CClinicalTrials.gg
Active, not recruitingNCT06073132EBShieldUpdated Jul 9, 2026

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)

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

Phase
Phase 2/3
Study type
Interventional
Enrollment
80
Allocation
Randomized
Ages
6 Months and older
Sex
All
01

Study 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.

Read the 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.

02

Conditions studied

  • Generalized Epidermolysis Bullosa Simplex

Keywords

  • Epidermolysis Bullosa Simplex
  • EBS
03

Who can participate

Ages eligible
6 Months and older
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  1. Patient is at least 6 months old at Visit 2 (Day 1/Baseline A).
  2. 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.
  3. Patient with ≥ 3% BSA of EBS lesions excluding palms and soles at Visit 2 (Day 1/Baseline A).
  4. Patient's EBS lesions within the Treatment Area have an IGA score of ≥3 at Visit 2 (Day 1/Baseline A).
  5. Patient/caregiver agrees to follow study medication application instructions.
  6. 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.
  7. Patient (and caregiver/legal guardian) is willing and able to comply with all study visits and all the protocol requirements, including completing questionnaires.
  8. Patient (and caregiver/legal guardian) is able to provide written informed consent; assent based on age.
  9. Female patient of childbearing potential must have a negative pregnancy test prior to randomization.
  10. 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

Exclusion Criteria:

  1. 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.
  2. 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.
  3. Patient has used any diacerein-containing product within 6 months prior to Visit 2 (Day 1/Baseline A).
  4. 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).
  5. 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.
  6. 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).
  7. 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.
  8. 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.)
  9. 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).
  10. 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).
  11. Patient has a history of allergy or hypersensitivity to any component of study medications, including diacerein or rhein.
  12. Patient is pregnant or breastfeeding/lactating.
  13. Patient has a planned or anticipated major surgical procedure or other activity that would interfere with their ability to comply with protocol requirements.
04

Study design

Phase
Phase 2 / Phase 3
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Quadruple (Participant, Care provider, Investigator, Outcomes assessor)
Enrollment
80 participants (estimated)

Study arms

  • Experimental
    Part A AC-203

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

    Drug: AC-203

  • Placebo comparator
    Part A Vehicle ointment

    Double-blind, Vehicle ointment, QD

    Drug: Vehicle

  • Experimental
    Part B AC-203

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

    Drug: AC-203

Interventions

  • DrugAC-203

    The investigational product is formulated as 1% topical ointment

  • DrugVehicle

    Vehicle-only control study medication is the same formulation as investigational product without active ingredient

05

What researchers measure

Primary outcomes

  1. 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)

Secondary outcomes

  1. 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)

  2. 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)

  3. 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)

  4. 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).

  5. 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)

06

Study locations

30 sites
  • Mission dermatology Center
    Rancho Santa Margarita, California 92688, United States
  • Stanford University
    Stanford, California 94304, United States
  • Children's Hospital Colorado
    Aurora, Colorado 80045, United States
  • Northwestern University - Lurie Childrens's Hospital
    Chicago, Illinois 60611, United States
  • Cincinnati Childrens Hospital
    Cincinnati, Ohio 45229, United States
  • Medical University of South Carolina
    Charleston, South Carolina 29425, United States
  • Texas Dermatology and Laser Specialists
    San Antonio, Texas 78218, United States
  • Premier Specialists
    Kogarah, Australia
  • Sydney Children's Hospital
    Randwick, Australia
  • Universitaetsklinik fuer Dermatologie und Allergologie
    Salzburg, Austria
  • UZ Leuven
    Leuven, Belgium
  • Dermatology Hospital of Southern Medical University
    Guangzhou, Guangdong, China
  • Hospital of Skin and Venereal Diseases of Thessaloniki
    Thessaloniki, Greece
  • Postgraduate Institute of Medical Education and Research (PGIMER)
    Chandigarh, India
  • Children's Health Ireland
    Dublin, Ireland
  • Tel Aviv Sourasky Medical Center
    Tel Aviv, Israel
  • Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano
    Milan, Italy
  • Università degli Studi di Modena e Reggio Emilia (UNIMORE)
    Modena, Italy
  • Istituto Dermopatico dell'Immacolata (IDI) - Istituto di
    Rome, Italy
  • UOS "Centro delle Dermatosi Croniche Complesse e Genodermatosi" UOC Dermatologia
    Rome, Italy
  • Hospital Tunku Azizah (Hospital Wanita Dan Kanak-kanak Kuala Lumpur)
    Kuala Lumpur, Malaysia
  • Asian Hospital
    City of Muntinlupa, Philippines
  • Iloilo Doctors Hospital
    Iloilo City, Philippines
  • Health Cube Medical Clinics
    Mandaluyong, Philippines
  • OT.CO Clinic Osipowicz & Turkowski
    Warsaw, Poland
  • Gangnam Severane Hospital
    Seoul, South Korea
  • Hospital Universitario La Paz
    Madrid, Spain
  • National Cheng Kung University Hospital
    Tainan, Taiwan
  • Sheikh Khalifa Medical City (SKMC)
    Abu Dhabi, United Arab Emirates
  • Great Ormond Street Hospital (GOSH) for Children NHS Foundation Trust - Somers Clinical Research Facility (CRF)
    London, United Kingdom
07

References and documents

Individual participant data

Plan to share: No

No publications or documents are linked to this record.

08

Registry details

Key details

Study ID
NCT06073132
Lead sponsor
TWi Biotechnology, Inc.
Responsible party
Sponsor
First posted
Oct 10, 2023
Start date
Apr 4, 2024
Primary completion
Jun 10, 2026
Completion
Mar 2027 (estimated)
Last update
Jul 9, 2026

Oversight

Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

Not currently enrolling

This study is active, not recruiting, as verified in Jul 2026. You cannot join it, but the record below documents what was studied.

Follow this study

Get an email when the registry record changes — status, dates, results — or when someone posts here.

Sign in to follow

Discussion

Questions 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.

Start the discussion