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Dupilumab in Severe Chronic Hand Eczema (DUPSHE)

Primary Purpose

Hand Eczema

Status
Active
Phase
Phase 2
Locations
Netherlands
Study Type
Interventional
Intervention
Dupilumab
Placebo
Sponsored by
University Medical Center Groningen
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Hand Eczema focused on measuring Hand eczema, Dupilumab

Eligibility Criteria

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

Inclusion Criteria:

  • Age ≥ 18 years and ≤ 75 years.
  • Severe or very severe chronic hand eczema as defined by a Physician Global Assessment (PGA) using a validated Photoguide.
  • Inflammatory subtypes of hand eczema: recurrent vesicular hand eczema or chronic fissured hand eczema.
  • An inadequate response to topical corticosteroids within 6 months before screening.
  • A history of prior alitretinoin exposure and inadequate response or intolerance to alitretinoin.
  • Patients has also received standard skin care, including emollients and barrier protection as appropriate, without significant improvement.
  • Patients has avoided irritants and contact allergens, if identified, without significant improvement.
  • Women of childbearing potential are required to use a highly effective (failure rate of <1% per year when used consistently and correctly) method of birth control, prior to receiving study intervention, during the study and for at least 10 weeks after receiving the last administration of study intervention. E.g., established use of oral, injected or implanted hormonal methods of contraception; placement of an intrauterine device or intrauterine system; barrier methods: condom or occlusive cap (diaphragm or cervical/vault caps) plus spermicidal foam/gel/film/cream/suppository (if available in their locale); male partner sterilization (the vasectomized partner should be the sole partner for that participant); true abstinence (when this is in line with the preferred and usual lifestyle of the participant). NOTE: If a female participant's childbearing potential changes after start of the study (e.g., a woman who is not heterosexually active becomes active, a premenarchal woman experiences menarche), she must begin practicing a highly effective method of birth control, as described above.
  • A woman of childbearing potential must have a negative serum or urine pregnancy test (β-human chorionic gonadotropin [β-hCG]) at screening and at Week 0 prior to administration of study intervention;
  • Agree not to receive a live virus or live bacterial vaccination during the study, or within 12 weeks after the last administration of study intervention.
  • Agree not to receive a Bacillus Calmette-Guérin (BCG) vaccination during the study, or within 12 months after the last administration of study intervention.
  • Be willing and able to adhere to the prohibitions and restrictions specified in this protocol.
  • Must sign an informed consent form (ICF) indicating that he or she understands the purpose of and procedures required for the study, and is willing to participate in the study.

Exclusion Criteria:

A potential subject who meets any of the following criteria will be excluded from participation in this study:

  • Other clinical subtypes of hand eczema, e.g. hyperkeratotic hand eczema, as defined by the Danish Contact Dermatitis Group24.
  • Treatment with alitretinoin, systemic immunosuppressive medication or UV radiation within the previous 4 weeks.
  • Patients with predominantly atopic dermatitis, in whom the hands are also involved, but no main concern. Patients with controlled atopic dermatitis, in which the hands are mainly affected, are eligible for inclusion.
  • Psoriasis of the hands.
  • Active bacterial, fungal, or viral infection of the hands.
  • Pregnant/lactating or planning to become pregnant during the study period.
  • Current malignancy (other than successfully treated non-metastatic cutaneous squamous cell or basal cell carcinoma and⁄or localized carcinoma in situ of the cervix).
  • Participant has known allergies, hypersensitivity, or intolerance to dupilumab or its excipients: L-arginine hydrochloride, L-histidine, polysorbate 80, sodium acetate, acetic acid, sucrose, water for injections.
  • Participants with active helminth and other parasitic infections.
  • Patients infected with human immunodeficiency virus (HIV) (positive serology for HIV antibody).
  • Patients testing positive for hepatitis B virus (HBV) or hepatitis C (HCV) infection.

Sites / Locations

  • University Medical Center Groningen

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Placebo Comparator

Arm Label

Dupilumab

Placebo

Arm Description

Patients with severe hand eczema with an inadequate response or intolerance to alitretinoin. This group will receive dupilumab injections (600mg subcutaneously as a loading dose, followed by 300mg subcutaneously once every two weeks).

