Phase 2b Study of GAM501 in the Treatment of Diabetic Ulcers of the Lower Extremities

Diabetic Foot Clinical Trial

— MATRIX  

Official title:

A Randomized, Double-Blind, Placebo-Controlled, Single- and Double-Dose, Comparator Arm (Standard of Care), Multicenter Phase 2b Study of Topical GAM501 (Ad5PDGF-B/Bovine Type I Collagen Gel) in the Treatment of Non-Healing Diabetic Ulcers of the Lower Extremities

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT00493051
• Other study ID #: SWHI-03
• Status: Completed
• Phase: Phase 2
• First received: June 25, 2007
• Last updated: February 8, 2010
• Start date: November 2007
• Est. completion date: December 2009

Study information

• Verified date: February 2010
• Source: Tissue Repair Company
• Contact: n/a
• Is FDA regulated: No
• Health authority: United States: Food and Drug Administration
• Study type: Interventional

Clinical Trial Summary

This is a Phase 2b, double-blind, randomized, placebo-controlled study to evaluate the safety and efficacy of one or two applications of topically applied GAM501 (Ad5PDGF-B/Bovine Type I Collagen Gel) in subjects ≥ 18 years old with non-healing diabetic foot ulcers. Approximately 210 adult subjects with Type I or Type II diabetes mellitus will be enrolled at approximately 30 investigational sites in the United States.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 124
• Est. completion date: December 2009
• Est. primary completion date: December 2009
• Accepts healthy volunteers: No
• Gender: Both
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Age 18 years or older

• Diagnosis of diabetes mellitus (Type I or II) requiring insulin or hypoglycemic agents to control blood sugars.

• Cutaneous, lower extremity ulcer of the foot that is =1.5 and =10.0 cm² in size and Wagner Classification Grade 1 in appearance. Note - Ulcer area must be calculated at Screening Visit and on the Treatment Day (Day 1) using measurements obtained by tracing the ulcer perimeter after debridement to confirm patient eligibility prior to randomization.

• Documented ulcer presence for =6 weeks prior to signing the informed consent form

• Recently debrided ulcer (within 2 weeks from screening visit)

• Ulcer free of all necrotic soft tissue

• Affected limb transcutaneous partial pressure oxygen (TcpO2) >40mmHg; or a toe pressure =40mmHg; or a Doppler waveform consistent with adequate flow in the foot (biphasic or triphasic waveforms) at screening

• Inability to perceive 10 grams pressure using a Semmes-Weinstein 5.07 monofilament in the peri-ulcer area

• Willing to adhere to wearing off-loading orthopedic shoe for up to 16 weeks (i.e., through 2 weeks after ulcer closure) starting on Day -14 (the first day of the screening run-in period)

• Willing to adhere to wearing customized shoes during the durability phase of the study

• Females of child-bearing potential must have a negative serum beta human chorionic gonadotropin hormone (ßhCG) test result from a sample obtained in the 7 days prior to Treatment Day 1 and be neither breastfeeding nor intending to become pregnant during the study

• All individuals (study patients/partners) of childbearing potential must agree to use a method of contraception deemed acceptable by the Investigator or agree to remain abstinent throughout the study

• Be able to understand and sign an informed consent form before entering into the study, and must be willing to comply with all study procedures

Exclusion Criteria:

• Any unstable medical condition judged by the Investigator or Medical Monitor that would cause the study to be detrimental to the patient

• Hemoglobin Alc (HbA1c) test result of >12% documented at the Screening Visit

• Ulcers caused primarily by untreated vascular insufficiency; or ulcers with an etiology not related to diabetes

• Ulcers on the heel

• More than three ulcers on the target lower extremity

• The ulcer to be studied is not anatomically distinct from another ulcer(s) (i.e., separated by <1 cm from another ulcer or would interfere with standard of care treatment of another ulcer). Only a single ulcer can be treated in this study.

• Ulcers which decrease in area by >30% during the screening 2-week run-in period

• Ulcers with underlying osteomyelitis

• Patients presenting with the clinical characteristics of cellulitis at the ulcer site (suppurative inflammation involving particularly the subcutaneous tissue, often mild erythema, tenderness, malaise, chills and fever)

• If either beta hemolytic streptococci (in any amount) or total bacterial load of >1e6 CFU/gram of tissue is present in the screening biopsy sample at the ulcer site, the patient should be given a single 7-day course of topical antibiotics and then redebrided and biopsied for quantitative culture. A second biopsy exceeding the limits above will result in exclusion from the study due to the high risk of local infection than may adversely affect ulcer closure.

