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    Clinical Trial Results:
    Multi-centre, Double-blind, Randomised, Active- and Placebo-Controlled, Confirmatory Trial to Demonstrate Efficacy and Safety of Traumed® Gel in Patients having Acute Ankle Sprain

    Summary
    EudraCT number
    2016-004792-50
    Trial protocol
    DE  
    Global end of trial date
    25 Mar 2021

    Results information
    Results version number
    v1(current)
    This version publication date
    04 Oct 2022
    First version publication date
    04 Oct 2022
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    C1502
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    -
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Biologische Heilmittel Heel GmbH
    Sponsor organisation address
    Dr.-Reckeweg-Str. 2 - 4, Baden-Baden, Germany, 76532
    Public contact
    Biologische Heilmittel Heel GmbH, Biologische Heilmittel Heel GmbH, +49 72215010, info@heel.com
    Scientific contact
    Biologische Heilmittel Heel GmbH, Biologische Heilmittel Heel GmbH, +49 72215010, info@heel.com
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    25 Mar 2021
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    25 Mar 2021
    Global end of trial reached?
    Yes
    Global end of trial date
    25 Mar 2021
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    The primary objective of the trial was to demonstrate the superior efficacy of Traumed gel versus Placebo gel in patients with acute unilateral ankle sprain.
    Protection of trial subjects
    Rescue medication was allowed for randomised patients: Paracetamol (acetaminophen) 500 mg/tablets to be taken for pain relief when necessary; allowed maximum dose: 4 tablets or 2000 mg/d, and not >2 tablets at a time. Patients were not allowed to take Paracetamol within 8 h prior to Visit 2. For further visits the restriction was 24 h. Paracetamol was not allowed within 24 h prior to Visit 3, Visit 4 and Visit 5. A procedure for emergency unblinding was available.
    Background therapy
    Supportive therapy was available for all patients: they received soft support (elastic bandage) on Day 1. All patients were trained how to use the elastic bandage and - if needed - the semi-rigid brace. If Grade 1: soft support during entire trial, as required; if Grade 2: provision of semi-rigid removable brace on Day 7; if Grade 3: withdrawal from trial/further treatment at investigator´s discretion. There was strong recommendation to use arm crutches during entire trial and with special importance until Day 4. The patients were only to partly weight the sprained ankle when using crutches. Use of RICE (simultaneous combination of all 4 elements Rest, Ice, Compression, and Elevation): restricted to time immediately after event, and before starting treatment with the investigational drug. After start of investigational treatment and during the entire course of the trial use of RICE was prohibited. The objective of RICE is to stop the injury-induced bleeding into the muscle tissue and thereby to minimise the extent of the injury.
    Evidence for comparator
    Controlled trials of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) as Diclofenac and others in patients with ankle sprain showed that compared with Placebo, NSAIDs were associated with improved pain control and function, decreased swelling, and more rapid return to activity. Reviews of Diclofenac have consistently demonstrated its efficacy in reducing pain and inflammation in acute and chronic conditions compared with Placebo. Diclofenac is considered to be the gold standard in the treatment of joint sprains and other conditions. Topical Diclofenac is well tolerated and associated with fewer side-effects than other topical NSAIDs, mostly mild, easily resolved local skin irritation (Banning 2008 Expert Opinion on Pharmacotherapy, 9, 2921-9, Zacher et al. 2008 Current Medical Research and Opinion, 24, 925-50, Simon et al. 2009 Pain, 143, 238-45). A systematic review and meta-analysis of blinded, randomised, placebo-, vehicle- or active-controlled trials concluded that topical Diclofenac appears to be generally well tolerated for cutaneous use in acute and chronic musculoskeletal conditions (Taylor et al. 2011 Current Medical Research and Opinion, 27, 605-22). For these reasons, Diclofenac gel was chosen as a comparator for this trial. In the other comparator arm a placebo gel was given.
    Actual start date of recruitment
    26 Feb 2018
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Germany: 809
    Worldwide total number of subjects
    809
    EEA total number of subjects
    809
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    786
    From 65 to 84 years
    23
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    28 German sites randomized 809 patients. Trial started in Q1/2018, planned recruitment period 12 months (mths). Recruitment interruption due to IMP expiry and resupply delay end of Dec 2019 till Feb 2020 and due to Sars-CoV-2 pandemic in spring 2020 (3 mths). Per Protocol Amendment v4.0 recruitment was extended by ~22 mths and ended on 18 Nov 2020.

    Pre-assignment
    Screening details
    809 patients (pts) with acute unilateral Grade (G) 1/2 sprain of the lateral ankle were enroled. G3 pts were not eligible. Following BfArM recommendations and EC agreement, 184 pts were excluded from main CTR population (625 pts) based on substantial amendment, final Blind Data Review Meeting decisions and individual patient listing in final SAP.

    Period 1
    Period 1 title
    Full Analysis Set (FAS)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator, Monitor, Data analyst, Carer, Assessor
    Blinding implementation details
    Trial personnel, Sponsor, CRO/ other third-party vendors were blinded during the trial. Each site had a team member responsible exclusively for handling the investigational medicinal product (IMP) and soft support/ semi-rigid brace, and who was not involved in any other trial procedures related to the patient. For the entire trial duration, only the team member responsible exclusively for handling IMP was present at IMP gel applications/ removing/ replacing bandages/ braces.

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Traumed gel
    Arm description
    Patients randomised to treatment with Traumed gel 3 g of gel 3 times/day for 7 days; main Clinical Trial Report (CTR) population. Full Analysis Set (FAS): n=622 treated patients; Traumed gel n=316 patients, Diclofenac gel n=151 patients; Placebo gel n=155 patients, based on a 2:1:1 randomisation ratio. FAS was to be used for intent-to-treat (ITT) analysis.
    Arm type
    Experimental

    Investigational medicinal product name
    Traumed
    Investigational medicinal product code
    Other name
    Tr14Gel
    Pharmaceutical forms
    Gel
    Routes of administration
    Topical, Topical use
    Dosage and administration details
    3 g of gel three times daily for 7 days. Area of ankle should be sufficiently covered. First/last investigational medicinal product (IMP) was applied during Screening/ Baseline Visit (Day 1) and End of Treatment Visit (Day 7). All other IMP applications were to be made by the patient during the 7-day treatment period.

    Arm title
    Diclofenac 1% gel
    Arm description
    Patients randomised to treatment with Diclofenac 1% gel, 3 g of gel 3 times/day for 7 days; main Clinical Trial Report (CTR) population. Full Analysis Set (FAS): n=622 treated patients; Traumed gel n=316 patients, Diclofenac gel n=151 patients; Placebo gel n=155 patients, based on a 2:1:1 randomisation ratio. FAS was to be used for intent-to-treat (ITT) analysis.
    Arm type
    Active comparator

    Investigational medicinal product name
    Diclofenac
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Gel
    Routes of administration
    Topical, Topical use
    Dosage and administration details
    3 g of Diclofenac 1 % gel three times daily for 7 days. Area of ankle should be sufficiently covered. First/last investigational medicinal product (IMP) was applied during Screening/ Baseline Visit (Day 1) and End of Treatment Visit (Day 7). All other IMP applications were to be made by the patient during the 7-day treatment period.

    Arm title
    Placebo gel
    Arm description
    Patients randomised to treatment with Placebo gel, 3 g of gel 3 times/day for 7 days; main Clinical Trial Report (CTR) population. Full Analysis Set (FAS): n=622 treated patients; Traumed gel n=316 patients, Diclofenac gel n=151 patients; Placebo gel n=155 patients, based on a 2:1:1 randomisation ratio. FAS was to be used for intent-to-treat (ITT) analysis.
    Arm type
    Placebo

    Investigational medicinal product name
    Placebo
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Gel
    Routes of administration
    Topical, Topical use
    Dosage and administration details
    3 g of gel three times daily for 7 days, to sufficiently cover the area of the ankle, applied by gentle rubbing. First/last investigational medicinal product (IMP) was applied during Screening/ Baseline Visit (Day 1) and End of Treatment Visit (Day 7). All other IMP applications were to be made by the patient during the 7-day treatment period.

    Number of subjects in period 1 [1]
    Traumed gel Diclofenac 1% gel Placebo gel
    Started
    316
    151
    155
    Completed
    314
    146
    155
    Not completed
    2
    5
    0
         Inclusion violation
    -
    1
    -
         Compliance < 80%
    -
    2
    -
         Premature discontinuation
    2
    -
    -
         Visit deviation
    -
    2
    -
    Notes
    [1] - The number of subjects reported to be in the baseline period are not the same as the worldwide number enrolled in the trial. It is expected that these numbers will be the same.
    Justification: Initially, N=809 patients (pts) were enroled. Following BfArM recommendations and in agreement with the Ethics Committee, 184 pts were excluded from main CTR population (based on substantial amendment, final Blind Data Review Meeting decisions and individual listing in final Statistical Analysis Plan). The remaining n=625 pts constitute the main Clinical Trial Report and Safety population.
    Period 2
    Period 2 title
    Per Protocol (PP) analysis set
    Is this the baseline period?
    No
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator, Monitor, Data analyst, Carer, Assessor
    Blinding implementation details
    Trial personnel, Sponsor, CRO/ other third-party vendors were blinded during the trial. Each site had a team member responsible exclusively for handling the investigational medicinal product (IMP) and soft support/ semi-rigid brace, and who was not involved in any other trial procedures related to the patient. For the entire trial duration, only the team member responsible exclusively for handling IMP was present at IMP gel applications/ removing/ replacing bandages/ braces.

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Traumed gel
    Arm description
    Patients randomised to treatment with Traumed gel 3 g of gel 3 times/day for 7 days; main Clinical Trial Report (CTR) population. Per Protocol (PP) analysis set: n=615 treated patients; Traumed gel n=314 patients, Diclofenac gel n=146 patients; Placebo gel n=155 patients, based on a 2:1:1 randomisation ratio.
    Arm type
    Experimental

    Investigational medicinal product name
    Traumed
    Investigational medicinal product code
    Other name
    Tr14Gel
    Pharmaceutical forms
    Gel
    Routes of administration
    Topical, Topical use
    Dosage and administration details
    3 g of gel three times daily for 7 days. Area of ankle should be sufficiently covered. First/last investigational medicinal product (IMP) was applied during Screening/ Baseline Visit (Day 1) and End of Treatment Visit (Day 7). All other IMP applications were to be made by the patient during the 7-day treatment period.

    Arm title
    Diclofenac 1% gel
    Arm description
    Patients randomised to treatment with Diclofenac 1% gel, 3 g of gel 3 times/day for 7 days; main Clinical Trial Report (CTR) population. Per Protocol (PP) analysis set: n=615 treated patients; Traumed gel n=314 patients, Diclofenac gel n=146 patients; Placebo gel n=155 patients, based on a 2:1:1 randomisation ratio.
    Arm type
    Active comparator

    Investigational medicinal product name
    Diclofenac
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Gel
    Routes of administration
    Topical, Topical use
    Dosage and administration details
    3 g of Diclofenac 1 % gel three times daily for 7 days. Area of ankle should be sufficiently covered. First/last investigational medicinal product (IMP) was applied during Screening/ Baseline Visit (Day 1) and End of Treatment Visit (Day 7). All other IMP applications were to be made by the patient during the 7-day treatment period.

    Arm title
    Placebo gel
    Arm description
    Patients randomised to treatment with Placebo gel, 3 g of gel 3 times/day for 7 days; main Clinical Trial Report (CTR) population. Per Protocol (PP) analysis set: n=615 treated patients; Traumed gel n=314 patients, Diclofenac gel n=146 patients; Placebo gel n=155 patients, based on a 2:1:1 randomisation ratio.
    Arm type
    Placebo

    Investigational medicinal product name
    Placebo
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Gel
    Routes of administration
    Topical, Topical use
    Dosage and administration details
    3 g of gel three times daily for 7 days, to sufficiently cover the area of the ankle, applied by gentle rubbing. First/last investigational medicinal product (IMP) was applied during Screening/ Baseline Visit (Day 1) and End of Treatment Visit (Day 7). All other IMP applications were to be made by the patient during the 7-day treatment period.

    Number of subjects in period 2
    Traumed gel Diclofenac 1% gel Placebo gel
    Started
    314
    146
    155
    Completed
    314
    146
    155

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Traumed gel
    Reporting group description
    Patients randomised to treatment with Traumed gel 3 g of gel 3 times/day for 7 days; main Clinical Trial Report (CTR) population. Full Analysis Set (FAS): n=622 treated patients; Traumed gel n=316 patients, Diclofenac gel n=151 patients; Placebo gel n=155 patients, based on a 2:1:1 randomisation ratio. FAS was to be used for intent-to-treat (ITT) analysis.

    Reporting group title
    Diclofenac 1% gel
    Reporting group description
    Patients randomised to treatment with Diclofenac 1% gel, 3 g of gel 3 times/day for 7 days; main Clinical Trial Report (CTR) population. Full Analysis Set (FAS): n=622 treated patients; Traumed gel n=316 patients, Diclofenac gel n=151 patients; Placebo gel n=155 patients, based on a 2:1:1 randomisation ratio. FAS was to be used for intent-to-treat (ITT) analysis.

