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LeucoPatch in the Management of Hard-to-heal Diabetic Foot Ulcers

Primary Purpose

Diabetic Foot Ulcer

Status
Completed
Phase
Phase 4
Locations
International
Study Type
Interventional
Intervention
LeucoPatch
Usual care
Sponsored by
Nottingham University Hospitals NHS Trust
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Diabetic Foot Ulcer

Eligibility Criteria

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

Inclusion Criteria:

  • People aged 18 years and over who have diabetes complicated by one or more ulcers on a foot or both feet below the level of the malleoli, excluding ulcers confined to the interdigital cleft.
  • Those with more than one eligible ulcer will have one - usually the largest or more clinically significant - selected at screening as the index ulcer.
  • Eligible ulcers will be hard-to-heal, meaning that the cross-sectional area will decrease by less than 50 % during a four week run-in period.
  • The cross-sectional area of the index ulcer will be ≥50 and ≤1000 mm2 at the end of the 4 week run-in period.
  • At randomisation, the index ulcer will be clinically non-infected according to IDSA criteria
  • Either the ankle-brachial index (ABPI) in the affected limb will be between 0.50 and 1.40 or the dorsalis pedis pulse and/or tibialis posterior pulse will be palpable.
  • HbA1c ≤108 mmol/mol at screening
  • Participants will have the capacity to understand study procedures, and will be able to provide written informed consent.

Exclusion Criteria:

  • Haemoglobin concentration <105 g/L or 6.5 mmol/L at screening.
  • Presence of sickle-cell anaemia, haemophilia, thrombocytopenia (<100x109/L) or other clinically significant blood dyscrasia
  • Known potential infectivity of blood products, including known HIV and hepatitis
  • Dialysis or an estimated GFR (based on cystatine C or serum creatinine) <20 ml/min/1.73m2
  • Increase in cross-sectional area of the index ulcer by ≥25% during the 4 week run-in period, or is either smaller than 50 mm2 or larger than 1000 mm2 at the end of that time.
  • Clinical signs of infection of the index ulcer or reason to suspect that infection is present at randomisation.
  • Revascularisation procedure in the affected limb planned, or undertaken within the preceding 4 weeks.
  • Current treatment with cytotoxic drugs or with systemically administered glucocorticoids or other immunosuppressants.
  • Treatment of foot ulcers with growth factors, stem cells or equivalent preparation within the preceding 8 weeks
  • The need for continued use of negative pressure wound therapy
  • Likely inability to comply with the need for weekly visits because of planned activity.
  • Participation in another interventional clinical foot ulcer-healing trial within last the 4 weeks at the time of screening.
  • Prior randomisation in this trial.
  • Judgement by the investigator that the patient does not have the capacity to understand the study procedures or provide written informed consent.

Sites / Locations

  • Steno Diabetes Center
  • Herlev Hospital
  • Nordsjællands Hospital
  • Bispebjerg Hospital
  • Kolding Sygehus
  • Odense University Hospital
  • Viborg Sårcenter
  • Centralsjukhuset Kristianstad
  • Skåne University Hospital
  • Karolinska University Hospital
  • Royal Cornwall Hospitals NHS Trust
  • South Devon Healthcare NHS Foundation Trust
  • The Ipswich Hospital NHS Trust
  • The Mid Yorkshire Hospitals NHS Trust
  • Barnsley Hospital NHS Foundation Trust
  • Bradford Teaching Hospitals NHS Foundation Trust
  • Lancashire Teaching Hospitals NHS Foundation Trust
  • Dartford and Gravesham NHS Trust
  • Derby Hospitals NHS Foundation Trust
  • The Dudley Group NHS Foundation Trust
  • Royal Devon & Exeter NHS Foundation Trust
  • Gateshead Health NHS Foundation Trust
  • Harrogate and District NHS Foundation Trust
  • The Leeds Teaching Hospitals NHS Trust
  • University Hospitals of Leicester NHSTrust
  • United Lincolnshire Hospitals NHS Trust
  • Norwich and Norwich University Hospitals NHS Foundation Trust
  • Nottingham University Hospitals NHS Trust
  • Royal Berkshire NHS Foundation Trust
  • Sheffield Teaching Hospitals NHS Foundation Trust
  • City Hospitals Sunderland NHS Foundation Trust
  • Royal Wolverhampton Hospitals NHS Trust

