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Study of Local Administration of DepoTXA for Reduced Postsurgical Bleeding in Subjects Undergoing TKA

Primary Purpose

Total Knee Arthroplasty

Status
Terminated
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
DepoTXA
Tranexamic Acid
Sponsored by
Pacira Pharmaceuticals, Inc
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Total Knee Arthroplasty

Eligibility Criteria

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

Inclusion Criteria:

  1. Male or female, ≥18 years of age at screening.
  2. Scheduled to undergo elective unilateral open TKA under general, spinal, or regional anesthesia.
  3. American Society of Anesthesiology (ASA) physical status 1, 2, or 3.
  4. Female subject must be surgically sterile; or at least 2 years postmenopausal; or have a monogamous partner who is surgically sterile; or practicing double-barrier contraception; or practicing abstinence (must agree to use double-barrier contraception in the event of sexual activity); or using an insertable, injectable, or transdermal, contraceptive approved by the FDA for greater than 2 months prior to screening and commit to the use of an acceptable form of birth control for the duration of the study and for 30 days after completion of the study.
  5. Able to provide informed consent, adhere to the study visit schedule, and complete all study assessments.

Exclusion Criteria:

  1. Currently pregnant, nursing, or planning to become pregnant during the study or within 1 month after study drug administration.
  2. Planned concurrent surgical procedure (e.g., bilateral TKA).
  3. Prior open knee surgery on ipsilateral knee. Prior arthroscopy is permitted.
  4. Subjects taking a medication with a known procoagulant effect (e.g., combination hormonal contraceptives, Factor IX complex concentrates or anti-inhibitor coagulant concentrates, or all-trans retinoic acid).
  5. Contraindication or hypersensitivity to TXA.
  6. History of thrombosis or prior Venous thromboembolism (VTE).
  7. Known coagulopathy or active intravascular clotting.
  8. Prior myocardial infarction.
  9. Prior cardiovascular accident (stroke) or subarachnoid hemorrhage.
  10. History of epilepsy.
  11. Presence of an intravascular stent.
  12. History of impaired kidney function, chronic respiratory disease, rheumatoid arthritis, coagulopathy, or loss of sensation in extremities.
  13. Renal insufficiency (serum creatinine level >2 mg/dL).
  14. Anemia (Hb level <10 g/dL).
  15. Uncontrolled anxiety, psychiatric, or neurological disorder that might interfere with study assessments.
  16. Acquired defective color vision.
  17. Malignancy in the last 2 years, with the exception of non-metastatic basal cell or squamous cell carcinoma of the skin or localized carcinoma in situ of the cervix.
  18. Suspected or known history of drug or alcohol abuse within the previous year.
  19. Body weight <50 kg (110 pounds) or a body mass index >44 kg/m2.
  20. Administration of an investigational drug within 30 days or 5 elimination half-lives of such investigational drug, whichever is longer, prior to study drug administration, or planned administration of another investigational product or procedure during the subject's participation in this study.

Sites / Locations

  • Ortho Arizona
  • University of Miami Hospital
  • Kendall Regional Medical Center
  • Ohio State University/Wexner Medical Center
  • Medical University of South Carolina

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm Type

Experimental

Experimental

Experimental

Active Comparator

Arm Label

DepoTXA 400mg

DepoTXA 800mg

DepoTXA 1200mg

IV Tranexamic acid (TXA)

Arm Description

400mg Intracapsular at the end of surgery one time

800mg Intracapsular at the end of surgery one time

1200mg Intracapsular at the end of surgery one time

1 g of IV TXA at the end of surgery

Outcomes

Primary Outcome Measures

Area Under the Plasma Concentration-versus-time Curve From Time 0 Extrapolated to Infinity After Drug Administration
Area Under the Plasma Concentration-versus-time Curve From Time 0 to the Last Collection Time After Drug Administration
Maximum Plasma Concentration (Cmax)
Time to Maximum Plasma Concentration (Tmax)
The Apparent Terminal Elimination Rate Constant
The Apparent Terminal Elimination Half-life

