Prove cliniche Nct

Clinical Trial Results:
A dual-center prospective phase I/II trial to establish safety, tolerability and to obtain first data on efficacy of losartan in children with recessive dystrophic epidermolysis bullosa (RDEB)

Summary
EudraCT number
2015-003670-32
Trial protocol
DE   AT  
Global end of trial date
12 Feb 2021

Results information
Results version number
v1(current)
This version publication date
03 Sep 2022
First version publication date
03 Sep 2022
Other versions

Trial information

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Trial identification
Sponsor protocol code
REFLECT
Additional study identifiers
ISRCTN number
-
US NCT number
-
WHO universal trial number (UTN)
-
Other trial identifiers
DRKS: DRKS00009269
Sponsors
Sponsor organisation name
Medical Center - University of Freiburg
Sponsor organisation address
Breisacher Str. 153, Freiburg, Germany, 79110
Public contact
Prof. Dr. Dimitra Kiritsi, Medical Center - University of Freiburg, ++49 761270-67100, dimitra.kiritsi@uniklinik-freiburg.de
Scientific contact
Prof. Dr. Dimitra Kiritsi, Medical Center - University of Freiburg, ++49 761270-67100, dimitra.kiritsi@uniklinik-freiburg.de
Paediatric regulatory details
Is trial part of an agreed paediatric investigation plan (PIP)
No
Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
No
Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
No
Results analysis stage
Analysis stage
Final
Date of interim/final analysis
01 Oct 2021
Is this the analysis of the primary completion data?
Yes
Primary completion date
12 Feb 2021
Global end of trial reached?
Yes
Global end of trial date
12 Feb 2021
Was the trial ended prematurely?
No
General information about the trial
Main objective of the trial
Establish tolerability and saftey of losartan in children with moderate to serve RDEB
Protection of trial subjects
Risk-based monitoring was done according to ICH-GCP E6 and SOPs to verify that patients’ rights and wellbeing are protected, reported trial data are accurate, complete and verifiable from source documents and that the trial is conducted in compliance with the currently approved protocol/amendment, with ICH-GCP and with the applicable regulatory requirements to ensure safety and integrity of clinical trial data.
Background therapy
-
Evidence for comparator
-
Actual start date of recruitment
27 Jul 2017
Long term follow-up planned
No
Independent data monitoring committee (IDMC) involvement?
Yes
Population of trial subjects
Number of subjects enrolled per country
Country: Number of subjects enrolled
Germany: 29
Worldwide total number of subjects
29
EEA total number of subjects
29
Number of subjects enrolled per age group
In utero
0
Preterm newborn - gestational age
0
Newborns (0-27 days)
0
Infants and toddlers (28 days-23 months)
0
Children (2-11 years)
24
Adolescents (12-17 years)
5
Adults (18-64 years)
0
From 65 to 84 years
0
85 years and over
0

Subject disposition

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Recruitment
Recruitment details
-

Pre-assignment
Screening details
-

Pre-assignment period milestones
Number of subjects started
29
Number of subjects completed
29

Period 1
Period 1 title
Overall (overall period)
Is this the baseline period?
Yes
Allocation method
Not applicable
Blinding used
Not blinded
Blinding implementation details
Not applicable: prospective, open, single-arm phase I/II clinical trial

Arms
Arm title
Losartan
Arm description
Study medication: Losartan potassium, 2.5 mg/ml, extemporaneous oral liquid suspension.
Arm type
Experimental

Investigational medicinal product name
Losartan HEXAL
Investigational medicinal product code
Losartan potassium
Other name
Pharmaceutical forms
Film-coated tablet, Oral liquid, Oral suspension
Routes of administration
Oral use
Dosage and administration details
Dosage form: Film-coated tablets Strength: 50 mg Maximum daily dose: 1.4 mg/kg

Number of subjects in period 1
Losartan
Started
29
Completed
29

Baseline characteristics

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Baseline characteristics reporting groups
Reporting group title
Overall
Reporting group description
-

Reporting group values
Overall Total
Number of subjects
29 29
Age categorical
Units: Subjects
    In utero
0 0
    Preterm newborn infants (gestational age < 37 wks)
0 0
    Newborns (0-27 days)
0 0
    Infants and toddlers (28 days-23 months)
0 0
    Children (2-11 years)
24 24
    Adolescents (12-17 years)
5 5
    Adults (18-64 years)
0 0
    From 65-84 years
0 0
    85 years and over
0 0
Age continuous
Units: years
    arithmetic mean (standard deviation)
6.44 ± 3.81 -
Gender categorical
Units: Subjects
    Female
13 13
    Male
16 16
Subject analysis sets

Subject analysis set title
SAF
Subject analysis set type
Safety analysis
Subject analysis set description
All analyses (safety and efficacy) were performed in the safety population (SAF) which included all patients who fulfilled the inclusion and exclusion criteria, and for whom treatment was started, i.e. 29 patients.

