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transitioning from 361 HCT/P Tissue to a Biologic (BLA)
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This study is a comparison of sensory recovery outcomes following the use of AVANCE Nerve Graft or hollow tube conduit for peripheral nerve gap repairs in the hand.
The CHANGE study is a post-marketing study designed as a prospective, single-blind, randomized, two phase study comparing clinical outcomes of AVANCE Nerve Graft to hollow tube conduits. The first phase (pilot phase) assesses projected differences expected between two treatment groups. The second phase of the study provides comparison data between the two treatment groups.
AVANCE Nerve Graft is current regulated in the United States as a 361 HCT/P Tissue for transplantation; not a Drug, Biologic, or Medical Device. Hollow tube conduits are currently regulated in the United States as medical devices.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Avance Nerve Graft | Active Comparator | Commercially available Avance Nerve Graft for repair of nerve gap |
|
| Hollow Tube Conduit | Active Comparator | Commercially available hollow tube conduit for repair of nerve gap. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Hollow tube nerve conduit, synthetic or biosynthetic | Device | Appropriately size matched hollow tube nerve conduit (Neurotube, NeuroLac, NeuraGen, NeuroMatrix, NeuroFlex) |
|
| Measure | Description | Time Frame |
|---|---|---|
| Recovery of Static 2-point Discrimination in the Affected Digit | Mean change in static 2-Point Discrimination between baseline and 12 months | 12 Months |
| Measure | Description | Time Frame |
|---|---|---|
| Moving 2-point Discrimination | Percent Change from Baseline of Moving 2-Point Discriminations at Month 12 | 12 months |
| Semmes-Weinstein Monofilament Assessment | Percent Change from Baseline of Semmes-Weinstein Monofilament Assessment at Month 12 |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Erick W DeVinney | Axogen Corporation | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Georgia Hand, Shoulder and Elbow | Atlanta | Georgia | 30309 | United States | ||
| Indiana Hand Center |
IPD will not be released to other researchers.
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Recruitment began on 22 June 2009 and ended on 23 May 2012.
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| ID | Title | Description |
|---|---|---|
| FG000 | Avance Nerve Graft | Commercially available Avance Nerve Graft for repair of nerve gap Processed Human Nerve Tissue Scaffold: Implantation of appropriate length of processed human nerve tissue scaffold at time of surgery. |
| FG001 | Hollow Tube Conduit |
| Title | Milestones | Reasons Not Completed | |||||
|---|---|---|---|---|---|---|---|
| Phase 1 (Pilot Phase) |
|
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| Processed Human Nerve Tissue | Other | Implantation of appropriate length of processed human nerve tissue at time of surgery. |
|
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| 12 months |
| 12-month DASH Core Module Scores | Summary of Disability of the Arm, Shoulder, and Hand (DASH) scores (Core Module) at Month 12 The Disabilities of the Arm, Shoulder and Hand (DASH) core module questionnaire is a 30-item questionnaire includes 21 physical function items, 6 symptom items, and 3 social/role function items. It is a patient reported questionnaire used to assess physical function and severity of symptoms in patients with musculoskeletal disorders of the upper limb. Each of the items in the DASH use a 5-point Likert scale to assess the corresponding severity or functional parameter. The outcome measure is scored based on the formula ([sum of n responses)/ - 30 (minimum score]/1.2 (range of scores ÷100), where n represents the number of completed items. Computed scores range from 0 (no disability) to 100 (most severe disability). | 12 months |
| 12-month DASH (Work Module) Scores | Summary of Disability of the Arm, Shoulder, and Hand (DASH) scores (Work Module) at Month 12 The Disabilities of the Arm, Shoulder and Hand (DASH) Work Module questionnaire is a 4-item questionnaire used to identify the job-specific difficulties that workers might experience but which may not affect their activities of daily living. It is a patient reported questionnaire used to assess the impact that musculoskeletal disorders of the upper limb have on a patient's ability to perform work-related tasks. Each of the items in the DASH Work Module use a 5-point Likert scale to assess the corresponding severity or functional parameter. The outcome measure is scored based on the formula ([sum of n responses)/ - 4 (minimum score]/0.16 (range of scores ÷100), where n represents the number of completed items. Computed scores range from 0 (no difficulty) to 100 (most severe difficulty). | 12 month |
