Safety and Activity of F14 for Management of Pain Following Total Knee Replacement
Primary Purpose
Total Knee Replacement, Postoperative Pain
Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Bupivacaine HCl
F14 (celecoxib)
Sponsored by
About this trial
This is an interventional treatment trial for Total Knee Replacement focused on measuring total knee replacement, pain, celecoxib, intra-articular
Eligibility Criteria
Inclusion Criteria:
- Male and/or female indicated for primary, unilateral TKR
- Between 45-80 years of age inclusive at the time of signing the informed consent
- Capable of giving signed informed consent and complying with requirements and restrictions listed in the informed consent form (ICF) and in this protocol
- Body Mass Index (BMI) ≤ 40 kg/m²
- Medically stable as determined by the Investigator based on pre-study medical history, physical examination, clinical laboratory tests, and 12-lead electrocardiogram (ECG) findings
- Absence of fixed flexion deformity exceeding 15°
- Absence of varus or valgus deformity exceeding 15°
- Minimum pre-operative flexion arc of 100°
- Absence of steroid, hyaluronic acid, platelet rich plasma, or any other type of therapeutic injection(s) in the index knee within 3 months before scheduled surgery
- American Society of Anesthesiologists Physical Status Classification System (ASA-PSC) score ≤ 3
- Females of childbearing potential with a negative pregnancy test at screening, who agree to employ adequate birth control measures for the full duration of the study
- Has undergone scheduled total knee replacement surgery of the index knee, which in the opinion of the Investigator, will not affect the participant's study follow-up
Exclusion Criteria:
- Allergy or hypersensitivity to active ingredient celecoxib. When an allergy to celecoxib is unknown,allergy or hypersensitivity to sulfonamide antibiotics or sulfa containing drugs
- Active or past infection in the index knee
- Previous total or partial knee arthroplasty in either knee within the past 6 months
- Prior arthroscopy in the index knee in the last 6 months; knee surgery other than arthroscopy (including cruciate ligament, cartilage or osteotomy) in the index knee in the last 12 months; knee surgery in the contralateral knee in the last 12 months (excluding total or partial knee replacement)
- Documented osteonecrosis or arthrotomy within previous 12 months
- Prior or current presence of hardware in index knee other than screws from previous ligament repair that do not require manipulation or removal for TKR surgery
- Other planned major surgery within 12 months of scheduled surgery
- Concurrent painful physical condition that may require analgesic treatment (such as an NSAID or opioid) in the postsurgical period for pain that is not strictly related to the TKR surgery emanating from other lower body joints in the ipsilateral (hip, ankle) or contralateral (hip, knee, ankle) or back (by body diagram)
- Current or historical evidence of any clinically significant disease or condition, especially cardiovascular, pulmonary or neurological conditions that, in the opinion of the Investigator, may increase the risk of surgery or complicate or affect the participant's study follow-up
- Strong narcotic use (e.g. Oxycontin®, Vicodin®, Percocet®) before scheduled study surgery for a prolonged period exceeding 30 days within the last 2 years
- History of alcohol abuse within previous 12 months (score of 4 on CAGE questionnaire)
- Known or suspected history of illicit drug abuse within 1 year before randomization, or history of opioid dependence within 2 years before scheduled surgery (score exceeding 5 on DAST-10 questionnaire)
- Participation in another clinical study involving an investigational product (IP) or device within 30 days before screening or scheduled participation in another clinical study involving an IP or device during the course of this study
- Use of pregabalin or gabapentin, or other drugs for neuropathic pain unless willing to discontinue at least 7 days prior to study surgery
- Current patient-reported seizure disorder
- Current peripheral neuropathy
- Current depression, mood or anxiety disorder (score exceeding 14 on PHQ-9 questionnaire)
- History of complex regional pain syndrome (CRPS)
- Diagnosis of clinically significant liver and/or renal abnormalities within previous 2 years
- Diagnosis of diabetes with HbA1c exceeding 7
- Current inflammatory arthritides (e.g., rheumatoid arthritis, lupus erythematosus, ankylosing spondylitis, psoriatic arthritis), or traumatic bone injuries within 12 months before scheduled surgery, but excepting clinically stable/non-active gout that does not affect the knee and does not interfere with walking
- Treatment with immunosuppressants, antipsychotics, anticholinergics, or anticonvulsants within 1 month of randomization
- Diagnosis of skin disorders including psoriasis, vascular insufficiency ulcers, and chronic venous stasis
- Participants with sleep apnea associated with a history of postoperative delirium. If symptomatic sleep apnea is currently treated with continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BIPAP), use must be continued postoperatively
- History of coronary or vascular stent placed within 3 months (may be extended to 1 year if medically indicated per physician discretion).
