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CompletedNCT03287791Updated Jul 31, 2019Results posted

A Study to Evaluate Safety and Equivalence of Generic Azelaic Acid Foam and Finacea® Foam in Participants With Rosacea

A Phase 3 interventional study of Generic Azelaic Acid Foam and Finacea® (Azelaic Acid) Foam in Rosacea, sponsored by Actavis Inc.. Completed at 26 sites in United States. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2019-07-31.

Sponsored by Actavis Inc. · Phase 3, Interventional, and Treatment

Phase
Phase 3
Study type
Interventional
Enrollment
924
Allocation
Randomized
Ages
18 Years and older
Sex
All
01

Study summary

The objectives of this study were to compare the safety and efficacy profiles of a generic Azelaic Acid Foam, 15% to the reference listed Finacea® (azelaic acid) Foam, 15% and to demonstrate therapeutic equivalence and safety of the two active foams in the treatment of moderate facial rosacea, and to demonstrate superiority of the Reference and Test products over the Vehicle.

Read the detailed description

Topical azelaic acid is used to treat inflammatory papules and pustules of mild to moderate rosacea. Other topical therapies and oral antibiotics are also used to treat rosacea symptoms. Finacea® (azelaic acid) Foam, 15% contains azelaic acid, a naturally occurring saturated dicarboxylic acid that has proven anti-inflammatory effects, as well as anti-keratinizing and antimicrobial actions.

02

Conditions studied

  • Rosacea

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03

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  • Participants had to be willing and able to provide written informed consent for the study
  • Healthy males or non-pregnant females ≥18 years-of-age with a clinical diagnosis of moderate facial rosacea
  • Participants had to have at least 8 and not more than 50 inflammatory facial lesions (that is, papules/pustules) and ≤2 nodules on the face. For the purposes of study treatment and evaluation, these lesions were limited to the facial treatment area including those present on the nose. Lesions involving the eyes and scalp were excluded from the count.
  • Participants had to have persistent erythema on the face with moderate (3) score
  • Participants had to have a mild (1) to moderate (2) score for telangiectasia on the face
  • Participants had to have a definite clinical diagnosis of moderate facial rosacea (severity score 3)
  • Participants had to be willing to minimize external factors that might trigger rosacea flare-ups (for example, spicy foods, thermally hot foods and drinks, hot environments, prolonged sun exposure, strong winds, and alcoholic beverages) during the course of the study
  • Participants had to be in general good health and free from any clinically significant disease other than rosacea on the face, that could have interfered with the study evaluations
  • Participants had to be willing and able to understand and comply with the requirements of the study, apply the medication as instructed, return for the required treatment period visits, comply with therapy prohibitions, and able to complete the study
  • Male participants and female participants of childbearing potential had to use accepted methods of birth control or had to agree to practice abstinence, from study start to 30 days after the last administration of study drug. All female participants were considered to be of childbearing potential unless they had been surgically sterilized (hysterectomy, bilateral oophorectomy, or tubal ligation) or had been postmenopausal for at least a year. Any of the following methods of birth control were acceptable: oral contraceptives, contraceptive patches/implants (for example, Norplant®), vaginal ring (NuvaRing®), Depo-Provera® (Medroxy progesterone acetate), double barrier methods (for example, condom and spermicide), or intrauterine device
  • Female participants of child bearing potential had to have a negative urine pregnancy test at baseline
  • Participants who used make-up had to have used the same brands/types of make-up for a minimum period of 14 days prior to study entry and had to agree to use the same make-up, brand/type, or frequency of use, throughout the study

Exclusion criteria

Exclusion Criteria:

