The ASPIRE Trial: AchilleS tendinoPathy Treated With cortIcosteRoid injEctions (ASPIRE)
16 juin 2026 mis à jour par: Adam Weir, Erasmus Medical Center
Achilles tendinopathy is a common and often persistent tendon disorder associated with pain, impaired function, and reduced participation in physical activities.
Standard care consists of education, load management advice, and progressive calf-strengthening exercises, yet about half of patients remain symptomatic.
Corticosteroid injections are frequently used in clinical practice, but evidence on long-term efficacy and safety remains inconclusive.
The ASPIRE trial is a multicentre, randomized, double-blind, placebo-controlled phase III trial evaluating whether 1-3 ultrasound-guided peritendinous corticosteroid injections added to standard care are safe and more effective than placebo injections plus standard care in adults with chronic midportion Achilles tendinopathy.
The primary outcomes are change in VISA-A score over 1 year and incidence of full-thickness Achilles tendon rupture during 1-year follow-up.
Aperçu de l'étude
Statut
Recrutement
Les conditions
Description détaillée
The ASPIRE trial is designed to address uncertainty regarding peritendinous corticosteroid injections as a second-line treatment for chronic midportion Achilles tendinopathy.
Participants are adults aged 18-65 years with clinically diagnosed and ultrasonographically confirmed chronic midportion Achilles tendinopathy, persistent symptoms for at least 6 months, and ongoing complaints despite standard care including at least 3 months of exercise therapy.
Participants are randomized 1:1 to receive either 1-3 ultrasound-guided peritendinous injections of methylprednisolone acetate 40 mg plus lidocaine, or 1-3 ultrasound-guided placebo injections with lidocaine only.
All participants receive the same standard care consisting of education, load management advice, and a structured progressive calf-muscle strengthening exercise programme supported by an online website.
Follow-up includes clinical assessments, questionnaires, ultrasound imaging, and functional testing at baseline, 3 months, and 1 year, with additional online questionnaires up to 10 years.
Type d'étude
Interventionnel
Inscription (Estimé)
276
Phase
- Phase 3
Contacts et emplacements
Cette section fournit les coordonnées de ceux qui mènent l'étude et des informations sur le lieu où cette étude est menée.
Coordonnées de l'étude
- Nom: Kristel van Abswoude, MD
- Numéro de téléphone: +31 6 49326353
- E-mail: aspire@erasmusmc.nl
Lieux d'étude
-
-
-
Rotterdam, Pays-Bas
- Recrutement
- Erasmus MC
-
Contact:
- k van Abswoude, MD
- Numéro de téléphone: +31 6 49326353
- E-mail: aspire@erasmusmc.nl
-
Contact:
- R.J de Vos, MD/PhD
- Numéro de téléphone: +31 10 7040136
- E-mail: r.devos@erasmusmc.nl
-
-
Critères de participation
Les chercheurs recherchent des personnes qui correspondent à une certaine description, appelée critères d'éligibilité. Certains exemples de ces critères sont l'état de santé général d'une personne ou des traitements antérieurs.
Critère d'éligibilité
Âges éligibles pour étudier
- Adulte
- Adulte plus âgé
Accepte les volontaires sains
Non
La description
Inclusion Criteria:
- Age 18-65 years
- Clinically diagnosed midportion Achilles tendinopathy confirmed by ultrasound
- Symptoms for at least 6 months
- Persistent complaints despite standard care, including education, load management advice and at least 3 months of exercise therapy / exercise programme
Exclusion Criteria:
• Clinical suspicion of insertional Achilles tendinopathy
- Clinical suspicion of Achilles tendon rupture
- Clinical suspicion of plantar flexor tenosynovitis
- Clinical suspicion of sural nerve pathology
- Clinical suspicion of peroneal tendon subluxation or peroneal tendinopathy
- Clinical suspicion of posterior ankle impingement syndrome
- Suspected systemic/inflammatory disorder as cause of symptoms
- Any condition preventing participation in active exercise programme
- History of Achilles tendon rupture of index tendon
- Previous local corticosteroid injection on index Achilles tendon
- Previous surgery on index Achilles tendon
- Refusal to undergo one of the study treatments
- Local skin infection, suspected systemic infection with fever, or other medical condition compromising injection safety
- Vitamin K antagonist use with INR >3.0 within 3 days before injection or unknown INR
- Current pregnancy or breastfeeding
- Medication-induced tendon pathology (quinolones or statins related to symptom onset)
- Inability to provide informed consent
- Participation in another concomitant interventional programme for Achilles tendinopathy
- Known hypersensitivity or allergy to Depo-Medrol or Lidocaine
- Participants with unstable or poorly controlled diabetes mellitus may be excluded at investigator discretion for safety reasons.
