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Regeneron AA Multicenter (Dupilumab)

Primary Purpose

Alopecia Areata

Status
Recruiting
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Dupilumab
Placebo
Sponsored by
Emma Guttman
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Alopecia Areata

Eligibility Criteria

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

INCLUSION CRITERIA:

  • Male or female subjects who are at least 18 years old at the time of informed consent.
  • Subject is able to understand and voluntarily sign an informed consent document prior to participation in any study assessments or procedures.
  • Subject is able to adhere to the study visit schedule and other protocol requirements.
  • Females of childbearing potential (FCBP) must have a negative pregnancy test at Screening and Baseline. While on investigational product and for at least 28 days after taking the last dose of investigational product (IP), FCBP who engage in activity in which conception is possible must use one of the approved contraceptive options described below:

    • Option 1: Any one of the following highly effective methods: hormonal contraception (oral, injection, implant, transdermal patch, vaginal ring); intrauterine device (IUD); tubal ligation; or partner's vasectomy, OR;
    • Option 2: Male or female condom (latex condom or non-latex condom NOT made out of natural [animal] membrane [for example, polyurethane]); PLUS one additional barrier method: (a) diaphragm with spermicide; (b) cervical cap with spermicide; or (c) contraceptive sponge with spermicide.
  • If subject is a female of non-childbearing potential, she must have documented history of infertility, be in a menopausal state for one year, or had a hysterectomy, bilateral tubal ligation, or bilateral oophorectomy.
  • Subject has a history of at least 6 months of moderate to severe AA (≥ 50% scalp involvement) as measured using the SALT score; OR subject has ≥ 95% loss of scalp hair for enrollment as AA totalis (AT) or universalis (AU) subtypes.
  • Subject has a screening IgE > 200 and/or personal and/or familial history of atopy.
  • Subjects must meet the following laboratory criteria:

    • White blood cell count ≥ 3000/mm3 (≥ 3.0 x 109/L) and < 14,000/mm3 (≤ 14 x 109/L).
    • Platelet count ≥ 100,000/μL (≥ 100 x 109/L).
    • Serum creatinine ≤ 1.5 mg/dL (≤ 132.6 μmol/L).
    • AST (SGOT) and ALT (SGPT) ≤ 2 x upper limit of normal (ULN). If the initial test shows ALT or AST > 2 times the ULN, one repeat test is allowed during the Screening Phase.
    • Total bilirubin ≤ 2 mg/dL (34 μmol/L). If the initial test shows total bilirubin > 2 mg/dL (34 μmol/L), one repeat test is allowed during the Screening Phase.
    • Hemoglobin ≥ 10 g/dL (≥ 6.2 mmol/L).
  • Subject is judged to be in otherwise good overall health following a detailed medical and medication history, physical examination, and laboratory testing.

EXCLUSION CRITERIA:

The presence of any of the following will exclude a subject from enrollment:

  • Subject is pregnant or breastfeeding.
  • Subject's cause of hair loss is indeterminable and/or they have concomitant causes of alopecia, such traction, cicatricial, pregnancy-related, drug-induced, telogen effluvium, or advanced androgenetic alopecia (i.e. Ludwig Type III or Norwood-Hamilton Stage ≥ V).
  • Subject has a history of AA with no evidence of hair regrowth for ≥ 7 years since their last episode of hair loss.
  • Severe, uncontrolled asthma or a history of life-threatening asthma exacerbations while on appropriate anti-asthmatic mediations.
  • Subject has an active bacterial, viral, or helminth parasitic infections; OR a history of ongoing, recurrent severe infections requiring systemic antibiotics
  • Subject with a known or suspected underlying immunodeficiency or immune-compromised state as determined by the investigator.
  • Subject has a concurrent or recent history of severe, progressive, or uncontrolled renal, hepatic, hematological, intestinal, metabolic, endocrine, pulmonary, cardiovascular, or neurological disease.
  • Active hepatitis B, hepatitis C, human immunodeficiency virus (HIV), or positive HIV serology at the time of screening for subjects determined by the investigators to be at high-risk for this disease.
  • Subject has a suspected or active lymphoproliferative disorder or malignancy; OR a history of malignancy within 5 years before the Baseline assessment, except for completely treated in situ non-melanoma skin and cervical cancers without evidence of metastasis.
  • Subject has received a live attenuated vaccine ≤ 30 days prior to study randomization.
  • Subject has any uncertain or clinically significant laboratory abnormalities that may affect interpretation of study data or endpoints.
  • Subject has any other medical or psychological condition that, in the opinion of the investigator, may present additional unreasonable risks as a result of their participation in the study and/or interfere with clinic visits and necessary study assessments.
  • History of adverse systemic or allergic reactions to any component of the study drug.
  • Severe, untreated asthma or a history of life-threatening asthma exacerbations while on appropriate anti-asthmatic mediations.
  • Use of systemic immunosuppressive medications, including, but not limited to, cyclosporine, systemic or intralesional corticosteroids, mycophenolate mofetil, azathioprine, methotrexate, tacrolimus, or ultraviolet (UV) phototherapy with/without Psoralen Ultraviolet A (PUVA) therapy within 4 weeks prior to randomization.
  • Use of an oral JAK inhibitor (tofacitinib, ruxolitinib, baricitinib, or investigational oral JAK Inhibitors) within 12 weeks prior to the Baseline visit.
  • Subject has been previously treated with dupiliumab.
  • Subject has used topical corticosteroids, and/or tacrolimus, and/or pimecrolimus within 1 week before the Baseline visit.
  • Subject currently uses or plans to use anti-retroviral therapy at any time during the study.

