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Hydroxychloroquine in Isolated Cutaneous Mastocytosis Patients or Indolent Systemic Mastocytosis With Associated Skin Involvement Patients (HCQMa)

Primary Purpose

Mastocytosis

Status
Not yet recruiting
Phase
Phase 2
Locations
France
Study Type
Interventional
Intervention
Hydroxychloroquine
Sponsored by
University Hospital, Toulouse
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Mastocytosis focused on measuring Mastocytosis, mast cell activation symptoms, hydroxychloroquine

Eligibility Criteria

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

Inclusion Criteria:

  1. Age > 18 years
  2. Isolated Cutaneous mastocytosis or indolent systemic mastocytosis with associated skin lesions defined according to WHO criteria (and / or international standards for cutaneous mastocytosis)
  3. Patient with at least one disability defined by the presence of the following symptoms assessed as moderate to severe:

    1. Cutaneous pruritus with score ≥ 5 on a VAS scale from 0 to 10
    2. Number of flushes / week ≥ 7
  4. Skin KIT mutation known
  5. Performance scale: OMS/ECOG ≤ 1
  6. Woman and man of childbearing age* under effective contraception during all the treatment by hydroxychloroquine, until 8 months after its cessation

Exclusion Criteria:

  • Non-symptomatic mastocytosis and / or without skin involvement
  • Advanced Systemic mastocytosis
  • History of ophthalmic disease and / or cardiac conduction disorders, in particular the prolongation of the QT interval as well as the risk factors for prolongation of the QT interval, such as heart disease (heart failure, myocardial infarction), pro-arrhythmic conditions (eg bradycardia <50 bpm), history of ventricular dysrhythmias, uncorrected hypokalemia and / or hypomagnesemia, concomitant treatment with interval prolonging agents QTagainst-indicating the use of hydroxychloroquine
  • Treatment with citalopram, escitalopram, hydroxyzine, domperidone, piperaquine due to the increased risk of ventricular rhythm disorders, especially torsades de pointes
  • Specific anti-tumor treatment (chemotherapy, radiotherapy) of less than 4 weeks before inclusion.
  • Concomitant specific anti-mast cell treatment
  • Contre-indication(s) to XYLOCAINE 10 mg/ml ADRENALINE 0,005 mg/ml, injectable solution: Known hypersensitivity to chlorhydrate de lidocaïne, to amide-type local anaesthetics or one of its excipients (sulfites), patients suffering from recurring porphyrias, coronary insufficiency, ventricular rhythm disorders, severe arterial hypertension, obstructive cardiomyopathy, hyperthyroidism.
  • Inclusion in another trial with an experimental therapeutic molecule
  • Change symptomatic treatment (including dosage) in the 4 weeks preceding the inclusion visit
  • Moderate to severe renal or hepatic failure or diabetes
  • History of organ transplant
  • Inability to give informed consent
  • Inability to undergo medical monitoring for geographical, social or psychic
  • Patients with major surgery scheduled in the next two weeks screening
  • Patient without health insurance
  • Pregnancy, Breastfeeding
  • Vulnerable Patient, defined as:
  • Esperanzae survival < 6 months
  • Patient with another uncontrolled severe disease
  • Patient under juridical protection

Sites / Locations

  • Larrey Hospital - Toulouse University Hospital

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Treatment

Arm Description

Patients will be treated by hydroxychloroquine at a dose of 6 to 6.5mg/kg/day

Outcomes

Primary Outcome Measures

Change of mast cell activation symptoms
The primary endpoint of this study is the change of mast cell activation symptoms as pruritus between the start of treatment and 12 months later. Skin pruritus will be assessed by the visual analogue scale from 0 to 10 at each visit.
Change of mast cell activation symptoms
The primary endpoint of this study is the change of mast cell activation symptoms as flushes between the start of treatment and 12 months later. The skin flush will be evaluated according to the absolute number of flushes / week at each visit

Secondary Outcome Measures

Difference on mast cell burden - serum tryptase level
The difference on mast cell burden between the start of treatment and 12 months later will be evaluated by variation of the level serum tryptase l expressed in μg / L.
Difference on skin mast cell burden - mast cells/mm²
The difference on mast cell burden between the start of treatment and 12 months later will be assessed by variation of the number of mast cells / mm² identified on the skin biopsies.
Difference of mast cell activation symptoms : diarrhea
The difference of diarrhea between the start of treatment and 12 months later evaluated by the absolute number of stools / day for diarrhea
Difference of mast cell activation symptoms : pollakiuria
The difference of pollakiuria between the start of treatment and 12 months later assessed by the absolute number of urinations / day for pollakiuria.
Difference of mast cell activation symptoms : arthralgia
The difference of arthralgia between the start of treatment and 12 months later evaluated by the absolute number of painful joints / day and the intensity of joint pain assessed by the visual analogue scale from 0 to 10 for arthralgia.
Difference of mast cell activation symptoms : discomfort
The difference of discomfort between the start of treatment and 12 months later evaluated by the absolute number of faintness / week
The safety of hydroxychloroquine treatment.
The safety of hydroxychloroquine treatment will be done by evaluation of adverse events
effectiveness of treatment
The correlation between the efficacy of treatment with the hydroxychloroquine and level of serum HCQ will be performed by the Bland-Altman test.