| 12- Month DASH (Sports/Performing Arts Module) | Summary of Disability of the Arm, Shoulder, and Hand (DASH) scores (Sports/Performing Arts Module) at month 12 The Disabilities of the Arm, Shoulder and Hand (DASH) Sports/Performing Arts Module questionnaire is a 4-item questionnaire used to identify the specific difficulties that professional athletes/performing artists might experience but which may not affect their activities of daily living. It is a patient reported questionnaire used to assess the impact that musculoskeletal disorders of the upper limb have on a patient's ability to perform sports or play a musical instrument. Each of the items in the DASH use a 5-point Likert scale to assess the corresponding severity or functional parameter. The outcome measure is scored based on the formula ([sum of n responses)/ - 4 (minimum score]/0.16 (range of scores ÷100), where n represents the number of completed items. Computed scores range from 0 (no difficulty) to 100 (most severe difficulty). | 12 months |
| Pain at 12-months | Summary of Pain Assessment using Visual Analogue Scale (VAS) at Month 12 The Visual Analog Scale (VAS) For Pain is a patient reported outcomes scale whereby the patient indicates his/her current pain level by making a mark on a continuous horizontal 10 centimeter (100 millimeter) line. The distance from the 0 millimeter to the patient's mark corresponds to the amount of pain the subject is currently experiencing. VAS for Pain data are recorded as the number of millimeters from the left of the line to the patients mark across the range of 0-100 millimeters, with 0 millimeter representing no pain and 100 millimeters representing "the worst pain imaginable". | 12-months |
| Thermal Discretion at 12-months | Summary of Thermal Discretion at Month 12 as determined by the Investigator. Thermal discretion was assessed by applying a hot and/or cold object to the patient's affected digit. Thermal discretion was reported as either present ("Yes") or not present ("No"). | 12-month |
| Protective Sensation Present at 12-months | Summary of Protective Sensation by Month 12 Semmes-Weinstein Monofilament (SWMF) assessment of protective sensation. The gauge of the monofilaments range from 2.83 (normal) to 6.65 (deep pressure sensation only). Protective Sensation Present (SWMF score of 3.61 or better), Protective Sensation Diminished (SWMF score of 4.31-3.84), Protective Sensation Absent (SWMF score of 4.56 or greater). | 12 months |
| Functional Recovery Classification (Medical Research Council Evaluation of Sensory Function) at 12-months | Summary of Functional Recovery Classification (Medical Research Council Evaluation of Sensory Function) at 12-months Patients were assessed for functional recovery of sensation on a scale from S0 to S4 with S0 representing absence of sensibility, S1 representing recovery of deep cutaneous pain sensibility, S2 representing the return of some degree of superficial cutaneous pain and tactile sensibility, S3 representing return of superficial cutaneous pain and tactile sensibility, S3+ representing return of sensibility as in S3 and some recovery of 2-point discrimination (a 2-PD score between 7-15mm), and S4 representing complete recovery of normal sensation as assessed by 2-point discrimination (score between 2-6mm). | 12 months |
| Indianapolis |
| Indiana |
| 46260 |
| United States |
| University of Kentucky | Lexington | Kentucky | 40536 | United States |
| Curtis National Hand Center | Baltimore | Maryland | 21218 | United States |
Commercially available hollow tube conduit for repair of nerve gap. Hollow tube nerve conduit, synthetic or biosynthetic: Appropriately size matched hollow tube nerve conduit (Neurotube, NeuroLac, NeuraGen, NeuroMatrix, NeuroFlex) |
| COMPLETED |
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| NOT COMPLETED |
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| Phase 2 (Comparative Phase) |
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All participants who were randomized and received one of the study treatments (Safety Population).