- Participation in active or pending personal injury or workers' compensation litigation related to index knee
- Current or planned use of medical marijuana or cannabidiol (CBD), unless willing to discontinue at least 10 days prior to study surgery and for 3 months following study surgery
- Unwilling or unable to discontinue use of NSAIDs within 7 days of scheduled surgery and for 3 months following study surgery, including low-dose aspirin for cardiac prophylaxis
- Has an allergy or contraindication to opioids
- Had a malignancy in the last year, except for non-metastatic basal cell or squamous cell carcinoma of the skin or localized carcinoma in situ of the cervix
- Positive urine drug screen for disallowed medication at screening or preoperatively on day of study surgery
Sites / Locations
- Panorama Orthopedics & Spine Center
- Midwest Clinical Research Center
- Endeavor Clinical Trials
Arms of the Study
Arm 1
Arm 2
Arm Type
Active Comparator
Experimental
Arm Label
Standard of care analgesia
F14 (celecoxib)
Arm Description
0.25% Bupivacaine HCl administered following total knee replacement
3.5 mL dose of F14 (celecoxib) concurrent with 0.25% Bupivacaine HCl administered following total knee replacement
Outcomes
Primary Outcome Measures
Peak pain intensity measured by visual analog scale (VAS)
Area under the curve (AUC) of visual analog scale (VAS) pain intensity scores
Summed pain intensity difference (SPID) of visual analog scale (VAS) pain intensity scores
Functional improvement by Timed Up and Go test
Total post-surgical opioid consumption (in MSO4 equivalents)
Secondary Outcome Measures
Peak pain intensity by visual analog score (VAS)
Pain, stiffness, and physical function by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC Parts A, B, C)
Time to first rescue medication
Proportion of participants using rescue medication
Benefit of analgesia by Overall Benefit of Analgesic Score (OBAS) questionnaire
Celecoxib concentration in plasma
Full Information
NCT ID
NCT03541655
First Posted
May 8, 2018
Last Updated
July 8, 2020
Sponsor
Arthritis Innovation Corporation
1. Study Identification
Unique Protocol Identification Number
NCT03541655
Brief Title
Safety and Activity of F14 for Management of Pain Following Total Knee Replacement
Official Title
A Phase 2, Randomized, Single-Blind, Active-Control, Parallel Group Study to Evaluate Safety and Activity of a Single Administration of F14 for Management of Postoperative Pain in Participants Undergoing Unilateral Total Knee Replacement
Study Type
Interventional
2. Study Status
Record Verification Date
July 2020
Overall Recruitment Status
Completed
Study Start Date
May 4, 2018 (Actual)
Primary Completion Date
June 20, 2019 (Actual)
Study Completion Date
March 30, 2020 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Arthritis Innovation Corporation
4. Oversight
Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No
5. Study Description
Brief Summary
The safety and activity of a single, 3.5 mL dose of F14 (celecoxib) concurrent with standard of care analgesia administered following total knee replacement will be compared to standard of care analgesia alone.
