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    Clinical Trial Results:
    Prospective randomized, double-blind, and placebo-controlled clinical trial with hydroxychloroquine (HCQ) in patients with erosive-inflammatory osteoarthritis (OA) of the finger joints (acronym: OA TREAT)

    Summary
    EudraCT number
    2011-001689-16
    Trial protocol
    DE  
    Global end of trial date
    05 Jul 2018

    Results information
    Results version number
    v1(current)
    This version publication date
    21 Mar 2022
    First version publication date
    21 Mar 2022
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    20110531
    Additional study identifiers
    ISRCTN number
    ISRCTN46445413
    US NCT number
    -
    WHO universal trial number (UTN)
    U1111-1121-1623
    Other trial identifiers
    German Register of Clinical Trials: DRKS00000796
    Sponsors
    Sponsor organisation name
    Charité - Universitätsmedizin Berlin
    Sponsor organisation address
    Charitéplatz 1, Berlin, Germany, 10117
    Public contact
    Dep. of Rheumatology, CC12, Charité - Universitätsmedizin Berlin, +49 30450513133, insider@charite.de
    Scientific contact
    Dep. of Rheumatology, CC12, Charité - Universitätsmedizin Berlin, +49 30450513133, insider@charite.de
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    05 Jul 2018
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    05 Jul 2018
    Global end of trial reached?
    Yes
    Global end of trial date
    05 Jul 2018
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    The aim of this study is to investigate efficacy and safety of HCQ by clinical and radiological outcome compared to placebo in patients with severe and refractory inflammatory hand OA.
    Protection of trial subjects
    Half-yearly visits to the ophthalmologist. Regular monitoring of liver and kidney values and blood count. Patients receive an NSAID/Cox-2 inhibitor in addition to the verum/placebo.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    01 Oct 2013
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Germany: 153
    Worldwide total number of subjects
    153
    EEA total number of subjects
    153
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    153
    From 65 to 84 years
    0
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    The subjects were recruited between 21.November 2013 to February 2017 in 47 study centres.

    Pre-assignment
    Screening details
    A total number of 220 subjects with clinical symptoms of inflammatory hand OA according the American College of Rheumatology classification and with hand radiographs showing radiological signs of digital erosive OA defined by grades 2 or higher, per Kellgren and Lawrence Scale.

    Period 1
    Period 1 title
    Overall Trial (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator, Monitor, Data analyst

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Verum HCQ
    Arm description
    Subjects received HCQ drom day 1 up to week 52
    Arm type
    Experimental

    Investigational medicinal product name
    Hydroxychloroquine
    Investigational medicinal product code
    6584604.00.00
    Other name
    Quensyl, Hydroxychloroquine sulfate
    Pharmaceutical forms
    Capsule, hard
    Routes of administration
    Oral use
    Dosage and administration details
    Hydroxychloroquine sulfate 200mg/capsule, dose 200mg resp. 400 mg HCQ depending on weight of subjects 30 - 49 kg one capsule every day 50 - 64 kg one capsule day one, two capsules every other day > 64 kg two capsules every day

    Arm title
    Placebo
    Arm description
    Subjects were trated with placebo
    Arm type
    Placebo

    Investigational medicinal product name
    Placebo
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Capsule, hard
    Routes of administration
    Oral use
    Dosage and administration details
    Subjects received placebo identical with study drug apart from the active ingredient, depending on weight of subjects 30 - 49 kg one capsule every day 50 - 64 kg one capsule day one, two capsules every other day > 64 kg two capsules every day

    Number of subjects in period 1
    Verum HCQ Placebo
    Started
    75
    78
    Completed
    52
    61
    Not completed
    23
    17
         Adverse event, serious fatal
    7
    -
         Consent withdrawn by subject
    7
    4
         Physician decision
    3
    1
         Adverse event, non-fatal
    3
    12
         Premature unblinding
    1
    -
         Lost to follow-up
    2
    -

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Verum HCQ
    Reporting group description
    Subjects received HCQ drom day 1 up to week 52

    Reporting group title
    Placebo
    Reporting group description
    Subjects were trated with placebo

    Reporting group values
    Verum HCQ Placebo Total
    Number of subjects
    75 78 153
    Age categorical
    Units: Subjects
        In utero
    0 0 0
        Preterm newborn infants (gestational age < 37 wks)
    0 0 0
        Newborns (0-27 days)
    0 0 0
        Infants and toddlers (28 days-23 months)
    0 0 0
        Children (2-11 years)
    0 0 0
        Adolescents (12-17 years)
    0 0 0
        Adults (18-64 years)
    75 78 153
        From 65-84 years
    0 0 0
        85 years and over
    0 0 0
    Gender categorical
    Units: Subjects
        Female
    68 60 128
        Male
    7 18 25

