Juvista (Avotermin) in Scars Following Varicose Vein Removal

Patients undergoing bilateral removal of the saphenous vein (by ligation and stripping) will be invited to participate in the study. Consenting patients will undergo a detailed screening examination, after which suitability to progress to randomisation to the study will be confirmed.

Suitable screened patients will attend for scheduled surgery of vein removal as normal - this is termed "Day 0" At the time of wound closure, IMP will be administered via intra-dermal injection to each of the incisional groin wounds, and exit wounds.

Each patient will serve as their own control with one leg being administered active IMP (at either a 5, 50, 200 or 500ng/100 ul)of dose solution, whilst the other leg is administered placebo solution. The study is double-blinded, so neither the Investigator nor patient will know which leg wounds receive which treatment.

Further to Day 0, the patients are requested to attend for a further 5 follow up visits (Week 6, Month 3, Month 5, Month 7 \& Month 12), where photographs of the scars will be taken, together with spectrophotometry readings to measure colour of the scar. At each visit, the Investigator and patient will rate their opinion of the scar, by global assessment scale \& VAS, together with patient completed questionnaires.

• Avotermin (Drug)

Primary outcomes

• Investigator scar assessment [7 & 12 months]
• Patient scar assessment [up to 12 months]
• Independent scar assessment [7 & 12 months]

Secondary outcomes

• Local tolerance [ongoing to 12 months]
• Adverse events [ongoing to12 months]

Sex: All, ages: 18 Years to 85 Years

Inclusion Criteria:

* Male and female patients between 18 and 85 years of age.
* Patients undergoing surgical removal of bilateral varicose veins by ligation and stripping, which will result in clinically similar (i.e. size and location) wounds at the groin and knee.
* Patients who have provided written informed consent.
* Patients with a body mass index between 15 and 35 kg/m2 inclusive.
* Patients with, in the opinion of the Investigator, clinically acceptable results for the laboratory tests specified in the trial protocol (see Protocol Section 6.4.1).
* Female patients of child bearing potential using method(s) of contraception acceptable to the Investigator and who agree to do so from at least the screening visit until one month after administration of the Investigational Medicinal Product.

Exclusion Criteria:

* Patients who have had previous surgical treatment for varicose veins.
* Patients with a history of a bleeding disorder.
* Patients with a chronic or currently active skin disorder which may adversely affect the healing of the acute wounds or involves the areas to be examined in this trial.
* Patients who on direct questioning and/or physical examination, have evidence of any past or present clinically significant medical condition that would impair wound healing.
* Patients who are taking or have taken investigational drugs in the 3 months prior to the screening visit.
* Patients with existing scars within 3cm of the potential trial wounds.
* Patients with diseases or conditions that could, in the opinion of the Investigator, interfere with the assessment of safety, tolerability or efficacy of the Investigational Product.
* Patients with a history of clinically significant hypersensitivity to any of the drugs or surgical dressings to be used in this trial.
* Patients who are taking regular, continuous, oral corticosteroid therapy.
* Patients undergoing investigations or changes in management for an existing medical condition.
* Patients who are pregnant or lactating.
* Patients who, in the opinion of the Investigator, are not likely to complete the trial.

• Results publication: McCollum PT, Bush JA, James G, Mason T, O'Kane S, McCollum C, Krievins D, Shiralkar S, Ferguson MW. Randomized phase II clinical trial of avotermin versus placebo for scar improvement. Br J Surg. 2011 Jul;98(7):925-34. doi: 10.1002/bjs.7438. Epub 2011 Mar 29. PMID 21618480

• Peter McCollum, MB MCh FRCS, Principal investigator, Hull Royal Infirmary