Clobetasol propionate emulsion formulation foam 0.05%: review of phase II open-label and phase III randomized controlled trials in steroid-responsive dermatoses in adults and adolescents.
BACKGROUND
Clobetasol propionate 0.05% emulsion foam was recently developed for use on multiple body sites.


OBJECTIVE
We sought to evaluate safety and efficacy of clobetasol emulsion foam 0.05% to treat steroid-responsive dermatoses in multiple age groups.


METHODS
A phase II open-label study evaluated the effect of clobetasol foam on the hypothalamic-pituitary-adrenal axis in 52 participants aged 6 years or older with mild-to-severe atopic dermatitis (AD). Cosyntropin stimulation test was used to determine the effect of clobetasol foam on hypothalamic-pituitary-adrenal axis, with a normal response considered to be a postinjection serum cortisol level greater than 18 mug/dL. Another phase II open-label pharmacokinetic safety study was conducted in 32 participants aged 12 years or older with mild-to-moderate plaque-type psoriasis. Pharmacokinetic parameters evaluated included maximal plasma concentration of clobetasol propionate, time to achieve maximum concentration, and area under the curve. Two phase III, randomized controlled studies assessed treatment success in participants aged 12 years or older with moderate-to-severe AD (N = 377) or mild-to-moderate plaque-type psoriasis (N = 497). In all studies, participants received study drug for 2 weeks. In the AD study, treatment success was determined using a composite end point requiring an Investigator's Static Global Assessment (ISGA) score of 0 or 1, erythema score of 0 or 1, induration/papulation score of 0 or 1, and improvement in the ISGA score of at least two grades from baseline. Likewise, the study in plaque-type psoriasis used a composite end point requiring an ISGA score of 0 or 1, erythema score of 0 or 1, scaling score of 0 or 1, plaque thickness score of 0, and improvement in the ISGA score of at least two grades from baseline.


RESULTS
Significantly more participants achieved treatment success on clobetasol foam than vehicle foam (P < .0001 and P = .0005 for each study). Reversible hypothalamic-pituitary-adrenal axis suppression was observed in 27% of participants aged 18 years or older and 47% in participants aged between 6 and younger than 12 years, but 0% in participants aged between 12 and younger than 18 years.


CONCLUSIONS
The studies evaluated short-term use only.


CONCLUSIONS
Clobetasol emulsion formulation foam is safe and effective for treatment of moderate-to-severe AD and mild-to-moderate plaque-type psoriasis in patients aged 12 years or older.
Kimball
Alexa Boer
AB
Clinical Unit for Research Trials in Skin, Massachusetts General and Brigham and Women's Hospitals, Harvard Medical School, Boston, Massachusetts.
Gold
Michael H
MH
Zib
Beth
B
Davis
Mark W
MW
D000279:Administration, Cutaneous; D000293:Adolescent; D000309:Adrenal Insufficiency / Q000139:chemically induced* / Q000175:diagnosis; D000328:Adult; D000367:Age Factors; D000368:Aged; D019540:Area Under Curve; D001682:Biological Availability; D002648:Child; D002990:Clobetasol / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D003366:Cosyntropin / Q000008:administration & dosage; D003876:Dermatitis, Atopic / Q000097:blood / Q000188:drug therapy*; D004655:Emulsions; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D008875:Middle Aged; D010912:Pituitary-Adrenal Function Tests; D011565:Psoriasis / Q000097:blood / Q000188:drug therapy*; D016896:Treatment Outcome
D004655:Emulsions; D007166:Immunosuppressive Agents; D003366:Cosyntropin; D002990:Clobetasol; D006854:Hydrocortisone