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CompletedNCT04681729Updated Sep 10, 2025Results posted

Dupilumab for the Treatment of Chronic Inducible Cold Urticaria in Patients Who Remain Symptomatic Despite the Use of H1-antihistamine (LIBERTY-CINDU CUrIADS)

A Phase 3 interventional study of Dupilumab SAR231893 and Placebo in Cold Urticaria, sponsored by Sanofi. Completed at 33 sites in 5 countries. Open to participants aged 12 Years to 80 Years. Per ClinicalTrials.gov, last updated 2025-09-10.

Sponsored by Sanofi · Phase 3, Interventional, and Treatment

Phase
Phase 3
Study type
Interventional
Enrollment
82
Allocation
Randomized
Ages
12 Years to 80 Years
Sex
All
01

Study summary

Primary Objective:

To demonstrate the efficacy of dupilumab in adult and adolescent participants with primary acquired chronic inducible cold urticaria (ColdU) who remain symptomatic despite the use of an H1-antihistamine

Secondary Objectives:

To demonstrate the efficacy of dupilumab on primary acquired chronic inducible ColdU disease control To demonstrate the efficacy of dupilumab on primary acquired chronic inducible ColdU local signs and symptoms (hives/wheals, itch, burning sensation and pain) after provocation test To demonstrate the efficacy of dupilumab on primary acquired chronic inducible ColdU disease activity To demonstrate improvement in health-related quality-of-life and overall disease status and severity To evaluate the ability of dupilumab in reducing the proportion of participants who require rescue therapy To evaluate the proportion of participants with cold exposure triggered urticaria To evaluate safety outcome measures To evaluate immunogenicity of dupilumab

Read the detailed description

The duration of study for each participant included 2-4 weeks of screening period, 24 weeks of treatment period and 12 weeks of post treatment period.

02

Conditions studied

  • Cold Urticaria
03

In context

Lead sponsor

Sanofi is the lead sponsor of 1,508 studies on the registry; 90 are open to participants now.

Of its 198 completed or terminated interventional studies of FDA-regulated products, 118 (60%) have results posted.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
12 Years to 80 Years
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  • Participant had to be ≥12 years to 80 years of age inclusive at the time of signing the informed consent
  • Participants who had a diagnosis of primary acquired chronic inducible ColdU defined as recurrence of itchy wheals and/or angioedema due to cold for longer than 6 weeks prior to screening visit (Visit 1)
  • Participants with positive ice cube provocation test, ie, presenting at least a confluent hive/wheal on the exposed skin area, at the screening visit (Visit 1) and randomization visit (Visit 2)
  • Participants meeting at least 1 of the following criteria despite regular/daily or as needed use of H1-antihistamine (AH):

    • Urticaria Control Test (UCT) (4 item) \<12 at the screening visit (Visit 1) and randomization visit (Visit 2)
    • Within 6 months prior to the screening visit, documented medical history of cold exposure triggered anaphylaxis or oropharyngeal edema
    • Within 6 months prior to the screening visit, documented medical history of cold exposure triggered urticaria requiring emergency medical care visit or treatment with epinephrine
  • Participants using a study defined H1-antihistamine regularly/daily or as needed for primary acquired chronic inducible cold urticaria
  • Body weight ≥30 kg

Exclusion criteria

Exclusion Criteria:

Participants were excluded from the study if any of the following criteria applied:

  • Clearly defined underlying etiology for urticaria other than primary acquired chronic inducible ColdU
  • Presence of skin morbidities other than cold urticaria that may interfere with the assessment of the study outcomes
  • Active atopic dermatitis
  • Severe concomitant illness(es) that, in the investigator's judgment, would have adversely affected the patient's participation in the study
  • Active tuberculosis or non-tuberculous mycobacterial infection, or a history of incompletely treated tuberculosis unless documented adequately treated.
  • Diagnosed active endoparasitic infections; suspected or high risk of endoparasitic infection
  • Active chronic or acute infection requiring treatment with systemic antibiotics, antivirals, antiprotozoals, or antifungals within 2 weeks before the screening visit and during the screening period
  • Known or suspected immunodeficiency
  • Active malignancy or history of malignancy within 5 years before the baseline visit, except completely treated in situ carcinoma of the cervix, completely treated and resolved non-metastatic squamous or basal cell carcinoma of the skin
  • History of systemic hypersensitivity or anaphylaxis to any other biologic therapy or any of its excipients.
  • Participation in prior dupilumab clinical study, or have been treated with commercially available dupilumab.

The above information was not intended to contain all considerations relevant to a patient's potential participation in a clinical trial.

05

Study design

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

Study arms

  • Experimental
    Dupilumab

    Dose regimens, on top of regular or as needed non-sedating H1-antihistamine

    Drug: Dupilumab SAR231893 · Drug: Non sedating H1-antihistamine

  • Placebo comparator
    Matched Placebo

    Placebo, on top of regular/as needed non-sedating H1-antihistamine

    Drug: Placebo · Drug: Non sedating H1-antihistamine

Interventions

  • DrugDupilumab SAR231893

    Pharmaceutical form: Injection solution Route of administration: Subcutaneous

  • DrugPlacebo

    Pharmaceutical form: Injection solution Route of administration: Subcutaneous

  • DrugNon sedating H1-antihistamine

    Pharmaceutical form: Tablet Route of administration: Oral

06

What researchers measure

Primary outcomes

  1. Percentage of Participants With Negative Ice Cube Provocation Test at Week 24

    The ice cube provocation test is the most frequently used provocation method for cold urticaria (ColdU). A negative ice cube provocation test was defined as the absence of confluent hives/wheal at the entire skin site of exposure after ice cube provocation test. Ice cube was applied on forearm skin for 5 minutes. Provocation test reading time was 10 minutes after removal of ice cube.

