Oleogel-S10 in Wound Healing of Split-Thickness Skin Graft Donor Sites (BSH-12)

Open, Blindly Evaluated, Prospective, Controlled, Randomized, Multicenter Phase III Clinical Trial to Compare Intra-individually the Efficacy and Tolerance of Oleogel-S10 Versus Standard of Care in Accelerating the Wound Healing of Split-Thickness Skin Graft Donor Sites

The main purpose of this phase III clinical trial was to compare intra-individually the efficacy, safety and tolerability of Oleogel-S10 and non-adhesive wound dressing versus non-adhesive wound dressing only in accelerating the wound healing of Split-Thickness Skin Graft (STSG) donor sites.

Study Overview

• Status: Completed
• Conditions: Wounds
• Intervention / Treatment: Drug: Oleogel-S10, non-adhesive wound dressing; Device: Non-adhesive wound dressing only

Detailed Description

Oleogel-S10 has shown efficacy and was well tolerated in previous clinical trials in participants with skin lesions. Especially the results in a previous study with STSG donor sites suggested that Oleogel-S10 should be efficacious and safe in the treatment of superficial wounds.

The present phase III clinical trial in STSG donor sites was initiated to demonstrate wound healing progress, i.e., the time to healing and the grade of epithelialization of the wound.

In this study, STSG donor sites were separated into 2 wound halves. Randomly assigned, 1 wound half was treated with Oleogel-S10 and non-adhesive wound dressing, the other wound half with non-adhesive wound dressing only (standard of care).

Wound healing progress was documented by photos which were assessed by expert reviewers blind to the treatment of the wound halves.

• Study Type: Interventional
• Enrollment (Actual): 107
• Phase: Phase 3

Contacts and Locations

Study Locations

• Austria
  • Graz, Austria
    • Medical University of Graz
  • Salzburg, Austria
    • Landesklinik für Dermatologie
  • Vienna, Austria
    • Medical University Vienna
• Bulgaria
  • Pleven, Bulgaria
    • University Multiprofile Hospital for Active Treatment-"Dr. Georgi Stranski" EAD
  • Plovdiv, Bulgaria
    • University Multiprofile Hospital for Active Treatment "Saint George"
  • Ruse, Bulgaria
    • Multiprofile Hospital for Active Treatment- Ruse
  • Sofia, Bulgaria
    • University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I.Pirogov"
  • Varna, Bulgaria
    • University Multiprofile Hospital for Active Treatment-Varna at MMA-Sofia
• Czechia
  • Brno, Czechia
    • Universtity Hospital Brno
  • Olomouc, Czechia
    • University Hospital Olomouc
• Finland
  • Lahti, Finland
    • Päijät-Hämeen keskussairaala
  • Pori, Finland
    • Satakunnan Keskussairaala
• Germany
  • Berlin, Germany
    • Trauma Hospital
  • Düsseldorf, Germany
    • University Hospital
  • Essen, Germany
    • Essen University Hospital
  • Frankfurt, Germany
    • University Hospital
  • Freiburg, Germany
    • University Medical Center
  • Greifswald, Germany
    • University Medicine Greifswald
  • Krefeld, Germany
    • HELIOS Clinic
  • Mainz, Germany
    • University Medical Center
  • München, Germany
    • Klinikum rechts der Isar
  • Offenbach, Germany
    • Klinikum Offenbach am Main
• Poland
  • Gdansk, Poland
    • Univesity Hospital Gdansk
  • Lublin, Poland
    • Samodzelny Publiczny Szpital Kliniczny Nr. 1

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:

• Presenting a split-thickness skin graft donor site wound with a minimum size of 15 cm2 and with a minimum width of 3 cm.
• Patient is able to understand the Informed Consent Form (ICF) provided and is prepared to comply with all study requirements, including the following: Visiting the trial site for wound dressing change and photo documentation every third or fourth day until both wound halves are closed (but no longer than 28 days after surgery).
• Willing to perform all necessary wound dressing changes at the trial site. Also the patient needs to agree to return to site for 3 and 12 months follow-up visits.
• Women of childbearing potential must apply highly effective method of birth control (failure rate less than 1% per year when used consistently and correctly (e.g., implants, injectables, combined oral contraceptives, some intrauterine contraceptive devices (IUDs), sexual abstinence, or a vasectomized partner)).