• Revascularization surgery on the leg with the wound to be treated =8 weeks prior to signing the informed consent form

• Surgery to lengthen Achilles tendon on the leg with the wound to be treated =8 weeks prior to signing the informed consent form

• Necrosis, purulence, or sinus tracts that cannot be removed by debridement on foot to be treated

• Needs concurrent topical antimicrobials to treat the ulcer site, or received such therapies within 7 days prior to signing the informed consent form

• Received dermal substitute or living skin equivalent (e.g., Dermagraft® or Appligraf®) within 30 days prior to signing the informed consent form

• Received prior PDGF-BB (Regranex®/becaplermin) therapy within 30 days prior to signing the informed consent form

• Has known sensitivity to products of bovine origin

• Life expectancy of less than 12 months

• Patients with a definite diagnosis of any immunodeficiency disorder

• Viral hepatitis [patient must have a negative hepatitis B surface-antigen (HBsAg) and hepatitis C antibody (HepCAb) test results obtained within 2 weeks prior to the Treatment Day (Day 1)]

• Active, uncontrolled connective tissue disease

• Renal failure as defined by serum creatinine >2.5 mg/dL

• Liver function studies (e.g., AST, ALT) that are >2.0 times upper limit of normal

• Poor nutritional status as measured by serum albumin <3.0 g/dL

• Active cancer or a history of cancer in the 5 years prior to signing the informed consent form (however, history of basal cell carcinoma is allowed)

• Active (i.e., recent onset of erythema, edema, and increased temperature of the foot with normal radiographs ) Charcot or other structural deformity that would prevent adequate off-loading of the study foot

• Treatment with any systemic corticosteroid, immunosuppressive chemotherapeutic agent, antiviral, or previous/current radiation therapy to lower extremity within 30 days prior to signing the informed consent form

• Received another investigational drug or biologic within 30 days prior to signing the informed consent form or currently participating in an investigational drug or biologic study

• A psychiatric condition or chronic alcohol or drug abuse problem, determined from the patient's medical history, which in the Investigator's opinion may pose a threat to patient compliance

• History of non-compliance with treatment or clinical visit attendance (i.e., this study requires that patients will comply with the protocol and ulcer care regimen)

Study Design

Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Caregiver, Investigator, Outcomes Assessor), Primary Purpose: Treatment

Related Conditions & MeSH terms

• Diabetic Foot

Intervention

Biological:
• GAM501
Ad5PDGF-B formulated in a collagen gel
• Placebo
Collagen gel

Other:
• Standard of care
moist dressing changes daily

Locations

Country	Name	City	State
United States	Leigh Valley Hospital	Allentown	Pennsylvania
United States	Johns Hopkins Bayview Medical Center	Baltimore	Maryland
United States	Bay Pines VAHCS	Bay Pines	Florida
United States	Boston Medical Center	Boston	Massachusetts
United States	University of North Carolina	Chapel Hill	North Carolina
United States	Absolute Foot Care	Chula Vista	California
United States	Presbyterian Hospital of Dallas	Dallas	Texas
United States	Dr. Jagpreet Mukker	Fresno	California
United States	Dr. Roy Kroeker DPM	Fresno	California
United States	University of Texas Medical Branch	Galveston	Texas
United States	St. Joseph Medical Center	Houston	Texas
United States	Karr Foot Kare	Lakeland	Florida
United States	Advanced Foot & Ankle Center	Las Vegas	Nevada
United States	Long Beach VA Health Care System	Long Beach	California
United States	Innovative Medical Technologies	Los Angeles	California
United States	LAC-USC Medical Center	Los Angeles	California
United States	Banner Baywood Medical Center	Mesa	Arizona
United States	University of Miami	Miami	Florida
United States	Baptist Medical Center South	Montgomery	Alabama
United States	North American Center for Limb Preservation	New Haven	Connecticut
United States	Division of Wound Healing & Regenerative Medicine NYU School of Medicine	New York City	New York
United States	Associated Foot & Ankle Specialists	Phoenix	Arizona
United States	Western Pennsylvania Hospital	Pittsburgh	Pennsylvania
United States	South Texas Foot Institute	San Antonio	Texas
United States	UCLA Medical Center Olive View	Sylmar	California
United States	Aung Foothealth Clinics	Tuscon	Arizona
United States	Warren General Hospital	Warren	Pennsylvania
United States	Providence Hospital Clinical Research Center	Washington Dc	District of Columbia
United States	Foot Doctors of Watsonville	Watsonville	California

Sponsors (2)

Lead Sponsor	Collaborator
Tissue Repair Company	Cardium Therapeutics

Country where clinical trial is conducted

United States, 

References & Publications (1)

Steed DL, Attinger C, Colaizzi T, Crossland M, Franz M, Harkless L, Johnson A, Moosa H, Robson M, Serena T, Sheehan P, Veves A, Wiersma-Bryant L. Guidelines for the treatment of diabetic ulcers. Wound Repair Regen. 2006 Nov-Dec;14(6):680-92. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Effect of GAM501 on the incidence of complete ulcer closure		Week 12 or earlier	No
Secondary	Time to complete ulcer closure		The time from treatment start to first visit when ulcer closure is documented	No
Secondary	The absolute change and percent change in ulcer area		From baseline ulcer area and measured at weekly intervals through week 12	No
Secondary	The durability of ulcer closure		Measured at 4 week intervals for 12 weeks from date of ulcer closure	No
Secondary	Ulcer healing trajectories will be assessed by plots of percentage of ulcer closure versus time		Week 12 or earlier	No
Secondary	Safety and tolerance		Week 12 or earlier	Yes

External Links

•   American Diabetes Association Web Page
•   MATRIX Phase 2b study website