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A Prospective Evaluation of the Cingal Injection for Hip Osteoarthritis (ECHO)

Primary Purpose

Hip Osteoarthritis

Status
Completed
Phase
Not Applicable
Locations
Canada
Study Type
Interventional
Intervention
Cingal
Sponsored by
McMaster University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Hip Osteoarthritis

Eligibility Criteria

40 Years - 65 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Adult men or women ages 40 to 65 years
  2. Hip OA (mild to moderate) diagnosed on x-ray and/or MRI (Tonnis grade 1 and 2)
  3. Patient is using only nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen/ paracetamol (Tylenol) for pain relief during the month before receiving Cingal
  4. Patient is willing to stop pain/anti-inflammatory medication at least two weeks prior to receiving Cingal through the end of the study (6 months)
  5. Patient speaks, reads, and understands the language of the clinical site
  6. Provision of informed consent

Exclusion Criteria:

  1. Evidence of hip dysplasia (centre edge angle less than 20 degrees)
  2. Presence of advanced hip OA (Tonnis Grade 3)
  3. Previous trauma to the affected hip requiring medical or surgical treatment
  4. Previous surgery on the affected hip or contralateral hip
  5. Severe acetabular deformities (e.g. acetabular protrusion, coxa profunda, circumferential labral ossification)
  6. Infections or skin diseases at target hip joint
  7. Immunosuppressive medication use
  8. Chronic pain syndromes
  9. Significant medical co-morbidities (requiring daily assistance for activities of daily living)
  10. History of paediatric hip disease (e.g. Legg-Calve-Perthes; slipped capital femoral epiphysis)
  11. Previous cartilage repair procedure (microfracture, Osteochondral Autograft Transplantation System (OATS) or Autologous Chondrocyte Implantation (ACI) with or without use of a scaffold (matrix) in the index hip)
  12. Known hypersensitivity (allergy) to hyaluronan preparations
  13. Known hypersensitivity (allergy) to triamcinolone hexacetonide preparations
  14. Known sensitivity to any of the materials in Cingal
  15. Patients with impaired cardio-renal function, endocrine, or other diseases or conditions that use of corticosteroid is warned
  16. HA intra-articular injections into the index hip within the last 6 months before receiving Cingal
  17. Corticosteroid therapy by systemic, intra-articular, or intramuscular route or oral corticosteroids within the last 6 months before receiving Cingal
  18. Any injection received in the hip prior to receiving or received concurrently with Cingal
  19. Uncontrolled diabetes
  20. Subject is a woman who is pregnant or breastfeeding or a woman of child bearing potential who refuses to use effective contraception during the course of the study
  21. Patient is incarcerated
  22. Any clinically significant or symptomatic vascular or neurologic disorder of the lower extremities
  23. Rheumatoid arthritis or gouty arthritis
  24. Current diagnosis of osteomyelitis
  25. Diagnosed musculoskeletal cancer or any diagnosed cancer, other than musculoskeletal if not on long term remission (e.g. at least 5 years or negative biopsy at last exam), except basal cell carcinoma
  26. Patients who are at higher risk for post-surgical bleeding (e.g., bleeding disorder; taking anticoagulants except low dose aspirin or anti-platelet agents [e.g. ASA, Plavix]) or post-surgical infection (e.g., taking immunosuppressants; have a severe infection or a history of serious infection)
  27. Participation in concurrent trial that involves a medical intervention
  28. Patient is currently receiving workman's compensation or disability, has been involved in an motor vehicle accident, or is in litigation for workman's compensation or disability claims
  29. Likely problems, in the judgment of the treating physician, with maintaining follow up (e.g. patients with no fixed address, plans to move out of town). This may include patients with severe mental disorders and drug addictions without adequate support.

Sites / Locations

  • McMaster University

Arms of the Study

Arm 1

Arm Type

Other

Arm Label

Cingal injection

Arm Description

Cingal will be administered by fellowship-trained physicians through ultrasound-guided injection using a 21-gauge needle into the joint space of the hip under sterile conditions. The needle track will be anesthetized with local anesthetic.