Subject analysis sets values
SAF
Number of subjects
29
Age categorical
Units: Subjects
    In utero
0
    Preterm newborn infants (gestational age < 37 wks)
0
    Newborns (0-27 days)
0
    Infants and toddlers (28 days-23 months)
0
    Children (2-11 years)
24
    Adolescents (12-17 years)
5
    Adults (18-64 years)
0
    From 65-84 years
0
    85 years and over
0
Age continuous
Units: years
    arithmetic mean (standard deviation)
±
Gender categorical
Units: Subjects
    Female
    Male

End points

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End points reporting groups
Reporting group title
Losartan
Reporting group description
Study medication: Losartan potassium, 2.5 mg/ml, extemporaneous oral liquid suspension.

Subject analysis set title
SAF
Subject analysis set type
Safety analysis
Subject analysis set description
All analyses (safety and efficacy) were performed in the safety population (SAF) which included all patients who fulfilled the inclusion and exclusion criteria, and for whom treatment was started, i.e. 29 patients.

Primary: Occurrence of a serious safety concern

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End point title
Occurrence of a serious safety concern [1]
End point description
The primary endpoint was defined as the occurrence of a serious safety concern, specified as one of the following side effects of losartan: • clinically relevant severe hypotension • immediate hypersensitivity reactions to the drug • clinical relevant severe hypo- und hyperkalaemia
End point type
Primary
End point timeframe
During study
Notes
[1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
Justification: Single arm trial.
End point values
SAF
Number of subjects analysed
29
Units: Number of patients
0
No statistical analyses for this end point

Secondary: Birmingham Epidermolysis Bullosa Severity Score

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End point title
Birmingham Epidermolysis Bullosa Severity Score
End point description
Birmingham Epidermolysis Bullosa Severity Score (BEBS) (0=best, 100=worst)
End point type
Secondary
End point timeframe
Difference between baseline and month 9
End point values
Losartan
Number of subjects analysed
28
Units: Severity Score
    arithmetic mean (confidence interval 95%)
-3.00 (-5.79 to -0.21)
No statistical analyses for this end point

Secondary: Epidermolysis Bullosa Disease Activity and Scarring Index (EBDASI) Total activity score

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End point title
Epidermolysis Bullosa Disease Activity and Scarring Index (EBDASI) Total activity score
End point description
Change in the total activity score (0=best, 276=worst) of the Epidermolysis Bullosa Disease Activity and Scarring Index
End point type
Secondary
End point timeframe
Difference between baseline and month 9
End point values
Losartan
Number of subjects analysed
28
Units: Scarring Index
    arithmetic mean (confidence interval 95%)
-7.36 (-16.13 to 1.41)
No statistical analyses for this end point

Secondary: Epidermolysis Bullosa Disease Activity and Scarring Index (EBDASI) – Total damage score

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End point title
Epidermolysis Bullosa Disease Activity and Scarring Index (EBDASI) – Total damage score
End point description
EBDASI total damage score (ranging from 0=best to 230=worst)
End point type
Secondary
End point timeframe
Difference between baseline and month 9
End point values
SAF
Number of subjects analysed
28
Units: Total damage score
    arithmetic mean (confidence interval 95%)
-10.50 (-20.81 to -0.19)
No statistical analyses for this end point

Secondary: Epidermolysis Bullosa Disease Activity and Scarring Index (EBDASI) – Overall total score

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End point title
Epidermolysis Bullosa Disease Activity and Scarring Index (EBDASI) – Overall total score
End point description
End point type
Secondary
End point timeframe
Difference between baseline and month 9
End point values
SAF
Number of subjects analysed
28
Units: Overall total score
    arithmetic mean (confidence interval 95%)
-17.86 (-31.11 to -4.61)
No statistical analyses for this end point