    Reporting group title
    Placebo gel
    Reporting group description
    Patients randomised to treatment with Placebo gel, 3 g of gel 3 times/day for 7 days; main Clinical Trial Report (CTR) population. Full Analysis Set (FAS): n=622 treated patients; Traumed gel n=316 patients, Diclofenac gel n=151 patients; Placebo gel n=155 patients, based on a 2:1:1 randomisation ratio. FAS was to be used for intent-to-treat (ITT) analysis.

    Reporting group values
    Traumed gel Diclofenac 1% gel Placebo gel Total
    Number of subjects
    316 151 155 622
    Age categorical
    Units: Subjects
        Adults (18-64 years)
    305 147 152 604
        From 65-84 years
    11 4 3 18
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    35.2 ( 14.11 ) 34.7 ( 13.53 ) 36.0 ( 13.66 ) -
    Gender categorical
    Units: Subjects
        Female
    156 64 68 288
        Male
    160 87 87 334
    Ethnic origin
    Units: Subjects
        Caucasian
    305 149 152 606
        Black
    3 0 2 5
        Asian
    1 0 0 1
        Other
    7 2 1 10
    Injury Grading
    Units: Subjects
        Grade 1
    216 109 103 428
        Grade 2
    100 42 52 194
        Grade 3
    0 0 0 0
    Body-Mass-Index (BMI)
    Units: kg/m^2
        arithmetic mean (standard deviation)
    26.2 ( 4.80 ) 24.7 ( 4.08 ) 26.2 ( 4.63 ) -
    Efficacy - VAS pain score on Passive Movement (VASPM)
    Units: mm
        arithmetic mean (standard deviation)
    74.9 ( 10.97 ) 74.9 ( 11.41 ) 75.5 ( 11.36 ) -
    Efficacy - VAS pain score at Rest (VASRS)
    Units: mm
        arithmetic mean (standard deviation)
    39.4 ( 24.65 ) 37.0 ( 23.87 ) 39.7 ( 23.88 ) -
    Efficacy - Foot and Ankle Ability Measure - Activities of Daily Living (FAAM)
    The FAAM-ADL subscale is part of the Foot and Ankle Ability Measure (FAAM) questionnaire and consists of 21 single items assessing Activities of Daily Living as standing, walking, going up stairs, etc. eCRF instruction was: “Please answer each question with the response that most closely describes your condition during the past week”, with minimum: 0 and maximum: 100.
    Units: Score
        arithmetic mean (standard deviation)
    51.4 ( 17.36 ) 50.6 ( 18.6 ) 49.7 ( 18.01 ) -

    End points

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    End points reporting groups
    Reporting group title
    Traumed gel
    Reporting group description
    Patients randomised to treatment with Traumed gel 3 g of gel 3 times/day for 7 days; main Clinical Trial Report (CTR) population. Full Analysis Set (FAS): n=622 treated patients; Traumed gel n=316 patients, Diclofenac gel n=151 patients; Placebo gel n=155 patients, based on a 2:1:1 randomisation ratio. FAS was to be used for intent-to-treat (ITT) analysis.

    Reporting group title
    Diclofenac 1% gel
    Reporting group description
    Patients randomised to treatment with Diclofenac 1% gel, 3 g of gel 3 times/day for 7 days; main Clinical Trial Report (CTR) population. Full Analysis Set (FAS): n=622 treated patients; Traumed gel n=316 patients, Diclofenac gel n=151 patients; Placebo gel n=155 patients, based on a 2:1:1 randomisation ratio. FAS was to be used for intent-to-treat (ITT) analysis.

    Reporting group title
    Placebo gel
    Reporting group description
    Patients randomised to treatment with Placebo gel, 3 g of gel 3 times/day for 7 days; main Clinical Trial Report (CTR) population. Full Analysis Set (FAS): n=622 treated patients; Traumed gel n=316 patients, Diclofenac gel n=151 patients; Placebo gel n=155 patients, based on a 2:1:1 randomisation ratio. FAS was to be used for intent-to-treat (ITT) analysis.
    Reporting group title
    Traumed gel
    Reporting group description
    Patients randomised to treatment with Traumed gel 3 g of gel 3 times/day for 7 days; main Clinical Trial Report (CTR) population. Per Protocol (PP) analysis set: n=615 treated patients; Traumed gel n=314 patients, Diclofenac gel n=146 patients; Placebo gel n=155 patients, based on a 2:1:1 randomisation ratio.

    Reporting group title
    Diclofenac 1% gel
    Reporting group description
    Patients randomised to treatment with Diclofenac 1% gel, 3 g of gel 3 times/day for 7 days; main Clinical Trial Report (CTR) population. Per Protocol (PP) analysis set: n=615 treated patients; Traumed gel n=314 patients, Diclofenac gel n=146 patients; Placebo gel n=155 patients, based on a 2:1:1 randomisation ratio.

    Reporting group title
    Placebo gel
    Reporting group description
    Patients randomised to treatment with Placebo gel, 3 g of gel 3 times/day for 7 days; main Clinical Trial Report (CTR) population. Per Protocol (PP) analysis set: n=615 treated patients; Traumed gel n=314 patients, Diclofenac gel n=146 patients; Placebo gel n=155 patients, based on a 2:1:1 randomisation ratio.

    Subject analysis set title
    Safety population
    Subject analysis set type
    Safety analysis
    Subject analysis set description
    The Safety population matches the main Cllinical Trial Report population of n=625 patients randomized 2:1:1 to Traumed gel n=318, Diclofenac 1% gel n=152 and Placebo n=155. There were no Safety exclusions from the randomized population. There were n=3 Full Analysis Set (FAS) exclusions from the Safety population due to no follow-up efficacy data, leaving a FAS of n=622.

    Primary: Area Under the Curve (AUC) for pain on passive movement in Visual Analog Scale (VAS) from Baseline to Day 4

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    End point title
    Area Under the Curve (AUC) for pain on passive movement in Visual Analog Scale (VAS) from Baseline to Day 4
    End point description
    Ankle pain measurement by 100 mm VAS with start 'no pain' (0 mm) and end 'most severe imaginable pain' patients may imagine in relation to their ankle sprain (100 mm). After 5 min rest, patients assessed their pain on a VAS scale (2nd efficacy assessment). Still at rest investigators performed flexion on the injured ankle: then patients assessed their pain on a VAS scale (1st efficacy assessment). Pain to be assessed: pain on passive movement. Endpoint data were calculated based on actual time of measurement. Missing values were replaced by Last Observation Carried Forward (LOCF). Statistical analysis based on Full Analysis Set n=622 (1st set for evaluation of superiority of Traumed versus (v) Placebo gel, 2nd set for evaluation of non-inferiority of Traumed v Diclofenac gel), and on the Per Protocol analysis set n=615 (1st set for evaluation of non-inferiority of Traumed v Diclofenac gel, 2nd set for evaluation of superiority of Traumed v Placebo gel). Absolute values are shown.
    End point type
    Primary
    End point timeframe
    Baseline (Visit 1) to Day 4 (Visit 3)
    End point values
    Traumed gel Diclofenac 1% gel Placebo gel Traumed gel Diclofenac 1% gel
    Number of subjects analysed
    316 [1]
    151 [2]
    155 [3]
    314 [4]
    146 [5]
    Units: mm
    median (full range (min-max))
        Day 4 (Visit 3)
    187.88 (51.46 to 370.72)
    197.16 (39.94 to 366.54)
    200.75 (86.08 to 374.43)
    187.50 (51.46 to 370.73)
    197.19 (76.74 to 366.54)
    Notes
    [1] - Full Analysis Set n=622
    [2] - Full Analysis Set n=622
    [3] - Full Analysis Set n=622
    [4] - Per Protocol analysis set n=615
    [5] - Per Protocol analysis set n=615
    Statistical analysis title
    Parametric Analysis (ANCOVA) - Day 4 (Visit 3)
    Statistical analysis description
    Hypothesis no. 1 (superiority) is based on the Full Analysis Set (FAS); FAS n=622.
    Comparison groups
    Traumed gel v Placebo gel
    Number of subjects included in analysis
    471
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    ≤ 0.0205
    Method
    ANCOVA
    Confidence interval
    Statistical analysis title
    Effect Sizes (Mann-Whitney); 2-Sided 95.0% CI D4V3
    Statistical analysis description
    Time point: Day 4 (Visit 3) - D4V3 Hypothesis no. 1 (superiority) is based on the Full Analysis Set (FAS); FAS n=622. CI, Confidence interval
    Comparison groups
    Traumed gel v Placebo gel
    Number of subjects included in analysis
    471
    Analysis specification
    Pre-specified
    Analysis type
    superiority [6]
    P-value
    = 0.0138
    Method
    Wilcoxon (Mann-Whitney)
    Parameter type
    Mann-Whitney estimator
    Point estimate
    0.5698
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.5163
         upper limit
    0.6233
    Notes
    [6] - Superiority is defined for LB-MW>0.50. LB, Lower Bound of the two-sided confidence interval; MW, Mann-Whitney estimator
    Statistical analysis title
    Parametric Analysis (ANCOVA) - Day 4 (Visit 3)
    Statistical analysis description
    Hypothesis no. 2 (non-inferiority) is based on the Per Protocol (PP) analysis set; PP n=615.
    Comparison groups
    Traumed gel v Diclofenac 1% gel
    Number of subjects included in analysis
    460
    Analysis specification
    Pre-specified
    Analysis type
    non-inferiority
    P-value
    = 0.4812
    Method
    ANCOVA
    Confidence interval
    Statistical analysis title
    Effect Sizes (Mann-Whitney); 2-Sided 95.0% CI D4V3
    Statistical analysis description
    Time point: Day 4 (Visit 3) - D4V3 Hypothesis no. 2 (non-inferiority) is based on the Per Protocol (PP) analysis set; PP n=615. CI, Confidence interval
    Comparison groups
    Traumed gel v Diclofenac 1% gel
    Number of subjects included in analysis
    460
    Analysis specification
    Pre-specified
    Analysis type
    non-inferiority [7]
    P-value
    = 0.3804
    Method
    Wilcoxon (Mann-Whitney)
    Parameter type
    Mann-Whitney estimator
    Point estimate
    0.5254
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.4698
         upper limit
    0.581
    Notes
    [7] - Non-inferiority is defined for LB-MW>0.407. LB, Lower Bound of the two-sided confidence interval; MW, Mann-Whitney estimator

    Primary: Area Under the Curve (AUC) for pain on passive movement in Visual Analog Scale (VAS) from Baseline to Day 7

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    End point title
    Area Under the Curve (AUC) for pain on passive movement in Visual Analog Scale (VAS) from Baseline to Day 7
    End point description
    Ankle pain measurement by 100 mm VAS with start 'no pain' (0 mm) and end 'most severe imaginable pain' patients may imagine in relation to their ankle sprain (100 mm). After 5 min rest, patients assessed their pain on a VAS scale (2nd efficacy assessment). Still at rest investigators performed flexion on the injured ankle: then patients assessed their pain on a VAS scale (1st efficacy assessment). Pain to be assessed: pain on passive movement. Endpoint data were calculated based on actual time of measurement. Missing values were replaced by Last Observation Carried Forward (LOCF). Statistical analysis based on Full Analysis Set n=622 (1st set for evaluation of superiority of Traumed versus (v) Placebo gel, 2nd set for evaluation of non-inferiority of Traumed v Diclofenac gel), and on the Per Protocol analysis set n=615 (1st set for evaluation of non-inferiority of Traumed v Diclofenac gel, 2nd set for evaluation of superiority of Traumed v Placebo gel). Absolute values are shown.
    End point type
    Primary
    End point timeframe
    Baseline (Visit 1) to Day 7 (Visit 4, End of Treatment)
    End point values
    Traumed gel Diclofenac 1% gel Placebo gel Traumed gel Diclofenac 1% gel
    Number of subjects analysed
    316 [8]
    151 [9]
    155 [10]
    314 [11]
    146 [12]
    Units: mm
    median (full range (min-max))
        Day 7 (Visit 4)
    294.14 (63.46 to 592.47)
    327.68 (53.93 to 637.79)
    353.42 (101.28 to 620.07)
    293.85 (63.46 to 592.47)
    327.93 (94.76 to 637.79)
    Notes
    [8] - Full Analysis Set n=622
    [9] - Full Analysis Set n=622
    [10] - Full Analysis Set n=622
    [11] - Per Protocol analysis set n=615
    [12] - Per Protocol analysis set n=615
    Statistical analysis title
    Parametric Analysis (ANCOVA) - Day 7 (Visit 4)
    Statistical analysis description
    Hypothesis no. 1 (superiority) is based on the Full Analysis Set (FAS); FAS n=622.
    Comparison groups
    Traumed gel v Placebo gel
    Number of subjects included in analysis
    471
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.0001
    Method
    ANCOVA
    Confidence interval
    Statistical analysis title
    Effect Sizes (Mann-Whitney); 2-Sided 95.0% CI D7V4
    Statistical analysis description
    Time point: Day 7 (Visit 4) - D7V4 Hypothesis no. 1 (superiority) is based on the Full Analysis Set (FAS); FAS n=622. CI, Confidence interval
    Comparison groups
    Traumed gel v Placebo gel
    Number of subjects included in analysis
    471
    Analysis specification
    Pre-specified
    Analysis type
    superiority [13]
    P-value
    < 0.0001
    Method
    Wilcoxon (Mann-Whitney)
    Parameter type
    Mann-Whitney estimator
    Point estimate
    0.6387
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.5862
         upper limit
    0.6911
    Notes
    [13] - Superiority is defined for LB-MW>0.50. LB, Lower Bound of the two-sided confidence interval; MW, Mann-Whitney estimator
    Statistical analysis title
    Parametric Analysis (ANCOVA) - Day 7 (Visit 4)
    Statistical analysis description
    Hypothesis no. 2 (non-inferiority) is based on the Per Protocol (PP) analysis set; PP n=615.
    Comparison groups
    Traumed gel v Diclofenac 1% gel
    Number of subjects included in analysis
    460
    Analysis specification
    Pre-specified
    Analysis type
    non-inferiority
    P-value
    = 0.0034
    Method
    ANCOVA
    Confidence interval
    Statistical analysis title
    Effect Sizes (Mann-Whitney); 2-Sided 95.0% CI D7V4
    Statistical analysis description
    Time point: Day 7 (Visit 4) - D7V4 Hypothesis no. 2 (non-inferiority) is based on the Per Protocol (PP) analysis set; PP n=615. CI, Confidence interval
    Comparison groups
    Traumed gel v Diclofenac 1% gel
    Number of subjects included in analysis
    460
    Analysis specification
    Pre-specified
    Analysis type
    non-inferiority [14]
    P-value
    = 0.0017
    Method
    Wilcoxon (Mann-Whitney)
    Parameter type
    Mann-Whitney estimator
    Point estimate
    0.591
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.537
         upper limit
    0.645
    Notes
    [14] - Non-inferiority is defined for LB-MW>0.407. LB, Lower Bound of the two-sided confidence interval; MW, Mann-Whitney estimator

