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
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
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

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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