Duloxetine in Osteoarthritis (OA) Pain
Primary Purpose
Osteoarthritis
Status
Completed
Phase
Phase 4
Locations
United States
Study Type
Interventional
Intervention
Duloxetine
Sugar pill
Sponsored by
About this trial
This is an interventional basic science trial for Osteoarthritis focused on measuring osteoarthritis, pain, brain, gray matter
Eligibility Criteria
Inclusion Criteria:
- Age: 45-80 years
- ACR criteria for OA including Kellgren-Lawrence radiographic OA grades II-IV
- VAS pain score >5/10 within 48 hrs of the phone screen and visit 1 (Screening)
- Knee OA for a minimum of 12 months
- Need for daily pain medication to manage symptoms of OA
Exclusion Criteria:
Currently taking MAO inhibitors or any centrally acting drug for analgesia, depression
- Narrow angle glaucoma
- Uncontrolled hypertension
- Co-existing inflammatory arthritis, fibromyalgia or other chronic pain state.
- If a female, pregnant, trying to become pregnant, or lactating
- Major depressive disorder
- Substantial alcohol use or history of significant liver disease
- Use of MAO inhibitors, triptans, serotonin precursors (tryptophan)
- Use of potent CYP1A2 inhibitors, Thioridazine, and anti-depressants
- Diabetes, type 1 or type 2
- Condition in which the Investigator believes would interfere with the subject's ability to comply with study instructions, or might confound the interpretation of the study results or put the subject at undue risk
MRI safety necessitates the exclusion of subjects having one or more of the following:
- Metal fragments in the eye or face, or having worked previously in the metal industry
- Implantation of any electronic devices such as (but not limited to) cardiac pacemakers, cardiac, defibrillators, and cochlear implants or nerve stimulators.
- Surgery on the blood vessels of the brain
- Claustrophobia (fear of enclosed places)
- Piercings or tattoos
- More than 250 lbs in weight
- Obvious brain abnormalities
Sites / Locations
- Northwestern University Feinberg School of Medicine
Arms of the Study
Arm 1
Arm 2
Arm Type
Experimental
Placebo Comparator
Arm Label
Duloxetine
Sugar pill
Arm Description
Duloxetine capsule 30mg once a day for one week, then 60mg once a day for 15 weeks, then 30mg once a day for one week.
Matching capsule given once a day for a total of 17 weeks.
Outcomes
Primary Outcome Measures
Change in Brain Gray Matter Volume
The change in gray matter volume is evaluated by subtracting the volume after the treatment (week 16) to the volume before treatment (baseline)
Secondary Outcome Measures
Change in Pain Magnitude
The Western Ontario and McMaster Osteoarthritis Index (WOMAC) score change was assess by subtracting WOMAC score after treatment (week 16) to the baseline WOMAC score. WOMAC score has a range from 0 up to 96, higher score meaning worse condition. The outcome is the decrease in WOMAC scores, meaning that the higher is the decrease, the most improvement in the condition.
Full Information
NCT ID
NCT01558700
First Posted
March 16, 2012
Last Updated
December 16, 2014
Sponsor
Northwestern University
Collaborators
Eli Lilly and Company
1. Study Identification
Unique Protocol Identification Number
NCT01558700
Brief Title
Duloxetine in Osteoarthritis (OA) Pain
Official Title
Brain Morphometries in OA Patients Treated With Duloxetine
Study Type
Interventional
2. Study Status
Record Verification Date
December 2014
Overall Recruitment Status
Completed
Study Start Date
March 2012 (undefined)
Primary Completion Date
April 2014 (Actual)
Study Completion Date
August 2014 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Northwestern University
Collaborators
Eli Lilly and Company
4. Oversight
Data Monitoring Committee
No
5. Study Description
Brief Summary
This study aims to determine in people with knee Osteoarthritis (OA) if relief of pain after treatment with either duloxetine or placebo is associated with changes in brain anatomy.
Detailed Description
This study and the hypotheses to be tested arise from work done in our group evaluating brain cortical changes in people with chronic back pain. These studies demonstrated a loss of about 1.5 cc of neocortical gray matter per year of living with the condition, not including gray matter lost due to aging. Since this original publication, more than ten studies have replicated this basic result, showing that distinct chronic pain conditions are associated with specific brain anatomical reorganization, characterized by regional decreases in grey matter density. Recently, other studies have shown that when chronic pain is completely reversed, these anatomical changes seem to at least partially reverse within the time span of 4-12 months, providing evidence for a time window for reversal of grey matter abnormalities A fundamental question that arises from these recent studies is the extent of reversibility of the brain atrophy associated with chronic pain following continuous use of a pain-relieving drug. Apkarian's lab has generated strong evidence that the brain anatomy of subjects with osteoarthritis (OA) is dramatically different from that of healthy subjects. Given that recent data show that hip replacement OA reverses brain atrophy, the investigators can now hypothesize with greater confidence that an effective analgesic should also reverse at least some of the brain atrophy observed in OA. Thus, a study in patients with chronic knee OA treated with duloxetine provides a unique opportunity to answer this question. Since OA patients in this study will have a single new agent for four months, one can directly examine the effects of treatment in relation to progression or regression of brain atrophy. One can also examine whether or not a placebo, which is thought to reflect attentional and motivational states, affects changes in atrophy, and if so, to what extent.
