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This study will evaluate the efficacy of two doses of Intra-Articular Injection of Ampionâ„¢ in Adults with pain due to osteoarthritis of the knee.
A Randomized, Placebo-controlled, Double-Blind Study to Evaluate the Efficacy and Safety of two Doses of Intra-Articular Injection of Ampionâ„¢ in Adults with pain due to osteoarthritis of the knee.
The primary trial objective is to evaluate whether there is greater efficacy of 10 mL Ampionâ„¢ versus 10 mL placebo than 4 mL Ampionâ„¢ versus 4 mL placebo intra-articular (IA) injection in improving knee pain, when applied to patients suffering from OA of the knee.
The secondary trial objective include: the evaluation of the safety of an intra-articular injection of Ampionâ„¢ when applied to patients suffering from OA of the knee, evaluation of the efficacy of intra-articular injection of Ampionâ„¢ and placebo on stiffness and function when applied to patients suffering from OA of the knee and evaluation of responder status defined by the Outcome Measures in Rheumatology Clinical Trials and Osteoarthritis Research Society International (OMERACT-OARSI) Criteria.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Ampion 4 mL Dose | Experimental | 4 mL Injection of Ampion |
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| Placebo 4 mL Dose | Placebo Comparator | 4 mL Injection of Placebo |
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| Ampion 10 mL Dose | Experimental | 10 mL Injection of Ampion |
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| Placebo 10 mL Dose | Placebo Comparator | 10 mL Injection of Placebo |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| 4 mL injection of Ampion | Biological | 4 mL Injection of Ampion |
| |
| Measure | Description | Time Frame |
|---|---|---|
| Change in Knee Pain | Mean Change in WOMAC A Pain (Western Ontario and McMaster Universities Arthritis Index) score from Baseline to 12 weeks. 5-point Likert scale (0=none to 4=extreme). A negative difference constitutes a decrease in pain with a greater negative value indicating a greater reduction in pain. | Scored at Baseline and 12 weeks |
| Measure | Description | Time Frame |
|---|---|---|
| Change in Knee Function | Mean change in WOMAC C function score (Western Ontario and McMaster Universities Arthritis Index) from Baseline to 12 weeks. 5-point Likert scale indicating limitation of function (0=none to 4=extreme). A greater negative value indicates a improvement in function. | Scored at Baseline and 12 weeks. |
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Inclusion Criteria:
Exclusion Criteria:
As a result of medical review and screening investigation, the Principal Investigator considers the patient unfit for the study
A history of allergic reactions to human albumin (reaction to non-human albumin such as egg albumin is not an exclusion criterion)
A history of allergic reactions to excipients in 5% human albumin (N-acetyltryptophan, sodium caprylate)
Presence of tense effusions
Inflammatory or crystal arthropathies, acute fractures, history of aseptic necrosis or joint replacement in the affected knee, as assessed locally by the Principal Investigator
Isolated patella femoral syndrome, also known as chondromalacia
Any other disease or condition interfering with the free use and evaluation of the index knee for the duration of the trial e.g. cancer, congenital defects, spine OA)
Major injury to the index knee within the 12 months prior to screening
Severe hip OA ipsilateral to the index knee
Any pain that could interfere with the assessment of index knee pain (e.g. pain in any other part of the lower extremities, pain radiating to the knee)
Any pharmacological or non-pharmacological treatment targeting OA started or changed during the 4 weeks prior to randomization or likely to be changed during the duration of the study
Use of the following medications:
Any human albumin treatment in the 3 months before randomization
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| Name | Affiliation | Role |
|---|---|---|
| Howard Levy, MD | Ampio Pharmaceuticals. Inc. | Study Director |
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| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 24498399 | Result | Bar-Or D, Salottolo KM, Loose H, Phillips MJ, McGrath B, Wei N, Borders JL, Ervin JE, Kivitz A, Hermann M, Shlotzhauer T, Churchill M, Slappey D, Clift V. A randomized clinical trial to evaluate two doses of an intra-articular injection of LMWF-5A in adults with pain due to osteoarthritis of the knee. PLoS One. 2014 Feb 3;9(2):e87910. doi: 10.1371/journal.pone.0087910. eCollection 2014. |
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No pharmacological or non-pharmacological treatment targeting OA started or changed during the 4 weeks prior to randomization or likely to be changed during the duration of the study.
