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A Study to Evaluate the Efficacy and Safety of NexoBrid in Subjects With Thermal Burns

Primary Purpose

Thermal Burns

Status
Completed
Phase
Phase 3
Locations
International
Study Type
Interventional
Intervention
NexoBrid
Standard of Care (SOC)
Gel Vehicle
Sponsored by
MediWound Ltd
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Thermal Burns focused on measuring fire/flame, scalds, contact

Eligibility Criteria

18 Years - 77 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria- Patient level

  1. Males and females; ≥ 18
  2. Thermal burns caused by fire/flame, scalds or contact,
  3. Patient total burns area ≥ 3% DPT and / or FT,
  4. Patient total burns area should be ≤ 30% TBSA; SPT, DPT and/or FT in depth,
  5. Informed consent can be obtained within 84 hours of the burn injury,
  6. Patients who are willing and able to sign a written consent form.

Inclusion Criteria - Wound level

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

    All planned target wounds (TWs) should meet the following criteria:

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

Exclusion Criteria- Patient level

  1. Patients who are unable to follow study procedures and follow up period.
  2. Modified Baux index ≥ 80,
  3. Patients with burned charred fingers, 3rd degree in depth and possibly devoid of circulation,
  4. Patients with abraded wound/s that cannot be treated by an enzymatic debrider application (NexoBrid) will be excluded from the study,
  5. Patients with electrical or chemical burns,
  6. Patients with circumferential (≥ 80% of the limb circumference) DPT and/or FT burns defined as Extremities at Risk (EAR) 2 as described in the protocol.
  7. The following pre-enrollment dressings: a. Flammacerium, b. Silver Nitrate (AgNO3),
  8. Patients with pre-enrolment wounds which are covered by eschar heavily saturated with iodine or by SSD pseudoeschar (e.g. pseudoeschar as a result of > 12 hours SSD treatment),
  9. Patients with pre-enrollment escharotomy.
  10. Patients with diagnosed infections as described in Section 11.9 of study protocol,
  11. Diagnosis of smoke inhalation injury.
  12. Pregnant women (positive pregnancy test) or nursing mothers.
  13. Poorly controlled diabetes mellitus (HbA1c>11%) in patients with known diabetes as captured in the medical history.
  14. BMI greater than 39.0 kg/m2 in patients with burn area up to 15% TBSA or BMI greater than 34.0 kg/m2 in patients with burn area more than 15% TBSA.
  15. ASA greater than 2 (Appendix 13- ASA classification system)
  16. Cardio-pulmonary disease (MI within 6 months prior to injury, 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).
  17. Pre-existing diseases which interfere with circulation (severe peripheral vascular disease, edema, lymphedema, regional lymph nodes, significant varicose veins),
  18. Any conditions that would preclude safe participation in the study 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)
  19. Chronic systemic steroid intake,
  20. History of allergy and/or known sensitivity to pineapples, papaya, Bromelain or papain,
  21. Current (within 12 months prior to screening) suicide attempt,
  22. Mentally incapacitated adults who are incapable of giving legal consent
  23. Enrollment in any investigational drug trial within 4 weeks prior to screening,
  24. Current (within 12 months prior to screening) alcohol or drug abuse (see definition in section 1.1)
  25. Prisoners and incarcerated,
  26. Patients who might depend on the clinical study site or investigator.

Sites / Locations

  • University of South Alabama Department of Surgery
  • Maricopa Medical Center
  • University of Colorado at Denver, Teaching
  • Medstar Washington Hospital Center
  • University of Florida- Dept. of Surgery
  • Joseph M. Still Research Foundation, Inc.
  • The University of Iowa Hospitals and Clinics
  • Burnett Burn Center at The University of Kansas Hospital
  • Johns Hopkins Bayview Medical Center
  • The General Hospital Corporation d/b/a Massachusetts General Hospital
  • New-York Presbyterian Hospital
  • Emergency Medicine Stony Brook University Hospital
  • Lehigh Valley Hospital and Health Network
  • Regional Medical Center ,Regional One Health
  • University of Texas Medical Branch
  • University of Utah Hospital
  • HarborView Medical Center
  • Columbia St. Mary's, Inc.
  • University Hospital, Department of Plastic Surgery
  • Klinika popálenin a rekonstrukční chirurgie, Fakultní nemocnice Brno
  • Khechinashvili University Hospital - Thermal Injuries
  • Unfallkrankenhaus Berlin Zentrum für Schwerbrandverletzte mit Plastischer Chirurgie
  • BG Universitätsklinikum Bergmannsheil GmbH
  • Rambam Medical Center
  • Hospital A. Cardarelli of Napoli
  • Ospedale di Cisanello
  • Spitalul Clinic de Urgenta de Chirurgie Plastica, Reparatorie si Arsuri
  • Spitalul Clinic de Urgenta "Sf. Ioan"
  • Spitalul Clinic de Urgenta "Bagdasar-Arseni"

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Placebo Comparator

Active Comparator

Arm Label

NexoBrid Gel

Gel Vehicle

Standard of Care (SOC)

Arm Description

NexoBrid Gel is applied to the burn wound at a dose of 2 g NexoBrid sterile powder mixed with 20g sterile Gel Vehicle per 1% of TBSA (~ surface of an adult palm) for four hours.