Detailed Description
This is a randomized, single-blind, active control study in participants undergoing primary unilateral total knee replacement (TKR). Fifty (50) participants will be randomized 1:1 to receive either a single, 3.5 mL dose of F14 (celecoxib) concurrent with standard of care analgesia, or only standard of care analgesia. F14 will be administered into the joint space at the end of surgery and just prior to wound closing. Safety will be evaluated through recording of adverse events, vital signs, ECG, physical and knee-specific examinations, laboratory blood tests and standing x-rays of the TKR obtained at 3 and 12 months. Post-operative pain will be assessed using visual analog scores (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaires and the Timed Up and Go test. Concomitant medication usage including MSO4 equivalents will be monitored daily for 3 months with participant drug diaries, and at the 12-month visit. Perceived benefit of analgesia will be compared using the Overall Benefit of Analgesic Score (OBAS). The pharmacokinetic profile of celecoxib in plasma will be assessed up to 3 months. Standardized physical therapy will be implemented post-operatively. Follow-up study visits will occur at 1, 2, 3, 4 (phone) and 6 weeks, 3 and 12 months.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Total Knee Replacement, Postoperative Pain
Keywords
total knee replacement, pain, celecoxib, intra-articular
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
Participant
Allocation
Randomized
Enrollment
20 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Standard of care analgesia
Arm Type
Active Comparator
Arm Description
0.25% Bupivacaine HCl administered following total knee replacement
Arm Title
F14 (celecoxib)
Arm Type
Experimental
Arm Description
3.5 mL dose of F14 (celecoxib) concurrent with 0.25% Bupivacaine HCl administered following total knee replacement
Intervention Type
Drug
Intervention Name(s)
Bupivacaine HCl
Other Intervention Name(s)
Marcaine
Intervention Description
0.25% Bupivacaine HCl
Intervention Type
Drug
Intervention Name(s)
F14 (celecoxib)
Intervention Description
Celecoxib in novel drug delivery system (BEPO™)
Primary Outcome Measure Information:
Title
Peak pain intensity measured by visual analog scale (VAS)
Time Frame
At 2 weeks
Title
Area under the curve (AUC) of visual analog scale (VAS) pain intensity scores
Time Frame
Through 72 hours
Title
Summed pain intensity difference (SPID) of visual analog scale (VAS) pain intensity scores
Time Frame
Through 72 hours
Title
Functional improvement by Timed Up and Go test
Time Frame
Through 3 months
Title
Total post-surgical opioid consumption (in MSO4 equivalents)
Time Frame
Through 3 months
Secondary Outcome Measure Information:
Title
Peak pain intensity by visual analog score (VAS)
Time Frame
Through 12 months
Title
Pain, stiffness, and physical function by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC Parts A, B, C)
Time Frame
Through 12 months
Title
Time to first rescue medication
Time Frame
Through 3 months
Title
Proportion of participants using rescue medication
Time Frame
Through 3 months
Title
Benefit of analgesia by Overall Benefit of Analgesic Score (OBAS) questionnaire
Time Frame
Through 4 weeks
Title
Celecoxib concentration in plasma
Time Frame
Through 12 months
10. Eligibility
Sex
All
Minimum Age & Unit of Time
45 Years
Maximum Age & Unit of Time
80 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Male and/or female indicated for primary, unilateral TKR
Between 45-80 years of age inclusive at the time of signing the informed consent
Capable of giving signed informed consent and complying with requirements and restrictions listed in the informed consent form (ICF) and in this protocol
Body Mass Index (BMI) ≤ 40 kg/m²
Medically stable as determined by the Investigator based on pre-study medical history, physical examination, clinical laboratory tests, and 12-lead electrocardiogram (ECG) findings
Absence of fixed flexion deformity exceeding 15°
Absence of varus or valgus deformity exceeding 15°
Minimum pre-operative flexion arc of 100°
Absence of steroid, hyaluronic acid, platelet rich plasma, or any other type of therapeutic injection(s) in the index knee within 3 months before scheduled surgery
American Society of Anesthesiologists Physical Status Classification System (ASA-PSC) score ≤ 3
Females of childbearing potential with a negative pregnancy test at screening, who agree to employ adequate birth control measures for the full duration of the study
Has undergone scheduled total knee replacement surgery of the index knee, which in the opinion of the Investigator, will not affect the participant's study follow-up
Exclusion Criteria:
Allergy or hypersensitivity to active ingredient celecoxib. When an allergy to celecoxib is unknown,allergy or hypersensitivity to sulfonamide antibiotics or sulfa containing drugs
