measures at screening.
  9. Known Irritable Bowel Disease-associated PG

Sites / Locations

    Arms of the Study

    Arm 1

    Arm Type

    Experimental

    Arm Label

    Experimental

    Arm Description

    2 s.c. secukinumab 150 mg injections

    Outcomes

    Primary Outcome Measures

    Efficacy - Investigator Global Assessment (IGA)
    Investigator Global Assessment (IGA) as measured by a 7 point scale anchored by 'Completely Clear" and "Worse"
    Efficacy - Investigator Global Assessment (IGA)
    Investigator Global Assessment (IGA) as measured by a 7 point scale anchored by 'Completely Clear" and "Worse"
    Efficacy - Investigator Global Assessment (IGA)
    Investigator Global Assessment (IGA) as measured by a 7 point scale anchored by 'Completely Clear" and "Worse"
    Efficacy - Investigator Global Assessment (IGA)
    Investigator Global Assessment (IGA) as measured by a 7 point scale anchored by 'Completely Clear" and "Worse"
    Efficacy - Investigator Global Assessment (IGA)
    Investigator Global Assessment (IGA) as measured by a 7 point scale anchored by 'Completely Clear" and "Worse"
    Efficacy - Investigator Global Assessment (IGA)
    Investigator Global Assessment (IGA) as measured by a 7 point scale anchored by 'Completely Clear" and "Worse"
    Efficacy - Investigator Global Assessment (IGA)
    Investigator Global Assessment (IGA) as measured by a 7 point scale anchored by 'Completely Clear" and "Worse"
    Efficacy - Investigator Global Assessment (IGA)
    Investigator Global Assessment (IGA) as measured by a 7 point scale anchored by 'Completely Clear" and "Worse"
    Efficacy - Investigator Global Assessment (IGA)
    Investigator Global Assessment (IGA) as measured by a 7 point scale anchored by 'Completely Clear" and "Worse"
    Efficacy - Subject Global Assessment (SGA)
    Subject Global Assessment (SGA) as measured by a 7 point scale anchored by 'Completely Clear" and "Worse"
    Efficacy - Subject Global Assessment (SGA)
    Subject Global Assessment (SGA) as measured by a 7 point scale anchored by 'Completely Clear" and "Worse"
    Efficacy - Subject Global Assessment (SGA)
    Subject Global Assessment (SGA) as measured by a 7 point scale anchored by 'Completely Clear" and "Worse"
    Efficacy - Subject Global Assessment (SGA)
    Subject Global Assessment (SGA) as measured by a 7 point scale anchored by 'Completely Clear" and "Worse"
    Efficacy - Subject Global Assessment (SGA)
    Subject Global Assessment (SGA) as measured by a 7 point scale anchored by 'Completely Clear" and "Worse"
    Efficacy - Subject Global Assessment (SGA)
    Subject Global Assessment (SGA) as measured by a 7 point scale anchored by 'Completely Clear" and "Worse"
    Efficacy - Subject Global Assessment (SGA)
    Subject Global Assessment (SGA) as measured by a 7 point scale anchored by 'Completely Clear" and "Worse"
    Efficacy - Subject Global Assessment (SGA)
    Subject Global Assessment (SGA) as measured by a 7 point scale anchored by 'Completely Clear" and "Worse"
    Efficacy - Ulcer Lesion Assessment PG Target Lesion
    Number of subjects achieving 50% improvement in PG lesion size
    Efficacy - Ulcer Lesion Assessment PG Target Lesion
    Number of subjects achieving resolution of inflammation with an erythema score of 0 and a border elevation of 0 on five point scales of none to very severe

    Secondary Outcome Measures

    Full Information

    First Posted
    February 12, 2020
    Last Updated
    May 25, 2021
    Sponsor
    Wake Forest University Health Sciences
    Collaborators
    Novartis
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    1. Study Identification

    Unique Protocol Identification Number
    NCT04274166
    Brief Title
    Secukinumab for the Inflammatory Phase of Pyoderma Gangrenosum
    Official Title
    The Efficacy and Safety of Secukinumab for the Inflammatory Phase of Pyoderma Gangrenosum
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    May 2021
    Overall Recruitment Status
    Withdrawn
    Why Stopped
    Contracting never completed, closed the IRB
    Study Start Date
    May 2021 (Anticipated)
    Primary Completion Date
    December 2021 (Anticipated)
    Study Completion Date
    April 2022 (Anticipated)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Sponsor
    Name of the Sponsor
    Wake Forest University Health Sciences
    Collaborators
    Novartis