Full Information

First Posted
October 6, 2021
Last Updated
October 6, 2021
Sponsor
University Hospital, Toulouse
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1. Study Identification

Unique Protocol Identification Number
NCT05084872
Brief Title
Hydroxychloroquine in Isolated Cutaneous Mastocytosis Patients or Indolent Systemic Mastocytosis With Associated Skin Involvement Patients
Acronym
HCQMa
Official Title
Hydroxychloroquine in Isolated Cutaneous Mastocytosis Patients or Indolent Systemic Mastocytosis With Associated Skin Involvement Patients: Proof of Concept Study
Study Type
Interventional

2. Study Status

Record Verification Date
October 2021
Overall Recruitment Status
Not yet recruiting
Study Start Date
October 2021 (Anticipated)
Primary Completion Date
January 2024 (Anticipated)
Study Completion Date
January 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University Hospital, Toulouse

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 treatment of systemic mastocytosis has two main axes: Control of mast cell activation symptoms and The control of proliferation (accumulation) of mast cells. There is no standard treatment and no treatment has a marketing authorization for the treatment of monoclonal indolent mastocytosis.
Detailed Description
Mastocytosis is an orphan disease related to the accumulation and / or the proliferation of abnormal mast cells in different tissues. In adults, a classic distinction is made between isolated cutaneous forms (10 to 15%) and systemic forms (85 to 90%). The treatment of systemic mastocytosis has two main axes: Control of mast cell activation symptoms and The control of proliferation (accumulation) of mast cells. There is no standard treatment and no treatment has a marketing authorization for the treatment of monoclonal indolent mastocytosis.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Mastocytosis
Keywords
Mastocytosis, mast cell activation symptoms, hydroxychloroquine

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2, Phase 3
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
30 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Treatment
Arm Type
Experimental
Arm Description
Patients will be treated by hydroxychloroquine at a dose of 6 to 6.5mg/kg/day
Intervention Type
Drug
Intervention Name(s)
Hydroxychloroquine
Intervention Description
Patients will be treated by hydroxychloroquine at a dose of 6 to 6.5mg/kg/day during 12 month
Primary Outcome Measure Information:
Title
Change of mast cell activation symptoms
Description
The primary endpoint of this study is the change of mast cell activation symptoms as pruritus between the start of treatment and 12 months later. Skin pruritus will be assessed by the visual analogue scale from 0 to 10 at each visit.
Time Frame
12 month
Title
Change of mast cell activation symptoms
Description
The primary endpoint of this study is the change of mast cell activation symptoms as flushes between the start of treatment and 12 months later. The skin flush will be evaluated according to the absolute number of flushes / week at each visit
Time Frame
12 month
Secondary Outcome Measure Information:
Title
Difference on mast cell burden - serum tryptase level
Description
The difference on mast cell burden between the start of treatment and 12 months later will be evaluated by variation of the level serum tryptase l expressed in μg / L.
Time Frame
12 month
Title
Difference on skin mast cell burden - mast cells/mm²
Description
The difference on mast cell burden between the start of treatment and 12 months later will be assessed by variation of the number of mast cells / mm² identified on the skin biopsies.
Time Frame
12 month
Title
Difference of mast cell activation symptoms : diarrhea
Description
The difference of diarrhea between the start of treatment and 12 months later evaluated by the absolute number of stools / day for diarrhea
Time Frame
12 month
Title
Difference of mast cell activation symptoms : pollakiuria
Description
The difference of pollakiuria between the start of treatment and 12 months later assessed by the absolute number of urinations / day for pollakiuria.
Time Frame
12 month
Title
Difference of mast cell activation symptoms : arthralgia
Description
The difference of arthralgia between the start of treatment and 12 months later evaluated by the absolute number of painful joints / day and the intensity of joint pain assessed by the visual analogue scale from 0 to 10 for arthralgia.
Time Frame
12 month
Title
Difference of mast cell activation symptoms : discomfort
Description
The difference of discomfort between the start of treatment and 12 months later evaluated by the absolute number of faintness / week
Time Frame
12 month
Title
The safety of hydroxychloroquine treatment.
Description
The safety of hydroxychloroquine treatment will be done by evaluation of adverse events
Time Frame
12 month
Title
effectiveness of treatment
Description
The correlation between the efficacy of treatment with the hydroxychloroquine and level of serum HCQ will be performed by the Bland-Altman test.
Time Frame
12 month

