Topical TolaSure gel to reduce blistering in generalized intermediate to severe epidermolysis bullosa simplex

A Phase II, Closed Label, Placebo Controlled, Randomized, Double-Blinded Clinical Trial to Evaluate the Efficacy and Safety of TolaSure Gel, 5% w/w Targeting Aggregated Mutant Keratin in Epidermolysis Bullosa Simplex (TAMES)

This trial will test whether daily TolaSure 5% topical gel reduces blistering and improves skin in people aged 4 and older with generalized intermediate to severe epidermolysis bullosa simplex.

Quick facts

• Phase: Phase 2
• Study type: Interventional
• Enrollment: 40 (estimated)
• Ages: 4 Years and up
• Sex: All
• Sponsor: BioMendics, LLC (Industry-sponsored)
• Drugs / interventions: chemotherapy, radiation
• Locations: 2 sites (Palo Alto, California and 1 other locations)
• Trial ID: NCT07027345 on ClinicalTrials.gov

What this trial studies

This randomized, double-blind Phase II study will enroll about 40 participants (target ~70% pediatric) with generalized intermediate to severe EBS who are experiencing an active blistering flare. Participants are randomized 1:1 to apply TolaSure 5% gel or a matched placebo daily to selected target lesional areas (~2–3% body surface area) for two months while blinded. After two months, all participants receive open-label TolaSure for an additional two months in a single-arm crossover, and a remote follow-up visit occurs two months after treatment ends, for a total of six months in the trial. Treatment kits and tubes are blinded and bundled by expected usage, and participants may opt to treat their feet throughout the study.

Who should consider this trial

Good fit: Adults and children aged 4 years and older with genetically or clinically confirmed generalized intermediate to severe EBS (often K5 or K14 mutations) who have an active qualifying blistering flare in the specified target areas are the ideal candidates.

Not a fit: Patients with mild EBS, other forms of epidermolysis bullosa, without active qualifying lesions, or with non-K5/K14 genetic causes are unlikely to receive benefit from this intervention.

Why it matters

Potential benefit: If effective, TolaSure could reduce blister frequency and severity and improve skin stability and quality of life for people with severe EBS.

How similar studies have performed: Preclinical and early clinical work on keratin-targeting topical approaches has shown promise, but controlled Phase II data in generalized severe EBS remain limited.

Eligibility criteria

Inclusion Criteria:

* Patient is a male or female at least 4 years of age.
* Patient has a documented diagnosis of generalize intermediate (previously Kӧbner) to severe (previously EBS-DM) autosomal dominant epidermolysis bullosa simplex (EBS) and/or genetic mutation in either the K14 or K5 genes consistent with generalized intermediate to severe EBS. The Investigator will determine patient eligibility based on historical phenotypic presentation of EBS symptoms along with genetic/diagnosis documentation in order to determine EBS severity. (If generalized intermediate to severe EBS is suspected but not diagnosed or genetically confirmed, confirmatory testing will be performed).
* Patient is actively flaring in one of the preferred target lesional areas (TLAs): 1) lower extremities (ideally below the knee and above the ankle or between the knee and top of the thigh) or 2) torso (excluding the groin and apocrine areas). The following skin conditions are required for treatment purposes:

  * A flare is defined as a minimum area of \~2-3% Body Surface Area (BSA) containing intact blisters (of varying size and number), and freshly ruptured blisters across 50% of the TLA (as assessed by the principal investigator (PI)). Skin erosions, keratoderma, fissures and/or erythema may also be present.
  * Patients will be permitted to treat their feet to assess plantar blister surface area but blistering on the feet is not a requirement for study inclusion.
  * TLA may not be infected (as assessed by PI) or have been treated with a topical antibiotic within 14 days.
* If the patient is a woman of childbearing potential (WOCBP),

  * Has a negative urine pregnancy test.
  * Agrees to use an approved effective form of birth control with failure rates \<1% per year (e.g., implant, injectable, combined oral contraceptive, intrauterine contraceptive device, sexual abstinence, vasectomized partner) during participation in the study (and at least 3 months thereafter).
  * Is not nursing.
* Patient's laboratory values (blood and urine) are within the range of normal or abnormal values are within normal levels for the disease and in the opinion of the PI the values are not clinically relevant for study participation.
* Patient is in good, general health and free of any known disease state or physical condition which, in the investigator's opinion, might impair evaluation of the EBS lesions or which exposes the subject to an unacceptable risk by study participation.
* Over the duration of the study, the patient agrees to not use any other topical therapies and/or impregnated dressings within the TLAs (e.g., medicated cleansers, CBD oil, MediHoney, Silvadine cream 1%, topicals containing antimicrobials, keratin, and/or collagen, lipido-colloid or polymeric membrane dressings, and/or hydrogels).
* Patient and/or legally appointed and authorized representative must be able and willing to follow study procedures and instructions in order to maintain compliance throughout the study period.
* The patient or legally appointed and authorized representative must have read, understood and signed an Institutional Review Board/Ethics Committee (IRB/EC) approved Informed Consent or Assent Form.

Exclusion Criteria:

* Patient's use of prior or concomitant medication or medical treatments/procedures:

  * Any investigational drug or therapy within 30 days.
  * Systemic steroidal therapy within 30 days.
  * Topical steroidal therapy within 14 days (Note: inhaled and ophthalmic products containing steroids are allowed).
  * Systemic antibiotic therapy within 7 days.
  * Currently receiving chemotherapy or radiation.
  * Surgery within the previous 2 weeks (except for minor surgery, cosmetic or dental procedures as determined by the investigator).
  * Started to take chronic medications (NSAIDs, antihistamines, etc.) at least 30 days prior to starting study medication.
* Patient's medical history includes:

  * Cancer that is currently undergoing treatment.
  * History of chronic and severe vitamin, mineral, or protein deficiency.
  * Current systemic infection.
  * HIV/AIDS.
  * Non-EBS skin disease (e.g., psoriasis, atopic dermatitis, eczema, sun damage, etc.), or condition (e.g., sunburn) that, in the opinion of the investigator, might put the patient at undue risk by study participation or interferes with the study medication application or the study assessments.
  * An illness (e.g., neurological, cardiovascular, respiratory, hepatic, renal, or metabolic disease), condition, or situation that in the opinion of the principal investigator is likely to interfere with the patient's participation in or completion of the study.
* Factors present in the patient and/or his/her legal representative that could interfere with study compliance such as inability to attend scheduled study visits or to perform study protocol procedures.
* Patient is a member of the investigational team or his/her immediate family.
* Other unspecified reasons that, in the opinion of the Investigator, make the patient unsuitable for enrollment.

Where this trial is running

Palo Alto, California and 1 other locations

• Stanford University School of Medicine, Dermatology Department — Palo Alto, California, United States (Recruiting)
• NU Dermatolgy CTU — Chicago, Illinois, United States (Recruiting)

Conditions Epidermolysis Bullosa Simplex; Epidermolysis Bullosa; EBS; Severe EBS; EBS Dowling-Meara; EBS Koebner; Skin Diseases; Keratin