Clinical trial NCT03455543: Dual Field PEMF Therapy in Lower Extremity Painful Diabetic Distal Symmetric Peripheral Neuropathy
Official title: A Multi-Center, Double-Blind, Sham-Controlled, Randomized Trial of Dual Field PEMF Therapy [Provant® Therapy System] in Lower Extremity Painful Diabetic Distal Symmetric Peripheral Neuropathy (DSPN) (The RELIEF Trial)
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Diabetic Neuropathy Peripheral
Lead sponsor: Regenesis Biomedical, Inc.
Sponsor class: INDUSTRY
First posted: 2018-03-06
Enrollment: 182
Sex: ALL
Minimum age (years): 22
Maximum age (years): 80
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: Two parallel groups, active device group versus sham device group. Subjects will be randomized 1:1 at baseline and treat with active PEMF or sham for 4 months.
Primary purpose: TREATMENT

Brief summary: Part A of this trial is a multi-center, prospective, double-blinded, sham-controlled, randomized clinical trial. Part A will evaluate PEMF treatment compared to sham treatment in patients with painful diabetic distal symmetric peripheral neuropathy (DSPN) when treatment is administered 30 minutes twice daily through a 120-day period (4 months). Part B is a 8-month open-label active treatment extension period designed to collect longer-term data on pain, medication use, quality of life and safety (Part B).Part B of this trial is a an extension period upon completion of Part A.

Detailed description: Eligible subjects will be entered into a 14-day ePRO diary run-in period to collect average baseline pain scores related to their diabetic neuropathy in the lower extremities, diary compliance, and analgesic consumption (maintenance and prn prescribed peripheral neuropathic pain medication pill counts). Subjects will collect electronic patient-reported outcome (ePRO) data each morning around the same time during the run-in period.

Subjects will return to the clinic at Baseline (Day 0) for review of eligibility, diary compliance, average baseline diabetic neuropathic pain score of ≥4 and \<9, and review of stable analgesic pain consumption profile during the 14-day run-in period. Qualified subjects based on diary compliance and average pain score will be randomized 1:1 (active: sham) and will be instructed to self-treat twice daily for 120 days. Subjects will record electronic patient-reported outcome (ePRO) data following each morning treatment for 120 days. Subjects consenting to distal thigh and distal leg skin biopsies during the Screening visit will have biopsies collected and sent to the central laboratory for assessment. All subjects will have baseline assessments conducted.

Subjects will receive a telephone call at Day 7 to ensure compliance to treatment and diary completion, provide follow-up information on the biopsy sites (if applicable), complete a blinding assessment as well as be assessed for safety and concomitant medication changes.

At Month 1 subjects will return to the clinic for evaluation of safety, concomitant medication changes, review device usage and ePRO diary completion, and Patient Global Impression (PGI). Treatment satisfaction will also be assessed.

At Month 2 subjects will return to the clinic for evaluation of safety, concomitant medication changes, treatment satisfaction, review of device usage (reports will be supplied to the site) and ePRO diary completion, quality of life outcomes (WPAIQ and NeuroQoL), Patient Global Impression (PGI), and interim visit measurements of SPP.

At Month 3, subjects will return to the clinic for evaluation of safety, concomitant medication changes, review device usage (reports will be supplied to the site) and ePRO diary completion, and Patient Global Impression (PGI). Treatment satisfaction will also be assessed.

At Month 4 (end of Part A / start of Part B), subjects will return to the clinic for evaluation of safety, treatment satisfaction, review of device usage (reports will be supplied to the site), HbA1c, concomitant medication changes, weight, quality of life outcomes (WPAIQ and NeuroQoL), PGI, final measurements of SPP, NCS, QST and be assessed to determine their Toronto Clinical Neuropathy Score. Those subjects who consented and had biopsies collected at the Enrollment visit, will have their end of study biopsies during this visit and samples sent directly to the central laboratory for assessment. Subjects will return the study device and complete a blinding assessment.

