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Investigation of 1.2% Sodium Hyaluronate for Treatment of Painful Chronic Osteoarthritis of the Knee

Primary Purpose

Osteoarthritis of the Knee

Status
Completed
Phase
Phase 3
Locations
United States
Study Type
Interventional
Intervention
1.2% Sodium Hyaluronate
Buffered Saline
Sponsored by
Ferring Pharmaceuticals
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Osteoarthritis of the Knee

Eligibility Criteria

40 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Chronic osteoarthritis (OA) of target knee confirmed by American College of Rheumatology (ACR) Criteria.
  • Pain due to OA in target knee present for at least 6 months.
  • During Screening and Baseline visits, subjects will require a visual analog scale (VAS) score (100 mm) of ≥ 41 mm and ≤ 90 mm, recorded immediately following a 50-foot walk, AND at Baseline, cannot have decreased >10mm (improvement) from Screening.
  • A bilateral standing anteroposterior (AP) X-ray confirming OA of the target knee.
  • Ability and willingness to use only acetaminophen as the analgesic (rescue) study medication
  • Ability to perform procedures required of the pain index evaluations (unassisted walking 50 feet on a flat surface and going up and down stairs).
  • Willingness and ability to complete efficacy and safety questionnaires and ability to read and understand study instructions.
  • Signed Subject Informed Consent Form

Exclusion Criteria:

  • Any major injury (including sports injuries) to the target knee within the prior 12 months.
  • Any surgery to the target knee, hip and contralateral hip within the prior 12 months.
  • Major and minor articular procedures
  • Inflammatory arthropathies such as rheumatoid arthritis, lupus arthropathy, or psoriatic arthritis.
  • Gout or calcium pyrophosphate (pseudogout) diseases of the target knee that have flared within the previous 6 months.
  • X-ray findings of acute fractures, severe loss of bone density, avascular necrosis, and/or severe bone or joint deformity in the target knee.
  • Osteonecrosis of either knee.
  • Fibromyalgia, pes anserine bursitis, lumbar radiculopathy, and/or neurogenic or vascular claudication.
  • Significant anterior knee pain due to diagnosed isolated patella-femoral syndrome or chondromalacia in the target knee.
  • Significant target knee joint infection or skin disorder/infection within the previous 6 months prior to study enrollment.
  • Symptomatic OA of the hips, spine, or ankle, if it would interfere with the evaluation of the target knee.
  • Known hypersensitivity to acetaminophen, sodium hyaluronate, or phosphate buffered saline solution.
  • Women of childbearing potential who are pregnant, nursing, or planning to become pregnant, and those who do not agree to remain on an acceptable method of birth control throughout the entire study period.
  • Recurrent medical history of severe allergic or immune-mediated reactions or other immune disorders.
  • Vascular insufficiency of lower limbs or peripheral neuropathy severe enough to interfere with the study evaluation.
  • Current treatment or treatment within the previous 2 years prior to Screening for any malignancy unless specific written permission is provided by the Sponsor (excluding basal cell or squamous cell carcinoma of the skin).
  • Chronic liver disease and active liver disease based on liver profile of aspartate aminotransferase (AST), alanine transaminase (ALT), and conjugated bilirubin >2 times the upper limit of normal.
  • Renal insufficiency based on serum creatinine >2.0 mg/dL.
  • Any clinically significant laboratory value based on clinical history that the Investigator feels may affect the study evaluation.
  • Any intercurrent chronic disease or condition that may interfere with the completion of the 6-month (or 12-month) follow-up of the study, such as liver disease, severe coronary disease, drug abuse, disordered mental state, or other clinically significant condition.
  • Current alcoholism, and/or any known current addiction to pain medications.
  • Any clinically significant finding that would place the patient at health risk, impact the study, or affect the completion of the study.
  • Any psychiatric illness that would prevent comprehension of the details and nature of the study.
  • Participation in any experimental device study within 6 months prior to the Screening, or an experimental drug study within 1 month prior to the Screening

