Repurposing Anti-TNF for Treating Dupuytren's Disease (RIDD)
Primary Purpose
Dupuytren's Disease
Status
Completed
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
Adalimumab
Saline
Sponsored by
About this trial
This is an interventional treatment trial for Dupuytren's Disease focused on measuring Dupuytren, adalimumab, anti TNF, phase II clinical trial, randomized controlled trial, double-blind method, Dupuytren's, Dupuytren's contracture
Eligibility Criteria
Inclusion Criteria:
- Participant is willing and able to give informed consent for participation in the study.
- Male or Female, aged 18 years or above.
- For Part 1: Diagnosed with DD affecting the fingers resulting in flexion deformities of ≥30° at the metacarpophalangeal joint and or the proximal interphalangeal joint with impaired hand function and awaiting surgery. Or for Part 2: Participants with early disease nodules who have shown or reported progression of the disease in the previous 6 months with flexion deformities of their fingers of ≤30° at the metacarpophalangeal and/or at the proximal interphalangeal joint, i.e. total flexion deformity of up to 60°.
- The DD nodule to be treated must be distinct and identifiable.
- Female participants of child bearing potential, and male participants whose partner is of child bearing potential, must be willing to ensure that they or their partner use effective contraception throughout the treatment period and for 5 months following the last research injection. Acceptable methods of contraception include: a combination of male condom with either cap, diaphragm or sponge with spermicide (double barrier methods), injectables, the combined oral contraceptive pill (at a stable dose for at least 3 months before entering the study), an intrauterine device, vasectomised partner, or true sexual abstinence (when this is in line with the preferred and usual lifestyle of the participant).
- Participant results from safety screening tests within normal ranges within 12 weeks of enrolment, with the exception that an earlier clear chest x-ray result may be used where this is in accordance with the time frames of local standard procedures for anti-TNF screening.
- Able (in the Investigators opinion) and willing to comply with all study requirements.
- Willing to allow his or her general practitioner to be notified of participation in the study.
- Sufficient language fluency to ensure informed consent is obtained and to complete the questionnaires pertaining to hand function.
Exclusion Criteria:
- For Part 1: Participant has previously had fasciectomy, dermofasciectomy, needle fasciotomy, collagenase injection, steroid injection or radiotherapy to treat Dupuytren's disease in the digit concerned. Or for Part 2: Participant has previously had fasciectomy, dermofasciectomy, needle fasciotomy, collagenase injection, steroid injection to the digit to be treated or radiotherapy to treat Dupuytren's disease in the hand concerned.
- Female participant who is pregnant, lactating or planning pregnancy during the course of the study and for 5 months following last injection.
- Male participant who is planning a pregnancy during the course of the study and for 5 months following last injection.
- Significant renal or hepatic impairment.
- For Part 1: Scheduled elective surgery or other procedures requiring general anaesthesia during the study other than the scheduled Dupuytren's surgery. Or for Part 2: Scheduled elective surgery or other procedures requiring general anaesthesia during the study
- Participant who has ever been diagnosed with cancer, is terminally ill or is inappropriate for placebo medication
- Systemic inflammatory disorder such as rheumatoid arthritis (RA) or inflammatory bowel disease.
- Any other significant disease or disorder which, in the opinion of the Investigator, may either put the participants at risk because of participation in the study, or may influence the result of the study, or the participant's ability to participate in the study.
- Participated in another research study involving an investigational medicinal product in the past 12 weeks.
- Known allergy to any anti-TNF agent.
- Have HIV or hepatitis B or C.
- Known to have an infection or history of repeated infections.
- History of Tuberculosis (TB).
- Have Multiple Sclerosis (MS) or other demyelinating disease.
- History of local injection site reactions.
- Needle phobia.
- Have moderate or severe heart failure.
- Part 1: Being treated with coumarin anticoagulants, such as warfarin.
- Have known lung fibrosis (thickening of lung tissue).
- Being treated with concomitant biologic DMARDS.
- Have received a live vaccine within the previous 4 weeks. Participants may receive concurrent vaccinations but must avoid the use of live vaccines for 12 weeks after their last injection.
- Part1: Have received parenteral steroid within the previous 6 weeks.
- Part 2: Participants at risk of Hepatitis B infection.
