Overview

This trial is active, not recruiting.

Condition infections
Treatments e-101 solution 300 gu/ml, saline solution
Phase phase 3
Sponsor Excited States, LLC
Collaborator Veristat, Inc.
Start date August 2012
End date October 2015
Trial size 1350 participants
Trial identifier NCT01297959, E-101:PH3:2012:004

Summary

This study is intended to determine the efficacy of topical application of E-101 Solution directly into the surgical incisional wound in the prevention of infection of superficial and deep surgical incisional wounds. E-101 Solution is an enzyme-based antiseptic that is being developed for direct application to a surgical incision.

United States No locations recruiting
Other Countries No locations recruiting

Study Design

Allocation randomized
Endpoint classification safety/efficacy study
Intervention model parallel assignment
Masking double blind (subject, outcomes assessor)
Primary purpose prevention
Arm
(Experimental)
e-101 solution 300 gu/ml
8 mL of E-101 Solution at a pMPO concentration of 300 GU/ml applied topically twice to surgical wound site (just after incision without penetration of the rectus fascia or linea alba and just prior to skin closure after closure of rectus fascia or linea alba).
(Placebo Comparator)
saline solution
8 mL of Placebo topically twice to surgical wound site (just after incision without penetration of the peritoneal fascia and just prior to skin closure).

Primary Outcomes

Measure
The incidence of superficial (skin and subcutaneous tissues) and deep (muscle and/or fascia) incisional surgical site infections (SSI) involving the primary open-laparotomy incision.
time frame: 30 days post-surgery

Secondary Outcomes

Measure
Mean CIWS (Clinical Infection Wound Score)
time frame: 30 days post-surgery
Proportion of subjects with incidence of incisional SSI, accompanied by findings of purulent drainage, wound abscess, or positive microbial culture from one or more incisional samples
time frame: 30 days post-surgery
Proportion of subjects with incidence of superficial and deep incisional SSI
time frame: 14 days post-surgery
Quality of life scores based on the EQ-5D-3L questionnaire obtained via interview of the subject by qualified study site personnel
time frame: At Screening, 7, 14, and 30 days post-surgery
Proportion of subjects re-hospitalized for SSI.
time frame: 30 days post-surgery
Proportion of subjects with each wound healing score by a blinded assessor on a standardized quantitative scale (termed Clinical Wound Healing Score [CWHS])
time frame: 3, 5, 7, 14, and 30 days post-surgery
Wound pain score assessments
time frame: 3, 5, 7, 14, and 30 days post-surgery
Incidence of detectable, induced antibodies to components of E-101 Solution
time frame: Up to 6 months post-surgery
Independent Adjudication Committee Review
time frame: 30 days post-surgery
Incidence of perinuclear anti-neutrophilic cytoplasmic antibody (p-ANCA)-associated vasculitis
time frame: 30 days, 6 months

Eligibility Criteria

Male or female participants at least 18 years old.

