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)

Last updated: November 17, 2025
Sponsor: TWi Biotechnology, Inc.
Overall Status: Active - Recruiting

Phase

2/3

Condition

Epidermolysis Bullosa

Pemphigus Vulgaris (Pv)

Treatment

AC-203

Vehicle

Clinical Study ID

NCT06073132
AC-203-EBS-007
  • Ages > 6
  • All Genders

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.

Eligibility Criteria

Inclusion

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 inKRT5 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 andover-the-counter medications, including topical therapies applied to the body, e.g.,medical cleansers, bleach cleansers, bleach baths, topical antiseptics, topicaldisinfectants, etc. for the duration of the study.

  7. Patient (and caregiver/legal guardian) is willing and able to comply with all studyvisits 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 priorto randomization.

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

Exclusion

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 withcutaneous erosions/ulcerations, that may confound assessments of efficacy or safety.

  2. Patient has a clinically significant underlying medical condition, psychiatriccondition (such as major depressive or psychotic disorder, severe intellectualdisability, or alcohol or drug use disorder), or requires concomitant medicationthat based on the investigator's judgement may impair evaluation of the TreatmentArea 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 systemicantibiotics within 7 days prior to Visit 2 (Day 1/Baseline A).

  5. Patient has uncontrolled diabetes mellitus (HbA1c ≥ 6.5%), hepatic enzymeabnormalities (alanine aminotransferase or aspartate aminotransferase >2.5 the upperlimit of normal (ULN), or total bilirubin >2.0x ULN), or renal abnormalities (estimated glomerular filtration rate [eGFR]< 30 ml/min/1.73 m2) during theScreening 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 steroidswithin 2 weeks prior to Visit 2 (Day 1/Baseline A) that might influence theassessment of the Treatment Area throughout the study period.

  8. Patient has been treated with topical steroids on the EBS lesions within 2 weeks orsystemic 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 weeksprior to Visit 2 (Day 1/Baseline A).

  10. Patient has been treated with any investigational drug or device within 30 days or 5half-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 studymedications, including diacerein or rhein.

  12. Patient is pregnant or breastfeeding/lactating.

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

Study Design

Total Participants: 80
Treatment Group(s): 2
Primary Treatment: AC-203
Phase: 2/3
Study Start date:
April 04, 2024
Estimated Completion Date:
January 31, 2027

Study 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.

Connect with a study center

  • Royal Melbourne Hospital

    Melbourne 2158177, Victoria 2145234 3052
    Australia

    Site Not Available

  • Premier Specialists

    Kogarah,
    Australia

    Site Not Available

  • Premier Specialists

    Kogarah 2161185,
    Australia

    Active - Recruiting

  • Sydney Children's Hospital

    Randwick,
    Australia

    Site Not Available

  • Sydney Children's Hospital

    Randwick 2208285,
    Australia

    Active - Recruiting

  • Universitaetsklinik fuer Dermatologie und Allergologie

    Salzburg,
    Austria

    Site Not Available

  • Universitaetsklinik fuer Dermatologie und Allergologie

    Salzburg 2766824,
    Austria

    Active - Recruiting

  • UZ Leuven

    Leuven,
    Belgium

    Site Not Available

  • UZ Leuven

    Leuven 2792482,
    Belgium

    Active - Recruiting

  • Hopital Necker-Enfants Malades

    Paris,
    France

    Site Not Available

  • Hopital Necker-Enfants Malades

    Paris 2988507,
    France

    Active - Recruiting

  • Andreas Syggros Hospital 1st University Clinic of Skin and Venereal Diseases of Athens

    Athens 264371, 16121
    Greece

    Site Not Available

  • Hospital of Skin and Venereal Diseases of Thessaloniki

    Thessaloniki,
    Greece

    Site Not Available

  • Hospital of Skin and Venereal Diseases of Thessaloniki

    Thessaloniki 734077,
    Greece

    Active - Recruiting

  • Sri Madhusudan Sai Institute of Medical Science

    Muddenahalli, Karnataka 562101
    India

    Site Not Available

  • Sri Madhusudan Sai Institute of Medical Science

    Muddenahalli 10852221, Karnataka 1267701 562101
    India

    Site Not Available

  • Postgraduate Institute of Medical Education and Research (PGIMER)

    Chandigarh,
    India

    Site Not Available

  • Postgraduate Institute of Medical Education and Research (PGIMER)

    Chandigarh 1274746,
    India

    Active - Recruiting

  • Children's Health Ireland

    Dublin,
    Ireland

    Site Not Available

  • Children's Health Ireland

    Dublin 2964574,
    Ireland

    Active - Recruiting

  • Tel Aviv Sourasky Medical Center

    Tel Aviv,
    Israel

    Site Not Available

  • Tel Aviv Sourasky Medical Center

    Tel Aviv 293397,
    Israel

    Active - Recruiting

  • IRCCS, AOUBO, Policlinico Sant'Orsola

    Bologna,
    Italy

    Site Not Available

  • IRCCS, AOUBO, Policlinico Sant'Orsola

    Bologna 3181928,
    Italy

    Active - Recruiting

  • Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano

    Milan,
    Italy

    Site Not Available

  • Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano

    Milan 3173435,
    Italy

    Active - Recruiting

  • Università degli Studi di Modena e Reggio Emilia (UNIMORE)

    Modena,
    Italy

    Site Not Available

  • Università degli Studi di Modena e Reggio Emilia (UNIMORE)

    Modena 3173331,
    Italy

    Active - Recruiting

  • Istituto Dermopatico dell'Immacolata (IDI) - Istituto di

    Rome,
    Italy

    Site Not Available

  • UOS "Centro delle Dermatosi Croniche Complesse e Genodermatosi" UOC Dermatologia

