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Beta Adrenergic Antagonist for the Healing of Chronic DFU (BAART-DFU)

Primary Purpose

Chronic Diabetic Foot Ulcers, Diabetic Neuropathic Ulcers, Non Healing Wound

Status
Active
Phase
Phase 3
Locations
United States
Study Type
Interventional
Intervention
Timolol
Non biologically active gel
Sponsored by
VA Office of Research and Development
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Chronic Diabetic Foot Ulcers

Eligibility Criteria

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

Inclusion Criteria:

  • Male or female subject of any race 18 years old or older
  • Lower extremity ulcer located anywhere on the foot (as defined as beginning below the malleoli of the ankle):

    • Of more than 30 days duration and less than 2 years duration
    • Surface area between 0.5cm2 and 20cm2 (as measured with the Silhouette imaging system at randomization). The ulcer with largest surface area meeting inclusion criteria will be selected as index ulcer
    • If two ulcers present with the same surface area, the ulcer of the longest duration will be selected as index ulcer
  • Documented Ankle Brachial Index (ABI) between 0.8 and 1.2 on the study limb or toe pressure over 65mmHg within 3 months of screening phase
  • Documented biopsy report to rule out malignancy of ulcer of > 6 months duration
  • Subject or legally authorized representative understands and is willing to give written informed consent
  • Subject or legally authorized representative is willing and able to comply with a trial (13 to 17 days) of protocol-specified standard care prior to randomization and to comply with all study requirements

Exclusion Criteria:

  • Ulcer of non-diabetic etiology, such as venous, arterial and burn wounds
  • Index ulcer is less than 3 cm in distance from any other ulcer on the same extremity
  • There are greater than 3 ulcers on the study foot
  • Index ulcer presents with any of the following: cellulitis, osteomyelitis, exposed bone, tendon or fascia, capsule , purulent exudate or gangrene
  • Index ulcer shows evidence of infection (defined as a moderate or severe rating of all of the following clinical signs/symptoms:

    • increased warmth
    • increased pain
    • erythema
    • malodorous exudate at Screening or at Randomization (Visit 1), OR total organism count > 1 x 105 colony forming units (CFU) from the screening visit study ulcer culture sample)
  • Index ulcer surface area has decreased or increased > 40% between Screening and at Randomization (Visit 1) as assessed by the Silhouette imaging system
  • Has acquired or is known to be infected with Human Immunodeficiency Virus (HIV)
  • Has active malignancy on the study foot
  • Has uncontrolled diabetes mellitus as defined by glycosylated hemoglobin A1C > 12%
  • Has immunodeficiency as defined by serum IgG, IgA, and IgM less than one-half the lower limit of normal
  • Has severe protein malnutrition as defined by serum albumin < 2.5 g/dL
  • Has serum aspartate aminotransferase (AST, SGOT, GOT) or serum alanine aminotransferase (ALT, SGPT, GPT) levels greater than twice the upper limit of normal
  • Has fatigue, palpitations, dyspnea, and/or angina at rest
  • Has a history, within the previous 12 months from date of Screening Visit, of alcohol or drug abuse, particularly methadone or heroin
  • Has received previous treatment with the following during the 60 days prior to Screening:

    • Immunosuppressive agents
    • radiation
    • chemotherapy
    • growth factors (epidermal growth factor, tumor necrosis factor, transforming growth factor, platelet derived growth factor, etc.)

      • at the site of the study ulcer, split- or full-thickness skin graft at the site of the study ulcer, biologically-active (or engineered) cellular or acellular product(s) at the site of the study ulcer, investigational drug or device
  • Has been hospitalized for treatment of a diabetic foot ulcer within the previous 30 days from Screening
  • Has history of heart block 2nd and 3rd degree
  • Female who is pregnant or refuses to use adequate contraceptive methods and is of childbearing age during the trial
  • Prisoners, institutionalized individuals or vulnerable population

Sites / Locations

  • VA Northern California Health Care System, Mather, CA

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Timolol

SOC plus non biologically active gel

Arm Description

Timoptic-XE plus standard of care (SOC)

