Diacerein orphan drug development for epidermolysis bullosa simplex: A phase 2/3 randomized, placebo-controlled, double-blind clinical trial

• Published in: Journal of the American Academy of Dermatology 2018-05, Vol.78 (5), p.892-901.e7
• Main Authors: Wally, Verena, Hovnanian, Alain, Ly, Juliette, Buckova, Hana, Brunner, Victoria, Lettner, Thomas, Ablinger, Michael, Felder, Thomas K., Hofbauer, Peter, Wolkersdorfer, Martin, Lagler, Florian B., Hitzl, Wolfgang, Laimer, Martin, Kitzmüller, Sophie, Diem, Anja, Bauer, Johann W.
• Format: Article
• Language: English
• Subjects: Administration, Topical; Anthraquinones - therapeutic use; Anti-Inflammatory Agents; Child; Child, Preschool; diacerein; Dose-Response Relationship, Drug; Double-Blind Method; Drug Administration Schedule; epidermolysis bullosa; Epidermolysis Bullosa Simplex - diagnosis; Epidermolysis Bullosa Simplex - drug therapy; Female; Follow-Up Studies; Humans; keratin; Male; Orphan Drug Production; Patient Compliance; rare genodermatosis; Risk Assessment; Severity of Illness Index; Treatment Outcome
• ISSN: 0190-9622; 1097-6787
• DOI: 10.1016/j.jaad.2018.01.019

Epidermolysis bullosa simplex (EBS) is a rare genetic, blistering skin disease for which there is no cure. Treatments that address the pathophysiology of EBS are needed. Compare the impact of 1% diacerein cream with placebo in reducing the number of blisters in EBS. In a randomized, placebo-controlled, phase 2/3 trial we used a 1% diacerein topical formulation to treat defined skin areas in 17 patients. In a 2-period crossover trial, patients were randomized to either placebo or diacerein for a 4-week treatment and a 3-month follow-up in period 1. After a washout, patients were crossed over during period 2. The prespecified primary end point was the proportion of patients with a reduction of number of blisters by more than 40% from baseline in selected areas over the treatment episode. Of the patients receiving diacerein, 86% in episode 1 and 37.5% in episode 2 met the primary end point (vs 14% and 17% with placebo, respectively). This effect was still significant after the follow-up. Changes in absolute blister numbers were significant for the diacerein group only. No adverse effects were observed. Low patient numbers and no invasive data acquisition because of clinical burden in children. This trial provides evidence of the impact of 1% diacerein cream in the treatment of EBS. [Display omitted]