    4. Oversight

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

    5. Study Description

    Brief Summary
    The purpose of this research study is to find out what effects (good and bad) secukinumab has on the subject and their pyoderma gangrenosum. Secukinumab is a type of medicine called human monoclonal antibodies. Monoclonal antibodies are proteins that recognize and attach to other specific proteins (in this case, immune system hormones called "cytokines") that your body produces. The cytokine (a "messenger" protein in the body) that secukinumab binds to and reduces the activity of is a naturally occurring cytokine called interleukin-17A (IL-17A). IL-17A is believed to be partly responsible for inflammation (pain, swelling, redness), and researchers believe that IL-17A may cause symptoms PG.
    Detailed Description
    This is a prospective, single center, Phase IIa study of secukinumab in the treatment of subjects diagnosed with PG. Subjects will be evaluated at Screening, Baseline (week 0), Week 1, Week 2, Week 3, Week 4, and then every 4 weeks for 24 weeks. The total duration of treatment is up to 20 weeks. Subjects may be treated for shorter durations if the lesions clear prior to week 20. Subjects will have a follow-up visit at 24 weeks, or 4 weeks after the last dose of study drug. Subjects will also have standard of care wound dressings done at each visit. Subjects will be given 300 mg of secukinumab SQ at week 0, 1, 2, 3, and 4, followed by injections every 4 weeks, for up to 20 weeks. Subjects may receive a dose increase at week 16 (if there is not at least a 25% reduction in target lesion size) to 300 mg every 2 weeks. Complete Blood Count (CBC), Comprehensive Metabolic panel (CMP), C- reactive protein (CRP), Erythrocyte sedimentation rate (ESR), Hepatitis panel, HIV test, Pregnancy test, and QuantiFERON gold TB test will be performed at screening. (Appendix 6) CBC, CMP, CRP, ESR will be performed at week 8 and week 20. Pain rating by Likert scale (A 10-point scale to rate the level of pain - Appendix 2), an Investigator Global Assessment (IGA) (Appendix 3), Subject Global Assessment (SGA) (Appendix 3), and Ulcer Lesion Assessment (Appendix 5) will be done at Screening, Baseline, and at Weeks 2, 4, 8, 12, 16, 20, and 24. Lesion photography will be done at Screening and all visits. Infection and adverse event assessments and concomitant medication assessments will be performed at each visit. Quality of life will be measured with the Dermatology Life Quality Index (DLQI) at Baseline and Week 20 (Appendix 4).

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Pyoderma Gangrenosum

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Phase 2
    Interventional Study Model
    Single Group Assignment
    Masking
    None (Open Label)
    Allocation
    N/A
    Enrollment
    0 (Actual)

    8. Arms, Groups, and Interventions

    Arm Title
    Experimental
    Arm Type
    Experimental
    Arm Description
    2 s.c. secukinumab 150 mg injections
    Intervention Type
    Drug
    Intervention Name(s)
    secukinumab 150 mg (2 injections per dose
    Other Intervention Name(s)
    secukinumab
    Intervention Description
    secukinumab 150 mg (2 injections per dose
    Primary Outcome Measure Information:
    Title
    Efficacy - Investigator Global Assessment (IGA)
    Description
    Investigator Global Assessment (IGA) as measured by a 7 point scale anchored by 'Completely Clear" and "Worse"
    Time Frame
    Screening visit
    Title
    Efficacy - Investigator Global Assessment (IGA)
    Description
    Investigator Global Assessment (IGA) as measured by a 7 point scale anchored by 'Completely Clear" and "Worse"
    Time Frame
    Change from Screening visit to Baseline visit.
    Title
    Efficacy - Investigator Global Assessment (IGA)
    Description
    Investigator Global Assessment (IGA) as measured by a 7 point scale anchored by 'Completely Clear" and "Worse"
    Time Frame
    Change from Baseline visit to Week 2.
    Title
    Efficacy - Investigator Global Assessment (IGA)
    Description
    Investigator Global Assessment (IGA) as measured by a 7 point scale anchored by 'Completely Clear" and "Worse"
    Time Frame
    Change from week 2 to week 4.
    Title
    Efficacy - Investigator Global Assessment (IGA)
    Description
    Investigator Global Assessment (IGA) as measured by a 7 point scale anchored by 'Completely Clear" and "Worse"
    Time Frame
    Change from Week 4 to week 8.
    Title
    Efficacy - Investigator Global Assessment (IGA)
    Description
    Investigator Global Assessment (IGA) as measured by a 7 point scale anchored by 'Completely Clear" and "Worse"
    Time Frame
    Change from Week 8 to week 12.
    Title
    Efficacy - Investigator Global Assessment (IGA)
    Description
    Investigator Global Assessment (IGA) as measured by a 7 point scale anchored by 'Completely Clear" and "Worse"
    Time Frame
    Change from Week 12 to week 16.
    Title
    Efficacy - Investigator Global Assessment (IGA)
    Description
    Investigator Global Assessment (IGA) as measured by a 7 point scale anchored by 'Completely Clear" and "Worse"
    Time Frame
    Change from Week 16 to week 20.
    Title
    Efficacy - Investigator Global Assessment (IGA)
    Description
    Investigator Global Assessment (IGA) as measured by a 7 point scale anchored by 'Completely Clear" and "Worse"
    Time Frame
    Change from Week 20 to week 24.
    Title
    Efficacy - Subject Global Assessment (SGA)
    Description
    Subject Global Assessment (SGA) as measured by a 7 point scale anchored by 'Completely Clear" and "Worse"
    Time Frame
    Baseline.
    Title
    Efficacy - Subject Global Assessment (SGA)
    Description
    Subject Global Assessment (SGA) as measured by a 7 point scale anchored by 'Completely Clear" and "Worse"
    Time Frame
    Change from Baseline to week 2.
    Title
    Efficacy - Subject Global Assessment (SGA)
    Description
    Subject Global Assessment (SGA) as measured by a 7 point scale anchored by 'Completely Clear" and "Worse"
    Time Frame
    Change from Week 2 to Week 4.
    Title
    Efficacy - Subject Global Assessment (SGA)
    Description
    Subject Global Assessment (SGA) as measured by a 7 point scale anchored by 'Completely Clear" and "Worse"
    Time Frame
    Change from Week 4 to Week 8. .
    Title
    Efficacy - Subject Global Assessment (SGA)
    Description
    Subject Global Assessment (SGA) as measured by a 7 point scale anchored by 'Completely Clear" and "Worse"
    Time Frame
    Change from Week 8 to Week 12.
    Title
    Efficacy - Subject Global Assessment (SGA)
    Description
    Subject Global Assessment (SGA) as measured by a 7 point scale anchored by 'Completely Clear" and "Worse"
    Time Frame
    Change from Week 12 to Week 16.
    Title
    Efficacy - Subject Global Assessment (SGA)
    Description
    Subject Global Assessment (SGA) as measured by a 7 point scale anchored by 'Completely Clear" and "Worse"
    Time Frame
    Change from Week 16 to Week 20.
    Title
    Efficacy - Subject Global Assessment (SGA)
    Description
    Subject Global Assessment (SGA) as measured by a 7 point scale anchored by 'Completely Clear" and "Worse"
    Time Frame
    Change from Week 20 to Week 24.
    Title
    Efficacy - Ulcer Lesion Assessment PG Target Lesion
    Description
    Number of subjects achieving 50% improvement in PG lesion size
    Time Frame
    Change from Screening visit, Baseline, and at Weeks 2, 4, 8, 12, 16, 20, and 24.
    Title
    Efficacy - Ulcer Lesion Assessment PG Target Lesion
    Description
    Number of subjects achieving resolution of inflammation with an erythema score of 0 and a border elevation of 0 on five point scales of none to very severe
    Time Frame
    Change from Screening visit, Baseline, and at Weeks 2, 4, 8, 12, 16, 20, and 24.

