Phase III Study to Evaluate Efficacy and Safety of DSC127 in Diabetic Foot Ulcers (STRIDE 1)

A Randomized, Double-blind, Parallel-group, Vehicle-controlled Phase 3 Clinical Trial to Evaluate the Efficacy and Safety of DSC127 in Treating Non-healing Foot Ulcers in Subjects With Diabetes Mellitus

The purpose of the study is to determine if DSC127 is effective in increasing incidence of complete wound closure at 10 weeks confirmed at a visit 2 weeks later when compared to the vehicle (gel without active ingredient) in subjects with diabetes mellitus (DM) who have chronic Wagner Grade 1 or 2 plantar neuropathic foot ulcers, 0.75 - 6 cm2 in size.

Study Overview

• Status: Terminated
• Conditions: Diabetic Foot Ulcers
• Intervention / Treatment: Drug: DSC127; Drug: placebo vehicle gel

Detailed Description

Subjects will undergo a two week screening period to assess plantar ulcer healing, and those healing less than 30% will be eligible for randomization, providing they meet all other inclusion criteria. Four weeks of blinded "treatment" follows the screening period, and an observation period of six weeks (to 10 weeks post first treatment) follows the 4-week treatment period. If the ulcer closes during the treatment or observation period, the closure will be confirmed two weeks later, and at this time the subject enters a durability assessment period of up to 12 weeks.

All aspects of Standard of Care are followed throughout the study period.

• Study Type: Interventional
• Enrollment (Actual): 266
• Phase: Phase 3

Contacts and Locations

Study Locations

• United States
  • Alabama
    • Mobile, Alabama, United States, 36680
      • WILMAX Clinical Research Inc
  • California
    • Fair Oaks, California, United States, 95628
      • Center for Clinical Research
    • Fresno, California, United States, 93710
      • Roy O Kroeker, DPM, Inc
    • Los Angeles, California, United States, 90010
      • Foot and Ankle Clinic
    • Pismo Beach, California, United States, 93449
      • Brian O'Carroll, DPM, Inc.
    • Sylmar, California, United States, 91342
      • UCLA Medical Center - Olive View
    • Tustin, California, United States, 92780
      • Orange County Research Center
  • Florida
    • Homestead, Florida, United States, 33030
      • Advanced Research Institute of Miami
    • Jacksonville, Florida, United States, 32209
      • UF Health Orthopaedic Surgery Clinic
    • Miami, Florida, United States, 33176
      • Miami Dade Medical Research Institute
    • Miami Lakes, Florida, United States, 33016
      • GF Professional Research
    • North Miami Beach, Florida, United States, 33013
      • Barry University Clinical Research
    • Saint Petersburg, Florida, United States, 33713
      • Professional Health Care of Pinellas
  • Indiana
    • Granger, Indiana, United States, 46530
      • Memorial Medical Group
    • LaPorte, Indiana, United States, 46350
      • LaPorte Medical Group
  • Massachusetts
    • Boston, Massachusetts, United States, 02118
      • Boston University Medical Center
  • North Carolina
    • Greenville, North Carolina, United States, 27834
      • East Carolina Foot and Ankle Specialists
  • Oregon
    • Eugene, Oregon, United States, 97401
      • Clinical Research Center
    • Portland, Oregon, United States, 97232
      • Center for Clinical Research
  • South Carolina
    • Aiken, South Carolina, United States, 29801
      • Carolina Musculoskeletel Institute
  • Tennessee
    • Chattanooga, Tennessee, United States, 37421
      • ClinSearch, LLC
  • Texas
    • Dallas, Texas, United States, 75216
      • Dallas VA Medical Center
    • Fort Worth, Texas, United States, 76104
      • Fort Worth Diagnostic Clinic
    • San Antonio, Texas, United States, 78229
      • Endeavor Clinical Trials
  • Virginia
    • Roanoke, Virginia, United States, 24016
      • Professional Education and Research Institute

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:

1. Male or female ambulatory subject age ≥18 years at the time of informed consent
2. Has type 1 or type 2 DM under metabolic control as confirmed by a glycosylated hemoglobin (HbA1c) of ≤12% and a serum creatinine level of ≤3mg/dL

3. At Screening and at Baseline (prior to randomization), subject has at least one ulcer that fulfills all of the following criteria:

   • Present for ≥1 month and ≤1 year
   • Partial- or full- thickness and not involving bone, tendon, or capsule (probing to tendon or capsule), i.e. Wagner Grade 1 or 2
   • Has no sign of infection or osteomyelitis
   • Plantar neuropathic ulcer; ulcer must be predominantly on the plantar surface of the foot to ensure adequate off-loading and may include the toes
   • Size of the target ulcer must be 0.75 - 6 cm2

   • Target ulcer must be non-healing as defined as <30% reduction in size in response to standard of care during the two week Screening Period

