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Lichen PlanusPhase 2NCT00285779

Use of Etanercept in the Treatment of Moderate to Severe Lichen Planus

A Phase 2 study testing Etanercept in people with Lichen Planus, run by Stanford University at 12 sites in United States.

Terminated

Stopped early. The study ended before it was planned to and will not resume.

Official record
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Trial summary

The purpose is to assess the response of subjects to etanercept (as compared to placebo) in treating the physical signs of mucosal and cutaneous lichen planus. The investigators also wish to assess the effect of etanercept on disease-related itching, pain, and serious adverse events in patients with lichen planus. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Lichen Planus
What is being tested?
Etanercept
Type of treatment
Injection or infusion
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
27 participants
Where
12 sitesUnited States
Study dates
Aug 2006to Nov 2009
Phase
Phase 2
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • At least 18 years old.
  • Must carry a diagnosis of lichen planus as determined by biopsy
  • Patients must have a score of 3 or greater on the physician global assessment (PGA).
  • Patient must be considered appropriate for systemic therapy based upon fulfilling one of the following criteria:
  • inability to maintain weight due to pain with eating, chewing, or swallowing;
  • dyspareunia or dysuria due to genital lesions;
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  • itch/pain of sufficient severity that activities of daily living are significantly affected
  • Must be off systemic lichen planus treatment for 4 weeks prior to starting etanercept
  • If using topical corticosteroid to the affected areas, the dose and frequency must be unchanged for 2 weeks prior to beginning the study agent and during the course of the study.
  • Must be off topical cyclosporine, tacrolimus, or pimecrolimus for 2 weeks prior to starting the study drug and for the entire duration of the study.
  • Must be able and willing to give written informed consent and comply with the requirements of the study protocol and must authorize release and use of protected health information.
  • Women of childbearing potential must have a negative pregnancy test at the time of entry into the study and must be practicing successful contraception for at least 3 months prior to the study.
  • Subject or designee must have the ability to self-inject investigational product.
  • Screening laboratory results are within the following parameters:
  • Hemoglobin > 10 g/dL
  • White blood cells > 3.5 x 10^9/L
  • Neutrophils > 1.5 x 10^9/L
  • Platelets > 100 x 10^9/L
  • Lymphocytes > 0.5 x 10^9/L
  • Serum creatinine < 1.5 mg/dL
  • Hepatitis C serology - nonreactive
  • AST and ALT < 2X upper limit of normal (ULN)

Who cannot join

  • Subject is currently enrolled in another investigational device or drug trial(s), or subject has received investigational agent(s) within 90 days of baseline visit.
  • Known HIV-positive status, any other immuno-suppressive disease, or inability to practice safe sex during the length of the study
  • Subject has been diagnosed with a malignancy within the past 5 years
  • Subject has signs or symptoms of a lymphoproliferative disease.
  • Other skin or mucosal disease that might interfere with lichen planus assessments.
  • Lichen planus variants including hypertrophic, atrophic, follicular (including lichen planopilaris), and bullous cutaneous forms.
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  • Patients with lichen sclerosis et atrophicus (LS\&A)
  • Clinical history and lesion distribution suspicious for a lichenoid drug eruption
  • Severe co-morbidities
  • History of tuberculosis (TB) or positive PPD at screening. Known history of active hepatitis B or C, or lupus, SLE, history of multiple sclerosis or prior episode of central nervous system demyelination, transverse myelitis, optic neuritis, epilepsy, psychiatric condition, or other chronic serious medical illnesses.
  • Subject has a diagnosis of congestive heart failure (CHF) of any severity
  • Use of a live vaccine 90 days prior to, or during this study.
  • Previous exposure and/or known sensitivity to etanercept
  • Concurrent use, or failure of, any TNF-inhibitor
  • Previous exposure to alefacept or efalizumab within 6 weeks of administration of study drug
  • Concurrent sulfasalazine therapy
  • Prior or concurrent cyclophosphamide therapy
  • Active severe infections, or prior infection requiring hospitalization or oral/intravenous antibiotics within 4 weeks before screening visit, or between the screening and baseline visits.
  • Active inflammatory bowel disease or peptic ulcer disease
  • Drug or alcohol abuse within 12 months of screening visit.
  • History of non-compliance with other therapies
  • Pregnant or lactating
  • Documented presence of any of the following:
  • Proteinuria > 1+ by dipstick screening
  • 24 Hour protein excretion > 0.5 g
  • Symptomatic liver disease with serum albumin < 3 G/DL
  • PT or PTT > ULN, or
  • Chronic liver disease
  • Documented forced vital capacity < 50% of predicted

Trial locations and contacts

12 sites in 1 country.

