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Use of NexoBrid for Treatment of Acute Deep Partial and Full Thickness Burn Injuries (NEXT)

Primary Purpose

Thermal Burn

Status
Available
Phase
Locations
United States
Study Type
Expanded Access
Intervention
NexoBrid
Sponsored by
MediWound Ltd
About
Eligibility
Locations
Outcomes
Full info

About this trial

This is an expanded access trial for Thermal Burn

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All Sexes

Inclusion Criteria patient level:

  1. Males and females ≥ 18 years of age,
  2. Thermal burns caused by fire/flame, scalds or contact,
  3. Patient total burns area ≥ 1% DPT and / or FT with eschar that should be removed in SOC,
  4. Patient total burns area to be treated should be ≤ 30% TBSA; SPT, DPT and/or FT in depth,
  5. Informed consent can be obtained within 84h of the burn injury,
  6. Patients who are willing and able to sign a written consent . Inclusion Criteria - Wound level

    • At least one wound (a continuous burn area) that is ≥0.5% TBSA (DPT and/or FT) (this minimal wound size should not include face, perineal or genital)

All planned TWs should meet the following criteria:

  • SPT areas that cannot be demarcated from DPT and FT areas should be less than 50% of the % TBSA of the TW, with eschar that should be removed in SOC,
  • Wound's blisters can be removed/ unroofed, as judged by the investigator.

Exclusion Criteria patient level:

  1. Modified Baux index ≥ 80,
  2. Patients with burned, charred fingers, 3rd degree in depth and possibly devoid of circulation,
  3. Patients with abraded wound/s that cannot be treated by an enzymatic debrider application (NexoBrid),
  4. Patients with pre enrolment escharotomy,
  5. Patients with electrical or chemical burns,
  6. The following pre-enrollment dressings: a. Flammacerium, b. Silver Nitrate (AgNO3),
  7. Patients with pre-enrolment wounds which are covered by eschar heavily saturated with Silver, Iodine or by SSD pseudoeschar (pseudoeschar as a result of > 12 hrs SSD treatment),
  8. Patients with diagnosed infections as described in the protocol,
  9. Diagnosis of smoke inhalation injury [12],
  10. Pregnant women (serum positive pregnancy test) or nursing mothers,
  11. Poorly controlled diabetes mellitus (HbA1c>11%) in patients with known diabetes as captured in the medical history,
  12. BMI greater than 39.0 kg/m2 in patients with burns area of up to 15% TBSA or BMI greater than 34.0 kg/m2 in patients with burns area of more than 15% %TBSA,
  13. American Society of Anesthesiologists (ASA) physical status classification system greater than 2
  14. Cardio-pulmonary disease (MI within 6 months prior to injury, severe or unstable Ischemic Heart Disease, severe or unstable heart failure, severe pulmonary hypertension, severe COPD or pre-existing oxygen-dependent pulmonary diseases, severe broncho-pneumonia within 1 month prior to injury, steroid dependent asthma or uncontrolled asthma),
  15. Pre-existing diseases which interfere with circulation (severe peripheral vascular disease, severe circulatory edema and/or lymphedema, regional lymph nodes dissection, significant varicose veins),
  16. Any conditions that would preclude safe treatment or adding further risk to the basic acute burn trauma (such as severe immuno-compromising diseases, life threatening trauma, severe pre-existing coagulation disorder, severe cardiovascular disorder, significant pulmonary disorder, significant liver disorder including post alcoholic abuse impaired function or neoplastic disease, blast injury),
  17. Chronic systemic steroid intake,
  18. History of allergy and/or known sensitivity to pineapples, papaya, Bromelain or papain.
  19. Enrollment in any investigational drug trial within 4 weeks prior to screening.

    -

Sites / Locations

  • University of South Alabama
  • Maricopa Medical Center
  • Medstar Washington Hospital Center
  • University of Florida
  • Jackson Memorial Hospital
  • The University of Iowa Hospitals and Clinics
  • University of Iowa Hospitals and Clinics
  • Burnett Burn Center at The University of Kansas Hospital
  • Johns Hopkins Burn Center
  • The General Hospital Corporation d/b/a Massachusetts General Hospital
  • Hennepin Healthcare
  • University of Missouri Health Care
  • New-York Presbyterian Hospital
  • Emergency Medicine Stony Brook University Hospital
  • The Oregon Clinic
  • Lehigh Valley Hospital and Health Network
  • Firefighters Regional Burn Center
  • University of Utah Hospital
  • Harborview Medical Center
  • Colombia St Mary's, Inc.

