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Naloxone Hydrochloride Study for Relief of Pruritus in Patients With MF or SS Forms of CTCL

Primary Purpose

Mycosis Fungoides, Lymphoma, T-Cell, Cutaneous, Sézary Syndrome

Status
Terminated
Phase
Phase 3
Locations
United States
Study Type
Interventional
Intervention
Naloxone Hydrochloride Lotion, 0.5%
Placebo Lotion
Sponsored by
Elorac, Inc.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Mycosis Fungoides focused on measuring Pruritus, Mycosis Fungoides, CTCL, naloxone, opiate antagonist, Sézary Syndrome

Eligibility Criteria

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

Inclusion Criteria:

All subjects must meet the following criteria for admission into the study:

  1. Signed informed consent has been obtained.
  2. Subject is at least 21 years of age.
  3. Diagnosis of mycosis fungoides (MF) or Sézary syndrome (SS) will be based on a combination of histological, clinical, and immunophenotypical criteria. The histological criteria will be based on skin biopsy from the most representative skin area. The diagnostic criteria used for each subject will be specified in the case report forms and the specific classification of MF or SS will be identified. The TNMB system will be used to classify the stage of disease (See Section 8.4 for details).
  4. Completion of the mSWAT assessment.
  5. A history of pruritus that meets following criteria:

    At Screening Day -7:

    • present on a daily basis for greater than one month prior to Screening Day -7,
    • NRS for Pruritus score ≥5 as rated by the subject at the Day -7 Visit. Note: If the score is <5 and subject is taking or has taken a medication which may be affecting pruritus (e.g. systemic antihistamine or topical steroid), and if Investigator and subject agree, subject may washout or continue washout of medication and return for Day -7 Visit procedures after washout.

    At Baseline Period 1 Day 0:

    • NRS for Pruritus score of at least 5 recorded in the subject diary on at least 4 of the 7 days preceding Baseline Period 1 Day 0.
  6. Pruritic treatment area of 5-95% of the subject's total treatable body surface area.
  7. Subject can be expected to reliably follow treatment instructions and visit schedule.
  8. Non-pregnant, non-lactating females of childbearing potential who agree to use medically acceptable forms of birth control (abstinence, hormonal contraceptives, diaphragm with spermicide, condom with spermicide, or intrauterine device) throughout the study or females of non-childbearing potential (surgically sterile [hysterectomy or bilateral tubal ligation] or post-menopausal ≥ 1 year). A negative urine pregnancy test must be confirmed at Baseline screening for all female subjects who are not post-menopausal > 1 year or surgically sterile.
  9. The subject agrees not to begin any new concomitant medications during their participation in the study, with the exception of medications necessary to treat infection, and to continue any concomitant medication throughout the study.
  10. Subject has no visual or motor impairments that will make it difficult to complete the Daily Diary or apply the study medication.
  11. Subject is able to speak, read, and write English and agrees to participate and comply with the study procedures.
  12. Subject has a body mass index (BMI) between 18.5 and 30.5 kglm2 (see Appendix C, Body Mass Index Table) (subjects in PK subset only).

Exclusion Criteria:

Subjects meeting any of the following criteria will be excluded from study participation:

  1. Pregnant or lactating female.
  2. History of clinically significant heart failure.
  3. Myocardial infarction within the past six months.
  4. A history of ventricular arrhythmia requiring treatment.
  5. Any medical condition which would, in the Investigator's opinion, preclude the subject from successfully participating in the study.
  6. A known allergy to naloxone hydrochloride or any excipient in the formulation.
  7. Previous naloxone use for pruritus.
  8. Positive urine drug screen at Day 0 for opiates. Positive urine drug screen for anything other than opiates not explained, e.g., by concomitant medication, would also exclude the subject.
  9. Treatment with any of the following during the restricted time period prior to Day -7, and at any time during the study, is not allowed:

Medication/Treatment Restriction:

Systemic narcotic analgesics (e.g. morphine, codeine) 7 days, Topical antihistamines to any skin surface [e.g. Zonalon® (doxepin)] 7 days, Other investigational drugs (excluding any therapies for the treatment of MF or SS) 30 days

Sites / Locations

  • University of Arkansas for Medical Sciences
  • City of Hope
  • Stanford University
  • USSF Health Morsani Center for Advanced Healthcare
  • Cleveland Clinic Indian River Hospital
  • Robert H. Lurie Comprehensive Cancer Center
  • Rush University Medical Center
  • Dawes Fretzin Clinical Research Group, LLC
  • University of Minnesota
  • St. Louis University Dermatology
  • Washington University School of Medicine St. Louis
  • Stony Brook Dermatology
  • University Hospitals Cleveland Medical Center
  • University of Texas MD Anderson Cancer Center
  • Inova Schar Cancer Institute
  • University of Washington / Seattle Cancer Care Alliance (SCCA)

