The effect of oxandrolone on the healing of chronic pressure ulcers in persons with spinal cord injury: a randomized trial.

William A Bauman, Ann M Spungen, Joseph F Collins, Dennis W Raisch, Chester Ho, George A Deitrick, Bernard A Nemchausky, Lance L Goetz, Jai S Park, Michael Schwartz, John L Merritt, Vidya Jayawardena, Paul Sandford, Sunil Sabharwal, Sally A Holmes, Fahima Nasar, Roy Sasaki, Vandana Punj, Karin F Zachow, Walter C Chua, MaryKutty D Thomas, Rose C Trincher

Index: Ann. Intern. Med. 158(10) , 718-26, (2013)

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Abstract

Anabolic steroids have been reported to improve wound healing.To determine whether oxandrolone increases the percentage of target pressure ulcers (TPUs) that heal compared with placebo and whether healed ulcers remain closed 8 weeks after treatment.Parallel-group, placebo-controlled, randomized trial conducted from 1 August 2005 to 30 November 2008. Patients, clinical care providers, study personnel, and statisticians were blinded to treatment assignment. (ClinicalTrials.gov: NCT00101361).16 inpatient spinal cord injury (SCI) services at Veterans Affairs medical centers.1900 prescreened, 779 screened, and 212 randomly assigned inpatients with SCI and stage III or IV TPUs.Oxandrolone, 20 mg/d (n = 108), or placebo (n = 104) until the TPU healed or 24 weeks.The primary outcome was healed TPUs. The secondary outcome was the percentage of TPUs that remained healed at 8-week follow-up.24.1% (95% CI, 16.0% to 32.1%) of TPUs in oxandrolone recipients and 29.8% (CI, 21.0% to 38.6%) in placebo recipients healed (difference, -5.7 percentage points [CI, -17.5 to 6.8 percentage points]; P = 0.40). At 8-week follow-up, 16.7% (CI, 9.6% to 23.7%) of oxandrolone recipients and 15.4% (CI, 8.5% to 22.3%) of placebo recipients retained a healed TPU (difference, 1.3 percentage points [CI, -8.8 to 11.2 percentage points]; P = 0.70). No serious adverse events were related to oxandrolone. Liver enzyme levels were elevated in 32.4% (CI, 23.6% to 41.2%) of oxandrolone recipients and 2.9% (CI, 0.0% to 6.1%) of placebo recipients (P < 0.001).Selection of severe wounds may have reduced treatment response. Approximately one third of patients did not complete the study in the treatment and placebo groups. The study was terminated after a futility analysis showed a low probability of detecting a significant difference between the groups.Oxandrolone showed no benefit over placebo for improving healing or the percentage of TPUs that remained closed after 8 weeks of treatment.U.S. Department of Veterans Affairs.