Clinical trial • Phase II/III • Musculoskeletal
Clodronate disodium for Knee osteoarthritis
Phase II/III trial of Clodronate disodium for Knee osteoarthritis.
Overview
- Trial Therapeutic Area
- Musculoskeletal
- Trial Disease
- Knee osteoarthritis
- Trial Stage
- Phase II/III
- Drug Modality
- Small molecule
Key dates
- Initial CTIS Submission Date
- 17-06-2024
- First CTIS Authorization Date
- 13-08-2024
Trial design
Randomised, placebo: matching placebo 2 ml once a week for 4 weeks (arm 4). active comparator arms: ia clodronate at multiple dose levels (arm 1: 2 mg/2 ml once a week for 4 weeks; arm 2: 5 mg/2 ml once a week for 4 weeks; arm 3: 10 mg/2 ml once a week for 4 weeks). phase iii compares the dtd (dose to be determined from phase ii) vs matching placebo.-controlled, adaptive Phase II/III trial across 14 sites in Italy.
- Randomised
- Yes
- Comparator
- Placebo: matching placebo 2 ml once a week for 4 weeks (Arm 4). Active comparator arms: IA clodronate at multiple dose levels (Arm 1: 2 mg/2 ml once a week for 4 weeks; Arm 2: 5 mg/2 ml once a week for 4 weeks; Arm 3: 10 mg/2 ml once a week for 4 weeks). Phase III compares the DTD (Dose to be Determined from Phase II) vs matching placebo.
- Adaptive
- True, interim analysis-driven adaptive elements: Phase II dose-finding design with multiple escalating dose arms; interim analysis led to discontinuation of lower-dose arms (noted as 'No longer in use as per interim analysis results'), selection of DTD for Phase III, and sample-size re-calculation after interim analysis.
- Single Multiple Or Escalation Dose Combined
- Yes
- Target Sample Size
- 296
- Trial Duration For Participant
- 49
Eligibility
Recruits 296 Vulnerable population selected. Consent: 'A signed ICF by the patient after exhaustive study discussion with the investigators.' Patient information and ICF documents available in Italian (patient-facing documents and ICF labeled _It). No mention of assent or consent by a legal representative..
- Pregnancy Exclusion
- Pregnant or breastfeeding women, or women planning to become pregnant during the study.
- Vulnerable Population
- Vulnerable population selected. Consent: 'A signed ICF by the patient after exhaustive study discussion with the investigators.' Patient information and ICF documents available in Italian (patient-facing documents and ICF labeled _It). No mention of assent or consent by a legal representative.
Inclusion criteria
- {"criterion_text":"- Female and male patients aged 50 up to 75 years at the signature of informed consent form (ICF)."}
- {"criterion_text":"- Diagnosis of knee OA according to the American College of Rheumatology, confirmed by Rx during the screening (a Rx performed in the last three (3) months before Screening Visit is accepted)."}
- {"criterion_text":"- Kellgren-Lawrence radiographic score between 2 and 3 degrees in the tibiofemoral joint."}
- {"criterion_text":"- Symptomatic knee OA (pain) since at least 6 months with a knee pain (VAS) ranging between 40 and 80 mm at Screening visit (the figure should be confirmed at Baseline)."}
- {"criterion_text":"- Female patients of childbearing potential must have a negative pregnancy test before each treatment and during the Visit 5 – Week 4 and they must use adequate methods of contraception throughout the course of the study."}
- {"criterion_text":"- A signed ICF by the patient after exhaustive study discussion with the investigators."}
Exclusion criteria
- {"criterion_text":"- BMI > 35 kg/m2 (Class II obesity)."}
- {"criterion_text":"- Any treatment with denosumab in the 12 months before Baseline."}
- {"criterion_text":"- Any treatment with paracetamol in the twelve (12) hours before Baseline."}
- {"criterion_text":"- Any knee surgery in the past or knee arthroplasty."}
- {"criterion_text":"- Any diagnostic or surgical arthroscopy of the knee in the six (6) months before Baseline."}
- {"criterion_text":"- Any jaw osteonecrosis in the last twenty-four (24) months before Baseline or at a risk of jaw osteonecrosis."}
- {"criterion_text":"- Any known hypersensitivity to the drug in the study and to its excipients or other bisphosphonates, and any hypersensitivity to paracetamol (rescue drug)."}
- {"criterion_text":"- Any participation in a clinical study in which the last administration of the investigational medicinal product was within two (2) weeks before consenting to study participation (i.e. signing ICF)."}
