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An International, Multicenter, Randomized, Double-Blind, Parallel Group, Vehicle-Controlled, Phase 2/3 Study With Open-Label Extension Evaluating the Efficacy and Safety of Diacerein 1% Ointment for the Treatment of Generalized Epidermolysis Bullosa Simplex (EBS)

PHASE2PHASE3RECRUITING

The proposed Phase 2/3 trial with double-blind and open-label extension phases is an international, multicenter study designed to assess the efficacy and safety of diacerein 1% ointment in patients with generalized EBS.

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Study details:

Epidermolysis bullosa simplex (EBS) is a genetic skin disorder characterized by skin fragility and recurrent blister formation, primarily caused by mutations in keratins 5 and 14. EBS has 3 common subtypes based on clinical severity and manifestations: localized EBS, intermediate EBS and severe EBS. Severe EBS and intermediate EBS collectively are also known as generalized EBS due to widespread blistering.

Disruption of the keratin 5/14 filament network in basal keratinocytes is a key factor in EBS pathogenesis, compromising skin integrity. The severity of EBS is linked to the extent of keratin mutations disrupting this network, particularly resulting in keratin aggregates in severe cases. Recent studies suggest that mutated keratin proteins can trigger inflammation, exacerbating EBS.

Elevated proinflammatory cytokines, like IL-1β and IL-6, are observed in EBS patients, and IFN-γ may mediate inflammation, promoting keratin aggregations. As a result, targeting inflammation is considered a potential therapeutic approach in EBS. AC-203 (diacerein 1% ointment) is a topical formulation of diacerein, well-known for its ability to inhibit IL-1β and other proinflammatory cytokines.

Moreover, diacerein and its active metabolite, rhein, have demonstrated ability in reducing keratin aggregates in keratinocytes derived from severe EBS. Taken together, with its anti-inflammatory property and ability to diminish keratin aggregation, AC-203 shows promise in reducing the clinical severity of EBS.

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Eligibility criteria

Researchers look for people who fit a certain description, called eligibility criteria. See if you qualify.

Inclusion criteria

Patient is at least 6 months old at Visit 2 (Day 1/Baseline A).

Patients has been clinically diagnosed with severe EBS or intermediate EBS, confirmed by documented genetic diagnosis to have autosomal dominant mutations in KRT5 or KRT14 gene.

Patients with ≥ 5% BSA of EBS lesions excluding palms and soles at Visit 2 (Day 1/Baseline A).

Patient's EBS lesions within the Treatment Area have an IGA score of ≥3 at Visit 2 (Day 1/Baseline A).

Patient/caregiver agrees to follow study medication application instructions.

Patient (and caregiver/legal guardian) agrees to report use of all prescription and over-the-counter medications, including topical therapies applied to the body, e.g., medical cleansers, bleach cleansers, bleach baths, topical antiseptics, topical disinfectants, etc. for the duration of the study.

Patient (and caregiver/legal guardian) is willing and able to comply with all study visits and all the protocol requirements, including completing questionnaires.

Patient (and caregiver/legal guardian) is able to provide written informed consent; assent based on age.

Female patient of childbearing potential must have a negative pregnancy test prior to randomization.

Female patient of childbearing potential is willing to practice highly effective contraception (i.e., pregnancy prevention method with a failure rate of < 1% per year) from Screening throughout the end of the study.

Exclusion criteria

Patient has a clinically significant skin disease other than EBS (e.g., psoriasis, atopic dermatitis, eczema, sun damage, etc.), or a vascular disorder associated with cutaneous erosions/ulcerations, that may confound assessments of efficacy or safety.

Patient has a clinically significant underlying medical condition, psychiatric condition (such as major depressive or psychotic disorder, severe intellectual disability, or alcohol or drug use disorder), or requires concomitant medication that based on the investigator's judgement may impair evaluation of the Treatment Area or exposes the patient to an unacceptable risk by study participation.

Patient has used any diacerein-containing product within 6 months prior to Visit 2 (Day 1/Baseline A).

Patient has had a cutaneous infection in the Treatment Area or use systemic antibiotics within 7 days prior to Visit 2 (Day 1/Baseline A).

Patient has uncontrolled diabetes mellitus (HbA1c ≥ 6.5%), hepatic enzyme abnormalities (alanine aminotransferase or aspartate aminotransferase >2.5 the upper limit of normal (ULN), or total bilirubin >2.0x ULN), or renal abnormalities (estimated glomerular filtration rate [eGFR]< 30 ml/min/1.73 m2) during the Screening period.

Patient has a current malignancy, or a history of treatment for a malignancy within 5 years (with the exception of treated non-melanoma cutaneous malignancy e.g., surgically resected with clear margins) prior to Visit 2 (Day 1/Baseline A).

Patient is treated with protocol-excluded topical therapies other than steroids within 2 weeks prior to Visit 2 (Day 1/Baseline A) that might influence the assessment of the Treatment Area throughout the study period.

Patient has been treated with topical steroids on the EBS lesions within 2 weeks or systemic steroids within 4 weeks. prior to Visit 2 (Day 1/Baseline A). (Note: inhaled and ophthalmic products containing steroids are allowed.)

