To Determine the Safety, Tolerability, Pharmacokinetics and Effect on Pain of a Single Intra-articular Administration of Canakinumab in Patients With Osteoarthritis in the Knee

Novartis

Status and phase: Completed; Phase 2

Conditions: Osteoarthritis

Treatments: Biological: Canakinumab; Drug: Placebo to canakinumab; Drug: Naproxen; Drug: Placebo to Naproxen

Study type: Interventional

Funder types: Industry

Identifiers

NCT01160822

2009-015017-48 (EudraCT Number)

CACZ885C2201

Details and patient eligibility

About

The purpose of this study was to determine whether, in patients with mild to moderate knee osteoarthritis, canakinumab is safe and tolerable when injected intra-articularly.

Full description

This is a randomized, double-blind, parallel group, placebo controlled 18 weeks study, consisting of two parts:

1. Part A: an ascending single dose part in which the safety and tolerability of up to 4 different canakinumab doses are studied (starting dose 150 mg, maximum dose 600 mg).
2. Part B: a double-dummy, active-controlled, parallel design part in which the pain reduction of the canakinumab dose selected from part A is studied in comparison to Placebo and Naproxen.

Enrollment: 169 patients

Sex: All

Ages: 40 to 80 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

1. Written informed consent must be obtained before any assessment is performed.
2. Male and female patients aged 40 - 80 years (inclusive).
3. Diagnosis of knee osteoarthritis
4. Radiographic evidence of tibiofemoral compartment osteoarthritis
5. Pain in the knee during the last 24 hours.The patients should also have had pain in the affected knee on most days over the last month.
6. Patients who are willing to discontinue all non-steroidal anti-inflammatory drugs (NSAIDs) or other analgesic medication taken for any condition, including their knee pain,
7. Patients who are on stable dose of opioids for at least 1 month before screening can continue to take their opioid at this stable dose throughout the study.
8. Patients must also be willing to abstain from any intra-articular or peri-articular injections to the knee or surgery during the treatment period
9. Patients who, if they are currently taking aspirin (325 mg/day or less; as anti-coagulants), are willing to remain on a stable dose one month prior to screening and throughout the study

Exclusion criteria

1. Subjects with known hypersensitivity to any biological or investigational drugs.

2. Patients with contraindications to knee injections

3. Patients with joint effusion

4. Patients should not have rheumatoid arthritis or any connective tissue like disease

5. Secondary osteoarthritis with history and/or any evidence of the following diseases: septic arthritis, inflammatory joint disease, gout, Paget's disease of the bone, articular fracture, major dysplasias or congenital abnormality, ochronosis, acromegaly, hemochromatosis, Wilson's disease, primary osteochondromatosis, juvenile chronic arthritis with continued activity in adulthood, heritable disorders (e.g. hypermobility). Patients with secondary osteoarthritis following menisectomy or injuries of a collateral or cruciate ligament are not excluded.

6. Presence or history of underlying metabolic, endocrine, hematologic, pulmonary, cardiac, blood, renal, hepatic, infectious, psychiatric or gastrointestinal conditions

7. Evidence of tuberculosis (TB)

8. One of the risk factors for TB such as:

   1. Substance abuse (e.g. injection or non-injection)
   2. Health-care workers with unprotected exposure to patients who are at high risk of TB
   3. Patients with TB disease before the identification and correct airborne precautions of the patient
   4. close contact (i.e. share the same air space in a household or other enclosed environment for a prolonged period (days or weeks, not minutes or hours)) with a person with active pulmonary TB disease.

9. Significant medical problems, including but not limited to the following: uncontrolled hypertension,congestive heart failure, uncontrolled diabetes type I and II

10. Subjects with evidence of hepatic or blood coagulation disorders (i.e. hemophilia, etc), anemia, idiopathic thrombocytopenic purpura, or gastrointestinal disorder: severe hepatic disease, history of alcohol and drug abuse; disease of gall bladder and pancreas; active peptic ulceration, gastrointestinal bleeding or history of severe gastro-esophageal reflux disease or severe hiatus hernia; inflammatory bowel disease.

11. Use of any therapeutic protein drug (e.g. anti-tumor necrosis factor alpha (TNFα) antibody)

12. Presence of severe renal function impairment. History of renal trauma, glomerulonephritis, patients with one kidney, or renal failure requiring regular dialysis treatment.

13. Pregnant or nursing (lactating) women, where pregnancy is defined as the state of a female after conception and until the termination of gestation, confirmed by a positive pregnancy test (serum or urine).

14. Subjects with known contra-indications to naproxen (e.g. heart or circulation problems, history of ulcer disease etc.), analgesics, antipyretics, or NSAIDs.

15. Disease of the spine or other lower extremity joints which may interfere with the assessment of the target joint.

16. Surgery on the knee within the last year. Observational arthroscopy, arthroscopic surgery or lavage of the knee within the last 6 months.

17. Use of assistive devices other than a cane (walking stick) or knee brace.

18. Subjects who have experienced, any time in the past, asthma, acute rhinitis, nasal polyps, angioneurotic edema, urticaria or other allergic-type reaction after taking acetylsalicylic acid (ASA)/ aspirin or NSAIDs.

19. Any history of prior peptic ulcer disease or prior NSAID gastrointestinal complications for the past 5 years.

Other protocol defined inclusion/exclusion criteria may apply.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Triple Blind

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169 participants in 5 patient groups, including a placebo group

Part A: Canakinumab

Experimental group

Description:

In this ascending dose part, participants received a single intra-articular injection of canakinumab. The beginning dose was 150 mg, escalating to the 300 mg dose and then to 600 mg.

Treatment:

Biological: Canakinumab

Part A: Placebo

Placebo Comparator group

Description:

Participants received a single intra-articular injection of canakinumab-matching placebo.

Treatment:

Drug: Placebo to canakinumab

Part B: Canakinumab

Experimental group

Description:

Participants received a single intra-articular injection of canakinumab on Day 1 and naproxen matching placebo tablets orally twice daily for 12 weeks.

Treatment:

Drug: Placebo to Naproxen

Biological: Canakinumab

Part B: Placebo

Placebo Comparator group

Description:

Participants received a single intra-articular injection of canakinumab matching placebo on Day 1 and naproxen matching placebo tablets orally twice daily for 12 weeks.

Treatment:

Drug: Placebo to canakinumab

Drug: Placebo to Naproxen

Part B: Naproxen

Active Comparator group

Description:

Participants received a single intra-articular injection of canakinumab matching placebo on Day 1 and naproxen 500mg tablets orally twice daily for 12 weeks.

Treatment:

Drug: Placebo to canakinumab

Drug: Naproxen