Sites / Locations

  • Apex Clinical Trials, LLC
  • Tucson Orthopaedic Institute
  • St. Joseph's Mercy Clinic
  • Rx Medical Research of Arkansas, Inc
  • Southbay Pharma Research
  • Providence Clinical Research
  • Triwest Research Associates
  • UCLA-Division of Rheumatology
  • Investigational Site
  • Colorado Arthritis Center, PC
  • Front Range Clinical Research
  • New England Research Associates, LLC
  • International Physicians Research
  • Investigational Site
  • Sunrise Medical Research
  • Tri-County Orthopaedic Center
  • Clinical Research Center LLC
  • National Pain Research Institute, LLC
  • Georgia Institute for Clinical Research
  • Pinnacle Orthopaedics and Sports Medicine
  • Lee Research Institute
  • Professional Research Network of Kansas
  • New Jersey Physicians, LLC
  • Research Department, Bone & Joint Hospital at St. Anthony
  • Omega Medical Research
  • Palmetto Medical Research
  • Palmetto Clinical Trial Services, LLC
  • Black Hills Orthopedic & Spine Center
  • Holston Medical Group
  • McKenzie Medical Center
  • Texas Orthopedic Specialists, PA
  • Memorial Bone & Joint Research Foundation
  • Discovery Clinical Trials (DCT) - Stone Oak, LLC
  • Northwest Clinical Research Center

Arms of the Study

Arm 1

Arm 2

Arm Type

Placebo Comparator

Experimental

Arm Label

IA-SA

IA-BioHA

Arm Description

Each participant received a single intra-articular (IA) injection of buffered saline (SA) into the target knee, and was followed for a total of 26 weeks in the double-blind period. Participants had the option of continuing into the open-label period in which they could receive a single intra-articular injection of 1.2% sodium hyaluronate (IA-BioHA) into the target knee and be followed for an additional 26 weeks.

Each participant received a single intra-articular (IA) injection of 1.2% sodium hyaluronate (BioHA) into the target knee, and was followed for a total of 26 weeks in the double-blind period. Participants had the option of continuing into the open-label period in which they received a single intra-articular injection of 1.2% sodium hyaluronate (IA-BioHA) into the target knee and were followed for an additional 26 weeks.

Outcomes

Primary Outcome Measures

Change From Baseline in the Visual Analogue Score (VAS) Pain Score of the 50-foot Walk Test at Week 26
The level of pain is estimated by the participant following a walk of 50 feet in length which is observed by the investigator. Pain estimates were recorded on a 100 millimeter visual analog scale. A score of 0 millimeters means there was no pain; a score of 100 millimeters means extreme pain. Change from baseline is calculated: week 26 VAS Pain Score - Baseline VAS Pain Score.

Secondary Outcome Measures

Change From Baseline in Western Ontario McMaster University Osteoarthritis Index (WOMAC) Disability Scores at Week 26
Adjusted mean of all WOMAC pain, stiffness and physical function subscores on Visual Analog Scale (VAS) of 100 mm; 0 mm = no pain, stiffness and difficulty; 100 mm = extreme pain, stiffness and difficulty. Change from baseline calculated as: Week 26 minus baseline.
Percentage of Participants With a >=20mm Improvement Between Baseline and Week 26 on the 50 Foot Walk Visual Analogue Scale (VAS) Pain Score.
The level of pain is estimated by the participant following a walk of 50 feet in length which is observed by the investigator. Pain estimates were recorded on a 100 millimeter visual analog scale. A score of 0 millimeters means there was no pain; a score of 100 millimeters means extreme pain. Change from baseline is calculated: week 26 VAS Pain Score - Baseline VAS Pain Score. The percent of participants who showed a 20mm or greater improvement in the pain scores at week 26 compared to baseline are reported.
Subjective Patient Assessment of Treatment at Week 26
At the end of the double-blind period (week 26), participants were asked: "Are you satisfied with the results of the injection?" Answers could be: 1=dissatisfied; 2=slightly satisfied; 3=satisfied; or 4=very satisfied.
Number of Tablets of Rescue Medication Used Between Visits
Acetaminophen (500-mg tablets) was provided to study participants as a rescue medication in case they needed a pain medication during the study. The mean number of tablets of rescue medication should have been summarized, however the data was not captured in a reliable way and is therefore not reported.
Change From Baseline in Patient Global Assessment at Week 26
Participants were asked to mark along a 100mm visual analog scale (VAS) indicating the point best representing the severity of the knee pain that day. The left side of the VAS was 0=no pain and the right side was 100 = extreme pain. Change from baseline was calculated as Week 26 - Baseline.
Percentage of Observed Osteoarthritis Research Society International (OARSI30) Responders Using the Visual Analogue Scale (VAS) to Assess Pain Following a 50-foot Walk at Week 26
Responders are identified based on a calculation of three scales: 50-foot walk test for pain, function (WOMAC Disability score) and global assessment (Patient Global Assessment Score) scales. Each of the individual scales was completed by the participant. A responder showed considerable improvement in pain or function (>=50 percent and absolute change of >=20 millimeters), or improvement in at least two of three categories: Pain and/or Function and/or Patient Global Assessment scales of >=20 percent and absolute change >=10 millimeter. Response at Week 26 is compared to baseline.

