search
Back to results

Cost-effectiveness of Adalimumab and Surgery vs Adalimumab in HS (HS-COST)

Primary Purpose

Hidradenitis Suppurativa

Status
Unknown status
Phase
Phase 4
Locations
Netherlands
Study Type
Interventional
Intervention
Wide Excision
Adalimumab Injection
Sponsored by
Erasmus Medical Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Hidradenitis Suppurativa focused on measuring Acne inversa, Adalimumab, Cost-effectiveness

Eligibility Criteria

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

Inclusion Criteria:

  • Age ≥18 years.
  • Moderate to (very) severe HS defined as a score of ≥3 points on the PGA (range 1-5) and with a DLQI of at least 11 (range 0-30).
  • Indication for adalimumab: i.e. uncontrolled disease (HS) under conventional therapy and/or minor surgery.
  • A diagnosis of HS for more than six months prior to baseline.
  • Clearance of HS can reasonably be achieved with three surgical interventions as based on consensus between two dermatosurgeons.
  • Willing and able to undergo general anaesthesia or procedural sedation and analgesia.
  • Able and willing to give written informed consent and to comply with the study requirements.

Exclusion Criteria:

  • Contraindication for treatment with adalimumab (sepsis or risk of sepsis, active or latent tuberculosis, serious active local and/or chronic infections, heart failure NYHA class III/IV, severe liver disease, pre-existing HIV, active viral hepatitis, demyelinating disease, or allergy to adalimumab or any other ingredients of HUMIRA®).
  • Previous or current use of adalimumab or other anti-TNF-α therapy.
  • Current or recurrent clinically significant skin condition in the HS treatment area other than HS.
  • Presence of other uncontrolled clinically significant major disease.
  • Pregnant and lactating women.
  • Malignancy (except basal cell carcinoma), lymphoproliferative disease or a history of malignancy.
  • Current use of oral antibiotics (a washout period of 14 days is required).
  • Current use of oral corticosteroids (a washout period of 30 days is required).

Sites / Locations

  • Erasmus MCRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Experimental

Arm Label

Adalimumab Monotherapy

Adalimumab + Surgery

Arm Description

Adalimumab injections will be administered through subcutaneously in a weekly dose of 40mg from week 4 up to 24 months (V8), after an initial dose of 160mg at week 0 and a 80mg dose at week 2, continued for 2 years in total.

Patients will be treated with a combination of adalimumab and wide excision, with a maximum of three surgical interventions within the first year. Adalimumab will be administered through subcutaneous injections in weekly dose of 40mg from week 4 up to 24 months (V8), after an initial dose of 160mg at week 0 and a 80mg dose at week 2, continued until the last surgery.

