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Study Investigating STA363 Compared to Placebo in Patients With Chronic Discogenic Low Back Pain (STA-02)

Primary Purpose

Discogenic Pain

Status
Active
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
STA363 containing 90 mg (60 mg/mL) lactic acid
STA363 containing 180 mg (120 mg/mL) lactic acid
Placebo
Sponsored by
Stayble Therapeutics
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Discogenic Pain

Eligibility Criteria

18 Years - 70 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Signed informed consent prior to any study related procedures.
  2. Male and female patients ≥18 and ≤70 years.
  3. Chronic discogenic low back pain present for more than 6 months prior to the screening visit.
  4. Insufficient response or lack of response to at least 6 months of non-operative treatment (analgesics and/or anti-inflammatory medications [paracetamol, non-steroidal anti-inflammatory agents (NSAIDs), opioids], physiotherapy, rehabilitation therapy etc.).
  5. Patients who meet all the following NRS selection criteria:

    1. Presence of ≥5 pain NRS assessments (entries) for 7 consecutive days.
    2. NRS daily pain scores between 3-9.
    3. Not more than two ratings "3".
  6. One or two treatable IVDs of Pfirrmann grade 2 to 3 on MRI at L2/3 to L5/S1 as confirmed by a central reader, AND the following criteria are met:

    1. Treatable IVD(s) must be IVD(s) with the highest Pfirrmann grade observed in the patient (e.g. a patient with one IVD of grade 3 and four IVDs of grade 2 is considered eligible only if IVD of grade 3 will be injected).
    2. Patients with treatable IVD(s) of grade 2 must have all other lumbar discs rated as grade 1.
    3. Not more than two IVDs of grade 3 at any lumbar level.
    4. No IVDs of grade 4 or 5 at any lumbar level.
  7. Ability to understand the written and verbal information about the study.

Exclusion Criteria:

  1. Treatment with any investigational product within 3 months prior to the screening visit.
  2. Patients with more than two painful IVDs.
  3. A painful IVD above L2/3 level.
  4. Current infection or prior history of spinal infection (e.g., discitis, septic arthritis, epidural abscess) or an active systemic infection.
  5. Previous lumbar spine surgery.
  6. Previous disc invasive treatment procedures at the affected level(s) (e.g., intradiscal electrothermal therapy, intradiscal radiofrequency thermocoagulation).
  7. Evidence of prior lumbar vertebral body fracture or trauma.
  8. Need for spinal decompression assessed by the Investigator.
  9. Presence of IVD extrusion or sequestration, or other radiologic findings that in the opinion of the investigator disqualify the patient from being included.
  10. Spondylolisthesis or retrolisthesis Grade 2 and above or spondylolysis at the index or adjacent level(s).
  11. Lumbar spondylitis or other undifferentiated spondyloarthropathy affecting the index IVD.
  12. Patients previously included in the study.
  13. Patients suffering from psychosomatic pain in the opinion of the Investigator.
  14. Leg pain of compressive origin.
  15. Patients requiring continuous treatment with warfarin or other anticoagulant therapy.
  16. History of significant neurologic or psychiatric disorders including dementia or seizures.
  17. Known alcohol and/or drug abuse.
  18. Severe intercurrent illness (e.g. rheumatic disease or chronic pain syndrome) or concomitant treatment (e.g. immunosuppressive drugs), which, in the opinion of the Investigator, may put the patient at risk when participating in the study, or affect the patient's ability to take part in the study.
  19. Pregnant or lactating females, or intention to become pregnant within the study period.
  20. Known allergy to any of the components of the drug product or placebo.
  21. Known allergy or intolerance to the contrast agent Omnipaque®.
  22. Known opioid allergy or intolerance.
  23. Any other condition that, in the opinion of the Investigator, precludes the patient from taking part in this study.
  24. Any specific contraindication for MRI such as claustrophobia, intracranial clips or pacemakers.

Sites / Locations

  • Alrijne Ziekenhuis Leiderdorp
  • Rijnstate Hospital Anesthesiology and Pain
  • Belgorod Regional Clinical Hospital of Saint Joasaph
  • Regional Clinical Hospital #3
  • Kirov State Medical University
  • Ochapovsky Regional Clinical Hospital #1
  • Krasnoyarsk Interdistrict Clinical Emergency Hospital
  • Siberian Research Clinical Center
  • Privolzhsky Research Medical University
  • Bekhterev Psychiatry and Neurology Center
  • LLC MART
  • Smolensk Regional Clinical Hospital
  • Tula Regional Clinical Hospital
  • Hospital Quirónsalud Córdoba
  • Complejo Hospitalario Ruber Juan Bravo
  • Hm Puerta Del Sur
  • Hospital Universitario Quirónsalud Madrid

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Experimental

Placebo Comparator

Arm Label

STA363 containing 90 mg (60 mg/mL) lactic acid

STA363 containing 180 mg (120 mg/mL) lactic acid

Placebo

Arm Description

STA363 containing 90 mg (60 mg/mL) lactic acid will be injected into the center of up to two intervertebral discs. Patients with two discs appropriate for treatment will be treated at both affected levels by two separate injections. Each patient will have 5 visits to study site and 1 telephone call. The patient's total time in the study will be approximately 61 weeks (~15 months) including an 8-week screening period.

STA363 containing 180 mg (120 mg/mL) lactic acid will be injected into the center of up to two intervertebral discs. Patients with two discs appropriate for treatment will be treated at both affected levels by two separate injections. Each patient will have 5 visits to study site and 1 telephone call. The patient's total time in the study will be approximately 61 weeks (~15 months) including an 8-week screening period.

Placebo will be injected into the center of up to two intervertebral discs. Patients with two discs appropriate for treatment will be treated at both affected levels by two separate injections. Each patient will have 5 visits to study site and 1 telephone call. The patient's total time in the study will be approximately 61 weeks (~15 months) including an 8-week screening period.

Outcomes

Primary Outcome Measures

Pain intensity at 6 months on a Numerical rating scale
Change from baseline at Month 6 in mean pain intensity measured on a Numerical rating scale (minimum value: 0; maximum value: 10) for 7 consecutive days. Lower scores means a better outcome.

Secondary Outcome Measures

Pain intensity at Month 1, Month 3 and Month 12 on a Numerical rating scale
Change from baseline at Month 1, 3 and 12 in mean pain intensity measured on a Numerical rating scale (minimum value: 0; maximum value: 10) for 7 consecutive days. Lower scores means a better outcome.
Oswestry Disability Index
Change from baseline in Oswestry Disability Index score (minimal-maximal values: 0-100 where a lower number means better outcome) at Month 1, Month 3, Month 6 and Month 12. Lower scores means a better outcome.
EuroQoL 5-dimension 5-level
Change from baseline in EuroQoL 5-dimension 5-level-index at Month 1, Month 3, Month 6 and Month 12. Higher scores means a better outcome.
Nucleus pulposus transformation
Quantitative changes in nucleus pulposus (NP) water content (reflecting transformation of NP into connective tissue) at Month 6 and Month 12 (T2-weighted magnetic resonance imaging [MRI] and quantification of T2). Lower scores means a better outcome.

Full Information

First Posted
December 1, 2020
Last Updated
August 21, 2023
Sponsor
Stayble Therapeutics
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1. Study Identification

Unique Protocol Identification Number
NCT04673461
Brief Title
Study Investigating STA363 Compared to Placebo in Patients With Chronic Discogenic Low Back Pain
Acronym
STA-02
Official Title
A Multi-country, Randomized, Double-blind, Placebo-controlled Study Investigating the Efficacy and Safety of STA363 at Two Concentrations (60 mg/mL and 120 mg/mL) Compared to Placebo in Patients With Chronic Discogenic Low Back Pain
Study Type
Interventional