Outcomes

Primary Outcome Measures

Secondary Outcome Measures

Full Information

First Posted
July 26, 2019
Last Updated
January 7, 2020
Sponsor
MediWound Ltd
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1. Study Identification

Unique Protocol Identification Number
NCT04040660
Brief Title
Use of NexoBrid for Treatment of Acute Deep Partial and Full Thickness Burn Injuries
Acronym
NEXT
Official Title
Use of NexoBrid for Treatment of Acute Deep Partial and Full Thickness Burn Injuries
Study Type
Expanded Access

2. Study Status

Record Verification Date
January 2020
Overall Recruitment Status
Available
Study Start Date
undefined (undefined)
Primary Completion Date
undefined (undefined)
Study Completion Date
undefined (undefined)

3. Sponsor/Collaborators

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

4. Oversight

5. Study Description

Brief Summary
Enzymatic eschar removal with NexoBrid allows initiating and completing the phase of removal of the offending eschar earlier upon admission, enabling earlier visualization of the wound bed for assessment of burn wound depth as well as preservation of viable dermal tissues, as further elaborated and supported by previous clinical studies. The depth determination is important for the planning and execution of the post eschar removal stage of wound closure phase (grafting or spontaneous epithelialization). Additional clinically meaningful attributes of NexoBrid enzymatic eschar removal is the ability to lower surgical burden as it allows to remove eschar in wounds that otherwise would have to undergo surgical excision as no other non-surgical treatment is available for early and effective eschar removal. MediWound has completed the recruitment of patients to study MW2010-03-02 (DETECT Study). The timeline for patients' follow-up and potential for approval in 2021/2022, creates a significant gap in the ability of clinical practitioner's to maintain their knowledge and skills in using NexoBrid as they no longer treat eligible patients. The expanded access protocol will allow to expand treatment to additional patients in up to 30 US burn centers (DETECT sites and additional sites), until the completion of the BLA assessment and possible marketing authorization of NexoBrid in the US. The proposed protocol will allow product availability to eligible population and keep the clinical use of the product knowledge active in the burn care community introducing it to their routine burn care. The purpose of this treatment protocol is to provide NexoBrid to patients with DPT and FT thermal burns on up to 30% TBSA. This protocol is also designed to collect and evaluate the safety and clinical performance of NexoBrid in this patient population.
Detailed Description
This is an Expanded Access (treatment) protocol to allow ongoing treatment of burn patients with NexoBrid following completion of the enrollment stage of protocol MW2010-03-02 (DETECT study). This protocol is also designed to collect and evaluate the safety and clinical performance of NexoBrid in patients suffering from DPT and FT thermal burns. Following the enrollment of a patient to the protocol, physicians will identify one or more target wounds (TWs) per patient according to the TW definition. All patient's DPT and FT burns that comply with the specified entrance criteria will be treated with NexoBrid and, therefore, must be designated as TWs. This will further allow an evaluation of the patient's systemic safety by allowing treatment of the patient's entire deep burns. Prior to initiation of eschar removal treatment, patients will be medicated with appropriate analgesia and undergo wound cleansing and dressing of all wounds with antibacterial solutions according to product instruction for use in order to ensure clean and moist eschar covered wound bed for NexoBrid application. Vital signs (Blood Pressure, Heart Rate and temperature) measurements and pain assessment will be performed within 24 hrs before start of treatment as well as haematology, biochemistry blood tests & PTT/INR. Pressure measurements for circumferential extremity wounds will be performed 1 hour before start of treatment and will be closely monitored during treatment. Following wound cleansing and soaking treatments, patients will undergo the eschar removal process. TWs of up to 15% total body surface area (TBSA) will be treated with a single application of NexoBrid for 4 hours. Patients with TWs >15% TBSA and up to 30% TBSA will be treated with 2 consecutive applications of 4 hours each. NexoBrid should not be applied to more than 15% TBSA in one session. PK samples will be taken from sub-set of patients with TWs area >15% TBSA. Pressure measurements for circumferential extremity wounds will be performed after the removal of NexoBrid. Post eschar removal completion, patients will undergo daily vital signs (Blood Pressure, Heart Rate and temperature measurements) and pain assessments for 1 week, starting on the morning following start of eschar removal. Blood tests (haematology and biochemistry) will be performed 24 ± 6 hrs post eschar removal as well as PTT/INR. Weekly assessments of wound healing progress including the dressings used until complete wound closure will be performed. Cosmesis (scar quality) evaluation (using MVSS) will be performed at 3 and 12 months post wound closure confirmation visit.

6. Conditions and Keywords

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

7. Study Design

8. Arms, Groups, and Interventions

Intervention Type
Drug
Intervention Name(s)
NexoBrid
Intervention Description
NexoBrid is presented as lyophilized powder and gel vehicle for preparation of a gel for cutaneous use. The API is a concentrate of proteolytic enzymes enriched in Bromelain extracted from the stem of Ananas comosus (pineapple plant)

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Eligibility Criteria
Inclusion Criteria patient level: Males and females ≥ 18 years of age, Thermal burns caused by fire/flame, scalds or contact, Patient total burns area ≥ 1% DPT and / or FT with eschar that should be removed in SOC, Patient total burns area to be treated should be ≤ 30% TBSA; SPT, DPT and/or FT in depth, Informed consent can be obtained within 84h of the burn injury, Patients who are willing and able to sign a written consent . Inclusion Criteria - Wound level At least one wound (a continuous burn area) that is ≥0.5% TBSA (DPT and/or FT) (this minimal wound size should not include face, perineal or genital) All planned TWs should meet the following criteria: SPT areas that cannot be demarcated from DPT and FT areas should be less than 50% of the % TBSA of the TW, with eschar that should be removed in SOC, Wound's blisters can be removed/ unroofed, as judged by the investigator. Exclusion Criteria patient level: Modified Baux index ≥ 80, Patients with burned, charred fingers, 3rd degree in depth and possibly devoid of circulation, Patients with abraded wound/s that cannot be treated by an enzymatic debrider application (NexoBrid), Patients with pre enrolment escharotomy, Patients with electrical or chemical burns, The following pre-enrollment dressings: a. Flammacerium, b. Silver Nitrate (AgNO3), Patients with pre-enrolment wounds which are covered by eschar heavily saturated with Silver, Iodine or by SSD pseudoeschar (pseudoeschar as a result of > 12 hrs SSD treatment), Patients with diagnosed infections as described in the protocol, Diagnosis of smoke inhalation injury [12], Pregnant women (serum positive pregnancy test) or nursing mothers, Poorly controlled diabetes mellitus (HbA1c>11%) in patients with known diabetes as captured in the medical history, BMI greater than 39.0 kg/m2 in patients with burns area of up to 15% TBSA or BMI greater than 34.0 kg/m2 in patients with burns area of more than 15% %TBSA, American Society of Anesthesiologists (ASA) physical status classification system greater than 2 Cardio-pulmonary disease (MI within 6 months prior to injury, severe or unstable Ischemic Heart Disease, severe or unstable heart failure, severe pulmonary hypertension, severe COPD or pre-existing oxygen-dependent pulmonary diseases, severe broncho-pneumonia within 1 month prior to injury, steroid dependent asthma or uncontrolled asthma), Pre-existing diseases which interfere with circulation (severe peripheral vascular disease, severe circulatory edema and/or lymphedema, regional lymph nodes dissection, significant varicose veins), Any conditions that would preclude safe treatment or adding further risk to the basic acute burn trauma (such as severe immuno-compromising diseases, life threatening trauma, severe pre-existing coagulation disorder, severe cardiovascular disorder, significant pulmonary disorder, significant liver disorder including post alcoholic abuse impaired function or neoplastic disease, blast injury), Chronic systemic steroid intake, History of allergy and/or known sensitivity to pineapples, papaya, Bromelain or papain. Enrollment in any investigational drug trial within 4 weeks prior to screening. -
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Limor Klein, PhD
Phone
972-77-9714176
Email
limord@mediwound.com
First Name & Middle Initial & Last Name or Official Title & Degree
Keren David-Zarbiv
Phone
972-77-9714103
Email
kerend@mediwound.com
Facility Information:
Facility Name
University of South Alabama
City
Mobile
State/Province
Alabama
ZIP/Postal Code
36617
Country
United States
Individual Site Status
Available
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Andrew Bright, DO
Phone
251-471-7971
Email
abright@health.southalabama.edu
First Name & Middle Initial & Last Name & Degree
Kelley Prutzman, RN
First Name & Middle Initial & Last Name & Degree
