Treatment of Diabetic Foot Ulcers With AUP1602-C
Primary Purpose
Diabetic Foot Ulcer
Status
Completed
Phase
Phase 1
Locations
International
Study Type
Interventional
Intervention
AUP1602-C
Sponsored by
About this trial
This is an interventional treatment trial for Diabetic Foot Ulcer
Eligibility Criteria
Inclusion Criteria:
- Male or female patients aged 18 to 80 years
- Patients with DM of type 1 or 2 having a glycosylated haemoglobin (HbA1c) of ≤11% and a serum creatinine level of ≤1.5 times the upper limit of normal (ULN)
Patients with at least one ulcer that fulfills all of the following criteria at screening and at baseline (prior to treatment start)
- Present for ≥1 month
- Located either in the plantar or on the dorsum of foot, or in the distal part of the leg, around the malleolar areato be accessible for administration of AUP1602-C/placebo and to be completely covered by the primary and secondary dressings
- Partial- or full-thickness, not involving bone or joints, i.e. University of Texas classification Grade 1A, 1C, 2A or 2C.
- No clinical signs of active infection or osteomyelitis
- Size of the target ulcer for DFU must be between 1-9 cm2 after debridement
- Chronic target ulcer, defined as <30% reduction in size in response to SoC during the 2-week screening period
- Target ulcer appropriately debrided (<10% black and at least 50% of red/pink on a colorimetric scale)
- Ulcer and periwound tissue suitable to using film dressings (i.e. no contraindications [e.g.: excessive exudation, maceration] and sufficient periwound space to hold the dressing)
- Patients with more than one ulcer will be included if ulcers are separated by a minimum of 5 cm healthy tissue but only one target ulcer will be selected for the investigational treatment (based on investigator decision)
- Patients with an ankle brachial index (ABI) ≥0.7 on the foot with the target ulcer
- Patients with an assessment of the baseline level of neuropathy of the foot using Semmes-Weinstein monofilaments
- Patients must adhere to wear therapeutic shoes or off-loading footwear if indicated
- A female patient of childbearing potential must have a negative serum pregnancy test at the time of Screening
- Patients must use a highly effective contraceptive measure (methods that can achieve a failure rate of less than 1% per year when used consistently and correctly), like hormonal contraception (oral pills, implantable device, or skin patch), intrauterine device, bilateral tubal occlusion, or double barrier throughout the study
- Patients who understand and are willing to comply with study procedures and give written informed consent prior to enrolment in the study or initiation of study procedures
Exclusion Criteria:
- Current or previous (within 2 weeks prior to start of screening/run-in period) treatment with another investigational drug and/or medical device or participation in another clinical study
- Current or previous (within 30 days prior to start of screening/run-in period) treatment with a biologic agent, growth factors or skin equivalents (e.g. Regranex®, Apligraf®, or Dermagraft®)
- Current or previous (within 2 weeks prior to first study drug dosing) treatment with active wound care agents (e.g. local and systemic antibiotics or silver dressings)
- Current or previous (within 2 weeks prior to first study drug dosing) use of corticosteroids and immunosuppressants
- Known hypersensitivity to any of the investigational drug or vehicle components
- Ulcer of University of Texas Grade ≥2, with deep abscess, or gangrene
- Target ulcer with known or suspected active infection which requires antimicrobials. Any antibiotic therapy must be completed or discontinued within 2 weeks prior to first study drug dosing
- Target ulcer positive for MRSA
- Target ulcer other than chronic non-healing DFU (e.g. pressure ulcers, burn wounds)
- Prior radiation therapy (within 6 weeks prior to first study drug dosing) of any part of the foot/leg bearing the target ulcer under study
- Sickle-cell anemia, Reynaud's, or other peripheral vascular disease including venous leg ulcers
- Infective endocarditis or increased risk for infective endocarditis, which includes, but is not limited to, prosthetic cardiac valve or prosthetic material used for cardiac valve repair, previous infective endocarditis, congenital heart disease, and cardiac transplantation recipients who develop cardiac valvulopathy, history of rheumatic fever or rheumatic heart disease diagnosed by echocardiogram, or history (within 10 years prior to enrollment) of IV drug abuse
- Active Charcot deformity of the study foot (i.e. foot is erythematous, warm, edematous, and is actively remodeling)
- Patients with other reasons for wound healing disturbances: e.g. bleeding disorders, vitamin K deficiency, hypocalcemia, major immune deficiencies
- Active malignant disease of any kind except for basal cell carcinoma (of the skin) not co-located with the target ulcer. A patient, who has had a malignant disease in the past, was treated and is currently disease-free and not on active treatment with an immune-suppressive therapy at least for 3 months, may be considered for study entry
- Pregnant or lactating woman
- Haemoglobin of less than 8.5 g/dL
- Transaminase levels greater than 3 times ULN
- Patients receiving haemodialysis or chronic ambulatory peritoneal dialysis (CAPD) therapy
- Positive for hepatitis B or C virus (HBV, HCV), or human immunodeficiency virus (HIV); serology test results not older than 3 months are accepted
- Planned surgery during the study period
- Known abuse of alcohol, drugs, or medical products. Tobacco use will be allowed
- Previous participation in this clinical study
- Any diagnosed unstable condition that could interfere with compliance, such as psychiatric disorder
- Myocardial infarction diagnosed within last 3 months prior to start of screening/run-in period
- Confirmed or suspected COVID-19 infection.