Full Information

First Posted
September 29, 2009
Last Updated
June 13, 2012
Sponsor
Ferring Pharmaceuticals
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1. Study Identification

Unique Protocol Identification Number
NCT00988091
Brief Title
Investigation of 1.2% Sodium Hyaluronate for Treatment of Painful Chronic Osteoarthritis of the Knee
Official Title
A 26 Week, Double-Blind, Randomized, Placebo-Controlled Study of the Efficacy and Safety of Single Intra-Articular Injection 1.2% Sodium Hyaluronate for Treatment of Painful Osteoarthritis of the Knee, With Optional 26-Week Open-Label Safety Extension
Study Type
Interventional

2. Study Status

Record Verification Date
June 2012
Overall Recruitment Status
Completed
Study Start Date
September 2009 (undefined)
Primary Completion Date
October 2010 (Actual)
Study Completion Date
April 2011 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Ferring Pharmaceuticals

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
Subjects with chronic osteoarthritis of the knee will be assigned to receive an injection of either 1.2% sodium hyaluronate or buffered saline to evaluate its effectiveness and safety for 26 weeks. After 26 weeks, subjects can elect to receive a second injection of 1.2% sodium hyaluronate and be followed for another 26 weeks.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Osteoarthritis of the Knee

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigator
Allocation
Randomized
Enrollment
596 (Actual)

8. Arms, Groups, and Interventions

Arm Title
IA-SA
Arm Type
Placebo Comparator
Arm Description
Each participant received a single intra-articular (IA) injection of buffered saline (SA) into the target knee, and was followed for a total of 26 weeks in the double-blind period. Participants had the option of continuing into the open-label period in which they could receive a single intra-articular injection of 1.2% sodium hyaluronate (IA-BioHA) into the target knee and be followed for an additional 26 weeks.
Arm Title
IA-BioHA
Arm Type
Experimental
Arm Description
Each participant received a single intra-articular (IA) injection of 1.2% sodium hyaluronate (BioHA) into the target knee, and was followed for a total of 26 weeks in the double-blind period. Participants had the option of continuing into the open-label period in which they received a single intra-articular injection of 1.2% sodium hyaluronate (IA-BioHA) into the target knee and were followed for an additional 26 weeks.
Intervention Type
Device
Intervention Name(s)
1.2% Sodium Hyaluronate
Other Intervention Name(s)
sodium hyaluronate
Intervention Description
IA-BioHA is supplied in a disposable 7 ml nominal volume glass syringe containing 60 mg/5 ml of 1.2% sodium hyaluronate. Participants are given a single injection in the target knee on Day 1 of the double-blind period and optionally on the first day of the open-label period (approximately week 27).
Intervention Type
Device
Intervention Name(s)
Buffered Saline
Other Intervention Name(s)
saline
Intervention Description
IA-SA is supplied in a disposable 7 ml nominal volume glass syringe containing 5 ml of phosphate buffered saline. Participants are given a single injection in the target knee on Day 1 of the double-blind period.
Primary Outcome Measure Information:
Title
Change From Baseline in the Visual Analogue Score (VAS) Pain Score of the 50-foot Walk Test at Week 26
Description
The level of pain is estimated by the participant following a walk of 50 feet in length which is observed by the investigator. Pain estimates were recorded on a 100 millimeter visual analog scale. A score of 0 millimeters means there was no pain; a score of 100 millimeters means extreme pain. Change from baseline is calculated: week 26 VAS Pain Score - Baseline VAS Pain Score.
Time Frame
Day 0 (baseline) through Week 26
Secondary Outcome Measure Information:
Title
Change From Baseline in Western Ontario McMaster University Osteoarthritis Index (WOMAC) Disability Scores at Week 26
Description
Adjusted mean of all WOMAC pain, stiffness and physical function subscores on Visual Analog Scale (VAS) of 100 mm; 0 mm = no pain, stiffness and difficulty; 100 mm = extreme pain, stiffness and difficulty. Change from baseline calculated as: Week 26 minus baseline.
Time Frame
Day 0 (baseline), week 26
Title
Percentage of Participants With a >=20mm Improvement Between Baseline and Week 26 on the 50 Foot Walk Visual Analogue Scale (VAS) Pain Score.
Description
The level of pain is estimated by the participant following a walk of 50 feet in length which is observed by the investigator. Pain estimates were recorded on a 100 millimeter visual analog scale. A score of 0 millimeters means there was no pain; a score of 100 millimeters means extreme pain. Change from baseline is calculated: week 26 VAS Pain Score - Baseline VAS Pain Score. The percent of participants who showed a 20mm or greater improvement in the pain scores at week 26 compared to baseline are reported.
Time Frame
Day 0 (baseline), Week 26
Title
Subjective Patient Assessment of Treatment at Week 26
Description
At the end of the double-blind period (week 26), participants were asked: "Are you satisfied with the results of the injection?" Answers could be: 1=dissatisfied; 2=slightly satisfied; 3=satisfied; or 4=very satisfied.
Time Frame
Week 26
Title
Number of Tablets of Rescue Medication Used Between Visits
Description
Acetaminophen (500-mg tablets) was provided to study participants as a rescue medication in case they needed a pain medication during the study. The mean number of tablets of rescue medication should have been summarized, however the data was not captured in a reliable way and is therefore not reported.
Time Frame
Day 1 to week 26
Title
Change From Baseline in Patient Global Assessment at Week 26
Description
Participants were asked to mark along a 100mm visual analog scale (VAS) indicating the point best representing the severity of the knee pain that day. The left side of the VAS was 0=no pain and the right side was 100 = extreme pain. Change from baseline was calculated as Week 26 - Baseline.
Time Frame
Day 0 (baseline), Week 26
Title
Percentage of Observed Osteoarthritis Research Society International (OARSI30) Responders Using the Visual Analogue Scale (VAS) to Assess Pain Following a 50-foot Walk at Week 26
Description
Responders are identified based on a calculation of three scales: 50-foot walk test for pain, function (WOMAC Disability score) and global assessment (Patient Global Assessment Score) scales. Each of the individual scales was completed by the participant. A responder showed considerable improvement in pain or function (>=50 percent and absolute change of >=20 millimeters), or improvement in at least two of three categories: Pain and/or Function and/or Patient Global Assessment scales of >=20 percent and absolute change >=10 millimeter. Response at Week 26 is compared to baseline.
Time Frame
Day 0 (baseline), week 26