Subjects that complete Part A will continue into the open-label extension period (Part B). All subjects will be reconsented if not completed at a prior visit and given an open-label active device. Subjects will record ePRO data for one week prior to the Month 6, 8, 10, and 12 visits following each morning treatment. Subjects will be reminded of the150-day (Month 5) phone call.

At Month 5, subjects will receive a telephone call to ensure compliance to treatment, and to be assessed for safety and concomitant medication changes.

At Month 6, subjects will receive a telephone call to ensure treatment compliance and collection of diary data, and to assess safety and concomitant medication changes.

At Month 7, subjects will receive a telephone call to ensure treatment compliance, and to assess safety and concomitant medication changes.

At Month 8, subjects will return to the clinic for evaluation of safety, measure QST, treatment satisfaction, review of device usage and collection of diary data, concomitant medication changes, quality of life outcomes (NeuroQoL), and PGI.

At Month 9, subjects will receive a telephone call to ensure treatment compliance, and to assess safety and concomitant medication changes.

At Month 10, subjects will receive a telephone call to ensure treatment compliance and collection of diary data, and to assess safety and concomitant medication changes.

At Month 11, subjects will receive a telephone call to ensure treatment compliance, and to assess safety and concomitant medication changes.

At Month 12 (end of open-label treatment extension), subjects will return to the clinic for evaluation of safety, weight, QST, NCS, TCNSS, PGI, treatment satisfaction, review of device usage and collection of diary data, concomitant medication changes, quality of life outcomes (NeuroQoL), and will return the study device. Subjects who consented and had biopsies collected at the 4 Month visit, will have their end of study biopsies performed during this visit.

Eligibility criteria: Inclusion Criteria:

* Type 1 or Type 2 diabetes
* Pain attributed to symmetrical lower extremity diabetic peripheral neuropathy for at least 6 months
* DPN pain over the preceding 24 hours is ≥4 and \<9 based on the 11-point NPRS (0-10)
* 22 to 80 years of age
* On stable diabetes treatment
* HbA1c less than or equal to 10%
* No recent changes to analgesic prescriptions
* ABI of ≥0.8 to ≤1.3
* Walks independently
* Willing and able to give consent
* If female, must be post-menopausal, surgically sterile, abstinent or practicing an effective method of birth control
* Can access an internet browser or smart phone

To be randomized after the 14-day run-in period, average pain (NPRS) must be ≥ 4 and \< 9 over preceding 7 days and subject must be 70% compliant with ePRO assessments (electronic diary)

Exclusion Criteria:

* Active, open ulcer on either extremity
* Significant peripheral vascular disease
* Venous insufficiency
* History of solid organ transplant or severe renal disease
* Diagnosed with a non-diabetic cause of chronic neuropathy
* Previous or current history of primary or tertiary hyperparathyroidism, hypercalcemia, psychiatric disorder, alcohol dependency, Hepatitis B or C, or HIV infection
* Significant cardiovascular disease
* Uncontrolled medical illness
* Requires or anticipates the need for surgery during the study
* Total foot depth of \>8 cm
* Has received any investigational drug or device within 30 days
* Has used systemic corticosteroids within 3 months
* History of malignancy within 5 years in treatment area
* A psychiatric disorder of sufficient severity
* Receiving prn narcotic medications
* History of drug or alcohol abuse within 1 year
* Implanted pacemaker, defibrillator, neurostimulator, spinal cord stimulator, bone stimulator, cochlear implant, or other implanted device with an implanted metal lead(s0
* Pregnant or planning to become pregnant
* Previous treatment with Provant Therapy
* Unwilling to follow instructions or comply with study instructions
* Pain from any other source that could confuse DPN pain assessment
* Clinically significant foot deformity
* Skin condition that could alter peripheral sensations
* Previous surgery to the spine or lower extremity with residual symptoms of pain or difficulty with movement.
* Clinically significant arthropathy