Plan d'étude
Cette section fournit des détails sur le plan d'étude, y compris la façon dont l'étude est conçue et ce que l'étude mesure.
Comment l'étude est-elle conçue ?
Détails de conception
- Objectif principal: Traitement
- Répartition: Randomisé
- Modèle interventionnel: Affectation parallèle
- Masquage: Quadruple
Armes et Interventions
Groupe de participants / Bras |
Intervention / Traitement |
|---|---|
|
Expérimental: Corticosteroid and Lidocaine Injection
Participants receive 1-3 ultrasound-guided peritendinous injections of Depo-Medrol (methylprednisolone acetate 40 mg) combined with lidocaine.
All participants receive one injection at baseline; up to two additional injections may be given within the first 8 weeks at intervals of 4 weeks if predefined criteria are met.
|
Education, load management advice, and a structured progressive calf-muscle strengthening exercise programme supported by an online website.
Participants receive 1-3 ultrasound-guided peritendinous injections of Depo-Medrol (methylprednisolone acetate 40 mg) combined with lidocaine.
Autres noms:
|
|
Comparateur placebo: Placebo Injection
Participants receive 1-3 ultrasound-guided peritendinous placebo injections consisting of lidocaine only.
All participants receive one injection at baseline; up to two additional injections may be given within the first 8 weeks at intervals of at least 4 weeks if predefined criteria are met.
|
Education, load management advice, and a structured progressive calf-muscle strengthening exercise programme supported by an online website.
Participants receive 1-3 ultrasound-guided peritendinous placebo injections consisting of lidocaine onl
Autres noms:
|
Que mesure l'étude ?
Principaux critères de jugement
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
|
Change in disability and symptoms measured with the VISA-A questionnaire.
Délai: Baseline to 1 year follow-up (timepoints: Baseline, 4 weeks, 8 weeks, 3 months, 6 months, 9 months, and 1-year).
|
Change in disability and symptoms during 1-year follow-up, measured with the validated Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire, scored from 0 to 100.
|
Baseline to 1 year follow-up (timepoints: Baseline, 4 weeks, 8 weeks, 3 months, 6 months, 9 months, and 1-year).
|
|
Incidence of full-thickness Achilles tendon rupture
Délai: During 1-year follow-up
|
Incidence of full-thickness Achilles tendon ruptures during 1-year follow-up, confirmed by medical records or clinical tests and imaging.
|
During 1-year follow-up
|
Mesures de résultats secondaires
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
|
Minor corticosteroid side effects / corticosteroid safety indicators
Délai: baseline, 3 months, 6 months, 9 months, and 1 year.
|
Body mass (kg)
|
baseline, 3 months, 6 months, 9 months, and 1 year.
|
|
Tendon-related symptoms and disability
Délai: baseline, 3 months, 6 months, 9 months, and 1 year
|
TENDINopathy Severity Assessment - Achilles (TENDINS-A) score.
