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Clinical Study for the Treatment of Adhesive Capsulitis of the Shoulder (AC)

Primary Purpose

Adhesive Capsulitis, Frozen Shoulder

Status
Completed
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
Collagenase Clostridium Histolyticum
Placebo
Sponsored by
Endo Pharmaceuticals
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Adhesive Capsulitis focused on measuring Adhesive Capsulitis, Frozen Shoulder, Shoulder Range of Motion limitation, Shoulder Pain

Eligibility Criteria

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

Inclusion Criteria:

  • Unilateral idiopathic adhesive capsulitis of one shoulder for at least 3 months but not more than 12 months (Frozen Stage)
  • Normal range of motion in the contralateral shoulder
  • Restricted active range of motion (AROM) in the affected shoulder defined as: a deficit of at least 60 degrees in total AROM in the affected shoulder as compared with the total AROM in the contralateral shoulder and a deficit of at least 30 degrees in AROM in at least one of the following planes as compared with the contralateral shoulder:

    • Forward flexion
    • Abduction
    • External rotation with the elbow up to 90 degrees abduction
    • Internal rotation with the elbow up to 90 degrees abduction

Exclusion Criteria:

  • Has received treatment for adhesive capsulitis or is planning to receive treatment for adhesive capsulitis at any time during the study including but not limited to:

    • physical therapy or acupuncture within 2 weeks before the first injection of study drug
    • intra-articular or intrabursal injection(s) of lidocaine; suprascapular nerve blocks; corticosteroids, electroanalgesic and/or thermoanalgesic modalities within 1 month before the screening visit
    • intra-articular or intrabursal injection(s) of sodium hyaluronate and/or glenohumeral distension arthrography within 3 months before the screening visit
    • surgical intervention (including shoulder manipulation under anesthesia) at any time
  • Has any of the following conditions, as determined by investigator to be potentially confounding to the evaluation of safety and efficacy:

    • Adhesive capsulitis as a result of traumatic injury (ie, direct injury to the shoulder such as fracture of the humerus or clavicle immediately preceding the onset of this episode of adhesive capsulitis). Traumatic events in the past that are not temporally related to the onset of this episode of adhesive capsulitis would not necessarily exclude a subject from participating in the study.
    • Active subacromial impingement in the affected shoulder
    • Calcified tendonitis in the affected shoulder
    • Glenohumeral joint arthritis in the affected shoulder
    • Arthrosis of the affected shoulder
    • Chondrolysis of the affected shoulder
    • Subscapularis tendon rupture of the affected shoulder
    • Other rotator cuff injuries of the affected shoulder
    • Uncontrolled hypertension
    • Uncontrolled diabetes
    • Uncontrolled thyroid disease
    • History of thrombosis or post-thrombosis syndrome
    • Physical impairment that would preclude performing the protocol defined exercises
    • Active infection in area to be treated
    • Clinically significant neurological disease
    • Bleeding disorder
    • Chronic use of anticoagulation medications and the subject cannot be cleared medically to stop taking medication for 7 days prior to each injection. Less than or equal to 150 mg aspirin is allowed during the study.
    • Known active hepatitis A, B, or C
    • Other significant medical condition (eg, morbid obesity, cervical disc disease), which in the investigator's opinion would make the subject unsuitable for enrollment in the study
  • Has received oral or intravenous steroids for any reason within 3 weeks before the screening visit
  • Has received an investigational drug or treatment within 30 days before the first dose of study drug.
  • Has a known allergy to collagenase or any other excipient of AA4500 or any other procedural medication.
  • Has, at any time, received collagenase for the treatment of adhesive capsulitis.
  • Is unable to undergo an x-ray or MRI (contraindication) evaluation of the affected shoulder.
  • Is planning to be treated with commercial XIAFLEX at any time during the study.

