Alitretinoin vs Azathioprine in Severe Non-hyperkeratotic Hand Eczema

Study Overview
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Brief Summary
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The purpose of this study is to compare the efficacy of alitretinoin and azathioprine in the treatment of patients with severe chronic non-hyperkeratotic hand eczema.

Official Title
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Efficacy of Oral Alitretinoin Versus Oral Azathioprine in Patients With Severe Chronic Non-hyperkeratotic Hand Eczema. A Randomized Prospective Open-label Trial With Blinded Outcome Assessment

Conditions
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Hand Eczema

Intervention / Treatment
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* Drug: Alitretinoin
* Drug: Azathioprine


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age ≥ 18 years and ≤ 75 years Severe or very severe chronic non-hyperkeratotic hand eczema for a minimum duration of 3 months as defined by a Physician Global Assessment (PGA) using a validated Photoguide Refractory to standard therapy, defined as: Patients received treatment with topical corticosteroids of class II or higher for at least 8 weeks within 3 months before enrolment, with either no response or a transient response. Patients had also received standard skin care, including emollients and barrier protection as appropriate, without significant improvement. Patients had avoided irritants and allergens, if identified, without significant improvement. Women of childbearing potential are required to use at least two forms of contraception for at least 1 month before starting treatment, during treatment, and for at least 1 month after finishing treatment; these women are required to take monthly pregnancy tests Able to provide written Informed Consent Able to speak and read the Dutch language Exclusion Criteria: General criteria prior to randomization Treatment with alitretinoin or azathioprine in the previous 3 months Hyperkeratotic palmar eczema as defined by the Danish Contact Dermatitis Group Patients with predominantly atopic dermatitis, in which the hands are also involved. Patients with mild atopic dermatitis, in which the hands are mainly affected are eligible for inclusion. Psoriasis Active bacterial, fungal, or viral infection of the hands Pregnant/lactating or planning to become pregnant during the study period Treatment with systemic medication or UV radiation within the previous 4 weeks Mentally incompetent Immunocompromised status Known or suspected allergy to ingredients in the study medications Inclusion in a study of an investigational drug within 60 days prior to start of treatment Current malignancy (other than successfully treated non-metastatic cutaneous squamous cell or basal cell carcinoma and⁄or localized carcinoma in situ of the cervix) Current active pancreatitis Living vaccine (including bacillus Calmette-Guérin (BCG), varicella, measles, mumps, rubella, yellow fever, oral polio and oral typhoid) in the last 2 weeks or the planned application of such a vaccine during the study period Evidence of alcohol abuse or drug addiction Chronic or recurrent infectious diseases Contact sensitizations with clinical relevance to the hands, in which exposure to allergens is not avoided Hypervitaminosis A due to the use of vitamin A supplements containing >2000 IU Use of drugs with potential to change the effective dosis of study drugs within the previous 2 weeks Laboratory exclusion criteria post randomization Alanine aminotransferase (ALAT) and ⁄or aspartate aminotransferase (ASAT) values > 200% of the upper limit of normal Impaired renal function as indicated by a clinically relevant abnormal creatinine value (to be determined by investigator or treating physician) Anemia as indicated by a clinically relevant lowered hemoglobin value (to be determined by investigator or treating physician) Alitretinoin specific Triglycerides > 200% of the upper limit of normal, Cholesterol or low density lipoprotein (LDL) cholesterol values > 200% of the upper limit of normal Uncontrolled hypothyroidism (to be determined by investigator or treating physician) Azathioprine specific • Patients with low or absent thiopurine methyltransferase (TPMT) activity (defined in our center as <52 nmol/gHb/hour, combined with genotyping showing homozygous of compound heterozygous mutations) and a subsequent risk for life-threatening myelotoxicity

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 75 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
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Alitretinoin<br>Patients with severe chronic non-hyperkeratotic hand eczema, randomized to treatment with alitretinoin. | Drug: Alitretinoin<br>* Oral alitretinoin capsule of 30mg once daily for a total of 24 weeks.<br>* Other names: ATC code: D11AH04;|
| Active Comparator: Azathioprine<br>Patients with severe chronic non-hyperkeratotic hand eczema, randomized to treatment with azathioprine. | Drug: Azathioprine<br>* Oral azathioprine tablets twice daily in a dose of 1.5 or 2.5mg/kg/day, depending on the thiopurine methyltransferase (TPMT) activity.<br>* Other names: ATC code: L04AX01;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Response to treatment/hand eczema severity (Photoguide) |  | 24 weeks (end of treatment) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Response to treatment/hand eczema severity (Photoguide) |  | 12 weeks | 
| Response to treatment/hand eczema severity (Hand Eczema Severity Index, HECSI) |  | Week 4, 8, 12, 24 | 
| Time to response |  | Week 4, 8, 12, 24 | 
| Patient reported improvement (Patient Global Assessment, PaGA) |  | Week 12 and 24 | 
| Safety and tolerability (adverse events) |  | Up to 24 weeks | 
| Cost-utility. QALY's: registered direct/indirect costs, combined with EQ-5D outcome |  | Week 12 and 24 | 
| Cost-effectiveness: registered direct/indirect costs combined with the primary and secondary effectiveness outcomes (Photoguide/HECSI) |  | Week 12 and 24 | 
| Quality of Life: questionnaire. |  | Week 12 and 24 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Alitretinoin, Azathioprine, Hand eczema