Sites / Locations
- Medizinische Hochschule Hannover (MHH) CRC Core Facility
- Mikomed
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
AUP1602-C
Arm Description
AUP1602-C will be administered topically once or repeatedly three times per week during the treatment period.
Outcomes
Primary Outcome Measures
Incidence of adverse events (AEs) and potential dose-limiting toxicities (DLTs)
Incidence of adverse events (AEs) and potential dose-limiting toxicities (DLTs) for safety, low, medium, and high dose cohorts of single and repeatedly administered AUP1602-C
Incidence of Treatment-Emergent Adverse Events
• Incidence of AEs
Incidence of Wound Closure
Percentage (%) of patients with a target ulcer achieving complete wound closure
Percentage (%) of wound size reduction (wound area measurements in cm^2)
Secondary Outcome Measures
Incidence of Wound Closure
Percentage (%) of wound area (cm^2) reduction
Percentage (%) of wound depth (mm) reduction
Percentage (%) of wound volume (mm^3) reduction
Measurements will be aggregated: Wound are and depth will be used to calculate wound volume.
Incidence of ulcer recurrence
Percentage (%) of patients with ulcer recurrence
Incidence of Wound Infections
Proportion of patients with local wound infections related to the target ulcer
Incidence of surgical procedures
Number of patients with local surgical procedures
Incidence of amputations (minor or major) related to the target ulcer
Changes in Quality of Life according to EQ-5D-5L
Change from baseline in health-related quality is assessed according to EuroQoL-5 Dimensions (EQ-5D-5L) patient quesionnaire. Five single-item dimensions (mobility, self-care, usual activities, pain/discomfort and anxiety/depression) are assessed. Result of the questionnaire is scored from 0 (worst health imaginable) to 100 (best health imaginable).
Changes in Quality of Life according to DLQI
Change from baseline in health-related quality is assessed according to Dermatology Life Quality Index (DLQI). It consists of 10 questions, where each question is scored from 0 (not affected at all) to 3 (very much affected). The DLQI score will be calculated as the sum of the 10 individual question scores and ranges from 0 to 30, with lower scores indicating better quality of life.
Changes in pain assessment according to VAS
Change from baseline in patient's pain intensity according to a numerical Visual Analog Scale (VAS) ranging from 0 = no pain to 10= worst imaginable pain.
Incidence of Adverse Events
Incidence of abnormal vital signs
Incidence of abnormal ECG data
Incidence of abnormal echocardiogram data
Incidence of abnormal ophthalmoscopy data
Incidence of abnormal physical examination findings
Incidence of abnormal laboratory data
Incidence of bacteria distribution
Assessment of biodistribution and shedding (yes / no)
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT04281992
Brief Title
Treatment of Diabetic Foot Ulcers With AUP1602-C
Official Title
A Phase 1/2A Clinical Study to Evaluate the Safety, Tolerability and Efficacy of Single and Repeated Doses of AUP1602-C as Topical Treatment of Diabetic Foot Ulcers
Study Type
Interventional
2. Study Status
Record Verification Date
September 2023
Overall Recruitment Status
Completed
Study Start Date
January 28, 2020 (Actual)
Primary Completion Date
March 20, 2023 (Actual)
Study Completion Date
March 20, 2023 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Aurealis Oy
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 is a two-part phase 1/2A study performed in diabetic foot ulcer (DFU) patients with chronic non-healing wounds to investigate the safety and efficacy of AUP1602-C.
Detailed Description
Study AP-W-CLI-2018-8 is the first clinical study of AUP1602-C in humans. It is a Phase 1/2A clinical study to evaluate the safety, tolerability and efficacy of a single and repeated doses of AUP-16 as topical treatment of DFU. The Phase 1 part will be a multicenter, open-label, non-randomized, uncontrolled dose-finding study with sequential dose escalations performed in dose cohorts comparing three doses of AUP-16 administered three times per week (low, medium, and high dose cohorts). This part will consist of four sequentially recruited cohorts. It is expected that a minimum of 15 patients may be required to determine the RP2D in phase 1 part.
