A Study to Look at the Effects of Four Weeks of Treatment on the Healing of Diabetic Foot Ulcers
Condition: Diabetic Foot Ulcers
MeSH terms: Diabetic Foot; Foot Ulcer; Ulcer
Intervention: Santyl; White Petrolatum
Intervention description: Apply an amount sufficient (thickness of a nickel) to cover the wound area. It will be applied once daily during the treatment phase, up to four weeks.; Apply an amount sufficient (thickness of a nickel) to cover the wound area. It will be applied once daily during the treatment phase, up to four weeks.
Intervention MeSH terms: Petrolatum
Phase: Phase 4
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Care Provider, Investigator)
Enrollment: 57.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: No

Summary:

      The purpose of this study is to assess the effect of four weeks of treatment with Santyl
      Ointment, compared to White Petrolatum, on the change from baseline in wound area of diabetic
      foot ulcers over four weeks, and on the proportion of subjects achieving complete wound
      closure within 12 weeks from initiation of treatment.
    

Eligibility criteria:

        Inclusion Criteria:

          -  The informed consent document Photography Release must be read, signed, and dated by
             the subject or the subject's legally authorized representative before conducting any
             study procedures or exams. In addition, the informed consent document must be signed
             and dated by the individual who consents the subject before conducting the screening
             visit. A photocopy of the signed informed consent document must be provided to the
             subject, and the original signed document placed in the subject's chart.

          -  Age 18 years and older. Subjects may be of either sex and of any race or skin type.

          -  Women of child-bearing potential (those who are not premenarchal, not surgically
             sterilized [hysterectomy or bilateral oophorectomy], or not post-menopausal) may
             participate in the study if they meet all of the following conditions:

               -  they are not breast feeding

               -  undertake an HCG serum pregnancy test, which must be negative

               -  they do not intend to become pregnant during the study

               -  they are using adequate birth control methods and they agree to continue using
                  those methods for the duration of the study

          -  Post-menopausal is defined as no period in the previous 12 months Adequate birth
             control methods are defined as: hormonal-topical, oral, implantable or injectable
             contraceptives; mechanical-spermicide in conjunction with a barrier such as a condom
             or diaphragm; IUD; or, surgical sterilization of partner. For non-sexually active
             females, abstinence may be regarded as an adequate method of birth control; however,
             if the subject becomes sexually active during the study, she must agree to use an
             adequate birth control method as described above for the remainder of the study.

        NOTE: Women who have had a bilateral tubal ligation are not considered to have been
        surgically sterilized and must agree to the conditions as specified above.

          -  Willing to make all required study visits and to use the Darco shoe off-loading device
             and insole.

          -  Able to follow instructions, particularly regarding the application of test articles
             and dressings at home. Able to apply the test article, or has a caregiver available to
             apply the test article according to the protocol.

          -  Have a diabetic foot ulcer, Wagner Grades† 1 or 2, on the plantar surface of the foot.

          -  Target ulcer present for at least 28 days, but no longer than 18 months, and has
             failed to close by ≥ 40% during the first 4 weeks of therapy administered during the
             past 4 to 8 weeks.

          -  Target ulcer area between 2 and 15 cm², post debridement, if required. 9- 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 > 30 mmHg OR a TcPO2 ≥ 40 mmHg;
             either secondary measure is acceptable, but if both are obtained, each must meet its
             respective cutoff.

          -  10. Reasonable control of blood glucose, as evidenced by a serum HbA1C ≤ 12% at
             screening.

          -  11.Acceptable state of health and nutrition as evidenced by a serum pre-albumin level
             ≥ 15 mg/dL (0.15 g/L) and serum albumin ≥ 2.0 g/dL (20 g/L) at screening.

          -  12. Hematology values in the following ranges: WBC ≥ 3.0x109/L Hgb ≥ 10.0 g/dL
             Neutrophils ≥ 1.5x109/L Platelets ≥ 75 x109/L Normal blood smear

          -  Blood chemistry values and urinalysis in the following ranges (Healthpoint Ranges):

        Total bilirubin ≤ 1.5 times the upper limit of normal (ULN) Alkaline phosphatase ≤ 2.5
        times the ULN Alanine transaminase (ALT) ≤ 2.5 times the ULN Aspartate transaminase (AST) ≤
        2.5 times the ULN Serum creatinine ≤ 1.5 times the ULN Urinalysis: WBC < 4/HPF; RBC < 4/HPF

        Exclusion Criteria:

          -  Contraindications or known hypersensitivity to the test articles or their components.

          -  Therapy with another investigational agent within 30 days, lower extremity angioplasty
             within 4 weeks, untreated osteomyelitis, or chemotherapy or radiation therapy within 5
             years prior to screening.

          -  Prior therapy of the target wound with Santyl.

          -  Current therapy with systemic antibiotics to treat a foot ulcer, or prescription
             topical antibiotics on the target ulcer.

          -  Target ulcer located over the heel (talus, distal calcaneous, navicular, or cuboid).

          -  Fracture of bones in the target ulcer foot occurring within the past 3 months.

          -  Cellulitis or abscess of the target ulcer foot.

          -  A positive result from the screening Quantitative Bacteriology (Qbac) biopsy. A wound
             will be considered infected if the laboratory findings reveal ≥ 106 colony forming
             units (cfu) per gram of tissue or > 1 beta-hemolytic Streptococcus per gram of tissue.

          -  Target ulcer tunneling, per probing.

          -  More than three DFU on the target foot. The target ulcer must be at least 2 cm from
             another ulcer.

          -  Concomitant severe burn, immunodeficiency disorder, hematologic disorder, or
             malignancy (other than non-melanoma skin cancer) beyond the in situ stage.

          -  Abnormal laboratory values that, in the opinion of the Principal Investigator, place
             the subject at risk for the study.

          -  Positive serum HCG pregnancy test.

          -  The Medical Monitor may declare any subject ineligible for a valid procedural or
             medical reason.