This Phase II clinical study will assess the efficacy, safety and tolerability of topical TolaSure Gel in adults and pediatric patients (4 years of age and older) diagnosed with generalized intermediate to severe epidermolysis bullosa simplex (EBS). Each patient (40 to complete) will be enrolled in the study and will be randomized to receive either TolaSure Gel or a topical Placebo for daily application for 2-months. After 2-months, all patients will receive TolaSure Gel to daily apply for an additional 2-months. A remote follow-up visit will occur 2-months after the end of study. Total time in the study is 6-months. Patients will be applying study medication to randomized treatment area(s) (a minimum of \~2-3% Body Surface Area (BSA)), with the option to treat their feet as well throughout the study.
This is a closed-label, Phase II clinical study to assess the efficacy, safety and tolerability of the investigational product (IP), topical TolaSure Gel, 5% w/w, in adults and pediatric patients diagnosed with generalized intermediate to severe epidermolysis bullosa simplex (EBS). TolaSure Gel, 5% w/w and Placebo tubes will be placed into kits where all labels (tubes and kit labels) will be blinded for drug content. Kits will be bundled (based on expected amount of study gel usage) and distributed randomly to patients \[Goal of patient population, 1:1 M:F and approximately 70% pediatric patients\]. Each patient (40 to complete) will be enrolled in the study and once a blistering flare is confirmed by the clinical study team, and the patient will be randomized to receive either TolaSure Gel, 5% w/w or Placebo (50:50 chance). For Part 1 of the study, daily application of randomized treatment for 2 months will be applied to selected Target Lesional Areas (TLAs; a minimum area of approximately 2-3% Body Surface Area (BSA)). If a TLA resolves completely the patient will continue to treat designated area(s). Additionally, patients have the option to daily treat their feet. For Part 2 of the study, a single arm crossover will then allow those patients that received Placebo to go on TolaSure Gel, 5% w/w for a subsequent 2 months. The patients already in the TolaSure Gel, 5% w/w cohort will continue with daily IP application for an additional 2 months as well. Again, patients have the option to continue to treat their feet. At Part 2 End of Study (EOS), patients will cease IP application and EOS procedures will be completed. Patients can have optional perilesional biopsies taken from a treated and untreated area to evaluate changes in ultrastructural pathology. A patient follow-up visit will occur after 6 months (2-months after last treatment application). The primary endpoint will assess changes in disease severity within the TLAs and recurrence of blistering using clinical imaging to assess blister surface area over time. The secondary efficacy endpoints will evaluate blistering on the feet, subject self-assessments including pain, itch, modified Foot Function Index (mFFI), and Quality of Life (QoL) assessment. Safety endpoints will include the incidence of treatment-emergent adverse events (TEAEs). In order to provide adequate assurance of subject safety, safety monitoring will include physical exams, vital sign measurements, clinical laboratory testing (blood and urinalysis), and urine pregnancy testing (as appropriate). These safety assessments in addition to adverse event (AE) reviews will be sufficient to identify potential TEAEs. The information obtained from these assessments will be utilized to examine the efficacy of TolaSure treatment in ameliorating EBS symptoms as well as the accuracy of the proposed mechanism of action (MOA) of TolaSure for this disease indication.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
40
TolaSure Topical Gel is applied once-daily to designated treatment areas for up to 4 months (Part 2 End of Study).
Topical Placebo Gel is applied once-daily to designated treatment areas for up to 2 months (Part 1 End of Study).
Stanford University School of Medicine, Dermatology Department
Palo Alto, California, United States
RECRUITINGNU Dermatolgy CTU
Chicago, Illinois, United States
RECRUITINGChange in Blister Surface Area of the Designated Treatment Area(s)
Clinical photography will be used to assess changes in disease severity within the target lesional area (TLA) and recurrence of blistering by measuring blister surface area in the designated TLA over time.