Outcomes

Primary Outcome Measures

Cost-utility
Cost-utility: costs / point change in QALY

Secondary Outcome Measures

Clinical efficacy using HiSCR
Assessment of clinical efficacy using HiSCR
Clinical efficacy using change in HS-PGA
Assessment of clinical efficacy using change in HS-PGA
Clinical efficacy using the number of flares
Assessment of clinical efficacy using the overall number of flares
Incidence and severity of treatment related adverse events
Assessment of tolerability and safety by recording the incidence and severity of all treatment related adverse events.
Cost-effectiveness
Cost-effectiveness: costs / point change in DLQI.
Quality of life using change in EQ-5D-5L
Assessment of changes in quality of life using the EuroQol-5D-5L (EQ-5D-5L)
Quality of life using change in DLQI
Assessment of changes in quality of life using the DLQI.
Quality of life using change in Skindex-17
Assessment of changes in quality of life using the Skindex-17
Treatment satisfaction
Assessment of treatment satisfaction on a 5 point Likert scale
High sensitivity CRP
Assessment of change in high sensitivity CRP.
Cytokines
Assessment of cytokines as possible predictive biomarkers in skin biopsies.
Change in parameters of metabolic syndrome
Assessment of the change in parameters of metabolic syndrome: waist circumference, blood pressure, fasting plasma glucose, triglycerides, and HDL levels.
Change in parameters of pre-diabetes
Assessment of the change in parameters of pre-diabetes using a HOMA model
Identification of blood metabolite profiles
Identification of metabolites or metabolite profiles related to HS phenotypes, disease severity.
Identification of metabolites associated with treatment response
Identification of metabolites (or metabolite profiles) predicting clinical response to treatment.
Assessment of changes in metabolite (profiles)
Assessment of changes in metabolites (or metabolite profiles) in response to treatment.
Relation between adalimumab trough concentrations and treatment response
Relation between adalimumab trough concentrations and treatment response
Relation between adalimumab trough concentrations in serum and skin samples
Relation between adalimumab trough concentrations in serum and adalimumab trough concentrations in skin biopsies.
Influence of patient characteristics on adalimumab serum trough concentrations
adalimumab trough concentrations
Predictive value of early dry-blood-spots
Predictive value of early adalimumab concentrations using dry-blood-spots on treatment response at 3 months
Objectively assessed therapy adherence using adalimumab trough concentrations
Objectively assessed therapy adherence using adalimumab trough concentrations
Objectively assessed therapy adherence using collected syringes
Objectively assessed therapy adherence using collected syringes
Patient reported therapy adherence using a diary
Patient reported therapy adherence using a diary recording date of every injection.
Impact of surgery on quality of life measured with DLQI
Assessment of the impact of wide excision on quality of life measured with DLQI
Impact of surgery on work productivity measured with WPAI
Assessment of the impact of wide excision on work productivity and activity, measured with WPAI.
Wound closure time
Assessment of time to complete healing after wide excision using patient reported closure time.
Recurrence rate
Assessment of the recurrence of HS lesions after wide excision

Full Information

First Posted
July 4, 2017
Last Updated
February 7, 2019
Sponsor
Erasmus Medical Center
Collaborators
Prothya Biosolutions
search

1. Study Identification

Unique Protocol Identification Number
NCT03221621
Brief Title
Cost-effectiveness of Adalimumab and Surgery vs Adalimumab in HS
Acronym
HS-COST
Official Title
Cost-effectiveness of Adalimumab With Adjuvant Surgery Versus Adalimumab Monotherapy in the Treatment of Hidradenitis Suppurativa'
Study Type
Interventional

2. Study Status

Record Verification Date
February 2019
Overall Recruitment Status
Unknown status
Study Start Date
July 31, 2018 (Actual)
Primary Completion Date
July 31, 2022 (Anticipated)
Study Completion Date
July 31, 2022 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Erasmus Medical Center
Collaborators
Prothya Biosolutions

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
The primary objective of this randomized controlled clinical trial in a real life setting is to evaluate the cost-utility of limumab monotherapy compared with the combination of adalimumab and a maximum of three surgeries after two years of treatment in adult patients with moderate to severe HS.
Detailed Description
The primary objective of this randomized controlled clinical trial in a real life setting is to evaluate the cost-utility of limumab monotherapy (Group A) with the combination of adalimumab and a maximum of three surgeries (Group B) years of treatment in adult patients with moderate to severe HS. Patients in group A will be treated with adalimumab monotherapy according to normal clinical practice and will be given the possibility to crossover into Group B when they do not achieve the HiSCR after 6 months of treatment. Additionally patients will be offered treatment with infliximab, according to clinical practice, until the last surgery. Patients in group B will receive adalimumab combined with a maximum of three adjuvant excisions of active lesions, both according to routine clinical practice.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Hidradenitis Suppurativa
Keywords
Acne inversa, Adalimumab, Cost-effectiveness

