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    Clinical Trial Results:
    A randomized, placebo-controlled, evaluator-blinded, study to assess the anti-inflammatory effects of topical erythromycin and clindamycin in patients with inflammatory facial acne

    Summary
    EudraCT number
    2017-003105-18
    Trial protocol
    NL  
    Global end of trial date
    08 May 2019

    Results information
    Results version number
    v1(current)
    This version publication date
    25 Mar 2022
    First version publication date
    25 Mar 2022
    Other versions
    Summary report(s)
    M3. CHDR1732_CSR_24Dec2019

    Trial information

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    Trial identification
    Sponsor protocol code
    CHDR1732
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    -
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Centre for Human Drug Research
    Sponsor organisation address
    Zernikedreef 8, Leiden, Netherlands, 2333 CL
    Public contact
    Principal Investigator, Centre for Human Drug Research, +31 715246400, clintrials@chdr.nl
    Scientific contact
    Principal Investigator, Centre for Human Drug Research, +31 715246400, clintrials@chdr.nl
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    24 Dec 2019
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    08 May 2019
    Global end of trial reached?
    Yes
    Global end of trial date
    08 May 2019
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    Objectives • To evaluate the effects of topically applied erythromycin and clindamycin in patients with facial AV • To explore skin and faecal microbiota in patients with AV; • To evaluate the effects of topically applied erythromycin and clindamycin on skin and faecal microbiota;
    Protection of trial subjects
    Erythromycin gel and clindamycin lotion have been on the market for over 30 years. They are both known to be safe and well tolerated. For the facial skin punch biopsies the following points were considered in the risk analysis: 1. A small biopsy of 2mm is minimally invasive (smallest possible diameter for maximal, efficient determination of biomarkers and primary study objective) 2. Patients with a Caucasian skin type (Fitzpatrick I and II) have lower chances for postinflammatory hyperpigmentation and hypertrophic scarring or keloid. Patients with a darker skin type will be excluded 3. Patients with positive history of pathological scar formation will be excluded 4. Acne patients have an irregular phenotype of the skin. Very small scars on less visible locations are not prominently apparent (hairline, jawline, lower cheek) 5. Healing of minimal biopsies resolves usually within 6-9 months without sequelae 6. Patients gave separate consent on the ICF for the biopsies, and declared to be informed about the risks and temporary cosmetic burden In conclusion, the investigators and dermatologist assessed the risk minimal for the patient and deemed this necessary to perform to answer the primary objective.
    Background therapy
    -
    Evidence for comparator
    No comparator was used.
    Actual start date of recruitment
    21 Dec 2017
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Netherlands: 30
    Worldwide total number of subjects
    30
    EEA total number of subjects
    30
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    30
    From 65 to 84 years
    0
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    21-Dec-2017 - 20-Mar-2019

    Pre-assignment
    Screening details
    Inclusion criteria: Healthy male and female subjects, 18 to 45 years of age. Mild to moderate inflammatory acne vulgaris on the face and present for at least 6 months Exclusion criteria: Severe acne where systemic treatment is needed. Use of any topical (anti-acne) medication. History of pathological scar formation.

    Period 1
    Period 1 title
    Overall trial (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Single blind
    Roles blinded
    Assessor [1]
    Blinding implementation details
    Only the assessor was blinded.

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Erythromycin
    Arm description
    Erythromycin 4% topical gel formulation
    Arm type
    Experimental

    Investigational medicinal product name
    Erythromycin 4% topical gel formulation
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Gel
    Routes of administration
    Topical
    Dosage and administration details
    BID facial application for 4 weeks.

    Arm title
    Clindamycin
    Arm description
    Clindamycin 1% topical lotion formulation
    Arm type
    Experimental

    Investigational medicinal product name
    Clindamycin 1% topical lotion formulation
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Cutaneous liquid
    Routes of administration
    Topical
    Dosage and administration details
    BID facial application for 4 weeks.

    Arm title
    Placebo
    Arm description
    70 % topical ethanol solution
    Arm type
    Placebo

    Investigational medicinal product name
    70 % topical ethanol solution
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Cutaneous/oromucosal solution
    Routes of administration
    Topical
    Dosage and administration details
    BID facial application for 4 weeks.

    Notes
    [1] - The roles blinded appear inconsistent with a simple blinded trial.
    Justification: Only the assessor was blinded.
    Number of subjects in period 1
    Erythromycin Clindamycin Placebo
    Started
    10
    10
    10
    Completed
    10
    10
    10

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Overall trial
    Reporting group description
    -

    Reporting group values
    Overall trial Total
    Number of subjects
    30 30
    Age categorical
    Units: Subjects
        Adults (18-64 years)
    30 30
    Gender categorical
    Units: Subjects
        Female
    14 14
        Male
    16 16

    End points

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    End points reporting groups
    Reporting group title
    Erythromycin
    Reporting group description
    Erythromycin 4% topical gel formulation

    Reporting group title
    Clindamycin
    Reporting group description
    Clindamycin 1% topical lotion formulation

    Reporting group title
    Placebo
    Reporting group description
    70 % topical ethanol solution

