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Efficacy and Safety of CIP-Isotretinoin in Patients With Severe Recalcitrant Nodular Acne

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00975143
Recruitment Status : Completed
First Posted : September 11, 2009
Results First Posted : July 4, 2014
Last Update Posted : July 4, 2014
Information provided by (Responsible Party):
Cipher Pharmaceuticals Inc.

Brief Summary:
The purpose of this study is to compare the efficacy and safety of CIP-Isotretinoin and a marketed (generic) formulation of isotretinoin when both are administered twice daily with meals.

Condition or disease Intervention/treatment Phase
Severe Nodular Acne Drug: CIP-Isotretinoin Drug: Isotretinoin Phase 3

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 925 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: A Double-Blind, Randomized, Phase III, Parallel Group Study Evaluating the Efficacy and Safety of CIP-Isotretinoin in Patients With Severe Recalcitrant Nodular Acne
Study Start Date : September 2009
Actual Primary Completion Date : May 2011
Actual Study Completion Date : May 2011

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Acne

Arm Intervention/treatment
Experimental: CIP-Isotretinoin Drug: CIP-Isotretinoin
0.5 mg/kg/day for 4 weeks, and 1 mg/kg/day for 16 weeks, taken orally, twice daily.

Active Comparator: Isotretinoin Drug: Isotretinoin
0.5 mg/kg/day for 4 weeks, and 1 mg/kg/day for 16 weeks, taken orally, twice daily.

Primary Outcome Measures :
  1. Co-primary Outcome 1: Change From Baseline in Total Nodular Lesion Count (Facial and Truncal) [ Time Frame: 20 weeks ]

    The change from Baseline to Week 20 in the total number of nodular lesions was calculated as the Week 20 lesion count minus Baseline lesion count and compared using Analysis of Covariance (ANCOVA), controlling for Baseline total nodular lesion count, gender and analysis site.

    The 95% CI of the adjusted least square mean difference (CIP-ISOTRETINOIN minus Isotretinoin) was also calculated using the ANCOVA model.

    Pre-defined criterion for non-inferiority: upper bound of the 95% CI for the treatment difference < 4.

  2. Co-Primary Outcome 2: Proportion of Patients Who Achieve at Least a 90% Reduction in Total Number of Nodular Lesions (Facial and Truncal). [ Time Frame: 20 weeks ]

    The percentage of patients in each group who achieved ≥90% reduction in the total nodular lesion count from Baseline to Week 20 was calculated along with its 95% CI (normal approximation). A 95% 2-sided CI on the difference between treatments (CIP-ISOTRETINOIN minus Isotretinoin) was also computed.

    Pre-defined criterion for non-inferiority: lower bound of the 95% CI for the treatment difference > -10.

Secondary Outcome Measures :
  1. Proportion of Patients Who Are Rated as Clear/Almost Clear on the Six-point Physicians' Global Assessment Scale (PGSA). [ Time Frame: 20 weeks ]
    PGSA categories: 1 (Almost clear); 2 (Mild); 3 (Moderate); 4 (Severe); 5 (Very severe). A grade of either 0 (clear) or 1 (almost clear) on the 6-point PGSA scale within the Week 20 analysis window was considered a success.

Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.

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Ages Eligible for Study:   12 Years to 54 Years   (Child, Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Severe recalcitrant nodular acne, which in the opinion of the investigator is compatible with isotretinoin treatment.
  • Ten (10) or more nodular lesions (facial and/or truncal).
  • Treatment-naïve patients without any prior exposure to systemic isotretinoin or other retinoids.
  • Age between 12 and 54 years.
  • Weight between 40 and 110 kg.
  • Negative serum human chorionic gonadotropin (hCG) pregnancy test consistent with a non-pregnant state (females only).
  • No significant disease or clinically significant finding in a physical examination.
  • No clinically significant abnormal laboratory value.
  • No clinically significant abnormal vital sign measurement.
  • Patients presenting with stable and controlled diabetes mellitus (Types I and II) may be included in the study. However, patients should not have had a hospitalization for any diabetes related complications in the last 12 months, and must be on stable medication for the preceding 6 months. To be included in the study, the patients should have Hemoglobin-A1c values ≤ 6.5% at screening and in the test done 3 - 4 months previously.
  • Patients with previously diagnosed Polycystic Ovarian Syndrome (PCOS) may be included in the study if in the opinion of the investigator they do not have any other clinically significant abnormality (e.g. metabolic syndrome or elevated lipids).

Exclusion Criteria:

  • Female patients will be excluded from the study if they:

    • Are pregnant;
    • Are at high risk for becoming pregnant or likely to become pregnant during treatment;
    • Will be breast-feeding or considering breast feeding during the course of the study.
  • Known history or presence of any clinically significant unstable medical condition(s) which in the opinion of the investigator could pose a risk for the safety of the patient including any previous history of gastrointestinal disease.
  • Patients with any skin disease or other condition that might interfere with the evaluation of recalcitrant nodular acne.
  • Patients will be interviewed using the SCID-CT current and lifetime modules for Major Depression, Mania, and Psychosis. Patients with a lifetime history of psychosis will be excluded. Patients with a history of major depressive, manic, hypomanic or mixed episodes will not be excluded unless they have had an episode during the preceding year.
  • Patients with any past or current psychotic symptoms.
  • Patients reporting any suicidal behaviour (including attempts, interrupted attempts, aborted attempts, or other preparatory behaviours), within the past year, or serious suicidal ideation in the past year, will be excluded from study participation.
  • A lifetime history of wishing to be dead, non-specific active suicidal thoughts or active suicidal ideation without intent to act will not result in exclusion.
  • Known history or suspected carcinoma.
  • Known history of liver or kidney disorders (hepatic and renal insufficiency).
  • Known history or current pseudotumor cerebri (benign intracranial hypertension).
  • Patients with HLA-B27 related disease, rheumatoid arthritis, rickets or other vitamin D depletion disease or phosphate metabolic disease, severe scoliosis > 15 Cobb angle, history of back surgery/injuries, ongoing use of anticonvulsants known to affect bone metabolism and other genetic or acquired rheumatologic and joint diseases.
  • All pediatric patients with serum 25-hydroxyvitamin D levels < 20 ng/mL.
  • Patients with hearing disorders who in the opinion of the investigator would not be able to participate in audiometric testing for the study.
  • Hypersensitivity or idiosyncratic reaction to isotretinoin, Vitamin A and/or any other drug substances with similar activity.
  • Allergy to soy beans, soy bean oil or any other ingredients in the study medications.
  • On a special diet within four weeks prior to drug administration (e.g., liquid, protein, raw food diet).
  • Difficulty consuming two (2) meals a day to sustain weight and health.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00975143

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Sponsors and Collaborators
Cipher Pharmaceuticals Inc.
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Study Chair: James J. Leyden, MD University of Pennsylvania
Study Chair: Guy Webster, MD Jefferson Medical College of Thomas Jefferson University
Study Director: Jason A. Gross, PharmD Cipher Pharmaceuticals Inc.

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Responsible Party: Cipher Pharmaceuticals Inc. Identifier: NCT00975143    
Other Study ID Numbers: ISOCT.08.01
First Posted: September 11, 2009    Key Record Dates
Results First Posted: July 4, 2014
Last Update Posted: July 4, 2014
Last Verified: June 2014
Keywords provided by Cipher Pharmaceuticals Inc.:
Additional relevant MeSH terms:
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Acne Vulgaris
Acneiform Eruptions
Skin Diseases
Sebaceous Gland Diseases
Dermatologic Agents