Using Derm-Maxx to treat diabetic foot ulcers that don't heal with standard care

A Randomized Controlled Multicenter Trial Examining the Effect of Derm-Maxx ADM on the Healing Rate of Chronic Diabetic Foot Ulcers

This study is testing if adding Derm-Maxx to standard treatment can help older adults with diabetic foot ulcers that haven't healed improve faster.

Quick facts

• Phase: Not applicable
• Study type: Interventional
• Enrollment: 150 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: Capsicure, LLC (Research network)
• Drugs / interventions: chemotherapy
• Locations: 11 sites (Athens, Alabama and 10 other locations)
• Trial ID: NCT06455475 on ClinicalTrials.gov

What this trial studies

This multicenter randomized open-label clinical study evaluates the effectiveness of Derm-Maxx as an additional treatment for patients with diabetic foot ulcers (DFUs) that have not responded to standard care. Eligible participants, primarily those aged 65 and older, will undergo a 2-week run-in period before being assigned to receive either Derm-Maxx combined with standard care or standard care alone. The study will track ulcer size changes and complete wound closure rates over a 12-week treatment period, with weekly assessments to monitor progress and any necessary dressing changes. Secondary outcomes will include pain levels and safety evaluations.

Who should consider this trial

Good fit: Ideal candidates are adults aged 18 and older with Type I or Type II Diabetes Mellitus and Wagner grade 1 or 2 diabetic foot ulcers that have not healed adequately with standard care.

Not a fit: Patients with diabetic foot ulcers that have been present for more than 12 months or those with ulcers not meeting the specified size criteria may not benefit from this study.

Why it matters

Potential benefit: If successful, this treatment could significantly improve healing rates for patients with chronic diabetic foot ulcers.

How similar studies have performed: While the use of acellular dermal matrices in wound care has been explored, this specific application of Derm-Maxx in diabetic foot ulcers represents a novel approach.

Eligibility criteria

Inclusion Criteria:

1. Subjects18 years of age or older. At least 50% of the enrolled population must be \> 65 years of age.
2. Subject history of Type I or Type II Diabetes Mellitus requiring treatment with oral medications and/or insulin replacement therapy.
3. Subjects with the following ulcer:

   A. Presence of a diabetic foot ulcer Wagner 1 or 2 grade at the first screening visit on any aspect of the foot, provided it is at or below the aspect of the medial malleolus. \[NOTE: If two or more DFUs are present with the same grade, the index ulcer is the largest ulcer and the only one evaluated in the study. Index ulcer must be more than 5 cm distant apart\].

   B. A diabetic foot ulcer present for greater than 4 weeks (documented in the medical record) but less than 12 months duration if being treated with active SOC.
4. Objectively, less than 20% healing in the two-week screening period prior to randomization.
5. Study ulcer is a minimum of 1.0 cm2 and a maximum of 25 cm2 post-debridement at first treatment visit.
6. Index ulcer and/or index ulcer limb may have had prior infection, but infection(s) must be adequately treated and controlled as defined by IDSA Guidelines Grade level 1.
7. The subject is able and willing to follow the protocol requirements.
8. Subject has signed informed consent.
9. Adequate circulation to the affected foot as demonstrated by a dorsum transcutaneous oxygen measurement (TCOM) or a skin perfusion pressure (SPP) measurement of ≥ 30 mmHg; an ABI between 0.7 and ≤ 1.3, or TBI of \>6 within 3 months of the first Screening Visit.
10. Negative pregnancy test for females of childbearing potential (e.g., not post- menopausal for at least one year or surgically sterile). Females of childbearing potential must be willing to use acceptable methods of contraception (birth control pills, barriers, or abstinence) starting at Screening and continuing through the duration of their study participation.
11. The index ulcer has been offloaded with protocol defined offloading device throughout the study run-in period for at least 14 days prior to randomization (Run- in period defined as Screening through TV1/Randomization).
12. The index ulcer has a clean base and is free of necrotic debris at time of placement of treatment product.

Exclusion Criteria:

1. Subject has a known life expectancy of \< 1 year.
2. Index ulcer has been present for \>1 year.
3. Patient does not have adequate 2-week historical data demonstrating \< 20% area reduction.
4. Subject is unable to comply with offloading device.
5. Presence of any condition(s) which seriously compromises the subject's ability to complete this study or has a known history of poor adherence to medical treatment.
6. Subject has ulcers that are completely necrotic or fibrotic tissue
7. Subject has major uncontrolled medical disorders such as serious cardiovascular, renal, liver or pulmonary disease, lupus, palliative care or sickle cell anemia.
8. Subject currently being treated for an active malignant disease or subjects with history of malignancy within the ulcer.
9. The Subject has other concurrent conditions that in the opinion of the Principal Investigator may compromise subject safety.
10. Known contraindications to acellular dermal matrices or known allergies to any of the Derm-Maxx components.
11. Concurrent participation in another clinical trial that involves an investigational drug or device that would interfere with this study.
12. Index ulcer has reduced in area by 20% or more after 2 weeks of standard of care from the first screening visit (S1) to the TV1/randomization visit.
13. Subject is pregnant or breastfeeding.
14. Subjects with a history of more than two weeks treatment with immunosuppressants (including systemic corticosteroids \>10mg daily dose), cytotoxic chemotherapy, or application of topical steroids to the ulcer surface within 30 days prior to randomization visit or who receive such medications during the screening period, or who are anticipated to require such medications during the course of the study.
15. Index ulcer has been previously treated with tissue engineered materials (e.g. Apligraf® or Dermagraft®) or other scaffold materials (e.g. Oasis, Matristem) within the last 30 days preceding the first treatment visit.
16. Affected extremity requiring hyperbaric oxygen during the trial or within 2 weeks of screening visit 1.
17. Presence of diabetes with poor metabolic control as documented with an HbA1c ≥12.0 within 30 days of randomization (TV1).
18. Index ulcer and/or index limb with presence of gangrene or unstable ischemia at screening (SV1).
19. Revascularization surgery on the lower extremity on which the index ulcer is located within 30 days of Screening Visit (SV1).
20. Index ulcer in the opinion of the Principal Investigator, is suspicious for cancer and should undergo an ulcer biopsy to rule out a neoplasm of the ulcer.
21. Any clinically significant finding, in the judgment of the Principal Investigator, that would place the subject at health risk, impact the study, or affect the completion of the study.

Where this trial is running

Athens, Alabama and 10 other locations

• North Alabama Research Center, LLC — Athens, Alabama, United States (Recruiting)
• Premium Podiatry — Encino, California, United States (Recruiting)
• Royal Research — Hollywood, Florida, United States (Recruiting)
• Bioresearch Partner — Miami, Florida, United States (Recruiting)
• Bioresearch Partner — Miami Lake, Florida, United States (Recruiting)
• Wahab Research — Las Vegas, Nevada, United States (Recruiting)
• Premium Foot and Ankle — Sanford, North Carolina, United States (Recruiting)
• Ohio Foot and Ankle Specialists — Ashtabula, Ohio, United States (Recruiting)
• Cleveland Foot and Ankle Clinic — Cleveland, Ohio, United States (Recruiting)
• ABC Podiatry — Columbus, Ohio, United States (Recruiting)
• Olympus Clinical Research — Sugar Land, Texas, United States (Recruiting)

Study contacts

• Principal investigator: Windy Cole, DPM — Capsicure, LLC
• Study coordinator: Marissa Docter, RN, BSN, MD

Conditions Diabetic Foot Ulcer; chronic ulcers; acellular dermal matrix; wound care