    Secondary: Area Under the Curve (AUC) for pain at rest in Visual Analog Scale (VAS) from Baseline to Day 4

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    End point title
    Area Under the Curve (AUC) for pain at rest in Visual Analog Scale (VAS) from Baseline to Day 4
    End point description
    Ankle pain was measured using a 100 mm VAS starting with 'no pain' (0 mm) and ending with 'most severe imaginable pain' the patient may have imagined in relation to his/her ankle sprain (100 mm). The patients were asked after 5 minutes rest to assess their pain themselves on a VAS scale. AUC for pain at rest in VAS from baseline to Day 4 (Visit 3) and Day 7 (Visit 4) was calculated based on actual time of pain measurement. Missing values were replaced by Last Observation Carried Forward (LOCF). Statistical analysis based on Full Analysis Set n=622 (1st set for evaluation of superiority of Traumed gel versus (v) Placebo gel, 2nd set for evaluation of non-inferiority of Traumed gel v Diclofenac gel), and on the Per Protocol analysis set n=615 (1st set for evaluation of non-inferiority of Traumed gel v Diclofenac gel, 2nd set for evaluation of superiority of Traumed gel v Placebo gel). Absolute values are shown.
    End point type
    Secondary
    End point timeframe
    Baseline (Visit 1) to Day 4 (Visit 3)
    End point values
    Traumed gel Diclofenac 1% gel Placebo gel Traumed gel Diclofenac 1% gel
    Number of subjects analysed
    316 [15]
    151 [16]
    155 [17]
    314 [18]
    146 [19]
    Units: mm
    median (full range (min-max))
        Day 4 (Visit 3)
    65.90 (2.48 to 305.50)
    58.59 (6.67 to 272.50)
    73.36 (2.49 to 259.22)
    65.38 (2.48 to 305.50)
    58.40 (6.67 to 272.50)
    Notes
    [15] - Full Analysis Set n=622
    [16] - Full Analysis Set n=622
    [17] - Full Analysis Set n=622
    [18] - Per Protocol analysis set n=615
    [19] - Per Protocol analysis set n=615
    Statistical analysis title
    Parametric Analysis (ANCOVA) - Day 4 (Visit 3)
    Statistical analysis description
    Hypothesis no. 1 (superiority) is based on the Full Analysis Set (FAS); FAS n=622.
    Comparison groups
    Traumed gel v Placebo gel
    Number of subjects included in analysis
    471
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.7015
    Method
    ANCOVA
    Confidence interval
    Statistical analysis title
    Effect Sizes (Mann-Whitney); 2-Sided 95.0% CI D4V3
    Statistical analysis description
    Time point: Day 4 (Visit 3) - D4V3 Hypothesis no. 1 (superiority) is based on the Full Analysis Set (FAS); FAS n=622. CI, Confidence interval
    Comparison groups
    Traumed gel v Placebo gel
    Number of subjects included in analysis
    471
    Analysis specification
    Pre-specified
    Analysis type
    superiority [20]
    P-value
    = 0.219
    Method
    Wilcoxon (Mann-Whitney)
    Parameter type
    Mann-Whitney estimator
    Point estimate
    0.5349
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.4808
         upper limit
    0.589
    Notes
    [20] - Superiority is defined for LB-MW>0.50. LB, Lower Bound of the two-sided confidence interval; MW, Mann-Whitney estimator
    Statistical analysis title
    Parametric Analysis (ANCOVA) - Day 4 (Visit 3)
    Statistical analysis description
    Hypothesis no. 2 (non-inferiority) is based on the Per Protocol (PP) analysis set; PP n=615.
    Comparison groups
    Traumed gel v Diclofenac 1% gel
    Number of subjects included in analysis
    460
    Analysis specification
    Pre-specified
    Analysis type
    non-inferiority
    P-value
    = 0.1189
    Method
    ANCOVA
    Confidence interval
    Statistical analysis title
    Effect Sizes (Mann-Whitney); 2-Sided 95.0% CI D4V3
    Statistical analysis description
    Time point: Day 4 (Visit 3) - D4V3 Hypothesis no. 2 (non-inferiority) is based on the Per Protocol (PP) analysis set; PP n=615. CI, Confidence interval
    Comparison groups
    Traumed gel v Diclofenac 1% gel
    Number of subjects included in analysis
    460
    Analysis specification
    Pre-specified
    Analysis type
    non-inferiority [21]
    P-value
    = 0.4074
    Method
    Wilcoxon (Mann-Whitney)
    Parameter type
    Mann-Whitney estimator
    Point estimate
    0.476
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.419
         upper limit
    0.533
    Notes
    [21] - Non-inferiority is defined for LB-MW>0.407. LB, Lower Bound of the two-sided confidence interval; MW, Mann-Whitney estimator

    Secondary: Area Under the Curve (AUC) for pain on passive movement in Visual Analog Scale (VAS) from Baseline to Day 2, and Final Visit

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    End point title
    Area Under the Curve (AUC) for pain on passive movement in Visual Analog Scale (VAS) from Baseline to Day 2, and Final Visit
    End point description
    Ankle pain measurement by 100 mm VAS with start 'no pain' (0 mm) and end 'most severe imaginable pain' patients may imagine in relation to their ankle sprain (100 mm). After 5 min rest, patients assessed their pain on a VAS scale (2nd efficacy assessment). Still at rest investigators performed flexion on the injured ankle: then patients assessed their pain on a VAS scale (1st efficacy assessment). Pain to be assessed: pain on passive movement. Endpoint data were calculated based on actual time of measurement. Missing values were replaced by Last Observation Carried Forward (LOCF). Statistical analysis based on Full Analysis Set n=622 (1st set for evaluation of superiority of Traumed versus (v) Placebo gel, 2nd set for evaluation of non-inferiority of Traumed v Diclofenac gel), and on the Per Protocol analysis set n=615 (1st set for evaluation of non-inferiority of Traumed v Diclofenac gel, 2nd set for evaluation of superiority of Traumed v Placebo gel). Absolute values are shown.
    End point type
    Secondary
    End point timeframe
    Baseline (Visit 1) to Day 2 (Visit 2) and Visit 5 (Day 14, Final Visit)
    End point values
    Traumed gel Diclofenac 1% gel Placebo gel Traumed gel Diclofenac 1% gel
    Number of subjects analysed
    316 [22]
    151 [23]
    155 [24]
    314 [25]
    146 [26]
    Units: mm
    median (full range (min-max))
        Day 2 (Visit 2)
    69.00 (30.40 to 114.40)
    70.49 (24.92 to 150.78)
    70.51 (39.97 to 97.51)
    68.88 (30.40 to 114.40)
    70.58 (34.71 to 98.85)
        Day 14 (Visit 5) Final Visit
    394.65 (66.96 to 1126.39)
    503.36 (57.43 to 1266.54)
    577.00 (101.28 to 1050.77)
    394.37 (66.96 to 1126.39)
    505.39 (98.76 to 1266.54)
    Notes
    [22] - Full Analysis Set n=622
    [23] - Full Analysis Set n=622
    [24] - Full Analysis Set n=622
    [25] - Per Protocol analysis set n=615
    [26] - Per Protocol analysis set n=615
    Statistical analysis title
    Parametric Analysis (ANCOVA) - Day 2 (Visit 2)
    Statistical analysis description
    Hypothesis no. 1 (superiority) is based on the Full Analysis Set (FAS); FAS n=622.
    Comparison groups
    Traumed gel v Placebo gel
    Number of subjects included in analysis
    471
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.2962
    Method
    ANCOVA
    Confidence interval
    Statistical analysis title
    Effect Sizes (Mann-Whitney); 2-Sided 95.0% CI D2V2
    Statistical analysis description
    Time point: Day 2 (Visit 2) - D2V2 Hypothesis no. 1 (superiority) is based on the Full Analysis Set (FAS); FAS n=622. CI, Confidence interval
    Comparison groups
    Traumed gel v Placebo gel
    Number of subjects included in analysis
    471
    Analysis specification
    Pre-specified
    Analysis type
    superiority [27]
    P-value
    = 0.2361
    Method
    Wilcoxon (Mann-Whitney)
    Parameter type
    Mann-Whitney estimator
    Point estimate
    0.5336
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.4792
         upper limit
    0.588
    Notes
    [27] - Superiority is defined for LB-MW>0.50. LB, Lower Bound of the two-sided confidence interval; MW, Mann-Whitney estimator
    Statistical analysis title
    Parametric Analysis (ANCOVA) - Day 14 (Visit 5)
    Statistical analysis description
    Hypothesis no. 1 (superiority) is based on the Full Analysis Set (FAS); FAS n=622.
    Comparison groups
    Traumed gel v Placebo gel
    Number of subjects included in analysis
    471
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.0001
    Method
    ANCOVA
    Confidence interval
    Statistical analysis title
    Effect Sizes (Mann-Whitney); 2-Sided 95.0% CI D14
    Statistical analysis description
    Time point: Day 14 (Visit 5) - D14V5 Hypothesis no. 1 (superiority) is based on the Full Analysis Set (FAS); FAS n=622. CI, Confidence interval
    Comparison groups
    Traumed gel v Placebo gel
    Number of subjects included in analysis
    471
    Analysis specification
    Pre-specified
    Analysis type
    superiority [28]
    P-value
    < 0.0001
    Method
    Wilcoxon (Mann-Whitney)
    Parameter type
    Mann-Whitney estimator
    Point estimate
    0.6803
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.6282
         upper limit
    0.7325
    Notes
    [28] - Superiority is defined for LB-MW>0.50. LB, Lower Bound of the two-sided confidence interval; MW, Mann-Whitney estimator
    Statistical analysis title
    Parametric Analysis (ANCOVA) - Day 2 (Visit 2)
    Statistical analysis description
    Hypothesis no. 2 (non-inferiority) is based on the Per Protocol (PP) analysis set; PP n=615.
    Comparison groups
    Traumed gel v Diclofenac 1% gel
    Number of subjects included in analysis
    460
    Analysis specification
    Pre-specified
    Analysis type
    non-inferiority
    P-value
    = 0.6359
    Method
    ANCOVA
    Confidence interval
    Statistical analysis title
    Effect Sizes (Mann-Whitney); 2-Sided 95.0% CI D2V2
    Statistical analysis description
    Time point: Day 2 (Visit 2) - D2V2 Hypothesis no. 2 (non-inferiority) is based on the Per Protocol (PP) analysis set; PP n=615. CI, Confidence interval
    Comparison groups
    Traumed gel v Diclofenac 1% gel
    Number of subjects included in analysis
    460
    Analysis specification
    Pre-specified
    Analysis type
    non-inferiority [29]
    P-value
    = 0.7227
    Method
    Wilcoxon (Mann-Whitney)
    Parameter type
    Mann-Whitney estimator
    Point estimate
    0.5103
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.454
         upper limit
    0.5665
    Notes
    [29] - Non-inferiority is defined for LB-MW>0.407. LB, Lower Bound of the two-sided confidence interval; MW, Mann-Whitney estimator
    Statistical analysis title
    Parametric Analysis (ANCOVA) - Day 14 (Visit 5)
    Statistical analysis description
    Hypothesis no. 2 (non-inferiority) is based on the Per Protocol (PP) analysis set; PP n=615.
    Comparison groups
    Traumed gel v Diclofenac 1% gel
    Number of subjects included in analysis
    460
    Analysis specification
    Pre-specified
    Analysis type
    non-inferiority
    P-value
    = 0.0001
    Method
    ANCOVA
    Confidence interval
    Statistical analysis title
    Effect Sizes (Mann-Whitney); 2-Sided 95.0% CI D14
    Statistical analysis description
    Time point: Day 14 (Visit 5) - D14V5 Hypothesis no. 2 (non-inferiority) is based on the Per Protocol (PP) analysis set; PP n=615. CI, Confidence interval
    Comparison groups
    Traumed gel v Diclofenac 1% gel
    Number of subjects included in analysis
    460
    Analysis specification
    Pre-specified
    Analysis type
    non-inferiority [30]
    P-value
    < 0.0001
    Method
    Wilcoxon (Mann-Whitney)
    Parameter type
    Mann-Whitney estimator
    Point estimate
    0.6234
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.5701
         upper limit
    0.6768
    Notes
    [30] - Non-inferiority is defined for LB-MW>0.407. LB, Lower Bound of the two-sided confidence interval; MW, Mann-Whitney estimator

