A Safety, Efficacy and Systemic Exposure Study of CD5789 Cream in Adults and Adolescents With Lamellar Ichthyosis

A Phase 2 Randomized, Multicenter, Double-blind, Vehicle Controlled, 90-Day, Safety, Efficacy & Systemic Exposure Study of Trifarotene (CD5789) Cream HE1 in Adults and Adolescents With Autosomal Recessive Ichthyosis With Lamellar Scale

This is a phase 2 randomized, multi-center, double-blind, vehicle controlled, 90 day, safety, efficacy, and systemic exposure study followed by a 90 day open-label extension of trifarotene cream in adults and adolescents with autosomal recessive ichthyosis with lamellar scale.

Study Overview

• Status: Terminated
• Conditions: Lamellar Ichthyosis
• Intervention / Treatment: Drug: CD5789 Cream 200 µg/g; Drug: CD5789 Cream 100 µg/g; Drug: CD5789 Cream Vehicle

Detailed Description

This is a 2-cohort, multicenter study in subjects with moderate to severe LI. Adults (Cohort A) and adults and adolescents (Cohort B) will be randomized in a double-blind fashion to 1 of 2 doses of active or vehicle and treated twice weekly for 90 days. Subjects who complete the randomized, double-blind portion of the study will be eligible to enter a 90 day, open-label extension study.

Approximately 15 adults (≥18 years old) will be randomized into the first cohort of subjects (Cohort A) in a 1:1:1 ratio and treated twice weekly for up to 90 days. If no safety issues are identified, both adults and adolescents (ages 12-17 years, inclusive) will be allowed to enroll in Cohort B. Subjects in Cohort B will be randomized 1:1:1 and treated twice weekly for up to 90 days in the same manner as subjects in Cohort A.

All subjects who complete 90 days of double-blind study treatment will be eligible to enroll in a 90 open-label extension. Subjects in the open-label extension will receive active twice weekly for up to 90 days.

• Study Type: Interventional
• Enrollment (Actual): 65
• Phase: Phase 2

Contacts and Locations

Study Locations

• Australia
  • Box Hill, Australia
    • Eastern Health Monash University
  • Brisbane, Australia
    • Veracity Clinical Research
  • Parkville, Australia
    • Royal Children's Hospital
  • Sydney, Australia
    • Premier Specialists Ptd Ltd
• Canada
  • Toronto, Canada
    • The Hospital for Sick Children
• France
  • Paris, France
    • Dermatologie pédiatrique
  • Rouen, France
    • CHU Charles Nicolle
  • Toulouse, France
    • CHU de Toulouse- Hospital Larrey
• Germany
  • Berlin, Germany
    • Charite - Universitaetsmedizin Berlin
  • Frankfurt, Germany
    • Universitätsklinkum Frankfurt
  • Hamburg, Germany
    • Kath. Kinderkrankenhaus Wilhelmstift
  • Munich, Germany
    • Ludwig-Maximilians University
  • Rostock, Germany
    • Universitatsmedizin Rostock
• Israel
  • Tel Aviv, Israel
    • Tel Aviv Sourasky MC
• Spain
  • Barcelona, Spain
    • Hospital Clinic de Barcelona
  • Madrid, Spain
    • Hospital Niño Jesús
  • Madrid, Spain, 28009
    • Hospital Niño Jesús
  • Madrid, Spain
    • Clinica Universidad de Navarra (Madrid)
  • Pamplona, Spain
    • Clinica Universidad de Navarra
• Ukraine
  • Dnipro, Ukraine, 49000
    • Medical Center of Private Enterprise "Dzerkalo"
  • Dnipro, Ukraine, 49074
    • Dnipropetrovsk State Hospital of Dermatovenerology
  • Dnipro, Ukraine, 49600
    • Medical Center "Family Medicine Clinic"
  • Ternopil', Ukraine, 46006
    • Ternopil Regional Clinical Dermatovenereological Dispensary
  • Uzhhorod, Ukraine, 88000
    • TDC PE "Asclepius"
  • Zaporizhzhya, Ukraine, 69063
    • Community Institution "Zaporizhzhya Regional Dermatovenereology Clinical Hospital"
• United Kingdom
  • London, United Kingdom
    • Royal London Hospital Barts Health Nhs Trust
• United States
  • California
    • San Diego, California, United States, 92123
      • TCR Medical Corporation
  • Colorado
    • Aurora, Colorado, United States, 80045
      • Children's Hospital Colorado
  • Connecticut
    • New Haven, Connecticut, United States, 06519
      • Yale University
  • Illinois
    • Skokie, Illinois, United States, 60077
      • NorthShore University HealthSystem
  • Indiana
    • Indianapolis, Indiana, United States, 46250
      • Dawes Fretzin Clinical Research Group, LLC
  • Maryland
    • Rockville, Maryland, United States, 20850
      • DermAssociates, PC
  • Massachusetts
    • Boston, Massachusetts, United States, 02114
      • Massachusetts General Hospital
  • Pennsylvania
    • Philadelphia, Pennsylvania, United States, 19104
      • Children's Hospital of Philadelphia
  • South Carolina
    • Charleston, South Carolina, United States, 29425
      • Medical University of South Carolina
  • Texas
    • San Antonio, Texas, United States, 78218
      • Texas Dermatology and Laser Specialists