The investigators consider the brain atrophy in chronic pain to be an overall marker of the extent of nervous system reorganization a subject has developed while living with the condition. Animal models of various chronic pain conditions repeatedly provide evidence for this idea, showing, for example, dramatic changes in the way pain is processed in the periphery, the spinal cord, and at the level of individual neurons. The investigators presume that these changes are the same ones contributing to atrophy in human chronic pain. However, most of underlying mechanisms remain to be uncovered. In addition, humans suffering from chronic pain exhibit a large number of cognitive and emotional deficits. The investigators presume that these deficits are directly related to the brain atrophies discovered in chronic pain conditions. Unfortunately, there are no direct studies linking brain regional atrophies to cognitive abilities in chronic pain, although such preliminary studies are underway in Apkarian's lab. Thus, in addition to the answering the previous questions, the present study will also allow us to investigate the extent to which reversing atrophy corresponds to reversing plasticity at multiple levels in the nervous system, as well as whether such reversal also corresponds to improvements in cognitive and emotional abilities.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Osteoarthritis
Keywords
osteoarthritis, pain, brain, gray matter
7. Study Design
Primary Purpose
Basic Science
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
40 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Duloxetine
Arm Type
Experimental
Arm Description
Duloxetine capsule 30mg once a day for one week, then 60mg once a day for 15 weeks, then 30mg once a day for one week.
Arm Title
Sugar pill
Arm Type
Placebo Comparator
Arm Description
Matching capsule given once a day for a total of 17 weeks.
Intervention Type
Drug
Intervention Name(s)
Duloxetine
Other Intervention Name(s)
Cymbalta
Intervention Description
Duloxetine capsule 30mg once a day for one week, then 60mg once a day for 15 weeks, then 30mg once a day for one week.
Intervention Type
Drug
Intervention Name(s)
Sugar pill
Other Intervention Name(s)
Placebo
Intervention Description
Matching capsule given once a day for a total of 17 weeks.
Primary Outcome Measure Information:
Title
Change in Brain Gray Matter Volume
Description
The change in gray matter volume is evaluated by subtracting the volume after the treatment (week 16) to the volume before treatment (baseline)
Time Frame
16 weeks compared to baseline
Secondary Outcome Measure Information:
Title
Change in Pain Magnitude
Description
The Western Ontario and McMaster Osteoarthritis Index (WOMAC) score change was assess by subtracting WOMAC score after treatment (week 16) to the baseline WOMAC score. WOMAC score has a range from 0 up to 96, higher score meaning worse condition. The outcome is the decrease in WOMAC scores, meaning that the higher is the decrease, the most improvement in the condition.
Time Frame
16 weeks compared to baseline
10. Eligibility
Sex
All
Minimum Age & Unit of Time
40 Years
Maximum Age & Unit of Time
80 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria:
Age: 45-80 years
ACR criteria for OA including Kellgren-Lawrence radiographic OA grades II-IV
VAS pain score >5/10 within 48 hrs of the phone screen and visit 1 (Screening)
Knee OA for a minimum of 12 months
Need for daily pain medication to manage symptoms of OA
Exclusion Criteria:
Currently taking MAO inhibitors or any centrally acting drug for analgesia, depression
Narrow angle glaucoma
Uncontrolled hypertension
Co-existing inflammatory arthritis, fibromyalgia or other chronic pain state.
If a female, pregnant, trying to become pregnant, or lactating
Major depressive disorder
Substantial alcohol use or history of significant liver disease
Use of MAO inhibitors, triptans, serotonin precursors (tryptophan)
Use of potent CYP1A2 inhibitors, Thioridazine, and anti-depressants
Diabetes, type 1 or type 2
Condition in which the Investigator believes would interfere with the subject's ability to comply with study instructions, or might confound the interpretation of the study results or put the subject at undue risk
MRI safety necessitates the exclusion of subjects having one or more of the following:
Metal fragments in the eye or face, or having worked previously in the metal industry
Implantation of any electronic devices such as (but not limited to) cardiac pacemakers, cardiac, defibrillators, and cochlear implants or nerve stimulators.
Surgery on the blood vessels of the brain
Claustrophobia (fear of enclosed places)
Piercings or tattoos
More than 250 lbs in weight
Obvious brain abnormalities
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Thomas Schnitzer, MD, PhD
Organizational Affiliation
Northwestern University Feinberg School of Medicine
Official's Role
Study Director
Facility Information:
Facility Name
Northwestern University Feinberg School of Medicine
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60611
Country
United States
12. IPD Sharing Statement
Citations:
PubMed Identifier
36269595
Citation
Leaney AA, Lyttle JR, Segan J, Urquhart DM, Cicuttini FM, Chou L, Wluka AE. Antidepressants for hip and knee osteoarthritis. Cochrane Database Syst Rev. 2022 Oct 21;10(10):CD012157. doi: 10.1002/14651858.CD012157.pub2.
Results Reference
derived
PubMed Identifier
27788130
Citation
Tetreault P, Mansour A, Vachon-Presseau E, Schnitzer TJ, Apkarian AV, Baliki MN. Brain Connectivity Predicts Placebo Response across Chronic Pain Clinical Trials. PLoS Biol. 2016 Oct 27;14(10):e1002570. doi: 10.1371/journal.pbio.1002570. eCollection 2016 Oct.
Results Reference
derived
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Duloxetine in Osteoarthritis (OA) Pain
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