Time frame: Day 1 (Baseline) and weekly until End of Study (2-months and maximum 4-months)
Plantar Blister Surface Area Reduction
Plantar blister surface area changes over time will be examined using clinical photography for those patients that choose treat their feet. This is an optional treatment area.
Time frame: Day 1 (Baseline) and weekly until End of Study (2-months and maximum 4-months)
Subject-reported Pain Score in Target Lesional Areas During Treatment Application
Using the adult or pediatric PROMIS® Measure form, peak pain during treatment application will be reported on a weekly basis until Part 2 End of Study (EOS, 4-months), with a possible assessment at the 6-month follow up visit. Pain trends in TolaSure Gel, 5% w/w and Placebo groups will be compared. The following PROMIS® Measure forms will be used depending on the patient's age: The Adult Pain Interference-Short Form 8a, Pediatric Pain Interference-Short Form 8a, and Parent Proxy Pain Interference-Short Form 8a. These scales are from 1 to 5 and relate to how much pain interferes with daily activities, with 1 indicating Never/Not at All and 5 indicating Almost Always/Very Much.
Time frame: Day 1 (Baseline) and weekly until End of Study (2-months and maximum 4-months)
Subject-reported Itch Score in Target Lesional Area
Using the adult or pediatric PROMIS® Measure form, itch characteristics will be reported on a weekly basis until Part 2 End of Study (EOS, 4-months), with a possible assessment at the 6-month follow up visit. Itch trends in TolaSure Gel, 5% w/w and Placebo groups will be compared. The following PROMIS® Measure forms will be used depending on the patient's age: The Adult Itch Interference-Short Form 8a, Pediatric Itch-Short Form 8a (PIQ-C), and Parent Proxy Itch-Short Form 8a (PIQ-C). These scales are from 1 to 5 and relate to how much itch interferes with daily activities and the level of itch, with 1 indicating Never/No Itch and 5 indicating Almost Always/Very Severe.
Time frame: Day 1 (Baseline) and weekly until End of Study (2-months and maximum 4-months)
Subject-reported Quality of Life (QoL)
Patient's quality of life (QoL) metrics, highlighting symptoms and daily living concerns of EBS patients, will be reported at Visit 2/ Baseline, Part 1 End of Study (EOS), and Part 2 EOS, with a possible assessment at the 6-month follow up visit. This QoL assessment will be given to patients in a questionnaire format. The questions focus on how EBS blistering areas affect daily physical and social activities as well as mental and emotional health. The scale range is from 0 to 10, with 0 being not at all affected and 10 being severely affected. QoL metrics in TolaSure Gel, 5% w/w and Placebo control groups will be examined.
Time frame: Day 1 (Baseline), Part 1 End of Study (2-months), Part 2 End of Study (4-months)
Subject-reported Modified Foot Function Index (mFFI)
Patient's modified Foot Function Index (mFFI), is a questionnaire about foot pathology as it relates to pain, disability, and/or activity restrictions. Questions relating to pain are on a 0 to 10 scale with 0 being no pain at all and 10 being the worst pain imaginable. Daily activity scores also range from 0 to 10 with 0 being Not at All/Not Difficult at All and 10 being All the Time/So Difficult. The mFFI questionnaire will be reported at Visit 2/ Baseline, Part 1 End of Study (EOS), and Part 2 EOS, with a possible assessment at the 6-month follow up visit. mFFI metrics in TolaSure Gel, 5% w/w and Placebo control groups will be examined.
Time frame: Day 1 (Baseline), Part 1 End of Study (2-months), Part 2 End of Study (4-months)
Incidence of treatment-emergent adverse events (TEAEs)
Safety monitoring will include clinical laboratory testing (blood and urine) and urine pregnancy testing (as appropriate) only at Visit 1/Screening and Part 2 EOS, physical examinations (including assessment of treatment areas), and vital sign measurements at baseline and bi-weekly until Part 1 EOS and Part 2 EOS. These assessments along with AE reviews will identify potential TEAEs.
Time frame: Day 1 (Baseline) and bi-weekly until End of Study (maximum 4-months)
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