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      Oleogel-S10 Phase 3 study “EASE” for epidermolysis bullosa: study design and rationale

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          Abstract

          Background

          Epidermolysis bullosa (EB) is a group of rare, genetic diseases that affect the integrity of epithelial tissues, most notably the skin. Patients experience recurrent skin wounding, with severity depending on type, sub-type, and mutation. Oleogel-S10, a formulation of birch bark extract, has demonstrated efficacy in a Phase 2 trial assessing re-epithelialization of wounds in EB. EASE (NCT03068780, EudraCT 2016–002066-32) is a randomized, Phase 3, placebo-controlled study designed to determine the efficacy of Oleogel-S10 versus placebo in patients with EB.

          Methods

          EASE is a Phase 3, two-phase study comprising a 90-day, double-blind, randomized, placebo-controlled phase, followed by 24 months of open-label, single-arm follow-up. Patients with junctional EB, dystrophic EB, or Kindler syndrome and target wounds (10 - 50cm 2) present for > 21 days and < 9 months, are randomized in a 1:1 ratio to receive wound dressings according to local standard of care with or without Oleogel-S10. Placebo is based on the Oleogel-S10 vehicle, which is sunflower oil formulated to have a consistency indistinguishable from that of the active product. The primary endpoint of the trial, directed by the US health authority according to the required study endpoints for chronic cutaneous ulcer and burn wounds, is to compare the efficacy of Oleogel-S10 versus placebo according to the proportion of patients with complete closure of the target wound within 45 ± 7 days of treatment. Additional EB-focused endpoints include wound burden, patient-reported outcomes, and safety.

          Results

          Results of the primary endpoint are anticipated to be available by H2 2019.

          Trial registration

          ClinicalTrials.gov, NCT03068780. EudraCT, 2016–002066-32. Registered on 3 March 2017.

          Electronic supplementary material

          The online version of this article (10.1186/s13063-019-3362-z) contains supplementary material, which is available to authorized users.

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          Most cited references27

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          The FLACC: a behavioral scale for scoring postoperative pain in young children.

          To evaluate the reliability and validity of the FLACC Pain Assessment Tool which incorporates five categories of pain behaviors: facial expression; leg movement; activity; cry; and consolability. Eighty-nine children aged 2 months to 7 years, (3.0 +/- 2.0 yrs.) who had undergone a variety of surgical procedures, were observed in the Post Anesthesia Care Unit (PACU). The study consisted of: 1) measuring interrater reliability; 2) testing validity by measuring changes in FLACC scores in response to administration of analgesics; and 3) comparing FLACC scores to other pain ratings. The FLACC tool was found to have high interrater reliability. Preliminary evidence of validity was provided by the significant decrease in FLACC scores related to administration of analgesics. Validity was also supported by the correlation with scores assigned by the Objective Pain Scale (OPS) and nurses' global ratings of pain. The FLACC provides a simple framework for quantifying pain behaviors in children who may not be able to verbalize the presence or severity of pain. Our preliminary data indicates the FLACC pain assessment tool is valid and reliable.
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            Inherited epidermolysis bullosa: updated recommendations on diagnosis and classification.

            Several new targeted genes and clinical subtypes have been identified since publication in 2008 of the report of the last international consensus meeting on diagnosis and classification of epidermolysis bullosa (EB). As a correlate, new clinical manifestations have been seen in several subtypes previously described. We sought to arrive at an updated consensus on the classification of EB subtypes, based on newer data, both clinical and molecular. In this latest consensus report, we introduce a new approach to classification ("onion skinning") that takes into account sequentially the major EB type present (based on identification of the level of skin cleavage), phenotypic characteristics (distribution and severity of disease activity; specific extracutaneous features; other), mode of inheritance, targeted protein and its relative expression in skin, gene involved and type(s) of mutation present, and--when possible--specific mutation(s) and their location(s). This classification scheme critically takes into account all published data through June 2013. Further modifications are likely in the future, as more is learned about this group of diseases. The proposed classification scheme should be of value both to clinicians and researchers, emphasizing both clinical and molecular features of each EB subtype, and has sufficient flexibility incorporated in its structure to permit further modifications in the future. Copyright © 2014 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.
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              Targeting Inflammatory Pathways by Triterpenoids for Prevention and Treatment of Cancer

              Traditional medicine and diet has served mankind through the ages for prevention and treatment of most chronic diseases. Mounting evidence suggests that chronic inflammation mediates most chronic diseases, including cancer. More than other transcription factors, nuclear factor-kappaB (NF-κB) and STAT3 have emerged as major regulators of inflammation, cellular transformation, and tumor cell survival, proliferation, invasion, angiogenesis, and metastasis. Thus, agents that can inhibit NF-κB and STAT3 activation pathways have the potential to both prevent and treat cancer. In this review, we examine the potential of one group of compounds called triterpenes, derived from traditional medicine and diet for their ability to suppress inflammatory pathways linked to tumorigenesis. These triterpenes include avicins, betulinic acid, boswellic acid, celastrol, diosgenin, madecassic acid, maslinic acid, momordin, saikosaponins, platycodon, pristimerin, ursolic acid, and withanolide. This review thus supports the famous adage of Hippocrates, “Let food be thy medicine and medicine be thy food”.
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                Author and article information

                Contributors
                +61 3 9342 4531 , johannes.kern@mh.org.au
                agnes.schwieger@kispi.uzh.ch
                sandra.loewe@amrytpharma.com
                mark.sumeray@amrytpharma.com
                chuck@csdbiostat.com
                anna.martinez@gosh.nhs.uk
                Journal
                Trials
                Trials
                Trials
                BioMed Central (London )
                1745-6215
                11 June 2019
                11 June 2019
                2019
                : 20
                : 350
                Affiliations
                [1 ]Dermatology Department, Royal Melbourne Hospital, Faculy of Medicine, Dentistry and Health Science, The University of Melbourne, Parkville, Victoria Australia
                [2 ]ISNI 0000 0000 9428 7911, GRID grid.7708.8, Department of Dermatology, , Faculty of Medicine, Medical Center - University of Freiburg, ; Freiburg, Germany
                [3 ]Department of Dermatology, University Childrens’ Hospital Zurich, Zurich, Switzerland
                [4 ]Amryt Pharmaceuticals DAC, Dublin, Ireland
                [5 ]CSD Biostatistics Inc., Oro Valley, AZ USA
                [6 ]GRID grid.420468.c, Department of Paediatric Dermatology, , Great Ormond Street Hospital NHS Foundation Trust, ; London, UK
                Article
                3362
                10.1186/s13063-019-3362-z
                6560757
                31186047
                6ed81046-aa14-45c5-b73e-db92ab3e574b
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 17 September 2018
                : 15 April 2019
                Funding
                Funded by: Amryt Pharmaceuticals DAC
                Categories
                Study Protocol
                Custom metadata
                © The Author(s) 2019

                Medicine
                epidermolysis bullosa,kindler syndrome,oleogel,birch bark,betulin,trial design,wound healing
                Medicine
                epidermolysis bullosa, kindler syndrome, oleogel, birch bark, betulin, trial design, wound healing

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