SOC plus non biologically active gel (hydrogel as placebo medication)

Outcomes

Primary Outcome Measures

Time to complete wound closure, as assessed over a 12 week period
Complete wound closure will be assessed by Investigators and is defined as 100% epithelialization of the wound site ("skin re-epithelialization without drainage or dressing requirements by Week 12).
Measurement of timolol serum during the treatment phase
Primary safety outcome

Secondary Outcome Measures

The time to wound closure between the two groups

Full Information

First Posted
September 12, 2017
Last Updated
September 6, 2023
Sponsor
VA Office of Research and Development
Collaborators
VA Northern California Health Care System
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1. Study Identification

Unique Protocol Identification Number
NCT03282981
Brief Title
Beta Adrenergic Antagonist for the Healing of Chronic DFU
Acronym
BAART-DFU
Official Title
Beta Adrenergic Antagonist For The Healing of Chronic Diabetic Foot Ulcers
Study Type
Interventional

2. Study Status

Record Verification Date
September 2023
Overall Recruitment Status
Active, not recruiting
Study Start Date
June 14, 2018 (Actual)
Primary Completion Date
December 1, 2023 (Anticipated)
Study Completion Date
March 31, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
VA Office of Research and Development
Collaborators
VA Northern California Health Care System

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
One in four Veterans is affected by diabetes and will develop a diabetic foot ulcer. Diabetic ulcers are very challenging to manage and are the most common cause of leg amputation. Many advanced treatments are expensive and difficult to use in the clinic or at home. Those newer therapies have shown little success in healing diabetic foot wounds. The investigators' laboratory and animal work has suggested that a safe medication, currently used as an eye drop for treatment of glaucoma, can heal these ulcers. The investigators are proposing to test this drop (timolol) directly on the surface of the foot ulcer to see if can improve healing faster than the current standard of care. To do this, the investigators propose a "randomized controlled trial" with two groups of patients with diabetic foot ulcers: one will receive standard of care with timolol while the other will receive standard of care with a gel (hydrogel, as placebo medicine).
Detailed Description
The trial is designed as a prospective, randomized, double-blinded controlled study of subjects presenting with diabetic foot ulcers. The purpose of this study is to evaluate the superiority of Timoptic-XE therapy in conjunction with standard of care (SOC) treatment (Group A: Timoptic-XE + SOC) versus SOC (Group B: SOC + plus a non-biologically active gel, i.e., hydrogel, as placebo medication) in the clinical effectiveness in promoting wound healing and closure.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Chronic Diabetic Foot Ulcers, Diabetic Neuropathic Ulcers, Non Healing Wound

