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Does Increasing Oxygen Nurture Your Symptomatic Ischemic Ulcer Sufficiently? (DIONYSIUS)

Primary Purpose

Peripheral Vascular Disease, Diabetic Foot Ulcer, Amputation

Status
Recruiting
Phase
Phase 4
Locations
Netherlands
Study Type
Interventional
Intervention
Hyperbaric oxygen
Sponsored by
Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Peripheral Vascular Disease focused on measuring Diabetic Foot Ulcer, Hyperbaric Oxygen, Peripheral Vascular Disease, HBOT, DFU, Major amputation, Diabetes, Ischemia

Eligibility Criteria

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

Inclusion Criteria: Type I or II diabetes One or more deep and clinically infected lower extremity ulcers, classified as Meggitt-Wagner class 3 or 4, Texas class 2C, 3C, 2D or 3D, or WIfI class W>1, I>1 and fI>0), present for at least 4 weeks or after a minor amputation because of a previously existing ischaemic DFU on a toe or forefoot. In case more than one ulcer is present, the largest will be observed as target ulcer Leg ischaemia, characterized by a highest ankle systolic blood pressure < 70 mmHg, or a toe systolic pressure < 50 mmHg or a TcpO2 < 40 mmHg Complete assessment of peripheral arterial lesions from the aorta to the pedal arteries with duplex ultrasonography, magnetic resonance angiography, computed tomography angiography and/or intraarterial digital subtraction angiography of the ipsilateral leg Patients have to be discussed in, and included after a multidisciplinary consultation. Adults Written informed consent Exclusion Criteria: Chronic Obstructive Pulmonary Disease (COPD) GOLD IV Treatment with chemotherapy, immunosuppressive drugs or systemic corticosteroids within last 3 months, as this interferes with normal wound healing End-stage renal disease requiring dialysis Metastasized malignancy Left ventricular failure with ejection fraction (EF) <20% or external pacemaker Recent thoracic surgery or middle ear surgery Severe epilepsy Uncontrollable high fever Pregnancy Insufficient proficiency of local language/English, or inability to complete the questionnaires

Sites / Locations

  • Amsterdam UMCRecruiting

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm Type

No Intervention

Experimental

Experimental

Experimental

Arm Label

Control

HBOT 20

HBOT 30

HBOT 40

Arm Description

Control group

Patients receiving 20 sessions of concurrent Hyperbaric oxygen treatment

Patients receiving 30 sessions of concurrent Hyperbaric oxygen treatment

Patients receiving at least 40 sessions of concurrent Hyperbaric oxygen treatment

Outcomes

Primary Outcome Measures

Major Amputations
Major amputations, defined as below the knee or above the knee amputations

Secondary Outcome Measures

Amputation-free survival
Time without amputation
Health-related quality of life
Quality of life based on various questionnaires (objective)
Complete wound healing
Complete wound healing
Pain scores
Pain scores taken by VAS questionnaire
Need for additional (vascular) interventions
Vascular interventions performed during time of inclusion
Cost-effectiveness and budget impact
Costs of healthcare resources, including HBOT, related to the total number of eligible patients for HBOT per year. QALYs, based on EQ-5D-5L
Mortality
Mortality
Patients perception of improvement
Quality of life based on various questionnaires (subjective)
TcpO2 before, during and after HBOT
Measurements of TcpO2 surrounding HBOT treatment

Full Information

First Posted
March 24, 2023
Last Updated
April 5, 2023
Sponsor
Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)
Collaborators
ZonMw: The Netherlands Organisation for Health Research and Development
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1. Study Identification

Unique Protocol Identification Number
NCT05804097
Brief Title
Does Increasing Oxygen Nurture Your Symptomatic Ischemic Ulcer Sufficiently?
Acronym
DIONYSIUS
Official Title
Does Increasing Oxygen Nurture Your Symptomatic Ischemic Ulcer Sufficiently?
Study Type
Interventional

2. Study Status

Record Verification Date
April 2023
Overall Recruitment Status
Recruiting
Study Start Date
October 8, 2021 (Actual)
Primary Completion Date
December 31, 2024 (Anticipated)
Study Completion Date
December 31, 2026 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)
Collaborators
ZonMw: The Netherlands Organisation for Health Research and Development

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
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
The goal of this multicenter, multi-national, multi-arm, multi-stage, randomized controlled trial, is to determine the added benefit of hyperbaric oxygen treatment (HBOT) in patients with diabetic foot ulcers and peripheral vascular disease. The main question is: - What is the difference is the major amputation rate between the study arms? Participants will be randomized to 20, 30 or 40 sessions of HBOT or a control group.
Detailed Description
Objective: The primary objective is to assess the (cost-) effectiveness of HBOT in addition to standard wound care and vascular surgical treatment for patients with a DFU and leg ischaemia. Study design: An international, multi-arm multi-stage (MAMS) design is chosen to conduct an efficient randomised clinical trial. At a planned interim analysis the best performing study arm(s) will be chosen to continue. Study population: We need up to 544 patients with a Meggitt-Wagner stage 3 or 4 DFU and proven peripheral ischaemia. Intervention: Patients will be randomised to receive standard care (wound treatment and surgical interventions following international guidelines) with either 0, 20, 30 or at least 40 sessions of HBOT. These sessions will compromise 90-120 minutes of HBOT at a pressure of 2.2-2.5 ATA according to international standards. Main study parameters/endpoints: The primary endpoint is major amputation rate after 12 months. Secondary objectives are amputation-free survival, wound healing, health-related quality of life and cost-effectiveness of the interventions.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Peripheral Vascular Disease, Diabetic Foot Ulcer, Amputation
Keywords
Diabetic Foot Ulcer, Hyperbaric Oxygen, Peripheral Vascular Disease, HBOT, DFU, Major amputation, Diabetes, Ischemia

