Repigmentation Using Apremilast and Phototherapy In Diffuse VITILIGO
Status:
Completed
Trial end date:
2019-11-25
Target enrollment:
Participant gender:
Summary
Vitiligo is a depigmentation disorder affecting 0.5 to 2% of the general population. It is an
acquired pigmentary disorder of the skin and mucous membranes that is characterized by
circumscribed, depigmented macules and patches. Apremilast is a phosphosdiesterase 4 (PDE4)
inhibitor that showed efficacy and very good tolerance in rheumatoid arthritis and psoriasis.
Apremilast induces a potent activation of the cyclic AMP (cAMP) pathway leading to
anti-inflammatory effect by decreasing the response of Th1 and Th17 lymphocytes.
Interestingly, the cAMP pathway is also well demonstrated to be the main pathway for
promoting melanogenesis and for inducing the differentiation and the proliferation of
melanocytes. The principal aims is to compare, after 24 weeks of treatment, the efficacy of
Apremilast at the label dosage in combination therapy with narrow band UVB versus placebo
therapy with narrow band UVB for repigmentation in patients with non-segmental vitiligo.
Patients with non-segmental vitiligo with BSA > 10% and patient with Vitiligo stable or
slowly progressive for 3 months , seeking for treatment in the Department of Dermatology,
University Hospital of Nice, France will be recruited into the study. The Patients are seen
in consultation by the investigator, selection criteria are checked. All patients will
receive full body narrow UVB treatment, twice weekly sessions of narrow UVB for 24 weeks.
From W24 to W48
- All responders* will receive narrow UVB treatment according the French clinical use
i.e.twice weekly sessions of narrowband UVB for 24 weeks.
- All responders* will be randomized to receive either apremilast** 30mg BID or placebo.
- Response is defined as an increase of at least 30 % in the VASI score at W24
compare to baseline **Responders initially randomized in the placebo arm will
benefit of the titration At week 24, the non responders patients will stop the
treatment and the study after the 4 weeks observationnal follow-up (W28).
Observational Follow-up Phase - W48 to W52 Four-week Observational Follow-up Phase for all
subjects who complete the study (responders and non responders) or discontinue the study
early.