A Phase 3 interventional study of Placebo and KX2-391 Ointment 1% in Actinic Keratoses, sponsored by Almirall, S.A.. Completed at 30 sites in United States. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2021-04-13.
Sponsored by Almirall, S.A. · Phase 3, Interventional, and Treatment
This Phase III study is designed to evaluate the efficacy and safety of KX2-391 Ointment in adult participants when applied to an area of skin containing 4-8 stable, clinically typical Actinic Keratosis (AK) lesions on the face or scalp.
This study was a double-blinded, multicenter, activity, and safety study of KX2-391 Ointment administered topically to the face or scalp of participants with actinic keratosis.
The study consists of Screening, Treatment, Follow-up, and Recurrence Follow-up Periods. Eligible participants received 5 consecutive days of topical treatment, to be applied at the study site. Activity (lesion counts) and safety evaluations was performed.
Exclusion Criteria
Location of the selected area is:
Use of the following therapies and/or medications within 2 weeks prior to the Screening visit:
Use of the following therapies and/or medications within 4 weeks prior to the Screening visit:
Vehicle Ointment was applied topically once daily for 5 consecutive days on face or scalp
Drug: Placebo
KX2-391 Ointment 1% was applied topically once daily for 5 consecutive days on face or scalp
Drug: KX2-391 Ointment 1%
Vehicle Ointment was used in participants with Clinically typical AK on the face or scalp.
The experimental drug, KX2-391 Ointment 1% was used in participants with Clinically typical AK on the face or scalp.
Percentage of Participants With Complete (100%) Clearance of Actinic Keratosis (AK) Lesions
Complete clearance rate was defined as the percentage of participants at Day 57 with no clinically visible AK lesions in the treatment area.
Time frame: Day 57
Percentage of Participants With Partial Clearance Rate of Actinic Keratosis Lesions at Day 57
Partial clearance rate of AK lesions was defined as the percentage of participants with a greater than or equal to (\>=) 75% reduction in the number of AK lesions identified at Baseline (Day 1 predose) in the treatment area.
Time frame: Day 57
Overall Change From Baseline in Actinic Keratosis Lesion Counts at Days 8, 15, 29 and 57
Overall the change from baseline in lesion count at each visit were summarized and reported using descriptive statistics by treatment location (face or scalp).
Time frame: Days 8, 15, 29 and 57
Percentage of Participants With Recurrence of Actinic Keratosis Lesions Who Achieved Complete Clearance at Day 57
Recurrence rate was estimated based on Kaplan-Meier method, with recurrence define as appearance of any AK lesions in the treatment area, including those recurred or newly identified.
Time frame: 3, 6, 9 and 12 months post-Day 57
Number of Participants With Maximal Post Baseline Local Skin Reaction (LSR)
Maximal post baseline LSR was defined as the highest grade of any LSR reported at any post baseline visits for a participant. The LSR assessment was an Investigator's (or sub-investigator's) assessment of the following signs on the treatment area: erythema, flaking/scaling, crusting, swelling, vesiculation/pustulation, and erosion/ulceration. The LSRs were graded on a 4-point scale ranging from 0=absent, 1=mild (slightly, barely perceptible), 2=moderate (distinct presence), and 3=severe (marked, intense).
Time frame: Day 57
Number of Participants With Pigmentation and Scarring in the Treatment Area
Absence or presence of pigmentation (i.e., hypopigmentation and hyperpigmentation) and scarring in the treatment area were assessed.
Time frame: Baseline (Day 1 predose), Days 5, 8, 15, 29 and 57
Number of Participants With Adverse Event (AE), Treatment-emergent Adverse Events (TEAEs), Serious Adverse Events (SAEs), Events of Special Interests
An AE was defined as any untoward medical occurrence in participant which does not necessarily have causal relationship with treatment. An AE was any unfavorable and unintended sign (including abnormal laboratory finding), symptom, or disease temporally associated with use of medicinal product, whether or not considered related to medicinal product. An SAE was any untoward medical occurrence that at any dose resulted in death; was life threatening; required persistent/significant disability/incapacity; resulted in initial or prolonged in patient hospitalization; was congenital anomaly/birth defect or otherwise considered medically important. TEAEs (serious and non-serious) were defined as either those AEs with onset after first dose or those pre-existing AEs that worsen after first dose. Events of special interest included skin cancers (including basal cell carcinoma, squamous cell carcinoma, melanoma and their location and treatment area), ocular exposure, overdose, and pregnancy.