The Phase 2A part, an extension of the Phase 1, will be a multi-center, open-label, randomized, placebo-controlled study of the recommended AUP1602-C dose and administration schedule from Phase 1 to confirm safety and to assess efficacy of the selected recommended phase 2 dose and schedule in DFU patients.
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 1, Phase 2
Interventional Study Model
Sequential Assignment
Model Description
Analyses for phase 1 part will be done by cohort and analyses for phase 2A part will be done by treatment arms.
Masking
None (Open Label)
Allocation
N/A
Enrollment
26 (Actual)
8. Arms, Groups, and Interventions
Arm Title
AUP1602-C
Arm Type
Experimental
Arm Description
AUP1602-C will be administered topically once or repeatedly three times per week during the treatment period.
Intervention Type
Biological
Intervention Name(s)
AUP1602-C
Intervention Description
AUP1602-C is topically applied on chronic wounds and covered by wound dressing.
Primary Outcome Measure Information:
Title
Incidence of adverse events (AEs) and potential dose-limiting toxicities (DLTs)
Description
Incidence of adverse events (AEs) and potential dose-limiting toxicities (DLTs) for safety, low, medium, and high dose cohorts of single and repeatedly administered AUP1602-C
Time Frame
4 weeks
Title
Incidence of Treatment-Emergent Adverse Events
Description
• Incidence of AEs
Time Frame
6 months
Title
Incidence of Wound Closure
Description
Percentage (%) of patients with a target ulcer achieving complete wound closure
Percentage (%) of wound size reduction (wound area measurements in cm^2)
Time Frame
6 months
Secondary Outcome Measure Information:
Title
Incidence of Wound Closure
Description
Percentage (%) of wound area (cm^2) reduction
Percentage (%) of wound depth (mm) reduction
Percentage (%) of wound volume (mm^3) reduction
Measurements will be aggregated: Wound are and depth will be used to calculate wound volume.
Time Frame
6 months
Title
Incidence of ulcer recurrence
Description
Percentage (%) of patients with ulcer recurrence
Time Frame
6 months
Title
Incidence of Wound Infections
Description
Proportion of patients with local wound infections related to the target ulcer
Time Frame
6 months
Title
Incidence of surgical procedures
Description
Number of patients with local surgical procedures
Incidence of amputations (minor or major) related to the target ulcer
Time Frame
6 months
Title
Changes in Quality of Life according to EQ-5D-5L
Description
Change from baseline in health-related quality is assessed according to EuroQoL-5 Dimensions (EQ-5D-5L) patient quesionnaire. Five single-item dimensions (mobility, self-care, usual activities, pain/discomfort and anxiety/depression) are assessed. Result of the questionnaire is scored from 0 (worst health imaginable) to 100 (best health imaginable).
Time Frame
6 months
Title
Changes in Quality of Life according to DLQI
Description
Change from baseline in health-related quality is assessed according to Dermatology Life Quality Index (DLQI). It consists of 10 questions, where each question is scored from 0 (not affected at all) to 3 (very much affected). The DLQI score will be calculated as the sum of the 10 individual question scores and ranges from 0 to 30, with lower scores indicating better quality of life.
Time Frame
6 months
Title
Changes in pain assessment according to VAS
Description
Change from baseline in patient's pain intensity according to a numerical Visual Analog Scale (VAS) ranging from 0 = no pain to 10= worst imaginable pain.
Time Frame
6 months
Title
Incidence of Adverse Events
Description
Incidence of abnormal vital signs
Incidence of abnormal ECG data
Incidence of abnormal echocardiogram data
Incidence of abnormal ophthalmoscopy data
Incidence of abnormal physical examination findings
Incidence of abnormal laboratory data
Time Frame
6 months
Title
Incidence of bacteria distribution
Description
Assessment of biodistribution and shedding (yes / no)
Time Frame
6 months
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:
Male or female patients aged 18 to 80 years
Patients with DM of type 1 or 2 having a glycosylated haemoglobin (HbA1c) of ≤11% and a serum creatinine level of ≤1.5 times the upper limit of normal (ULN)
Patients with at least one ulcer that fulfills all of the following criteria at screening and at baseline (prior to treatment start)
Present for ≥1 month
Located either in the plantar or on the dorsum of foot, or in the distal part of the leg, around the malleolar areato be accessible for administration of AUP1602-C/placebo and to be completely covered by the primary and secondary dressings
Partial- or full-thickness, not involving bone or joints, i.e. University of Texas classification Grade 1A, 1C, 2A or 2C.