Recruitment of subjects occurred in medical clinics during the months of March, April, and May 2013.
| ID | Title | Description |
|---|---|---|
| FG000 | Ampion 4 mL Dose | 4 mL Injection of Ampion |
| FG001 | Placebo 4 mL Dose | 4 mL Injection of Placebo |
| Title | Milestones | Reasons Not Completed | |||||
|---|---|---|---|---|---|---|---|
| Overall Study |
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| 10 mL Injection of Ampion |
| Biological |
10 mL Injection of Ampion |
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| 4 mL Injection of Placebo | Drug | 4 mL Injection of Placebo |
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| 10 mL Injection of Placebo | Drug | 10 mL Injection of Placebo |
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| Change in Knee Stiffness. |
Mean Change in WOMAC B stiffness score from Baseline to 12 weeks. 5-point Likert scale (0=none to 4=extreme). A negative difference constitutes a reduction in stiffness. |
| Scored at Baseline and 12 weeks. |
| Change in Patient's Global Assessment | Patients are asked the following question: "Considering all the ways in which your arthritis affects you, please indicate how you are doing." 5-point Likert scale (0 = very well, 1 = well, 2 = fair, 3 = poor, 4 = very poor). A negative value constitutes an improvement in patient's assessment of disease severity. | Scored at Baseline and 12 weeks. |
| FG002 |
| Ampion 10 mL Dose |
10 mL Injection of Ampion |
| FG003 | Placebo 10 mL Dose | 10 mL Injection of Placebo |
| Week 6 |
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| COMPLETED |
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| NOT COMPLETED |
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| ID | Title | Description |
|---|---|---|
| BG000 | Ampion 4 mL Dose | 4 mL Injection of Ampion |
| BG001 | Placebo 4 mL Dose | 4 mL Injection of Placebo |
| BG002 | Ampion 10 mL Dose | 10 mL Injection of Ampion |
| BG003 | Placebo 10 mL Dose | 10 mL Injection of Placebo |
| BG004 | Total | Total of all reporting groups |
| Units | Counts |
|---|---|
| Participants |
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| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean | Standard Deviation | years |
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| Sex: Female, Male | Count of Participants | Participants |
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| Ethnicity (NIH/OMB) | Count of Participants | Participants |
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| Race (NIH/OMB) | Count of Participants | Participants |
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| Region of Enrollment | Number | participants |
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| Weight (kg) | Mean | Standard Deviation | kg |
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| BMI (kg/m^2) | Mean | Standard Deviation | kg/m^2 |
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| Kellgren-Lawrence (KL) Grade | Kellgren-Lawrence grading is based on the radiologic features of osteoarthritis. Ann Rheum Dis. 1957;16:494-502. Grade II (Mild): Definite osteophytes, possible joint space narrowing. Grade III (Moderate): Moderate osteophytes, definite joint space narrowing, some sclerosis, possible bone-end deformity. Grade IV (Severe): Large osteophytes, marked joint space narrowing, severe sclerosis, definite bone ends deformity. | Count of Participants | Participants |
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| WOMAC Pain | The Western Ontario and McMaster Universities Arthritis Index (WOMAC) 3.1 evaluates Pain (5 items): during walking, using stairs, in bed, sitting or lying, and standing upright. Subjects respond to each subscale by using a 5-point Likert score. (0=none; 1=mild; 2=moderate; 3=severe; 4=extreme). Mean of the 5 scores constitutes the Baseline Pain Score. Higher scores are indicative of higher levels of self-reported pain. | Mean | Standard Deviation | score on a scale |
| ||||||||||||||
| WOMAC Stiffness | The Western Ontario and McMaster Universities Arthritis Index (WOMAC) 3.1 evaluates stiffness (2 items): after first waking and later in the day. Subjects respond to each subscale by using a 5-point Likert score. (0=none; 1=mild; 2=moderate; 3=severe; 4=extreme). Mean of the 5 scores constitutes the Baseline Stiffness Score. Higher scores are indicative of higher levels of self-reported joint stiffness. | Mean | Standard Deviation | score on a scale |
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| WOMAC Function | WOMAC 3.1 evaluates Physical Function (17 items): using stairs, rising from sitting, standing, bending, walking, getting in/out of a car, shopping, putting on / taking off socks, rising from bed, lying in bed, getting in/out of bath, sitting, getting on/off toilet, heavy/light domestic duties. Subjects respond to each subscale by using a 5-point Likert score. (0=none; 1=mild; 2=moderate; 3=severe; 4=extreme). Mean of the 17 scores constitutes the Baseline Function Score. Higher scores are indicative of higher levels of limitations of self-reported physical function. | Mean | Standard Deviation | score on a scale |
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| Patient's Global Assessment (PGA) | The Patient's Global Assessment of disease severity has subjects answer the following question: "Considering all the ways in which your arthritis affects you, please indicate how you are doing." Patients respond by using a 5-point Likert score (0=very well; 1=well; 2=fair; 3=poor; 4=very poor). Higher scores indicate greater patient's assessment of disease severity due to arthritis. | Mean | Standard Deviation | score on a scale |
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| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Change in Knee Pain | Mean Change in WOMAC A Pain (Western Ontario and McMaster Universities Arthritis Index) score from Baseline to 12 weeks. 5-point Likert scale (0=none to 4=extreme). A negative difference constitutes a decrease in pain with a greater negative value indicating a greater reduction in pain. | Intent to Treat (ITT) | Posted | Mean | 95% Confidence Interval | score on a scale | Scored at Baseline and 12 weeks |
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| Secondary | Change in Knee Function | Mean change in WOMAC C function score (Western Ontario and McMaster Universities Arthritis Index) from Baseline to 12 weeks. 5-point Likert scale indicating limitation of function (0=none to 4=extreme). A greater negative value indicates a improvement in function. | Intent to Treat (ITT) | Posted | Mean | 95% Confidence Interval | score on a scale | Scored at Baseline and 12 weeks. |
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| Secondary | Change in Knee Stiffness. | Mean Change in WOMAC B stiffness score from Baseline to 12 weeks. 5-point Likert scale (0=none to 4=extreme). A negative difference constitutes a reduction in stiffness. | Intent to Treat (ITT) | Posted | Mean | 95% Confidence Interval | score on a scale | Scored at Baseline and 12 weeks. |
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| Secondary | Change in Patient's Global Assessment | Patients are asked the following question: "Considering all the ways in which your arthritis affects you, please indicate how you are doing." 5-point Likert scale (0 = very well, 1 = well, 2 = fair, 3 = poor, 4 = very poor). A negative value constitutes an improvement in patient's assessment of disease severity. | Intent to Treat (ITT) | Posted | Mean | 95% Confidence Interval | score on a scale | Scored at Baseline and 12 weeks. |
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12 Weeks
Patients will be followed for the occurrence of Adverse Events (AEs) until 12 weeks after the first dose of study medication and additionally for AEs in the study knee for those patients who opt to continue in the 20 week follow-up visit.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Ampion 4 mL Dose | 4 mL Injection of Ampion | 0 | 83 | 0 | 83 | 23 | 83 |
| EG001 | Placebo 4 mL Dose | 4 mL Injection of Placebo | 0 | 83 | 2 | 83 | 38 | 83 |
| EG002 | Ampion 10 mL Dose | 10 mL Injection of Ampion | 0 | 82 | 3 | 82 | 17 | 82 |
| EG003 | Placebo 10 mL Dose | 10 mL Injection of Placebo | 0 | 81 | 2 | 81 | 29 | 81 |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Bradycardia | Cardiac disorders | MedDRA (15.1) | Systematic Assessment |
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| Chest Discomfort | General disorders | MedDRA (15.1) | Systematic Assessment |
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| Chest Pain | General disorders | MedDRA (15.1) | Systematic Assessment |
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| Arthritis Bacterial | Infections and infestations | MedDRA (15.1) | Systematic Assessment |
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| Osteomyelitis | Infections and infestations | MedDRA (15.1) | Systematic Assessment |
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| Renal Failure Acute | Renal and urinary disorders | MedDRA (15.1) | Systematic Assessment |
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| Dermatitis Allergic | Skin and subcutaneous tissue disorders | MedDRA (15.1) | Systematic Assessment |
