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Aczone Gel 7.5% in the Treatment of Acne Vulgaris in Patients With Skin of Color

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ClinicalTrials.gov Identifier: NCT03681470
Recruitment Status : Recruiting
First Posted : September 24, 2018
Last Update Posted : May 2, 2019
Sponsor:
Information provided by (Responsible Party):
Andrew Alexis, MD, Icahn School of Medicine at Mount Sinai

Brief Summary:
Acne vulgaris is a common skin disease characterized by inflammatory papules, pustules, and comedones that is prevalent in men and women of color. Research has demonstrated that Aczone ® (dapsone) gel, 7.5% used once daily is effective, safe, and well-tolerated for the treatment of acne in both men and women; however, limited data is available regarding its efficacy and safety in skin of color (SOC). The current study aims to investigate the therapeutic impact of Aczone gel 7.5% in SOC males and females ages 18 and older with acne vulgaris. The study will also evaluate the impact of Aczone ® gel on hyperpigmentation and PIH of the face.

Condition or disease Intervention/treatment Phase
Acne Vulgaris Drug: Aczone Gel Phase 4

Detailed Description:

Acne vulgaris is a common skin disease characterized by inflammatory papules, pustules, and comedones that is prevalent in men and women of color. In fact, acne is the most common dermatologic diagnosis made in SOC populations. Although individuals of all skin types can develop acne vulgaris, there are important differences in darker skin types that are important to consider when choosing an optimal treatment.

Complications from acne are of great concern in this population, as keloids, hypertrophic scars, and post-inflammatory hyperpigmentation (PIH) are more common in skin of color. PIH may last for weeks to months and, in many cases, is more troublesome to patients than the acne itself. Overall, facial acne and its sequelae have a greater impact on perception of appearance, negative emotions, and social functioning in women of color than white women.

Dapsone is a sulfone compound with anti-inflammatory properties that has been shown to be effective in the treatment of acne vulgaris in SOC. Aczone ® (dapsone) gel, 5% administered twice daily has been associated with significant improvement in overall acne severity, acne signs, and impact on quality of life in women of color. Two phase III trials of a newer formulation of Aczone ® (dapsone) gel, 7.5% used once daily demonstrated that this product is effective, safe, and well-tolerated for the treatment of acne in both men and women; however, limited data is available regarding its efficacy and safety in SOC.

Further, some investigators of the phase IV study on the safety and efficacy of dapsone gel 5% in SOC anecdotally reported improvement in hyperpigmentation over 12 weeks, although this was not a planned efficacy outcome. Further research is needed on the potential effects of dapsone gel on hyperpigmentation and PIH in SOC.

The current study will investigate the therapeutic impact of Aczone gel 7.5% in SOC males and females ages 18 and older with acne vulgaris. The study will also evaluate the impact of Aczone gel on post-inflammatory hyperpigmentation using the Postacne Hyperpigmentation Index (PAHPI) and mexameter-measured melanin index (MI).


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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 20 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: An Open-label Study to Investigate the Efficacy and Tolerability of Aczone Gel, 7.5% in the Treatment of Acne Vulgaris in Men and Women With Skin of Color
Actual Study Start Date : April 9, 2019
Estimated Primary Completion Date : September 30, 2019
Estimated Study Completion Date : October 30, 2019

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Acne
Drug Information available for: Dapsone

Arm Intervention/treatment
Experimental: Patients with Acne Vulgaris
Acne Vulgaris in Patients With Skin of Color
Drug: Aczone Gel
Aczone Gel 7.5%
Other Name: Dapsone




Primary Outcome Measures :
  1. Mean change from baseline to week 12 in Global Acne Assessment Score (GAAS) [ Time Frame: baseline and week 12 ]

    GAAS assesses acne severity on a 5-point score:

    0 - None: No evidence of facial acne vulgaris.