Patients with severe hand eczema with an inadequate response or intolerance to alitretinoin. This group will receive placebo injections (600mg subcutaneously as a loading dose, followed by 300mg subcutaneously once every two weeks).

Outcomes

Primary Outcome Measures

Response to treatment/hand eczema severity (Hand Eczema Severity Index, HECSI)
HECSI is an instrument used in clinical trials to rate the severity of 6 clinical signs of hand eczema and the extent of the lesions on each of 5 hand areas by use of standard scales. The total HECSI score is based on a 4-point severity scale ranging from 0 (none/absent) to 3 (severe) and a 5-point scale rating the affected area(s) ranging from 0 (0% affected area) to 4 (76% to 100% affected area). A decrease in score relates to an improvement in signs and symptoms. Response is defined as HECSI-75: the proportion of patients wit a HECSI score of ≥75% improvement from baseline.

Secondary Outcome Measures

Response to treatment/hand eczema severity (Photographic guide)
The photographic guide is a five-point scale that provides a global clinical assessment of hand eczema severity ranging from 0 to 4, where 0 indicates clear, 1 is almost clear, 2 is moderate, 4 is severe; and 5 indicates very severe hand eczema. A decrease in score relates to an improvement in signs and symptoms.
Response to treatment/hand eczema/foot eczema severity (Physician Global Assessment)
A decrease in score relates to an improvement in signs and symptoms.
Response to treatment/hand eczema/foot eczema severity (modified Total Lesion Symptom Score, mTLSS)
mTLSS combines an evaluation of hand and foot eczema lesions severity; scores are summed, extending from a base estimation of 0 (no signs or symptoms) to the most extreme of 18 (more serious disease).
Response to treatment/hand eczema severity (Hand Eczema Severity Index, HECSI)
HECSI is an instrument used in clinical trials to rate the severity of 6 clinical signs of hand eczema and the extent of the lesions on each of 5 hand areas by use of standard scales. The total HECSI score is based on a 4-point severity scale ranging from 0 (none/absent) to 3 (severe) and a 5-point scale rating the affected area(s) ranging from 0 (0% affected area) to 4 (76% to 100% affected area). A decrease in score relates to an improvement in signs and symptoms.
Patient reported change (Patient Global Assessment, PaGA)
Percentage of change of hand eczema symptoms assessed by PaGA. 0 indicates clear or almost clear (at least 90% clearing of disease signs and symptoms compared to baseline), 5 means worsening of symptoms compared to baseline.
Changeof pruritus (Numerical Rating Scale, NRS)
Pruritus NRS is an assessment tool that is used to report the intensity of a patient's pruritus, both maximum and average intensity, during a 24-hour recall period. Maximum itch intensity on a scale of 0 - 10 (0 = no itch; 10 = worst itch imaginable).
Change of pain (Numerical Rating Scale, NRS)
Pain NRS is an assessment tool that is used to report the intensity of a patient's pain, both maximum and average intensity, during a 24-hour recall period. Maximum pain intensity on a scale of 0 - 10 (0 = no pain; 10 = worst pain imaginable).
Change of hand eczema related quality of life (Quality of Life in Hand Eczema Questionnaire, QOLHEQ)
The Quality Of Life in Hand Eczema Questionnaire (QOLHEQ) is an instrument to assess disease specific Health Related Quality of Life (HRQOL) in patients suffering from hand eczema. The construct HRQOL includes all impairments or limiting conditions caused by the health state of an individual. The QOLHEQ is a disease specific instrument, thereby only assessing impairments caused by hand eczema. It consists out of 30 items which can be summarized according to four domains of HRQOL: Impairments because of (1) symptoms, (2) emotions, (3) limitations in functioning or (4) because of treatment and prevention. A high score is indicative of a poor hand eczema related HRQOL.
Changeof quality of life (Dermatology Life Quality Index, DLQI)
DLQI is a 10-item, validated questionnaire to assess the impact of skin disease symptoms and treatment on quality of life (QOL); over the past week, with an overall scoring of 0 (disease has no effect on patient's life) to 30 (disease has an extremely large effect on patient's life); a high score is indicative of a poor QoL.
Change of work productivity and impairment (Work Productivity and Activity Impairment, WPAI)
The WPAI consists of 6 items, assessing absenteeism, presenteeism, work productivity loss and activity impairment. Higher scores indicate less productivity and a greater impairment.
Change of anxiety and depression (Hospital Anxiety and Depression scale, HADS)
HADS is a 14-item questionnaire, 7 items for anxiety and 7 items for depression symptoms; possible scores range from 0 to 21 for each subscale. The following cut-off scores are recommended for both subscales: 7 to 8 for possible presence, 10 to 11 for probable presence, and 14 to 15 for severe anxiety or depression.
Cost-utility. Quality-adjusted life-years (QALY's): registered direct/indirect costs, combined with EQ-5D-5L outcome
Cost-effectiveness: registered direct/indirect costs combined with the primary and secondary effectiveness outcomes (HECSI and PG)
Safety and tolerability (adverse events)

