A prospective short-term study to evaluate methodologies for the assessment of disease extent, impact, and wound evolution in patients with dystrophic epidermolysis bullosa

Amy S Paller; Elena Pope; Dan Rudin; Anna Malyala; Deborah Ramsdell; Ramsey Johnson; Hal Landy; Dedee F Murrell; DEB Investigators

doi:10.1186/s13023-022-02461-z

A prospective short-term study to evaluate methodologies for the assessment of disease extent, impact, and wound evolution in patients with dystrophic epidermolysis bullosa

Orphanet J Rare Dis. 2022 Aug 13;17(1):314. doi: 10.1186/s13023-022-02461-z.

Authors

Amy S Paller¹, Elena Pope², Dan Rudin³, Anna Malyala³, Deborah Ramsdell³, Ramsey Johnson³, Hal Landy³, Dedee F Murrell⁴; DEB Investigators

Affiliations

¹ Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, 676 North St Clair Street, Suite 1600, Chicago, IL, 60611-2997, USA. apaller@northwestern.edu.
² Section of Pediatric Dermatology, The Hospital for Sick Children, and University of Toronto, Toronto, ON, Canada.
³ Phoenix Tissue Repair, Boston, MA, USA.
⁴ Department of Dermatology, St George Hospital, University of NSW, Sydney, NSW, Australia.

Abstract

Background: Standardized assessments for dystrophic epidermolysis bullosa (DEB) are needed. This prospective, multicenter, 4-week, observational study was designed to evaluate DEB assessments for suitability as clinical trial endpoints.

Methods: Patients with confirmed DEB diagnosis and ≥ 5 measurable wounds were included. The primary outcome was change from baseline in wound surface area (WSA) of 5 selected wounds by 3-dimensional imaging. Secondary endpoints were change from baseline in clinician global assessment (CGA) of WSA, wound characteristics, disease-related questionnaires and instruments (disease severity, quality of life [QoL], pain and disability, and itch), and tolerability of procedures.

Results: Of 30 enrolled patients, 29 completed the study (of whom, 28 had recessive DEB). Median age was 17.8 years (range, 3.8-58.7). All patients developed new or recurrent wounds during the 4-week study. Of the wounds selected at baseline, 45/150 (30.0%) healed by week 2; an additional 38 healed by week 4, while 8 of those healed at week 2 had recurred by week 4 for a total of 75/150 (50.0%) healed wounds at week 4. Mean values for WSA, CGA, and disease-related questionnaire and instrument scores remained steady during this 4-week observational study. Of the 10 disease-related questionnaires and instruments assessed, the scores for the Epidermolysis Bullosa Disease Activity and Scarring Index (EBDASI) and the Instrument for Scoring Clinical Outcomes for Research of Epidermolysis Bullosa (iscorEB) did not substantially overlap between moderate and severe disease. Between mild and moderate disease, only the EBDASI scores did not substantially overlap.

Conclusions: These results stress the dynamic nature of wounds, even during a 4-week period of observation, and suggest that a combination of clinician-assessed outcomes and patient-/caregiver-reported outcomes is needed to provide a comprehensive assessment of DEB severity and impact. In addition, these results support the use of EBDASI and iscorEB to monitor disease severity as both produced scores that did not substantially overlap between disease severity strata. Clinical trial registration ClinicalTrials.gov, NCT02178969 . Registered 4 June 2014, https://clinicaltrials.gov/ct2/show/NCT02178969 .

Keywords: Clinician-assessed outcomes; Disease severity; Dystrophic epidermolysis bullosa; EBDASI; Outcome measures; Patient-reported outcomes; Quality of life; iscorEB.

Publication types

Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Epidermolysis Bullosa Dystrophica*
Epidermolysis Bullosa* / complications
Humans
Prospective Studies
Quality of Life
Severity of Illness Index

Associated data

ClinicalTrials.gov/NCT02178969