    Secondary: Area Under the Curve (AUC) for pain at rest in Visual Analog Scale (VAS) from Baseline to Day 2, 7 and Final Visit

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    End point title
    Area Under the Curve (AUC) for pain at rest in Visual Analog Scale (VAS) from Baseline to Day 2, 7 and Final Visit
    End point description
    Ankle pain was measured using a 100 mm VAS starting with 'no pain' (0 mm) and ending with 'most severe imaginable pain' the patient may have imagined in relation to his/her ankle sprain (100 mm). The patients were asked after 5 minutes rest to assess their pain themselves on a VAS scale. AUC for pain at rest in VAS from baseline to Day 4 (Visit 3) and Day 7 (Visit 4) was calculated based on actual time of pain measurement. Missing values were replaced by Last Observation Carried Forward (LOCF). Statistical analysis based on Full Analysis Set n=622 (1st set for evaluation of superiority of Traumed gel versus (v) Placebo gel, 2nd set for evaluation of non-inferiority of Traumed gel v Diclofenac gel), and on the Per Protocol analysis set n=615 (1st set for evaluation of non-inferiority of Traumed gel v Diclofenac gel, 2nd set for evaluation of superiority of Traumed gel v Placebo gel). Absolute values are shown.
    End point type
    Secondary
    End point timeframe
    Baseline (Visit 1) to Day 2 (Visit 2), Day 7 (Visit 4, End of Treatment) and Day 14 (Visit 5, Final Visit)
    End point values
    Traumed gel Diclofenac 1% gel Placebo gel Traumed gel Diclofenac 1% gel
    Number of subjects analysed
    316 [31]
    151 [32]
    155 [33]
    314 [34]
    146 [35]
    Units: mm
    median (full range (min-max))
        Day 2 (Visit 2)
    28.0 (0 to 107.4)
    25.4 (2.6 to 86.5)
    31.4 (0 to 91.5)
    27.4 (0.0 to 107.4)
    24.9 (2.6 to 86.5)
        Day 7 (Visit 4)
    90.3 (2.5 to 570.5)
    91.6 (11.5 to 435.5)
    109.8 (2.5 to 504.3)
    90.1 (2.5 to 570.5)
    88.4 (11.5 to 435.5)
        Day 14 (Visit 5)
    116.1 (2.5 to 895.5)
    130.4 (12.5 to 872.0)
    159.7 (2.5 to 896.5)
    113.4 (2.5 to 895.5)
    128.9 (12.5 to 872.0)
    Notes
    [31] - Full Analysis Set n=622
    [32] - Full Analysis Set n=622
    [33] - Full Analysis Set n=622
    [34] - Per Protocol analysis set n=615
    [35] - Per Protocol analysis set n=615
    Statistical analysis title
    Parametric Analysis (ANCOVA) - Day 2 (Visit 2)
    Statistical analysis description
    Hypothesis no. 1 (superiority) is based on the Full Analysis Set (FAS); FAS n=622.
    Comparison groups
    Traumed gel v Placebo gel
    Number of subjects included in analysis
    471
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.9383
    Method
    ANCOVA
    Confidence interval
    Statistical analysis title
    Effect Sizes (Mann-Whitney); 2-Sided 95.0% CI D2V2
    Statistical analysis description
    Time point: Day 2 (Visit 2) - D2V2 Hypothesis no. 1 (superiority) is based on the Full Analysis Set (FAS); FAS n=622. CI, Confidence interval
    Comparison groups
    Traumed gel v Placebo gel
    Number of subjects included in analysis
    471
    Analysis specification
    Pre-specified
    Analysis type
    superiority [36]
    P-value
    = 0.584
    Method
    Wilcoxon (Mann-Whitney)
    Parameter type
    Mann-Whitney estimator
    Point estimate
    0.5155
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.4609
         upper limit
    0.5702
    Notes
    [36] - Superiority is defined for LB-MW>0.50. LB, Lower Bound of the two-sided confidence interval; MW, Mann-Whitney estimator
    Statistical analysis title
    Parametric Analysis (ANCOVA) - Day 7 (Visit 4)
    Statistical analysis description
    Hypothesis no. 1 (superiority) is based on the Full Analysis Set (FAS); FAS n=622.
    Comparison groups
    Traumed gel v Placebo gel
    Number of subjects included in analysis
    471
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.2219
    Method
    ANCOVA
    Confidence interval
    Statistical analysis title
    Effect Sizes (Mann-Whitney); 2-Sided 95.0% CI D7V4
    Statistical analysis description
    Time point: Day 7 (Visit 4) - D7V4 Hypothesis no. 1 (superiority) is based on the Full Analysis Set (FAS); FAS n=622. CI, Confidence interval
    Comparison groups
    Traumed gel v Placebo gel
    Number of subjects included in analysis
    471
    Analysis specification
    Pre-specified
    Analysis type
    superiority [37]
    P-value
    = 0.0166
    Method
    Wilcoxon (Mann-Whitney)
    Parameter type
    Mann-Whitney estimator
    Point estimate
    0.5679
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.5148
         upper limit
    0.6211
    Notes
    [37] - Superiority is defined for LB-MW>0.50. LB, Lower Bound of the two-sided confidence interval; MW, Mann-Whitney estimator
    Statistical analysis title
    Parametric Analysis (ANCOVA) - Day 14 (Visit 5)
    Statistical analysis description
    Hypothesis no. 1 (superiority) is based on the Full Analysis Set (FAS); FAS n=622.
    Comparison groups
    Traumed gel v Placebo gel
    Number of subjects included in analysis
    471
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.0816
    Method
    ANCOVA
    Confidence interval
    Statistical analysis title
    Effect Sizes (Mann-Whitney); 2-Sided 95.0% CI D14
    Statistical analysis description
    Time point: Day 14 (Visit 5) - D14V5 Hypothesis no. 1 (superiority) is based on the Full Analysis Set (FAS); FAS n=622. CI, Confidence interval
    Comparison groups
    Traumed gel v Placebo gel
    Number of subjects included in analysis
    471
    Analysis specification
    Pre-specified
    Analysis type
    superiority [38]
    P-value
    = 0.0005
    Method
    Wilcoxon (Mann-Whitney)
    Parameter type
    Mann-Whitney estimator
    Point estimate
    0.5991
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.5467
         upper limit
    0.6514
    Notes
    [38] - Superiority is defined for LB-MW>0.50. LB, Lower Bound of the two-sided confidence interval; MW, Mann-Whitney estimator
    Statistical analysis title
    Parametric Analysis (ANCOVA) - Day 2 (Visit 2)
    Statistical analysis description
    Hypothesis no. 2 (non-inferiority) is based on the Per Protocol (PP) analysis set; PP n=615.
    Comparison groups
    Traumed gel v Diclofenac 1% gel
    Number of subjects included in analysis
    460
    Analysis specification
    Pre-specified
    Analysis type
    non-inferiority
    P-value
    = 0.1074
    Method
    ANCOVA
    Confidence interval
    Statistical analysis title
    Effect Sizes (Mann-Whitney); 2-Sided 95.0% CI D2V2
    Statistical analysis description
    Time point: Day 2 (Visit 2) - D2V2 Hypothesis no. 2 (non-inferiority) is based on the Per Protocol (PP) analysis set; PP n=615. CI, Confidence interval
    Comparison groups
    Traumed gel v Diclofenac 1% gel
    Number of subjects included in analysis
    460
    Analysis specification
    Pre-specified
    Analysis type
    non-inferiority [39]
    P-value
    = 0.3017
    Method
    Wilcoxon (Mann-Whitney)
    Parameter type
    Mann-Whitney estimator
    Point estimate
    0.4701
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.4128
         upper limit
    0.5274
    Notes
    [39] - Non-inferiority is defined for LB-MW>0.407. LB, Lower Bound of the two-sided confidence interval; MW, Mann-Whitney estimator
    Statistical analysis title
    Parametric Analysis (ANCOVA) - Day 7 (Visit 4)
    Statistical analysis description
    Hypothesis no. 2 (non-inferiority) is based on the Per Protocol (PP) analysis set; PP n=615.
    Comparison groups
    Traumed gel v Diclofenac 1% gel
    Number of subjects included in analysis
    460
    Analysis specification
    Pre-specified
    Analysis type
    non-inferiority
    P-value
    = 0.4099
    Method
    ANCOVA
    Confidence interval
    Statistical analysis title
    Effect Sizes (Mann-Whitney); 2-Sided 95.0% CI D7V4
    Statistical analysis description
    Time point: Day 7 (Visit 4) - D7V4 Hypothesis no. 2 (non-inferiority) is based on the Per Protocol (PP) analysis set; PP n=615. CI, Confidence interval
    Comparison groups
    Traumed gel v Diclofenac 1% gel
    Number of subjects included in analysis
    460
    Analysis specification
    Pre-specified
    Analysis type
    non-inferiority [40]
    P-value
    = 0.9441
    Method
    Wilcoxon (Mann-Whitney)
    Parameter type
    Mann-Whitney estimator
    Point estimate
    0.502
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.446
         upper limit
    0.5581
    Notes
    [40] - Non-inferiority is defined for LB-MW>0.407. LB, Lower Bound of the two-sided confidence interval; MW, Mann-Whitney estimator
    Statistical analysis title
    Parametric Analysis (ANCOVA) - Day 14 (Visit 5)
    Statistical analysis description
    Hypothesis no. 2 (non-inferiority) is based on the Per Protocol (PP) analysis set; PP n=615.
    Comparison groups
    Traumed gel v Diclofenac 1% gel
    Number of subjects included in analysis
    460
    Analysis specification
    Pre-specified
    Analysis type
    non-inferiority
    P-value
    = 0.7509
    Method
    ANCOVA
    Confidence interval
    Statistical analysis title
    Effect Sizes (Mann-Whitney); 2-Sided 95.0% CI D14
    Statistical analysis description
    Time point: Day 14 (Visit 5) - D14V5 Hypothesis no. 2 (non-inferiority) is based on the Per Protocol (PP) analysis set; PP n=615. CI, Confidence interval
    Comparison groups
    Traumed gel v Diclofenac 1% gel
    Number of subjects included in analysis
    460
    Analysis specification
    Pre-specified
    Analysis type
    non-inferiority [41]
    P-value
    = 0.3431
    Method
    Wilcoxon (Mann-Whitney)
    Parameter type
    Mann-Whitney estimator
    Point estimate
    0.5275
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.4723
         upper limit
    0.5827
    Notes
    [41] - Non-inferiority is defined for LB-MW>0.407. LB, Lower Bound of the two-sided confidence interval; MW, Mann-Whitney estimator

    Secondary: Change from Baseline of pain on passive movement in Visual Analog Scale (VAS) to Day 4, Day 7 and Final Visit

