Efficacy and Safety of CIP-Isotretinoin in Patients With Severe Recalcitrant Nodular Acne

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00975143
Recruitment Status : Completed
First Posted : September 11, 2009
Results First Posted : July 4, 2014
Last Update Posted : July 4, 2014
Information provided by (Responsible Party):
Cipher Pharmaceuticals Inc.

September 9, 2009
September 11, 2009
July 4, 2012
July 4, 2014
July 4, 2014
September 2009
May 2011   (Final data collection date for primary outcome measure)
  • Co-primary Outcome 1: Change From Baseline in Total Nodular Lesion Count (Facial and Truncal) [ Time Frame: 20 weeks ]

    The change from Baseline to Week 20 in the total number of nodular lesions was calculated as the Week 20 lesion count minus Baseline lesion count and compared using Analysis of Covariance (ANCOVA), controlling for Baseline total nodular lesion count, gender and analysis site.

    The 95% CI of the adjusted least square mean difference (CIP-ISOTRETINOIN minus Isotretinoin) was also calculated using the ANCOVA model.

    Pre-defined criterion for non-inferiority: upper bound of the 95% CI for the treatment difference < 4.

  • Co-Primary Outcome 2: Proportion of Patients Who Achieve at Least a 90% Reduction in Total Number of Nodular Lesions (Facial and Truncal). [ Time Frame: 20 weeks ]

    The percentage of patients in each group who achieved ≥90% reduction in the total nodular lesion count from Baseline to Week 20 was calculated along with its 95% CI (normal approximation). A 95% 2-sided CI on the difference between treatments (CIP-ISOTRETINOIN minus Isotretinoin) was also computed.

    Pre-defined criterion for non-inferiority: lower bound of the 95% CI for the treatment difference > -10.

Co-primary outcomes: a) Total nodular lesion count (facial and truncal); and b) Proportion of patients who achieve at least a 90% reduction in total number of nodular lesions (facial and truncal). [ Time Frame: 20 weeks ]
Complete list of historical versions of study NCT00975143 on Archive Site
Proportion of Patients Who Are Rated as Clear/Almost Clear on the Six-point Physicians' Global Assessment Scale (PGSA). [ Time Frame: 20 weeks ]
PGSA categories: 1 (Almost clear); 2 (Mild); 3 (Moderate); 4 (Severe); 5 (Very severe). A grade of either 0 (clear) or 1 (almost clear) on the 6-point PGSA scale within the Week 20 analysis window was considered a success.
Proportion of patients who are rated as clear/almost clear on the six-point Physicians' Global Assessment Scale. [ Time Frame: 20 weeks ]
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Efficacy and Safety of CIP-Isotretinoin in Patients With Severe Recalcitrant Nodular Acne
A Double-Blind, Randomized, Phase III, Parallel Group Study Evaluating the Efficacy and Safety of CIP-Isotretinoin in Patients With Severe Recalcitrant Nodular Acne
The purpose of this study is to compare the efficacy and safety of CIP-Isotretinoin and a marketed (generic) formulation of isotretinoin when both are administered twice daily with meals.
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Phase 3
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Severe Nodular Acne
  • Drug: CIP-Isotretinoin
    0.5 mg/kg/day for 4 weeks, and 1 mg/kg/day for 16 weeks, taken orally, twice daily.
  • Drug: Isotretinoin
    0.5 mg/kg/day for 4 weeks, and 1 mg/kg/day for 16 weeks, taken orally, twice daily.
  • Experimental: CIP-Isotretinoin
    Intervention: Drug: CIP-Isotretinoin
  • Active Comparator: Isotretinoin
    Intervention: Drug: Isotretinoin
Not Provided

*   Includes publications given by the data provider as well as publications identified by Identifier (NCT Number) in Medline.
May 2011
May 2011   (Final data collection date for primary outcome measure)

Inclusion Criteria:

