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2ccPA Study in Patients With Symptomatic Knee Osteoarthritis

Primary Purpose

Osteoarthritis (OA) of the Knee

Status
Completed
Phase
Phase 1
Locations
Taiwan
Study Type
Interventional
Intervention
2ccPA
placebo
Sponsored by
Orient Europharma Co., Ltd.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Osteoarthritis (OA) of the Knee focused on measuring 2ccPA

Eligibility Criteria

40 Years - 75 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Male or female subjects who are aged between 40 and 75 years old (inclusive)
  2. Subjects diagnosed with symptomatic knee OA for at least 6 months prior to study entry (randomization)
  3. Subjects whose radiographic evidence of knee OA are classified as grade II or III (according to Kellgren and Lawrence grading system)
  4. Subjects with OA knee pain on the majority of days in the past 30 days prior to study entry (randomization).
  5. A score of over 8 and below 16 out of 20 for the WOMAC pain subscale in the index knee in screening
  6. Male subjects must agree to practice medically acceptable contraceptive regimen (i.e., sterilization surgery, barrier method, abstention) from screening visit until at least 1 month after the study treatment.
  7. Subjects who are willing to sign the informed consent form (ICF)
  8. Subjects with normal liver and renal function:

ALT and AST do not exceed 1.5 ULN (upper limit of normal) Serum Cr levels do not exceed 1.0 ULN

Exclusion Criteria:

  1. Subjects with known hypersensitivity to study medication
  2. Female subjects who are pregnant or lactating. Women of childbearing potential must agree to practice medically acceptable contraceptive regimen from screening visit until at least 1 month after the study treatment and must have a negative urine pregnancy test no earlier than 72 hours prior to study treatment.
  3. Intra-articular use of corticosteroid, hyaluronic acid or other intra-articular injection in study knee within 3 months prior to study entry (randomization)
  4. Use of chondroitin and/ or glucosamine within 4 weeks prior to study entry (randomization)
  5. Subjects with known malignancy
  6. History of Reiter's syndrome, rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, lymphoma, arthritis associated with inflammatory bowel disease, sarcoidosis and amyloidosis
  7. Prior arthroscopic or open surgery on the study knee within 6 months prior to study entry (randomization)
  8. Clinical signs and symptoms of active knee infection or being treated for knee infection at screening
  9. Patients with active inflammation: patients with CRP higher than upper limit of normal range at screening visit will be excluded from the study.
  10. Subjects with concurrent medical or arthritic condition that could interfere with evaluation of the index knee joint, including fibromyalgia, based on investigator's clinical judgment
  11. More significant pain from the back or the hip than the knee
  12. Skin breakdown or lesion on the study knee that is not suitable for injection, based on investigator's discretion
  13. Prior knee replacement on the study knee or planned knee replacement during the study period
  14. Subjects with (1) meniscus tears which requires repairment surgery OR (2) anterior cruciate ligament rupture based on screening MRI results
  15. Patients with known severe synovitis, synovium necrosis in the target knee joint judged by investigator at screening
  16. Patients with PT/ APTT higher than the upper limit of normal range at screening
  17. History of drug or alcohol dependence in the past 3 years
  18. Having known infection with HIV-1, HBV, HCV
  19. Use of any investigational drug or participation in any drug study within 4 weeks prior to study entry (randomization)
  20. Subjects who are unwilling or unable to comply with study procedures
  21. Any clinical condition, including the presence of laboratory abnormalities, which places the subject at unacceptable risk to participate in the study or confounds the ability to interpret data from the study as judged by the investigator.

