Trial to Evaluate the Safety and Effectiveness of Treatment With COMS One Device in Subjects With Diabetic Foot Ulcers

Official title

Concurrent Optical and Magnetic Stimulation (COMS) for Treatment of Refractory Diabetic Foot Ulcer; a Prospective Randomized, Sham-controlled, Double-blinded, Pivotal Clinical Trial

Overview

The purpose of this clinical trial is to evaluate the safety and effectiveness of the treatment with the COMS One device in subjects with refractory diabetic foot ulcers (DFUs). The prospective randomized, double-blinded, sham-controlled trial is designed to demonstrate superiority of wound closure of the COMS One device to a sham-control device through 24 weeks post-application, when each is administered in conjunction with standard of care (SOC) in the treatment of DFUs.

Detailed description

The purpose of this clinical trial is to evaluate the safety and effectiveness of the treatment with the COMS One device in subjects with refractory diabetic foot ulcers (DFUs). The prospective randomized, double-blinded, sham-controlled trial is designed to demonstrate superiority of wound closure of the COMS One device to a sham-control device through 24 weeks post-application, when each is administered in conjunction with standard of care (SOC) in the treatment of DFUs.

Primary Objective:

The COMS One Therapy System is intended to promote wound healing in chronic DFUs. As part of the clinical investigation, the primary objective is to determine time to complete wound healing, defined as complete skin re-epithelialization without drainage confirmed by 2 consecutive trial visits 2 weeks apart.

Secondary Objectives:

Secondary objectives are confirmation of safety and assessment of wound healing parameters as well as subject and site reported outcomes.

A total of 450 subjects with refractory DFU will be screened. It is expected that 50% of subjects will be excluded from the trial if either of the following occurs between screening and randomization: \>30% wound closure over a period of 2 weeks or \>50% wound closure over a period of 4 weeks (measured post-debridement). The remaining 224 subjects will be randomized into two groups (112 Subjects Sham device treated; 112 Subjects COMS One device treated) to account for approximately 10% missing data due to early trial withdrawal or missed endpoint assessment.

Interventions

• Device COMS One device
  The COMS One device incorporates technologies for optical and magnetic stimulation. The optical stimulation component is designed to emit light by two types of light emitting diodes (LEDs) in the wavelength of 660 nm (red) and 830 nm (near infrared) range of the electromagnetic spectra. The magnetic stimulation component is generated by a coil emitting pulse modulated magnetic fields in the extremely low frequency (ELF) range of the electromagnetic spectra. The COMS One is a lightweight, portabl
• Device Sham device
  The Sham device is a lightweight, portable device. The device is applied via a single use disposable component (COMStouch) that provides a base and sterile barrier for the unit. The device is attached via a single use strap (COMSfix). The device has been slightly adapted in order to make sure blinding is achieved/maintained. The specific features that have been modified for the purposes of blinding include the following: 1) therapeutic output, and 2) sensor detecting whether the device is lying

Primary outcome measures

• Complete wound healing [Time frame: 24 weeks post-application]

Secondary outcome measures (9)

• Time to ≥50% wound area reduction [Time frame: Through 24 weeks]
• Time to ≥90% wound area reduction [Time frame: Through 24 weeks]
• Incidence of complete wound closure [Time frame: 8 week, 12 week, 16 week, 20 week and 24 week]
• Partial wound closure [Time frame: 8 week, 12 week, 16 week, 20 week and 24 week]
• Incidence of all related or serious adverse events [Time frame: Up to week 12 and week 24]
• Time to target diabetic foot ulcer re-occurrence [Time frame: Up to 24 weeks]
• Time to amputation [Time frame: Up to 24 weeks]
• Pain assessment [Time frame: Week 1, Week 8, Week 12, Week 24]
• Quality of life survey [Time frame: Week 1, Week 8, Week 12, Week 24]