     • If more than one ulcer is present that meets the inclusion criteria, the largest one will be considered the Target ulcer.
     • If there are two ulcers of the same size that meet all criteria, the one with the higher Wagner Grade will be considered the Target ulcer.
     • If there are two ulcers of the same size and the same Wagner Grade, the one present for the longest qualifying time will be the Target ulcer.
4. Has an ankle brachial index (ABI) ≥ 0.7 on the foot with the target ulcer
5. Has an assessment of the baseline level of neuropathy of the foot using Semmes-Weinstein filaments.
6. A female subject of childbearing potential must have a negative serum pregnancy test at the time of Screening, and must be willing to use a medically acceptable method of birth control, such as Essure®, hormonal contraception (oral pills, implantable device, or skin patch), intrauterine device, tubal ligation, or double barrier throughout the study. A female subject of childbearing potential who practices abstinence is not required to employ birth control.
7. Has the ability and willingness to understand and comply with study procedures and to give written informed consent prior to enrollment in the study or initiation of study procedures

Exclusion Criteria:

1. Has a known hypersensitivity to any of the investigational drug or vehicle components
2. Has been exposed to any investigational agent within 30 days of entry into the study
3. A female who is pregnant or nursing
4. Has active malignant disease of any kind except for basal cell carcinoma (of the skin). A subject, who has had a malignant disease in the past, was treated and is currently disease-free, may be considered for study entry.
5. Has a hemoglobin of less than 8.5 gm/dL.
6. Transaminase levels greater than 3 × normal
7. Is receiving hemodialysis or chronic ambulatory peritoneal dialysis (CAPD) therapy
8. Has had prior radiation therapy of any part of the foot with the target ulcer under study
9. Use of systemic corticosteroids and immunosuppressants (within the 8 weeks prior to screening)
10. Has an ulcer primarily ischemic in etiology
11. Has sickle-cell anemia, Reynaud's, or other peripheral vascular disease
12. Has received a biologic agent, growth factors or skin equivalents (Regranex®, Apligraft, or Dermagraft), in the past 30 days
13. Has a target ulcer which is determined to be clinically infected and requires antimicrobials. Any antibiotic therapy must be completed or discontinued at screening.
14. Has a Wagner Grade 3 or greater DFU, deep abscess, or gangrene
15. Has uncontrolled hypertension, in the opinion of the Investigator.
16. Any other finding, which in the opinion of the Investigator, may interfere with the assessment of the product or participation of the subject in the study.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Quadruple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: DSC127; DSC127 0.03% in a vehicle gel (hydroxyethyl cellulose (HEC) with parabens)	Drug: DSC127; DSC127 0.03%, daily topical application to diabetic foot ulcer for a period of up to 28 days or until ulcer closure, whichever is sooner
Placebo Comparator: Vehicle gel; Vehicle gel comprising HEC with parabens	Drug: placebo vehicle gel

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The proportion of subjects with a target ulcer which achieves complete wound closure (skin re-epithelialization without drainage or dressing requirements) up to 10 weeks (confirmed at a study visit 2 weeks later).	Primary endpoint of complete closure is assessed by the Principal Investigator at the site; ulcer measurements are calculated through tracings submitted to the Canfield system and photographs are collected as confirmation of closure via the Canfield system.	Target ulcer must achieve complete wound closure by 10 weeks post first treatment

Secondary Outcome Measures

Outcome Measure	Time Frame
Time to the visit where the target ulcer achieves confirmed complete wound closure	Weekly assessments to ten weeks post first treatment dose

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percent reduction in ulcer area per week (closure rate)	Calculated weekly for up to ten weeks	Weekly ulcer tracings to calculate area of ulcer, measurements continue to ten weeks post first treatment dose
Incidence of target ulcer recurrence, time to ulcer recurrence, and number of days target ulcer remains closed after confirmed complete wound closure has been established.		Assessed during a 12 week durability period following the confirmation of complete wound closure

Collaborators and Investigators

• Sponsor: Integra LifeSciences Corporation
• Collaborators: Integrium
• Investigators: Study Director: Gere S diZerega, MD, Integra LifeSciences Corporation

Study record dates

Study Major Dates

• Study Start: February 1, 2013
• Primary Completion (Actual): December 1, 2015
• Study Completion (Actual): December 1, 2015

Study Registration Dates

• First Submitted: March 15, 2013
• First Submitted That Met QC Criteria: April 11, 2013
• First Posted (Estimate): April 12, 2013

Study Record Updates

• Last Update Posted (Actual): December 12, 2017
• Last Update Submitted That Met QC Criteria: December 8, 2017
• Last Verified: December 1, 2017

More Information

Terms related to this study

• Keywords: diabetic foot ulcers; Wagner Grade 1 or 2 foot ulcers
• 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: DSC127-2012-01