    1. - Minimal: Few noninflammatory lesions are present; a few inflammatory lesions (papules/pustules) may be present; no nodulo-cystic lesions present.
    2. - Mild: Several to many noninflammatory lesions are present; a few inflammatory lesions are present; no nodulo-cystic lesions present.
    3. - Moderate: Many noninflammatory and inflammatory lesions are present; no nodulo-cystic lesions are present.
    4. - Severe: Significant degree of inflammatory disease; papules and pustules are a predominant feature; a few nodulo-cystic lesions are present (no more than 2)


Secondary Outcome Measures :
  1. Change from baseline in Global Acne Assessment Score (GAAS) at week 4 [ Time Frame: baseline and week 4 ]

    GAAS assesses acne severity on a 5-point score:

    0 - None: No evidence of facial acne vulgaris.

    1. - Minimal: Few noninflammatory lesions are present; a few inflammatory lesions (papules/pustules) may be present; no nodulo-cystic lesions present.
    2. - Mild: Several to many noninflammatory lesions are present; a few inflammatory lesions are present; no nodulo-cystic lesions present.
    3. - Moderate: Many noninflammatory and inflammatory lesions are present; no nodulo-cystic lesions are present.
    4. - Severe: Significant degree of inflammatory disease; papules and pustules are a predominant feature; a few nodulo-cystic lesions are present (no more than 2)

  2. Change from baseline in Global Acne Assessment Score (GAAS) at week 18 [ Time Frame: baseline and week 18 ]

    GAAS assesses acne severity on a 5-point score:

    0 - None: No evidence of facial acne vulgaris.

    1. - Minimal: Few noninflammatory lesions are present; a few inflammatory lesions (papules/pustules) may be present; no nodulo-cystic lesions present.
    2. - Mild: Several to many noninflammatory lesions are present; a few inflammatory lesions are present; no nodulo-cystic lesions present.
    3. - Moderate: Many noninflammatory and inflammatory lesions are present; no nodulo-cystic lesions are present.
    4. - Severe: Significant degree of inflammatory disease; papules and pustules are a predominant feature; a few nodulo-cystic lesions are present (no more than 2)

  3. Change from baseline in Global Acne Assessment Score (GAAS) at week 24 [ Time Frame: baseline and week 24 ]

    GAAS assesses acne severity on a 5-point score:

    0 - None: No evidence of facial acne vulgaris.

    1. - Minimal: Few noninflammatory lesions are present; a few inflammatory lesions (papules/pustules) may be present; no nodulo-cystic lesions present.
    2. - Mild: Several to many noninflammatory lesions are present; a few inflammatory lesions are present; no nodulo-cystic lesions present.
    3. - Moderate: Many noninflammatory and inflammatory lesions are present; no nodulo-cystic lesions are present.
    4. - Severe: Significant degree of inflammatory disease; papules and pustules are a predominant feature; a few nodulo-cystic lesions are present (no more than 2)

  4. Change from baseline in Post Acne Hyperpigmentation Index (PAHPI) at weeks 12 [ Time Frame: baseline and week 12 ]

    PAHPI will be scored using the following formula:

    Weighted Total PAHPI = S (lesion size) + I (lesion intensity) + N (lesion number). Total PAHPI Score can range from 6-22, with higher number indicating more pigmentation.


  5. Change from baseline in Post Acne Hyperpigmentation Index (PAHPI) at weeks 18. [ Time Frame: baseline and week 18 ]

    PAHPI will be scored using the following formula:

    Weighted Total PAHPI = S (lesion size) + I (lesion intensity) + N (lesion number). Total PAHPI Score can range from 6-22, with higher number indicating more pigmentation.


  6. Change from baseline in Post Acne Hyperpigmentation Index (PAHPI) at weeks 24. [ Time Frame: baseline and week 24 ]

    PAHPI will be scored using the following formula:

    Weighted Total PAHPI = S (lesion size) + I (lesion intensity) + N (lesion number). Total PAHPI Score can range from 6-22, with higher number indicating more pigmentation.