12 sites in 1 country

United States12 sites

  • David Fivenson, M.D. Dermatology, PLLC

    Ann Arbor, Michigan, 48103

  • University of Michigan

    Ann Arbor, Michigan, 48109

  • Emory University

    Atlanta, Georgia, 30322

  • Tufts - New England Medical Center

    Boston, Massachusetts, 02111

  • University Hospitals of Cleveland

    Cleveland, Ohio, 44106

  • Cleveland Clinic Foundation

    Cleveland, Ohio, 44195

  • Wright State University School of Medicine

    Dayton, Ohio, 45408

  • University of Louisville

    Louisville, Kentucky, 40202

  • Mount Sinai School of Medicine

    New York, New York, 10029

  • Oregon Health & Science University

    Portland, Oregon, 97239

  • Stanford University Medical Center

    Stanford, California, 94305

  • Wake Forest University School of Medicine

    Winston-Salem, North Carolina, 26157

Other trials in United States

About this study

Official title: A Double-Blind, Randomized, Multicenter Pilot Study to Evaluate the Efficacy and Safety of Etanercept 50mg SC Twice Weekly in the Treatment of Moderate to Severe Lichen Planus

The purpose is to assess the response of subjects to etanercept (as compared to placebo) in treating the physical signs of mucosal and cutaneous lichen planus. The investigators also wish to assess the effect of etanercept on disease-related itching, pain, and serious adverse events in patients with lichen planus.

Read the detailed description

Lichen planus affects up to 1% of the worldwide population. Recent estimates suggest approximately 0.44% of the US population suffers from this disease. Oral or genital involvement occurs in 60-70% of patients, and it may be the sole manifestation of disease in 20-30% of patients.

Lichen planus is a mucocutaneous disorder that can involve the skin, oral or genital mucosa, conjunctiva, and nails. On the skin, the disease presents as multiple papules, which can be localized or generalized, that are often extremely itchy. Mucosal disease can consist of either asymptomatic plaques or extremely painful erosive lesions. The disease course is unpredictable and typically lasts 1-2 years but can follow a chronic, relapsing course. Erosive mucosal disease is important to aggressively treat for many reasons: First, the associated pain can be debilitating for the patient. Patients with severe oral lichen planus can become malnourished due to pain associated with eating. Vulvar disease can cause dyspareunia, burning pain, and discharge; second, the disease tends to be chronic, with little chance for self-resolution; third, erosive disease is associated with an increased risk of squamous cell carcinoma in the affected areas. These cancers occur in up to 1% of patients over a 3-year period, and they can be aggressive and even-life threatening for the patient if not recognized and treated early.

Several lines of evidence suggest that TNF-alpha plays a role in the pathogenesis of lichen planus. It has been shown that there are increased levels of TNF-alpha in the serum of these patients. In addition, skin and mucosal biopsies show increased TNF-alpha produced by the infiltrating lymphocytes as well as the basal keratinocytes. It has been suggested that the expression of TNF-alpha receptor on the basal keratinocytes may contribute to apoptosis. Also, TNFR1 (a TNF-alpha receptor) is expressed by the infiltrating mononuclear cells as well as the keratinocytes. Increased levels of soluble TNF receptors are also found in the serum of patients with lichen planus. A recent report also has shown that polymorphisms in the TNF-alpha gene are associated with both oral and cutaneous lichen planus. Finally, thalidomide, which partly functions as a potent inhibitor of TNF-alpha transcription, has been shown to be effective (in small case series and reports) in selected patients for the treatment of oral and genital lichen planus. However, thalidomide is a potent teratogen and cannot be used in women of childbearing potential. In addition, thalidomide usage not uncommonly results in neurotoxicity, which can be permanent, and thus limits use of this drug. Despite the evidence for a role of TNF-alpha in LP there are no reports of any TNF inhibitors being used for this disease.

