Wound closure in epidermolysis bullosa: data from the vehicle arm of the phase 3 ESSENCE Study

Dedee F Murrell; Amy S Paller; Christine Bodemer; John Browning; Milos Nikolic; Jay A Barth; Hjalmar Lagast; Eva Krusinska; Allen Reha; ESSENCE Study Group

doi:10.1186/s13023-020-01435-3

Wound closure in epidermolysis bullosa: data from the vehicle arm of the phase 3 ESSENCE Study

Orphanet J Rare Dis. 2020 Jul 21;15(1):190. doi: 10.1186/s13023-020-01435-3.

Authors

Dedee F Murrell¹, Amy S Paller², Christine Bodemer³, John Browning⁴, Milos Nikolic⁵, Jay A Barth⁶, Hjalmar Lagast⁶, Eva Krusinska⁶, Allen Reha⁶; ESSENCE Study Group

Affiliations

¹ University of New South Wales, Sydney, NSW, Australia.
² Departments of Dermatology and Pediatric Dermatology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair, Suite 1600, Chicago, IL, 60611-2997, USA. apaller@northwestern.edu.
³ EB Expert Centre (MAGEC), Department of Dermatology, Necker-Enfants Malades Hospital, Paris Centre University, Paris, France.
⁴ Texas Dermatology & Laser Specialists, San Antonio, TX, USA.
⁵ Clinical Center of Serbia, Department of Dermatology, University of Belgrade, Belgrade, Serbia.
⁶ Amicus Therapeutics, Inc., Cranbury, NJ, USA.

Abstract

Background: Chronic wounds are a fundamental issue for patients with epidermolysis bullosa (EB). Herein, we assess the natural history of wound closure in patients with EB who were randomly assigned to the vehicle-control arm of the multicenter, randomized, double-blind, phase 3 ESSENCE (NCT02384460) trial.

Methods: ESSENCE was designed to assess the efficacy and safety of a topical cream formulation of 6% allantoin (SD-101 6%) vs vehicle (SD-101 0%) in patients ≥1 month old who had a diagnosis of EB (simplex, recessive dystrophic, or intermediate junctional) and a target wound 10-50 cm² present for ≥21 days. Time to complete target wound closure and the proportion of patients with target wound closure over time were analyzed overall and by parameters including patient age and baseline body surface area index (BSAi) of total wound burden (< 5% and ≥ 5%). Changes in BSAi of lesional skin, pain, and itching were also assessed.

Results: The vehicle-control arm included 87 patients. Mean (standard deviation [SD]) time to target wound closure within 3 months was 53.6 (28.6) days, with a range of 14 to 142 days. The proportion of patients with target wound closure increased over time from 7.1% at day 14 to 53.6% at month 3. Mean (SD) changes from baseline in BSAi of total wound burden and BSAi of lesional skin at month 3 were -2.3% (6.3) and -5.0% (13.5) of total body coverage, respectively. Reductions in pain and itching were observed at day 7 and maintained for 3 months. Faster healing times and a greater proportion of patients with wound closure were observed in patients aged 1 month to < 2 years; those with wounds < 30 days old, and in those with BSAi of total body wound burden < 5%.

Conclusions: Treatment response observed in the vehicle-control arm of the ESSENCE study was unexpectedly high and may have been due to unforeseen benefits of vehicle or enhanced wound care provided by the clinical trial staff. These observations will help inform the study design of future trials in patients with EB.

Trial registration: ClinicalTrials.gov , NCT02384460 ; Date of registration: February 13, 2015; First participant enrollment: March 11, 2015.

Keywords: Epidermolysis bullosa; Natural history; Wound closure.

Publication types

Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Double-Blind Method
Epidermolysis Bullosa* / drug therapy
Humans
Infant, Newborn
Wound Healing

Associated data

ClinicalTrials.gov/NCT02384460