0-100; 0= worts, 100= best
|
baseline, 3 months, 6 months, 9 months, and 1 year
|
|
Pain outcomes
Délai: Assessed at baseline, 3 months, 6 months, 9 months, and 1 year
|
Pain during activity, measured on a VAS 0-10 scale
|
Assessed at baseline, 3 months, 6 months, 9 months, and 1 year
|
|
Global perceived improvement
Délai: Assessed at 3 months, 6 months, 9 months, and 1 year
|
Global Rating of Change (GROC), 11-point scale
|
Assessed at 3 months, 6 months, 9 months, and 1 year
|
|
Physical function / functional test outcomes
Délai: Assessed at baseline, 3 months, and 1 year
|
Maximum VAS pain (0-10) during or after palpation of the Achilles tendon
|
Assessed at baseline, 3 months, and 1 year
|
|
Healthcare use
Délai: Assessed at baseline, 3 months, 6 months, 9 months, and 1 year
|
Medical Consumption Questionnaire (iMCQ) for healthcare use The economic evaluation will be published separately. |
Assessed at baseline, 3 months, 6 months, 9 months, and 1 year
|
|
Imaging outcomes: tendon structure
Délai: Assessed at baseline, 3 months, and 1 year
|
Ultrasound and ultrasound tissue characterisation of Achilles tendon where the degree of collagen disorganisation is assed using: echo types I, echo types II, echo types III, echo types IV, combined percentage echo types I + II
|
Assessed at baseline, 3 months, and 1 year
|
|
Imaging outcomes: neovascularisation / Doppler flow
Délai: Assessed at baseline, 3 months, and 1 year
|
percentage of Doppler flow within the color box, quantified with the Surface Area Quantification (SAQ) method
|
Assessed at baseline, 3 months, and 1 year
|
|
Minor corticosteroid side effects / corticosteroid safety indicators
Délai: baseline, 3 months, and 1 year.
|
Body fat percentage
|
baseline, 3 months, and 1 year.
|
|
Minor corticosteroid side effects / corticosteroid safety indicators
Délai: baseline, 3 months, and 1 year
|
Waist circumference (cm)
|
baseline, 3 months, and 1 year
|
|
Minor corticosteroid side effects / corticosteroid safety indicators
Délai: baseline, 3 months, 6 months, 9 months, and 1 year.
|
Hot flushes (5-point scale)
|
baseline, 3 months, 6 months, 9 months, and 1 year.
|
|
Minor corticosteroid side effects / corticosteroid safety indicators
Délai: baseline, 3 months, 6 months, 9 months, and 1 year
|
Menstrual disturbances (if applicable, 5-point scale)
|
baseline, 3 months, 6 months, 9 months, and 1 year
|
|
Minor corticosteroid side effects / corticosteroid safety indicators
Délai: baseline, 3 months, 6 months, 9 months, and 1 year.
|
Sleep disturbances (5-point scale)
|
baseline, 3 months, 6 months, 9 months, and 1 year.
|
|
Minor corticosteroid side effects / corticosteroid safety indicators
Délai: baseline, 3 months, 6 months, 9 months, and 1 year.
|
Appetite (5-point scale)
|
baseline, 3 months, 6 months, 9 months, and 1 year.
|
|
Physical function / functional test outcomes
Délai: Assessed at baseline, 3 months, and 1 year
|
Maximum VAS pain (0-10) during or after 5 single-leg heel rises
|
Assessed at baseline, 3 months, and 1 year
|
|
Physical function / functional test outcomes
Délai: Assessed at baseline, 3 months, and 1 year
|
Maximum VAS pain (0-10) during or after 5 hops
|
Assessed at baseline, 3 months, and 1 year
|
|
Physical function / functional test outcomes
Délai: Assessed at baseline, 3 months, and 1 year
|
Heel Rise Endurance Test (HRET) - repetitions
|
Assessed at baseline, 3 months, and 1 year
|
|
productivity loss
Délai: Assessed at baseline, 3 months, 6 months, 9 months, and 1 year
|
Institute for Medical Technology Assessment Productivity Cost Questionnaire (iPCQ for productivity loss).
The economic evaluation will be published separately
|
Assessed at baseline, 3 months, 6 months, 9 months, and 1 year
|
|
Imaging outcomes: tendon structure on ultrasound
Délai: Assessed at baseline, 3 months, and 1 year
|
tendon volume (cubic centimeters)
|
Assessed at baseline, 3 months, and 1 year
|
|
Imaging outcomes: tendon structure on ultrasound
Délai: Assessed at baseline, 3 months, and 1 year
|
maximum cross-sectional area (square cm)
|
Assessed at baseline, 3 months, and 1 year
|
|
Imaging outcomes: tendon structure on ultrasound
Délai: Assessed at baseline, 3 months, and 1 year
|
tendon maximum diameter (cm)
|
Assessed at baseline, 3 months, and 1 year
|
|
Pain outcomes
Délai: Assessed at baseline, 3 months, 6 months, 9 months, and 1 year
|
Pain after activity, measured on a VAS 0-10 scale
|
Assessed at baseline, 3 months, 6 months, 9 months, and 1 year
|
|
Health-related quality of life
Délai: Assessed at baseline, 3 months, 6 months, 9 months, and 1 year
|
Euro Quality of life 5 Dimensions, 5 Levels questionnaire (EQ-5D-5L).