No clinical signs of active infection or osteomyelitis
Size of the target ulcer for DFU must be between 1-9 cm2 after debridement
Chronic target ulcer, defined as <30% reduction in size in response to SoC during the 2-week screening period
Target ulcer appropriately debrided (<10% black and at least 50% of red/pink on a colorimetric scale)
Ulcer and periwound tissue suitable to using film dressings (i.e. no contraindications [e.g.: excessive exudation, maceration] and sufficient periwound space to hold the dressing)
Patients with more than one ulcer will be included if ulcers are separated by a minimum of 5 cm healthy tissue but only one target ulcer will be selected for the investigational treatment (based on investigator decision)
Patients with an ankle brachial index (ABI) ≥0.7 on the foot with the target ulcer
Patients with an assessment of the baseline level of neuropathy of the foot using Semmes-Weinstein monofilaments
Patients must adhere to wear therapeutic shoes or off-loading footwear if indicated
A female patient of childbearing potential must have a negative serum pregnancy test at the time of Screening
Patients must use a highly effective contraceptive measure (methods that can achieve a failure rate of less than 1% per year when used consistently and correctly), like hormonal contraception (oral pills, implantable device, or skin patch), intrauterine device, bilateral tubal occlusion, or double barrier throughout the study
Patients who understand and are willing to comply with study procedures and give written informed consent prior to enrolment in the study or initiation of study procedures
Exclusion Criteria:
Current or previous (within 2 weeks prior to start of screening/run-in period) treatment with another investigational drug and/or medical device or participation in another clinical study
Current or previous (within 30 days prior to start of screening/run-in period) treatment with a biologic agent, growth factors or skin equivalents (e.g. Regranex®, Apligraf®, or Dermagraft®)
Current or previous (within 2 weeks prior to first study drug dosing) treatment with active wound care agents (e.g. local and systemic antibiotics or silver dressings)
Current or previous (within 2 weeks prior to first study drug dosing) use of corticosteroids and immunosuppressants
Known hypersensitivity to any of the investigational drug or vehicle components
Ulcer of University of Texas Grade ≥2, with deep abscess, or gangrene
Target ulcer with known or suspected active infection which requires antimicrobials. Any antibiotic therapy must be completed or discontinued within 2 weeks prior to first study drug dosing
Target ulcer positive for MRSA
Target ulcer other than chronic non-healing DFU (e.g. pressure ulcers, burn wounds)
Prior radiation therapy (within 6 weeks prior to first study drug dosing) of any part of the foot/leg bearing the target ulcer under study
Sickle-cell anemia, Reynaud's, or other peripheral vascular disease including venous leg ulcers
Infective endocarditis or increased risk for infective endocarditis, which includes, but is not limited to, prosthetic cardiac valve or prosthetic material used for cardiac valve repair, previous infective endocarditis, congenital heart disease, and cardiac transplantation recipients who develop cardiac valvulopathy, history of rheumatic fever or rheumatic heart disease diagnosed by echocardiogram, or history (within 10 years prior to enrollment) of IV drug abuse
Active Charcot deformity of the study foot (i.e. foot is erythematous, warm, edematous, and is actively remodeling)
Patients with other reasons for wound healing disturbances: e.g. bleeding disorders, vitamin K deficiency, hypocalcemia, major immune deficiencies
Active malignant disease of any kind except for basal cell carcinoma (of the skin) not co-located with the target ulcer. A patient, who has had a malignant disease in the past, was treated and is currently disease-free and not on active treatment with an immune-suppressive therapy at least for 3 months, may be considered for study entry
Pregnant or lactating woman
Haemoglobin of less than 8.5 g/dL
Transaminase levels greater than 3 times ULN
Patients receiving haemodialysis or chronic ambulatory peritoneal dialysis (CAPD) therapy
Positive for hepatitis B or C virus (HBV, HCV), or human immunodeficiency virus (HIV); serology test results not older than 3 months are accepted
Planned surgery during the study period
Known abuse of alcohol, drugs, or medical products. Tobacco use will be allowed
Previous participation in this clinical study
Any diagnosed unstable condition that could interfere with compliance, such as psychiatric disorder
Myocardial infarction diagnosed within last 3 months prior to start of screening/run-in period
Confirmed or suspected COVID-19 infection.
Facility Information:
Facility Name
Medizinische Hochschule Hannover (MHH) CRC Core Facility
City
Hannover
Country
Germany
Facility Name
Mikomed
City
Łódź
Country
Poland
12. IPD Sharing Statement
Plan to Share IPD
Undecided
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Treatment of Diabetic Foot Ulcers With AUP1602-C
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