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A Study to Evaluate the Safety and Efficacy of CNTX-6970 in Subjects With Knee Osteoarthritis Pain.

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT05025787
Recruitment Status : Recruiting
First Posted : August 27, 2021
Last Update Posted : March 10, 2023
Sponsor:
Information provided by (Responsible Party):
Maurizio Fava, MD, Massachusetts General Hospital

Study Description
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Brief Summary:
The primary objective of this study is to evaluate the safety and efficacy of two doses of CNTX-6970 for the treatment of pain related to OA of the knee compared to placebo. CNTX-6970 is being developed as a new treatment for chronic pain, including painful osteoarthritis of the knee.

Condition or disease Intervention/treatment Phase
Knee Osteoarthritis Drug: Celecoxib Drug: CNTX-6970 Drug: Placebo Phase 2

Detailed Description:

The study will employ a randomized, allocation-concealed, multicenter, placebo-controlled, multi-period crossover design (Schmid et al, 2018). This multi-period crossover randomized, controlled trial allows comparability and assessment of efficacy through repeated exposures within each subject to the active treatment and a control (placebo) in randomized sequence. Such multi-period crossover designs are ideal for treatments with rapid onset of action and short half-life such as the asset under study here. We have strived to minimize the complexity of this powerful design by using only 2 blocks with 2 periods each. The modest additional complexity of the proposed multi-period crossover design, compared to a parallel-groups design, is justified by the marked improvement in efficiency. The gains in efficiency afforded by the multi-period crossover design allow a substantial reduction in sample size without sacrificing statistical power. For example, our simulation experiments (with sample sizes ranging from 30 to 50, carryover effects ranging from 0 to 0.2, and an effect size of 0.4) indicated that the parallel design yields statistical power ranging from 0.20-0.25, whereas our proposed 2-block multi-period crossover design yields power ranging from 0.9-1.0.

The trial will compare an active treatment vs. placebo. Each arm of the study will employ a multi-period crossover design with two blocks. Each block will consist of two treatment periods with each period lasting 6 weeks. Treatment assignments (active drug versus placebo) will be randomized for each patient to the two periods within each block. The period length of 6 weeks was chosen based on several considerations: (i) Most efficacious analgesic drugs demonstrate separation from placebo by 6 weeks; (ii) The decision to move CNTX-6970 forward to Phase 3 will require a clinically meaningful separation from placebo by 6 weeks; (iii) In this Phase 2 study, implementing a treatment block longer than 6 weeks would make the overall design more challenging and burdensome by extending the duration of overall testing beyond 6 months; (iv) Recent meta-analyses suggest that anti-inflammatory treatments such as NSAIDs reach peak effects on pain within a 4-week timeframe in patients with knee osteoarthritis, and multiple RCTs have specifically demonstrated efficacy for celecoxib at 2-6 weeks (Osani et al, 2020).

The comparison with celecoxib is used to evaluate "assay sensitivity," i.e., to assess the study protocol's ability to demonstrate superiority of an established efficacious treatment (celecoxib 100mg BID). In this study, the placebo will consist of inactive tablets identical to the active treatment tablets. Treatment assignments (active drug versus placebo) will be randomized for each patient to the two treatment periods within each block

Study Design
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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 150 participants
Allocation: Randomized
Intervention Model: Crossover Assignment
Intervention Model Description: The study will employ a randomized, allocation-concealed, multicenter, placebo-controlled, multi-period crossover design.
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Masking Description: Blinding of the randomization assignment from trial subjects, staff from the Clinical Sites, CCC, and DCC will be ensured through the use of the IXRS.
Primary Purpose: Treatment
Official Title: EN20-01: A 24 Week Study to Evaluate the Safety and Efficacy of CNTX-6970 in Subjects With Moderate to Severe Knee Osteoarthritis Pain.
Actual Study Start Date : October 25, 2021
Estimated Primary Completion Date : September 30, 2023
Estimated Study Completion Date : May 10, 2024

