Dupilumab for the treatment of chronic inducible cold urticaria in patients who remain symptomatic despite the use of H1-antihistamine

JRCT ID: jRCT2061200063

Registered date:18/03/2021

Basic Information

• Recruitment status: Not Recruiting
• Health condition(s) or Problem(s) studied: Cold Urticaria
• Date of first enrollment: 13/07/2021
• Target sample size: 78
• Countries of recruitment: United States,Japan,Argentina,Japan,Canada,Japan,Germany,Japan
• Study type: Interventional

Intervention(s)

Drug: Dupilumab SAR231893
Pharmaceutical form:Injection solution, Route of administration: Subcutaneous

Drug: Placebo
Pharmaceutical form:Injection solution, Route of administration: Subcutaneous

Drug: Non sedating H1-antihistamine
Pharmaceutical form:Tablet, Route of administration: Oral

Outcome(s)

Primary Outcome

Proportion of participants with negative ice cube provocation test at Week 24 compared with placebo [Time frame: Week 24]
Negative ice cube provocation test is defined as the absence of a confluent hives/wheal at the entire skin site of exposure after ice cube provocation test.

Secondary Outcome

1. Change from baseline in urticaria control test at Week 24 compared with placebo [Time Frame: Baseline to Week 24]
The UCT is a PRO questionnaire for assessing urticaria control. It is comprised of 4 items (UCT-4). The UCT-4 total score is 0-16, with a score of 16 for complete disease control.

2. Proportion of well-controlled participants at Week 24 compared with placebo [Time Frame: Week 24]
The UCT is a PRO questionnaire for assessing urticaria control. It is comprised of 4 items (UCT-4). The UCT-4 total score is 0-16, with a score of 16 for complete disease control. Well-controlled is UCT-4 total score >=12.

3. Proportion of participants with an improvement of >=3 in UCT-4 item from baseline to Week 24 compared with placebo [Time Frame: Baseline to Week 24]
The UCT is a PRO questionnaire for assessing urticaria control. It is comprised of 4 items (UCT-4). The UCT-4 total score is 0-16, with a score of 16 for complete disease control.

4. Change from baseline in local wheal intensity at the provocation site at Week 12 and 24 using the wheal intensity Likert scale compared with placebo [Time Frame: Baseline to Week 12 and Week 24]
The Wheal intensity Likert scale (ranging from 0 to 5) is a clinician-reported outcome measure comprised of a single item assessing the intensity of patients' cutaneous reaction rated as follows: 0=no wheals; 1=numerous small, noncoalescent wheals; 2= a large, regular, slightly edematous, coalescent wheal; 3=a large and moderately edematous wheal; 4=a large, regular, and significantly edematous wheal without pseudopodia; and 5=a large, very edematous wheal with pseudopodia.

5. Change from baseline in local itch severity at the provocation site at Week 12 and 24 using the Peak Pruritus Numerical Rating Scale (NRS) compared with placebo [Time Frame: Baseline to Week 12 and Week 24]
The peak pruritus NRS is a patient-reported outcome (PRO) comprised of a single item rated on a scale from 0 ("No itch") to 10 ("Worst itch imaginable").

6. Change from baseline in local skin burning sensation at the provocation site at Week 12 and Week 24 using the peak burning sensation NRS compared with placebo [Time Frame: Baseline to Week 12 and Week 24]
The peak burning sensation NRS is a PRO comprised of a single item rated on a scale from 0 ("No burning sensation") to 10 ("Worst imaginable burning sensation").

7. Change from baseline in local pain severity at the provocation site at Week 12 and Week 24 using the peak pain sensation NRS compared with placebo [Time Frame: Baseline to Week 12 and Week 24]
The peak pain NRS is a PRO comprised of a single item rated on a scale from 0 ("No pain") to 10 ("Worst imaginable pain")

8. Proportion of participants with negative ice cube provocation test at Week 12 compared with placebo [Time Frame: Week 12]
Negative ice cube provocation test is defined as the absence of a confluent hives/wheal at the entire skin site of exposure after ice cube provocation test.

9. Change from baseline in cold urticaria signs and symptoms severity at Week 24 on cold exposure days as measured by ColdUAS compared with placebo [Time Frame: Baseline to Week 24]
Cold Urticaria Activity Score (ColdUAS) is a disease specific PRO questionnaire designed to determine cold urticaria disease activity.

