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Corticosteroids/β2-agonists in Hair in Asthmatic Patients (CorticHair) (CorticHair)

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ClinicalTrials.gov Identifier: NCT03691961
Recruitment Status : Recruiting
First Posted : October 2, 2018
Last Update Posted : October 2, 2018
Sponsor:
Information provided by (Responsible Party):
Hopital Foch

Brief Summary:

This feasibility study will be open-label with two dose groups: patients receiving budesonide/formoterol Turbuhaler® at a total daily dose [400 to 800 µg[ (group 1) and patients receiving a total daily dose ≥800 µg/day (group 2) to investigate whether there is a relationship between dose and hair concentration.

The objective of this feasibility study is to determine if the product administered to the patient is detectable and quantifiable in hair in order to have a mean to monitor adherence to the treatment. This study does not in any way evaluate the efficacy or safety of the medicinal product, which will be used in accordance with its marketing authorization.


Condition or disease Intervention/treatment Phase
Asthma Other: Hair sampling Diagnostic Test: Hair's drug concentrations Not Applicable

Detailed Description:

Asthma affects 3-10% of the European population and is a heterogeneous disease in its clinical manifestations and also in its response to treatment. Since therapy is often started at young age and given over many years, with adjustments made on disease control, long-term adherence and efficacy are particular concerns.

Adherence to inhaled controller medications is a major challenge to obtain disease control and to avoid serious asthma flare-ups or unnecessary treatment stepping up. In addition to adherence concerns, poor asthma control may also be the consequence of a poor inhalation technique and the resulting insufficient drug exposure.

To overcome adherence issues, patients are encouraged to self-manage their disease and the use of new technologies such as inhaler reminders, electronic devices and/or smartphone applications may be helpful. Although there is a margin to improve and monitor adherence, assessing the efficiency of the inhalation technique in daily routine and its consequences in terms of drug exposure is much harder.

The traditional monitoring of pharmacological therapies involves therapeutic drug monitoring, i.e. the measure of drug concentration in plasma. But drugs concentration in plasma most only reflect the quantity of drug in the body in the last 24-48 hrs only. Hence, therapeutic drug monitoring is not used for inhaled asthma treatments, in part because of the limited interest in assessing only a 24-48 hrs exposure and of the very low plasma concentrations which are very challenging to measure.

Since drugs present in the bloodstream also reach and stay in the forming hair where their concentrations can be measured and interpreted as an overall chronic exposure, hair analysis could become a valuable tool in the monitoring of inhaled asthma treatments, with the use of very specific mass spectrometry techniques and of the most sensitive last-generation mass spectrometers.


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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 24 participants
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Intervention Model Description: Half of the patients is enrolled in each group according to the individual dose decided by the clinician in charge as the optimal dose to treat the disease. The optimized dose to treat the disease is decided independently of the participation to the study.
Masking: None (Open Label)
Primary Purpose: Other
Official Title: Therapeutic Drug Monitoring of Corticosteroids/β2-agonists in Hair in Asthmatic Patients: an Open-label Feasibility Study
Actual Study Start Date : September 24, 2018
Estimated Primary Completion Date : January 24, 2020
Estimated Study Completion Date : January 24, 2020

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Asthma

Arm Intervention/treatment
Experimental: Medium dose of Symbicort Turbuhaler®

The population is asthmatic patients meeting the inclusion and exclusion criteria for whom the optimized total daily dose to treat the disease is ≥400 to 800 µg budesonide of budesonide/formoterol Symbicort Turbuhaler®.

Hair sampling after 4 months treatment.

Analysis of hair's drug concentrations.

Other: Hair sampling
After 4 months of treatment, a strand of hair from the vertex posterior region of the scalp about the width of a thin pencil and with a length equal to or greater than 3 cm will be cut.

Diagnostic Test: Hair's drug concentrations
The hair's concentrations of budesonide/formoterol is analysed with mass spectrometry.

Experimental: High dose of Symbicort Turbuhaler®

The population is asthmatic patients meeting the inclusion and exclusion criteria for whom the optimized total daily dose to treat the disease is ≥800 µg budesonide of budesonide/formoterol Symbicort TurbuhalerTurbuhaler®.

Hair sampling after 4 months treatment.

Analysis of hair's drug concentrations.

Other: Hair sampling
After 4 months of treatment, a strand of hair from the vertex posterior region of the scalp about the width of a thin pencil and with a length equal to or greater than 3 cm will be cut.

Diagnostic Test: Hair's drug concentrations
The hair's concentrations of budesonide/formoterol is analysed with mass spectrometry.




Primary Outcome Measures :
  1. Budesonide/formoterol hair concentrations (active substance and metabolites) [ Time Frame: 4 months ]
    After 4 months of treatment, the hair's concentrations of budesonide/formoterol is analyzed with mass spectrometry.


Secondary Outcome Measures :
  1. Budesonide/formoterol concentration in three 1-cm hair segments (active substance and metabolites) [ Time Frame: 4 months ]
    After 4 months of treatment, the concentrations of budesonide/formoterol in three 1-cm hair segments is analyzed with mass spectrometry.