Secondary Outcome Measures

Summary of Neurological Assessments (Proportion of Subjects Who Were Oriented and Proportion of Subjects Who Had Any of the Neurologic Events) at Each Assessed Timepoint
Neurological assessment at 12, 24, 36, 48, 60, 72, and 96 hours after study drug administration
Incidence of Reoperation Due to Hematoma or Wound Dehiscence
Number of subjects who underwent reoperation due to hematoma or wound dehiscence
Incidence of Transfusion (Number of Units, Number of Units/Subject, Number of Subjects Transfused)
Number of Participants With 90˚ Passive and Active Knee Flexion
Time to Complete Timed Up-and-Go (TUG) Test
Physical therapy assessment (Timed Up-and-Go (TUG) test) was conducted once postsurgically on Day 1; at approximately 8:00 am and 8:00 pm (±2 hours) daily from Day 2 through hospital discharge; and on Day 7
Change in Knee and Thigh Measurements
Leg difference in change from baseline is calculated by = (Operated Leg Change from Baseline) - (Non-Operated Leg Change from Baseline)
Area Under the Curve (AUC) of NRS From 0-24 Hours, 0-48 Hours, and 24-48 Hours
Numerical rating scale (NRS) at rest pain score (0 [no pain] to 10 [worst possible pain]) upon arrival at the PACU; at each in-hospital vital sign assessment beginning with the 2-hour assessment and ending with the 48-hour assessment; and the Day-7 follow-up visit. Summary is provided as area under the curve (AUC) of NRS from timepoint 0 to 24 hours, 0 to 48 hours, and 24 to 48 hours.

Full Information

First Posted
September 28, 2016
Last Updated
December 10, 2020
Sponsor
Pacira Pharmaceuticals, Inc
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1. Study Identification

Unique Protocol Identification Number
NCT02922582
Brief Title
Study of Local Administration of DepoTXA for Reduced Postsurgical Bleeding in Subjects Undergoing TKA
Official Title
A Randomized, Single-Blind, Active-Controlled, Dose-Ranging Study to Evaluate the Pharmacokinetics, Safety, and Efficacy of Local Administration of DepoTXA for Reduced Postsurgical Bleeding in Subjects Undergoing Total Knee Arthroplasty
Study Type
Interventional

2. Study Status

Record Verification Date
December 2020
Overall Recruitment Status
Terminated
Why Stopped
Slow Enrollment
Study Start Date
October 28, 2016 (Actual)
Primary Completion Date
November 27, 2017 (Actual)
Study Completion Date
November 27, 2017 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Pacira Pharmaceuticals, Inc

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
This is a Phase 2, randomized, single-blind, active-controlled dose-ranging study in subjects scheduled to undergo total knee arthroplasty (TKA).
Detailed Description
Approximately 60 subjects (15 per arm) are planned for enrollment. Subjects will be randomized in a 1:1:1:1 ratio to receive either DepoTXA 400 mg, DepoTXA 800 mg, DepoTXA 1200 mg, or IV TXA (Cyklokapron® 1 gram).

6. Conditions and Keywords

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

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
Participant
Allocation
Randomized
Enrollment
16 (Actual)

