Metformin for the Treatment of Hidradenitis Suppurativa (HS)

Study Overview
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Brief Summary
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A randomized controlled trial investigating the metformin is the treatment for hidradenitis suppurativa. Metformin combined with doxycycline will be compared to the standard treatment of doxycycline monotherapy for HS severity and the effect on the pre-diabetic condition.

Official Title
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Rediscovery of Metformin for the Chronic Disabling Auto-inflammatory Disease Hidradenitis Suppurativa

Conditions
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Hidradenitis Suppurativa

Intervention / Treatment
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* Combination Product: Metformin


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age ≥18 years at baseline A diagnosis of HS for at least 1 year prior to baseline mild to moderately active disease defined by a HS Physician Global Assessment (HS-PGA) score of 2-3 and the Refined Hurley classification of mild to moderate at baseline Indication for systemic therapy; i.e. uncontrolled disease under conventional topical therapy. Able and willing to give written informed consent and to comply with the study requirements Exclusion Criteria: Pregnant and lactating women Concomitant diabetes mellitus Use of antibiotics within 14 days prior to baseline Use of immunosuppressing/modulating therapies within 28 days prior to baseline A known allergy to metformin or doxycycline or any of the ingredients metformin or doxycycline

Ages Eligible for Study
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Minimum Age: 18 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
Interventional Model Description: randomized controlled trial
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Metformin combined with doxycycline<br> | Combination Product: Metformin<br>* Metformin in combination with doxycycline<br>|
| Placebo Comparator: Doxycyline combined with placebo<br> | Combination Product: Metformin<br>* Metformin in combination with doxycycline<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| IHS4 | International Hidradenitis Suppurativa Severity Score System (IHS4) | 24 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Insulin resistance | • Change in insulin resistance from baseline using the HOMA-IR (based on fasting glucose and insulin levels) and differences between the groups at week 12 and 24. | 12 and 24 weeks | 
| Lesion Count | • Change in lesion count from baseline and differences between the groups at 12 and 24 week. Difference in lesion count will be assessed between the groups at week 12 and 24. | 12 and 24 weeks | 
| NRS-Pain | Change in skin related pain from baseline, on a numerical rating scale, and differences between the groups at week 12 (V2) and 24 (V4) | 12 and 24 weeks | 
| Cost-effectiveness | • For cost-effectiveness the direct medical costs will be will be assessed using the iMTA Medical Consumption Questionnaire (iMCQ), The measurement will be at baseline, at 12 weeks and at 24 weeks. Productivity losses will be collected using the iMTA Productivity Cost Questionnaire (iPCQ) includes three modules measuring productivity losses of paid work due to 1) absenteeism and 2) presenteeism and productivity losses related to 3) unpaid work. The friction cost method for valuing the production losses will be applied in accordance to the Dutch manual for costing studies. Hence, the productivity loss will be valued per worker by age and gender and, for long term absences, taking into account that productivity costs to society is confined to the period needed to replace a worker (the friction period). Cost effectiveness will be estimated using Dutch manual for costing studies in economic evaluations (publication of the Health Care Institute (ZIN). | 24 weeks | 
| Bio-markers | The correlation between baseline calprotectin levels and disease severity for both groups. The correlation between calprotectin levels and treatment response in each group at week 12 and 24. | 24 weeks | 
| Safety and Tolerability | • Incidence and severity of all adverse events (according to medDRA) will be analysed throughout the study, and renal function and lactate will be assessed at every visit. | up to 24 weeks | 
| Metabolic syndrome | Change in parameters of metabolic syndrome (waist circumference, blood pressure, HDL cholesterol, and triglycerides) from baseline and differences between the groups at week 12 and 24. | 12 and 24 weeks | 
| Pre-diabetic disorder | Change in HbA1c from baseline and differences between the groups at week 12 and week 24. | 12 and 24 weeks | 
| HiSCR | The percentage of HiSCR achievers (a ≥ 50% reduction in inflammatory lesion count (abscesses + inflammatory nodules), and no increase in abscesses or draining fistulas when compared with baseline) and the difference between the groups at week 12 and 24. | 12 and 24 weeks | 
| HS-PGA | The change in HS-PGA from baseline and the difference between the groups at week 12 and 24. | 12 and 24 weeks | 
| Flares | Change in self-reported frequency of flares from baseline and differences between the groups at week 12 and 24. | 12 and 24 weeks | 
| DLQI | Change in quality of life from baseline and differences between the groups, measured with the Dermatologic Life Quality Index and the EQ-5D, at week 12 and 24. | 12 and 24 weeks | 
| Treatment satisfaction | Difference in treatment satisfaction and recommendation on a 5- and 3-point Likert scale respectively at week 12 and 24 between the groups. | up to 24 weeks |