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This is an open-label study to compare systemic exposure to triamcinolone acetonide following a dose of extended-release FX006 or immediate-release TAcs (triamcinolone acetonide suspension) in patients with osteoarthritis of the shoulder (glenohumeral joint) or hip
This is a randomized, open-label, single dose study that will be conducted in male and female patients ≥40 years of age with OA of either the shoulder or the hip.
Approximately 24 patients with OA of the shoulder and approximately 24 patients with OA of the hip will be randomized to one of two treatment groups (1:1) and treated with a single IA injection of either:
Each patient will be screened to confirm the diagnosis of OA of either the shoulder or hip and eligibility based on the other inclusion/exclusion requirements and will be randomized to treatment on Day 1. Each patient will be evaluated for a total of 12 weeks following the IA injection. Following screening, sampling for pharmacokinetics (PK) and safety will be completed at 10 out-patient visits scheduled on Study Days 1 [calendar day of injection], 2, 3, 5, 8, 15, 22, 29, 57, and 85.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| FX006 32 mg | Experimental | Single intra-articular (IA) injection of FX006 32 mg |
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| TAcs 40 mg | Active Comparator | Single intra-articular (IA) injection of TAcs 40 mg |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| FX006 32 mg | Drug | Extended-release 32 mg FX006 IA injection |
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| Measure | Description | Time Frame |
|---|---|---|
| Concentration of Triamcinolone Acetonide (TA) in Blood Plasma | Characterize the Pharmacokinetic Profile of FX006 and TCA IR [Time Frame: Day 1 (pre-treatment,1, 2, 3, 4, 5, 6, 8,10, and 12 hrs. post-dose) and Days 2, 3, 5, 8, 15, 22, 29, 57,and 85] For the PK analysis and individual concentration vs. time plots, a concentration that is BLOQ is assigned a value of zero if it occurs in a profile before the first measurable concentration. If a BLOQ value occurs after a measurable concentration in a profile and is followed by a value above the lower limit of quantification, then the BLOQ is treated as missing data. If a BLOQ value occurs at the end of the collection interval (after the last quantifiable concentration) it is set to zero. If two BLOQ values occur in succession after Cmax, the profile is deemed to have terminated at the first BLOQ value and any subsequent concentrations are set to zero for PK calculations | 12 Weeks |
| Total Number of Treatment Emergent Adverse Events | Analyses of adverse events (AE) were performed for events considered treatment-emergent (TE). TE was defined as any AE with onset after administration of the 1st dose of study drug or any event present at baseline but worsened in intensity through the study. Severity was graded by the PI using the Common Terminology Criteria for AEs Version 4.0. Grading went from Grade 1 (Mild) to Grade 5 (Death Related to AE). | 12 Weeks |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Scott Kelley, MD | Pacira Pharmaceuticals, Inc | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| TriWest Research Associates, LLC | El Cajon | California | 92020 | United States | ||
| Biosolutions Clinical Research Center |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 35258839 | Derived | Kivitz A, Mehra P, Hanson P, Kwong L, Cinar A, Lufkin J, Kelley S. A Randomized, Open-Label, Single-Dose Study to Assess Safety and Systemic Exposure of Triamcinolone Acetonide Extended-Release in Patients With Hip Osteoarthritis. Rheumatol Ther. 2022 Apr;9(2):679-691. doi: 10.1007/s40744-022-00430-3. Epub 2022 Mar 8. | |
| 34350546 |
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The recruitment period for this study was from December 2017 to July 2018. The patients were enrolled at medical clinics.
