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Topical Erythropoietin Hydrogel Formulation for Diabetic Foot Ulcers (Remede d'Or)

Primary Purpose

Diabetic Foot Ulcer

Status
Completed
Phase
Phase 1
Locations
Israel
Study Type
Interventional
Intervention
A hydrogel containing erythropoietin
Hydrogel (as a part of SOC)
Sponsored by
Remedor Biomed Ltd
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Diabetic Foot Ulcer focused on measuring erythropoietin, diabetic chronic wounds, wound healing, chronic wounds, topical treatment, re-epithelization, inflammation

Eligibility Criteria

18 Years - 80 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

Patients must satisfy all of the following inclusion criteria to be included in the study:

  1. Male or female over the age of 18;
  2. Diabetes Mellitus type 2;
  3. Have a single non-infected Diabetic Hard-to-Heal wound (ulcers/foot ulcers), Wagner grade I or II documented for at least 4 weeks that has not shown signs of healing despite standard treatment;
  4. 2 sq.cm. ≤ Wound area at start of treatment ≤ 10 sq.cm.;
  5. At least moderate blood perfusion into the affected limb as defined by Ankle Brachial Index (ABI) of >0.4 or if ABI >1.3 then toe pressure > 50 mmHg;
  6. Undergo a current physical examination, which reveals no clinically significant abnormalities, except diabetes or diabetic ulcer/wound related condition;
  7. Be available for the entire study period, and be able and willing to adhere to protocol requirements;
  8. Provide written informed consent prior to admission into the study;
  9. no surgical revascularization of the limb with the DFU was done in the previous two months.

Exclusion Criteria:

Patients will be excluded from the study if they meet any of the following exclusion criteria:

  1. Diabetes Mellitus non Type 2;
  2. Have a glycosylated haemoglobin (HbA1c) >10.0%;
  3. Have a body mass index (BMI) > 40 Kg/m2;
  4. Have visible bone exposure at wound site;
  5. Subjects whose study ulcer size decreases by more than 30% during this initial standard-of-care phase (pre-treatment phase);
  6. Have any signs of infection in the wound (which could be linked to raised body temperature), abscess, cellulitis, necrosis, erythema, mild drainage or known osteomyelitis;
  7. Have a history of HIV or a clinically significant cardiac, gastrointestinal, endocrine, neurological, liver, or kidney disease;
  8. Anemia (Hemoglobin < 9 g/dL) or White Blood Cells count > 11,000/μL or Platelets count < 100,000/μL or liver function tests > 3 times upper normal lab values or Creatinine > 3 mg/dL; any indication of malnourishment (Albumin < 3 g/dL); INR>2 or any other clinically significant blood and urinalysis tests per the physician's discretion
  9. Have any clinically significant chronic or acute illness during the 4 weeks prior to admission into the study, except diabetes type2 or during screening period;
  10. Patients on concomitant medications that alter blood glucose levels (e.g. ACE inhibitors, lipid lowering agents, etc.) who have not been on a stable dosage regimen for at least 4 weeks prior to entry into the study and who cannot maintain a stable dosage throughout the study;
  11. Malignant disease except Basal Cell Carcinoma or Cervical Carcinoma in situ; Chemotherapy treatment or severely immunosuppressed for any reason that would limit or preclude healing in the opinion of the Investigator;
  12. Females who are pregnant, lactating, of child-bearing potential, or post-menopausal for less than 2 years, not using a medically approved method of contraception (i.e., oral, transdermal, or implanted contraceptives, intrauterine device, diaphragm, condom, abstinence, or surgical sterility), or females who test positive on a blood-based pregnancy test;
  13. Participation in a clinical study or use of an investigational drug within 30 days prior to admission to this study;
  14. Residing in a nursing facility and/or are bed-ridden (unable to come to receive treatment at the clinic).