    Time frame: Week 24

Secondary outcomes

  1. Change From Baseline in Urticaria Control Test (UCT) Scale Scores at Week 24

    UCT is validated patient reported outcome (PRO) questionnaire used for assessing urticaria control. UCT has been developed and validated with participants Chronic Spontaneous Urticaria (CSU) and Chronic inducible urticaria (CIndU). It comprised of 4 items: severity of physical symptoms of urticaria (itch, hives and/or swelling); quality of life (QoL) impairment; frequency of treatment being not sufficient to control urticaria; overall urticarial control. Each item was rated on a 5-point Likert scale ranged from 0 (high disease activity) to 4 (low disease activity). The UCT total score was calculated as sum of all 4 individual item scores,ranged from 0 to 16. Higher scores indicated low disease activity, complete disease control, and vice-versa. Least square (LS) mean and standard error (SE) were analyzed using Analysis of covariance (ANCOVA) model with corresponding Baseline value, intervention group, region and background H1-antihistamine regular/daily use (Yes or No) as covariates.

    Time frame: Baseline to Week 24

  2. Percentage of Participants With Urticaria Control Test Score >=12 at Week 24

    The UCT is a validated PRO questionnaire used for assessing urticaria control. The questionnaire has been developed and validated with participants with CSU and CIndU. It comprised of 4 items: severity of physical symptoms of urticaria (itch, hives and/or swelling); QoL impairment; frequency of treatment being not sufficient to control urticaria; overall urticarial control. Each item was rated on a 5-point Likert scale ranging from 0 to 4, with low score indicating high disease activity and low disease control, and vice-versa. The UCT total score was calculated as sum of all 4 individual item scores, which ranged from 0 to 16. Higher scores indicated low disease activity and complete disease control, and vice-versa. A score of \>=12 on the scale indicates well-controlled urticaria. Percentage of participants with UCT score \>=12 (i.e., well controlled urticaria) at Week 24 are reported in this endpoint.

    Time frame: Week 24

  3. Percentage of Participants With an Improvement of >=3 Points From Baseline in Urticaria Control Test Score at Week 24

    The UCT is a validated PRO questionnaire used for assessing urticaria control. The questionnaire has been developed and validated with participants with CSU and CIndU. It comprised of 4 items: severity of physical symptoms of urticaria (itch, hives and/or swelling); QoL impairment; frequency of treatment being not sufficient to control urticaria; overall urticarial control. Each item was rated on a 5-point Likert scale ranging from 0 (high disease activity) to 4 (low disease activity), with low score indicating high disease activity and low disease control, and vice-versa. The UCT total score was calculated as sum of all 4 individual item scores, which ranged from 0 to 16. Higher scores indicated low disease activity and complete disease control, and vice-versa.

    Time frame: Baseline to Week 24

  4. Change From Baseline in Local Wheal Intensity Likert Scale Score at Weeks 12 and 24

    Wheal intensity Likert scale (ranging from 0 to 5) is a clinician-reported endpoint completed at the study visit, 10 minutes after removal of the ice cube from the participants' arm. The scale comprised of a single item assessing the intensity of participants' cutaneous reaction rated as follows: 0 = no wheals; 1 = numerous small, non-coalescent wheals; 2 = a large, regular, slightly edematous, coalescent wheal; 3 = a large and moderately edematous wheal; 4 = a large, regular, and significantly edematous wheal without pseudopodia; and 5 = a large, very edematous wheal with pseudopodia. Higher score indicated greater severity. LS mean and SE were analyzed using ANCOVA model with the corresponding Baseline value, intervention group, region and background H1-antihistamine regular/daily use (Yes or No) as covariates.

    Time frame: Baseline, Week 12 and Week 24

  5. Change From Baseline in Local Itch Severity Scale Score at Weeks 12 and 24

    Local itch (pruritus) severity was assessed using the peak pruritus numerical rating scale (NRS). Peak pruritus NRS is a PRO comprised of a single item rated on a scale ranged from 0 ("No itch") to 10 ("Worst itch imaginable"), where higher scores indicated worse itch. Participants were asked to rate the intensity of their worst local site itch (pruritus) 10 minutes after removal of the ice cube. LS mean and SE were analyzed using ANCOVA model with the corresponding Baseline value, intervention group, region and background H1-antihistamine regular/daily use (Yes or No) as covariates.

    Time frame: Baseline, Week 12 and Week 24

  6. Change From Baseline in Local Skin Burning Sensation Scale Score at Weeks 12 and 24

    Local skin burning sensation was assessed using peak burning sensation NRS which is a PRO comprised of a single item rated on a scale ranged from 0 ("No burning sensation") to 10 ("Worst imaginable burning sensation"). Higher score indicated worst burning sensation. Participants were asked to rate the intensity of the worst local site burning sensation of their skin 10 minutes after the removal of the ice cube. LS mean and SE were analyzed using ANCOVA model with the corresponding Baseline value, intervention group, region and background H1-antihistamine regular/daily use (Yes or No) as covariates.