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| ID | Title | Description |
|---|---|---|
| FG000 | FX006 32 mg Shoulder | Single intra-articular (IA) injection of FX006 32 mg FX006 32 mg: Extended-release 32 mg FX006 IA injection in the Shoulder |
| FG001 | TAcs 40 mg Shoulder |
| Title | Milestones | Reasons Not Completed | |||||
|---|---|---|---|---|---|---|---|
| Overall Study |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot | Yes | No | No | Study Protocol | Apr 5, 2018 | Sep 25, 2019 |
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| TAcs 40 mg | Drug | Immediate-release 40mg TAcs IA injection |
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| La Mesa |
| California |
| 91942 |
| United States |
| Artemis Institute for Clinical Research | San Diego | California | 92103 | United States |
| LA Biomed at Harbor-UCLA Medical Center | Torrance | California | 90509 | United States |
| Rochester Clinical Research | Rochester | New York | 14609 | United States |
| Altoona Center for Clinical Research | Duncansville | Pennsylvania | 16635 | United States |
| Hanson P, Kivitz A, Mehra P, Kwong L, Cinar A, Lufkin J, Kelley SD. Safety and Systemic Exposure of Triamcinolone Acetonide Following Ultrasound-Guided Intra-Articular Injection of Triamcinolone Extended-Release or Standard Triamcinolone Acetonide in Patients with Shoulder Osteoarthritis: An Open-Label, Randomized Study. Drugs R D. 2021 Sep;21(3):285-293. doi: 10.1007/s40268-021-00348-1. Epub 2021 Aug 4. |
Single intra-articular (IA) injection of TAcs 40 mg
TAcs 40 mg: Immediate-release 40mg TAcs IA injection in the Shoulder
| FG002 | FX006 32 mg Hip | Single intra-articular (IA) injection of FX006 32 mg FX006 32 mg: Extended-release 32 mg FX006 IA injection in the Hip |
| FG003 | TAcs 40 mg Hip | Single intra-articular (IA) injection of TAcs 40 mg TAcs 40 mg: Immediate-release 40mg TAcs IA injection in the Hip |
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| NOT COMPLETED |
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| ID | Title | Description |
|---|---|---|
| BG000 | FX006 32 mg Shoulder | Single intra-articular (IA) injection of FX006 32 mg in the Shoulder FX006 32 mg: Extended-release 32 mg FX006 IA injection |
| BG001 | TAcs 40 mg Shoulder | Single intra-articular (IA) injection of TAcs 40 mg in the Shoulder TAcs 40 mg: Immediate-release 40mg TAcs IA injection |
| BG002 | FX006 32 mg Hip | Single intra-articular (IA) injection of FX006 32 mg in the Hip FX006 32 mg: Extended-release 32 mg FX006 IA injection |
| BG003 | TAcs 40 mg Hip | Single intra-articular (IA) injection of TAcs 40 mg in the Hip TAcs 40 mg: Immediate-release 40mg TAcs IA injection |
| 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 | Age at Consent | 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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| Body Mass Index (BMI) | Body Mass Index calculated at Baseline | Mean | Standard Deviation | kg/mg^2 |
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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 | Concentration of Triamcinolone Acetonide (TA) in Blood Plasma | Characterize the Pharmacokinetic Profile of FX006 and TCA IR [Time Frame: Day 1 (pre-treatment,1, 2, 3, 4, 5, 6, 8,10, and 12 hrs. post-dose) and Days 2, 3, 5, 8, 15, 22, 29, 57,and 85] For the PK analysis and individual concentration vs. time plots, a concentration that is BLOQ is assigned a value of zero if it occurs in a profile before the first measurable concentration. If a BLOQ value occurs after a measurable concentration in a profile and is followed by a value above the lower limit of quantification, then the BLOQ is treated as missing data. If a BLOQ value occurs at the end of the collection interval (after the last quantifiable concentration) it is set to zero. If two BLOQ values occur in succession after Cmax, the profile is deemed to have terminated at the first BLOQ value and any subsequent concentrations are set to zero for PK calculations | All patients in the Safety population who received study drug, completed scheduled sampling and had sufficient plasma concentration data. 50 of 55 patients were included. Four unique patients for whom hip was the index joint were excluded due to IP administration deviations. One of the four was also found to be enrolled at 2 separate study centers. | Posted | Geometric Mean | 95% Confidence Interval | pg/mL | 12 Weeks |
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| Primary | Total Number of Treatment Emergent Adverse Events | Analyses of adverse events (AE) were performed for events considered treatment-emergent (TE). TE was defined as any AE with onset after administration of the 1st dose of study drug or any event present at baseline but worsened in intensity through the study. Severity was graded by the PI using the Common Terminology Criteria for AEs Version 4.0. Grading went from Grade 1 (Mild) to Grade 5 (Death Related to AE). | All patients randomized to receive either FX006 or TAcs in the hip or shoulder. | Posted | Number | Events | 12 Weeks |
|
Adverse events were collected following IA administration through the final study visit at 12 weeks.