Sites / Locations

  • Alabama Orthopaedic Center-Research
  • Coastal Clinical Research
  • Arizona Research Center, Inc.
  • Advance Med Clinical Research
  • Triwest Research Associates
  • Core Orthopedic Medical Center
  • Temecula Rheumatology & Internal Medicine
  • Clearview Medical Research
  • Colorado Orthopedic Consultants, PC
  • Florida Research Associates
  • Shrock Orthopedic Research, LLC
  • Jewett Orthopedic Clinic
  • Clinical Research of West Florida
  • Non-Surgical Orthopedics, P.C. / Georgia Institute for Clinical Research, LLC
  • Injury Care Medical Center
  • Rockford Orthopedic Associates
  • Rockford Orthopedics Associates
  • Indiana Hand to Shoulder Center
  • PRN of Kansas
  • Central Kentucky Research Associates
  • Bone and Joint Clinic
  • MedPharmics, LLC
  • Arthritis and Rheumatism Associates, PC
  • Great Falls Clinic
  • Nevada Orthopedic & Spine Center
  • Stony Brook University Medical Center (SUNY)
  • Triangle Orthopedic Associates, PA
  • Wake Research Associates
  • The Neuromusculoskeletal Center of the Cascades d.b.a. The Center
  • Blair Orthopedic Associates, Inc.
  • University of Pennsylvania Penn Orthopaedics
  • Texas Orthopedic Specialist
  • Centex Studies
  • Commonwealth Orthopaedics & Rehabilitation
  • Danville Orthopedic Clinic, Inc.
  • Sports Medicine Professionals
  • Hunter Clinical Research
  • Royal Prince Alfred
  • St George Hospital
  • Peninsula Private Hospital
  • QPharm
  • Menzies Research Institute
  • Emeritus Research
  • Epworth Hospital
  • Repatriation Hospital
  • Hand and Upper Limb Centre

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Collagenase Clostridium Histolyticum

Placebo

Arm Description

Up to 3 injections of .58 mg/1 mL of collagenase clostridium histolyticum (CCH), minimum of 21 days apart and home shoulder exercise.

Up to 3 1-mL injections of placebo, minimum of 21 days apart and home shoulder exercise.

Outcomes

Primary Outcome Measures

Change From Baseline to Day 95 in Active Forward Flexion
Active range of motion (AROM) measurement using a goniometer to assess forward flexion in the affected shoulder

Secondary Outcome Measures

Change From Baseline to Day 95 in Adapted American Shoulder and Elbow Surgeons (ASES) Function Subscale
Function subscale score ranging from 0-50, with 0 being most dysfunctional, derived from participant assessment of ability to do 10 activities with affected shoulder/arm where 0=unable to do to, 1=very difficult to do, 2=somewhat difficult, and 3=not difficult, and calculated as (cumulative total score for the 10 activity items) × (5/3); adapted from ASES Standardized Shoulder Assessment Form, Patient Self-Evaluation (United States adapted version).
Change From Baseline to Day 95 in Pain With Movement Using 11-point Numeric Rating Scale (NRS)
Participant assessment of pain in response to "How bad is the pain upon movement of your affected shoulder at its worst in the last 24 hours?" using an 11-point NRS where 0=no pain at all and 10=pain as bad as it can be.
Change From Baseline to Day 95 in Active Abduction
AROM measurement using a goniometer to assess abduction in the affected shoulder
Change From Baseline to Day 95 in Passive Forward Flexion
Passive range of motion (PROM) measurement using a goniometer to assess forward flexion in the affected shoulder
Change From Baseline to Day 95 in Passive Abduction
PROM measurement using a goniometer to assess abduction in the affected shoulder
Change From Baseline to Day 95 in Active Internal Rotation
AROM measurement using a goniometer to assess internal rotation in the affected shoulder
Change From Baseline to Day 95 in Active External Rotation
AROM measurement using a goniometer to assess external rotation in the affected shoulder
Change From Baseline to Day 95 in Passive Internal Rotation
PROM measurement using a goniometer to assess internal rotation in the affected shoulder
Change From Baseline to Day 95 in Passive External Rotation
PROM measurement using a goniometer to assess external rotation in the affected shoulder
Change From Baseline to Day 95 in Adapted ASES Pain Subscale
Pain subscale score ranging from 0-50, with 0 being greatest pain, derived from participant overall assessment of pain in response to "How bad is the pain in your affected shoulder today?" using an 11-point NRS where 0=no pain at all and 10=pain as bad as it can be and calculated as (10 - NRS score) x 5; adapted from ASES Standardized Shoulder Assessment Form, Patient Self-Evaluation
Subject Satisfaction With Treatment at Day 95
Participant assessment of satisfaction with treatment rated as very satisfied, quite satisfied, neither satisfied nor dissatisfied, quite dissatisfied, or very dissatisfied.
Investigator Assessment of Improvement With Treatment at Day 95
Investigator assessment of degree of improvement in severity of the participant's treated shoulder compared with screening rated as very much improved, much improved, minimally improved, no change, minimally worse, much worse, or very much worse.