Full Information

First Posted
June 12, 2020
Last Updated
August 18, 2022
Sponsor
University Medical Center Groningen
Collaborators
Genzyme, a Sanofi Company
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1. Study Identification

Unique Protocol Identification Number
NCT04512339
Brief Title
Dupilumab in Severe Chronic Hand Eczema
Acronym
DUPSHE
Official Title
Dupilumab in Severe Chronic Hand Eczema With Inadequate Response or Intolerance to Alitretinoin
Study Type
Interventional

2. Study Status

Record Verification Date
August 2022
Overall Recruitment Status
Active, not recruiting
Study Start Date
August 1, 2020 (Actual)
Primary Completion Date
August 2022 (Anticipated)
Study Completion Date
August 2022 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University Medical Center Groningen
Collaborators
Genzyme, a Sanofi Company

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 purpose of this study is to investigate the efficacy of dupilumab in hand eczema patients with an inadequate response or intolerance to alitretinoin.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Hand Eczema
Keywords
Hand eczema, Dupilumab

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Model Description
2:1 randomization. Two-thirds will receive dupilumab injections (loading dose of 600mg subcutaneously followed by 300 mg subcutaneously every 2 weeks). One-third will receive placebo injections.
Masking
ParticipantInvestigator
Allocation
Randomized
Enrollment
30 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Dupilumab
Arm Type
Active Comparator
Arm Description
Patients with severe hand eczema with an inadequate response or intolerance to alitretinoin. This group will receive dupilumab injections (600mg subcutaneously as a loading dose, followed by 300mg subcutaneously once every two weeks).
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Patients with severe hand eczema with an inadequate response or intolerance to alitretinoin. This group will receive placebo injections (600mg subcutaneously as a loading dose, followed by 300mg subcutaneously once every two weeks).
Intervention Type
Drug
Intervention Name(s)
Dupilumab
Other Intervention Name(s)
Dupixent
Intervention Description
Dupilumab injections (blinded labels)
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Placebo injections (blinded labels), matching the dupilumab injections in quantity and appearance
Primary Outcome Measure Information:
Title
Response to treatment/hand eczema severity (Hand Eczema Severity Index, HECSI)
Description
HECSI is an instrument used in clinical trials to rate the severity of 6 clinical signs of hand eczema and the extent of the lesions on each of 5 hand areas by use of standard scales. The total HECSI score is based on a 4-point severity scale ranging from 0 (none/absent) to 3 (severe) and a 5-point scale rating the affected area(s) ranging from 0 (0% affected area) to 4 (76% to 100% affected area). A decrease in score relates to an improvement in signs and symptoms. Response is defined as HECSI-75: the proportion of patients wit a HECSI score of ≥75% improvement from baseline.
Time Frame
16 weeks
Secondary Outcome Measure Information:
Title
Response to treatment/hand eczema severity (Photographic guide)
Description
The photographic guide is a five-point scale that provides a global clinical assessment of hand eczema severity ranging from 0 to 4, where 0 indicates clear, 1 is almost clear, 2 is moderate, 4 is severe; and 5 indicates very severe hand eczema. A decrease in score relates to an improvement in signs and symptoms.
Time Frame
Week 4, 8, 12, 16
Title
Response to treatment/hand eczema/foot eczema severity (Physician Global Assessment)
Description
A decrease in score relates to an improvement in signs and symptoms.
Time Frame
Week 4, 8, 12, 16
Title
Response to treatment/hand eczema/foot eczema severity (modified Total Lesion Symptom Score, mTLSS)
Description
mTLSS combines an evaluation of hand and foot eczema lesions severity; scores are summed, extending from a base estimation of 0 (no signs or symptoms) to the most extreme of 18 (more serious disease).