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 10 years and older (Child, Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

1. For Cohort A: subject is ≥18 years old; for Cohort B: subject is ≥12 years old.
2. Subject has known diagnosis of LI.
3. Subject has moderate to severe (IGA 3-4) LI on the IGA of LI severity.
4. Subject has signed an ICF at Screening before any investigational procedures. Subjects <18 years of age (or Age of Majority) must sign an assent form in conjunction with an ICF signed by the parent/legal representative.
5. Subject who is participating in optional photography has signed a photography ICF.
6. Subject who is participating in the optional PK substudy has signed a PK ICF. Minors, in the event of their reaching majority during the study, should be capable of giving consent to take part in the PK substudy.

7. Subject is not of childbearing potential, who is postmenopausal (absence of menstrual bleeding for 1 year before Baseline, without any other medical reason), or has documented hysterectomy, bilateral salpingectomy, or bilateral oophorectomy. For individuals with permanent infertility due to an alternate medical cause other than the above, (e.g., Mullerian agenesis, androgen insensitivity), investigator discretion should be applied to determining study entry.

   OR

   • Subject is a woman of childbearing potential (WOCBP), i.e., a female ≥12 years of age (regardless of whether they have experienced/reported menarche), or a male subject with sexual partners capable of reproduction who agrees to use 2 effective forms of contraception during the study and for at least 1 month after the last study drug application. The 2 authorized forms of contraception are condom used with 1 of the following methods of contraception:
   • bilateral tubal ligation
   • combined oral contraceptives (estrogens and progesterone), vaginal ring, or implanted or injectable hormonal contraceptives with a stable dose for at least 1 month before Baseline; hormonal contraceptives must inhibit ovulation
   • intrauterine device (IUD) inserted at least 1 month before Baseline OR Agrees to abstain from heterosexual intercourse during study participation and for 1 month after the last application of study drug and to use a highly effective contraceptive as backup if he or she becomes sexually active during the study. Abstinence is only acceptable if this is the subject's usual lifestyle. Periodic abstinence (calendar, symptothermal, postovulation methods), withdrawal (coitus interruptus), spermicides only, and lactational amenorrhoea method are not acceptable methods of contraception.

   AND Male subjects may not donate sperm during the study and for at least 1 month after the last study drug application.

   Note: Female subjects who are premenstrual at screening should nonetheless follow the pregnancy testing schedule for WOCBP even if they abstain from sexual intercourse while in the study and for at least 1 month after the last study drug application.

8. Women of childbearing potential must be nonlactating and have negative pregnancy test results at Screening (serum) and on Day 1 before study drug administration (urine).
9. Subject is reliable and capable of adhering to the protocol and visit schedule, in the investigator's judgment, and has signed informed consent/assent, as applicable.
10. Subject is taking no more than 3500 IU/day Vitamin A (e.g., as in a multivitamin).

