TWB-103 for Adult Patients With Split-Thickness Skin Graft Donor Site Wounds

Phase 1

Completed

Conditions: Donor Site Complication

Interventions: Drug: TWB-103 Group
Drug: Placebo Group

Registration Number: NCT02737748

Lead Sponsor: Transwell Biotech Co., Ltd.

Brief Summary: Primary objective:

1. To evaluate the safety of TWB-103 in split-thickness skin graft donor site wounds (DSW) for Phase I in terms of Incidence of treatment-related AEs and SAEs (including infections and bleeding)

2. To evaluate the efficacy for Phase I+II of TWB-103 in split-thickness skin graft donor site wounds (DSW) in terms of The healing time from DSW creation to 100% re-epithelialization

Secondary objective:

1. To evaluate the efficacy of TWB-103 in split-thickness skin graft donor site wounds (DSW) in secondary efficacy endpoints

2. To evaluate the safety of TWB-103 in split-thickness skin graft donor site wounds (DSW) in secondary safety endpoints

Detailed Description: The study was designed to evaluate the safety and efficacy of the TWB-103 in adult subjects with split-thickness skin graft donor site wounds (DSW). In Phase I proportion, eligible subjects were recruited sequentially with one week staggering of treatment. Eligible subjects were randomized into TWB-103 or Placebo groups in a 1:1 ratio. Phase I was planned to recruit 3 evaluable subjects each in TWB-103 and Placebo groups. Evaluable subjects in Phase I were (1) he/she who received at least one dose and had follow-up evaluation at least 14 days after the first dose or (2) he/she who received at least one dose and had early withdrawn due to safety reasons before Day 28. When all of those 6 evaluable subjects completed the planned treatment period (14 days or till first 100% re-epithelialization, which came first), the recruitment was temporarily stopped for 14 days for safety observation. The safety data before and on Day 28 Visit were reviewed by the sponsor and the principal investigator. If no safety issue was decided, the study would enter Phase II portion and eligible subjects would be randomized into a 1:1 ratio into one of the TWB-103 and Placebo groups. The dosing regimen designed in Phase II portion was the same as it was designed in Phase I portion.

Subjects were instructed to attend scheduled visits at Screening, Day 0 (treatment start the day), Day 3, Day 7, Day 10, and Day 14 (end of treatment). All subjects were scheduled to attend a follow-up visit on Day 28 to evaluate the status of the target wound and then enter a 360-day follow-up phase. During the 360-day follow-up, four follow-up visits were scheduled at 90±14 days, 180±14 days, 270±14 days, and 360±14 days following the subject's Day 28 visit (if no Day 42 visit) or Day 42 visit.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 48

Inclusion Criteria

Female/male patients, aged 20-65 years old
Presenting a split-thickness skin graft donor site wound with a minimum size of 15 cm2 but no more than 100 cm2, with a minimum width of 3 cm and with an approximate thickness of 0.010~0.012 inches. The graft cannot be harvested from a site from which a skin graft was previously obtained.
If the primary wound is a result of a thermal or chemical burn, the total body surface area of the said wound must be less than 15%.
Females of childbearing potential must have a documented negative serum pregnancy test done at the screening visit, which is within 2 weeks prior the DSW creation and the treatment
Both male and female patients must agree to use highly effective contraceptives from signing informed consent to 30 days after the last dose administration.
Willing to comply with the study protocol and to sign the Informed Consent Form

Exclusion Criteria

Female patients who are pregnant or lactating or planning a pregnancy and any male patient whose partner (wife) planning a pregnancy from signing informed consent to 30 days after the last dose administration.
Clinically significant disease or condition that may compromise graft take and/or donor site healing (e.g. the presence of a bleeding disorder, capillary fragility, venous or arterial disorder directly affecting the donor site to be treated, known or suspected systemic malignancies, human immunodeficiency virus infection, renal or liver disease, uncontrolled diabetes mellitus, thrombocytopenia, vasculitis, poor nutritional status).
Patients who are currently receiving or have received the following treatments within 4 weeks prior to study entry are excluded from the study:
1. systemic or inhaled corticosteroids or immunosuppressant agents; or
2. therapeutic doses of anticoagulants (e.g. Coumadin, Heparin, low molecular weight Heparin) for pre-existing medical conditions, for whom a dose interruption from Screening through the end of the study period is contraindicated.
Autoimmune disease, e.g. lupus erythematosus, multiple sclerosis.
Hematologic disease, malignancy or hypo-immunity.
History of HIV or congenital immunodeficiency.
History of alcoholism or drug abuse.
Have used any tobacco product within 1 week prior to Day 0.
Patients previously treated with any cell-based product, including autologous tissue at the treatment site.
Received an investigational drug, device or biological/bioactive treatment within 30 days prior to Screening Visit.
Any clinical condition or significant concurrent disease judged by the investigator to complicate the evaluation of the trial treatment.
History of sensitivity to bovine or porcine origin materials, or human serum albumin.
DSWs located in the face, over joints, lower legs or the buttocks
Any of the following hematologic abnormalities: (Hemoglobin < 10.0 g/dL, ANC < 1,500/μL, platelets < 75,000 /μL)
Any of the following serum chemistry abnormalities: (Total bilirubin > 1.5 × ULN, AST or ALT > 3 × ULN, gamma-GT > 2.5 x ULN, Alk-P > 2.5 x ULN, serum albumin < 2.7 g/dL, creatinine >1.5 x ULN, any other ≥ Grade 2 laboratory abnormality (based on CTCAE) at baseline (other than those listed above)
DSWs in area with active skin infection or with skin condition that is considered highly susceptible to infection judged by the investigator