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    End point title
    Change from Baseline of pain on passive movement in Visual Analog Scale (VAS) to Day 4, Day 7 and Final Visit
    End point description
    Ankle pain measurement by 100 mm VAS with start 'no pain' (0 mm) and end 'most severe imaginable pain' patients may imagine in relation to their ankle sprain (100 mm). After 5 min rest, patients assessed their pain on a VAS scale (2nd efficacy assessment). Still at rest investigators performed flexion on the injured ankle: then patients assessed their pain on a VAS scale (1st efficacy assessment). Pain to be assessed: pain on passive movement. Missing values were replaced by Last Observation Carried Forward (LOCF). Statistical analysis based on Full Analysis Set n=622 (1st set for evaluation of superiority of Traumed versus (v) Placebo gel, 2nd set for evaluation of non-inferiority of Traumed v Diclofenac gel), and on the Per Protocol analysis set n=615 (1st set for evaluation of non-inferiority of Traumed v Diclofenac gel, 2nd set for evaluation of superiority of Traumed v Placebo gel). Change from Baseline on the VAS pain on passive movement scale at time of measurement is shown.
    End point type
    Secondary
    End point timeframe
    Baseline (Visit 1) to Day 4 (Visit 3), Day 7 (Visit 4, End of Treatment) and Day 14 (Visit 5, Final Visit)
    End point values
    Traumed gel Diclofenac 1% gel Placebo gel Traumed gel Diclofenac 1% gel
    Number of subjects analysed
    316 [42]
    151 [43]
    155 [44]
    314 [45]
    146 [46]
    Units: mm
    median (full range (min-max))
        Day 4 (Visit 3)
    -30.0 (-94.0 to 10.0)
    -21.0 (-92.0 to 7.0)
    -20.0 (-78.0 to 17.0)
    -30.0 (-94.0 to 10.0)
    -21.0 (-92.0 to 7.0)
        Day 7 (Visit 4)
    -49.5 (-94.0 to 9.0)
    -40.0 (-92.0 to 2.0)
    -35.0 (-92.0 to 11.0)
    -50.0 (-94.0 to -3.0)
    -40.0 (-92.0 to 2.0)
        Day 14 (Visit 5)
    -65.5 (-98.0 to 9.0)
    -60.0 (-97.0 to 5.0)
    -57.0 (-94.0 to -1.0)
    -66.5 (-98.0 to 4.0)
    -61.0 (-97.0 to 5.0)
    Notes
    [42] - Full Analysis Set n=622
    [43] - Full Analysis Set n=622
    [44] - Full Analysis Set n=622
    [45] - Per Protocol analysis set n=615
    [46] - Per Protocol analysis set n=615
    Statistical analysis title
    Parametric Analysis (ANCOVA) - Day 4 (Visit 3)
    Statistical analysis description
    Hypothesis no. 1 (superiority) is based on the Full Analysis Set (FAS); FAS n=622.
    Comparison groups
    Traumed gel v Placebo gel
    Number of subjects included in analysis
    471
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.0001
    Method
    ANCOVA
    Confidence interval
    Statistical analysis title
    Effect Sizes (Mann-Whitney); 2-Sided 95.0% CI D4V3
    Statistical analysis description
    Time point: Day 4 (Visit 3) - D4V3 Hypothesis no. 1 (superiority) is based on the Full Analysis Set (FAS); FAS n=622. CI, Confidence interval
    Comparison groups
    Traumed gel v Placebo gel
    Number of subjects included in analysis
    471
    Analysis specification
    Pre-specified
    Analysis type
    superiority [47]
    P-value
    < 0.0001
    Method
    Wilcoxon (Mann-Whitney)
    Parameter type
    Mann-Whitney estimator
    Point estimate
    0.6468
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.5945
         upper limit
    0.6992
    Notes
    [47] - Superiority is defined for LB-MW>0.50. LB, Lower Bound of the two-sided confidence interval; MW, Mann-Whitney estimator
    Statistical analysis title
    Parametric Analysis (ANCOVA) - Day 7 (Visit 4)
    Statistical analysis description
    Hypothesis no. 1 (superiority) is based on the Full Analysis Set (FAS); FAS n=622.
    Comparison groups
    Traumed gel v Placebo gel
    Number of subjects included in analysis
    471
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.0001
    Method
    ANCOVA
    Confidence interval
    Statistical analysis title
    Effect Sizes (Mann-Whitney); 2-Sided 95.0% CI D7V4
    Statistical analysis description
    Time point: Day 7 (Visit 4) - D7V4 Hypothesis no. 1 (superiority) is based on the Full Analysis Set (FAS); FAS n=622. CI, Confidence interval
    Comparison groups
    Traumed gel v Placebo gel
    Number of subjects included in analysis
    471
    Analysis specification
    Pre-specified
    Analysis type
    superiority [48]
    P-value
    < 0.0001
    Method
    Wilcoxon (Mann-Whitney)
    Parameter type
    Mann-Whitney estimator
    Point estimate
    0.6629
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.6107
         upper limit
    0.715
    Notes
    [48] - Superiority is defined for LB-MW>0.50. LB, Lower Bound of the two-sided confidence interval; MW, Mann-Whitney estimator
    Statistical analysis title
    Parametric Analysis (ANCOVA) - Day 14 (Visit 5)
    Statistical analysis description
    Hypothesis no. 1 (superiority) is based on the Full Analysis Set (FAS); FAS n=622.
    Comparison groups
    Traumed gel v Placebo gel
    Number of subjects included in analysis
    471
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.0001
    Method
    ANCOVA
    Confidence interval
    Statistical analysis title
    Effect Sizes (Mann-Whitney); 2-Sided 95.0% CI D14
    Statistical analysis description
    Time point: Day 14 (Visit 5) - D14V5 Hypothesis no. 1 (superiority) is based on the Full Analysis Set (FAS); FAS n=622. CI, Confidence interval
    Comparison groups
    Traumed gel v Placebo gel
    Number of subjects included in analysis
    471
    Analysis specification
    Pre-specified
    Analysis type
    superiority [49]
    P-value
    < 0.0001
    Method
    Wilcoxon (Mann-Whitney)
    Parameter type
    Mann-Whitney estimator
    Point estimate
    0.6403
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.5878
         upper limit
    0.6928
    Notes
    [49] - Superiority is defined for LB-MW>0.50. LB, Lower Bound of the two-sided confidence interval; MW, Mann-Whitney estimator
    Statistical analysis title
    Parametric Analysis (ANCOVA) - Day 4 (Visit 3)
    Statistical analysis description
    Hypothesis no. 2 (non-inferiority) is based on the Per Protocol (PP) analysis set; PP n=615.
    Comparison groups
    Traumed gel v Diclofenac 1% gel
    Number of subjects included in analysis
    460
    Analysis specification
    Pre-specified
    Analysis type
    non-inferiority
    P-value
    = 0.0019
    Method
    ANCOVA
    Confidence interval
    Statistical analysis title
    Effect Sizes (Mann-Whitney); 2-Sided 95.0% CI D4V3
    Statistical analysis description
    Time point: Day 4 (Visit 3) - D4V3 Hypothesis no. 2 (non-inferiority) is based on the Per Protocol (PP) analysis set; PP n=615. CI, Confidence interval
    Comparison groups
    Traumed gel v Diclofenac 1% gel
    Number of subjects included in analysis
    460
    Analysis specification
    Pre-specified
    Analysis type
    non-inferiority [50]
    P-value
    = 0.0005
    Method
    Wilcoxon (Mann-Whitney)
    Parameter type
    Mann-Whitney estimator
    Point estimate
    0.6001
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.5459
         upper limit
    0.6542
    Notes
    [50] - Non-inferiority is defined for LB-MW>0.407. LB, Lower Bound of the two-sided confidence interval; MW, Mann-Whitney estimator
    Statistical analysis title
    Parametric Analysis (ANCOVA) - Day 7 (Visit 4)
    Statistical analysis description
    Hypothesis no. 2 (non-inferiority) is based on the Per Protocol (PP) analysis set; PP n=615.
    Comparison groups
    Traumed gel v Diclofenac 1% gel
    Number of subjects included in analysis
    460
    Analysis specification
    Pre-specified
    Analysis type
    non-inferiority
    P-value
    < 0.0001
    Method
    ANCOVA
    Confidence interval
    Statistical analysis title
    Effect Sizes (Mann-Whitney); 2-Sided 95.0% CI D7V4
    Statistical analysis description
    Time point: Day 7 (Visit 4) - D7V4 Hypothesis no. 2 (non-inferiority) is based on the Per Protocol (PP) analysis set; PP n=615. CI, Confidence interval
    Comparison groups
    Traumed gel v Diclofenac 1% gel
    Number of subjects included in analysis
    460
    Analysis specification
    Pre-specified
    Analysis type
    non-inferiority [51]
    P-value
    = 0.0002
    Method
    Wilcoxon (Mann-Whitney)
    Parameter type
    Mann-Whitney estimator
    Point estimate
    0.6072
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.5533
         upper limit
    0.6611
    Notes
    [51] - Non-inferiority is defined for LB-MW>0.407. LB, Lower Bound of the two-sided confidence interval; MW, Mann-Whitney estimator
    Statistical analysis title
    Parametric Analysis (ANCOVA) - Day 14 (Visit 5)
    Statistical analysis description
    Hypothesis no. 2 (non-inferiority) is based on the Per Protocol (PP) analysis set; PP n=615.
    Comparison groups
    Traumed gel v Diclofenac 1% gel
    Number of subjects included in analysis
    460
    Analysis specification
    Pre-specified
    Analysis type
    non-inferiority
    P-value
    = 0.0006
    Method
    ANCOVA
    Confidence interval
    Statistical analysis title
    Effect Sizes (Mann-Whitney); 2-Sided 95.0% CI D14
    Statistical analysis description
    Time point: Day 14 (Visit 5) - D14V5 Hypothesis no. 2 (non-inferiority) is based on the Per Protocol (PP) analysis set; PP n=615. CI, Confidence interval
    Comparison groups
    Traumed gel v Diclofenac 1% gel
    Number of subjects included in analysis
    460
    Analysis specification
    Pre-specified
    Analysis type
    non-inferiority [52]
    P-value
    = 0.0094
    Method
    Wilcoxon (Mann-Whitney)
    Parameter type
    Mann-Whitney estimator
    Point estimate
    0.5752
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.5202
         upper limit
    0.6302
    Notes
    [52] - Non-inferiority is defined for LB-MW>0.407. LB, Lower Bound of the two-sided confidence interval; MW, Mann-Whitney estimator

    Secondary: Change from Baseline of pain at rest in Visual Analog Scale (VAS) to Day 4, 7 and Final Visit