Sites / Locations
- The University Medical Centre
- NHS Lothian
- Oxford University Hospitals NHS Foundation Trust
Arms of the Study
Arm 1
Arm 2
Arm Type
Experimental
Placebo Comparator
Arm Label
Anti-TNF
Placebo
Arm Description
adalimumab
saline
Outcomes
Primary Outcome Measures
Dose Response: expression of mRNA for α-SMA
Early Disease: change in nodule hardness between baseline at 12 months
Tonometry
Secondary Outcome Measures
Dose Response: expression of mRNA for COL-1A1, COL-3A1, cadherin 11
Dose Response: Levels of α-SMA and collegen protein
Dose Response: Nodule hardness
Tonometry
Dose Response: Visual comparison of surgical wounds using hand photographs
Dose Response & Early Disease: Change in nodule size and vascularity from baseline
Pixel analysis of ultrasound imaging
Dose Response and Early Disease: participant injection experience
Numeric rating scale of pain
Dose Response & Early Disease: Adverse event assessment
Assessment of the injection site for pre-specified Adverse Events; surgery site assessment (Dose response only): wound assessment criteria, Centres for Disease Control and Prevention.
Early Disease: Nodule hardness
Tonometry
Early Disease: range of motion of the affected digit
Goniometer reading
Early Disease: Grip strength
Jamar meter
Early Disease: patient reported outcomes
Michigan Hand Outcomes Questionnaire
Early Disease: patient reported outcomes
Participant identified activity most restricted by DD scored on a scale of 1-10
Early Disease: progression to surgery of the digit being assessed
Full Information
NCT ID
NCT03180957
First Posted
May 23, 2017
Last Updated
April 19, 2021
Sponsor
University of Oxford
Collaborators
Department of Health, United Kingdom, Wellcome Trust, 180 Therapeutics LP
1. Study Identification
Unique Protocol Identification Number
NCT03180957
Brief Title
Repurposing Anti-TNF for Treating Dupuytren's Disease
Acronym
RIDD
Official Title
A Multi-centre, Double Blind, Randomised, Placebo-controlled, Parallel Group, Phase II Trial to Determine the Efficacy of Intra-nodular Injection of Anti-TNF to Control Disease Progression in Early Dupuytren's Disease, With a Dose Response.
Study Type
Interventional
2. Study Status
Record Verification Date
October 2019
Overall Recruitment Status
Completed
Study Start Date
March 2, 2016 (Actual)
Primary Completion Date
November 2020 (Actual)
Study Completion Date
December 2020 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University of Oxford
Collaborators
Department of Health, United Kingdom, Wellcome Trust, 180 Therapeutics LP
4. Oversight
Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
Dupuytren's disease is a very common condition, affecting 4% of the general UK and US population. It causes the fingers to curl irreversibly into the palm and can be extremely disabling. The disease usually starts as a small firm lump (nodule) in the palm, and in about 40% of patients advances to form cords that pull the fingers into the palm. There is no approved treatment for the early stage of disease. Once patients have established deformities, the diseased tissue can removed by surgery or cut using less invasive techniques such as a needle or an enzyme. However, recovery following surgery usually takes several months and recurrence rates with the less invasive techniques are high.
The investigators have unravelled the cellular process that initiates and maintains the disease progress and identified tumour necrosis factor (TNF) as a new target for treatment. Based on these findings the investigators plan to test the effects of adalimumab, an anti-TNF drug which currently approved for use in patients with rheumatoid arthritis and other inflammatory conditions. The aim of the study is to find out whether treatment by injection with adalimumab directly into the diseased tissue will control the advance of early Dupuytren's disease better than a placebo injection with normal saline.
The investigators will first carry out a small trial in up to 40 patients with established disease to determine the best dose that reduces the activity of the cells responsible for the disorder (Dose Response study). In this part patients who will be having surgery to remove their diseased tissue will receive a single injection of adalimumab into the nodule in their hand about 2 weeks before surgery. The tissue that is then removed during surgery will be analysed in the investigator's laboratories to determine the effect of the drug on the tissue. Patients will be followed for 12 weeks after surgery.
In the second part of the study the investigators will assess whether the optimal dose of the drug prevents early disease advancing in 138 patients (Early Disease study). Patients who take part in the second part of the study will receive a total of 4 injections of adalimumab into the nodule in their hand at three monthly intervals. They will then be checked at 3 & 9 months after the last injection. In additional to assessing the effect of the injections on the nodule and hand function, information will also be collected to assess the cost effectiveness of the treatment.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Dupuytren's Disease
Keywords
Dupuytren, adalimumab, anti TNF, phase II clinical trial, randomized controlled trial, double-blind method, Dupuytren's, Dupuytren's contracture
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Masking Description
During Dose Response part of the trial the Investigator will be blinded. During the Early Disease part of the trial the Investigator will not be blinded but will not carry out any outcome assessments.
