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A Study to Evaluate the Efficacy and Safety of NexoBrid in Children With Thermal Burns Compared the Standard of Care

Primary Purpose

Thermal Burns

Status
Active
Phase
Phase 3
Locations
International
Study Type
Interventional
Intervention
NexoBrid
Standard of Care
Sponsored by
MediWound Ltd
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Thermal Burns

Eligibility Criteria

0 Years - 17 Years (Child)All SexesDoes not accept healthy volunteers

Inclusion Criteria

  1. Stage 1: Males and females between 4 years to 18 years of age, Stage 2 (upon DSMB review): Males and females between 1 year to 18 years of age, Stage 3 (upon DSMB review): Males and females between 0 years to 18 years of age.
  2. Thermal burns caused by fire/flame, scalds or contact.
  3. Patient total burns area ≥ 1% DPT and / or FT,
  4. Patient total burns area should be ≤ 30% TBSA; SPT, DPT and/or FT in depth,
  5. Signed written informed consent by a legal guardian can be obtained within 84 hours of the burn injury.

At least one wound (a continuous burn area which can be treated in one session; might include several anatomical areas) in a patient should meet all following criteria:

  1. Wound that is ≥ 1% TBSA (DPT and/or FT) (not including face, perineal or genital),
  2. Wound is composed of DPT and/or FT in depth. Superficial partial thickness areas may be included in the wound area only if cannot be separated from deeper areas (e.g. surrounded by or mixed with DPT areas) and might interfere with the treatment of the deeper areas,
  3. Wound that is potentially intended for surgical eschar removal,
  4. Wound's blisters can be unroofed, as judged by the investigator.

Exclusion Criteria:

  1. Patients weighing less than 3kg,
  2. Patients who are unable to follow study procedures and follow up period,
  3. Patients with electrical or chemical burns,
  4. Patient with a continuous burn area above 15% TBSA,
  5. Patients with no DPT and/or FT burn area (only SPT wounds),
  6. Patient with circumferential anterior/posterior trunk fire/flame burns, >15% TBSA (Circumferential is defined as encircling ≥ 80% of the trunk circumference),
  7. The following pre-enrolment dressings: a. Flammacerium, b. Silver Nitrate (AgNO3),
  8. Patients with diagnosed infections,
  9. Diagnosis of smoke inhalation injury,
  10. Patients with pre-enrolment wounds which are covered by eschar saturated with iodine or by SSD pseudoeschar (e.g. pseudoeschar as a result of >12h SSD treatment),
  11. Patients with pre-enrolment escharotomy,
  12. Pregnant women (positive pregnancy test) or nursing mothers,
  13. Poorly controlled diabetes mellitus (HbA1c>9%),
  14. Known Cardio-pulmonary disease, oxygen-dependent pulmonary diseases, broncho-pneumonia, uncontrolled asthma,
  15. Known conditions which interfere with circulation (peripheral vascular disease, edema, lymphedema, surgery to the regional lymph nodes, obesity),
  16. Any known conditions that would preclude safe participation in the study or adding further risk to the basic acute burn trauma (such as immuno-compromising diseases, life threatening trauma, severe pre-existing coagulation disorder, pulmono-cardiovascular, liver or neoplastic disease),
  17. ASA greater than 2
  18. Chronic systemic steroid intake,
  19. History of allergy and/or known sensitivity to pineapples, papaya, Bromelain or papain,
  20. Current (within 12 months prior to screening) suicide attempt,
  21. Enrollment in any investigational drug trial within 4 weeks prior to screening,
  22. Current (within 12 months prior to screening) alcohol (daily consumption > 3 units for males and >2 units for females) or drug abuse,
  23. Prisoners and incarcerated
  24. Patients who might depend on the clinical study site or investigator.
  25. Patient expresses objection to participate in the study.
  26. Patients with other severe cutaneous trauma at the same sites as the burns (i.e. blunt, avulsion or deep abrasion) or previous burn(s) at the same treatment site(s)
  27. General condition of patient would contraindicate surgery

Sites / Locations

  • Maricopa Special Health Care District
  • University Of Florida
  • University of Miami
  • The University of South Florida Board of Trustees
  • University of Iowa Hospitals and Clinics
  • University of Kansas Medical Center Research Institute, Inc.
  • Shriners Hospital for Children
  • Stony Brook University Medical Center
  • Legacy Emanuel Hospital & Health Center dba Legacy Research Institute
  • Drexel University
  • Shawn Jekins Children's Hospital
  • University of Utah
  • Harborview Medical Center
  • University Hospital, Department of Plastic Surgery
  • S. Khechinashvili University Hospital
  • Unfallkrankenhaus Berlin Zentrum für Schwerbrandverletzte mit Plastischer Chirurgie
  • Klinikum Stuttgart - Olgahospital
  • MRE Bethesda Gyermekkórháza
  • B.A.Z Megyei Kórház és Egyetemi Oktatókórház
  • Klinikai Kozpont Gyermekgyogyaszati Klinika
  • Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg
  • Krishna Rajendra Hospital
  • Vardhman Mahavir Medical College (VLCC) and Safdarjung Hospital
  • Universitary Integrated Hospital Verona (AOUI Verona),
  • Acute Burn Care &Trauma Surgery, Dept Surgery/Burn Center, Rode Kruis Ziekenhuis, LUMC University Leiden
  • Uniwersytecki Szpital Dzieciecy w Krakowie
  • Szpital Dzieciecy im.prof.dr.med Jana Bogdanowicza, Oddzial Chirurgii i Urologii Dzieciecej z Pododdzialem Leczenia Oparzen
  • Spitalul Clinic de Urgenta pentru Copii "Sfanta Maria"
  • Spitalul Clinic de Urgenta Tg- Mures
  • Univerzitná nemocnica Bratislava, Klinika popálenin a rekonštrukčnej chirurgie
  • La Paz University Hospital
  • Boulevar Sur s/n
  • CNPE "City clinical hospital of immediate and urgent medical aid n.a.Meshchaninov" of Kharkiv CC and State institution 'Zaitsev V.T. Institute of general and urgent surgery of the National academy of medical sciences of Ukraine'
  • Communal institution "Odessa Regional Clinical Medical Center"
  • Birmingham Children´s Hospital NHS Foundation Trust
  • Royal Manchester Children's Hospital

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

NexoBrid Gel

Standard of Care

Arm Description

NexoBrid Gel is applied to the burn wound at a dose of 2g or 5g NexoBrid sterile powder mixed with 20g or 50g sterile Gel Vehicle per 180cm^2 of TBSA for four hours.

Non surgical and Surgical Debridement

Outcomes

Primary Outcome Measures

Earlier eschar removal (in days)
Demonstrate superiority over SOC for eschar removal as measured by a survival analysis of incidence of complete eschar removal as a function of time. Eschar removal will be measured at the end of the debridement starting from randomization date.

Secondary Outcome Measures

Full Information

First Posted
October 27, 2014
Last Updated
July 24, 2022
Sponsor
MediWound Ltd
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1. Study Identification

Unique Protocol Identification Number
NCT02278718
Brief Title
A Study to Evaluate the Efficacy and Safety of NexoBrid in Children With Thermal Burns Compared the Standard of Care
Official Title
A Multicenter, Multinational, Randomized, Controlled, Open Label Study, Performed in Children With Thermal Burns, to Evaluate the Efficacy and Safety of NexoBrid as Compared to Standard of Care (SOC) Treatment
Study Type
Interventional

2. Study Status

Record Verification Date
July 2022
Overall Recruitment Status
Active, not recruiting
Study Start Date
May 2015 (Actual)
Primary Completion Date
April 2021 (Actual)
Study Completion Date
December 2022 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
MediWound Ltd

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This study will be a two-arms study intending to demonstrate superiority of NexoBrid treatment over SOC in children with thermal burns. The study objective is to evaluate the safety and clinical benefit of NexoBrid in hospitalized children (0-17 years) with deep partial and/or full thickness thermal burns of 1-30% TBSA and to compare NexoBrid to standard of care (SOC).
Detailed Description
A total of 160 patients will be randomized into NexoBrid and SOC treatment (80 patients per arm). Age distribution will be managed as follows: 45 patients 0-23 months old 45 patients 24 months-3 years old 30 patients 4-11 years old 20 patients 12-17 years old The remaining 20 patients will be enrolled to any of the above groups, per their age during enrollment. The study will be conducted in three stages. In Stage I, at least 24 children age 4-18 years, hospitalized in burn units, with deep partial thickness burns ranging from 1%-30% TBSA, and who meet the entrance criteria, will be enrolled. Upon completion of stage I, a safety analysis will be performed on safety parameters and the results will be evaluated by a Data Safety Monitoring Board (DSMB) as defined in the agreed charter. If the DSMB does not have any safety concerns, Stage II will commence, this time enrolling at least 26 additional children aged of 1-18 years according to the study procedures. A DSMB will be convened to assess the safety data of the first 50 patients enrolled at stages 1 & 2. If the DSMB has not found any safety concerns, stage III will commence in which patients from the age of birth to 18 years will be included (stage III will include 110 remaining patients required to reach a total of 160 patients). Following the enrollment of a subject to the study and prior to randomization, physicians will define one or more Target Wounds (TWs) per subject according to TWs definition. All subjects' DPT and FT burns that fit the specified criteria are intended to receive study treatment per randomized study arm and therefore, must be designated as TWs. Prior to eschar removal treatment with NexoBrid or SOC subjects will be medicated with appropriate analgesia and undergo wound cleansing and dressing of all wounds with antibacterial solutions. Following wound cleansing and antibacterial treatments, subjects will undergo the eschar removal process as per treatment assignment (NexoBrid or SOC, following randomization). Subsequent to eschar removal, all wounds will be assessed and treated in the same manner, in accordance with post-eschar removal wound care strategy. Furthermore, subjects will undergo daily assessments (Vital signs (VS) and pain assessments) for one week and weekly assessments thereafter, until wound closure. Following wound closure, subjects will be followed up at 6 weeks, 12 weeks, and after that, at 6, 12, 18 and 24 months (for a blinded assessment of cosmesis, function and QoL evaluation). All subjects will be invited to one additional extended follow up visit that will occur at least 30 months after wound closure confirmation for a blinded assessment of cosmesis, function and QoL evaluation.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Thermal Burns

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
Outcomes Assessor
Allocation
Randomized
Enrollment
145 (Actual)

