A Phase 2/3 interventional study of AC-203 and Vehicle in Generalized Epidermolysis Bullosa Simplex, sponsored by TWi Biotechnology, Inc.. Active, not recruiting at 30 sites in 18 countries. Open to participants aged 6 Months and older. Per ClinicalTrials.gov, last updated 2026-07-09.
Sponsored by TWi Biotechnology, Inc. · Phase 2/3, Interventional, and Treatment
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.
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.
Exclusion Criteria:
Double-blind, AC-203 Diacerein 1% ointment, QD
Drug: AC-203
Double-blind, Vehicle ointment, QD
Drug: Vehicle
Open-label extension phase, AC-203 Diacerein 1% ointment, QD
Drug: AC-203
The investigational product is formulated as 1% topical ointment
Vehicle-only control study medication is the same formulation as investigational product without active ingredient
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)
Time frame: from Baseline A (Visit 2/Day 1) to Week 8 (Visit 5/EOT)
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
Time frame: 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.
Time frame: 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
Time frame: 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.
Time frame: 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"
Time frame: from Baseline A (Visit 2/Day 1) to Week 8 (Visit 5/EOT)
Plan to share: No
No publications or documents are linked to this record.
This study is active, not recruiting, as verified in Jul 2026. You cannot join it, but the record below documents what was studied.
Get an email when the registry record changes — status, dates, results — or when someone posts here.
Sign in to followQuestions and observations about this study, from anyone following it. Not medical advice, and not a channel to the study team — their contact details are on the registry record.
Sign in to join the discussion. Reading takes no account; posting does. You choose a display name, and a pseudonym is the default.
Nothing here yet. If you are running this trial, taking part in it, or weighing whether to, this is the place to say so.
Epidermolysis Bullosa Simplex
TWi Biotechnology, Inc.