- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04111627
Exercise Plus Duloxetine for Knee Osteoarthritis
April 8, 2024 updated by: Alan Rathbun, University of Maryland, Baltimore
A Feasibility and Pilot Study of Combined Treatment Protocol Using Aerobic Exercise and Duloxetine in Older Adults With Symptomatic Knee Osteoarthritis and Comorbid Depression
This study evaluates the addition of duloxetine to aerobic exercise in the treatment of symptomatic knee osteoarthritis and depressive symptoms in adults.
All participants will receive the receive the treatment protocol, which will first be evaluated in terms of feasibility and then pilot tested.
Study Overview
Status
Recruiting
Conditions
Intervention / Treatment
Detailed Description
Symptomatic knee osteoarthritis (OA) affects 10% of men and 13% of women 60 years or older, and depressive symptoms are common, occurring in one-fifth of these patients.
Depressive symptoms worsen knee OA disease severity and are a barrier to pain management and engagement in physical activity.
Guidelines recommend depression treatment in older adults with knee OA but provide no direction on how to simultaneously manage the co-occurrence of physical and mental morbidity.
Treatment recommendations advise exercise to manage pain and disability and improve psychosocial health in knee OA patients; however, compliance to exercise programs is low in persons with chronic pain and disability and is only made worse by comorbid depression.
Adherence is critical to the efficacy of depression treatments using exercise training, and no such exercise program has ever been designed for and tested in OA patients with co-occurring depressive symptoms in a way to enhance compliance.
Duloxetine is the only antidepressant medication indicated for pain management in knee OA patients that has demonstrated efficacy and tolerability when treating depression in older adults and is a viable pharmacological complement to exercise.
There are no protocols that combine treatments using interventions that affect symptoms of both knee OA and depression, and the study goals are to evaluate the feasibility of and then pilot test a protocol comprised of aerobic exercise training plus duloxetine for the treatment of symptomatic knee OA and comorbid depression.
Study Type
Interventional
Enrollment (Estimated)
30
Phase
- Phase 2
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Contact
- Name: Alan M Rathbun, PhD, MPH
- Phone Number: 410-706-5151
- Email: arathbun@som.umaryland.edu
Study Locations
-
-
Maryland
-
Baltimore, Maryland, United States, 21201
- Recruiting
- University of Maryland School of Medicine
-
Contact:
- Alan M Rathbun, PhD, MPH
- Phone Number: 410-706-5151
- Email: arathbun@som.umaryland.edu
-
-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
40 years and older (Adult, Older Adult)
Accepts Healthy Volunteers
No
Description
Inclusion Criteria:
- English speaking
- 40 years or older
- Symptomatic knee osteoarthritis fulfilling 1986 American College of Rheumatology criteria
- No plan for surgical knee osteoarthritis intervention within six months of enrollment
- Major depressive disorder satisfying diagnostic criteria according to the DSM-V
- Ability to participate in a supervised aerobic exercise program
Exclusion Criteria:
- Already performing aerobic or resistive exercise 2x/week or more
- Taking duloxetine, antipsychotics, benzodiazepines, or opioid analgesics
- Other medications deemed by study team to endanger the health of the participant or unduly confound the results
- Cognitive impairment (Mini-Mental State Examination score < 20)
- Past or current bipolar disorder or psychotic symptoms according to the DSM-V
- Substance abuse disorder or suicidal ideation within the previous year
- Not able to participate in a supervised exercise program based on the presence of unstable angina, recent MI (within last 3 months), hemiparetic gait, inability to walk at least 1mph on treadmill safely, poorly controlled hypertension (resting blood pressure > 190/110), peripheral arterial disease with current foot or leg ulcers, or cardiac or pulmonary disease with exercise tolerance NYHA class 3 or higher.
