Botox Versus Tacrolimus in Psoriasis Vulgaris

NCT06203470 | Not Yet Recruiting Phase 4

• 1 other identifier: BTP
• Study Type: interventional
• Target: 60
• Locations: 0 countries
• Sites: N/A

Brief Summary

Psoriasis is a systemic chronic relapsing immune-mediated disease which often requires a long-term therapy. Psoriasis occurs in around 2-3% of the total global population. In Egypt, the prevalence of psoriasis ranges between 0.19% and 3%. Besides, it could have profound implications on the patients' psychological state and quality of life. It is presented by erythematous, scaly plaques over the preferred sites. The pathogenesis of this highly complex disease is still far from being fully understood. Keratinocytes' hyperproliferation and immune system dysfunctions are well recognized contributors, with numerous treatments targeting these unique immunologic dysfunctions.

Conditions

Psoriasis Vulgaris

Outcome Measures

Primary Outcomes (1)

• To evaluate the efficacy and safety of Mesobotox for treatment of plaque psoriasis as a monotherapy versus its combination with a topical Calcineurin inhibitor 0.03% ointment and topical Calcineurin inhibitor 0.03% ointment alone.

  This will be evaluated by measuring the (Psoriasis severity (TES) score) which is a physician-based, four-point scoring system in which the thickness, erythema, and scales within each plaque will be rated from 0 (none) to 3 (severe) to evaluate the therapeutic outcome within different groups before and after treatment.

  6 months

Secondary Outcomes (2)

• To explore the treatment effects on the histopathological features of psoriasis.

  2 months

• To explore the treatment effects on the immunohistochemical features of psoriasis.

  2 months

Study Arms (3)

Botox group

EXPERIMENTAL

Patients will receive a single intradermal injection of Mesobotox as a monotherapy. Botulinum toxin injection: Botox injections will be intradermal. Concentration will be 100 U to be diluted with 5-ml sterile physiological sodium chloride solution. Each patient will receive individual injections of 1 U using a grid with points set at a distance of 1 cm apart. Up to two plaques per patient will be selected, whose diameter would not exceed 5-10 cm2. Each patient will receive a single BoNT-A injection

Drug: Botulinum Toxin-A

Botox and Tacrolimus group

EXPERIMENTAL

Patients will receive a single intradermal injection of Mesobotox of the same dilution followed by topical application of Tacrolimus 0.03% ointment twice daily for 3 months.

Drug: Botulinum Toxin-A; Drug: Tacrolimus

Tacrolimus group

EXPERIMENTAL

Patients will apply Tacrolimus (0.03%) as a monotherapeutic twice daily for 3 months

Drug: Tacrolimus

Interventions

Botulinum Toxin-A DRUG

Botulinum Toxin-A (BoNT-A) is an injectable neuromodulator produced by Clostridium Botulinum, a Gram-positive bacillus that causes Botulism.

Botox and Tacrolimus group; Botox group

Tacrolimus DRUG

topical Calcineurin inhibitor

Botox and Tacrolimus group; Tacrolimus group

Eligibility Criteria

• Age: 18 Years - 60 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• Patients with clinical diagnosis of mild to moderate psoriasis vulgaris
• Patients who stopped any systemic therapy or phototherapy for at least 3 months and topical therapy for at least 4 weeks prior to enrollment.

You may not qualify if:

• Psoriasis vulgaris involving \> 10% of the body surface area, pustular or erythrodermic psoriasis.
• Patients with neuromuscular disease or history of epilepsy.
• Pregnant or lactating females.
• Patients with any current dermatological disease.
• Patients with any current systemic disease.

Sponsors & Collaborators

• Assiut University: lead

Related Publications (17)

• Armstrong AW, Mehta MD, Schupp CW, Gondo GC, Bell SJ, Griffiths CEM. Psoriasis Prevalence in Adults in the United States. JAMA Dermatol. 2021 Aug 1;157(8):940-946. doi: 10.1001/jamadermatol.2021.2007.

  PMID: 34190957 BACKGROUND

• Omar SS, Helaly HA. Prevalence of ocular findings in a sample of Egyptian patients with psoriasis. Indian J Dermatol Venereol Leprol. 2018 Jan-Feb;84(1):34-38. doi: 10.4103/ijdvl.IJDVL_1239_15.

  PMID: 29067934 BACKGROUND

• Goff KL, Karimkhani C, Boyers LN, Weinstock MA, Lott JP, Hay RJ, Coffeng LE, Norton SA, Naldi L, Dunnick C, Armstrong AW, Dellavalle RP. The global burden of psoriatic skin disease. Br J Dermatol. 2015 Jun;172(6):1665-1668. doi: 10.1111/bjd.13715. Epub 2015 May 6. No abstract available.

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• Khattab FM, Samir MA. Botulinum toxin type-A versus 5-fluorouracil in the treatment of plaque psoriasis: Comparative study. J Cosmet Dermatol. 2021 Oct;20(10):3128-3132. doi: 10.1111/jocd.14306. Epub 2021 Jul 14.

  PMID: 34146460 BACKGROUND

• Kubanov AA, Katunina OR, Chikin VV. Expression of Neuropeptides, Neurotrophins, and Neurotransmitters in the Skin of Patients with Atopic Dermatitis and Psoriasis. Bull Exp Biol Med. 2015 Jul;159(3):318-22. doi: 10.1007/s10517-015-2951-4. Epub 2015 Jul 24.

  PMID: 26201903 BACKGROUND

• Popescu MN, Beiu C, Iliescu MG, Mihai MM, Popa LG, Stanescu AMA, Berteanu M. Botulinum Toxin Use for Modulating Neuroimmune Cutaneous Activity in Psoriasis. Medicina (Kaunas). 2022 Jun 16;58(6):813. doi: 10.3390/medicina58060813.

