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

Официальное название

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

Обзор

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.

Подробное описание

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.

Вмешательства

• Устройство 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
• Устройство 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

Первичные конечные точки

• Complete wound healing [Срок оценки: 24 weeks post-application]

Вторичные конечные точки (9)

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

Критерии участия

Критерии включения

• 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

Критерии исключения

• 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%

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Нет

Дизайн исследования

Распределение

Рандомизированное

Модель

Параллельные группы

Маскирование

Двойное слепое

Основная цель

Лечение

Центры проведения

США · 30 центров

• 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
• … и ещё 22 центра

Публикации

• 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

Идентификаторы

NCT: NCT05758545 · COMS_03

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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