Full Information

First Posted
December 2, 2013
Last Updated
September 7, 2017
Sponsor
Endo Pharmaceuticals
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1. Study Identification

Unique Protocol Identification Number
NCT02006719
Brief Title
Clinical Study for the Treatment of Adhesive Capsulitis of the Shoulder
Acronym
AC
Official Title
A Randomized, Double-blind, Placebo-controlled Study of the Safety and Efficacy of AA4500 for the Treatment of Adhesive Capsulitis of the Shoulder
Study Type
Interventional

2. Study Status

Record Verification Date
September 2017
Overall Recruitment Status
Completed
Study Start Date
November 2013 (undefined)
Primary Completion Date
December 2014 (Actual)
Study Completion Date
December 2014 (Actual)

3. Sponsor/Collaborators

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

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
The objectives of this study are to assess the safety, effectiveness, and immunogenicity of AA4500 in the treatment of adhesive capsulitis.
Detailed Description
Study is a Phase 2b, double-blind, placebo-controlled study of the safety and efficacy of AA4500 for the treatment of adhesive capsulitis of the shoulder. To be eligible for treatment, a subject must have unilateral idiopathic adhesive capsulitis of the shoulder with restricted range of motion in the affected shoulder for at least 3 months but not more than 12 months. Subjects will be screened for study eligibility within 28 days before injection of study drug. Approximately 300 adult women and men are to be enrolled in this study. Following screening and determination of study eligibility, subjects will be randomized 3:1 to receive 0.58 mg of AA4500 or placebo. Subjects will receive up to 3 injections of study drug. Each injection will be separated by a minimum of 21 days. Subjects will also be instructed in home shoulder exercises after the first injection.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Adhesive Capsulitis, Frozen Shoulder
Keywords
Adhesive Capsulitis, Frozen Shoulder, Shoulder Range of Motion limitation, Shoulder Pain

