Topical Simvastatin for Treating Infantile Hemangioma (TSTIH)

A Pilot Study Using Topical Statins to Treat Children With Infantile Hemangioma

This is a 48-week, open-label pilot study to evaluate the safety, including systemic exposure and skin tolerability, and preliminary efficacy of 5% simvastatin ointment in the treatment of 15 children with newly diagnosed superficial proliferating IH.

The primary objective:

To evaluate the safety, including systemic exposure and skin tolerability of topical treatment with 5% simvastatin ointment for superficial proliferating IH over 48 weeks.

The secondary objective:

1.1 To evaluate the efficacy and durability of 5% simvastatin ointment when topical treatment is administered twice daily for 24 weeks, followed by a 24-week post-treatment follow-up period. Evaluation is performed at each clinic visit via investigator global assessment (IGA) based on standardized 3D digital photography and hemangioma activity score (HAS).

1.2 To evaluate the impact of 5% simvastatin ointment on quality of life using the IH-QoL questionnaire.

The exploratory objective:

To explore whether clinical response and regrowth following topical 5% simvastatin treatment are associated with SOX18-mevalonate pathway-axis activation in infantile hemangioma tissue.

Study Overview

• Status: Not yet recruiting
• Conditions: Hemangioma Skin
• Intervention / Treatment: Drug: 5% simvastatin ointment

• Study Type: Interventional
• Enrollment (Estimated): 15
• Phase: Early Phase 1

Contacts and Locations

• Study Contact: Name: Joyce Teng, MD, PhD; Phone Number: 650-724-9627; Email: jteng3@stanford.edu
• Study Contact Backup: Name: Ramrada Lekwuttikarn, MD; Phone Number: 650-313-8207; Email: ramrada1@stanford.edu

Study Locations

• United States
  • California
    • Palo Alto, California, United States, 94304
      • Stanford University
      • Contact: Ramrada Lekwuttikarn, MD; Phone Number: 650-313-8207; Email: ramrada1@stanford.edu
      • Contact: Chaw-Ning Lee, MD; Phone Number: 650-497-7230; Email: cnlee06@stanford.edu
      • Sub-Investigator: Dawn Siegel, MD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

Participants may be included in the study only if they meet all of the following criteria:

1. Healthy children aged between 3-6 months without medical disorders that contradict topical statin treatment.
2. Infants with newly diagnosed superficial IH. [3] Participants must possess at least one IH lesion with the longest diameter equal to or greater than 1 cm but less than 1% BSA, located on any part of the body except the lips.

[4] Written informed consent from the parent(s)/guardian(s) must be obtained before any study procedure is performed.

[5] Parent(s)/guardian(s) are willing to comply with the study protocol

Exclusion Criteria:

Participants meeting any of the following criteria will not be eligible to participate in the study:

1. IH is primarily characterized as subcutaneous, and deep, with minimal cutaneous involvement for evaluation.
2. IH with active ulceration at screening visit.
3. IH to be treated involving the lips mainly.
4. IH with high-risk criteria that need systemic propranolol treatment to avoid the delay with standard treatment
5. Participants with concurrent skin conditions that may impede accurate clinical assessment of the IH.
6. Participants with hereditary or metabolic disorders requiring systemic statin therapy.
7. Participants who are allergic to statins, or other ingredients present in the topical medication.

8. Participants who have received any of the following treatments for their IH:

   i) Topical medical therapy, i.e. imiquimod, sirolimus, timolol, intermediate or high strength steroids, etc. within the past 4 weeks ii) Systemic medical therapy, i.e. beta blockers, steroids, sirolimus for IH within the past 3 months iii) Surgical intervention including laser treatment within the past 6 weeks

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: 5% simvastatin ointment; Participants will be applied 5% simvastatin ointment on IH lesion	Drug: 5% simvastatin ointment; 5% simvastatin ointment will be applied directly on IH lesion twice per day for 24 weeks