Time Frame
Week 4, 8, 12, 16
Title
Response to treatment/hand eczema severity (Hand Eczema Severity Index, HECSI)
Description
HECSI is an instrument used in clinical trials to rate the severity of 6 clinical signs of hand eczema and the extent of the lesions on each of 5 hand areas by use of standard scales. The total HECSI score is based on a 4-point severity scale ranging from 0 (none/absent) to 3 (severe) and a 5-point scale rating the affected area(s) ranging from 0 (0% affected area) to 4 (76% to 100% affected area). A decrease in score relates to an improvement in signs and symptoms.
Time Frame
Week 4, 8, 12, 16
Title
Patient reported change (Patient Global Assessment, PaGA)
Description
Percentage of change of hand eczema symptoms assessed by PaGA. 0 indicates clear or almost clear (at least 90% clearing of disease signs and symptoms compared to baseline), 5 means worsening of symptoms compared to baseline.
Time Frame
Week 4, 8, 12, 16
Title
Changeof pruritus (Numerical Rating Scale, NRS)
Description
Pruritus NRS is an assessment tool that is used to report the intensity of a patient's pruritus, both maximum and average intensity, during a 24-hour recall period. Maximum itch intensity on a scale of 0 - 10 (0 = no itch; 10 = worst itch imaginable).
Time Frame
Week 4, 8, 12, 16
Title
Change of pain (Numerical Rating Scale, NRS)
Description
Pain NRS is an assessment tool that is used to report the intensity of a patient's pain, both maximum and average intensity, during a 24-hour recall period. Maximum pain intensity on a scale of 0 - 10 (0 = no pain; 10 = worst pain imaginable).
Time Frame
Week 4, 8, 12, 16
Title
Change of hand eczema related quality of life (Quality of Life in Hand Eczema Questionnaire, QOLHEQ)
Description
The Quality Of Life in Hand Eczema Questionnaire (QOLHEQ) is an instrument to assess disease specific Health Related Quality of Life (HRQOL) in patients suffering from hand eczema. The construct HRQOL includes all impairments or limiting conditions caused by the health state of an individual. The QOLHEQ is a disease specific instrument, thereby only assessing impairments caused by hand eczema. It consists out of 30 items which can be summarized according to four domains of HRQOL: Impairments because of (1) symptoms, (2) emotions, (3) limitations in functioning or (4) because of treatment and prevention. A high score is indicative of a poor hand eczema related HRQOL.
Time Frame
Week 4, 8, 12, 16
Title
Changeof quality of life (Dermatology Life Quality Index, DLQI)
Description
DLQI is a 10-item, validated questionnaire to assess the impact of skin disease symptoms and treatment on quality of life (QOL); over the past week, with an overall scoring of 0 (disease has no effect on patient's life) to 30 (disease has an extremely large effect on patient's life); a high score is indicative of a poor QoL.
Time Frame
Week 4, 8, 12, 16
Title
Change of work productivity and impairment (Work Productivity and Activity Impairment, WPAI)
Description
The WPAI consists of 6 items, assessing absenteeism, presenteeism, work productivity loss and activity impairment. Higher scores indicate less productivity and a greater impairment.
Time Frame
Week 4, 8, 12, 16
Title
Change of anxiety and depression (Hospital Anxiety and Depression scale, HADS)
Description
HADS is a 14-item questionnaire, 7 items for anxiety and 7 items for depression symptoms; possible scores range from 0 to 21 for each subscale. The following cut-off scores are recommended for both subscales: 7 to 8 for possible presence, 10 to 11 for probable presence, and 14 to 15 for severe anxiety or depression.
Time Frame
Week 4, 8, 12, 16
Title
Cost-utility. Quality-adjusted life-years (QALY's): registered direct/indirect costs, combined with EQ-5D-5L outcome
Time Frame
Week 4, 8, 12, 16
Title
Cost-effectiveness: registered direct/indirect costs combined with the primary and secondary effectiveness outcomes (HECSI and PG)
Time Frame
Week 4, 8, 12, 16
Title
Safety and tolerability (adverse events)
Time Frame
Up to 16 weeks