Sites / Locations

  • Icahn School of Medicine at Mount Sinai
  • UR Dermatology at College TownRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Dupilumab

Placebo

Arm Description

Dupilumab: weekly 300mg SC injections Manufacturer: Regeneron

Placebo: weekly SC injections of equivalent volume Manufacturer: Regeneron

Outcomes

Primary Outcome Measures

Change in the SALT score
Changes in the SALT score from baseline compared to week 48. SALT score is the sum of percentage of hair loss in all areas (higher score indicates greater hair loss). The change between baseline and Week 48 will be compared.

Secondary Outcome Measures

Number of patients achieving an absolute SALT score of ≤ 20
Number of patients achieving an absolute SALT score of ≤ 20. SALT score is the sum of percentage of hair loss in all areas (higher score indicates greater hair loss). Total percentage of patients with absolute SALT score of ≤ 20 will be calculated.
Number of patients achieving improvement in Severity of Alopecia Tool (SALT) score
Number of patients achieving improvement in Severity of Alopecia Tool (SALT) score. SALT score is the sum of percentage of hair loss in all areas (higher score indicates greater hair loss). The proportion of patients achieving at least 30%/50%/75%/90% improvement will be calculated from weeks 16 to week 48.
Number of patients achieving improvement in Severity of Alopecia Tool (SALT) score
SALT score is the sum of percentage of hair loss in all areas (higher score indicates greater hair loss). The proportion of patients achieving at least 30%/50%/75%/90% improvement will be calculated from weeks 64 to week 96.
Change in the Alopecia Areata Symptom Impact Scale (AASIS)
Changes in the Alopecia Areata Symptom Impact Scale (AASIS) from baseline compared to Week 48. AASIS scale measures how the severe the subjects feel their alopecia areata symptoms have been in the past week (scale 0-10 where 0 indicates the symptom was not present and 10 indicates the symptom was as bad as you can imagine), where higher scores indicate worse symptoms.
Change in the Alopecia Areata Quality of Life questionnaire (AA-QoL)
Changes in the Alopecia Areata Quality of Life questionnaire (AA-QoL) from Baseline compared to Week 48. AA-QoL scale measures how severe the subjects feel their alopecia areata symptoms have been in the past week (scale options: very much, a lot, a little, not at all).
Change in Alopecia Areata Physician's Global Assessment (aaPGA) scores
Changes in Alopecia Areata Physician's Global Assessment (aaPGA) scores from Baseline compared to Week 48. The aaPGA is used to assess the clinical response to treatment based on a 6-point scale ranging from 0 (no regrowth) to 5 (100% regrowth), where higher scores indicate greater hair regrowth. The number of patients with a score of 0 or 1 will be compared.
Difference in Alopecia Areata Physician's Global Assessment (aaPGA) scores
Difference in Alopecia Areata Physician's Global Assessment (aaPGA) scores between dupilumab-treated group and placebo-treated group from Baseline compared to Week 48. The aaPGA is used to assess the clinical response to treatment based on a 6-point scale ranging from 0 (no regrowth) to 5 (100% regrowth), where higher scores indicate greater hair regrowth. The number of patients with a score of 0 or 1 will be compared.
Change in Eyelash Assessment Score
Changes in eyelash scores from Weeks 16 through 48. Eyelash Assessment Score measures hair loss. Scale: 0= None, 1= Minimal eyelashes, 2= Moderate eyelashes, 3= Prominent eyelashes, 4= Very prominent eyelashes. Score change from baseline will be calculated, where higher scores indicate greater eyelash loss.
Change in Eyebrow Assessment Score
Changes in eyebrow scores from Weeks 16 through 48. Eyebrow Assessment Score measures hair loss. Scale: 0= None, 1= Minimal eyebrows, 2= Moderate eyebrows, 3= Prominent eyebrows, 4= Very prominent eyebrows. Score change from baseline will be calculated, where higher scores indicate greater eyebrow loss.
Number of adverse events reported
Number of adverse events reported throughout the study. The adverse event will be described and categorized as treatment emergent, serious, abnormal in vital signs, and abnormal in lab parameters.