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
322 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Collagenase Clostridium Histolyticum
Arm Type
Experimental
Arm Description
Up to 3 injections of .58 mg/1 mL of collagenase clostridium histolyticum (CCH), minimum of 21 days apart and home shoulder exercise.
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Up to 3 1-mL injections of placebo, minimum of 21 days apart and home shoulder exercise.
Intervention Type
Biological
Intervention Name(s)
Collagenase Clostridium Histolyticum
Other Intervention Name(s)
AA4500, Xiaflex, Xiapex
Intervention Description
Treatment of Adhesive Capsulitis
Intervention Type
Other
Intervention Name(s)
Placebo
Intervention Description
Placebo injection
Primary Outcome Measure Information:
Title
Change From Baseline to Day 95 in Active Forward Flexion
Description
Active range of motion (AROM) measurement using a goniometer to assess forward flexion in the affected shoulder
Time Frame
Baseline, day 95
Secondary Outcome Measure Information:
Title
Change From Baseline to Day 95 in Adapted American Shoulder and Elbow Surgeons (ASES) Function Subscale
Description
Function subscale score ranging from 0-50, with 0 being most dysfunctional, derived from participant assessment of ability to do 10 activities with affected shoulder/arm where 0=unable to do to, 1=very difficult to do, 2=somewhat difficult, and 3=not difficult, and calculated as (cumulative total score for the 10 activity items) × (5/3); adapted from ASES Standardized Shoulder Assessment Form, Patient Self-Evaluation (United States adapted version).
Time Frame
Baseline, day 95
Title
Change From Baseline to Day 95 in Pain With Movement Using 11-point Numeric Rating Scale (NRS)
Description
Participant assessment of pain in response to "How bad is the pain upon movement of your affected shoulder at its worst in the last 24 hours?" using an 11-point NRS where 0=no pain at all and 10=pain as bad as it can be.
Time Frame
Baseline, day 95
Title
Change From Baseline to Day 95 in Active Abduction
Description
AROM measurement using a goniometer to assess abduction in the affected shoulder
Time Frame
Baseline, day 95
Title
Change From Baseline to Day 95 in Passive Forward Flexion
Description
Passive range of motion (PROM) measurement using a goniometer to assess forward flexion in the affected shoulder
Time Frame
Baseline, day 95
Title
Change From Baseline to Day 95 in Passive Abduction
Description
PROM measurement using a goniometer to assess abduction in the affected shoulder
Time Frame
Baseline, day 95
Title
Change From Baseline to Day 95 in Active Internal Rotation
Description
AROM measurement using a goniometer to assess internal rotation in the affected shoulder
Time Frame
Baseline, day 95
Title
Change From Baseline to Day 95 in Active External Rotation
Description
AROM measurement using a goniometer to assess external rotation in the affected shoulder
Time Frame
Baseline, day 95
Title
Change From Baseline to Day 95 in Passive Internal Rotation
Description
PROM measurement using a goniometer to assess internal rotation in the affected shoulder
Time Frame
Baseline, day 95
Title
Change From Baseline to Day 95 in Passive External Rotation
Description
PROM measurement using a goniometer to assess external rotation in the affected shoulder
Time Frame
Baseline, day 95
Title
Change From Baseline to Day 95 in Adapted ASES Pain Subscale
Description
Pain subscale score ranging from 0-50, with 0 being greatest pain, derived from participant overall assessment of pain in response to "How bad is the pain in your affected shoulder today?" using an 11-point NRS where 0=no pain at all and 10=pain as bad as it can be and calculated as (10 - NRS score) x 5; adapted from ASES Standardized Shoulder Assessment Form, Patient Self-Evaluation
Time Frame
Baseline, day 95
Title
Subject Satisfaction With Treatment at Day 95
Description
Participant assessment of satisfaction with treatment rated as very satisfied, quite satisfied, neither satisfied nor dissatisfied, quite dissatisfied, or very dissatisfied.
Time Frame
Day 95
Title
Investigator Assessment of Improvement With Treatment at Day 95
Description
Investigator assessment of degree of improvement in severity of the participant's treated shoulder compared with screening rated as very much improved, much improved, minimally improved, no change, minimally worse, much worse, or very much worse.
Time Frame
Day 95