Patient has been treated with: (a) an approved biologic anti-inflammatory therapy (such as monoclonal antibodies that target to modulate the immune responses) and (b) other immunosuppressive/immunomodulatory therapies or chemotherapy within 8 weeks prior to Visit 2 (Day 1/Baseline A).

Patient has been treated with any investigational drug or device within 30 days or 5 half-lives, whichever is longer, prior to Visit 2 (Day 1/Baseline A).

Patient has a history of allergy or hypersensitivity to any component of study medications, including diacerein or rhein.

Patient is pregnant or breastfeeding/lactating.

Patient has a planned or anticipated major surgical procedure or other activity that would interfere with their ability to comply with protocol requirements.

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Eligibility

Age eligible for study : 6 and older

Healthy volunteers accepted : No

Gender eligible for study: All

Things to know

Study dates

Study start: 2024-04-04

Primary completion: 2025-08-01

Study completion finish: 2026-03-01

Study type

TREATMENT

Phase

PHASE2

PHASE3

Trial ID

NCT06073132

Intervention or treatment

DRUG: AC-203

DRUG: Vehicle

Conditions

• Generalized Epidermolysis Bullosa Simplex

Image related to Generalized Epidermolysis Bullosa Simplex

Condition: Generalized Epidermolysis Bullosa Simplex
DRUG: AC-203 and other drugs
Randwick, Not Specified, Australia and more
Sponsor: TWi Biotechnology, Inc.

You may be eligible to participate in this trial based on your search. Check eligibility by answering some questions.

Are you running this trial? If you're a clinic or sponsor, you can claim this study. Claim or learn more.

Find a site

Closest Location:

Sydney Children's Hospital

Research sites nearby

Select from list below to view details:

Sydney Children's Hospital
Randwick, Not Specified, Australia
Premier Specialists
Kogarah, Not Specified, Australia

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Participant Group/Arm	Intervention/Treatment
EXPERIMENTAL: Part A AC-203 Double-blind, AC-203 Diacerein 1% ointment, QD	DRUG: AC-203 The investigational product is formulated as 1% topical ointment
PLACEBO_COMPARATOR: Part A Vehicle ointment Double-blind, Vehicle ointment, QD	DRUG: Vehicle Vehicle-only control study medication is the same formulation as investigational product without active ingredient
EXPERIMENTAL: Part B AC-203 Open-label extension phase, AC-203 Diacerein 1% ointment, QD	DRUG: AC-203 The investigational product is formulated as 1% topical ointment

What is the study measuring?

Primary outcome

Primary Outcome Measure	Primary Outcome Description	Primary Outcome Time Frame
Proportion of patients achieving treatment success on the IGA of the Treatment Area, in which treatment success is defined as a score of 0 or 1 with at least a 2-point reduction	The static IGA is the investigator's visual clinical assessment of the average overall intensity of lesions in the designated Treatment Area at a particular time point. EBS-IGA is a 5-point scale is a 5-point scale (clear=0; almost clear=1; mild=2; moderate=3; severe=4)	from Baseline A (Visit 2/Day 1) to Week 8 (Visit 5/EOT)

Secondary outcome

Secondary Outcome Measure	Secondary Outcome Description	Secondary Outcome Time Frame
Change in % BSA of EBS lesions in the Treatment Area	The Body Surface Area (BSA) of the Assessment Area will be collected for all lesions included within the Treatment Area using the palmar method	from Baseline A (Visit 2/Day 1) to Week 8 (Visit 5/EOT)
Change in pain intensity score	Wong-Baker FACES® Pain Rating Scale will be used for patients 3 years and older.	Baseline A (Visit 2/Day 1) to Week 8 (Visit 5/EOT)
Change in pruritus intensity score	ItchyQuant will be used for patients aged 6 years and older, including adult patients	from Baseline A (Visit 2/Day 1) to Week 8 (Visit 5/EOT)
Change in EBDASI score (skin activity)	The EBDASI is a valid and reliable EB-specific outcome measurement tool to assess the overall extent of disease activity and damage in patients with various subtypes of EB, including EBS. Section I (skin), the severity of disease, including erosion/blisters/crusting etc., will be measured at 12 different skin sites.	from Baseline A (Visit 2/Day 1) to Week 8 (Visit 5/EOT).
Change in the QOLEB score	The Life Epidermolysis Bullosa (QOLEB) questionnaire is a valid and reliable, EB-specific QOL measurement tool, for the quantification of QOL in patients with various subtypes of EB, including EBS. It consists of 17 questions with four response choices from "not at all" to "constant"	from Baseline A (Visit 2/Day 1) to Week 8 (Visit 5/EOT)

Frequently Asked Questions

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References

Clinical Trials Gov: An International, Multicenter, Randomized, Double-Blind, Parallel Group, Vehicle-Controlled, Phase 2/3 Study With Open-Label Extension Evaluating the Efficacy and Safety of Diacerein 1% Ointment for the Treatment of Generalized Epidermolysis Bullosa Simplex (EBS)