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Intra-articular Oxygen-ozone Therapy for the Treatment of Knee Osteoarthritis Compared With Hyaluronic Acid

Primary Purpose

Knee Osteoarthritis

Status
Unknown status
Phase
Phase 3
Locations
Italy
Study Type
Interventional
Intervention
Ozone
Hyaluronic Acid
Sponsored by
Humanitas Clinical and Research Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Knee Osteoarthritis focused on measuring Oxygene-Ozone, Ozone, Hyaluronic acid, Osteoarthritis

Eligibility Criteria

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

Inclusion Criteria:

  1. Male or female at least 18 years of age at time of screening.
  2. Ability to comply with study procedures and visit schedules and able to follow oral and written instructions.
  3. Patients with symptomatic OA in one knee from 3 months
  4. A standing knee radiograph showing a K-L grade of 2 to 3 and an absence of severe osteoarthritis (defined as advanced stage osteoarthritis, including large osteophytes, chronic fractures or bone remodeling, severe deformity or bone attrition, and/or bone-on-bone contact indicative of severe osteoarthritis/full thickness cartilage loss).
  5. Body mass index ≤ 40 kg/m2.
  6. A WOMAC LK 3.1 pain subscale total score ≥ 9 and ≤ 19.
  7. Has undergone at least one prior conservative OA treatment (e.g. physical therapy, simple analgesics).
  8. Signed an ethics committee-reviewed an approved informed consent form.

Exclusion Criteria:

  1. Presence of clinically observed active infection or severe inflammation in the index knee joint or skin disease/breakdown or infection in the area of the planned injection site of the index knee.
  2. Presence of symptomatic OA in the non-study knee at screening; if unclear then the WOMAC LK 3.1 pain subscale for the non-index knee must be ≤ 5.0.
  3. Diagnosed with rheumatoid arthritis, Reiter's syndrome, psoriatic arthritis, gout, ankylosing spondylitis, or arthritis secondary to other inflammatory diseases; Human Immunodeficiency Virus (HIV), viral hepatitis; chondrocalcinosis, Paget's disease, or villonodular synovitis.
  4. Diagnosed with leukemia, known presence of metastatic malignant cells, or ongoing or planned chemotherapeutic treatment.
  5. Disease of spine, hip or other lower extremity joints judged by the investigator to be contributing to the pain in the index knee (e.g. sciatica, nerve pain, hip OA). Note: Patients with contralateral knee replacement, or hip replacement in either hip, may be enrolled provided there is sufficient pain relief after knee replacement or hip replacement that analgesics are not required.
  6. Untreated symptomatic injury of the index knee (e.g., acute traumatic injury, anterior cruciate ligament injury, clinically symptomatic meniscus injury characterized by mechanical issue such as locking or catching).
  7. Presence of surgical hardware or other foreign body intended to treat arthritis or cartilage-related pathology in the index knee. Note: this does not include small hardware (e.g. screws).
  8. Presence of venous or lymphatic stasis in the index leg.
  9. Orally administered systemic steroid use within 2 weeks prior to screening
  10. Planned/anticipated surgery of the index knee during the study period.
  11. Major surgery of the index knee within 12 months prior to screening.
  12. Minor surgery (e.g. arthroscopy) of the index knee within 6 months prior to screening.
  13. Any documented clinically significant degree of cognitive impairment or other condition, finding, or psychiatric illness at screening, which, in the opinion of the investigator, could compromise patient safety or interfere with the assessment of the safety and treatment effects of the study injection.
  14. Pregnant or nursing mothers or women planning to become pregnant during the time they will be participating in the study.
  15. Know hypersensitivity (allergy) to hyaluronan (sodium hyaluronate) preparations.
  16. Previously documented failed treatment with OOT or Sinovial
  17. Known drug or alcohol dependence currently or within the last year.
  18. Use of any investigational drug or device within 30 days prior to screening.
  19. Use of any investigational biologics within 60 days prior to screening.

Sites / Locations

  • Humanitas Clinical and Research HospitalRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

Ozone

Hyaluronic acid

Arm Description

Participant will receive an intraarticular injection of oxygen-ozone, once a week for three weeks. During procedure a clear ultrasound image is to be taken to document needle placement in the synovial space. The injector may choose the position of the knee (e.g., extended or bent) and the approach for the injection (e.g., medial or lateral).