Full Information

First Posted
September 20, 2022
Last Updated
August 16, 2023
Sponsor
Emma Guttman
Collaborators
Regeneron Pharmaceuticals
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1. Study Identification

Unique Protocol Identification Number
NCT05551793
Brief Title
Regeneron AA Multicenter (Dupilumab)
Official Title
Dupilumab in the Treatment of Alopecia Areata Patients With an Atopic Background and/or High IgE
Study Type
Interventional

2. Study Status

Record Verification Date
August 2023
Overall Recruitment Status
Recruiting
Study Start Date
April 10, 2023 (Actual)
Primary Completion Date
December 2025 (Anticipated)
Study Completion Date
December 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Emma Guttman
Collaborators
Regeneron Pharmaceuticals

4. Oversight

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

5. Study Description

Brief Summary
This is a prospective, randomized, double blind, placebo-controlled clinical trial. The study will take place at 4 sites. This trial will enroll a total of 68 patients with moderate to severe AA (affecting more than 50% of the scalp) at the time of screening with a targeted 54 subjects completers through Week 48. AA subjects must have evidence of hair regrowth within the last 7 years of their last episode of hair loss; and have screening IgE ≥ 200 and/or have personal and/or familial history of atopy. Subjects will be randomized (2:1) to either receive weekly dupilumab or placebo for 48 weeks, with all subjects completing participation through Week 48 receiving an additional 48 weeks of dupilumab (through Week 96).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Alopecia Areata