8. Arms, Groups, and Interventions

Arm Title
DepoTXA 400mg
Arm Type
Experimental
Arm Description
400mg Intracapsular at the end of surgery one time
Arm Title
DepoTXA 800mg
Arm Type
Experimental
Arm Description
800mg Intracapsular at the end of surgery one time
Arm Title
DepoTXA 1200mg
Arm Type
Experimental
Arm Description
1200mg Intracapsular at the end of surgery one time
Arm Title
IV Tranexamic acid (TXA)
Arm Type
Active Comparator
Arm Description
1 g of IV TXA at the end of surgery
Intervention Type
Drug
Intervention Name(s)
DepoTXA
Intervention Type
Drug
Intervention Name(s)
Tranexamic Acid
Primary Outcome Measure Information:
Title
Area Under the Plasma Concentration-versus-time Curve From Time 0 Extrapolated to Infinity After Drug Administration
Time Frame
Baseline; 5, 15, and 30 min; at 1, 2, 4, 6, 8, 12, 16, and 24 hours after study drug administration for all treatment groups. Additional blood samples were collected at 36, 48, 60, 72, and 96 hours for DepoTXA-treated subjects.
Title
Area Under the Plasma Concentration-versus-time Curve From Time 0 to the Last Collection Time After Drug Administration
Time Frame
Baseline; 5, 15, and 30 min; at 1, 2, 4, 6, 8, 12, 16, and 24 hours after study drug administration for all treatment groups. Additional blood samples were collected at 36, 48, 60, 72, and 96 hours for DepoTXA-treated subjects.
Title
Maximum Plasma Concentration (Cmax)
Time Frame
Baseline; 5, 15, and 30 min; at 1, 2, 4, 6, 8, 12, 16, and 24 hours after study drug administration for all treatment groups. Additional blood samples were collected at 36, 48, 60, 72, and 96 hours for DepoTXA-treated subjects.
Title
Time to Maximum Plasma Concentration (Tmax)
Time Frame
Baseline; 5, 15, and 30 min; at 1, 2, 4, 6, 8, 12, 16, and 24 hours after study drug administration for all treatment groups. Additional blood samples were collected at 36, 48, 60, 72, and 96 hours for DepoTXA-treated subjects.
Title
The Apparent Terminal Elimination Rate Constant
Time Frame
Baseline; 5, 15, and 30 min; at 1, 2, 4, 6, 8, 12, 16, and 24 hours after study drug administration for all treatment groups. Additional blood samples were collected at 36, 48, 60, 72, and 96 hours for DepoTXA-treated subjects.
Title
The Apparent Terminal Elimination Half-life
Time Frame
Baseline; 5, 15, and 30 min; at 1, 2, 4, 6, 8, 12, 16, and 24 hours after study drug administration for all treatment groups. Additional blood samples were collected at 36, 48, 60, 72, and 96 hours for DepoTXA-treated subjects.
Secondary Outcome Measure Information:
Title
Summary of Neurological Assessments (Proportion of Subjects Who Were Oriented and Proportion of Subjects Who Had Any of the Neurologic Events) at Each Assessed Timepoint
Description
Neurological assessment at 12, 24, 36, 48, 60, 72, and 96 hours after study drug administration
Time Frame
12, 24, 36, 48, 60, 72, and 96 hours after study drug administration
Title
Incidence of Reoperation Due to Hematoma or Wound Dehiscence
Description
Number of subjects who underwent reoperation due to hematoma or wound dehiscence
Time Frame
Through day 60
Title
Incidence of Transfusion (Number of Units, Number of Units/Subject, Number of Subjects Transfused)
Time Frame
Day 60
Title
Number of Participants With 90˚ Passive and Active Knee Flexion
Time Frame
24, 48, and 72 hours
Title
Time to Complete Timed Up-and-Go (TUG) Test
Description
Physical therapy assessment (Timed Up-and-Go (TUG) test) was conducted once postsurgically on Day 1; at approximately 8:00 am and 8:00 pm (±2 hours) daily from Day 2 through hospital discharge; and on Day 7
Time Frame
Day 1; at approximately 8:00 am and 8:00 pm (±2 hours) daily from Day 2 through hospital discharge; and on Day 7
Title
Change in Knee and Thigh Measurements
Description
Leg difference in change from baseline is calculated by = (Operated Leg Change from Baseline) - (Non-Operated Leg Change from Baseline)
Time Frame
48 hours and Day 7
Title
Area Under the Curve (AUC) of NRS From 0-24 Hours, 0-48 Hours, and 24-48 Hours
Description
Numerical rating scale (NRS) at rest pain score (0 [no pain] to 10 [worst possible pain]) upon arrival at the PACU; at each in-hospital vital sign assessment beginning with the 2-hour assessment and ending with the 48-hour assessment; and the Day-7 follow-up visit. Summary is provided as area under the curve (AUC) of NRS from timepoint 0 to 24 hours, 0 to 48 hours, and 24 to 48 hours.
Time Frame
Preoperative; arrival in Post-Anesthesia Care Unit (PACU); 2, 4, 6, 8, 12, 16, 24, 36, 48 hours, Day 7