Andrew Bright, DO
Facility Name
Maricopa Medical Center
City
Phoenix
State/Province
Arizona
ZIP/Postal Code
85008
Country
United States
Individual Site Status
Available
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Kevin Foster, MD
Phone
602-344-5624
Email
kevin_foster@dmgaz.org
First Name & Middle Initial & Last Name & Degree
Suzanne Osborne, RN
Phone
602-344-5141
Email
suzanne.osborn@mihs.org
First Name & Middle Initial & Last Name & Degree
Kevin Foster, MD
Facility Name
Medstar Washington Hospital Center
City
Washington
State/Province
District of Columbia
ZIP/Postal Code
20010
Country
United States
Individual Site Status
Available
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Jeffrey Shupp, MD
Phone
202-877-7347
Email
jeffrey.w.shupp@medstar.net
First Name & Middle Initial & Last Name & Degree
Melissa McLawhorn
Phone
202-877-6181
Email
Melissa.M.Mclawhorn@medstar.net
First Name & Middle Initial & Last Name & Degree
Jeffrey Shupp, MD
Facility Name
University of Florida
City
Gainesville
State/Province
Florida
ZIP/Postal Code
32610
Country
United States
Individual Site Status
Available
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Joshua Carson, MD
Email
Joshua.Carson@surgery.ufl.edu
First Name & Middle Initial & Last Name & Degree
Tera Thigpin
Phone
352-265-0111
Email
tera.thigpin@surgery.ufl.edu
First Name & Middle Initial & Last Name & Degree
Joshua Carson, MD
Facility Name
Jackson Memorial Hospital
City
Miami
State/Province
Florida
ZIP/Postal Code
33136
Country
United States
Individual Site Status
Available
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Louis Pizano, MD
Phone
305-585-1178
Email
lpizano@med.miami.edu
First Name & Middle Initial & Last Name & Degree
Ron Manning
Phone
305-355-4990
Email
rmanning@med.miami.edu
First Name & Middle Initial & Last Name & Degree
Louis Pizano, MD
Facility Name
The University of Iowa Hospitals and Clinics
City
Iowa City
State/Province
Iowa
ZIP/Postal Code
52242
Country
United States
Individual Site Status
Available
Facility Contact:
First Name & Middle Initial & Last Name & Degree
lucy wibbenmeyer, MD
Phone
319-356-3551
Email
lucy-wibbenmeyer@uiowa.edu
First Name & Middle Initial & Last Name & Degree
Elizabeth Morgan
Phone
319-356-1304
Email
elizabeth-morgan@uiowa.edu
First Name & Middle Initial & Last Name & Degree
lucy wibbenmeyer, MD
Facility Name
University of Iowa Hospitals and Clinics
City
Iowa City
State/Province
Iowa
ZIP/Postal Code
52242
Country
United States
Individual Site Status
Available
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Lucy Wibbenmeyer, MD
Phone
319-356-1304
Email
lucy-wibbenmeyer@uiowa.edu
Facility Name
Burnett Burn Center at The University of Kansas Hospital
City
Kansas City
State/Province
Kansas
ZIP/Postal Code
66160
Country
United States
Individual Site Status
Available
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Dhaval Bhavsar, MD
Phone
913-588-2000
Email
dbhavsar@kumc.edu
First Name & Middle Initial & Last Name & Degree
Jessica Reynolds, RN
Phone
913-588-0068
Email
jreynolds11@kumc.edu
First Name & Middle Initial & Last Name & Degree
Dhaval Bhavsar, MD
Facility Name
Johns Hopkins Burn Center
City
Baltimore
State/Province
Maryland
ZIP/Postal Code
21287
Country
United States
Individual Site Status
Available
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Julie Caffrey, MD
Email
jcaffre5@jhmi.edu
First Name & Middle Initial & Last Name & Degree
Vidhi Javia
Phone
443-287-7848
Email
vjavia1@jhmi.edu
First Name & Middle Initial & Last Name & Degree
Julie Caffrey, MD
Facility Name
The General Hospital Corporation d/b/a Massachusetts General Hospital
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02114
Country
United States
Individual Site Status
Available
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Jeremy Goverman, MD
Phone
617-726-3712
Email
JGOVERMAN@mgh.harvard.edu
First Name & Middle Initial & Last Name & Degree
Jennifer Levin, RN
Email
Jlevin7@partners.org
First Name & Middle Initial & Last Name & Degree
Jeremy Goverman, MD
Facility Name
Hennepin Healthcare
City
Minneapolis
State/Province
Minnesota
ZIP/Postal Code
55415
Country
United States
Individual Site Status
Available
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Frederick Endorf, MD
Email
Frederick.Endorf@hcmed.org
First Name & Middle Initial & Last Name & Degree