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| ID | Title | Description |
|---|---|---|
| BG000 | Avance Nerve Graft | Commercially available Avance Nerve Graft for repair of nerve gap Processed Human Nerve Tissue: Implantation of appropriate length of processed human nerve tissue scaffold at time of surgery. |
| BG001 | Hollow Tube Conduit | Commercially available hollow tube conduit for repair of nerve gap. Hollow tube nerve conduit, synthetic or biosynthetic: Appropriately size matched hollow tube nerve conduit (Neurotube, NeuroLac, NeuraGen, NeuroMatrix, NeuroFlex) |
| BG002 | Total | Total of all reporting groups |
| Units | Counts |
|---|---|
| Participants |
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| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Age, Categorical | Count of Participants | Participants |
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| Age, Continuous | Mean | Full Range | years |
| |||||||||||||||||
| Sex: Female, Male | Count of Participants | Participants |
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| Region of Enrollment | Number | participants |
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| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Recovery of Static 2-point Discrimination in the Affected Digit | Mean change in static 2-Point Discrimination between baseline and 12 months | Number of subjects | Posted | Mean | Standard Error | percent change from baseline | 12 Months |
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| Secondary | Moving 2-point Discrimination | Percent Change from Baseline of Moving 2-Point Discriminations at Month 12 | Modified Intent-to-Treat Population (mITT): All participants who were randomized, received one of the study treatments, and completed at least the 3 month follow-up visit. | Posted | Mean | Standard Error | percentage | 12 months |
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| Secondary | Semmes-Weinstein Monofilament Assessment | Percent Change from Baseline of Semmes-Weinstein Monofilament Assessment at Month 12 | Modified Intent-to-Treat Population (mITT): All participants who were randomized, received one of the study treatments, and completed at least the 3 month follow-up visit. | Posted | Mean | Standard Error | percentage | 12 months |
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| Secondary | 12-month DASH Core Module Scores | Summary of Disability of the Arm, Shoulder, and Hand (DASH) scores (Core Module) at Month 12 The Disabilities of the Arm, Shoulder and Hand (DASH) core module questionnaire is a 30-item questionnaire includes 21 physical function items, 6 symptom items, and 3 social/role function items. It is a patient reported questionnaire used to assess physical function and severity of symptoms in patients with musculoskeletal disorders of the upper limb. Each of the items in the DASH use a 5-point Likert scale to assess the corresponding severity or functional parameter. The outcome measure is scored based on the formula ([sum of n responses)/ - 30 (minimum score]/1.2 (range of scores ÷100), where n represents the number of completed items. Computed scores range from 0 (no disability) to 100 (most severe disability). | Modified Intent-to-Treat Population (mITT): All participants who were randomized, received one of the study treatments, and completed at least the 3 month follow-up visit. | Posted | Mean | Standard Error | score on a scale | 12 months |
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| Secondary | 12-month DASH (Work Module) Scores | Summary of Disability of the Arm, Shoulder, and Hand (DASH) scores (Work Module) at Month 12 The Disabilities of the Arm, Shoulder and Hand (DASH) Work Module questionnaire is a 4-item questionnaire used to identify the job-specific difficulties that workers might experience but which may not affect their activities of daily living. It is a patient reported questionnaire used to assess the impact that musculoskeletal disorders of the upper limb have on a patient's ability to perform work-related tasks. Each of the items in the DASH Work Module use a 5-point Likert scale to assess the corresponding severity or functional parameter. The outcome measure is scored based on the formula ([sum of n responses)/ - 4 (minimum score]/0.16 (range of scores ÷100), where n represents the number of completed items. Computed scores range from 0 (no difficulty) to 100 (most severe difficulty). | Modified Intent-to-Treat Population (mITT): All participants who were randomized, received one of the study treatments, and completed at least the 3 month follow-up visit. | Posted | Mean | Standard Error | score on a scale | 12 month |
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| Secondary | 12- Month DASH (Sports/Performing Arts Module) | Summary of Disability of the Arm, Shoulder, and Hand (DASH) scores (Sports/Performing Arts Module) at month 12 The Disabilities of the Arm, Shoulder and Hand (DASH) Sports/Performing Arts Module questionnaire is a 4-item questionnaire used to identify the specific difficulties that professional athletes/performing artists might experience but which may not affect their activities of daily living. It is a patient reported questionnaire used to assess the impact that musculoskeletal disorders of the upper limb have on a patient's ability to perform sports or play a musical instrument. Each of the items in the DASH use a 5-point Likert scale to assess the corresponding severity or functional parameter. The outcome measure is scored based on the formula ([sum of n responses)/ - 4 (minimum score]/0.16 (range of scores ÷100), where n represents the number of completed items. Computed scores range from 0 (no difficulty) to 100 (most severe difficulty). | Modified Intent-to-Treat Population (mITT): All participants who were randomized, received one of the study treatments, and completed at least the 3 month follow-up visit. | Posted | Mean | Standard Error | score on a scale | 12 months |
