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A Study Examining the Medication Apremilast as Treatment for Chronic Itch

Primary Purpose

Itch

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Apremilast
Sponsored by
Washington University School of Medicine
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Itch focused on measuring itch, pruritus, CIP

Eligibility Criteria

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

Inclusion Criteria:

Key Inclusion Criteria: A subject who meets all of the following criteria may be included in the study:

  • Male and non-pregnant, non-lactating female subjects aged 18 years or older
  • Diagnosed with chronic idiopathic pruritus (CIP) with an NRS Itch Score of ≥ 7 at both Screening and Baseline
  • Diagnosis of CIP for at least 6 weeks prior to screening
  • Willingness to avoid pregnancy or fathering of children
  • Ability and willingness to provide written informed consent
  • Willing and able to comply with all study requirements and restrictions
  • Willing to not participate in any other interventional trial for the duration of their participation
  • Subjects must be in good health as determined by medical history, physical examination, electrocardiogram, clinical laboratory tests and vital signs
  • Failure of a course 2-week course of treatment with topical triamcinolone 0.1% ointment BID
  • Histopathological demonstration of skin eosinophils, mast cell activation, lymphocytic infiltration, and/or dermal edema

Exclusion Criteria:

Key Exclusion Criteria: A subject who meets any of the following criteria will be excluded from the study:

  • Chronic pruritus due to a defined primary dermatologic disorder (e.g., atopic dermatitis, psoriasis, etc.)
  • Patients with a prior diagnosis of excoriation disorder
  • Use of topical treatments for CIP (other than bland emollients) within 1 week of Baseline
  • Systemic immunosuppressive or immunomodulating drugs within 4 weeks of Baseline
  • Subjects with cytopenias at screening, defined as:

    • Leukocytes < 3 × 109/L.
    • Neutrophils < lower limit of normal.
    • Lymphocytes < 0.5 × 109/L
    • Hemoglobin < 10 g/dL.
    • Platelets < 100 × 109/L.
  • Unwilling or unable to follow medication restrictions described in Section 5.6.3, or unwilling or unable to sufficiently washout from use of restricted medication
  • Under medical treatment for a skin disease with a therapy listed in the prohibited medications section that may influence the results of the study
  • Current clinically significant cardiovascular, respiratory, neurologic, hepatic, hematopoietic, renal gastrointestinal, endocrine or metabolic dysfunction unless currently controlled and stable, including (but not limited to) the following: Positive for Hepatitis C antibody test (anti-HCF) Positive for hepatitis B surface antigen (HBsAg) or hepatitis B core antibody (HBcAb) Positive for HIV (DUO test, p24 antigen)
  • Active malignancy
  • Active substance abuse or history of substance abuse within 6 months of screening
  • History (including family history) or current evidence of congenital long QT syndrome or known acquired QT prolongation
  • Exposure to any investigational medication, including placebo, within 60 days of the Baseline Visit
  • Subjects who had previously received apremilast
  • Subjects with severely impaired liver function (Child-Pugh Class C) or end-stage renal disease on dialysis or at least 1 of the following:

    • Serum creatinine > 1.5 mg/dL
    • Alanine aminotransferase or aspartate aminotransferase ≥ 1.5 × upper limit of normal
  • Anyone affiliated with the site or sponsor and/or anyone who may consent under duress
  • Any other sound medical reason as determined by the Investigator including any condition which may lead to an unfavorable risk-benefit of study participation, may interfere with study compliance or may confound results.

Sites / Locations

  • Washington University Division of Dermatology

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

open label

Arm Description

All participants will receive Apremilast 30 mg BID.

Outcomes

Primary Outcome Measures

Absolute NRS Itch Score at Week 16 (End of Treatment)
Participants will complete a Numeric Rating Scale for itch (0 representing "no itching" through 10 representing "worst itch imaginable") will be recalled from prior 24 hours and the prior week. 0 is the best score (minimum) and 10 is the worst score (maximum) in terms of clinical outcome. This is an ordinal scale that runs from 0 to 10.

