ENERGI-F703 gel, as a new topical treatment for diabetic foot and leg ulcers: A multicenter, randomized, double-blind, phase II trial

Jui-Yung Yang, Cha-Chun Chen, Shun-Cheng Chang, Jiun-Ting Yeh, Hui-Fu Huang, Hwang-Chi Lin, Shang-Hsi Lin, Yu-Hsien Lin, Lin-Gwei Wei, Tom J Liu, Shih-Yuan Hung, Hui-Mei Yang, Hui-Hsiu Chang, Chih-Hsin Wang, Yuan-Sheng Tzeng, Chieh-Huei Huang, Chang-Yi Chou, Ying-Sheng Lin, Shih-Yi Yang, Han-Min Chen, Jiun-Tsai Lin, Yi-Fang Cheng, Guang-Huar Young, Chun-Fang Huang, Ya-Chun Kuo, Niann-Tzyy Dai, Jui-Yung Yang, Cha-Chun Chen, Shun-Cheng Chang, Jiun-Ting Yeh, Hui-Fu Huang, Hwang-Chi Lin, Shang-Hsi Lin, Yu-Hsien Lin, Lin-Gwei Wei, Tom J Liu, Shih-Yuan Hung, Hui-Mei Yang, Hui-Hsiu Chang, Chih-Hsin Wang, Yuan-Sheng Tzeng, Chieh-Huei Huang, Chang-Yi Chou, Ying-Sheng Lin, Shih-Yi Yang, Han-Min Chen, Jiun-Tsai Lin, Yi-Fang Cheng, Guang-Huar Young, Chun-Fang Huang, Ya-Chun Kuo, Niann-Tzyy Dai

Abstract

Background: Diabetic foot and leg ulcers are a major cause of disability among patients with diabetes mellitus. A topical gel called ENERGI-F703, applied twice daily and with adenine as its active pharmaceutical ingredient, accelerated wound healing in diabetic mice. The current study evaluated the safety and efficacy of ENERGI-F703 for patients with diabetic foot and leg ulcers.

Methods: This randomized, double-blind, multicenter, phase II trial recruited patients from eight medical centers in Taiwan. Patients with intractable diabetic foot and leg ulcers (Wagner Grade 1-3 without active osteomyelitis) were randomly assigned (2:1) to receive topical ENERGI-F703 gel or vehicle gel twice daily for 12 weeks or until complete ulcer closure. The investigator, enrolled patients and site personnel were masked to treatment allocation. Intention to treat (ITT) population and safety population were patient to primary analyses and safety analyses, respectively. Primary outcome was complete ulcer closure rate at the end of treatment. This trial is registered with ClinicalTrials.gov, number NCT02672436.

Findings: Starting from March 15th, 2017 to December 26th, 2019, 141 patients were enrolled as safety population and randomized into ENERGI-F703 gel (n = 95) group or vehicle gel (n = 46) group. In ITT population, ENERGI-F703 (n = 90) and vehicle group showed ulcer closure rates of 36.7% (95% CI = 26.75% - 47.49%) and 26.2% (95% CI = 13.86% - 42.04%) with difference of 9.74 % (95 % CI = -6.74% - 26.23%) and 25% quartiles of the time to complete ulcer closure of 69 days and 84 days, respectively. There were 25 (26.3%) patients in ENERGI-F703 group and 11 (23.9%) patients in vehicle group experiencing serious adverse events and five deaths occurred during the study period, none of them related to the treatment.

Interpretation: Our study suggests that ENERGI-F703 gel is a safe and well-tolerated treatment for chronic diabetic foot and leg ulcers. Further studies are needed to corroborate our findings in light of limitations.

Funding: Energenesis Biomedical Co., Ltd.

Keywords: ATP; Adenine; Adenosine triphosphate; Diabetic foot ulcer; Diabetic wound healing.

Conflict of interest statement

This project was sponsored by Energenesis Biomedical Co. Ltd. Han-Min Chen, Jiun-Tsai Lin, Yi-Fang Cheng, Guang-Huar Young, Chun-Fang Huang, Ya-Chun Kuo are current employees of Energenesis Biomedical Co., Ltd. All other authors have no conflicts of interest to declare.

© 2022 The Authors.

Figures

Figure 1
Figure 1
Consolidated Standard of Reporting Trials (CONSORT) flow diagram of the study.
Figure 2
Figure 2
Kaplan-Meier with CI diagram of time to complete ulcer closure with ENERGI-F703 Gel compared to vehicle gel for patients with baseline ulcer ≥ 1.5 cm2 but < 25 cm2, those with ≤ Grade 2 ulcer at baseline in the ITT population. The comparison between two groups was performed by log-rank test. The ENERGI-F703 Gel group showed an increased cumulative complete ulcer closure rate than vehicle gel group.

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