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    End point title
    Change from Baseline of pain at rest in Visual Analog Scale (VAS) to Day 4, 7 and Final Visit
    End point description
    Ankle pain was measured using a 100 mm VAS starting with 'no pain' (0 mm) and ending with 'most severe imaginable pain' the patient may have imagined in relation to his/her ankle sprain (100 mm). The patients were asked after 5 minutes rest to assess their pain themselves on a VAS scale. Missing values were replaced by Last Observation Carried Forward (LOCF). Statistical analysis based on Full Analysis Set n=622 (1st set for evaluation of superiority of Traumed gel versus (v) Placebo gel, 2nd set for evaluation of non-inferiority of Traumed gel v Diclofenac gel), and on the Per Protocol (PP) analysis set n=615 (1st set for evaluation of non-inferiority of Traumed gel v Diclofenac gel, 2nd set for evaluation of superiority of Traumed gel v Placebo gel. Change from Baseline on the VAS pain at rest scale at time of measurement is shown.
    End point type
    Secondary
    End point timeframe
    Baseline (Visit 1) to Day 4 (Visit 3), Day 7 (Visit 4, End of Treatment) and Day 14 (Visit 5; Final Visit)
    End point values
    Traumed gel Diclofenac 1% gel Placebo gel Traumed gel Diclofenac 1% gel
    Number of subjects analysed
    316 [53]
    151 [54]
    155 [55]
    314 [56]
    146 [57]
    Units: mm
    median (full range (min-max))
        Day 4 (Visit 3)
    -14.0 (-95.0 to 23.0)
    -11.0 (-87.0 to 10.0)
    -10.0 (-75.0 to 17.0)
    -14.0 (-95.0 to 23.0)
    -11.0 (-87.0 to 10.0)
        Day 7 (Visit 4)
    -21.0 (-95.0 to 7.0)
    -17.0 (-87.0 to 3.0)
    -20.0 (-77.0 to 15.0)
    -21.0 (-95.0 to 7.0)
    -15.5 (-87.0 to 3.0)
        Day 14 (Visit 5)
    -29.0 (-95.0 to 5.0)
    -24.0 (-88.0 to 6.0)
    -27.0 (-95.0 to 21.0)
    -29.0 (-95.0 to 0.0)
    -22.5 (-88.0 to 6.0)
    Notes
    [53] - Full Analysis Set n=622
    [54] - Full Analysis Set n=622
    [55] - Full Analysis Set n=622
    [56] - Per Protocol analysis set n=615
    [57] - Per Protocol analysis set n=615
    Statistical analysis title
    Parametric Analysis (ANCOVA) - Day 4 (Visit 3)
    Statistical analysis description
    Hypothesis no. 1 (superiority) is based on the Full Analysis Set (FAS); FAS n=622.
    Comparison groups
    Traumed gel v Placebo gel
    Number of subjects included in analysis
    471
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.0438
    Method
    ANCOVA
    Confidence interval
    Statistical analysis title
    Effect Sizes (Mann-Whitney); 2-Sided 95.0% CI D4V3
    Statistical analysis description
    Time point: Day 4 (Visit 3) - D4V3 Hypothesis no. 1 (superiority) is based on the Full Analysis Set (FAS); FAS n=622. CI, Confidence interval
    Comparison groups
    Traumed gel v Placebo gel
    Number of subjects included in analysis
    471
    Analysis specification
    Pre-specified
    Analysis type
    superiority [58]
    P-value
    = 0.0273
    Method
    Wilcoxon (Mann-Whitney)
    Parameter type
    Mann-Whitney estimator
    Point estimate
    0.5625
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.5083
         upper limit
    0.6168
    Notes
    [58] - Superiority is defined for LB-MW>0.50. LB, Lower Bound of the two-sided confidence interval; MW, Mann-Whitney estimator
    Statistical analysis title
    Parametric Analysis (ANCOVA) - Day 7 (Visit 4)
    Statistical analysis description
    Hypothesis no. 1 (superiority) is based on the Full Analysis Set (FAS); FAS n=622.
    Comparison groups
    Traumed gel v Placebo gel
    Number of subjects included in analysis
    471
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.0807
    Method
    ANCOVA
    Confidence interval
    Statistical analysis title
    Effect Sizes (Mann-Whitney); 2-Sided 95.0% CI D7V4
    Statistical analysis description
    Time point: Day 7 (Visit 4) - D7V4 Hypothesis no. 1 (superiority) is based on the Full Analysis Set (FAS); FAS n=622. CI, Confidence interval
    Comparison groups
    Traumed gel v Placebo gel
    Number of subjects included in analysis
    471
    Analysis specification
    Pre-specified
    Analysis type
    superiority [59]
    P-value
    = 0.0663
    Method
    Wilcoxon (Mann-Whitney)
    Parameter type
    Mann-Whitney estimator
    Point estimate
    0.552
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.4975
         upper limit
    0.6066
    Notes
    [59] - Superiority is defined for LB-MW>0.50. LB, Lower Bound of the two-sided confidence interval; MW, Mann-Whitney estimator
    Statistical analysis title
    Parametric Analysis (ANCOVA) - Day 14 (Visit 5)
    Statistical analysis description
    Hypothesis no. 1 (superiority) is based on the Full Analysis Set (FAS); FAS n=622.
    Comparison groups
    Traumed gel v Placebo gel
    Number of subjects included in analysis
    471
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.1675
    Method
    ANCOVA
    Confidence interval
    Statistical analysis title
    Effect Sizes (Mann-Whitney); 2-Sided 95.0% CI D14
    Statistical analysis description
    Time point: Day 14 (Visit 5) - D14V5 Hypothesis no. 1 (superiority) is based on the Full Analysis Set (FAS); FAS n=622. CI, confidence interval
    Comparison groups
    Placebo gel v Traumed gel
    Number of subjects included in analysis
    471
    Analysis specification
    Pre-specified
    Analysis type
    superiority [60]
    P-value
    = 0.2805
    Method
    Wilcoxon (Mann-Whitney)
    Parameter type
    Mann-Whitney estimator
    Point estimate
    0.5306
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.4758
         upper limit
    0.5853
    Notes
    [60] - Superiority is defined for LB-MW>0.50. LB, Lower Bound of the two-sided confidence interval; MW, Mann-Whitney estimator
    Statistical analysis title
    Parametric Analysis (ANCOVA) - Day 4 (Visit 3)
    Statistical analysis description
    Hypothesis no. 2 (non-inferiority) is based on the Per Protocol (PP) analysis set; PP n=615.
    Comparison groups
    Traumed gel v Diclofenac 1% gel
    Number of subjects included in analysis
    460
    Analysis specification
    Pre-specified
    Analysis type
    non-inferiority
    P-value
    = 0.1389
    Method
    ANCOVA
    Confidence interval
    Statistical analysis title
    Effect Sizes (Mann-Whitney); 2-Sided 95.0% CI D4V3
    Statistical analysis description
    Time point: Day 4 (Visit 3) - D4V3 Hypothesis no. 2 (non-inferiority) is based on the Per Protocol (PP) analysis set; PP n=615. CI, Confidence interval
    Comparison groups
    Traumed gel v Diclofenac 1% gel
    Number of subjects included in analysis
    460
    Analysis specification
    Pre-specified
    Analysis type
    non-inferiority [61]
    P-value
    = 0.0798
    Method
    Wilcoxon (Mann-Whitney)
    Parameter type
    Mann-Whitney estimator
    Point estimate
    0.5507
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.4954
         upper limit
    0.606
    Notes
    [61] - Non-inferiority is defined for LB-MW>0.407. LB, Lower Bound of the two-sided confidence interval; MW, Mann-Whitney estimator
    Statistical analysis title
    Parametric Analysis (ANCOVA) - Day 7 (Visit 4)
    Statistical analysis description
    Hypothesis no. 2 (non-inferiority) is based on the Per Protocol (PP) analysis set; PP n=615.
    Comparison groups
    Traumed gel v Diclofenac 1% gel
    Number of subjects included in analysis
    460
    Analysis specification
    Pre-specified
    Analysis type
    non-inferiority
    P-value
    = 0.0346
    Method
    ANCOVA
    Confidence interval
    Statistical analysis title
    Effect Sizes (Mann-Whitney); 2-Sided 95.0% CI D7V4
    Statistical analysis description
    Time point: Day 7 (Visit 4) - D7V4 Hypothesis no. 2 (non-inferiority) is based on the Per Protocol (PP) analysis set; PP n=615. CI, Confidence interval
    Comparison groups
    Traumed gel v Diclofenac 1% gel
    Number of subjects included in analysis
    460
    Analysis specification
    Pre-specified
    Analysis type
    non-inferiority [62]
    P-value
    = 0.0184
    Method
    Wilcoxon (Mann-Whitney)
    Parameter type
    Mann-Whitney estimator
    Point estimate
    0.5683
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.5132
         upper limit
    0.6233
    Notes
    [62] - Non-inferiority is defined for LB-MW>0.407. LB, Lower Bound of the two-sided confidence interval; MW, Mann-Whitney estimator
    Statistical analysis title
    Parametric Analysis (ANCOVA) - Day 14 (Visit 5)
    Statistical analysis description
    Hypothesis no. 2 (non-inferiority) is based on the Per Protocol (PP) analysis set; PP n=615.
    Comparison groups
    Traumed gel v Diclofenac 1% gel
    Number of subjects included in analysis
    460
    Analysis specification
    Pre-specified
    Analysis type
    non-inferiority
    P-value
    = 0.0915
    Method
    ANCOVA
    Confidence interval
    Statistical analysis title
    Effect Sizes (Mann-Whitney); 2-Sided 95.0% CI D14
    Statistical analysis description
    Time point: Day 14 (Visit 5) - D14V5 Hypothesis no. 2 (non-inferiority) is based on the Per Protocol (PP) analysis set; PP n=615. CI, Confidence interval
    Comparison groups
    Traumed gel v Diclofenac 1% gel
    Number of subjects included in analysis
    460
    Analysis specification
    Pre-specified
    Analysis type
    non-inferiority [63]
    P-value
    = 0.1561
    Method
    Wilcoxon (Mann-Whitney)
    Parameter type
    Mann-Whitney estimator
    Point estimate
    0.5411
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.4857
         upper limit
    0.5965
    Notes
    [63] - Non-inferiority is defined for LB-MW>0.407. LB, Lower Bound of the two-sided confidence interval; MW, Mann-Whitney estimator

    Secondary: Change from Baseline to Day 2, 4, 7 and Final Visit in the Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL) subscale