Gel Vehicle is applied to the burn wound at a dose of 20 g sterile Gel per 1% of TBSA (~ surface of an adult palm) for four hours.

Subjects in the SOC group may be treated with a combination of surgical and non-surgical eschar removal procedures, according to the investigator's judgment.

Outcomes

Primary Outcome Measures

Primary Endpoint: Number of Participants With Complete Eschar Removal.
Comparison of NexoBrid over Gel Vehicle for eschar removal as measured by Number of Participants with complete eschar removal at the end of the topical agent soaking period by a blinded assessor.

Secondary Outcome Measures

Secondary Endpoint: Number of Participants With Surgical Excision Performed or Eschar Removal for NexoBrid vs SOC (FAS)
Comparison of NexoBrid over SOC in number of Participants with surgical need for excisional eschar removal as measured by an analysis of incidence of surgical eschar removal (tangential/ minor/ avulsion/ Versajet and/or dermabrasion excision).
Secondary Endpoint: Comparison of Time (Days) to Complete Eschar Removal
Comparison of NexoBrid over SOC with regard to the time (in days) when complete eschar removal has been achieved. Results of the Generalized Wilcoxon-Gehan Test Adjusted for Overall TW Depths, TBSA Group, Center Group, and Number of TWs (FAS)
Secondary Endpoint: Patient-Level Comparison of Actual Blood Loss (Volume in mL) Related to Eschar Removal for NexoBrid vs SOC (FAS)
Comparison of NexoBrid over SOC with regard to the blood loss (volume in mL) occurred during the eschar removal procedures.

Full Information

First Posted
May 22, 2014
Last Updated
June 11, 2023
Sponsor
MediWound Ltd
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1. Study Identification

Unique Protocol Identification Number
NCT02148705
Brief Title
A Study to Evaluate the Efficacy and Safety of NexoBrid in Subjects With Thermal Burns
Official Title
A Multicenter, Multinational, Randomized, Controlled, Assessor Blinded Study, Performed in Subjects With Thermal Burns, to Evaluate the Efficacy and Safety of NexoBrid Compared to Gel Vehicle and Compared to Standard of Care
Study Type
Interventional

2. Study Status

Record Verification Date
June 2023
Overall Recruitment Status
Completed
Study Start Date
May 27, 2015 (Actual)
Primary Completion Date
June 12, 2018 (Actual)
Study Completion Date
August 20, 2020 (Actual)

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 three-arms study intending to demonstrate superiority of NexoBrid treatment over the Gel Vehicle placebo control treatment and over SOC in thermal burn subjects. The study objectives are: To demonstrate the efficacy of enzymatic eschar removal with NexoBrid by providing complete eschar removal as compared with Gel vehicle, To demonstrate the efficacy of enzymatic eschar removal with NexoBrid by providing earlier complete eschar removal, reduction in patients' surgical burden and its related blood loss as compared to SOC, To assess the safety of NexoBrid compared to SOC, including demonstration that treatment with NexoBrid does not cause an unacceptable level of harm on wound closure outcome and long term outcomes of cosmesis and function.
Detailed Description
This is a multi-center, multi-national, randomized, controlled, assessor blinded, three-arm study aiming to demonstrate superiority of NexoBrid treatment over Gel Vehicle control and over SOC treatment in thermal burn subjects with burns. Following the enrollment of a patient to the study and prior to randomization Physicians will define one or more Target Wounds (TWs) per subject according to TWs definition. All subjects' deep (DPT and FT) burns that comply with the specified entrance criteria are intended to receive study treatment per the randomized study arm. The randomization procedure will be initiated only after all Target wounds of a subject have been defined. Patients will be assigned to the treatment arm in a 3:3:1 ratio (NexoBrid: SOC : Gel Vehicle). Patients will be treated in the same way in all study arms (NexoBrid, SOC or Gel vehicle) except for the eschar removal stage which will be performed as per the randomization study arm. Prior to initiation of eschar removal treatment, 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, SOC or Gel Vehicle, following randomization). Subsequent to complete eschar removal, all wounds will be assessed and treated in the same manner, in accordance with post-eschar removal wound care strategy. Post eschar removal, subjects will undergo daily vital signs and pain assessments, until hospital discharge (HD) and weekly assessments of wound progress, until wound closure. Following wound closure confirmation visit, subjects will be followed up at 1, 3, 6, 12, 18 and 24 months post wound closure for long term outcomes evaluation.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Thermal Burns
Keywords
fire/flame, scalds, contact