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

LeucoPatch

Usual care

Arm Description

Usual care supplemented by the application of LeucoPatch centrifugates that comprise autologous fibrin patches containing living white cells and platelets

Usual care provided in a multidisciplinary foot care clinic, in accordance with international guidelines

Outcomes

Primary Outcome Measures

Healing
Healing will be defined as complete epithelialisation without discharge that is maintained for 4 weeks and is confirmed by an observer blind to randomisation group.

Secondary Outcome Measures

Full Information

First Posted
August 22, 2014
Last Updated
June 21, 2018
Sponsor
Nottingham University Hospitals NHS Trust
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1. Study Identification

Unique Protocol Identification Number
NCT02224742
Brief Title
LeucoPatch in the Management of Hard-to-heal Diabetic Foot Ulcers
Official Title
LeucoPatch in the Management of Hard-to-heal Diabetic Foot Ulcers
Study Type
Interventional

2. Study Status

Record Verification Date
June 2018
Overall Recruitment Status
Completed
Study Start Date
August 2013 (Actual)
Primary Completion Date
October 2017 (Actual)
Study Completion Date
May 2018 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Nottingham University Hospitals NHS Trust

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
Diabetic foot ulcers are the source of considerable suffering and cost and there are currently no wound care products available that have been demonstrated to improve healing, or that are cost effective. There have however been a small number of studies which have examined the use of platelets or fluid derived from platelets, either from the patient's own blood or from blood bank products. These have suggested some promise, but have suffered from technical difficulties in making a suitable wound care product or the volume of blood required to derive the product. It is thought that the reason why they may work is that growth factors released by the platelets may stimulate the wound to heal. This study will be a formal, randomised controlled trial to assess a new device for creating a wound care product which is a plug or patch comprising fibrin, white cells and platelets derived from 18 mls of the patients own blood. The application of this fibrin/white cell/platelet patch to the patients wound on a weekly basis will be compared with usual best care in patients with hard to heal Diabetic Foot Ulcers in a secondary care setting in 25 centres in the United Kingdom, Denmark and Sweden.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Diabetic Foot Ulcer

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Masking
Outcomes Assessor
Allocation
Randomized
Enrollment
269 (Actual)

8. Arms, Groups, and Interventions

Arm Title
LeucoPatch
Arm Type
Experimental
Arm Description
Usual care supplemented by the application of LeucoPatch centrifugates that comprise autologous fibrin patches containing living white cells and platelets
Arm Title
Usual care
Arm Type
Active Comparator
Arm Description
Usual care provided in a multidisciplinary foot care clinic, in accordance with international guidelines
Intervention Type
Device
Intervention Name(s)
LeucoPatch
Intervention Description
LeucoPatch® is prepared by centrifuging one or more 18mL aliquots of the participant's venous blood in the LeucoPatch device and bench-top centrifuge. The centrifugation yields a tough layer of fibrin, with viable white cells and platelets, and this is applied directly to the wound surface using sterile forceps. The wound is then covered with an inert primary dressing, secondary protective dressing and the ulcerated area protected with appropriate off-loading. The patch is prepared and applied each week for up to 20 weeks or until the wound is judged healed.
Intervention Type
Other
Intervention Name(s)
Usual care
Intervention Description
Usual wound care provided in a multidisciplinary foot care clinic , in accordance with international guidelines. Components of usual wound care include: Formal assessment of ulcer and surrounding skin Provision of any necessary off-loading Debridement (i) sharp, (ii) other as appropriate (but excluding the use of larvae) Appropriate dressing products Appropriate antibiotic therapy Nutrition and self care Optimal glycaemic control Revascularisation if deemed clinically necessary Continued close observation
Primary Outcome Measure Information:
Title
Healing
Description
Healing will be defined as complete epithelialisation without discharge that is maintained for 4 weeks and is confirmed by an observer blind to randomisation group.
Time Frame
Within 20 weeks of randomisation