Secondary Outcome Measures

Absolute DLQI at Week 16
Participants will complete a 10 question Dermatology Quality of Life survey at baseline through Week 16 The DLQI is a numerical scale that scores multiple parameters of skin symptoms on a scale from 0 to 30. 0-1 = no effect at all on a patient's life (most favorable clinical outcome and minimum score), 1-5 = small effect on patient's life, 6-10 = moderate effect on patient's life, 11-20 = very large effect on patient's life, 21-30 = extremely large effect on patient's life (worse clinical outcome and maximum score).
NRS at Screening, Baseline and Weeks 2,4,8,12,16,and 18
Participants' itch will be measured utilizing the Numeric Rating Scale for itch (0 representing "no itching" through 10 representing "worst itch imaginable") will be recalled from prior 24 hours and the prior week. 0 is the best score (minimum) and 10 is the worst score (maximum) in terms of clinical outcome. This is an ordinal scale that runs from 0 to 10.
DLQI at Screening, Baseline, and Weeks 2,4,8,12,16 and 18
Participants will complete a 10 question Dermatology Life Quality Index questionnaire at Screening, Baseline, and Weeks 2,4,8,12,16,18.

Full Information

First Posted
July 28, 2017
Last Updated
June 23, 2021
Sponsor
Washington University School of Medicine
Collaborators
Celgene Corporation
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1. Study Identification

Unique Protocol Identification Number
NCT03239106
Brief Title
A Study Examining the Medication Apremilast as Treatment for Chronic Itch
Official Title
An Open Label Study of Apremilast in Chronic Idiopathic Pruritus
Study Type
Interventional

2. Study Status

Record Verification Date
June 2021
Overall Recruitment Status
Completed
Study Start Date
December 1, 2017 (Actual)
Primary Completion Date
October 31, 2018 (Actual)
Study Completion Date
September 19, 2019 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Washington University School of Medicine
Collaborators
Celgene Corporation

4. Oversight

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

5. Study Description

Brief Summary
Chronic Itch is a debilitating condition affecting many people. Currently, there are no FDA-approved treatments. Apremilast is an FDA-approved oral medication used to successfully treat the inflammatory skin disorder psoriasis and the inflammatory disorder psoriatic arthritis. This study examines if apremiliast taken twice daily relieves chronic itch.
Detailed Description
There is no FDA-approved medication for chronic idiopathic pruritus (CIP). Apremilast has demonstrated notable activity and is approved for treatment in other pruritic inflammatory skin conditions such as psoriasis. The drug is currently being investigated as therapy for atopic dermatitis. Additionally, the investigators have preliminary data to suggest that apremilast's anti-inflammatory properties may work via neuromodulation targeting neuronal cytokine pathways. The proposed study plans to assess the efficacy of apremilast 30 mg BID in the setting of CIP. Durable response to a medication is typically seen within one to two months of starting an efficacious medication in subjects who respond. Therefore, the investigators have designed this study to end at Week 16 to definitively determine efficacy and conclude the study with confidence with regard to both efficacy and failure.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Itch
Keywords
itch, pruritus, CIP

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
open label
Arm Type
Experimental
Arm Description
All participants will receive Apremilast 30 mg BID.
Intervention Type
Drug
Intervention Name(s)
Apremilast
Other Intervention Name(s)
Otezla
Intervention Description
Apremilast 30 mg BID daily
Primary Outcome Measure Information:
Title
Absolute NRS Itch Score at Week 16 (End of Treatment)
Description
Participants will complete a Numeric Rating Scale for itch (0 representing "no itching" through 10 representing "worst itch imaginable") will be recalled from prior 24 hours and the prior week. 0 is the best score (minimum) and 10 is the worst score (maximum) in terms of clinical outcome. This is an ordinal scale that runs from 0 to 10.
Time Frame
Week 16
Secondary Outcome Measure Information:
Title
Absolute DLQI at Week 16
Description
Participants will complete a 10 question Dermatology Quality of Life survey at baseline through Week 16 The DLQI is a numerical scale that scores multiple parameters of skin symptoms on a scale from 0 to 30. 0-1 = no effect at all on a patient's life (most favorable clinical outcome and minimum score), 1-5 = small effect on patient's life, 6-10 = moderate effect on patient's life, 11-20 = very large effect on patient's life, 21-30 = extremely large effect on patient's life (worse clinical outcome and maximum score).
Time Frame
Week 16
Title
NRS at Screening, Baseline and Weeks 2,4,8,12,16,and 18
Description
Participants' itch will be measured utilizing the Numeric Rating Scale for itch (0 representing "no itching" through 10 representing "worst itch imaginable") will be recalled from prior 24 hours and the prior week. 0 is the best score (minimum) and 10 is the worst score (maximum) in terms of clinical outcome. This is an ordinal scale that runs from 0 to 10.
Time Frame
Screening through Week 18 (follow up visit)
Title
DLQI at Screening, Baseline, and Weeks 2,4,8,12,16 and 18
Description
Participants will complete a 10 question Dermatology Life Quality Index questionnaire at Screening, Baseline, and Weeks 2,4,8,12,16,18.
Time Frame
Screening through Week 18 (follow up visit)