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    End point title
    Change from Baseline to Day 2, 4, 7 and Final Visit in the Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL) subscale
    End point description
    The FAAM is a validated questionnaire, developed to meet the need for a self-reported evaluative instrument that assesses physical function of individuals with musculoskeletal disorders of the leg, foot, and ankle. It is well-established and widely used. The FAAM-ADL subscale is part of the FAAM questionnaire and consists of 21 single items assessing Activities of Daily Living as standing, walking, going up stairs, etc. Possible responses for items: 'no'/ 'slight'/ 'moderate'/ 'extreme difficulty'/ 'unable to do' and 'not applicable'. The response to each item on the FAAM-ADL subscale was recorded from 4 ‘no difficulty’ and 0 ‘unable to do’. For this analysis scores were transformed: a lower score represents a higher level of physical function (normalised of mean, %max neg. score). Missing values are replaced by Last Observation Carried Forward (LOCF). Analysis based on Full Analysis Set n=622 and Per Protocol analysis set n=615. Change from Baseline at time of measurement is shown.
    End point type
    Secondary
    End point timeframe
    Baseline (Visit 1) to Day 2 (Visit 2), Day 4 (Visit 3), Day 7 (Visit 4, End of Treatment) and Day 14 (Visit 5, Final Visit)
    End point values
    Traumed gel Diclofenac 1% gel Placebo gel Traumed gel Diclofenac 1% gel
    Number of subjects analysed
    316 [64]
    151 [65]
    155 [66]
    314 [67]
    146 [68]
    Units: Score
    median (full range (min-max))
        Day 2 (Visit 2)
    -3.6 (-33.3 to 59.5)
    -2.4 (-47.6 to 47.6)
    -0.6 (-36.9 to 61.9)
    -3.6 (-33.3 to 59.5)
    -2.4 (-47.6 to 47.6)
        Day 4 (Visit 3)
    -17.9 (-61.9 to 36.9)
    -15.2 (-69.1 to 35.7)
    -11.2 (-51.2 to 56.0)
    -17.7 (-61.9 to 36.9)
    -15.2 (-69.1 to 35.7)
        Day 7 (Visit 4)
    -29.1 (-78.4 to 23.2)
    -26.2 (-85.7 to 22.6)
    -22.6 (-64.8 to 46.4)
    -29.1 (-78.4 to 23.2)
    -26.2 (-85.7 to 22.6)
        Day 14 (Visit 5)
    -42.7 (-85.7 to 12.4)
    -39.7 (-95.2 to 7.1)
    -35.7 (-86.2 to 36.9)
    -42.8 (-85.7 to 12.4)
    -39.5 (-95.2 to 7.1)
    Notes
    [64] - Full Analysis Set n=622
    [65] - Full Analysis Set n=622
    [66] - Full Analysis Set n=622
    [67] - Per Protocol analysis set n=615
    [68] - Per Protocol analysis set n=615
    Statistical analysis title
    Parametric Analysis (ANCOVA) - Day 2 (Visit 2)
    Statistical analysis description
    Hypothesis no. 1 (superiority) is based on the Full Analysis Set; FAS n=622. FAAM-ADL Subscale (normalis. of mean, %max neg score), Change from Baseline, Last Observation Carried Forward (LOCF)
    Comparison groups
    Traumed gel v Placebo gel
    Number of subjects included in analysis
    471
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.0093
    Method
    ANCOVA
    Confidence interval
    Statistical analysis title
    Effect Sizes (Mann-Whitney); 2-Sided 95.0% CI D2V2
    Statistical analysis description
    Time point: Day 2 (Visit 2) - D2V2 Hypothesis no. 1 (superiority) is based on the Full Analysis Set; FAS n=622. CI, Confidence interval
    Comparison groups
    Traumed gel v Placebo gel
    Number of subjects included in analysis
    471
    Analysis specification
    Pre-specified
    Analysis type
    superiority [69]
    P-value
    = 0.0002
    Method
    Wilcoxon (Mann-Whitney)
    Parameter type
    Mann-Whitney estimator
    Point estimate
    0.6062
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.5538
         upper limit
    0.6587
    Notes
    [69] - Superiority is defined for LB-MW>0.50. LB, Lower Bound of the two-sided confidence interval; MW, Mann-Whitney estimator
    Statistical analysis title
    Parametric Analysis (ANCOVA) - Day 4 (Visit 3)
    Statistical analysis description
    Hypothesis no. 1 (superiority) is based on the Full Analysis Set; FAS n=622. FAAM-ADL Subscale (normalis. of mean, %max neg score), Change from Baseline, Last Observation Carried Forward (LOCF)
    Comparison groups
    Traumed gel v Placebo gel
    Number of subjects included in analysis
    471
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.0001
    Method
    ANCOVA
    Confidence interval
    Statistical analysis title
    Effect Sizes (Mann-Whitney); 2-Sided 95.0% CI D4V3
    Statistical analysis description
    Time point: Day 4 (Visit 3) - D4V3 Hypothesis no. 1 (superiority) is based on the Full Analysis Set; FAS n=622. CI, Confidence interval
    Comparison groups
    Traumed gel v Placebo gel
    Number of subjects included in analysis
    471
    Analysis specification
    Pre-specified
    Analysis type
    superiority [70]
    P-value
    < 0.0001
    Method
    Wilcoxon (Mann-Whitney)
    Parameter type
    Mann-Whitney estimator
    Point estimate
    0.6516
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.5993
         upper limit
    0.704
    Notes
    [70] - Superiority is defined for LB-MW>0.50. LB, Lower Bound of the two-sided confidence interval; MW, Mann-Whitney estimator
    Statistical analysis title
    Parametric Analysis (ANCOVA) - Day 7 (Visit 4)
    Statistical analysis description
    Hypothesis no. 1 (superiority) is based on the Full Analysis Set; FAS n=622. FAAM-ADL Subscale (normalis. of mean, %max neg score), Change from Baseline, Last Observation Carried Forward (LOCF)
    Comparison groups
    Traumed gel v Placebo gel
    Number of subjects included in analysis
    471
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.0001
    Method
    ANCOVA
    Confidence interval
    Statistical analysis title
    Effect Sizes (Mann-Whitney); 2-Sided 95.0% CI D7V4
    Statistical analysis description
    Time point: Day 7 (Visit 4) - D7V4 Hypothesis no. 1 (superiority) is based on the Full Analysis Set; FAS n=622. CI, Confidence interval
    Comparison groups
    Traumed gel v Placebo gel
    Number of subjects included in analysis
    471
    Analysis specification
    Pre-specified
    Analysis type
    superiority [71]
    P-value
    < 0.0001
    Method
    Wilcoxon (Mann-Whitney)
    Parameter type
    Mann-Whitney estimator
    Point estimate
    0.6335
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.5812
         upper limit
    0.6859
    Notes
    [71] - Superiority is defined for LB-MW>0.50. LB, Lower Bound of the two-sided confidence interval; MW, Mann-Whitney estimator
    Statistical analysis title
    Parametric Analysis (ANCOVA) - Day 14 (Visit 5)
    Statistical analysis description
    Hypothesis no. 1 (superiority) is based on the Full Analysis Set; FAS n=622. FAAM-ADL Subscale (normalis. of mean, %max neg score), Change from Baseline, Last Observation Carried Forward (LOCF)
    Comparison groups
    Traumed gel v Placebo gel
    Number of subjects included in analysis
    471
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.0001
    Method
    ANCOVA
    Confidence interval
    Statistical analysis title
    Effect Sizes (Mann-Whitney); 2-Sided 95.0% CI D14
    Statistical analysis description
    Time point: Day 14 (Visit 5) - D14V5 Hypothesis no. 1 (superiority) is based on the Full Analysis Set; FAS n=622. CI, Confidence interval
    Comparison groups
    Traumed gel v Placebo gel
    Number of subjects included in analysis
    471
    Analysis specification
    Pre-specified
    Analysis type
    superiority [72]
    P-value
    = 0.0001
    Method
    Wilcoxon (Mann-Whitney)
    Parameter type
    Mann-Whitney estimator
    Point estimate
    0.6092
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.5561
         upper limit
    0.6623
    Notes
    [72] - Superiority is defined for LB-MW>0.50. LB, Lower Bound of the two-sided confidence interval; MW, Mann-Whitney estimator
    Statistical analysis title
    Parametric Analysis (ANCOVA) - Day 2 (Visit 2)
    Statistical analysis description
    Hypothesis no. 2 (non-inferiority) is based on the Per Protocol (PP) analysis set; PP n=615. FAAM-ADL Subscale (normalis. of mean, %max neg score), Change from Baseline, Last Observation Carried Forward (LOCF)
    Comparison groups
    Traumed gel v Diclofenac 1% gel
    Number of subjects included in analysis
    460
    Analysis specification
    Pre-specified
    Analysis type
    non-inferiority
    P-value
    = 0.2868
    Method
    ANCOVA
    Confidence interval
    Statistical analysis title
    Effect Sizes (Mann-Whitney), 2-Sided 95.0% CI D2V2
    Statistical analysis description
    Time point: Day 2 (Visit 2) - D2V2 Hypothesis no. 2 (non-inferiority) is based on the Per Protocol (PP) analysis set; PP n=615. CI, Confidence interval
    Comparison groups
    Traumed gel v Diclofenac 1% gel
    Number of subjects included in analysis
    460
    Analysis specification
    Pre-specified
    Analysis type
    non-inferiority [73]
    P-value
    = 0.0526
    Method
    Wilcoxon (Mann-Whitney)
    Parameter type
    Mann-Whitney estimator
    Point estimate
    0.5562
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.5016
         upper limit
    0.6107
    Notes
    [73] - Non-inferiority is defined for LB-MW>0.407. LB, Lower Bound of the two-sided confidence interval; MW, Mann-Whitney estimator
    Statistical analysis title
    Parametric Analysis (ANCOVA) - Day 4 (Visit 3)
    Statistical analysis description
    Hypothesis no. 2 (non-inferiority) is based on the Per Protocol (PP) analysis set; PP n=615. FAAM-ADL Subscale (normalis. of mean, %max neg score), Change from Baseline, Last Observation Carried Forward (LOCF)
    Comparison groups
    Traumed gel v Diclofenac 1% gel
    Number of subjects included in analysis
    460
    Analysis specification
    Pre-specified
    Analysis type
    non-inferiority
    P-value
    = 0.106
    Method
    ANCOVA
    Confidence interval
    Statistical analysis title
    Effect Sizes (Mann-Whitney), 2-Sided 95.0% CI D4V3
    Statistical analysis description
    Time point: Day 4 (Visit 3) - D4V3 Hypothesis no. 2 (non-inferiority) is based on the Per Protocol (PP) analysis set; PP n=615. CI, Confidence interval
    Comparison groups
    Traumed gel v Diclofenac 1% gel
    Number of subjects included in analysis
    460
    Analysis specification
    Pre-specified
    Analysis type
    non-inferiority [74]
    P-value
    = 0.0306
    Method
    Wilcoxon (Mann-Whitney)
    Parameter type
    Mann-Whitney estimator
    Point estimate
    0.5629
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.5077
         upper limit
    0.6181
    Notes
    [74] - Non-inferiority is defined for LB-MW>0.407. LB, Lower Bound of the two-sided confidence interval; MW, Mann-Whitney estimator
    Statistical analysis title
    Parametric Analysis (ANCOVA) - Day 7 (Visit 4)
    Statistical analysis description
    Hypothesis no. 2 (non-inferiority) is based on the Per Protocol (PP) analysis set; PP n=615. FAAM-ADL Subscale (normalis. of mean, %max neg score), Change from Baseline, Last Observation Carried Forward (LOCF)
    Comparison groups
    Traumed gel v Diclofenac 1% gel
    Number of subjects included in analysis
    460
    Analysis specification
    Pre-specified
    Analysis type
    non-inferiority
    P-value
    = 0.0864
    Method
    ANCOVA
    Confidence interval
    Statistical analysis title
    Effect Sizes (Mann-Whitney), 2-Sided 95.0% CI D7V4
    Statistical analysis description
    Time point: Day 7 (Visit 4) - D7V4 Hypothesis no. 2 (non-inferiority) is based on the Per Protocol (PP) analysis set; PP n=615. CI, Confidence interval
    Comparison groups
    Traumed gel v Diclofenac 1% gel
    Number of subjects included in analysis
    460
    Analysis specification
    Pre-specified
    Analysis type
    non-inferiority [75]
    P-value
    = 0.0657
    Method
    Wilcoxon (Mann-Whitney)
    Parameter type
    Mann-Whitney estimator
    Point estimate
    0.5534
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.498
         upper limit
    0.6088
    Notes
    [75] - Non-inferiority is defined for LB-MW>0.407. LB, Lower Bound of the two-sided confidence interval; MW, Mann-Whitney estimator
    Statistical analysis title
    Parametric Analysis (ANCOVA) - Day 14 (Visit 5)
    Statistical analysis description
    Hypothesis no. 2 (non-inferiority) is based on the Per Protocol (PP) analysis set; PP n=615. FAAM-ADL Subscale (normalis. of mean, %max neg score), Change from Baseline, Last Observation Carried Forward (LOCF)
    Comparison groups
    Traumed gel v Diclofenac 1% gel
    Number of subjects included in analysis
    460
    Analysis specification
    Pre-specified
    Analysis type
    non-inferiority
    P-value
    = 0.1236
    Method
    ANCOVA
    Confidence interval
    Statistical analysis title
    Effect Sizes (Mann-Whitney), 2-Sided 95.0% CI D14
    Statistical analysis description
    Time point: Day 14 (Visit 5) - D14V5 Hypothesis no. 2 (non-inferiority) is based on the Per Protocol (PP) analysis set; PP n=615. CI, Confidence interval
    Comparison groups
    Traumed gel v Diclofenac 1% gel
    Number of subjects included in analysis
    460
    Analysis specification
    Pre-specified
    Analysis type
    non-inferiority [76]
    P-value
    = 0.1754
    Method
    Wilcoxon (Mann-Whitney)
    Parameter type
    Mann-Whitney estimator
    Point estimate
    0.5393
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.4836
         upper limit
    0.5951
    Notes
    [76] - Non-inferiority is defined for LB-MW>0.407. LB, Lower Bound of the two-sided confidence interval; MW, Mann-Whitney estimator

    Secondary: Amount of rescue medication (doses)

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    End point title
    Amount of rescue medication (doses)
    End point description
    Use of rescue medication was documented in the eCRF based on the information given in the patient diary and the drug accountability for rescue medication during the trial. Paracetamol (acetaminophen), 500 mg/tablet when necessary for pain with a maximum of 4 tablets or 2000 mg/day (but not more than 2 tablets at a time), was permitted as rescue medication for relieving pain in all three treatment groups. Patients were not allowed to take paracetamol within 8 h prior to Day 2 (Visit 2). For further Visits the restriction was 24 h. The number of tablets taken was validated summarised up to the Visit for analysis (absolute values are shown). Analysis was based on Full Analysis Set n=622 and Per Protocol analysis set n=615.
    End point type
    Secondary
    End point timeframe
    Number paracetamol taken until visit Day 4 (Visit 3), Day 7 (Visit 4, End of Treatment) and Day 14 (Visit 5, Final Visit)
    End point values
    Traumed gel Diclofenac 1% gel Placebo gel Traumed gel Diclofenac 1% gel
    Number of subjects analysed
    316 [77]
    151 [78]
    155 [79]
    314 [80]
    146 [81]
    Units: Tablets
    arithmetic mean (standard deviation)
        Day 4 (Visit 3)
    0.5 ( 1.68 )
    0.3 ( 1.20 )
    0.3 ( 1.32 )
    0.3 ( 0.97 )
    0.2 ( 0.61 )
        Day 7 (Visit 4)
    0.7 ( 2.27 )
    0.4 ( 1.62 )
    0.4 ( 1.90 )
    0.4 ( 1.34 )
    0.2 ( 0.77 )
        Day 14 (Visit 5)
    0.8 ( 3.11 )
    0.5 ( 1.92 )
    0.5 ( 2.23 )
    0.6 ( 1.92 )
    0.2 ( 0.98 )
    Notes
    [77] - Full Analysis Set n=622
    [78] - Full Analysis Set n=622
    [79] - Full Analysis Set n=622
    [80] - Per Protocol analysis set n=615
    [81] - Per Protocol analysis set n=615
    Statistical analysis title
    Parametric Analysis (ANCOVA) - Day 4 (Visit 3)
    Statistical analysis description
    Hypothesis no. 1 (superiority) is based on the Full Analysis Set; FAS n=622.
    Comparison groups
    Traumed gel v Placebo gel
    Number of subjects included in analysis
    471
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.0998
    Method
    ANCOVA
    Confidence interval
    Statistical analysis title
    Effect Sizes (Mann-Whitney); 2-Sided 95.0% CI D4V3
    Statistical analysis description
    Time point: Day 4 (Visit 3) - D4V3 Hypothesis no. 1 (superiority) is based on the Full Analysis Set; FAS n=622. CI, Confidence interval
    Comparison groups
    Traumed gel v Placebo gel
    Number of subjects included in analysis
    471
    Analysis specification
    Pre-specified
    Analysis type
    superiority [82]
    P-value
    = 0.0916
    Method
    Wilcoxon (Mann-Whitney)
    Parameter type
    Mann-Whitney estimator
    Point estimate
    0.4731
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.4442
         upper limit
    0.5021
    Notes
    [82] - Superiority is defined for LB-MW>0.50. LB, Lower Bound of the two-sided confidence interval; MW, Mann-Whitney estimator
    Statistical analysis title
    Parametric Analysis (ANCOVA) - Day 7 (Visit 4)
    Statistical analysis description
    Hypothesis no. 1 (superiority) is based on the Full Analysis Set; FAS n=622.
    Comparison groups
    Traumed gel v Placebo gel
    Number of subjects included in analysis
    471
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.1794
    Method
    ANCOVA
    Confidence interval
    Statistical analysis title
    Effect Sizes (Mann-Whitney); 2-Sided 95.0% CI D7V4
    Statistical analysis description
    Time point: Day 7 (Visit 4) - D7V4 Hypothesis no. 1 (superiority) is based on the Full Analysis Set; FAS n=622. CI, Confidence interval
    Comparison groups
    Traumed gel v Placebo gel
    Number of subjects included in analysis
    471
    Analysis specification
    Pre-specified
    Analysis type
    superiority [83]
    P-value
    = 0.3204
    Method
    Wilcoxon (Mann-Whitney)
    Parameter type
    Mann-Whitney estimator
    Point estimate
    0.4836
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.4523
         upper limit
    0.5148
    Notes
    [83] - Superiority is defined for LB-MW>0.50. LB, Lower Bound of the two-sided confidence interval; MW, Mann-Whitney estimator
    Statistical analysis title
    Parametric Analysis (ANCOVA) - Day 14 (Visit 5)
    Statistical analysis description
    Hypothesis no. 1 (superiority) is based on the Full Analysis Set; FAS n=622.
    Comparison groups
    Traumed gel v Placebo gel
    Number of subjects included in analysis
    471
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.1643
    Method
    ANCOVA
    Confidence interval
    Statistical analysis title
    Effect Sizes (Mann-Whitney); 2-Sided 95.0% CI D14
    Statistical analysis description
    Time point: Day 14 (Visit 5) - D14V5 Hypothesis no. 1 (superiority) is based on the Full Analysis Set; FAS n=622. CI, Confidence interval
    Comparison groups
    Traumed gel v Placebo gel
    Number of subjects included in analysis
    471
    Analysis specification
    Pre-specified
    Analysis type
    superiority [84]
    P-value
    = 0.3745
    Method
    Wilcoxon (Mann-Whitney)
    Parameter type
    Mann-Whitney estimator
    Point estimate
    0.4854
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.4543
         upper limit
    0.5165
    Notes
    [84] - Superiority is defined for LB-MW>0.50. LB, Lower Bound of the two-sided confidence interval; MW, Mann-Whitney estimator
    Statistical analysis title
    Parametric Analysis (ANCOVA) - Day 4 (Visit 3)
    Statistical analysis description
    Hypothesis no. 2 (non-inferiority) is based on the Per Protocol (PP) analysis set; PP n=615.
    Comparison groups
    Traumed gel v Diclofenac 1% gel
    Number of subjects included in analysis
    460
    Analysis specification
    Pre-specified
    Analysis type
    non-inferiority
    P-value
    = 0.0451
    Method
    ANCOVA
    Confidence interval
    Statistical analysis title
    Effect Sizes (Mann-Whitney); 2-Sided 95.0% CI D4V3
    Statistical analysis description
    Time point: Day 4 (Visit 3) - D4V3 Hypothesis no. 2 (non-inferiority) is based on the Per Protocol (PP) analysis set; PP n=615. CI, Confidence interval
    Comparison groups
    Traumed gel v Diclofenac 1% gel
    Number of subjects included in analysis
    460
    Analysis specification
    Pre-specified
    Analysis type
    non-inferiority [85]
    P-value
    = 0.0383
    Method
    Wilcoxon (Mann-Whitney)
    Parameter type
    Mann-Whitney estimator
    Point estimate
    0.467
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.4391
         upper limit
    0.4949
    Notes
    [85] - Non-inferiority is defined for LB-MW>0.407. LB, Lower Bound of the two-sided confidence interval; MW, Mann-Whitney estimator
    Statistical analysis title
    Parametric Analysis (ANCOVA) - Day 7 (Visit 4)
    Statistical analysis description
    Hypothesis no. 2 (non-inferiority) is based on the Per Protocol (PP) analysis set; PP n=615.
    Comparison groups
    Traumed gel v Diclofenac 1% gel
    Number of subjects included in analysis
    460
    Analysis specification
    Pre-specified
    Analysis type
    non-inferiority
    P-value
    = 0.0346
    Method
    ANCOVA
    Confidence interval
    Statistical analysis title
    Effect Sizes (Mann-Whitney); 2-Sided 95.0% CI D7V4
    Statistical analysis description
    Time point: Day 7 (Visit 4) - D7V4 Hypothesis no. 2 (non-inferiority) is based on the Per Protocol (PP) analysis set; PP n=615. CI, Confidence interval
    Comparison groups
    Traumed gel v Diclofenac 1% gel
    Number of subjects included in analysis
    460
    Analysis specification
    Pre-specified
    Analysis type
    non-inferiority [86]
    P-value
    = 0.0253
    Method
    Wilcoxon (Mann-Whitney)
    Parameter type
    Mann-Whitney estimator
    Point estimate
    0.4638
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.4357
         upper limit
    0.4919
    Notes
    [86] - Non-inferiority is defined for LB-MW>0.407. LB, Lower Bound of the two-sided confidence interval; MW, Mann-Whitney estimator
    Statistical analysis title
    Parametric Analysis (ANCOVA) - Day 14 (Visit 5)
    Statistical analysis description
    Hypothesis no. 2 (non-inferiority) is based on the Per Protocol (PP) analysis set; PP n=615.
    Comparison groups
    Traumed gel v Diclofenac 1% gel
    Number of subjects included in analysis
    460
    Analysis specification
    Pre-specified
    Analysis type
    non-inferiority
    P-value
    = 0.0462
    Method
    ANCOVA
    Confidence interval
    Statistical analysis title
    Effect Sizes (Mann-Whitney); 2-Sided 95.0% CI D14
    Statistical analysis description
    Time point: Day 14 (Visit 5) - D14V5 Hypothesis no. 2 (non-inferiority) is based on the Per Protocol (PP) analysis set; PP n=615. CI, Confidence interval
    Comparison groups
    Traumed gel v Diclofenac 1% gel
    Number of subjects included in analysis
    460
    Analysis specification
    Pre-specified
    Analysis type
    non-inferiority [87]
    P-value
    = 0.052
    Method
    Wilcoxon (Mann-Whitney)
    Parameter type
    Mann-Whitney estimator
    Point estimate
    0.4685
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.4398
         upper limit
    0.4972
    Notes
    [87] - Non-inferiority is defined for LB-MW>0.407. LB, Lower Bound of the two-sided confidence interval; MW, Mann-Whitney estimator