Sites / Locations

  • HaEmek Medical Center
  • Rambam Health Care Campus
  • Edith Wolfson Medical Center
  • Galilee Medical Center
  • Poriya Medical Center (a.k.a. Baruch Padeh Medical Center)

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Treatment group (erythropoietin)

Control group (standard of care)

Arm Description

10 patients receive RMD-G1 (gel with 2000 IU/ml of erythropoietin) as an adjunct therapy to standard of care (SOC). Topical application on wound bed, daily for 12 weeks.

10 patients receive SOC alone daily for 12 weeks. A moisturizing gel is applied on wound bed as a part of SOC.

Outcomes

Primary Outcome Measures

Number of participants without adverse events following RMD-G1 treatment
Absence of serious adverse events associated with the RMD-G1 treatment.
Number of participants with the reduction of wound area by 75%$ or more
Wound area will be assessed weekly for 75% closure or more of the wound area, which is defined as 75% epithelialization of the wound with no secretions.

Secondary Outcome Measures

Number of patients with hypersensitivity at the wound site.
Weekly assessments of wound site for signs of hypersensitivity to the RMD-G1 treatment.
Speed of healing
The time to reach complete wound closure (days).
Reduction of wound area
Absolute wound area regression (AWAR) (cm2) will be assessed weekly.
Partial wound closure
The number of participants with a wound surface area regression ≥ 50% and ≥ 75% by week 4.
Rate of wound closure
Mean rate of wound closure (sq. cm./day) will be assessed weekly.
Recurrence of closed wounds
Number of wound recurrence cases

Full Information

First Posted
August 12, 2012
Last Updated
March 17, 2019
Sponsor
Remedor Biomed Ltd
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1. Study Identification

Unique Protocol Identification Number
NCT02361931
Brief Title
Topical Erythropoietin Hydrogel Formulation for Diabetic Foot Ulcers
Acronym
Remede d'Or
Official Title
Prospective, Multicenter, Single-blind, Randomized, Controlled Clinical Trial on Safety and Efficacy of a Novel Topical Formulation Containing Erythropoietin for the Treatment of Diabetic Foot Ulcers
Study Type
Interventional

2. Study Status

Record Verification Date
March 2019
Overall Recruitment Status
Completed
Study Start Date
March 21, 2016 (Actual)
Primary Completion Date
June 11, 2018 (Actual)
Study Completion Date
June 12, 2018 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Remedor Biomed Ltd

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
Remedor has developed a patented technology (RMD-G1), which comprises erythropoietin (EPO) as the active pharmaceutical ingredient (API) in a carbopol-based hydrogel with an FN matrix. RMD-G1 was designed to maintain EPO stability and activity over long periods and to optimize the administration of EPO onto the wound bed. RMD-G1 is indicated for treating DFUs in adult patients with diabetes mellitus and aims to accelerate the healing of diabetic foot ulcers. RMD-G1 is an adjunct treatment, and not a substitute for good diabetic wound care, which includes initial debridement, wound cleansing, pressure relief, and infection control. In this trial, RMD-G1 is applied daily onto a clean wound at 0.25g per sq. cm. wound surface. After its application, the wound will be covered with a dressing in order to prevent leakage of the hydrogel and contamination of the wound area.
Detailed Description
Delayed healing of a neuroischaemic diabetic foot ulcer (DFU) has been related to prolonged local inflammatory response, an unstable provisional matrix, increased degradation of the extracellular matrix, lack of growth factors and their receptors that are crucial for healing, fibroblast dysfunction, impaired neovascularization, increased oxidative stress, and cellular apoptosis in the wound bed, all of which collectively hinder re-epithelialisation and wound closure. Erythropoietin (EPO) is an approved drug which is widely used for treating anaemia. EPO is a well-known glycoprotein hormone, which is primarily produced by the tubular cells of the kidney. EPO is widely known for regulating the red blood cell mass by stimulating differentiation and proliferation of precursor cells and hindering apoptosis of erythroid cells in the bone marrow. Millions of people have received EPO since its market approval by the US Food and Drug Administration in 1989 as a treatment of anaemia in patients with chronic kidney disease and later on as a treatment for chemotherapy-associated anaemia. There is growing evidence that both systemic administration and topical EPO application to skin wounds in animals with experimentally-induced diabetes mellitus (DM) and in patients with DM accelerates the healing of these wounds. This accelerated wound healing is mediated by EPO because it concomitantly suppresses the inflammatory response and apoptosis and stimulates angiogenesis, re-epithelialization, and collagen deposition. Growing studies in experimental healthy and diabetic animals have demonstrated that systemic or topical treatment with EPO onto acute and chronic wounds and burns is safe and effective. Recently, the molecular mechanisms of EPO action in wound repair have been elucidated. EPO acts on all cutaneous cells that are involved in the wound healing process by promoting cellular differentiation and proliferation, exerting cytoprotective actions, and inhibiting inflammation and apoptosis due to the presence of EPO receptors in these cells [Hamed et al. 2014]. The aim of this multicenter, single-blind, randomized, controlled clinical trial is to evaluate the safety and efficacy of topical RMD-G1 treatment for DFUs. This study is an exploratory proof-of-concept study on RMD-G1 treatment for DFU.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Diabetic Foot Ulcer
Keywords
erythropoietin, diabetic chronic wounds, wound healing, chronic wounds, topical treatment, re-epithelization, inflammation

