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DRESS SyndromeEarly Phase 1NCT04988256

Cyclosporine Vs Steroids in DRESS

A Early Phase 1 study testing Cyclosporine and Methylprednisolone and Prednisone in people with DRESS Syndrome and Drug-Induced Hypersensitivity Syndrome, run by University of Southern California at 1 site in United States.

Enrolling by invitation

Enrolling by invitation. The study team selects and invites participants, usually from an existing group of patients.

Sites and contacts
Official record
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Trial summary

Current treatments for patients with drug reaction with eosinophilia and systemic symptoms (DRESS) include supportive care, steroids and cyclosporine. No randomized controlled trial (RCT) exists in comparing these treatments and all available literature comes in the form of case reports and case series. Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Cyclosporine and Methylprednisolone and Prednisone
Could I receive a placebo?
No, everyone receives an active treatment
How many people
50 participants
Where
1 siteUnited States
Study dates
27 Sep 2021to 30 Jun 2026
Phase
Early Phase 1
Are there results?
Not yet: the study is under way

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

  • Adults with a RegiSCAR score of greater than 4 (i.e a likely diagnosis of DRESS)

Who cannot join

  • Active sepsis
  • Active hepatitis B or C
  • Active tuberculosis
  • Documented allergy to steroids or cyclosporine
  • Estimated glomerular filtration rate (eGFR) < 30 (unless on dialysis, in which case they will be included)

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

United States1 site
  • USC

    Los Angeles, California, 90033

Other trials in United States

About this study

Official title: A Randomized Controlled Pilot Trial of Cyclosporine Vs Steroids in DRESS

Current treatments for patients with drug reaction with eosinophilia and systemic symptoms (DRESS) include supportive care, steroids and cyclosporine. No randomized controlled trial (RCT) exists in comparing these treatments and all available literature comes in the form of case reports and case series. These two treatments are considered standard of care and this trial seeks only to compare outcomes of DRESS between these two therapies. No additional labs, therapies or procedures will be used apart from those that are routinely done for patients with this diagnosis.

This will be a pilot study to determine efficacy of the two therapies with particular endpoints in mind so that the investigators can study the safety of these two therapies in patients with DRESS.

Data suggests a potential benefit for adults with DRESS using either steroids or cyclosporine but the investigators are seeking a comparison of efficacy of these two therapies. The study population will include adults with a Registry of Severe Cutaneous Adverse Reaction (RegiSCAR) score of greater than 4 (i.e. a likely diagnosis of DRESS). The investigators will exclude patients with sepsis, active Hepatitis B or C, active tuberculosis, a documented allergy to steroids or cyclosporine, and patients with an estimated glomerular filtration rate (eGFR) < 30 (unless on dialysis in which case the participants will be included).

Read the detailed description

Current treatments for patients with drug reaction with eosinophilia and systemic symptoms (DRESS) include supportive care, steroids, cyclosporine and to a lesser extent, intravenous immunoglobulin (IVIG). Regarding IVIG, a recent case series suggests no improved benefit in adults. No randomized controlled trial (RCT) exists in comparing these treatments and all available literature comes in the form of case reports and case series. These two treatments are considered standard of care and this trial seeks only to compare outcomes of DRESS between these two therapies. No additional labs, therapies or procedures will be used apart from those that are routinely done for patients with this diagnosis.

This will be a pilot study to determine efficacy of the two therapies with particular endpoints in mind so that the investigators can study the safety of these two therapies in patients with DRESS. Hopefully, this study will allow the investigators to better power a full prospective trial in the future.

This is a potentially life-threatening severe cutaneous adverse reaction (SCAR) with significant potential morbidity. Data suggests a potential benefit for adults with DRESS using either steroids or cyclosporine but the investigators are seeking a comparison of efficacy of these two therapies. The study population will include adults with a Registry of Severe Cutaneous Adverse Reaction (RegiSCAR) score of greater than 4 (i.e. a likely diagnosis of DRESS). The investigators will exclude patients with sepsis, active Hepatitis B or C, active tuberculosis, a documented allergy to steroids or cyclosporine, and patients with an estimated glomerular filtration rate (eGFR) < 30 (unless on dialysis in which case the participants will be included).

Participants will be randomized using a randomization protocol at all sites. Primary endpoints will include percentage of participants with complete or near complete resolution of organ involvement as well as erythema resolution at day 7 and day 30.