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Osteoarthritis
Drug Information available for: Celecoxib

Arms and Interventions
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Arm Intervention/treatment
Active Comparator: Active comparator
The active comparator in the trial is Celecoxib 100mg BID
 Drug: Celecoxib
Celecoxib 100mg BID was selected as the active comparator for its documented analgesic effects and favorable gastrointestinal (GI) profile.
Other Name: Celebrex
Experimental: 100mg BID
The lower dose proposed in this Phase 2 trial (100mg BID), which provides 1/3 of the exposure to CNTX-6970 relative to the higher dose, will generate informative data on the dose-related effects of the compound.
 Drug: CNTX-6970
CNTX-6970, a novel potent antagonist of CCR2 with lesser effects on CCR5, is being developed as a new treatment for chronic pain, including painful osteoarthritis of the knee
Experimental: 300mg BID
The higher dose (i.e., 300mg BID) demonstrated good tolerability and safety, as well as over 90% inhibition of the binding of monocyte chemoattractant protein-1 to its CCR-2 receptor. Moreover, this dose produced nearly 90% binding inhibition at the CCR-5 receptor as well.
 Drug: CNTX-6970
CNTX-6970, a novel potent antagonist of CCR2 with lesser effects on CCR5, is being developed as a new treatment for chronic pain, including painful osteoarthritis of the knee
Placebo Comparator: Placebo
Placebo
 Drug: Placebo
BID


Outcome Measures
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Primary Outcome Measures :
  1. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC-A) [ Time Frame: 24 Weeks ]
    The primary outcome measure used to assess efficacy will be patient-reported knee pain using the WOMAC Part A (Bellamy, et al., 1988).We will use the numerical rating scale version of the WOMAC, with the subject assessing each of 5 questions using an 11-point (0 to 10) scale; the total score is the sum of the individual item scores (range 0-50). A higher WOMAC score represents worse symptom severity.

  2. Treatment emergent adverse events (TEAEs) [ Time Frame: 24 Weeks ]
    The primary safety endpoint is the incidence of treatment emergent adverse events (TEAEs), reported between the administration of study drug on Day 1 and the completion of the study at week 24 or early termination.


Secondary Outcome Measures :
  1. Numeric Rating Scale (NRS) [ Time Frame: 24 Weeks ]
    Daily Knee Pain Intensity on a 0-10 Numeric Rating Scale (NRS). Pain intensity is reported by patients with chronic pain as one of the most important targets of treatment, and daily pain intensity ratings are a recommended core outcome measure for clinical trials of treatments for chronic pain. Daily ratings are preferable to ratings of recalled pain over longer time periods such as a week, as daily ratings minimize the influence of recall biases (Dworkin et al., 2005). Participants provide one-daily reports (at the end of the day) of their average knee pain intensity on a 0-10 pain intensity NRS over the course of a week, and those daily ratings are averaged to compute a mean knee pain intensity score. Participants will record their Daily Pain Intensity Numeric Rating Scale (NRS) 0-10 each day for one week prior to each clinic visit using NEForm.

  2. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC-C) [ Time Frame: 24 Weeks ]
    WOMAC-C (Function subscale) (Bellamy et al, 1988). The WOMAC-physical function subscale contains 17 items assessing daily functioning, each using an 11-point (0 to 10) numerical rating scale. The total index score (0-170) is the sum of the items. A higher WOMAC function score represents worse functioning and less ability to engage in daily activities.

  3. Hospital Anxiety and Depression Scale (HADS) [ Time Frame: 24 Weeks ]
    The HADS is a 14-item self-report questionnaire designed to assess symptoms of anxiety and depression in those with medical illness (Norton et al, 2013). This scale has 14 items, 7 related to anxiety and 7 to depression, rated on 4 points (0 to 3) in domains of intensity or frequency. Scoring is done separately for depression and for anxiety and each domain is interpreted as normal for scores of 0-7, borderline abnormal (borderline case) for scores of 8-10 and abnormal (case) for scores of 11-21. This scale is used to assess depression and anxiety in addition to HEAL/EPPIC-Net core data elements (CDEs) because of its higher sensitivity to change especially in patients with medical illnesses.

