Dupilumab for the Treatment of Moderate to Severe Chronic Hepatic Pruritus

Mayo Clinic9 enrolled

Overview

To investigate the potential efficacy of dupilumab in the treatment of moderate to severe chronic hepatic pruritus.

This is a 22-week (2 week screening, 18-week treatment period followed by a 2 week followup), phase II, open label, exploratory study to investigate the potential efficacy of FDA approved dupilumab in the treatment of adults with moderate to severe chronic hepatic pruritus. Subjects will be screened at outpatient clinic visit appointments and interested qualified subjects will be consented and offered participation in this trial. Once consent has been obtained, baseline values will be established and subjects will begin treatment and follow-up for the next 20 weeks. A final visit will be needed for evaluation and questionnaire completion.

Study Type

INTERVENTIONAL

Allocation

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Pruritus

Interventions

Dupilumab 300Mg Solution for InjectionDRUG

Subcutaneous (SC) dupilumab selected for this study is 300 mg every 2 weeks for 18 weeks.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Male and/or female subjects 18 years or older with chronic pruritus of moderate to severe severity in the setting of intrahepatic or extrahepatic cholestatic liver disease. Chronic is defined as greater than 6 weeks of symptom duration. Pruritus severity is based on the peak pruritus numerical rating score of ≥ 4 (moderate severity). * Documentation of a personally signed and dated informed consent indicating that the subject or their legally acceptable representative has been informed of all pertinent aspects of the trial. * Willingness and ability to comply with scheduled clinic visits, physical exams, laboratory tests, questionnaires, effective contraception use, and other trial procedures. Exclusion Criteria: * Male and/or female subjects under 18 years of age. * Pruritus due to a primary inflammatory skin dermatosis or other forms of psychogenic pruritus utilizing skin biopsies as needed. * Pregnant females * History of intrahepatic cholestasis of pregnancy * Any form of chronic hepatic pruritus associated with underlying malignancy * Liver transplant recipients * Allergy to dupilumab or its ingredients * Inability to provide informed consent * Concomitant use of selective opioid antagonists * Subjects with severe asthma (requiring high-dose inhaled or systemic corticosteroids) will be excluded from the study. * Patients with known helminth infections

Locations (1)

Mayo Clinic Florida

Jacksonville, Florida, United States

Outcomes

Primary Outcomes

Change in Peak Pruritus Numerical Rating Score (PRNS)

Pruritus severity is measured using the peak PNRS assessed as a single, self-completed item that assesses the intensity of peak (worst) pruritus during the past 24 hours using the query: "On a scale of 0 to 10, with 0 being 'no itch 'and 10 being 'worst itch imaginable', how would you rate your itch at the worst moment during the previous 24 hours?". Measured before and after treatment. Scores range from 0 to 10 with higher scores indicating a worse outcome.

Time frame: Baseline; 20 weeks

Secondary Outcomes

Change in Weekly Average Peak Pruritus Numerical Rating Score (PRNS) ≥3 From Baseline

Pruritus severity is measured using the peak PNRS assessed as a single, self-completed item that assesses the intensity of peak (worst) pruritus during the past 24 hours using the query: "On a scale of 0 to 10, with 0 being 'no itch 'and 10 being 'worst itch imaginable', how would you rate your itch at the worst moment during the previous 24 hours?". Scores range from 0 to 10 with higher scores indicating a worse outcome.

Time frame: Baseline; week 6,12,18

Verbal Rating Scale (VRS) Score

The number of subjects who rated their intensity of pruritus as 0=none, 1=mild, 2-moderate, 3=severe. The verbal rating scale measures the intensity of pruritus. Subjects are asked to rate their pruritus intensity as 0=none; 1= mild; 2=moderate; and 3=severe/intense. Scores range from 0 to 3, with higher scores indicating a worse outcome.

Time frame: Baseline; week 12,18

Change in Chronic Liver Disease Questionnaire (CLDQ) Score

This is a validated 29 question quality life instrument for patients with chronic liver disease evaluating systemic symptoms, fatigue, physical activity, emotional function, and worry. Subjects are asked to respond to each question using the following scale: 6=all of the time; 5=most of the time; 4=a good bit of the time; 3=some of the time; 2=a little of the time; 1=hardly any of the time; and 0=none of the time. Total scores range from 0 to 174 with lower scores indicating better health-related quality of life.

Data from ClinicalTrials.gov

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