Inclusion Criteria: 1. Scheduled to undergo elective colon and/or rectal surgical procedures involving open laparotomy, hand-assisted laparoscopy, and laparoscopic-assisted approaches. The principal incision must have a length of > 5 cm and < 35 cm in length. Eligible surgeries are: left hemicolectomy, right hemicolectomy, transverse colectomy, ileocolic resection, total abdominal colectomy with ileorectal anastomosis, total abdominal proctocolectomy (portion of specimen to be extracted via laparotomy), low anterior resection, sigmoid resection, non-emergent Hartmann procedure, colostomy takedown through laparotomy (not peristomal) incision, ileo-pouch anal anastomosis, and abdominal perineal resection of the rectum. 2. Able to give informed consent. 3. Male or female ≥18 years of age. 4. If female, is non-pregnant (negative pregnancy test result at the Screening/Randomization Visit) and non-lactating. 5. If female, is either not of childbearing potential (defined as postmenopausal for at least 1 year or surgically sterile [status post bilateral tubal occlusion, bilateral oophorectomy, or hysterectomy]) or practicing 1 of the following methods of birth control and agrees to continue with this regimen over the study surveillance period: - Oral, implantable, or injectable contraceptives for 3 consecutive months before the Baseline/Randomization Visit - Intrauterine device - Double barrier method (condoms, sponge, or diaphragm with spermicidal jellies or cream) - Not sexually-active. Agreement to be available for evaluation at the study site for scheduled visits. Exclusion Criteria: 1. Hypersensitivity to porcine products. 2. History of known anti-myeloperoxidase autoantibodies (i.e., pANCA), as well as patients with known idiopathic necrotizing glomerulonephritis and certain systemic vasculitis conditions [e.g., microscopic polyangiitis of small blood vessels, Wegener's granulomatosis, and Churg-Strauss Syndrome]). 3. Use of microbial sealant (IntegusealTM), any antibiotic-embedded suture, or any antimicrobial-embedded suture to close the principal incision or any suture in the surgical field that has not been formally approved by the relevant local national regulatory authority. 4. Absolute contraindication to general anesthesia. 5. Hypersensitivity reactions to steri-strip tapes, medical-surgery tapes, adhesives, or sutures. (Note: If there can be assurances that the subject will not be exposed to these materials that cause hypersensitivity, alternatives will be allowed.) 6. History of keloid or hypertrophic scarring within or near an incision from a prior surgery. 7. Body mass index [BMI]: > 50 or < 20 (both due to the extremely high risk of poor wound healing). 8. ASA score > 3. 9. Undergoing emergency colorectal surgery such that standard bowel preparation and other standard preoperative precautions and assessments cannot be performed in time before the index-surgery. 10. The planned index-surgery involves removal or placement of mesh (either synthetic or biological) as part of closure in the principal incision or traversing any part of a pre-existing mesh (either synthetic or biological) in the principal incision. 11. There are clinical signs of overt infection necessitating systemic antibiotics via oral, intramuscular, or intravenous routes (e.g., infection of the abdominal wall, peritonitis, pneumonia, and sepsis/septic shock) prior to the index-surgery. 12. Preoperative severe neutropenia (total neutrophil count ≤500 X 109/L). (Note: Testing should be performed at the local laboratory.) 13. Receiving any oral or intravenous antibiotics within 24 hours prior to the index-surgery. (Note: It is permissible to administer conventional oral prophylactic antibiotics as bowel preparation up to the time of the index- surgical procedure, as well as intravenous or intramuscular prophylactic antibiotics just prior to the index-surgery as per the treating surgeon's standard of care.) 14. Preoperative evaluation that the intra-abdominal process might preclude full closure of the skin incision due to severe or morbid obesity (i.e., any mechanical reason that would prevent/preclude primary intent wound healing) at the principal incision. 15. History of major organ transplantation (e.g., lung, liver, or kidney), including bone marrow transplantation, or intent to perform major organ transplant as a concomitant surgery. 16. History of a complicated laparotomy within 30 days prior to planned index-surgery. 17. Planning to undergo a second colorectal surgical procedure (e.g., colostomy or ileostomy takedown) or any other general surgery in less than 30 days of index-surgery. 18. Likely preoperative urinary tract infection, as evident by: i) symptoms of upper urinary tract infection (e.g., fever and/or flank pain) or ii) symptoms of lower urinary tract infection (e.g., urinary frequency, dysuria, urgency, and/or suprapubic pain); accompanied by any one of the following: 1) bacteriuria of ≥104 bacteria/mL urine or 2) positive urine leucocyte esterase or positive nitrite urine dipstick tests. Also exclude any man under age 60 years who has both positive urine nitrite and leucocyte esterase dipstick tests - even if he is asymptomatic (unless he has predisposing factors for urinary tract infection - e.g., spinal cord injury). (Note: Testing should be performed at the local laboratory.) 19. Undergoing a significant concomitant surgical procedure (e.g., hysterectomy) or any mesh repair (either synthetic or biological mesh) as part of closure. The following concomitant procedures are allowed: appendectomy, cholecystectomy, oophorectomy, removal of Meckel's diverticulum, primary repair of small ventral hernia (i.e., <30 cm2), liver biopsy/wedge resection (but not liver resection). 20. Patients with a condition (e.g., recurrent urinary tract infections, nail infections, sinusitis, dental infections, vaginitis/vaginosis, or chronic bronchitis) requiring frequent or chronic administration of antimicrobials (received antibiotics/antimicrobials at least twice for ≥ 2 weeks during past 6 months). 21. Preoperative prothrombin time or INR > 2 x upper limit of normal. (Note: Testing should be performed at the local laboratory.) 22. Postsurgical life expectancy ≤ 60 days (in the Investigator's or Sponsor's opinion). 23. Any patient in which the planned surgery would include: i) placement of a stoma in the principal incision; ii) placement of a drain into the supra-peritoneal fascia space that emerges through the principal incision; iii) placement of a drain into the intraperitoneal space that emerges through the principal incision; and iv) supplementation of any of the irrigation fluid with antibiotic or antiseptic drugs. 24. Patients with severe COPD that are likely to need > 24 hours postoperative ventilator support (e.g., patients on chronic or intermittent supplemental oxygen or an estimated forced expiratory volume in 1 second (FEV1) less than 50% of expected based on bedside spirometry). 25. If, in the opinion of Investigator, the potential subject would likely be unable to maintain adequate care of the principal incision post-operatively. 26. Anticipate that patient will not be available for study visits/ procedures or if in the opinion of Investigator there is concern that patient might not comply with study visits/procedures (e.g., due to ongoing illicit drug usage or alcohol abuse). 27. Lack of willingness to have personal study-related data collected, archived, or transmitted under a blinded condition to regulatory agencies. 28. Participation within 30 days before the start of this study in any experimental drug or device study; or currently participating in a study in which the administration of investigational drug or device within 60 days is anticipated.

Additional Information

Official title Phase 3 Study of the Efficacy and Safety of Topical E-101 Solution to Prevent Incisional Infections Among Colorectal Surgery Patients (Triple IN Study-INhibition of INcisional INfections)
Principal investigator Michael J Stamos, MD
Description The purpose of this standard-of-care, pivotal Phase 3 study is to evaluate the efficacy and safety of topical E-101 Solution after direct application into the principal surgical incision in the prevention of superficial and deep incisional surgical site infections (SSI) within 30 days after elective colorectal surgery. The study is intended to support a target indication statement of: "E-101 Solution is indicated for the prophylaxis of incisional surgical site infections following elective colorectal surgery". E-101 Solution is comprised of the active ingredients of glucose oxidase (GO) and porcine myeloperoxidase (pMPO) that produce coupled reactions after the addition of glucose substrate. The hypothesis is that E-101 Solution topically applied directly into the principal incision is safe and significantly reduces the incidence of incisional SSI compared to placebo topical application. (The principal surgical incision is ≥ 5cm and < 35 cm used as a hand port, colorectal specimen extraction port, or extracorporeal manipulation port depending on the specific colorectal surgical approach.)
Trial information was received from ClinicalTrials.gov and was last updated in September 2015.
Information provided to ClinicalTrials.gov by Excited States, LLC.