Emily Kittelson
Phone
612-873-6396
Email
Emily.Kittelson@hcmed.org
First Name & Middle Initial & Last Name & Degree
Frederick Endorf, MD
Facility Name
University of Missouri Health Care
City
Columbia
State/Province
Missouri
ZIP/Postal Code
65212
Country
United States
Individual Site Status
Available
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Jeffrey Litt, DO
Phone
573-884-6779
Email
littjs@health.missouri.edu
First Name & Middle Initial & Last Name & Degree
Jennifer Randolph, RN
Phone
573-882-4387
Email
randolphjl@health.missouri.edu
First Name & Middle Initial & Last Name & Degree
Jeffrey Litt, MO
Facility Name
New-York Presbyterian Hospital
City
New York
State/Province
New York
ZIP/Postal Code
10065
Country
United States
Individual Site Status
Available
Facility Contact:
First Name & Middle Initial & Last Name & Degree
James Gallagher, MD
Phone
212-746-7913
Email
jag9027@med.cornell.edu
First Name & Middle Initial & Last Name & Degree
Angela Rabbitts, RN
Phone
212-746-5881
Email
anr2002@med.cornell.edu
First Name & Middle Initial & Last Name & Degree
James Gallagher, MD
Facility Name
Emergency Medicine Stony Brook University Hospital
City
Stony Brook
State/Province
New York
ZIP/Postal Code
11794
Country
United States
Individual Site Status
Available
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Adam Singer, Dr
Phone
631-444-7857
Email
adam.singer@stonybrookmedicine.edu
First Name & Middle Initial & Last Name & Degree
Maria (Merry) Taylor, RN
Phone
631-444-8345
Email
PhaMaria.Taylor@stonybrookmedicine.edu
First Name & Middle Initial & Last Name & Degree
Adam Singer, MD
Facility Name
The Oregon Clinic
City
Portland
State/Province
Oregon
ZIP/Postal Code
972227
Country
United States
Individual Site Status
Available
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Kristin Hickey
Phone
503-413-5447
First Name & Middle Initial & Last Name & Degree
Michael J Mosier, MD
Facility Name
Lehigh Valley Hospital and Health Network
City
Allentown
State/Province
Pennsylvania
ZIP/Postal Code
18103
Country
United States
Individual Site Status
Available
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Sigrid Blome-Eberwein, MD
Phone
610-402-1485
Email
Sigri.Blome-Eberwein@lvhn.org
First Name & Middle Initial & Last Name & Degree
Mary Sobotor, CCRC
Phone
610-402-1592
Email
Mary.Sobotor@lvhn.org
First Name & Middle Initial & Last Name & Degree
Sigrid Blome-Eberwein, MD
Facility Name
Firefighters Regional Burn Center
City
Memphis
State/Province
Tennessee
ZIP/Postal Code
38103
Country
United States
Individual Site Status
Available
Facility Contact:
First Name & Middle Initial & Last Name & Degree
William Hickerson, MD
Phone
901-448-2579
Email
whicker@uthsc.edu
First Name & Middle Initial & Last Name & Degree
William Hickerson, MD
Facility Name
University of Utah Hospital
City
Salt Lake City
State/Province
Utah
ZIP/Postal Code
84132
Country
United States
Individual Site Status
Available
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Giavonni Lewis, MD
Phone
801-581-8990
Email
giavonni.lewis@hsc.utah.edu
First Name & Middle Initial & Last Name & Degree
Martin Carricaburu
Phone
801-581-3363
Email
martin.carricaburu@hsc.utah.edu
First Name & Middle Initial & Last Name & Degree
Giavonni Lewis, MD
Facility Name
Harborview Medical Center
City
Seattle
State/Province
Washington
ZIP/Postal Code
98104
Country
United States
Individual Site Status
Available
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Tam Pham, MD
Phone
206-744-3140
Email
tpham94@uw.edu
First Name & Middle Initial & Last Name & Degree
Emily Eschelbach, RN
Phone
206-744-3587
Email
eschee13@uw.edu
First Name & Middle Initial & Last Name & Degree
Tam Pham, MD
Facility Name
Colombia St Mary's, Inc.
City
Milwaukee
State/Province
Wisconsin
ZIP/Postal Code
53211
Country
United States
Individual Site Status
Available
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Nicholas Meyer, MD
Email
whicker@uthsc.edu
First Name & Middle Initial & Last Name & Degree
Margaret Wilson
Phone
414-585-1498
Email
Margaret.Wilson2@ascension.org
First Name & Middle Initial & Last Name & Degree
Nicholas Meyer, MD

12. IPD Sharing Statement

Learn more about this trial

Use of NexoBrid for Treatment of Acute Deep Partial and Full Thickness Burn Injuries

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