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Unilateral idiopathic adhesive capsulitis of one shoulder for at least 3 months but not more than 12 months (Frozen Stage) Normal range of motion in the contralateral shoulder Restricted active range of motion (AROM) in the affected shoulder defined as: a deficit of at least 60 degrees in total AROM in the affected shoulder as compared with the total AROM in the contralateral shoulder and a deficit of at least 30 degrees in AROM in at least one of the following planes as compared with the contralateral shoulder: Forward flexion Abduction External rotation with the elbow up to 90 degrees abduction Internal rotation with the elbow up to 90 degrees abduction Exclusion Criteria: Has received treatment for adhesive capsulitis or is planning to receive treatment for adhesive capsulitis at any time during the study including but not limited to: physical therapy or acupuncture within 2 weeks before the first injection of study drug intra-articular or intrabursal injection(s) of lidocaine; suprascapular nerve blocks; corticosteroids, electroanalgesic and/or thermoanalgesic modalities within 1 month before the screening visit intra-articular or intrabursal injection(s) of sodium hyaluronate and/or glenohumeral distension arthrography within 3 months before the screening visit surgical intervention (including shoulder manipulation under anesthesia) at any time Has any of the following conditions, as determined by investigator to be potentially confounding to the evaluation of safety and efficacy: Adhesive capsulitis as a result of traumatic injury (ie, direct injury to the shoulder such as fracture of the humerus or clavicle immediately preceding the onset of this episode of adhesive capsulitis). Traumatic events in the past that are not temporally related to the onset of this episode of adhesive capsulitis would not necessarily exclude a subject from participating in the study. Active subacromial impingement in the affected shoulder Calcified tendonitis in the affected shoulder Glenohumeral joint arthritis in the affected shoulder Arthrosis of the affected shoulder Chondrolysis of the affected shoulder Subscapularis tendon rupture of the affected shoulder Other rotator cuff injuries of the affected shoulder Uncontrolled hypertension Uncontrolled diabetes Uncontrolled thyroid disease History of thrombosis or post-thrombosis syndrome Physical impairment that would preclude performing the protocol defined exercises Active infection in area to be treated Clinically significant neurological disease Bleeding disorder Chronic use of anticoagulation medications and the subject cannot be cleared medically to stop taking medication for 7 days prior to each injection. Less than or equal to 150 mg aspirin is allowed during the study. Known active hepatitis A, B, or C Other significant medical condition (eg, morbid obesity, cervical disc disease), which in the investigator's opinion would make the subject unsuitable for enrollment in the study Has received oral or intravenous steroids for any reason within 3 weeks before the screening visit Has received an investigational drug or treatment within 30 days before the first dose of study drug. Has a known allergy to collagenase or any other excipient of AA4500 or any other procedural medication. Has, at any time, received collagenase for the treatment of adhesive capsulitis. Is unable to undergo an x-ray or MRI (contraindication) evaluation of the affected shoulder. Is planning to be treated with commercial XIAFLEX at any time during the study.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Neil H Schusterman, MD FACP
Organizational Affiliation
Endo Pharmaceuticals
Official's Role
Study Director
Facility Information:
Facility Name
Alabama Orthopaedic Center-Research
City
Birmingham
State/Province
Alabama
ZIP/Postal Code
35209
Country
United States
Facility Name
Coastal Clinical Research
City
Mobile
State/Province
Alabama
ZIP/Postal Code
36608
Country
United States
Facility Name
Arizona Research Center, Inc.
City
Phoenix
State/Province
Arizona
ZIP/Postal Code
85023
Country
United States
Facility Name
Advance Med Clinical Research
City
Carlsbad
State/Province
California
ZIP/Postal Code
92008
Country
United States
Facility Name
Triwest Research Associates
City
El Cajon
State/Province
California
ZIP/Postal Code
92020
Country
United States
Facility Name
Core Orthopedic Medical Center
City
Encinitas
State/Province
California
ZIP/Postal Code
92024
Country
United States
Facility Name
Temecula Rheumatology & Internal Medicine
City
Murrieta
State/Province