Sites / Locations

  • Veteran General Hospital Taipei
  • Tri-Service General Hospital
  • Mackay Memorial Hospital
  • Kaohsiung Chang Gung Memorial Hospital
  • National Cheng Kung University Hospital

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

2ccPA

Placebo

Arm Description

Only day 1 Intra-articular injection can be given under direct ultrasound guidance; the only one strength for 2ccPA injection vial is 2,400 μg (1.2 mL per vial). IP name: 2-carba-cyclic phosphatidic acid (2ccPA)

Only day 1 Intra-articular injection can be given under direct ultrasound guidance; placebo

Outcomes

Primary Outcome Measures

Adverse events will be coded with MedDRA and analyzed by system organ class (SOC) and preferred term. The number of subjects who experience DLT will be calculated at each dose level and the result of MTD will be provided.
To determine safety and tolerability as well as the maximal tolerated dose (MTD) of a single-dose 2ccPA in symptomatic knee OA

Secondary Outcome Measures

20% improvement in the The Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain and physical function subscales
Proportion of subjects with a 20% improvement in the WOMAC pain and physical function subscales on Day 2, Day 3, Day 8, Day 15, Day 29 post treatment, compared with placebo group and baseline
50% improvement in the The Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain and physical function subscales
Proportion of subjects with a 50% improvement in the WOMAC pain and physical function subscales on Day 2, Day 3, Day 8, Day 15, Day 29 post treatment, compared with placebo group and baseline
70% improvement in the The Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain and physical function subscales
Proportion of subjects with a 70% improvement in the WOMAC pain and physical function subscales on Day 2, Day 3, Day 8, Day 15, Day 29 post treatment, compared with placebo group and baseline
Maximum plasma concentration (Cmax) of 2ccPA
Pharmacokinetic profile of 2ccPA
Time to maximum plasma concentration (Tmax) of 2ccPA
Pharmacokinetic profile of 2ccPA
Area under plasma concentration-time curve (AUC) of 2ccPA
Pharmacokinetic profile of 2ccPA
Apparent total body clearance (CL/F) of 2ccPA
Pharmacokinetic profile of 2ccPA
Apparent volume of distribution (Vz/F) of 2ccPA
Pharmacokinetic profile of 2ccPA
Elimination half-life (t1/2) of 2ccPA
Pharmacokinetic profile of 2ccPA
Synovial fluid 2ccPA level
Changes from baseline (pre-dose) in synovial fluid 2ccPA and synovial fluid matrix metalloproteinase (MMP)-1, -3 and -13 levels at 24 hours after 2ccPA treatment
Synovial fluid matrix metalloproteinase (MMP)-1 level
Changes from baseline (pre-dose) in synovial fluid 2ccPA and synovial fluid matrix metalloproteinase (MMP)-1, -3 and -13 levels at 24 hours after 2ccPA treatment
Synovial fluid matrix metalloproteinase (MMP)-3 level
Changes from baseline (pre-dose) in synovial fluid 2ccPA and synovial fluid matrix metalloproteinase (MMP)-1, -3 and -13 levels at 24 hours after 2ccPA treatment
Synovial fluid matrix metalloproteinase (MMP)-13 level
Changes from baseline (pre-dose) in synovial fluid 2ccPA and synovial fluid matrix metalloproteinase (MMP)-1, -3 and -13 levels at 24 hours after 2ccPA treatment
Serum prostaglandin E2 (PGE2) level
Changes from baseline (pre-dose) in serum prostaglandin E2 (PGE2) levels at 30 minutes, 1 hour, 2 hours, 4 hours, 12 hours and 24 hours after 2ccPA treatment
Serum matrix metalloproteinase (MMP)-1 level
Changes from baseline (pre-dose) in serum matrix metalloproteinase (MMP)-1,at 30 minutes, 1 hour, 2 hours, 4 hours, 12 hours and 24 hours after 2ccPA treatment
Serum matrix metalloproteinase (MMP)-3 levels
Changes from baseline (pre-dose) in serum matrix metalloproteinase (MMP)-3,at 30 minutes, 1 hour, 2 hours, 4 hours, 12 hours and 24 hours after 2ccPA treatment
Serum matrix metalloproteinase (MMP)-13 level
Changes from baseline (pre-dose) in serum matrix metalloproteinase (MMP)-13,at 30 minutes, 1 hour, 2 hours, 4 hours, 12 hours and 24 hours after 2ccPA treatment
Plasma concentration of 2ccPA
Plasma concentration of 2ccPA at pre-dose and at 15 minutes, 30 minutes, 1 hour, 2 hours, 4 hours, 6 hours, 8 hours, 12 hours, 24 hours and 48 hours after 2ccPA treatment
Joint space narrowing
To investigate joint space narrowing by MRI at Day 85, compared with baseline and the placebo group
Ectopic bone formation
To investigate ectopic bone formation by MRI at Day 85, compared with baseline and the placebo group

