Open Label, Drug-Drug Interaction (DDI) Study of Dupilumab (REGN668/SAR231893) in Patients With Moderate to Severe Atopic Dermatitis (AD)
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ClinicalTrials.gov Identifier: NCT02647086 |
Recruitment Status :
Completed
First Posted : January 6, 2016
Last Update Posted : August 22, 2016
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This is an open-label, single-sequence DDI study designed to examine the effects of dupilumab on the pharmacokinetics of selected cytochrome P450 substrates in adult patients with moderate to severe AD.
The study consists of a screening period (day -35 to -2), study period 1 (day -1 to 7), study period 2 (day 8 to 50), and a follow-up period (day 51 to 135 [end of study]).
Following completion of study period 2 (Day 50), patients will be given the option to enroll into the Open-Label Extension (OLE) study R668-AD-1225. Patients who decline will be followed for the next 12 weeks (Day 135).
Condition or disease | Intervention/treatment | Phase |
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Atopic Dermatitis | Drug: Dupilumab Drug: Midazolam Drug: Omeprazole Drug: Warfarin Drug: Caffeine Drug: Metoprolol | Phase 1 |
Study Type : | Interventional (Clinical Trial) |
Actual Enrollment : | 14 participants |
Allocation: | Non-Randomized |
Intervention Model: | Single Group Assignment |
Masking: | None (Open Label) |
Primary Purpose: | Basic Science |
Official Title: | An Open-Label, Drug-Drug Interaction Study to Examine the Effects of Dupilumab on the Pharmacokinetics of Selected Cytochrome P450 Substrates in Adult Patients With Moderate to Severe Atopic Dermatitis |
Study Start Date : | December 2015 |
Actual Primary Completion Date : | July 2016 |
Actual Study Completion Date : | July 2016 |

Arm | Intervention/treatment |
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Experimental: Period 1
Patients will receive selected Cytochrome P450 substrates (Midazolam, Omeprazole, Warfarin, Caffeine, Metoprololin) in period 1 (day 1)
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Drug: Midazolam
Cytochrome P450 substrate Drug: Omeprazole Cytochrome P450 substrate Drug: Warfarin Cytochrome P450 substrate Drug: Caffeine Cytochrome P450 substrate Drug: Metoprolol Cytochrome P450 substrate |
Experimental: Period 2
Patients will receive dupilumab starting in Period 2 (day 8) and continue weekly through day 50; Patients will receive selected Cytochrome P450 substrates (Midazolam, Omeprazole, Warfarin, Caffeine, Metoprolol) in period 2 (at day 36).
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Drug: Dupilumab
Other Name: REGN668/SAR231893 Drug: Midazolam Cytochrome P450 substrate Drug: Omeprazole Cytochrome P450 substrate Drug: Warfarin Cytochrome P450 substrate Drug: Caffeine Cytochrome P450 substrate Drug: Metoprolol Cytochrome P450 substrate |
- Ratio of Area Under Curve last (AUClast) and maximum concentration (Cmax) for Cytochrome P450 substrates from pre-dupilumab administration at baseline (period 1, day 1) [ Time Frame: At Baseline (day 1) ]
- Ratio of AUClast and Cmax for CYP substrates 4 weeks after initiating a weekly regimen of dupilumab (period 2, day 36) [ Time Frame: At day 36 ]
- Incidence of treatment-emergent adverse events (TEAEs) from day of first administration of dupilumab to end of study (day 50 for patients who enroll in the OLE study; day 134 for patients who decline participation in the OLE). [ Time Frame: Baseline up to day 134 ]