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Model Description
Randomized controlled trial
Masking
None (Open Label)
Allocation
Randomized
Enrollment
544 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Control
Arm Type
No Intervention
Arm Description
Control group
Arm Title
HBOT 20
Arm Type
Experimental
Arm Description
Patients receiving 20 sessions of concurrent Hyperbaric oxygen treatment
Arm Title
HBOT 30
Arm Type
Experimental
Arm Description
Patients receiving 30 sessions of concurrent Hyperbaric oxygen treatment
Arm Title
HBOT 40
Arm Type
Experimental
Arm Description
Patients receiving at least 40 sessions of concurrent Hyperbaric oxygen treatment
Intervention Type
Drug
Intervention Name(s)
Hyperbaric oxygen
Intervention Description
90-120 min sessions of hyperbaric oxygen treatment of 2.2-2.5 ATA
Primary Outcome Measure Information:
Title
Major Amputations
Description
Major amputations, defined as below the knee or above the knee amputations
Time Frame
12 months after inclusion
Secondary Outcome Measure Information:
Title
Amputation-free survival
Description
Time without amputation
Time Frame
Complete follow-up (up to 3 years)
Title
Health-related quality of life
Description
Quality of life based on various questionnaires (objective)
Time Frame
Complete follow-up (up to 3 years)
Title
Complete wound healing
Description
Complete wound healing
Time Frame
12 months after inclusion
Title
Pain scores
Description
Pain scores taken by VAS questionnaire
Time Frame
12 months after inclusion
Title
Need for additional (vascular) interventions
Description
Vascular interventions performed during time of inclusion
Time Frame
Complete follow-up (up to 3 years)
Title
Cost-effectiveness and budget impact
Description
Costs of healthcare resources, including HBOT, related to the total number of eligible patients for HBOT per year. QALYs, based on EQ-5D-5L
Time Frame
Complete follow-up (up to 3 years)
Title
Mortality
Description
Mortality
Time Frame
Complete follow-up (up to 3 years)
Title
Patients perception of improvement
Description
Quality of life based on various questionnaires (subjective)
Time Frame
Complete follow-up (up to 3 years)
Title
TcpO2 before, during and after HBOT
Description
Measurements of TcpO2 surrounding HBOT treatment
Time Frame
During intervention period

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Type I or II diabetes One or more deep and clinically infected lower extremity ulcers, classified as Meggitt-Wagner class 3 or 4, Texas class 2C, 3C, 2D or 3D, or WIfI class W>1, I>1 and fI>0), present for at least 4 weeks or after a minor amputation because of a previously existing ischaemic DFU on a toe or forefoot. In case more than one ulcer is present, the largest will be observed as target ulcer Leg ischaemia, characterized by a highest ankle systolic blood pressure < 70 mmHg, or a toe systolic pressure < 50 mmHg or a TcpO2 < 40 mmHg Complete assessment of peripheral arterial lesions from the aorta to the pedal arteries with duplex ultrasonography, magnetic resonance angiography, computed tomography angiography and/or intraarterial digital subtraction angiography of the ipsilateral leg Patients have to be discussed in, and included after a multidisciplinary consultation. Adults Written informed consent Exclusion Criteria: Chronic Obstructive Pulmonary Disease (COPD) GOLD IV Treatment with chemotherapy, immunosuppressive drugs or systemic corticosteroids within last 3 months, as this interferes with normal wound healing End-stage renal disease requiring dialysis Metastasized malignancy Left ventricular failure with ejection fraction (EF) <20% or external pacemaker Recent thoracic surgery or middle ear surgery Severe epilepsy Uncontrollable high fever Pregnancy Insufficient proficiency of local language/English, or inability to complete the questionnaires
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Joost R Meijering, MD
Phone
0031627163204
Email
dionysius@amsterdamumc.nl
First Name & Middle Initial & Last Name or Official Title & Degree
Dirk T Ubbink, MD, PhD
Email
d.ubbink@amsterdamumc.nl
Facility Information:
Facility Name
Amsterdam UMC
City
Amsterdam
State/Province
Noord-Hollad
ZIP/Postal Code
1105 AZ
Country
Netherlands
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Joost R Meijering, MD
Phone
0031627163204
Email
dionysius@amsterdamumc.nl
First Name & Middle Initial & Last Name & Degree
Hillian Nederhoed, MD, PHD
First Name & Middle Initial & Last Name & Degree
Joost Meijering, MD

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
Individual participant data that underlie the results reported in this article after deidentification (text, tables, figures and appendices).
IPD Sharing Time Frame
Immediately following publication and 10 years following article publication.
IPD Sharing Access Criteria
Researchers who provide a scientifically good reason to require access. If approved data can be shared after the signing a Data Access Agreement.

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Does Increasing Oxygen Nurture Your Symptomatic Ischemic Ulcer Sufficiently?

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