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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 | FX006 32 mg Shoulder | Single intra-articular (IA) injection of FX006 32 mg in the Shoulder FX006 32 mg: Extended-release 32 mg FX006 IA injection | 0 | 12 | 0 | 12 | 4 | 12 |
| EG001 | TAcs 40 mg Shoulder | Single intra-articular (IA) injection of TAcs 40 mg in the Shoulder TAcs 40 mg: Immediate-release 40mg TAcs IA injection | 0 | 13 | 0 | 13 | 3 | 13 |
| EG002 | FX006 32 mg Hip | Single intra-articular (IA) injection of FX006 32 mg in the Hip FX006 32 mg: Extended-release 32 mg FX006 IA injection | 0 | 15 | 0 | 15 | 4 | 15 |
| EG003 | TAcs 40 mg Hip | Single intra-articular (IA) injection of TAcs 40 mg in the Hip TAcs 40 mg: Immediate-release 40mg TAcs IA injection | 0 | 15 | 0 | 15 | 7 | 15 |
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| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Ear Pain | Ear and labyrinth disorders | MeDRA 20.1 | Systematic Assessment |
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| Gastrooesophageal Reflux Disease | Gastrointestinal disorders | MeDRA 20.1 | Systematic Assessment |
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| Nausea | Gastrointestinal disorders | MeDRA 20.1 | Systematic Assessment |
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| Influenza Like Illness | General disorders | MeDRA 20.1 | Systematic Assessment |
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| Injection Site Hypoaesthesia | General disorders | MeDRA 20.1 | Systematic Assessment | And Administrative Site Conditions |
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| Nasopharyngitis | Infections and infestations | MeDRA 20.1 | Systematic Assessment |
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| Upper Respiratory Tract Infection | Infections and infestations | MeDRA 20.1 | Systematic Assessment |
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| Urinary Tract Infection | Infections and infestations | MeDRA 20.1 | Systematic Assessment |
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| Viral Upper Respiratory Tract Infection | Infections and infestations | MeDRA 20.1 | Systematic Assessment |
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| Contusion | Injury, poisoning and procedural complications | MeDRA 20.1 | Systematic Assessment |
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| Fall | Injury, poisoning and procedural complications | MeDRA 20.1 | Systematic Assessment |
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| Incision Site Pain | Injury, poisoning and procedural complications | MeDRA 20.1 | Systematic Assessment |
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| Periorbital Haemorrhage | Injury, poisoning and procedural complications | MeDRA 20.1 | Systematic Assessment |
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| Road Traffic Accident | Injury, poisoning and procedural complications | MeDRA 20.1 | Systematic Assessment |
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| Skin Abrasion | Injury, poisoning and procedural complications | MeDRA 20.1 | Systematic Assessment |
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| Blood Pressure Increased | Investigations | MeDRA 20.1 | Systematic Assessment |
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| Gout | Metabolism and nutrition disorders | MeDRA 20.1 | Systematic Assessment |
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| Arthralgia | Musculoskeletal and connective tissue disorders | MeDRA 20.1 | Systematic Assessment |
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| Back Pain | Musculoskeletal and connective tissue disorders | MeDRA 20.1 | Systematic Assessment |
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| Joint Range of Motion Decreased | Musculoskeletal and connective tissue disorders | MeDRA 20.1 | Systematic Assessment |
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| Muscular Weakness | Musculoskeletal and connective tissue disorders | MeDRA 20.1 | Systematic Assessment |
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| Musculoskeletal Discomfort | Musculoskeletal and connective tissue disorders | MeDRA 20.1 | Systematic Assessment |
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| Musculoskeletal Pain | Musculoskeletal and connective tissue disorders | MeDRA 20.1 | Systematic Assessment |
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| Osteoarthritis | Musculoskeletal and connective tissue disorders | MeDRA 20.1 | Systematic Assessment |
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| Pain In Extremity | Musculoskeletal and connective tissue disorders | MeDRA 20.1 | Systematic Assessment |
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| Headache | Nervous system disorders | MeDRA 20.1 | Systematic Assessment |
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| Hypoaesthesia | Nervous system disorders | MeDRA 20.1 | Systematic Assessment |
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| Testicular Pain | Reproductive system and breast disorders | MeDRA 20.1 | Systematic Assessment |
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| Cough | Respiratory, thoracic and mediastinal disorders | MeDRA 20.1 | Systematic Assessment |
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| Respiratory Tract Congestion | Respiratory, thoracic and mediastinal disorders | MeDRA 20.1 | Systematic Assessment |
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| Melanocytic Hypoplasia | Skin and subcutaneous tissue disorders | MeDRA 20.1 | Systematic Assessment |
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| Hot Flush | Vascular disorders | MeDRA 20.1 | Systematic Assessment |
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4 patients with hip as index joint, were excluded from the PK population. 3 patients had incomplete FX006 administration. 1 patient enrolled at 2 different study centers; receiving TAcs and FX006 5 days apart in the same hip with no TEAEs reported.
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Scott Kelley MD, Chief Medical Officer | Flexion Therapeutics | 781-305-7142 | skelley@flexiontherapeutics.com |
| Prot_000.pdf |
| SAP | No | Yes | No | Statistical Analysis Plan | Oct 17, 2018 | Sep 25, 2019 | SAP_001.pdf |
| ID | Term |
|---|---|
| D015207 | Osteoarthritis, Hip |
| D010003 | Osteoarthritis |
| D010146 | Pain |
| ID | Term |
|---|---|
| D001168 | Arthritis |
| D007592 | Joint Diseases |
| D009140 | Musculoskeletal Diseases |
| D012216 | Rheumatic Diseases |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
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| ID | Term |
|---|---|
| C000631825 | FX006 |
| D014221 | Triamcinolone |
| ID | Term |
|---|---|
| D011245 | Pregnadienes |
| D011278 | Pregnanes |
| D013256 | Steroids |
| D000072473 | Fused-Ring Compounds |
| D011083 | Polycyclic Compounds |
| D013259 | Steroids, Fluorinated |
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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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| TAcs 40 mg Hip |
Single intra-articular (IA) injection of TAcs 40 mg in the Hip TAcs 40 mg: Immediate-release 40mg TAcs IA injection |
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