  • Severe recalcitrant nodular acne, which in the opinion of the investigator is compatible with isotretinoin treatment.
  • Ten (10) or more nodular lesions (facial and/or truncal).
  • Treatment-naïve patients without any prior exposure to systemic isotretinoin or other retinoids.
  • Age between 12 and 54 years.
  • Weight between 40 and 110 kg.
  • Negative serum human chorionic gonadotropin (hCG) pregnancy test consistent with a non-pregnant state (females only).
  • No significant disease or clinically significant finding in a physical examination.
  • No clinically significant abnormal laboratory value.
  • No clinically significant abnormal vital sign measurement.
  • Patients presenting with stable and controlled diabetes mellitus (Types I and II) may be included in the study. However, patients should not have had a hospitalization for any diabetes related complications in the last 12 months, and must be on stable medication for the preceding 6 months. To be included in the study, the patients should have Hemoglobin-A1c values ≤ 6.5% at screening and in the test done 3 - 4 months previously.
  • Patients with previously diagnosed Polycystic Ovarian Syndrome (PCOS) may be included in the study if in the opinion of the investigator they do not have any other clinically significant abnormality (e.g. metabolic syndrome or elevated lipids).

Exclusion Criteria:

  • Female patients will be excluded from the study if they:

    • Are pregnant;
    • Are at high risk for becoming pregnant or likely to become pregnant during treatment;
    • Will be breast-feeding or considering breast feeding during the course of the study.
  • Known history or presence of any clinically significant unstable medical condition(s) which in the opinion of the investigator could pose a risk for the safety of the patient including any previous history of gastrointestinal disease.
  • Patients with any skin disease or other condition that might interfere with the evaluation of recalcitrant nodular acne.
  • Patients will be interviewed using the SCID-CT current and lifetime modules for Major Depression, Mania, and Psychosis. Patients with a lifetime history of psychosis will be excluded. Patients with a history of major depressive, manic, hypomanic or mixed episodes will not be excluded unless they have had an episode during the preceding year.
  • Patients with any past or current psychotic symptoms.
  • Patients reporting any suicidal behaviour (including attempts, interrupted attempts, aborted attempts, or other preparatory behaviours), within the past year, or serious suicidal ideation in the past year, will be excluded from study participation.
  • A lifetime history of wishing to be dead, non-specific active suicidal thoughts or active suicidal ideation without intent to act will not result in exclusion.
  • Known history or suspected carcinoma.
  • Known history of liver or kidney disorders (hepatic and renal insufficiency).
  • Known history or current pseudotumor cerebri (benign intracranial hypertension).
  • Patients with HLA-B27 related disease, rheumatoid arthritis, rickets or other vitamin D depletion disease or phosphate metabolic disease, severe scoliosis > 15 Cobb angle, history of back surgery/injuries, ongoing use of anticonvulsants known to affect bone metabolism and other genetic or acquired rheumatologic and joint diseases.
  • All pediatric patients with serum 25-hydroxyvitamin D levels < 20 ng/mL.
  • Patients with hearing disorders who in the opinion of the investigator would not be able to participate in audiometric testing for the study.
  • Hypersensitivity or idiosyncratic reaction to isotretinoin, Vitamin A and/or any other drug substances with similar activity.
  • Allergy to soy beans, soy bean oil or any other ingredients in the study medications.
  • On a special diet within four weeks prior to drug administration (e.g., liquid, protein, raw food diet).
  • Difficulty consuming two (2) meals a day to sustain weight and health.
Sexes Eligible for Study: All
12 Years to 54 Years   (Child, Adult)
Contact information is only displayed when the study is recruiting subjects
Canada,   United States
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Cipher Pharmaceuticals Inc.
Cipher Pharmaceuticals Inc.
Not Provided
Study Chair: James J. Leyden, MD University of Pennsylvania
Study Chair: Guy Webster, MD Jefferson Medical College of Thomas Jefferson University
Study Director: Jason A. Gross, PharmD Cipher Pharmaceuticals Inc.
Cipher Pharmaceuticals Inc.
June 2014

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP