E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Painful osteoarthritis of the knee joint.
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MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 9.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10023476 |
E.1.2 | Term | Knee osteoarthritis |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
Primary outcome: Change in WOMAC pain score at 24 weeks (Western Ontario and McMasters Universities Index)
To judge the effectiveness of methotrexate at reducing pain in the osteoarthritic knee joint after 24 weeks of treatment, by reducing synovitis in the joint. |
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E.2.2 | Secondary objectives of the trial |
1) Changes on ultrasound scan at baseline and 24 weeks. Ultrasound images will be scored for synovitis. 2) Change in OAQoL score (osteoarthritis quality of life score) 3) Change in HADS score (hospital anxiety and depression score) 4) Change in other WOMAC subscales (stiffness and function) 5) Change in West Haven-Yale Multidimensional Pain Inventory scores
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E.2.3 | Trial contains a sub-study | Yes |
E.2.3.1 | Full title, date and version of each sub-study and their related objectives |
Sub-study of knee osteoarthritis Version 3.1. 2nd, March 2009.
Various scientific hypotheses will be tested in a biological sub-study. As part of an in-house investigation of biomarkers, serum, plasma and DNA will be collected and stored from blood samples taken on the same day as the knee ultrasound scan, i.e. at baseline and 24 weeks, for assessment of auto-antibodies, inflammatory, vascular, synovial, cartilage and bone markers in this and future studies (subject to further ethical review of such studies). |
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E.3 | Principal inclusion criteria |
1. Knee pain on most days in the last 3 months.
2. Insufficient pain relief from, or inability to tolerate NSAIDs and/or opioids.
3. Patient able to identify a predominantly painful knee (the signal knee).
4. Moderate to severe pain of the signal knee as defined by a score of ≥40mm on a VAS (0-100mm) using the question “On average, how would you rate your knee pain during the last 3 months?”
5. Fulfil clinical ACR Criteria for knee OA.
6. A previous radiograph (X-Ray) of the signal knee with changes consistent with osteoarthritis.
7. Men and women must use adequate birth control measures (e.g. abstinence, oral contraceptives, Intra-uterine device, barrier method with spermicide, or surgical sterilisation) for the duration of the study and should continue such precautions for 6 months after receiving the last infusion or dose of methotrexate. If female and have potential for child bearing then a negative pregnancy test must be performed prior to starting treatment.
8. The patient must be able to adhere to the study visit schedule and other protocol requirements.
9. The patient must be capable of giving informed consent and the consent must be obtained prior to any screening procedures.
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E.4 | Principal exclusion criteria |
1.1. The presence of any rheumatic diseases that could be responsible for secondary osteoarthritis. 2. Use of intra-articular hyaluronic acid in the signal knee within the 6 months preceding enrolment in the study 3. The use of oral, parenteral, intra-articular or intra-muscular steroids in the 2 months preceding enrolment into the study 4. Knee injury, diagnostic arthroscopy or knee surgery within the 3 months preceding enrolment in the study 5. The presence of non-OA causes of pain in the signal knee, e.g. referred hip pain, osteonecrosis. 6. Women who are pregnant, nursing, or men or women planning pregnancy within 12 months after screening (i.e. approximately 6 months following last study medications). 7. Use of any investigational (unlicensed) drug within 1 month prior to screening or within 5 half-lives of the investigational agent, whichever is longer.
8. Significant haematological or biochemical abnormality
a. Haemoglobin 8.5 g/dL b. WCC 3.5 x 109/L c. Neutrophils 1.5 x 109/L d. Platelets 100 x 109/L e. ALT 2 times ULN for the laboratory conducting the test. f. Creatinine > 1.5 times ULN for the laboratory conducting the test
9. Have current signs or symptoms of severe, progressive or uncontrolled renal, hepatic, haematological, gastrointestinal, endocrine, pulmonary, cardiac, neurologic, or cerebral disease.
10. Intake of alcohol above the recommended government guidelines (2 units per day for women, 3 units per day for men).
11. Poor tolerability of venepuncture or lack of adequate venous access for required blood sampling during the study period.
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E.5 End points |
E.5.1 | Primary end point(s) |
The end points are defined as: • Completion of 24 weeks in the study • Withdrawal due to any reason
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | Yes |
E.6.4 | Safety | No |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | Yes |
E.8 Design of the trial |
E.8.1 | Controlled | No |
E.8.1.1 | Randomised | Information not present in EudraCT |
E.8.1.2 | Open | Information not present in EudraCT |
E.8.1.3 | Single blind | Information not present in EudraCT |
E.8.1.4 | Double blind | Information not present in EudraCT |
E.8.1.5 | Parallel group | Information not present in EudraCT |
E.8.1.6 | Cross over | Information not present in EudraCT |
E.8.1.7 | Other | Yes |
E.8.1.7.1 | Other trial design description |
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E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | Information not present in EudraCT |
E.8.2.2 | Placebo | Information not present in EudraCT |
E.8.2.3 | Other | Information not present in EudraCT |
E.8.3 |
The trial involves single site in the Member State concerned
| Yes |
E.8.4 | The trial involves multiple sites in the Member State concerned | No |
E.8.5 | The trial involves multiple Member States | No |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | No |
E.8.6.2 | Trial being conducted completely outside of the EEA | Information not present in EudraCT |
E.8.7 | Trial has a data monitoring committee | No |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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The last visit of the last subject in the trial |
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 1 |
E.8.9.1 | In the Member State concerned months | 6 |
E.8.9.1 | In the Member State concerned days | |