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
35 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Timolol
Arm Type
Experimental
Arm Description
Timoptic-XE plus standard of care (SOC)
Arm Title
SOC plus non biologically active gel
Arm Type
Placebo Comparator
Arm Description
SOC plus non biologically active gel (hydrogel as placebo medication)
Intervention Type
Drug
Intervention Name(s)
Timolol
Other Intervention Name(s)
Timoptic-XE
Intervention Description
Topical application of Timolol on non-healing diabetic foot ulcers
Intervention Type
Drug
Intervention Name(s)
Non biologically active gel
Other Intervention Name(s)
Hydrogel
Intervention Description
Topical application of non biologically active gel (Hydrogel- standard of care) on non-healing diabetic foot ulcers
Primary Outcome Measure Information:
Title
Time to complete wound closure, as assessed over a 12 week period
Description
Complete wound closure will be assessed by Investigators and is defined as 100% epithelialization of the wound site ("skin re-epithelialization without drainage or dressing requirements by Week 12).
Time Frame
12 weeks
Title
Measurement of timolol serum during the treatment phase
Description
Primary safety outcome
Time Frame
31 weeks
Secondary Outcome Measure Information:
Title
The time to wound closure between the two groups
Time Frame
31 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male or female subject of any race 18 years old or older Lower extremity ulcer located anywhere on the foot (as defined as beginning below the malleoli of the ankle): Of more than 30 days duration and less than 2 years duration Surface area between 0.5cm2 and 20cm2 (as measured with the Silhouette imaging system at randomization). The ulcer with largest surface area meeting inclusion criteria will be selected as index ulcer If two ulcers present with the same surface area, the ulcer of the longest duration will be selected as index ulcer Documented Ankle Brachial Index (ABI) between 0.8 and 1.2 on the study limb or toe pressure over 65mmHg within 3 months of screening phase Documented biopsy report to rule out malignancy of ulcer of > 6 months duration Subject or legally authorized representative understands and is willing to give written informed consent Subject or legally authorized representative is willing and able to comply with a trial (13 to 17 days) of protocol-specified standard care prior to randomization and to comply with all study requirements Exclusion Criteria: Ulcer of non-diabetic etiology, such as venous, arterial and burn wounds Index ulcer is less than 3 cm in distance from any other ulcer on the same extremity There are greater than 3 ulcers on the study foot Index ulcer presents with any of the following: cellulitis, osteomyelitis, exposed bone, tendon or fascia, capsule , purulent exudate or gangrene Index ulcer shows evidence of infection (defined as a moderate or severe rating of all of the following clinical signs/symptoms: increased warmth increased pain erythema malodorous exudate at Screening or at Randomization (Visit 1), OR total organism count > 1 x 105 colony forming units (CFU) from the screening visit study ulcer culture sample) Index ulcer surface area has decreased or increased > 40% between Screening and at Randomization (Visit 1) as assessed by the Silhouette imaging system Has acquired or is known to be infected with Human Immunodeficiency Virus (HIV) Has active malignancy on the study foot Has uncontrolled diabetes mellitus as defined by glycosylated hemoglobin A1C > 12% Has immunodeficiency as defined by serum IgG, IgA, and IgM less than one-half the lower limit of normal Has severe protein malnutrition as defined by serum albumin < 2.5 g/dL Has serum aspartate aminotransferase (AST, SGOT, GOT) or serum alanine aminotransferase (ALT, SGPT, GPT) levels greater than twice the upper limit of normal Has fatigue, palpitations, dyspnea, and/or angina at rest Has a history, within the previous 12 months from date of Screening Visit, of alcohol or drug abuse, particularly methadone or heroin Has received previous treatment with the following during the 60 days prior to Screening: Immunosuppressive agents radiation chemotherapy growth factors (epidermal growth factor, tumor necrosis factor, transforming growth factor, platelet derived growth factor, etc.) at the site of the study ulcer, split- or full-thickness skin graft at the site of the study ulcer, biologically-active (or engineered) cellular or acellular product(s) at the site of the study ulcer, investigational drug or device Has been hospitalized for treatment of a diabetic foot ulcer within the previous 30 days from Screening Has history of heart block 2nd and 3rd degree Female who is pregnant or refuses to use adequate contraceptive methods and is of childbearing age during the trial Prisoners, institutionalized individuals or vulnerable population
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Sara E. Dahle, DPM MPH
Organizational Affiliation
VA Northern California Health Care System, Mather, CA
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Rivkah R. Isseroff, MD
Organizational Affiliation
VA Northern California Health Care System, Mather, CA
Official's Role
Principal Investigator
Facility Information:
Facility Name
VA Northern California Health Care System, Mather, CA
City
Sacramento
State/Province
California
ZIP/Postal Code
95655-4200
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
32513257
Citation
Kaur R, Tchanque-Fossuo C, West K, Hadian Y, Gallegos A, Yoon D, Ismailyan L, Schaefer S, Dahle SE, Isseroff RR. Beta-adrenergic antagonist for the healing of chronic diabetic foot ulcers: study protocol for a prospective, randomized, double-blinded, controlled and parallel-group study. Trials. 2020 Jun 8;21(1):496. doi: 10.1186/s13063-020-04413-z.
Results Reference
derived

Learn more about this trial

Beta Adrenergic Antagonist for the Healing of Chronic DFU

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