E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Pain due to osteoarthritis of the hip or knee |
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E.1.1.1 | Medical condition in easily understood language |
Pain of the knee or hip due to a joint disease that results from breakdown of joint cartilage and underlying bone
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E.1.1.2 | Therapeutic area | Body processes [G] - Bones and nerves physological processes [G11] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 20.0 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10023476 |
E.1.2 | Term | Knee osteoarthritis |
E.1.2 | System Organ Class | 100000004859 |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 20.0 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10020108 |
E.1.2 | Term | Hips osteoarthritis |
E.1.2 | System Organ Class | 100000004859 |
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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 |
The primary objective of the study is to evaluate the effect of fasinumab compared to placebo on peripheral nerves in patients with pain due to osteoarthritis of the hip or knee. |
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E.2.2 | Secondary objectives of the trial |
The secondary objectives of the study are: - To evaluate the efficacy of fasinumab compared to placebo in patients with pain due to osteoarthritis of the hip or knee - To evaluate the safety and tolerability of fasinumab compared to placebo in patients with pain due to osteoarthritis of the hip or knee - To characterize the concentrations of fasinumab in serum in patients with pain due to osteoarthritis of the hip or knee - To evaluate the immunogenicity of fasinumab in patients with pain due to osteoarthritis of the hip or knee
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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 |
Genomics Sub-study The purpose of the genomic analyses is to identify genomic associations with collagen and bone turnover, osteoarthritis, pain, and response to fasinumab. |
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E.3 | Principal inclusion criteria |
A patient must meet the following criteria to be eligible for inclusion in the study: 1.Male and female patients ≥18 years of age at screening visit 2.Provide signed informed consent signed by study patient or legally acceptable representative 3.Body mass index ≤39 at screening visit 4.A clinical diagnosis of osteoarthritis of the knee or hip based on the American College of Rheumatology criteria with radiologic evidence of osteoarthritis (K-L score ≥2 for the index joint) at the screening visit, with the following definitions: •The index joint is defined as the joint with osteoarthritis under evaluation for this study •A joint previously treated with JR surgery cannot be the index joint •A joint previously surgically modified within the past year cannot be the index joint (with the exception of cruciate ligament reconstruction surgery, patellar fracture repair surgery, or meniscal repair) •If a patient has a K-L score of ≥2 at more than 1 knee or hip joint, the index joint is the joint with the greatest WOMAC pain subscore at the screening visit •If 2 or more knee or hip joints have a K-L score of ≥2 and the same WOMAC pain subscore, the index joint is the joint with the greater K-L score •If 2 or more joints have a K-L score of ≥2, the same WOMAC pain subscores, and the same K-L scores, then the investigator may choose 1 of these joints as the index joint 5.Moderate-to-severe pain in the index joint defined as a WOMAC average pain subscale score of ≥4 at both the screening and randomization visits 6.Willing to discontinue current pain medications and to adhere to study requirements for rescue treatments (paracetamol/acetaminophen to be taken as needed with a maximum daily dose of 2500 mg [countries where 500 mg strength tablets/capsules are available] or 2600 mg [countries where 325 mg strength tablets/capsules are available]) 7.A history of at least 12 weeks of analgesics use for pain due to osteoarthritis of the knee or hip, as defined by a.Inadequate pain relief from acetaminophen/paracetamol AND b.Intolerance to or inadequate pain relief from at least 1 oral NSAID AND c.Intolerance to or inadequate pain relief from opioid or tramadol therapy, unwillingness to take opioid or tramadol therapy for a medically acceptable reason, or lack of access to an opioid or to tramadol 8.A history of regular use of analgesic medications for osteoarthritis pain (defined as an average of 4 days per week over the 4 weeks prior to the screening visit), including oral NSAIDs, selective cyclooxygenase 2 inhibitors, opioids, paracetamol/acetaminophen, or combinations thereof 9.Consent to allow all radiographs and medical/surgical/hospitalization records of care received elsewhere prior to and during the study period to be shared with the investigator 10.Willing to maintain current activity and exercise levels throughout the study 11.Willing and able to comply with clinic visits and study-related procedures and willing to provide follow-up information related to any JR surgery that occurs within the period of time covered by their intended participation in the study 12.Able to understand and complete study-related questionnaires
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E.4 | Principal exclusion criteria |
Key Exclusion criteria: 1.History or presence at the screening visit of non-osteoarthritis inflammatory joint disease (eg, rheumatoid arthritis, lupus erythematosus, psoriatic arthritis, pseudo-gout, gout, spondyloarthropathy, polymyalgia rheumatica, joint infections within the past 5 years), Paget's disease of the spine, pelvis or femur, neuropathic disorders, multiple sclerosis, fibromyalgia, tumors or infections of the spinal cord, or renal osteodystrophy 2.History or presence on imaging of arthropathy (osteonecrosis, subchondral insufficiency fracture, rapidly progressive osteoarthritis type 1 or type 2), stress fracture, recent stress fracture, neuropathic joint arthropathy, hip dislocation (prosthetic hip dislocation is eligible), knee dislocation (patella dislocation is eligible), congenital hip dysplasia with degenerative joint disease, extensive subchondral cysts, evidence of bone fragmentation or collapse, or primary metastatic tumor with the exception of chondromas or pathologic fractures during the screening period 3.Trauma to the index joint within 3 