Participant will receive an intraarticular injection of hyaluronic acid, once a week for three weeks. During procedure a clear ultrasound image is to be taken to document needle placement in the synovial space. The injector may choose the position of the knee (e.g., extended or bent) and the approach for the injection (e.g., medial or lateral).

Outcomes

Primary Outcome Measures

Western Ontario and McMaster Universities Osteoarthritis Index using the Likert scale, Version 3.1, Pain subscale (WOMAC LK 3.1)
Assessment of pain. Score range 0-20. Higher scores indicate worse pain.

Secondary Outcome Measures

The Western Ontario and McMaster Universities Osteoarthritis Index using the Likert scale, Version 3.1(WOMAC LK 3.1)
Assessment of pain, stiffness and function. Score range 0-20 for Pain, 0-8 for Stiffness, and 0-68 for Physical Function. Higher scores indicate worse pain, stiffness, and functional limitations.
Numeric Rating Scale (NRS)
Assessment of pain. Score range 0-10. Higher scores indicate worse pain.
Knee Injury and Osteoarthritis Outcome Score (KOOS)
Assessment of Pain, other Symptoms, Function in daily living, Function in Sport and Recreation, and knee-related Quality of Life (QOL). Score range 0-100, with zero representing extreme knee problems and 100 representing no knee problems

Full Information

First Posted
June 8, 2020
Last Updated
June 13, 2020
Sponsor
Humanitas Clinical and Research Center
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1. Study Identification

Unique Protocol Identification Number
NCT04426721
Brief Title
Intra-articular Oxygen-ozone Therapy for the Treatment of Knee Osteoarthritis Compared With Hyaluronic Acid
Official Title
Intra-articular Oxygen-ozone Therapy for the Treatment of Knee Osteoarthritis: a Randomized, Double-blind, Clinical Trial Compared With Hyaluronic Acid
Study Type
Interventional

2. Study Status

Record Verification Date
June 2020
Overall Recruitment Status
Unknown status
Study Start Date
June 2020 (Anticipated)
Primary Completion Date
December 2021 (Anticipated)
Study Completion Date
December 2022 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Humanitas Clinical and Research Center

4. Oversight

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

5. Study Description

Brief Summary
Knee osteoarthritis is a very common pathology, characterized by pain, stiffness and functional deficit. The various therapeutic options used include anti-inflammatory drug treatment, physiokinesitherapy, minimally invasive procedures and, finally, in non-responsive cases, surgical treatment. To date, several studies have been conducted on the intra-articular use of oxygen-ozone in knee osteoarthritis and its potential therapeutic benefits. However, the methodological quality of the RCTs available in the literature is not satisfactory, so it is necessary to define a standardized protocol for therapy and procedures. The aim of this study will be to develop a rigorous protocol to evaluate the effectiveness of intra-articular oxygen-ozone therapy (OOT) in knee osteoarthritis and compare it with injection therapy with hyaluronic acid (HA), currently widely used in the treatment of knee osteoarthritis.
Detailed Description
Osteoarthritis is a degenerative condition that causes pain, impaired function and affects daily activities. In knee osteoarthritis, there is destruction of cartilage and subchondral bone, with the consequent narrowing of articular space. Besides the biomechanical factors, trauma and obesity; it is believed that inflammation plays an important role. Treatment options for painful knee osteoarthritis are often unsatisfactory, as represented by 40% of patients reporting persisting postoperative pain following total knee arthroplasty . There are no currently approved knee osteoarthritis treatments capable of slowing OA-related structural progression, so the main goals of the conservative treatment are to provide symptomatic relief, improve joint function, and delay surgical intervention. One of the main actions of intra-articular treatments, ranging from corticosteroids to hyaluronic acid (HA) and biologic products is to reduce inflammatory distress within the joint. In recent years, there has been a growing interest in the effects of ozone, which can be safely delivered intra-articularly and whose use is in constant increase in an outpatient setting due to the ease of preparation methods. From the literature, it is widely accepted that ozone has the biological properties of inducing analgesia, anti-inflammatory, and antioxidant effects mediated by activating the cellular metabolism and inhibiting prostaglandin synthesis, reduce edema and inflammation, and therefore reduce pain and improves function in knee osteoarthritis. Intra-articular oxygen-ozone has been used in the medical domain for several decades. Although some articles have reported promising results on the effectiveness of oxygen-ozone in knee osteoarthritis, the evidence is however low . Currently, few RCTs have compared the efficacy and safety of ozone therapy versus HA intra-articular injections in patients affected by knee osteoarthritis. This study will compare the efficacy of OOT injection to HA in patients with symptomatic OA in one knee, who have failed at least one prior conservative OA therapy (e.g. physiotherapy, simple analgesics). This will be done using a double blind, randomized controlled trial with study subjects receiving a cycle of three injection of OOT or HA. The primary efficacy measure will be pain measured by the WOMAC LK 3.1 scale; other measures of efficacy will include function, stiffness, and quality of life. In addition to clinical efficacy measures, safety will be assessed by tracking adverse events. During screening, potential subjects who provide informed consent will be assessed for eligibility. Screening will consist in checking the presence of inclusion and exclusion criteria, including a WOMAC LK 3.1 pain subscale score ≥ 9 and ≤ 19 and by providing objective physiological evidence of OA using the Kellgren-Lawrence scale (assessed from radiographs). Subjects will also provide demographic and medication use information. Baseline X-ray and MRI will be collected.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Knee Osteoarthritis
Keywords
Oxygene-Ozone, Ozone, Hyaluronic acid, Osteoarthritis

