A Trial of APPA in the Treatment of Knee Osteoarthritis

A Placebo-controlled, Double-blinded, Randomized, Trial Using a Combination of Apocynin and Paeonol (APPA) for the Treatment of Knee Osteoarthritis

A placebo controlled study of APPA in 150 participants with Osteoarthritis of the knee

Study Overview

• Status: Completed
• Conditions: Osteoarthritis
• Intervention / Treatment: Drug: Placebo; Drug: APPA

Detailed Description

This is a multicenter, randomized, double-blind, placebo-controlled, parallel group, 4-week trial of a fixed-dose combination of apocynin and paeonol (APPA) administered orally twice daily versus placebo twice daily. Approximately 150 subjects will be randomized to one of the two treatment groups.

• Study Type: Interventional
• Enrollment (Actual): 152
• Phase: Phase 2

Contacts and Locations

Study Locations

• Denmark
  • Copenhagen, Denmark
    • Sanos Clinic

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 75 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. Subject is able to read and understand the language and content of the study material, understand the requirements for study visits, and is willing to provide information at the scheduled evaluations and appropriate written informed consent has been obtained.
2. Femorotibial osteoarthritis of the knee, according the American College of Rheumatology (ACR) clinical and radiographic criteria (Altman et al., 1986) (Appendix A).
3. Radiological OA grade 2 or 3 of the target knee, using the Kellgren-Lawrence method (Kellgren and Lawrence, 1957) as graded by central, independent reading of X-ray obtained during screening, or on a recent (within 6 months) X-ray image which fulfills the protocol specifications for reading.
4. Age between 40 years and 85 years at the time of screening, both included; of either sex.
5. Pain score rated on an 11-point numerical rating scale of the target knee of ≥ 20 and ≤ 45 out of 50 in response to the WOMAC pain sub-score (5 questions), at the time of screening and baseline. The subject should have undergone a washout-period of at least 5 half-lives of any analgesic medication before completing the screening and baseline questionnaires.
6. Women of child-bearing potential must use a highly effective method of contraception(please see Appendix B). Postmenopausal status is defined as being amenorrheic for at least 1 year prior to screening. Sexually active men with a female partner of childbearing potential must ensure that their female partner uses a highly effective method of contraception and agree to use condom from enrolment up to at least 3 months after the study end. Furthermore, male participants must agree not to donate sperm throughout the study and at least 3 months after he study end.
7. Knee pain in the target knee for 14 days of the preceding month (periarticular knee pain due to OA and not due to non-OA conditions such as bursitis, tendonitis, etc.) based on subject report.
8. Inadequate response to or intolerance to analgesics and/or non-steroidal anti-inflammatory drugs (NSAIDs) as reported by the subject

Exclusion Criteria:

1. Known or suspected hypersensitivity to or previous hypersensitivity reactions to APPA, or any of the excipients in the investigational product.