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Key Inclusion Criteria: A subject who meets all of the following criteria may be included in the study: Male and non-pregnant, non-lactating female subjects aged 18 years or older Diagnosed with chronic idiopathic pruritus (CIP) with an NRS Itch Score of ≥ 7 at both Screening and Baseline Diagnosis of CIP for at least 6 weeks prior to screening Willingness to avoid pregnancy or fathering of children Ability and willingness to provide written informed consent Willing and able to comply with all study requirements and restrictions Willing to not participate in any other interventional trial for the duration of their participation Subjects must be in good health as determined by medical history, physical examination, electrocardiogram, clinical laboratory tests and vital signs Failure of a course 2-week course of treatment with topical triamcinolone 0.1% ointment BID Histopathological demonstration of skin eosinophils, mast cell activation, lymphocytic infiltration, and/or dermal edema Exclusion Criteria: Key Exclusion Criteria: A subject who meets any of the following criteria will be excluded from the study: Chronic pruritus due to a defined primary dermatologic disorder (e.g., atopic dermatitis, psoriasis, etc.) Patients with a prior diagnosis of excoriation disorder Use of topical treatments for CIP (other than bland emollients) within 1 week of Baseline Systemic immunosuppressive or immunomodulating drugs within 4 weeks of Baseline Subjects with cytopenias at screening, defined as: Leukocytes < 3 × 109/L. Neutrophils < lower limit of normal. Lymphocytes < 0.5 × 109/L Hemoglobin < 10 g/dL. Platelets < 100 × 109/L. Unwilling or unable to follow medication restrictions described in Section 5.6.3, or unwilling or unable to sufficiently washout from use of restricted medication Under medical treatment for a skin disease with a therapy listed in the prohibited medications section that may influence the results of the study Current clinically significant cardiovascular, respiratory, neurologic, hepatic, hematopoietic, renal gastrointestinal, endocrine or metabolic dysfunction unless currently controlled and stable, including (but not limited to) the following: Positive for Hepatitis C antibody test (anti-HCF) Positive for hepatitis B surface antigen (HBsAg) or hepatitis B core antibody (HBcAb) Positive for HIV (DUO test, p24 antigen) Active malignancy Active substance abuse or history of substance abuse within 6 months of screening History (including family history) or current evidence of congenital long QT syndrome or known acquired QT prolongation Exposure to any investigational medication, including placebo, within 60 days of the Baseline Visit Subjects who had previously received apremilast Subjects with severely impaired liver function (Child-Pugh Class C) or end-stage renal disease on dialysis or at least 1 of the following: Serum creatinine > 1.5 mg/dL Alanine aminotransferase or aspartate aminotransferase ≥ 1.5 × upper limit of normal Anyone affiliated with the site or sponsor and/or anyone who may consent under duress Any other sound medical reason as determined by the Investigator including any condition which may lead to an unfavorable risk-benefit of study participation, may interfere with study compliance or may confound results.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Brian S. Kim, MD
Organizational Affiliation
Washington University School of Medicine
Official's Role
Principal Investigator
Facility Information:
Facility Name
Washington University Division of Dermatology
City
Saint Louis
State/Province
Missouri
ZIP/Postal Code
63108
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No

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A Study Examining the Medication Apremilast as Treatment for Chronic Itch

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