Using Santyl on Diabetic Foot Ulcers

A Comparison of Collagenase Santyl® Ointment Used Adjunctively to Sharp Surgical Debridement and Sharp Surgical Debridement in the Care of Diabetic Foot Wounds

Subjects enrolled in this study will either use Santyl daily or follow standard care procedures for up to 6 weeks for their diabetic foot wound. After 6 weeks of treatment, the subjects will continue into the follow-up phase for an additional 6 weeks. Study doctors will look at the wound in the office each week (up to 12 weeks) to see if the wound is healing. Depending on a number of factors at each office visit, the study doctors may also use a procedure called sharp debridement to remove dead skin from the wound.

This study will test the hypothesis that daily treatment of diabetic foot wounds with Santyl will result in more rapid healing, healthier wounds, and fewer required sharp debridements over the study period than for diabetic foot wounds treated in other ways.

Study Overview

• Status: Completed
• Conditions: Diabetic Foot Ulcers; Diabetic Foot Wounds
• Intervention / Treatment: Biological: Santyl; Procedure: Control

• Study Type: Interventional
• Enrollment (Actual): 55
• Phase: Phase 4

Contacts and Locations

Study Locations

• United States
  • Arizona
    • Phoenix, Arizona, United States, 85015
      • Associated Foot and Ankle Specialists
    • Tucson, Arizona, United States, 85710
      • Aung Foothealth Clinics
  • Michigan
    • Southfield, Michigan, United States, 48076
      • Foot Healthcare Associates, PC
  • New Jersey
    • Summit, New Jersey, United States, 07901
      • Overlook Hospital Wound Care Center
  • Texas
    • Fort Worth, Texas, United States, 76107
      • UNTHSC Fort Worth
    • San Antonio, Texas, United States, 78229
      • Endeavor Clinical Trials
    • San Antonio, Texas, United States, 78212
      • Robert Wunderlich

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

INCLUSION CRITERIA

• 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.
• Subjects 18 years of age or older. Subjects may be 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.
• A target ulcer which is 0.5 cm2 - 10 cm2 inclusive (as measured at the Screening Visit) with a duration ≥ 30 days (documented in the patient's history or by patient report of onset) which requires sharp surgical debridement.
• Adequate arterial blood flow as evidenced by an ankle brachial index (ABI) of > 0.7 and ≤ 1.1. If the ABI is greater than 1.1, then a toe pressure of > 40 mmHg OR a TcPO2 ≥ 40 mmHg must be present. Either toe pressure or TcPO2 is also acceptable as a stand-alone measurement, but if both are obtained, each must meet its respective cutoff.
• Alternatively, a Doppler waveform consistent with adequate flow to the region of the foot with the target ulcer (biphasic or triphasic waveforms) is acceptable.
• A target ulcer that is not infected based on clinical assessment.
• Willing and able to make all required study visits.
• 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.
• Willing to use an appropriate off-loading device whenever necessary to keep weight off of any foot ulcers.
• History of diabetes mellitus (Type 1 or 2) requiring insulin or oral hypoglycemic medications to control blood glucose levels.

• CBC and blood chemistry values as follows:

  • Serum albumin ≥ 2.0 g/dL
  • Pre-albumin levels of ≥ 15 mg/dL
  • Alkaline phosphatase ≤ 500 U/L
  • Alanine aminotransferase (ALT) ≤ 200 U/L
  • Aspartate aminotransferase (AST) ≤ 175 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

EXCLUSION CRITERIA

• Contraindications or hypersensitivity to the use of the study medications or their components.
• Target ulcer does not require debridement.
• Uncontrolled bleeding disorder.
• Cellulitis of the target wound, lymphangitic streaking, deep tissue abscess, gangrene, or infection of muscle, tendon, joint or bone.
• Infection with systemic toxicity or metabolic instability (e.g., fever, chills, tachycardia, hypotension, confusion, vomiting, leukocytosis, acidosis, severe hyperglycemia, azotemia).