months prior to the screening visit 4.History or presence of signs or symptoms of compression neuropathy, including carpal tunnel syndrome or sciatica 5.Patient is not a candidate for MRI 6.Is scheduled for a JR surgery to be performed during the study period or who would be unwilling or unable to undergo JR surgery if one eventually became necessary 7.Patients with abnormal nerve conduction parameters at any nerve based on standards detailed in the study manual and according to the eligibility report provided by the central reader 8.Patients receiving, or who plan to receive, interventions, devices, or medications that alter nerve conduction or are contraindicated in patients undergoing nerve conduction studies (eg, edema, tarsal tunnel syndrome) 9.History or presence at the screening visit of autonomic neuropathy, diabetic neuropathy, or other peripheral neuropathy, including reflex sympathetic dystrophy and complex regional pain syndrome 10.History or diagnosis of chronic autonomic failure syndrome including pure autonomic failure, multiple system atrophy (Shy-Drager syndrome) 11.Known allergy or sensitivity to monoclonal antibodies 12.Poorly controlled diabetes (defined as any single value of hemoglobin A1c [HbA1c] >9.0%) at the screening visit 13.Known history of human immunodeficiency virus (HIV) infection 14.Known history of ocular herpes simplex virus, herpes simplex virus pneumonia, or herpes simplex virus encephalitis 15.History of sickle cell disease, including sickle cell anemia and β-thalassemia 16.Confirmed elevated screening alanine aminotransferase (ALT) or aspartate aminotransferase (AST) ≥2.5 times the upper limit of normal (ULN) 17.Resting heart rate of <50 beats per minute (bpm) or >100 bpm (by vital sign assessment or as captured during electrocardiogram [ECG] assessment) at the screening or randomization visits 30.Use of a monoamine reuptake inhibitor, tricyclic antidepressants, selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors for treatment of pain within 4 weeks prior to the screening visit 31.Has positive urine drug test results during screening (eg, amphetamines/methamphetamines, barbiturates, benzodiazepines, cannabinoids, cocaine, and opiates), unless in the opinion of the investigator, the positive test results may be due to the patient’s current permitted medications. 32.History of (within 5 years prior to the screening visit) or current alcoholism, alcohol abuse, substance abuse, or abuse of prescription pain medication 33.History of cannabis use for the treatment of pain within the past 6 months prior to the screening visit 34.Ongoing participation in a clinical research study evaluating another investigational drug or having received another investigational product within 30 days or 5 half-lives of the screening visit, whichever is longer 35.Exposure to an anti-NGF antibody prior to the screening visit or known sensitivity or intolerance to anti-NGF antibodies or participation in a clinical trial evaluating anti-NGF antibodies 36.Member of the clinical site study team and/or his/her immediate family, unless prior approval granted by the sponsor 37.Pregnant or breastfeeding women 38.Women of childbearing potential who have a positive pregnancy test result or do not have their pregnancy test result at baseline 39.Women of childbearing potential who are unwilling to practice highly effective contraception prior to start of the first treatment, during the study, and for at least 20 weeks after the last dose. |
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E.5 End points |
E.5.1 | Primary end point(s) |
The primary endpoints of the study are: - Change from baseline to week 16 in peroneal motor nerve conduction velocity - Change from baseline to week 16 in peroneal motor nerve action potential amplitude - Change from baseline to week 16 in sural sensory nerve conduction velocity - Change from baseline to week 16 in sural sensory nerve action potential amplitude - Change from baseline to week 16 in ulnar sensory nerve conduction velocity - Change from baseline to week 16 in ulnar sensory nerve action potential amplitude
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
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E.5.2 | Secondary end point(s) |
The secondary endpoints of the study are: - Change from baseline to week 16 in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale score - Change from baseline to week 16 in WOMAC physical function subscale score
Additional safety endpoints in this study are: - Incidence of AA (as confirmed by an independent adjudication committee) - Incidence of DA (as confirmed by an independent adjudication committee) - Incidence of treatment-emergent adverse event (TEAEs) - Incidence of SNS dysfunction (as diagnosed after consultation with an appropriate specialist, such as a neurologist and/or cardiologist) - Incidence of peripheral sensory AEs that require a neurology or other specialty consultation - Incidence of all-cause joint replacement (JR) surgeries through week 16 and through the end of follow-up period (week 36) - Incidence of JRs at telephone survey approximately 52 weeks after last dose of study drug
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
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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 | No |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | Yes |
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) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | Yes |
E.8.1.5 | Parallel group | Yes |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | Yes |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 2 |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 8 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 16 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
Poland |
United Kingdom |
United States |
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E.8.7 | Trial has a data monitoring committee | Yes |
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 end of the study is defined as the last phone contact for the last patient. The last phone contact will be conducted at 52 weeks following the last dose of study drug. |
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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 | 5 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 1 |
E.8.9.2 | In all countries concerned by the trial months | 10 |
E.8.9.2 | In all countries concerned by the trial days | 0 |