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
TWB-103 Group	TWB-103 Group	Subjects will receive TWB-103 2 to 3 times till 100% re-epithelialization or up to 10 days (around once every 3 days).
Placebo Group	Placebo Group	Subjects will receive placebo 2 to 3 times till 100% re-epithelialization or up to 10 days (around once every 3 days).

Primary Outcome Measures

Name	Time	Method
Number of Participants With Treatment-related AEs and SAEs (Including Infections and Bleeding)	Day 0~Day 28	The number of participants with treatment-related AEs and SAEs (including infections and bleeding) will be observed for the 7 patients in Phase I
The Healing Time From DSW Creation to the First 100% Re-epithelialization With Confirmation for at Least 10 Days Apart Assessed by the Investigator	Days 42 or earlier	The healing time from DSW creation to the first 100% re-epithelialization with confirmation for at least 10 days apart assessed by the investigator for all patients in Phase I and II.
Number of Participants Reached Confirmed Healing Within 28 Days.	Days 42 or earlier	The number of participants in Phase I and II reached confirmed healing by the investigator within 28 days.

Secondary Outcome Measures

Name	Time	Method
Changes in Post-treatment Vital Signs-body Temperature Compared to Baseline	Days 3, 7, 10, 14, 28, 42	Changes in post-treatment vital signs-body temperature will be analyzed for all patients in Phase I and II.
Changes in Post-treatment General Laboratory Assessment-hematology-Hemoglobin Compared to Baseline	Days 3, 7, 10, 14, 28, 42	Changes in post-treatment general laboratory assessment-hematology-hemoglobin will be analyzed for all patients in Phase I and II.
Changes in Post-treatment General Laboratory Assessment-hematology-Hematocrit Compared to Baseline	Days 3, 7, 10, 14, 28, 42	Changes in post-treatment general laboratory assessment-hematology-hematocrit will be analyzed for all patients in Phase I and II.
Changes in Post-treatment General Laboratory Assessment-hematology-platelets Compared to Baseline	Days 3, 7, 10, 14, 28, 42	Changes in post-treatment general laboratory assessment-hematology-platelets will be analyzed for all patients in Phase I and II.
Changes in Post-treatment General Laboratory Assessment-hematology-red Blood Cells Compared to Baseline	Days 3, 7, 10, 14, 28, 42	Changes in post-treatment general laboratory assessment-hematology-red blood cells will be analyzed for all patients in Phase I and II.
Changes in Post-treatment General Laboratory Assessment-biochemistry-aspartate Aminotransferase Compared to Baseline	Days 3, 7, 10, 14, 28, 42	Changes in post-treatment general laboratory assessment-biochemistry-aspartate aminotransferase will be analyzed for all patients in Phase I and II.
Changes in Post-treatment General Laboratory Assessment-biochemistry-alanine Aminotransferase Compared to Baseline	Days 3, 7, 10, 14, 28, 42	Changes in post-treatment general laboratory assessment-biochemistry-alanine aminotransferase will be analyzed for all patients in Phase I and II.
Changes in Post-treatment General Laboratory Assessment-biochemistry-serum Creatinine Compared to Baseline	Days 3, 7, 10, 14, 28, 42	Changes in post-treatment general laboratory assessment-biochemistry-serum creatinine will be analyzed for all patients in Phase I and II.
Changes in Post-treatment General Laboratory Assessment-biochemistry-blood Urea Nitrogen Compared to Baseline	Days 3, 7, 10, 14, 28, 42	Changes in post-treatment general laboratory assessment-biochemistry-blood urea nitrogen will be analyzed for all patients in Phase I and II.
Changes in Post-treatment General Laboratory Assessment-biochemistry-Albumin Compared to Baseline	Days 3, 7, 10, 14, 28, 42	Changes in post-treatment general laboratory assessment-biochemistry-albumin will be analyzed for all patients in Phase I and II.
Changes in Post-treatment General Laboratory Assessment-biochemistry-bilirubin Compared to Baseline	Days 3, 7, 10, 14, 28, 42	Changes in post-treatment general laboratory assessment-biochemistry-bilirubin will be analyzed for all patients in Phase I and II.
Changes in Post-treatment General Laboratory Assessment-biochemistry-gamma-glutamyl Transferase Compared to Baseline	Days 3, 7, 10, 14, 28, 42	Changes in post-treatment general laboratory assessment-biochemistry-gamma-glutamyl transferase will be analyzed for all patients in Phase I and II.
