Amnioband and Standard of Care vs. Standard of Care Alone in the Treatment of Venous Leg Ulcers
Primary Purpose
Venous Leg Ulcers
Status
Unknown status
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Weekly application of Amnioband
Biweekly application of Amnioband
Standard of Care
Sponsored by
About this trial
This is an interventional treatment trial for Venous Leg Ulcers focused on measuring human amniotic membrane, compression therapy, venous leg ulcer
Eligibility Criteria
Inclusion Criteria:
- At least 18 years old.
- Ankle Brachial Pressure Index (ABI) > 0.75 OR SPP > 30 mmHg OR TCOM > 30 mmHg.*
- Presence of a venous leg ulcer extending through the full thickness of the skin but not down to muscle, tendon or bone.
- The largest ulcer will be designated the index ulcer and the only one included in the study. If other ulcerations are present on the same leg they have to be more than 2 cm apart from the index ulcer.
- Study ulcer (i.e. current episode of ulceration) has been present for greater than one month prior to the initial screening visit, and has failed to respond to documented conservative measures for greater than (1) one month duration and is excluded if it has undergone 12 months of continuous high strength compression therapy over its duration.
- Study ulcer is a minimum of 2 cm2 and a maximum of 20 cm2 at the randomization visit.
- The target ulcer has been treated with compression therapy for at least 14 days prior to randomization.
- Ulcer has a clean, granulating base with minimal adherent slough at the randomization visit.
- Females of childbearing potential must be willing to use acceptable methods of contraception (birth control pills, barriers, or abstinence).
- Subject understands and is willing to participate in the clinical study and can comply with weekly visits and the follow-up regimen.
- Subject has read and signed the IRB/IEC approved Informed Consent Form before screening procedures are undertaken.
Exclusion Criteria:
- Study ulcer(s) deemed by the investigator to be caused by a medical condition other than venous insufficiency.
- Study ulcer exhibits clinical signs and symptoms of infection.
- Known allergy to the components of the multi-layer compression bandaging, or who cannot tolerate multi-layer compression therapy.
- Study ulcer, in the opinion of the investigator, is suspicious for cancer should undergo an ulcer biopsy to rule out a carcinoma of the ulcer.
- Subjects with a history of more than two weeks treatment with immunosuppressants (including systemic corticosteroids), cytotoxic chemotherapy, or application of topical steroids to the ulcer surface within one month prior to initial screening, or who receive such medications during the screening period, or who are anticipated to require such medications during the course of the study.
- Subjects on any investigational drug(s) or therapeutic device(s) within 30 days preceding Screening.
- Study ulcer improving greater than 30% during the screening phase if the subject was not in adequate compression 14 days prior to screening.
- History of drug or alcohol abuse.
- History of radiation at the ulcer site.
- Presence of one or more medical conditions, as determined by medical history, hematologic, active auto-immune or immune diseases that, in the opinion of the Investigator, would make the subject an inappropriate candidate for this ulcer healing study.
- History of having Acquired Immunodeficiency Syndrome (AIDS) or HIV.
- Study ulcer has been previously treated with tissue engineered materials (e.g. Apligraf® or Dermagraft®) or other scaffold materials (e.g. Oasis, Matristem) within the last 30 days
- Study ulcer requiring negative pressure wound therapy or hyperbaric oxygen during the course of the trial.
- Presence of any condition(s) which seriously compromises the subject's ability to complete this study, or has a known history of poor adherence with medical treatment.
- Ulcers on the dorsum of the foot or with more than 50% of the ulcer below the malleolus are excluded.
- Pregnant or breast feeding.
- Presence of diabetes with poor metabolic control as documented with a HgA1c > 12.0 within last 90 days
- Patients with renal dysfunction whose serum creatinine levels are 3.0mg/dl or greater within the last 90 days
- History of usage of tobacco products within the last 30 days
- History of Liver disease with active Cirrhosis of the liver
Sites / Locations
- Brigham and Women's Hospital Wound Care CenterRecruiting
- Premier SurgicalRecruiting
- Inspira Medical Center - Elmer Wound Care Center
- St John Medical Center
- The Foot and Ankle Wellness CenterRecruiting
- Armstrong County Memorial HospitalRecruiting
- SerenaGroup Research InstituteRecruiting
- Martinsville Research InstituteRecruiting
Arms of the Study
Arm 1
Arm 2
Arm 3
Arm Type
Active Comparator
Experimental
Experimental
Arm Label
Standard of Care
Weekly application of Amnioband
Biweekly application of Amnioband
Arm Description
Subjects randomized to this group will receive standard of care (multi-layer compression therapy).