Allocation
Randomized
Enrollment
209 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Anti-TNF
Arm Type
Experimental
Arm Description
adalimumab
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
saline
Intervention Type
Drug
Intervention Name(s)
Adalimumab
Other Intervention Name(s)
Humira
Intervention Type
Drug
Intervention Name(s)
Saline
Primary Outcome Measure Information:
Title
Dose Response: expression of mRNA for α-SMA
Time Frame
Analysis of tissue removed at 12-18 days post-treatment
Title
Early Disease: change in nodule hardness between baseline at 12 months
Description
Tonometry
Time Frame
12 months
Secondary Outcome Measure Information:
Title
Dose Response: expression of mRNA for COL-1A1, COL-3A1, cadherin 11
Time Frame
Analysis of tissue removed at 12-18 days post-treatment
Title
Dose Response: Levels of α-SMA and collegen protein
Time Frame
Analysis of tissue removed at 12-18 days post-treatment
Title
Dose Response: Nodule hardness
Description
Tonometry
Time Frame
2 weeks post treatment
Title
Dose Response: Visual comparison of surgical wounds using hand photographs
Time Frame
2 weeks post surgery
Title
Dose Response & Early Disease: Change in nodule size and vascularity from baseline
Description
Pixel analysis of ultrasound imaging
Time Frame
2 weeks post treatment (dose response) / 18 months (early disease)
Title
Dose Response and Early Disease: participant injection experience
Description
Numeric rating scale of pain
Time Frame
Baseline (Dose response) / 12 months (early disease)
Title
Dose Response & Early Disease: Adverse event assessment
Description
Assessment of the injection site for pre-specified Adverse Events; surgery site assessment (Dose response only): wound assessment criteria, Centres for Disease Control and Prevention.
Time Frame
2 weeks (dose response) / 12 months (early disease)
Title
Early Disease: Nodule hardness
Description
Tonometry
Time Frame
18 months post treatment
Title
Early Disease: range of motion of the affected digit
Description
Goniometer reading
Time Frame
18 months
Title
Early Disease: Grip strength
Description
Jamar meter
Time Frame
18 months
Title
Early Disease: patient reported outcomes
Description
Michigan Hand Outcomes Questionnaire
Time Frame
18 months
Title
Early Disease: patient reported outcomes
Description
Participant identified activity most restricted by DD scored on a scale of 1-10
Time Frame
18 months
Title
Early Disease: progression to surgery of the digit being assessed
Time Frame
18 months
Other Pre-specified Outcome Measures:
Title
Dose Response & Early Disease: Circulating levels of adalimumab in the blood
Time Frame
2 weeks (dose response) / 12 months (early disease)
Title
Dose Response & Early Disease: Circulating levels of antibodies to adalimumab in the blood
Time Frame
2 weeks (dose response) / 12 months (early disease)
Title
Dose Response: Acceptability of the injection and return to paid work
Description
Patient-completed questionnaire: numeric rating scale
Time Frame
12 weeks post-surgery
Title
Early Disease: Cost effectiveness
Description
EQ-5D-5L data
Time Frame
18 months
Title
Early disease: Analysis of resource use data
Description
Patient completed questionnaire about health & social care and financial costs of Dupuytren's disease
Time Frame
18 months
Title
Dose Response & Early Disease: Exploratory Objective: Investigation of newly identified relevant molecular markers
Time Frame
Dose Response: 12-18 days post treatment (tissue)/ 2 weeks post treatment (blood). Early Disease: 3 & 12 months post 1st treatment (blood)
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Participant is willing and able to give informed consent for participation in the study.
Male or Female, aged 18 years or above.
For Part 1: Diagnosed with DD affecting the fingers resulting in flexion deformities of ≥30° at the metacarpophalangeal joint and or the proximal interphalangeal joint with impaired hand function and awaiting surgery. Or for Part 2: Participants with early disease nodules who have shown or reported progression of the disease in the previous 6 months with flexion deformities of their fingers of ≤30° at the metacarpophalangeal and/or at the proximal interphalangeal joint, i.e. total flexion deformity of up to 60°.
The DD nodule to be treated must be distinct and identifiable.
