Efficacy and Safety Study of Dovramilast in People With Leprosy Type 2 Reaction

A 12-week, Open-label, Randomized, Standard of Care Controlled, Dose-ranging Safety and Efficacy Study of Dovramilast in People With Moderate to Severe Acute or Recurrent Leprosy Type 2 Reaction

Dovramilast has not been approved for leprosy type 2 reaction (erythema nodosum leprosum, ENL) or any other disease anywhere in the world. In this study, an experimental drug called dovramilast is being tested to see how it compares to current treatments for leprosy type 2 reaction. Specifically, this study aims to assess the efficacy of 100mg or 150 mg dovramilast compared with standard treatments (also known as standard of care). This study also aims to assess the safety of two strengths in adults with leprosy type 2 reaction.

Study Overview

• Status: Recruiting
• Conditions: Erythema Nodosum Leprosum
• Intervention / Treatment: Drug: Dovramilast; Drug: Prednisolone; Drug: Thalidomide

• Study Type: Interventional
• Enrollment (Estimated): 45
• Phase: Phase 2

Contacts and Locations

Study Locations

• Benin
  • Abomey-Calavi, Benin
    • Not yet recruiting
    • Centre de Dépistage de Traitement de la Lèpre et de l'Ulcère de Burulli
• Côte d’Ivoire
  • Divo, Côte d’Ivoire
    • Not yet recruiting
    • Chr de Divo
• Indonesia
  • Yogyakarta, Indonesia
    • Not yet recruiting
    • Universitas Gadjah Mada
• Madagascar
  • Tôlanaro, Madagascar
    • Not yet recruiting
    • Programme national lutte contre la lèpre
    • Contact: Andrinamira Randrianantoandro; Email: andriamiradomoina@gmail.com
• Philippines
  • Manila, Philippines
    • Recruiting
    • Philippine General Hospital, University of the Philippines, Manila
    • Contact: Dofitas; Phone Number: 63285548400; Email: bldofitas@up.edu.ph
• United States
  • Washington
    • Seattle, Washington, United States, 98104
      • Not yet recruiting
      • Harborview Medical Center, University of Washington

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Aged 18 years of age or older.
2. Provision of written informed consent.
3. Laboratory confirmed previous or current Mycobacterium leprae or Mycobacterium lepromatosis infection.

4. Leprosy type 2 reaction meeting the following criteria:

   • Either:

     i. Acute (first episode and no treatment initiated) or ii. Recurrent (at least one further episode occurring 28 days or more after withdrawal of leprosy type 2 reaction treatment).

   • Presence of at least 10 leprosy type 2 reaction tender papular and/or nodular skin lesions (not including scars).
   • An ENLIST score of at least 9.
5. If a woman of reproductive potential, agree to the use of two reliable contraceptive measures (at least one of which is a highly effective form of contraception) from Screening until at least 4 weeks after completion of treatment with dovramilast or standard of care. Refer to Special Considerations for additional information.
6. If male (including those who have had a successful vasectomy), agree to using a latex condom during any sexual contact with women of reproductive potential from Screening until at least 4 weeks after completion of treatment with dovramilast or standard of care.

Exclusion Criteria:

