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Safety and Tolerability of Single and Multiple Doses of SoftOx Biofilm Eradicator (SBE) in Chronic Leg Wounds

Primary Purpose

Chronic Leg Ulcer, Venous Leg Ulcer

Status
Completed
Phase
Phase 1
Locations
Denmark
Study Type
Interventional
Intervention
SoftOx Biofilm Eradicator (Groups 1 to 7)
Sterile isotonic saline (Groups 1 to 4)
Sponsored by
SoftOx Solutions AS
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Chronic Leg Ulcer focused on measuring lower extremities infection biofilm antimicrobial

Eligibility Criteria

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

INCLUSION CRITERIA To be eligible for this study, patients must fulfil all of the following criteria: Male and female patients aged 18 and above at time of informed consent. Chronic (present for at least 4 weeks) leg wound, as judged by the Investigator, with a size of at least 1 cm2 and maximally 100 cm2 (measured as the width x length) on the day of the (first) administration of IMP. Patients must have given written informed consent before any study-related activities are carried out and must be able to understand the full nature and purpose of the study, including possible risks and adverse effects. EXCLUSION CRITERIA Patients are not eligible for this study if they fulfil any of the following exclusion criteria: Any surgical or medical condition, including findings in the medical history or in the pre-study assessments, or any other significant disease, that in the opinion of the Investigator, constitutes a risk or a contraindication for the participation of the patient in the study or that could interfere with the study objectives, conduct, or evaluation at screening or time of the (first) administration of IMP. Known or clinical suspicion of cancer in the leg wound at screening or time of the (first) administration of IMP, e.g., basal cell carcinoma or squamous cell carcinoma. Clinical symptoms of COVID-19 or positive test for SARS-CoV-2 (testing according to local procedures) at screening or on the day of the (first) administration of IMP. Clinical infection requiring systemic antibiotics at time of the (first) administration of IMP. Severe ischaemia in the target leg at screening or time of the (first) administration of IMP defined as an ankle brachial index (ABI) < 0.5. Necrotic tissue in leg wound at time of the (first) administration of IMP. Clinically significantly reduced perception of sensation or pain assessed in proximity of the wound at screening. A pain score from the leg wound above 4 assessed on a 10 cm VAS , where 0 cm indicates no pain at all and 10 cm indicates the worst imaginable pain at time of the (first) administration of IMP. Use of opioids from time of screening to end of study, unless used a at stable dose, as judged by the Investigator. Participation in the treatment phase of a clinical study with an investigational new drug within 30 days or 5 half-lives (whichever is longer) before the (first) administration of IMP. Has previously received SBE in any of the concentrations tested in the current study. Pregnant or lactating at screening or time of the (first) administration of IMP. Ascertained or presumptive allergy/ hypersensitivity to any components of the IMP; history of anaphylaxis to drugs or serious allergic reactions leading to hospitalisation or any other allergy reaction in general, which the Investigator considers may affect the safety of the patient and/or outcome of the study. Inability to communicate or cooperate with the Investigator (e.g., language problems, illiteracy, poor mental status) or to comply with the requirements of the study. Other factors which in the opinion of the Investigator may interfere with study conduct. Legal incapacity or limited legal capacity.

Sites / Locations

  • Bispebjerg University Hospital

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm 5

Arm 6

Arm 7

Arm Type

Experimental

Experimental

Experimental

Experimental

Experimental

Experimental

Experimental

Arm Label

Group 1

Group 2

Group 3

Group 4

Group 5

Group 6

Group 7

Arm Description

Single dose of 500ppm HOCl + 1 % HAc, or placebo

Single dose of 500ppm HOCl + 2 % HAc, or placebo

Single dose of 500ppm HOCl + 3 % HAc, or placebo

Single dose of 1000ppm HOCl + 3 % HAc, or placebo

Multiple doses (OD for 5 days) of xppm HOCl + x% HAc#

Multiple doses (BID for 5 days) of xppm HOCl + x% HAc#

Multiple doses (TID for 5 days) of xppm HOCl + x% HAc#

Outcomes

Primary Outcome Measures

Nature, occurrence, and severity of adverse events (AEs)
Clinically significant abnormal values of vital signs (systolic and diastolic blood pressure, pulse rate, respiratory rate, body temperature), safety blood and urine parameters, ECG, and physical examination will be reported as AEs.
Change from baseline in wound pain assessed by use of visual analogue scale (VAS).
Change from baseline i.e., the last value before the (first) administration of IMP, in wound pain as assessed by use of a 10 cm VAS, where 0 cm indicated no pain at all, and 10 cm indicated the worst imaginable pain at the time of assessment.