    Primary: Change in Investigator Global Assessment Acne (IGA)

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    End point title
    Change in Investigator Global Assessment Acne (IGA) [1]
    End point description
    Acne severity will be assessed at screening and every study visit by the Investigator Global Assessment for facial acne (clear, almost clear, mild, moderate, severe, very severe). This will be done by a treatment blinded evaluator.
    End point type
    Primary
    End point timeframe
    Day 0, day 7, day 14, day 21, day 28 and day 42
    Notes
    [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: See uploaded CSR for endpoints and analyses.
    End point values
    Erythromycin Clindamycin Placebo
    Number of subjects analysed
    10
    10
    10
    Units: Number of participants
        Mild
    9
    7
    6
        Moderate
    1
    4
    4
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Signing of informed consent form until end of study.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    21.1
    Reporting groups
    Reporting group title
    Erythromycin
    Reporting group description
    Subjects treated with erythromycin

    Reporting group title
    Clindamycine
    Reporting group description
    Subjects treated with clindamycine

    Reporting group title
    Placebo
    Reporting group description
    Subjects treated with placebo

    Serious adverse events
    Erythromycin Clindamycine Placebo
    Total subjects affected by serious adverse events
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 10 (0.00%)
    0 / 10 (0.00%)
         number of deaths (all causes)
    0
    0
    0
         number of deaths resulting from adverse events
    0
    0
    0
    Injury, poisoning and procedural complications
    Concussion
    alternative dictionary used: MedDRA 18
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 10 (0.00%)
    0 / 10 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 0%
    Non-serious adverse events
    Erythromycin Clindamycine Placebo
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    7 / 10 (70.00%)
    6 / 10 (60.00%)
    7 / 10 (70.00%)
    Nervous system disorders
    Migraine
         subjects affected / exposed
    0 / 10 (0.00%)
    0 / 10 (0.00%)
    2 / 10 (20.00%)
         occurrences all number
    0
    0
    4
    headache
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 10 (0.00%)
    0 / 10 (0.00%)
         occurrences all number
    1
    0
    0
    General disorders and administration site conditions
    Application site dysaesthesia
         subjects affected / exposed
    0 / 10 (0.00%)
    1 / 10 (10.00%)
    0 / 10 (0.00%)
         occurrences all number
    0
    1
    0
    Influenza like illness
         subjects affected / exposed
    1 / 10 (10.00%)
    2 / 10 (20.00%)
    3 / 10 (30.00%)
         occurrences all number
    1
    2
    3
    Fatigue
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 10 (0.00%)
    0 / 10 (0.00%)
         occurrences all number
    1
    0
    0
    Immune system disorders
    Seasonal allergy
         subjects affected / exposed
    1 / 10 (10.00%)
    1 / 10 (10.00%)
    0 / 10 (0.00%)
         occurrences all number
    1
    1
    0
    Asthma
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 10 (0.00%)
    0 / 10 (0.00%)
         occurrences all number
    1
    0
    0
    Reproductive system and breast disorders
    Dysmenorrhoea
         subjects affected / exposed
    1 / 10 (10.00%)
    1 / 10 (10.00%)
    0 / 10 (0.00%)
         occurrences all number
    1
    1
    0
    Gastrointestinal disorders
    Nausea
         subjects affected / exposed
    0 / 10 (0.00%)
    0 / 10 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    0
    1
    Toothache
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 10 (0.00%)
    0 / 10 (0.00%)
         occurrences all number
    1
    0
    0
    Abdominal pain upper
         subjects affected / exposed
    0 / 10 (0.00%)
    1 / 10 (10.00%)
    0 / 10 (0.00%)
         occurrences all number
    0
    1
    0
    Skin and subcutaneous tissue disorders
    Skin abrasion
         subjects affected / exposed
    0 / 10 (0.00%)
    1 / 10 (10.00%)
    0 / 10 (0.00%)
         occurrences all number
    0
    1
    0
    Eczema eyelids
         subjects affected / exposed
    0 / 10 (0.00%)
    0 / 10 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    0
    1
    Infections and infestations
    Nasopharyngitis
         subjects affected / exposed
    1 / 10 (10.00%)
    2 / 10 (20.00%)
    2 / 10 (20.00%)
         occurrences all number
    1
    2
    2
    Gastroenteritis
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 10 (0.00%)
    0 / 10 (0.00%)
         occurrences all number
    1
    0
    0

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    22 Feb 2018
    -Screening period extended from 14 days to 21 days -Comedo extraction for P. acnes culture is added -Faeces questionnaire added

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported
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    The status and protocol content of GB trials is no longer updated since 1 January 2021. For the UK, as of 31 January 2021, EU Law applies only to the territory of Northern Ireland (NI) to the extent foreseen in the Protocol on Ireland/NI. Legal notice
    As of 31 January 2023, all EU/EEA initial clinical trial applications must be submitted through CTIS . Updated EudraCT trials information and information on PIP/Art 46 trials conducted exclusively in third countries continues to be submitted through EudraCT and published on this website.

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