California
ZIP/Postal Code
92563
Country
United States
Facility Name
Clearview Medical Research
City
Santa Clarita
State/Province
California
ZIP/Postal Code
91350
Country
United States
Facility Name
Colorado Orthopedic Consultants, PC
City
Englewood
State/Province
Colorado
ZIP/Postal Code
80110
Country
United States
Facility Name
Florida Research Associates
City
DeLand
State/Province
Florida
ZIP/Postal Code
32720
Country
United States
Facility Name
Shrock Orthopedic Research, LLC
City
Fort Lauderdale
State/Province
Florida
ZIP/Postal Code
33316
Country
United States
Facility Name
Jewett Orthopedic Clinic
City
Orlando
State/Province
Florida
ZIP/Postal Code
32822
Country
United States
Facility Name
Clinical Research of West Florida
City
Tampa
State/Province
Florida
ZIP/Postal Code
33603
Country
United States
Facility Name
Non-Surgical Orthopedics, P.C. / Georgia Institute for Clinical Research, LLC
City
Marietta
State/Province
Georgia
ZIP/Postal Code
30060
Country
United States
Facility Name
Injury Care Medical Center
City
Boise
State/Province
Idaho
ZIP/Postal Code
83713
Country
United States
Facility Name
Rockford Orthopedic Associates
City
Rockford
State/Province
Illinois
ZIP/Postal Code
61107
Country
United States
Facility Name
Rockford Orthopedics Associates
City
Rockford
State/Province
Illinois
ZIP/Postal Code
61114
Country
United States
Facility Name
Indiana Hand to Shoulder Center
City
Indianapolis
State/Province
Indiana
ZIP/Postal Code
46260
Country
United States
Facility Name
PRN of Kansas
City
Wichita
State/Province
Kansas
ZIP/Postal Code
67203
Country
United States
Facility Name
Central Kentucky Research Associates
City
Lexington
State/Province
Kentucky
ZIP/Postal Code
40509
Country
United States
Facility Name
Bone and Joint Clinic
City
Gretna
State/Province
Louisiana
ZIP/Postal Code
70056
Country
United States
Facility Name
MedPharmics, LLC
City
Metairie
State/Province
Louisiana
ZIP/Postal Code
70006
Country
United States
Facility Name
Arthritis and Rheumatism Associates, PC
City
Wheaton
State/Province
Maryland
ZIP/Postal Code
20902
Country
United States
Facility Name
Great Falls Clinic
City
Great Falls
State/Province
Montana
ZIP/Postal Code
59405
Country
United States
Facility Name
Nevada Orthopedic & Spine Center
City
Las Vegas
State/Province
Nevada
ZIP/Postal Code
89128
Country
United States
Facility Name
Stony Brook University Medical Center (SUNY)
City
Stony Brook
State/Province
New York
ZIP/Postal Code
11794
Country
United States
Facility Name
Triangle Orthopedic Associates, PA
City
Durham
State/Province
North Carolina
ZIP/Postal Code
27704
Country
United States
Facility Name
Wake Research Associates
City
Raleigh
State/Province
North Carolina
ZIP/Postal Code
27612
Country
United States
Facility Name
The Neuromusculoskeletal Center of the Cascades d.b.a. The Center
City
Bend
State/Province
Oregon
ZIP/Postal Code
97701
Country
United States
Facility Name
Blair Orthopedic Associates, Inc.
City
Altoona
State/Province
Pennsylvania
ZIP/Postal Code
16602
Country
United States
Facility Name
University of Pennsylvania Penn Orthopaedics
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19087
Country
United States
Facility Name
Texas Orthopedic Specialist
City
Bedford
State/Province
Texas
ZIP/Postal Code
76021
Country
United States
Facility Name
Centex Studies
City
Houston
State/Province
Texas
ZIP/Postal Code
77062
Country
United States
Facility Name
Commonwealth Orthopaedics & Rehabilitation
City
Arlington
State/Province
Virginia
ZIP/Postal Code
22205
Country
United States
Facility Name
Danville Orthopedic Clinic, Inc.
City
Danville
State/Province
Virginia
ZIP/Postal Code
24541
Country
United States
Facility Name
Sports Medicine Professionals
City
Richmond
State/Province
Victoria
ZIP/Postal Code
3121
Country
Australia
Facility Name
Hunter Clinical Research
City
NSW
Country
Australia
Facility Name
Royal Prince Alfred
City
NSW
Country
Australia
Facility Name
St George Hospital
City
NSW
Country
Australia
Facility Name
Peninsula Private Hospital
City
Queensland
Country
Australia
Facility Name
QPharm
City
Queensland
Country
Australia
Facility Name
Menzies Research Institute
City
Tasmania
Country
Australia
Facility Name
Emeritus Research
City
VIC
Country
Australia
Facility Name
Epworth Hospital
City
VIC
Country
Australia
Facility Name
Repatriation Hospital
City
VIC
Country
Australia
Facility Name
Hand and Upper Limb Centre
City
WA
Country
Australia

12. IPD Sharing Statement

Learn more about this trial

Clinical Study for the Treatment of Adhesive Capsulitis of the Shoulder

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