ABCESS2: Efficacy of an Adapted Antibiotherapy in Hurley Stage 2 Hidradenitis Suppurativa Patients
Study Details
Study Description
Brief Summary
The study evaluates the efficacy of an adapted antibiotherapy in Hurley stage 2 active Hidradenitis Suppurativa patients versus tetracycline derivative
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
Phase 3 |
Detailed Description
The antibiotic strategy is targeted against specific pathobionts which have been identified in HS lesions by the investigator's team.
Half of participants will receive a 3-week course of ceftriaxone + metronidazole treatment followed by 3 weeks of rifampicin + moxifloxacin + metronidazole combination, then 6 weeks of rifampin + moxifloxacin (experimental groupe), versus a 12 weeks course of lymecycline (control group) Double blind treatment phase will stop at week 12. All patients whatever their randomization arm or their remission status will begin follow-up treatment according to standard care recommendations (Société Française de Dermatologie): lymecycline, doxycycline or cotrimoxazole. Prescription will be upon decision of the investigator.
This maintenance treatment is not experimental.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: Experimental treatment a 3-week course of ceftriaxone (Rocephin) IV injection (daily dose 2g/day) + oral metronidazole (daily dose 1500mg) followed by a 3-week course of oral rifampicin (Rifadin with 10mg/kg/day) + moxifloxacin (Izilox daily dose 400mg) + metronidazole (daily dose 1500mg) followed by a 6-week course of oral rifampicin (Rifadin with 10mg/kg/day) + moxifloxacin (Izilox daily dose 400mg). A placebo for lymecycline will also be administered during this intensive treatment phase |
Drug: ROCEPHIN, metronidazole, RIFADIN, IZILOX, placebo combination therapy
a 3-week course of ceftriaxone injection + oral metronidazole followed by a 3-week course of oral rifampicin + moxifloxacin +metronidazole followed by a 6-week course of oral rifampicin + moxifloxacin
Other Names:
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| Active Comparator: Control 12-week course of oral lymecycline (Tetralysal daily dose 452mg) Placebos for all experimental drugs will also be administered during this intensive treatment phase |
Drug: Lymecyclin and corresponding placebos of the experimental arm
12-week course of oral lymecycline.
Other Names:
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Outcome Measures
Primary Outcome Measures
- Percentage of patients reaching clinical remission at week 12, defined by an improvement of 90% of the IHS4 score from the baseline (IHS4 (1)) [at week 12]
The clinical remission is defined as a 90% improvement of the International Hidradenitis Suppurativa Severity Score (IHS4) at week 12 compared to the baseline. The IHS4 score is a validated composite score developped to assess dynamically HS severity (1). It is calculated by adding the number of inflammatory nodules to the number of abscesses multiplied by 2 and to the number of draining tunnels multiplied by 4. A total score of 3 or less corresponds to mild severity HS, 4-10 to moderate severity HS and 11 or higher to severe disease.