• Any of the following:

  • Target ulcer tunneling
  • Target ulcer requires hyperbaric or negative pressure therapy per the investigator's medical judgment
  • Target ulcer is on the heel and cannot be offloaded
  • Target ulcer is over a Charcot deformity which cannot be offloaded
• NOTE: A heel ulcer or an ulcer over a Charcot is not excluded unless effective offloading is not possible.
• Current, ongoing osteomyelitis of the target foot as determined by medical history.
• Participation in another investigational clinical study within thirty (30) days of the Screening Visit.
• A target ulcer which involves underlying tissues (i.e., fat, fascia, tendon, muscle, bone).
• A target ulcer on a non-neuropathic foot (neuropathic defined as inability to perceive 10 grams pressure using a Semmes-Weinstein 5.07 or equivalent monofilament in the periwound area).
• NOTE: Monofilament test result must be documented.
• Diagnosis of chronic granulomatous disease, leukocyte adhesion defects, or severe neutropenia.

• Current treatment (at the time of the Screening Visit) with any of the following:

  • Systemic corticosteroids
  • Immunosuppressive agents
  • Chemotherapeutic agents
  • Antiviral agents
  • Platelet-derived growth factor (e.g., Regranex)
  • Living skin equivalent (e.g., Apligraf)
  • Dermal substitute (e.g., Dermagraft, Integra, etc.)
  • Systemic antibiotic therapy or topical antibiotic treatment of the target ulcer
• Radiation therapy to the target lower extremity within 30 days prior to screening The Medical Monitor and/or Investigator may declare any subject ineligible for a valid medical reason.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: TREATMENT
• Allocation: RANDOMIZED
• Interventional Model: PARALLEL
• Masking: NONE

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
ACTIVE_COMPARATOR: Santyl; 2mm Santyl applied once daily.	Biological: Santyl; 2 mm Santyl applied once daily
ACTIVE_COMPARATOR: Control; Standard Care	Procedure: Control; Standard Care; Other Names: Standard Care

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Mean Percent Change in Wound Area	Wound area was measured using the ARANZ Silhouette digital wound imaging and measurement device. The average percent (%) of change from baseline of the target wound area at the end of the 6-week treatment period and the end of the entire 12-week study period respectively, was calculated using a two-way ANCOVA model.	6 and 12 weeks

Collaborators and Investigators

• Sponsor: Healthpoint

Publications and helpful links

General Publications

• Motley TA, Gilligan AM, Lange DL, Waycaster CR, Dickerson JE Jr. Cost-effectiveness of clostridial collagenase ointment on wound closure in patients with diabetic foot ulcers: economic analysis of results from a multicenter, randomized, open-label trial. J Foot Ankle Res. 2015 Feb 28;8:7. doi: 10.1186/s13047-015-0065-x. eCollection 2015. Erratum In: J Foot Ankle Res. 2016;9:28.

Study record dates

Study Major Dates

• Study Start: August 1, 2011
• Primary Completion (ACTUAL): November 1, 2012
• Study Completion (ACTUAL): March 1, 2013

Study Registration Dates

• First Submitted: August 2, 2011
• First Submitted That Met QC Criteria: August 2, 2011
• First Posted (ESTIMATE): August 3, 2011

Study Record Updates

• Last Update Posted (ESTIMATE): July 24, 2014
• Last Update Submitted That Met QC Criteria: June 30, 2014
• Last Verified: June 1, 2014

More Information

Terms related to this study

• Keywords: Diabetic Foot Ulcers; Diabetic Foot Wounds
• Additional Relevant MeSH Terms: Pathologic Processes; Cardiovascular Diseases; Vascular Diseases; Skin Diseases; Endocrine System Diseases; Diabetic Angiopathies; Leg Ulcer; Skin Ulcer; Diabetes Complications; Diabetes Mellitus; Diabetic Neuropathies; Foot Diseases; Diabetic Foot; Foot Ulcer; Ulcer
• Other Study ID Numbers: 017-101-09-030