Female participants of child bearing potential, and male participants whose partner is of child bearing potential, must be willing to ensure that they or their partner use effective contraception throughout the treatment period and for 5 months following the last research injection. Acceptable methods of contraception include: a combination of male condom with either cap, diaphragm or sponge with spermicide (double barrier methods), injectables, the combined oral contraceptive pill (at a stable dose for at least 3 months before entering the study), an intrauterine device, vasectomised partner, or true sexual abstinence (when this is in line with the preferred and usual lifestyle of the participant).
Participant results from safety screening tests within normal ranges within 12 weeks of enrolment, with the exception that an earlier clear chest x-ray result may be used where this is in accordance with the time frames of local standard procedures for anti-TNF screening.
Able (in the Investigators opinion) and willing to comply with all study requirements.
Willing to allow his or her general practitioner to be notified of participation in the study.
Sufficient language fluency to ensure informed consent is obtained and to complete the questionnaires pertaining to hand function.
Exclusion Criteria:
For Part 1: Participant has previously had fasciectomy, dermofasciectomy, needle fasciotomy, collagenase injection, steroid injection or radiotherapy to treat Dupuytren's disease in the digit concerned. Or for Part 2: Participant has previously had fasciectomy, dermofasciectomy, needle fasciotomy, collagenase injection, steroid injection to the digit to be treated or radiotherapy to treat Dupuytren's disease in the hand concerned.
Female participant who is pregnant, lactating or planning pregnancy during the course of the study and for 5 months following last injection.
Male participant who is planning a pregnancy during the course of the study and for 5 months following last injection.
Significant renal or hepatic impairment.
For Part 1: Scheduled elective surgery or other procedures requiring general anaesthesia during the study other than the scheduled Dupuytren's surgery. Or for Part 2: Scheduled elective surgery or other procedures requiring general anaesthesia during the study
Participant who has ever been diagnosed with cancer, is terminally ill or is inappropriate for placebo medication
Systemic inflammatory disorder such as rheumatoid arthritis (RA) or inflammatory bowel disease.
Any other significant disease or disorder which, in the opinion of the Investigator, may either put the participants at risk because of participation in the study, or may influence the result of the study, or the participant's ability to participate in the study.
Participated in another research study involving an investigational medicinal product in the past 12 weeks.
Known allergy to any anti-TNF agent.
Have HIV or hepatitis B or C.
Known to have an infection or history of repeated infections.
History of Tuberculosis (TB).
Have Multiple Sclerosis (MS) or other demyelinating disease.
History of local injection site reactions.
Needle phobia.
Have moderate or severe heart failure.
Part 1: Being treated with coumarin anticoagulants, such as warfarin.
Have known lung fibrosis (thickening of lung tissue).
Being treated with concomitant biologic DMARDS.
Have received a live vaccine within the previous 4 weeks. Participants may receive concurrent vaccinations but must avoid the use of live vaccines for 12 weeks after their last injection.
Part1: Have received parenteral steroid within the previous 6 weeks.
Part 2: Participants at risk of Hepatitis B infection.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Jagdeep Nanchahal, PhD FRCS
Organizational Affiliation
University of Oxford
Official's Role
Principal Investigator
Facility Information:
Facility Name
The University Medical Centre
City
Groningen
ZIP/Postal Code
9700 RB
Country
Netherlands
Facility Name
NHS Lothian
City
Edinburgh
ZIP/Postal Code
EH1 3EG
Country
United Kingdom
Facility Name
Oxford University Hospitals NHS Foundation Trust
City
Oxford
ZIP/Postal Code
OX3 9DU
Country
United Kingdom
12. IPD Sharing Statement
Plan to Share IPD
No
Citations:
PubMed Identifier
29983350
Citation
Nanchahal J, Ball C, Davidson D, Williams L, Sones W, McCann FE, Cabrita M, Swettenham J, Cahoon NJ, Copsey B, Anne Francis E, Taylor PC, Black J, Barber VS, Dutton S, Feldmann M, Lamb SE. Anti-Tumour Necrosis Factor Therapy for Dupuytren's Disease: A Randomised Dose Response Proof of Concept Phase 2a Clinical Trial. EBioMedicine. 2018 Jul;33:282-288. doi: 10.1016/j.ebiom.2018.06.022. Epub 2018 Jul 6.
Results Reference
derived
Links:
URL
http://ridd.octru.ox.ac.uk/
Description
Trial website
Learn more about this trial
Repurposing Anti-TNF for Treating Dupuytren's Disease
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