The Efficacy and Safety of Intra-Arterial Administration of REX-001 to treat ischaemic rest pain in Subjects with Critical Limb Ischaemia Rutherford Category 4 and Diabetes Mellitus: A Pivotal, Placebo Controlled, Double-Blind, Parallel-Group, Adaptive Trial
- Conditions
- peripheral artery diseaserest pain in legs and feet10047066
- Registration Number
- NL-OMON47803
- Lead Sponsor
- Rexgenero Limited
- Brief Summary
Not available
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- Withdrawn
- Sex
- Not specified
- Target Recruitment
- 6
1. Aged >= 18 to <= 85 years.
2. Diagnosis of Type I or II DM, established more than one year ago.
3. Glycosylated hemoglobin (HbA1c) < 9%.
4. Subjects with poor or no (surgical or endovascular) revascularization option, classified as CLI Rutherford Category 4.
The blood circulation in these subjects must be compromised at screening defined as:
• Ankle systolic pressure < 50 mm Hg, or
• Toe systolic pressure < 30 mm Hg, or
• Transcutaneous oxygen pressure (tcpO2) < 30 mm Hg, and
• Flat or barely pulsatile ankle or metatarsal pulse volume recording (PVR)
The subject should have rest pain without tissue loss, and the rest pain must be persistent and require analgesics for at least two weeks for the subject to be eligible. Subjects with non-compressible vessels must qualify on toe pressure or tcpO2.
Poor or no revascularization option means that, in the opinion of the Investigator, revascularization using surgical or endovascular methods is not feasible due to unsuitable anatomy of existing vessels ,existing comorbidity and/or previously failed surgical or endovascular revascularization.
1. Advanced CLI defined as presence of major tissue loss (i.e.as significant ulceration and/or gangrene) proximal to the metatarsal heads (CLI Rutherford Category 6). Significant ulceration/gangrene means any ulceration that extends beyond the subcutaneous tissue layer, or any gangrene or tissue necrosis proximal to the metatarsal heads.
2. CLI Rutherford Category 5.
3. Uncontrolled or untreated proliferative retinopathy.
4. Failed surgical or endovascular revascularization on the index leg within 10 days prior to screening.
5. Subjects in whom arterial insufficiency in the lower extremity is the result of acute limb ischaemia or an immunological or inflammatory or non-atherosclerotic disorder (e.g., thromboangiitis obliterans (Buerger*s Disease), or systemic sclerosis (both limited and diffuse forms).
6. Clinical evidence of invasive infection on index leg defined as major tissue loss at the mid-foot or heel involving tendon and/or bone, and/or when according to the Investigator intravenous antibiotics are required to treat the infection.
7. At screening, the presence of only neuropathic ulcers on the index leg.
8. Amputation at or above the talus on the index leg.
9. Planned major amputation within the first month after randomization.
10. Subjects who may not be healthy enough to successfully complete all protocol requirements including BM collection, or who are not expected to survive more than 12 months, or in whom results may be particularly difficult to assess, as assessed by the Investigator.
Study & Design
- Study Type
- Interventional
- Study Design
- Not specified
- Primary Outcome Measures
Name Time Method <p>Primary Efficacy Endpoint:<br /><br>Change in Rutherford classification from CLI Category 4 to Category 3 or lower<br /><br>12 months after administration of REX-001 or placebo. Success is defined as<br /><br>complete relief of ischaemic rest pain with the absence of the development of<br /><br>ischaemic lesions on the index leg.</p><br>
- Secondary Outcome Measures
Name Time Method <p>The following secondary endpoints at 12 months after administration of REX-001<br /><br>or placebo are defined:<br /><br>• Change in Rutherford score (Categories 0-6).<br /><br>• Presence of ischaemic ulcers (yes/no).<br /><br>• Amputation free survival (AFS). </p><br>