2. Study Status

Record Verification Date
August 2023
Overall Recruitment Status
Active, not recruiting
Study Start Date
July 31, 2020 (Actual)
Primary Completion Date
September 1, 2023 (Anticipated)
Study Completion Date
October 31, 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Stayble Therapeutics

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
This is a phase IIb, prospective, multi-country, multicenter, randomized, double-blind, placebo-controlled, parallel group study to investigate the efficacy, safety and transformation of NP following single intradiscal injection of STA363 (lactic acid) into one or two IVDs compared to placebo for the treatment of discogenic low back pain. This study will be conducted in Russia, Spain and the Netherlands.
Detailed Description
This is a phase IIb, prospective, multi-country, multicenter, randomized, double-blind, placebo-controlled, parallel group study to investigate the efficacy, safety and transformation of NP following single intradiscal injection of STA363 (lactic acid) into one or two IVDs compared to placebo for the treatment of discogenic low back pain. This study will be conducted in Russia, Spain and the Netherlands. The primary objective is to demonstrate superiority of STA363 over placebo in reducing low back pain as measured by the NRS. A total of 168 patients will be screened in the study with the aim to recruit 126 patients to be randomly allocated to one of the three treatment groups: Group 1 - 42 patients will receive STA363 containing 90 mg (60 mg/mL) lactic acid Group 2 - 42 patients will receive STA363 containing 180 mg (120 mg/mL) lactic acid Group 3 - 42 patients will receive placebo The investigational medical product (IMP) will be injected into the center of up to two IVDs. Patients with two discs appropriate for treatment will be treated at both affected levels by two separate injections. Each patient will have 5 visits to study site and 1 telephone call. The patient's total time in the study will be approximately 61 weeks (~15 months) including an 8-week screening period. Each patient will perform a screening visit (Visit 1) maximum 60 days before planned treatment. Randomization and treatment will be performed at Visit 2 (Day 1) after confirmation of patient's eligibility for the study. The IMP will be administered, monitored by fluoroscopy or other available method of real-time x-ray imaging to ensure that an injection is correctly placed in the IVD nucleus and that no leakage occurs. Immediately after treatment the patients should remain supine for as long as possible (at least 1 hour). For safety reasons, patients will be allowed to leave the clinic not earlier than 2 hours after the last injection. After leaving the clinic, patients will be offered analgesics and/or other measures according to standard clinical practice. They will also be given advice on restricted physical activity during the first two weeks after injection. Patients should not drive or operate machinery for 12 hours following the treatment procedure. Patients will be followed up at 1 month (Visit 3/Day 30±7, visit to study site), 3 months (Visit 4/Day 90±7, telephone call), 6 months (Visit 5/Day 180±7, visit to study site) and 12 months (Visit 6/Day 360±7, visit to study site) after treatment. Follow-up MRI will be conducted as part of Visit 5 and Visit 6, to assess the transformation of the NP into connective tissue and other disc characteristics.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Discogenic Pain

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Model Description
Three treatment groups: STA363 60 mg/mL STA363 120 mg/mL Placebo
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Masking Description
The test and reference IMPs will be identical in appearance. The kits will not contain any other information about treatment. Therefore, all site staff and patients will be blinded at treatment administration.
Allocation
Randomized
Enrollment
110 (Actual)