8. Arms, Groups, and Interventions

Arm Title
NexoBrid Gel
Arm Type
Experimental
Arm Description
NexoBrid Gel is applied to the burn wound at a dose of 2g or 5g NexoBrid sterile powder mixed with 20g or 50g sterile Gel Vehicle per 180cm^2 of TBSA for four hours.
Arm Title
Standard of Care
Arm Type
Active Comparator
Arm Description
Non surgical and Surgical Debridement
Intervention Type
Drug
Intervention Name(s)
NexoBrid
Intervention Description
NexoBrid is an enzymatic debriding agent for Eschar Removal.
Intervention Type
Procedure
Intervention Name(s)
Standard of Care
Intervention Description
Surgical or Non-Surgical methods for Eschar Removal
Primary Outcome Measure Information:
Title
Earlier eschar removal (in days)
Description
Demonstrate superiority over SOC for eschar removal as measured by a survival analysis of incidence of complete eschar removal as a function of time. Eschar removal will be measured at the end of the debridement starting from randomization date.
Time Frame
participants will be followed from randomization date and daily for the duration of hospital stay, an expected average of 3 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
0 Years
Maximum Age & Unit of Time
17 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria Stage 1: Males and females between 4 years to 18 years of age, Stage 2 (upon DSMB review): Males and females between 1 year to 18 years of age, Stage 3 (upon DSMB review): Males and females between 0 years to 18 years of age. Thermal burns caused by fire/flame, scalds or contact. Patient total burns area ≥ 1% DPT and / or FT, Patient total burns area should be ≤ 30% TBSA; SPT, DPT and/or FT in depth, Signed written informed consent by a legal guardian can be obtained within 84 hours of the burn injury. At least one wound (a continuous burn area which can be treated in one session; might include several anatomical areas) in a patient should meet all following criteria: Wound that is ≥ 1% TBSA (DPT and/or FT) (not including face, perineal or genital), Wound is composed of DPT and/or FT in depth. Superficial partial thickness areas may be included in the wound area only if cannot be separated from deeper areas (e.g. surrounded by or mixed with DPT areas) and might interfere with the treatment of the deeper areas, Wound that is potentially intended for surgical eschar removal, Wound's blisters can be unroofed, as judged by the investigator. Exclusion Criteria: Patients weighing less than 3kg, Patients who are unable to follow study procedures and follow up period, Patients with electrical or chemical burns, Patient with a continuous burn area above 15% TBSA, Patients with no DPT and/or FT burn area (only SPT wounds), Patient with circumferential anterior/posterior trunk fire/flame burns, >15% TBSA (Circumferential is defined as encircling ≥ 80% of the trunk circumference), The following pre-enrolment dressings: a. Flammacerium, b. Silver Nitrate (AgNO3), Patients with diagnosed infections, Diagnosis of smoke inhalation injury, Patients with pre-enrolment wounds which are covered by eschar saturated with iodine or by SSD pseudoeschar (e.g. pseudoeschar as a result of >12h SSD treatment), Patients with pre-enrolment escharotomy, Pregnant women (positive pregnancy test) or nursing mothers, Poorly controlled diabetes mellitus (HbA1c>9%), Known Cardio-pulmonary disease, oxygen-dependent pulmonary diseases, broncho-pneumonia, uncontrolled asthma, Known conditions which interfere with circulation (peripheral vascular disease, edema, lymphedema, surgery to the regional lymph nodes, obesity), Any known conditions that would preclude safe participation in the study or adding further risk to the basic acute burn trauma (such as immuno-compromising diseases, life threatening trauma, severe pre-existing coagulation disorder, pulmono-cardiovascular, liver or neoplastic disease), ASA greater than 2 Chronic systemic steroid intake, History of allergy and/or known sensitivity to pineapples, papaya, Bromelain or papain, Current (within 12 months prior to screening) suicide attempt, Enrollment in any investigational drug trial within 4 weeks prior to screening, Current (within 12 months prior to screening) alcohol (daily consumption > 3 units for males and >2 units for females) or drug abuse, Prisoners and incarcerated Patients who might depend on the clinical study site or investigator. Patient expresses objection to participate in the study. Patients with other severe cutaneous trauma at the same sites as the burns (i.e. blunt, avulsion or deep abrasion) or previous burn(s) at the same treatment site(s) General condition of patient would contraindicate surgery
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Lior Rosenberg, Prof.
Organizational Affiliation
MediWound Ltd
Official's Role
Study Chair
First Name & Middle Initial & Last Name & Degree
Yaron Shoham, Dr.
Organizational Affiliation
MediWound Ltd
Official's Role
Study Director
Facility Information:
Facility Name
Maricopa Special Health Care District
City
Phoenix
State/Province
Arizona
ZIP/Postal Code
85008
Country
United States
Facility Name
