Alitretinoin vs Cyclosporine in Severe Recurrent Vesicular 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 cyclosporine in the treatment of patients with severe recurrent vesicular hand eczema.

Official Title
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Efficacy of Oral Alitretinoin Versus Oral Cyclosporine in Patients With Severe Recurrent Vesicular 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: cyclosporin A


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age ≥ 18 years and ≤ 75 years Severe or very severe recurrent vesicular 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 contact 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 Treated with alitretinoin or cyclosporine in the previous 3 months Other morphologic types of hand eczema as defined by the Danish Contact Dermatitis Group Patients with predominantly atopic dermatitis, in which the hands are also involved. (Patients with controlled atopic dermatitis, in which the hands are mainly affected, are eligible for inclusion.) Psoriasis of the hands 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 Uncontrolled arterial hypertension (minimally 3 measurements). Systolic pressure > 160 mmHg or diastolic pressure > 95 mmHg, despite starting anti-hypertensive medication (first choice amlodipine 5 mg/day) 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 Evidence of alcohol abuse or drug addiction Malabsorption Currently active gout Recurring convulsions / epilepsy 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 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) Cyclosporine specific: Impaired renal function as indicated by a clinically relevant abnormal creatinine value (to be determined by investigator or treating physician) Uremia Hyperkalemia Hyperuricemia in patients with a medical history of gout

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 recurrent vesicular 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: Cyclosporin A<br>Patients with severe recurrent vesicular hand eczema, randomized to treatment with cyclosporin A. | Drug: cyclosporin A<br>* Oral cyclosporine A start dose 5 mg/kg/day (split in 2 doses), decreasing the dose after 8 weeks to 3 - 3.5 mg/kg/day (split in 2 doses). The treatment period is 24 weeks.<br>* Other names: Neoral;|

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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Hand eczema, Alitretinoin, Cyclosporine A