  4. PROMIS Sleep Disturbance Scale - 6A [ Time Frame: 24 Weeks ]
    PROMIS Sleep Disturbance Scale - 6A (Yu et al, 2011). Sleep disruption has a bi-directional relationship with chronic pain and is an important secondary outcome to measure in pain trials (Edwards et al, 2016). The Patient-Reported Outcomes Measurement Information System (PROMIS) Sleep Disturbance short form is a convenient 6-item scale that correlates strongly with the longer forms. It shows greater measurement precision for assessing sleep disturbance than other commonly-used (and much longer) questionnaires such as the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale; its brevity and convenience are a major advantage for both research and clinical settings (Yu et al, 2011). The PROMIS Sleep Disturbance Scale is expressed as a T-score, with a population mean of 50 and SD of 10. Possible T scores in this distribution range from 31.7 to 76.1.

  5. Patient Global Impression of Change (PGIC) [ Time Frame: 24 Weeks ]
    The PGIC is a single-item measure of patient-reported improvement that is widely used as a general outcome measure in studies of chronic pain patients, including OA patients (Salaff et al, 2004). It is often used as an index of treatment-associated change, and patient-reported improvements in the form of PGIC scores correlate robustly with significant improvement in pain intensity, pain interference with activities of daily living, mood, and quality of life (Perrot and Lanteri-Minet, 2019).

  6. Staircase-evoked pain assessment [ Time Frame: 24 Weeks ]
    This procedure consists of stepping fully up and down onto an 8in (20.32cm) high platform with both feet a total of 24 times. The lead leg is alternated between each up/down cycle. Subjects are instructed to use their normal gait for completing this task and are encouraged to complete the task despite increasing pain, without stopping if possible. The procedure is timed, and current knee pain intensity on a 0-10 Numeric Rating Scale (NRS) is assessed immediately before and following the procedure while the subject is in a seated, resting position.

  7. Actigraphy [ Time Frame: 24 Weeks ]
    The actigraphy device will be worn for a week before each study visit through week 24 (weeks 0, 3, 6, 9, 12, 15, 18, 21 and 24). Before the baseline visit, the actigraphy device will be worn for 1 week. Mean daily step counts will be used as an index of physical activity.

  8. Ecological Momentary Assessment (EMA) [ Time Frame: 24 Weeks ]
    Temporal assessment of OA pain will be assessed via Ecological Momentary Assessment (EMA), available on the same device where patients will input their weekly other measures (e.g., WOMAC-A). The EMA protocol calls for responding to simple questions related to the patient's pain at several randomly selected times during the day. The EMA protocol will be activated during one of the two study blocks (in randomized fashion), and patients will be asked to complete the EMA measures daily.

  9. Bedside Quantitative Sensory Testing (QST) [ Time Frame: 24 Weeks ]
    Bedside Quantitative Sensory Testing (QST) measures of mechanical and thermal hyperalgesia, and temporal summation. These will be assessed at baseline and at the end of each treatment period (weeks 6, 12, 18, and 24). Four representative measures will be obtained: Mechanical hyperalgesia from 0-10 (higher is worse), heat hyperalgesia from 0-10 (higher is worse), cold hyperalgesia from 0-10 (higher is worse), and temporal summation from 0-10 (higher is worse).

  10. Serum levels of cytokines and chemokines [ Time Frame: 24 Weeks ]
    These will be assessed at baseline and at the end of each treatment period (weeks 0, 6, 12, 18 and 24).Serum levels are measured in Picograms per millilitre (pg/mL). Serum analysis will include cytokines and chemokines as a part of establishing biomarker for treatment of OA pain with CNTX-6970.

