Lower extremity ulcers pose significant clinical, humanistic and economic burdens on society. Millions of Americans are afflicted with painful, open, draining sores on their lower extremities. These sores are referred to as venous leg ulcerations (VLUs).1-5 Under the best of circumstances these ulcers require weeks or months to heal. Not uncommonly wound care specialists see patients who have suffered for years or faced amputation of the limb as their only option to alleviate the pain. Standard of care will result in healing in 50% of venous leg ulcers in 12 weeks. However, roughly half of patients suffering from venous ulcers will require advanced therapy. Human amniotic membrane replaces the damaged extracellular matrix characteristic of chronic ulcers. In addition, it contains cytokines that may accelerate healing. In clinical practice and recent studies, Dehydrated Human Amniotic Membrane has appeared to be as effective as bioengineered skin products. This RCT is designed to evaluate Amnioband Dehydrated Human Amniotic Membrane in venous leg ulcers.
This study is a multi-center, randomized, trial designed to evaluate the safety and effectiveness of Amnioband Dehydrated Human Amniotic Membrane plus multi-layer compression therapy versus multi-layer compression alone in the healing of venous leg ulcers. The Standard of Care therapy in this study is multi-layer compression therapy. A number of compression bandaging systems are commercially available. The choice of compression will be at the discretion of the principle investigator. The Screening Phase (1-14 days) consists of a series of screening assessments designed to determine eligibility followed by, for those who meet the eligibility criteria (described in more detail below), At or up to 14 days before the first Screening Period Visit (S1), written informed consent from the subject will be obtained by the Investigator or suitably qualified designee before the performance of any other protocol-specific procedure. Subjects who have not been treated with compression therapy for the target ulcer must receive a minimum of 14 days of compression prior to enrollment. At the first Screening Period Visit (S1), the Investigator will select the study (target) ulcer. Each subject will have only one VLU selected as the study (target) ulcer. In the situation where a subject has more than one VLU at the S1 visit, the Investigator will select the largest VLU that meets the eligibility criteria of the protocol as the study (target) ulcer. The Screening Period is designed to determine whether subjects are eligible to proceed to the Treatment Period of the study. The Treatment Phase (12 Weeks) begins with a series of assessments designed to confirm the subjects' continued eligibility. Subjects who continue to meet eligibility criteria will be randomized to one of three groups: (1) standard of care: multi-layer compression (2) weekly application of Amnioband Dehydrated Human Amniotic Membrane (3) biweekly applications of Amnioband Dehydrated Human Amniotic Membrane. During the Treatment Phase, subjects will be evaluated on a weekly basis. Efficacy evaluations each week will include Investigator assessment of ulcer healing and measurements of ulcer size using a digital camera device. Safety evaluations during the Treatment Phase will consist of adverse event assessments at each visit. Subjects in any of the three groups whose ulcers do not achieve closure at 12 weeks will be deemed treatment failures. Subjects in the control arm may cross over to the Amnioband arm if they fail to achieve closure although these subjects will not be included in the analysis.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
240
Weekly application of Amnioband.
Biweekly application (every two weeks) of Amnioband.
Standard of care for this study is weekly multi-layer compression bandaging.
Brigham and Women's Hospital Wound Care Center
Boston, Massachusetts, United States
RECRUITINGPremier Surgical
Brick, New Jersey, United States
RECRUITINGInspira Medical Center - Elmer Wound Care Center
Elmer, New Jersey, United States
COMPLETEDSt John Medical Center
Tulsa, Oklahoma, United States
COMPLETEDThe Foot and Ankle Wellness Center
Ford City, Pennsylvania, United States
RECRUITINGArmstrong County Memorial Hospital
Kittanning, Pennsylvania, United States
RECRUITINGSerenaGroup Research Institute
Pittsburgh, Pennsylvania, United States
RECRUITINGMartinsville Research Institute
Martinsville, Virginia, United States
RECRUITINGTime to complete ulcer closure
Ulcer closure is based on wound area measurement and absence of wound exudate.
Time frame: 12 weeks
Proportion of ulcers achieving 40% ulcer closure
This is measured by wound area.
Time frame: 4 weeks
Percentage of ulcers achieving complete closure
This is measured by wound area and absence of wound exudate.
Time frame: 12 weeks
Incidence of adverse events
Time frame: 12 weeks
Cost effectiveness
The per unit cost of providing wound care is known. The use of amniotic membrane to standard of care will be compared in terms of the cost of achieving healing.
Time frame: 12 weeks
Reduction in pain between treatment groups
Pain is measured by subject report on a scale of 0 to 10.
Time frame: 12 weeks
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