Efficacy of Combining Topical Antibiotic/Steroid/Moisturizer Therapy Compared to Active Comparator in Atopic Dermatitis.

Overview

Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin disease that occurs most commonly during early infancy and childhood. It is frequently associated with abnormalities in skin barrier function, allergen sensitization and recurrent skin infections. AD is a major public health problem worldwide, with prevalence in children of 10-20% and 2-5% of the general population. The skin of AD patients is susceptible to colonization and infection with Staphylococcus aureus (SA )which contribute significantly to the severity of the clinical manifestations of eczema, triggering a vicious cycle. Fusidic Acid (FA) cream is a topical antibiotic widely used in the treatment of skin and soft tissue infections and infected atopic dermatitis. However in recent years, the emergence of drug-resistant organisms, e.g. Methicillin- resistant Staphylococcus aureus (MRSA) has led to scrutiny of antibiotic use. Prolonged use of topical FA has been linked with emergence of FA-resistant Staphylococcus aureus (FRSA) . Fusidic acid is a natural antibiotic, extracted from cultures of Fusidium coccineum, which has a powerful antibacterial action. Topical use of Fusidic acid is fully in line with therapeutic strategies that recommend the use of an antibiotic with the narrowest activity spectrum to minimize the risk of resistance. In AD with infected lesions, combined treatment with antibiotic and steroid demonstrates greater efficacy over the use of steroid. Trial Design: A three-center, double blind, randomized ,phase II , parallel group, efficacy trial. Type of Intervention: A triple compounded cream containing a topical antibiotic , topical steroid and moisturizer. Type of control: Active control containing a double compounded cream comprising a topical steroid and moisturizer . Study population and Setting: A sample of 78 subjects will be recruited from Red Cross Children's Hospital , Nelson Mandela Academic Hospital and King Edward Hospital Estimated duration of trial: 12 months. Duration of participation: Each subject will participate in the trial for a maximum of 140 days. Primary endpoint: reduction in SCORAD scores; frequency of clinical flares for AD and improvement in the quality of life at 140 days. The benefit of this trial is that it provides a simple and effective approach to the management of atopic eczema.

Full Title of Study: “A Multicentre Study Evaluating the Efficacy of Combining Topical Antibiotic/Steroid/Moisturizer Therapy Compared to Standard of Care in the Treatment of Severe Atopic Dermatitis, a Phase II Randomized, Clinical Trial”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Treatment
    • Masking: Triple (Participant, Investigator, Outcomes Assessor)
  • Study Primary Completion Date: July 30, 2018

Interventions

  • Other: Polyethylene glycol hexadecyl ether & Betamethasone valerate cream 0.1%
    • Polyethylene glycol hexadecyl ether -Moisturizer. Betamethasone valerate cream 0.1% -Topical steroid
  • Other: Fusidic acid, polyethylene glycol hexadecyl ether & Betamethasone valerate cream 0.1%
    • Polyethylene glycol hexadecyl ether -Moisturizer. Betamethasone valerate cream 0.1% -Topical steroid Fusidic Acid – Topical Antibiotic

Arms, Groups and Cohorts

  • Active Comparator: Group R
    • Polyethylene glycol hexadecyl ether & betamethasone valerate cream 0.1% . ( 4 applications per day for 14 days treatment to taper fortnightly)
  • Experimental: Group A
    • Fusidic acid & Polyethylene glycol hexadecyl ether,& betamethasone valerate cream 0.1%). ( 4 applications per day for 14 days treatment to taper fortnightly)

Clinical Trial Outcome Measures

Primary Measures

  • SCORAD scores
    • Time Frame: 20 weeks
    • Reduction of SCORAD scores in the treatment group (A) of patients comparing with scores in the control group (R), at the end of the study with reference to baseline

Secondary Measures

  • Infants Dermatitis’ Quality of Life (IDQOL) index
    • Time Frame: 20 weeks
    • Improvement in the Infants Dermatitis’ Quality of Life (IDQOL) index in group (A) patients compared to that of the control group (R) at the end of the study compared to baseline
  • Frequency of AD relapse episodes
    • Time Frame: 20 Weeks
    • Comparison of the frequency of AD relapse episodes in group (A) patients compared to the frequency of relapse episodes in control group (R) patients.
  • Time to AD Relapse
    • Time Frame: 20 weeks
    • Comparison of the time to AD relapse episodes in group (A) patients compared to the time to relapse episodes in control group (R) patients.

Participating in This Clinical Trial

Inclusion Criteria

  • Participants must have a parent/legally authorized representative, who is able to give informed consent and willing and able to comply with all the required study procedures. Assent is required from children who in the investigator's judgement, are capable of understanding the nature of the study. – Participants must have have AD as defined by the UK Working Party Criteria – Participants can be female or male, older than 2 years but younger than 10 years (up to their 10th birthday) – Participants must not be on systemic antibiotics treatment at recruitment – Participants must have a baseline SCORAD score of 50 or above (severe AD) – Participants must be eligible for second line treatment agents for AD (systemic or photo therapy) Exclusion Criteria:
  • Participants must not be systemic agents (e.g. immunosuppressive) for AD – Participants must not be younger than 2 years or over 10 years in age. – Participants must not be using g bleach baths as a staphylococcus eradication measure at the time of enrollment, – Participants must not have mild-moderate AD (SCORAD< 50) – Participants must not be immune-compromised with AD – Participants must not be on photo therapy for AD – Participants must not be using wet wrap therapy for AD
  • Gender Eligibility: All

    Minimum Age: 2 Years

    Maximum Age: 10 Years

    Are Healthy Volunteers Accepted: No

    Investigator Details

    • Lead Sponsor
      • Red Cross War Memorial Childrens Hospital
    • Provider of Information About this Clinical Study
      • Principal Investigator: Dr Carol Hlela, Dr – Red Cross War Memorial Childrens Hospital
    • Overall Official(s)
      • Dr Carol Hlela, MBCHB, Principal Investigator, Red Cross Children’s War Memorial Hospital
    • Overall Contact(s)
      • Dr Carol Hlela, MBCHB, 0741724141, carol.hlela@uct.ac.za

    References

    Sidbury R, Tom WL, Bergman JN, Cooper KD, Silverman RA, Berger TG, Chamlin SL, Cohen DE, Cordoro KM, Davis DM, Feldman SR, Hanifin JM, Krol A, Margolis DJ, Paller AS, Schwarzenberger K, Simpson EL, Williams HC, Elmets CA, Block J, Harrod CG, Smith Begolka W, Eichenfield LF. Guidelines of care for the management of atopic dermatitis: Section 4. Prevention of disease flares and use of adjunctive therapies and approaches. J Am Acad Dermatol. 2014 Dec;71(6):1218-33. doi: 10.1016/j.jaad.2014.08.038. Epub 2014 Sep 26.

    Cardona ID, Cho SH, Leung DY. Role of bacterial superantigens in atopic dermatitis : implications for future therapeutic strategies. Am J Clin Dermatol. 2006;7(5):273-9. Review.

    Huang JT, Abrams M, Tlougan B, Rademaker A, Paller AS. Treatment of Staphylococcus aureus colonization in atopic dermatitis decreases disease severity. Pediatrics. 2009 May;123(5):e808-14. doi: 10.1542/peds.2008-2217.

    Langan SM, Thomas KS, Williams HC. What is meant by a "flare" in atopic dermatitis? A systematic review and proposal. Arch Dermatol. 2006 Sep;142(9):1190-6. Review.

    Totté JE, van der Feltz WT, Hennekam M, van Belkum A, van Zuuren EJ, Pasmans SG. Prevalence and odds of Staphylococcus aureus carriage in atopic dermatitis: a systematic review and meta-analysis. Br J Dermatol. 2016 Oct;175(4):687-95. doi: 10.1111/bjd.14566. Epub 2016 Jul 5. Review.

    Nakamura Y, Oscherwitz J, Cease KB, Chan SM, Muñoz-Planillo R, Hasegawa M, Villaruz AE, Cheung GY, McGavin MJ, Travers JB, Otto M, Inohara N, Núñez G. Staphylococcus δ-toxin induces allergic skin disease by activating mast cells. Nature. 2013 Nov 21;503(7476):397-401. doi: 10.1038/nature12655. Epub 2013 Oct 30.

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