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A Pilot Study Using Anakinra/Kineret for the Treatment of Patients With Severe Atopic Dermatitis

Primary Purpose

Anakinra, Kineret, Atopic Dermatitis

Status
Terminated
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Anakinra
Sponsored by
National Institute of Allergy and Infectious Diseases (NIAID)
About
Eligibility
Locations
Outcomes
Full info

About this trial

This is an interventional treatment trial for Anakinra focused on measuring Kineret, Anakinra, Atopic Dermatitis, Eczema, Allergic Disease

Eligibility Criteria

10 Years - 30 Years (Child, Adult)All SexesDoes not accept healthy volunteers
  • INCLUSION CRITERIA:

To be eligible for enrollment in this protocol, participants must fulfill all of the following criteria:

  1. Must be 10 years to 30 years of age
  2. Patient or legal guardian must be able to give informed consent
  3. Must have evidence of severe atopic dermatitis as determined by the investigators and a SCORAD score >40 performed within 90 days of study entry
  4. Must have report from primary physician documenting lack of sufficient response to topical corticosteroids for > 6 months
  5. Must have skin test or radioallergosorbent test (RAST) showing sensitivity to greater than or equal to 3 food and/or airborne allergens
  6. Must have a baseline CBC that demonstrates:

    • White Blood Cell Count (WBC) greater than or equal to lower limit of normal for age
    • Absolute Neutrophil Count (ANC) greater than or equal to lower limit of normal for age

      c. Platelet Count greater than or equal to lower limit of normal for age

  7. Must not be pregnant or breastfeeding
  8. If subject is a female that has begun menstruation, and is sexually active, she must agree to consistently use contraception throughout study participation. Acceptable forms of contraception are:

    • Condoms, male or female, with spermicide
    • Diaphragm or cervical cap with spermicide
    • Intrauterine device
    • Contraceptive pills or patch, Norplant, Depo-Provera or other FDA-approved contraceptive method
    • Male partner has previously undergone a vasectomy for which there is documentation of aspermatogenic sterility
    • Abstinence
  9. Must have a primary care physician
  10. Must be willing to submit blood and skin tissue for storage

EXCLUSION CRITERIA:

A patient will be ineligible to participate in this protocol if any of the following criteria are fulfilled:

  1. Patient is taking oral or injectable immunomodulators (such as methotrexate, imuran, and cyclosporine) or biologics (such as etanercept or omalizumab).
  2. Patient requires systemic immunosuppression at any time during the study
  3. Patient has known diseases of immunodysregulation or immunodeficiency.
  4. Any chronic medical condition other than atopic dermatitis, allergy/asthma and infection, such as heart disease, diabetes and autoimmunity that, in the investigator s opinion, places the patient at undue risk by participating in the study.
  5. History of anaphylactic reaction or hypersensitivity to anakinra.
  6. The presence of certain types of acquired abnormalities of immunity such as human immunodeficiency virus (HIV), cytotoxic chemotherapy for malignancy could be grounds for possible exclusion if, in the opinion of the investigator, the presence of such disease process interferes with evaluating a coexisting abnormality of immunity that is a subject of study under this protocol.
  7. The presence of any dermatologic diagnosis which, in the investigator's opinion, is not consistent with atopic dermatitis and would impair the ability to assess drug response.
  8. Has a diagnosis of active tuberculosis with consistent findings from a PPD skin test, computerized tomography (CT) scan or Chest x-ray. Those subjects found to have a positive PPD will be referred back to their primary care physician for appropriate management.
  9. Has received a live vaccine within 4 weeks prior to therapy or potential need for a live vaccine during the study.
  10. Is unwilling to undergo testing or procedures associated with this protocol.
  11. The patient or guardian is unable or unwilling to give daily injections.

Sites / Locations

  • National Institutes of Health Clinical Center, 9000 Rockville Pike

Outcomes

Primary Outcome Measures

Improvement of Atopic Dermatitis symptoms without increase in serious infections; Response to treatment with a 30 percent decrease in SCORAD score.

Secondary Outcome Measures

Determine immunological phenotype and cytokine profile of peripheral blood before and after treatment with Anakinra; Determine impact of IL-1 r neutralization on total and antigen specific allergen sensitivity.