Outcomes

Primary Outcome Measures

Patient reported hip pain as measured by Visual Analog Scale
The primary objective of this observational study is to determine, among individuals with hip OA ages 40-65 years, the effect of Cingal on patient-reported hip pain, as measured by a Visual Analogue Scale (VAS), at 6-months post-injection.

Secondary Outcome Measures

Hip Function, as measured by the Hip Disability and Osteoarthritis Outcome Score (HOOS)
The HOOS was designed to assess patient opinions about their hip and associated problems in an adult population with a hip disability with or without OA. The HOOS has been extensively validated and consists of 5 subscales for pain, other symptoms, function in activities of daily living, function in sports and recreation, and hip-related quality of life.
Health-related quality of life (HRQL) as measured by the Short Form-12 questionnaire (SF-12)
The SF-12 may be self or interview-administered and can help document mental and physical components of quality of life. Points can range from 0-100, where a zero score indicates the lowest level of health and 100 indicates the highest level of health.
Physical activity levels as measured by a wrist-worn activity tracker
To be worn for one week prior to each follow-up visit.
Complications, including infection and other adverse events at 6-months post-injection.
Adverse events
Range of motion
ROM will be measured with standard anterior and posterior impingement tests, the log roll test, and hip flexion/extension, abduction/adduction, and internal/external rotation.

Full Information

First Posted
September 6, 2019
Last Updated
September 20, 2023
Sponsor
McMaster University
Collaborators
Anika Therapeutics, Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT04084704
Brief Title
A Prospective Evaluation of the Cingal Injection for Hip Osteoarthritis
Acronym
ECHO
Official Title
A Prospective Evaluation of the Cingal Injection for Hip Osteoarthritis (ECHO Study)
Study Type
Interventional

2. Study Status

Record Verification Date
September 2023
Overall Recruitment Status
Completed
Study Start Date
September 1, 2020 (Actual)
Primary Completion Date
June 7, 2023 (Actual)
Study Completion Date
June 7, 2023 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
McMaster University
Collaborators
Anika Therapeutics, Inc.

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
Osteoarthritis (OA) of the hip is one of the ten most disabling diseases in the developed world. Because OA gradually worsens over time, the sooner treatment is started, the more likely its impact is lessened. Hip OA is characterized by joint pain, cartilage degeneration, and an increase in disability. Multiple treatments are used to manage the degenerating hip as well as the associated pain. These include physiotherapy and rehabilitation, bracing, other walking aids, oral medications, injections, and in severe cases, surgery. Prior research has shown that injection of hyaluronic acid (HA) and corticosteroids can slow down OA degradation. This study will look at the effects of injecting Cingal into the hip, which expands on its current approved use in the treatment of knee OA.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Hip Osteoarthritis

