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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)

Primary Purpose

Generalized Epidermolysis Bullosa Simplex

Status
Not yet recruiting
Phase
Phase 2
Locations
Study Type
Interventional
Intervention
AC-203
Vehicle
Sponsored by
TWi Biotechnology, Inc.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Generalized Epidermolysis Bullosa Simplex focused on measuring Epidermolysis Bullosa Simplex, EBS

Eligibility Criteria

6 Months - undefined (Child, Adult, Older Adult)All SexesDoes not accept healthy volunteers

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 hands and feet 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) and prior to Visit 7 (Week 16/Baseline B). 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 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 or systemic corticosteroids within 4 weeks and with other immunosuppressive/immunomodulatory therapies or chemotherapy within 8 weeks prior to Visit 2 (Day 1/Baseline A) and prior to Visit 7 (Week 16/Baseline B). Patient has been treated with an approved or investigational biologic anti-inflammatory therapy (such as monoclonal antibodies that target to modulate the immune responses) 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.

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm 3

    Arm Type

    Experimental

    Placebo Comparator

    Experimental

    Arm Label

    Part A AC-203

    Part A Vehicle ointment

    Part B AC-203

    Arm Description

    Double-blind, AC-203 Diacerein 1% ointment, QD

    Double-blind, Vehicle ointment, QD

    Open-label extension phase, AC-203 Diacerein 1% ointment, QD

    Outcomes

    Primary Outcome Measures

    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)

    Secondary Outcome Measures

    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
    Change in pain intensity score (Numeric Rating Scale for pain)
    NRS (Numerical Rating Scale) is a numerical scale that measures the intensity of pain.Scale ranges from 0 to 10, where 0 is no pain and 10 being maximum/ worst imaginable pain.
    Change in pruritus intensity score (Numeric Rating Scale for pruritus)
    NRS (Numerical Rating Scale) is a numerical scale that measures the intensity of pruritus, with 10 being the greatest intensity. 0 is no itch and 10 being maximum// worst imaginable itch.
    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"
    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.

    Full Information

    First Posted
    September 12, 2023
    Last Updated
    October 3, 2023
    Sponsor
    TWi Biotechnology, Inc.
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    1. Study Identification

    Unique Protocol Identification Number
    NCT06073132
    Brief Title
    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)
    Official Title
    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)
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    October 2023
    Overall Recruitment Status
    Not yet recruiting
    Study Start Date
    December 2023 (Anticipated)
    Primary Completion Date
    August 2025 (Anticipated)
    Study Completion Date
    March 2026 (Anticipated)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Sponsor
    Name of the Sponsor
    TWi Biotechnology, Inc.

    4. Oversight

    Studies a U.S. FDA-regulated Drug Product
    Yes
    Studies a U.S. FDA-regulated Device Product
    No
    Data Monitoring Committee
    Yes

    5. Study Description

    Brief Summary
    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.
    Detailed Description
    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.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Generalized Epidermolysis Bullosa Simplex
    Keywords
    Epidermolysis Bullosa Simplex, EBS

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Phase 2, Phase 3
    Interventional Study Model
    Parallel Assignment
    Masking
    ParticipantCare ProviderInvestigatorOutcomes Assessor
    Allocation
    Randomized
    Enrollment
    80 (Anticipated)

    8. Arms, Groups, and Interventions

    Arm Title
    Part A AC-203
    Arm Type
    Experimental
    Arm Description
    Double-blind, AC-203 Diacerein 1% ointment, QD
    Arm Title
    Part A Vehicle ointment
    Arm Type
    Placebo Comparator
    Arm Description
    Double-blind, Vehicle ointment, QD
    Arm Title
    Part B AC-203
    Arm Type
    Experimental
    Arm Description
    Open-label extension phase, AC-203 Diacerein 1% ointment, QD
    Intervention Type
    Drug
    Intervention Name(s)
    AC-203
    Intervention Description
    The investigational product is formulated as 1% topical ointment
    Intervention Type
    Drug
    Intervention Name(s)
    Vehicle
    Intervention Description
    Vehicle-only control study medication is the same formulation as investigational product without active ingredient
    Primary Outcome Measure Information:
    Title
    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
    Description
    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)
    Time Frame
    from Baseline A (Visit 2/Day 1) to Week 8 (Visit 5/EOT)
    Secondary Outcome Measure Information:
    Title
    Change in % BSA of EBS lesions in the Treatment Area
    Description
    The Body Surface Area (BSA) of the Assessment Area will be collected for all lesions included within the Treatment Area using the palmar method
    Time Frame
    from Baseline A (Visit 2/Day 1) to Week 8 (Visit 5/EOT)
    Title
    Change in pain intensity score (Numeric Rating Scale for pain)
    Description
    NRS (Numerical Rating Scale) is a numerical scale that measures the intensity of pain.Scale ranges from 0 to 10, where 0 is no pain and 10 being maximum/ worst imaginable pain.
    Time Frame
    Baseline A (Visit 2/Day 1) to Week 8 (Visit 5/EOT)
    Title
    Change in pruritus intensity score (Numeric Rating Scale for pruritus)
    Description
    NRS (Numerical Rating Scale) is a numerical scale that measures the intensity of pruritus, with 10 being the greatest intensity. 0 is no itch and 10 being maximum// worst imaginable itch.
    Time Frame
    from Baseline A (Visit 2/Day 1) to Week 8 (Visit 5/EOT)
    Title
    Change in the QOLEB score
    Description
    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"
    Time Frame
    from Baseline A (Visit 2/Day 1) to Week 8 (Visit 5/EOT)
    Title
    Change in EBDASI score (skin activity)
    Description
    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.
    Time Frame
    from Baseline A (Visit 2/Day 1) to Week 8 (Visit 5/EOT).

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    6 Months
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    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 hands and feet 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) and prior to Visit 7 (Week 16/Baseline B). 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 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 or systemic corticosteroids within 4 weeks and with other immunosuppressive/immunomodulatory therapies or chemotherapy within 8 weeks prior to Visit 2 (Day 1/Baseline A) and prior to Visit 7 (Week 16/Baseline B). Patient has been treated with an approved or investigational biologic anti-inflammatory therapy (such as monoclonal antibodies that target to modulate the immune responses) 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.
    Central Contact Person:
    First Name & Middle Initial & Last Name or Official Title & Degree
    Sandy Lin, PhD
    Phone
    +886-2-2657-1788
    Email
    sandy.lin@twibiotech.com
    First Name & Middle Initial & Last Name or Official Title & Degree
    Twibiotech
    Phone
    +886-2-2657-1788
    Email
    info.tw@twibiotech.com

    12. IPD Sharing Statement

    Plan to Share IPD
    No

    Learn more about this trial

    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)

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