Primary outcomes:
measure: Change in Pain Intensity
timeFrame: Baseline through 4 months
Secondary outcomes:
measure: Patients With 2 Point or 30% Reduction in Pain at 4 Months
timeFrame: Baseline to 4 months
measure: Patient Global Impression at 4 Months
timeFrame: Baseline through 4 months.
measure: Time to 30% or 2-point Reduction in NPRS, Whichever Comes First, Through 4 Months
timeFrame: Through 4 months
measure: Change in Neuropathy Related Quality of Life (NeuroQoL) Between Baseline and End of Treatment at 4 Months.
timeFrame: Baseline to 4 months
measure: Change is Skin Perfusion Pressure (SPP) for Baseline to End of Treatment at 4 Months
timeFrame: Baseline to 4 months
measure: Changes in Nerve Conduction Studies of Velocity Between Baseline and End of Treatment at 4 Months.
timeFrame: Baseline to 4 Months
measure: Changes in Quantitative Sensory Testing (QST) Between Baseline and End of Treatment at 4 Months.
timeFrame: Baseline to 4 months
measure: Changes in Nerve Conduction Studies of Amplitude Between Baseline and End of Treatment at 4 Months.
timeFrame: Baseline to 4 Months
Other outcomes:
measure: Exploratory Endpoint: Changes in the Work Productivity and Activity Impairment Questionnaire (WPAIQ) (Questions 2-4)
timeFrame: Baseline to 4 Months
measure: Exploratory Endpoint: Changes in Intraepidermal Nerve Fiber Density (IENFD) at the Distal Thigh and Distal Leg - Part A
timeFrame: Baseline to Month 4
measure: Exploratory Endpoint: Change in Pain Intensity During Part B
timeFrame: Baseline through 12 months
measure: Exploratory Endpoint: Changes in Nerve Conduction Studies of Velocity During Part B
timeFrame: Baseline to Month 12
measure: Exploratory Endpoint: Change in Neuropathy Related Quality of Life (NeuroQoL) During Part B
timeFrame: Baseline to Month 12
measure: Exploratory Endpoint: Changes in Nerve Conduction Studies of Amplitude During Part B
timeFrame: Baseline to Month 12
measure: Exploratory Endpoint: Changes in the Work Productivity and Activity Impairment Questionnaire (WPAIQ) (Questions 5-6)
timeFrame: Baseline to 4 Months
measure: Exploratory Endpoint: Changes in Intraepidermal Nerve Fiber Density (IENFD) at the Distal Thigh and Distal Leg - Part B
timeFrame: Baseline to Month 12
Locations:
city: Mesa
country: United States
facility: Physician's Research Group
state: Arizona
city: Northridge
country: United States
facility: Valley Clinical Research
state: California
city: Sacramento
country: United States
facility: Northern California Research
state: California
city: Tustin
country: United States
facility: Diabetes Research Center
state: California
city: Denver
country: United States
facility: Mountain View Clinical Research
state: Colorado
city: Eustis
country: United States
facility: Lake Internal Medicine Associates
state: Florida
city: Fort Myers
country: United States
facility: Clinical Physiology Associates
state: Florida
city: Miami
country: United States
facility: Spotlight Research Center
state: Florida
city: Winter Haven
country: United States
facility: Clinical Research of Central Florida
state: Florida
city: Blue Ridge
country: United States
facility: River Birch Research Alliance, LLC
state: Georgia
city: Evansville
country: United States
facility: MediSphere Medical Research Center, LLC
state: Indiana
city: Wichita
country: United States
facility: Heartland Research Associate, LLC
state: Kansas
city: Hazelwood
country: United States
facility: Healthcare Research Network
state: Missouri
city: Kansas City
country: United States
facility: The Center for Pharmaceutical Research, LLC
state: Missouri
city: Las Vegas
country: United States
facility: Palm Research Center
state: Nevada
city: Westfield
country: United States
facility: Great Lakes Medical Resarch
state: New York
city: Cary
country: United States
facility: Wake Family Medicine, PC
state: North Carolina
city: Renton
country: United States
facility: Rainier Clinical Research
state: Washington
Study officials:
References: