Evaluation of lyophilized human amnion/chorion membrane (LHACM) in the management of nonhealing diabetic foot ulcers: an interim analysis of the CAMPAIGN trial

Authors

  • Thomas E Serena Author
  • Brianna Tramelli Author
  • Brittany Bonafide Author
  • Zwelithini Tunyiswa Author

DOI:

https://doi.org/10.63676/tk3kw419

Keywords:

interim analysis, diabetic foot ulcer, chronic wounds, tissue regeneration, Cellular, acellular, and matrix-like products

Abstract

Background: Diabetic foot ulcers (DFUs) are chronic wounds that contribute significantly to morbidity, mortality, and healthcare costs. Despite current standard-of-care (SOC) approaches, healing rates re-main suboptimal, emphasizing the urgent need for innovative and cost-effective treatment options.

Methods: An interim analysis of this multicenter, prospective, randomized controlled platform clinical trial evaluated the efficacy of multiple lyophilized human amnion/chorion membrane (LHACMs) with SOC versus SOC alone. The primary endpoint was percentage of target ulcers achieving complete wound closure in 12 weeks, defined as 100% re-epithelialization without drainage for two consecutive weeks, confirmed by blinded independent review.

Results: The statistical analysis revealed that the treatment arm improved full wound closure at 12 weeks over SOC by 2.6 (credible interval: 0.81 – 5.0) in terms of relative. The estimated probability of complete wound closure under SOC was 23% (6.5%–42%), compared with 47% (37%–59%) under the treatment arm. This corresponds to a posterior absolute difference of 24% (4%–43%). This suggests a posterior probability advantage of 98.5% for LHACM.

Conclusion: The interim analysis revealed that the placental membranes products trended to-ward superiority over SOC. Bayesian posterior estimates indicated 98.5% higher probabilities of wound closure and improved healing trajectories in the treatment group. These interim data provide early evidence of clinical benefit, subject to confirmation with full trial completion.

References

International Diabetes Federation. IDF Diabetes Atlas, 10th edn. Brussels, Belgium: 2021. https://www.diabetesatlas.org (accessed 30 October 2025)

Wu Y, Ding Y, Tanaka Y, Zhang W. Risk factors contributing to type 2 diabetes and recent advances in the treatment and prevention. Int J Med Sci. 2014;11(11):1185-1200. https://doi.org/10.7150/ijms.10001

McDermott K, Fang M, Boulton AJM, Selvin E, Hicks CW. Etiology, Epidemiology, and Disparities in the Burden of Diabetic Foot Ulcers. Diabetes Care. 2023;46(1):209-221. https://doi.org/10.2337/dci22-0043

Game F. Classification of diabetic foot ulcers. Diabetes Metab Res Rev. 2016;32 Suppl 1:186-194. https://doi/org/10.1002/dmrr.2746

Alsanawi Y, Alismail H, AlabdRabalnabi M, et al. Pathogenesis and management of diabetic foot ulcers. International Journal Of Community Medicine And Public Health. 2018; 5(11), 4953. https://doi.org/10.18203/2394-6040.ijcmph20184249

Hoffstad O, Mitra N, Walsh J, Margolis DJ. Diabetes, lower-extremity amputation, and death. Diabetes Care. 2015;38(10):1852-1857.https://doi.org/10.2337/dc15-0536

Geiss LS, Li Y, Hora I, Albright A, Rolka D, Gregg EW. Resurgence of Diabetes-Related Nontraumatic Lower-Extremity Amputation in the Young and Middle-Aged Adult U.S. Population. Diabetes Care. 2019;42(1):50-54. https://doi.org/10.2337/dc18-1380

Harding JL, Andes LJ, Rolka DB, et al. National and State-Level Trends in Nontraumatic Lower-Extremity Amputation Among U.S. Medicare Beneficiaries With Diabetes, 2000-2017. Diabetes Care. 2020;43(10):2453-2459. https://doi.org/10.2337/dc20-0586

