Pirfenidone Plus M-DDO Gel in Moderate and Severe Acne

NCT03076320 | Completed Phase 1

• 3 other identifiers: IBMMTG 15-02008/16267/15
• Study Type: interventional
• Target: 82
• Locations: 1 country
• Sites: 1

Brief Summary

Acne vulgaris is a complex skin disorder involving multiple abnormalities of the pilosebaceous unit. Acne is the most common skin disease during puberty and worsens throughout adolescence. However, epidemiological studies suggest that acne can arise at any age, most frequently affecting individuals between puberty and 30 years of age, with 79%-95% of subjects aged between 16 years and 18 years and 80% of subjects between puberty and 30 years of age. Acne is considered the main reason for consultation with the dermatologist in institutional and private clinical practice. Clinical features include seborrhoea, non-inflammatory lesions, inflammatory lesions and various degrees of scarring. There are many classifications of acne and scarring severity. Moderate to severe acne is about 15-20%. Facial acne scarring affects both sexes equally and occurs to some degree in up to 95% of cases. There is a significant correlation between the initial acne grade and the overall severity of scarring at all sites and in both sexes. This would suggest that treatment aimed at reducing the severity of acne might reduce the incidence of scarring. Both superficial inflammatory acne lesions as well as deep nodular lesions seem capable of producing scars. Conventional therapies recommended for the treatment of acne vulgaris include retinoids, benzoyl peroxide (BPO), antibiotics, and hormonal therapy. Combination therapy using agents with complementary mechanisms provides the opportunity to target multiple pathogenetic causes of acne vulgaris. The combination in gel with 0.1% adapalene and 2.5% BPO is a once-daily treatment of acne vulgaris. In several double- blind, randomized controlled trials (RCTs), the Adapalene-BPO (A-BPO) combination therapy applied once daily for 12 weeks significantly reduced the number of both inflammatory and non-inflammatory lesions in subjects with moderate acne vulgaris. In Mexico there is an available commercial product of this combination (Effezel®; Galderma). The limitation of this topical therapy is the low tolerability by patients as they can experiment several levels of irritation, erythema, dryness, desquamation, burning, and itching), and patients are advised to expect these side effects, which contribute to discontinue therapy if it becomes severe. On the other hand, 5-methyl-1-phenyl-2-(1h)-pyridone or pirfenidone (PFD) is a wide-spectrum antifibrotic drug that modulates diverse cytokines action, involving TGF-β, TNF-α, epidermal growth factor, platelet-derived growth factor, VEGF, IGF-1, fibroblast growth factor, interferon-γ, interleukin (IL)-1, IL-6, and IL-8 and it has shown promising effects in vitro and in vivo settings. Also, PFD has proven effective in the prevention and regression of pulmonary fibrosis, peritoneal sclerosis, hepatic cirrhosis, uterine fibromyoma, left ventricular fibrosis, renal interstitial fibrosis, and breast capsular contracture in experimental models. A recently open phase II clinical trial evaluated the therapeutic use of PFD gel in localized scleroderma. Results showed it acts on both the inflammatory and the fibrotic phases. The other component of Zaxcell is modified-diallyl disulfide oxide (M-DDO) an antimicrobial and antiseptic agent, which has been proved in patients with chronic diabetic ulcer as a potent germicide and has show to increase the beneficial effect of PFD preventing infections, accelerating and improving ulcer resolution. (Observations not published). According to this, the investigators believe that Zaxcell (PFD + M-DDO) could play an important role in the modulation of inflammatory and scarring process in acne. The investigators hypothesis is that PFD in patients with moderate to severe acne modulates amplification of the inflammatory response, regulating the inflammasome activation, macrophage polarization and its activity in regulating the wound healing process of the skin in an early fashion. Zaxcell is an innovative gel with a synergetic mode of action that could modulate the inflammatory response. Furthermore, has antiseptic properties and regulates the process of wound healing, fibrogenic and scarring process. In vitro and in vivo studies provide an initial body of evidence on the safety and clinical benefits of PFD, the main component of Zaxcell as a promising candidate for the treatment of moderate to severe acne.