Secondary Outcome Measures
- Change in Physician Global Assessment (PGA) [from baseline to week 52]
Physician assessment describe by differents severity : from Clear (no nodule) to Very severe (more than 5 abscesses or fistulas) Score evaluated at baseline / week 6 / week 12/ week 24/ week 52
- Change in Modified Sartorius score [from baseline to week 52]
Score calculated by points from 0 (better) with differents parameters involved such as location / number / size / type of lesions Score evaluated at baseline / week 6 / week 12/ week 24/ week 52
- Change in Hurley Score [from baseline to week 52]
Score described with 3 stages from I (less severity) to III (most severe) Score evaluated at baseline / week 6 / week 12/ week 24/ week 52
- Change in Hidradenitis Suppurativa Severity Score (IHS4) score [from baseline to week 52]
Score calculated by points from <3pts (Mild) to > 11pts (Severe) by nb of nodules, nb of abscesses and nb of draining tunnels Score evaluated at baseline / week 6 / week 12/ week 24/ week 52
- Change in Hidradenitis Suppurativa Clinical Response (HiSCR) score [from baseline to week 52]
Global Assessment score of clear, minimal, or mild evaluated by (i) at least a 50% reduction in AN (abscess and nodule count), (ii) no increase in the number of abscesses and (iii) no increase in the number of draining fistulas from baseline Score evaluated at baseline / week 6 / week 12/ week 24/ week 52
- Change in Dermatology Life Quality Index (DLQI) score (Patient's HS evaluation) [from baseline to week 52]
Evaluated with the Dermatology Life Quality Index (DLQI) Score calculated by points from 0 to 30 following patient answers on quality of life questions Score evaluated at baseline / week 6 / week 12/ week 24/ week 52
- Change of patient pain [from baseline to week 52]
Intensity of pain evaluated with the visual analog scale (VAS) from 0 (no pain) to 10 (pain as bad as it could possible be) Score evaluated at baseline / week 6 / week 12/ week 24/ week 52
- Microbiological bacterial Change on the worst lesion microbiome at W12 [at baseline and week 12]
By identification of microbiology bacterial metagenomics (by skin lesional swab sample)
- Microbiological metagenomics Change on the worst lesion microbiome at W12 [at baseline and week 12]
By identification of multidrug resistant bacteria (by rectal swab sample)
- Number of pain killers received by patients [from baseline to week 52]
Number of pain killers prescribed for flares (acute worsening of one or more HS lesions)
- Number of antibiotic treatments received by patients [from baseline to week 52]
Number of antibiotic treatments prescribed for flares (acute worsening of one or more HS lesions)
- Time without flare of HS [from baseline to week 52]
Evaluated by number of flares reported or not using a patient journal
- Change in BMI [from baseline to week 52]
Calculated by combined weight and height measures
- Abnormal biological value of Hemoglobin [from baseline to week 12]
measured in g/L, compared to normal ranges
- Abnormal biological value of white cells [from baseline to week 12]
measured in units of cells / mm3 , compared to normal ranges
- Abnormal biological value of neutrophils [from baseline to week 12]
measured in units of cells / mm3 , compared to normal ranges
- Abnormal biological value of platelet count [from baseline to week 12]
measured in units of cells / mm3 , compared to normal ranges
- Abnormal value of AST liver enzyme [from baseline to week 12]
AST value > 4 x Upper limit of normal
- Abnormal value of ALT liver enzyme [from baseline to week 12]
ALT value > 4 x Upper limit of normal
- Number of adverse events of all kind [from baseline to week 52]
AE defined by SOC and PT according to MedDra dictonnary
- Non complete drug administration [from baseline to week 12]
Evaluated by total number of capsules not taken according to patient journal
Eligibility Criteria
Criteria
Inclusion Criteria:
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Adults < 60 years old
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Diagnosis of HS according to European Dermatology guidelines:
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Recurrent inflammation occurring more than 2 times in the past 6 months in the inverse regions of the body, presenting with nodules, sinus-tracts and/or scarring.