Armstrong DG, Swerdlow MA, Armstrong AA, Conte MS, Padula WV, Bus SA. Five year mortality and direct costs of care for people with diabetic foot complications are comparable to cancer. J Foot Ankle Res. 2020;13(1):16. https://doi.org/10.1186/s13047-020-00383-2

Fife CE, Eckert KA, Carter MJ. Publicly Reported Wound Healing Rates: The Fantasy and the Reality. Adv Wound Care (New Rochelle). 2018;7(3):77-94. https://doi.org/10.1089/wound.2017.0743

Lim JZ, Ng NS, Thomas C. Prevention and treatment of diabetic foot ulcers. J R Soc Med. 2017;110(3):104-109. https://doi.org/10.1177/0141076816688346

Ha JH, Jin H, Park JU. Association between socioeconomic position and diabetic foot ulcer outcomes: a population-based cohort study in South Korea. BMC Public Health. 2021;21(1):1395. Published 2021 Jul 14. https://doi.org/10.1186/s12889-021-11406-3

Armstrong DG, Kanda VA, Lavery LA, Marston W, Mills JL Sr, Boulton AJ. Mind the gap: disparity between research funding and costs of care for diabetic foot ulcers. Diabetes Care. 2013;36(7):1815-1817. https://doi.org/10.2337/dc12-2285

Wu S, Carter M, Cole W, et al. Best practice for wound repair and regeneration use of cellular, acellular and matrix-like products (CAMPs). J Wound Care. 2023;32(Sup4b):S1-S31. https://doi.org/10.12968/jowc.2023.32.Sup4b.S1

Almeida GHDR, Rinaldi JC, Calomeno CVAQ, et al. Unlocking the regenerative properties of extraembryonic membrane-derived biomaterials in tissue engineering. Acta Biomater. 2025;203:94-134. https://doi.org/10.1016/j.actbio.2025.07.028

Serena TE, Tramelli B, King E, Maloumi S. A multicentre, prospective, randomized controlled modified platform trial evaluating purion processed lyophilized human amnion/ chorion membrane and standard of care versus standard of care alone in the treatment of non-healing diabetic foot ulcers. International Journal of Tissue Repair. 2025; 1(1). https://doi.org/10.63676/ctkc9r79

Oltmann M, Kyle D, Gilbert TJ 3rd, Devlin C, Forsyth RA, Shahbazi S. Clinical outcomes of lyophilised human amnion/chorion membrane in treatment of hard-to-heal diabetic foot ulcers in complex cases: a case series. J Wound Care. 2025;34(3):187-194. https://doi.org/10.12968/jowc.2025.0022

Abril-Pla O, Andreani V, Carroll C, et al. PyMC: a modern, and comprehensive probabilistic programming framework in Python. PeerJ Comput Sci. 2023;9:e1516. https://doi.org/10.7717/peerj-cs.1516

Tettelbach W, Cazzell S, Reyzelman AM, Sigal F, Caporusso JM, Agnew PS. A confirmatory study on the efficacy of dehydrated human amnion/chorion membrane dHACM allograft in the management of diabetic foot ulcers: A prospective, multicentre, randomised, controlled study of 110 patients from 14 wound clinics. Int Wound J. 2019;16(1):19-29. https://doi.org/10.1111/iwj.12976

Tettelbach W, Cazzell S, Sigal F, et al. A multicentre prospective randomised controlled comparative parallel study of dehydrated human umbilical cord (EpiCord) allograft for the treatment of diabetic foot ulcers. Int Wound J. 2019;16(1):122-130. https://doi.org/10.1111/iwj.13001

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Published

2025-10-31

Data Availability Statement

The data is proprietary but is available on request to the corresponding author.

How to Cite

Evaluation of lyophilized human amnion/chorion membrane (LHACM) in the management of nonhealing diabetic foot ulcers: an interim analysis of the CAMPAIGN trial. (2025). International Journal of Tissue Repair, 1(1). https://doi.org/10.63676/tk3kw419