A Trial to Investigate the Safety and Efficacy of Intra-articular 4P004 Injection in Subjects With Knee Synovitis and Osteoarthritis (INFLAM MOTION)

A Multicenter, Randomized, Double-blind, Placebo-controlled, Proof of Concept Trial to Investigate the Efficacy and Safety of Intra-articular 4P004 in Subjects With Knee Synovitis and Osteoarthritis

This phase 2a trial is an international, multicenter, randomized, double-blind, placebo-controlled trial to investigate the efficacy and safety of one single intra-articular (IA) injection of 4P004 or placebo in:

• patients between 40 and 80 years of age,
• with synovitis and grade 2 to 4 osteoarthritis (OA) of the knee according to Kellgren and Lawrence (KL) classification.

Study Overview

• Status: Recruiting
• Conditions: Knee Osteoarthritis; Synovitis of Knee
• Intervention / Treatment: Drug: 4P004; Drug: Placebo (NaCl 0.9%)

• Study Type: Interventional
• Enrollment (Estimated): 129
• Phase: Phase 2

Contacts and Locations

• Study Contact: Name: Francis Berenbaum, MD, PhD; Phone Number: +330144974059; Email: francis@4movingbiotech.com
• Study Contact Backup: Name: Odile Fleurot, MD; Email: odile.fleurot@4p-pharma.com

Study Locations

• Canada
  • Ajax, Canada
    • Recruiting
    • Durham Bone and Joint Specialists
    • Contact: Fathi Abuzgaya, MD
  • London, Canada
    • Recruiting
    • SJHC London Rheumatology Centre
    • Contact: Thomas Appleton, MD
  • Québec, Canada
    • Not yet recruiting
    • G.R.M.O. (Groupe de recherche en maladies osseuses) Inc
    • Contact: Louis Bessette, MD
• Denmark
  • Frederiksberg, Denmark
    • Recruiting
    • Parker Institute Bispebjerg, Frederiksberg Hospital
    • Contact: Henning Bliddal, MD
  • Herlev, Denmark
    • Recruiting
    • Sanos Clinic Herlev
    • Contact: Bernt Husoy, MD
• France
  • Montpellier, France
    • Recruiting
    • CHU Montpellier
    • Contact: Christian Jorgensen, MD
  • Nice, France
    • Recruiting
    • CHU de Nice
    • Contact: Christian Roux, MD
  • Paris, France
    • Recruiting
    • Hôpital Cochin
    • Contact: François Rannou, MD
  • Paris, France
    • Recruiting
    • Hôpital Lariboisière
    • Contact: Augustin Latourte, MD
  • Reims, France
    • Recruiting
    • Centre Hospitalier Universitaire CHU de Reims - Hopital Maison Blanche
    • Contact: Jean-Hugues Salmon, MD
• Poland
  • Krakow, Poland
    • Recruiting
    • Care Access Kraków
    • Contact: Wojciech Sydor, MD
  • Warsaw, Poland
    • Not yet recruiting
    • MICS Centrum Medyczne Warszawa
    • Contact: Agnieszka Zielinska, MD
  • Warsaw, Poland
    • Recruiting
    • Centrum Medyczne Reuma Park
    • Contact: Anna Zubrzycka-Sienkiewicz, MD
• Spain
  • A Coruña, Spain, 15702
    • Recruiting
    • Clínica Gaias Santiago
    • Contact: Juan Antonio García Meijide, MD
  • A Coruña, Spain
    • Recruiting
    • Complejo Hospitalario Universitario de A Coruna - Hospital Universitario de A Coruna
    • Contact: Francisco Javier Blanco Garcia, MD
  • Alicante, Spain
    • Recruiting
    • HLA Clínica Vistahermosa
    • Contact: Laura Martinez Gil, MD
  • Sabadell, Spain
    • Not yet recruiting