  • Pregnant or lactating or planning to become pregnant during the study period
  • Presence of any skin condition on the face that could have interfered with the diagnosis or assessment of rosacea
  • Excessive facial hair (for example, beards, sideburns, moustaches) that would interfere could have interfered with diagnosis or assessment of rosacea
  • History of hypersensitivity or allergy to azelaic acid, propylene glycol, or any other component of the formulation
  • The use within 6 months prior to baseline of oral retinoids (for example, Accutane®) or therapeutic Vitamin A supplements of greater than 10,000 units/day (multivitamins were allowed)
  • The use of estrogens or oral contraceptives for less than 3 months prior to baseline
  • The use within 1 month prior to baseline of the following:

    • topical retinoids to the face
    • systemic antibiotics known to have an impact on the severity of facial rosacea (for example, containing tetracycline and its derivatives, erythromycin and its derivatives, sulfamethoxazole, or trimethoprim)
    • systemic corticosteroids
  • Use within two weeks prior to baseline of the following:

    • topical corticosteroids
    • topical antibiotics
    • topical medications for rosacea (for example, metronidazole, azelaic acid)
  • Antipruritics, including antihistamines, within 24 hours of any study visit
  • Participants with moderate or severe rhinophyma, dense telangiectasia (score 3, severe), or plaque-like facial edema
  • Participants with a severe irritation grade for erythema, dryness, scaling, pruritus, stinging/burning, and edema
  • Ocular rosacea (for example, conjunctivitis, blepharitis, or keratitis) of sufficient severity to require topical or systemic antibiotics
  • A participant who had used a sauna during the 2 weeks prior to study entry and during the study
  • Participants who had performed wax epilation of the face within 14 days prior to baseline
  • A participant who had a history of being unresponsive to topical azelaic acid therapy
  • A participant who had any clinically significant condition or situation, other than the condition being studied that, in the opinion of the Investigator, could have interfered with the study evaluations or optimal participation in the study
  • A participant who had used any topical azelaic acid therapy within 30 days of baseline visit
  • Participants who had participated in an investigational drug study (for example, participants had been treated with an investigational drug) within 30 days prior to baseline were excluded from study participation. Participants who were participating in non-treatment studies such as observational studies or registry studies could be considered for inclusion
  • Participants who had been previously randomized in this study
  • Participants who had laser therapy (for telangiectasia or other conditions) and phototherapy to the facial area within 180 days prior to study entry
  • Participants who had cosmetic procedures (for example, facials), which could affect the efficacy and safety profile of the investigational product within 14 days prior to study entry
  • Employees or staff of the research site were excluded from participation in the study
  • No more than 1 participant from the same household was allowed to participate in the study
04

Study design

Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Quadruple (Participant, Care provider, Investigator, Outcomes assessor)
Enrollment
924 participants (actual)

Study arms

  • Experimental
    Generic Azelaic Acid Foam

    A thin layer of generic azelaic acid, 15% topical foam was to be gently massaged into the entire facial area twice daily, once in the morning and once in the evening, for 12 weeks. Contact with the mouth, eyes, and other mucous membranes was to be avoided. Hands were to be washed following application of study drug. Participants were instructed not to bathe, shower, wash, or swim for at least 4 hours after application of study drug. Participants were provided with mild cleanser, a towel, sunscreen, and moisturizing lotion to be used on treated areas while participating in the study.

    Drug: Generic Azelaic Acid Foam · Other: Cleanser · Other: Sunscreen · Other: Towel · Other: Moisturizing Lotion

  • Active comparator
    Finacea® (Azelaic Acid) Foam

    A thin layer of Finacea (azelaic acid), 15% topical foam was to be gently massaged into the entire facial area twice daily, once in the morning and once in the evening, for 12 weeks. Contact with the mouth, eyes, and other mucous membranes was to be avoided. Hands were to be washed following application of study drug. Participants were instructed not to bathe, shower, wash, or swim for at least 4 hours after application of study drug. Participants were provided with mild cleanser, a towel, sunscreen, and moisturizing lotion to be used on treated areas while participating in the study.