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Model Description
Patients will be treated with either the combination of adalimumab and surgery or adalimumab monotherapy for two years, both according to normal clinical practice. Patients on adalimumab monotherapy will be given the possibility to crossover into Group B when they do not achieve the HiSCR after 6 months of treatment. Additionally patients will be offered treatment with infliximab, according to clinical practice, until he last surgery.
Masking
None (Open Label)
Allocation
Randomized
Enrollment
128 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Adalimumab Monotherapy
Arm Type
Active Comparator
Arm Description
Adalimumab injections will be administered through subcutaneously in a weekly dose of 40mg from week 4 up to 24 months (V8), after an initial dose of 160mg at week 0 and a 80mg dose at week 2, continued for 2 years in total.
Arm Title
Adalimumab + Surgery
Arm Type
Experimental
Arm Description
Patients will be treated with a combination of adalimumab and wide excision, with a maximum of three surgical interventions within the first year. Adalimumab will be administered through subcutaneous injections in weekly dose of 40mg from week 4 up to 24 months (V8), after an initial dose of 160mg at week 0 and a 80mg dose at week 2, continued until the last surgery.
Intervention Type
Procedure
Intervention Name(s)
Wide Excision
Intervention Description
Wide excision is performed under general anaesthesia or procedural sedation and analgesia (PSA). All lesional tissue, including fibrosis, is electrosurgically removed until the area is clear. The subcutaneous fat and epithelised sinus floors are left intact where possible. The wounds are left open to heal by secondary intention.
Intervention Type
Drug
Intervention Name(s)
Adalimumab Injection
Other Intervention Name(s)
Humira
Intervention Description
Adalimumab will be administered through subcutaneous injections in weekly dose of 40mg from week 4 up to 24 months (V8), after an initial dose of 160mg at week 0 and a 80mg dose at week 2 until end of study or last surgery.
Primary Outcome Measure Information:
Title
Cost-utility
Description
Cost-utility: costs / point change in QALY
Time Frame
2 years
Secondary Outcome Measure Information:
Title
Clinical efficacy using HiSCR
Description
Assessment of clinical efficacy using HiSCR
Time Frame
2 years
Title
Clinical efficacy using change in HS-PGA
Description
Assessment of clinical efficacy using change in HS-PGA
Time Frame
2 years
Title
Clinical efficacy using the number of flares
Description
Assessment of clinical efficacy using the overall number of flares
Time Frame
2 years
Title
Incidence and severity of treatment related adverse events
Description
Assessment of tolerability and safety by recording the incidence and severity of all treatment related adverse events.
Time Frame
2 years
Title
Cost-effectiveness
Description
Cost-effectiveness: costs / point change in DLQI.
Time Frame
2 years
Title
Quality of life using change in EQ-5D-5L
Description
Assessment of changes in quality of life using the EuroQol-5D-5L (EQ-5D-5L)
Time Frame
2 years
Title
Quality of life using change in DLQI
Description
Assessment of changes in quality of life using the DLQI.
Time Frame
2 years
Title
Quality of life using change in Skindex-17
Description
Assessment of changes in quality of life using the Skindex-17
Time Frame
2 years
Title
Treatment satisfaction
Description
Assessment of treatment satisfaction on a 5 point Likert scale
Time Frame
2 years
Title
High sensitivity CRP
Description
Assessment of change in high sensitivity CRP.
Time Frame
2 years
Title
Cytokines
Description
Assessment of cytokines as possible predictive biomarkers in skin biopsies.
Time Frame
3 months
Title
Change in parameters of metabolic syndrome
Description
Assessment of the change in parameters of metabolic syndrome: waist circumference, blood pressure, fasting plasma glucose, triglycerides, and HDL levels.
Time Frame
2 years
Title
Change in parameters of pre-diabetes
Description
Assessment of the change in parameters of pre-diabetes using a HOMA model
Time Frame
2 years
Title
Identification of blood metabolite profiles
Description
Identification of metabolites or metabolite profiles related to HS phenotypes, disease severity.
Time Frame
3 months
Title
Identification of metabolites associated with treatment response
Description
Identification of metabolites (or metabolite profiles) predicting clinical response to treatment.
Time Frame
3 months
Title
Assessment of changes in metabolite (profiles)
Description