1. Chronic leprosy type 2 reaction, defined as the reaction occurring for 24 weeks or more during which a subject has required treatment either continuously or where any treatment free period had been < 28 days.
2. Receipt of thalidomide, lenalidomide, pomalidomide, systemic corticosteroids, clofazimine (> 50 mg/day), apremilast or any other phosphodiesterase (PDE) 4 inhibitor, or immunosuppressive/immunomodulatory treatment within 28 days of Baseline.
3. Receipt of an investigational agent within 28 days of Baseline or 5 half-lives of the investigational agent (whichever is longer).
4. Leprosy type 2 reaction with orchitis, uveitis, iritis, or severe neuritis (Grade 3 or greater severe neuritis).
5. Current diagnosis of leprosy type 1 reaction or Lucio's phenomenon.
6. Current tuberculosis, malaria, cutaneous or visceral leishmaniasis or other serious bacterial, viral, or parasitic infection at Screening or Baseline.
7. Active systemic fungal infection requiring or undergoing treatment.
8. Other than leprosy type 2 reaction, any clinically significant (as determined by the Investigator) cardiac, endocrinologic, pulmonary, neurologic, psychiatric, hepatic, renal, hematologic, immunologic disease, or other major disease that is currently uncontrolled.
9. Other than leprosy type 2 reaction, any other dermatological condition that could, in the opinion of the Investigator, interfere with the study assessments.
10. Chronic hepatitis B, chronic hepatitis C, or human immunodeficiency virus (HIV) positive.
11. Pregnant women or breastfeeding mothers.
12. Use (or planned use) of antimetabolites or alkylating agents, rifampin use more frequent than monthly, phenobarbital, carbamazepine, phenytoin, traditional or herbal preparations (including St. John's wort), foods (including grapefruit) known to affect activity of the cytochrome (CYP)3A4 enzyme or use (or planned use) of all strong CYP3A and P-gp inhibitors including ketoconazole, itraconazole, voriconazole, posaconazole, clarithromycin, ritonavir, cobicistat, diltiazem. Substrates of CYP3A4, CYP2C9, CYP2C19, and P-gp should be used with caution when concomitantly administered with dovramilast.
13. Known or suspected active substance abuse or a history of substance abuse within 6 months prior to Screening.
14. Prior history of suicide attempt at any time in the subject's lifetime prior to Screening or Randomization, or major psychiatric illness requiring hospitalization within the last 3 years.
15. Current diagnosis of depression, and/or history of suicide ideation

16. History of or presence of cardiac disease, including:

    • Clinically significant abnormal electrocardiogram
    • QTcF > 450 msec
17. Receipt of a vaccination within 7 days of Baseline.
18. Known or suspected hypersensitivity to: PDE4 inhibitors including dovramilast or apremilast; thalidomide; prednisolone, or; excipients used in the formulation of dovramilast, thalidomide or prednisolone.
19. Body Mass Index < 15 kg/m^2 or > 35 kg/m^2.
20. Unable to, or significant difficulty with, swallowing tablets/capsules.
21. Anemia requiring transfusion.
22. History of or current pancreatitis.
23. Known or suspected cirrhosis of the liver.

24. The following laboratory abnormalities:

    • White blood cells (WBC) < 2.5 x 10^9/ L.
    • Neutrophils (granulocytes) < 1.0 x 10^9/L.
    • Platelets < 80 x 10^9/L.
    • Aspartate aminotransferase or alanine aminotransferase > 2 times the upper limit of reference range.
    • Albumin < 30 mg/dL.
    • Bilirubin > 2 mg/dL
    • Calculated creatinine clearance (Cockcroft Gault) < 50 milliliter (mL)/minute.
    • Lipase ≥ 1.6 times the upper limit
25. Previous participation in this study
26. Unwilling, unlikely or unable to comply with all protocol specified assessments, including photographic assessments
27. Enrolled in another leprosy type 2 reaction treatment study

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Dovramilast 100 mg	Drug: Dovramilast; Dovramilast
Experimental: Dovramilast 150 mg	Drug: Dovramilast; Dovramilast
Active Comparator: Standard of care; Prednisolone (or thalidomide US sites only)	Drug: Prednisolone; Standard of care; Drug: Thalidomide; Standard of care (US only)