Secondary: Hand function assessment score of Colville and Terrill

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End point title
Hand function assessment score of Colville and Terrill
End point description
Hand function assessment score of Colville and Terrill, ranging from 0=best to 3=worst. Improvement of at least 1 level.
End point type
Secondary
End point timeframe
Difference between baseline and month 9
End point values
SAF
Number of subjects analysed
28
Units: Number of patients
3
No statistical analyses for this end point

Secondary: Mayo Dysphagia Questionnaire-day 30 (MDQ-30)

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End point title
Mayo Dysphagia Questionnaire-day 30 (MDQ-30)
End point description
The Mayo Dysphagia Questionnaire-day 30 (MDQ-30) was used to assess oesophageal involvement. Dysphagia score: 0=best, 100=worst
End point type
Secondary
End point timeframe
Difference between baseline and month 9
End point values
SAF
Number of subjects analysed
28
Units: Dysphagia score
    arithmetic mean (confidence interval 95%)
3.04 (-7.20 to 13.27)
No statistical analyses for this end point

Secondary: Itch Assessment Scale

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End point title
Itch Assessment Scale
End point description
Itch assessment scale for the pediatric burn patients, ranging from 0=best to 4=worst. Improvement of at least one level.
End point type
Secondary
End point timeframe
Difference between baseline and month 9
End point values
SAF
Number of subjects analysed
28
Units: Number of patients
12
No statistical analyses for this end point

Secondary: Wong-Baker FACES Scale for Pain

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End point title
Wong-Baker FACES Scale for Pain
End point description
Wong-Baker FACES Scale for Pain (ranging from 0=best to 10=worst). Improvement of at least 1 level.
End point type
Secondary
End point timeframe
Difference between baseline and month 9
End point values
SAF
Number of subjects analysed
28
Units: Number of patients
9
No statistical analyses for this end point

Secondary: Quality of Life in EB (QOLEB)

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End point title
Quality of Life in EB (QOLEB)
End point description
The change in the total score (0=best, 51=worst) of the Quality of Life in EB (QOLEB) during the study.
End point type
Secondary
End point timeframe
Difference between baseline and month 9
End point values
SAF
Number of subjects analysed
29
Units: QoL
    arithmetic mean (confidence interval 95%)
0.54 (-2.40 to 3.47)
No statistical analyses for this end point

Secondary: Children’s Dermatology Life Quality Index (CDLQI) - Total scale

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End point title
Children’s Dermatology Life Quality Index (CDLQI) - Total scale
End point description
Change in the total scale (0=best, 30=worst) of the Children’s Dermatology Life Quality Index (CDLQI) during the study
End point type
Secondary
End point timeframe
Difference between baseline and month 9
End point values
SAF
Number of subjects analysed
28
Units: CDLQI
    arithmetic mean (confidence interval 95%)
-2.64 (-4.35 to -0.94)
No statistical analyses for this end point

Secondary: Morphometric Scoring Instrument of Pseudosyndactyly Progression

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End point title
Morphometric Scoring Instrument of Pseudosyndactyly Progression
End point description
Maximal distance of thumb and index finger – Mean of left and right
End point type
Secondary
End point timeframe
Difference between baseline and month 9
End point values
SAF
Number of subjects analysed
28
Units: Maximal distance
    arithmetic mean (confidence interval 95%)
6.92 (3.48 to 10.37)
No statistical analyses for this end point

Secondary: Adverse event

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End point title
Adverse event
End point description
Number of patient with at least one adverse event
End point type
Secondary
End point timeframe
During the whole study period
End point values
SAF
Number of subjects analysed
29
Units: Number of patients
25
No statistical analyses for this end point

Secondary: Adverse event of severe intensity

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End point title
Adverse event of severe intensity
End point description
Number of patients with at least one AE of severe intensity
End point type
Secondary
End point timeframe
During study
End point values
SAF
Number of subjects analysed
29
Units: Number of patients
2
No statistical analyses for this end point

Secondary: Adverse event possibly related to study medication

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End point title
Adverse event possibly related to study medication
End point description
Number of patients with at least one AE possibly related to study medication
End point type
Secondary
End point timeframe
During study
End point values
SAF
Number of subjects analysed
29
Units: Number of patients
1
No statistical analyses for this end point

Secondary: Severe adverse event possibly related to study medication

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End point title
Severe adverse event possibly related to study medication
End point description
Number of patients with at least one severe adverse event possibly related to study medication
End point type
Secondary
End point timeframe
During study
End point values
SAF
Number of subjects analysed
29
Units: Number of patients
0
No statistical analyses for this end point

