Study to Evaluate the Safety and Tolerability of AC-1101 Topical Gel in Patients with Granuloma Annulare

Inclusion criteria

• Patients 18 years of age or older, male or female, will be enrolled.
• Diagnosis of granuloma annulare with supportive skin biopsy (diagnostic shave biopsy or punch biopsy) or historical biopsy (a provided report would be sufficient and would not require to repeat the diagnostic biopsy). A biopsy at any point is sufficient. If a diagnostic biopsy has never been performed, one will be performed prior to enrollment in the study. Patients with both localized and generalized GA will be enrolled in the proposed study.
• Other subtypes of GA, such as linear, perforating, and subcutaneous will be excluded from the study. If there is suspicion that GA is medication-induced, the patient will not be enrolled. GA in association with human immunodeficiency virus (HIV) or malignancy will be excluded.
• Patients with 1-20% BSA of active Granuloma Annulare lesions will be enrolled.
• Duration of active GA must be at least two years with no significant change in size or number of lesions in the 6 months prior to treatment as supported by a combination of record review and history/patient interview.
• Patients who might be recalcitrant to or intolerant of conventional treatment, such as antibiotics (e.g., doxycycline or minocycline), triple antibiotic therapy of rifampin, ofloxacin, and minocycline, topical corticosteroids, topical calcineurin inhibitors, intralesional/intramuscular corticosteroid and/or phototherapy.
• Adequate organ function and marrow function meaured at screening (Visit 1) and enrollment (Visit 2) as defined below:

• Hemoglobin ≥ 12.0 g/dL for male and 10.5 g/dL for female;
• Absolute neutrophil count ≥ 1,300 /µL;
• Absolute lymphocytes: 1.0-4.0 x 109/L (1000-4000 cells/mm3) as the reference range;
• Platelets ≥ 75,000/µL;
• Total bilirubin ≤ 1.5 x upper normal limit;
• AST(SGOT)/ALT(SGPT) ≤ 2.5 x upper normal limit;
• eGFR ≥ 60mL/min/1.73m2
• Females of childbearing potential who are sexually active with a male partner must be willing to use one of the following acceptable contraceptive methods throughout the study and for 30 days after the last study drug administration.

• Intra-uterine contraceptive device without hormone release system placed at least 4 weeks prior to study drug administration.
• Male partner using condom with intravaginally applied spermicide started at least 21 days prior to study drug administration.
• Sterile male partner (vasectomized since at least 6 months).
• Barrier method of contraception: condoms (male or female) with or without a spermicidal agent, diaphragm or cervical cap with spermicide, bilateral tubal occlusion, sexual abstinence (when this is in line with preferred and usual lifestyle). No combined hormonal contraceptive methods (such as most oral pills, rings or patches) are permitted.
• Capable of consent: Able to read, understand, and sign the Informed Consent Form (ICF), answer the study questionnaires, communicate with the Investigator, and understand and comply with protocol requirements.
• Patients must speak English.
• Patients must have health insurance.

Exclusion criteria

• Patients with active malignancy will not be permitted to enroll in the proposed study. Patients with a history of treated nonmelanoma skin cancer will be eligible to enroll.
• Patients under treatment with biologics or other systemic immunosuppressive medications (e.g., methotrexate (MTX), mycophenolate) within the last 3 months.
• Presence of any clinically significant abnormality at physical examination, clinically significant abnormal laboratory assessment or positive test for hepatitis B (HBs-Ag), hepatitis C (HCV-Ab), or HIV found during medical screening.
• History of allergic reactions to tofacitinib or other related drugs, or to any excipient in the formulation.
• Positive pregnancy test at screening. If a woman becomes pregnant during the study, she will stop the study medication and be removed from the study. She will be urged to follow up with her Primary Care Physician or obstetrician-gynecologist. The study doctors will ask to follow the pregnancy to its outcome.
• Women of childbearing potential who are unable or unwilling to use birth control (oral pills, rings or patches are not permitted) while taking the medication.
• Pregnant or breast-feeding women.
• Current active smokers.
• Participation in a clinical research study involving the administration of an investigational or marketed drug or device within 30 days prior to the first dosing, administration of a biological product in the context of a clinical research study within 90 days prior to the first dosing, or concomitant participation in an investigational study involving drug or device administration.
• History of active tuberculosis or exposure to endemic areas within 8 weeks prior to QuantiFERON®-TB testing performed at screening.
• Positive QuantiFERON®-TB indicating possible tuberculosis infection.
• Immunization with a live attenuated vaccine within 1 month prior to dosing or planned vaccination during the study.
• History of clinically significant opportunistic infection, e.g., invasive fungal infections or pneumocystis pneumonia.
• Serious local infection, e.g., cellulitis, abscess, or systemic infection, e.g., septicemia, within 3 months prior to screening.
• Use of medications for the timeframes specified below, with the exception of medications exempted by the Investigator on a case-by-case basis, such as Acetaminophen (2g in 24-hour period) because they are judged unlikely to affect the PK profile of the study drug or subject safety:

• Prescription medications within 14 days prior to the first dosing with the exception of on-going medications to treat existing comorbid disorders, as judged by the Investigator.
• Topical medications inlcuding antibiotics or corticosteriod applied to the designated treatment area.
• Depot injection or implant of any drug within 3 months prior to the first dosing.
• Any drugs known to significantly induce or inhibit hepatic drug metabolism via the CYP3A4 and CYP2C19 enzymes within 30 days prior to first dosing.
• Fever associated with a symptomatic viral or bacterial infection, within 2 weeks prior to the first dosing.
• Subjects with a personal history of significant coronary heart disease, heart failure, and/or cerebrovascular disease.
• Any reason that, in the opinion of the Investigator, would prevent the subject from participating in the study.