Evaluation of Windowed Casts With and Without Regranex® Gel for Healing Diabetic Neuropathic 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: NCT00446472
Recruitment Status : Unknown
Verified June 2010 by Southern California Institute for Research and Education.
Recruitment status was:  Recruiting
First Posted : March 12, 2007
Last Update Posted : June 4, 2010
Heritage Medical Research Institute
Information provided by:
Southern California Institute for Research and Education

Brief Summary:
The objective of this study is to compare the effectiveness and safety of windowed casts with Regranex® (topical becaplermin gel) versus placebo (inactive medication) for treatment of diabetic ulcers on the legs and feet.

Condition or disease Intervention/treatment Phase
Diabetic Foot Ulcers Drug: Regranex® Drug: Hydrogel Not Applicable

Detailed Description:

Management of diabetic leg or foot ulcers is based on certain principals: 1) effective off-loading of pressure on the wound via specialized shoes, cast braces, or casts, 2) removal of infected or necrotic tissue vial surgery or non-surgical methods, and 3) optimization of wound healing by interventions that promote wound repair such as nutritional support, provision of optimal moisture balance and growth factor therapy.

Application of casts or cast braces [below knee, removable boots with protective padding] to protect and immobilize the ankle and foot have been demonstrated to provide superior wound healing than less cumbersome types of shoe gear (1-3). The benefit of casting may be the result of more effective off-loading of pressure than can be achieved with other devices, but the inability of patients to remove their casts also appears to an important factor, as non-compliance with removable cast-braces has been shown to be a pervasive and significant issue (4,5). One critical concept in diabetic foot ulcer management is the relation between chronically and limb loss — for each year a wound persists, a patient has a 25% risk for major amputation due to complications from infection (6-8). Limb loss has a profound effect on Diabetics' quality of life and rate of lower limb loss among diabetics is four per 1,000 person years in comparison with three per 10,000 person years (9-10).

Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 60 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary Purpose: Treatment
Official Title: Evaluation of Windowed Casts With and Without Regranex® Gel for Healing
Study Start Date : April 2007
Estimated Primary Completion Date : September 2010
Estimated Study Completion Date : September 2010

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Foot Health
Drug Information available for: Becaplermin

Arm Intervention/treatment
Experimental: 1
Randomized to Regranex gel
Drug: Regranex®
Regranex gel will be used for a total of 16 weeks
Other Name: Becaplermin

Active Comparator: 2
Placebo hydrogel will be used for a total of 16 weeks
Drug: Hydrogel
Placebo hydrogel will be applied for 16 weeks

Primary Outcome Measures :
  1. Completely healed wounds [ Time Frame: 4 months ]

Information from the National Library of Medicine

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Ages Eligible for Study:   21 Years to 85 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Subject must sign an informed consent
  • Have a history of compliance and reliability in following study required treatment regimen.
  • Have diabetic mellitus Type I or Type II and have a glycohemoglobin Alc less than l0
  • Presence of one or two ulcers in lower extremities

    1. Wounds cannot be positioned more than 2.5cm proximal to the malleoli, but may involve any more distal position of the foot
    2. Type 2 Diabetic Mellitus Neuropathic ulcers present at least for 3months with failure to heal
    3. Post-operation wounds in DM patients with wound present for minimum 4 weeks after surgery and wound surface area has failed to decrease more than 20% in 4 weeks
    4. Ulcer(s) must be stage II or III full-thickness (extending through the subcutaneous tissue or beyond - Wagner grade II or III)
    5. No joint, tendon or bone exposure
    6. Located on the lower extremity.
    7. Ulcer size measures 1cm2 < 16 cm2
    8. No osteomyelitis affecting the area of the ulcer
    9. If two wounds, both can be incorporated into one window when cast applied
  • Adequate foot arterial circulation evidenced by palpable ankle pulses or Doppler with ABI less than or equal to 0.8. If non-compressible, must have triphasic wave Doppler velocity waveforms or toe/brachial pressure greater than or equal to 0.6.

Exclusion criteria:

  • Female subjects who are within child bearing age range.
  • Previous sensitivity to Regranex® Gel.
  • Use of topical antibiotics, enzymatic debriders on the selected ulcer(s) within 30 days preceding randomization.
  • Osteomyelitis affecting the area of the selected ulcer(s)
  • Exposed bone, joint or tendon at ulcer site (Wagner III or higher)
  • Presence of more than two full-thickness ulcers on targeted lower extremity
  • Requirement for systemic antibiotics use within 7 days of study entry
  • Inability to tolerate cast
  • Presence of systemic or local cancer of any kind
  • Life expectancy less than 1 year
  • Subjects with end stage renal failure requiring chronic hemodialysis
  • Concomitant use of Pletal or other vasodilators
  • Ankle Brachial Index less or equal to 0.8 or toe pressure index less than 0.6
  • ESR>20
  • Demonstration of poor compliance including a chronic alcohol, psychiatric condition or drug abuse problems

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): NCT00446472

United States, California
VA Long Beach Healthcare System Recruiting
Long Beach, California, United States, 90822
Contact: Christine Ma Agas    562-826-8000 ext 2889   
Principal Investigator: Ian Gordon, M.D., Ph.D.         
VA Greater Los Angeles Healthcare System Recruiting
Los Angeles, California, United States, 90073
Contact: Aksone Nouvong, D.P.M.    310-268-3193   
Principal Investigator: Aksone Nouvong, D.P.M.         
Sponsors and Collaborators
Southern California Institute for Research and Education
Heritage Medical Research Institute
Principal Investigator: Ian Gordon, M.D., Ph.D. VA Long Beach Healthcare System
Principal Investigator: Aksone Nouvong, D.P.M. VA Greater Los Angeles Healthcare System

Additional Information:
U.S. Department of Health and Human Services. Healthy People 2010: Understanding and improving health, vol.2. Washington, DC: US Government Printing Office, 2000

Responsible Party: Ian Gordon, M.D., VA Long Beach Health Care System Identifier: NCT00446472     History of Changes
Other Study ID Numbers: #778
First Posted: March 12, 2007    Key Record Dates
Last Update Posted: June 4, 2010
Last Verified: June 2010

Keywords provided by Southern California Institute for Research and Education:
diabetes mellitus
diabetic neuropathies
peripheral vascular diseases

Additional relevant MeSH terms:
Diabetic Foot
Foot Ulcer
Diabetic Angiopathies
Vascular Diseases
Cardiovascular Diseases
Leg Ulcer
Skin Ulcer
Skin Diseases
Diabetes Complications
Diabetes Mellitus
Endocrine System Diseases
Diabetic Neuropathies
Foot Diseases
Angiogenesis Inducing Agents
Angiogenesis Modulating Agents
Growth Substances
Physiological Effects of Drugs