0-100 score.
0=worst, 100=best
|
Assessed at baseline, 3 months, 6 months, 9 months, and 1 year
|
|
Return to sport / physical activity level
Délai: Assessed at baseline, 3 months, 6 months, 9 months, and 1 year.
|
Return to desired sports participation using a 7-point scale.
0= worst, 7 full return to sports = best
|
Assessed at baseline, 3 months, 6 months, 9 months, and 1 year.
|
|
Minor corticosteroid side effects
Délai: baseline, 3 months, and 1 year.
|
Visible skin abnormalities at the injection site scored as present or absent
|
baseline, 3 months, and 1 year.
|
Collaborateurs et enquêteurs
C'est ici que vous trouverez les personnes et les organisations impliquées dans cette étude.
Parrainer
Collaborateurs
Les enquêteurs
- Chercheur principal: Robert Jan de Vos, MD, PhD, Erasmus Medical Centre
Publications et liens utiles
La personne responsable de la saisie des informations sur l'étude fournit volontairement ces publications. Il peut s'agir de tout ce qui concerne l'étude.
Liens utiles
Dates d'enregistrement des études
Ces dates suivent la progression des dossiers d'étude et des soumissions de résultats sommaires à ClinicalTrials.gov. Les dossiers d'étude et les résultats rapportés sont examinés par la Bibliothèque nationale de médecine (NLM) pour s'assurer qu'ils répondent à des normes de contrôle de qualité spécifiques avant d'être publiés sur le site Web public.
Dates principales de l'étude
Début de l'étude (Réel)
3 juin 2026
Achèvement primaire (Estimé)
31 décembre 2027
Achèvement de l'étude (Estimé)
31 octobre 2028
Dates d'inscription aux études
Première soumission
2 juin 2026
Première soumission répondant aux critères de contrôle qualité
10 juin 2026
Première publication (Réel)
16 juin 2026
Mises à jour des dossiers d'étude
Dernière mise à jour publiée (Réel)
18 juin 2026
Dernière mise à jour soumise répondant aux critères de contrôle qualité
16 juin 2026
Dernière vérification
1 juin 2026
Plus d'information
Termes liés à cette étude
Mots clés
Termes MeSH pertinents supplémentaires
- Administration des services de santé
- Qualité des soins de santé, accès et évaluation
- Produits chimiques organiques
- Qualité des soins de santé
- Composés polycycliques
- Indicateurs de qualité, soins de santé
- Anilides
- Amides
- Composés aniline
- Amines
- Acétanilides
- Prégnades
- Grossesse
- Stéroïdes
- Composés à anneau fusionné
- Grossissement
- Méthylprednisolone
- Prednisolone
- Acétate de méthylprednisolone
- Lidocaïne
- Standard de soins
Autres numéros d'identification d'étude
- MEC-2026-0210
- 2025-524057-13-00 (Ctis)
- ZonMw grant number: 1014102241 (Autre identifiant: ZonMw)
Plan pour les données individuelles des participants (IPD)
Prévoyez-vous de partager les données individuelles des participants (DPI) ?
OUI
Description du régime IPD
upon reasonable request.
Délai de partage IPD
as yet undetermined
Critères d'accès au partage IPD
as yet undetermined
Type d'informations de prise en charge du partage d'IPD
- PROTOCOLE D'ÉTUDE
- SÈVE
- CIF
Informations sur les médicaments et les dispositifs, documents d'étude
Étudie un produit pharmaceutique réglementé par la FDA américaine
Non
Étudie un produit d'appareil réglementé par la FDA américaine
Non
Ces informations ont été extraites directement du site Web clinicaltrials.gov sans aucune modification. Si vous avez des demandes de modification, de suppression ou de mise à jour des détails de votre étude, veuillez contacter register@clinicaltrials.gov. Dès qu'un changement est mis en œuvre sur clinicaltrials.gov, il sera également mis à jour automatiquement sur notre site Web .