  2. Budesonide/formoterol hair's concentration compared to the daily observance. [ Time Frame: 4 months ]
    Patient cumulative dose is estimated from daily observance recorded by the patient in the observance record.

  3. Correlation between budesonide/formoterol hair concentrations, forced expiratory volume in 1 second (FEV1), and asthma control questionnaire (ACQ) [ Time Frame: 4 months ]
    FEV1 (measured according to a standardized spirometry technique), and ACQ (patients with a score below 1.0 will have adequately controlled asthma and above 1.0 their asthma will not be well controlled) are collected at the inclusion visit and the 4 months visit



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 49 Years   (Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Provision of informed consent prior to any study specific procedure
  • Outpatients with asthma, of either gender, aged ≥18 and <50 years at visit 1
  • Controlled or partly controlled asthma according to the Global Initiative for Asthma (GINA) guideline
  • Receiving a constant daily dose ≥400 µg budesonide of budesonide/formoterol Turbuhaler® for more than 2 months
  • No treatment step-down is planned in the 3 next months
  • ACQ (Asthma Control Questionnaire) score ≤ 1.50
  • Patient with healthcare insurance

Exclusion Criteria:

  • Pregnant women or women wishing to become pregnant in the next 3 months
  • Patients with body mass index (BMI) <18 or >30
  • Patients with known kidney or liver disease (creatinine clearance < 60 mL/min/1.73 m² or alanine aminotransferase (ALAT) > 5N)
  • Smokers or former smokers < 3 years
  • Patients with simultaneous asthma and chronic obstructive pulmonary disease (COPD) (or defined as having asthma-COPD overlap syndrome)
  • Other budesonide- or formoterol-containing drugs (e.g Foradil®, Rhinocort®, Mikicort®, Entocort®…)
  • CYP3A4 inducers (systemic corticosteroid, rifampicin, phenobarbital, carbamazepine…)
  • CYP3A4 inhibitors (macrolides, azole antifungals, valproic acid, amiodarone, fluoxetine)
  • Hair treatment (coloration, bleaching, perming…)
  • Hairless patients, hair implants or hair extensions
  • Length of hair from the vertex posterior region < 5 cm or planning to cut hair from this region shorter than 5 cm in the next 4 months
  • Patient deprived of liberty by judicial or administrative decision
  • Major protected by law

Information from the National Library of Medicine

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): NCT03691961


Contacts
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Contact: Stanislas Grassin-Delyle, Dr 33 (0)1 70 42 94 22 s.grassindelyle@hopital-foch.org

Locations
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France
Foch Hospital Recruiting
Suresnes, France, 92150
Contact: Hélène Salvator, Dr    33 (0)1 46 25 29 55    h.salvator@hopital-foch.com   
Principal Investigator: Hélène Salvator, Dr         
Sponsors and Collaborators
Hopital Foch
Investigators
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Study Director: Stanislas Grassin-Delyle, Dr University Versailles Saint Quentin / Foch Hospital

Publications:
Chèze, M. and Gaulier, J.-M. (2014). Chapter 8 - Drugs Involved in Drug-Facilitated Crimes (DFC): Analytical Aspects: 2—Hair A2 - Kintz, Pascal. Toxicological Aspects of Drug-Facilitated Crimes. Oxford, Academic Press: 181-222.
Fabresse, N. (2015). Mise au point et validation d'une méthode de dosage des anabolisants stéroïdiens dans le sang et les cheveux par spectrométrie de masse haute résolution Orbitrap Application à deux cas médico-légaux, http://www.sudoc.fr/188207155: 93.
FDA.
Lemaire-Hurtel, A.-S., Durand-Maugard, C., Berquin, P., Antonios, M., Hary, L., Andrejak, M., Masson, H., Manaouil, C., Abe, E. and Alvarez, J.-C. (2010).
Mancebo, M., Grassin-Delyle, S., Essid, A., Bataille, J., Guérard, P., Delyle, A. G. and Alvarez, J.-C. (2011).
Pecoraro, V. and Astore, I. P. L. (1990). Measurements of hair growth under physiological conditions. Hair and Hair Diseases. C. E. Orfanos and R. Happle. Berlin, Heidelberg, Springer Berlin Heidelberg: 237-254.

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Responsible Party: Hopital Foch
ClinicalTrials.gov Identifier: NCT03691961     History of Changes
Other Study ID Numbers: 2017047F
First Posted: October 2, 2018    Key Record Dates
Last Update Posted: October 2, 2018
Last Verified: September 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No

Additional relevant MeSH terms:
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Anti-Asthmatic Agents
Formoterol Fumarate
Budesonide
Budesonide, Formoterol Fumarate Drug Combination
Bronchodilator Agents
Autonomic Agents
Peripheral Nervous System Agents
Physiological Effects of Drugs
Respiratory System Agents
Adrenergic beta-2 Receptor Agonists
Adrenergic beta-Agonists
Adrenergic Agonists
Adrenergic Agents
Neurotransmitter Agents
Molecular Mechanisms of Pharmacological Action
Anti-Inflammatory Agents
Glucocorticoids
Hormones
Hormones, Hormone Substitutes, and Hormone Antagonists