    Time frame: Baseline, Week 12 and Week 24

  7. Change From Baseline in Local Pain Severity Scale Score at Weeks 12 and 24

    Local pain severity was assessed using peak pain NRS. The peak pain NRS is a PRO comprised of a single item rated on a scale ranged from 0 ("No pain") to 10 ("Worst imaginable pain"). Higher score indicated worst pain. Participants were asked to rate the intensity of their worst local site pain 10 minutes after removal of the ice cube. LS mean and SE was analyzed using ANCOVA model with the corresponding Baseline value, intervention group, region and background H1-antihistamine regular/daily use (Yes or No) as covariates.

    Time frame: Baseline, Week 12 and Week 24

  8. Percentage of Participants With Negative Ice Cube Provocation Test at Week 12

    The ice cube provocation test is the most frequently used provocation method for ColdU. A negative ice cube provocation test was defined as the absence of confluent hives/wheal at the entire skin site of exposure after ice cube provocation test. Ice cube was applied on forearm skin for 5 minutes. Provocation test reading time was 10 minutes after removal of ice cube.

    Time frame: Week 12

  9. Change From Baseline in Cold Urticaria Signs and Symptoms Severity Scale Score at Week 24

    Cold Urticaria Activity Score (ColdUAS) is disease-specific PRO questionnaire designed to determine cold urticaria disease activity. Intended for participants with cold urticaria aged 12 years old and above; developed and comprehensively tested with adults and adolescent participants with cold urticaria. Disease activity assessment was based on daily documentation of cold-induced skin reactions (wheals and swelling), skin sensations (itching, burning, pain or feeling hot), avoidance behavior and trigger exposure, and overall symptoms severity. Skin reaction, skin sensations, exposition to cold temperatures that usually cause ColdU symptoms and overall symptom severity were rated on a 4-point scale ranged from 0 (less severe) to 4 (more severe), where higher score indicated more signs and symptoms. LS mean and SE were analyzed using ANCOVA model with corresponding Baseline value, intervention group, region and background H1-antihistamine regular/daily use (Yes/No) as covariates.

    Time frame: Baseline, Week 24

  10. Change From Baseline in Percentage of Cold Urticaria Sign and Symptom-Free Days at Week 24

    ColdUAS: disease-specific PRO questionnaire to determine cold urticaria disease activity in adults and adolescents with cold urticaria. For change from Baseline in percentage of cold urticaria sign and symptom-free days, responses to ColdUAS question (Q) 1 (rating severity of signs: wheals and swelling) and ColdUAS, Q2 (rating severity of symptoms: itch, burning, pain, or feeling hot) on days exposed to cold (ColdUAS Q3 responded Yes) were used. Within 14-day interval before each visit the number of sign and symptom-free days (ColdUAS Q1=0 and Q2=0) on days exposed to cold (ColdUAS Q3 greater than \>0) was counted and divided by total number of days exposed to cold in this interval. Percentage of cold urticaria sign and symptom free days = sign and symptom free days/cold exposure days in 14 days window\*100. LS mean and SE by ANCOVA model with the corresponding Baseline value, intervention group, region and background H1-antihistamines regular/daily use (Yes/No) as covariates.

    Time frame: Baseline, Week 24

  11. Change From Baseline in Health-related Quality-of-life (HRQoL) as Measured by Dermatology Life Quality Index (DLQI) Scale Scores at Week 24

    DLQI is a PRO developed to measure dermatology-specific HRQoL in adults. It comprises 10 items assessing the impact of skin disease on participant's HRQoL over the previous week. The items cover symptoms, leisure activities, work/school or holiday time, personal relationships including intimate, side effects of treatment, and emotional reactions to having a skin disease. It is a validated questionnaire used in clinical practice and clinical trials. For 9-items; response scale was a 4-point Likert scale ranging from 0 = "Not at all" to 3 = "Very much", where higher score=more impact of QoL, and vice-versa. The remaining 1 item about work/studying was rated on a 3-point Likert scale ranged from 0="Not at all" to 2="A lot". DLQI total score was the sum of score of all the items and ranged from 0 to 30, with a high score indicated poor HRQoL, and vice-versa. LS mean and SE from ANCOVA model.

    Time frame: Baseline, Week 24

  12. Change From Baseline in Cold Urticaria Quality of Life (ColdU-QoL) Scale Score at Week 24

    The ColdU-QoL questionnaire is a disease-specific PRO questionnaire designed to assess the impact of cold urticaria on participant's HRQoL. It has been developed and comprehensively tested with adults and adolescent participants with cold urticaria. The questionnaire contains 19 items, each rated using a 5-point Likert scale ranged from 0 (Not at all / Never) to 4 (Very much / Very often). The total raw score of the ColdU-QoL was transformed to a 0 to 100 score for analysis using the formula: ColdU-QoL total score = Sum of the score of all completed items/Maximum possible sum of the score of all completed items\*100. Higher scores indicated higher ColdU-related QoL impairment, and vice-versa. LS mean and SE were analyzed from ANCOVA model with the corresponding Baseline value, intervention group, region and background H1-antihistamine regular/daily use (Yes or No) as covariates.

    Time frame: Baseline, Week 24

  13. Percentage of Participants Receiving Rescue Therapy for Primary Acquired Chronic Inducible Cold Urticaria

    Rescue therapy included additional doses of H1-antihistamines and short course of oral corticosteroids (OCS).