    • Corporacio Sanitaria Parc Tauli - Hospital de Sabadell
    • Contact: Cristobal Orellana Garrido, MD
  • Santiago de Compostela, Spain
    • Recruiting
    • Clinica Nuestra Senora de la Esperanza
    • Contact: Manuel Pombo Suarez, MD
  • Seville, Spain
    • Recruiting
    • Hospital Quirónsalud Sagrado Corazón
    • Contact: Paula Cejas Caceres, MD
• United States
  • Arizona
    • Tucson, Arizona, United States, 85712-2805
      • Recruiting
      • Tucson Orthopaedic Institute
      • Contact: Nebojsa Skrepnik, MD
  • Illinois
    • Chicago, Illinois, United States, 60611
      • Recruiting
      • Northwestern University Feinberg School of Medicine
      • Contact: Thomas Schnitzer, MD
  • Massachusetts
    • Burlington, Massachusetts, United States, 01803
      • Recruiting
      • Skylight Health Research Burlington
      • Contact: Timothy McAlindon, MD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Participants who have the capacity to give informed consent and who are willing to comply with all trial related procedures and assessments.
• Participants between 40 and 80 years of age.
• Female participant of childbearing potential (defined as any woman unless postmenopausal for at least one year or surgically sterile) must use highly effective methods of contraception as defined in the protocol. Highly effective contraceptive measures must be continued throughout the trial until the final visit.
• Bodyweight > 40 kg.
• Body mass index (BMI) ≥ 18.5 and ≤ 35.
• Ambulatory (single assistive devices such as canes allowed).
• Widespread Pain Index (WPI) ≤ 4.
• Pain NRS (0-10) < 4 in the contralateral knee.
• History of OA-related pain of the TK for at least 6 months.
• Moderate to severe pain of the TK the majority of days during the last 3 months as per participant's judgement.
• Moderate to severe pain of the TK on the WOMAC Pain subscale prior to the Randomization visit (V2) complying with: a) Complete WOMAC Pain diary for at least 7 of the last 10 days prior to V2 (including V2/D1 rating which is mandatory), and b) Diary reported WOMAC Pain between 5 and 9 for at least 7 of the last 10 days.
• History of insufficient pain relief, intolerance, or contraindication to NSAIDs, and at least a history of insufficient pain relief from at least one of the following therapies: a) Acetaminophen/paracetamol, b) Opioids including tramadol, or c) Corticosteroids, hyaluronate IA injections (efficacy less than 3 months according to the patient).
• KL grade 2 to 4 on the Schuss radiograph.
• Predominant femorotibial OA based on the OA Research Society International. (OARSI) Atlas reading (Altman & Gold, 2007).
• Presence of synovitis in the TK assessed locally using PDUS, and synovial thickness of ≥ 5 mm evaluated through a longitudinal view of the suprapatellar pouch and axial views of the medial and lateral patellofemoral pouches.
• Negative urine drug screen (performed locally): amphetamines, barbiturates, cocaine.
• CE-MRI Central reading to confirm synovitis with a synovial Semi-Quantitative (SQ) ≥ 9 or a SQ score ≥7 with at least one site with a score ≥ 2.