    Secondary: Time to 50% improvement of pain at rest measured by Visual Analog Scale (VAS)

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    End point title
    Time to 50% improvement of pain at rest measured by Visual Analog Scale (VAS)
    End point description
    In accordance with the final Statistical Analysis Plan, the time to 50% improvement of pain was evaluated for both, pain on passive movement and pain at rest at all patient visits using the percent change from Baseline (recorded at Day 1). The time to 50% improvement (stable) of pain at rest (days) was calculated from the VAS raw data, based on the actual date and time of pain measurements. In case of missing data for time to 50% improvement (no 50% improvement reached during observational period) the variable was technically evaluated as 'censored' observation with replacement of missing days by the last existing visit. The analysis was based on Full Analysis Set n=622 and Per Protocol analysis set n=615. Absolute values are shown.
    End point type
    Secondary
    End point timeframe
    Baseline (Visit 1) to Day 14 (Visit 5, Final Visit)
    End point values
    Traumed gel Diclofenac 1% gel Placebo gel Traumed gel Diclofenac 1% gel
    Number of subjects analysed
    316 [88]
    151 [89]
    155 [90]
    314 [91]
    146 [92]
    Units: Days
    median (full range (min-max))
        Time to 50% Improvement (Stable) of Pain at Rest
    3.99 (0.89 to 14.89)
    5.46 (0.94 to 14.20)
    6.00 (0.96 to 14.84)
    3.99 (0.89 to 14.89)
    5.97 (0.94 to 14.20)
    Notes
    [88] - Full Analysis Set n=622
    [89] - Full Analysis Set n=622
    [90] - Full Analysis Set n=622
    [91] - Per Protocol analysis set n=615
    [92] - Per Protocol analysis set n=615
    Statistical analysis title
    Kaplan-Meier Function, Cumulative % with Event
    Statistical analysis description
    Kaplan-Meier (KM) curves for time-to-event (including censored values) were performed and tested for group differences by means of the Peto-Logrank test (time-to-event (logrank) test) as specified in the protocol. Analysis based on Full Analysis Set (FAS); FAS n=622.
    Comparison groups
    Traumed gel v Placebo gel
    Number of subjects included in analysis
    471
    Analysis specification
    Pre-specified
    Analysis type
    superiority [93]
    P-value
    = 0.0023
    Method
    Peto-Logrank
    Confidence interval
    Notes
    [93] - KM curve shows a superiority of Traumed gel versus Placebo gel, with a difference of the two medians (KM function) by two days in favour of Traumed gel.
    Statistical analysis title
    Kaplan-Meier Function, Cumulative % with Event
    Statistical analysis description
    Kaplan-Meier (KM) curves for time-to-event (including censored values) were performed and tested for group differences by means of the Peto-Logrank test (time-to-event (logrank) test) as specified in the protocol. Analysis based on Per Protocol (PP) analysis set; PP n=615.
    Comparison groups
    Traumed gel v Diclofenac 1% gel
    Number of subjects included in analysis
    460
    Analysis specification
    Pre-specified
    Analysis type
    non-inferiority [94]
    P-value
    = 0.2481
    Method
    Peto-Logrank
    Confidence interval
    Notes
    [94] - KM curve shows a slight superiority of Traumed gel versus Diclofenac gel, with a difference of the two medians (KM function) by two days in favour of Traumed gel.

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Adverse Events (AEs) were assessed at each Visit: Baseline Visit 1, Visit 2 (Day 2), Visit 3 (Day 4), Visit 4 (Day 7, End of Treatment) to Visit 5 (Day 14, Final Visit).
    Adverse event reporting additional description
    AE collection/reporting in eCRF during entire trial. They were patient-reported, elicited by investigator (INV) questioning, detected through physical examination/other means. AE description by duration, start/end, intensity, INV causality, action/s taken, concomitant diseases/resp. medication in general start, end/dosage rescue medication outcome.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    21.0
    Reporting groups
    Reporting group title
    Traumed gel
    Reporting group description
    Patients receiving test product. No safety exclusions from randomised population: total safety data set equals randomised population (n=625; main Clinical Trial Report population).

    Reporting group title
    Diclofenac 1% gel
    Reporting group description
    Patients receiving reference product. No safety exclusions from randomised population: total safety data set equals randomised population (n=625; main Clinical Trial Report population).

    Reporting group title
    Placebo gel
    Reporting group description
    Patients receiving Placebo. No safety exclusions from randomised population: total safety data set equals randomised population (n=625; main Clinical Trial Report population).

    Serious adverse events
    Traumed gel Diclofenac 1% gel Placebo gel
    Total subjects affected by serious adverse events
         subjects affected / exposed
    0 / 318 (0.00%)
    1 / 152 (0.66%)
    0 / 155 (0.00%)
         number of deaths (all causes)
    0
    0
    0
         number of deaths resulting from adverse events
    0
    0
    0
    Injury, poisoning and procedural complications
    Upper Arm Fracture (Humerus Fracture) right
         subjects affected / exposed
    0 / 318 (0.00%)
    1 / 152 (0.66%)
    0 / 155 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 0%
    Non-serious adverse events
    Traumed gel Diclofenac 1% gel Placebo gel
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    9 / 318 (2.83%)
    2 / 152 (1.32%)
    6 / 155 (3.87%)
    Injury, poisoning and procedural complications
    Weber a Frakture
         subjects affected / exposed
    1 / 318 (0.31%)
    0 / 152 (0.00%)
    0 / 155 (0.00%)
         occurrences all number
    1
    0
    0
    Distorsion Forefoot
         subjects affected / exposed
    1 / 318 (0.31%)
    0 / 152 (0.00%)
    0 / 155 (0.00%)
         occurrences all number
    1
    0
    0
    Sacroiliac sprain
         subjects affected / exposed
    0 / 318 (0.00%)
    0 / 152 (0.00%)
    1 / 155 (0.65%)
         occurrences all number
    0
    0
    1
    Nervous system disorders
    Migraine
         subjects affected / exposed
    1 / 318 (0.31%)
    0 / 152 (0.00%)
    0 / 155 (0.00%)
         occurrences all number
    1
    0
    0
    Headache
         subjects affected / exposed
    1 / 318 (0.31%)
    0 / 152 (0.00%)
    0 / 155 (0.00%)
         occurrences all number
    3
    0
    0
    Tension Headache
         subjects affected / exposed
    1 / 318 (0.31%)
    0 / 152 (0.00%)
    0 / 155 (0.00%)
         occurrences all number
    1
    0
    0
    General disorders and administration site conditions
    Application site burning after prerious existing mosquito bite
         subjects affected / exposed
    0 / 318 (0.00%)
    0 / 152 (0.00%)
    1 / 155 (0.65%)
         occurrences all number
    0
    0
    1
    Skin and subcutaneous tissue disorders
    Dry skin
         subjects affected / exposed
    0 / 318 (0.00%)
    0 / 152 (0.00%)
    1 / 155 (0.65%)
         occurrences all number
    0
    0
    1
    Dry skin over treated (skin) area
         subjects affected / exposed
    1 / 318 (0.31%)
    2 / 152 (1.32%)
    0 / 155 (0.00%)
         occurrences all number
    1
    1
    0
    Musculoskeletal and connective tissue disorders
    Neck pain
         subjects affected / exposed
    1 / 318 (0.31%)
    0 / 152 (0.00%)
    0 / 155 (0.00%)
         occurrences all number
    1
    0
    0
    Knee pain left
         subjects affected / exposed
    0 / 318 (0.00%)
    0 / 152 (0.00%)
    1 / 155 (0.65%)
         occurrences all number
    0
    0
    1
    Infections and infestations
    Akute nasopharyngitis
         subjects affected / exposed
    0 / 318 (0.00%)
    0 / 152 (0.00%)
    1 / 155 (0.65%)
         occurrences all number
    0
    0
    1
    Common cold
         subjects affected / exposed
    1 / 318 (0.31%)
    0 / 152 (0.00%)
    1 / 155 (0.65%)
         occurrences all number
    1
    0
    1
    Abscess ellebow right
         subjects affected / exposed
    1 / 318 (0.31%)
    0 / 152 (0.00%)
    0 / 155 (0.00%)
         occurrences all number
    1
    0
    0

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    03 Feb 2020
    Amendment to protocol version 3.0: Sample size was enhanced following German Competent Authority (BfArM) recommendation to compensate cases for whom maintenance of blinding procedures could have been not adhered to as planned. Final sample size was enhanced to n=202 patients for Diclofenac 1% gel and Placebo gel each and to n=404 patients for the Traumed gel group. New total planned patient number was n=808. Reason: To ensure planned power and internal validity for evaluating the predefined trial objectives and reaching unbiased conclusions by including only those cases in the analysis sample with blinding compliance fully confirmed.

    Interruptions (globally)

    Were there any global interruptions to the trial? Yes
    Date
    Interruption
    Restart date
    18 Dec 2019
    The trial was not prematurely terminated but enrolment was suspended due to lack of investigational medicinal product from Dec 2019 to Feb 2020.
    17 Feb 2020
    23 Mar 2020
    The trial was not prematurely terminated but enrolment was suspended due to the SARS-CoV-2 pandemic from Mar 2020 to Jun 2020.
    25 Jun 2020

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    NA

    Online references

    http://www.ncbi.nlm.nih.gov/pubmed/23889885
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