Weekly application of Amnioband plus standard of care.
Biweekly application of Amnioband plus standard of care.
Outcomes
Primary Outcome Measures
Time to complete ulcer closure
Ulcer closure is based on wound area measurement and absence of wound exudate.
Secondary Outcome Measures
Proportion of ulcers achieving 40% ulcer closure
This is measured by wound area.
Percentage of ulcers achieving complete closure
This is measured by wound area and absence of wound exudate.
Incidence of adverse events
Cost effectiveness
The per unit cost of providing wound care is known. The use of amniotic membrane to standard of care will be compared in terms of the cost of achieving healing.
Reduction in pain between treatment groups
Pain is measured by subject report on a scale of 0 to 10.
Full Information
NCT ID
NCT02609594
First Posted
November 16, 2015
Last Updated
September 6, 2018
Sponsor
SerenaGroup, Inc.
Collaborators
Musculoskeletal Transplant Foundation
1. Study Identification
Unique Protocol Identification Number
NCT02609594
Brief Title
Amnioband and Standard of Care vs. Standard of Care Alone in the Treatment of Venous Leg Ulcers
Official Title
A Multi-center Randomized Controlled Clinical Trial Evaluating Two Application Regimens of Amnioband Dehydrated Human Amniotic Membrane and Standard of Care vs. Standard of Care Alone in the Treatment of Venous Leg Ulcers
Study Type
Interventional
2. Study Status
Record Verification Date
September 2018
Overall Recruitment Status
Unknown status
Study Start Date
November 2015 (undefined)
Primary Completion Date
December 2018 (Anticipated)
Study Completion Date
December 2018 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
SerenaGroup, Inc.
Collaborators
Musculoskeletal Transplant Foundation
4. Oversight
Data Monitoring Committee
No
5. Study Description
Brief Summary
Lower extremity ulcers pose significant clinical, humanistic and economic burdens on society. Millions of Americans are afflicted with painful, open, draining sores on their lower extremities. These sores are referred to as venous leg ulcerations (VLUs).1-5 Under the best of circumstances these ulcers require weeks or months to heal. Not uncommonly wound care specialists see patients who have suffered for years or faced amputation of the limb as their only option to alleviate the pain.
Standard of care will result in healing in 50% of venous leg ulcers in 12 weeks. However, roughly half of patients suffering from venous ulcers will require advanced therapy. Human amniotic membrane replaces the damaged extracellular matrix characteristic of chronic ulcers. In addition, it contains cytokines that may accelerate healing. In clinical practice and recent studies, Dehydrated Human Amniotic Membrane has appeared to be as effective as bioengineered skin products. This RCT is designed to evaluate Amnioband Dehydrated Human Amniotic Membrane in venous leg ulcers.
Detailed Description
This study is a multi-center, randomized, trial designed to evaluate the safety and effectiveness of Amnioband Dehydrated Human Amniotic Membrane plus multi-layer compression therapy versus multi-layer compression alone in the healing of venous leg ulcers.
The Standard of Care therapy in this study is multi-layer compression therapy. A number of compression bandaging systems are commercially available. The choice of compression will be at the discretion of the principle investigator.
The Screening Phase (1-14 days) consists of a series of screening assessments designed to determine eligibility followed by, for those who meet the eligibility criteria (described in more detail below), At or up to 14 days before the first Screening Period Visit (S1), written informed consent from the subject will be obtained by the Investigator or suitably qualified designee before the performance of any other protocol-specific procedure.
Subjects who have not been treated with compression therapy for the target ulcer must receive a minimum of 14 days of compression prior to enrollment.
At the first Screening Period Visit (S1), the Investigator will select the study (target) ulcer. Each subject will have only one VLU selected as the study (target) ulcer. In the situation where a subject has more than one VLU at the S1 visit, the Investigator will select the largest VLU that meets the eligibility criteria of the protocol as the study (target) ulcer.