  7. Change from baseline in Melanin Index (MI) of target lesion at weeks 12 [ Time Frame: baseline and week 12 ]

    A narrowband reflectance spectrophotometer (mexameter MX-16) will be used to measure the degree of pigmentation of involved and adjacent uninvolved skin of one representation facial PIH lesion.

    The mexameter contains 16 light emitting diodes arranged circularly that emit light at wavelengths of 568nm (green), 660nm (red), and 880nm (near infrared). The machine then measures the amount of light absorbed and reflected by the skin to measure the melanin content (melanin index or "M" - red and near infrared light)


  8. Change from baseline in Melanin Index (MI) of target lesion at weeks 18 [ Time Frame: baseline and week 18 ]

    A narrowband reflectance spectrophotometer (mexameter MX-16) will be used to measure the degree of pigmentation of involved and adjacent uninvolved skin of one representation facial PIH lesion.

    The mexameter contains 16 light emitting diodes arranged circularly that emit light at wavelengths of 568nm (green), 660nm (red), and 880nm (near infrared). The machine then measures the amount of light absorbed and reflected by the skin to measure the melanin content (melanin index or "M" - red and near infrared light)


  9. Change from baseline in Melanin Index (MI) of target lesion at weeks 24 [ Time Frame: baseline and week 24 ]

    A narrowband reflectance spectrophotometer (mexameter MX-16) will be used to measure the degree of pigmentation of involved and adjacent uninvolved skin of one representation facial PIH lesion.

    The mexameter contains 16 light emitting diodes arranged circularly that emit light at wavelengths of 568nm (green), 660nm (red), and 880nm (near infrared). The machine then measures the amount of light absorbed and reflected by the skin to measure the melanin content (melanin index or "M" - red and near infrared light)


  10. Change from baseline in the proportion of subjects with score of 0 or 1 on ASIS "dark spot" score at weeks 4 [ Time Frame: baseline and week 4 ]
    The participant assesses signs of acne vulgaris using the Acne Symptom and Impact Scale (ASIS). The sign domain is a composite of 9 items of the 17 items on the overall scale. Each of the items is answered on a 5-point scale: 0 (best) to 4 (worst). The sign domain score is calculated as the average of the 9 items for a total possible score of 0 to 4. Higher scores indicate the presence of more severe signs of acne.

  11. Change from baseline in the proportion of subjects with score of 0 or 1 on ASIS "dark spot" score at week 12 [ Time Frame: baseline and week 12 ]
    The participant assesses signs of acne vulgaris using the ASIS. The sign domain is a composite of 9 items of the 17 items on the overall scale. Each of the items is answered on a 5-point scale: 0 (best) to 4 (worst). The sign domain score is calculated as the average of the 9 items for a total possible score of 0 to 4. Higher scores indicate the presence of more severe signs of acne.

  12. Change from baseline in the proportion of subjects with score of 0 or 1 on ASIS "dark spot" score at week 18 [ Time Frame: baseline and week 18 ]
    The participant assesses signs of acne vulgaris using the ASIS. The sign domain is a composite of 9 items of the 17 items on the overall scale. Each of the items is answered on a 5-point scale: 0 (best) to 4 (worst). The sign domain score is calculated as the average of the 9 items for a total possible score of 0 to 4. Higher scores indicate the presence of more severe signs of acne.

  13. Change from baseline in the proportion of subjects with score of 0 or 1 on ASIS "dark spot" score at week 24 [ Time Frame: baseline and week 24 ]
    The participant assesses signs of acne vulgaris using the ASIS. The sign domain is a composite of 9 items of the 17 items on the overall scale. Each of the items is answered on a 5-point scale: 0 (best) to 4 (worst). The sign domain score is calculated as the average of the 9 items for a total possible score of 0 to 4. Higher scores indicate the presence of more severe signs of acne.