Secondary endpoints will be:

  1. fever presence, resolution of facial edema, resolution of pruritus, lymphadenopathy, eosinophil count at days 7 and 30
  2. days of hospitalization
  3. mortality at days 7, 30 and 90
  4. viral reactivation at days 30, 60 and 90
  5. those with autoimmune development by day 30 and day 90
  6. 30 day re-admission rate.
Being tested
Cyclosporine, Methylprednisolone and Prednisone
Medical subject headings
Drug Hypersensitivity Syndrome

What participants receive

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

  • CyclosporineDrug

    Patients randomized to cyclosporine will be treated as mentioned under "Arm/Group Description"

  • Methylprednisolone and PrednisoneDrug

    All patients randomized to steroids will initially be treated with IV methylprednisolone and eventually started on an oral prednisone taper.

Study groups in NCT04988256
Study groupRoleWhat they receive
CyclosporineActive comparatorAll Patients start with 5 mg/kg/day (3 mg/kg/day if renal impairment) PO divided bid for 7 days (or IV if patient is NPO) 1. If complete resolution, stop cyclosporine and monitor closely for relapse a. If patient relapses, give 5 (3 if renal impairment) mg/kg/day PO divided bid PO for 7 days i. If down-trending, start oral taper regimen ii. If not down-trending, switch to steroid arm 2. If >25% improvement and labs are down-trending, start the oral taper regimen. 3. If 0-25% improvement, give 5 (3 if renal impairment) mg/kg/day PO divided bid for 3 days 1. If down-trending, start oral taper regimen 2. If not down-trending, switch to steroid arm 4. If no improvement or up-trending labs at 7 days, switch to steroid arm Oral Taper Regimen set as 3 mg/kg PO divided bid for 14 days, then 2 mg/kg PO divided bid for 20 days. If renal impairment, oral taper regimen set as 2 mg/kg PO divided bid for 14 days, then 1 mg/kg PO divided bid for 20 days
Receives: Drug: Cyclosporine
CorticosteroidsExperimentalAll Patients start with 500 mg IV Methylprednisolone for 3 days 1. If >25% improvement (must be >25% in all involved organs), start the taper regimen 2. If 0-25% improvement (in ≥1 involved internal organ), give 500 mg IV Methylprednisolone for 4 days 1. If no improvement, switch to cyclosporine arm of treatment 2. If 0-25% improvement, give 500 mg IV Methylprednisolone for 3 days i. If labs are down-trending, start the taper regimen ii. If labs are not down-trending, switch to cyclosporine arm of the study c. If >25% improvement, start the taper regimen Taper Regimen set as: 1. 125 mg IV Methylprednisolone x3 days 2. 1.2 mg/kg PO prednisone x1 week 3. 1 mg/kg PO prednisone x1 week 4. 0.8 mg/kg PO prednisone x1 week 5. 0.6 mg/kg PO prednisone x1 week 6. 0.4 mg/kg PO prednisone x1 week 7. 0.2 mg/kg PO prednisone x1 week 8. 0.1 mg/kg PO prednisone x1 week 9. 0.05 mg/kg PO prednisone x1 week
Receives: Drug: Methylprednisolone and Prednisone

What is being measured

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

  1. Percentage of patients with complete or near complete resolution of organ involvement at day 30, on steroid therapy and cyclosporine therapy

    Measured by the following quantitative metrics:

    • Creatinine within 1.25x of baseline or upper limit of normal, whichever is higher
    • Aspartate Aminotransferase (AST) within 1.5x of baseline or upper limit of normal, whichever is higher
    • Troponin-T, Creatine Kinase Myocardial Band (CK-MB), Pro B-type Natriuretic Peptide (Pro-BNP), and lipase within 1.25x of baseline or upper limit of normal, whichever is higher
    • Resolution of interstitial pneumonitis on chest x-ray

    Measured: Day 7

  2. Percentage of patients with complete or near complete resolution of organ involvement at day 30, on steroid therapy and cyclosporine therapy

    Measured by the following quantitative metrics:

    • Creatinine within 1.25x of baseline or upper limit of normal, whichever is higher
    • Aspartate Aminotransferase (AST) within 1.5x of baseline or upper limit of normal, whichever is higher
    • Troponin-T, Creatine Kinase Myocardial Band (CK-MB), Pro B-type Natriuretic Peptide (Pro-BNP), and lipase within 1.25x of baseline or upper limit of normal, whichever is higher
    • Resolution of interstitial pneumonitis on chest x-ray