The Screening Period is designed to determine whether subjects are eligible to proceed to the Treatment Period of the study.
The Treatment Phase (12 Weeks) begins with a series of assessments designed to confirm the subjects' continued eligibility. Subjects who continue to meet eligibility criteria will be randomized to one of three groups: (1) standard of care: multi-layer compression (2) weekly application of Amnioband Dehydrated Human Amniotic Membrane (3) biweekly applications of Amnioband Dehydrated Human Amniotic Membrane.
During the Treatment Phase, subjects will be evaluated on a weekly basis. Efficacy evaluations each week will include Investigator assessment of ulcer healing and measurements of ulcer size using a digital camera device. Safety evaluations during the Treatment Phase will consist of adverse event assessments at each visit.
Subjects in any of the three groups whose ulcers do not achieve closure at 12 weeks will be deemed treatment failures. Subjects in the control arm may cross over to the Amnioband arm if they fail to achieve closure although these subjects will not be included in the analysis.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Venous Leg Ulcers
Keywords
human amniotic membrane, compression therapy, venous leg ulcer
7. Study Design
Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
240 (Anticipated)
8. Arms, Groups, and Interventions
Arm Title
Standard of Care
Arm Type
Active Comparator
Arm Description
Subjects randomized to this group will receive standard of care (multi-layer compression therapy).
Arm Title
Weekly application of Amnioband
Arm Type
Experimental
Arm Description
Weekly application of Amnioband plus standard of care.
Arm Title
Biweekly application of Amnioband
Arm Type
Experimental
Arm Description
Biweekly application of Amnioband plus standard of care.
Intervention Type
Other
Intervention Name(s)
Weekly application of Amnioband
Intervention Description
Weekly application of Amnioband.
Intervention Type
Other
Intervention Name(s)
Biweekly application of Amnioband
Intervention Description
Biweekly application (every two weeks) of Amnioband.
Intervention Type
Other
Intervention Name(s)
Standard of Care
Intervention Description
Standard of care for this study is weekly multi-layer compression bandaging.
Primary Outcome Measure Information:
Title
Time to complete ulcer closure
Description
Ulcer closure is based on wound area measurement and absence of wound exudate.
Time Frame
12 weeks
Secondary Outcome Measure Information:
Title
Proportion of ulcers achieving 40% ulcer closure
Description
This is measured by wound area.
Time Frame
4 weeks
Title
Percentage of ulcers achieving complete closure
Description
This is measured by wound area and absence of wound exudate.
Time Frame
12 weeks
Title
Incidence of adverse events
Time Frame
12 weeks
Title
Cost effectiveness
Description
The per unit cost of providing wound care is known. The use of amniotic membrane to standard of care will be compared in terms of the cost of achieving healing.
Time Frame
12 weeks
Title
Reduction in pain between treatment groups
Description
Pain is measured by subject report on a scale of 0 to 10.
Time Frame
12 weeks
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
At least 18 years old.
Ankle Brachial Pressure Index (ABI) > 0.75 OR SPP > 30 mmHg OR TCOM > 30 mmHg.*
Presence of a venous leg ulcer extending through the full thickness of the skin but not down to muscle, tendon or bone.
The largest ulcer will be designated the index ulcer and the only one included in the study. If other ulcerations are present on the same leg they have to be more than 2 cm apart from the index ulcer.
Study ulcer (i.e. current episode of ulceration) has been present for greater than one month prior to the initial screening visit, and has failed to respond to documented conservative measures for greater than (1) one month duration and is excluded if it has undergone 12 months of continuous high strength compression therapy over its duration.
Study ulcer is a minimum of 2 cm2 and a maximum of 20 cm2 at the randomization visit.
The target ulcer has been treated with compression therapy for at least 14 days prior to randomization.
Ulcer has a clean, granulating base with minimal adherent slough at the randomization visit.
Females of childbearing potential must be willing to use acceptable methods of contraception (birth control pills, barriers, or abstinence).
Subject understands and is willing to participate in the clinical study and can comply with weekly visits and the follow-up regimen.