- {"criterion_text":"- Inadequate organ function defined by the following laboratory parameters: Absolute Neutrophil Count (ANC) < 1500/^l ; Haemoglobin (Hb) < 9 g/dl (< Hb 5.6 mmol/L) ; Platelet Count < 100.000/^l ; Serum Creatinine > 1.5 x ULN or eGFR < 60 mL/min (as per Cockroft-Gault formula) ; ALT or AST > 1.5 x ULN ; Serum Total Bilirubin > 1.5 x ULN"}
- {"criterion_text":"- Pregnant or breastfeeding women, or women planning to become pregnant during the study."}
- {"criterion_text":"- Any positive or suspected history of alcoholism or drug use."}
- {"criterion_text":"- Joint instability due to other reasons than knee OA, such as f.i. algo dystrophic syndrome, either partial or complete rupture of internal / externals ligaments, kneecap instability, etc."}
- {"criterion_text":"- Clinically significant (i.e.) gastrointestinal, renal, hepatic, pulmonary, cardiovascular or neurological disease that could interfere with the outcome of the study or the patient’s ability to comply with study requirements."}
- {"criterion_text":"- Patients unwilling or unable to comply with the protocol."}
- {"criterion_text":"- Otherwise located lower limb pain, such as hip pain."}
- {"criterion_text":"- Other musculoskeletal disorders related to the target knee."}
- {"criterion_text":"- Any treatment with IA drugs in the last three (3) month before Day 0- Baseline (including any formulation of corticosteroids, or hyaluronic acid injections)."}
- {"criterion_text":"- Corticosteroid use by any systemic route, and hyaluronic acid injections or in-tra-articular corticosteroids for any other joint in the previous month will be not permitted."}
- {"criterion_text":"- Any treatment with systemic non-steroidal anti-inflammatory drugs (NSAIDs) in the week before Baseline, or any steroid anti-inflammatory drugs and chon-droprotective drugs in the thirty (30) days before Baseline."}
- {"criterion_text":"- Any treatment with systemic bisphosphonates in the last twelve (12) months before Baseline."}
- {"criterion_text":"- Any treatment with glucosamine or chondroitin sulfate, diacerein and matrix metalloproteinase (MMP) inhibitors in the 4 weeks before Baseline."}
Endpoints
Primary endpoints
- {"endpoint_text":"- A clodronate dose will be considered as effective when a ≥ 8.5 mm reduction in the VAS of knee pain will be observed at Week 7 vs. Placebo.","definition_or_measurement_approach":"Measured using the Visual Analogue Scale (VAS) for knee pain at Week 7; effectiveness defined as a ≥ 8.5 mm reduction vs. placebo."}
Secondary endpoints
- {"endpoint_text":"- Mean changes in the VAS of knee pain observed at each other visit than Week 7 vs. Placebo and vs Baseline.","definition_or_measurement_approach":"Mean change in VAS of knee pain at each study visit compared with placebo and baseline."}
- {"endpoint_text":"- Mean changes in the VAS of knee pain observed 120 minutes after IA injection at Baseline, Weeks 1, 2 and 3 vs predose assessment.","definition_or_measurement_approach":"Mean change in VAS measured 120 minutes post intra-articular injection at specified visits versus predose assessment."}
- {"endpoint_text":"- Mean changes in the Lequesne Algo-functional Index at each visit vs Placebo and vs Baseline.","definition_or_measurement_approach":"Mean change in Lequesne Algo-functional Index at each visit compared with placebo and baseline."}
- {"endpoint_text":"- Mean changes in the WOMAC Index at each visit vs Placebo and vs Baseline.","definition_or_measurement_approach":"Mean change in WOMAC index at each visit compared with placebo and baseline."}
- {"endpoint_text":"- Mean changes in the Range of Motion at each visit vs Placebo and vs Baseline.","definition_or_measurement_approach":"Mean change in knee range of motion (extension/flexion) at each visit compared with placebo and baseline."}
- {"endpoint_text":"- Use of rescue drug consumption (paracetamol) across the patients visits.","definition_or_measurement_approach":"Measurement of paracetamol consumption (rescue medication) across patient visits."}
Recruitment
- Planned Sample Size
- 296
- Recruitment Window Months
- 35
- Consent Approach
- Informed consent obtained via a signed ICF by the patient after exhaustive study discussion with the investigators. Patient information and consent documents are available in Italian (documents labeled _It). No mention of assent procedures or consent by legal representative in the available materials.