Exclusion criteria:

1. Subject has any variant of ichthyosis other than LI or another disorder of keratinization, including syndromic ichthyoses.
2. Subject has current moderate or severe stinging/burning at Screening.
3. Subject has an ongoing cutaneous infection or any other significant concomitant skin disease (other than the LI) which, in the investigator's opinion, may interfere with the study assessments.
4. Subject with fasting triglycerides >200 mg/dL or >2.25 mmol/L and/or total cholesterol >250 mg/dL or >6.5 mmol/L. Subjects whose triglycerides and/or total cholesterol are within normal limits with a stable dose of lipid-lowering agents for at least 6 months may be included.
5. Subject was previously treated with trifarotene/CD5789 in an acne or ichthyosis study.
6. Subject has any other significant concomitant disease, or poorly controlled medical condition other than LI that in the investigator's opinion may put him or her at risk if he or she takes part in the study, and/or that may interfere with the study assessments.
7. Subject has a medical condition that potentially alters bone metabolism (e.g., osteoporosis, thyroid dysfunction, Cushing syndrome, Crohn's disease, or ulcerative colitis). Subjects with hypothyroidism who are on a stable dose of thyroid hormone replacement therapy and whose thyroid-stimulating hormone (TSH) is normal may be included
8. Subject is being treated for major depression disorder and/or has a history of major depression or suicide attempt requiring hospitalization, medications, and close psychiatric surveillance to prevent suicide attempts.
9. Subject with positive serology for hepatitis B surface antigen, hepatitis C, or are known to be HIV positive or to have AIDS at Screening.

10. Subject with any of the following laboratory values at Screening:

    1. Aspartate aminotransferase or alanine aminotransferase >1.5 × upper limit of normal defined by the laboratory
    2. Total bilirubin >1.25 × ULN at Screening. Subjects with known Gilbert's syndrome may be included with total bilirubin >1.25 × ULN
    3. Hemoglobin <12.5 g/dL for men and <11.5 g/dL for women
    4. Platelets <150 × 109/L or >400 × 109/L.
11. Subject has any clinically other significant abnormal laboratory value (hematology, chemistry, or urinalysis) at Screening that, in the investigator's opinion, may put the subject at risk if he or she takes part in the study, and/or that may interfere with the study assessments.
12. Subject has had recent systemic malignancy (e.g., within 5 years) with exception of nonmelanoma skin cancer or cervical intraepithelial neoplasia of Grade 1 who are >6 months post-treatment.
13. Subject has a history of long QT syndrome or has clinically significant electrocardiogram (ECG) abnormalities, including clinically significant conduction disorders or significant arrhythmias, or QTcF interval >450 ms.
14. Subject has a known allergy or sensitivity to any of the components of the investigational products.
15. Subject has been exposed to excessive UV radiations on the treated zones within 1 month before Baseline visit or is planning intensive UV exposure during the study (e.g., occupational exposure to the sun, sunbathing, phototherapy, etc.).
16. Subject is inherently sensitive to sunlight.
17. Subject is unable or unwilling to stop use of topical or systemic retinoids.
18. Subject is presumed to be abusing drug or alcohol at Screening or Baseline Visits based on medical history or current clinical symptoms.
19. Subject is participating in another interventional clinical trial.
20. Subject is institutionalized.
21. Subject is in any way related to the sponsor, investigator, or site personnel.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Quadruple

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: CD5789 Cream 200 µg/g; CD5789 200 µg/g, topical, 50g	Drug: CD5789 Cream 200 µg/g; A fixed dose (determined at Visit 1) of 200 µg/g applied topically twice weekly to up to 90% BSA
Experimental: CD5789 Cream 100 µg/g; CD5789 100 µg/g, topical, 50g	Drug: CD5789 Cream 100 µg/g; A fixed dose (determined at Visit 1) of 100 µg/g applied topically twice weekly to up to 90% BSA
Placebo Comparator: CD5789 Cream Vehicle; CD5789 Cream Vehicle, topical, 50g	Drug: CD5789 Cream Vehicle; A fixed dose (determined at Visit 1) applied topically twice weekly, up to 36 g per dose up to 90% BSA