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.
Ages Eligible for Study: | 18 Years and older (Adult, Older Adult) |
Sexes Eligible for Study: | All |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Male or female patient, aged 18 years or older
- Diagnosis of Chronic AD, defined as diagnosis of AD for at least 3 years before the screening visit
- Eczema Area Severity Index (EASI) score ≥16 at the screening and baseline visits
- Investigator's Global Assessment (IGA) score ≥3 (on the 0 to 4 IGA scale) at the screening and baseline visits
- ≥10% Body Surface Area (BSA) of AD involvement at the screening and baseline visits
- Patients with documented recent history (within 6 months before the screening visit) of inadequate response to outpatient treatment with topical medications, or for whom topical treatments are otherwise medically inadvisable (eg, because of important side effects or safety risks)
- Provide signed informed consent
Exclusion Criteria:
- Prior participation in a dupilumab clinical trial
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The use of any of the following treatments within 4 weeks before the baseline visit:
- Systemic corticosteroids
- Immunosuppressive/immunomodulating drugs
- Phototherapy for AD
- Administration, within 14 days before baseline or within a period of 5 times the elimination half-life of the medication before baseline, whichever is longer, of any medication that is a known inducer or inhibitor of either one or more of the following CYP enzymes: CYP3A, CYP2C19, CYP2C9, CYD2D6, and CYP1A2. Patients who are on any of these medications at the time of screening and cannot be safely taken off these medications will be excluded from the study.
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Any contraindication to one or more of the following drugs, according to the applicable labeling:
- Midazolam
- Omeprazole
- Warfarin
- Caffeine
- Metoprolol
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Consumption of any 1 or more of the following food items and/ or beverages within 1 week prior to baseline:
- Grapefruit or grapefruit juice, apple or apple juice, orange or orange juice, lemons or lemon juice, limes or lime juice
- Vegetables from the mustard green family (eg, broccoli)
- Charbroiled meats
- Caffeinated beverages, foods or drugs containing caffeine Patients who are not willing to abstain from the consumption of these food items and/or beverages for certain periods during the study will also be excluded
- History of excessive consumption of beverages containing caffeine (more than 4 cups or glasses per day). Patients who are not willing to abstain from the consumption of caffeine during certain periods of the study will also be excluded
- History or presence of alcohol or drug abuse within last 2 years
- History of smoking within last 2 years
- Poor metabolizers for CYP2C9, CYP2C19, or CYP2D6 based on genotyping
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Presence of any one or more of the following lab abnormalities at screening:
- Platelet count ≤100 x 10^3/µL
- Neutrophils ≤1 x 10^3/µL
- Creatinine phosphokinase (CPK) >10 x upper limit of normal (ULN)
- International normalized ratio (INR) ≥2
- Active chronic or acute infection requiring treatment with systemic antibiotics, antivirals, antiprotozoals, or antifungals within 2 weeks before the screening visit, or superficial skin infections within 1 week before the screening visit
- Known or suspected immunodeficiency, including history of invasive opportunistic infections (eg, tuberculosis, histoplasmosis, listeriosis, coccidioidomycosis, pneumocystosis, aspergillosis) despite infection resolution, or otherwise recurrent infections of abnormal frequency or prolonged duration suggesting an immune compromised status, as judged by the investigator
- History of human immunodeficiency virus (HIV) infection or positive HIV serology at screening
- Positive with hepatitis B surface antigen (HBsAg), hepatitis B core antibody (HBcAb), or hepatitis C antibody (Hep C Ab) at the screening visit. NOTE: Patients who are HBsAg negative and HBsAb positive are considered immune after a natural infection has cleared or they have been vaccinated against hepatitis B. Therefore, they are acceptable for the study.
- History of malignancy within 5 years before the baseline visit, except completely treated in situ carcinoma of the cervix, and completely treated and resolved non-metastatic squamous or basal cell carcinoma of the skin
- History of clinical endoparasitosis (ie, helminth infection) within 12 months before the baseline visit, or high risk of helminth infection, such as residence within or recent travel (within 12 months before the baseline visit) to areas endemic for endoparasitoses, where the circumstances are consistent with parasite exposure (eg, extended stay, rural or slum areas, lack of running water, consumption of uncooked, undercooked, or otherwise potentially contaminated food, close contact with carriers and vectors, etc), unless subsequent medical assessments (eg, stool exam, blood tests, etc) have ruled out the possibility of parasite infection/infestation
- Female patients who are pregnant, breastfeeding, or planning to become pregnant or breastfeed during the study
- Women who are using any form of hormonal contraceptives (eg, oral, injectables, implants, patches, rings, hormone-impregnated intrauterine devices [IUDs]) for birth control
- Women unwilling to use adequate birth control, if of reproductive potential and sexually active.

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02647086
United States, Arkansas | |
Regeneron Study Site | |
Little Rock, Arkansas, United States | |
United States, Colorado | |
Regeneron Study Site | |
Centennial, Colorado, United States | |
United States, Minnesota | |
Regeneron Study Site | |
Minneapolis, Minnesota, United States | |
United States, New Jersey | |
Regeneron Study Site | |
Berlin, New Jersey, United States | |
United States, North Carolina | |
Regeneron Study Site | |
Raleigh, North Carolina, United States |
Study Director: | Clinical Trial Management | Regeneron Pharmaceuticals |
Responsible Party: | Regeneron Pharmaceuticals |
ClinicalTrials.gov Identifier: | NCT02647086 |
Other Study ID Numbers: |
R668-AD-1433 |
First Posted: | January 6, 2016 Key Record Dates |
Last Update Posted: | August 22, 2016 |
Last Verified: | August 2016 |
Eczema |
Dermatitis, Atopic Dermatitis Eczema Skin Diseases Skin Diseases, Genetic Genetic Diseases, Inborn Skin Diseases, Eczematous Hypersensitivity, Immediate Hypersensitivity Immune System Diseases Metoprolol Midazolam Caffeine Omeprazole Warfarin |
Adjuvants, Anesthesia Hypnotics and Sedatives Central Nervous System Depressants Physiological Effects of Drugs Anti-Anxiety Agents Tranquilizing Agents Psychotropic Drugs Anesthetics, Intravenous Anesthetics, General Anesthetics GABA Modulators GABA Agents Neurotransmitter Agents Molecular Mechanisms of Pharmacological Action Anticoagulants |