This is a double-blind, placebo-controlled pilot study to observe the safety and efficacy of etanercept in patients with lichen planus.

This study will consist of 3 periods: first, a double-blind period (weeks 0-12) in which subjects will be randomized to etanercept 50 mg twice weekly or placebo; second, an open-label period (weeks 12-24) in which subjects who were randomized to placebo treatment, who have not achieved a complete remission, will be rolled over to use etanercept at 50 mg twice weekly. Subjects who previously received etanercept during weeks 0-12, who have not achieved a complete remission, will be continued on etanercept at a lower dosage of 25 mg twice weekly for weeks 12-24; third, an 8 week follow-up period for all subjects.

Conditions
Lichen Planus
Being tested
Etanercept, Placebo
Medical subject headings
Lichen Planus

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • EtanerceptDrug

    Also called Enbrel

    etanercept 50 mg twice weekly for 12 weeks

  • PlaceboDrug

Study groups in NCT00285779
Study groupRoleWhat they receive
Placebo injectionPlacebo comparatorpatients receive normal saline injection twice weekly for weeks 1-12
Receives: Drug: Placebo
EtanerceptExperimentalpatients receive etanercept injection twice weekly for weeks 1-12.
Receives: Drug: Etanercept

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. The Percentage of Patients Achieving a Response in Mucosal Disease (or Cutaneous Disease if no Mucosal Disease) at 12 Weeks

    Physician global assessment of disease scores: 0=clear; 1=minimal disease; 2=mild disease; 3=moderate disease; 4=severe disease. Subjects had a level >=3 at baseline. To be considered a responder, the subject must achieve a level of 0 or 1, or, at least a 2 point improvement in the scale.

    Measured: 12 weeks

Secondary outcomes (14)

  1. Count of Patients Achieving a Response in Cutaneous or Mucosal Disease at 24 Weeks

    Physician global assessment of disease scores: 0=clear; 1=minimal disease; 2=mild disease; 3=moderate disease; 4=severe disease. Subjects had a level >=3 at baseline. To be considered a responder, the subject must achieve a level of 0 or 1, or, at least a 2 point improvement in the scale.

    Measured: Baseline; Week 24

  2. The Physician Assessment of Surface Area of Disease (PSAD) for Oral Disease at 12 and 24 Weeks

    The percentage of surface area involved with disease is reported as assessed by the physician using a Likert scale. Assessment scores range from 0-5, with lower scores corresponding lower percentage of surface area with disease. 0=clear, 1=<2%, 2=2-9%, 3=10-29%, 4=30-50%, 5=>50%.

    Measured: Baseline; Week 12; Week 24

  3. The Physician Assessment of Surface Area of Disease (PSAD) for Genital Disease at 12 and 24 Weeks

    The percentage of surface area involved with disease is reported as assessed by the physician using a Likert scale. Assessment scores range from 0-5, with lower scores corresponding lower percentage of surface area with disease. 0=clear, 1=<2%, 2=2-9%, 3=10-29%, 4=30-50%, 5=>50%.

    Measured: Baseline; Week 12; Week 24

  4. The Physician Assessment of Surface Area of Disease (PSAD) for Skin Disease at 12 and 24 Weeks

    The percentage of surface area involved with disease is reported as assessed by the physician using a Likert scale. Assessment scores range from 0-5, with lower scores corresponding lower percentage of surface area with disease. 0=clear, 1=<2%, 2=2-9%, 3=10-29%, 4=30-50%, 5=>50%.

    Measured: Baseline; Week 12; Week 24

  5. Cutaneous Target Lesion Scores - Erythema, at 12 and 24 Weeks

    This is an investigator-based assessment of a single preselected target skin lesion. Assessment scores range from 0-3 on a Likert scale, with higher scores meaning worse erythema. 0=clear, 1=mild/pink, 2=moderately red, 3=severely red/violaceous.

    Measured: Week 12; Week 24

  6. Cutaneous Target Lesion Scores - Elevation, at 12 and 24 Weeks

    This is an investigator-based assessment of a single preselected target skin lesion. Assessment scores range from 0-3 on a Likert scale, with higher scores meaning worse elevation. 0=flat, 1=barely palpable (<0.5 mm), 2=moderate (0.5 mm-1 mm), 3=severe (>1 mm).