  14. Proportion of subjects with GAAS of 0 (none) or 1 (minimal) at weeks 4 [ Time Frame: Week 4 ]

    GAAS assesses acne severity:

    0 - None: No evidence of facial acne vulgaris.

    1 - Minimal: Few noninflammatory lesions are present; a few inflammatory lesions (papules/pustules) may be present; no nodulo-cystic lesions present.


  15. Proportion of subjects with GAAS of 0 (none) or 1 (minimal) at week 12 [ Time Frame: Week 12 ]

    GAAS assesses acne severity:

    0 - None: No evidence of facial acne vulgaris.

    1 - Minimal: Few noninflammatory lesions are present; a few inflammatory lesions (papules/pustules) may be present; no nodulo-cystic lesions present.


  16. Proportion of subjects with GAAS of 0 (none) or 1 (minimal) at weeks 18 [ Time Frame: Week 18 ]

    GAAS assesses acne severity:

    0 - None: No evidence of facial acne vulgaris.

    1 - Minimal: Few noninflammatory lesions are present; a few inflammatory lesions (papules/pustules) may be present; no nodulo-cystic lesions present.


  17. Proportion of subjects with GAAS of 0 (none) or 1 (minimal) at weeks 24 [ Time Frame: Week 24 ]

    GAAS assesses acne severity:

    0 - None: No evidence of facial acne vulgaris.

    1 - Minimal: Few noninflammatory lesions are present; a few inflammatory lesions (papules/pustules) may be present; no nodulo-cystic lesions present.


  18. Percent change from baseline in all lesion counts (inflammatory, noninflammatory, and total) at weeks 4 [ Time Frame: Week 4 ]
  19. Percent change from baseline in all lesion counts (inflammatory, noninflammatory, and total) at weeks 12 [ Time Frame: Week 12 ]
  20. Percent change from baseline in all lesion counts (inflammatory, noninflammatory, and total) at weeks 18 [ Time Frame: Week 18 ]
  21. Percent change from baseline in all lesion counts (inflammatory, noninflammatory, and total) at weeks 24 [ Time Frame: Week 24 ]


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:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Provide written, signed and dated informed consent prior to initiating any study-related activities.
  • Male or female subjects who are ≥ 18 years of age
  • Subjects with Fitzpatrick Skin Type IV, V, or VI
  • Subjects with moderate to severe acne as defined by investigator- assessed Global Acne Assessment Score (GAAS) of 3 or 4 at screening
  • Facial acne vulgaris with 20 to 50 (inclusive) inflammatory lesions and 30 to 100 (inclusive)non inflammatory lesion
  • Stable non-progressive or regressive acne vulgaris in the investigator's opinion
  • Females of childbearing potential (FCBP) must have a negative pregnancy test at Screening and Baseline. A female is considered not to be of childbearing potential if she is post-menopausal with at least 12 consecutive months of amenorrhea or has undergone surgical sterilization. While on investigational product and for at least 28 days after taking the last dose of investigational product, FCBP who engage in activity in which conception is possible must use one of the approved contraceptive options described below:

Option 1: Any one of the following highly effective methods: hormonal contraception (oral, injection, implant, transdermal patch, vaginal ring); intrauterine device (IUD); tubal ligation; or partner's vasectomy; OR Option 2: Male or female condom (latex condom or nonlatex condom NOT made out of natural [animal] membrane [for example, polyurethane]; PLUS one additional barrier method: (a) diaphragm with spermicide; (b) cervical cap with spermicide; or (c) contraceptive sponge with spermicide.