    Drug: Finacea® (Azelaic Acid) Foam · Other: Cleanser · Other: Sunscreen · Other: Towel · Other: Moisturizing Lotion

  • Placebo comparator
    Vehicle Foam

    A thin layer of the vehicle topical foam was to be gently massaged into the entire facial area twice daily, once in the morning and once in the evening, for 12 weeks. Contact with the mouth, eyes, and other mucous membranes was to be avoided. Hands were to be washed following application of study drug. Participants were instructed not to bathe, shower, wash, or swim for at least 4 hours after application of study drug. Participants were provided with mild cleanser, a towel, sunscreen, and moisturizing lotion to be used on treated areas while participating in the study.

    Drug: Vehicle Foam · Other: Cleanser · Other: Sunscreen · Other: Towel · Other: Moisturizing Lotion

Interventions

  • DrugGeneric Azelaic Acid Foam

    Topical foam, generic formulation of the brand product.

  • DrugFinacea® (Azelaic Acid) Foam

    Topical foam, brand product.

  • DrugVehicle Foam

    Topical foam, placebo. Has no active ingredient.

  • OtherCleanser

    A mild cleanser provided to participants, so they can wash their face prior to applying the study drug.

  • OtherSunscreen

    Sunscreen provided to participants, so they can apply it to their face when outdoors.

  • OtherTowel

    A soft towel provided to participants, so they can pat their face dry after washing and prior to applying the study drug.

  • OtherMoisturizing Lotion

    Moisturizing lotion provided to participants, so they can apply it to their face, as needed.

05

What researchers measure

Primary outcomes

  1. Percent Change From Baseline in the Inflammatory Lesions (Papules and Pustules) Counts at Week 12

    All facial papules, pustules, and nodules, located above the jaw line and extending to the hairline, were counted. When counting facial lesions, lesions present on the nose were included. The total count for each lesion type was recorded and the total number of inflammatory lesions (papules and pustules) were calculated. A papule with a pustule on its apex was counted as a pustule. Counts of nodules and cysts were reported separately and not included in the inflammatory counts. Papule defined as inflammatory lesion; small (≤5 mm in diameter), solid palpable lesion, usually with inflamed elevation of the skin that does not contain pus. Pustule defined as inflammatory lesion; small (≤5 mm in diameter), inflamed skin swelling that is filled with pus. Cyst and nodule defined as palpable solid or soft lesion \>5 mm in diameter.

    Time frame: Baseline, 12 weeks

Secondary outcomes

  1. Percentage of Participants With Treatment Success Based on IGE Score

    Treatment success defined as an Investigator's Global Evaluation (IGE) score at Week 12 of 0 (clear) or 1 (almost clear). Any other outcome was considered a failure. Participants who were discontinued prematurely from the study due to lack of treatment effect after at least 8 weeks of compliant treatment were considered as treatment failures. The IGE score was based on a 5-point scale ranging from 0 to 4 (0=clear, 1=almost clear, 2=mild, 3=moderate, and 4=severe).

    Time frame: Baseline and 12 Weeks

06

Results

Posted Jul 17, 2019

Participant flow

The populations for this study included the Safety Population, the modified Intent-to-Treat (mITT) population, and the Per-Protocol (PP) Population.

Participant flow — Overall Study
MilestoneGeneric Azelaic Acid FoamFinacea (Azelaic Acid) FoamVehicle Foam
Started312312300
Safety population306297291
Mitt population291291283
Pp population262259245
Completed280276264
Not completed323636
Withdrew: Insufficient therapeutic response001
Withdrew: Adverse event043
Withdrew: Withdrawal by subject121217
Withdrew: Missed more than 6 consecutive doses322
Withdrew: Lost to follow-up81411
Withdrew: Protocol violation721
Withdrew: Participant was enrolled at 2 sites101
Withdrew: Too much time between 2 visits010
Withdrew: Non-compliance010
Withdrew: Did not meet inclusion criteria100

Outcome measures

PrimaryPercent Change From Baseline in the Inflammatory Lesions (Papules and Pustules) Counts at Week 12