Full Information

First Posted
May 11, 2010
Last Updated
December 14, 2019
Sponsor
National Institute of Allergy and Infectious Diseases (NIAID)
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1. Study Identification

Unique Protocol Identification Number
NCT01122914
Brief Title
A Pilot Study Using Anakinra/Kineret for the Treatment of Patients With Severe Atopic Dermatitis
Official Title
A Pilot Study Using Anakinra/Kineret for the Treatment of Patients With Severe Atopic Dermatitis
Study Type
Interventional

2. Study Status

Record Verification Date
April 7, 2015
Overall Recruitment Status
Terminated
Study Start Date
April 14, 2010 (undefined)
Primary Completion Date
April 7, 2015 (Actual)
Study Completion Date
April 7, 2015 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
National Institute of Allergy and Infectious Diseases (NIAID)

4. Oversight

5. Study Description

Brief Summary
Background: Severe atopic dermatitis, also known as eczema, is a chronic inflammatory skin condition that affects both children and adults and causes severe itching and skin redness. Current treatments of atopic dermatitis include topical creams and lotions, light therapy, and medications. However, the difficulty with long-term treatment for the chronic and severe nature of the disease requires more effective and better-tolerated therapeutic options. Anakinra is a drug that blocks a substance called interleukin-1 (IL-1), which may be important in causing the inflammation in atopic dermatitis. Researchers are interested in determining whether anakinra can be used to help treat atopic dermatitis. Anakinra has been approved by the Food and Drug Administration to treat rheumatoid arthritis in adults and children, but it has not been approved for use in adults or children with atopic dermatitis and is considered an experimental treatment in this study. In this study Anakinra will be administered as an injection under the skin every day for 3 months Objectives: - To assess the safety and effectiveness of using anakinra to treat severe atopic dermatitis in children. Eligibility: - Children between 10 and 18 years of age who have been diagnosed with severe atopic dermatitis that has not responded to standard treatment. Design: Initial Screening: Participants will have an initial screening visit with a complete physical examination and medical history, blood and urine tests, photographs of the skin ,skin biopsy, and other tests as required. Run-in Period: At the screening visit, participants will receive a diary card and will be asked to track their atopic dermatitis symptoms on standard treatment for 2 months. Start of Treatment: At the end of the 2 month Run-in period participants will return for an inpatient visit (2 days) to receive the initial dose of anakinra and will be watched for any side effects. During the inpatient visit, participants will have additional examinations and blood and urine tests, and will be instructed on how to administer the anakinra injections at home. Treatment Period: - Participants will return once a week for the first 2 weeks of treatment, at the end of the first month, and then once a month for the following 2 months, for a physical exam and blood tests. Participants will be asked to record symptoms related to their atopic dermatitis, anakinra administration and any side effects related to the anakinra on the diary card. The diary cards will be reviewed and collected at each visit.- End of Treatment Period: At the end of 3 months of treatment with anakinra, participants will again be asked to record symptoms related to their atopic dermatitis on the diary card. Participants will be seen once a month for 3 months for a physical exam, blood tests and review of the diary card. . The final study visit will take place at the end of the 3rd month and will include a physical exam, blood tests, photographs and skin biopsy.
Detailed Description
Severe refractory atopic dermatitis is a chronic inflammatory pruritic skin condition that affects both children and adults. The disease is marked by periods of exacerbation and remission. Symptoms of atopic dermatitis may resolve by adolescence; however, it is estimated that the disease may persist in 50 percent of affected children well into adulthood. Current possible treatments of atopic dermatitis include the use of topical corticosteroids, calcineurin inhibitors, phototherapy, as well as systemic medications i.e., methotrexate, cyclosporine, azathioprine, mycophenolate mofetil and interferon gamma. The difficulty with long-term treatment of this disease lies in its chronic nature associated with severe episodes. The combination of chronicity and severity of episodes of this diseases demands more effective and better-tolerated therapeutic options than those that are currently available. While the pathways of allergic inflammation are different than those of other inflammatory conditions, certain elements may overlap, providing targets for immune modulation. One of these targets is the interleukin-1 (IL-1) receptor. The IL-1 receptor plays an important role in the development and maintenance of Th2 responses. Genetic, in vivo and in vitro data demonstrate a significant role for IL-1 signaling allergic and skin inflammatory conditions. This pilot study is therefore designed to assess the safety and efficacy of IL-1ra, a natural inhibitor of the IL-1 receptor, in disrupting atopic pathophysiologic pathways. Specifically, we will treat severe refractory atopic dermatitis associated with evidence of multiple specific allergic sensitivities. Up to 8 patients ages 10-30 with severe refractory dermatitis will be enrolled. Patients will be initially evaluated to establish the diagnosis of severe refractory AD as evidenced by SCORAD score greater than 40, followed by a 2 month (8 week) run-in period, a 3 month (12 week) treatment period of 3mg/kg/day anakinra given subcutaneously, followed by a 3 month (12 week) post-treatment evaluation period. In order to be considered evaluable for response, patients must have received a minimum of 67 out of 84 doses (80 percent) of anakinra. The primary endpoint is lack of an increase in serious infections, the secondary endpoint is a reduction of 30 percent or more in SCORAD score, and tertiary endpoints are cellular phenotypic and cytokine responses to IL-1 receptor blockade in atopic patients.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Anakinra, Kineret, Atopic Dermatitis, Eczema, Allergic Disease
Keywords
Kineret, Anakinra, Atopic Dermatitis, Eczema, Allergic Disease