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Placebo Comparator

Arm Label

Naloxone Hydrochloride Lotion, 0.5%

Placebo Lotion

Arm Description

Naloxone Hydrochloride Lotion 0.5%

Placebo Lotion

Outcomes

Primary Outcome Measures

Numeric Rating Scale (NRS) for Pruritus
Change from Baseline to Day 14 in average NRS for Pruritus for each Treatment Period

Secondary Outcome Measures

Responder Analysis - The difference in the proportion of subjects with a meaningful clinically significant improvement at the end of the two periods.
The difference in the proportion of subjects with a meaningful clinically significant improvement at the end of the two periods. A clinically significant improvement is defined as an improvement of at least one category on the 4-point (none, mild, moderate, severe) Likert Scale verbal rating scale (VRS) and at least two points on the 11-point NRS for Pruritus. The NRS for Pruritus scores will be converted to VRS scores as follows for the analysis: 0=none, 1-3=mild, 4-6=moderate, and 7-10=severe.
Numeric Rating Scale for Sleep
The change from Baseline at each week of the NRS for Sleep average score for each Treatment Period.
Numeric Rating Scale for Pruritus
The change from Baseline at Week 1 of the NRS for Pruritus average score for each Treatment Period.
Categorical Rating Scale (CRS) for Skin Integrity
The change from Baseline at Week 2 of the CRS for Skin Integrity for each Treatment Period.
Pruritus Quality of Life Score (PQOL)
The change from Baseline in the final categorization of the PQOL at Day 14 of each Treatment Period

Full Information

First Posted
June 15, 2016
Last Updated
October 26, 2022
Sponsor
Elorac, Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT02811783
Brief Title
Naloxone Hydrochloride Study for Relief of Pruritus in Patients With MF or SS Forms of CTCL
Official Title
A Double Blind Randomized Vehicle Controlled Crossover Study to Evaluate the Safety and Efficacy of Topical Naloxone Hydrochloride Lotion 0.5% for the Relief of Pruritus in Patients With the MF or SS Forms of Cutaneous T-Cell Lymphoma
Study Type
Interventional

2. Study Status

Record Verification Date
October 2022
Overall Recruitment Status
Terminated
Why Stopped
Sponsor decision
Study Start Date
January 2017 (Actual)
Primary Completion Date
September 2022 (Actual)
Study Completion Date
September 2022 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Elorac, Inc.

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
This multi-center, double-blind, vehicle-controlled, randomized crossover design study will evaluate the safety and efficacy of topically applied naloxone lotion, 0.5%, for the treatment of pruritus in patients with the mycosis fungoides (MF) or Sézary syndrome (SS) Forms of Cutaneous T-cell Lymphoma (CTCL). This study will also determine if there is systemic absorption of the drug in a subset of subjects and if so, describe the range and mean plasma levels reached after two weeks of three time daily (TID) dosing. Funding Source - FDA OOPD
Detailed Description
There will be 160 subjects enrolled in the study. The study consists of a Screening Period of up to 7 days during which inclusion / exclusion criteria will be reviewed. Subjects meeting inclusion / exclusion criteria including the diagnostic criteria for MF or SS and a score of at least 5 on the 11-Point Numeric Rating Scale (NRS) for Pruritus will complete the one week Screening Period. Subjects will complete a daily diary for NRS for Pruritus scores and Sleep scores. At the end of the Screening Period, subjects who have a NRS for Pruritus score of at least 5 recorded in the diary on at least 4 of the 7 days preceding Day 0 will be eligible to continue. Baseline assessments will be recorded for vital signs, pruritic body surface area, skin integrity, PQOL, and laboratory results. The Baseline period will be followed by a 2 week Treatment Period 1 in which subjects will be randomized to Naloxone Lotion 0.5% or Placebo Lotion to be applied TID for 14 days. During the 2 week Treatment Period subjects will complete daily diaries of NRS for Pruritis scores and Sleep scores. On Day 14 subjects will return to the clinic to review diaries, adverse events (AEs), concomitant medications, and to record body surface area for pruritus, skin integrity, PQOL, and laboratory results. Subjects will then enter a Washout Period for up to 56 days until the subject again scores at least 5 on the NRS for Pruritus on 4 consecutive or 4 of the past 7 days or 56 days pass. Subjects will then enter a 2 week Treatment Period 2 during which the same procedures as Treatment Period 1 will be performed except subjects will receive the alternate treatment to that assigned in Treatment Period 1. Subjects will then have the option to enter a 26 Week Open Label Treatment Period 3 during which the same procedures as Treatment Period 1 and 2 will be performed except subjects will return only at Week 13 and Week 26 and all subjects will be treated with Naloxone Lotion 0.5%.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Mycosis Fungoides, Lymphoma, T-Cell, Cutaneous, Sézary Syndrome
Keywords
Pruritus, Mycosis Fungoides, CTCL, naloxone, opiate antagonist, Sézary Syndrome