Time frame: Baseline (Day 1 predose) up to Day 57
Number of Participants With Adverse Events, Serious Adverse Events, Events of Special Interests Within the Treatment Area After Day 57 and up to 12 Months Post-Day 57
An AE was defined as any untoward medical occurrence in a participant which does not necessarily have a causal relationship with the treatment. An AE was any unfavorable and unintended sign (including an abnormal laboratory finding), symptom, or disease temporally associated with use of a medicinal product, whether or not considered related to the medicinal product. An SAE was any untoward medical occurrence that at any dose resulted in death; was life threatening; required persistent/significant disability/incapacity; resulted in initial or prolonged in patient hospitalization; was congenital anomaly/birth defect or otherwise considered medically important. Events of special interest included skin cancers (including basal cell carcinoma, squamous cell carcinoma, melanoma and their location and treatment area), ocular exposure, overdose, and pregnancy.
Time frame: From Day 57 up to 12-months post-Day 57
Number of Participants With Clinically Significant Safety Observations- Hematology, Blood Chemistry, Urinalysis
Assessed laboratory parameters included hematology, blood chemistry and urinalysis. Clinical significance and abnormal observations were determined by the investigator.
Time frame: From Baseline (Day 1 predose) up to Day 57
Number of Participants With Clinically Significant Safety Observations- Vital Signs
Vital signs included measurement of pulse rate, systolic and diastolic blood pressure, respiratory rate, and body temperature. Clinical significance was determined by the investigator.
Time frame: From Baseline (Day 1 predose) up to Day 57
Number of Participants With Clinically Significant Safety Observations- Physical Examination
A physical examination included weight and height measurements was performed. Clinical significance was determined by the investigator.
Time frame: From Baseline (Day 1 predose) up to Day 57
Number of Participants With Clinically Significant Safety Observations- Electrocardiograms (ECGs)
ECG parameters included heart rhythm, heart rate, QRS intervals, QT intervals, RR intervals and corrected QT (QTc) intervals. Clinical significance was determined by the investigator.
Time frame: From Baseline (Day 1 predose) up to Day 57
This study was conducted at 31 sites in United States from 18 September 2017 to 24 April 2019.
| Milestone | Placebo | KX2-391 Ointment 1% |
|---|---|---|
| Started | 176 | 175 |
| Completed | 174 | 175 |
| Not completed | 2 | 0 |
| Withdrew: Death | 1 | 0 |
| Withdrew: Withdrawn of consent | 1 | 0 |
| Milestone | Placebo | KX2-391 Ointment 1% |
|---|---|---|
| Started | 8 | 77 |
| Completed | 2 | 22 |
| Not completed | 6 | 55 |
| Withdrew: Lost to follow-up | 0 | 1 |
| Withdrew: Withdrawal of consent | 1 | 3 |
| Withdrew: Ak recurrence during the recurrence follow-up period | 5 | 51 |
Complete clearance rate was defined as the percentage of participants at Day 57 with no clinically visible AK lesions in the treatment area.
| percentage of participants | Placebo | KX2-391 Ointment 1% |
|---|---|---|
| Percentage of Participants With Complete (100%) Clearance of Actinic Keratosis (AK) Lesions | 5 | 44 |
Partial clearance rate of AK lesions was defined as the percentage of participants with a greater than or equal to (\>=) 75% reduction in the number of AK lesions identified at Baseline (Day 1 predose) in the treatment area.
| percentage of participants | Placebo | KX2-391 Ointment 1% |
|---|---|---|
| Percentage of Participants With Partial Clearance Rate of Actinic Keratosis Lesions at Day 57 | 16 | 68 |
Overall the change from baseline in lesion count at each visit were summarized and reported using descriptive statistics by treatment location (face or scalp).
| lesion count | Placebo | KX2-391 Ointment 1% |
|---|---|---|
| Day 8 | 0.0 (-7 to 3) | -1.0 (-8 to 4) |
| Day 15 | 0.0 (-7 to 2) | -4.0 (-8 to 4) |
| Day 29 | -1.0 (-7 to 4) | -4 (-8 to 1) |
| Day 57 | -1.0 (-7 to 5) | -5.0 (-8 to 0) |
Recurrence rate was estimated based on Kaplan-Meier method, with recurrence define as appearance of any AK lesions in the treatment area, including those recurred or newly identified.
| percentage of participants | KX2-391 Ointment 1% |
|---|---|
| 3 Months Post-Day 57 | 33 |
| 6 Months Post-Day 57 | 30 |
| 9 Months Post-Day 57 | 33 |
| 12 months Post-Day 57 | 18 |
Maximal post baseline LSR was defined as the highest grade of any LSR reported at any post baseline visits for a participant. The LSR assessment was an Investigator's (or sub-investigator's) assessment of the following signs on the treatment area: erythema, flaking/scaling, crusting, swelling, vesiculation/pustulation, and erosion/ulceration. The LSRs were graded on a 4-point scale ranging from 0=absent, 1=mild (slightly, barely perceptible), 2=moderate (distinct presence), and 3=severe (marked, intense).