    Time frame: From first investigational medicinal product (IMP) administration (Day 1) up to Week 24

  14. Percentage of Participants With Cold Exposure Triggered Urticaria That Required Hospitalization/Emergency Medical Care Visit or Treatment With Epinephrine

    Percentage of participants with cold exposure triggered urticaria that required hospitalization/emergency medical care visit or treatment with epinephrine are reported in this endpoint.

    Time frame: From first IMP administration (Day 1) up to 14 weeks after last IMP administration (i.e., up to Week 36)

  15. Number of Participants With Treatment-emergent Adverse Events (TEAEs) and Treatment-emergent Serious Adverse Events (TESAEs)

    An Adverse Event (AE) was defined as any untoward medical occurrence in a participant who received study drug and did not necessarily have to have a causal relationship with the treatment. Serious adverse events (SAEs) was defined as any untoward medical occurrence that at any dose: resulted in death, was life-threatening, required inpatient hospitalization or prolongation of existing hospitalization, resulted in persistent or significant disability/incapacity, was a congenital anomaly/birth defect, or was a medically important event. TEAEs were defined as AEs that developed, worsened or became serious during the treatment-emergent period (from the first IMP administration to the last IMP administration + 14 weeks).

    Time frame: From first IMP administration (Day 1) up to 14 weeks after last IMP administration (i.e., up to Week 36)

  16. Number of Participants With Treatment-emergent Antidrug Antibodies (ADA) Response

    ADA response was categorized as: Treatment-emergent and Treatment-boosted. Treatment-emergent ADAs were defined as a positive response in the ADA assay post-first dose, when baseline results were negative or missing. Treatment-boosted ADAs: defined as an ADA positive response in the assay post first dose that was \>=4-fold over baseline titer levels, when Baseline results were positive. Titer values were defined as low titer (\< 1,000); moderate (1,000 less than or equal to \[\<=\] titer \<=10,000) and high titer (\> 10,000).

    Time frame: From first IMP administration (Day 1) up to 14 weeks after last IMP administration (i.e., up to Week 36)

07

Results

Posted Feb 21, 2024

Participant flow

Study was conducted at 32 active sites in 5 countries. A total of 123 participants were screened between 10 December 2020 and 22 June 2022, of which 41 were screen failures. Screen failures were mainly due to not meeting eligibility criteria.

Participant flow — Overall Study
MilestonePlaceboDupilumab
Started4042
Completed3031
Not completed1011
Withdrew: Lack of efficacy22
Withdrew: Withdrawal by subject89

Outcome measures

PrimaryPercentage of Participants With Negative Ice Cube Provocation Test at Week 24

The ice cube provocation test is the most frequently used provocation method for cold urticaria (ColdU). A negative ice cube provocation test was defined as the absence of confluent hives/wheal at the entire skin site of exposure after ice cube provocation test. Ice cube was applied on forearm skin for 5 minutes. Provocation test reading time was 10 minutes after removal of ice cube.

Time frame:
Week 24
Reported as:
Number · percentage of participants
Percentage of Participants With Negative Ice Cube Provocation Test at Week 24
percentage of participantsPlaceboDupilumab
Percentage of Participants With Negative Ice Cube Provocation Test at Week 2437.540.5
Statistical analysis
  • Placebo vs Dupilumab · Cochran-Mantel-Haenszel · p = 0.9492 (Cochran-Mantel-Haenszel test was performed on the association between the ice cube provocation test result and intervention group, stratified by region and background H1-antihistamine regular/daily use (Yes or No). Threshold of significance at 0.01.) · Odds ratio (or): 1.03 · 95% CI 0.41 to 2.56
SecondaryChange From Baseline in Urticaria Control Test (UCT) Scale Scores at Week 24

UCT is validated patient reported outcome (PRO) questionnaire used for assessing urticaria control. UCT has been developed and validated with participants Chronic Spontaneous Urticaria (CSU) and Chronic inducible urticaria (CIndU). It comprised of 4 items: severity of physical symptoms of urticaria (itch, hives and/or swelling); quality of life (QoL) impairment; frequency of treatment being not sufficient to control urticaria; overall urticarial control. Each item was rated on a 5-point Likert scale ranged from 0 (high disease activity) to 4 (low disease activity). The UCT total score was calculated as sum of all 4 individual item scores,ranged from 0 to 16. Higher scores indicated low disease activity, complete disease control, and vice-versa. Least square (LS) mean and standard error (SE) were analyzed using Analysis of covariance (ANCOVA) model with corresponding Baseline value, intervention group, region and background H1-antihistamine regular/daily use (Yes or No) as covariates.

Time frame:
Baseline to Week 24
Reported as:
Least squares mean · score on a scale
Change From Baseline in Urticaria Control Test (UCT) Scale Scores at Week 24
score on a scalePlaceboDupilumab
Change From Baseline in Urticaria Control Test (UCT) Scale Scores at Week 243.75 ± 0.894.36 ± 0.80
SecondaryPercentage of Participants With Urticaria Control Test Score >=12 at Week 24

The UCT is a validated PRO questionnaire used for assessing urticaria control. The questionnaire has been developed and validated with participants with CSU and CIndU. It comprised of 4 items: severity of physical symptoms of urticaria (itch, hives and/or swelling); QoL impairment; frequency of treatment being not sufficient to control urticaria; overall urticarial control. Each item was rated on a 5-point Likert scale ranging from 0 to 4, with low score indicating high disease activity and low disease control, and vice-versa. The UCT total score was calculated as sum of all 4 individual item scores, which ranged from 0 to 16. Higher scores indicated low disease activity and complete disease control, and vice-versa. A score of \>=12 on the scale indicates well-controlled urticaria. Percentage of participants with UCT score \>=12 (i.e., well controlled urticaria) at Week 24 are reported in this endpoint.