2. For women of childbearing potential:

   1. Pregnancy (i.e. positive pregnancy test at Screening) or breastfeeding
   2. Failure to agree to practice a highly effective method of contraception (see Appendix B), from enrolment up to at least 3 months after the study end.
3. For sexually active men with a female partner of childbearing potential: Failure to agree to ensure that their female partner uses a highly effective method of contraception, to agree to use condom (see Appendix B) from enrolment up to at least 3 months after the study end, and to agree not to donate sperm throughout the study and at least 3 months after the study end.
4. Intra-articular delivery of corticosteroids within 3 months or hyaluronic acid within 6 months of screening in the target knee or into any other joint within 30 days of screening.
5. Systemic corticosteroid treatment of more than 14 days during the past 6 months prior to screening.
6. Major surgery or arthroscopy of the target knee within the previous year prior to screening.
7. Planned surgery on either knee within the next 3 months.
8. Use of a currently unapproved investigational drug, device or biologic within 3 months prior to screening.
9. Presence of inflammatory arthritis, such as rheumatoid arthritis, psoriatic arthritis, polymyalgia rheumatica, gout or pseudogout with history of clinical attacks.
10. Current malignancy or treatment for malignancy within the past five years, with the exception of treated non-melanoma skin cancer, unless affecting the target knee area, or carcinoma in situ events.
11. Any other abnormal laboratory results or significant medical conditions that the Investigator believes should preclude the subject's participation in the trial.
12. Prior septic arthritis of the target knee.
13. Known osteoarthritis of the hip(s) if pain in either or both hip(s) exceeds that of the target knee using the WOMAC Hip Pain sub-score for that hip at the time of screening
14. Presence of significant radicular back pain, as reported by the subject.
15. Presence of severe pain in either knee, defined as > 45 out of 50 in response to the WOMAC pain sub-score (5 questions), at the time of screening or baseline, regardless of the eligibility of the contralateral knee.
16. Body Mass Index > 40.0 kg/m2.
17. Estimated glomerular filtration rate < 30 mL/min using the Modification of Diet in Renal Disease (MDRD) method.
18. Substantial use of moderate or higher strength opioid medication for the treatment of pain within 6 weeks before the screening visit, as evaluated by the investigator.
19. Use of duloxetine, pregabalin, or gabapentin within 4 weeks before the baseline visit.
20. History of alcohol or drug abuse within the past 5 years prior to randomization.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Quadruple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: APPA; APPA, an oral combination of two isomers: 4-hydroxy-3-methoxyacetophenone (4H3MA) & 2-hydroxy-4-methoxyacetophenone (2H4MA) administered to 75 participants as 2 x 400mg capsules b.d. for 28 days .	Drug: APPA; APPA, an oral combination of two isomers: 4-hydroxy-3-methoxyacetophenone (4H3MA) & 2-hydroxy-4-methoxyacetophenone (2H4MA).
Placebo Comparator: Placebo; 2 capsules b.d. for 28 days	Drug: Placebo; Placebo capsules

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
WOMAC pain score	change from baseline in WOMAC pain sub-score of the target knee as evaluated at week 4.	28 days

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Changes from baseline in WOMAC total score and the WOMAC function and stiffness scores at week 4		28 days
Changes from baseline in constant, intermittent and total OA pain assessed by ICOAP scores at week 4 Changes from baseline in constant, intermittent and total OA pain assessed by ICOAP scores at week 4		28 days
Changes from baseline in WOMAC pain weight-bearing score (questions 1, 2, and 5) and non-weight bearing score (questions 3 and 4) at week 4		28 days
Changes from baseline in physical function assessed by the 20 Meter Walk Test gait speed at week 4		28 days
Change from baseline in the weekly mean of the average daily pain intensity at Week 4		28 days
Area-under-effect curves of the weekly mean of the average daily pain intensity at Week 4		28 days
OMERACT-OARSI responder rate at week 4		28 days
Total dose of rescue medication calculated as the sum of tablets used, based on pill counts		28 days
Time between baseline and first use of rescue medication		28 days
Changes from baseline in the Patient Global Assessment (PGA) score at week 4		28 days
Changes from baseline in quality of life assessed by the EQ5D at week 4		28 days
Safety	Nature, incidence and severity of AEs. Changes in laboratory safety parameters, vital signs, 12-lead ECG parameters, and weight	28 days

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Changes in serum and urine biomarkers of joint tissue turnover	At baseline, and during the trial, serum and urine will be collected, for measurement of biomarkers reflecting collagen- and proteoglycan turnover	28 days
Time to achieve a clinically relevant pain reduction defined as a decrease from baseline of at least 1 points out of 10 in the 11-point average of daily pain score		28 days
Time to achieve "moderate improvement" and time to achieve "high improvement" in OMERACT-OARSI response		28 days

Collaborators and Investigators

• Sponsor: AKL Research and Development
• Collaborators: NBCD A/S
• Investigators: Study Director: Asger Bihlet, Nordic Bioscience Clinical Development

Study record dates

Study Major Dates

• Study Start (Actual): September 9, 2020
• Primary Completion (Actual): September 30, 2021
• Study Completion (Actual): October 1, 2021

Study Registration Dates

• First Submitted: November 30, 2020
• First Submitted That Met QC Criteria: December 7, 2020
• First Posted (Actual): December 8, 2020

Study Record Updates

• Last Update Posted (Actual): November 17, 2021
• Last Update Submitted That Met QC Criteria: November 16, 2021
• Last Verified: November 1, 2021

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Joint Diseases; Musculoskeletal Diseases; Rheumatic Diseases; Arthritis; Osteoarthritis; Osteoarthritis, Knee
• Other Study ID Numbers: APPA-P2-1

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: No
• Studies a U.S. FDA-regulated device product: No