Epidermolysis Bullosa: Drug Repurposing Trials

Gareth Bacon Excerpts

Tuesday 9th May 2023 Commons Chamber

[Gareth Bacon (Orpington) (Con)]

Epidermolysis bullosa is dreadful. It is often referred to as butterfly skin. It is a little known and rare genetic skin blistering condition, which causes skin to blister and tear at the slightest touch. BE—I will be kind to myself and refer to it in the rest of my speech as BE—causes excruciating, lifelong pain, and can have a devastating impact on the physical and mental wellbeing of patients. It can also greatly affect patients’ families because of the constant treatment needed. In many cases, this means several hours of bandaging and unbandaging the most affected parts of the body daily. In its most severe form, EB also affects internal organs and eyes, causes severe problems when it comes to eating and drinking, and requires extensive healthcare—and there is no cure. It is believed that EB affects around 5,000 people in the UK, although there is limited information available from the NHS. Although that is a relatively small number, the severity of the condition is such that it has a deep impact.

I was asked to secure this Adjournment debate by some of my constituents, DEBRA, which is a UK-wide charity supporting people with EB and their care givers, healthcare professionals and researchers who work with EB. The charity exists to improve quality of life for people living with EB, and to fund pioneering research to find effective treatments. The charity works in partnership with the NHS to deliver EB healthcare services. There are four centres of excellence delivering specialist care in the UK, along with additional hospital care and clinics at other locations. The charity has a proud record of funding EB research in the UK and internationally, funding the first clinical trials in gene therapy. Its current focus is on fulfilling its mission to help people with EB live a life free of pain, a point I will return to later in my speech.

Many colleagues may be familiar with DEBRA from some of its network of more than 100 charity shops, which are the main source of the charity’s income. I was able to visit one of the DEBRA shops, located in Locksbottom in my Orpington constituency, a few months ago, and I met not only the volunteers there, but a local constituent called Wendy, who suffers with EB. This particular lady has been suffering from EB since birth, and she told me of her experience and the experience of others who have an even more severe type of the condition.

As a child and even as a young lady, Wendy did not know that she had EB because doctors had not diagnosed the condition, which, particularly in the early years, is difficult to spot. She did, however, suffer constantly from blisters on her feet and her legs. Wendy told me about how, while she was growing up in constant pain, she would try to hide her wounds from friends and classmates, and would avoid wearing skirts to avoid causing unpleasant reactions from others. Yet as terrible as this sounds, Wendy told me her case was not uncommon and not as severe as it was for other patients.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Gentleman for bringing this debate forward. He raises an issue that affects not only his constituents, but mine and those of others across Northern Ireland, so I commend him. Does he not agree that this dreadful disease, which is named the butterfly disease because it is unusual, has the capacity to limit life and the quality of life, and that the funding for the treatments he refers to, which can provide relief to constituents in all of our constituencies—in his, mine and those of others in this House—is vital? Would he urge the Minister, who is a very compassionate man and understands the issue very well, to give even the smallest bit of funding towards research to try to find a cure for the disease and to help the lives of those who have it?

[Gareth Bacon]

I thank the hon. Gentleman for his kind words and the way he expressed them, and I agree entirely with those sentiments. Without giving out too many spoilers at this stage, there will be a request for a small amount of funding towards the end of my speech.

What I learned during the visit I referred to was truly moving, and I am particularly grateful to have met Wendy. I also thank DEBRA’s director of research, Dr Sagair Hussain, and the excellent staff at the charity shop in my constituency, for inviting me to visit them and learn more about how they help individuals who live with this painful condition. In the spirit of thanking people, I also thank the Minister for his interest in this subject and for being here this evening to respond to the debate, and the Minister for Social Care for recently answering a written parliamentary question that I tabled about EB.

I stress that we cannot merely wait for a cure for this condition. We need to make a difference for patients who are suffering today and those who will be living with the condition for the foreseeable future. All EB patients are crying out for better therapeutic treatments, which have the potential vastly to improve their lives. DEBRA has set an objective of securing two to three treatments from drugs that are already licensed for other conditions, to radically improve the quality of life experienced by people with EB. In reply to my recent written question, the Minister for Social Care said that medicines that are potential candidates for repurposing in this way should be put forward for consideration for support from the Medicines Repurposing Programme. I am grateful for her guidance, and officials from the MRP have been in touch with DEBRA since to talk about the programme’s work. That is excellent news.

