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Santyl Applications to Diabetic Foot Ulcers

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT02111291
Recruitment Status : Completed
First Posted : April 11, 2014
Last Update Posted : February 17, 2016
Information provided by (Responsible Party):

Brief Summary:
The current trial examines the potential benefits of continuous 12 week treatment with Santyl, measured in terms of wound bed appearance. The visual appearance of granulation tissue will be recorded at each visit for the purpose of examining the relationship between wound bed appearance and progress towards healing. In support of this longer treatment regimen with Santyl, a recent animal study found that application of Santyl for 12 weeks was safe and well tolerated. Therefore, the present study is designed to test the hypothesis that daily treatment of diabetic foot ulcers (DFU) with Santyl for up to 12 weeks will result in more rapid development of granulation tissue than DFU treated with supportive care.

Condition or disease Intervention/treatment Phase
Diabetic Foot Ulcers Diabetic Foot Wounds Biological: Collagenase SANTYL® Ointment Biological: Hydrogel (if needed) and foam dressing Phase 4

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 215 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Clinical Outcomes Associated With Enzymatic Debridement of Diabetic Foot Ulcers for Up To 12 Weeks With Clostridial Collagenase (Santyl®) Ointment
Study Start Date : April 2014
Actual Primary Completion Date : December 2015
Actual Study Completion Date : December 2015

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Experimental: SANTYL® Biological: Collagenase SANTYL® Ointment
Daily application directly to the ulcer bed, approximately 2 mm thick.

Sham Comparator: Supportive Care Biological: Hydrogel (if needed) and foam dressing
Daily application of hydrogel directly to the ulcer bed (if necessary), covered with foam dressing

Primary Outcome Measures :
  1. Time to Well-established Granulation Tissue [ Time Frame: 12 Weeks ]

Secondary Outcome Measures :
  1. Adverse Event [ Time Frame: 12 Weeks ]

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

Subjects will be considered qualified for enrollment if they meet the following criteria:

  1. Provide written informed consent, which will consist of reading, signing, and dating the informed consent document after the Investigator, sub-Investigator or other designated study staff member has explained the study procedures, risks, and contact information.
  2. Eighteen (18) years of age or older, of either sex, and of any race or skin type provided that their skin color, in the opinion of the Investigator, will not interfere with the study assessments.
  3. Willing and able to make all required study visits.
  4. Able to follow instructions and perform the dressing changes at home or have a caregiver who can perform the dressing changes according to the protocol.
  5. Willing to use an appropriate off-loading device whenever necessary to keep weight off of any foot ulcers.
  6. An ulcer present on any part of the plantar surface of the foot or plantar surface of the hallux which is 0.5 cm2 - 10 cm2 inclusive (as measured at the Screening Visit) with a duration ≥ 6 weeks but not more than 52 weeks (12 months) documented in the patient's history or by patient report of onset which requires debridement.
  7. Adequate arterial blood flow as evidenced by an ankle brachial index (ABI) of > 0.70 and ≤ 1.20. If ABI > 1.2, perfusion at or near the site of the ulcer should be confirmed; the foot is warm to the touch and has palpable pulses.
  8. Separation of at least 5 cm (closest ulcer edge to other closest ulcer edge) if ≥ 2 ulcers are present.
  9. Diabetes mellitus (Type 1 or 2) requiring insulin or oral/injectable medications to control blood glucose levels.
  10. Target ulcer is not infected based on clinical assessment.

Exclusion Criteria:

Any one (1) of the following criteria will disqualify a potential Subject from participation in the study.

  1. Contraindications or hypersensitivity to the use of clostridial collagenase or hydrogel.
  2. Undergoing therapy with another investigational agent within thirty (30) days of Visit 1, or planned participation overlapping with this study.
  3. Bleeding disorder that would preclude sharp debridement during the study.
  4. Active cellulitis of the target ulcer, lymphangitic streaking, deep tissue abscess, gangrene, or infection of muscle, tendon, joint or bone.
  5. Infection with systemic toxicity or metabolic instability (e.g., fever, chills, tachycardia, hypotension, confusion, vomiting, leukocytosis, acidosis, severe hyperglycemia, azotemia).
  6. A target ulcer which involves the underlying tissues of tendon, muscle, or bone.
  7. Diagnosis of chronic granulomatous disease, leukocyte adhesion defects, or severe neutropenia.
  8. Current treatment (at the time of the Screening Visit) with any of the following:

    • Systemic corticosteroids. If corticosteroid treatment was for ≥ 10 days, there must be a 1 week interval between discontinuation and screening.
    • Immunosuppressive agents
    • Chemotherapeutic agents
    • Antiviral agents
    • Systemic antibiotic therapy or topical antibiotic treatment of the target ulcer
  9. Treatment of target ulcer with bioactive therapies within 1 month of screening:

    • Platelet-derived growth factor (e.g., Regranex)
    • Living skin equivalent (e.g., Apligraf)
    • Dermal substitute (e.g., Dermagraft, Integra, Oasis, etc.)
  10. Treatment of target ulcer for any length of time with clostridial collagenase ointment (SANTYL®) if within 12 weeks prior to screening.
  11. Target ulcer that failed to develop well-established granulation tissue when treated with clostridial collagenase ointment (SANTYL®) for at least 4 weeks.
  12. Radiation therapy to the target lower extremity within 30 days prior to screening.
  13. Medical or physical condition that, in the opinion of the Investigator, would preclude safe subject participation in the study.
  14. Blood counts and blood chemistry values as follows:

    • Alanine aminotransferase (ALT) > 3x upper limit of normal
    • Aspartate aminotransferase (AST) > 3x upper limit of normal
    • Gamma Glutamyl Transferase (GGT) > 2.5x upper limit of normal
    • Serum albumin < 2.0 g/dL • Pre-albumin levels of < 10 mg/dL
    • Alkaline phosphatase > 500 U/L • Serum total bilirubin > 3.0 mg/dL
    • Serum BUN > 75 mg/dL • Serum creatinine > 4.5 mg/dL
    • HbA1c > 12% • Hemoglobin (Hgb) < 8.0 g/dL
    • WBC < 2.0 x 109/L • Absolute neutrophil count < 1.0 x 109/L
    • Platelet count < 50 x 109/L • INR > 1.5x upper limit of normal

Furthermore, prior to randomization at Visit 1, the following exclusion criteria will apply:

  1. Use of excluded concomitant medications or therapies between Screening and Visit 1.
  2. A clinically diagnosed infection of the target ulcer requiring treatment.
  3. Muscle, tendon, or bone exposure in the target ulcer.
  4. After debridement at Visit 1, the ulcer area is >12 cm2.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT02111291

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Sponsors and Collaborators
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Study Chair: Hebert B Slade, MD Smith and Nephew Biotherapeutics

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Responsible Party: Healthpoint Identifier: NCT02111291     History of Changes
Other Study ID Numbers: 017-101-09-034
First Posted: April 11, 2014    Key Record Dates
Last Update Posted: February 17, 2016
Last Verified: February 2016
Keywords provided by Healthpoint:
Diabetic Foot Ulcers
Additional relevant MeSH terms:
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Diabetic Foot
Foot Ulcer
Pathologic Processes
Diabetic Angiopathies
Vascular Diseases
Cardiovascular Diseases
Leg Ulcer
Skin Ulcer
Skin Diseases
Diabetes Complications
Diabetes Mellitus
Endocrine System Diseases
Diabetic Neuropathies
Foot Diseases