Ph 3 Efficacy and Safety of B-VEC for the Treatment of DEB

Phase 3

Completed

• Conditions: Dystrophic Epidermolysis Bullosa; Dominant Dystrophic Epidermolysis Bullosa; Recessive Dystrophic Epidermolysis Bullosa
• Interventions: Other: Placebo; Biological: Topical Beremagene Geperpavec

• Registration Number: NCT04491604
• Lead Sponsor: Krystal Biotech, Inc.

Brief Summary

To determine whether administration of topical B-VEC improves wound healing as compared to placebo, and to evaluate durability, repeat dosing (Primary Endpoint) and further obtain safety and tolerability data.

Detailed Description

Thirty-one (31) participants with DEB, aged 6 months or older at time of consent were enrolled for this Phase III study. The trial duration for each subject was about 6 months, with administration occurring once weekly. A Safety Follow-up Visit occurring 30 days from the date of final treatment with the Investigational Product also occurred. Each subject provided one pair of primary target wounds, with one wound from each pair randomized to be treated with B-VEC and the other wound with placebo. In addition to the primary target wound pair(s), additional wounds (secondary wounds) were selected to be treated with B-VEC. Throughout the study, participants complete questionnaires, had images captured of their study wounds, underwent physical exams, had vital signs and safety labs monitored.

Study Timeline

• Study First Submitted: 2020-07-22
• Study First Submitted QC: 2020-07-27
• Study First Posted: 2020-07-29
• Study Start: 2020-08-17
• Primary Completion: 2021-10-29
• Study Completion: 2022-01-14
• Status Verified: 2022-12
• Results First Submitted: 2022-12-08
• Results First Submitted QC: 2023-01-25
• Last Update Submitted: 2023-01-25
• Results First Posted: 2023-02-17
• Last Update Posted: 2023-02-17

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 31

Inclusion Criteria

1. The subject 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 and must be able to and willing to follow study procedures and instructions.

2. Age ≥ 6 months and older at the time of Informed Consent.

3. Clinical diagnosis of the Dystrophic Epidermolysis Bullosa.

4. Confirmation of DEB diagnosis (either DDEB or RDEB) by genetic testing including COL7A1.

5. Two (2) cutaneous wounds meeting the following criteria:

   1. Location: similar in size, located in similar anatomical regions, and have similar appearance
   2. Appearance: clean with adequate granulation tissue, excellent vascularization, and do not appear infected.

6. Subjects and caregivers who, in the opinion of the Investigator, are able to understand the study, co-operate with the study procedures and are willing to return to the clinic for all the required follow-up visits.

7. Male or Female of childbearing potential must use a reliable birth control method throughout the duration of the study and for three (3) months post last dose of B-VEC.

8. Negative pregnancy test at Visit 1 (Week 1), if applicable.

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Exclusion Criteria

1. Medical instability limiting ability to travel to the Investigative Center.
2. Diseases or conditions that could interfere with the assessment of safety and efficacy of the study treatment and compliance of the subject with study visits/procedures, as determined by the Investigator.
3. Current evidence or a history of squamous cell carcinoma in the area that will undergo treatment.
4. Subjects actively receiving chemotherapy or immunotherapy at Visit 1 (Week 1).
5. Active drug or alcohol addiction as determined by the Investigator.
6. Hypersensitivity to local anesthesia (lidocaine/prilocaine cream).
7. Participation in an interventional clinical trial within the past three (3) months (not including BVEC administration).
8. Receipt of a skin graft in the past three (3) months.
9. Pregnant or nursing women.

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Placebo	Placebo	Matching masked inactive topical gel
B-VEC	Topical Beremagene Geperpavec	Topical gel of non-integrating, replication-incompetent HSV-1 expressing the human collagen VII protein

Primary Outcome Measures

Name	Time	Method
Primary Wound With Complete Wound Healing (100% Wound Closure) on Weeks 22 and 24 or Weeks 24 and 26	26 weeks post-baseline	The primary wound was defined as a responder wound that met either of the following conditions: * Complete wound healing on Week 22 and Week 24, or; * Complete wound healing on Week 24 and Week 26.; For subjects with missing primary wound healing data, a multiple imputation approach (10 repliates) was used. The total numbers of primary wounds with complete healing for B-VEC and Placebo presented below were the average of those from the multiple imputation replicates, and therefore, they would not be whole numbers (integers).

Secondary Outcome Measures

Name	Time	Method
Primary Wound With Complete Wound Healing (100% Wound Closure) on Weeks 8 and 10 or Weeks 10 and 12	12 weeks post-baseline	The primary wound was defined as a responder wound that met either of the following conditions: * Complete wound healing on Week 8 and Week 10, or; * Complete wound healing on Week 10 and Week 12.; For subjects with missing primary wound healing data, a multiple imputation approach (10 repliates) was used. The total numbers of primary wounds with complete healing for B-VEC and Placebo presented below were the average of those from the multiple imputation replicates, and therefore, they would not be whole numbers (integers).
Primary Wound Pain Severity (Visual Analog Scale (VAS)) Change for Ages 6 and Above Subjects at Weeks 22, 24, and 26.	26 weeks post-baseline	Changes from baseline at Weeks 22, 24, and 26 in primary wound pain severity (visual analog scale (VAS)) for ages 6 and above subjects. The Visual Analog Scale scores from 0 (no pain) to 10 (the worst possible pain). Negative values in changes from baseline mean improvement in pain severity.

Trial Locations

Locations (3)

Mission Dermatology Center; 🇺🇸 Rancho Santa Margarita, California, United States

Stanford University; 🇺🇸 Stanford, California, United States

Pediatric Skin Research, LLC; 🇺🇸 Coral Gables, Florida, United States