Changes in Post-treatment General Laboratory Assessment-biochemistry-alkaline Phosphatase Compared to Baseline	Days 3, 7, 10, 14, 28, 42	Changes in post-treatment general laboratory assessment-biochemistry-alkaline phosphatase will be analyzed for all patients in Phase I and II.
Changes in Post-treatment Physical Examination Compared to Baseline	Days 3, 7, 10, 14, 28, 42	Changes in post-treatment physical examination will be analyzed for all patients in Phase I and II.
Changes in Post-treatment Vital Signs-pulse Rate Compared to Baseline	Days 3, 7, 10, 14, 28, 42	Changes in post-treatment vital signs-pulse rate will be analyzed for all patients in Phase I and II.
The Healing Time From DSW Creation to the First 100% Re-epithelialization With Confirmation for at Least 10 Days Apart, Assessed by the First Additional Evaluator	Days 42 or earlier	The healing time from DSW creation to the first 100% re-epithelialization with confirmation for at least 10 days apart assessed by the investigator for all patients in Phase I and II. The first additional evaluator judged the healing status by looking at the photos of DSW.
Number of Participants With Complete Wound Closure at Day 7, 10 and 14 After DSW Creation.	Day 7, 10 and 14	Complete wound closure is defined as skin 100% re-epithelialization without drainage or dressing requirements. This endpoint will be in all patients in Phase I and II.
The Healing Percentage of Wounds (Ratio of Healing Area and Original Area) at Days 7, 10 and 14 After DSW Creation	Day 7, 10 and 14	The healing percentage of wounds will be calculated based on the healing area measured on Day 7, 10 and 14, comparing to the original area measured on Day 0 for all patients in Phase I and II.
The Pain Change From Baseline to Post-wound Creation Visits Based on Short-form McGill Pain Questionnaire Score	Days 3, 7, 10, 14, 28, 42, Day 90/180/270/360 from Day 28 or 42	All patients in Phase I and II will evaluate the pain based on Short-form McGill pain questionnaire at each visit. The visual analogue scale (VAS) for pain is a continuous scale comprised of a horizontal line, usually, 10 cm (= 100 mm) in length, scored from 0 (none) to 10 (extreme). On this scale, a higher score in VAS indicates the worse pain.
Number of Participants With AEs and SAEs	Screening~ Day 360 from Day 28 or 42	The number of participants with AEs and SAEs will be analyzed for all patients in Phase I and II.
Changes in Post-treatment Vital Signs-systolic Blood Pressure Compared to Baseline	Days 3, 7, 10, 14, 28, 42	Changes in post-treatment vital signs-systolic blood pressure will be analyzed for all patients in Phase I and II.
Changes in Post-treatment Vital Signs-diastolic Blood Pressure Compared to Baseline	Days 3, 7, 10, 14, 28, 42	Changes in post-treatment vital signs-diastolic blood pressure will be analyzed for all patients in Phase I and II.
Changes in Post-treatment General Laboratory Assessment-hematology-white Blood Cells Compared to Baseline	Days 3, 7, 10, 14, 28, 42	Changes in post-treatment general laboratory assessment-hematology-white blood cells will be analyzed for all patients in Phase I and II.
Changes in Post-treatment General Laboratory Assessment-hematology-neutrophils Compared to Baseline	Days 3, 7, 10, 14, 28, 42	Changes in post-treatment general laboratory assessment-hematology-neutrophils will be analyzed for all patients in Phase I and II.
Number of Participants With Treatment-related AEs and SAEs (Including Infections and Bleeding)	Screening~ Day 360 from Day 28 or 42	The number of participants with treatment-related AEs and SAEs (including infections and bleeding) will be observed for all patients in Phase I and II
The Number of Censored Subjects Assessed by the Investigator and the First Additional Evaluator	Days 42 or earlier	The number of censored subjects in Phase I and II assessed by the investigator and the first additional evaluator. The first additional evaluator judged the healing status by looking at the photos of DSW. If the 100% re-epithelialization was not observed by Day 28 visit, the healing time was censored on the day of the last visit up to Day 28 visit. If the 100% re-epithelialization was observed by Day 28 visit but no confirmation was made, the healing time was censored on day of the last visit up to Day 28 visit.