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Parallel Assignment
Masking
Participant
Allocation
Randomized
Enrollment
20 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Treatment group (erythropoietin)
Arm Type
Experimental
Arm Description
10 patients receive RMD-G1 (gel with 2000 IU/ml of erythropoietin) as an adjunct therapy to standard of care (SOC). Topical application on wound bed, daily for 12 weeks.
Arm Title
Control group (standard of care)
Arm Type
Placebo Comparator
Arm Description
10 patients receive SOC alone daily for 12 weeks. A moisturizing gel is applied on wound bed as a part of SOC.
Intervention Type
Drug
Intervention Name(s)
A hydrogel containing erythropoietin
Other Intervention Name(s)
Standard of care (SOC)
Intervention Description
Standard of wound care, which includes initial debridement, wound cleansing, pressure relief, and infection control. RMD-G1 applied daily onto a clean wound at 0.25g per sq.cm. of wound surface. After its application, the wound is covered with a dressing in order to prevent leakage of the gel and contamination of the wound area.
Intervention Type
Drug
Intervention Name(s)
Hydrogel (as a part of SOC)
Other Intervention Name(s)
Standard of care (SOC)
Intervention Description
Standard of wound care, which includes initial debridement, wound cleansing, pressure relief, and infection control. Hydrogel applied daily onto a clean wound at 0.25g per sq.cm. of wound surface. After its application, the wound is covered with a dressing in order to prevent leakage of the gel and contamination of the wound area.
Primary Outcome Measure Information:
Title
Number of participants without adverse events following RMD-G1 treatment
Description
Absence of serious adverse events associated with the RMD-G1 treatment.
Time Frame
24 weeks
Title
Number of participants with the reduction of wound area by 75%$ or more
Description
Wound area will be assessed weekly for 75% closure or more of the wound area, which is defined as 75% epithelialization of the wound with no secretions.
Time Frame
12 weeks
Secondary Outcome Measure Information:
Title
Number of patients with hypersensitivity at the wound site.
Description
Weekly assessments of wound site for signs of hypersensitivity to the RMD-G1 treatment.
Time Frame
12 weeks
Title
Speed of healing
Description
The time to reach complete wound closure (days).
Time Frame
12 weeks
Title
Reduction of wound area
Description
Absolute wound area regression (AWAR) (cm2) will be assessed weekly.
Time Frame
12 weeks
Title
Partial wound closure
Description
The number of participants with a wound surface area regression ≥ 50% and ≥ 75% by week 4.
Time Frame
4 weeks
Title
Rate of wound closure
Description
Mean rate of wound closure (sq. cm./day) will be assessed weekly.
Time Frame
12 weeks
Title
Recurrence of closed wounds
Description
Number of wound recurrence cases
Time Frame
24 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
80 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients must satisfy all of the following inclusion criteria to be included in the study: Male or female over the age of 18; Diabetes Mellitus type 2; Have a single non-infected Diabetic Hard-to-Heal wound (ulcers/foot ulcers), Wagner grade I or II documented for at least 4 weeks that has not shown signs of healing despite standard treatment; 2 sq.cm. ≤ Wound area at start of treatment ≤ 10 sq.cm.; At least moderate blood perfusion into the affected limb as defined by Ankle Brachial Index (ABI) of >0.4 or if ABI >1.3 then toe pressure > 50 mmHg; Undergo a current physical examination, which reveals no clinically significant abnormalities, except diabetes or diabetic ulcer/wound related condition; Be available for