The DupiMorph study evaluates the efficacy of Dupilumab in localized scleroderma patients. Dupilumab is approved in the US and EU for the treatment of moderate/severe atopic dermatitis and since 2018 in the US for severe asthma therapy.
Localized scleroderma (LS) comprises a heterogenous group of sclerotic skin disorders. The incidence of LS is reported to be approximately 27 cases/ 1x106 and is hence approximately 2-3-fold higher compared to systemic scleroderma. Although in most cases not lethal the disease can significantly impact quality of life. Depending on the location of fibrosis, the disorder can cause bone deformities, alopecia, skin atrophy or lesions with severe hypo-/hyperpigmentation. The disease is pathomechanistically poorly understood and no effective therapy is currently approved. The most promising treatments up to date include methotrexate ± pulsed corticosteroids or phototherapy with PUVA or UVA1. Yet, the number of treated patients in these studies is low. The response rates are low and inconsistent with approximately 50% of patients treated with UVA1 experience a recurrence within three years. There are no studies on efficacy of topical corticosteroids in LS. Small pilot studies and few case reports describe regression of lesions after topical calcineurin inhibitors. In addition, current therapies can only be applied for a short time during the acute phase due to the side effect profile after long-term use (e.g. skin atrophy in response to topical steroids, skin cancer in response to long term UV therapy, multiple side effects by long- term use of methotrexate and/or corticosteroids). Hence, this study evaluates, in comparison with placebo, the efficacy of Dupilumab administered subcutaneously every 14 days in patients with Morphea (plaque type) or generalized localized scleroderma (affecting at least three anatomic sites).
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
45
First dose: 600 mg (2 syringes); subsequent doses: 300 mg (1 syringe)
First dose: 2 syringes, no active substance; subsequent doses: 1 syringe, no active substance
Charité - Universitätsmedizin Berlin Klinik für Dermatologie, Venerologie und Allergologie
Berlin, Germany
Uniklinik Köln, Klinik für Dermatologie und Venerologie
Cologne, Germany
Helios St. Elisabeth Klinik Oberhausen, Klinik für Dermatologie, Venerologie und Allergologie
Oberhausen, Germany
Universitäts-Hautklinik Tübingen
Tübingen, Germany
LoSCAT target lesion
Treatment response is assessed using the LoSCAT (Localized Scleroderma Cutaneous Assessment Tool). Target lesion will be assessed at Baseline and End of Treatment. Score reduction by 50% after 24 weeks (End of Treatment Visit V14) compared to Baseline Visit (V1) is defined as treatment response.
Time frame: Baseline to End of Treatment Visit, 24 weeks
mLoSSI all lesions
Change in mLoSSI (Localized Scleroderma Skin Activity Index) of all existing lesions during treatment, at End of Treatment Visit and during follow-up
Time frame: Baseline to Follow-Up Visit, 48 weeks
LoSDI all lesions
Change in LoSDI (Localized Scleroderma Skin Damage Index) of all existing lesions during treatment, at End of Treatment Visit and during follow-up
Time frame: Baseline to Follow-Up Visit, 48 weeks
Number of lesions
Count of all existing non-target and new lesions on the entire integument during treatment, at End of Treatment Visit and during follow-up
Time frame: Baseline to Follow-Up Visit, 48 weeks
DLQI
Change in DermatoLogy Quality of life Index (DLQI). The DLQI is calculated by summing the score of each question resulting in a maximum of 30 and a minimum of 0. The higher the score, the more quality of life is impaired.
Time frame: Baseline to Follow-Up Visit, 48 weeks
RNAseq
Gene signature of localized scleroderma after Dupilumab treatment: RNA- seq of tissue biopsies obtained from the lesion (lilac ring, optional: center) before (baseline visit V1) and after treatment (EoT V14) and healthy skin before treatment
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Time frame: Baseline to End of Treatment Visit, 24 weeks
RT-qPCR
Quantification of change in gene expression of genes identified by RNAseq in tissue of localized scleroderma patients after Dupilumab treatment: RT-qPCR of tissue biopsies obtained from the lesion (lilac ring, optional: center) before (baseline visit V1) and after treatment (End of Treatment Visit V14) and healthy skin before treatment
Time frame: Baseline to End of Treatment Visit, 24 weeks
Adverse events (AEs)
Adverse events will be documented throughout the study
Time frame: Baseline to Follow-Up Visit, 48 weeks
Physical examination
Physical examination (general appearance including skin, head and throat (head, eyes, ears, nose, and throat), lymph nodes, respiratory, cardiovascular, musculoskeletal, and neurological systems) will be documented throughout the study.
Time frame: Baseline to Follow-Up Visit, 48 weeks
Body weight
Body weight will be documented throughout the study.
Time frame: Baseline to Follow-Up Visit, 48 weeks
Blood pressure
Blood pressure will be documented throughout the study.
Time frame: Baseline to Follow-Up Visit, 48 weeks
Pulse rate
Pulse rate will be documented throughout the study.
Time frame: Baseline to Follow-Up Visit, 48 weeks
Body temperature
Body temperature will be documented throughout the study.
Time frame: Baseline to Follow-Up Visit, 48 weeks
Haematocrit (HcT)
Haematocrit (HcT) will be documented at End of Treatment Visit and during follow-up
Time frame: Baseline to Follow-Up Visit, 48 weeks
Haemoglobin
Haemoglobin (Hgb) will be documented at End of Treatment Visit and during follow-up
Time frame: Baseline to Follow-Up Visit, 48 weeks
Blood cell count
Platelet count and differential White blood cell count will be documented at End of Treatment Visit and during follow-up
Time frame: Baseline to Follow-Up Visit, 48 weeks
Blood Enzymes
Clinical Chemistry parameters (Aspartate aminotransferase (AST), Alanine aminotransferase (ALT), Gamma-glutamyl transferase (GGT), Lactic dehydrogenase (LDH)) will be documented at End of Treatment Visit and during follow-up
Time frame: Baseline to Follow-Up Visit, 48 weeks
Clinical Chemistry
Clinical Chemistry parameters (Creatinine) will be documented at End of Treatment Visit and during follow-up
Time frame: Baseline to Follow-Up Visit, 48 weeks
Anti-nuclear antibodies (ANAs) levels
Change in anti-nuclear antibodies (ANAs) levels
Time frame: Baseline to Follow-Up Visit, 48 weeks
Serum cytokine levels
Change in serum levels of IL-4, IL-5, IL-13, periostin, dipeptidyl peptidase-4
Time frame: Baseline to Follow-Up Visit, 48 weeks