Active or past infection in the index knee
Previous total or partial knee arthroplasty in either knee within the past 6 months
Prior arthroscopy in the index knee in the last 6 months; knee surgery other than arthroscopy (including cruciate ligament, cartilage or osteotomy) in the index knee in the last 12 months; knee surgery in the contralateral knee in the last 12 months (excluding total or partial knee replacement)
Documented osteonecrosis or arthrotomy within previous 12 months
Prior or current presence of hardware in index knee other than screws from previous ligament repair that do not require manipulation or removal for TKR surgery
Other planned major surgery within 12 months of scheduled surgery
Concurrent painful physical condition that may require analgesic treatment (such as an NSAID or opioid) in the postsurgical period for pain that is not strictly related to the TKR surgery emanating from other lower body joints in the ipsilateral (hip, ankle) or contralateral (hip, knee, ankle) or back (by body diagram)
Current or historical evidence of any clinically significant disease or condition, especially cardiovascular, pulmonary or neurological conditions that, in the opinion of the Investigator, may increase the risk of surgery or complicate or affect the participant's study follow-up
Strong narcotic use (e.g. Oxycontin®, Vicodin®, Percocet®) before scheduled study surgery for a prolonged period exceeding 30 days within the last 2 years
History of alcohol abuse within previous 12 months (score of 4 on CAGE questionnaire)
Known or suspected history of illicit drug abuse within 1 year before randomization, or history of opioid dependence within 2 years before scheduled surgery (score exceeding 5 on DAST-10 questionnaire)
Participation in another clinical study involving an investigational product (IP) or device within 30 days before screening or scheduled participation in another clinical study involving an IP or device during the course of this study
Use of pregabalin or gabapentin, or other drugs for neuropathic pain unless willing to discontinue at least 7 days prior to study surgery
Current patient-reported seizure disorder
Current peripheral neuropathy
Current depression, mood or anxiety disorder (score exceeding 14 on PHQ-9 questionnaire)
History of complex regional pain syndrome (CRPS)
Diagnosis of clinically significant liver and/or renal abnormalities within previous 2 years
Diagnosis of diabetes with HbA1c exceeding 7
Current inflammatory arthritides (e.g., rheumatoid arthritis, lupus erythematosus, ankylosing spondylitis, psoriatic arthritis), or traumatic bone injuries within 12 months before scheduled surgery, but excepting clinically stable/non-active gout that does not affect the knee and does not interfere with walking
Treatment with immunosuppressants, antipsychotics, anticholinergics, or anticonvulsants within 1 month of randomization
Diagnosis of skin disorders including psoriasis, vascular insufficiency ulcers, and chronic venous stasis
Participants with sleep apnea associated with a history of postoperative delirium. If symptomatic sleep apnea is currently treated with continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BIPAP), use must be continued postoperatively
History of coronary or vascular stent placed within 3 months (may be extended to 1 year if medically indicated per physician discretion).
Participation in active or pending personal injury or workers' compensation litigation related to index knee
Current or planned use of medical marijuana or cannabidiol (CBD), unless willing to discontinue at least 10 days prior to study surgery and for 3 months following study surgery
Unwilling or unable to discontinue use of NSAIDs within 7 days of scheduled surgery and for 3 months following study surgery, including low-dose aspirin for cardiac prophylaxis
Has an allergy or contraindication to opioids
Had a malignancy in the last year, except for non-metastatic basal cell or squamous cell carcinoma of the skin or localized carcinoma in situ of the cervix
Positive urine drug screen for disallowed medication at screening or preoperatively on day of study surgery
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Jared Foran, MD
Organizational Affiliation
Panorama Orthopedics & Spine Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
Panorama Orthopedics & Spine Center
City
Denver
State/Province
Colorado
ZIP/Postal Code
80401
Country
United States
Facility Name
Midwest Clinical Research Center
City
Dayton
State/Province
Ohio
ZIP/Postal Code
45417
Country
United States
Facility Name
Endeavor Clinical Trials
City
San Antonio
State/Province
Texas
ZIP/Postal Code
78229
Country
United States
12. IPD Sharing Statement
Plan to Share IPD
No
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Safety and Activity of F14 for Management of Pain Following Total Knee Replacement
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