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Crossover Assignment
Masking
ParticipantInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
59 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Naloxone Hydrochloride Lotion, 0.5%
Arm Type
Active Comparator
Arm Description
Naloxone Hydrochloride Lotion 0.5%
Arm Title
Placebo Lotion
Arm Type
Placebo Comparator
Arm Description
Placebo Lotion
Intervention Type
Drug
Intervention Name(s)
Naloxone Hydrochloride Lotion, 0.5%
Intervention Description
Topical TID for 2 weeks
Intervention Type
Drug
Intervention Name(s)
Placebo Lotion
Intervention Description
Topical TID for 2 weeks
Primary Outcome Measure Information:
Title
Numeric Rating Scale (NRS) for Pruritus
Description
Change from Baseline to Day 14 in average NRS for Pruritus for each Treatment Period
Time Frame
Baseline and 2 Weeks
Secondary Outcome Measure Information:
Title
Responder Analysis - The difference in the proportion of subjects with a meaningful clinically significant improvement at the end of the two periods.
Description
The difference in the proportion of subjects with a meaningful clinically significant improvement at the end of the two periods. A clinically significant improvement is defined as an improvement of at least one category on the 4-point (none, mild, moderate, severe) Likert Scale verbal rating scale (VRS) and at least two points on the 11-point NRS for Pruritus. The NRS for Pruritus scores will be converted to VRS scores as follows for the analysis: 0=none, 1-3=mild, 4-6=moderate, and 7-10=severe.
Time Frame
Baseline and 2 Weeks
Title
Numeric Rating Scale for Sleep
Description
The change from Baseline at each week of the NRS for Sleep average score for each Treatment Period.
Time Frame
Baseline and 1 and 2 weeks
Title
Numeric Rating Scale for Pruritus
Description
The change from Baseline at Week 1 of the NRS for Pruritus average score for each Treatment Period.
Time Frame
Baseline and 1 week
Title
Categorical Rating Scale (CRS) for Skin Integrity
Description
The change from Baseline at Week 2 of the CRS for Skin Integrity for each Treatment Period.
Time Frame
Baseline and 2 weeks
Title
Pruritus Quality of Life Score (PQOL)
Description
The change from Baseline in the final categorization of the PQOL at Day 14 of each Treatment Period
Time Frame
Baseline and Day 14 of each Treatment period