Secondary: Serious adverse event

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End point title
Serious adverse event
End point description
Number of patients with at least one serious adverse event
End point type
Secondary
End point timeframe
During study
End point values
SAF
Number of subjects analysed
29
Units: Number of patients
4
No statistical analyses for this end point

Secondary: Serious adverse event possibly related to study medication

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End point title
Serious adverse event possibly related to study medication
End point description
Number of patients with at least one SAE possibly related to study medication
End point type
Secondary
End point timeframe
During study
End point values
SAF
Number of subjects analysed
29
Units: Number of patients
0
No statistical analyses for this end point

Secondary: Serious adverse event leading to death

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End point title
Serious adverse event leading to death
End point description
Number of patients with at least one SAE leading to death
End point type
Secondary
End point timeframe
During study
End point values
SAF
Number of subjects analysed
29
Units: Number of patients
0
No statistical analyses for this end point

Adverse events

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Adverse events information
Timeframe for reporting adverse events
Complete study
Assessment type
Systematic
Dictionary used for adverse event reporting
Dictionary name
MedDRA
Dictionary version
22
Reporting groups
Reporting group title
Losartan
Reporting group description
Losartan

Serious adverse events
Losartan
Total subjects affected by serious adverse events
     subjects affected / exposed
4 / 29 (13.79%)
     number of deaths (all causes)
1
     number of deaths resulting from adverse events
0
Blood and lymphatic system disorders
Anaemia
     subjects affected / exposed
2 / 29 (6.90%)
     occurrences causally related to treatment / all
0 / 2
     deaths causally related to treatment / all
0 / 0
General disorders and administration site conditions
General physical health deterioration
     subjects affected / exposed
1 / 29 (3.45%)
     occurrences causally related to treatment / all
0 / 1
     deaths causally related to treatment / all
0 / 0
Product issues
Device failure
     subjects affected / exposed
1 / 29 (3.45%)
     occurrences causally related to treatment / all
0 / 1
     deaths causally related to treatment / all
0 / 0
Infections and infestations
Bacterial infection
     subjects affected / exposed
1 / 29 (3.45%)
     occurrences causally related to treatment / all
0 / 1
     deaths causally related to treatment / all
0 / 0
Device related infection
     subjects affected / exposed
1 / 29 (3.45%)
     occurrences causally related to treatment / all
0 / 1
     deaths causally related to treatment / all
0 / 0
Pseudomonal sepsis
     subjects affected / exposed
1 / 29 (3.45%)
     occurrences causally related to treatment / all
0 / 1
     deaths causally related to treatment / all
0 / 0
Skin bacterial infection
     subjects affected / exposed
1 / 29 (3.45%)
     occurrences causally related to treatment / all
0 / 1
     deaths causally related to treatment / all
0 / 0
Wound infection bacterial
     subjects affected / exposed
1 / 29 (3.45%)
     occurrences causally related to treatment / all
0 / 1
     deaths causally related to treatment / all
0 / 0
Frequency threshold for reporting non-serious adverse events: 0%
Non-serious adverse events
Losartan
Total subjects affected by non serious adverse events
     subjects affected / exposed
23 / 29 (79.31%)
Injury, poisoning and procedural complications
Eye injury
     subjects affected / exposed
1 / 29 (3.45%)
     occurrences all number
1
Limb injury
     subjects affected / exposed
1 / 29 (3.45%)
     occurrences all number
1
Investigations
Body temperature increased
     subjects affected / exposed
2 / 29 (6.90%)
     occurrences all number
2
Pain threshold decreased
     subjects affected / exposed
1 / 29 (3.45%)
     occurrences all number
1
Surgical and medical procedures
Artificial crown procedure
     subjects affected / exposed
1 / 29 (3.45%)
     occurrences all number
1
Parasitic infection prophylaxis
     subjects affected / exposed
1 / 29 (3.45%)
     occurrences all number
1
Respiratory, thoracic and mediastinal disorders
Cough
     subjects affected / exposed
1 / 29 (3.45%)
     occurrences all number
1
Epistaxis
     subjects affected / exposed