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The Percentage of Subjects in Each Treatment Group Who Experienced Successful Resolution of LI.	The percentage of subjects in each treatment group who experienced successful resolution of LI where "success" is defined as clear/almost clear on treated areas and at least a 2-grade change from Baseline at Day 90/end-of-treatment (EOT) in the Double-blind Period on the 5-point IGA full body scale.	90 Days

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Total 16-point Visual Index for Ichthyosis Severity (VIIS)	5-point Visual Index for Ichthyosis Severity (VIIS) for scaling (overall 16 points) for scaling, i.e. 0-4 points for 4 body areas: chest/abdomen, back, arms and legs) where minimum is 0 and maximum is 16 (e.g. 4 points for each of the four body parts). 0 (Clear) No scaling; (Almost Clear) Very fine, non-coalescent scales; (Mild) Small and thin, non-coalescent scales; (Moderate) Large and rather thick scales starting to coalesce; (Severe) Very large, adherent, coalescent and very thick scales	90 Days
The Difference in Mean Scores Using Individual Score for Roughness	The amount of roughness of the skin will be measured on a 5-point scale. 0 (Clear) Smooth skin; (Almost Clear) Hardly palpably roughness; (Mild) Mild roughness (fine sand paper-like); (Moderate) Moderate, coarse roughness (coarse sand paper-like); (Severe) Very coarse skin (broken cornflakes-like)	90 Days
The Difference in Mean Scores Using Palm Sole Assessment	Thickening of the skin on the palms and soles will be measured on a 5-point scale: 0 (Clear) No thickening, no roughness, no fissure; (Almost Clear) Only slight thickening, minimal to no roughness, no fissures; (Mild) Some thickening, mild roughness on palpation, few fissures may be present; (Moderate) Substantial and diffuse thickening, coarse roughness on palpation may be present, fissures may be present; (Severe) Very thickened and rough skin, numerous fissures	90 Days
The Difference in Proportion of Subjects With Presence of Fissures on Palms Between the Active and Vehicle Groups	Fissuring will be assessed by recording the presence or absence of fissures, the number of fissures present, and the pain associated with each fissure. The subject will assess pain associated with fissures as ranging from 0-3 (none, mild, moderate, severe) at day 90 between the active trifarotene cream HE1 and vehicle groups	90 Days
Quality of Life Measurement Per Dermatology Life Quality Index (DLQI)	The DLQI, or the Dermatology Quality of Life Index, is a dermatology-specific Quality of Life instrument. It is a simple 10-question validated questionnaire with 6 domains (symptoms and feelings, daily activities, leisure, work and school, personal relationships, and treatment); higher scores indicate poorer quality of life. Responses collected are on a scale of 0-3 depending on the question relevance to the subject. Response (Score) Very much (scored 3) A lot (scored 2) A little (scored 1) Not at all (scored 0) Not relevant (scored 0) A minimum score of 0 and maximum score of 30 is obtained by summing the score of each question. The higher the score, the more quality of life is impaired. 0-1 = no effect at all on patient's life 2-5 = 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	90 Days
The Difference in Proportion of Subjects With Presence of Fissures on Soles Between the Active and Vehicle Groups	Fissuring will be assessed by recording the presence or absence of fissures, the number of fissures present, and the pain associated with each fissure. The subject will assess pain associated with fissures as ranging from 0-3 (none, mild, moderate, severe) at day 90 between the active trifarotene cream HE1 and vehicle groups	90 Days