| Participants | Placebo | KX2-391 Ointment 1% |
|---|---|---|
| Erythema-Grade 0 | 81 | 6 |
| Erythema-Grade 1 | 84 | 48 |
| Erythema-Grade 2 | 11 | 116 |
| Erythema-Grade 3 | 0 | 5 |
| Flaking/Scaling-Grade 0 | 72 | 16 |
| Flaking/Scaling-Grade 1 | 90 | 70 |
| Flaking/Scaling-Grade 2 | 14 | 78 |
| Flaking/Scaling-Grade 3 | 0 | 11 |
| Crusting-Grade 0 | 140 | 84 |
| Crusting-Grade 1 | 33 | 69 |
| Crusting-Grade 2 | 3 | 20 |
| Crusting-Grade 3 | 0 | 2 |
| Swelling-Grade 0 | 163 | 107 |
| Swelling-Grade 1 | 12 | 55 |
| Swelling-Grade 2 | 1 | 12 |
| Swelling-Grade 3 | 0 | 1 |
| Vesiculation/Pustulation-Grade 0 | 174 | 158 |
| Vesiculation/Pustulation-Grade 1 | 2 | 14 |
| Vesiculation/Pustulation-Grade 2 | 0 | 2 |
| Vesiculation/Pustulation-Grade 3 | 0 | 1 |
| Erosion/Ulceration-Grade 0 | 168 | 155 |
| Erosion/Ulceration-Grade 1 | 8 | 15 |
| Erosion/Ulceration-Grade 2 | 0 | 5 |
| Erosion/Ulceration-Grade 3 | 0 | 0 |
Absence or presence of pigmentation (i.e., hypopigmentation and hyperpigmentation) and scarring in the treatment area were assessed.
| Participants | Placebo | KX2-391 Ointment 1% |
|---|---|---|
| Hypopigmentation: Baseline | 21 | 21 |
| Hypopigmentation: Day 5 | 19 | 11 |
| Hypopigmentation: Day 8 | 21 | 10 |
| Hypopigmentation: Day 15 | 23 | 12 |
| Hypopigmentation: Day 29 | 23 | 17 |
| Hypopigmentation: 57 | 20 | 13 |
| Hyperpigmentation: Baseline | 27 | 22 |
| Hyperpigmentation: Day 5 | 24 | 18 |
| Hyperpigmentation: Day 8 | 23 | 17 |
| Hyperpigmentation: Day 15 | 26 | 20 |
| Hyperpigmentation: Day 29 | 25 | 18 |
| Hyperpigmentation: Day 57 | 23 | 12 |
| Scarring: Baseline | 10 | 12 |
| Scarring: Day 5 | 8 | 8 |
| Scarring: Day 8 | 9 | 7 |
| Scarring: Day 15 | 7 | 8 |
| Scarring: Day 29 | 7 | 9 |
| Scarring: Day 57 | 7 | 7 |
An AE was defined as any untoward medical occurrence in participant which does not necessarily have causal relationship with treatment. An AE was any unfavorable and unintended sign (including abnormal laboratory finding), symptom, or disease temporally associated with use of medicinal product, whether or not considered related to medicinal product. An SAE was any untoward medical occurrence that at any dose resulted in death; was life threatening; required persistent/significant disability/incapacity; resulted in initial or prolonged in patient hospitalization; was congenital anomaly/birth defect or otherwise considered medically important. TEAEs (serious and non-serious) were defined as either those AEs with onset after first dose or those pre-existing AEs that worsen after first dose. Events of special interest included skin cancers (including basal cell carcinoma, squamous cell carcinoma, melanoma and their location and treatment area), ocular exposure, overdose, and pregnancy.
| Participants | Placebo | KX2-391 Ointment 1% |
|---|---|---|
| Participants with AE | 62 | 66 |
| Participants with any TEAE | 57 | 57 |
| Participants with SAE | 2 | 0 |
| Participants with events of special interest | 4 | 5 |
An AE was defined as any untoward medical occurrence in a participant which does not necessarily have a causal relationship with the treatment. An AE was any unfavorable and unintended sign (including an abnormal laboratory finding), symptom, or disease temporally associated with use of a medicinal product, whether or not considered related to the medicinal product. An SAE was any untoward medical occurrence that at any dose resulted in death; was life threatening; required persistent/significant disability/incapacity; resulted in initial or prolonged in patient hospitalization; was congenital anomaly/birth defect or otherwise considered medically important. Events of special interest included skin cancers (including basal cell carcinoma, squamous cell carcinoma, melanoma and their location and treatment area), ocular exposure, overdose, and pregnancy.
| Participants | Placebo | KX2-391 Ointment 1% |
|---|---|---|
| Participants with any AE | 0 | 4 |
| Participants with any SAE | 0 | 1 |
| Participants with events of special interest | 0 | 0 |
Assessed laboratory parameters included hematology, blood chemistry and urinalysis. Clinical significance and abnormal observations were determined by the investigator.