  PMID: 35744076 BACKGROUND

• Khattab FM. Evaluation of Botulinum Toxin A as an Optional Treatment for Atopic Dermatitis. J Clin Aesthet Dermatol. 2020 Jul;13(7):32-35. Epub 2020 Jul 1.

  PMID: 32983334 BACKGROUND

• Gonzalez C, Franco M, Londono A, Valenzuela F. Breaking paradigms in the treatment of psoriasis: Use of botulinum toxin for the treatment of plaque psoriasis. Dermatol Ther. 2020 Nov;33(6):e14319. doi: 10.1111/dth.14319. Epub 2020 Oct 8.

  PMID: 32949180 BACKGROUND

• Zhang Y, Zhang H, Jiang B, Yan S, Lu J. A promising therapeutic target for psoriasis: Neuropeptides in human skin. Int Immunopharmacol. 2020 Oct;87:106755. doi: 10.1016/j.intimp.2020.106755. Epub 2020 Jul 28.

  PMID: 32736190 BACKGROUND

• Chen SQ, Chen XY, Cui YZ, Yan BX, Zhou Y, Wang ZY, Xu F, Huang YZ, Zheng YX, Man XY. Cutaneous nerve fibers participate in the progression of psoriasis by linking epidermal keratinocytes and immunocytes. Cell Mol Life Sci. 2022 Apr 30;79(5):267. doi: 10.1007/s00018-022-04299-x.

  PMID: 35488965 BACKGROUND

• Amalia SN, Uchiyama A, Baral H, Inoue Y, Yamazaki S, Fujiwara C, Sekiguchi A, Yokoyama Y, Ogino S, Torii R, Hosoi M, Ishikawa O, Motegi SI. Suppression of neuropeptide by botulinum toxin improves imiquimod-induced psoriasis-like dermatitis via the regulation of neuroimmune system. J Dermatol Sci. 2021 Jan;101(1):58-68. doi: 10.1016/j.jdermsci.2020.11.003. Epub 2020 Nov 6.

  PMID: 33176965 BACKGROUND

• Barros PO, Ferreira TB, Vieira MM, Almeida CR, Araujo-Lima CF, Silva-Filho RG, Hygino J, Andrade RM, Andrade AF, Bento CA. Substance P enhances Th17 phenotype in individuals with generalized anxiety disorder: an event resistant to glucocorticoid inhibition. J Clin Immunol. 2011 Feb;31(1):51-9. doi: 10.1007/s10875-010-9466-6. Epub 2010 Sep 24.

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• Bera MM, Lu B, Martin TR, Cui S, Rhein LM, Gerard C, Gerard NP. Th17 cytokines are critical for respiratory syncytial virus-associated airway hyperreponsiveness through regulation by complement C3a and tachykinins. J Immunol. 2011 Oct 15;187(8):4245-55. doi: 10.4049/jimmunol.1101789. Epub 2011 Sep 14.

  PMID: 21918196 BACKGROUND

• Wollina U, Tirant M, Vojvodic A, Lotti T. Treatment of Psoriasis: Novel Approaches to Topical Delivery. Open Access Maced J Med Sci. 2019 Aug 30;7(18):3018-3025. doi: 10.3889/oamjms.2019.414. eCollection 2019 Sep 30.

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• Kattimani V, Tiwari RVC, Gufran K, Wasan B, Shilpa PH, Khader AA. Botulinum Toxin Application in Facial Esthetics and Recent Treatment Indications (2013-2018). J Int Soc Prev Community Dent. 2019 Mar-Apr;9(2):99-105. doi: 10.4103/jispcd.JISPCD_430_18. Epub 2019 Apr 12.

  PMID: 31058058 BACKGROUND

• Ward NL, Kavlick KD, Diaconu D, Dawes SM, Michaels KA, Gilbert E. Botulinum neurotoxin A decreases infiltrating cutaneous lymphocytes and improves acanthosis in the KC-Tie2 mouse model. J Invest Dermatol. 2012 Jul;132(7):1927-30. doi: 10.1038/jid.2012.60. Epub 2012 Mar 15. No abstract available.

  PMID: 22418873 BACKGROUND

• Wallin EF, Hill DL, Linterman MA, Wood KJ. The Calcineurin Inhibitor Tacrolimus Specifically Suppresses Human T Follicular Helper Cells. Front Immunol. 2018 May 31;9:1184. doi: 10.3389/fimmu.2018.01184. eCollection 2018.

  PMID: 29904381 BACKGROUND

MeSH Terms

Interventions

Botulinum Toxins, Type A; Tacrolimus

Intervention Hierarchy (Ancestors)

Botulinum Toxins; Metalloendopeptidases; Endopeptidases; Peptide Hydrolases; Hydrolases; Enzymes; Enzymes and Coenzymes; Metalloproteases; Bacterial Proteins; Proteins; Amino Acids, Peptides, and Proteins; Bacterial Toxins; Toxins, Biological; Biological Factors; Macrolides; Lactones; Organic Chemicals

Central Study Contacts

Amira Ali, MD

CONTACT

0201005263721; amiraali21@yahoo.com

Ayman Mahran, MD

CONTACT

02012231210000; aymanderma@yahoo.com

Study Design

• Study Type: interventional
• Phase: phase 4
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: principal investigator

Study Record Dates

• First Submitted: December 15, 2023
• First Posted: January 12, 2024
• Study Start: June 1, 2024
• Primary Completion (Estimated): June 1, 2026
• Study Completion (Estimated): October 1, 2026
• Last Updated: June 12, 2024

Record last verified: 2024-06

Data Sharing

• IPD Sharing: Will share