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Factorial Assignment
Masking
Outcomes Assessor
Allocation
Randomized
Enrollment
175 (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 2 g NexoBrid sterile powder mixed with 20g sterile Gel Vehicle per 1% of TBSA (~ surface of an adult palm) for four hours.
Arm Title
Gel Vehicle
Arm Type
Placebo Comparator
Arm Description
Gel Vehicle is applied to the burn wound at a dose of 20 g sterile Gel per 1% of TBSA (~ surface of an adult palm) for four hours.
Arm Title
Standard of Care (SOC)
Arm Type
Active Comparator
Arm Description
Subjects in the SOC group may be treated with a combination of surgical and non-surgical eschar removal procedures, according to the investigator's judgment.
Intervention Type
Drug
Intervention Name(s)
NexoBrid
Intervention Type
Procedure
Intervention Name(s)
Standard of Care (SOC)
Intervention Type
Drug
Intervention Name(s)
Gel Vehicle
Primary Outcome Measure Information:
Title
Primary Endpoint: Number of Participants With Complete Eschar Removal.
Description
Comparison of NexoBrid over Gel Vehicle for eschar removal as measured by Number of Participants with complete eschar removal at the end of the topical agent soaking period by a blinded assessor.
Time Frame
post application (post 2 h soaking)
Secondary Outcome Measure Information:
Title
Secondary Endpoint: Number of Participants With Surgical Excision Performed or Eschar Removal for NexoBrid vs SOC (FAS)
Description
Comparison of NexoBrid over SOC in number of Participants with surgical need for excisional eschar removal as measured by an analysis of incidence of surgical eschar removal (tangential/ minor/ avulsion/ Versajet and/or dermabrasion excision).
Time Frame
Post application (post 2 h soaking) for NexoBrid arm and immediately post surgical excision for SOC arm.
Title
Secondary Endpoint: Comparison of Time (Days) to Complete Eschar Removal
Description
Comparison of NexoBrid over SOC with regard to the time (in days) when complete eschar removal has been achieved. Results of the Generalized Wilcoxon-Gehan Test Adjusted for Overall TW Depths, TBSA Group, Center Group, and Number of TWs (FAS)
Time Frame
From randomization until complete eschar removal. For NexoBrid, assessed post application (post 2 h soaking) and for SOC assessed immediately post last dressing change for non-surgical SOC arm and immediately post excision for surgical SOC arm.
Title
Secondary Endpoint: Patient-Level Comparison of Actual Blood Loss (Volume in mL) Related to Eschar Removal for NexoBrid vs SOC (FAS)
Description
Comparison of NexoBrid over SOC with regard to the blood loss (volume in mL) occurred during the eschar removal procedures.
Time Frame
For NexoBrid arm, blood loss during NexoBrid application until post soaking. For SOC arm, blood loss during SOC procedures, through last dressing change for non-surgical SOC arm and through excision surgery for surgical SOC arm.