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    18 Years
    Maximum Age & Unit of Time
    75 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: 1. Must give written informed consent. 2. Has a diagnosis of pyoderma gangrenosum, as determined by the investigator based on the following diagnostic criteria4: a. Diagnosis requires both major criteria and at least two minor criteria i. Major criteria Rapid progression of a painful, necrolytic cutaneous ulcer with an irregular, violaceous, and undermined border Other causes of cutaneous ulceration have been excluded ii. Minor criteria 1. History suggestive of pathergy or clinical finding of cribriform scarring 2. Systemic diseases associated with PG 3. Histopathologic findings (sterile dermal neutrophilia, ± mixed inflammation, ± lymphocytic vasculitis) 4. Treatment response (rapid response to systemic steroid treatment) 3. PG global assessment of moderate to severe, with at least one ulcer measuring at least 3 cm in diameter. 4. 18 years of age or greater. 5. Must require systemic therapy for their pyoderma gangrenosum, as determined by the investigator prior to Baseline. Currently prescribed low-dose corticosteroids (≤ 10 mg/day), and other medications within one week prior to investigational drug administration, may be continued with no change in dose or frequency during the study. Exclusion Criteria: Female subjects who are not postmenopausal for at least 1 year, surgically sterile, or willing to practice effective contraception during the study. Nursing mothers, pregnant women and women planning to become pregnant while on study are to be excluded. Current enrollment in any investigational study in which the subject is receiving any type of drug, biologic, or non-drug therapy (participation in registry-type studies is allowed). Serious local infection (e.g., cellulitis, abscess) or systemic infection (e.g., pneumonia, septicemia) within the 3 months prior to the first dose of investigational drug. Treatment with another investigational drug or approved therapy for investigational use within 28 days prior to investigational drug administration. Treatment with high dose (>10 mg/day) systemic steroids (prednisone) within one week prior to investigational drug administration. Treatment with cyclosporine, thalidomide, methotrexate, mycophenolate mofetil, azathioprine, or other systemic immunosuppressant agents within the 14 days prior to investigational drug administration (requirement of a 2-week washout). Known HIV+, known viral hepatitis infection, known tuberculosis infection. Any subject with a current or history of a malignancy in the last five years (excluding treated basal cell carcinoma). Clinically significant abnormal laboratory measures at screening. Known Irritable Bowel Disease-associated PG
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    William W Huang, MD. MPH
    Organizational Affiliation
    Wake Forest University Health Sciences
    Official's Role
    Principal Investigator

    12. IPD Sharing Statement

    Plan to Share IPD
    No

    Learn more about this trial

    Secukinumab for the Inflammatory Phase of Pyoderma Gangrenosum

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