10. Eligibility

Sex
All
Minimum Age & Unit of Time
40 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Chronic osteoarthritis (OA) of target knee confirmed by American College of Rheumatology (ACR) Criteria. Pain due to OA in target knee present for at least 6 months. During Screening and Baseline visits, subjects will require a visual analog scale (VAS) score (100 mm) of ≥ 41 mm and ≤ 90 mm, recorded immediately following a 50-foot walk, AND at Baseline, cannot have decreased >10mm (improvement) from Screening. A bilateral standing anteroposterior (AP) X-ray confirming OA of the target knee. Ability and willingness to use only acetaminophen as the analgesic (rescue) study medication Ability to perform procedures required of the pain index evaluations (unassisted walking 50 feet on a flat surface and going up and down stairs). Willingness and ability to complete efficacy and safety questionnaires and ability to read and understand study instructions. Signed Subject Informed Consent Form Exclusion Criteria: Any major injury (including sports injuries) to the target knee within the prior 12 months. Any surgery to the target knee, hip and contralateral hip within the prior 12 months. Major and minor articular procedures Inflammatory arthropathies such as rheumatoid arthritis, lupus arthropathy, or psoriatic arthritis. Gout or calcium pyrophosphate (pseudogout) diseases of the target knee that have flared within the previous 6 months. X-ray findings of acute fractures, severe loss of bone density, avascular necrosis, and/or severe bone or joint deformity in the target knee. Osteonecrosis of either knee. Fibromyalgia, pes anserine bursitis, lumbar radiculopathy, and/or neurogenic or vascular claudication. Significant anterior knee pain due to diagnosed isolated patella-femoral syndrome or chondromalacia in the target knee. Significant target knee joint infection or skin disorder/infection within the previous 6 months prior to study enrollment. Symptomatic OA of the hips, spine, or ankle, if it would interfere with the evaluation of the target knee. Known hypersensitivity to acetaminophen, sodium hyaluronate, or phosphate buffered saline solution. Women of childbearing potential who are pregnant, nursing, or planning to become pregnant, and those who do not agree to remain on an acceptable method of birth control throughout the entire study period. Recurrent medical history of severe allergic or immune-mediated reactions or other immune disorders. Vascular insufficiency of lower limbs or peripheral neuropathy severe enough to interfere with the study evaluation. Current treatment or treatment within the previous 2 years prior to Screening for any malignancy unless specific written permission is provided by the Sponsor (excluding basal cell or squamous cell carcinoma of the skin). Chronic liver disease and active liver disease based on liver profile of aspartate aminotransferase (AST), alanine transaminase (ALT), and conjugated bilirubin >2 times the upper limit of normal. Renal insufficiency based on serum creatinine >2.0 mg/dL. Any clinically significant laboratory value based on clinical history that the Investigator feels may affect the study evaluation. Any intercurrent chronic disease or condition that may interfere with the completion of the 6-month (or 12-month) follow-up of the study, such as liver disease, severe coronary disease, drug abuse, disordered mental state, or other clinically significant condition. Current alcoholism, and/or any known current addiction to pain medications. Any clinically significant finding that would place the patient at health risk, impact the study, or affect the completion of the study. Any psychiatric illness that would prevent comprehension of the details and nature of the study. Participation in any experimental device study within 6 months prior to the Screening, or an experimental drug study within 1 month prior to the Screening
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Clinical Development Support