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: People aged 18 years and over who have diabetes complicated by one or more ulcers on a foot or both feet below the level of the malleoli, excluding ulcers confined to the interdigital cleft. Those with more than one eligible ulcer will have one - usually the largest or more clinically significant - selected at screening as the index ulcer. Eligible ulcers will be hard-to-heal, meaning that the cross-sectional area will decrease by less than 50 % during a four week run-in period. The cross-sectional area of the index ulcer will be ≥50 and ≤1000 mm2 at the end of the 4 week run-in period. At randomisation, the index ulcer will be clinically non-infected according to IDSA criteria Either the ankle-brachial index (ABPI) in the affected limb will be between 0.50 and 1.40 or the dorsalis pedis pulse and/or tibialis posterior pulse will be palpable. HbA1c ≤108 mmol/mol at screening Participants will have the capacity to understand study procedures, and will be able to provide written informed consent. Exclusion Criteria: Haemoglobin concentration <105 g/L or 6.5 mmol/L at screening. Presence of sickle-cell anaemia, haemophilia, thrombocytopenia (<100x109/L) or other clinically significant blood dyscrasia Known potential infectivity of blood products, including known HIV and hepatitis Dialysis or an estimated GFR (based on cystatine C or serum creatinine) <20 ml/min/1.73m2 Increase in cross-sectional area of the index ulcer by ≥25% during the 4 week run-in period, or is either smaller than 50 mm2 or larger than 1000 mm2 at the end of that time. Clinical signs of infection of the index ulcer or reason to suspect that infection is present at randomisation. Revascularisation procedure in the affected limb planned, or undertaken within the preceding 4 weeks. Current treatment with cytotoxic drugs or with systemically administered glucocorticoids or other immunosuppressants. Treatment of foot ulcers with growth factors, stem cells or equivalent preparation within the preceding 8 weeks The need for continued use of negative pressure wound therapy Likely inability to comply with the need for weekly visits because of planned activity. Participation in another interventional clinical foot ulcer-healing trial within last the 4 weeks at the time of screening. Prior randomisation in this trial. Judgement by the investigator that the patient does not have the capacity to understand the study procedures or provide written informed consent.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Frances Game, FRCP
Organizational Affiliation
University Hospitals of Derby and Burton NHS Foundation Trust
Official's Role
Principal Investigator
Facility Information:
Facility Name
Steno Diabetes Center
City
Gentofte
Country
Denmark
Facility Name
Herlev Hospital
City
Herlev
Country
Denmark
Facility Name
Nordsjællands Hospital
City
Hillerød
Country
Denmark
Facility Name
Bispebjerg Hospital
City
Kobenhavn NV
Country
Denmark
Facility Name
Kolding Sygehus
City
Kolding
ZIP/Postal Code
6000
Country
Denmark
Facility Name
Odense University Hospital
City
Odense
Country
Denmark
Facility Name
Viborg Sårcenter
City
Viborg
Country
Denmark
Facility Name
Centralsjukhuset Kristianstad
City
Kristianstad
Country
Sweden
Facility Name
Skåne University Hospital
City
Lund
Country
Sweden
Facility Name
Karolinska University Hospital
City
Solna
Country
Sweden
Facility Name
Royal Cornwall Hospitals NHS Trust
City
Truro
State/Province
Cornwall
ZIP/Postal Code
TRI 3LJ
Country
United Kingdom
Facility Name
South Devon Healthcare NHS Foundation Trust
City
Torquay
State/Province
Devon
ZIP/Postal Code
TQ2 7AA
Country
United Kingdom
Facility Name
The Ipswich Hospital NHS Trust
City
Ipswich
State/Province
Suffolk
ZIP/Postal Code
IP4 5PD
Country
United Kingdom
Facility Name
The Mid Yorkshire Hospitals NHS Trust
City
Pontefract
State/Province
West Yorkshire
ZIP/Postal Code
WF8 1PL
Country
United Kingdom
Facility Name
Barnsley Hospital NHS Foundation Trust
City
Barnsley
ZIP/Postal Code
S75 2EP
Country
United Kingdom
Facility Name
Bradford Teaching Hospitals NHS Foundation Trust
City
Bradford
ZIP/Postal Code
BD9 6RJ
Country
United Kingdom
Facility Name
Lancashire Teaching Hospitals NHS Foundation Trust
City
Chorley
ZIP/Postal Code
PR7 1PP
Country
United Kingdom
Facility Name
Dartford and Gravesham NHS Trust
City
Dartford
ZIP/Postal Code
DA2 8DA
Country
United Kingdom
Facility Name
Derby Hospitals NHS Foundation Trust
City
Derby
ZIP/Postal Code
DE22 3NE
Country
United Kingdom
Facility Name
The Dudley Group NHS Foundation Trust
City
Dudley
ZIP/Postal Code
DY1 2HQ
Country
United Kingdom
Facility Name
Royal Devon & Exeter NHS Foundation Trust
City
Exeter
ZIP/Postal Code
EX2 5DW
Country
United Kingdom
Facility Name
Gateshead Health NHS Foundation Trust
City
Gateshead
ZIP/Postal Code
NE9 6SX
Country
United Kingdom
Facility Name
Harrogate and District NHS Foundation Trust
City
Harrogate
ZIP/Postal Code
HG2 7SX
Country
United Kingdom
Facility Name
The Leeds Teaching Hospitals NHS Trust
City
Leeds
ZIP/Postal Code
LS1 3EX
Country
United Kingdom
Facility Name
University Hospitals of Leicester NHSTrust
City
Leicester
ZIP/Postal Code
LE5 4PW
Country
United Kingdom
Facility Name
United Lincolnshire Hospitals NHS Trust
City
Lincoln
ZIP/Postal Code
LN2 5QY
Country
United Kingdom
Facility Name
Norwich and Norwich University Hospitals NHS Foundation Trust
City
Norwich
ZIP/Postal Code
NR4 7UY
Country
United Kingdom
Facility Name
Nottingham University Hospitals NHS Trust
City
Nottingham
ZIP/Postal Code
NG7 2UH
Country
United Kingdom
Facility Name
Royal Berkshire NHS Foundation Trust
City
Reading
ZIP/Postal Code
RG1 5BS
Country
United Kingdom
Facility Name
Sheffield Teaching Hospitals NHS Foundation Trust
City
Sheffield
ZIP/Postal Code
S5 7AU
Country
United Kingdom
Facility Name
City Hospitals Sunderland NHS Foundation Trust
City
Sunderland
ZIP/Postal Code
SR4 7TP
Country
United Kingdom
Facility Name
Royal Wolverhampton Hospitals NHS Trust
City
Wolverhampton
ZIP/Postal Code
WV10 0QP
Country
United Kingdom

12. IPD Sharing Statement

Citations:
PubMed Identifier
30243803
Citation
Game F, Jeffcoate W, Tarnow L, Jacobsen JL, Whitham DJ, Harrison EF, Ellender SJ, Fitzsimmons D, Londahl M; LeucoPatch II trial team. LeucoPatch system for the management of hard-to-heal diabetic foot ulcers in the UK, Denmark, and Sweden: an observer-masked, randomised controlled trial. Lancet Diabetes Endocrinol. 2018 Nov;6(11):870-878. doi: 10.1016/S2213-8587(18)30240-7. Epub 2018 Sep 19.
Results Reference
derived

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LeucoPatch in the Management of Hard-to-heal Diabetic Foot Ulcers

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