Short-term Safety, Efficacy and Mode of Action of Apremilast in Moderate Suppurative Hidradenitis

Study Overview
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Brief Summary
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Study design: A double-blind randomised placebo-controlled trial Intervention: Randomized placebo controlled treatment of 20 HS patients of which fifteen patients will be randomized to apremilast and five patients to placebo. The total duration of the treatment period per subject is 16 weeks. Primary objectives: To evaluate the expression profile of inflammatory cytokines in HS lesional skin at week four (t=4) and week sixteen (t=16): of patients receiving apremilast compared to placebo; within both groups relative to baseline (t=0). Secondary objectives: To prospectively evaluate the clinical efficacy of apremilast. To assess the effect of apremilast on patient reported outcomes measures. To assess the short-term safety and tolerability of apremilast in patients with hidradenitis suppurativa.

Detailed Description
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Rationale: Hidradenitis suppurativa (HS) is a chronic, inflammatory, recurrent, debilitating skin disease. It is characterized by painful, deep-seated, inflamed boils in the inverse areas of the body, most commonly the axillae, inguinal and anogenital regions. Systemic therapy with immunosuppressive agents (systemic corticosteroids, dapsone, cyclosporin) has been investigated in the past decades and has shown limited efficacy. The use of the selective immunosuppressant apremilast has not yet been evaluated in HS. The investigators hypothesize a beneficial effect of apremilast in HS patients, similar to the efficacy of apremilast in psoriasis patients. Namely, it has been shown that the immune dysregulation in the pathogenesis of HS shows many similarities with that of psoriasis. Moreover, the TNF-α blocker adalimumab was registered for HS after approval for the treatment in patients with psoriasis.

Official Title
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Short-term Safety, Efficacy and Mode of Action of Apremilast in Moderate Suppurative Hidradenitis: A Randomised Double-blind Placebo Controlled Trial

Conditions
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Hidradenitis Suppurativa

Intervention / Treatment
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* Drug: Apremilast
* Drug: Placebo Oral Tablet


Participation Criteria
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Eligibility Criteria
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Key inclusion criteria: Adult (≥ 18 years of age) male or female patients with moderate HS according to a PGA of 3 on the 5-point HS-Physician Global Assessment (HS-PGA); HS of more than 6 months duration; have lesions in at least two anatomical locations. Key exclusion criteria: Contra-indication for apremilast; previous use of apremilast; have any current and/or recurrent clinically significant skin condition in the treatment area other than HS; Presence of other uncontrolled major disease; Pregnant or lactating women.

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
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Apremilast<br>N=15 | Drug: Apremilast<br>* Fifteen patients will be supplied of apremilast for daily oral use; 16 weeks.<br>* Other names: Otezla, CC-10004;|
| Placebo Comparator: Placebo Oral Tablet<br>N=5 | Drug: Placebo Oral Tablet<br>* Five patients will be supplied with placebo tablets with identical labeling as apremilast for daily use; 16 weeks.<br>* Other names: Placebo comparator;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change of expression levels of inflammatory cytokine mRNA in HS lesional skin. | measurement by qPCR | t=16 weeks | 
| Change of expression levels of inflammatory cytokine protein in HS lesional skin. | measurement by ELISA | t=16 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Abscesses count | Total number of abscesses [A] | t=0 weeks, t=4 weeks, t=16 weeks | 
| Nodule count | Total number of inflammatory [N] and non-inflammatory nodules | t=0 weeks, t=4 weeks, t=16 weeks | 
| Fistula count | Total count of draining fistulas | t=0 weeks, t=4 weeks, t=16 weeks | 
| Hidradenitis Suppurativa Physician's Global Assessment (HS-PGA) score | Based on the HS lesion count | t=0 weeks, t=4 weeks, t=16 weeks | 
| Hidradenitis Suppurativa Clinical Response (HiSCR) | Based on the AN count; The proposed definition of 50% and 30% responders to treatment (HiSCR achievers) is respectively: (i) at least a 50% and 30% reduction in ANs, (ii) no increase in the number of abscesses, and (iii) no increase in the number of draining fistulas from baseline. | t=0 weeks, t=16 weeks | 
| Numerical Rating Scale (NRS) | To assess the patient reported outcome measures (PROMs) pain, pruritus and patient disease global assessment score; | t=0 weeks, t=4 weeks, t=16 weeks | 
| Dermatology Life Quality Index (DLQI) | To assess the patient reported outcome measures (PROM) quality of life | t=0 weeks, t=4 weeks, t=16 weeks | 
| Incidence of Treatment-Emergent Adverse Events | Vital signs: heart rate, temperature, blood pressure. Patient reported adverse events Safety laboratories: White blood cell count, Absolute neutrophil count, Hemoglobin, Platelets, Serum Creatinine, ALT, Alkaline phosphatase | Multiple time points between t=0 weeks and t=16 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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acne inversa