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Efficacy and Safety of a Intra-articular Injection, ENKO1, in Patients With Symptomatic Knee Osteoarthritis. (ENKORE)

Primary Purpose

Osteoarthritis, Knee

Status
Completed
Phase
Not Applicable
Locations
Spain
Study Type
Interventional
Intervention
ENKO 1
Durolane
Sponsored by
OPKO Health, Inc.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Osteoarthritis, Knee focused on measuring Osteoarthritis, Knee, Chondroitin Sulfate, Hyaluronic Acid, Intra-articular Injection, Viscosupplementation, Pain Relief, Biomarkers

Eligibility Criteria

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

Inclusion Criteria:

  • Medial femorotibial compartment knee OA.
  • Fulfilment of ACR criteria for knee OA (knee pain + grinding + stiffness in the morning < 30 minutes).
  • Patients with a clinical course of disease longer than 6 months.
  • Global pain score greater than 60 mm on a 0-100 mm VAS on the knee under study.
  • Grade II or III according to the Kellgren and Lawrence classification system for the knee under study (on a posteroanterior X-ray performed under weight-bearing and for 6 months before randomisation).
  • Patients taking analgesics for at least 3 months before randomisation and whom are dissatisfied with their current therapy.
  • Patients who have given their consent in writing to take part in the study.
  • Woman of childbearing age must take a urine pregnancy test which must be negative at the randomisation visit and be currently using an effective contraceptive method for at least 2 menstrual cycles (oral contraceptives, intrauterine device, tubal ligation or other effective procedures).

Exclusion Criteria:

  • Isolated symptomatic patellofemoral osteoarthritis.
  • Microcrystalline osteoarthritis.
  • Prosthesis in knee under study.
  • Joint lavage or arthroscopy or any surgery on the knee under study in the 6 months before randomisation.
  • Paget's disease of bone, chondromatosis or villonodular sinovitis.
  • Inflammatory, infectious or metabolic arthritis (rheumatoid arthritis, spondyloarthropathy or connective tissue diseases).
  • Haemochromatosis, ochronosis or haemophilia.
  • History of diseases that the investigator considers likely to interfere with the functional disability assessment.
  • Knee surgery planned during the study period.

Other disease-related criteria:

  • BMI greater than or equal to 30.
  • Immunodeficiency or a serious or progressive disease (heart, lung, liver, kidney, haematological, neoplastic or infectious disease).
  • Skin diseases or infections in the area of the injection site.
  • Previous history of venous thromboembolism (including pulmonary embolism) or high risk of venous thromboembolism.
  • Venous or lymphatic stasis of the leg under study.
  • Severe acute or chronic disease that the investigator considers incompatible with the conduct of the study.
  • Disease that the investigator considers likely to interfere with the study results or to expose the patient to an additional risk.
  • Alcohol or drug abuse or dependence.

Previous or concomitant treatment-related criteria:

  • Patients who have taken a SYSADOA, SERM or a drug/dietary supplement containing glucosamine, chondroitin sulfate, diacerein or avocado-soybean extracts in the 3 months before randomisation
  • Patients who have taken paracetamol in the 24 hours before randomisation or any other symptomatic analgesic drug, including NSAIDs (except aspirin up to 325 mg/day for cardiovascular prophylaxis), in the 48 hours before randomisation
  • Patients who have received any corticosteroid treatment by any route of administration (other than inhalers or the ocular or auricular routes) in the month before randomisation
  • Patients who have received an intra-articular steroid injection in the knee under study in the month before randomisation or patients who have received intra-articular hyaluronic acid in the target knee in the 6 months before randomisation
  • Patients who have received any local or topical treatment on the target knee in the 2 weeks before randomisation

Criteria related to concomitant medication:

  • Hypersensitivity to paracetamol or NSAIDs

Study product-related criteria:

  • Known allergy to the study treatments or to any of its ingredients.

Other criteria:

  • Patients likely to be unable to comply with the protocol instructions and/or treatment, in the investigator's opinion
  • Patients who have taken part in a clinical trial in the preceding 2 months or taking part in a trial at the time of randomisation
  • Patients linguistically or mentally incapable of understanding the nature, objectives and possible consequences of the study; or who refuse to be subject to its limitations
  • Patients who are family or colleagues (secretary, nurse, technician, etc.) of the investigator.
  • Women: pregnant or breastfeeding

Sites / Locations

  • Clínica Diagonal
  • Consell calatà de l'Esport
  • Consorci Sanitari de Terrassa
  • Clínica Novo Sancti Petri
  • Clínica IQTRA
  • Hospital de Torrelodones
  • Clínica Dr. Casermeiro
  • Instituto Médico Arriaza
  • Hospital del Mar
  • Instituto POAL del Reumatología
  • Hospital Sant Rafael
  • Hospital Clínic de Barcelona
  • BiClinic
  • AMS Centro Médico del Ejercicio
  • Clínica ISMEC
  • Clínica Gastaldi
  • Clínica Traumatológica Dr. Baró
  • Hospital Vithas San José

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

ENKO 1

Durolane

Arm Description

ENKO 1 administered by single intra-articular injection.

Durolane administered by single intra-articular injection.

Outcomes

Primary Outcome Measures

Pain Relief
Assessed using VAS (Visual Analogue Scale) Huskisson 0-100mm Pain relief scored on a scale of 0 to 10. 0 means No pain and 10 means worst possible pain.

Secondary Outcome Measures

Pain Relief
Assessed using VAS (Visual Analogue Scale) Huskisson 0-100mm Pain relief scored on a scale of 0 to 10. 0 means No pain and 10 means Worst possible pain.
Evaluation of functional WESTERN ONTARIO AND MCMASTER OSTEOARTHRITIS INDEX (WOMAC) index score (Pain subscale)
Validated questionnaire for patients with osteoarthritis of the knee. 5 items: during walking, using stairs, in bed, sitting or lying, and standing upright. The test questions are scored on a scale of 0-4, which correspond to: None (0), Mild (1), Moderate (2), Severe (3), and Extreme (4). The scores for each subscale are summed up, with a possible score range of 0-20 for Pain, 0-8 for Stiffness, and 0-68 for Physical Function. Usually a sum of the scores for all three subscales gives a total WOMAC score. Higher scores on the WOMAC indicate worse pain, stiffness, and functional limitations.
Evaluation of functional WESTERN ONTARIO AND MCMASTER OSTEOARTHRITIS INDEX (WOMAC) index score (Stiffness subscale)
Validated questionnaire for patients with osteoarthritis of the knee. 2 items: after first waking and later in the day. The test questions are scored on a scale of 0-4, which correspond to: None (0), Mild (1), Moderate (2), Severe (3), and Extreme (4). The scores for each subscale are summed up, with a possible score range of 0-20 for Pain, 0-8 for Stiffness, and 0-68 for Physical Function. Usually a sum of the scores for all three subscales gives a total WOMAC score. Higher scores on the WOMAC indicate worse pain, stiffness, and functional limitations.
Evaluation of functional WESTERN ONTARIO AND MCMASTER OSTEOARTHRITIS INDEX (WOMAC) index score (Functional capacity subscale)
Validated questionnaire for patients with osteoarthritis of the knee. 17 items): using stairs, rising from sitting, standing, bending, walking, getting in / out of a car, shopping, putting on / taking off socks, rising from bed, lying in bed, getting in / out of bath, sitting, getting on / off toilet, heavy domestic duties, light domestic duties. The test questions are scored on a scale of 0-4, which correspond to: None (0), Mild (1), Moderate (2), Severe (3), and Extreme (4). The scores for each subscale are summed up, with a possible score range of 0-20 for Pain, 0-8 for Stiffness, and 0-68 for Physical Function. Usually a sum of the scores for all three subscales gives a total WOMAC score. Higher scores on the WOMAC indicate worse pain, stiffness, and functional limitations.
Evaluation of percentage of patients who respond to treatment
Evaluation of percentage of patients who respond to treatment according to the OMERACT-OARSI criteria.
Global evaluation of the activity of the disease and of the respond to treatment by patient.
Global evaluation of the activity of disease by the patient (VAS (Visual Analogue Scale) from 0-100mm). Scale from 0 to 10, which correspond to: Mild (0-2), Moderate (3-7) and Intense (8-10). where 0 is better outcome and 10 is the worst outcome.
Evaluation of Health status of patients
Evaluation of Health status by quality of life questionnaire 12-Item Short Form Survey (SF-12). It consists of 12 items from the 8 dimensions of the SF-36 Physical Function, Social Function, Physical Role, Emotional Role, Mental Health, Vitality, Body Pain, General Health and evaluate intensity and frequency of each item. Scale ranges: Minimum 12 and maximum 60 scores. When 12 means better and 60 is the worse outcome.
Evaluation of concomitant medication intake
Daily intake of Paracetamol (maximum 3g/day)
Evaluation of synovitis
Clinical valoration of synovial joint swelling.
Biomarkers
Blood sample analysis of serum soluble biomarkers according to current validation by THE BIOMARKERS CONSORTIUM. Pre-selected biomarkers: Concentration of Serum CTXI, Serum NTXI, Serum-HA, Serum-PIIANP and Serum CTXII.
Adverse events
Number of Participants with any Adverse event.

Full Information

First Posted
November 28, 2018
Last Updated
March 19, 2021
Sponsor
OPKO Health, Inc.
Collaborators
Osteoarthritis Foundation International (OAFI)
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1. Study Identification

Unique Protocol Identification Number
NCT03762408
Brief Title
Efficacy and Safety of a Intra-articular Injection, ENKO1, in Patients With Symptomatic Knee Osteoarthritis.
Acronym
ENKORE
Official Title
Comparative Study of the Efficacy and Safety of an Intra-articular Injection of ENKO 1 vs Durolane in Patients With Symptomatic Osteoarthritis of the Knee.
Study Type
Interventional

2. Study Status

Record Verification Date
March 2021
Overall Recruitment Status
Completed
Study Start Date
December 15, 2017 (Actual)
Primary Completion Date
May 29, 2020 (Actual)
Study Completion Date
May 29, 2020 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
OPKO Health, Inc.
Collaborators
Osteoarthritis Foundation International (OAFI)

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
Clinical trial with medical device, multicenter, single-blind (blind third party evaluation), randomized, comparative and in two paralell groups, to demonstrate the treatment according to usual clinical practice, of the combination of 50 mg Sodium Hyaluronate and 50 mg Chondroitin Sulfate (ENKO 1) in a single administration, has non-inferiority efficacy vs the comparator (Durolane; 60 mg HA crosslinked) in patients with symptomatic knee osteoarthritis after three months of follow-up.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Osteoarthritis, Knee
Keywords
Osteoarthritis, Knee, Chondroitin Sulfate, Hyaluronic Acid, Intra-articular Injection, Viscosupplementation, Pain Relief, Biomarkers

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
Outcomes Assessor
Masking Description
Single-blinded (blind third party evaluation) The physician performing the infiltration will be different and cannot be related to the investigator evaluating the results.
Allocation
Randomized
Enrollment
175 (Actual)

