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Hydroxychloroquine/Atorvastatin in the Treatment of Osteoarthritis (OA) of the Knee

Primary Purpose

Osteoarthritis of the Knee

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Hydroxychloroquine/Atorvastatin
Sponsored by
Stanford University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Osteoarthritis of the Knee focused on measuring OA, Knee

Eligibility Criteria

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

Inclusion Criteria:

  1. Ambulatory subjects with OA of the knee with symptoms for at least 6 months and pain on the majority of days in the last 30 days. Symptoms must include knee joint pain.
  2. Male or female adults age >40 years with a body mass index <35
  3. Radiographic evidence of at least one osteophyte in either knee on posteroanterior (PA) and lateral standing, flexed x-ray.
  4. A Kellegren-Lawrence score of 2-3, or KL score of 1 accompanied by a clinically apparent effusion in the index knee.
  5. A WOMAC pain score of >8 on the index knee at screening visit.

Exclusion Criteria:

  1. A requirement for treatment with high potency opioids for pain relief.
  2. Unwilling to abstain from NSAIDs and/or other analgesic medications except acetaminophen (i.e., COX-2 inhibitors, tramadol) for 48 hours and acetaminophen for 24 hours prior to pain assessments during the study. Subjects taking low dose aspirin for cardiovascular health may remain on their stable dose throughout the study.
  3. On an unstable dose of NSAIDs or analgesics for at least 1 months prior to screening visit 1.
  4. Using a handicap assistance device (i.e., cane, walker) >50% of the time.
  5. Undergoing new physical therapy or participating in a weight loss or exercise program that has not been stable for at least 3 months prior to screening visit 1 and will not remain stable during their participation in the study.
  6. Had a previous history of arthroscopic or open surgery to the index knee in the past 6 months or planned surgery during study follow up.
  7. Had joint replacement surgery in the index knee.
  8. Received corticosteroid, short acting hyaluronic acid, or other intraarticular injections of the index knee within 3 months of screening visit 1 and/or not willing to abstain from treatments for the duration of the study
  9. A history in the past 5-10 years of reactive arthritis, rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, arthritis associated with inflammatory bowel disease, sarcoidosis, amyloidosis or fibromyalgia.
  10. Clinical signs and symptoms of active knee infection or radiographic evidence of crystal disease other than chondrocalcinosis (i.e. gout).
  11. A history of abnormal laboratory results >2.5 x ULN indicative of any significant medical disease, which in the opinion of the investigator, would preclude the subjects participation in the study
  12. Any of the following abnormal laboratory results during screening:

    • ALT and/or AST >2.5x ULN
    • Hemoglobin <9 g/dL
    • WBC <3500 cells/mm3
    • Lymphocyte count <1000 cells/mm3
    • Serum creatinine >1.5 x ULN or calculated Glomerular filtration rate less than 50.
    • Creatine phosphokinase level > 2x ULN
  13. A history of malignancy in the past ten years (<10 years), with the exception of resected basal cell carcinoma, squamous cell carcinoma of the skin, or resected cervical atypia or carcinoma in situ.
  14. Significant hip pain, ipsilateral to the index knee that may interfere with assessments of index knee pain
  15. A known or clinically suspected infection with human immunodeficiency virus (HIV), or hepatitis C or B viruses
  16. Participated within 3 months or will participate concurrently in another investigational drug or vaccine study
  17. A history of drug or alcohol dependence or abuse in the past 3 years
  18. A female with reproductive capability who is unwilling to use birth control for the duration of the study and/or intends to conceive within 12 months of dosing.
  19. Ongoing use of hydroxychloroquine, or any anti-malarial, or prior history of use within past 3 months or any prior history of history of allergy, hypersensitivity or toxicity to antimalarial use.
  20. Ongoing use of a statin (HMG Co A reductase inhibitor), or use within past 3 months or any prior history of history of allergy, hypersensitivity, or toxicity to statin use.
  21. Use of fibric acid derivative in past 3 months.
  22. Other serious, non-malignant, significant, acute or chronic medical or psychiatric illness that, in the judgment of the investigator, could compromise subject safety, limit the subject's ability to complete the study, and/or compromise the objectives of the study.-

Sites / Locations

  • Stanford University

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Hydroxychloroquine/Atorvastatin open label

Arm Description

Outcomes

Primary Outcome Measures

Change in Synovitis
MRI readings performed independently by two musculoskeletal radiologists, using a semi-quantitative scoring system based on MRI assessment of knee OASynovitis scored using axial & sagittal CE-MRI sequence, while effusion & bone marrow lesions were scored using non-CE-MRI sequences of parent study. Synovitis defined as enhancing thickened synovium (>2 mm) & was evaluated at nine sites of joint-medial & lateral parapatellar recess, suprapateller, infrapatellar, intercondylar, medial & lateral perimeniscal, & adjacent to anterior & posterior cruciate ligaments (ACL/PCL) in all subjects. Synovial thickness was scored semi-quantitatively based on maximal thickness in any slice at each site as follows: grade 0 if <2mm, grade 1 if 2-4 mm & grade 2 if >4mm. For assessment of whole knee synovitis scores of all sites were summed and categorized: 0-4 normal or equivocal synovitis; 5-8 mild synovitis; 9-12 moderate synovitis & >/= 13 severe synovitis.

Secondary Outcome Measures

Full Information

First Posted
May 31, 2012
Last Updated
July 11, 2018
Sponsor
Stanford University
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1. Study Identification

Unique Protocol Identification Number
NCT01645176
Brief Title
Hydroxychloroquine/Atorvastatin in the Treatment of Osteoarthritis (OA) of the Knee
Official Title
Hydroxychloroquine/Atorvastatin in the Treatment of OA of the Knee
Study Type
Interventional

2. Study Status

Record Verification Date
July 2018
Overall Recruitment Status
Completed
Study Start Date
May 2012 (undefined)
Primary Completion Date
April 2016 (Actual)
Study Completion Date
October 2016 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Stanford University

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this study of a combination therapy of hydroxychloroquine and atorvastatin is to learn about the effects in inflammation and pain in patients with Osteoarthritis of the knee. These medications are FDA approved and commercially available.

6. Conditions and Keywords

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

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
21 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Hydroxychloroquine/Atorvastatin open label
Arm Type
Experimental
Intervention Type
Drug
Intervention Name(s)
Hydroxychloroquine/Atorvastatin
Intervention Description
Hydroxychloroquine 200-600 mg /day Atorvastatin 40 mg/day
Primary Outcome Measure Information:
Title
Change in Synovitis
Description
MRI readings performed independently by two musculoskeletal radiologists, using a semi-quantitative scoring system based on MRI assessment of knee OASynovitis scored using axial & sagittal CE-MRI sequence, while effusion & bone marrow lesions were scored using non-CE-MRI sequences of parent study. Synovitis defined as enhancing thickened synovium (>2 mm) & was evaluated at nine sites of joint-medial & lateral parapatellar recess, suprapateller, infrapatellar, intercondylar, medial & lateral perimeniscal, & adjacent to anterior & posterior cruciate ligaments (ACL/PCL) in all subjects. Synovial thickness was scored semi-quantitatively based on maximal thickness in any slice at each site as follows: grade 0 if <2mm, grade 1 if 2-4 mm & grade 2 if >4mm. For assessment of whole knee synovitis scores of all sites were summed and categorized: 0-4 normal or equivocal synovitis; 5-8 mild synovitis; 9-12 moderate synovitis & >/= 13 severe synovitis.
Time Frame
baseline and 16 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
40 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Ambulatory subjects with OA of the knee with symptoms for at least 6 months and pain on the majority of days in the last 30 days. Symptoms must include knee joint pain. Male or female adults age >40 years with a body mass index <35 Radiographic evidence of at least one osteophyte in either knee on posteroanterior (PA) and lateral standing, flexed x-ray. A Kellegren-Lawrence score of 2-3, or KL score of 1 accompanied by a clinically apparent effusion in the index knee. A WOMAC pain score of >8 on the index knee at screening visit. Exclusion Criteria: A requirement for treatment with high potency opioids for pain relief. Unwilling to abstain from NSAIDs and/or other analgesic medications except acetaminophen (i.e., COX-2 inhibitors, tramadol) for 48 hours and acetaminophen for 24 hours prior to pain assessments during the study. Subjects taking low dose aspirin for cardiovascular health may remain on their stable dose throughout the study. On an unstable dose of NSAIDs or analgesics for at least 1 months prior to screening visit 1. Using a handicap assistance device (i.e., cane, walker) >50% of the time. Undergoing new physical therapy or participating in a weight loss or exercise program that has not been stable for at least 3 months prior to screening visit 1 and will not remain stable during their participation in the study. Had a previous history of arthroscopic or open surgery to the index knee in the past 6 months or planned surgery during study follow up. Had joint replacement surgery in the index knee. Received corticosteroid, short acting hyaluronic acid, or other intraarticular injections of the index knee within 3 months of screening visit 1 and/or not willing to abstain from treatments for the duration of the study A history in the past 5-10 years of reactive arthritis, rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, arthritis associated with inflammatory bowel disease, sarcoidosis, amyloidosis or fibromyalgia. Clinical signs and symptoms of active knee infection or radiographic evidence of crystal disease other than chondrocalcinosis (i.e. gout). A history of abnormal laboratory results >2.5 x ULN indicative of any significant medical disease, which in the opinion of the investigator, would preclude the subjects participation in the study Any of the following abnormal laboratory results during screening: ALT and/or AST >2.5x ULN Hemoglobin <9 g/dL WBC <3500 cells/mm3 Lymphocyte count <1000 cells/mm3 Serum creatinine >1.5 x ULN or calculated Glomerular filtration rate less than 50. Creatine phosphokinase level > 2x ULN A history of malignancy in the past ten years (<10 years), with the exception of resected basal cell carcinoma, squamous cell carcinoma of the skin, or resected cervical atypia or carcinoma in situ. Significant hip pain, ipsilateral to the index knee that may interfere with assessments of index knee pain A known or clinically suspected infection with human immunodeficiency virus (HIV), or hepatitis C or B viruses Participated within 3 months or will participate concurrently in another investigational drug or vaccine study A history of drug or alcohol dependence or abuse in the past 3 years A female with reproductive capability who is unwilling to use birth control for the duration of the study and/or intends to conceive within 12 months of dosing. Ongoing use of hydroxychloroquine, or any anti-malarial, or prior history of use within past 3 months or any prior history of history of allergy, hypersensitivity or toxicity to antimalarial use. Ongoing use of a statin (HMG Co A reductase inhibitor), or use within past 3 months or any prior history of history of allergy, hypersensitivity, or toxicity to statin use. Use of fibric acid derivative in past 3 months. Other serious, non-malignant, significant, acute or chronic medical or psychiatric illness that, in the judgment of the investigator, could compromise subject safety, limit the subject's ability to complete the study, and/or compromise the objectives of the study.-
Facility Information:
Facility Name
Stanford University
City
Stanford
State/Province
California
ZIP/Postal Code
94305
Country
United States

12. IPD Sharing Statement

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Hydroxychloroquine/Atorvastatin in the Treatment of Osteoarthritis (OA) of the Knee

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