Geography
- Total Number Of Sites
- 14
- Total Number Of Participants
- 278
Italy
- Earliest CTIS Part Ii Submission Date
- 15-02-2024
- Latest Decision Or Authorization Date
- 29-04-2026
- Processing Time Days
- 804
- Number Of Sites
- 14
- Number Of Participants
- 278
Sites
- Site Name
- Istituti Clinici Scientifici Maugeri S.p.A. Societa' Benefit In Forma Abbreviata Istituti Clinici Scientifici Maugeri S.p.A. Sb O Anche Ics Maugeri S.p.A. Sb O Maugeri S.p.A. Sb
- Department Name
- U.O.S. Reumatologia Riabilitativa
- Contact Person Name
- Lul Abdi-Ali
- Contact Person Email
- lul.abdiali@icsmaugeri.it
- Site Name
- Careggi University Hospital
- Department Name
- Dipartimento di Biomedicina AOU Careggi - S.O.D. di Reumatologia
- Contact Person Name
- Serena Guiducci
- Contact Person Email
- serena.guiducci@unifi.it
- Site Name
- Azienda Ospedaliero-Universitaria San Luigi Gonzaga
- Department Name
- Dipartimento di Ortopedia e Traumatologia
- Contact Person Name
- Filippo Castoldi
- Contact Person Email
- filippo.castoldi@unito.it
- Site Name
- ASST Grande Ospedale Metropolitano Niguarda
- Department Name
- Rheumatology division, Department of Polyspecialistic medicines
- Contact Person Name
- Nicola Ughi
- Contact Person Email
- nicola.ughi@ospedaleniguarda.it
- Site Name
- Azienda Ospedaliera Universitaria Integrata Verona
- Department Name
- Medicina Interna D
- Contact Person Name
- Luca Dalle Carbonare
- Contact Person Email
- luca.dallecarbonare@univr.it
- Site Name
- Azienda Sanitaria Locale Della Provincia Di Barletta Andria Trani
- Department Name
- Ortopedia Ospedale Lorenzo Bonomo
- Contact Person Name
- Vito Giuseppe Giovanni Conserva
- Contact Person Email
- conserva.v@gmail.com
- Site Name
- Azienda Ospedaliero-Universitaria Ss.Antonio E Biagio E C.Arrigo Alessandria
- Department Name
- Centro Riabilitativo Polifunzionale Teresio Borsalino
- Contact Person Name
- Marco Invernizzi
- Contact Person Email
- marco.invernizzi@med.uniupo.it
- Site Name
- Ospedale Israelitico
- Department Name
- Traumatologia
- Contact Person Name
- Maria Chiara Meloni
- Contact Person Email
- chiarameloni@gmail.com
- Site Name
- Ospedale San Pellegrino
- Department Name
- Ortopedia e Traumatologia
- Contact Person Name
- Paolo Roberto Fabrizio Ferrari
- Contact Person Email
- ferraripaolorobertodoc@gmail.com
- Site Name
- Provincia Religiosa Di S.Pietro Dell' Ordine Ospedaliero Di San Giovanni Di Dio Fatebenefratelli
- Department Name
- Medicina Interna
- Contact Person Name
- Alberto Migliore
- Contact Person Email
- migliore.alberto@fbfrm.it
- Site Name
- Universita' Degli Studi Di Genova
- Department Name
- DISC - Clinica Ortopedica
- Contact Person Name
- Matteo Formica
- Contact Person Email
- matteo.formica@hsanmartino.it
- Site Name
- Ospedale Villa Scassi - Sampierdarena-ASL3-Azienda sociosanitaria ligure