    Measured: Week 12; Week 24

  7. Cutaneous Target Lesion Scores - Scale, at 12 and 24 Weeks

    This is an investigator-based assessment of a single preselected target skin lesion. Assessment scores range from 0-3 on a Likert scale, with higher scores meaning worse scaling. 0=none, 1=fine/dusty scale, 2=moderate scale, 3=thick/tenacious scale.

    Measured: Week 12; Week 24

  8. Cutaneous Target Lesion Scores - Total, at 12 and 24 Weeks

    This score sums all of the 3 elements of the target lesion score (erythema, elevation, scale) described in Outcome Measures 6-8. Assessment scores range from 0-9 on a Likert scale, with higher numbers meaning more severe disease in the target skin lesion.

    Measured: Week 12; Week 24

  9. Patient Assessment of Pain on a Visual Analogue Scale (VAS) at 12 and 24 Weeks

    Participants were asked to indicate their pain level by marking it on a 10 cm linear VAS scale. The number of centimeters from the left end of the line to the mark was measured in cm. Total range was 0-10. Lower scores correspond to less pain, higher scores correspond to more pain.

    Measured: Baseline; Week 12; Week 24

  10. Patient Assessment of Pruritus (Itching) on a Visual Analogue Scale (VAS) at 12 and 24 Weeks

    Participants were asked to indicate their itching level by marking it on a 10 cm linear VAS scale. The number of centimeters from the left end of the line to the mark was measured in cm. Total range was 0-10. Lower scores correspond to less itching, higher scores correspond to more itching.

    Measured: Baseline; Week 12; Week 24

  11. Patient Assessment of Overall Disease Severity (Patient Global Assessment) at 12 and 24 Weeks

    Participants were asked to indicate their rate their overall assessment of disease severity compared to where it was at their baseline visit. The scale ranges from 0-5, with lower scores correspond to more disease improvement. 0=clear/no disease, 1=much improved (>75% improved), 2=improved (25-75%), 3=minimally improved (<25%), 4=no change, 5=worsened disease.

    Measured: Baseline; Week 12; Week 24

  12. The Count of Subjects Experiencing Serious Adverse Events (SAEs) by Week 12 and Week 24

    A serious adverse event was defined as any untoward medical occurrence that at any dose: results in death, is life-threatening, requires inpatient hospitalization or prolongation of existing hospitalization, results in persistent or significant disability/incapacity, or is a congenital anomaly/birth defect.

    Measured: Baseline; Week 12; Week 24

  13. The Count of Placebo Patients Who do Not Have a Complete Response (Defined as a Physician Global Assessment of "Clear") at 12 Weeks

    A complete response is defined as a score of 0 (representing "no disease") on the Physician Global Assessment. Physician global assessment of disease scores: 0=clear; 1=minimal disease; 2=mild disease; 3=moderate disease; 4=severe disease. This endpoint is the number of patients on placebo that had any score other than 0 on this measure.

    Measured: 12 weeks

  14. The Percentage of Placebo and Study-drug Patients Able to Discontinue Use of Topical Corticosteroids Through Week 24

    Measured: 24 weeks

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted2 Feb 2006 (estimated)
  2. Study startAug 2006
  3. Primary completionNov 2009
  4. Study completionNov 2009

Why it stopped: Slow recruitment

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Triple blind
Who is masked
Participant, Investigator, Outcomes assessor
Enrolment
27 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT00285779
Sponsor's protocol ID
20041132
Status last verified
Mar 2018
First submitted
31 Jan 2006
Last updated
21 Mar 2018
Data monitoring committee
Yes

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Etanercept in people with Lichen Planus, run by Stanford University at 12 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 22 inclusion and 29 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: stopped early, as of the sponsor's last update on 21 Mar 2018. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 12 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 3 Mar 2015). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

The Percentage of Patients Achieving a Response in Mucosal Disease (or Cutaneous Disease if no Mucosal Disease) at 12 Weeks (time frame: 12 weeks). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT00285779.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 21 Mar 2018.

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