Secondary Outcome Measures

Change from baseline in wound bacterial burden (number of colony-forming units per mL; CFU/mL)
The bacterial burden of wounds was assessed using surface swabs (collected with the Z technique) at baseline, i.e., before the first administration of IMP, 20 min after the administration of IMP (on the treatment day for the single-dose groups, on each day of treatment for the OD multiple-dose group and after the second administration on each day of treatment for the BID multiple-dose group) and at the Follow-up visit.

Full Information

First Posted
October 18, 2021
Last Updated
January 24, 2023
Sponsor
SoftOx Solutions AS
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1. Study Identification

Unique Protocol Identification Number
NCT05710094
Brief Title
Safety and Tolerability of Single and Multiple Doses of SoftOx Biofilm Eradicator (SBE) in Chronic Leg Wounds
Official Title
Single-centre, Randomised, Double-blinded, Placebo-controlled Ascending Single Doses of SoftOx Biofilm Eradicator (SBE) and Open-label Once-, Twice-, and Thrice-daily Dosing of SBE for Five Days in Patients With Chronic Leg Wounds.
Study Type
Interventional

2. Study Status

Record Verification Date
January 2023
Overall Recruitment Status
Completed
Study Start Date
October 19, 2021 (Actual)
Primary Completion Date
August 19, 2022 (Actual)
Study Completion Date
August 19, 2022 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
SoftOx Solutions AS

4. Oversight

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

5. Study Description

Brief Summary
Single-centre clinical study investigating the safety and tolerability of randomised, double-blinded, placebo-controlled ascending single doses of topically applied SoftOx Biofilm Eradicator (SBE) in patients with chronic leg wounds and of open-label once daily, twice daily, and thrice daily dosing of topically applied SBE for five days in patients with chronic leg wounds. The primary objective of the study is to assess the safety and tolerability of single and multiple doses of topically applied SBE in patients with chronic leg wounds. A secondary objective of the study is to assess changes in bacterial burden in the leg wound after treatment with SBE.
Detailed Description
The study enrolled subjects with chronic leg wounds, i.e., the intended target population for SBE. The first part of the study aimed to identify the highest tolerated dose of SBE in a randomised, double-blind, and placebo-controlled manner with sequential evaluation of 4 single ascending doses. As a precaution, sentinel and staggered dosing was applied in the single-dose groups: the safety of two subjects treated on two different days (at least one of whom was treated with SBE) was reviewed before commencing dosing of the remaining subjects in a single-dose group (sentinel dosing), with an interval of at least 1 hour between the dosing of different subjects (staggered dosing). The starting dose of 500 µg/mL HOCl + 1% HAc was based on previous knowledge concerning the MIC and MBC of SBE and the results obtained in a 28-day, repeated-dose toxicology study in minipigs. The latter indicated that up to 1000 µg/mL + 3% HAc (the highest dose tested) was well-tolerated. Choosing 500 µg/mL HOCl + 1% HAc as the starting dose in the current study provided a safety factor of 2 for HOCl and a safety factor of 3 for HAc. The highest well-tolerated dose of SBE in the non-clinical toxicology study was chosen as the highest single dose to be evaluated in the current study. Dose-escalation steps in the single-dose groups were conservatively defined with escalation factors ranging from 1 to 2. Prior to dose escalation, blinded results were evaluated by the Safety Monitoring Committee (SMC). The second part of the study aimed to evaluate the safety and tolerability of multiple dosing of SBE. The multiple-dose groups tested different dosing regimens with formulations determined by the SMC based on the safety and tolerability of the formulations evaluated in the first part of the study. Three multiple-dose groups (once-, twice-, and thrice-daily administrations) were planned.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Chronic Leg Ulcer, Venous Leg Ulcer
Keywords
lower extremities infection biofilm antimicrobial