8. Arms, Groups, and Interventions

Arm Title
ENKO 1
Arm Type
Experimental
Arm Description
ENKO 1 administered by single intra-articular injection.
Arm Title
Durolane
Arm Type
Active Comparator
Arm Description
Durolane administered by single intra-articular injection.
Intervention Type
Device
Intervention Name(s)
ENKO 1
Intervention Description
50 mg of HA/ 50 mg of CS in 5 ml
Intervention Type
Device
Intervention Name(s)
Durolane
Intervention Description
60 mg HA crosslinked in 3 ml
Primary Outcome Measure Information:
Title
Pain Relief
Description
Assessed using VAS (Visual Analogue Scale) Huskisson 0-100mm Pain relief scored on a scale of 0 to 10. 0 means No pain and 10 means worst possible pain.
Time Frame
Change from baseline pain relief at 6 months.
Secondary Outcome Measure Information:
Title
Pain Relief
Description
Assessed using VAS (Visual Analogue Scale) Huskisson 0-100mm Pain relief scored on a scale of 0 to 10. 0 means No pain and 10 means Worst possible pain.
Time Frame
0, 1, 6 and 12 weeks.
Title
Evaluation of functional WESTERN ONTARIO AND MCMASTER OSTEOARTHRITIS INDEX (WOMAC) index score (Pain subscale)
Description
Validated questionnaire for patients with osteoarthritis of the knee. 5 items: during walking, using stairs, in bed, sitting or lying, and standing upright. The test questions are scored on a scale of 0-4, which correspond to: None (0), Mild (1), Moderate (2), Severe (3), and Extreme (4). The scores for each subscale are summed up, with a possible score range of 0-20 for Pain, 0-8 for Stiffness, and 0-68 for Physical Function. Usually a sum of the scores for all three subscales gives a total WOMAC score. Higher scores on the WOMAC indicate worse pain, stiffness, and functional limitations.
Time Frame
-7, 0, 1, 6, 12 and 24 weeks.
Title
Evaluation of functional WESTERN ONTARIO AND MCMASTER OSTEOARTHRITIS INDEX (WOMAC) index score (Stiffness subscale)
Description
Validated questionnaire for patients with osteoarthritis of the knee. 2 items: after first waking and later in the day. The test questions are scored on a scale of 0-4, which correspond to: None (0), Mild (1), Moderate (2), Severe (3), and Extreme (4). The scores for each subscale are summed up, with a possible score range of 0-20 for Pain, 0-8 for Stiffness, and 0-68 for Physical Function. Usually a sum of the scores for all three subscales gives a total WOMAC score. Higher scores on the WOMAC indicate worse pain, stiffness, and functional limitations.
Time Frame
-7, 0, 1, 6, 12 and 24 weeks.
Title
Evaluation of functional WESTERN ONTARIO AND MCMASTER OSTEOARTHRITIS INDEX (WOMAC) index score (Functional capacity subscale)
Description
Validated questionnaire for patients with osteoarthritis of the knee. 17 items): using stairs, rising from sitting, standing, bending, walking, getting in / out of a car, shopping, putting on / taking off socks, rising from bed, lying in bed, getting in / out of bath, sitting, getting on / off toilet, heavy domestic duties, light domestic duties. The test questions are scored on a scale of 0-4, which correspond to: None (0), Mild (1), Moderate (2), Severe (3), and Extreme (4). The scores for each subscale are summed up, with a possible score range of 0-20 for Pain, 0-8 for Stiffness, and 0-68 for Physical Function. Usually a sum of the scores for all three subscales gives a total WOMAC score. Higher scores on the WOMAC indicate worse pain, stiffness, and functional limitations.
Time Frame
-7, 0, 1, 6, 12 and 24 weeks.
Title
Evaluation of percentage of patients who respond to treatment
Description
Evaluation of percentage of patients who respond to treatment according to the OMERACT-OARSI criteria.
Time Frame
0, 1, 6, 12 and 24 weeks.
Title
Global evaluation of the activity of the disease and of the respond to treatment by patient.
Description
Global evaluation of the activity of disease by the patient (VAS (Visual Analogue Scale) from 0-100mm). Scale from 0 to 10, which correspond to: Mild (0-2), Moderate (3-7) and Intense (8-10). where 0 is better outcome and 10 is the worst outcome.
Time Frame
0, 1, 6, 12 and 24 weeks.
Title
Evaluation of Health status of patients
Description
Evaluation of Health status by quality of life questionnaire 12-Item Short Form Survey (SF-12). It consists of 12 items from the 8 dimensions of the SF-36 Physical Function, Social Function, Physical Role, Emotional Role, Mental Health, Vitality, Body Pain, General Health and evaluate intensity and frequency of each item. Scale ranges: Minimum 12 and maximum 60 scores. When 12 means better and 60 is the worse outcome.
Time Frame
0, 1, 6, 12 and 24 weeks.
Title
Evaluation of concomitant medication intake
Description
Daily intake of Paracetamol (maximum 3g/day)
Time Frame
-7, 0, 1, 6, 12 and 24 weeks.
Title
Evaluation of synovitis
Description
Clinical valoration of synovial joint swelling.
Time Frame
-7, 0, 1, 6, 12 and 24 weeks.
Title
Biomarkers
Description
Blood sample analysis of serum soluble biomarkers according to current validation by THE BIOMARKERS CONSORTIUM. Pre-selected biomarkers: Concentration of Serum CTXI, Serum NTXI, Serum-HA, Serum-PIIANP and Serum CTXII.
Time Frame
-7 and 12 weeks
Title
Adverse events
Description
Number of Participants with any Adverse event.
Time Frame
0, 1, 6, 12 and 24 weeks.