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Signs: Involvement of axilla, genitofemoral area, perineum, gluteal area (and infra-mammary areafor women). Presence of nodules (inflamed or noninflamed), sinus tracts (inflamed or noninflamed), abscesses, scarring (atrophic, mesh-like, red, hypertrophic or linear)
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Active HS with i) ≥ 1 year of evolution and ii) ≥ 4 flares during the previous year
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Clinical severity of HS at inclusion: Hurley stage 2
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BMI < 35
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Written informed consent from patient
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Patient able to complete DLQI
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Patients affiliated to the French health system (Assurance Maladie), except French state medical aid beneficiaries (Aide Médicale d'Etat)
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Active compatible contraception for men and women of childbearing or inability to procreate
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Available laboratory blood test performed within the last 2-months
Non inclusion Criteria:
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Person < 18 and ≥ 60 years old
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Former stage 3 HS
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Previous use of the experimental treatment
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Unauthorized drugs for the study during the month preceding the inclusion
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Any contra-indication to study treatments or excipient (e.g. lactose, cornstarch, riboflavin notably):
pregnancy, breastfeeding, known allergy to experimental or reference drugs, wheat allergy, tendinopathy, QT prolongation, bradycardia, heart failure, heart rhythm disturbances, hydroelectrolytic disorders, hypokalemia, coagulation disorders, severe liver/kidney dysfunction, porphyria, mandatory use of nonsteroidal anti-inflammatory drugs (NSAIDs) for other medical conditions
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Unbalanced diabetes (ie HbA1c above 7%)
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Dysphagia, untreated gastro-oesophageal reflux/ulcer
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BMI ≥ 35
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Immune suppression, inflammatory disease, including gastroenterologic and rheumatologic inflammatory conditions
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Lactase deficiency, lactose and galactose intolerance
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Malabsorption syndrome
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Person living in the same household as another patient
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Person under guardianship or curatorship
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Individuals with any condition which, in the opinion of the investigator, might interfere with the evaluation of the study objectives (e.g patient unable to complete DLQI, or poor predictable observance
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Participation in another interventional research on health products studies
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Patients requiring repeated (more than 3/year) use of antibiotics for a chronic disease other than HS
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Alcohol-dependant patients defined as an addiction to alcohol with a negative impact on health, social or personal life
Exclusion criteria:
Pregnancy QT prolongation Abnormal result of routine lab tests corresponding to contra-indication to study treatments Unauthorized drug for the study during all the study (from study treatments interactions listed in the SmPC, Cf. unauthorized drug listed in non-inclusion criteria).
Development of hypersensitivity to any of the study products and/or excipients (e.g. lactose, corn starch, riboflavin).
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Hôpital Edouard Herriot | Lyon | France | ||
| 2 | Hôpital de la Timone | Marseille | France | ||
| 3 | Centre Médical de l'Institut Pasteur | Paris | France | ||
| 4 | Hopital St Joseph | Paris | France | ||
| 5 | CHU de Rouen | Rouen | France |
Sponsors and Collaborators
- Institut Pasteur
- Centre Hospitalier Universitaire de Caen
- Hôpital Necker-Enfants Malades
- Ministry of Health, France
- Assistance Publique Hopitaux De Marseille
Investigators
- Principal Investigator: Maïa Delage-Toriel, MD, Institut Pasteur
Study Documents (Full-Text)
None provided.More Information
Publications
- Guet-Revillet H, Coignard-Biehler H, Jais JP, Quesne G, Frapy E, Poiree S, Le Guern AS, Le Fleche-Mateos A, Hovnanian A, Consigny PH, Lortholary O, Nassif X, Nassif A, Join-Lambert O. Bacterial pathogens associated with hidradenitis suppurativa, France. Emerg Infect Dis. 2014 Dec;20(12):1990-8. doi: 10.3201/eid2012.140064.
- Guet-Revillet H, Jais JP, Ungeheuer MN, Coignard-Biehler H, Duchatelet S, Delage M, Lam T, Hovnanian A, Lortholary O, Nassif X, Nassif A, Join-Lambert O. The Microbiological Landscape of Anaerobic Infections in Hidradenitis Suppurativa: A Prospective Metagenomic Study. Clin Infect Dis. 2017 Jul 15;65(2):282-291. doi: 10.1093/cid/cix285.
- Join-Lambert O, Coignard H, Jais JP, Guet-Revillet H, Poiree S, Fraitag S, Jullien V, Ribadeau-Dumas F, Theze J, Le Guern AS, Behillil S, Lefleche A, Berche P, Consigny PH, Lortholary O, Nassif X, Nassif A. Efficacy of rifampin-moxifloxacin-metronidazole combination therapy in hidradenitis suppurativa. Dermatology. 2011 Feb;222(1):49-58. doi: 10.1159/000321716. Epub 2010 Nov 25.
- 2018-018