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
77 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria- Patient level Males and females; ≥ 18 Thermal burns caused by fire/flame, scalds or contact, Patient total burns area ≥ 3% DPT and / or FT, Patient total burns area should be ≤ 30% TBSA; SPT, DPT and/or FT in depth, Informed consent can be obtained within 84 hours of the burn injury, Patients who are willing and able to sign a written consent form. 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 including face, perineal or genital area. All planned target wounds (TWs) should meet the following criteria: SPT area that cannot be demarcated from DPT and FT areas should be less than 50% of the % TBSA of the TW. Wound's blisters can be removed/ unroofed, as judged by the investigator. Exclusion Criteria- Patient level Patients who are unable to follow study procedures and follow up period. 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) will be excluded from the study, Patients with electrical or chemical burns, Patients with circumferential (≥ 80% of the limb circumference) DPT and/or FT burns defined as Extremities at Risk (EAR) 2 as described in the protocol. The following pre-enrollment dressings: a. Flammacerium, b. Silver Nitrate (AgNO3), Patients with pre-enrolment wounds which are covered by eschar heavily saturated with iodine or by SSD pseudoeschar (e.g. pseudoeschar as a result of > 12 hours SSD treatment), Patients with pre-enrollment escharotomy. Patients with diagnosed infections as described in Section 11.9 of study protocol, Diagnosis of smoke inhalation injury. Pregnant women (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 burn area up to 15% TBSA or BMI greater than 34.0 kg/m2 in patients with burn area more than 15% TBSA. ASA greater than 2 (Appendix 13- ASA classification system) Cardio-pulmonary disease (MI within 6 months prior to injury, 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, edema, lymphedema, regional lymph nodes, significant varicose veins), Any conditions that would preclude safe participation in the study 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, Current (within 12 months prior to screening) suicide attempt, Mentally incapacitated adults who are incapable of giving legal consent Enrollment in any investigational drug trial within 4 weeks prior to screening, Current (within 12 months prior to screening) alcohol or drug abuse (see definition in section 1.1) Prisoners and incarcerated, Patients who might depend on the clinical study site or investigator.
Facility Information:
Facility Name
University of South Alabama Department of Surgery
City
Mobile
State/Province
Alabama
ZIP/Postal Code
36617
Country
United States
Facility Name
Maricopa Medical Center
City
Phoenix
State/Province
Arizona
ZIP/Postal Code
85008
Country
United States
Facility Name
University of Colorado at Denver, Teaching
City
Aurora
State/Province
Colorado
ZIP/Postal Code
80045
Country
United States
Facility Name
Medstar Washington Hospital Center
City
Washington
State/Province
District of Columbia
ZIP/Postal Code
20010
Country
United States
Facility Name
University of Florida- Dept. of Surgery
City
Gainesville
State/Province
Florida
ZIP/Postal Code
32610
Country
United States
Facility Name
Joseph M. Still Research Foundation, Inc.
City
Augusta
State/Province
Georgia
ZIP/Postal Code
30909
Country
United States
Facility Name
The University of Iowa Hospitals and Clinics
City
Iowa City
State/Province
Iowa
ZIP/Postal Code
52242
Country
United States
Facility Name
Burnett Burn Center at The University of Kansas Hospital
City
Kansas City
State/Province
Kansas
ZIP/Postal Code
66160
Country
United States
Facility Name
Johns Hopkins Bayview Medical Center
City
Baltimore
State/Province
Maryland
ZIP/Postal Code
8163
Country
United States
Facility Name
The General Hospital Corporation d/b/a Massachusetts General Hospital
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02114
Country
United States
Facility Name
New-York Presbyterian Hospital
City
New York
State/Province
New York
ZIP/Postal Code
10065
Country
United States
Facility Name
Emergency Medicine Stony Brook University Hospital
City
Stony Brook
State/Province
New York
ZIP/Postal Code
11794
Country
United States
Facility Name
Lehigh Valley Hospital and Health Network
City
Allentown
State/Province
Pennsylvania
ZIP/Postal Code
18103
Country
United States
Facility Name
Regional Medical Center ,Regional One Health
City
Memphis
State/Province
Tennessee
ZIP/Postal Code
38103
Country
United States
Facility Name
University of Texas Medical Branch
City
Galveston
State/Province
Texas
ZIP/Postal Code
77550
Country
United States
Facility Name
University of Utah Hospital
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
Columbia St. Mary's, Inc.
City
Milwaukee
State/Province
Wisconsin
ZIP/Postal Code
53211
Country
United States
Facility Name
University Hospital, Department of Plastic Surgery
City
Gent
ZIP/Postal Code
B 9000
Country
Belgium
Facility Name
Klinika popálenin a rekonstrukční chirurgie, Fakultní nemocnice Brno
City
Brno
ZIP/Postal Code
62500
Country
Czechia
Facility Name
Khechinashvili University Hospital - Thermal Injuries
City
Tbilisi
ZIP/Postal Code
0179
Country
Georgia
Facility Name
Unfallkrankenhaus Berlin Zentrum für Schwerbrandverletzte mit Plastischer Chirurgie
City
Berlin
Country
Germany
Facility Name
BG Universitätsklinikum Bergmannsheil GmbH
City
Bochum
ZIP/Postal Code
44789
Country
Germany
Facility Name
Rambam Medical Center
City
Haifa
Country
Israel
Facility Name
Hospital A. Cardarelli of Napoli
City
Napoli
Country
Italy
Facility Name
Ospedale di Cisanello
City
Pisa
ZIP/Postal Code
56125
Country
Italy
Facility Name
Spitalul Clinic de Urgenta de Chirurgie Plastica, Reparatorie si Arsuri
City
Bucharest
ZIP/Postal Code
010713
Country
Romania
Facility Name
Spitalul Clinic de Urgenta "Sf. Ioan"
City
Bucharest
ZIP/Postal Code
042122
Country
Romania
Facility Name
Spitalul Clinic de Urgenta "Bagdasar-Arseni"
City
Bucharest
ZIP/Postal Code
41915
Country
Romania

12. IPD Sharing Statement

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A Study to Evaluate the Efficacy and Safety of NexoBrid in Subjects With Thermal Burns

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