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The Anti-Freaze-F Study- "Anti-TNF for Treatment of Frozen Shoulder - a Feasibility Study" (Anti-FreazeF)

Primary Purpose

Frozen Shoulder

Status
Completed
Phase
Phase 2
Locations
United Kingdom
Study Type
Interventional
Intervention
Adalimumab Injection
Placebo
Sponsored by
University of Oxford
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Frozen Shoulder focused on measuring Adhesive capsulitis

Eligibility Criteria

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

Inclusion Criteria:

  1. Men and women aged 18 years and above.
  2. With a new episode of shoulder pain attributable to pain-predominant stage of frozen shoulder (i.e. within approximately 3 months of onset of symptoms) diagnosed using criteria set out in the BESS guidelines (33) (Appendix 1);
  3. Who are not being considered for surgery;
  4. Able to understand spoken and written English;
  5. Willing and able to give informed consent for trial participation and comply with all study requirements and time line;
  6. Willing to allow his or her General Practitioner be notified of participation in the trial.
  7. If female and of child-bearing potential OR if male and their partner is of child-bearing potential - willing to use effective contraception throughout the treatment period and for 5 months after the last injection.-

Exclusion Criteria:

  1. Those with frozen shoulder secondary to significant shoulder trauma (e.g., dislocation, fracture or full thickness tear requiring surgery) or other causes (e.g. recent breast cancer surgery or radiotherapy);
  2. Those with a neurological disease affecting the shoulder;
  3. Those with bilateral concurrent frozen shoulder;
  4. Those with other shoulder disorders (e.g., inflammatory arthritis, rotator cuff disorders, glenohumeral joint instability) or with red flags consistent with the criteria set out in the BESS guidelines (33);
  5. Those who have received corticosteroid injection for shoulder pain in the last 12 weeks to either shoulder;
  6. Those currently taking any anti-TNF drug;
  7. Those being treated with coumarin anticoagulants, such as warfarin;
  8. Those who have participated in another research study involving an investigational medicinal product in the past 12 weeks;
  9. Those with significant renal or hepatic impairment;
  10. Those with contra-indications to anti-TNF injection:

10.1 Known allergy to any anti-TNF agent or any of the excipients; 10.2 Known Active tuberculosis (TB) or history of TB. 10.3 Known Active infection (chronic or localised) or known history of recurring infections or condition which may predispose patients to infection, including the use of concomitant immunosuppressive medications; 10.4 Known Moderate to severe heart failure (NYHA class III/IV); 10.5 Those known to have HIV, Hepatitis B or C; 10.6 Those at risk of Hepatitis B infection; 10.7 Those diagnosed with Multiple Sclerosis (MS) or other central or peripheral nervous system demyelinating disorders; 10.8 Those who have ever been diagnosed with cancer, except basal cell carcinoma (BCC); 10.9 Those requiring live vaccination prior towithin 12 weeks after of the last trial injection or within the 4 weeks prior to randomisation; 10.10 Those taking biologic DMARDS; 10.11 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

Sites / Locations

  • Good Hope Hospital
  • Conquest Hospital
  • Grantham & District Hospital, United Lincolnshire Hospitals
  • Sandwell General Hospital

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Placebo Comparator

Arm Label

Arm A

Arm B

Arm Description

Participants will receive 2 injections of adalimumab. First injection: 160mg in 3.2ml Second injection approximately 2-3 weeks later 80mg in 1.6ml

Participants will receive 2 injections of placebo First injection: 3.2ml Second injection approximately 2-3 weeks later 1.6ml