Organizational Affiliation
Ferring Pharmaceuticals
Official's Role
Study Director
Facility Information:
Facility Name
Apex Clinical Trials, LLC
City
Homewood
State/Province
Alabama
Country
United States
Facility Name
Tucson Orthopaedic Institute
City
Tucson
State/Province
Arizona
Country
United States
Facility Name
St. Joseph's Mercy Clinic
City
Hot Springs
State/Province
Arkansas
Country
United States
Facility Name
Rx Medical Research of Arkansas, Inc
City
Little Rock
State/Province
Arkansas
Country
United States
Facility Name
Southbay Pharma Research
City
Buena Park
State/Province
California
Country
United States
Facility Name
Providence Clinical Research
City
Burbank
State/Province
California
Country
United States
Facility Name
Triwest Research Associates
City
La Mesa
State/Province
California
Country
United States
Facility Name
UCLA-Division of Rheumatology
City
Los Angeles
State/Province
California
Country
United States
Facility Name
Investigational Site
City
Santa Barbara
State/Province
California
Country
United States
Facility Name
Colorado Arthritis Center, PC
City
Englewood
State/Province
Colorado
Country
United States
Facility Name
Front Range Clinical Research
City
Wheatridge
State/Province
Colorado
Country
United States
Facility Name
New England Research Associates, LLC
City
Trumball
State/Province
Connecticut
Country
United States
Facility Name
International Physicians Research
City
Aventura
State/Province
Florida
Country
United States
Facility Name
Investigational Site
City
Ft. Lauderdale
State/Province
Florida
Country
United States
Facility Name
Sunrise Medical Research
City
Lauderdale Lakes
State/Province
Florida
Country
United States
Facility Name
Tri-County Orthopaedic Center
City
Leesburg
State/Province
Florida
Country
United States
Facility Name
Clinical Research Center LLC
City
Wellington
State/Province
Florida
Country
United States
Facility Name
National Pain Research Institute, LLC
City
Winter Park
State/Province
Florida
Country
United States
Facility Name
Georgia Institute for Clinical Research
City
Marietta
State/Province
Georgia
Country
United States
Facility Name
Pinnacle Orthopaedics and Sports Medicine
City
Marietta
State/Province
Georgia
Country
United States
Facility Name
Lee Research Institute
City
Shawnee
State/Province
Kansas
Country
United States
Facility Name
Professional Research Network of Kansas
City
Wichita
State/Province
Kansas
Country
United States
Facility Name
New Jersey Physicians, LLC
City
Passaic
State/Province
New Jersey
Country
United States
Facility Name
Research Department, Bone & Joint Hospital at St. Anthony
City
Oklahoma City
State/Province
Oklahoma
Country
United States
Facility Name
Omega Medical Research
City
Warwick
State/Province
Rhode Island
Country
United States
Facility Name
Palmetto Medical Research
City
Mt. Pleasant
State/Province
South Carolina
Country
United States
Facility Name
Palmetto Clinical Trial Services, LLC
City
Simpsonville
State/Province
South Carolina
Country
United States
Facility Name
Black Hills Orthopedic & Spine Center
City
Rapid City
State/Province
South Dakota
Country
United States
Facility Name
Holston Medical Group
City
Kingsport
State/Province
Tennessee
Country
United States
Facility Name
McKenzie Medical Center
City
McKenzie
State/Province
Tennessee
Country
United States
Facility Name
Texas Orthopedic Specialists, PA
City
Grapevine
State/Province
Texas
Country
United States
Facility Name
Memorial Bone & Joint Research Foundation
City
Houston
State/Province
Texas
Country
United States
Facility Name
Discovery Clinical Trials (DCT) - Stone Oak, LLC
City
San Antonio
State/Province
Texas
Country
United States
Facility Name
Northwest Clinical Research Center
City
Bellevue
State/Province
Washington
Country
United States

12. IPD Sharing Statement

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Investigation of 1.2% Sodium Hyaluronate for Treatment of Painful Chronic Osteoarthritis of the Knee

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