Phase 2a Dose-Ranging Study to Evaluate Safety and Effectiveness of AA4500 in Treatment of Dupuytren's Disease Nodules
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ClinicalTrials.gov Identifier: NCT02193828 |
Recruitment Status :
Completed
First Posted : July 18, 2014
Results First Posted : July 7, 2015
Last Update Posted : October 5, 2017
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Condition or disease | Intervention/treatment | Phase |
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Dupuytren's Disease | Biological: Collagenase clostridium histolyticum Biological: Placebo | Phase 2 |
Approximately 13 sites in the United States and Australia, approximately 90 study subjects.
After all pre-injection procedures are completed on day 1, eligible men and women will be randomized in a 1:1:1 ratio to dose group and then in a 4:1 ratio to treatment group. Study drug will be administered into a palmar nodule located on the selected hand.
AA4500 (collagenase clostridium histolyticum) 3 doses (low, medium, and high) after reconstitution with sterile diluent (0.3 mg/mL calcium chloride dihydrate in 0.9% sodium chloride). Each dose of study drug will be injected into the nodule. The injection will be administered in 3 different volumes according to randomization.
Placebo after reconstitution with sterile diluent (0.3 mg/mL calcium chloride dihydrate in 0.9% sodium chloride). Each dose of study drug will be injected into the nodule. The injection will be administered in 3 different volumes according to randomization.
Follow up visits for the evaluation of safety and efficacy will be required for all subjects on days 8, 29, and 57.
Study Type : | Interventional (Clinical Trial) |
Actual Enrollment : | 76 participants |
Allocation: | Randomized |
Intervention Model: | Parallel Assignment |
Masking: | Triple (Participant, Care Provider, Investigator) |
Primary Purpose: | Treatment |
Official Title: | A Phase 2a, Double-blind, Randomized, Placebo-Controlled, Dose-Ranging Study to Evaluate the Safety and Effectiveness of AA4500 in the Treatment of Dupuytren's Disease Nodules |
Study Start Date : | July 2014 |
Actual Primary Completion Date : | December 2014 |
Actual Study Completion Date : | December 2014 |

Arm | Intervention/treatment |
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Experimental: AA4500 0.25 mg
Collagenase clostridium histolyticum, single 0.25 mg injection
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Biological: Collagenase clostridium histolyticum
Single injection into nodule
Other Names:
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Experimental: AA4500 0.40 mg
Collagenase clostridium histolyticum, single 0.40 mg injection
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Biological: Collagenase clostridium histolyticum
Single injection into nodule
Other Names:
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Experimental: AA4500 0.60 mg
Collagenase clostridium histolyticum, single 0.60 mg injection
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Biological: Collagenase clostridium histolyticum
Single injection into nodule
Other Names:
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Placebo Comparator: Placebo
Placebo, single 0.25 mg, 0.40 mg, or 0.60 mg injection
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Biological: Placebo
Single injection into nodule |
- Percent Change From Baseline in Surface Area and Volume of the Treated Nodule at Day 57 Using Caliper Measurements [ Time Frame: Baseline, Day 57 ]Percent change from baseline in surface area and volume of the treated nodule was determined from hand-held caliper measurements of the length and width of the nodule. Percent change = 100*(Day 57 area [or volume] - baseline area [or volume])/baseline area [or volume]. A negative value represents the improvement from baseline (decreased size) while a positive value represents worsening.
- Percent Change From Baseline in Surface Area and Volume of the Treated Nodule at Day 57 Using Ultrasound [ Time Frame: Baseline, Day 57 ]Percent change from baseline in surface area and volume of the treated nodule was determined from ultrasound measurements of the length, width, and depth of the nodule. Percent change = 100*(Day 57 area [or volume] - baseline area [or volume])/baseline area [or volume]. A negative value represents the improvement from baseline (decreased size) while a positive value represents worsening.
- Change From Baseline in Consistency of the Treated Nodules at Day 57 [ Time Frame: Baseline, Day 57 ]Investigators determined the consistency of the nodule through palpitation using a 5-point scale: 5 = hard (solid), 4 = firm throughout, 3 = moderate firmness, 2 = soft, and 1 = non-palpable. The change scores could range from +4 (greatest worsening in consistency) to -4 (greatest improvement in consistency); a negative change from baseline value reflects improvement from baseline (softening) while a positive value reflects worsening.
- Percent Change From Baseline in Hardness of the Treated Nodule at Day 57 [ Time Frame: Baseline, Day 57 ]A durometer was used to assess nodule hardness on a scale of 0 (soft) to 100 (hard). Percent change = 100*(Day 57 hardness - baseline hardness)/baseline hardness. A negative value represents the improvement from baseline (softening) while a positive value represents worsening.
- Change From Baseline in Nodular Pain of the Treated Nodule at Day 57 [ Time Frame: Baseline, Day 57 ]After the nodule was squeezed using a dynamometer, subjects were asked to rate the amount of pain they felt on an 11-point visual analog scale (VAS) from 0 (no pain or discomfort) to 10 (extreme pain or discomfort). A negative change from baseline value reflects improvement from baseline (less pain) while a positive value reflects worsening.
- Investigator Global Assessment of Improvement With Treatment [ Time Frame: Day 57 ]Investigators were asked to determine the degree of improvement in the subject's treated nodule compared with screening on a 7-point scale: 1 = very much improved, 2 = much improved, 3 = minimally improved, 4 = no change, 5 = minimally worse, 6 = much worse, and 7 = very much worse.
- Subject Satisfaction With Treatment [ Time Frame: Day 57 ]Subjects were asked to rate their satisfaction with treatment on a 5-point scale: 1 = very satisfied, 2 = quite satisfied, 3 = neither satisfied nor dissatisfied, 4 = quite dissatisfied, and 5 = very dissatisfied.
- Composite Responder Analysis [ Time Frame: Day 57 ]A composite responder is a subject who had an improved assessment [values of 1 (very much improved), 2 (much improved), or 3 (minimally improved)] on the investigator global assessment and had a satisfied assessment [values of 1 (very satisfied) or 2 (quite satisfied)] on the subject assessment.