8. Arms, Groups, and Interventions

Arm Title
STA363 containing 90 mg (60 mg/mL) lactic acid
Arm Type
Experimental
Arm Description
STA363 containing 90 mg (60 mg/mL) lactic acid will be injected into the center of up to two intervertebral discs. Patients with two discs appropriate for treatment will be treated at both affected levels by two separate injections. Each patient will have 5 visits to study site and 1 telephone call. The patient's total time in the study will be approximately 61 weeks (~15 months) including an 8-week screening period.
Arm Title
STA363 containing 180 mg (120 mg/mL) lactic acid
Arm Type
Experimental
Arm Description
STA363 containing 180 mg (120 mg/mL) lactic acid will be injected into the center of up to two intervertebral discs. Patients with two discs appropriate for treatment will be treated at both affected levels by two separate injections. Each patient will have 5 visits to study site and 1 telephone call. The patient's total time in the study will be approximately 61 weeks (~15 months) including an 8-week screening period.
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Placebo will be injected into the center of up to two intervertebral discs. Patients with two discs appropriate for treatment will be treated at both affected levels by two separate injections. Each patient will have 5 visits to study site and 1 telephone call. The patient's total time in the study will be approximately 61 weeks (~15 months) including an 8-week screening period.
Intervention Type
Drug
Intervention Name(s)
STA363 containing 90 mg (60 mg/mL) lactic acid
Intervention Description
STA363 (90 mg) will be injected into maximally two pain-generating degenerated intervertebral discs
Intervention Type
Drug
Intervention Name(s)
STA363 containing 180 mg (120 mg/mL) lactic acid
Intervention Description
STA363 (180 mg) will be injected into maximally two pain-generating degenerated intervertebral discs
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Placebo will be injected into maximally two pain-generating degenerated intervertebral discs
Primary Outcome Measure Information:
Title
Pain intensity at 6 months on a Numerical rating scale
Description
Change from baseline at Month 6 in mean pain intensity measured on a Numerical rating scale (minimum value: 0; maximum value: 10) for 7 consecutive days. Lower scores means a better outcome.
Time Frame
6 months
Secondary Outcome Measure Information:
Title
Pain intensity at Month 1, Month 3 and Month 12 on a Numerical rating scale
Description
Change from baseline at Month 1, 3 and 12 in mean pain intensity measured on a Numerical rating scale (minimum value: 0; maximum value: 10) for 7 consecutive days. Lower scores means a better outcome.
Time Frame
1 month, 3 months and 12 months
Title
Oswestry Disability Index
Description
Change from baseline in Oswestry Disability Index score (minimal-maximal values: 0-100 where a lower number means better outcome) at Month 1, Month 3, Month 6 and Month 12. Lower scores means a better outcome.
Time Frame
1 month, 3 months, 6 months and 12 months
Title
EuroQoL 5-dimension 5-level
Description
Change from baseline in EuroQoL 5-dimension 5-level-index at Month 1, Month 3, Month 6 and Month 12. Higher scores means a better outcome.
Time Frame
1 month, 3 months, 6 months and 12 months
Title
Nucleus pulposus transformation
Description
Quantitative changes in nucleus pulposus (NP) water content (reflecting transformation of NP into connective tissue) at Month 6 and Month 12 (T2-weighted magnetic resonance imaging [MRI] and quantification of T2). Lower scores means a better outcome.
Time Frame
6 and 12 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
70 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Signed informed consent prior to any study related procedures. Male and female patients ≥18 and ≤70 years. Chronic discogenic low back pain present for more than 6 months prior to the screening visit. Insufficient response or lack of response to at least 6 months of non-operative treatment (analgesics and/or anti-inflammatory medications [paracetamol, non-steroidal anti-inflammatory agents (NSAIDs), opioids], physiotherapy, rehabilitation therapy etc.). Patients who meet all the following NRS selection criteria: Presence of ≥5 pain NRS assessments (entries) for 7 consecutive days. NRS daily pain scores between 3-9. Not more than two ratings "3". One or two treatable IVDs of Pfirrmann grade 2 to 3 on MRI at L2/3 to L5/S1 as confirmed by a central reader, AND the following criteria are met: Treatable IVD(s) must be IVD(s) with the highest Pfirrmann grade observed in the patient (e.g. a patient with one IVD of grade 3 and four IVDs of grade 2 is considered eligible only if IVD of grade 3 will be injected). Patients with treatable IVD(s) of grade 2 must have all other lumbar discs rated as grade 1. Not more than two IVDs of grade 3 at any lumbar level. No IVDs of grade 4 or 5 at any lumbar level. Ability to understand the written and verbal information about the study. Exclusion Criteria: Treatment with any investigational product within 3 months prior to the screening visit. Patients with more than two painful IVDs. A painful IVD above L2/3 level. Current infection or prior history of spinal infection (e.g., discitis, septic arthritis, epidural abscess) or an active systemic infection. Previous lumbar spine surgery. Previous disc invasive treatment procedures at the affected level(s) (e.g., intradiscal electrothermal therapy, intradiscal radiofrequency thermocoagulation). Evidence of prior lumbar vertebral body fracture or trauma. Need for spinal decompression assessed by the Investigator. Presence of IVD extrusion or sequestration, or other radiologic findings that in the opinion of the investigator disqualify the patient from being included. Spondylolisthesis or retrolisthesis Grade 2 and above or spondylolysis at the index or adjacent level(s). Lumbar spondylitis or other undifferentiated spondyloarthropathy affecting the index IVD. Patients previously included in the study. Patients suffering from psychosomatic pain in the opinion of the Investigator. Leg pain of compressive origin. Patients requiring continuous treatment with warfarin or other anticoagulant therapy. History of significant neurologic or psychiatric disorders including dementia or seizures. Known alcohol and/or drug abuse. Severe intercurrent illness (e.g. rheumatic disease or chronic pain syndrome) or concomitant treatment (e.g. immunosuppressive drugs), which, in the opinion of the Investigator, may put the patient at risk when participating in the study, or affect the patient's ability to take part in the study. Pregnant or lactating females, or intention to become pregnant within the study period. Known allergy to any of the components of the drug product or placebo. Known allergy or intolerance to the contrast agent Omnipaque®. Known opioid allergy or intolerance. Any other condition that, in the opinion of the Investigator, precludes the patient from taking part in this study. Any specific contraindication for MRI such as claustrophobia, intracranial clips or pacemakers.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Jan Willem Kallewaard, MD, PhD
Organizational Affiliation
Rijnstate Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
Alrijne Ziekenhuis Leiderdorp
City
Leiderdorp
Country
Netherlands
Facility Name
Rijnstate Hospital Anesthesiology and Pain
City
Velp
Country
Netherlands
Facility Name
Belgorod Regional Clinical Hospital of Saint Joasaph
City
Belgorod
Country
Russian Federation
Facility Name
Regional Clinical Hospital #3
City
Chelyabinsk
Country
Russian Federation
Facility Name
Kirov State Medical University
City
Kirov
Country
Russian Federation
Facility Name
Ochapovsky Regional Clinical Hospital #1
City
Krasnodar
Country
Russian Federation
Facility Name
Krasnoyarsk Interdistrict Clinical Emergency Hospital
City
Krasnoyarsk
Country
Russian Federation
Facility Name
Siberian Research Clinical Center
City
Krasnoyarsk
Country
Russian Federation
Facility Name
Privolzhsky Research Medical University
City
Nizhniy Novgorod
Country
Russian Federation
Facility Name
Bekhterev Psychiatry and Neurology Center
City
Saint Petersburg
Country
Russian Federation
Facility Name
LLC MART
City
Saint Petersburg
Country
Russian Federation
Facility Name
Smolensk Regional Clinical Hospital
City
Smolensk
Country
Russian Federation
Facility Name
Tula Regional Clinical Hospital
City
Tula
Country
Russian Federation
Facility Name
Hospital Quirónsalud Córdoba
City
Córdoba
Country
Spain
Facility Name
Complejo Hospitalario Ruber Juan Bravo
City
Madrid
Country
Spain
Facility Name
Hm Puerta Del Sur
City
Móstoles
Country
Spain
Facility Name
Hospital Universitario Quirónsalud Madrid
City
Pozuelo De Alarcón
Country
Spain

12. IPD Sharing Statement

Plan to Share IPD
No

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Study Investigating STA363 Compared to Placebo in Patients With Chronic Discogenic Low Back Pain

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