    End points

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    End points reporting groups
    Reporting group title
    Verum HCQ
    Reporting group description
    Subjects received HCQ drom day 1 up to week 52

    Reporting group title
    Placebo
    Reporting group description
    Subjects were trated with placebo

    Primary: Changes of AUSCAN Index for pain and hand disability from baseline to end of treatment (week 52)

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    End point title
    Changes of AUSCAN Index for pain and hand disability from baseline to end of treatment (week 52)
    End point description
    End point type
    Primary
    End point timeframe
    from baseline to week 52
    End point values
    Verum HCQ Placebo
    Number of subjects analysed
    75
    78
    Units: score
    arithmetic mean (full range (min-max))
        AUSCAN pain
    26.65 (23.91 to 29.38)
    26.47 (23.88 to 29.06)
        AUSCAN function
    48.1 (43.03 to 53.18)
    51.3 (46.58 to 56.01)
    Statistical analysis title
    ANCOVA analyses
    Statistical analysis description
    the multiple endpoint test according to Läuter and O'Brien was applied to the 52‐ week outcome in the AUSCAN pain and hand function scales. To increase the accuracy, the Läuter SSsum test was applied to the baseline‐adjusted week 52 values of the two AUSCAN scales. The SS test is a one‐sided test. In the second step, a separate analysis of the AUSCAN pain and hand function scales was performed. These analyses were performed by an analysis of covariance (ANCOVA) with the corresponding AUSCAN
    Comparison groups
    Verum HCQ v Placebo
    Number of subjects included in analysis
    153
    Analysis specification
    Post-hoc
    Analysis type
    superiority
    P-value
    < 0.05
    Method
    ANCOVA
    Confidence interval

    Secondary: change efficacy in measure HCQ between baseline and week 26

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    End point title
    change efficacy in measure HCQ between baseline and week 26
    End point description
    Efficacy of HCQ determined by AUSCAN score, patient’s global assessment of disease activity, patient’s assessment of stiffness and physician’s global assessment of disease activity from baseline to week 26
    End point type
    Secondary
    End point timeframe
    from baseline to week 26
    End point values
    Verum HCQ Placebo
    Number of subjects analysed
    75
    78
    Units: score
    arithmetic mean (full range (min-max))
        AUSCAN pain
    26.66 (24.36 to 28.95)
    25.94 (23.77 to 28.12)
        AUSCAN function
    51.07 (47.04 to 55.11)
    51.35 (47.77 to 54.94)
        AUSCAN stiffness
    4.82 (4.3 to 5.35)
    5.06 (4.55 to 5.57)
        Physican global
    3.35 (2.96 to 3.74)
    3.88 (3.54 to 4.23)
        Patient global
    4.87 (4.33 to 5.4)
    5.34 (4.8 to 5.88)
    No statistical analyses for this end point

    Secondary: Radiographic progression from baseline to week 52

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    End point title
    Radiographic progression from baseline to week 52
    End point description
    for p-value HCQ vs. placebo see attachment table 8
    End point type
    Secondary
    End point timeframe
    from baseline to week 52
    End point values
    Verum HCQ Placebo
    Number of subjects analysed
    75
    78
    Units: score
    arithmetic mean (full range (min-max))
        Kallmann score (modified)
    53.59 (52.11 to 55.07)
    52.8 (51.42 to 54.19)
        Erosion score (modified)
    12.34 (11.65 to 13.04)
    11.45 (10.79 to 12.1)
        Osteophytes
    14.69 (14.31 to 15.06)
    14.74 (14.39 to 15.1)
        Joint space narrowing
    17.87 (17.42 to 18.32)
    17.92 (17.5 to 18.34)
        Laterial deformity
    2.57 (2.41 to 2.73)
    2.57 (2.42 to 2.72)
        Subchondral cysts
    3.67 (3.32 to 4.01)
    3.84 (3.52 to 4.16)
        Sclerosis
    2.41 (2.14 to 2.68)
    2.32 (2.07 to 2.57)
    No statistical analyses for this end point

    Secondary: change quality of life in measure HCQ vs. placebo from baseline to week 26 and week 52

