Intradiscal rhGDF-6 for the Treatment of Lumbar Disc Degeneration (CBT005)
A Phase I/II, Open-label, Single Administration Clinical Trial to Evaluate the Safety, Tolerability and Preliminary Efficacy of Intradiscal rhGDF-6 for the Treatment of Lumbar Disc Degeneration
The goal of this clinical trial is to find out if a new medicine can help people who have long-lasting back pain caused by damaged spinal discs. The study will also check if the medicine is safe to use.
The main questions this study aims to answer are:
Is the medicine safe, and what amount works best? Can it reduce long-term back pain?
Researchers will test a medicine called CBT005, which contains a healing protein, by injecting it into the spinal discs. They will watch closely to see how people respond to the treatment.
Participants will:
Receive one study injection into the spinal disc Visit the clinic in person during the first 12 months for checkups Receive phone calls at 24 and 36 months to see how they are doing Still be able to get other pain treatments in the future, including surgery, if needed
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Study Type
Study Type
Enrollment (Estimated)
Enrollment
Phase
Phase
- Phase 2
- Phase 1
Contacts and Locations
Study Contact
Study Contact
- Name: Ashish Diwan
- Phone Number: +61 409257177
- Email: ashish@cartago-biotech.com
Study Contact Backup
- Name: Neha Chopra
- Phone Number: +61 478943074
- Email: neha@cartago-biotech.com
Study Locations
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New South Wales
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Kogarah, New South Wales, Australia, 2217
- Spine & Scoliosis Service
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Contact:
- Nerida Clinical Coordinator, Registered Nurse
- Phone Number: 0285667166
- Email: info@spine-service.org
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Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria
- Persistent low back pain, with at least 3 months of non-surgical therapy, at one symptomatic disc or two symptomatic lumbar disc levels (from L2 to S1).
- MRI scans show Pfirrmann disc degeneration grade 2 to 4 or High Intensity Zone (HIZ) signal change with or without Modic endplate changes.
- Symptoms are a fair bit or a lot bothersome, which require medication or other types of treatments or very disrupting (in response to question*).
- Preoperative Oswestry Disability Index (ODI) score greater than or equal to 30%
- Visual Analog Score for back pain ≥40 mm.
- Any gender, 18 years of age or older
- Clinician diagnosed discogenic pain
- A signed HREC-approved Informed Consent Form
- Able to meet the protocol follow-up schedule and activities
- Females of childbearing potential must have a negative urine/serum pregnancy test at screening (Baseline Visit) and on the day of administration prior to injection *Question defined in full protocol
Exclusion Criteria
- People unable to have an MRI
- Abnormal neurological exam at baseline (e.g., chronic radiculopathy)
- Active radicular pain due to anatomical compression such as stenosis or disc herniation
- Symptomatic facet joints and/or severe facet degeneration at the index level or adjacent segments
- Symptomatic Sacro-iliac joint
- MRI findings demonstrate any of the following: Suspected disc appears normal or >50% decrease in disc height or Presence of symptomatic osteophytes
- Any prior lumbar spinal surgeries at suspected symptomatic level; prior surgery at the adjacent levels is acceptable including fusion or arthroplasty, provided the said adjacent level is not independently symptomatic.
- Presence of spondylolisthesis (anterolisthesis, retrolisthesis is acceptable)
- Symptomatic disc degeneration at more than 2 lumbar levels (multi-level disc degeneration based on MRI findings is acceptable with up to two symptomatic level. Only the symptomatic levels will be treated)
- Evidence of active infection
- Immunosuppressive therapy within 3 months prior to investigational product administration
- Either continuous or cumulative use of more than 2 months use in the past 6 months of an oral or systemic steroid. Inhaled steroids are acceptable
- Tumor in the spine
- People with any current and previous cancer. An exemption to this is previous BCCs which have been successfully removed.
- Non-contained herniated nucleus pulposus
- Any prior intradiscal therapies (chemonucleolysis, IDET, intradiscal steroid injection) at the same level being treated, other than rhGDF-6.
- Any non-intradiscal steroid injection less than 2 months prior to administration. Does not include isolated joint injections outside the lumbar region.
- Nerve block injection less than 2 months prior to injection of study medication.