- Department Name
- Dpartment of Trauma and Orthopedics- Department of surgery
- Contact Person Name
- Luca Pandolfo
- Contact Person Email
- luca.pandolfo@asl3.liguria.it
- Site Name
- Azienda Ospedaliera Universitaria Senese
- Department Name
- Scienze Mediche
- Contact Person Name
- Bruno Frediani
- Contact Person Email
- bruno.frediani@unisi.it
- Site Name
- Fondazione Poliambulanza
- Department Name
- Orthopedics and Traumatology
- Contact Person Name
- Francesco Benazzo
- Contact Person Email
- francesco.benazzo@poliambulanza.it
Sponsor
Primary sponsor
- Full Name
- Spa Societa Prodotti Antibiotici S.p.A.
- Organisation Type
- Pharmaceutical company
- Country Of Registered Address
- Italy
Third parties
- {"country":"Italy","full_name":"Product Life Italia S.r.l.","duties_or_roles":"sponsorDuties codes: 1,10,11,5,6,8","organisation_type":"Pharmaceutical company"}
Investigational products
- Investigational Product Name
- disodium clodronate (2 mg/2 ml formulation)
- Active Substance
- Clodronate disodium
- Modality
- Small molecule
- Routes Of Administration
- Intra-articular
- Route
- Intra-articular
- Authorisation Status
- Authorized (prodAuthStatus 1), MIA number aM - 80/2021
- Starting Dose
- 2 mg (once weekly, 2 ml)
- Dose Levels
- 2 mg once weekly x4 weeks (total 8 mg)
- Frequency
- Once a week for 4 weeks
- Maximum Dose
- 8 mg (total over 4 weeks)
- Dose Escalation Increase
- 2 mg -> 5 mg -> 10 mg
- Investigational Product Name
- disodium clodronate (5 mg/2 ml formulation)
- Active Substance
- Clodronate disodium
- Modality
- Small molecule
- Routes Of Administration
- Intra-articular
- Route
- Intra-articular
- Authorisation Status
- Authorized (prodAuthStatus 1), MIA number aM - 80/2021
- Starting Dose
- 5 mg (once weekly, 2 ml)
- Dose Levels
- 5 mg once weekly x4 weeks (total 20 mg)
- Frequency
- Once a week for 4 weeks
- Maximum Dose
- 20 mg (total over 4 weeks)
- Dose Escalation Increase
- 2 mg -> 5 mg -> 10 mg
- Investigational Product Name
- disodium clodronate (10 mg/2 ml formulation)
- Active Substance
- Clodronate disodium
- Modality
- Small molecule
- Routes Of Administration
- Intra-articular
- Route
- Intra-articular
- Authorisation Status
- Authorized (prodAuthStatus 1), MIA number aM - 80/2021
- Starting Dose
- 10 mg (once weekly, 2 ml)
- Dose Levels
- 10 mg once weekly x4 weeks (total 40 mg)
- Frequency
- Once a week for 4 weeks
- Maximum Dose
- 40 mg (total over 4 weeks)
- Dose Escalation Increase
- 2 mg -> 5 mg -> 10 mg
- Investigational Product Name
- The Placebo composition is identical to the IMP, except for the active substance.
- Modality
- Other
- Starting Dose
- Placebo 2 ml (once weekly)
- Dose Levels
- Placebo 2 ml once weekly x4 weeks (total 0 mg clodronate)
- Frequency
- Once a week for 4 weeks
- Maximum Dose
- 0 mg
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