    Rome,
    Italy

    Active - Recruiting

  • Istituto Dermopatico dell'Immacolata (IDI) - Istituto di

    Rome 3169070,
    Italy

    Active - Recruiting

  • UOS "Centro delle Dermatosi Croniche Complesse e Genodermatosi" UOC Dermatologia

    Rome 3169070,
    Italy

    Active - Recruiting

  • Gangnam Severane Hospital

    Seoul,
    Korea, Republic of

    Site Not Available

  • Hospital Tunku Azizah (Hospital Wanita Dan Kanak-kanak Kuala Lumpur)

    Kuala Lumpur,
    Malaysia

    Site Not Available

  • Hospital Tunku Azizah (Hospital Wanita Dan Kanak-kanak Kuala Lumpur)

    Kuala Lumpur 1735161,
    Malaysia

    Active - Recruiting

  • Asian Hospital

    City of Muntinlupa 1699076,
    Philippines

    Active - Recruiting

  • Southern Philippines Medical Center (SPMC)

    Davao,
    Philippines

    Site Not Available

  • Iloilo Doctors Hospital

    Iloilo,
    Philippines

    Site Not Available

  • Iloilo Doctors Hospital

    Iloilo City 1711005,
    Philippines

    Active - Recruiting

  • Health Cube Medical Clinics

    Mandaluyong,
    Philippines

    Site Not Available

  • Health Cube Medical Clinics

    Mandaluyong 1701966,
    Philippines

    Active - Recruiting

  • Asian Hospital

    Muntinlupa,
    Philippines

    Site Not Available

  • OT.CO Clinic Osipowicz & Turkowski

    Warsaw,
    Poland

    Site Not Available

  • OT.CO Clinic Osipowicz & Turkowski

    Warsaw 756135,
    Poland

    Active - Recruiting

  • Gangnam Severane Hospital

    Seoul 1835848,
    South Korea

    Active - Recruiting

  • Hospital Universitario La Paz

    Madrid,
    Spain

    Site Not Available

  • Hospital Universitario La Paz

    Madrid 3117735,
    Spain

    Active - Recruiting

  • National Cheng Kung University Hospital

    Tainan,
    Taiwan

    Site Not Available

  • National Cheng Kung University Hospital

    Tainan 1668355,
    Taiwan

    Active - Recruiting

  • National Cheng Kung University Hospital

    Tainan City 1668355,
    Taiwan

    Site Not Available

  • Sheikh Khalifa Medical City (SKMC)

    Abu Dhabi,
    United Arab Emirates

    Site Not Available

  • Sheikh Khalifa Medical City (SKMC)

    Abu Dhabi 292968,
    United Arab Emirates

    Active - Recruiting

  • Great Ormond Street Hospital (GOSH) for Children NHS Foundation Trust - Somers Clinical Research Facility (CRF)

    London,
    United Kingdom

    Site Not Available

  • Great Ormond Street Hospital (GOSH) for Children NHS Foundation Trust - Somers Clinical Research Facility (CRF)

    London 2643743,
    United Kingdom

    Active - Recruiting

  • University Hospitals Birmingham NHS Foundation Trust (UHB)

    Solihull,
    United Kingdom

    Site Not Available

  • University Hospitals Birmingham NHS Foundation Trust (UHB)

    Solihull 2637546,
    United Kingdom

    Active - Recruiting

  • Mission dermatology Center

    Rancho Santa Margarita, California 92688
    United States

    Site Not Available

  • Stanford University

    Stanford, California 94304
    United States

    Site Not Available

  • Mission dermatology Center

    Rancho Santa Margarita 5386082, California 5332921 92688
    United States

    Active - Recruiting

  • Stanford University

    Stanford 5398563, California 5332921 94304
    United States

    Active - Recruiting

  • Children's Hospital Colorado

    Aurora, Colorado 80045
    United States

    Site Not Available

  • Children's Hospital Colorado

    Aurora 5412347, Colorado 5417618 80045
    United States

    Active - Recruiting

  • Pediatric Center of Excellence (PCE) - Miami Pediatric Endocrinology, LLC

    Miami, Florida 33146
    United States

    Site Not Available

  • Pediatric Center of Excellence (PCE) - Miami Pediatric Endocrinology, LLC

    Miami 4164138, Florida 4155751 33146
    United States

    Active - Recruiting

  • Pediatric Skin Research, LLC

    Miami 4164138, Florida 4155751 33146
    United States

    Active - Recruiting

  • Northwestern University - Lurie Childrens's Hospital

    Chicago, Illinois 60611
    United States

    Site Not Available

  • Northwestern University - Lurie Childrens's Hospital

    Chicago 4887398, Illinois 4896861 60611
    United States

    Active - Recruiting

  • Stony Brook Dermatology

    Stony Brook, New York 11790
    United States

    Site Not Available

  • Stony Brook Dermatology

    Stony Brook 5139865, New York 5128638 11790
    United States

    Active - Recruiting

  • Cincinnati Childrens Hospital

    Cincinnati, Ohio 45229
    United States

    Site Not Available

  • Cincinnati Childrens Hospital

    Cincinnati 4508722, Ohio 5165418 45229
    United States

    Active - Recruiting

  • Medical University of South Carolina

    Charleston, South Carolina 29425
    United States

    Site Not Available

  • Medical University of South Carolina

    Charleston 4574324, South Carolina 4597040 29425
    United States

    Active - Recruiting

  • Texas Dermatology and Laser Specialists

    San Antonio, Texas 78218
    United States

    Site Not Available

  • Texas Dermatology and Laser Specialists

    San Antonio 4726206, Texas 4736286 78218
    United States

    Active - Recruiting

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