Full Information

First Posted
April 10, 2018
Last Updated
April 29, 2021
Sponsor
Orient Europharma Co., Ltd.
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1. Study Identification

Unique Protocol Identification Number
NCT04229394
Brief Title
2ccPA Study in Patients With Symptomatic Knee Osteoarthritis
Official Title
Phase I Safety, Tolerability, and Pharmacokinetics Study of 2ccPA in Patients With Symptomatic Knee Osteoarthritis
Study Type
Interventional

2. Study Status

Record Verification Date
April 2021
Overall Recruitment Status
Completed
Study Start Date
February 13, 2018 (Actual)
Primary Completion Date
March 22, 2021 (Actual)
Study Completion Date
March 22, 2021 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Orient Europharma Co., Ltd.

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
This clinical trial is designed to determine safety and tolerability as well as the MTD of a single-dose 2ccPA and PK data in symptomatic knee OA.
Detailed Description
Osteoarthritis (OA) is a degenerative disease frequently associated with symptoms such as inflammation, stiffness, muscle weakness, joint swollen and joint pain. 2-carba-cyclic phosphatidic acid (2ccPA) is the derivative of natural occurring phospholipid mediator, cyclic phosphatidic acid (cPA). Previous studies suggested that 2ccPA inhibits inflammation and may relieve the pain caused by osteoarthritis. This clinical study aims to assess the safety, tolerability, and pharmacokinetics as well as the maximal tolerated dose (MTD) of a single-dose 2ccPA in symptomatic knee OA. Safety and efficacy data for the design and conduction of subsequent studies will also be collected.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Osteoarthritis (OA) of the Knee
Keywords
2ccPA

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Masking Description
The subjects and study site personnel (other than the study site pharmacists) are all blinded to the treatment assignment. An un-blind pharmacist is necessary for study drug preparation.
Allocation
Randomized
Enrollment
40 (Actual)

