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Open Access Highly Accessed Study protocol

UK Dermatology Clinical Trials Network’s STOP GAP trial (a multicentre trial of prednisolone versus ciclosporin for pyoderma gangrenosum): protocol for a randomised controlled trial

Fiona F Craig1, Kim S Thomas2*, Eleanor J Mitchell3, Hywel C Williams2, John Norrie4, James M Mason6, Anthony D Ormerod5* and on behalf of the UK Dermatology Clinical Trials Network’s STOP GAP Trial Team

Author Affiliations

1 Department of Dermatology, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, AB25 2ZN, UK

2 University of Nottingham, Centre of Evidence Based Dermatology, King’s Meadow Campus, Lenton Lane, Nottingham, NG7 2NR, UK

3 Nottingham Clinical Trials Unit, Nottingham Health Science Partners, C Floor, South Block, Queen’s Medical Centre, Derby Road, Nottingham, NG7 2UH, UK

4 University of Aberdeen, Centre for Healthcare Randomised Trials, Health Services Research Unit, 3 rd floor, Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, UK

5 Division of Applied Medicine, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZN, UK

6 University of Durham, School of Medicine and Health, University of Durham, Queen's Campus, Wolfson Research Institute, University Boulevard, Stockton-on-Tees, TS17 6BH, UK

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Trials 2012, 13:51  doi:10.1186/1745-6215-13-51

Published: 28 April 2012

Abstract

Background

Pyoderma gangrenosum (PG) is a rare inflammatory skin disorder characterised by painful and rapidly progressing skin ulceration. PG can be extremely difficult to treat and patients often require systemic immunosuppression. Recurrent lesions of PG are common, but the relative rarity of this condition means that there is a lack of published evidence regarding its treatment. A systematic review published in 2005 found no randomised controlled trials (RCTs) relating to the treatment of PG. Since this time, one small RCT has been published comparing infliximab to placebo, but none of the commonly used systemic treatments for PG have been formally assessed. The UK Dermatology Clinical Trials Network’s STOP GAP Trial has been designed to address this lack of trial evidence.

Methods

The objective is to assess whether oral ciclosporin is more effective than oral prednisolone for the treatment of PG. The trial design is a two-arm, observer-blind, parallel-group, randomised controlled trial comparing ciclosporin (4 mg/kg/day) to prednisolone (0.75 mg/kg/day). A total of 140 participants are to be recruited over a period of 4 years, from up to 50 hospitals in the UK and Eire. Primary outcome of velocity of healing at 6 weeks is assessed blinded to treatment allocation (using digital images of the ulcers). Secondary outcomes include: (i) time to healing; (ii) global assessment of improvement; (iii) PG inflammation assessment scale score; (iv) self-reported pain; (v) health-related quality of life; (vi) time to recurrence; (vii) treatment failures; (viii) adverse reactions to study medications; and (ix) cost effectiveness/utility. Patients with a clinical diagnosis of PG (excluding granulomatous PG); measurable ulceration (that is, not pustular PG); and patients aged over 18 years old who are able to give informed consent are included in the trial. Randomisation is by computer generated code using permuted blocks of randomly varying size, stratified by lesion size, and presence or absence of underlying systemic disease (for example, rheumatoid arthritis).

Patients who require topical therapy are asked to enter a parallel observational study (case series). If topical therapy fails and systemic therapy is required, participants are then considered for inclusion in the randomised trial.

Trial registration

Current controlled trials: ISRCTN35898459. Eudract No.2008-008291-14.

Keywords:
Ciclosporin (cyclosporin); Prednisolone; Pyoderma gangrenosum; RCT