Time frame:
Week 24
Reported as:
Number · percentage of participants
Percentage of Participants With Urticaria Control Test Score >=12 at Week 24
percentage of participantsPlaceboDupilumab
Percentage of Participants With Urticaria Control Test Score >=12 at Week 2427.533.3
SecondaryPercentage of Participants With an Improvement of >=3 Points From Baseline in Urticaria Control Test Score at Week 24

The UCT is a validated PRO questionnaire used for assessing urticaria control. The questionnaire has been developed and validated with participants with CSU and CIndU. It comprised of 4 items: severity of physical symptoms of urticaria (itch, hives and/or swelling); QoL impairment; frequency of treatment being not sufficient to control urticaria; overall urticarial control. Each item was rated on a 5-point Likert scale ranging from 0 (high disease activity) to 4 (low disease activity), with low score indicating high disease activity and low disease control, and vice-versa. The UCT total score was calculated as sum of all 4 individual item scores, which ranged from 0 to 16. Higher scores indicated low disease activity and complete disease control, and vice-versa.

Time frame:
Baseline to Week 24
Reported as:
Number · percentage of participants
Percentage of Participants With an Improvement of >=3 Points From Baseline in Urticaria Control Test Score at Week 24
percentage of participantsPlaceboDupilumab
Percentage of Participants With an Improvement of >=3 Points From Baseline in Urticaria Control Test Score at Week 2430.045.2
SecondaryChange From Baseline in Local Wheal Intensity Likert Scale Score at Weeks 12 and 24

Wheal intensity Likert scale (ranging from 0 to 5) is a clinician-reported endpoint completed at the study visit, 10 minutes after removal of the ice cube from the participants' arm. The scale comprised of a single item assessing the intensity of participants' cutaneous reaction rated as follows: 0 = no wheals; 1 = numerous small, non-coalescent wheals; 2 = a large, regular, slightly edematous, coalescent wheal; 3 = a large and moderately edematous wheal; 4 = a large, regular, and significantly edematous wheal without pseudopodia; and 5 = a large, very edematous wheal with pseudopodia. Higher score indicated greater severity. LS mean and SE were analyzed using ANCOVA model with the corresponding Baseline value, intervention group, region and background H1-antihistamine regular/daily use (Yes or No) as covariates.

Time frame:
Baseline, Week 12 and Week 24
Reported as:
Least squares mean · score on a scale
Change From Baseline in Local Wheal Intensity Likert Scale Score at Weeks 12 and 24
score on a scalePlaceboDupilumab
Week 12-1.49 ± 0.23-1.19 ± 0.23
Week 24-1.52 ± 0.28-1.55 ± 0.27
SecondaryChange From Baseline in Local Itch Severity Scale Score at Weeks 12 and 24

Local itch (pruritus) severity was assessed using the peak pruritus numerical rating scale (NRS). Peak pruritus NRS is a PRO comprised of a single item rated on a scale ranged from 0 ("No itch") to 10 ("Worst itch imaginable"), where higher scores indicated worse itch. Participants were asked to rate the intensity of their worst local site itch (pruritus) 10 minutes after removal of the ice cube. LS mean and SE were analyzed using ANCOVA model with the corresponding Baseline value, intervention group, region and background H1-antihistamine regular/daily use (Yes or No) as covariates.

Time frame:
Baseline, Week 12 and Week 24
Reported as:
Least squares mean · score on a scale
Change From Baseline in Local Itch Severity Scale Score at Weeks 12 and 24
score on a scalePlaceboDupilumab
Week 12-2.12 ± 0.58-2.52 ± 0.59
Week 24-2.18 ± 0.63-2.43 ± 0.62
SecondaryChange From Baseline in Local Skin Burning Sensation Scale Score at Weeks 12 and 24

Local skin burning sensation was assessed using peak burning sensation NRS which is a PRO comprised of a single item rated on a scale ranged from 0 ("No burning sensation") to 10 ("Worst imaginable burning sensation"). Higher score indicated worst burning sensation. Participants were asked to rate the intensity of the worst local site burning sensation of their skin 10 minutes after the removal of the ice cube. LS mean and SE were analyzed using ANCOVA model with the corresponding Baseline value, intervention group, region and background H1-antihistamine regular/daily use (Yes or No) as covariates.

Time frame:
Baseline, Week 12 and Week 24
Reported as:
Least squares mean · score on a scale
Change From Baseline in Local Skin Burning Sensation Scale Score at Weeks 12 and 24
score on a scalePlaceboDupilumab
Week 12-1.60 ± 0.60-2.43 ± 0.61
Week 24-1.76 ± 0.69-2.04 ± 0.68
SecondaryChange From Baseline in Local Pain Severity Scale Score at Weeks 12 and 24

Local pain severity was assessed using peak pain NRS. The peak pain NRS is a PRO comprised of a single item rated on a scale ranged from 0 ("No pain") to 10 ("Worst imaginable pain"). Higher score indicated worst pain. Participants were asked to rate the intensity of their worst local site pain 10 minutes after removal of the ice cube. LS mean and SE was analyzed using ANCOVA model with the corresponding Baseline value, intervention group, region and background H1-antihistamine regular/daily use (Yes or No) as covariates.