    Measured: Day 30

  3. Percentage of patients with complete or near complete resolution of erythema at day 7, on steroid therapy and cyclosporine therapy

    Clinical measurement of erythema

    Measured: Day 7

  4. Percentage of patients with complete or near complete resolution of erythema at day 30, on steroid therapy and cyclosporine therapy

    Clinical measurement of erythema

    Measured: Day 30

Secondary outcomes (20)
  1. Percentage of patients with resolution of fever

    Less than 38 degrees Celsius for at least 24 hours

    Measured: Day 7

  2. Percentage of patients with resolution of fever

    Less than 38 degrees Celsius for at least 24 hours

    Measured: Day 30

  3. Percentage of patients with resolution of facial edema

    Clinical resolution of edema for at least 24 hours

    Measured: Day 7

  4. Percentage of patients with resolution of facial edema

    Clinical resolution of edema for at least 24 hours

    Measured: Day 30

  5. Percentage of patients with resolution of pruritus

    Resolution for at least 24 hours

    Measured: Day 7

  6. Percentage of patients with resolution of pruritus

    Resolution for at least 24 hours

    Measured: Day 30

  7. Percentage of patients with resolution of lymphadenopathy

    Clinical resolution of lymphadenopathy for at least 24 hours

    Measured: Day 7

  8. Percentage of patients with resolution of lymphadenopathy

    Clinical resolution of lymphadenopathy for at least 24 hours

    Measured: Day 30

  9. Absolute eosinophil proportion compared to peak value

    Proportion of absolute eosinophils

    Measured: Day 7

  10. Absolute eosinophil proportion compared to peak value

    Proportion of absolute eosinophils

    Measured: Day 30

  11. Patients with autoimmune disease development

    Measured by titers of autoimmune markers (Antinuclear Antibody (ANA), Thyroid Stimulating Hormone (TSH)) compared to baseline

    Measured: Day 30

  12. Patients with autoimmune disease development

    Measured by titers of autoimmune markers (Antinuclear Antibody (ANA), Thyroid Stimulating Hormone (TSH)) compared to baseline

    Measured: Day 90

  13. Total days of hospitalization after initial dermatology consult

    Number of days

    Measured: 0-120 days

  14. Viral reactivation

    Measured by titers of Human Herpesvirus 6 (HHV6), Cytomegalovirus (CMV), and Epstein-Barr Virus (EBV)

    Measured: Day 30

  15. Viral reactivation

    Measured by titers of Human Herpesvirus 6 (HHV6), Cytomegalovirus (CMV), and Epstein-Barr Virus (EBV)

    Measured: Day 60

  16. Viral reactivation

    Measured by titers of Human Herpesvirus 6 (HHV6), Cytomegalovirus (CMV), and Epstein-Barr Virus (EBV)

    Measured: Day 90

  17. Mortality

    Proportion of patient mortality

    Measured: Day 7

  18. Mortality

    Proportion of patient mortality

    Measured: Day 30

  19. Mortality

    Proportion of patient mortality

    Measured: Day 90

  20. 30-day readmission rate

    Proportion of patients re-admitted to the hospital within 30 days of discharge

    Measured: Day 30

Timeline

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

  1. First posted3 Aug 2021
  2. Study start27 Sep 2021
  3. Primary completion30 Apr 2026 (estimated)
  4. Study completion30 Jun 2026 (estimated)

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
Early Phase 1
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
50 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04988256
Sponsor's protocol ID
HS-20-00118
Status last verified
Dec 2024
First submitted
24 Jun 2021
Last updated
30 Mar 2025
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A Early Phase 1 study testing Cyclosporine and Methylprednisolone and Prednisone in people with DRESS Syndrome and Drug-Induced Hypersensitivity Syndrome, run by University of Southern California at 1 site 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 1 inclusion and 5 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: enrolling by invitation, as of the sponsor's last update on 30 Mar 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site 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. 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?

Early Phase 1 (sometimes called Phase 0) studies give a very small amount of a treatment to a few people, mainly to see how the body handles it.

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

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

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?

Percentage of patients with complete or near complete resolution of organ involvement at day 30, on steroid therapy and cyclosporine therapy (time frame: Day 7). The study lists 4 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
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 30 Mar 2025.

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