Topical Brimonidine to Reduce Inflammation After IPL-treatment in Patients With Facial Telangiectasias

Telangiectasias Clinical Trial

Official title:

Topical Brimonidine Reduces IPL-induced Erythema Without Affecting Efficacy: a Randomized Controlled Trial in Patients With Facial Telangiectasias

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT02761174
• Other study ID #: 2015-004789-27
• Status: Completed
• Phase: Phase 4
• First received: March 17, 2016
• Last updated: January 3, 2018
• Start date: March 13, 2016
• Est. completion date: January 13, 2017

Study information

• Verified date: January 2018
• Source: Bispebjerg Hospital
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The aim of the study is to investigate whether brimonidine cream can reduce IPL-induced inflammation in terms of redness, swelling and pain in patients with facial vascular lesions (telangiectasias). Furthermore, the effect of brimonidine cream on IPL-efficacy is evaluated one month after final IPL-treatment.

The hypothesis is that brimonidine, which has been proved effective in reduction of symptomatic erythema in patients with rosacea, also may have the ability to reduce IPL-induced erythema. Since the potential reduction in erythema is caused by vasoconstriction, brimonidine may further reduce IPL-induced oedema and pain.

Description:

Study design The study is designed as a dual-centre, randomized, intra-individual, split-face clinical controlled trial with blinded outcome assessment. A total of 20 patients with moderate to severe facial telangiectasias, without other clinical active dermatological disease in the skin, will be included. Severity and distribution (cheek, nose and chin) of telangiectasias must be symmetrical between facial sides in the individual patient at inclusion. All patients will receive IPL-treatments to both sides of the face. Before the first IPL-treatment, the left and right side of the face will be randomized to either brimonidine (Mirvaso) or only IPL-treatment and air-cooling (control), respectively. The study is conducted in an international collaboration between Bispebjerg Hospital, Department of Dermatology in Denmark and "Skinperium" private practice in Belgium.

Interventions Patients are asked to attend 3 treatment days and 2 follow-up visits. Treatment days are planed with 3 weeks intervals (± 5 days) and follow-up visits are planned at trial day 2 (one day after treatment day 1) and at 1 month (± 5 days) after the final treatment day. The consultations are estimated to last between half an hour and two hours. Patients are further asked to fill out patient diaries in the first 6 days after follow-up visit at trial day 2.

At each treatment day, patients receive 1) IPL of their whole face, 2) brimonidine is thereafter applied to the facial side randomized to treatment followed by 3) air-cooling, which is applied to the whole face of the patient in accordance with clinical guidelines.

Efficacy endpoints & evaluation methods

Primary efficacy endpoint:

To investigate whether topical brimonidine can reduce IPL-induced inflammatory response

Secondary efficacy endpoints:

1. IPL-induced treatment efficacy on telangiectasias with and without application of brimonidine

2. Patient-evaluated subjective discomfort and pain in the treatment area

3. Overall patient satisfaction

Primary efficacy endpoint is quantified by reduction in erythema and oedema assessed by blinded clinical on-site evaluation and by blinded photo-evaluation.

Secondary efficacy endpoints regarding point 1 are quantified by blinded photo-evaluation obtained with a Visia camera, in which baseline-photos are compared to photos from the final follow-up visit. Point 2 and 3 are evaluated on two separate 0-10 point Visual Analogue Scales (VAS) on discomfort/pain and patient satisfaction, respectively. Patient satisfaction is further evaluated in patient diaries.

Product Mirvaso® (brimonidine tartrate (3,3mg/1g), Galderma Nordic) One gram of gel contains 3.3 mg of brimonidine, equivalent to 5 mg of brimonidine tartrate.

Excipient(s) with known effect:

One gram of gel contains 1 mg methylparahydroxybenzoate (E218) and 55 mg propylene glycol.