Exclusion Criteria:

• Diseases or conditions that could, in the opinion of the Investigator, interfere with the assessment of safety or efficacy.
• A skin disorder that is chronic or currently active and which the Investigator considers will adversely affect the healing of the acute wounds or involves the areas to be examined in this trial.
• A history of clinically significant hypersensitivity to any of the drugs, surgical dressings or excipients to be used in this trial.
• Known multiple allergic disorders.
• Taking, or have taken, any investigational drugs within 3 months prior to the screening visit.
• Pregnant or breast feeding women are not allowed to participate in the study.
• Inappropriate to participate in the study, for any reason, in the opinion of the investigator.
• Mental incapacity or language barriers precluding adequate understanding the Informed consent form or co-operation or willingness to follow study procedures.
• Previous participation in this study.
• Employee at the investigational site, relative or spouse of the investigator.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Single Group Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Oleogel-S10, non-adhesive wound dressing; A split-thickness skin graft (STSG) donor site wound >15cm2 in size was divided in 2 halves. One half was randomized to Oleogel-S10 treatment and non-adhesive wound dressing (intra-individual comparison). Oleogel-S10 was administered (1 cm or 100 mg per cm2 wound area corresponding to thickness of about 1 mm or 0.04 inch) every 3 to 4 days until 95% epithelialization of the wound or end of treatment at Day 28.	Drug: Oleogel-S10, non-adhesive wound dressing; 1 cm or 100 mg Oleogel-S10 per cm2 wound area (corresponds to thickness of approximately 1 mm or 0.04 inch) every 3 to 4 days until 95% epithelialization of the wound or end of treatment at Day 28.; Other Names: Episalvan®
Other: Non-adhesive wound dressing only; A STSG donor site wound >15cm2 in size was divided in 2 halves. One half was randomized to treatment with non-adhesive wound dressing only (intra-individual comparison). Non-adhesive wound dressings are standard of care (SOC) in the treatment of STSG donor sites. Wound dressings were changed every 3 to 4 days until 95% epithelialization of the wound or end of treatment at Day 28.	Device: Non-adhesive wound dressing only; Soft silicone faced polyurethane foam dressing such as Mepilex® only every 3 to 4 days until 95% epithelialization of the wound or end of treatment at Day 28.; Other Names: Mepilex®