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigator
Allocation
Randomized
Enrollment
68 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Dupilumab
Arm Type
Experimental
Arm Description
Dupilumab: weekly 300mg SC injections Manufacturer: Regeneron
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Placebo: weekly SC injections of equivalent volume Manufacturer: Regeneron
Intervention Type
Drug
Intervention Name(s)
Dupilumab
Intervention Description
Dupilumab: 300mg SC injections
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Placebo: SC injections of equivalent volume
Primary Outcome Measure Information:
Title
Change in the SALT score
Description
Changes in the SALT score from baseline compared to week 48. SALT score is the sum of percentage of hair loss in all areas (higher score indicates greater hair loss). The change between baseline and Week 48 will be compared.
Time Frame
Baseline and Week 48
Secondary Outcome Measure Information:
Title
Number of patients achieving an absolute SALT score of ≤ 20
Description
Number of patients achieving an absolute SALT score of ≤ 20. SALT score is the sum of percentage of hair loss in all areas (higher score indicates greater hair loss). Total percentage of patients with absolute SALT score of ≤ 20 will be calculated.
Time Frame
Week 48
Title
Number of patients achieving improvement in Severity of Alopecia Tool (SALT) score
Description
Number of patients achieving improvement in Severity of Alopecia Tool (SALT) score. SALT score is the sum of percentage of hair loss in all areas (higher score indicates greater hair loss). The proportion of patients achieving at least 30%/50%/75%/90% improvement will be calculated from weeks 16 to week 48.
Time Frame
Weeks 16 up to 48
Title
Number of patients achieving improvement in Severity of Alopecia Tool (SALT) score
Description
SALT score is the sum of percentage of hair loss in all areas (higher score indicates greater hair loss). The proportion of patients achieving at least 30%/50%/75%/90% improvement will be calculated from weeks 64 to week 96.
Time Frame
Weeks 64 up to 96
Title
Change in the Alopecia Areata Symptom Impact Scale (AASIS)
Description
Changes in the Alopecia Areata Symptom Impact Scale (AASIS) from baseline compared to Week 48. AASIS scale measures how the severe the subjects feel their alopecia areata symptoms have been in the past week (scale 0-10 where 0 indicates the symptom was not present and 10 indicates the symptom was as bad as you can imagine), where higher scores indicate worse symptoms.
Time Frame
Baseline and Week 48
Title
Change in the Alopecia Areata Quality of Life questionnaire (AA-QoL)
Description
Changes in the Alopecia Areata Quality of Life questionnaire (AA-QoL) from Baseline compared to Week 48. AA-QoL scale measures how severe the subjects feel their alopecia areata symptoms have been in the past week (scale options: very much, a lot, a little, not at all).
Time Frame
Baseline and Week 48
Title
Change in Alopecia Areata Physician's Global Assessment (aaPGA) scores
Description
Changes in Alopecia Areata Physician's Global Assessment (aaPGA) scores from Baseline compared to Week 48. The aaPGA is used to assess the clinical response to treatment based on a 6-point scale ranging from 0 (no regrowth) to 5 (100% regrowth), where higher scores indicate greater hair regrowth. The number of patients with a score of 0 or 1 will be compared.
Time Frame
Baseline and Week 48
Title
Difference in Alopecia Areata Physician's Global Assessment (aaPGA) scores
Description
Difference in Alopecia Areata Physician's Global Assessment (aaPGA) scores between dupilumab-treated group and placebo-treated group from Baseline compared to Week 48. The aaPGA is used to assess the clinical response to treatment based on a 6-point scale ranging from 0 (no regrowth) to 5 (100% regrowth), where higher scores indicate greater hair regrowth. The number of patients with a score of 0 or 1 will be compared.
Time Frame
Baseline to Week 48
Title
Change in Eyelash Assessment Score
Description
Changes in eyelash scores from Weeks 16 through 48. Eyelash Assessment Score measures hair loss. Scale: 0= None, 1= Minimal eyelashes, 2= Moderate eyelashes, 3= Prominent eyelashes, 4= Very prominent eyelashes. Score change from baseline will be calculated, where higher scores indicate greater eyelash loss.
Time Frame
Weeks 16 up to 48
Title
Change in Eyebrow Assessment Score
Description
Changes in eyebrow scores from Weeks 16 through 48. Eyebrow Assessment Score measures hair loss. Scale: 0= None, 1= Minimal eyebrows, 2= Moderate eyebrows, 3= Prominent eyebrows, 4= Very prominent eyebrows. Score change from baseline will be calculated, where higher scores indicate greater eyebrow loss.
Time Frame
Weeks 16 up to 48
Title
Number of adverse events reported
Description
Number of adverse events reported throughout the study. The adverse event will be described and categorized as treatment emergent, serious, abnormal in vital signs, and abnormal in lab parameters.
Time Frame
Baseline up to Week 96

