Scientific Substantiation and Assessment of the Effectiveness of Pathogenetic Methods of Therapy for Congenital Ichthyosis in Children

Study Overview
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Brief Summary
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This is an experimental non-randomized clinical study aimed at expanding the indications for the use of biological drugs with the aim of using them for the pathogenetic therapy of children with congenital ichthyosis.

Detailed Description
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This is an experimental non-randomized clinical study aimed at expanding the indications for the use of biological drugs with the aim of using them for the pathogenetic therapy of children with congenital ichthyosis. The study will include 50 children aged 6 months to 18 years with a clinically and genetically confirmed diagnosis of congenital ichthyosis. Patients will be divided into 4 groups who will receive symptomatic therapy (using active external agents, emollients and / or systemic retinoids) or biologics targeting the cytokines IL-12 / IL-23, IL-4 / IL-13 and IL -17A. Immunophenotyping of all patients will be performed, the cytokine profile and spectrum of sensitization and the degree of NF-kB activation in lymphocytes will be determined. In experimental group №3, 10 patients with Netherton syndrome will receive dupilumab, in experimental group №2, 10 patients will receive ustekinumab, and in experimental group №1 10 patients will receive secukinumab. Efficiency will be assessed using the Ichthyosis Area Severity Index (IASI), determination of the level of TEWL, and the change in quality of life will also be assessed using the Children's Dermatological Life Quality Index (CDLQI) in comparison from baseline, than at 16 and 52 weeks. Throughout the study, the safety profile (registration of the development of infectious diseases) will be assessed.

Official Title
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Scientific Substantiation and Assessment of the Effectiveness of Pathogenetic Methods of Therapy for Congenital Ichthyosis in Children

Conditions
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Congenital Ichthyosis

Intervention / Treatment
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* Drug: Secukinumab Injection
* Drug: Ustekinumab Injection
* Drug: Dupilumab Injection
* Other: Symptomatic therapy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: The subject has signed an informed consent; parental or legal representative consent for patients under 18 years of age, as well as additional consent for patients aged ≥ 15 and <18. At the time of participation in the study, the age of the subject is not less than 6 months and not more than 18 years. At the time of participation in the study, a clinical diagnosis was established: Congenital ichthyosis with various clinical forms, with the exception of vulgar and X - linked congenital ichthyosis (genetic research is not a prerequisite for participation in the study). Subjects should have at least moderate IASI erythema associated with his / her ichthyosis, and a decrease in the quality of life according to CDLQI ≥ 10 Absence of signs of severe infectious diseases (pneumonia, tuberculosis, etc.) No previous history of the use of the following genetically engineered biological drugs: ustekinumab, secukinumab, dupilumab Exclusion Criteria: Subjects who have an allergic reaction to ustekinumab, secukinumab or other components of the drugs. Subjects who have bacterial and/or fungal diseases. Subjects who have problems in dynamic observation. Subjects who will have a worsening of clinical symptoms

Ages Eligible for Study
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Minimum Age: 6 Months
Maximum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Experimental group №1 (Secukinumab )<br>Secukinumab - subcutaneous injections into the shoulder according to the schedule of 0,1,2,3 weeks, then injections 1 time in 3 months up to 52 weeks of therapy. | Drug: Secukinumab Injection<br>* Pathogenetic therapy with biologic drugs<br>|
| Experimental: Experimental group №2 (Ustekinumab)<br>Ustekinumab - subcutaneous injections in the shoulder on schedule 0; 1 month, then every 2 months up to 52 weeks of therapy. | Drug: Ustekinumab Injection<br>* Pathogenetic therapy with biologic drugs<br>|
| Experimental: Experimental group №3 (Dupilumab)<br>Dupilumab - subcutaneous injections in the shoulder: for patients weighing from 15 to <30 kg: initial dose - 600 mg (2 injections of 300 mg), then 300 mg every 4 weeks; for patients weighing from 30 to <60 kg: initial dose - 400 mg (2 injections of 200 mg), then 200 mg every 2 weeks; for patients weighing 60 kg or more: the initial dose is 600 mg (2 injections of 300 mg), then 300 mg every 2 weeks. | Drug: Dupilumab Injection<br>* Pathogenetic therapy with biologic drugs<br>|
| Active Comparator: Control group (Symptomatic therapy)<br>symptomatic therapy with emollients + systemic retinoids | Other: Symptomatic therapy<br>* Active external agents, Emollients, systemic retinoids if needed<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Ichthyosis Area Severity Index (IASI) | Clinical measures included the Ichthyosis Area Severity Index (IASI), which integrates erythema (IASI-E) and scaling (IASI-S) | From Baseline up to 16 weeks | 
| Change in Ichthyosis Area Severity Index (IASI) | Clinical measures included the Ichthyosis Area Severity Index (IASI), which integrates erythema (IASI-E) and scaling (IASI-S) | 52 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Transepidermal water loss (TEWL) level change | Change in transepidermal water loss (TEWL) while rebuilding the epidermal barrier of the skin (an indicator of the effectiveness of the therapy). Measured in g/hm2. | From Baseline up to 16 weeks | 
| Transepidermal water loss (TEWL) level change | Change in transepidermal water loss (TEWL) while rebuilding the epidermal barrier of the skin (an indicator of the effectiveness of the therapy). Measured in g/hm2. | 52 weeks | 
| Change in the Children's Dermatology Life Quality Index (CDLQI) | increasing The Children's Dermatology Life Quality Index, as an indicator of the effectiveness of therapy. The CDLQI is calculated by summing the score of each question resulting in a maximum of 30 and a minimum of 0. The higher the score, the more quality of life is impaired. The CDLQI can also be expressed as a percentage of the maximum possible score of 30. | From Baseline up to 16 weeks | 
| Change in the Children's Dermatology Life Quality Index (CDLQI) | Change in the Children's Dermatology Life Quality Index (CDLQI), as an indicator of the effectiveness of therapy. The CDLQI is calculated by summing the score of each question resulting in a maximum of 30 and a minimum of 0. The higher the score, the more quality of life is impaired. The CDLQI can also be expressed as a percentage of the maximum possible score of 30. | 52 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Congenital ichthyosis, Netherton syndrome, Autosomal recessive congenital ichthyosis, Biologic therapy