  11. MCP-1/CCR-2 [ Time Frame: 24 Weeks ]
    Monocyte chemoattractant serum protein-1(MCP-1)/CCR-2 receptor binding inhibition by CNTX-6970. This will be assessed at baseline and at the end of each treatment period (weeks 0, 6, 12, 18 and 24). This test provides a single score, expressed as a percentage, 0-100%, with higher scores indicating more binding inhibition.


Eligibility Criteria
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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.


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Ages Eligible for Study:   40 Years to 90 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

A subject will be eligible for study participation if they meet all of the following criteria:

  1. Individuals between 40 and 90 years of age (inclusive) at the time of the Screening Visit.
  2. Willing to use a mobile smart device during the study period. Individuals who do not have access to a mobile device will be provided with one for the duration of the study and trained in its use.
  3. Can understand the nature of the study and protocol requirements and is willing to comply with study drug administration requirements and discontinue prohibited concomitant medications.
  4. Radiography of both knees with a posterior-anterior, fixed-flexion view taken during the Screening visit. The Index knee must show evidence of chronic OA with a K-L Grading Scale of 1, 2, 3, or 4. Such evidence will be provided by a central reading of the radiography of both knees from an expert radiologist of the CCC of EPPIC-Net.
  5. Moderate to severe pain in the Index knee associated with OA and stable for a minimum of 6 months prior to Screening in the opinion of the investigator.
  6. Confirmation of OA of the index knee: American College of Rheumatology (ACR) diagnostic criteria.
  7. Subjects must have failed 2 or more prior therapies. Failure is deemed to be inadequate relief in the opinion of the investigator.
  8. Body mass index (BMI) of ≤ 40 kg/m2.
  9. Willing to refrain from illicit drug use during the study, and to have illicit drug testing at screening and at later time points.

A subject will be excluded from the study if they meet any of the following criteria:

  1. Any form of joint replacement surgery, open surgery, or arthroscopic surgery of the index knee/knee joint with 12 months of Screening.
  2. Any painful condition(s) of the index knee due to disease other than OA. For example, periarticular or referred pain involving the index knee, or from joint disease other than OA associated with the index knee.
  3. Other chronic pain anywhere in the lower extremities (e.g. hips, legs, feet) that is equal or greater in intensity or impairment than index knee pain or that requires the use of analgesic medications. This includes radicular low back pain with radiation to the knee.
  4. Documented history of neuropathic arthropathy in the knee.
  5. Significant instability (e.g., cruciate ligament tear or rupture or previous repair) within the past 5 years or current misalignment (>10 degrees varus or valgus) of the index knee.

  6. Plans to have surgery, invasive procedures, or intra-articular (IA) injections of the index knee or procedure or surgery otherwise contraindicated for study participation while in the study.

    a. Concomitant Medications for Pain - i. Continuous use of one of the following medications prescribed for pain: tramadol, gabapentin, duloxetine, pregabalin, milnacipran, or tricyclic antidepressants that is:

    1. chronic for at least 12 weeks; and
    2. at a stable dose for at least 4 weeks before Screening ii. Intermittent use of opioids that is:
    1. ongoing for at least 4 weeks before Screening;
    2. at a frequency no more than 4 days/week; and
    3. not be taken within 24 hours of a study visit iii. As needed use of acetaminophen

    b. Concomitant Medications for Non-Pain Indications That May Impact Pain - i. Continuous use of medication for non-pain indications that are known to potentially impact pain, e.g. duloxetine for depression, that is at a stable dose for at least 12 weeks prior to Screening.