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
ParticipantOutcomes Assessor
Allocation
Randomized
Enrollment
120 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Ozone
Arm Type
Experimental
Arm Description
Participant will receive an intraarticular injection of oxygen-ozone, once a week for three weeks. During procedure a clear ultrasound image is to be taken to document needle placement in the synovial space. The injector may choose the position of the knee (e.g., extended or bent) and the approach for the injection (e.g., medial or lateral).
Arm Title
Hyaluronic acid
Arm Type
Active Comparator
Arm Description
Participant will receive an intraarticular injection of hyaluronic acid, once a week for three weeks. During procedure a clear ultrasound image is to be taken to document needle placement in the synovial space. The injector may choose the position of the knee (e.g., extended or bent) and the approach for the injection (e.g., medial or lateral).
Intervention Type
Drug
Intervention Name(s)
Ozone
Other Intervention Name(s)
Oxygene-Ozone therapy; O2-O3
Intervention Description
10 cc of oxygen-ozone
Intervention Type
Drug
Intervention Name(s)
Hyaluronic Acid
Other Intervention Name(s)
Sinovial forte
Intervention Description
Sinovial forte 32 mg\2ml
Primary Outcome Measure Information:
Title
Western Ontario and McMaster Universities Osteoarthritis Index using the Likert scale, Version 3.1, Pain subscale (WOMAC LK 3.1)
Description
Assessment of pain. Score range 0-20. Higher scores indicate worse pain.
Time Frame
3 months
Secondary Outcome Measure Information:
Title
The Western Ontario and McMaster Universities Osteoarthritis Index using the Likert scale, Version 3.1(WOMAC LK 3.1)
Description
Assessment of pain, stiffness and function. Score range 0-20 for Pain, 0-8 for Stiffness, and 0-68 for Physical Function. Higher scores indicate worse pain, stiffness, and functional limitations.
Time Frame
1,3,6,12 months
Title
Numeric Rating Scale (NRS)
Description
Assessment of pain. Score range 0-10. Higher scores indicate worse pain.
Time Frame
1,3,6,12 months
Title
Knee Injury and Osteoarthritis Outcome Score (KOOS)
Description
Assessment of Pain, other Symptoms, Function in daily living, Function in Sport and Recreation, and knee-related Quality of Life (QOL). Score range 0-100, with zero representing extreme knee problems and 100 representing no knee problems
Time Frame
1,3,6,12 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male or female at least 18 years of age at time of screening. Ability to comply with study procedures and visit schedules and able to follow oral and written instructions. Patients with symptomatic OA in one knee from 3 months A standing knee radiograph showing a K-L grade of 2 to 3 and an absence of severe osteoarthritis (defined as advanced stage osteoarthritis, including large osteophytes, chronic fractures or bone remodeling, severe deformity or bone attrition, and/or bone-on-bone contact indicative of severe osteoarthritis/full thickness cartilage loss). Body mass index ≤ 40 kg/m2. A WOMAC LK 3.1 pain subscale total score ≥ 9 and ≤ 19. Has undergone at least one prior conservative OA treatment (e.g. physical therapy, simple analgesics). Signed an ethics committee-reviewed an approved informed consent form. Exclusion Criteria: Presence of clinically observed active infection or severe inflammation in the index knee joint or skin disease/breakdown or infection in the area of the planned injection site of the index knee. Presence of symptomatic OA in the non-study knee at screening; if unclear then the WOMAC LK 3.1 pain