Subject has read and signed the IRB/IEC approved Informed Consent Form before screening procedures are undertaken.
Exclusion Criteria:
Study ulcer(s) deemed by the investigator to be caused by a medical condition other than venous insufficiency.
Study ulcer exhibits clinical signs and symptoms of infection.
Known allergy to the components of the multi-layer compression bandaging, or who cannot tolerate multi-layer compression therapy.
Study ulcer, in the opinion of the investigator, is suspicious for cancer should undergo an ulcer biopsy to rule out a carcinoma of the ulcer.
Subjects with a history of more than two weeks treatment with immunosuppressants (including systemic corticosteroids), cytotoxic chemotherapy, or application of topical steroids to the ulcer surface within one month prior to initial screening, or who receive such medications during the screening period, or who are anticipated to require such medications during the course of the study.
Subjects on any investigational drug(s) or therapeutic device(s) within 30 days preceding Screening.
Study ulcer improving greater than 30% during the screening phase if the subject was not in adequate compression 14 days prior to screening.
History of drug or alcohol abuse.
History of radiation at the ulcer site.
Presence of one or more medical conditions, as determined by medical history, hematologic, active auto-immune or immune diseases that, in the opinion of the Investigator, would make the subject an inappropriate candidate for this ulcer healing study.
History of having Acquired Immunodeficiency Syndrome (AIDS) or HIV.
Study ulcer has been previously treated with tissue engineered materials (e.g. Apligraf® or Dermagraft®) or other scaffold materials (e.g. Oasis, Matristem) within the last 30 days
Study ulcer requiring negative pressure wound therapy or hyperbaric oxygen during the course of the trial.
Presence of any condition(s) which seriously compromises the subject's ability to complete this study, or has a known history of poor adherence with medical treatment.
Ulcers on the dorsum of the foot or with more than 50% of the ulcer below the malleolus are excluded.
Pregnant or breast feeding.
Presence of diabetes with poor metabolic control as documented with a HgA1c > 12.0 within last 90 days
Patients with renal dysfunction whose serum creatinine levels are 3.0mg/dl or greater within the last 90 days
History of usage of tobacco products within the last 30 days
History of Liver disease with active Cirrhosis of the liver
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Heather Connell, CCRP
Phone
617-383-3979
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Linda Squillante
Organizational Affiliation
Musculoskeletal Transplant Foundation
Official's Role
Study Director
Facility Information:
Facility Name
Brigham and Women's Hospital Wound Care Center
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02115
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Laurie Bayer, PA-C
Phone
617-732-8743
First Name & Middle Initial & Last Name & Degree
Indranil Sinha, MD
Facility Name
Premier Surgical
City
Brick
State/Province
New Jersey
ZIP/Postal Code
08723
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Jarrod Kaufman, MD
Phone
732-262-1600
Facility Name
Inspira Medical Center - Elmer Wound Care Center
City
Elmer
State/Province
New Jersey
ZIP/Postal Code
08318
Country
United States
Individual Site Status
Completed
Facility Name
St John Medical Center
City
Tulsa
State/Province
Oklahoma
ZIP/Postal Code
74135
Country
United States
Individual Site Status
Completed
Facility Name
The Foot and Ankle Wellness Center
City
Ford City
State/Province
Pennsylvania
ZIP/Postal Code
16226
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Matthew Sabo, DPM
Phone
724-763-4080
Facility Name
Armstrong County Memorial Hospital
City
Kittanning
State/Province
Pennsylvania
ZIP/Postal Code
16201
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Keyur Patel, MD
Phone
724-543-8893
Facility Name
SerenaGroup Research Institute
City
Pittsburgh
State/Province
Pennsylvania
ZIP/Postal Code
15222
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Thomas Serena, MD
Phone
814-688-4000
Facility Name
Martinsville Research Institute
City
Martinsville
State/Province
Virginia
ZIP/Postal Code
24112
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Kim Young
Phone
540-676-5886
First Name & Middle Initial & Last Name & Degree
Nathan Young, DPM
12. IPD Sharing Statement
Learn more about this trial
Amnioband and Standard of Care vs. Standard of Care Alone in the Treatment of Venous Leg Ulcers
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