10. Eligibility

Sex
All
Minimum Age & Unit of Time
40 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Medial femorotibial compartment knee OA. Fulfilment of ACR criteria for knee OA (knee pain + grinding + stiffness in the morning < 30 minutes). Patients with a clinical course of disease longer than 6 months. Global pain score greater than 60 mm on a 0-100 mm VAS on the knee under study. Grade II or III according to the Kellgren and Lawrence classification system for the knee under study (on a posteroanterior X-ray performed under weight-bearing and for 6 months before randomisation). Patients taking analgesics for at least 3 months before randomisation and whom are dissatisfied with their current therapy. Patients who have given their consent in writing to take part in the study. Woman of childbearing age must take a urine pregnancy test which must be negative at the randomisation visit and be currently using an effective contraceptive method for at least 2 menstrual cycles (oral contraceptives, intrauterine device, tubal ligation or other effective procedures). Exclusion Criteria: Isolated symptomatic patellofemoral osteoarthritis. Microcrystalline osteoarthritis. Prosthesis in knee under study. Joint lavage or arthroscopy or any surgery on the knee under study in the 6 months before randomisation. Paget's disease of bone, chondromatosis or villonodular sinovitis. Inflammatory, infectious or metabolic arthritis (rheumatoid arthritis, spondyloarthropathy or connective tissue diseases). Haemochromatosis, ochronosis or haemophilia. History of diseases that the investigator considers likely to interfere with the functional disability assessment. Knee surgery planned during the study period. Other disease-related criteria: BMI greater than or equal to 30. Immunodeficiency or a serious or progressive disease (heart, lung, liver, kidney, haematological, neoplastic or infectious disease). Skin diseases or infections in the area of the injection site. Previous history of venous thromboembolism (including pulmonary embolism) or high risk of venous thromboembolism. Venous or lymphatic stasis of the leg under study. Severe acute or chronic disease that the investigator considers incompatible with the conduct of the study. Disease that the investigator considers likely to interfere with the study results or to expose the patient to an additional risk. Alcohol or drug abuse or dependence. Previous or concomitant treatment-related criteria: Patients who have taken a SYSADOA, SERM or a drug/dietary supplement containing glucosamine, chondroitin sulfate, diacerein or avocado-soybean extracts in the 3 months before randomisation Patients who have taken paracetamol in the 24 hours before randomisation or any other symptomatic analgesic drug, including NSAIDs (except aspirin up to 325 mg/day for cardiovascular prophylaxis), in the 48 hours before randomisation Patients who have received any corticosteroid treatment by any route of administration (other than inhalers or the ocular or auricular routes) in the month before randomisation Patients who have received an intra-articular steroid injection in the knee under study in the month before randomisation or patients who have received intra-articular hyaluronic acid in the target knee in the 