Clinical trial NCT02224742: LeucoPatch in the Management of Hard-to-heal Diabetic Foot Ulcers
Official title: LeucoPatch in the Management of Hard-to-heal Diabetic Foot Ulcers
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE4
Conditions: Diabetic Foot Ulcer
Lead sponsor: Nottingham University Hospitals NHS Trust
Sponsor class: OTHER
First posted: 2014-08-25
Enrollment: 269
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: Diabetic foot ulcers are the source of considerable suffering and cost and there are currently no wound care products available that have been demonstrated to improve healing, or that are cost effective. There have however been a small number of studies which have examined the use of platelets or fluid derived from platelets, either from the patient's own blood or from blood bank products. These have suggested some promise, but have suffered from technical difficulties in making a suitable wound care product or the volume of blood required to derive the product. It is thought that the reason why they may work is that growth factors released by the platelets may stimulate the wound to heal.

This study will be a formal, randomised controlled trial to assess a new device for creating a wound care product which is a plug or patch comprising fibrin, white cells and platelets derived from 18 mls of the patients own blood. The application of this fibrin/white cell/platelet patch to the patients wound on a weekly basis will be compared with usual best care in patients with hard to heal Diabetic Foot Ulcers in a secondary care setting in 25 centres in the United Kingdom, Denmark and Sweden.


Eligibility criteria: Inclusion Criteria:

* People aged 18 years and over who have diabetes complicated by one or more ulcers on a foot or both feet below the level of the malleoli, excluding ulcers confined to the interdigital cleft.
* Those with more than one eligible ulcer will have one - usually the largest or more clinically significant - selected at screening as the index ulcer.
* Eligible ulcers will be hard-to-heal, meaning that the cross-sectional area will decrease by less than 50 % during a four week run-in period.
* The cross-sectional area of the index ulcer will be ≥50 and ≤1000 mm2 at the end of the 4 week run-in period.
* At randomisation, the index ulcer will be clinically non-infected according to IDSA criteria
* Either the ankle-brachial index (ABPI) in the affected limb will be between 0.50 and 1.40 or the dorsalis pedis pulse and/or tibialis posterior pulse will be palpable.
* HbA1c ≤108 mmol/mol at screening
* Participants will have the capacity to understand study procedures, and will be able to provide written informed consent.

Exclusion Criteria:

* Haemoglobin concentration \<105 g/L or 6.5 mmol/L at screening.
* Presence of sickle-cell anaemia, haemophilia, thrombocytopenia (\<100x109/L) or other clinically significant blood dyscrasia
* Known potential infectivity of blood products, including known HIV and hepatitis
* Dialysis or an estimated GFR (based on cystatine C or serum creatinine) \<20 ml/min/1.73m2
* Increase in cross-sectional area of the index ulcer by ≥25% during the 4 week run-in period, or is either smaller than 50 mm2 or larger than 1000 mm2 at the end of that time.
* Clinical signs of infection of the index ulcer or reason to suspect that infection is present at randomisation.
* Revascularisation procedure in the affected limb planned, or undertaken within the preceding 4 weeks.
* Current treatment with cytotoxic drugs or with systemically administered glucocorticoids or other immunosuppressants.
* Treatment of foot ulcers with growth factors, stem cells or equivalent preparation within the preceding 8 weeks
* The need for continued use of negative pressure wound therapy
* Likely inability to comply with the need for weekly visits because of planned activity.
* Participation in another interventional clinical foot ulcer-healing trial within last the 4 weeks at the time of screening.
* Prior randomisation in this trial.
* Judgement by the investigator that the patient does not have the capacity to understand the study procedures or provide written informed consent.

Primary outcomes:
measure: Healing
timeFrame: Within 20 weeks of randomisation
Secondary outcomes:
Other outcomes:
Locations:
city: Gentofte
country: Denmark
facility: Steno Diabetes Center
city: Herlev
country: Denmark
facility: Herlev Hospital
city: Hillerød
country: Denmark
facility: Nordsjællands Hospital
city: Kobenhavn NV
country: Denmark
facility: Bispebjerg Hospital
city: Kolding
country: Denmark
facility: Kolding Sygehus
city: Odense
country: Denmark
facility: Odense University Hospital
city: Viborg
country: Denmark
facility: Viborg Sårcenter
city: Kristianstad
country: Sweden
facility: Centralsjukhuset Kristianstad
city: Lund
country: Sweden
facility: Skåne University Hospital
city: Solna
country: Sweden
facility: Karolinska University Hospital
city: Truro
country: United Kingdom
facility: Royal Cornwall Hospitals NHS Trust
state: Cornwall
city: Torquay
country: United Kingdom
facility: South Devon Healthcare NHS Foundation Trust
state: Devon
city: Ipswich
country: United Kingdom
facility: The Ipswich Hospital NHS Trust
state: Suffolk
city: Pontefract
country: United Kingdom
facility: The Mid Yorkshire Hospitals NHS Trust
state: West Yorkshire
city: Barnsley
country: United Kingdom
facility: Barnsley Hospital NHS Foundation Trust
city: Bradford
country: United Kingdom
facility: Bradford Teaching Hospitals NHS Foundation Trust
city: Chorley
country: United Kingdom
facility: Lancashire Teaching Hospitals NHS Foundation Trust
city: Dartford
country: United Kingdom
facility: Dartford and Gravesham NHS Trust
city: Derby
country: United Kingdom
facility: Derby Hospitals NHS Foundation Trust
city: Dudley
country: United Kingdom
facility: The Dudley Group NHS Foundation Trust
city: Exeter
country: United Kingdom
facility: Royal Devon & Exeter NHS Foundation Trust
city: Gateshead
country: United Kingdom
facility: Gateshead Health NHS Foundation Trust
city: Harrogate
country: United Kingdom
facility: Harrogate and District NHS Foundation Trust
city: Leeds
country: United Kingdom
facility: The Leeds Teaching Hospitals NHS Trust
city: Leicester
country: United Kingdom
facility: University Hospitals of Leicester NHSTrust
city: Lincoln
country: United Kingdom
facility: United Lincolnshire Hospitals NHS Trust
city: Norwich
country: United Kingdom
facility: Norwich and Norwich University Hospitals NHS Foundation Trust
city: Nottingham
country: United Kingdom
facility: Nottingham University Hospitals NHS Trust
city: Reading
country: United Kingdom
facility: Royal Berkshire NHS Foundation Trust
city: Sheffield
country: United Kingdom
facility: Sheffield Teaching Hospitals NHS Foundation Trust
city: Sunderland
country: United Kingdom
facility: City Hospitals Sunderland NHS Foundation Trust
city: Wolverhampton
country: United Kingdom
facility: Royal Wolverhampton Hospitals NHS Trust
Study officials:
affiliation: University Hospitals of Derby and Burton NHS Foundation Trust
name: Frances Game, FRCP
role: PRINCIPAL_INVESTIGATOR
References:
citation: Game F, Jeffcoate W, Tarnow L, Jacobsen JL, Whitham DJ, Harrison EF, Ellender SJ, Fitzsimmons D, Londahl M; LeucoPatch II trial team. LeucoPatch system for the management of hard-to-heal diabetic foot ulcers in the UK, Denmark, and Sweden: an observer-masked, randomised controlled trial. Lancet Diabetes Endocrinol. 2018 Nov;6(11):870-878. doi: 10.1016/S2213-8587(18)30240-7. Epub 2018 Sep 19.