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Resorbable Glass Fiber Matrix in the Treatment of Diabetic Foot Ulcers

Primary Purpose

Diabetic Foot Ulcer, Ulcer Foot, Diabetic Foot

Status
Completed
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Offloading
Additional (outer) Dressing Application
Mirragen Wound Matrix Dressing
Fibracol Wound Dressing
Sponsored by
ETS Wound Care, LLC
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Diabetic Foot Ulcer focused on measuring DFU, Ulcer

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  • At least 18 years old.
  • Presence of a DFU, Wagner 1 (see Appendix B for definitions), extending at least through the dermis provided it is below the medial aspect of the malleolus.
  • The index ulcer will be the largest ulcer if two or more DFUs are present with the same Wagner grade and will be the only one evaluated in the study. If other ulcerations are present on the same foot they must be more than 2 cm distant from the index ulcer.
  • Index ulcer (i.e. current episode of ulceration) has been present for greater than 4 weeks prior to SV1 and less than 1-year, as of the date the subject consents for study.
  • Index ulcer is a minimum of 1.0 cm2 and a maximum of 25 cm2 at SV1 and TV1.
  • Adequate circulation to the affected foot as documented by a dorsal transcutaneous oxygen measurement (TCOM) or a skin perfusion pressure (SPP) measurement of ≥ 30 mmHg, or an Ankle Branchial Index (ABI) between 0.7 and 1.3 within 3 months of SV1, using the affected study extremity. As an alternative arterial Doppler ultrasound can be performed evaluating for biphasic dorsalis pedis and posterior tibial vessels at the level of the ankle or a Toe Brachial Index (TBI) of > 0.6 is acceptable.
  • The target ulcer has been offloaded for at least 14 days prior to randomization.
  • Females of childbearing potential must be willing to use acceptable methods of contraception (birth control pills, barriers or abstinence) during the course of the study and undergo pregnancy tests.
  • Subject understands and is willing to participate in the clinical study and can comply with weekly visits.

Exclusion Criteria:

  • Index ulcer(s) deemed by the investigator to be caused by a medical condition other than diabetes.
  • Index ulcer, in the opinion of the investigator, is suspicious for cancer and should undergo an ulcer biopsy to rule out a carcinoma of the ulcer.
  • Subjects with a history of more than two weeks treatment with immune-suppressants (including systemic corticosteroids >10mg daily dose), cytotoxic chemotherapy, or application of topical steroids to the ulcer surface within 1-month prior to first SV1, or who receive such medications during the screening period or who are anticipated to require such medications during the course of the study.
  • Subjects taking a selective COX-2 inhibitor, such as Celecoxib, for any condition.
  • Subjects on any investigational drug(s) or therapeutic device(s) within 30 days preceding SV1.
  • History of radiation at the ulcer site (regardless of time since last radiation treatment).
  • Index ulcer has been previously treated or will need to be treated with any prohibited therapies. (See Section 7.3 of this protocol for a list of prohibited medications and therapies).
  • Presence of any condition(s) which seriously compromises the subject's ability to complete this study or has a known history of poor adherence with medical treatment.
  • Osteomyelitis or bone infection of the affected foot as verified by x-ray within 30 days prior to randomization. (In the event of an ambiguous diagnosis, the Principal Investigator will make the final decision).
  • Subject is pregnant or breast-feeding.
  • Presence of diabetes with poor metabolic control as documented with an HbA1c > 12.0 within 90 days of randomization.
  • Subjects with end stage renal disease as evidenced by a serum creatinine ≥ 3.0 mg/dL within 6 months of randomization.
  • Index ulcer has reduced in area by 20% or more after 14 days of SOC from SV1 to the TV1/randomization visit.

Sites / Locations

  • Alan M Jacobs and Associates
  • Lower Extremity Institute of Research and Therapy
  • Martinsville Research Institute
  • Professional Education and Research Institute
  • Shenandoah Lower Extremity Research Institute

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

Mirragen Wound Matrix Dressing

Fibracol Wound Dressing

Arm Description

MIRRAGEN™ Advanced Wound Matrix is intended for the use in the management of wounds including diabetic ulcers. Wound matrix dressing to be used per manufacturer instructions for use on diabetic foot wounds in conjunction with offloading and Additional (outer) Dressing Application with moisture retention dressing

A commercially available wound dressing to be used per manufacturer's instructions for use on diabetic foot wounds in conjunction with offloading and Additional (outer) Dressing Application with moisture retention dressing moisture retention dressing

Outcomes

Primary Outcome Measures

Percentage of index ulcers healed at 12 weeks
examine percent of ulcers healed at week twelve

Secondary Outcome Measures

Percentage of index ulcers healed at 6 weeks
examine percent of ulcers healed at week six
Time to heal within 6 and 12 weeks
examine time to healing at both six and twelve weeks
Percent Area Reduction (PAR) at 6 and 12 weeks
examine PAR at both six and twelve weeks
Changes in peripheral neuropathy using Semmes Weinstein Monofilament "10"point discrimination test
Each clinical trial participant will be examined by the principal investigator with a Semmes Weinstein monofilament wire at 10 points on the study foot, this standardized exam will be scored out of a total of 10 at each visit and recorded
Changes in wound quality of life, the " Wound Quality of Life Questionnaire" will be given to the clinical trial participants and administered during each visit
The Wound-QoL, or wound quality of life questionnaire, measures the disease-specific, health-related quality of life of patients with chronic wounds. It consists of 17 items on impairments which are always assessed in retrospect to the preceding seven days. This questionnaire will be given to clinical trial participants at each visit, with the scale scores recorded. Each question is scored. Answers to each item are coded with numbers (0='not at all' to 4='very much'). As noted above the score will be reported with a minimam score of "0" and a maximum score of 68
Change in pain levels during trial, using the FACES pain scales which measure pain on a range of 0-10, zero being no pain and 10 being the most severe pain
The FACES pain scale will be administered to the clinical trial participants at each visit. The trial participant will select their pain level with a series of faces that correspond to a number between 0 which implies no pain , up to 10 which implies the most severe pain. The scores will be recorded for each clinical trial participant on each visit
Difference in cellulitis and/or infection at 12 weeks
Examine difference in infection rate over twelve weeks

Full Information

First Posted
January 3, 2018
Last Updated
August 1, 2022
Sponsor
ETS Wound Care, LLC
Collaborators
Professional Education and Research Institute
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1. Study Identification

Unique Protocol Identification Number
NCT03398538
Brief Title
Resorbable Glass Fiber Matrix in the Treatment of Diabetic Foot Ulcers
Official Title
A Multi-center, Randomized Controlled Clinical Trial Evaluating the Effect of Resorbable Glass Fiber Matrix in the Treatment of Diabetic Foot Ulcers
Study Type
Interventional

2. Study Status

Record Verification Date
August 2022
Overall Recruitment Status
Completed
Study Start Date
December 26, 2017 (Actual)
Primary Completion Date
October 31, 2018 (Actual)
Study Completion Date
October 31, 2018 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
ETS Wound Care, LLC
Collaborators
Professional Education and Research Institute

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
This study is a prospective, multi-center, randomized controlled trial designed to collect patient outcome data on 2 commercially available SOC dressings treatments for Diabetic Foot Wounds
Detailed Description
This study is a prospective, multi-center, RCT designed to collect patient outcome data on two commercially available SOC treatments for DFUs. The trial will be single blinded in regard to wound healing assessment (another clinician, other than the investigator at each site will assess wound healing) and confirmation of wound healing will be overseen by an independent adjudication committee made up of wound care experts. The study will last twelve weeks, with a two week screening period prior to enrollment. There are two standard of care arms in the study: Arm 1: The SOC therapy in this study is offloading of the DFU (CAM boots or total contact casting [TCC] if the subject's foot is too large for a CAM), appropriate sharp or surgical debridement, infection management (systemic antibiotics only in conjunction with debridement) and wound care covering with bioactive resorbable glass fiber dressing, MIRRAGEN™Advanced Wound Matrix, followed by a padded 3-layer dressing comprised of 4x4 gauze pads, soft roll and compressive wrap (DynaflexTM or equivalent). Arm 2: The SOC therapy in this study is offloading of the DFU (CAM boots or total contact casting [TCC] if the subject's foot is too large for a CAM), appropriate sharp or surgical debridement, infection management (systemic antibiotics only in conjunction with debridement) and wound care covering with calcium alginate Fibracol dressing followed by a padded 3-layer dressing comprised of 4x4 gauze pads, soft roll and compressive wrap (DynaflexTM or equivalent).

6. Conditions and Keywords

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

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Model Description
Multi-center, Randomized Controlled Clinical Trial Evaluating the Effect of Resorbable Glass Fiber Matrix in the Treatment of Diabetic Foot Ulcers
Masking
None (Open Label)
Allocation
Randomized
Enrollment
40 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Mirragen Wound Matrix Dressing
Arm Type
Experimental
Arm Description
MIRRAGEN™ Advanced Wound Matrix is intended for the use in the management of wounds including diabetic ulcers. Wound matrix dressing to be used per manufacturer instructions for use on diabetic foot wounds in conjunction with offloading and Additional (outer) Dressing Application with moisture retention dressing
Arm Title
Fibracol Wound Dressing
Arm Type
Active Comparator
Arm Description
A commercially available wound dressing to be used per manufacturer's instructions for use on diabetic foot wounds in conjunction with offloading and Additional (outer) Dressing Application with moisture retention dressing moisture retention dressing
Intervention Type
Other
Intervention Name(s)
Offloading
Other Intervention Name(s)
Pressure relief
Intervention Description
Patient will be offloaded in a diabetic camboot after treatment, or total contact cast if patient cannot be fit with diabetic offloading boot
Intervention Type
Other
Intervention Name(s)
Additional (outer) Dressing Application
Other Intervention Name(s)
Outer protective dressing
Intervention Description
Application of outer a moisture retentive dressing, and a multi-layer compression dressing.
Intervention Type
Other
Intervention Name(s)
Mirragen Wound Matrix Dressing
Intervention Description
Application of Mirragen to wound site along with standard of care treatment
Intervention Type
Other
Intervention Name(s)
Fibracol Wound Dressing
Intervention Description
Application of Fibracol Alginate along with standard of care treatment
Primary Outcome Measure Information:
Title
Percentage of index ulcers healed at 12 weeks
Description
examine percent of ulcers healed at week twelve
Time Frame
12 weeks
Secondary Outcome Measure Information:
Title
Percentage of index ulcers healed at 6 weeks
Description
examine percent of ulcers healed at week six
Time Frame
6 week
Title
Time to heal within 6 and 12 weeks
Description
examine time to healing at both six and twelve weeks
Time Frame
6 and 12 weeks
Title
Percent Area Reduction (PAR) at 6 and 12 weeks
Description
examine PAR at both six and twelve weeks
Time Frame
6 and 12 weeks
Title
Changes in peripheral neuropathy using Semmes Weinstein Monofilament "10"point discrimination test
Description
Each clinical trial participant will be examined by the principal investigator with a Semmes Weinstein monofilament wire at 10 points on the study foot, this standardized exam will be scored out of a total of 10 at each visit and recorded
Time Frame
12 weeks
Title
Changes in wound quality of life, the " Wound Quality of Life Questionnaire" will be given to the clinical trial participants and administered during each visit
Description
The Wound-QoL, or wound quality of life questionnaire, measures the disease-specific, health-related quality of life of patients with chronic wounds. It consists of 17 items on impairments which are always assessed in retrospect to the preceding seven days. This questionnaire will be given to clinical trial participants at each visit, with the scale scores recorded. Each question is scored. Answers to each item are coded with numbers (0='not at all' to 4='very much'). As noted above the score will be reported with a minimam score of "0" and a maximum score of 68
Time Frame
12 weeks
Title
Change in pain levels during trial, using the FACES pain scales which measure pain on a range of 0-10, zero being no pain and 10 being the most severe pain
Description
The FACES pain scale will be administered to the clinical trial participants at each visit. The trial participant will select their pain level with a series of faces that correspond to a number between 0 which implies no pain , up to 10 which implies the most severe pain. The scores will be recorded for each clinical trial participant on each visit
Time Frame
12 weeks
Title
Difference in cellulitis and/or infection at 12 weeks
Description
Examine difference in infection rate over twelve weeks
Time Frame
12 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: At least 18 years old. Presence of a DFU, Wagner 1 (see Appendix B for definitions), extending at least through the dermis provided it is below the medial aspect of the malleolus. The index ulcer will be the largest ulcer if two or more DFUs are present with the same Wagner grade and will be the only one evaluated in the study. If other ulcerations are present on the same foot they must be more than 2 cm distant from the index ulcer. Index ulcer (i.e. current episode of ulceration) has been present for greater than 4 weeks prior to SV1 and less than 1-year, as of the date the subject consents for study. Index ulcer is a minimum of 1.0 cm2 and a maximum of 25 cm2 at SV1 and TV1. Adequate circulation to the affected foot as documented by a dorsal transcutaneous oxygen measurement (TCOM) or a skin perfusion pressure (SPP) measurement of ≥ 30 mmHg, or an Ankle Branchial Index (ABI) between 0.7 and 1.3 within 3 months of SV1, using the affected study extremity. As an alternative arterial Doppler ultrasound can be performed evaluating for biphasic dorsalis pedis and posterior tibial vessels at the level of the ankle or a Toe Brachial Index (TBI) of > 0.6 is acceptable. The target ulcer has been offloaded for at least 14 days prior to randomization. Females of childbearing potential must be willing to use acceptable methods of contraception (birth control pills, barriers or abstinence) during the course of the study and undergo pregnancy tests. Subject understands and is willing to participate in the clinical study and can comply with weekly visits. Exclusion Criteria: Index ulcer(s) deemed by the investigator to be caused by a medical condition other than diabetes. Index ulcer, in the opinion of the investigator, is suspicious for cancer and should undergo an ulcer biopsy to rule out a carcinoma of the ulcer. Subjects with a history of more than two weeks treatment with immune-suppressants (including systemic corticosteroids >10mg daily dose), cytotoxic chemotherapy, or application of topical steroids to the ulcer surface within 1-month prior to first SV1, or who receive such medications during the screening period or who are anticipated to require such medications during the course of the study. Subjects taking a selective COX-2 inhibitor, such as Celecoxib, for any condition. Subjects on any investigational drug(s) or therapeutic device(s) within 30 days preceding SV1. History of radiation at the ulcer site (regardless of time since last radiation treatment). Index ulcer has been previously treated or will need to be treated with any prohibited therapies. (See Section 7.3 of this protocol for a list of prohibited medications and therapies). Presence of any condition(s) which seriously compromises the subject's ability to complete this study or has a known history of poor adherence with medical treatment. Osteomyelitis or bone infection of the affected foot as verified by x-ray within 30 days prior to randomization. (In the event of an ambiguous diagnosis, the Principal Investigator will make the final decision). Subject is pregnant or breast-feeding. Presence of diabetes with poor metabolic control as documented with an HbA1c > 12.0 within 90 days of randomization. Subjects with end stage renal disease as evidenced by a serum creatinine ≥ 3.0 mg/dL within 6 months of randomization. Index ulcer has reduced in area by 20% or more after 14 days of SOC from SV1 to the TV1/randomization visit.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
David Armstrong, DPM, MD, PhD
Organizational Affiliation
USC / Salsa
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Charles M Zelen, DPM
Organizational Affiliation
Professional Education and Research Institute
Official's Role
Principal Investigator
Facility Information:
Facility Name
Alan M Jacobs and Associates
City
Saint Louis
State/Province
Missouri
ZIP/Postal Code
63117
Country
United States
Facility Name
Lower Extremity Institute of Research and Therapy
City
Youngstown
State/Province
Ohio
ZIP/Postal Code
44512
Country
United States
Facility Name
Martinsville Research Institute
City
Martinsville
State/Province
Virginia
ZIP/Postal Code
23116
Country
United States
Facility Name
Professional Education and Research Institute
City
Roanoke
State/Province
Virginia
ZIP/Postal Code
24016
Country
United States
Facility Name
Shenandoah Lower Extremity Research Institute
City
Troutville
State/Province
Virginia
ZIP/Postal Code
24019
Country
United States

12. IPD Sharing Statement

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Resorbable Glass Fiber Matrix in the Treatment of Diabetic Foot Ulcers

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