Cream Compared to NB-UVB Alone in Patients With Non-segmental Vitiligo Clinical Trial
Official title:
Effect of Fluticasone Proprionate 0.05% Cream on Narrow Band UV-B Phototherapy in Active Vitiligo: a Randomised Single Blinded Controlled Trial
Rationale: Vitiligo vulgaris is a common acquired pigment disorder, which is characterised
by the development of depigmented macules. It develops probably due to immunedestruction of
melanocytes. Most effective therapies are immunsuppresive:
1. local immunesuppressives like corticosteroids and calcineurin inhibitors
2. phototherapy like PUVA and NB-UVB phototherapy. NB-UVB is the first choice A
synergistic effect of UVA and topical corticosteroids (fluticasone proprionate 0.05%
cream) has been described by Westerhof et al. in 1999. To our knowledge to date there
are no publications comparing NB-UVB combined with a topical corticosteroid and NB-UVB
alone.
Objective: The objective of this study is to evaluate the clinical effects (onset and degree
of repigmentation) of fluticasone proprionate 0.05% cream (thrice weekly) on NB-UVB
phototherapy twice weekly for a period of 12 months.
Study design: Prospective single blinded randomised controlled study. Study population:
Consecutive patients ≥ 18 years, diagnosed with active vitiligo vulgaris who will receive
NB-UVB phototherapeutic treatment at the Netherlands Institute for Pigment Disorders at the
Academic Medical Centre (AMC), University of Amsterdam.
Methods: The patient will be randomised for either NB-UVB phototherapy and fluticasone
proprionate 0.05% cream or NB-UVB phototherapy alone for 12 consecutive months.
Main study parameters/endpoints: The onset and degree of repigmentation is assessed by
digital image analysis of a target lesion and blinded global physician assessment.
Furthermore, the patients and doctors satisfaction will be assessed and changes of
immunohistochemical parameters will be analysed in skin biopsies.
Nature and extent of the burden and risks associated with participation, benefit and group
relatedness: Subjects participating in the study will be asked to visit the institute 4
times. The time investment will be 20 minutes per visit. Additionally, patients will be
asked for consent to take punch biopsies (3 mm) at the beginning and at the end of the
treatment period. Hence, skin biopsies are not compulsory for participation in this study.
Patients may chose to participate in the clinical non invasive part of the study. Known side
effects of the NB-UVB phototherapy are redness, pruritus, xerosis cutis, burning sensation
and conjunctivitis. These side-effects however, are largely dose-dependent and avoidable.
Corticosteroid associated systemic side-effects (suppression of the adrenocortex) will be
minimized by treating only a limited body surface [a maximum of 30% body surface] and by
using an intermittent application scheme of three days a week in the long term treatment.
The regions which are known to have a higher absorption are excluded (periorbital, axillary,
inguinal and genital area). Both topical corticosteroids and NB-UVB are part of the Dutch
and British guidelines for the treatment of vitiligo. There is no presumptive evidence or
indication that the combination of these therapies may result in a higher risk of side
effects.
All together the burden due to the study is low and the risk for systemic or local side
effects is low.
| Status | Recruiting |
| Enrollment | 50 |
| Est. completion date | |
| Est. primary completion date | August 2011 |
| Accepts healthy volunteers | Accepts Healthy Volunteers |
| Gender | Both |
| Age group | 18 Years and older |
| Eligibility |
Inclusion Criteria: - non-segmental vitiligo - Eligible for NB-UVB therapy - Subjects attending the outpatient department of the SNIP - patients > 18 years - Skin type II-V - patients with active vitiligo: progression of older lesions or development of new lesion during the last 6 months - Subject is willing and able to give written informed consent Exclusion Criteria: - Personal or a family history of skin cancer ( non-melanoma skincancer: first degree family members, melanoma: any family members) - Personal history of photosensitivity and/or phototoxicity disorders - pregnancy - Taking medication known to cause photosensitivity, phototoxicity, immune suppression and chronic or very frequent use of any medication that can influence the UVB response (e.g. tetracycline, retinoids, sulfonamids, psoralens) - Other skin diseases that would impair the evaluation of repigmentation - not able to have 2 times weekly NB-UVB phototherapy - With local immunosuppressive treatment or 6 weeks prior to enrolment. For these patients a washout period of 6 weeks will be required. - Contact-allergy for any of the parts in fluticasone proprionate |
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Single Blind (Outcomes Assessor), Primary Purpose: Treatment
| Country | Name | City | State |
|---|---|---|---|
| Netherlands | Netherlands Institute for Pigments Disorders | Amsterdam |
| Lead Sponsor | Collaborator |
|---|---|
| Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA) |
Netherlands,
| Type | Measure | Description | Time frame | Safety issue |
|---|---|---|---|---|
| Primary | Repigmentation of the vitiligo lesions | Degree of repigmentation is assessed by digital analysis of a target lesion by a blinded global physician assessment | 15 months | No |
| Secondary | Patients satisfaction | satisfaction/preference | 15 months | No |