All facial papules, pustules, and nodules, located above the jaw line and extending to the hairline, were counted. When counting facial lesions, lesions present on the nose were included. The total count for each lesion type was recorded and the total number of inflammatory lesions (papules and pustules) were calculated. A papule with a pustule on its apex was counted as a pustule. Counts of nodules and cysts were reported separately and not included in the inflammatory counts. Papule defined as inflammatory lesion; small (≤5 mm in diameter), solid palpable lesion, usually with inflamed elevation of the skin that does not contain pus. Pustule defined as inflammatory lesion; small (≤5 mm in diameter), inflamed skin swelling that is filled with pus. Cyst and nodule defined as palpable solid or soft lesion \>5 mm in diameter.

Time frame:
Baseline, 12 weeks
Reported as:
Mean · percent change
Percent Change From Baseline in the Inflammatory Lesions (Papules and Pustules) Counts at Week 12
percent changeGeneric Azelaic Acid FoamFinacea (Azelaic Acid) FoamVehicle Foam
Percent Change From Baseline in the Inflammatory Lesions (Papules and Pustules) Counts at Week 12-64.28 ± 25.050-65.15 ± 26.419-57.84 ± 30.626
Statistical analysis
  • Generic Azelaic Acid Foam vs Vehicle Foam · ANOVA · p = <.0001 · Mean difference (final values): -11.27 · 95% CI -16.80 to -5.73
  • Finacea (Azelaic Acid) Foam vs Vehicle Foam · ANOVA · p = 0.0007 · Median difference (final values): -9.71 · 95% CI -15.28 to -4.14
SecondaryPercentage of Participants With Treatment Success Based on IGE Score

Treatment success defined as an Investigator's Global Evaluation (IGE) score at Week 12 of 0 (clear) or 1 (almost clear). Any other outcome was considered a failure. Participants who were discontinued prematurely from the study due to lack of treatment effect after at least 8 weeks of compliant treatment were considered as treatment failures. The IGE score was based on a 5-point scale ranging from 0 to 4 (0=clear, 1=almost clear, 2=mild, 3=moderate, and 4=severe).

Time frame:
Baseline and 12 Weeks
Reported as:
Number · percentage of participants
Percentage of Participants With Treatment Success Based on IGE Score
percentage of participantsGeneric Azelaic Acid FoamFinacea (Azelaic Acid) FoamVehicle Foam
Percentage of Participants With Treatment Success Based on IGE Score39.748.333.5

Adverse events

Collected over Baseline up to Day 84. Non-serious events are listed at a 0% frequency threshold.

Adverse event summary by group
GroupDeathsSeriousOther
Generic Azelaic Acid Foam0/306 (0%)0/306 (0%)129/306 (42.2%)
Finacea (Azelaic Acid) Foam0/297 (0%)2/297 (0.7%)128/297 (43.1%)
Vehicle Foam0/291 (0%)1/291 (0.3%)125/291 (43%)
Most frequent serious events
Most frequent serious events
EventGeneric Azelaic Acid FoamFinacea (Azelaic Acid) FoamVehicle Foam
HypocalcaemiaEndocrine disorders0/3060/2971/291
Prostate cancerRenal and urinary disorders0/3061/2970/291
CellulitisImmune system disorders0/3061/2970/291
Most frequent other events
Showing 10 of 74
Most frequent other events
EventGeneric Azelaic Acid FoamFinacea (Azelaic Acid) FoamVehicle Foam
Application site drynessGeneral disorders45/30629/29752/291
Application site pruritusGeneral disorders51/30643/29728/291
Application site painGeneral disorders47/30641/29728/291
Application site erythemaGeneral disorders30/30628/29734/291
Application site reactionGeneral disorders22/30619/29720/291
HeadacheNervous system disorders15/3069/29712/291
Application site swellingGeneral disorders2/3066/2978/291
InfluenzaInfections and infestations6/3060/2972/291
Application site oedemaGeneral disorders3/3064/2975/291
SinusitisInfections and infestations1/3065/2970/291

Baseline characteristics

Randomized participants with evidence in diary card of using ≥1 dose of study drug (Safety Population).