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Parallel Assignment
Model Description
Randomised, double-blinded, placebo-controlled ascending single dose groups (Groups 1 to 4); followed by open-label multiple ascending dose groups (Groups 5 to 7)
Masking
ParticipantInvestigatorOutcomes Assessor
Masking Description
Blinding and unblinding procedures applied only to the single-dose groups, i.e., Groups 1-4, randomized to receive SBE (active) or sterile saline (placebo). The computer-generated randomisation list was kept strictly confidential, accessible only to authorised persons, until the time of unblinding of the study. The following procedures were implemented in the single-dose groups to minimise the risk of unintended unblinding: i. Blinded staff prepared the patient's leg wound for the administration of IMP. ii. Both patient and blinded staff applied a nose clip, prior to and during IMP administration, until all materials used for the treatment (plastic wrapping, gauze, gallipot, etc.) had been removed and the room had been vented for a couple of minutes by opening a window.
Allocation
Randomized
Enrollment
28 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Group 1
Arm Type
Experimental
Arm Description
Single dose of 500ppm HOCl + 1 % HAc, or placebo
Arm Title
Group 2
Arm Type
Experimental
Arm Description
Single dose of 500ppm HOCl + 2 % HAc, or placebo
Arm Title
Group 3
Arm Type
Experimental
Arm Description
Single dose of 500ppm HOCl + 3 % HAc, or placebo
Arm Title
Group 4
Arm Type
Experimental
Arm Description
Single dose of 1000ppm HOCl + 3 % HAc, or placebo
Arm Title
Group 5
Arm Type
Experimental
Arm Description
Multiple doses (OD for 5 days) of xppm HOCl + x% HAc#
Arm Title
Group 6
Arm Type
Experimental
Arm Description
Multiple doses (BID for 5 days) of xppm HOCl + x% HAc#
Arm Title
Group 7
Arm Type
Experimental
Arm Description
Multiple doses (TID for 5 days) of xppm HOCl + x% HAc#
Intervention Type
Drug
Intervention Name(s)
SoftOx Biofilm Eradicator (Groups 1 to 7)
Other Intervention Name(s)
SS0350
Intervention Description
SBE is a water-based formulation containing hypochlorous acid (HOCl) at concentrations of 500-1000 µg/mL and acetic acid (HAc) at concentrations of 1-3 %. Both active ingredients are naturally occurring molecules and have a long history of safe use in medicinal products and in solutions approved as medical devices. Both molecules, exhibit broad-spectrum antimicrobial activity at the concentrations present in SBE. The antimicrobial effect of HOCl is rapid and powerful by acting on and disrupting the function of key microbial molecules such as proteins, lipids, and nucleic acids, while remaining safe to mammalian cells and not promoting the emergence of new resistant microbes. Moreover, HOCl is active against biofilms, and some studies suggest that HOCl may also increase oxygenation of the wound site leading to improved healing.
Intervention Type
Device
Intervention Name(s)
Sterile isotonic saline (Groups 1 to 4)
Other Intervention Name(s)
Irriflex
Intervention Description
Sterile isotonic saline was used as placebo because it is part of standard of care, used as an irrigation solution at dressing change and has the same appearance as SBE
Primary Outcome Measure Information:
Title
Nature, occurrence, and severity of adverse events (AEs)
Description
Clinically significant abnormal values of vital signs (systolic and diastolic blood pressure, pulse rate, respiratory rate, body temperature), safety blood and urine parameters, ECG, and physical examination will be reported as AEs.
Time Frame
From the start of the first administration of IMP to 3 to 5 days after the last administration of IMP
Title
Change from baseline in wound pain assessed by use of visual analogue scale (VAS).
Description
Change from baseline i.e., the last value before the (first) administration of IMP, in wound pain as assessed by use of a 10 cm VAS, where 0 cm indicated no pain at all, and 10 cm indicated the worst imaginable pain at the time of assessment.
Time Frame
From the start of the first administration of IMP to 3 to 5 days after the last administration of IMP
Secondary Outcome Measure Information:
Title
Change from baseline in wound bacterial burden (number of colony-forming units per mL; CFU/mL)
Description
The bacterial burden of wounds was assessed using surface swabs (collected with the Z technique) at baseline, i.e., before the first administration of IMP, 20 min after the administration of IMP (on the treatment day for the single-dose groups, on each day of treatment for the OD multiple-dose group and after the second administration on each day of treatment for the BID multiple-dose group) and at the Follow-up visit.
Time Frame
From the start of the first administration of IMP to 3 to 5 days after the last administration of IMP
Other Pre-specified Outcome Measures:
Title
Change from baseline in wound area
Description
The area of the wound in cm2 was calculated by the width x length (both in cm) of the wound. Wound area was estimated at screening, at baseline, i.e., before the (first) administration of IMP, and at the Follow-up visit.
Time Frame
From the start of the first administration of IMP to 3 to 5 days after the last administration of IMP