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The proportion of dovramilast (100 mg or 150 mg) recipients achieving a 75% improvement in leprosy type 2 reaction skin lesions at week 12	The proportion of subjects achieving a reduction of leprosy type 2 reaction skin lesion count of at least 75% from Baseline at Week 12 without the need for rescue. Rescue is defined as: A change from dovramilast at any dose to standard of care or dose maintenance beyond taper time points defined in standard of care treatment guidelines (and specified in this protocol), or; Standard of care dose increase, switching to or adding another leprosy type 2 reaction treatment	12 weeks
Incidence and severity of adverse events	The incidence and severity of adverse events, changes in vital signs and blood dyscrasias	12 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Resolution of fever to ≤ Grade 1	Proportion of subjects with resolution of fever to ≤ Grade 1 among the subgroup of subjects with fever present at Baseline at Grade 2 or greater.	12 weeks
Skin lesion count changes	• Change from Baseline in skin lesion count up to and including Week 12.	12 weeks
Change from Baseline ENLIST (Erythema Nodosum Leprosum International Study ) severity scale score		At each post Baseline time point
Change from Baseline of each of the following parameters when present at Baseline at Grade 2 or greater	Leprosy type 2 reaction lesions with respect to: number, inflammation, and extent; Neuritis; Pain:; Fever; Peripheral edema with respect to location and severity; Inflammation of joints and/or digits; Lymphadenopathy	from baseline to Week 12
Changes in neuropathy from Baseline grade		12 weeks
Time to resolution	For each individual leprosy type 2 reaction when present at least Grade 1 at Baseline	12 weeks
Proportion of subjects requiring Rescue medication and time to initiation of Rescue medication		12 weeks
Total amount of treatment for leprosy type 2 reaction administered		12 weeks
Recurrences	Recurrence is defined as new signs and symptoms consistent with leprosy type 2 reaction. The number of Recurrence episodes requiring treatment.	48 weeks
Exposure metrics of dovramilast	Area under the curve (AUC)	48 weeks
Exposure metrics of the dovramilast metabolite M15	Area under the curve (AUC)	48 weeks
Skin lesion count changes	• Proportion of Responders at each post-Baseline timepoint.	12 weeks
Skin lesion count changes	Proportion of subjects achieving a reduction of leprosy type 2 reaction skin lesion count from Baseline of 50%, 90% and 100% without Rescue at Week 12.	12 weeks
Exposure metrics of dovramilast	Including AUC, Cmax, and Tmax.	48 weeks
Exposure metrics of dovramilast	Cmax	48 weeks
Exposure metrics of dovramilast	Tmax.	48 weeks

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Quantification of immunological markers in whole blood samples by central laboratory, blinded to patient identification, treatment arm, and study visit	Concentration of inflammatory cytokines	48 weeks
Quantification of immunological markers in skin biopsies by central laboratory, blinded to patient identification, treatment arm, and study visit	Leukocyte infiltration of skin lesions by histology	48 weeks

Collaborators and Investigators

• Sponsor: Medicines Development for Global Health

Study record dates

Study Major Dates

• Study Start (Estimated): May 25, 2026
• Primary Completion (Estimated): January 1, 2027
• Study Completion (Estimated): December 1, 2027

Study Registration Dates

• First Submitted: August 7, 2025
• First Submitted That Met QC Criteria: September 7, 2025
• First Posted (Actual): September 15, 2025

Study Record Updates

• Last Update Posted (Actual): May 26, 2026
• Last Update Submitted That Met QC Criteria: May 21, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: Leprosy type 2 reaction; dovramilast
• Additional Relevant MeSH Terms: Organic Chemicals; Heterocyclic Compounds, 1-Ring; Heterocyclic Compounds; Heterocyclic Compounds, 2-Ring; Heterocyclic Compounds, Fused-Ring; Carboxylic Acids; Polycyclic Compounds; Piperidines; Pregnadienes; Pregnanes; Steroids; Fused-Ring Compounds; Pregnadienetriols; Phthalimides; Phthalic Acids; Acids, Carbocyclic; Piperidones; Isoindoles; Prednisolone; Thalidomide
• Other Study ID Numbers: MDGH-DOV-2001

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

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