  7. Corticosteroid injection in the index knee within 90 days of Screening or during study participation.
  8. Received IA viscosupplementation (e.g., Synvisc®, Hyalgan®) within 90 days of Screening or any time during study participation.
  9. History of clearly documented allergic reaction to celecoxib (Celebrex®), or to sulfa drugs.
  10. Use of an investigational medication within 30 days of Screening, or 5 pharmacokinetic or pharmacodynamic half-lives (whichever is longer) or scheduled to receive such an agent while participating in the current study.
  11. Current therapy with any immunosuppressive therapy, including corticosteroids (>5 mg/day of prednisone).
Contacts and Locations
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Information from the National Library of Medicine

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): NCT05025787


Contacts
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Contact: Aderonke Pederson, MD (617) 643-8248 apederson@mgh.harvard.edu
Contact: Allison Campbell (617) 595-8372 acampbell17@mgh.harvard.edu

Locations
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Sponsors and Collaborators
Maurizio Fava, MD
Investigators
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Principal Investigator: Maurizio Fava, MD Massachusetts General Hosptial
More Information
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Publications:
Centrexion Investigator's Brochure for CNTX-6970. Version 2, 21 February 2019.
Evans K, Romero H, Katz N. Qualitative evaluation and responsiveness of the staircase-evoked pain procedure (STEPP) in two clinical trials of treatments for knee osteoarthritis (OA). https://www.oarsijournal.com/article/S1063-4584(20)30302-2/abstract DOI:https://doi.org/10.1016/j.joca.2020.02.235.
Lundeen J, McCall WV, Looney S. Dealing with Methodological Issues in the Functional Data Analysis of Actigraphy Data. Journal of Biometrics & Biostatistics 2019; 10: 429.
Schmid CH, Duan N. Statistical design and analytic considerations for N-of-1 trials. Design and Implementation of N-of-1 Trials: A User's Guide Rockville, MD: Agency for Healthcare Research and Quality; 2014. p. 33-52.
Sullivan MJL, Bishop S, Pivik J. The pain catastrophizing scale: development and validation. Psychol Assess 1995; 7: 432-524.
van Buuren S, Groothuis-Oudshoorn K. Multivariate Imputation by Chained Equations in R. Journal of Statistical Software, 2011, 45(3), 1-67.

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Responsible Party: Maurizio Fava, MD, Psychiatrist in Chief, Massachusetts General Hospital
ClinicalTrials.gov Identifier: NCT05025787    
Other Study ID Numbers: 2021p002273 (EN20-01)
First Posted: August 27, 2021    Key Record Dates
Last Update Posted: March 10, 2023
Last Verified: March 2023
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Yes
Plan Description:

The EPPIC-Net DCC's NYU Center for Biospecimen Research and Development (CBRD) will store and manage biological samples (biosamples) collected in this clinical trial. The samples will be used for the present study and also for potential future research as permitted by the study-specific informed consent form. Biosamples stored for this study may include, but are not limited to: whole blood, plasma, stool, synovial fluid, and/or derivatives of these specimens. The samples will be stored only for the period defined in the informed consent form, which may be indefinite. Biospecimens may be shared in accordance with the protocol-defined data and sample sharing plan and the informed consent form.

Biosamples will be documented in LabVantage, a secure network linking biospecimens to corresponding clinical and pathological data. LabVantage does not include any identifying personal health information (PHI). The CBRD and LabVantage meet all General Lab Protocol (GLP) and FDA guidelines.
Supporting Materials: Informed Consent Form (ICF)

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Additional relevant MeSH terms:
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Osteoarthritis
Osteoarthritis, Knee
Arthritis
Joint Diseases
Musculoskeletal Diseases
Rheumatic Diseases
Celecoxib
Anti-Inflammatory Agents, Non-Steroidal
Analgesics, Non-Narcotic
Analgesics
 Sensory System Agents
Peripheral Nervous System Agents
Physiological Effects of Drugs
Anti-Inflammatory Agents
Antirheumatic Agents
Cyclooxygenase 2 Inhibitors
Cyclooxygenase Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action