10. Change from baseline in the proportion of cold urticaria sign and symptom free days at Week 24 on cold exposure days as measured by ColdUAS, compared with placebo [Time Frame: Baseline to Week 24]
ColdUAS is a disease specific PRO questionnaire designed to determine cold urticaria disease activity.

11. Change from baseline in health-related quality-of-life (HRQoL) as measured by Dermatology Life Quality Index (DLQI) at Week 24 compared with placebo [Time Frame: Baseline to Week 24]
The DLQI is a PRO developed to measure dermatology-specific HRQoL in patients >=16 years old. Overall scoring ranges from 0 to 30, with a high score indicative of a poor HRQoL.

12. Change from baseline in HRQoL as measured by Children's Dermatology Life Quality Index (CDLQI) at Week 24 compared with placebo [Time Frame: Baseline to Week 24]
The CDLQI is a validated questionnaire designed to measure the impact of skin disease on children's (>=12 to <16 years old) HRQoL. The CDLQI total score is 0-30. The higher the score, the greater the impact is on the child's HRQoL.

13. Change from baseline in Cold Urticaria Quality of Life (ColdU QoL) at Week 24 compared with placebo [Time Frame: Baseline to Week 24]
ColdU-QoL questionnaire is a disease-specific PRO questionnaire designed to assess the impact of cold urticaria on patients' health-related QoL.

14. Proportion of participants receiving rescue therapy for primary acquired chronic inducible ColdU during the planned treatment period compared with placebo [Time Frame: Baseline to Week 24]

15. Proportion of participants with cold exposure urticaria requiring emergency medical care visit or treatment with epinephrine [Time Frame: Baseline to Week 24] At provocation test and/or at home.

16. Percentages of participants experiencing treatment--emergent adverse events (TEAEs) or serious adverse events (SAEs) [Time Frame: Throughout the study up to Week 36]

17. Incidence of treatment-emergent antidrug antibodies (ADA) against dupilumab over time [Time Frame: Throughout the study up to Week 36]

Key inclusion & exclusion criteria

• Age minimum: >= 12age old
• Age maximum: <= 80age old
• Gender: Both

Include criteria

- Participant must be >=12 years to 80 years of age inclusive at the time of signing the informed consent
- Participants who have a diagnosis of primary acquired chronic inducible ColdU defined as recurrence of itchy wheals and/or angioedema due to cold for longer than 6 weeks prior to screening visit (Visit 1)
- Participants with positive ice cube provocation test, ie, presenting at least a confluent hive/wheal on the exposed skin area, at the screening visit (Visit 1) and randomization visit (Visit 2)
- Participants meeting at least 1 of the following criteria despite regular/daily or as needed use of H1-AH:
- - Urticaria Control Test (UCT) (4 item) <12 at the screening visit (Visit 1) and randomization visit (Visit 2)
- - Within 6 months prior to the screening visit, documented medical history of cold exposure triggered anaphylaxis or oropharyngeal edema
- - Within 6 months prior to the screening visit, documented medical history of cold exposure triggered urticaria requiring emergency medical care visit or treatment with epinephrine
- Participants using a study defined H1-antihistamine regularly/daily or as needed for primary acquired chronic inducible cold urticaria
- Body weight >= 30 kg

Exclude criteria

Participants are excluded from any of the studies if any of the following criteria apply:
- Clearly defined underlying etiology for urticaria other than primary acquired chronic inducible ColdU
- Presence of skin morbidities other than cold urticaria that may interfere with the assessment of the study outcomes
- Active atopic dermatitis
- Severe concomitant illness(es) that, in the investigator's judgment, would adversely affect the patient's participation in the study
- Active tuberculosis or non-tuberculous mycobacterial infection, or a history of incompletely treated tuberculosis unless documented adequately treated."
- Diagnosed active endoparasitic infections; suspected or high risk of endoparasitic infection
- Active chronic or acute infection requiring treatment with systemic antibiotics, antivirals, antiprotozoals, or antifungals within 2 weeks before the screening visit and during the screening period
- Known or suspected immunodeficiency
- Active malignancy or history of malignancy within 5 years before Visit 1, except completely treated in situ carcinoma of the cervix, completely treated and resolved non-metastatic squamous or basal cell carcinoma of the skin
- History of systemic hypersensitivity or anaphylaxis to any other biologic therapy, or any of its excipients
- Participation in prior dupilumab clinical study, or have been treated with commercially available dupilumab.

Related Information

• Primary Sponsor: Tanaka Tomoyuki
• Secondary ID(s): NCT04681729,2020-003756-33