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Clinical Laboratory Evaluations	The number of subjects with clinical laboratory values categorized as below (vital signs, 12 lead electrocardiogram, Physical Exam), within, or above normal ranges will be evaluated (changes from baseline for each clinical laboratory parameter by treatment group and by study visit).	180 Days
Measurement of 12-lead ECG Readings	The number of subjects with normal and abnormal ECG findings will be measured for each treatment group at each time point for QT and the QT interval corrected for heart rate (QTc) calculated using Fridericia's QT correction methods.	180 Days
The Difference in Mean Ectropion Scores Between the Active and Vehicle Groups	The Ectropion Severity Score (ESS), is a proven system to be reliable and sensitive to the presence of ectropion and has a maximum score of 8 points (0-8). A higher score indicates a worse ectropion. The score takes the severity of ectropion in terms of lateral and medial apposition, scleral show, conjunctival show, and roundness of the eye into account and gives an indication of the functional aspects involved in ectropion by scoring redness, excess tear film, and the position of the lacrimal punctum A point scale of 0=Nonaffected, 0.5=Emerging, 1= Affected is assigned to 8 observations.; Lateral apposition; Medial apposition; Sceral show; Conjunctival show; Excess team film; Redness of the eye; Round canthus; Punctum lacrimale	180 Days
Quality of Life Measurement Per EQ-5D-5L	The EQ-5D is a standardized instrument developed by the EuroQol Group as a measure of health-related quality of life used in a wide range of health conditions and treatments. The EQ-5D consists of a descriptive system and the EQ visual analog scale (VAS). Descriptive system of health-related quality of life states consisting of 5 dimensions (mobility, self-care, usual activities, pain/discomfort, anxiety/depression) each of which can take 1 of 5 responses.; no problem; slight problems; moderate problems; severe problems; extreme problems It should be noted that the numerals 1-5 have no arithmetic properties and should not be used as a cardinal score. The EQ VAS records the respondent's self-rated health on a 20 cm vertical, visual analogue scale with endpoints labelled 100-'the best health you can imagine' and 0-'the worst health you can imagine'. This information can be used as a quantitative measure of health as judged by the individual respondents.	180 Days
Incidents of Adverse Events	The number of subjects with AEs will be collected for each treatment group	180 Days
Measurement of Local Tolerability	Local tolerability will be assessed on a 0-3 scale (none, mild, moderate, severe).	180 Days
Measurement of Vital Signs	Blood pressure (systolic blood pressure [SBP], diastolic blood pressure [DBP] and pulse will be measured. Measurement of actual values and changes from baseline will be calculated. Vital signs The number of subjects with vital signs values categorized as below, within, or above normal ranges (change from baseline for each parameter by period, by treatment group and by study visit).	180 Days
Physical Examination Findings	The number of subjects with normal and abnormal findings in the complete physical examination for each treatment group. This is a limited physical examination to include HEENT, cardiorespiratory, abdomen, and range of motion.	180 Days
Measurement of Area Under the Plasma Concentration Versus Time Curve (AUC)	Measurement of the extent of absorption using estimates of the area-under-the-curve (AUC).	180 Days
Measurement of Peak Plasma Concentration (Cmax)	Measurement of therate-of-absorption using the maximum concentration (Cmax) and the time of Cmax (Tmax).	180 Days

Collaborators and Investigators

• Sponsor: Mayne Pharma International Pty Ltd
• Investigators: Principal Investigator: Keith A. Choate, MD, Yale University

Study record dates

Study Major Dates

• Study Start (Actual): May 1, 2019
• Primary Completion (Actual): September 3, 2021
• Study Completion (Actual): September 3, 2021

Study Registration Dates

• First Submitted: October 24, 2018
• First Submitted That Met QC Criteria: November 8, 2018
• First Posted (Actual): November 13, 2018

Study Record Updates

• Last Update Posted (Actual): August 14, 2023
• Last Update Submitted That Met QC Criteria: July 20, 2023
• Last Verified: February 1, 2023

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Skin Diseases; Congenital Abnormalities; Infant, Newborn, Diseases; Genetic Diseases, Inborn; Skin Diseases, Genetic; Skin Abnormalities; Keratosis; Ichthyosiform Erythroderma, Congenital; Ichthyosis; Ichthyosis, Lamellar; Dermatologic Agents; Trifarotene
• Other Study ID Numbers: 18-ICH-001

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No