Efficacy of Levocetirizine Fourfold Dosage in Chronic Spontaneous Urticaria

NCT02372604 | Completed Phase 3

• 1 other identifier: 2014.849
• Study Type: interventional
• Target: 15
• Locations: 0 countries
• Sites: N/A

Brief Summary

Chronic Spontaneous Urticaria (CSU), defined by the persistence of daily or almost daily urticaria over 6 weeks, affects 0.5% to 1% of the general population. In more than half of the cases, it lasts more than 2 years. It can dramatically alter the quality of life, in particular sleep, and generates numerous consultations and hospitalizations, with an average annual cost per patient close to 2000 euros in Europe. The treatment is based on the validated 2nd generation anti-H1 antihistamines dosage of one tablet per day whose effectiveness is satisfactory, however about half the time. In cases of severe CSU refractory to treatment with anti-H1 licensed dosage, few therapeutic alternatives exist, still off-label: the monketulast, an anti-leukotriene, ciclosporine or methotrexate, as immunosuppressants. Various studies have shown the important benefit of an expensive anti-IgE biological: the omaluzimab. Several open studies have also suggested superior efficacy and good tolerability of anti-H1 in higher dosage (double, triple or quadruple) including levocetirizine. The off-label use of these high dosages of anti-H1 is growing very rapidly in France, tending to replace the use of anti-H1 first generation or substitution to another 2nd generation anti-H1 recommended by the French Society of Dermatology. This study, under the aegis of the Urticaria Group of the French Society of Dermatology, intends to compare the efficacy of levocetirizine 4 tablets/day versus 1 tablet/day in the treatment of CSU resistant to anti-H1 licensed dosage.

Conditions

Chronic Spontaneous Urticaria

Keywords

Chronic spontaneous urticaria; Levocetirizine; H1-antihistamine; Fourfold dosage; Efficacy; Tolerance; UAS7 (Urticaria activity score); resistant

Outcome Measures

Primary Outcomes (1)

• UAS7≤6 (Proportion of patients with a UAS7≤6).

  The UAS7 (Urticaria activity score) is calculated as the sum of UAS over 1 week.

  After 5 weeks of treatment (plus or minus 2 days; week 5- visit 3).

Secondary Outcomes (5)

• Score of pruritus -> Assessment of the weekly score of pruritus

  5 weeks -> After 5 weeks of treatment (visit 3).

• Complete remission of urticaria at week 5

  5 weeks -> After 5 weeks of treatment (visit 3).

• Complete remission of urticaria

  10 weeks -> After 10 weeks of treatment (visit 4).

• Quality of life -> Evolution of the quality of life (between week 0, week 5 and week 10).

  week 0, week 5 and week 10 -> At the study beginning (week 0), at the week 5 of the study and finally at the end of the study (week 10).

• Tolerance of the treatment -> assessment of the tolerance of the H1-antihistamine in up 4 times conventional doses compared to the regulatory dosage of H1-antihistamine.

  week 0, week 5 and week 10 -> At the study beginning (week 0), at the week 5 of the study and finally at the end of the study (week 10).

Study Arms (2)

Group1 : Regulatory dosage

ACTIVE COMPARATOR

In a first time, every day, one tablet of 5 mg of levocetirizine is taken the morning and a second tablet of placebo is taken the evening, during 5 weeks (between visit 2 and 3). In a second time,and after primary endpoint assessment, every day, one tablet of 10 mg of levocetirizine is taken the morning and a second tablet of 10 mg of levocetirizine is taken the evening, during 5 weeks (between visit 3 and 4).

Drug: Levocetirizine (as levocetirizine dihydrochloride), 5mg ( then 20 mg) per day . Oral administration.

Group 2 : fourfold dosage

EXPERIMENTAL

In a first time, every day, one tablet of 10 mg of levocetirizine is taken the morning and a second tablet of 10 mg of levocetirizine is taken the evening, during 5 weeks (between visit 2 and 3). In a second time, every day, one tablet of 5 mg of levocetirizine is taken the morning and a second tablet of placebo is taken the evening, during 5 weeks (between visit 3 and 4).

Drug: Levocetirizine, (as levocetirizine dihydrochloride) 20 mg ( then 5 mg) per day. Oral administration.

Interventions

Levocetirizine (as levocetirizine dihydrochloride), 5mg ( then 20 mg) per day . Oral administration. DRUG

Week 1 to week 5, every day : - the morning : 5 mg of levocetirizine (capsule) * the evening : placebo capsule Week 6 to week 10, every day : - the morning : 10 mg of levocetirizine (capsule) * the evening : 10 mg of levocetirizine (capsule))

Group1 : Regulatory dosage

Levocetirizine, (as levocetirizine dihydrochloride) 20 mg ( then 5 mg) per day. Oral administration. DRUG

Week 1 to week 5, every day : - the morning : 10 mg of levocetirizine (tablet) * the evening : 10 mg of levocetirizine(tablet) Week 6 to week 10, every day : - the morning : 5 mg of levocetirizine (tablet) * the evening : placebo tablet

Group 2 : fourfold dosage

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Subject must be ≥18 years of age at screening.
• Chronic spontaneous urticaria already treated with anti-H1 for at least two months without sufficient efficacy.
• Urticaria Activity Score (UAS7) \>12 at the randomization visit (visit 2).
• For female :
• Of non-childbearing potential: e.g. postmenopausal (absence of menstrual bleeding for 1 years), or having had a hysterectomy or bilateral ovariectomy or tubal ligation.
• Patient agrees not to take other treatments than those provided in the study.
• Willingness and ability to comply with the protocol requirements.
• Written informed consent given prior to any study-related procedure.
• Subject affiliated to the National Social Security System.

You may not qualify if:

• Pregnancy, breastfeeding or planned pregnancy during the study.
• Inducible urticaria (except immediate dermographism associated with CSU)
• Differential diagnosis of CSU (urticarial vasculitis).
• Known hypersensitivity to antihistamine.
• Known hypersensitivity to one of the product components, to hydroxyzine or to piperazine derivative.
• Sleepiness disorders or with Epworth sleepiness scale \>15.
• Treatment with systemic corticosteroids within the month before the screening visit.
• Treatment with montelukast within the week before the screening visit.
• Treatment with H2-antihistamine within the week before the screening visit.
• Treatment with immunosuppressive drugs (e.g. methotrexate, cyclosporine, azathioprine, mycophenolate mofetil …) within the month before the screening visit.
• Known congenital galactosemia, glucose and galactose malabsorption, lactase deficiency, or lactose and fructose intolerance.
• Swallowing disorders.
• Liver dysfunction with transaminase greater than twice the normal value.
• Renal failure with creatinine clearance \<50mL/min (calculated by MDRD formula).
• Regular or excessive alcohol consumption.

Sponsors & Collaborators

• Hospices Civils de Lyon: lead

MeSH Terms

Conditions

Chronic Urticaria

Interventions

levocetirizine

Condition Hierarchy (Ancestors)

Urticaria; Skin Diseases, Vascular; Skin Diseases; Skin and Connective Tissue Diseases; Hypersensitivity, Immediate; Hypersensitivity; Immune System Diseases; Chronic Disease; Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Study Officials

• Frédéric BERARD, Professor

  Service d'Allergologie et Immunologie Clinique - Centre Hospitalier Universitaire Lyon Sud

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: phase 3
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, INVESTIGATOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: February 20, 2015
• First Posted: February 26, 2015
• Study Start: July 1, 2015
• Primary Completion: December 1, 2016
• Study Completion: December 1, 2016
• Last Updated: September 18, 2018

Record last verified: 2018-09