Conditions

Acne Vulgaris Superficial Mixed Comedonal and Inflammatory

Keywords

Modified diallyl disulfide oxide (M-DDO); Pirfenidone (PFD); Adapalene + Benzoyl peroxide (A-BPO)

Outcome Measures

Primary Outcomes (1)

• Assessing change of lesions with IGA scale (Investigators' Global Assessment)

  Number or lesions

  1, 2, 3, 4, 5 and 6 months

Secondary Outcomes (3)

• Histopathological modification on the inflammatory lesions and improvement in the scarring process

  1 and 3 months

• 2. Expression levels of key molecules involved in acne inflammation and scar remodeling

  1 and 3 months

• Photonumeric scale

  1, 3 and 6 months

Study Arms (2)

PFD+M-DDO

EXPERIMENTAL

Pirfenidone with M-DDO Active ingredients: Pirfenidone 10% with modified oxide diallyl disulfide (M-DDO) 0.016% Dosage form: gel. Dosage: standard finger tip unit (0.5g for an area of 100 to 120 square centimeters). Frequency an duration: topically applied every 12 hours for 6 months.

Combination Product: PDF+M-DDO

A+PBO

ACTIVE COMPARATOR

Adapalene with benzoyl peroxide Active ingredients: 0.1% Adapalene with 2.5% benzoyl peroxide. Dosage form: gel. Dosage: standard finger tip unit (0.5g for an area of 100 to 120 square centimeters). Frequency and duration: topically applied every 12 hours for 6 month

Combination Product: A+PBO

Interventions

PDF+M-DDO COMBINATION_PRODUCT

Participants with moderate and severe acne will be treated two times a day on the face and superior back with a smooth layer (standard finger tip unit 0.5 g for an area of 100 to 120 square centimeters) of Zaxcell (Pirfenidone with M-DDO) in form of a gel. Patients have to wait 20 min without cover those sites.

Also known as: Zaxcell, 5-methyl-phenyl-2(1h)- pyridone with M-DDO

PFD+M-DDO

A+PBO COMBINATION_PRODUCT

Participants with moderate and severe acne will be treated once a day (at night) on the face and superior back with a smooth layer (standard finger tip unit 0.5 g for an area of 100 to 120 square centimeters) of Effezel (Adapalene with benzoyl peroxide) in form of a gel. Patients have to wait 20 min without cover those sites

Also known as: Effezel, Adapalene with benzoyl peroxide

A+PBO

Eligibility Criteria

• Age: 12 Years - 25 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64)

You may qualify if:

• Subjects of both genders male or female of any race, 12 to 25 years or age.
• Subjects with a clinical diagnosis of acne vulgaris with facial and back involvement.
• Subjects with a minimum of 20 but not more tan 150 inflammatory lesions on the face (including the nose)
• Subjects with a minimum of 30 but no more 200 non-inflammatory lesions on the face (including the nose)
• Subjects with minimum of 20 but no more than 250 inflammatory lesions on the superior back area.
• Investigator's Global Assessment (IGA) score of 3 or 4, corresponding to moderate and severe acne. Subjects with no more than two active nodules at baseline.
• Subjects that agree to fill a clinical history, access to physical exploration and biochemical analysis samples, biopsy of the back and photo-documentation of affected areas on the face and back.
• Consent to participate, verified by signing an approved written Informed Consent Form, or for subjects under age 18, an assent form in conjunction with a signed Informed Consent Form from a parent/guardian.
• Patients willing to sign a compliance letter to apply treatment as indicated by the principal investigator.
• Willingness and capacity of protocol compliance (for subjects under 18 years of age, parent/guardian must be wiling and able to comply with study requirements).
• Subjects willing to share personal information and data as verified by signing a written authorization, as applicable

You may not qualify if:

• Acne conglobata, acne fulminans, secondary acne.
• Subjects with another chronic inflammatory disease of the skin.
• Subjects with severe acne requiring isotretinoin therapy or other dermatological conditions, which might, in the opinion of the Investigator, interfere with the study evaluation or pose a risk to patient safety during the study.
• Pregnancy, nursing or planning a pregnancy.
• Men with facial hair that would interfere with the assessments.
• Subjects with background history of keloid scarring.
• Known sensitivities to the study preparations.
• Participation in another investigational drug or device research study within 30 day of enrollment.
• Specified washout period to baselines for systemic or topical medications.
• Subjects refusing to the biopsy of the back and photographic procedures.