2 / 29 (6.90%)
     occurrences all number
2
Nervous system disorders
Headache
     subjects affected / exposed
3 / 29 (10.34%)
     occurrences all number
6
Eye disorders
Eye pain
     subjects affected / exposed
1 / 29 (3.45%)
     occurrences all number
1
Ear and labyrinth disorders
Vertigo
     subjects affected / exposed
1 / 29 (3.45%)
     occurrences all number
1
General disorders and administration site conditions
Fatigue
     subjects affected / exposed
1 / 29 (3.45%)
     occurrences all number
1
Impaired healing
     subjects affected / exposed
1 / 29 (3.45%)
     occurrences all number
1
Pyrexia
     subjects affected / exposed
2 / 29 (6.90%)
     occurrences all number
2
Temperature intolerance
     subjects affected / exposed
2 / 29 (6.90%)
     occurrences all number
2
Gastrointestinal disorders
Abdominal pain
     subjects affected / exposed
1 / 29 (3.45%)
     occurrences all number
2
Constipation
     subjects affected / exposed
1 / 29 (3.45%)
     occurrences all number
2
Diarrhoea
     subjects affected / exposed
2 / 29 (6.90%)
     occurrences all number
2
Dysphagia
     subjects affected / exposed
2 / 29 (6.90%)
     occurrences all number
2
Gastritis
     subjects affected / exposed
1 / 29 (3.45%)
     occurrences all number
1
Nausea
     subjects affected / exposed
3 / 29 (10.34%)
     occurrences all number
4
Odynophagia
     subjects affected / exposed
1 / 29 (3.45%)
     occurrences all number
1
Tooth disorder
     subjects affected / exposed
1 / 29 (3.45%)
     occurrences all number
1
Vomiting
     subjects affected / exposed
2 / 29 (6.90%)
     occurrences all number
6
Skin and subcutaneous tissue disorders
Blister
     subjects affected / exposed
1 / 29 (3.45%)
     occurrences all number
1
Pruritus
     subjects affected / exposed
3 / 29 (10.34%)
     occurrences all number
3
Vitiligo
     subjects affected / exposed
1 / 29 (3.45%)
     occurrences all number
1
Musculoskeletal and connective tissue disorders
Groin pain
     subjects affected / exposed
1 / 29 (3.45%)
     occurrences all number
1
Infections and infestations
Conjunctivitis
     subjects affected / exposed
2 / 29 (6.90%)
     occurrences all number
2
Croup infectious
     subjects affected / exposed
1 / 29 (3.45%)
     occurrences all number
1
Gastrointestinal viral infection
     subjects affected / exposed
1 / 29 (3.45%)
     occurrences all number
1
Hand-foot-and-mouth disease
     subjects affected / exposed
1 / 29 (3.45%)
     occurrences all number
1
Medical device site infection
     subjects affected / exposed
1 / 29 (3.45%)
     occurrences all number
2
Nasopharyngitis
     subjects affected / exposed
5 / 29 (17.24%)
     occurrences all number
6
Oral herpes
     subjects affected / exposed
1 / 29 (3.45%)
     occurrences all number
1
Oral infection
     subjects affected / exposed
1 / 29 (3.45%)
     occurrences all number
1
Otitis media
     subjects affected / exposed
1 / 29 (3.45%)
     occurrences all number
1
Pseudomonas infection
     subjects affected / exposed
1 / 29 (3.45%)
     occurrences all number
1
Tinea infection
     subjects affected / exposed
1 / 29 (3.45%)
     occurrences all number
1
Urinary tract infection
     subjects affected / exposed
2 / 29 (6.90%)
     occurrences all number
2
Upper respiratory tract infection
     subjects affected / exposed
1 / 29 (3.45%)
     occurrences all number
1
Viral infection
     subjects affected / exposed
1 / 29 (3.45%)
     occurrences all number
1
Wound infection
     subjects affected / exposed
2 / 29 (6.90%)
     occurrences all number
3

More information

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Substantial protocol amendments (globally)

Were there any global substantial amendments to the protocol? Yes
Date
Amendment
21 May 2019
Administrative changes, update of the responsibility list: • change of coordinating investigator • departure of one of the project manager from the CTU Formal specification of the inclusion criterion 3: OLD: Male or female patients from 2 to 16 years (age of >25 months); NEW: Male or female patients from 2 to 16 years (starting from the 25th month of life).
18 Feb 2020
Administrative changes, update of the responsibility list: • change of coordinating investigator Synopsis and chapter 3.4 Trial timetable: • Updates regarding timelines

Interruptions (globally)

Were there any global interruptions to the trial? No

Limitations and caveats

Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
None reported
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