Topical Timolol Benefit in Venous Ulcers

Phase 2

Completed

Brief Summary: Background: Venous Leg ulcers are a frequent pathology in dermatology and complex in their management. At the origin of high health costs and strong repercussions on quality of life for patients, they require long management and may be subject to possible complications.

In spite of appropriate treatment, 50-60% of these ulcers are not healed at 24 weeks.

Purpose: Topical beta adrenergic antagonists have shown efficacy in wound healing. The purpose of this study is to evaluate the efficacy and safety of treatment of chronic venous ulcers with topical timolol.

Detailed Description: Abstract: Complicating severe stages of chronic venous insufficiency, venous leg ulcers are common in dermatology and responsible for important health care costs. Healing remains long with many persistent cases after one year, despite compression and local dressings. Several pharmacological studies have demonstrated a benefit of beta-blockers on the wound healing process: present in the skin, the beta-adrenergic receptors play a role in wound healing. Their stimulation inhibits healing while blocking them promotes angiogenesis, fibroblast migration and keratinocyte migration. Using the topical timolol in several patients seems to confirm these effects: all ulcers treated with timolol healed in a few weeks whereas they did not evolve under local care and compression.

The purpose of this study is to demonstrate whether there is an interest in topical timolol for venous leg ulcers in combination with compression and wound dressings versus placebo. The primary endpoint is to evaluate the healing rate to W12. The effects will be evaluated with photography, evaluation of the surface of the ulcer at W12 compared to W0. The research of side effects will also be evaluated.

Recruitment & Eligibility

Inclusion Criteria

Affiliated to a social security scheme patients
Informed consent
Patients over 18 years
Ulcer lasting for at least 24 weeks with no improvement observed after 4 weeks of well conducted treatment (compression and local care)
Presence of one or more venous leg ulcers (objectified by a Doppler ultrasound dated within 6 months and ABPI ≥ 0.8)
Ulcers with a surface of 5 to 50 cm ² and at granulation stage
Study ulcer must be at least 2 cm from Any Other ulcer on same extremity.
If several ulcers present, the greatest is selected
Granulation tissue ≥ 50%

Exclusion Criteria

Minors under guardianship, deprived of liberty, not looking at treatment, lack of signed consent, pregnant women, demented patients
Ulcer lasting for less than 24 weeks
Granulation tissue <50%
Obliterative arteritis (ABPI <0.8)
Infection of the ulcer (need to treat the infection before any inclusion criteria be compatible)
Non-cardioselective beta-blocker treatment
Bradycardiac treatment
Patients under diltiazem, verapamil (calcium antagonists)
Reaching underlying noble structures, tumor acutisation wound
Immunosuppression
Diabetes unbalanced (HbA1c> 8%)
Severe Malnutrition (albumin <25g / L)
Anemia <10g/dl
Contraindication to beta-blockers

Arm && Interventions

Group	Intervention	Description
Timolol	Local care treatment	Patients will receive one drop of timolol every 6cm ² every other day for twelve weeks in combination with dressings and compression.
Control	Local care treatment	Local care treatment only (dressing and compression applied every other day)
Timolol	Timolol	Patients will receive one drop of timolol every 6cm ² every other day for twelve weeks in combination with dressings and compression.

Primary Outcome Measures

Name	Time	Method
Success rate	12 weeks	Assess the healing rate in patients treated with topical timolol associated with wound dressing and compression for 12 weeks, compared to patients treated with wound dressing and compression. Success is defined as an ulcer surface relative reduction \>= 40%

Secondary Outcome Measures

Name	Time	Method
Complete healing	12 weeks	Complete healing of the ulcer i.e. 100% regression of the ulcer surface and replaced by an epidermised tissue.
Tolerance (cardiac-related serious adverse events)	12 weeks	To assess local and cardiac safety of timolol by cardiac-related serious adverse events evaluation
Quality of life evolution	Baseline and 12 weeks	Evaluation of the quality of life of patients by the Dermatology Life Quality Index (DLQI) scale at baseline and after 12 weeks of treatment