Anakinra in Hidradenitis Suppurativa

This study is ongoing, but not recruiting participants.
Sponsor:
Information provided by (Responsible Party):
Evangelos J. Giamarellos-Bourboulis, M.D., University of Athens
ClinicalTrials.gov Identifier:
NCT01558375
First received: March 15, 2012
Last updated: February 3, 2014
Last verified: February 2014

March 15, 2012
February 3, 2014
March 2012
June 2014   (final data collection date for primary outcome measure)
The efficacy of anakinra in patients with HS of Hurley II and III stage disease. [ Time Frame: 24 weeks ] [ Designated as safety issue: No ]
This will be defined by the changes of scoring parameters between the two study groups over visits.
Same as current
Complete list of historical versions of study NCT01558375 on ClinicalTrials.gov Archive Site
  • The effect of anakinra in the ex vivo function of monocytes of patients with HS. [ Time Frame: 24 weeks ] [ Designated as safety issue: No ]
    This will be defined by the differences of cytokines produced by PBMCs between the two study groups over visits.
  • The effect of anakinra on the time to new exacerbation [ Time Frame: 24 weeks ] [ Designated as safety issue: No ]
    This will be defined by the differences between the two study groups over visits.
  • The safety of anakinra in patients with hidradenitis suppurativa [ Time Frame: 24 weeks ] [ Designated as safety issue: Yes ]
    This will be assessed by the development of serious and non-serious drug-related adverse events
Same as current
Not Provided
Not Provided
 
Anakinra in Hidradenitis Suppurativa
A Double-blind, Randomized, Placebo-controlled Clinical Trial of the Safety and Efficacy of Anakinra in Patients With Hidradenitis Suppurativa

Aim of this double-blind, randomized, controlled clinical trial is to compare the safety and the efficacy of anakinra over placebo for the management of patients with hidradenitis suppurativa (HS) of Hurley II and Hurley III disease stage. Patients will be evaluated on subsequent follow-up visits. Two scores will be applied: disease activity as assessed in the protocol by the investigator; and Sartorius score. Primary efficacy endpoint will be the comparisons of visual analogue scores, of disease activity, of Sartorius score and of dermatology life quality index between the two groups of treatment over follow-up.

Hidradenitis suppurativa (HS) is a chronic devastating skin disorder affecting areas rich in apocrine glands. Nodules appear in the affected areas; they progressively become swollen and rupture with the release of pus. This process occurs repeatedly leading to sinus tract formation and scars. This disease course creates a frustrating situation for the patients but also for physicians. Traditional treatments comprise short-courses of antibiotics and surgical excision. However, relapse is the rule so that HS leads to severe impairment of the quality of life. The Dermatology Quality Life Index (DQLI) for HS is 8.9 being higher than any other skin disorder.

This devastating disorder has often been neglected and considered a rare situation. However, HS seems to indiscriminately affect the global population. Although the exact epidemiology is largely unknown, the point-prevalence is reported to range between 1% and 4%. A recent large epidemiological survey in France reports 0.97% disease prevalence.

The exact pathophysiology of HS is unknown. Smoking, dietary habits and genetic predisposition have all been linked with HS. However, a recent survey by our group in 56 patients, disclosed a severe derangement of the monocyte function and of subsequent antigen processing in these patients. The percentage of natural killer (NK) cells was increased and that of CD4-lymphocytes decreased compared to healthy controls probably implying the existence of an autoimmune predilection for the disorder. We have previously demonstrated defective lipopolysaccharide (LPS)-induced production of the pro-inflammatory cytokines, tumour necrosis factor(TNF) and interleukin (IL)-6 by blood monocytes of patients with HS.

As a consequence, a hypothesis for the implication of some autoimmune of autoinflammatory mechanism in the pathogenesis of HS was started to be created over the last years. The hypothesis is further reinforced by positive results from the administration of TNF antagonists in prospective studies with limited number of patients one of these was conducted by our study group. Subcutaneous treatment with 50mg etanercept once weekly for 12 weeks in 10 patients, reduced patients' suffering, attenuated local signs of inflammation and retarded disease relapse.

Anakinra is a recombinant interleukin-1 (IL-1) receptor antagonist (IL-1Ra). Anakinra blocks the biologic activity of naturally occurring IL-1, including inflammation and cartilage degradation associated with rheumatoid arthritis, by competitively inhibiting the binding of IL-1 to the interleukin-1 type receptor, which is expressed in many tissues and organs. IL-1 is produced in response to inflammatory stimuli and mediates various physiologic responses, including inflammatory and immunologic reactions. The biological properties of anakinra and the existing clinical and laboratory data favoring a derangement of the immune response in HS, prompted to investigate whether anakinra would be efficient in the management of patients with HS.

Interventional
Phase 2
Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Hidradenitis Suppurativa
  • Drug: Water for injection
    Placebo syringes will contain 0.67ml of sterile water for injection. This will be injecteda daily for 12 weeks.
    Other Name: Sterile water
  • Drug: Anakinra
    Anakinra will be supplied in single use pre-filed glass syringes with 27-gauge needles. Anakinra syringe will contain 100mg of anakinra at a volume of 0.67 ml. This will be injected subcutaneously daily for 12 weeks.
    Other Name: Recombinant human IL-1 receptor antagonist
  • Placebo Comparator: Water for injection
    Placebo syringes will contain 0.67ml of sterile water for injection. This will be injected daily for 12 weeks.
    Intervention: Drug: Water for injection
  • Experimental: Anakinra
    Anakinra will be supplied in single use pre-filed glass syringes with 27-gauge needles. Anakinra syringe will contain 100mg of anakinra at a volume of 0.67 ml. This will be injected subcutaneously daily for 12 weeks.
    Intervention: Drug: Anakinra

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Active, not recruiting
20
June 2014
June 2014   (final data collection date for primary outcome measure)

Inclusion Criteria:

  • written informed consent provided by the patient;
  • age above 18 years;
  • diagnosis of hidradenitis suppurativa; and
  • disease of Hurley II or III severity stage

Exclusion Criteria:

  • history of systemic lupus erythematosus, of rheumatoid arthritis of of seronegative inflammatory arthritis;
  • any prior administration of any type of anti-TNF therapy over the last six months;
  • administration of any live (attenuated) vaccine over the last 4 weeks;
  • history of recurrent vein thrombosis or embolism compatible with anti-cardiolipin syndrome;
  • any present or smoldering infection;
  • hepatic dysfunction defined as any value of transaminases, of γ-glutamyl transpeptidase or of bilirubin> 2 x upper normal limit;
  • history of haematological or solid tumor malignancy, arterial hypertension, liver cirrhosis, HIV infection, and hepatitis virus B or C infection
  • history of episodes mimicking demyelinating disorders or a definite diagnosis of multiple sclerosis
  • any creatinine value above 1.5 mg/dl
  • intake of corticosteroids defined as daily intake of prednisone or equivalent more than 1mg/kg for the last three weeks;
  • neutropenia defined as <1000 neutrophils/mm3; and
  • pregnancy or lactation
Both
18 Years and older
No
Contact information is only displayed when the study is recruiting subjects
Greece
 
NCT01558375
HIDRA03
Yes
Evangelos J. Giamarellos-Bourboulis, M.D., University of Athens
University of Athens
Not Provided
Study Chair: Evangelos J Giamarellos-Bourboulis, MD, PhD University of Athens, Medical School, Greece
Principal Investigator: Dimitrios Rigopoulos, MD, PhD University of Athens, Medical School, Greece
University of Athens
February 2014

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP