Onreltea (Brimonidine) Gel In Pediatric Patients With Capillary Malformations

Study Overview
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Brief Summary
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Capillary Malformations (CM) affect a significant proportion of otherwise healthy children and may lead to psychological discomfort if left untreated. A significant proportion of untreated lesions undergo soft tissue thickening and darker discoloration later in life due to progressive ectasia of the affected vessels. While laser treatment is available, its use may be limited due to need for repeated sedation/general anesthetic use, partial response and cost. The investigators propose to conduct an open-label, prospective, cohort study using Onreltea ( Brimonidine) gel for treatment of facial capillary malformations in children. The study medication will be applied topically on affected area of the skin daily for 12 weeks. Follow up visits will occur at at Week 1,4,8,12, and 16 to assess the efficacy and safety of the proposed treatment. The study second aim is to explore the feasibility of conducting a multicenter placebo controlled study.

Detailed Description
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The investigators are planning to enroll in the study 20 participants at SickKids. It is a prospective, open label, cohort study. Patients enrolled in the study will be followed at the Hospital For Sick Children for 16 weeks. They will come for the study visits 6 times: in 1 week, 4,8,12, and 16 weeks after the treatment has been started. During each study visit the study investigators will assess any changes in the characteristics of CM lesion(s) captured by a Chromometer *, Analogue Scale and Erythema Assessment tools. Participants or their parents will assess the changes at the final study visit (VAS and EA tools). Patients will be provided with study medication for all duration of the study treatment (12 weeks). The results of the treatment will be compared with the baseline data to evaluate the efficacy and safety of Onreltea (Brimonidine) gel in children with facial capillary malformations.

Official Title
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Onreltea (Brimonidine) Gel In Pediatric Patients With Capillary Malformations: A Prospective, Open-label, Cohort Study

Conditions
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Capillary Malformations

Intervention / Treatment
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* Drug: Brimonidine 0.33% gel


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: diagnosis of facial capillary malformation (port-wine stain, PWS) made by a dermatologist age: 12-17 years of age weight > 45 kg lesions with a surface area < 100 cm2 signed consent and assent for study participation Exclusion Criteria: skin breakdown overlying the malformation due to other dermatological conditions (e.g. eczema, psoriasis) current or treatment with laser the past 3 months other topical treatments used within the past 4 weeks (e.g. rapamycin, corticosteroids, calcineurin inhibitors, etc) known chronic renal or hepatic disorders known cardiovascular disorders other systemic medications that potentially interact with Brimonidine (opiates, chlorpromazine, methyphenidate, reserpine, etc) mixed capillary/ venous or lymphatic malformations known allergy to one of the constituents of Onreltea pregnancy, or sexually active subjects of child-bearing potential (CBP), unwilling to use contraception during the study (such as barrier method, or oral contraceptives).

Ages Eligible for Study
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Minimum Age: 12 Years
Maximum Age: 17 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Onreltea ( Brimonidine)<br>All the patients enrolled in the study will apply Onreltea ( Brimonidine 0.33%) gel on the affected skin area for 12 weeks (from Day 0 to Week 12 visit). | Drug: Brimonidine 0.33% gel<br>* Topical application of Brimonidine 0.33% gel on Capillary Malformation (CM) lesion once daily for 12 weeks<br>* Other names: Onreltea;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The change in the color of the capillary malformation using Chroma meter values (Δa, ΔE) at 12 weeks. | Measurement of erythema will be performed using Chroma Meter, CR-400, Konica, Minolta, Osaka, Japan. The meter readings will result in 3 values: L- refers to the relative light intensity, ranging from 0 (black) to +100 (white); a-captures color saturation, ranging from +60 (green) to -60 (red) and b- captures color spectrum from +60 (blue) to -60 (yellow). In most studies both, changes in a (Δa) and overall changes in the composite score (ΔE calculated as √((ΔL*before-ΔL*after)^2+(Δa*before-Δa*after)^2+(Δb*before-ΔL*after)^2 ) are obtained. | 12 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes in the color of the lesion (Δa, ΔE) at each follow up visit including the last visit at 16 weeks compared to baseline | Same as in primary outcome measure | 1,4,8,16 weeks | 
| Changes in CEA scores at 12, 16 weeks compared to baseline | A Clinician Erythema Assessment scale (CEA), consisting of a 0-4 numerical scale as follows: 0- clear skin, no erythema almost clear skin, slight redness mild erythema, definite redness moderate erythema, marked redness severe erythema, fiery redness | 12 and 16 weeks | 
| Changes in the iVAS at 12 and 16 weeks compared to baseline | Investigator's assessment of changes on the Visual Analogue Scale ( iVAS) | 12 and 16 weeks | 
| Correlation between iVAS, pVAS, CEA, pEA and Chroma Meter values | pVAS - patient/parent's Visual Analogue Scale assessment; pEA- patient/parent Erythema Assessment | 1,4,8,12,16 weeks | 
| Percentage of patients achieving 75% and 100% resolution of the lesion | by iVAS and chromo meter values | 12 weeks | 
| Frequency of observed and reported adverse events (AE) | AE documented in patient diary and mentioned at each study visit | 16 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Capillary malformations, Onrealtea, port-wine stain, treatment, topical