E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
mild to moderate toenail onychomycosis |
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MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 8.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10030338 |
E.1.2 | Term | Onychomycosis |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
To demonstrate the superiority of topical 10% terbinafine HCl NSO versus 5% amorolfine nail lacquer in terms of complete cure rate at the end of study (week 52), after treating patients with mild to moderate toenail onychomycosis for 48 weeks, where the complete cure is defined as having negative mycology culture, negative KOH microscopy and 0% residual involvement of onychomycosis of the target toenail. |
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E.2.2 | Secondary objectives of the trial |
• To demonstrate the superiority of 10% terbinafine HCl NSO over 5% amorolfine nail lacquer in mycological cure (negative culture for dermatophytes and negative KOH microscopy) and in clinical effectiveness (≤ 10% residual involvement of the target toenail and culture negative for dermatophytes and negative KOH microscopy) after treating patients with mild to moderate toenail onychomycosis for 48 weeks.
• To assess the safety of and tolerability of 10% terbinafine HCl NSO versus 5% amorolfine nail lacquer in terms of reported adverse events and laboratory values.
Exploratory objective(s)
• To explore the efficacy in terms of complete cure rate, mycological cure rate, and clinical effectiveness at week 24 and week 36.
• To explore the efficacy in terms of clinical cure (defined as 0% residual involvement of onychomycosis of the target toenail) at week 52.
• To explore patient’s satisfaction with medication for the treatment of onychomycosis.
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. Outpatients of either sex and 18 – 75 years of age.
2. Clinically suspected dermatophyte infection confirmed by a positive KOH microscopy and culture performed by the central mycology laboratory.
3. The target toenail area must have at least 25% to no more than 75% disease involvement without spikes.
4. At least 1 large (great) toenail meeting the infection criteria. If more than 1 large toenail is infected and meets inclusion/exclusion criteria, both toenails should be sampled for culture. The toenail with greater involvement will be selected as the target nail. If both large toenails have the same degree of involvement, the right toenail will be selected as the “target” toenail.
5. The target large toenail must be confirmed as having at least a minimum of 1 mm growth, measured by the site, within the 4-6 week screening period. |
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E.4 | Principal exclusion criteria |
1. Patients who have had systemic antifungal therapy within 6 months prior to screening for the study.
2. Patients who have used prescription or commercially available topical antifungal therapy indicated for onychomycosis within 3 months prior to screening, or commercially available topical antifungal therapy for onychomycosis or any other commercially available topical antifungal therapy applied directly to the toenails within 1 month prior to screening.
3. Patients who have used other investigational drugs at the time of enrollment or within 30 days.
4. Nail infection due to an organism other than a dermatophyte (mixed infections[dermatophyte and non-dermatophyte] are not allowed).
5. The target foot has severe plantar (moccasin) tinea pedis infection that would require systemic therapy (as determined by the investigator). Mild to moderate tinea pedis infection should be treated with Lamisil® DermGel, or with Lamisil® Cream if Lamisil® DermGel is unavailable, to eliminate fungal reservoir as needed prior to baseline or at any time during the trial. Other topical treatments indicated for tinea pedis may be recommended at the discretion of the investigator.
6. Patients with the target toenail involving the matrix (lunula) or having less than 2mm clear (unaffected) nail plate length beyond the proximal fold.
7. Presence of dermatophytoma (defined as thick masses of fungal hyphae and necrotic keratin between the nail plate and nail bed) on the target nail.
8. Patients with abnormalities of the target nail that could prevent obtaining a normal appearing nail if clearing of the infection is achieved (i.e. tumors, chemical damage, genetic disorders, pigmentary disorders, psoriasis, collagen vascular disease, lichen planus, peripheral vascular disease, traumatic onychodystrophy due to chronic stimuli, structural deformity, severe diabetic foot neuropathy).
9. Patients with abnormal findings (laboratory or physical) or conditions which are considered to be clinically important by the investigator and indicative of conditions that could jeopardize patient safety or interfere with the interpretation of the results of the study. Please note: diabetic patients may be enrolled in the study if their diabetes is well-controlled.
10. Patients with a history of malignancy of any organ system within the past year, whether or not there is recurrence or metastases, with the exception of localized basal cell or squamous cell carcinoma of the skin for which medical intervention should be planned.
11. Known pregnant or lactating women at the time of enrollment or patients who plan to become pregnant during the study period.
12. Patients with sensitivity to terbinafine or amorolfine or excipients of the formulations.
13. Patients not likely or unable to cooperate with study requirements including those witha recent history of alcohol or drug abuse, or are currently known to abuse alcohol or drugs.
14. Patients not willing to stop professional pedicures, or not willing to remove or discontinue the use of any nail polish product or other nail cosmetic product on their toenails at the screening visit and throughout the study. |
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E.5 End points |
E.5.1 | Primary end point(s) |
Demonstrate superiority of terbinafine vs amorolfine for complete cure rate at week 52 |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | No |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | Yes |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | Yes |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | Yes |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | No |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 10 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 33 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | Information not present in EudraCT |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
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E.8.7 | Trial has a data monitoring committee | No |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 1 |
E.8.9.1 | In the Member State concerned months | 7 |
E.8.9.1 | In the Member State concerned days | |
E.8.9.2 | In all countries concerned by the trial years | 1 |
E.8.9.2 | In all countries concerned by the trial months | 7 |