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Actinic KeratosesPhase 4NCT02736760

Daylight-PDT With MAL for AK and Photodamaged Skin

A Phase 4 study testing Daylight photodynamic therapy using Methylaminolevulinate (MAL) and Cryosurgery in people with Actinic Keratoses and Photodamaged Skin, run by University Hospital Regensburg at 4 sites in Germany.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

This study is a multicenter study investigating the clinical efficacy of repetitive daylight-PDT with MAL (Methylaminolevulinate) compared to cryosurgery in regard to prophylaxis and treatment of AKs (actinic keratoses) in the face. Patients will be randomly allocated to treatment groups. Read more about this study

Who is it for?
Ages 40 years and older
Conditions the study is for
Actinic Keratoses, Photodamaged Skin
What is being tested?
Daylight photodynamic therapy using Methylaminolevulinate (MAL) and Cryosurgery
Type of treatment
Surgery or procedure
Could I receive a placebo?
No, everyone receives an active treatment
How many people
58 participants
Where
4 sitesGermany
Study dates
3 Mar 2016to 9 Sep 2018
Phase
Phase 4
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 40 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Written informed consent has been signed prior to or at Screening Visit
  • Male and female patients with Fitzpatrick skin type I-IV
  • Age > 40 years
  • Negative pregnancy test in women of childbearing age
  • Women in child-bearing age using highly efficient contraceptive methods (<1% failure rate per year)
  • Clinical diagnosis of actinic keratosis (AK)
  • A minimum of five non-hyperkeratotic, non-pigmented AK lesions in the face.
  • Glogau Photodamage Classification Type II (moderate) - IV (severe)

Who cannot join

  • Diagnosis of porphyria
  • Hyperkeratotic or pigmented AK in the face
  • Malignant skin tumors in the face or on the capillitium, requiring treatment
  • Patients with clinically relevant suppression of the immune system (e.g. drug induced, infection) or organ transplant patients
  • Pregnancy or lactation
  • Planned aesthetic treatments in the face in the next 24 months (filler, peeling, botulinumtoxin, skin resurfacing)
Show all 20Show fewer
  • Known intolerance or allergy to MAL or to any other ingredient of Metvix® 160mg/g cream
  • Known intolerance to Actinica® lotion
  • Photosensitivity
  • Suspected lack of compliance (e.g. due to dementia)
  • Simultaneous participation in another clinical study or participation in another clinical study in the 30 days directly preceding inclusion
  • Concomitant UV-phototherapy
  • Skin diseases that might interfere with response evaluation of study treatment
  • Skin sun sensitivity type V or VI according to Fitzpatrick
  • PDT in the face during 6 months preceding study treatment
  • Non-permitted medication:
  • Topical treatment in the face during 4 weeks preceding study treatment with diclofenac, hydrochinone, peeling, 5-FU, ingenolmebutate, retinoids, podophyllin, azelaic acid, imiquimod or other agents, that could interfere with the evaluation of the efficacy of the study treatment, according to the investigator.
  • Systemic treatment with retinoids
  • Conditions that might interfere with the ability to understand the study and thus give written informed consent
  • Rejuvenating treatments of the face during 3 months preceding study treatment, including filler, botulinumtoxin and IPL

Trial locations and contacts

4 sites in 1 country.

Germany4 sites
  • Hautzentrum Köln

    Cologne, 50966

  • University Hospital Düsseldorf.

    Düsseldorf, 40225

  • Klinikum Vest GmbH Knappschaftskrankenhaus

    Recklinghausen, 45657

  • University hospital Regensburg

    Regensburg, Bavaria, 93053

Other trials in Germany

About this study

Official title: Prospective, Randomized, Controlled, Multicenter, Two-armed, Study Comparing Daylight Photodynamic Therapy Using MAL With Cryosurgery for the Treatment and Prophylaxis of Actinic Keratoses in Photodamaged Skin of the Face

This study is a multicenter study investigating the clinical efficacy of repetitive daylight-PDT with MAL (Methylaminolevulinate) compared to cryosurgery in regard to prophylaxis and treatment of AKs (actinic keratoses) in the face. Patients will be randomly allocated to treatment groups. 5 PDT (photodynamic therapy) treatment sessions (visits 1-5) will be performed within 18 months. In the control group, cryosurgery will be performed at visit 1, and in case of non-cleared or newly occurred AKs at visits 2-5.

In the PDT group the patients will apply a chemical sunscreen (SPF 50+) to the whole face and other light-exposed, unprotected areas of the skin. After at least 15 minutes a lesion preparation of AKs (removal of crusts) will be performed and MAL will be applied in a thin layer to the whole face. Within 30 min after MAL application patients expose themselves to daylight for 2 hours. In the control group, cryosurgery will be performed using liquid nitrogen spray in each AK lesion; this will be done at visit 1 and, if necessary, also at visits 2-5. At visits 2-6, the efficacy of the treatment will be evaluated by the observer by documenting all existing and newly appearing AKs in the face.