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: Age ≥ 18 years and ≤ 75 years. Severe or very severe chronic hand eczema as defined by a Physician Global Assessment (PGA) using a validated Photoguide. Inflammatory subtypes of hand eczema: recurrent vesicular hand eczema or chronic fissured hand eczema. An inadequate response to topical corticosteroids within 6 months before screening. A history of prior alitretinoin exposure and inadequate response or intolerance to alitretinoin. Patients has also received standard skin care, including emollients and barrier protection as appropriate, without significant improvement. Patients has avoided irritants and contact allergens, if identified, without significant improvement. Women of childbearing potential are required to use a highly effective (failure rate of <1% per year when used consistently and correctly) method of birth control, prior to receiving study intervention, during the study and for at least 10 weeks after receiving the last administration of study intervention. E.g., established use of oral, injected or implanted hormonal methods of contraception; placement of an intrauterine device or intrauterine system; barrier methods: condom or occlusive cap (diaphragm or cervical/vault caps) plus spermicidal foam/gel/film/cream/suppository (if available in their locale); male partner sterilization (the vasectomized partner should be the sole partner for that participant); true abstinence (when this is in line with the preferred and usual lifestyle of the participant). NOTE: If a female participant's childbearing potential changes after start of the study (e.g., a woman who is not heterosexually active becomes active, a premenarchal woman experiences menarche), she must begin practicing a highly effective method of birth control, as described above. A woman of childbearing potential must have a negative serum or urine pregnancy test (β-human chorionic gonadotropin [β-hCG]) at screening and at Week 0 prior to administration of study intervention; Agree not to receive a live virus or live bacterial vaccination during the study, or within 12 weeks after the last administration of study intervention. Agree not to receive a Bacillus Calmette-Guérin (BCG) vaccination during the study, or within 12 months after the last administration of study intervention. Be willing and able to adhere to the prohibitions and restrictions specified in this protocol. Must sign an informed consent form (ICF) indicating that he or she understands the purpose of and procedures required for the study, and is willing to participate in the study. Exclusion Criteria: A potential subject who meets any of the following criteria will be excluded from participation in this study: Other clinical subtypes of hand eczema, e.g. hyperkeratotic hand eczema, as defined by the Danish Contact Dermatitis Group24. Treatment with alitretinoin, systemic immunosuppressive medication or UV radiation within the previous 4 weeks. Patients with predominantly atopic dermatitis, in whom the hands are also involved, but no main concern. Patients with controlled atopic dermatitis, in which the hands are mainly affected, are eligible for inclusion. Psoriasis of the hands. Active bacterial, fungal, or viral infection of the hands. Pregnant/lactating or planning to become pregnant during the study period. Current malignancy (other than successfully treated non-metastatic cutaneous squamous cell or basal cell carcinoma and⁄or localized carcinoma in situ of the cervix). Participant has known allergies, hypersensitivity, or intolerance to dupilumab or its excipients: L-arginine hydrochloride, L-histidine, polysorbate 80, sodium acetate, acetic acid, sucrose, water for injections. Participants with active helminth and other parasitic infections. Patients infected with human immunodeficiency virus (HIV) (positive serology for HIV antibody). Patients testing positive for hepatitis B virus (HBV) or hepatitis C (HCV) infection.
Facility Information:
Facility Name
University Medical Center Groningen
City
Groningen
ZIP/Postal Code
9713 GZ
Country
Netherlands

12. IPD Sharing Statement

Plan to Share IPD
No
IPD Sharing Plan Description
Data will be published anonymously and will not be possible to trace back to individual participants.

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Dupilumab in Severe Chronic Hand Eczema

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