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    End point title
    change quality of life in measure HCQ vs. placebo from baseline to week 26 and week 52
    End point description
    more results and details to SF36 and p-value, see attachment
    End point type
    Secondary
    End point timeframe
    from baseline up to week 26 and from baseline up to week 52
    End point values
    Verum HCQ Placebo
    Number of subjects analysed
    75
    78
    Units: score
    arithmetic mean (full range (min-max))
        Health Assessment Questionaire (HAQ) 26 weeks
    0.89 (0.81 to 0.97)
    0.89 (0.81 to 0.97)
        Health Assessment Questionaire (HAQ) 52 weeks
    0.86 (0.77 to 0.95)
    0.81 (0.72 to 0.89)
        SF-SACRAH 26 weeks
    4.19 (3.77 to 4.62)
    4.2 (3.79 to 4.6)
        SF-SACRAH 52 weeks
    3.99 (3.48 to 4.49)
    4.29 (3.84 to 4.74)
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    During the whole trial
    Adverse event reporting additional description
    Events were reported to the sponsor close to the time of the visit, SAEs immediately after becoming known within 24 hours. The sponsor's pharmacovigilance department and the medical monitor are responsible for further monitoring. The Safety Monitoring Board decides annually or in case of serious events on the continuation of the study.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    16.1
    Reporting groups
    Reporting group title
    Verum - HCQ
    Reporting group description
    -