Time frame:
Baseline, Week 12 and Week 24
Reported as:
Least squares mean · score on a scale
Change From Baseline in Local Pain Severity Scale Score at Weeks 12 and 24
score on a scalePlaceboDupilumab
Week 12-1.82 ± 0.54-2.14 ± 0.55
Week 24-1.60 ± 0.58-2.28 ± 0.57
SecondaryPercentage of Participants With Negative Ice Cube Provocation Test at Week 12

The ice cube provocation test is the most frequently used provocation method for ColdU. A negative ice cube provocation test was defined as the absence of confluent hives/wheal at the entire skin site of exposure after ice cube provocation test. Ice cube was applied on forearm skin for 5 minutes. Provocation test reading time was 10 minutes after removal of ice cube.

Time frame:
Week 12
Reported as:
Number · percentage of participants
Percentage of Participants With Negative Ice Cube Provocation Test at Week 12
percentage of participantsPlaceboDupilumab
Percentage of Participants With Negative Ice Cube Provocation Test at Week 1235.031.0
SecondaryChange From Baseline in Cold Urticaria Signs and Symptoms Severity Scale Score at Week 24

Cold Urticaria Activity Score (ColdUAS) is disease-specific PRO questionnaire designed to determine cold urticaria disease activity. Intended for participants with cold urticaria aged 12 years old and above; developed and comprehensively tested with adults and adolescent participants with cold urticaria. Disease activity assessment was based on daily documentation of cold-induced skin reactions (wheals and swelling), skin sensations (itching, burning, pain or feeling hot), avoidance behavior and trigger exposure, and overall symptoms severity. Skin reaction, skin sensations, exposition to cold temperatures that usually cause ColdU symptoms and overall symptom severity were rated on a 4-point scale ranged from 0 (less severe) to 4 (more severe), where higher score indicated more signs and symptoms. LS mean and SE were analyzed using ANCOVA model with corresponding Baseline value, intervention group, region and background H1-antihistamine regular/daily use (Yes/No) as covariates.

Time frame:
Baseline, Week 24
Reported as:
Least squares mean · score on a scale
Change From Baseline in Cold Urticaria Signs and Symptoms Severity Scale Score at Week 24
score on a scalePlaceboDupilumab
Change From Baseline in Cold Urticaria Signs and Symptoms Severity Scale Score at Week 24-1.04 ± 0.23-1.28 ± 0.22
SecondaryChange From Baseline in Percentage of Cold Urticaria Sign and Symptom-Free Days at Week 24

ColdUAS: disease-specific PRO questionnaire to determine cold urticaria disease activity in adults and adolescents with cold urticaria. For change from Baseline in percentage of cold urticaria sign and symptom-free days, responses to ColdUAS question (Q) 1 (rating severity of signs: wheals and swelling) and ColdUAS, Q2 (rating severity of symptoms: itch, burning, pain, or feeling hot) on days exposed to cold (ColdUAS Q3 responded Yes) were used. Within 14-day interval before each visit the number of sign and symptom-free days (ColdUAS Q1=0 and Q2=0) on days exposed to cold (ColdUAS Q3 greater than \>0) was counted and divided by total number of days exposed to cold in this interval. Percentage of cold urticaria sign and symptom free days = sign and symptom free days/cold exposure days in 14 days window\*100. LS mean and SE by ANCOVA model with the corresponding Baseline value, intervention group, region and background H1-antihistamines regular/daily use (Yes/No) as covariates.

Time frame:
Baseline, Week 24
Reported as:
Least squares mean · percentage of days
Change From Baseline in Percentage of Cold Urticaria Sign and Symptom-Free Days at Week 24
percentage of daysPlaceboDupilumab
Change From Baseline in Percentage of Cold Urticaria Sign and Symptom-Free Days at Week 2415.66 ± 7.4927.82 ± 7.26
SecondaryChange From Baseline in Health-related Quality-of-life (HRQoL) as Measured by Dermatology Life Quality Index (DLQI) Scale Scores at Week 24

DLQI is a PRO developed to measure dermatology-specific HRQoL in adults. It comprises 10 items assessing the impact of skin disease on participant's HRQoL over the previous week. The items cover symptoms, leisure activities, work/school or holiday time, personal relationships including intimate, side effects of treatment, and emotional reactions to having a skin disease. It is a validated questionnaire used in clinical practice and clinical trials. For 9-items; response scale was a 4-point Likert scale ranging from 0 = "Not at all" to 3 = "Very much", where higher score=more impact of QoL, and vice-versa. The remaining 1 item about work/studying was rated on a 3-point Likert scale ranged from 0="Not at all" to 2="A lot". DLQI total score was the sum of score of all the items and ranged from 0 to 30, with a high score indicated poor HRQoL, and vice-versa. LS mean and SE from ANCOVA model.