Outcomes

Primary Outcome Measures

Rate of recruitment of participants with pain predominant frozen shoulder
Ability to screen and identify potential participants with pain-predominant early stage frozen shoulder (i.e. within approximately 3 months of onset of symptoms).
Number of participants consenting to be included in the trial .
Willingness of eligible participants to consent and be randomised to intervention.
Days between baseline assessment and time to first injection.
Practicalities of delivering the intervention, including time to first injection (within 2 weeks of randomisation).
Days Between first injection and second injection.
Practicalities of delivering the intervention, including time between first injection and second injection (within 4-6 weeks of randomisation).
Standard deviation of the Shoulder Pain and Disability Index (SPADI) score and attrition rate at 3 months from baseline in order to estimate the sample size for a definitive trial.
SPADI score range from 0 to 100, lower scores indicate better outcome

Secondary Outcome Measures

Pain (Shoulder Pain And Disability Index, 5-item subscale)
score range from 0 to 100, lower scores indicate better outcome
Function (Shoulder Pain And Disability Index, 8-item subscale)
score range from 0 to 100, lower scores indicate better outcome
Fear Avoidance Belief Questionnaire
score range from 0 to 24, higher scores indicate better outcomes
Pain Self Efficacy Questionnaire
score range from 0 to 12, higher scores indicate better outcomes
Insomnia Severity Index
Sleep disturbance will be measured using the Insomnia Severity Index, score range from 0 to 28, higher scores indicate worse outcomes
Return to desired activities (RDA)
Return to desired activities will be measured using an adapted version of the Disabilities of the Arm, Shoulder and Hand (QUICKDASH) questionnaire
Global impression of change
this will be measured using the Likert scale, score range from -5 to +5, higher scores indicate better outcomes
Number of visits to Healthcare Professionals
Adverse events graded 3 or above (clinician assessed) related to intra-articular injection of adalimumab in the shoulder
Shoulder range of motion in degrees using a goniometer

Full Information

First Posted
February 17, 2022
Last Updated
June 14, 2023
Sponsor
University of Oxford
Collaborators
National Institute for Health Research, United Kingdom, 180 Life Sciences
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1. Study Identification

Unique Protocol Identification Number
NCT05299242
Brief Title
The Anti-Freaze-F Study- "Anti-TNF for Treatment of Frozen Shoulder - a Feasibility Study"
Acronym
Anti-FreazeF
Official Title
Anti-TNF (Adalimumab) Injection for the Treatment of Adults With Frozen Shoulder During the Pain-predominant Phase: a Multi-centre, Randomised, Double Blind, Parallel Group, Feasibility Study
Study Type
Interventional

2. Study Status

Record Verification Date
November 2022
Overall Recruitment Status
Completed
Study Start Date
July 21, 2022 (Actual)
Primary Completion Date
May 9, 2023 (Actual)
Study Completion Date
June 12, 2023 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University of Oxford
Collaborators
National Institute for Health Research, United Kingdom, 180 Life Sciences

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
Frozen shoulder is a common condition affecting approximately 9% of people aged 25-64 years. During the early phase the pain is usually unbearable and the later restriction in movement is severely limiting. It occurs when the flexible tissue (capsule) that surrounds the shoulder joint becomes inflamed, thickened and tight. The pain can be very severe and lasts 3-9 months, followed by a 4-12 month period of increasing stiffness, after which the condition usually improves. Frozen shoulder often affects a person's ability to sleep, carry out everyday activities, and work. Current treatments include rest, painkillers, anti-inflammatories, physiotherapy and steroid injections. If stiffness persists, surgery is sometimes recommended. However, there is no evidence that any of these treatments lead to significant benefit in the long term, with many being ineffective. The aim of this study is to find out if it is possible to run a larger trial to test whether an injection of adalimumab can reduce pain and prevent the disease from getting worse, if given during the early painful phase of frozen shoulder. The investigators need to conduct this smaller study first to be sure it's possible to identify and treat people with early stage frozen shoulder, before they conduct a much larger trial to find out if this treatment works. In this study the investigators will include 84 adults from 5 sites with painful early stage frozen shoulder who have not yet received treatment. People will be randomised to receive either an injection of the drug adalimumab or a dummy injection of saline (placebo) directly into the shoulder joint, both guided by ultrasound. All participants will also receive standardized advice on how to manage their shoulder pain. The investigators will assess participants before treatment and three months later. Adalimumab has been used very successfully to treat other inflammatory diseases such as rheumatoid arthritis. This study has been funded by the NIHR RfPB programme and 180 Life Sciences.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Frozen Shoulder
Keywords
Adhesive capsulitis

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2, Phase 3
Interventional Study Model
Sequential Assignment
Model Description
Participants will be randomised to either receive Adalimumab or Placebo.
Masking
ParticipantInvestigatorOutcomes Assessor
Masking Description
The participant will be blinded along with the assessor and other site staff. The injector and pharmacy will not be blinded.
Allocation
Randomized
Enrollment
9 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Arm A
Arm Type
Active Comparator
Arm Description
Participants will receive 2 injections of adalimumab. First injection: 160mg in 3.2ml Second injection approximately 2-3 weeks later 80mg in 1.6ml
Arm Title
Arm B
Arm Type
Placebo Comparator
Arm Description
Participants will receive 2 injections of placebo First injection: 3.2ml Second injection approximately 2-3 weeks later 1.6ml
Intervention Type
Drug
Intervention Name(s)
Adalimumab Injection
Intervention Description
40mg in 0.8ml preparation in vials from Fresenius Kabi Ltd
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Saline [0.9% NaCl]
Primary Outcome Measure Information:
Title
Rate of recruitment of participants with pain predominant frozen shoulder
Description
Ability to screen and identify potential participants with pain-predominant early stage frozen shoulder (i.e. within approximately 3 months of onset of symptoms).
Time Frame
At 12 Months
Title
Number of participants consenting to be included in the trial .
Description
Willingness of eligible participants to consent and be randomised to intervention.
Time Frame
At 12 Months
Title
Days between baseline assessment and time to first injection.
Description
Practicalities of delivering the intervention, including time to first injection (within 2 weeks of randomisation).
Time Frame
at 2 weeks
Title
Days Between first injection and second injection.
Description
Practicalities of delivering the intervention, including time between first injection and second injection (within 4-6 weeks of randomisation).
Time Frame
At 6 weeks
Title
Standard deviation of the Shoulder Pain and Disability Index (SPADI) score and attrition rate at 3 months from baseline in order to estimate the sample size for a definitive trial.
Description
SPADI score range from 0 to 100, lower scores indicate better outcome
Time Frame
3 Months
Secondary Outcome Measure Information:
Title
Pain (Shoulder Pain And Disability Index, 5-item subscale)
Description
score range from 0 to 100, lower scores indicate better outcome
Time Frame
These will be recorded at baseline and 3 months
Title
Function (Shoulder Pain And Disability Index, 8-item subscale)
Description
score range from 0 to 100, lower scores indicate better outcome
Time Frame
These will be recorded at baseline and 3 months
Title
Fear Avoidance Belief Questionnaire
Description
score range from 0 to 24, higher scores indicate better outcomes
Time Frame
This will be measured at baseline and 3 months
Title
Pain Self Efficacy Questionnaire
Description
score range from 0 to 12, higher scores indicate better outcomes
Time Frame
These will be recorded at baseline and 3 months
Title
Insomnia Severity Index
Description
Sleep disturbance will be measured using the Insomnia Severity Index, score range from 0 to 28, higher scores indicate worse outcomes
Time Frame
These will be recorded at baseline and 3 months
Title
Return to desired activities (RDA)
Description
Return to desired activities will be measured using an adapted version of the Disabilities of the Arm, Shoulder and Hand (QUICKDASH) questionnaire
Time Frame
These will be recorded at baseline and 3 months
Title
Global impression of change
Description
this will be measured using the Likert scale, score range from -5 to +5, higher scores indicate better outcomes
Time Frame
These will be recorded at baseline and 3 months
Title
Number of visits to Healthcare Professionals
Time Frame
These will be recorded at baseline and 3 months
Title
Adverse events graded 3 or above (clinician assessed) related to intra-articular injection of adalimumab in the shoulder
Time Frame
These will be recorded after the first injection and at 3 months
Title
Shoulder range of motion in degrees using a goniometer
Time Frame
These will be recorded at baseline and 3 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Men and women aged 18 years and above. With a new episode of shoulder pain attributable to pain-predominant stage of frozen shoulder (i.e. within approximately 3 months of onset of symptoms) diagnosed using criteria set out in the BESS guidelines (33) (Appendix 1); Who are not being considered for surgery; Able to understand spoken and written English; Willing and able to give informed consent for trial participation and comply with all study requirements and time line; Willing to allow his or her General Practitioner be notified of participation in the trial. If female and of child-bearing potential OR if male and their partner is of child-bearing potential - willing to use effective contraception throughout the treatment period and for 5 months after the last injection.- Exclusion Criteria: Those with frozen shoulder secondary to significant shoulder trauma (e.g., dislocation, fracture or full thickness tear requiring surgery) or other causes (e.g. recent breast cancer surgery or radiotherapy); Those with a neurological disease affecting the shoulder; Those with bilateral concurrent frozen shoulder; Those with other shoulder disorders (e.g., inflammatory arthritis, rotator cuff disorders, glenohumeral joint instability) or with red flags consistent with the criteria set out in the BESS guidelines (33); Those who have received corticosteroid injection for shoulder pain in the last 12 weeks to either shoulder; Those currently taking any anti-TNF drug; Those being treated with coumarin anticoagulants, such as warfarin; Those who have participated in another research study involving an investigational medicinal product in the past 12 weeks; Those with significant renal or hepatic impairment; Those with contra-indications to anti-TNF injection: 10.1 Known allergy to any anti-TNF agent or any of the excipients; 10.2 Known Active tuberculosis (TB) or history of TB. 10.3 Known Active infection (chronic or localised) or known history of recurring infections or condition which may predispose patients to infection, including the use of concomitant immunosuppressive medications; 10.4 Known Moderate to severe heart failure (NYHA class III/IV); 10.5 Those known to have HIV, Hepatitis B or C; 10.6 Those at risk of Hepatitis B infection; 10.7 Those diagnosed with Multiple Sclerosis (MS) or other central or peripheral nervous system demyelinating disorders; 10.8 Those who have ever been diagnosed with cancer, except basal cell carcinoma (BCC); 10.9 Those requiring live vaccination prior towithin 12 weeks after of the last trial injection or within the 4 weeks prior to randomisation; 10.10 Those taking biologic DMARDS; 10.11 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
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Jagdeep Nanchahal
Organizational Affiliation
University of Oxford
Official's Role
Principal Investigator
Facility Information:
Facility Name
Good Hope Hospital
City
Sutton Coldfield
State/Province
Birmingham
ZIP/Postal Code
B75 7RR
Country
United Kingdom
Facility Name
Conquest Hospital
City
Saint Leonards-on-Sea
State/Province
Hastings
ZIP/Postal Code
TN37 7RD
Country
United Kingdom
Facility Name
Grantham & District Hospital, United Lincolnshire Hospitals
City
Grantham
State/Province
Lincolnshire
ZIP/Postal Code
NG31 8DG
Country
United Kingdom
Facility Name
Sandwell General Hospital
City
West Bromwich
State/Province
West Midlands
ZIP/Postal Code
B71 4HJ
Country
United Kingdom

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
Summary results data will be available on the trial registration database within 12 months of the end of the trial. Requests for data (anonymised participant data) will only be provided at the end of the trial to external researchers who provide a methodologically sound proposal to the trial team aff@kennedy.ox.ac.uk (will be required to sign a data sharing access agreement with the Sponsor) and in accordance with the NIHR guidance. Participant consent for this is included in the informed consent form for the study
IPD Sharing Access Criteria
Available on request

Learn more about this trial

The Anti-Freaze-F Study- "Anti-TNF for Treatment of Frozen Shoulder - a Feasibility Study"

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