Eligibility criteria

Inclusion criteria

• Subjects are male or female, ≥22 and ≤90 years of age
• Female subjects of childbearing potential must be willing to use acceptable methods of contraception (birth control pills, barriers, or abstinence) starting at screening and throughout the duration of their study participation.
• The participant (or LAR if applicable) must be able to understand and sign the informed consent form (ICF) and comply with requirements set in the protocol including trial visits, trial treatment and dressing regimens and compliance with required offloading device (if applicable)
• Type 1 or Type 2 diabetes mellitus
• Presence of one full-thickness DFU located at or below the malleoli (If the subject has more than one DFU that meets eligibility criteria, the investigator will designate one DFU as the target DFU to be treated in the trial)
• Wagner Grade 1 or 2 (without bone exposure)
• There is a minimum 2 cm margin between the target DFU and any other ulcer on that same foot, post-debridement
• Target DFU duration >30 days and <52 weeks
• Target DFU area between 0.5 - 25 cm2 at screening (Target DFU is ≥ 0.5cm2 after debridement at start of Run-In Phase)
• Adequate vascular perfusion of the target limb (same limb as where the target DFU is located) as evidenced by: either a skin perfusion pressure (SPP) measurement of ≥30mmHg OR an ankle-brachial index (ABI) >0.7 but less than 1.2 or a toe-brachial index (TBI) >0.4 but less than 1.1 or a transcutaneous oxygen pressure (TcPO2) >40mmHg

Exclusion criteria

• Known pregnancy or lactating
• Active skin cancer, a history of skin cancer or any other localized cancer, precancerous lesions or large moles in the areas to be treated.
• Subject who is taking any medications the Investigator believes may interfere with healing of the target DFU
• Subject who is currently undergoing treatment for an active systemic infection, including osteomyelitis
• Wagner Grade 3, 4 or 5
• Participation in another trial with investigational drug or device within the 30 days preceding and during the present trial
• Any co-morbid medical condition which places the subject at unreasonable risks in the opinion of the Investigator
• Subject has chronic renal insufficiency requiring dialysis (end stage renal disease)
• Subject is being treated with systemic corticosteroids (prednisone, dexamethasone, hydrocortisone, methylprednisolone, or similar) >10mg/day for more than 10 days or any dose >30 days
• For subjects in the 2-Week Run-In Phase: more than 30% closure of target DFU at Screening Run-In Phase Visit I or Randomization/Baseline Visit or more than 50% closure of target DFU between the 2 Week Historical Period and Randomization/Baseline Visit (measured post-debridement)
• For subjects in the 4-Week Run-In Phase: more than 30% closure of target DFU at Screening Run-In Visit II or between Screening Run-In Phase Visit II and Randomization/Baseline Visit or more than 50% closure of target DFU between Screening Run-In Phase Visit I and Randomization/Baseline Visit (measured post-debridement)
• Blood chemistry or counts values as follows (based on subject's medical files):

• Pre-albumin <10 mg/dL OR albumin <2.8 g/dL
• Serum BUN >60 mg/dL
• Serum creatinine >4.0 mg/dL
• WBC <2.0 x 109/L
• Hemoglobin <8.0 g/dL
• Absolute neutrophil <1.0 x 109/L
• Platelet count <50 x 109/L
• HbA1C >12%

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Double blind

Primary purpose

Treatment

Study locations

United States · 30 centers

• Titan Clinical Research — Mesa
• Southern Arizona VA Health Care System — Tucson
• Center for Clinical Research Inc. — Castro Valley
• VA Central California Healthcare — Fresno
• Limb Preservation Platform, Inc. — Fresno
• Angel City Research, Inc. — Los Angeles
• UCLA Ronald Regan - Department of Surgery — Los Angeles
• Center for Clinical Research Inc. — San Francisco
• … and 22 more centers

Publications

• Galiano RD, Li RA, Lantis JC, Oropallo A, Ulloa J, Iafrati M, Lavery LA, O'Connell J, Nouvong A. The trial design of the concurrent optical and magnetic stimulation (COMS) therapy study for refractory diabetic foot ulcers (MAVERICKS): a multicenter, randomized, sham-controlled, double-blind investigational device exemption clinical study. Wounds. 2025 Aug;37(8):275-282. doi: 10.25270/wnds/25037. PMID 40931367

Identifiers

NCT: NCT05758545 · COMS_03

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