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

NCT ID: NCT03052348

Last Updated: 2017-09-25

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

78 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-11-01

Study Completion Date

2018-08-30

Brief Summary

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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.

Detailed Description

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Conditions

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Severe Atopic Dermatitis

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Fusidic acid, polyethylene glycol hexadecyl ether \& Betamethasone valerate cream 0.1%
Primary Study Purpose

TREATMENT

Blinding Strategy

TRIPLE

Participants Investigators Outcome Assessors
Participants will be given creams (containing either the intervention or control regimens - both white in color) in unlabelled opaque containers. Participants, investigators and the outcomes assessor evaluating the outcome of interest (SCORAD) will be blinded to the treatment allocations.

Study Groups

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Group R

Polyethylene glycol hexadecyl ether \& betamethasone valerate cream 0.1% . ( 4 applications per day for 14 days treatment to taper fortnightly)

Group Type ACTIVE_COMPARATOR

Polyethylene glycol hexadecyl ether & Betamethasone valerate cream 0.1%

Intervention Type OTHER

Polyethylene glycol hexadecyl ether -Moisturizer. Betamethasone valerate cream 0.1% -Topical steroid

Group A

Fusidic acid \& Polyethylene glycol hexadecyl ether,\& betamethasone valerate cream 0.1%). ( 4 applications per day for 14 days treatment to taper fortnightly)

Group Type EXPERIMENTAL

Fusidic acid, polyethylene glycol hexadecyl ether & Betamethasone valerate cream 0.1%

Intervention Type OTHER

Polyethylene glycol hexadecyl ether -Moisturizer. Betamethasone valerate cream 0.1% -Topical steroid Fusidic Acid - Topical Antibiotic

Interventions

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Polyethylene glycol hexadecyl ether & Betamethasone valerate cream 0.1%

Polyethylene glycol hexadecyl ether -Moisturizer. Betamethasone valerate cream 0.1% -Topical steroid

Intervention Type 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

Intervention Type OTHER

Other Intervention Names

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Cetomacrogol 400g, Reg No PL 00240/0014. Lenovate cream, 15g, Reg No. 27/13.4.1/0493 Cetomacrogol 400g, Reg No PL 00240/0014. Lenovate cream, 15g, Reg No. 27/13.4.1/0493 Fusidic Acid (Fucidin cream), 15 g, Reg No. Q/20.1.6/128

Eligibility Criteria

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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
Minimum Eligible Age

2 Years

Maximum Eligible Age

10 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Red Cross War Memorial Childrens Hospital

OTHER

Sponsor Role lead

Responsible Party

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Dr Carol Hlela

Dr

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Dr Carol Hlela, MBCHB

Role: PRINCIPAL_INVESTIGATOR

Red Cross Children's War Memorial Hospital

Locations

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Nelson Mandela Academic Hospital

Mthatha, Eastern Cape, South Africa

Site Status

King Edward Hospital

Durban, KwaZulu-Natal, South Africa

Site Status

Red Cross War Memorial Children's Hospital

Cape Town, Western Cape, South Africa

Site Status

Countries

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South Africa

Central Contacts

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Dr Carol Hlela, MBCHB

Role: CONTACT

0741724141

Dr Richard Aron, MBCHB

Role: CONTACT

021 4225 999

Facility Contacts

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Avumile Mankahla, MBCHB

Role: primary

0836547566

Noluvuyo Qikani, MBCHB

Role: backup

0833821188

Ncoza Dlova, MBCHB

Role: primary

0312604530

References

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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.

Reference Type BACKGROUND
PMID: 25264237 (View on PubMed)

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. doi: 10.2165/00128071-200607050-00001.

Reference Type BACKGROUND
PMID: 17007538 (View on PubMed)

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.

Reference Type BACKGROUND
PMID: 19403473 (View on PubMed)

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. doi: 10.1001/archderm.142.9.1190.

Reference Type BACKGROUND
PMID: 16983006 (View on PubMed)

Totte 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.

Reference Type BACKGROUND
PMID: 26994362 (View on PubMed)

Nakamura Y, Oscherwitz J, Cease KB, Chan SM, Munoz-Planillo R, Hasegawa M, Villaruz AE, Cheung GY, McGavin MJ, Travers JB, Otto M, Inohara N, Nunez G. Staphylococcus delta-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.

Reference Type BACKGROUND
PMID: 24172897 (View on PubMed)

Other Identifiers

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RedCrossWMCH

Identifier Type: -

Identifier Source: org_study_id