Sponsors & Collaborators

• University of Guadalajara: lead
• Hospital Civil de Guadalajara: collaborator
• Cell Pharma: collaborator

Study Sites (1)

Hospital Civil de Guadalajara Fray Antonio Alcalde

Guadalajara, Jalisco, 44280, Mexico

Location

Related Publications (6)

• Gollnick HP, Finlay AY, Shear N; Global Alliance to Improve Outcomes in Acne. Can we define acne as a chronic disease? If so, how and when? Am J Clin Dermatol. 2008;9(5):279-84. doi: 10.2165/00128071-200809050-00001.

  PMID: 18717602 BACKGROUND

• Kang S, Cho S, Chung JH, Hammerberg C, Fisher GJ, Voorhees JJ. Inflammation and extracellular matrix degradation mediated by activated transcription factors nuclear factor-kappaB and activator protein-1 in inflammatory acne lesions in vivo. Am J Pathol. 2005 Jun;166(6):1691-9. doi: 10.1016/s0002-9440(10)62479-0.

  PMID: 15920154 BACKGROUND

• Macias-Barragan J, Sandoval-Rodriguez A, Navarro-Partida J, Armendariz-Borunda J. The multifaceted role of pirfenidone and its novel targets. Fibrogenesis Tissue Repair. 2010 Sep 1;3:16. doi: 10.1186/1755-1536-3-16.

  PMID: 20809935 BACKGROUND

• Zhou R, Jiang X. Effects of adapalene-benzoyl peroxide combination gel in treatment or maintenance therapy of moderate or severe acne vulgaris: a meta-analysis. Ann Dermatol. 2014 Feb;26(1):43-52. doi: 10.5021/ad.2014.26.1.43. Epub 2014 Feb 17.

  PMID: 24648685 BACKGROUND

• Rodriguez-Castellanos M, Tlacuilo-Parra A, Sanchez-Enriquez S, Velez-Gomez E, Guevara-Gutierrez E. Pirfenidone gel in patients with localized scleroderma: a phase II study. Arthritis Res Ther. 2015 Jan 28;16(6):510. doi: 10.1186/s13075-014-0510-4.

  PMID: 25533576 BACKGROUND

• Holland DB, Jeremy AH. The role of inflammation in the pathogenesis of acne and acne scarring. Semin Cutan Med Surg. 2005 Jun;24(2):79-83. doi: 10.1016/j.sder.2005.03.004.

  PMID: 16092795 BACKGROUND

MeSH Terms

Interventions

Pyridones; Adapalene; Benzoyl Peroxide

Intervention Hierarchy (Ancestors)

Pyridines; Heterocyclic Compounds, 1-Ring; Heterocyclic Compounds; Naphthalenes; Polycyclic Aromatic Hydrocarbons; Hydrocarbons, Aromatic; Hydrocarbons, Cyclic; Hydrocarbons; Organic Chemicals; Polycyclic Compounds; Benzoates; Acids, Carbocyclic; Carboxylic Acids; Benzene Derivatives

Study Design

• Study Type: interventional
• Phase: phase 1
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Director of Institute of Molecular Biology in Medicine

Study Record Dates

• First Submitted: March 6, 2017
• First Posted: March 10, 2017
• Study Start: March 27, 2017
• Primary Completion: January 31, 2019
• Study Completion: March 31, 2019
• Last Updated: July 6, 2023

Record last verified: 2023-07

Locations

ME (1)