Time frame:
Baseline, Week 24
Reported as:
Least squares mean · score on a scale
Change From Baseline in Health-related Quality-of-life (HRQoL) as Measured by Dermatology Life Quality Index (DLQI) Scale Scores at Week 24
score on a scalePlaceboDupilumab
Change From Baseline in Health-related Quality-of-life (HRQoL) as Measured by Dermatology Life Quality Index (DLQI) Scale Scores at Week 24-4.70 ± 1.08-4.32 ± 1.00
SecondaryChange From Baseline in Cold Urticaria Quality of Life (ColdU-QoL) Scale Score at Week 24

The ColdU-QoL questionnaire is a disease-specific PRO questionnaire designed to assess the impact of cold urticaria on participant's HRQoL. It has been developed and comprehensively tested with adults and adolescent participants with cold urticaria. The questionnaire contains 19 items, each rated using a 5-point Likert scale ranged from 0 (Not at all / Never) to 4 (Very much / Very often). The total raw score of the ColdU-QoL was transformed to a 0 to 100 score for analysis using the formula: ColdU-QoL total score = Sum of the score of all completed items/Maximum possible sum of the score of all completed items\*100. Higher scores indicated higher ColdU-related QoL impairment, and vice-versa. LS mean and SE were analyzed from ANCOVA model with the corresponding Baseline value, intervention group, region and background H1-antihistamine regular/daily use (Yes or No) as covariates.

Time frame:
Baseline, Week 24
Reported as:
Least squares mean · score on a scale
Change From Baseline in Cold Urticaria Quality of Life (ColdU-QoL) Scale Score at Week 24
score on a scalePlaceboDupilumab
Change From Baseline in Cold Urticaria Quality of Life (ColdU-QoL) Scale Score at Week 24-20.12 ± 3.81-20.07 ± 3.65
SecondaryPercentage of Participants Receiving Rescue Therapy for Primary Acquired Chronic Inducible Cold Urticaria

Rescue therapy included additional doses of H1-antihistamines and short course of oral corticosteroids (OCS).

Time frame:
From first investigational medicinal product (IMP) administration (Day 1) up to Week 24
Reported as:
Number · percentage of participants
Percentage of Participants Receiving Rescue Therapy for Primary Acquired Chronic Inducible Cold Urticaria
percentage of participantsPlaceboDupilumab
H1-antihistamines32.545.2
OCS2.50
SecondaryPercentage of Participants With Cold Exposure Triggered Urticaria That Required Hospitalization/Emergency Medical Care Visit or Treatment With Epinephrine

Percentage of participants with cold exposure triggered urticaria that required hospitalization/emergency medical care visit or treatment with epinephrine are reported in this endpoint.

Time frame:
From first IMP administration (Day 1) up to 14 weeks after last IMP administration (i.e., up to Week 36)
Reported as:
Number · percentage of participants
Percentage of Participants With Cold Exposure Triggered Urticaria That Required Hospitalization/Emergency Medical Care Visit or Treatment With Epinephrine
percentage of participantsPlaceboDupilumab
Hospitalization/emergency medical care visit00
Epinephrine treatment00
SecondaryNumber of Participants With Treatment-emergent Adverse Events (TEAEs) and Treatment-emergent Serious Adverse Events (TESAEs)

An Adverse Event (AE) was defined as any untoward medical occurrence in a participant who received study drug and did not necessarily have to have a causal relationship with the treatment. Serious adverse events (SAEs) was defined as any untoward medical occurrence that at any dose: resulted in death, was life-threatening, required inpatient hospitalization or prolongation of existing hospitalization, resulted in persistent or significant disability/incapacity, was a congenital anomaly/birth defect, or was a medically important event. TEAEs were defined as AEs that developed, worsened or became serious during the treatment-emergent period (from the first IMP administration to the last IMP administration + 14 weeks).

Time frame:
From first IMP administration (Day 1) up to 14 weeks after last IMP administration (i.e., up to Week 36)
Reported as:
Count of participants · Participants
Number of Participants With Treatment-emergent Adverse Events (TEAEs) and Treatment-emergent Serious Adverse Events (TESAEs)
ParticipantsPlaceboDupilumab
TEAEs2723
TESAEs01
SecondaryNumber of Participants With Treatment-emergent Antidrug Antibodies (ADA) Response

ADA response was categorized as: Treatment-emergent and Treatment-boosted. Treatment-emergent ADAs were defined as a positive response in the ADA assay post-first dose, when baseline results were negative or missing. Treatment-boosted ADAs: defined as an ADA positive response in the assay post first dose that was \>=4-fold over baseline titer levels, when Baseline results were positive. Titer values were defined as low titer (\< 1,000); moderate (1,000 less than or equal to \[\<=\] titer \<=10,000) and high titer (\> 10,000).

Time frame:
From first IMP administration (Day 1) up to 14 weeks after last IMP administration (i.e., up to Week 36)
Reported as:
Count of participants · Participants
Number of Participants With Treatment-emergent Antidrug Antibodies (ADA) Response
ParticipantsPlaceboDupilumab
Treatment-emergent ADAs04
Treatment-boosted ADAs00

Adverse events

Collected over From first IMP administration (Day 1) up to 14 weeks after last IMP administration (i.e., up to Week 36). Non-serious events are listed at a 5% frequency threshold.