6 months before randomisation Patients who have received any local or topical treatment on the target knee in the 2 weeks before randomisation Criteria related to concomitant medication: Hypersensitivity to paracetamol or NSAIDs Study product-related criteria: Known allergy to the study treatments or to any of its ingredients. Other criteria: Patients likely to be unable to comply with the protocol instructions and/or treatment, in the investigator's opinion Patients who have taken part in a clinical trial in the preceding 2 months or taking part in a trial at the time of randomisation Patients linguistically or mentally incapable of understanding the nature, objectives and possible consequences of the study; or who refuse to be subject to its limitations Patients who are family or colleagues (secretary, nurse, technician, etc.) of the investigator. Women: pregnant or breastfeeding
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Luisa Varela, Ph, MSc
Organizational Affiliation
OPKO Health, Inc.
Official's Role
Study Chair
First Name & Middle Initial & Last Name & Degree
Jordi Monfort, MD, PhD
Organizational Affiliation
Hospital del Mar
Official's Role
Principal Investigator
Facility Information:
Facility Name
Clínica Diagonal
City
Esplugues De Llobregat
State/Province
Barceloma
ZIP/Postal Code
08950
Country
Spain
Facility Name
Consell calatà de l'Esport
City
Esplugues De Llobregat
State/Province
Barcelona
ZIP/Postal Code
08950
Country
Spain
Facility Name
Consorci Sanitari de Terrassa
City
Terrassa
State/Province
Barcelona
ZIP/Postal Code
08227
Country
Spain
Facility Name
Clínica Novo Sancti Petri
City
Chiclana de la Frontera
State/Province
Cádiz
ZIP/Postal Code
11139
Country
Spain
Facility Name
Clínica IQTRA
City
Torrejón De Ardoz
State/Province
Madrid
ZIP/Postal Code
28002
Country
Spain
Facility Name
Hospital de Torrelodones
City
Torrelodones
State/Province
Madrid
ZIP/Postal Code
28250
Country
Spain
Facility Name
Clínica Dr. Casermeiro
City
Mijas Costa
State/Province
Málaga
ZIP/Postal Code
29651
Country
Spain
Facility Name
Instituto Médico Arriaza
City
A Coruña
ZIP/Postal Code
15009
Country
Spain
Facility Name
Hospital del Mar
City
Barcelona
ZIP/Postal Code
08003
Country
Spain
Facility Name
Instituto POAL del Reumatología
City
Barcelona
ZIP/Postal Code
08022
Country
Spain
Facility Name
Hospital Sant Rafael
City
Barcelona
ZIP/Postal Code
08035
Country
Spain
Facility Name
Hospital Clínic de Barcelona
City
Barcelona
ZIP/Postal Code
08036
Country
Spain
Facility Name
BiClinic
City
Madrid
ZIP/Postal Code
28027
Country
Spain
Facility Name
AMS Centro Médico del Ejercicio
City
Málaga
ZIP/Postal Code
29004
Country
Spain
Facility Name
Clínica ISMEC
City
Sevilla
ZIP/Postal Code
41001
Country
Spain
Facility Name
Clínica Gastaldi
City
Valencia
ZIP/Postal Code
46015
Country
Spain
Facility Name
Clínica Traumatológica Dr. Baró
City
Valladolid
ZIP/Postal Code
47004
Country
Spain
Facility Name
Hospital Vithas San José
City
Vitoria Gasteiz
ZIP/Postal Code
01008
Country
Spain

12. IPD Sharing Statement

Plan to Share IPD
Undecided

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Efficacy and Safety of a Intra-articular Injection, ENKO1, in Patients With Symptomatic Knee Osteoarthritis.

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