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Age > 18 years Isolated Cutaneous mastocytosis or indolent systemic mastocytosis with associated skin lesions defined according to WHO criteria (and / or international standards for cutaneous mastocytosis) Patient with at least one disability defined by the presence of the following symptoms assessed as moderate to severe: Cutaneous pruritus with score ≥ 5 on a VAS scale from 0 to 10 Number of flushes / week ≥ 7 Skin KIT mutation known Performance scale: OMS/ECOG ≤ 1 Woman and man of childbearing age* under effective contraception during all the treatment by hydroxychloroquine, until 8 months after its cessation Exclusion Criteria: Non-symptomatic mastocytosis and / or without skin involvement Advanced Systemic mastocytosis History of ophthalmic disease and / or cardiac conduction disorders, in particular the prolongation of the QT interval as well as the risk factors for prolongation of the QT interval, such as heart disease (heart failure, myocardial infarction), pro-arrhythmic conditions (eg bradycardia <50 bpm), history of ventricular dysrhythmias, uncorrected hypokalemia and / or hypomagnesemia, concomitant treatment with interval prolonging agents QTagainst-indicating the use of hydroxychloroquine Treatment with citalopram, escitalopram, hydroxyzine, domperidone, piperaquine due to the increased risk of ventricular rhythm disorders, especially torsades de pointes Specific anti-tumor treatment (chemotherapy, radiotherapy) of less than 4 weeks before inclusion. Concomitant specific anti-mast cell treatment Contre-indication(s) to XYLOCAINE 10 mg/ml ADRENALINE 0,005 mg/ml, injectable solution: Known hypersensitivity to chlorhydrate de lidocaïne, to amide-type local anaesthetics or one of its excipients (sulfites), patients suffering from recurring porphyrias, coronary insufficiency, ventricular rhythm disorders, severe arterial hypertension, obstructive cardiomyopathy, hyperthyroidism. Inclusion in another trial with an experimental therapeutic molecule Change symptomatic treatment (including dosage) in the 4 weeks preceding the inclusion visit Moderate to severe renal or hepatic failure or diabetes History of organ transplant Inability to give informed consent Inability to undergo medical monitoring for geographical, social or psychic Patients with major surgery scheduled in the next two weeks screening Patient without health insurance Pregnancy, Breastfeeding Vulnerable Patient, defined as: Esperanzae survival < 6 months Patient with another uncontrolled severe disease Patient under juridical protection
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Maella Severino-Freire, MD
Phone
05 67 77 81 41
Ext
+33
Email
severino-freire.m@chu-toulouse.fr
First Name & Middle Initial & Last Name or Official Title & Degree
Cristina Bulai Livideanu, MD
Phone
05 67 77 81 35
Ext
+33
Email
livideanu.c@chu-toulouse.fr
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Maella Severino-Freire, MD
Organizational Affiliation
Toulouse University Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
Larrey Hospital - Toulouse University Hospital
City
Toulouse
ZIP/Postal Code
31059
Country
France

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
31009132
Citation
Fradet M, Negretto M, Tournier E, Laurent C, Apoil PA, Evrard S, Degboe Y, Del Mas V, Lamant L, Dubreuil P, Laroche M, Mailhol C, Hermine O, Paul C, Bulai Livideanu C. Frequency of isolated cutaneous involvement in adult mastocytosis: a cohort study. J Eur Acad Dermatol Venereol. 2019 Sep;33(9):1713-1718. doi: 10.1111/jdv.15638. Epub 2019 May 17.
Results Reference
background
PubMed Identifier
26899198
Citation
Severino M, Chandesris MO, Barete S, Tournier E, Sans B, Laurent C, Apoil PA, Lamant L, Mailhol C, Laroche M, Fraitag S, Hanssens K, Dubreuil P, Hermine O, Paul C, Bulai Livideanu C. Telangiectasia macularis eruptiva perstans (TMEP): A form of cutaneous mastocytosis with potential systemic involvement. J Am Acad Dermatol. 2016 May;74(5):885-91.e1. doi: 10.1016/j.jaad.2015.10.050. Epub 2016 Feb 19.
Results Reference
background

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Hydroxychloroquine in Isolated Cutaneous Mastocytosis Patients or Indolent Systemic Mastocytosis With Associated Skin Involvement Patients

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