In addition, I was delighted to hear that some innovative treatments for EB are either in trials or are being considered by the National Institute for Health and Care Excellence. Specifically, NHS England is working with NICE on the evaluation of two products for EB: birch bark extract for skin wounds, and a gene therapy with a name that I find particularly difficult to pronounce, although I will give it a shot—beremagene geperpavec. I have almost certainly mispronounced that, but it is still encouraging news. However, my understanding is that those two treatments will be available only to a fraction of the total number of people suffering from EB. That is why the repurposing process for more mainstream therapeutics is so important.

DEBRA has identified six anti-inflammatory drugs that could help with EB. Several of those are already available for people with more common skin conditions such as eczema and psoriasis, but for people with EB they could be nothing short of life-changing. They have the potential to transform thousands of lives by improving wound healing, reducing pain, and lowering the burden on the family members and carers of those with EB.

[Wera Hobhouse (Bath) (LD)]

Does the hon. Gentleman agree that the problem with skin conditions, particularly rare conditions, is that people are also embarrassed and want to hide them, which adds insult to injury?

[Gareth Bacon]

I agree with the hon. Lady. That was very much the story for Wendy, the lady I met in the shop, and she was not alone in that. It is particularly true when people are young and have EB but doctors are unable to diagnose it at that stage. They do not know why they have open and weeping sores. These things sometimes attract a smell as well, and as a result people are ashamed of their condition. It has a bad social stigma and is bad for their sense of morale.

The drugs would also have a significant economic benefit. For example, research by an expert dermatology professor at King’s College London found that, when used for EB, one of the drugs has been reported to reduce daily bandaging time from three hours to one by reducing the severity of the wounds, and to reduce skin itch by 60%. That in turn would save time and money for the NHS, and reduce stress on the family unit supporting the patient. Studies by the London School of Economics in 2016 and 2022 reported that EB has a wider economic impact, as parents and family members are currently obliged to reduce labour market participation due to the informal care of their loved one. The same study also revealed a higher prevalence of psychological and psychiatric symptoms among those with EB—that refers back to the point made by the hon. Member for Bath (Wera Hobhouse)—indicating a further tranche of support costs that could be reduced if treatments were improved. The most recent LSE study, published in September 2022, said that the annual cost per patient with dystrophic EB—the most severe form of the condition—is about £45,800, depending on the level of disability. That takes into account direct and indirect costs for patients and care givers. So the benefits are hugely significant, but, to enter the MRP process, the treatments in question will need to go through research trials to prove their efficacy in treating EB. To pay for that, DEBRA is seeking just £10 million from the Department of Health and Social Care, the NHS and the devolved Administrations to go with a further £5 million from its own fundraising campaign. That relatively small amount of money would do so much to address the misery caused by this awful condition.

[James Sunderland (Bracknell) (Con)]

I know a bit about EB. The headquarters of DEBRA are in Bracknell, and I have visited them on a number of occasions. DEBRA’s work is incredible; I am full of admiration for what it does. Having come across people suffering from EB, which is a terrible, dreadful, debilitating disease, I can say with complete authority that the money we are asking for today is an absolute drop in the ocean in terms of the UK’s overall health budget. Actually, we need to be throwing the kitchen sink at this and doing what we can to repurpose these drugs to give the patients and sufferers—these fantastic people—a better quality of life. I urge the Minister please to do whatever he can to ensure that £10 million is just the start. Does my hon. Friend agree that we need to do everything possible for these sufferers?

[Gareth Bacon]

I am extremely grateful to my hon. Friend for his intervention and for hosting a reception for EB and for DEBRA here in June, I believe.

[James Sunderland]

It is on 19 June.

[Gareth Bacon]

You heard it here first—19 June. I will attend, and I very much hope that hon. Members will join us in the Terrace Pavilion.

As I conclude my remarks, I have three requests of the Minister. First, will he agree in principle to the Government supporting this request for funding? Secondly, I understand that the MRP process tends to focus on generic drugs, but most of the treatments identified as candidates by DEBRA are not generics. Will he therefore confirm that the MRP will consider non-generic drugs for potential use to treat EB? I have a list for him, in case he needs to see it. Finally, will he agree to meet me and representatives of DEBRA to discuss these proposals for drug repurposing and the many other ways in which we can support patients with EB and alleviate their often devastating symptoms?