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Evaluation of the safety and tolerability of the 5% simvastatin ointment over 48 weeks	The primary endpoint is the evaluation of the safety and tolerability of the 5% simvastatin ointment over 48 weeks, defined by the following three combined components: Adverse Events: The incidence, severity, and proportion of participants experiencing adverse events (AEs) from Week 0 through Week 48.; Systemic Exposure: The proportion of participants with detectable serum simvastatin levels, alongside descriptive statistics of measured concentrations, at Week 24 (End of Treatment).; Skin Tolerability: The incidence and maximum severity score of local skin reactions at the treatment site at Week 24 (End of Treatment).	Baseline through week 48

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
To evaluation of the efficacy and durability of the 5% simvastatin ointment over 48 weeks: Key Efficacy Endpoints (Week 24)	The secondary endpoint is the evaluation of the efficacy and durability of the 5% simvastatin ointment over 48 weeks, defined by the following three combined components: 1. Key Efficacy Endpoints (Week 24); Percentage of participants achieving 50% HAS reduction from baseline at week 24 Percentage of participants achieving a 75% HAS reduction from baseline at week 24.; Percentage of participants achieving complete or nearly complete resolution of the targeted IH (IGA 0 or 1), defined as a minimal degree of telangiectasia, skin thickening, and no definitive palpable cutaneous texture changes, at week 24.; Percentage of participants achieving targeted IH stabilization - (no noticeable change to baseline) at week 24.; Percentage of patients whose have 50% improvement captured by 3D photographs and agreed by blinded assessor at week 24; Percentage of participants with a significant improvement in quality-of-life, defined as > 50% reduction in the IH-QoL questionnaire score from base	Baseline through week 24
To evaluation of the efficacy and durability of the 5% simvastatin ointment over 48 weeks: Treatment Failure and Durability Endpoints	The secondary endpoint is the evaluation of the efficacy and durability of the 5% simvastatin ointment over 48 weeks, defined by the following three combined components: 2. Treatment Failure and Durability Endpoints; Disease Progression: Percentage of participants whose targeted IH progresses to the point of requiring systemic therapy, laser, or surgical interventions (resulting in Early Termination).; Treatment Rebound (Durability): Percentage of participants experiencing targeted IH regrowth during the 24-week follow-up period (Weeks 24 to 48), alongside the median and range of time (in weeks) from Week 24 to the first notable rebound	Baseline through week 48
To evaluation of the efficacy and durability of the 5% simvastatin ointment over 48 weeks: Time-to-Event Assessments	The secondary endpoint is the evaluation of the efficacy and durability of the 5% simvastatin ointment over 48 weeks, defined by the following three combined components: 3. Time-to-Event Assessments; Time to Notable Response: The median and range of time (in weeks) from baseline to the first documented 25% reduction in HAS.; Time to Progression: The median time to progression requiring rescue therapy (systemic, laser, or surgery), estimated using the Kaplan-Meier method. Participants without disease progression will be censored at Week 24 (or at their date of early discontinuation).	Baseline through week 48

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Exploratory endpoint	Exploratory endpoint: • The relationship between SOX18-mevalonate pathway-axis activation, as assessed by immunofluorescent staining of available infantile hemangioma tissue, and clinical response through Week 24 and regrowth status at Week 48.	Baseline through week 48

Collaborators and Investigators

• Sponsor: Joyce Teng
• Collaborators: National Institutes of Health (NIH); Stanford University
• Investigators: Principal Investigator: Joyce Teng, MD, PhD, Stanford University

Study record dates

Study Major Dates

• Study Start (Estimated): November 1, 2026
• Primary Completion (Estimated): March 31, 2028
• Study Completion (Estimated): June 30, 2029

Study Registration Dates

• First Submitted: February 15, 2024
• First Submitted That Met QC Criteria: February 15, 2024
• First Posted (Actual): February 22, 2024

Study Record Updates

• Last Update Posted (Actual): September 14, 2026
• Last Update Submitted That Met QC Criteria: September 9, 2026
• Last Verified: September 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Skin Diseases; Neoplasms by Histologic Type; Neoplasms; Congenital Abnormalities; Skin Abnormalities; Neoplasms, Vascular Tissue; Hemangioma, Capillary; Port-Wine Stain; Hemangioma; Molecular Mechanisms of Pharmacological Action; Enzyme Inhibitors; Antimetabolites; Anticholesteremic Agents; Hypolipidemic Agents; Lipid Regulating Agents; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Simvastatin
• Other Study ID Numbers: 73840

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