Read the detailed description

This study is a multicenter study investigating the clinical efficacy of repetitive daylight-PDT with MAL compared to cryosurgery in regard to prophylaxis and treatment of AKs in the face. Patients will be randomly allocated to treatment groups. 5 PDT treatment sessions (visits 1-5) will be performed within 18 months. In the control group, cryosurgery will be performed at visit 1, and in case of non-cleared or newly occurred AKs at visits 2-5.

Before application of the photosensitizer, an organic sunscreen (Actinica® lotion, LSF 50+) without mineral filters will be applied In the entire face.

After an absorption time of approximately 15 minutes and before applying MAL (Metvix®), the surface of the AK lesions will be prepared gently with a curette or a scalpel to remove scales and crusts and roughen the surface of the AK-lesions. This is to facilitate penetration of the cream and light to the AK lesions.

After lesion preparation, MAL (Metvix®) will be uniformly applied on the whole face in a thin layer.

Within 30 min after MAL application the patients go outside and expose themselves for 2 hours to daylight. Daylight-PDT can be performed from March until October, during non-rainy weather with an outdoor temperature of at least 10° Celsius. Daylight exposure must start at least 3 hours before sunset.

At the end of the exposure, residual photosensitizer is washed off and the patients spend the rest of the day indoors.

Cryosurgery of AK lesions will be investigated as standard reference therapy. Single freeze-thaw cryosurgery is performed using an open spraying procedure with liquid nitrogen with nozzle size C. After formation of an ice-ball of the required size, freeze time starts. Freeze time should lie between 5 s and 10 s.

Being tested
Daylight photodynamic therapy using Methylaminolevulinate (MAL), Cryosurgery
Medical subject headings
Keratosis, Actinic

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Daylight photodynamic therapy using Methylaminolevulinate (MAL)Drug

    Also called Daylight-PDT

    In the Daylight photodynamic therapy arm the patients will apply a sunscreen to the whole face which is followed by lesion preparation of AKs. Following this, MAL will be applied in a thin layer to the whole face. Within 30 min after MAL application patients expose themselves to daylight for 2 hours.

    5 photodynamic therapy treatment sessions (visits 1-5) will be performed within 18 months.

  • CryosurgeryProcedure or surgery

    In the control group, cryosurgery as standard reference therapy will be performed at visit 1, and in case of non-cleared or newly occurred AKs at visits 2-5. Cryosurgery of AK lesions will be investigated as standard reference therapy. Single freeze-thaw cryosurgery is performed using an open spraying procedure with liquid nitrogen with nozzle size C. After formation of an ice-ball of the required size, freeze time starts. Freeze time should lie between 5 s and 10 s.

Study groups in NCT02736760
Study groupRoleWhat they receive
Daylight photodynamic therapy (PDT)ExperimentalOne intervention in the daylight photodynamic therapy arm: Daylight photodynamic therapy using Methylaminolevulinate (MAL) will be performed five times within 18 months (visits 1-5). In the PDT group the patients will apply a chemical sunscreen (SPF 50+) to the whole face and other light-exposed, unprotected areas of the skin. After at least 15 minutes a lesion preparation of AKs (removal of crusts) will be performed and methylaminolevulinate (MAL) will be applied in a thin layer to the whole face. Within 30 min after MAL application patients expose themselves to daylight for 2 hours.
Receives: Drug: Daylight photodynamic therapy using Methylaminolevulinate (MAL)
CryosurgeryActive comparatorIn the control group, cryosurgery will be performed at visit 1, and in case of non-cleared or newly occurred AKs at visits 2-5. In the control group, cryosurgery will be performed using liquid nitrogen spray in each AK lesion; this will be done at visit 1 and, if necessary, also at visits 2-5. At visits 2-6, the efficacy of the treatment will be evaluated by the observer by documenting all existing and newly appearing AKs in the face.
Receives: Procedure: Cryosurgery

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. The cumulative number of observed AKs at time points 2 to 6 (3 months after the first treatment to 24 months after the first treatment).

    Newly occured AK lesions are counted at visit 2, visit 3, visit 4, visit 5 and visit 6.

    The number of newly occured AK lesions during the study are added up, therefore we included the term "cumulative".

    Measured: 24 months after the first treatment

Secondary outcomes (7)
  1. Complete clearance of AKs on lesion basis

    completely cleared AK lesions

    The first treatment ist performed at day 0 The second treatment is performed 3 months after the first treatment. The third treatment is performed 3 months after the second treatment. The fourth treatment is performed 6 months after the third treatment. The fifth treatment is performed 6 months after the fourth treatment.

    Measured: This outcome measure is assessed three months after the first and the second treatment and 6 months after the third, fourth and fifth treatment.