subscale for the non-index knee must be ≤ 5.0. Diagnosed with rheumatoid arthritis, Reiter's syndrome, psoriatic arthritis, gout, ankylosing spondylitis, or arthritis secondary to other inflammatory diseases; Human Immunodeficiency Virus (HIV), viral hepatitis; chondrocalcinosis, Paget's disease, or villonodular synovitis. Diagnosed with leukemia, known presence of metastatic malignant cells, or ongoing or planned chemotherapeutic treatment. Disease of spine, hip or other lower extremity joints judged by the investigator to be contributing to the pain in the index knee (e.g. sciatica, nerve pain, hip OA). Note: Patients with contralateral knee replacement, or hip replacement in either hip, may be enrolled provided there is sufficient pain relief after knee replacement or hip replacement that analgesics are not required. Untreated symptomatic injury of the index knee (e.g., acute traumatic injury, anterior cruciate ligament injury, clinically symptomatic meniscus injury characterized by mechanical issue such as locking or catching). Presence of surgical hardware or other foreign body intended to treat arthritis or cartilage-related pathology in the index knee. Note: this does not include small hardware (e.g. screws). Presence of venous or lymphatic stasis in the index leg. Orally administered systemic steroid use within 2 weeks prior to screening Planned/anticipated surgery of the index knee during the study period. Major surgery of the index knee within 12 months prior to screening. Minor surgery (e.g. arthroscopy) of the index knee within 6 months prior to screening. Any documented clinically significant degree of cognitive impairment or other condition, finding, or psychiatric illness at screening, which, in the opinion of the investigator, could compromise patient safety or interfere with the assessment of the safety and treatment effects of the study injection. Pregnant or nursing mothers or women planning to become pregnant during the time they will be participating in the study. Know hypersensitivity (allergy) to hyaluronan (sodium hyaluronate) preparations. Previously documented failed treatment with OOT or Sinovial Known drug or alcohol dependence currently or within the last year. Use of any investigational drug or device within 30 days prior to screening. Use of any investigational biologics within 60 days prior to screening.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Cristiano Sconza, MD
Phone
3332781989
Ext
0039
Email
cristiano.sconza@humanitas.it
First Name & Middle Initial & Last Name or Official Title & Degree
Roberta Amenta, MD
Phone
3286935530
Ext
0039
Email
roberta8928@gmail.com
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Cristiano Sconza, MD
Organizational Affiliation
Humanitas Clinical and Research Hospital
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Berardo Di Matteo, MD, PhD
Organizational Affiliation
Humanitas Clinical and Research Hospital
Official's Role
Study Chair
Facility Information:
Facility Name
Humanitas Clinical and Research Hospital
City
Rozzano
State/Province
Milano
ZIP/Postal Code
20089
Country
Italy
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Cristiano Sconza, MD
Phone
3332781989
Email
cristiano.sconza@humanitas.it
First Name & Middle Initial & Last Name & Degree
Roberta Amenta, MD
Phone
3286935530
Email
roberta8928@gmail.com

12. IPD Sharing Statement

Plan to Share IPD
Undecided

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Intra-articular Oxygen-ozone Therapy for the Treatment of Knee Osteoarthritis Compared With Hyaluronic Acid

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