10. Eligibility

Sex
All
Minimum Age & Unit of Time
21 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: All subjects must meet the following criteria for admission into the study: Signed informed consent has been obtained. Subject is at least 21 years of age. Diagnosis of mycosis fungoides (MF) or Sézary syndrome (SS) will be based on a combination of histological, clinical, and immunophenotypical criteria. The histological criteria will be based on skin biopsy from the most representative skin area. The diagnostic criteria used for each subject will be specified in the case report forms and the specific classification of MF or SS will be identified. The TNMB system will be used to classify the stage of disease (See Section 8.4 for details). Completion of the mSWAT assessment. A history of pruritus that meets following criteria: At Screening Day -7: present on a daily basis for greater than one month prior to Screening Day -7, NRS for Pruritus score ≥5 as rated by the subject at the Day -7 Visit. Note: If the score is <5 and subject is taking or has taken a medication which may be affecting pruritus (e.g. systemic antihistamine or topical steroid), and if Investigator and subject agree, subject may washout or continue washout of medication and return for Day -7 Visit procedures after washout. At Baseline Period 1 Day 0: NRS for Pruritus score of at least 5 recorded in the subject diary on at least 4 of the 7 days preceding Baseline Period 1 Day 0. Pruritic treatment area of 5-95% of the subject's total treatable body surface area. Subject can be expected to reliably follow treatment instructions and visit schedule. Non-pregnant, non-lactating females of childbearing potential who agree to use medically acceptable forms of birth control (abstinence, hormonal contraceptives, diaphragm with spermicide, condom with spermicide, or intrauterine device) throughout the study or females of non-childbearing potential (surgically sterile [hysterectomy or bilateral tubal ligation] or post-menopausal ≥ 1 year). A negative urine pregnancy test must be confirmed at Baseline screening for all female subjects who are not post-menopausal > 1 year or surgically sterile. The subject agrees not to begin any new concomitant medications during their participation in the study, with the exception of medications necessary to treat infection, and to continue any concomitant medication throughout the study. Subject has no visual or motor impairments that will make it difficult to complete the Daily Diary or apply the study medication. Subject is able to speak, read, and write English and agrees to participate and comply with the study procedures. Subject has a body mass index (BMI) between 18.5 and 30.5 kglm2 (see Appendix C, Body Mass Index Table) (subjects in PK subset only). Exclusion Criteria: Subjects meeting any of the following criteria will be excluded from study participation: Pregnant or lactating female. History of clinically significant heart failure. Myocardial infarction within the past six months. A history of ventricular arrhythmia requiring treatment. Any medical condition which would, in the Investigator's opinion, preclude the subject from successfully participating in the study. A known allergy to naloxone hydrochloride or any excipient in the formulation. Previous naloxone use for pruritus. Positive urine drug screen at Day 0 for opiates. Positive urine drug screen for anything other than opiates not explained, e.g., by concomitant medication, would also exclude the subject. Treatment with any of the following during the restricted time period prior to Day -7, and at any time during the study, is not allowed: Medication/Treatment Restriction: Systemic narcotic analgesics (e.g. morphine, codeine) 7 days, Topical antihistamines to any skin surface [e.g. Zonalon® (doxepin)] 7 days, Other investigational drugs (excluding any therapies for the treatment of MF or SS) 30 days
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Scott B Phillips, MD
Organizational Affiliation
Elorac, Inc.
Official's Role
Study Director
Facility Information:
Facility Name
University of Arkansas for Medical Sciences
City
Little Rock
State/Province
Arkansas
ZIP/Postal Code
72205
Country
United States
Facility Name
City of Hope
City
Duarte
State/Province
California
ZIP/Postal Code
91010
Country
United States
Facility Name
Stanford University
City
Palo Alto
State/Province
California
ZIP/Postal Code
94304
Country
United States
Facility Name
USSF Health Morsani Center for Advanced Healthcare
City
Tampa
State/Province
Florida
ZIP/Postal Code
33612
Country
United States
Facility Name
Cleveland Clinic Indian River Hospital
City
Vero Beach
State/Province
Florida
ZIP/Postal Code
32960
Country
United States
Facility Name
Robert H. Lurie Comprehensive Cancer Center
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60611
Country
United States
Facility Name
Rush University Medical Center
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60612
Country
United States
Facility Name
Dawes Fretzin Clinical Research Group, LLC
City
Indianapolis
State/Province
Indiana
ZIP/Postal Code
46250
Country
United States
Facility Name
University of Minnesota
City
Minneapolis
State/Province
Minnesota
ZIP/Postal Code
55455
Country
United States
Facility Name
St. Louis University Dermatology
City
Saint Louis
State/Province
Missouri
ZIP/Postal Code
63104
Country
United States
Facility Name
Washington University School of Medicine St. Louis
City
Saint Louis
State/Province
Missouri
ZIP/Postal Code
63110
Country
United States
Facility Name
Stony Brook Dermatology
City
Stony Brook
State/Province
New York
ZIP/Postal Code
11790
Country
United States
Facility Name
University Hospitals Cleveland Medical Center
City
Cleveland
State/Province
Ohio
ZIP/Postal Code
44106
Country
United States
Facility Name
University of Texas MD Anderson Cancer Center
City
Houston
State/Province
Texas
ZIP/Postal Code
77030
Country
United States
Facility Name
Inova Schar Cancer Institute
City
Fairfax
State/Province
Virginia
ZIP/Postal Code
22031
Country
United States
Facility Name
University of Washington / Seattle Cancer Care Alliance (SCCA)
City
Seattle
State/Province
Washington
ZIP/Postal Code
98109
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
32632956
Citation
Valipour A, Jager M, Wu P, Schmitt J, Bunch C, Weberschock T. Interventions for mycosis fungoides. Cochrane Database Syst Rev. 2020 Jul 7;7(7):CD008946. doi: 10.1002/14651858.CD008946.pub3.
Results Reference
derived

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Naloxone Hydrochloride Study for Relief of Pruritus in Patients With MF or SS Forms of CTCL

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