| Participants | Placebo | KX2-391 Ointment 1% |
|---|---|---|
| Hematology | 0 | 0 |
| Blood chemistry | 1 | 1 |
| Urinalysis | 0 | 3 |
Vital signs included measurement of pulse rate, systolic and diastolic blood pressure, respiratory rate, and body temperature. Clinical significance was determined by the investigator.
| Participants | Placebo | KX2-391 Ointment 1% |
|---|---|---|
| Number of Participants With Clinically Significant Safety Observations- Vital Signs | 0 | 0 |
A physical examination included weight and height measurements was performed. Clinical significance was determined by the investigator.
| Participants | Placebo | KX2-391 Ointment 1% |
|---|---|---|
| Number of Participants With Clinically Significant Safety Observations- Physical Examination | 0 | 0 |
ECG parameters included heart rhythm, heart rate, QRS intervals, QT intervals, RR intervals and corrected QT (QTc) intervals. Clinical significance was determined by the investigator.
| Participants | Placebo | KX2-391 Ointment 1% |
|---|---|---|
| Number of Participants With Clinically Significant Safety Observations- Electrocardiograms (ECGs) | 0 | 0 |
Collected over From Baseline (Day 1 predose) up to 15 months (12 months post-Day 57). Non-serious events are listed at a 0% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Placebo | 1/176 (0.6%) | 2/176 (1.1%) | 62/176 (35.2%) |
| KX2-391 Ointment 1% | 0/175 (0%) | 1/175 (0.6%) | 68/175 (38.9%) |
| Event | Placebo | KX2-391 Ointment 1% |
|---|---|---|
| SepsisInfections and infestations | 0/176 | 1/175 |
| Haemoglobin decreasedInvestigations | 0/176 | 1/175 |
| Hairy cell leukaemiaNeoplasms benign, malignant and unspecified (incl cysts and polyps) | 0/176 | 1/175 |
| Aortic valve stenosisCardiac disorders | 1/176 | 0/175 |
| Myocardial infarctionCardiac disorders | 1/176 | 0/175 |
| Completed suicidePsychiatric disorders | 1/176 | 0/175 |
| Event | Placebo | KX2-391 Ointment 1% |
|---|---|---|
| Application site pruritusGeneral disorders | 8/176 | 13/175 |
| Application site painGeneral disorders | 6/176 | 11/175 |
| Upper respiratory tract infectionInfections and infestations | 7/176 | 7/175 |
| Viral upper respiratory tract infectionInfections and infestations | 5/176 | 5/175 |
| Skin abrasionInjury, poisoning and procedural complications | 5/176 | 4/175 |
| Squamous cell carcinomaNeoplasms benign, malignant and unspecified (incl cysts and polyps) | 1/176 | 4/175 |
| BronchitisInfections and infestations | 4/176 | 3/175 |
| HeadacheNervous system disorders | 2/176 | 3/175 |
| InfluenzaInfections and infestations | 3/176 | 1/175 |
| Basal cell carcinomaNeoplasms benign, malignant and unspecified (incl cysts and polyps) | 3/176 | 1/175 |
Intent to treat (ITT) population included all participants randomized in the study.
| Age, Continuous(years) | Placebo | KX2-391 Ointment 1% | Total |
|---|---|---|---|
| Mean | 70.2 ± 9.41 | 69.5 ± 8.55 | 69.9 ± 8.99 |
| Sex: Female, Male(Participants) | Placebo | KX2-391 Ointment 1% | Total |
|---|---|---|---|
| Female | 22 | 28 | 50 |
| Male | 154 | 147 | 301 |
| Ethnicity (NIH/OMB)(Participants) | Placebo | KX2-391 Ointment 1% | Total |
|---|---|---|---|
| Hispanic or Latino | 5 | 2 | 7 |
| Not Hispanic or Latino | 171 | 173 | 344 |
| Unknown or Not Reported | 0 | 0 | 0 |
| Race (NIH/OMB)(Participants) | Placebo | KX2-391 Ointment 1% | Total |
|---|---|---|---|
| American Indian or Alaska Native | 1 | 0 | 1 |
| Asian | 0 | 0 | 0 |
| Native Hawaiian or Other Pacific Islander | 0 | 0 | 0 |
| Black or African American | 0 | 0 | 0 |
| White | 175 | 175 | 350 |
| More than one race | 0 | 0 | 0 |
| Unknown or Not Reported | 0 | 0 | 0 |
| Number of AK Lesions(Lesions) | Placebo | KX2-391 Ointment 1% | Total |
|---|---|---|---|
| Mean | 5.9 ± 1.35 | 5.8 ± 1.28 | 5.8 ± 1.31 |
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Almirall, S.A.