University Of Florida
City
Gainesville
State/Province
Florida
ZIP/Postal Code
32610
Country
United States
Facility Name
University of Miami
City
Miami
State/Province
Florida
ZIP/Postal Code
33146
Country
United States
Facility Name
The University of South Florida Board of Trustees
City
Tampa
State/Province
Florida
ZIP/Postal Code
33620
Country
United States
Facility Name
University of Iowa Hospitals and Clinics
City
Iowa City
State/Province
Iowa
ZIP/Postal Code
52242
Country
United States
Facility Name
University of Kansas Medical Center Research Institute, Inc.
City
Kansas City
State/Province
Kansas
ZIP/Postal Code
66160
Country
United States
Facility Name
Shriners Hospital for Children
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02114
Country
United States
Facility Name
Stony Brook University Medical Center
City
Stony Brook
State/Province
New York
ZIP/Postal Code
11794
Country
United States
Facility Name
Legacy Emanuel Hospital & Health Center dba Legacy Research Institute
City
Portland
State/Province
Oregon
ZIP/Postal Code
97232
Country
United States
Facility Name
Drexel University
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19134
Country
United States
Facility Name
Shawn Jekins Children's Hospital
City
Charleston
State/Province
South Carolina
ZIP/Postal Code
29425s
Country
United States
Facility Name
University of Utah
City
Salt Lake City
State/Province
Utah
ZIP/Postal Code
84132
Country
United States
Facility Name
Harborview Medical Center
City
Seattle
State/Province
Washington
ZIP/Postal Code
98104
Country
United States
Facility Name
University Hospital, Department of Plastic Surgery
City
Gent
ZIP/Postal Code
B 9000
Country
Belgium
Facility Name
S. Khechinashvili University Hospital
City
Tbilisi
ZIP/Postal Code
0179
Country
Georgia
Facility Name
Unfallkrankenhaus Berlin Zentrum für Schwerbrandverletzte mit Plastischer Chirurgie
City
Berlin
ZIP/Postal Code
12683
Country
Germany
Facility Name
Klinikum Stuttgart - Olgahospital
City
Stuttgart
ZIP/Postal Code
D-70176
Country
Germany
Facility Name
MRE Bethesda Gyermekkórháza
City
Budapest
ZIP/Postal Code
H-1146
Country
Hungary
Facility Name
B.A.Z Megyei Kórház és Egyetemi Oktatókórház
City
Miskolc
ZIP/Postal Code
H-3526
Country
Hungary
Facility Name
Klinikai Kozpont Gyermekgyogyaszati Klinika
City
Pécs
ZIP/Postal Code
H-7624
Country
Hungary
Facility Name
Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg
City
New Delhi
State/Province
Delhi
ZIP/Postal Code
110001
Country
India
Facility Name
Krishna Rajendra Hospital
City
Mysuru
ZIP/Postal Code
570001
Country
India
Facility Name
Vardhman Mahavir Medical College (VLCC) and Safdarjung Hospital
City
New Delhi
ZIP/Postal Code
110029
Country
India
Facility Name
Universitary Integrated Hospital Verona (AOUI Verona),
City
Verona
ZIP/Postal Code
37126
Country
Italy
Facility Name
Acute Burn Care &Trauma Surgery, Dept Surgery/Burn Center, Rode Kruis Ziekenhuis, LUMC University Leiden
City
Beverwijk
ZIP/Postal Code
1942
Country
Netherlands
Facility Name
Uniwersytecki Szpital Dzieciecy w Krakowie
City
Kraków
ZIP/Postal Code
30-663
Country
Poland
Facility Name
Szpital Dzieciecy im.prof.dr.med Jana Bogdanowicza, Oddzial Chirurgii i Urologii Dzieciecej z Pododdzialem Leczenia Oparzen
City
Warszawa
Country
Poland
Facility Name
Spitalul Clinic de Urgenta pentru Copii "Sfanta Maria"
City
Iasi
ZIP/Postal Code
700309
Country
Romania
Facility Name
Spitalul Clinic de Urgenta Tg- Mures
City
Târgu-Mureş
ZIP/Postal Code
54000
Country
Romania
Facility Name
Univerzitná nemocnica Bratislava, Klinika popálenin a rekonštrukčnej chirurgie
City
Bratislava
ZIP/Postal Code
826 06
Country
Slovakia
Facility Name
La Paz University Hospital
City
Madrid
ZIP/Postal Code
28046
Country
Spain
Facility Name
Boulevar Sur s/n
City
Valencia
ZIP/Postal Code
46026
Country
Spain
Facility Name
CNPE "City clinical hospital of immediate and urgent medical aid n.a.Meshchaninov" of Kharkiv CC and State institution 'Zaitsev V.T. Institute of general and urgent surgery of the National academy of medical sciences of Ukraine'
City
Kharkiv
ZIP/Postal Code
61103
Country
Ukraine
Facility Name
Communal institution "Odessa Regional Clinical Medical Center"
City
Odesa
ZIP/Postal Code
65049
Country
Ukraine
Facility Name
Birmingham Children´s Hospital NHS Foundation Trust
City
Birmingham
Country
United Kingdom
Facility Name
Royal Manchester Children's Hospital
City
Manchester
ZIP/Postal Code
M13 9WL
Country
United Kingdom

12. IPD Sharing Statement

Citations:
PubMed Identifier
24074719
Citation
Rosenberg L, Krieger Y, Bogdanov-Berezovski A, Silberstein E, Shoham Y, Singer AJ. A novel rapid and selective enzymatic debridement agent for burn wound management: a multi-center RCT. Burns. 2014 May;40(3):466-74. doi: 10.1016/j.burns.2013.08.013. Epub 2013 Sep 26.
Results Reference
background
Links:
URL
http://www.ncbi.nlm.nih.gov/pubmed/?term=nexobrid
Description
Related Info

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A Study to Evaluate the Efficacy and Safety of NexoBrid in Children With Thermal Burns Compared the Standard of Care

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