the entire study period, and be able and willing to adhere to protocol requirements; Provide written informed consent prior to admission into the study; no surgical revascularization of the limb with the DFU was done in the previous two months. Exclusion Criteria: Patients will be excluded from the study if they meet any of the following exclusion criteria: Diabetes Mellitus non Type 2; Have a glycosylated haemoglobin (HbA1c) >10.0%; Have a body mass index (BMI) > 40 Kg/m2; Have visible bone exposure at wound site; Subjects whose study ulcer size decreases by more than 30% during this initial standard-of-care phase (pre-treatment phase); Have any signs of infection in the wound (which could be linked to raised body temperature), abscess, cellulitis, necrosis, erythema, mild drainage or known osteomyelitis; Have a history of HIV or a clinically significant cardiac, gastrointestinal, endocrine, neurological, liver, or kidney disease; Anemia (Hemoglobin < 9 g/dL) or White Blood Cells count > 11,000/μL or Platelets count < 100,000/μL or liver function tests > 3 times upper normal lab values or Creatinine > 3 mg/dL; any indication of malnourishment (Albumin < 3 g/dL); INR>2 or any other clinically significant blood and urinalysis tests per the physician's discretion Have any clinically significant chronic or acute illness during the 4 weeks prior to admission into the study, except diabetes type2 or during screening period; Patients on concomitant medications that alter blood glucose levels (e.g. ACE inhibitors, lipid lowering agents, etc.) who have not been on a stable dosage regimen for at least 4 weeks prior to entry into the study and who cannot maintain a stable dosage throughout the study; Malignant disease except Basal Cell Carcinoma or Cervical Carcinoma in situ; Chemotherapy treatment or severely immunosuppressed for any reason that would limit or preclude healing in the opinion of the Investigator; Females who are pregnant, lactating, of child-bearing potential, or post-menopausal for less than 2 years, not using a medically approved method of contraception (i.e., oral, transdermal, or implanted contraceptives, intrauterine device, diaphragm, condom, abstinence, or surgical sterility), or females who test positive on a blood-based pregnancy test; Participation in a clinical study or use of an investigational drug within 30 days prior to admission to this study; Residing in a nursing facility and/or are bed-ridden (unable to come to receive treatment at the clinic).
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Yehuda Ullman, Professor
Organizational Affiliation
Rambam Health Care Campus
Official's Role
Study Chair
Facility Information:
Facility Name
HaEmek Medical Center
City
Afula
Country
Israel
Facility Name
Rambam Health Care Campus
City
Haifa
Country
Israel
Facility Name
Edith Wolfson Medical Center
City
H̱olon
Country
Israel
Facility Name
Galilee Medical Center
City
Nahariya
Country
Israel
Facility Name
Poriya Medical Center (a.k.a. Baruch Padeh Medical Center)
City
Tiberias
Country
Israel

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
33504262
Citation
Hamed S, Ullmann Y, Belokopytov M, Shoufani A, Kabha H, Masri S, Feldbrin Z, Kogan L, Kruchevsky D, Najjar R, Liu PY, Kerihuel JC, Akita S, Teot L. Topical Erythropoietin Accelerates Wound Closure in Patients with Diabetic Foot Ulcers: A Prospective, Multicenter, Single-Blind, Randomized, Controlled Trial. Rejuvenation Res. 2021 Aug;24(4):251-261. doi: 10.1089/rej.2020.2397. Epub 2021 Apr 1.
Results Reference
derived

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Topical Erythropoietin Hydrogel Formulation for Diabetic Foot Ulcers

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