Exclusion Criteria:

• Pregnant or breastfeeding women.
• Significant malalignment of anatomical axis (medial angle formed by the femur and tibia) of the TK (varus > 10°, valgus > 10°) by radiography.
• Secondary OA such as joint dysplasia, aseptic osteonecrosis, joint infection, acromegaly, Paget disease, hemochromatosis, joint crystal disease or any inflammatory joint disease.
• Any known active infections including skin infections at the site injection or increased predisposition for the development of infections.
• Any partial knee replacement of the TK.
• Acute fracture or IA trauma to the TK within 12 months prior to the screening visit.
• Major knee surgery performed within the previous 12 months or planned during the trial.
• Arthroscopy of the TK within 6 months prior to the screening visit.
• Presence of any painful conditions that could confound accurate assessment of pain from OA in the TK, such as fibromyalgia, peripheral neuropathy or vascular insufficiency.
• Treatment with systemic corticosteroids (other than IA) at a dose greater than 10 mg prednisone or the equivalent per day for more than 7 days within 4 weeks prior to the screening visit.
• Treatment of the TK with any IA injection (including corticosteroids, hyaluronic acid derivatives, Platelet Rich Plasma….) within 24 weeks prior to the screening visit.
• Any treatment with glucosamine, chondroitin sulfate, or other nutraceuticals with potential activity on OA within the previous 3 months prior to the screening visit.
• Treatment with duloxetine for OA (allowed if given for depressive disorders at stable dose since at least 3 months before V1).
• Any significant psychiatric illness unless well controlled since at least 6 months.
• Current treatment with combination of insulin and liraglutide (Xultophy®) or with GLP-1 agonist administered once a week (semaglutide, dulaglutide).
• High-risk of bleeding.
• Congestive Heart Failure stage III or IV in the New York Heart Association classification.
• History or current diagnosis of electrocardiogram ECG abnormalities indicating significant safety risk (such as ischemia, significant cardiac arrhythmias).
• Glycemia < 4.4 mmol/L (or 80 mg/dL) at screening.
• Clinically significant abnormal laboratory test at screening, in particular: haemoglobin <10 g/dL, white blood cell <3000/µL (3.0 Giga/L), absolute neutrophil count <1000/µL (1.0 Giga/L), platelets count <100,000/µL (100 Giga/L), alanine aminotransferase or aspartate aminotransferase >2.5 upper limit of normal (ULN), total bilirubin >1.5 ULN, lipasemia >1 ULN.
• Estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2, using Chronic Kidney Disease - EPIdemiology (CKD EPI) 2021 Formula.
• Any other abnormal laboratory results that the Investigator believes should preclude the subject's participation in the trial.
• History of hypersensitivity to IMP or excipients (liraglutide or disodium phosphate dihydrate, propylene glycol, phenol).
• Any contraindication for MRI (cardiac pacemaker, deep brain stimulators, intraocular metal, cerebral aneurysm clips, recent stents, cochlear implants, neurostimulators and implantable pumps) or inability to undergo MRI (e.g., body size, leg not fitting in the coil, claustrophobia).
• History of hypersensitivity reactions to a gadolinium-based contrast agent.
• Any CE-MRI Central reading additional diagnoses: posterior meniscal root tears, subchondral insufficiency fractures, osteonecrosis, malignant bone marrow infiltration, solid tumours, and traumatic fracture or bone bruise using ROAMES (Roemer et al., 2020).
• Previous participation in clinical research with a disease-modifying OA drug during the last 2 years.
• Participation in an interventional clinical research trial within 3 months before screening.
• Participants who, in the investigator's judgement, are at risk of falling.
• Participants with a history, or current diagnosis, of pancreatitis, thyroid cancer (including medullary thyroid carcinoma), multiple endocrine neoplasia type-2 (MEN2), diabetic ketoacidosis, type-1 diabetes mellitus (T1DM), inflammatory bowel disease, or diabetic gastroparesis.
• Participants currently, or within the last 10 days, taking any anticoagulant treatment.

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: 4P004 (2mL); One IA injection in the knee of 4P004 (2mL) on the day of randomization	Drug: 4P004; Single intra-articular injection in the knee joint; Other Names: Liraglutide
Placebo Comparator: Placebo (NaCl 0.9% 2mL); One IA injection in the knee of Placebo (NaCl 0.9% 2mL) on the day of randomization	Drug: Placebo (NaCl 0.9%); Single intra-articular injection in the knee joint

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change from Baseline at Week 4 in the weekly average of Target Knee (TK) daily pain intensity using the WOMAC (Western Ontario and McMaster Universities Arthritis Index) Pain subscore	The WOMAC is a questionnaire widely used in the evaluation of knee osteoarthritis. It contains 24 items measuring 3 subscales: physical function (17 items), pain (5 items), and stiffness (2 items). Scores are calculated for each subscale and summed up, with a possible score range of 0-20 for Pain, 0-8 for Stiffness, and 0-68 for Physical Function. The sum of the scores for all three subscales gives a total WOMAC score. Higher scores on the WOMAC indicate worse pain, stiffness, and functional limitations.	Baseline and Week 4