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.
Ages Eligible for Study: | 18 Years and older (Adult, Older Adult) |
Sexes Eligible for Study: | All |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Provide a signed and dated informed consent
- Be a man or woman ≥ 18 years of age
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Have a diagnosis of Dupuytren's disease AND have at least one palmar nodule on the selected hand that is:
- Palpable
- Measures between 0.5 cm and 2.0 cm in length and between 0.5 cm and 2.0 cm in width using hand-held calipers n
- Not directly associated with a Dupuytren's cord
- Have a negative urine pregnancy test at screening and before injection of study drug and be using a highly effective (ie, < 1% failure rate) contraception method as judged by the investigator (eg, abstinence, intrauterine device [IUD], hormonal [estrogen/progestin] contraceptives, or barrier control) for at least one menstrual cycle prior to study enrollment and for the duration of the study or be surgically sterile (if female of childbearing potential); or be a postmenopausal female (no menses for at least 1 year or hysterectomy)
- Be able to comply with the study visit schedule as specified in the protocol
Exclusion Criteria:
- Received steroid injections (eg, tri-amcinolone acetonide) on the selected nodule within 3 months before administration of study drug
- Has a chronic muscular, neurological, or neuromuscular disorder that affects the hands
- Has a known systemic allergy to collagenase or any other excipient of AA4500
- Has received any collagenase treatments (eg, Santyl® ointment and/or XIAFLEX®/XIAPEX®) within 30 days before injection of study drug in the hand selected for treatment
- Is currently receiving or plans to receive anticoagulant medication or has received anticoagulant medication (except for ≤ 150 mg aspirin daily) within 7 days before injection of study drug
- Has a known recent history of stroke, bleeding, or other medical condition, which in the investigator's opinion would make the subject unsuitable for enrollment in the study
- Received an investigational drug within 30 days before injection of study drug
- Is pregnant or intends on becoming pregnant during the study or is breastfeeding a child
- Has any clinically significant medical history or condition(s), including conditions that affect the hands, that would, in the opinion of the investigator, substantially increase the risk associated with the subject's participation in the protocol or compromise the scientific objectives of the study
- Had surgery on the selected hand within 3 months before the screening visit
- Has jewelry on the hand to be treated that cannot be removed

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02193828
United States, Arizona | |
Tucson Orthopaedic Institute | |
Tucson, Arizona, United States, 85712 | |
United States, California | |
CORE Orthopaedic Medical Center | |
Encinitas, California, United States, 92024 | |
Marin Endocrine Care & Research, Inc. | |
Greenbrae, California, United States, 94904 | |
Brigid Freyne, MD, Inc. | |
Murrieta, California, United States, 92563 | |
United States, Indiana | |
Indiana Hand to Shoulder Center | |
Indianapolis, Indiana, United States, 46260 | |
United States, New York | |
State University of New York | |
Stony Brook, New York, United States, 11794 | |
United States, North Carolina | |
OrthoCarolina Research Institute, Inc. | |
Charlotte, North Carolina, United States, 28207 | |
United States, Oklahoma | |
Orthopedic and Reconstructive Center | |
Oklahoma City, Oklahoma, United States, 73109 | |
United States, Pennsylvania | |
Blair Orthopedic Associates, Inc. | |
Altoona, Pennsylvania, United States, 16602 | |
Australia, Queensland | |
Brisbane Hand & Upper Limb Clinic | |
Brisbane, Queensland, Australia, 4000 | |
Houston Medical | |
Kippa Ring, Queensland, Australia, 4021 |
Study Director: | Veronica Urdaneta, MD MPH | Endo Pharmaceuticals |
Responsible Party: | Endo Pharmaceuticals |
ClinicalTrials.gov Identifier: | NCT02193828 |
Other Study ID Numbers: |
AUX-CC-750 |
First Posted: | July 18, 2014 Key Record Dates |
Results First Posted: | July 7, 2015 |
Last Update Posted: | October 5, 2017 |
Last Verified: | September 2017 |
Dupuytren's nodules |
Dupuytren Contracture Fibroma Neoplasms, Fibrous Tissue Neoplasms, Connective Tissue Neoplasms, Connective and Soft Tissue Neoplasms by Histologic Type |
Neoplasms Contracture Muscular Diseases Musculoskeletal Diseases Connective Tissue Diseases |