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
INCLUSION CRITERIA To be eligible for this study, patients must fulfil all of the following criteria: Male and female patients aged 18 and above at time of informed consent. Chronic (present for at least 4 weeks) leg wound, as judged by the Investigator, with a size of at least 1 cm2 and maximally 100 cm2 (measured as the width x length) on the day of the (first) administration of IMP. Patients must have given written informed consent before any study-related activities are carried out and must be able to understand the full nature and purpose of the study, including possible risks and adverse effects. EXCLUSION CRITERIA Patients are not eligible for this study if they fulfil any of the following exclusion criteria: Any surgical or medical condition, including findings in the medical history or in the pre-study assessments, or any other significant disease, that in the opinion of the Investigator, constitutes a risk or a contraindication for the participation of the patient in the study or that could interfere with the study objectives, conduct, or evaluation at screening or time of the (first) administration of IMP. Known or clinical suspicion of cancer in the leg wound at screening or time of the (first) administration of IMP, e.g., basal cell carcinoma or squamous cell carcinoma. Clinical symptoms of COVID-19 or positive test for SARS-CoV-2 (testing according to local procedures) at screening or on the day of the (first) administration of IMP. Clinical infection requiring systemic antibiotics at time of the (first) administration of IMP. Severe ischaemia in the target leg at screening or time of the (first) administration of IMP defined as an ankle brachial index (ABI) < 0.5. Necrotic tissue in leg wound at time of the (first) administration of IMP. Clinically significantly reduced perception of sensation or pain assessed in proximity of the wound at screening. A pain score from the leg wound above 4 assessed on a 10 cm VAS , where 0 cm indicates no pain at all and 10 cm indicates the worst imaginable pain at time of the (first) administration of IMP. Use of opioids from time of screening to end of study, unless used a at stable dose, as judged by the Investigator. Participation in the treatment phase of a clinical study with an investigational new drug within 30 days or 5 half-lives (whichever is longer) before the (first) administration of IMP. Has previously received SBE in any of the concentrations tested in the current study. Pregnant or lactating at screening or time of the (first) administration of IMP. Ascertained or presumptive allergy/ hypersensitivity to any components of the IMP; history of anaphylaxis to drugs or serious allergic reactions leading to hospitalisation or any other allergy reaction in general, which the Investigator considers may affect the safety of the patient and/or outcome of the study. Inability to communicate or cooperate with the Investigator (e.g., language problems, illiteracy, poor mental status) or to comply with the requirements of the study. Other factors which in the opinion of the Investigator may interfere with study conduct. Legal incapacity or limited legal capacity.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
David Peick Sonne, MD; PhD
Organizational Affiliation
Bispebjerg and Frederiksberg Hospital
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Glenn Gundersen, PhD
Organizational Affiliation
SoftOx Solutions A/S
Official's Role
Study Director
Facility Information:
Facility Name
Bispebjerg University Hospital
City
Copenhagen
ZIP/Postal Code
2400
Country
Denmark

12. IPD Sharing Statement

Plan to Share IPD
No

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Safety and Tolerability of Single and Multiple Doses of SoftOx Biofilm Eradicator (SBE) in Chronic Leg Wounds

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