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change from Baseline at Week 2, Week 6, Week 8, Week 10 and Week 12 in the weekly average of TK (Target Knee) daily pain intensity using the WOMAC (Western Ontario and McMaster Universities Arthritis Index) Pain subscore	The WOMAC is a questionnaire widely used in the evaluation of knee osteoarthritis. It contains 24 items measuring 3 subscales: physical function (17 items), pain (5 items), and stiffness (2 items). Scores are calculated for each subscale and summed up, with a possible score range of 0-20 for Pain, 0-8 for Stiffness, and 0-68 for Physical Function. The sum of the scores for all three subscales gives a total WOMAC score. Higher scores on the WOMAC indicate worse pain, stiffness, and functional limitations.	Baseline, Week 2, Week 6, Week 8, Week 10 and Week 12
Change from Baseline at Week 2, Week 4, Week 8 and Week 12 in the NRS (Numeric Rating Scale) pain (scale 0-10) in a nominated pain aggravating activity	The numeric rating scale (NRS) is a pain screening tool, commonly used to assess pain severity at that moment in time, using a 0-10 scale, with zero meaning "no pain" and 10 meaning "the worst pain imaginable.	Baseline, Week 2, Week 4, Week 8 and Week 12
Change from Baseline at Week 2, Week 4, Week 8 and Week 12 in WOMAC (Western Ontario and McMaster Universities Arthritis Index) subscores and total score	The WOMAC is a questionnaire widely used in the evaluation of knee osteoarthritis. It contains 24 items measuring 3 subscales: physical function (17 items), pain (5 items), and stiffness (2 items). Scores are calculated for each subscale and summed up, with a possible score range of 0-20 for Pain, 0-8 for Stiffness, and 0-68 for Physical Function. The sum of the scores for all three subscales gives a total WOMAC score. Higher scores on the WOMAC indicate worse pain, stiffness, and functional limitations.	Baseline, Week 2, Week 4, Week 8 and Week 12
Change from Baseline at Week 2, Week 4, Week 8 and Week 12 in the Patient Global Assessment of Osteoarthritis (PGA-OA)	The PGA-OA is a 1-item questionnaire designed to assess the participant's impression of disease severity adapted from Guy et al., 1976, to the specific disease as a Patient-reported Outcome measurement "Considering all the ways your knee osteoarthritis affects you, how are you doing these last seven days ?". PGA-OA is measured on a 5-point Likert scale, with higher scores indicating worse symptoms (1= "very good" to 5 = "very poor").	Baseline, Week 2, Week 4, Week 8 and Week 12
Percentage (%) of OMERACT-OARSI Responders at Week 2, Week 4, Week 8 and Week 12		Week 2, Week 4, Week 8 and Week 12
Incidence and severity of TEAEs (Treatment-Emergent Adverse Events) during the trial		From randomization to end of trial, up to 12 weeks
Absolute changes from Baseline in clinical laboratory assessment - hematology parameter: total blood cells count (in cell/L)		From randomization to end of trial (up to 12 weeks)
Absolute changes from Baseline in clinical laboratory assessments - hematology parameter: hemoglobin (in g/L)		From randomization to end of trial (up to 12 weeks)
Absolute changes from Baseline in clinical laboratory assessment - blood chemistry: AST (in U/L)		From randomization to end of trial (up to 12 weeks)
Absolute changes from Baseline in clinical laboratory assessment - blood chemistry: ALT (in U/L)		From randomization to end of trial (up to 12 weeks)
Absolute changes from Baseline in clinical laboratory assessment - blood chemistry: lipase (in U/L)		From randomization to end of trial (up to 12 weeks)
Absolute changes from Baseline in clinical laboratory assessment - blood chemistry: fasting glycemia (in mmol/L)		From randomization to end of trial (up to 12 weeks)
Absolute changes from Baseline in clinical laboratory assessment - blood chemistry: total bilirubin (in umol/L)		From randomization to end of trial (up to 12 weeks)
Absolute changes from Baseline in Vital signs: systolic and diastolic blood pressure (BP)		From randomization to end of trial (up to 12 weeks)
Absolute changes from Baseline in Vital signs: pulse rate		From randomization to end of trial (up to 12 weeks)

Collaborators and Investigators

• Sponsor: 4Moving Biotech
• Investigators: Study Chair: Francis Berenbaum, MD, PhD, 4

Study record dates

Study Major Dates

• Study Start (Actual): June 17, 2025
• Primary Completion (Estimated): July 1, 2026
• Study Completion (Estimated): September 1, 2026

Study Registration Dates

• First Submitted: September 24, 2025
• First Submitted That Met QC Criteria: November 5, 2025
• First Posted (Actual): November 10, 2025

Study Record Updates

• Last Update Posted (Actual): April 14, 2026
• Last Update Submitted That Met QC Criteria: April 10, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: Osteoarthritis; Liraglutide; OA; Knee OA
• Additional Relevant MeSH Terms: Musculoskeletal Diseases; Arthritis; Joint Diseases; Rheumatic Diseases; Osteoarthritis; Osteoarthritis, Knee; Hormones; Hormones, Hormone Substitutes, and Hormone Antagonists; Inorganic Chemicals; Chlorine Compounds; Sodium Compounds; Gastrointestinal Hormones; Glucagon-Like Peptides; Proglucagon; Chlorides; Hydrochloric Acid; Glucagon-Like Peptide 1; Liraglutide; Sodium Chloride
• Other Study ID Numbers: 4MB-4P004-P-INFLAM; 2024-518916-38-00 (Ctis)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

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