Adverse event summary by group
GroupDeathsSeriousOther
Placebo0/39 (0%)0/39 (0%)16/39 (41%)
Dupilumab0/43 (0%)1/43 (2.3%)14/43 (32.6%)
Most frequent serious events
Most frequent serious events
EventPlaceboDupilumab
Bipolar DisorderPsychiatric disorders0/391/43
Most frequent other events
Most frequent other events
EventPlaceboDupilumab
Covid-19Infections and infestations8/395/43
Injection Site ReactionGeneral disorders1/396/43
Injection Site PainGeneral disorders1/394/43
Suspected Covid-19Infections and infestations3/392/43
Injection Site ErythemaGeneral disorders0/393/43
PyrexiaGeneral disorders2/390/43
Accidental OverdoseInjury, poisoning and procedural complications2/391/43
HeadacheNervous system disorders2/391/43
Eczema AsteatoticSkin and subcutaneous tissue disorders2/390/43

Baseline characteristics

Randomized population consisted of all participants from the screened population who had been allocated to randomized intervention by interactive response technology regardless of whether the treatment kit was used or not.

Age, Continuous
Age, Continuous(years)PlaceboDupilumabTotal
Mean37.9 ± 16.333.0 ± 13.135.4 ± 14.9
Sex: Female, Male
Sex: Female, Male(Participants)PlaceboDupilumabTotal
Female303363
Male10919
Race (NIH/OMB)
Race (NIH/OMB)(Participants)PlaceboDupilumabTotal
American Indian or Alaska Native000
Asian4610
Native Hawaiian or Other Pacific Islander000
Black or African American101
White353570
More than one race011
Unknown or Not Reported000
08

Study locations

33 sites
  • Allergy and Asthma Medical Group and Research Center-Site Number:8400001
    San Diego, California 92123, United States
  • Treasure Valley Medical Research-Site Number:8400007
    Boise, Idaho 83706, United States
  • Allergy & Asthma Specialists, PSC-Site Number:8400003
    Owensboro, Kentucky 42301, United States
  • Johns Hopkins University (Asthma and Allergy Center)-Site Number:8400005
    Baltimore, Maryland 21224, United States
  • Bernstein Allergy Group Inc-Site Number:8400004
    Cincinnati, Ohio 45231, United States
  • Investigational Site Number :0320001
    CABA, Buenos Aires C1023AAB, Argentina
  • Investigational Site Number :0320005
    CABA, Buenos Aires C1181ACH, Argentina
  • Investigational Site Number :0320006
    CABA, Buenos Aires C1414AIF, Argentina
  • Investigational Site Number :0320002
    Rosario, Santa Fe Province 2000, Argentina
  • Investigational Site Number :0320004
    San Miguel de Tucumán, Tucumán Province T4000AXL, Argentina
  • Investigational Site Number :0320003
    Buenos Aires, C1121ABE, Argentina
  • Investigational Site Number :1240008
    Edmonton, Alberta T5J 3S9, Canada
  • Investigational Site Number :1240010
    Edmonton, Alberta T6G 1C3, Canada
  • Investigational Site Number :1240007
    Hamilton, Ontario L8L 3C3, Canada
  • Investigational Site Number :1240009
    Hamilton, Ontario L8S1G5, Canada
  • Investigational Site Number :1240001
    Toronto, Ontario M3B 3S6, Canada
  • Investigational Site Number :1240011
    Montreal, Quebec H4A 3T2, Canada
  • Investigational Site Number :1240005
    Saint-Charles-Borromée, Quebec J6E 2B4, Canada
  • Investigational Site Number :1240006
    Sherbrooke, Quebec J1L 0H8, Canada
  • Investigational Site Number :1240002
    Québec, G1V 4W2, Canada
  • Investigational Site Number :2760002
    Berlin, 10117, Germany
  • Investigational Site Number :2760004
    Dresden, 01307, Germany
  • Investigational Site Number :2760007
    Erlangen, 91054, Germany
  • Investigational Site Number :2760006
    Hanover, 30625, Germany
  • Investigational Site Number :2760005
    Leipzig, 04103, Germany
  • Investigational Site Number :2760001
    Mainz, 55131, Germany
  • Investigational Site Number :3920002
    Nagoya, Aichi-ken 454-8509, Japan
  • Investigational Site Number :3920003
    Hiroshima, Hiroshima 734-8551, Japan
  • Investigational Site Number :3920008
    Kamimashiki Gun, Kumamoto 861-3106, Japan
  • Investigational Site Number :3920007
    Sakai-shi, Osaka 593-8324, Japan
  • Investigational Site Number :3920010
    Koto-ku, Tokyo 136-0074, Japan
  • Investigational Site Number :3920011
    Tachikawa-shi, Tokyo 190-0023, Japan
  • Investigational Site Number :3920009
    Habikino-Shi, 583-0872, Japan
09

References and documents

Study documents

  • Study protocol · Sep 27, 2022
  • Statistical analysis plan · Oct 3, 2022

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

Individual participant data

Plan to share: Yes — Qualified researchers may request access to patient level data and related study documents including the clinical study report, study protocol with any amendments, blank case report form, statistical analysis plan, and dataset specifications. Patient level data will be anonymized and study documents will be redacted to protect the privacy of trial participants. Further details on Sanofi's data sharing criteria, eligible studies, and process for requesting access can be found at: https://vivli.org

10

Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Sep 10, 2025, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
11

Registry details

Key details

Study ID
NCT04681729
Lead sponsor
Sanofi
Collaborators
Regeneron Pharmaceuticals
Responsible party
Sponsor
First posted
Dec 23, 2020
Start date
Dec 10, 2020
Primary completion
Feb 2, 2023
Completion
Apr 20, 2023
Results posted
Feb 21, 2024
Last update
Sep 10, 2025

Study contacts

Clinical Sciences & Operations
study director · Sanofi

Oversight

Data monitoring committee
No
FDA-regulated drug
Yes
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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