Topical Sirolimus Ointment for Cutaneous Angiofibromas in Subjects With Tuberous Sclerosis Complex

Phase 2TerminatedNCT03363763

Aucta Pharmaceuticals, Inc24 enrolled

Overview

The objective of this study is to evaluate the safety and efficacy of sirolimus (0.2% and 0.4% formulations) and its vehicle when applied topically once daily for 12 weeks for the treatment of cutaneous angiofibromas in pediatric subjects with tuberous sclerosis complex (TSC).

This is a Phase 2, randomized, double-blind, placebo-controlled, multicenter study designed to assess the safety and efficacy of topically-applied sirolimus for the treatment of cutaneous angiofibromas in pediatric subjects with TSC. Approximately 45 subjects will be enrolled at investigational sites in the United States (US) and China, though other countries may be added in the future. Approximately 45 subjects who meet the study entry criteria will randomly be assigned in a 1:1:1 ratio to receive 1 of 3 treatments: sirolimus 0.2% ointment, sirolimus 0.4% ointment, or placebo ointment. The randomization is stratified by site. Subjects, or a parent/guardian, will apply the study medication topically to the cutaneous angiofibromas on the face once daily at night before going to bed for 12 weeks. Subjects who complete the double-blind phase of the study, with an overall compliance rate \>80% as determined by the dosing diary, will be offered entry into an open-label period for an additional 12 weeks. The maximum study duration for each subject will be approximately 30 weeks and includes a screening period of up to 4 weeks, a blinded treatment period of 12 weeks, optional open-label period of 12 weeks, and a follow-up period of 2 weeks. An interim analysis will be performed when all subjects have completed the double-blind phase (Visit 5 - Week 12). The data will be unblinded to assess for efficacy and results reported.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

QUADRUPLE

Enrollment

Conditions

Angiofibroma of Face Tuberous Sclerosis

Interventions

Sirolimus 0.2%DRUG

Ointment for topical administration hs x 12 weeks

Sirolimus 0.4%DRUG

Ointment for topical administration hs x 12 weeks

Placebo ointmentDRUG

Placebo ointment comparator for topical administration hs x 12 weeks

Eligibility

Sex: ALLMin age: 2 YearsMax age: 21 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. Generally healthy males or non-pregnant females aged 2 to 21 years, inclusive, at the time of screening. 2. Diagnosis of TSC with visible facial angiofibromas of at least grade 3 up to grade 5, inclusive, based on the IGA. 3. Subjects with 3 or more isolated, measurable lesions of facial angiofibroma, with color grading score ≥2 for each of the 3 lesions. 4. Females of childbearing potential must have a negative urine pregnancy test (or a negative serum pregnancy test if a urine pregnancy test cannot be obtained) (For China, different pregnancy test would be followed) and if sexually active or become sexually active during the study, must agree to use an effective form of birth control for the duration of the study. Females using oral contraceptives must also use a barrier method of contraception during the study. Sexually active male subjects and/or their female partners should also use appropriate contraception. Effective contraception is defined as follows: * Oral/implant/injectable/transdermal/estrogenic vaginal ring contraceptives, intrauterine device, condom with spermicide, diaphragm with spermicide. * Abstinence or partner's vasectomy are acceptable if the female agrees to implement one of the other acceptable methods of birth control if her partner changes. 5. The subject and/or their parent or guardian must be willing and able to provide written informed consent/assent. 6. Willing and able to comply with all trial requirements. 7. Subject or parent/guardian must be able to complete the subject self-assessment survey and subject diary in English or another language into which the documents have been officially translated. 8. Subjects should be in good general health based on the subject's medical history, physical exam, and impression of the study doctor. Exclusion Criteria: 9. Has any chronic or acute medical condition, that in the opinion of the investigator, may pose a risk to the safety of the subject during the trial period, or may interfere with the assessment of safety or efficacy in this trial. 10. Has received oral therapy or topical therapy of an mTOR inhibitor (sirolimus, temsirolimus, or everolimus) within 1 month of Baseline or other dermatological treatment to facial angiofibromas within 1 month of baseline. (Sunscreen is expected to be used in this patient population and is not considered treatment.) 11. Is currently receiving any form of immunosuppression therapy or has previously experienced significant immune dysfunction. 12. Has a history of sensitivity to any component of the investigational product. 13. Is pregnant, plans to become pregnant during the course of the study, or is breastfeeding. 14. Has other dermatologic conditions, pigmentation, scarring, pigmented lesions or sunburn in the treatment area that would preclude or prevent adequate assessment of changes to their facial angiofibromas. 15. Has facial hair (e.g., beard, sideburns, mustache) that could interfere with study assessments. 16. Has had laser surgery or cryotherapy to facial angiofibromas within 6 months preceding study entry. 17. Requires the use of any concomitant medication that, in the investigator's opinion, has the potential to cause an adverse effect when given with the investigational product or will interfere with the interpretation of the study results (see Section 16.1 Appendix 1 for Potential Drug Interactions). 18. Has participated in another clinical trial or received an investigational product within 3 months prior to screening.

Locations (8)

Translational Genomics Research

Phoenix, Arizona, United States

Children's Hospital of Los Angeles, Division of Neurology

Los Angeles, California, United States

Children's Clinical Research Organization, Children's Hospital Colorado

Aurora, Colorado, United States

Outcomes

Primary Outcomes

The Percentage of Participants Achieved at Least 2-grade Improvement

The Investigator's Global Assessment (IGA) was recorded on a 5-point scale, 0 (minimum) to 5 (maximum) \[0 = Clear skin with no signs of erythema and no disease related lesions, 1 = Slight redness with few disease related lesions, 2 = Greater than Grade 1; definite redness with scattered, some disease related lesions, 3 = Greater than Grade 2; marked redness, concentrated, many disease related lesions, 4 = Greater than Grade 3; very bright redness, confluent, highly concentrated disease related lesions, 5= Greater than Grade 4; fiery redness, very extensive disease related lesions covering very large area of the face\]. A higher score indicates a more severe, worse outcome.

Time frame: Double-blind phase and Open-label phase Weeks 4 and 12

The Change in Baseline in Investigator's Global Assessment (IGA) by Visit

Time frame: Double-blind phase and Open-label phase Weeks 4 and 12

Secondary Outcomes

The Percentage of Subjects With at Least 30% Improvement in the Facial Angiofibromas Severity Index (FASI) Score.

The Facial Angiofibromas Severity Index (FASI) is derived from the measurements of erythema, average size, and lesion extension. The FASI score is the sum of scores of Erythema, Size, and Extension. Erythema was recorded on a 4-point grade scale from 0 (minimum) to 4 (maximum) \[0 = clear skin with no signs of erythema, 1 = almost clear; slight redness, 3= moderate erythema; marked redness, 4= severe erythema; very bright redness\]. Size was recorded on a 4-point grade scale from 0 (minimum) to 4 (maximum) \[0 = no lesions, 1= few lesions, average size \</= 2mm, 2 = scattered, some lesions, average lesion size \>2-to \</= 5 mm, 3 = concentrated, many lesions, average lesion size \> 5mmg to \</= 10mm, 4 = confluent, highly concentrated lesions\]. Extension was recorded on a grade scale of 0 (minimum), 2, and 3 (maximum) \[0 = no lesions, 2 = \</= 50% of the cheek surface, 3 = \>50% of the cheek surface\]. A higher score for Erythema, Size, and Extension means a more severe, worse outcome.

Data from ClinicalTrials.gov

This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.