  2. Complete clearance of AKs on patient basis

    completely cleared AK lesions on patient basis

    The first treatment ist performed at day 0 The second treatment is performed 3 months after the first treatment. The third treatment is performed 3 months after the second treatment. The fourth treatment is performed 6 months after the third treatment. The fifth treatment is performed 6 months after the fourth treatment.

    Measured: This outcome measure is assessed three months after the first and the second treatment and 6 months after the third, fourth and fifth treatment.

  3. Photodamage parameters (fine lines, mottled pigmentation, tactile roughness, teleangiectasias, sallowness and global score for photoaging) will be evaluated on a 5-point scale according to Dover et al.

    Photodamage parameters will be evaluated on a 5-point scale according to Dover et al. at all visits during the study

    The first treatment ist performed at day 0 (visit 1) The second treatment is performed 3 months after the first treatment (visit 2) The third treatment is performed 3 months after the second treatment (visit 3) The fourth treatment is performed 6 months after the third treatment (visit 4) The fifth treatment is performed 6 months after the fourth treatment (visit 5) The last visit is performed 6 months after the fifth treatment (visit 6)

    Measured: This outcome measure is assessed at day 0 (= the first treatment), three months after the first and the second treatment and 6 months after the third, fourth and fifth treatment.

  4. Visual pain score

    For evaluation of tolerability of daylight-PDT and cryosurgery, a pain score (VAS) will be assessed and documented.

    The first treatment ist performed at day 0 (visit 1) The second treatment is performed 3 months after the first treatment (visit 2) The third treatment is performed 3 months after the second treatment (visit 3) The fourth treatment is performed 6 months after the third treatment (visit 4) The fifth treatment is performed 6 months after the fourth treatment (visit 5) The last visit is performed 6 months after the fifth treatment (visit 6)

    Measured: This outcome measure is assessed at day 0 (= the first treatment), three months after the first and the second treatment and 6 months after the third, fourth and fifth treatment

  5. Adverse events

    All adverse events and serious adverse events will be adequately documented.

    The first treatment ist performed at day 0 (visit 1) The second treatment is performed 3 months after the first treatment (visit 2) The third treatment is performed 3 months after the second treatment (visit 3) The fourth treatment is performed 6 months after the third treatment (visit 4) The fifth treatment is performed 6 months after the fourth treatment (visit 5) The last visit is performed 6 months after the fifth treatment (visit 6)

    Measured: This outcome measure is assessed at day 0 (= the first treatment), three months after the first and the second treatment and 6 months after the third, fourth and fifth treatment

  6. Patient satisfaction with cosmetic results

    For evaluation of satisfaction with cosmetic results, patients and investigators fill in a standardized rating scale

    The first treatment ist performed at day 0 (visit 1) The second treatment is performed 3 months after the first treatment (visit 2) The third treatment is performed 3 months after the second treatment (visit 3) The fourth treatment is performed 6 months after the third treatment (visit 4) The fifth treatment is performed 6 months after the fourth treatment (visit 5) The last visit is performed 6 months after the fifth treatment (visit 6)

    Measured: This outcome measure is assessed three months after day 0 and the second treatment and 6 months after the third, fourth and fifth treatment

  7. Skin-related quality of life

    For evaluation of skin-related quality of life, study participants fill in the Dermatology Life Quality Index, a 10-item questionnaire for routine clinical use. Patients are asked about the impact of their AK and photodamaged skin and its treatment on their lives. Patients' quality of life is expressed in a single score ranging from 0 (no impact) to 30 (severe impact).

    Measured: This outcome measure is assessed at day 0 and 24 months after day 0

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted13 Apr 2016 (estimated)
  2. Study start3 Mar 2016
  3. Primary completion9 Sep 2018
  4. Study completion9 Sep 2018

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 4
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
58 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02736760
Sponsor's protocol ID
Daylight_01
Status last verified
Nov 2020
First submitted
11 Mar 2016
Last updated
9 Nov 2020
Results posted
No
Data monitoring committee
Yes

Publications

  • Kohl E, Koller M, Zeman F, Szeimies RM, Philipp-Dormston WG, Prager W, Gerber PA, Karrer S. Daylight photodynamic therapy versus cryosurgery for the treatment and prophylaxis of actinic keratoses of the face - protocol of a multicenter, prospective, randomized, controlled, two-armed study. BMC Dermatol. 2017 Oct 25;17(1):12. doi: 10.1186/s12895-017-0064-7.

    PubMed 29070025

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing Daylight photodynamic therapy using Methylaminolevulinate (MAL) and Cryosurgery in people with Actinic Keratoses and Photodamaged Skin, run by University Hospital Regensburg at 4 sites in Germany.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 8 inclusion and 20 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 9 Nov 2020. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 4 sites in Germany. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

The cumulative number of observed AKs at time points 2 to 6 (3 months after the first treatment to 24 months after the first treatment). (time frame: 24 months after the first treatment). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02736760, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 9 Nov 2020.

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