Other excipients:

• Carbomer Methylparahydroxybenzoate (E218) Phenoxyethanol

• Glycerol

• Titanium dioxide

• Propylene glycol

• Sodium hydroxide

• Purified water

Statistic analysis Primary efficacy endpoint is difference in inflammation between brimonidine vs. control.

Wilcoxon signed-rank test will be used for paired comparison to evaluate eventual differences between brimonidine vs. control. Analysis on Per-Protocol will only include the patients completing the study according to protocol.

Sample size Estimation of sample size is based on clinical on-site evaluation on inflammation 30 minutes after incubation of brimonidine (effect of brimonidine is evident after 30 minutes cf.´Summary of Product Characteristics) and 24 hours after application.

With a power of 90%, a type I error probability of 5% and an estimated standard deviation of 25%, we should include 17 patients to detect a minimum relevant difference (MIREDIF) of 20% between brimonidine and control. We choose a 20% MIREDIF, since a reduction in inflammation <20%, based on a resource economic point of view is considered clinical irrelevant. Based on earlier experience and duration of the trial, a 15% dropout rate should be taken into account and therefore, a total of 20 patients will be included.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 19
• Est. completion date: January 13, 2017
• Est. primary completion date: July 11, 2016
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 65 Years

Eligibility

Inclusion Criteria:

• Patients with moderate to severe facial telangiectasias referred to laser or IPL-treatment. Severity and distribution of telangiectasias must be symmetrical between left and right side of the face in the individual patient

• Telangiectasias may be observed in connection with rosacea, but rosacea must not demonstrate clinical active inflammation or acne

• 18-65 years of age

• Fitzpatrick skin type I-III

• Fertile women must document non-reactive urine pregnancy test at the day of inclusion

• During the study, fertile women must be using effective birth control. Effective contraception is defined as follows:

• Injectable, implantable or orally taken hormones;

• Intrauterine device;

• Trans-abdominal surgical sterilization;

• Sterilization implant device;

• Surgical sterilization of male partner;

• Complete abstinence from sexual intercourse for two weeks before exposure to study medication and throughout the clinical study

• Verbal and written consent to participate in the study

• Documentation of medicine status

Exclusion Criteria:

• Clinical active dermatological disease in the face

• Wounds, dermatitis, tattoos or scars in treatment area

• Allergies to ingredients in Mirvaso

• Current treatment with monoamine oxidase inhibitors, tricyclic or tetracyclic antidepressants which interacts with the noradrenergic transmission

• Current treatment with other systemic adrenergic receptor agonists or antagonists

• Patients with known liver or renal disease

• UV-exposure (solarium or sunbathing) or other treatment within the last month that enhances skin pigmentation

• Use of other topical agents that may interact with treatment

• Local or systemic treatment with photosensitizing drugs

• Pregnancy and breastfeeding women

• Current participation in other clinical trials

• Patients that are considered incapable of complying with the protocol, i.e. patients suffering from dementia, alcoholism or psychiatric conditions

Related Conditions & MeSH terms

• Telangiectasias
• Telangiectasis

Intervention

Drug:
• Brimonidine
Patients receive brimonidine to half of their face, whereas the other half receives no treatment and thereby patients are their own control

Other:
• IPL+air-cooling
IPL+air-cooling are applied to the whole face and the control side thereby only receives IPL+air-cooling

Locations

Country	Name	City	State
Denmark	Bispebjerg Hospital	Copenhagen NV

Sponsors (3)

Lead Sponsor	Collaborator
Merete Haedersdal	Ellipse A/S Agern Allé 11, 2970 Hørsholm, Skinperium, Christine Dierickx

Country where clinical trial is conducted

Denmark, 

References & Publications (27)

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Fowler J, Tan J, Jackson JM, Meadows K, Jones T, Jarratt M, Leoni M; Brimonidine Phase III Study Group. Treatment of facial erythema in patients with rosacea with topical brimonidine tartrate: correlation of patient satisfaction with standard clinical endpoints of improvement of facial erythema. J Eur Acad Dermatol Venereol. 2015 Mar;29(3):474-81. doi: 10.1111/jdv.12587. Epub 2014 Jul 30. — View Citation