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male or female, ≥18 years of age at screening. Scheduled to undergo elective unilateral open TKA under general, spinal, or regional anesthesia. American Society of Anesthesiology (ASA) physical status 1, 2, or 3. Female subject must be surgically sterile; or at least 2 years postmenopausal; or have a monogamous partner who is surgically sterile; or practicing double-barrier contraception; or practicing abstinence (must agree to use double-barrier contraception in the event of sexual activity); or using an insertable, injectable, or transdermal, contraceptive approved by the FDA for greater than 2 months prior to screening and commit to the use of an acceptable form of birth control for the duration of the study and for 30 days after completion of the study. Able to provide informed consent, adhere to the study visit schedule, and complete all study assessments. Exclusion Criteria: Currently pregnant, nursing, or planning to become pregnant during the study or within 1 month after study drug administration. Planned concurrent surgical procedure (e.g., bilateral TKA). Prior open knee surgery on ipsilateral knee. Prior arthroscopy is permitted. Subjects taking a medication with a known procoagulant effect (e.g., combination hormonal contraceptives, Factor IX complex concentrates or anti-inhibitor coagulant concentrates, or all-trans retinoic acid). Contraindication or hypersensitivity to TXA. History of thrombosis or prior Venous thromboembolism (VTE). Known coagulopathy or active intravascular clotting. Prior myocardial infarction. Prior cardiovascular accident (stroke) or subarachnoid hemorrhage. History of epilepsy. Presence of an intravascular stent. History of impaired kidney function, chronic respiratory disease, rheumatoid arthritis, coagulopathy, or loss of sensation in extremities. Renal insufficiency (serum creatinine level >2 mg/dL). Anemia (Hb level <10 g/dL). Uncontrolled anxiety, psychiatric, or neurological disorder that might interfere with study assessments. Acquired defective color vision. Malignancy in the last 2 years, with the exception of non-metastatic basal cell or squamous cell carcinoma of the skin or localized carcinoma in situ of the cervix. Suspected or known history of drug or alcohol abuse within the previous year. Body weight <50 kg (110 pounds) or a body mass index >44 kg/m2. Administration of an investigational drug within 30 days or 5 elimination half-lives of such investigational drug, whichever is longer, prior to study drug administration, or planned administration of another investigational product or procedure during the subject's participation in this study.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Hassan Danesi, MD
Organizational Affiliation
Pacira Pharmaceuticals
Official's Role
Study Director
Facility Information:
Facility Name
Ortho Arizona
City
Gilbert
State/Province
Arizona
ZIP/Postal Code
85296
Country
United States
Facility Name
University of Miami Hospital
City
Miami
State/Province
Florida
ZIP/Postal Code
33136
Country
United States
Facility Name
Kendall Regional Medical Center
City
Miami
State/Province
Florida
ZIP/Postal Code
33175
Country
United States
Facility Name
Ohio State University/Wexner Medical Center
City
Columbus
State/Province
Ohio
ZIP/Postal Code
43210
Country
United States
Facility Name
Medical University of South Carolina
City
Charleston
State/Province
South Carolina
ZIP/Postal Code
29425
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
Undecided

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Study of Local Administration of DepoTXA for Reduced Postsurgical Bleeding in Subjects Undergoing TKA

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