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
100 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Cingal injection
Arm Type
Other
Arm Description
Cingal will be administered by fellowship-trained physicians through ultrasound-guided injection using a 21-gauge needle into the joint space of the hip under sterile conditions. The needle track will be anesthetized with local anesthetic.
Intervention Type
Device
Intervention Name(s)
Cingal
Intervention Description
Cingal will be administered by fellowship-trained physicians through ultrasound-guided injection using a 21-gauge needle into the joint space of the hip under sterile conditions. The needle track will be anesthetized with local anesthetic.
Primary Outcome Measure Information:
Title
Patient reported hip pain as measured by Visual Analog Scale
Description
The primary objective of this observational study is to determine, among individuals with hip OA ages 40-65 years, the effect of Cingal on patient-reported hip pain, as measured by a Visual Analogue Scale (VAS), at 6-months post-injection.
Time Frame
6 months
Secondary Outcome Measure Information:
Title
Hip Function, as measured by the Hip Disability and Osteoarthritis Outcome Score (HOOS)
Description
The HOOS was designed to assess patient opinions about their hip and associated problems in an adult population with a hip disability with or without OA. The HOOS has been extensively validated and consists of 5 subscales for pain, other symptoms, function in activities of daily living, function in sports and recreation, and hip-related quality of life.
Time Frame
6 months
Title
Health-related quality of life (HRQL) as measured by the Short Form-12 questionnaire (SF-12)
Description
The SF-12 may be self or interview-administered and can help document mental and physical components of quality of life. Points can range from 0-100, where a zero score indicates the lowest level of health and 100 indicates the highest level of health.
Time Frame
6 months
Title
Physical activity levels as measured by a wrist-worn activity tracker
Description
To be worn for one week prior to each follow-up visit.
Time Frame
6 months
Title
Complications, including infection and other adverse events at 6-months post-injection.
Description
Adverse events
Time Frame
6 months
Title
Range of motion
Description
ROM will be measured with standard anterior and posterior impingement tests, the log roll test, and hip flexion/extension, abduction/adduction, and internal/external rotation.
Time Frame
6 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
40 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Adult men or women ages 40 to 65 years Hip OA (mild to moderate) diagnosed on x-ray and/or MRI (Tonnis grade 1 and 2) Patient is using only nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen/ paracetamol (Tylenol) for pain relief during the month before receiving Cingal Patient is willing to stop pain/anti-inflammatory medication at least two weeks prior to receiving Cingal through the end of the study (6 months) Patient speaks, reads, and understands the language of the clinical site Provision of informed consent Exclusion Criteria: Evidence of hip dysplasia (centre edge angle less than 20 degrees) Presence of advanced hip OA (Tonnis Grade 3) Previous trauma to the affected hip requiring medical or surgical treatment Previous surgery on the affected hip or contralateral hip Severe acetabular deformities (e.g. acetabular protrusion, coxa profunda, circumferential labral ossification) Infections or skin diseases at target hip joint Immunosuppressive medication use Chronic pain syndromes Significant medical co-morbidities (requiring daily assistance for activities of daily living) History of paediatric hip disease (e.g. Legg-Calve-Perthes; slipped capital femoral epiphysis) Previous cartilage repair procedure (microfracture, Osteochondral Autograft Transplantation System (OATS) or Autologous Chondrocyte Implantation (ACI) with or without use of a scaffold (matrix) in the index hip) Known hypersensitivity (allergy) to hyaluronan preparations Known hypersensitivity (allergy) to triamcinolone hexacetonide preparations Known sensitivity to any of the materials in Cingal Patients with impaired cardio-renal function, endocrine, or other diseases or conditions that use of corticosteroid is warned HA intra-articular injections into the index hip within the last 6 months before receiving Cingal Corticosteroid therapy by systemic, intra-articular, or intramuscular route or oral corticosteroids within the last 6 months before receiving Cingal Any injection received in the hip prior to receiving or received concurrently with Cingal Uncontrolled diabetes Subject is a woman who is pregnant or breastfeeding or a woman of child bearing potential who refuses to use effective contraception during the course of the study Patient is incarcerated Any clinically significant or symptomatic vascular or neurologic disorder of the lower extremities Rheumatoid arthritis or gouty arthritis Current diagnosis of osteomyelitis Diagnosed musculoskeletal cancer or any diagnosed cancer, other than musculoskeletal if not on long term remission (e.g. at least 5 years or negative biopsy at last exam), except basal cell carcinoma Patients who are at higher risk for post-surgical bleeding (e.g., bleeding disorder; taking anticoagulants except low dose aspirin or anti-platelet agents [e.g. ASA, Plavix]) or post-surgical infection (e.g., taking immunosuppressants; have a severe infection or a history of serious infection) Participation in concurrent trial that involves a medical intervention Patient is currently receiving workman's compensation or disability, has been involved in an motor vehicle accident, or is in litigation for workman's compensation or disability claims Likely problems, in the judgment of the treating physician, with maintaining follow up (e.g. patients with no fixed address, plans to move out of town). This may include patients with severe mental disorders and drug addictions without adequate support.
Facility Information:
Facility Name
McMaster University
City
Hamilton
State/Province
Ontario
ZIP/Postal Code
L8N3Z5
Country
Canada

12. IPD Sharing Statement

Plan to Share IPD
No

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A Prospective Evaluation of the Cingal Injection for Hip Osteoarthritis

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