Age, Continuous
Age, Continuous(years)Generic Azelaic Acid FoamFinacea (Azelaic Acid) FoamVehicle FoamTotal
Mean51.6 ± 14.2052.3 ± 15.1451.0 ± 15.0951.6 ± 14.80
Sex: Female, Male
Sex: Female, Male(Participants)Generic Azelaic Acid FoamFinacea (Azelaic Acid) FoamVehicle FoamTotal
Female212220204636
Male947787258
Ethnicity (NIH/OMB)
Ethnicity (NIH/OMB)(Participants)Generic Azelaic Acid FoamFinacea (Azelaic Acid) FoamVehicle FoamTotal
Hispanic or Latino185177180542
Not Hispanic or Latino121120111352
Unknown or Not Reported0000
Race (NIH/OMB)
Race (NIH/OMB)(Participants)Generic Azelaic Acid FoamFinacea (Azelaic Acid) FoamVehicle FoamTotal
American Indian or Alaska Native0000
Asian0101
Native Hawaiian or Other Pacific Islander0000
Black or African American44311
White302292288882
More than one race0000
Unknown or Not Reported0000
Inflammatory Lesion Count
Inflammatory Lesion Count(inflammatory lesions)Generic Azelaic Acid FoamFinacea (Azelaic Acid) FoamVehicle FoamTotal
Mean17.1 ± 8.8516.7 ± 7.8817.7 ± 8.8817.1 ± 8.55
07

Study locations

26 sites
  • Investigative Site 2
    Encino, California, United States
  • Investigative Site 10
    La Mesa, California, United States
  • Investigative Site 19
    Brandon, Florida, United States
  • Investigative Site 1
    Hialeah, Florida, United States
  • Investigative Site 9
    Hialeah, Florida, United States
  • Investigative Site 23
    Lauderdale Lakes, Florida, United States
  • Investigative Site 11
    Miami, Florida, United States
  • Investigative Site 15
    Miami, Florida, United States
  • Investigative Site 20
    Miami, Florida, United States
  • Investigative Site 12
    Miramar, Florida, United States
  • Investigative Site 25
    Ocala, Florida, United States
  • Investigative Site 22
    Pembroke Pines, Florida, United States
  • Investigative Site 18
    Tampa, Florida, United States
  • Investigative Site 16
    Savannah, Georgia, United States
  • Investigative Site 14
    Plainfield, Indiana, United States
  • Investigative Site 13
    Wichita, Kansas, United States
  • Investigative Site 6
    New Orleans, Louisiana, United States
  • Investigative Site 17
    Omaha, Nebraska, United States
  • Investigative Site 8
    High Point, North Carolina, United States
  • Investigative Site 3
    Cincinnati, Ohio, United States
  • Investigative Site 21
    Philadelphia, Pennsylvania, United States
  • Investigative Site 4
    Dallas, Texas, United States
  • Investigative Site 26
    El Paso, Texas, United States
  • Investigative Site 7
    New Braunfels, Texas, United States
  • Investigative Site 5
    Norfolk, Virginia, United States
  • Investigative Site 24
    Spokane, Washington, United States
08

References and documents

Study documents

  • Study protocol · Mar 28, 2016
  • Statistical analysis plan · Apr 6, 2017

Documents are hosted by the registry — open the source record to download them.

09

Registry details

Key details

Study ID
NCT03287791
Lead sponsor
Actavis Inc.
Responsible party
Sponsor
First posted
Sep 19, 2017
Start date
Jul 19, 2016
Primary completion
Jun 22, 2017
Completion
Jun 22, 2017
Results posted
Jul 17, 2019
Last update
Jul 31, 2019

Study contacts

Study Director
study director · Teva Pharmaceuticals USA

Oversight

Data monitoring committee
No
FDA-regulated drug
Yes
FDA-regulated device
No
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