  • Must be in general good as judged by the Investigator
  • Subject is willing to avoid excessive or prolonged exposure of the treated skin to ultraviolet light (i.e. sunlight, tanning beds) throughout the study
  • Subject is willing to follow study instructions and complete study assessments without assistance and is likely to complete all required visits

Exclusion Criteria:

  • Diagnosis of other dermatologic diagnosis that, in the opinion of the investigator, would interfere with diagnosis, examination, or treatment of the studied condition (i.e. psoriasis, atopic dermatitis, lupus, dermatomyositis, seborrheic dermatitis, perioral dermatitis, etc.)
  • Subjects with severe cystic acne, acne conglobate, acne fulminans, or secondary acne (chloracne or drug-induced acne)
  • Uncontrolled systemic disease(s) that, in the opinion of the investigator, would put the patient at significant risk if enrolled in the study or would interfere with subject's participation in the study
  • Subjects with a history of clinically significant hemolysis, anemia, or enteritis (regional enteritis, ulcerative colitis, pseudomembranous colitis, antibiotic-associated colitis)
  • Subjects with allergy or sensitivity to the study drug or its components
  • Subjects who have not complied with the proper wash-out periods:

    • Topical anti-inflammatory medications, salicylic acid, corticosteroids, antibiotics, antibacterials, peroxide-containing products, or retinoids within 2 weeks of baseline
    • Systemic antibiotics, corticosteroids, antimalarials or oral dapsone within 4 weeks of baseline Other anti-acne medication, including isotretinoin or spironolactone, within 6 months of baseline
    • Chemical peels or other facial acne procedures (laser therapy, light therapy) within 3 months of baseline
    • Treatment with botulinum toxin of any serotype in the face within 6 months of baseline
    • Estrogens/Birth control pills must have been started ≥ 90 days prior to baseline and use must be continued during the study without alteration or discontinuation.
    • Pregnant or breast feeding.
    • Subjects with evidence of alcohol or substance abuse.
    • Use of any investigational drug within 4 weeks prior to randomization, or 5 pharmacokinetic/pharmacodynamic half-lives, if known (whichever is longer).

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 ClinicalTrials.gov identifier (NCT number): NCT03681470


Contacts
Layout table for location contacts
Contact: Ahuva Cices 212-523-4511 ahuva.cices@mountsinai.org
Contact: Ingrid Sanabria-Gonzalez 212-523-3812 ingrid.sanabria@mountsinai.org

Locations
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United States, New York
Mount Sinai West Recruiting
New York, New York, United States, 10023
Contact: Ingrid Sanabria-Gonzalez    212-523-3812    Ingrid.Sanabria@mountsinai.org   
Sponsors and Collaborators
Icahn School of Medicine at Mount Sinai
Investigators
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Principal Investigator: Andrew Alexis, MD, MPH Icahn School of Medicine at Mount Sinai

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Responsible Party: Andrew Alexis, MD, Chair, Department of Dermatology, Icahn School of Medicine at Mount Sinai
ClinicalTrials.gov Identifier: NCT03681470     History of Changes
Other Study ID Numbers: GCO 17-2662
HSM# 17-01277 ( Other Identifier: Icahn School of Medicine at Mount Sinai )
First Posted: September 24, 2018    Key Record Dates
Last Update Posted: May 2, 2019
Last Verified: April 2019
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Yes
Plan Description: IDP will be shared with Allergan
Supporting Materials: Study Protocol
Statistical Analysis Plan (SAP)
Informed Consent Form (ICF)
Clinical Study Report (CSR)
Analytic Code
Time Frame: Data will become available upon completion of the study and will remain available until final publication of the data
Access Criteria: Will only be shared with staff of Allergen directly involved with oversight of clinical study

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Andrew Alexis, MD, Icahn School of Medicine at Mount Sinai:
skin of color
acne
skin diseases
Additional relevant MeSH terms:
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Acne Vulgaris
Acneiform Eruptions
Skin Diseases
Sebaceous Gland Diseases
Dapsone
Anti-Infective Agents
Antimalarials
Antiprotozoal Agents
Antiparasitic Agents
Folic Acid Antagonists
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Leprostatic Agents
Anti-Bacterial Agents