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Holmes AD, Waite KA, Chen MC, Palaniswamy K, Wiser TH, Draelos ZD, Rafal ES, Werschler WP, Harvey AE. Dermatological Adverse Events Associated with Topical Brimonidine Gel 0.33% in Subjects with Erythema of Rosacea: A Retrospective Review of Clinical Studies. J Clin Aesthet Dermatol. 2015 Aug;8(8):29-35. Review. — View Citation

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Moore A, Kempers S, Murakawa G, Weiss J, Tauscher A, Swinyer L, Liu H, Leoni M. Long-term safety and efficacy of once-daily topical brimonidine tartrate gel 0.5% for the treatment of moderate to severe facial erythema of rosacea: results of a 1-year open-label study. J Drugs Dermatol. 2014 Jan;13(1):56-61. — View Citation

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Piwnica D, Rosignoli C, de Ménonville ST, Alvarez T, Schuppli Nollet M, Roye O, Jomard A, Aubert J. Vasoconstriction and anti-inflammatory properties of the selective a-adrenergic receptor agonist brimonidine. J Dermatol Sci. 2014 Jul;75(1):49-54. doi: 10.1016/j.jdermsci.2014.04.002. Epub 2014 Apr 16. — View Citation

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Tanghetti EA. Split-face randomized treatment of facial telangiectasia comparing pulsed dye laser and an intense pulsed light handpiece. Lasers Surg Med. 2012 Feb;44(2):97-102. doi: 10.1002/lsm.21151. Epub 2011 Dec 16. — View Citation

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Tierney E, Hanke CW. Randomized controlled trial: Comparative efficacy for the treatment of facial telangiectasias with 532 nm versus 940 nm diode laser. Lasers Surg Med. 2009 Oct;41(8):555-62. doi: 10.1002/lsm.20811. — View Citation

Uebelhoer NS, Bogle MA, Stewart B, Arndt KA, Dover JS. A split-face comparison study of pulsed 532-nm KTP laser and 595-nm pulsed dye laser in the treatment of facial telangiectasias and diffuse telangiectatic facial erythema. Dermatol Surg. 2007 Apr;33(4):441-8. — View Citation

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* Note: There are 27 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Reduction in erythema quantified by blinded clinical on-site evaluation and by blinded photo-evaluation.	Erythema is evaluated on the international validated, "Clinician's Erythema Assessment" (CEA) 5-point scale: 0, Clear Clear skin with no signs of erythema; Almost clear Almost clear; slight redness; Mild Mild erythema; definite redness; Moderate Moderate erythema; marked redness; Severe Severe erythema; fiery redness	Throughout the study, a period of 10 weeks
Primary	Reduction in oedema quantified by blinded clinical on-site evaluation and by blinded photo-evaluation.	Oedema is evaluated on a 4-point scale: 0 = no oedema, 1 = little oedema, 2 = moderate oedema and 3 = severe oedema.	Throughout the study, a period of 10 weeks
Secondary	The effect of brimonidine on IPL-efficacy quantified by blinded photo-evaluation obtained with a Visia camera, in which baseline-photos are compared to photos from the final follow-up visit.	Baseline photos are compared to photos at final follow-up visit approximate 10 weeks after.	At the end of the study (after 10 weeks)
Secondary	Patient discomfort and pain	Patient discomfort and pain are evaluated on a numeric Visual Analogue Scale (VAS) from 0 (no discomfort/pain) to 10 (extreme discomfort/pain) separately for brimonidine and control	Throughout the study, a period of 10 weeks
Secondary	Patient overall satisfaction	Patients evaluate their overall satisfaction with brimonidine to reduce IPL-induced inflammation on a numeric VAS from 0 (poor outcome) to 10 (excellent outcome). Inflammation is described as redness, swelling and pain to the patient.	Throughout the study, a period of 10 weeks

External Links

•   European Medicines Agency