- Active cancer that is currently undergoing treatment (receiving chemotherapy and/or radiation therapy)
- Pregnant or lactating women
- Other conditions deemed by study team to endanger the health of the participant or unduly confound the results
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Aerobic exercise plus Duloxetine
Participants will have a starting duloxetine dosage of 30 mg/day and be titrated up to a daily optimal dosage of 60 mg/day as tolerated during the first 12-weeks of the study.
Twelve weeks after the receipt of their prescription, participants will be evaluated for the need to increase medication dosage to 90 mg/day.
After duloxetine initiation, participants will be provided an exercise prescription that includes a progressive walking program aiming to achieve 50 minutes of moderate-intensity physical activity, three times per week, over 24 weeks.
|
Participants with symptomatic knee osteoarthritis and depressive symptoms will be enrolled in a progressive walking program designed to reduce pain and disability and improve psychosocial health.
Duloxetine is an FDA-approved selective serotonin and norepinephrine reuptake inhibitor antidepressant approved for the treatment of neuropathic pain in symptomatic knee osteoarthritis as well as depression in adults.
Participants with symptomatic knee osteoarthritis and depressive symptoms will receive duloxetine to decrease pain and depression severity to enhance their ability to engage in aerobic exercise.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Knee Osteoarthritis Outcomes Scale (KOOS) pain subscale
Time Frame: Change from Baseline Pain Severity at 12 weeks
|
The self-reported KOOS pain subscale is sensitive to changes in knee OA symptoms, and consists of nine items scored on a Likert scale (0 [No problems] to 4 [Extreme Problems]) that ranges from 0-36, with higher values indicating greater severity.
|
Change from Baseline Pain Severity at 12 weeks
|
Hamilton Depression Rating Scale (HAM-D)
Time Frame: Change from Baseline Depression Severity at 12 weeks
|
The HAM-D is clinician-administered, 21-item questionnaire, designed to rate the severity of depression in patients.
Individual scores are based on the first 17 items, each with a possible score of 0-4 (0=Absent; 4=Extreme Symptoms) or 0-2 (0=Absent; 2=Frequent), yielding an overall range of 0-54.
Higher scores indicate greater depression severity.
|
Change from Baseline Depression Severity at 12 weeks
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Maximal oxygen consumption
Time Frame: Change from Baseline Peak Maximal Oxygen Consumption at 12 weeks
|
Peak maximal oxygen consumption will be assessed while patients are walking on a treadmill, when they are respiring through a non-rebreather mask to collect expired air.
Carbon dioxide and oxygen gas concentrations will be measured, and the final 20 seconds of oxygen consumption are averaged to determine peak consumption.
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Change from Baseline Peak Maximal Oxygen Consumption at 12 weeks
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Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Collaborators
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
October 7, 2021
Primary Completion (Estimated)
September 30, 2024
Study Completion (Estimated)
December 30, 2025
Study Registration Dates
First Submitted
September 18, 2019
First Submitted That Met QC Criteria
September 30, 2019
First Posted (Actual)
October 1, 2019
Study Record Updates
Last Update Posted (Actual)
April 10, 2024
Last Update Submitted That Met QC Criteria
April 8, 2024
Last Verified
April 1, 2024
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Behavioral Symptoms
- Joint Diseases
- Musculoskeletal Diseases
- Rheumatic Diseases
- Arthritis
- Depression
- Osteoarthritis
- Osteoarthritis, Knee
- Physiological Effects of Drugs
- Neurotransmitter Agents
- Molecular Mechanisms of Pharmacological Action
- Peripheral Nervous System Agents
- Analgesics
- Sensory System Agents
- Psychotropic Drugs
- Neurotransmitter Uptake Inhibitors
- Membrane Transport Modulators
- Antidepressive Agents
- Dopamine Agents
- Serotonin and Noradrenaline Reuptake Inhibitors
- Duloxetine Hydrochloride
Other Study ID Numbers
- HP-00089160
- K01AG064041 (U.S. NIH Grant/Contract)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
NO
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Yes
Studies a U.S. FDA-regulated device product
No
product manufactured in and exported from the U.S.
No
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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