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| Secondary | Pain at 12-months | Summary of Pain Assessment using Visual Analogue Scale (VAS) at Month 12 The Visual Analog Scale (VAS) For Pain is a patient reported outcomes scale whereby the patient indicates his/her current pain level by making a mark on a continuous horizontal 10 centimeter (100 millimeter) line. The distance from the 0 millimeter to the patient's mark corresponds to the amount of pain the subject is currently experiencing. VAS for Pain data are recorded as the number of millimeters from the left of the line to the patients mark across the range of 0-100 millimeters, with 0 millimeter representing no pain and 100 millimeters representing "the worst pain imaginable". | Modified Intent-to-Treat Population (mITT): All participants who were randomized, received one of the study treatments, and completed at least the 3 month follow-up visit. | Posted | Mean | Standard Error | units on a scale | 12-months |
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| Secondary | Thermal Discretion at 12-months | Summary of Thermal Discretion at Month 12 as determined by the Investigator. Thermal discretion was assessed by applying a hot and/or cold object to the patient's affected digit. Thermal discretion was reported as either present ("Yes") or not present ("No"). | Modified Intent-to-Treat Population (mITT): All participants who were randomized, received one of the study treatments, and completed at least the 3 month follow-up visit. | Posted | Count of Participants | Participants | 12-month |
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| Secondary | Protective Sensation Present at 12-months | Summary of Protective Sensation by Month 12 Semmes-Weinstein Monofilament (SWMF) assessment of protective sensation. The gauge of the monofilaments range from 2.83 (normal) to 6.65 (deep pressure sensation only). Protective Sensation Present (SWMF score of 3.61 or better), Protective Sensation Diminished (SWMF score of 4.31-3.84), Protective Sensation Absent (SWMF score of 4.56 or greater). | Modified Intent-to-Treat Population (mITT): All participants who were randomized, received one of the study treatments, and completed at least the 3 month follow-up visit. | Posted | Count of Participants | Participants | 12 months |
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| Secondary | Functional Recovery Classification (Medical Research Council Evaluation of Sensory Function) at 12-months | Summary of Functional Recovery Classification (Medical Research Council Evaluation of Sensory Function) at 12-months Patients were assessed for functional recovery of sensation on a scale from S0 to S4 with S0 representing absence of sensibility, S1 representing recovery of deep cutaneous pain sensibility, S2 representing the return of some degree of superficial cutaneous pain and tactile sensibility, S3 representing return of superficial cutaneous pain and tactile sensibility, S3+ representing return of sensibility as in S3 and some recovery of 2-point discrimination (a 2-PD score between 7-15mm), and S4 representing complete recovery of normal sensation as assessed by 2-point discrimination (score between 2-6mm). | Modified Intent-to-Treat Population (mITT): All participants who were randomized, received one of the study treatments, and completed at least the 3 month follow-up visit. | Posted | Count of Participants | Participants | 12 months |
|
Adverse Events were collected from the time of randomization through 1 year.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Avance Nerve Graft | Commercially available Avance Nerve Graft for repair of nerve gap Processed Human Nerve Tissue: Implantation of appropriate length of processed human nerve tissue scaffold at time of surgery. | 0 | 14 | 1 | 14 | 0 | 14 |
| EG001 | Hollow Tube Conduit | Commercially available hollow tube conduit for repair of nerve gap. Hollow tube nerve conduit, synthetic or biosynthetic: Appropriately size matched hollow tube nerve conduit (Neurotube, NeuroLac, NeuraGen, NeuroMatrix, NeuroFlex) | 0 | 9 | 1 | 9 | 1 | 9 |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Osteomyleitis | Musculoskeletal and connective tissue disorders | Non-systematic Assessment | Grade 2 infection in the affected digit possibly related to the synthetic implant |
| |
| Infection | Infections and infestations | Non-systematic Assessment | Infection of grade 2 severity which resulted in prolonged hospitalization |
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| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Occasional Pain | Nervous system disorders | Non-systematic Assessment | Occasional Pain |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Vice President, Clinical and Translational Sciences | AxoGen, Inc | 3864626829 | edevinney@axogeninc.com |
| >=65 years |
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| Male |
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Commercially available hollow tube conduit for repair of nerve gap. Hollow tube nerve conduit, synthetic or biosynthetic: Appropriately size matched hollow tube nerve conduit (Neurotube, NeuroLac, NeuraGen, NeuroMatrix, NeuroFlex) |
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| Participants |
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| Protective Sensation Absent |
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| S3 |
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| S3+ |
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| S4 |
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