8. Arms, Groups, and Interventions

Arm Title
2ccPA
Arm Type
Experimental
Arm Description
Only day 1 Intra-articular injection can be given under direct ultrasound guidance; the only one strength for 2ccPA injection vial is 2,400 μg (1.2 mL per vial). IP name: 2-carba-cyclic phosphatidic acid (2ccPA)
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Only day 1 Intra-articular injection can be given under direct ultrasound guidance; placebo
Intervention Type
Drug
Intervention Name(s)
2ccPA
Other Intervention Name(s)
2-carba-cyclic phosphatidic acid
Intervention Description
Four dose cohorts (50 μg, 200 μg, 800 μg, and 2,400 μg) are planned in this study sequentially. study group: one dose intra-articular on day1
Intervention Type
Drug
Intervention Name(s)
placebo
Intervention Description
A total of 8 subjects will be recruited and randomized in each dose cohort with a 3:1 ratio (6 subjects in the 2ccPA treatment arm and 2 subjects in the placebo arm). control group: one dose intra-articular on day 1
Primary Outcome Measure Information:
Title
Adverse events will be coded with MedDRA and analyzed by system organ class (SOC) and preferred term. The number of subjects who experience DLT will be calculated at each dose level and the result of MTD will be provided.
Description
To determine safety and tolerability as well as the maximal tolerated dose (MTD) of a single-dose 2ccPA in symptomatic knee OA
Time Frame
85 days
Secondary Outcome Measure Information:
Title
20% improvement in the The Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain and physical function subscales
Description
Proportion of subjects with a 20% improvement in the WOMAC pain and physical function subscales on Day 2, Day 3, Day 8, Day 15, Day 29 post treatment, compared with placebo group and baseline
Time Frame
85 days
Title
50% improvement in the The Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain and physical function subscales
Description
Proportion of subjects with a 50% improvement in the WOMAC pain and physical function subscales on Day 2, Day 3, Day 8, Day 15, Day 29 post treatment, compared with placebo group and baseline
Time Frame
85 days
Title
70% improvement in the The Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain and physical function subscales
Description
Proportion of subjects with a 70% improvement in the WOMAC pain and physical function subscales on Day 2, Day 3, Day 8, Day 15, Day 29 post treatment, compared with placebo group and baseline
Time Frame
85 days
Title
Maximum plasma concentration (Cmax) of 2ccPA
Description
Pharmacokinetic profile of 2ccPA
Time Frame
at baseline (pre-dose), 15 ± 5 minutes, 30 ± 5 minutes, 1 hour ± 10 minutes, 2 hours ± 10 minutes, 4 hours ± 10 minutes, 6 hours ± 10 minutes, 8 hours ± 10 minutes, 12 ± 2 hours, 24 ± 2 hours (Day 2) and 48 ± 2 hours (Day 3) after 2ccPA treatment.
Title
Time to maximum plasma concentration (Tmax) of 2ccPA
Description
Pharmacokinetic profile of 2ccPA
Time Frame
at baseline (pre-dose), 15 ± 5 minutes, 30 ± 5 minutes, 1 hour ± 10 minutes, 2 hours ± 10 minutes, 4 hours ± 10 minutes, 6 hours ± 10 minutes, 8 hours ± 10 minutes, 12 ± 2 hours, 24 ± 2 hours (Day 2) and 48 ± 2 hours (Day 3) after 2ccPA treatment.
Title
Area under plasma concentration-time curve (AUC) of 2ccPA
Description
Pharmacokinetic profile of 2ccPA
Time Frame
at baseline (pre-dose), 15 ± 5 minutes, 30 ± 5 minutes, 1 hour ± 10 minutes, 2 hours ± 10 minutes, 4 hours ± 10 minutes, 6 hours ± 10 minutes, 8 hours ± 10 minutes, 12 ± 2 hours, 24 ± 2 hours (Day 2) and 48 ± 2 hours (Day 3) after 2ccPA treatment.
Title
Apparent total body clearance (CL/F) of 2ccPA
Description
Pharmacokinetic profile of 2ccPA
Time Frame
at baseline (pre-dose), 15 ± 5 minutes, 30 ± 5 minutes, 1 hour ± 10 minutes, 2 hours ± 10 minutes, 4 hours ± 10 minutes, 6 hours ± 10 minutes, 8 hours ± 10 minutes, 12 ± 2 hours, 24 ± 2 hours (Day 2) and 48 ± 2 hours (Day 3) after 2ccPA treatment.
Title
Apparent volume of distribution (Vz/F) of 2ccPA
Description
Pharmacokinetic profile of 2ccPA
Time Frame
at baseline (pre-dose), 15 ± 5 minutes, 30 ± 5 minutes, 1 hour ± 10 minutes, 2 hours ± 10 minutes, 4 hours ± 10 minutes, 6 hours ± 10 minutes, 8 hours ± 10 minutes, 12 ± 2 hours, 24 ± 2 hours (Day 2) and 48 ± 2 hours (Day 3) after 2ccPA treatment.
Title
Elimination half-life (t1/2) of 2ccPA
Description
Pharmacokinetic profile of 2ccPA
Time Frame
at baseline (pre-dose), 15 ± 5 minutes, 30 ± 5 minutes, 1 hour ± 10 minutes, 2 hours ± 10 minutes, 4 hours ± 10 minutes, 6 hours ± 10 minutes, 8 hours ± 10 minutes, 12 ± 2 hours, 24 ± 2 hours (Day 2) and 48 ± 2 hours (Day 3) after 2ccPA treatment.
Title
Synovial fluid 2ccPA level
Description
Changes from baseline (pre-dose) in synovial fluid 2ccPA and synovial fluid matrix metalloproteinase (MMP)-1, -3 and -13 levels at 24 hours after 2ccPA treatment
Time Frame
before intra-articular injection treatment and 24 hours ± 2 hours after intra-articular injection.
Title
Synovial fluid matrix metalloproteinase (MMP)-1 level
Description
Changes from baseline (pre-dose) in synovial fluid 2ccPA and synovial fluid matrix metalloproteinase (MMP)-1, -3 and -13 levels at 24 hours after 2ccPA treatment
Time Frame
before intra-articular injection treatment and 24 hours ± 2 hours after intra-articular injection.
Title
Synovial fluid matrix metalloproteinase (MMP)-3 level
Description
Changes from baseline (pre-dose) in synovial fluid 2ccPA and synovial fluid matrix metalloproteinase (MMP)-1, -3 and -13 levels at 24 hours after 2ccPA treatment
Time Frame
before intra-articular injection treatment and 24 hours ± 2 hours after intra-articular injection.
Title
Synovial fluid matrix metalloproteinase (MMP)-13 level
Description
Changes from baseline (pre-dose) in synovial fluid 2ccPA and synovial fluid matrix metalloproteinase (MMP)-1, -3 and -13 levels at 24 hours after 2ccPA treatment
Time Frame
before intra-articular injection treatment and 24 hours ± 2 hours after intra-articular injection.
Title
Serum prostaglandin E2 (PGE2) level
Description
Changes from baseline (pre-dose) in serum prostaglandin E2 (PGE2) levels at 30 minutes, 1 hour, 2 hours, 4 hours, 12 hours and 24 hours after 2ccPA treatment
Time Frame
at 1 hour, 12 hours, 24 hours, 48 hours, Day 8 and Day 15 (PGE2 only) after 2ccPA treatment
Title
Serum matrix metalloproteinase (MMP)-1 level
Description
Changes from baseline (pre-dose) in serum matrix metalloproteinase (MMP)-1,at 30 minutes, 1 hour, 2 hours, 4 hours, 12 hours and 24 hours after 2ccPA treatment
Time Frame
at 1 hour, 12 hours, 24 hours, 48 hours, Day 8 and Day 15 (PGE2 only) after 2ccPA treatment
Title
Serum matrix metalloproteinase (MMP)-3 levels
Description
Changes from baseline (pre-dose) in serum matrix metalloproteinase (MMP)-3,at 30 minutes, 1 hour, 2 hours, 4 hours, 12 hours and 24 hours after 2ccPA treatment
Time Frame
at 1 hour, 12 hours, 24 hours, 48 hours, Day 8 and Day 15 (PGE2 only) after 2ccPA treatment
Title
Serum matrix metalloproteinase (MMP)-13 level
Description
Changes from baseline (pre-dose) in serum matrix metalloproteinase (MMP)-13,at 30 minutes, 1 hour, 2 hours, 4 hours, 12 hours and 24 hours after 2ccPA treatment
Time Frame
at 1 hour, 12 hours, 24 hours, 48 hours, Day 8 and Day 15 (PGE2 only) after 2ccPA treatment
Title
Plasma concentration of 2ccPA
Description
Plasma concentration of 2ccPA at pre-dose and at 15 minutes, 30 minutes, 1 hour, 2 hours, 4 hours, 6 hours, 8 hours, 12 hours, 24 hours and 48 hours after 2ccPA treatment
Time Frame
at pre-dose and at 15 minutes, 30 minutes, 1 hour, 2 hours, 4 hours, 6 hours, 8 hours, 12 hours, 24 hours and 48 hours after 2ccPA treatment
Title
Joint space narrowing
Description
To investigate joint space narrowing by MRI at Day 85, compared with baseline and the placebo group
Time Frame
85 days
Title
Ectopic bone formation
Description
To investigate ectopic bone formation by MRI at Day 85, compared with baseline and the placebo group
Time Frame
85 days

10. Eligibility

Sex
All
Minimum Age & Unit of Time
40 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male or female subjects who are aged between 40 and 75 years old (inclusive) Subjects diagnosed with symptomatic knee OA for at least 6 months prior to study entry (randomization) Subjects whose radiographic evidence of knee OA are classified as grade II or III (according to Kellgren and Lawrence grading system) Subjects with OA knee pain on the majority of days in the past 30 days prior to study entry (randomization). A score of over 8 and below 16 out of 20 for the WOMAC pain subscale in the index knee in screening Male subjects must agree to practice medically acceptable contraceptive regimen (i.e., sterilization surgery, barrier method, abstention) from screening visit until at least 1 month after the study treatment. Subjects who are willing to sign the informed consent form (ICF) Subjects with normal liver and renal function: ALT and AST do not exceed 1.5 ULN (upper limit of normal) Serum Cr levels do not exceed 1.0 ULN Exclusion Criteria: Subjects with known hypersensitivity to study medication Female subjects who are pregnant or lactating. Women of childbearing potential must agree to practice medically acceptable contraceptive regimen from screening visit until at least 1 month after the study treatment and must have a negative urine pregnancy test no earlier than 72 hours prior to study treatment. Intra-articular use of corticosteroid, hyaluronic acid or other intra-articular injection in study knee within 3 months prior to study entry (randomization) Use of chondroitin and/ or glucosamine within 4 weeks prior to study entry (randomization) Subjects with known malignancy History of Reiter's syndrome, rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, lymphoma, arthritis associated with inflammatory bowel disease, sarcoidosis and amyloidosis Prior arthroscopic or open surgery on the study knee within 6 months prior to study entry (randomization) Clinical signs and symptoms of active knee infection or being treated for knee infection at screening Patients with active inflammation: patients with CRP higher than upper limit of normal range at screening visit will be excluded from the study. Subjects with concurrent medical or arthritic condition that could interfere with evaluation of the index knee joint, including fibromyalgia, based on investigator's clinical judgment More significant pain from the back or the hip than the knee Skin breakdown or lesion on the study knee that is not suitable for injection, based on investigator's discretion Prior knee replacement on the study knee or planned knee replacement during the study period Subjects with (1) meniscus tears which requires repairment surgery OR (2) anterior cruciate ligament rupture based on screening MRI results Patients with known severe synovitis, synovium necrosis in the target knee joint judged by investigator at screening Patients with PT/ APTT higher than the upper limit of normal range at screening History of drug or alcohol dependence in the past 3 years Having known infection with HIV-1, HBV, HCV Use of any investigational drug or participation in any drug study within 4 weeks prior to study entry (randomization) Subjects who are unwilling or unable to comply with study procedures Any clinical condition, including the presence of laboratory abnormalities, which places the subject at unacceptable risk to participate in the study or confounds the ability to interpret data from the study as judged by the investigator.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Hsiang-Cheng Chen, PHD
Organizational Affiliation
Tri-Service General Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
Veteran General Hospital Taipei
City
Taipei
ZIP/Postal Code
112
Country
Taiwan
Facility Name
Tri-Service General Hospital
City
Taipei
ZIP/Postal Code
114
Country
Taiwan
Facility Name
Mackay Memorial Hospital
City
Taipei
ZIP/Postal Code
25160
Country
Taiwan
Facility Name
Kaohsiung Chang Gung Memorial Hospital
City
Taipei
ZIP/Postal Code
833
Country
Taiwan
Facility Name
National Cheng Kung University Hospital
City
Taipei
Country
Taiwan

12. IPD Sharing Statement

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2ccPA Study in Patients With Symptomatic Knee Osteoarthritis

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