- Known autoimmune disease
- Type 1 Insulin-dependent diabetes mellitus (Type II, non-insulin dependent diabetes mellitus is allowed)
- Pregnant or lactating, or wishes to become pregnant within the first 12 months of the study
- Involved in pending litigation of the spine (including workers compensation cases)
- Demonstrates signs of non-organic pain (e.g., Waddell's Signs)
- Based on clinical history, physical examination and participant presentation, participant has, or is suspected to have, a history of alcohol and/or drug abuse that would preclude participants from providing adequate consent and/or complying with study requirements
- Prisoner
- Morbid Obesity, defined as Body Mass Index (BMI) ≥40
- Life expectancy less than 2 years
- Any significant psychological disturbance past or present, that could impair the consent process or ability to complete participant self-report questionnaires
- Any reason not cited above that, in the opinion of the Principal Investigator, would pose a risk to either the participant or to the integrity of the clinical trial
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
|
Active Comparator: Low dose
2mg dose of Growth differentiation factor 6
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Low dose: 2mg dose of Growth differentiation factor 6
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Active Comparator: High dose
4mg dose of Growth differentiation factor 6
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High Dose: 4 mg dose of Growth differentiation factor 6
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What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Neurological Status
Time Frame: From enrollment through to 12 months
|
Safety will be evaluated by assessing neurologic status and the type, frequency, and severity of adverse events through 12 months.
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From enrollment through to 12 months
|
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Oswestry Disability Index (ODI)
Time Frame: Enrollment through to 12 months
|
The Oswestry Disability Index (ODI) assesses functional limitations in activities of daily living related to back pain.
The ODI consists of 10 questions, each addressing a specific aspect of daily living affected by back pain, such as pain intensity, personal care, lifting, walking, sitting, standing, sleeping, sexual activity, social life, and travel.
Each question has six statements that correlate to a score of 0 to 5. The patient chooses the statement that best describes their current condition, with higher scores indicating greater disability.
The total score is calculated by summing the individual question scores and then dividing by the total possible score (which is 50) and multiplying by 100 to get a percentage disability.
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Enrollment through to 12 months
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Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Visual Analog Scale
Time Frame: From enrollment through to 12 months
|
VAS will be meausred on a millimeter (mm) scale.
It is a 100-mm continuous line used to measure subjective experiences like pain, fatigue, or quality of life.
Scores will be calculated by measuring the distance in millimeters from the left anchor (usually "no symptom") to the patient's mark.
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From enrollment through to 12 months
|
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EQ5D-5L
Time Frame: From enrollment through to 12 months
|
The EQ-5D-5L is a widely used generic health-related quality of life instrument developed in the 1980s by the EuroQol Group to assess and compare health status across different diseases and populations.
An EQ-5D 5L health state is converted into a utility score by subtracting the weighted values assigned to the selected levels in each of the five health dimensions from a baseline of 1.
The weights assigned to each level within the health dimensions reflect the relative impact of those health problems on overall quality of life.
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From enrollment through to 12 months
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Collaborators and Investigators
Sponsor
Sponsor
Publications and helpful links
General Publications
- Wei A, Williams LA, Bhargav D, Shen B, Kishen T, Duffy N, Diwan AD. BMP13 prevents the effects of annular injury in an ovine model. Int J Biol Sci. 2009 Jun 3;5(5):388-96. doi: 10.7150/ijbs.5.388.
- Miyazaki S, Diwan AD, Kato K, Cheng K, Bae WC, Sun Y, Yamada J, Muehleman C, Lenz ME, Inoue N, Sah RL, Kawakami M, Masuda K. ISSLS PRIZE IN BASIC SCIENCE 2018: Growth differentiation factor-6 attenuated pro-inflammatory molecular changes in the rabbit anular-puncture model and degenerated disc-induced pain generation in the rat xenograft radiculopathy model. Eur Spine J. 2018 Apr;27(4):739-751. doi: 10.1007/s00586-018-5488-1. Epub 2018 Feb 19.
Study record dates
Study Major Dates
Study Start (Estimated)
Study Start
Primary Completion (Estimated)
Primary Completion
Study Completion (Estimated)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Actual)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Pain
- Neurologic Manifestations
- Bone Diseases
- Musculoskeletal Diseases
- Spinal Diseases
- Pathological Conditions, Signs and Symptoms
- Signs and Symptoms
- Back Pain
- Intervertebral Disc Degeneration
- Physiological Effects of Drugs
- Reproductive Control Agents
- Contraceptive Agents, Female
- Contraceptive Agents
- Pharmacologic Actions
- Chemical Actions and Uses
- Therapeutic Uses
- Contraceptives, Oral
Other Study ID Numbers
Other Study ID Numbers
- 001-CBT-005 Intradiscal rhGDF6
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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