    Reporting group title
    Placebo
    Reporting group description
    -

    Serious adverse events
    Verum - HCQ Placebo
    Total subjects affected by serious adverse events
         subjects affected / exposed
    7 / 75 (9.33%)
    15 / 78 (19.23%)
         number of deaths (all causes)
    1
    0
         number of deaths resulting from adverse events
    0
    0
    Vascular disorders
    Vascular disorder
         subjects affected / exposed
    1 / 75 (1.33%)
    0 / 78 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Surgical and medical procedures
    Surgical and medical procedures
         subjects affected / exposed
    1 / 75 (1.33%)
    0 / 78 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Respiratory, thoracic and mediastinal disorder
         subjects affected / exposed
    0 / 75 (0.00%)
    1 / 78 (1.28%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Injury, poisoning and procedural complications
    Injury, poisoning and procedural complications
         subjects affected / exposed
    0 / 75 (0.00%)
    3 / 78 (3.85%)
         occurrences causally related to treatment / all
    0 / 0
    3 / 3
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Congenital, familial and genetic disorders
    congenital, familial and genetic disorder
         subjects affected / exposed
    0 / 75 (0.00%)
    1 / 78 (1.28%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cardiac disorders
    cardiac disorders
         subjects affected / exposed
    0 / 75 (0.00%)
    1 / 78 (1.28%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Nervous system disorders
    nervous disorder
         subjects affected / exposed
    1 / 75 (1.33%)
    1 / 78 (1.28%)
         occurrences causally related to treatment / all
    1 / 1
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Ear and labyrinth disorders
    Ear and labyrinth disorder
         subjects affected / exposed
    0 / 75 (0.00%)
    3 / 78 (3.85%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 3
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Eye disorders
    Eye disorders
         subjects affected / exposed
    0 / 75 (0.00%)
    3 / 78 (3.85%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 3
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gastrointestinal disorders
    gastrointestinal disorders
         subjects affected / exposed
    1 / 75 (1.33%)
    0 / 78 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Skin and subcutaneous tissue disorders
    Skin and subcutaneous tissue disorders
         subjects affected / exposed
    1 / 75 (1.33%)
    0 / 78 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Renal and urinary disorders
    Renal and urinary disorders
         subjects affected / exposed
    0 / 75 (0.00%)
    1 / 78 (1.28%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Musculoskeletal and connective tissue disorders
    Musculoskeletal disorder
         subjects affected / exposed
    1 / 75 (1.33%)
    1 / 78 (1.28%)
         occurrences causally related to treatment / all
    0 / 32
    0 / 50
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Infections and infestations
    infection
         subjects affected / exposed
    1 / 75 (1.33%)
    0 / 78 (0.00%)
         occurrences causally related to treatment / all
    1 / 46
    0 / 43
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 1.5%
    Non-serious adverse events
    Verum - HCQ Placebo
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    69 / 75 (92.00%)
    23 / 78 (29.49%)
    Vascular disorders
    Hypertension
         subjects affected / exposed
    5 / 75 (6.67%)
    2 / 78 (2.56%)
         occurrences all number
    7
    2
    Nervous system disorders
    Migraine
         subjects affected / exposed
    3 / 75 (4.00%)
    2 / 78 (2.56%)
         occurrences all number
    6
    2
    Headache
         subjects affected / exposed
    9 / 75 (12.00%)
    7 / 78 (8.97%)
         occurrences all number
    18
    13
    Paraesthesia
         subjects affected / exposed
    0 / 75 (0.00%)
    3 / 78 (3.85%)
         occurrences all number
    0
    5
    Dizziness
         subjects affected / exposed
    5 / 75 (6.67%)
    1 / 78 (1.28%)
         occurrences all number
    6
    1
    General disorders and administration site conditions
    Influenza like illness
         subjects affected / exposed
    12 / 75 (16.00%)
    11 / 78 (14.10%)
         occurrences all number
    15
    13
    Ear and labyrinth disorders
    Vertigo
         subjects affected / exposed
    1 / 75 (1.33%)
    4 / 78 (5.13%)
         occurrences all number
    2
    4
    Gastrointestinal disorders
    Nausea
         subjects affected / exposed
    4 / 75 (5.33%)
    2 / 78 (2.56%)
         occurrences all number
    5
    2
    Abdominal pain upper
         subjects affected / exposed
    6 / 75 (8.00%)
    5 / 78 (6.41%)
         occurrences all number
    10
    6
    Diarrhoea
         subjects affected / exposed
    7 / 75 (9.33%)
    2 / 78 (2.56%)
         occurrences all number
    8
    2
    Gastritis
         subjects affected / exposed
    5 / 75 (6.67%)
    2 / 78 (2.56%)
         occurrences all number
    5
    5
    Skin and subcutaneous tissue disorders
    Rash
         subjects affected / exposed
    6 / 75 (8.00%)
    2 / 78 (2.56%)
         occurrences all number
    8
    2
    Psychiatric disorders
    Depressed mood
         subjects affected / exposed
    4 / 75 (5.33%)
    0 / 78 (0.00%)
         occurrences all number
    4
    0
    Musculoskeletal and connective tissue disorders
    Arthralgia
         subjects affected / exposed
    3 / 75 (4.00%)
    2 / 78 (2.56%)
         occurrences all number
    3
    7
    Back pain
         subjects affected / exposed
    4 / 75 (5.33%)
    10 / 78 (12.82%)
         occurrences all number
    4
    12
    Joint effusion
         subjects affected / exposed
    2 / 75 (2.67%)
    1 / 78 (1.28%)
         occurrences all number
    4
    1
    Muscle disorder
         subjects affected / exposed
    7 / 75 (9.33%)
    7 / 78 (8.97%)
         occurrences all number
    7
    10
    Neck pain
         subjects affected / exposed
    1 / 75 (1.33%)
    2 / 78 (2.56%)
         occurrences all number
    1
    4
    Osteoarthritis
         subjects affected / exposed
    4 / 75 (5.33%)
    8 / 78 (10.26%)
         occurrences all number
    6
    9
    Infections and infestations
    Nasopharyngitis
         subjects affected / exposed
    4 / 75 (5.33%)
    4 / 78 (5.13%)
         occurrences all number
    6
    5
    Upper respiratory tract infection
         subjects affected / exposed
    8 / 75 (10.67%)
    10 / 78 (12.82%)
         occurrences all number
    8
    12
    Urinary tract infection
         subjects affected / exposed
    1 / 75 (1.33%)
    4 / 78 (5.13%)
         occurrences all number
    4
    7
    Bronchitis
         subjects affected / exposed
    9 / 75 (12.00%)
    1 / 78 (1.28%)
         occurrences all number
    9
    2
    Gastroenteritis
         subjects affected / exposed
    2 / 75 (2.67%)
    7 / 78 (8.97%)
         occurrences all number
    3
    9

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    15 Jan 2014
    The main reason for the amendment was to clarify and to find better wordings for the inclusion and exclusion criteria.
    25 Jun 2014
    The primary reason for the amendment is the additional information about possible cardiomyopathy with resulting heart failure when taking HCQ (reason: Fachinformation/ Product information had been changed)
    03 Nov 2014
    The primary reason for the amendment is the change of production of the IMP by another pharmacy.
    18 Dec 2015
    The primary reason for the amendment was the adjustment of the primary and secondary outcome parameters and the resulting adjustment of the subject numbers. The co‐primary outcome parameter of x‐ray progression was changed into a secondary parameter. Therefore, the subject number was reduced to 220.

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported

    Online references

    http://www.ncbi.nlm.nih.gov/pubmed/34215704
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