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
INCLUSION CRITERIA: Male or female subjects who are at least 18 years old at the time of informed consent. Subject is able to understand and voluntarily sign an informed consent document prior to participation in any study assessments or procedures. Subject is able to adhere to the study visit schedule and other protocol requirements. Females of childbearing potential (FCBP) must have a negative pregnancy test at Screening and Baseline. While on investigational product and for at least 28 days after taking the last dose of investigational product (IP), FCBP who engage in activity in which conception is possible must use one of the approved contraceptive options described below: Option 1: Any one of the following highly effective methods: hormonal contraception (oral, injection, implant, transdermal patch, vaginal ring); intrauterine device (IUD); tubal ligation; or partner's vasectomy, OR; Option 2: Male or female condom (latex condom or non-latex condom NOT made out of natural [animal] membrane [for example, polyurethane]); PLUS one additional barrier method: (a) diaphragm with spermicide; (b) cervical cap with spermicide; or (c) contraceptive sponge with spermicide. If subject is a female of non-childbearing potential, she must have documented history of infertility, be in a menopausal state for one year, or had a hysterectomy, bilateral tubal ligation, or bilateral oophorectomy. Subject has a history of at least 6 months of moderate to severe AA (≥ 50% scalp involvement) as measured using the SALT score; OR subject has ≥ 95% loss of scalp hair for enrollment as AA totalis (AT) or universalis (AU) subtypes. Subject has a screening IgE > 200 and/or personal and/or familial history of atopy. Subjects must meet the following laboratory criteria: White blood cell count ≥ 3000/mm3 (≥ 3.0 x 109/L) and < 14,000/mm3 (≤ 14 x 109/L). Platelet count ≥ 100,000/μL (≥ 100 x 109/L). Serum creatinine ≤ 1.5 mg/dL (≤ 132.6 μmol/L). AST (SGOT) and ALT (SGPT) ≤ 2 x upper limit of normal (ULN). If the initial test shows ALT or AST > 2 times the ULN, one repeat test is allowed during the Screening Phase. Total bilirubin ≤ 2 mg/dL (34 μmol/L). If the initial test shows total bilirubin > 2 mg/dL (34 μmol/L), one repeat test is allowed during the Screening Phase. Hemoglobin ≥ 10 g/dL (≥ 6.2 mmol/L). Subject is judged to be in otherwise good overall health following a detailed medical and medication history, physical examination, and laboratory testing. EXCLUSION CRITERIA: The presence of any of the following will exclude a subject from enrollment: Subject is pregnant or breastfeeding. Subject's cause of hair loss is indeterminable and/or they have concomitant causes of alopecia, such traction, cicatricial, pregnancy-related, drug-induced, telogen effluvium, or advanced androgenetic alopecia (i.e. Ludwig Type III or Norwood-Hamilton Stage ≥ V). Subject has a history of AA with no evidence of hair regrowth for ≥ 7 years since their last episode of hair loss. Severe, uncontrolled asthma or a history of life-threatening asthma exacerbations while on appropriate anti-asthmatic mediations. Subject has an active bacterial, viral, or helminth parasitic infections; OR a history of ongoing, recurrent severe infections requiring systemic antibiotics Subject with a known or suspected underlying immunodeficiency or immune-compromised state as determined by the investigator. Subject has a concurrent or recent history of severe, progressive, or uncontrolled renal, hepatic, hematological, intestinal, metabolic, endocrine, pulmonary, cardiovascular, or neurological disease. Active hepatitis B, hepatitis C, human immunodeficiency virus (HIV), or positive HIV serology at the time of screening for subjects determined by the investigators to be at high-risk for this disease. Subject has a suspected or active lymphoproliferative disorder or malignancy; OR a history of malignancy within 5 years before the Baseline assessment, except for completely treated in situ non-melanoma skin and cervical cancers without evidence of metastasis. Subject has received a live attenuated vaccine ≤ 30 days prior to study randomization. Subject has any uncertain or clinically significant laboratory abnormalities that may affect interpretation of study data or endpoints. Subject has any other medical or psychological condition that, in the opinion of the investigator, may present additional unreasonable risks as a result of their participation in the study and/or interfere with clinic visits and necessary study assessments. History of adverse systemic or allergic reactions to any component of the study drug. Severe, untreated asthma or a history of life-threatening asthma exacerbations while on appropriate anti-asthmatic mediations. Use of systemic immunosuppressive medications, including, but not limited to, cyclosporine, systemic or intralesional corticosteroids, mycophenolate mofetil, azathioprine, methotrexate, tacrolimus, or ultraviolet (UV) phototherapy with/without Psoralen Ultraviolet A (PUVA) therapy within 4 weeks prior to randomization. Use of an oral JAK inhibitor (tofacitinib, ruxolitinib, baricitinib, or investigational oral JAK Inhibitors) within 12 weeks prior to the Baseline visit. Subject has been previously treated with dupiliumab. Subject has used topical corticosteroids, and/or tacrolimus, and/or pimecrolimus within 1 week before the Baseline visit. Subject currently uses or plans to use anti-retroviral therapy at any time during the study.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Giselle Singer
Phone
212-241-3288
Email
giselle.singer@mssm.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Emma Guttman-Yassky, MD, PhD
Organizational Affiliation
Icahn School of Medicine at Mount Sinai
Official's Role
Principal Investigator
Facility Information:
Facility Name
Icahn School of Medicine at Mount Sinai
City
New York
State/Province
New York
ZIP/Postal Code
10029
Country
United States
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Giselle Singer
Phone
212-241-3288
Email
giselle.singer@mssm.edu
First Name & Middle Initial & Last Name & Degree
Emma Guttman-Yassky
Facility Name
UR Dermatology at College Town
City
Rochester
State/Province
New York
ZIP/Postal Code
14620
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Alicia Papalia
Phone
585-273-4195
Email
Alicia_papalia@urmc.rochester.edu
First Name & Middle Initial & Last Name & Degree
Lisa Beck

12. IPD Sharing Statement

Plan to Share IPD
No
IPD Sharing Plan Description
Not shared

Learn more about this trial

Regeneron AA Multicenter (Dupilumab)

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