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Intra-individual Difference in Time to Wound Closure	Intra-individual difference in time to wound closure between wound halves, either treated with Oleogel-S10 and non-adhesive wound dressing or treated with non-adhesive wound dressing only. Independent experts were blind to treatment and assessed efficacy based on chronological series of cropped and coded photographs by wound half that were taken before start of treatment, during wound dressing changes and at the end of treatment. Difference in time to wound closure was calculated for every individual participant as [time taken for wound half treated with Oleogel-S10 to close] - [time taken for wound half treated with non-adhesive wound dressing to close], i.e., results below 0 indicate earlier wound closure of Oleogel-S10 treatment. The overall mean difference in time to wound closure was calculated based on all mean differences in time to wound closure of individual participants. Hence, primary outcome data derived from mean difference in time to wound closure by participant.	up to 4 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Time From Surgery Until Wound Closure is Achieved	Time from surgery until wound closure is achieved, separately for wound halves treated with Oleogel-S10 and non-adhesive wound dressing vs. non-adhesive wound dressing only. While outcome measure 1 (intra-individual difference in time to wound closure) was calculated based on mean intra-individual difference in time to wound closure in 107 participants with missing values replaced by a value of 0, for outcome measure 2 missing values were not replaced. For 5 of the 107 wounds data were missing, thus the reported values are calculated from 102 STSG donor site wound halves by intervention (Oleogel-S10 and non-adhesive wound dressing vs. non-adhesive wound dressing only).	up to 4 weeks
Percentage of Participants With Earlier Healing	Percentage of participants with earlier healing of wound area treated with Oleogel-S10 and non-adhesive wound dressing compared to non-adhesive wound dressing only	up to 4 weeks
Percentage of Participants With Wound Closure at Different Time Points	For separate time points (Day 7, Day 10, Day 14, Day 18, Day 21, and Day 28), the frequencies of wound areas which have reached wound closure were calculated.	up to 4 weeks
Percentage of Wound Epithelialization at Different Time Points as Assessed by the Investigator	A study team member assessed the progress of wound healing by treatment regimen and noted the degree of epithelialization (expressed in percent of the original wound size) at wound dressing changes on Day 7, Day 10, Day 14, Day 18, Day 21, and Day 28.	up to 4 weeks
Likert Scale Rating of Efficacy	Participants and investigators were asked to grade the efficacy of Oleogel-S10 and non-adhesive wound dressing versus non-adhesive wound dressing only on a 5-point Likert scale (treatment with Oleogel-S10 is much more effective, treatment with Oleogel-S10 is more effective, both treatments have the same efficacy, non-adhesive wound dressing only is more effective, non-adhesive wound dressing only is much more effective).	up to 4 weeks
Cosmetic Outcome at 3 and 12 Months After Surgery, Respectively	Blinded photographic evaluation which wound half resembles more closely the surrounding skin with regard to texture, redness, growth of hair, and pigmentation.	3 months and 12 months
Likert Scale Rating of Tolerability	Participants and investigators were asked to evaluate the tolerability of Oleogel-S10 and non-adhesive wound dressing versus non-adhesive wound dressing only (standard of care) on a 5-point Likert scale (treatment with Oleogel-S10 is much better tolerated, treatment with Oleogel-S10 is better tolerated, both treatments are equally well tolerated, standard of care is better tolerated, standard of care is much better tolerated).	up to 4 weeks
Pharmacokinetic (PK) Data (Number of Plasma Samples With Measurable Betulin Concentration)	Systemic presence/concentration of betulin in blood plasma samples. Plasma samples were collected in weekly intervals and at the end of treatment (when wound closure was achieved or at Day 28). Samples were analysed in a central laboratory with a validated LC-MS/MS method with a lower limit of quantification (LLOQ) of 1 ng/mL.	up to 4 weeks
Pharmacokinetic (PK) Data (Plasma Betulin Concentration)	Systemic presence/concentration of betulin in blood plasma samples - values for the number of samples with measurable values in samples above the lower limit of quantification (LLOQ) of 1 ng/mL	up to 4 weeks
Frequency of Adverse Events		Day 0 (start of treatment) until end of treatment (Day 28 or earlier if full wound closure was achieved earlier).
Severity of Adverse Events	Adverse Events were graded according to the National Cancer Institute (NCI) Common Toxicity Criteria for Adverse Events (CTCAE) as being mild (NCI CTCAE Grade 1), moderate (NCI CTCAE Grade 2), severe (NCI CTCAE Grade 3), life-threatening (NCI CTCAE Grade 4) or death (NCI CTCAE Grade 5).	Day 0 (start of treatment) until end of treatment (Day 28 or earlier if full wound closure was achieved earlier).
Adverse Events by Relationship to Study Medication	Adverse events were assessed as being 'unlikely', 'possibly' or 'probably' related to study medication, 'not related' to study medication or the relationship to study medication was rated as 'unknown'.	Day 0 (start of treatment) until end of treatment (Day 28 or earlier if full wound closure was achieved earlier).

Collaborators and Investigators

• Sponsor: Birken AG
• Investigators: Principal Investigator: Hans Robert Metelmann, Prof, Universitätsmedizin Greifswald MKG-Chirurgie/Plastische Operationen

Publications and helpful links

General Publications

• Barret JP, Podmelle F, Lipovy B, Rennekampff HO, Schumann H, Schwieger-Briel A, Zahn TR, Metelmann HR; BSH-12 and BSG-12 study groups. Accelerated re-epithelialization of partial-thickness skin wounds by a topical betulin gel: Results of a randomized phase III clinical trials program. Burns. 2017 Sep;43(6):1284-1294. doi: 10.1016/j.burns.2017.03.005. Epub 2017 Apr 8.

Study record dates

Study Major Dates

• Study Start: August 1, 2012
• Primary Completion (Actual): August 1, 2013
• Study Completion (Actual): September 1, 2014

Study Registration Dates

• First Submitted: July 29, 2012
• First Submitted That Met QC Criteria: August 3, 2012
• First Posted (Estimate): August 6, 2012

Study Record Updates

• Last Update Posted (Actual): January 23, 2018
• Last Update Submitted That Met QC Criteria: May 27, 2017
• Last Verified: May 1, 2017

More Information

Terms related to this study

• Keywords: Wound healing; Split-Thickness Skin Graft (STSG) donor site; Split-thickness skin graft; STSG; Skin grafting; Superficial wound; Partial-thickness wound; Time to wound closure
• Additional Relevant MeSH Terms: Wounds and Injuries
• Other Study ID Numbers: BSH-12; 2012-000777-23 (EudraCT Number)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No