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
1 (Actual)

8. Arms, Groups, and Interventions

Intervention Type
Drug
Intervention Name(s)
Anakinra
Primary Outcome Measure Information:
Title
Improvement of Atopic Dermatitis symptoms without increase in serious infections; Response to treatment with a 30 percent decrease in SCORAD score.
Time Frame
2 years
Secondary Outcome Measure Information:
Title
Determine immunological phenotype and cytokine profile of peripheral blood before and after treatment with Anakinra; Determine impact of IL-1 r neutralization on total and antigen specific allergen sensitivity.
Time Frame
2 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
10 Years
Maximum Age & Unit of Time
30 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
INCLUSION CRITERIA: To be eligible for enrollment in this protocol, participants must fulfill all of the following criteria: Must be 10 years to 30 years of age Patient or legal guardian must be able to give informed consent Must have evidence of severe atopic dermatitis as determined by the investigators and a SCORAD score >40 performed within 90 days of study entry Must have report from primary physician documenting lack of sufficient response to topical corticosteroids for > 6 months Must have skin test or radioallergosorbent test (RAST) showing sensitivity to greater than or equal to 3 food and/or airborne allergens Must have a baseline CBC that demonstrates: White Blood Cell Count (WBC) greater than or equal to lower limit of normal for age Absolute Neutrophil Count (ANC) greater than or equal to lower limit of normal for age c. Platelet Count greater than or equal to lower limit of normal for age Must not be pregnant or breastfeeding If subject is a female that has begun menstruation, and is sexually active, she must agree to consistently use contraception throughout study participation. Acceptable forms of contraception are: Condoms, male or female, with spermicide Diaphragm or cervical cap with spermicide Intrauterine device Contraceptive pills or patch, Norplant, Depo-Provera or other FDA-approved contraceptive method Male partner has previously undergone a vasectomy for which there is documentation of aspermatogenic sterility Abstinence Must have a primary care physician Must be willing to submit blood and skin tissue for storage EXCLUSION CRITERIA: A patient will be ineligible to participate in this protocol if any of the following criteria are fulfilled: Patient is taking oral or injectable immunomodulators (such as methotrexate, imuran, and cyclosporine) or biologics (such as etanercept or omalizumab). Patient requires systemic immunosuppression at any time during the study Patient has known diseases of immunodysregulation or immunodeficiency. Any chronic medical condition other than atopic dermatitis, allergy/asthma and infection, such as heart disease, diabetes and autoimmunity that, in the investigator s opinion, places the patient at undue risk by participating in the study. History of anaphylactic reaction or hypersensitivity to anakinra. The presence of certain types of acquired abnormalities of immunity such as human immunodeficiency virus (HIV), cytotoxic chemotherapy for malignancy could be grounds for possible exclusion if, in the opinion of the investigator, the presence of such disease process interferes with evaluating a coexisting abnormality of immunity that is a subject of study under this protocol. The presence of any dermatologic diagnosis which, in the investigator's opinion, is not consistent with atopic dermatitis and would impair the ability to assess drug response. Has a diagnosis of active tuberculosis with consistent findings from a PPD skin test, computerized tomography (CT) scan or Chest x-ray. Those subjects found to have a positive PPD will be referred back to their primary care physician for appropriate management. Has received a live vaccine within 4 weeks prior to therapy or potential need for a live vaccine during the study. Is unwilling to undergo testing or procedures associated with this protocol. The patient or guardian is unable or unwilling to give daily injections.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Joshua D Milner, M.D.
Organizational Affiliation
National Institute of Allergy and Infectious Diseases (NIAID)
Official's Role
Principal Investigator
Facility Information:
Facility Name
National Institutes of Health Clinical Center, 9000 Rockville Pike
City
Bethesda
State/Province
Maryland
ZIP/Postal Code
20892
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
14991059
Citation
Leung DY, Boguniewicz M, Howell MD, Nomura I, Hamid QA. New insights into atopic dermatitis. J Clin Invest. 2004 Mar;113(5):651-7. doi: 10.1172/JCI21060.
Results Reference
background
PubMed Identifier
15007345
Citation
Adjers K, Pessi T, Karjalainen J, Huhtala H, Hurme M. Epistatic effect of IL1A and IL4RA genes on the risk of atopy. J Allergy Clin Immunol. 2004 Mar;113(3):445-7. doi: 10.1016/j.jaci.2003.12.582.
Results Reference
background
PubMed Identifier
17340015
Citation
Schmitt J, Schakel K, Schmitt N, Meurer M. Systemic treatment of severe atopic eczema: a systematic review. Acta Derm Venereol. 2007;87(2):100-11. doi: 10.2340/00015555-0207.
Results Reference
background

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A Pilot Study Using Anakinra/Kineret for the Treatment of Patients With Severe Atopic Dermatitis

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