Assessment of changes in metabolites (or metabolite profiles) in response to treatment.
Time Frame
3 months
Title
Relation between adalimumab trough concentrations and treatment response
Description
Relation between adalimumab trough concentrations and treatment response
Time Frame
3 months
Title
Relation between adalimumab trough concentrations in serum and skin samples
Description
Relation between adalimumab trough concentrations in serum and adalimumab trough concentrations in skin biopsies.
Time Frame
3 months
Title
Influence of patient characteristics on adalimumab serum trough concentrations
Description
adalimumab trough concentrations
Time Frame
3 months
Title
Predictive value of early dry-blood-spots
Description
Predictive value of early adalimumab concentrations using dry-blood-spots on treatment response at 3 months
Time Frame
3 months
Title
Objectively assessed therapy adherence using adalimumab trough concentrations
Description
Objectively assessed therapy adherence using adalimumab trough concentrations
Time Frame
2 years
Title
Objectively assessed therapy adherence using collected syringes
Description
Objectively assessed therapy adherence using collected syringes
Time Frame
2 years
Title
Patient reported therapy adherence using a diary
Description
Patient reported therapy adherence using a diary recording date of every injection.
Time Frame
2 years
Title
Impact of surgery on quality of life measured with DLQI
Description
Assessment of the impact of wide excision on quality of life measured with DLQI
Time Frame
8 weeks after each surgery
Title
Impact of surgery on work productivity measured with WPAI
Description
Assessment of the impact of wide excision on work productivity and activity, measured with WPAI.
Time Frame
8 weeks after each surgery
Title
Wound closure time
Description
Assessment of time to complete healing after wide excision using patient reported closure time.
Time Frame
through study completion, an average of 15 months
Title
Recurrence rate
Description
Assessment of the recurrence of HS lesions after wide excision
Time Frame
through study completion, an average of 15 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Age ≥18 years. Moderate to (very) severe HS defined as a score of ≥3 points on the PGA (range 1-5) and with a DLQI of at least 11 (range 0-30). Indication for adalimumab: i.e. uncontrolled disease (HS) under conventional therapy and/or minor surgery. A diagnosis of HS for more than six months prior to baseline. Clearance of HS can reasonably be achieved with three surgical interventions as based on consensus between two dermatosurgeons. Willing and able to undergo general anaesthesia or procedural sedation and analgesia. Able and willing to give written informed consent and to comply with the study requirements. Exclusion Criteria: Contraindication for treatment with adalimumab (sepsis or risk of sepsis, active or latent tuberculosis, serious active local and/or chronic infections, heart failure NYHA class III/IV, severe liver disease, pre-existing HIV, active viral hepatitis, demyelinating disease, or allergy to adalimumab or any other ingredients of HUMIRA®). Previous or current use of adalimumab or other anti-TNF-α therapy. Current or recurrent clinically significant skin condition in the HS treatment area other than HS. Presence of other uncontrolled clinically significant major disease. Pregnant and lactating women. Malignancy (except basal cell carcinoma), lymphoproliferative disease or a history of malignancy. Current use of oral antibiotics (a washout period of 14 days is required). Current use of oral corticosteroids (a washout period of 30 days is required).
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Kelsey van Straalen, MD
Phone
+ 31 107040110
Email
k.vanstraalen@eramsusmc.nl
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Martijn van Doorn, MD, PhD
Organizational Affiliation
Erasmus Medical Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
Erasmus MC
City
Rotterdam
Country
Netherlands
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Kelsey van Straalen, MD
Phone
+ 31 107040110
Email
k.vanstraalen@erasmusmc.nl
First Name & Middle Initial & Last Name & Degree
Martijn van Doorn, MD, PhD
First Name & Middle Initial & Last Name & Degree
Errol Prens, MD, PhD
First Name & Middle Initial & Last Name & Degree
Hessel van der Zee, MD, PhD
First Name & Middle Initial & Last Name & Degree
Allard Vossen, MD
First Name & Middle Initial & Last Name & Degree
Kelsey van Straalen, MD

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

Cost-effectiveness of Adalimumab and Surgery vs Adalimumab in HS

We'll reach out to this number within 24 hrs