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D010019: Osteomyelitis

Developed by Shray Alag, The Harker School
Sections: Correlations, Clinical Trials, and HPO

Correlations computed by analyzing all clinical trials.

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Correlated Drug Terms (2)


Name (Synonyms) Correlation
drug2893 Riboflavin Placebo Wiki 1.00
drug2895 Rifampin Wiki 0.50

Correlated MeSH Terms (0)


Name (Synonyms) Correlation

Correlated HPO Terms (1)


Name (Synonyms) Correlation
HP:0002754 Osteomyelitis HPO 1.00

Clinical Trials

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There is one clinical trial.


1 CSP #2001 - Investigation of Rifampin to Reduce Pedal Amputations for Osteomyelitis in Diabetics (VA Intrepid)

The purpose of this research study is to determine if rifampin, an antibiotic (a medicine that treats infections), is effective in treating osteomyelitis (infection of the bone) of the foot in diabetic patients. Despite use of powerful antibiotics prescribed over a long period of time, many diabetic patients remain at a high risk for needing an amputation of part of the foot or lower leg because the osteomyelitis is not cured. Some small research studies have shown that addition of rifampin to other antibiotics is effective in treating osteomyelitis in both diabetics and non-diabetics. However, because few diabetics with osteomyelitis have been studied, there is no definite proof that it is better than the usual treatments for diabetic patients. If this study finds that adding rifampin to the usual antibiotics prescribed for osteomyelitis reduces the risk for amputations, doctors will be able to more effectively treat many Veteran patients with this serious infection. Improving treatment outcomes is an important healthcare goal of the VA.

NCT03012529
Conditions
  1. Osteomyelitis
  2. Diabetes
  3. Amputation
Interventions
  1. Drug: Rifampin
  2. Drug: Riboflavin Placebo
MeSH:Osteomyelitis
HPO:Osteomyelitis

Primary Outcomes

Description: The primary endpoint is amputation-free survival, ending with amputation or death from any cause. Amputation is defined as surgical treatment of osteomyelitis by removal or debridement of necrotic/infected bone (all or part of a bone) from a lower extremity limb or digit on the ipsilateral side of the protocol-treated osteomyelitis. Debridement prior to randomization may include removal of bone. Because this debridement occurs early, prior to exposure to study drug or placebo, removal of bone at that time is not a study endpoint.

Measure: Amputation-Free Survival

Time: Assessed 2 years post intervention

Secondary Outcomes

Description: Time from randomization to the occurrence of the components of the primary outcome: the first occurrence of ipsilateral amputation alone the first occurrence of ipsilateral above-ankle amputation the first occurrence of ipsilateral through the ankle (e.g. Symes amputation) or below-ankle amputation proximal to the metatarsal-phalangeal joint the first occurrence of ipsilateral below-ankle amputation at or distal to the metatarsal-phalangeal joint all cause death Endpoint will be determined by chart review by the Study Coordinator, with confirmation by the Site Investigator, and as needed, by the Study Chair.

Measure: Time to Amputation

Time: Assessed 2 years post intervention

Description: New courses of antibacterial therapy for ipsilateral foot infection during the first year after randomization (yes/no per patient). Endpoint will be determined by chart review by the Study Coordinator, with consultation with the Site Investigator as needed to confirm that the new course of treatment is directed toward continued or recurrent osteomyelitis of the initially affected lower extremity. The new course will require there be at least a 14 day interval between the end of the initial back-bone antibiotic therapy course.

Measure: New course of antibacterial therapy for ipsilateral foot infection

Time: Assessed 2 years post intervention

Description: Quality of life, measured by the 36-Item Short Form Health Survey (SF-36; Ware & Sherbourne, 1992) and its physical and mental health subscales. This is a widely used self-report instrument that will be administered by the Study Coordinator at baseline, 3-, 6- and 12-months.

Measure: Quality of Life - SF-36

Time: Assessed 12 months post intervention

Description: Ambulatory status, measured by the Study Coordinator, using a modified item from the Amputee Mobility Predictor Questionnaire56. The patient's "usual method of ambulation within the home" will be assessed by a single self-report item at baseline, 3-, 6- and 12-months using the following response categories: No assistive device required to move about Cane Crutches Walker Wheelchair Bed bound

Measure: Ambulatory Status

Time: Assessed 12 months post intervention

Description: Incidence of falls, measured by self-reported frequency of falls and falls that required medical attention in the one-month periods preceding research visits at Baseline, 3-, 6- and 12-months.

Measure: Incidence of Falls

Time: Assessed 12 months post intervention

Description: Incidence of adverse events related to direct toxicity of rifampin in active drug vs. placebo groups: Nausea requiring dividing the dose to twice a day Rash requiring study drug discontinuation Nausea requiring study drug discontinuation Grade 3 or 4 liver enzyme (ALT) elevations Local Site Investigators, with assistance from their Study Coordinators, will be responsible for reporting adverse events which will be used to analyze these secondary endpoints.

Measure: Incidence of adverse events related to direct toxicity of rifampin

Time: Assessed 3 months post intervention

Description: Incidence of adverse events from drug interactions in active drug vs. placebo groups: Cardiovascular: Myocardial infarction, cerebrovascular accident, hospitalization for hypertensive emergency Glycemic control: Hospitalization for a primary diagnosis of hypoglycemia or uncontrolled diabetes Local Site Investigators, with assistance from their Study Coordinators, will be responsible for reporting adverse events which will be used to analyze these secondary endpoints.

Measure: Incidence of adverse events from drug interactions

Time: Assessed 3 months post intervention

Description: Overall comparative dropout data during the 6-week intervention based on drug intolerance/drug interactions/adverse events in active drug vs. placebo groups. Dropout endpoint will be determined by chart review by the Study Coordinator and by telephone calls to the subject.

Measure: Comparative dropout

Time: Assessed 6 weeks post intervention

Description: Remission of osteomyelitis at 12 months (yes/no). Remission is defined as epithelialization of any overlying soft tissue defect and the absence of local signs and symptoms of inflammation. Endpoint will be determined by physical examination by the Site Investigator at the 12 month visit.

Measure: Remission of osteomyelitis

Time: Assessed at 1 year post intervention

Description: Complete epithelialization of the wound at 6 weeks and at 3, 6 and 12 months (yes/no). Endpoint will be determined by physical examination by the Site Investigator at the 3, 6 and 12 month visits.

Measure: Complete epithelialization of the wound

Time: Assessed 1 year post intervention

Description: Time from randomization to the first occurrence of ipsilateral amputation for the treatment of osteomyelitis related to the index osteomyelitis. Relatedness will be determined by the LSI or qualified Co-investigator on thePrimary Outcome case report form. An episode of ipsilateral osteomyelitis is considered related to the index osteomyelitis if it involves the same bone or a contiguous bone.

Measure: First occurrence of ipsilateral amputation related to index osteomyelitis

Time: Assessed 2 years post intervention

HPO Nodes


Reports

Data processed on September 26, 2020.

An HTML report was created for each of the unique drugs, MeSH, and HPO terms associated with COVID-19 clinical trials. Each report contains a list of either the drug, the MeSH terms, or the HPO terms. All of the terms in a category are displayed on the left-hand side of the report to enable easy navigation, and the reports contain a list of correlated drugs, MeSH, and HPO terms. Further, all reports contain the details of the clinical trials in which the term is referenced. Every clinical trial report shows the mapped HPO and MeSH terms, which are also hyperlinked. Related HPO terms, with their associated genes, protein mutations, and SNPs are also referenced in the report.

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