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| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Arthralgia | Musculoskeletal and connective tissue disorders | MedDRA (15.1) | Systematic Assessment |
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| Headache | Nervous system disorders | MedDRA (15.1) | Systematic Assessment |
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| Injection Site Pain | General disorders | MedDRA (15.1) | Systematic Assessment |
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| Sinusitis | Infections and infestations | MedDRA (15.1) | Systematic Assessment |
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| Fall | Injury, poisoning and procedural complications | MedDRA (15.1) | Systematic Assessment |
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| Joint Stiffness | Musculoskeletal and connective tissue disorders | MedDRA (15.1) | Systematic Assessment |
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| Joint Swelling | Musculoskeletal and connective tissue disorders | MedDRA (15.1) | Systematic Assessment |
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| Ligament Sprain | Injury, poisoning and procedural complications | MedDRA (15.1) | Systematic Assessment |
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| Upper Respiratory Infection | Infections and infestations | MedDRA (15.1) | Systematic Assessment |
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| Gastroenteritis | Infections and infestations | MedDRA (15.1) | Systematic Assessment |
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| Muscle Spasms | Musculoskeletal and connective tissue disorders | MedDRA (15.1) | Systematic Assessment |
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| Oedema Peripheral | General disorders | MedDRA (15.1) | Systematic Assessment |
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| Chest Pain | General disorders | MedDRA (15.1) | Systematic Assessment |
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| Epistaxis | Respiratory, thoracic and mediastinal disorders | MedDRA (15.1) | Systematic Assessment |
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| Gastroenteritis Viral | Infections and infestations | MedDRA (15.1) | Systematic Assessment |
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The relatively small number of subjects in each arm may account for lack of statistical significance of improvement in Knee pain of 10 mL.
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr. Howard Levy / Chief Medical Officer | Ampio Pharmaceuticals | 720-437-6500 | clinicaltrials@ampiopharma.com |
| ID | Term |
|---|---|
| D020370 | Osteoarthritis, Knee |
| D010003 | Osteoarthritis |
| ID | Term |
|---|---|
| D001168 | Arthritis |
| D007592 | Joint Diseases |
| D009140 | Musculoskeletal Diseases |
| D012216 | Rheumatic Diseases |
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| ID | Term |
|---|---|
| D012965 | Sodium Chloride |
| ID | Term |
|---|---|
| D002712 | Chlorides |
| D006851 | Hydrochloric Acid |
| D017606 | Chlorine Compounds |
| D007287 | Inorganic Chemicals |
| D017670 | Sodium Compounds |
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| Male |
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| Not Hispanic or Latino |
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| Unknown or Not Reported |
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| Asian |
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| Native Hawaiian or Other Pacific Islander |
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| Black or African American |
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| White |
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| More than one race |
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| Unknown or Not Reported |
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| Kellgren-Lawrence Grade III |
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| Kellgren-Lawrence Grade IV |
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Adjusted for injection volume and baseline WOMAC score. |
| Superiority |
| ANOVA | 0.093 | Adjusted for injection volume and baseline WOMAC score. | Superiority |
10 mL Injection of Ampion |
| OG005 | Placebo 10 mL Dose | 10 mL Injection of Placebo |
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| OG005 | Placebo 10 mL Dose | 10 mL Injection of Placebo |
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10 mL Injection of Ampion |
| OG005 | Placebo 10 mL Dose | 10 mL Injection of Placebo |
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