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Symptomatic Osteoarthritis of the KneeEarly Phase 1NCT02995083

Intra-articular Injections for Knee Osteoarthritis: A Single Blinded Prospective Randomized Trial

A Early Phase 1 study testing 40 mg Depo-Medrol in 1 ml, 9 ml of 1% lidocaine, Normal Saline 10 ml and Air 10 ml in people with Symptomatic Osteoarthritis of the Knee, run by Rush University Medical Center.

Withdrawn

Withdrawn. The study stopped before anyone enrolled.

Official record
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Trial summary

To investigate the clinical benefit of intra-articular injections of saline in patients with symptomatic osteoarthritis of the knee and compare the clinical response of saline to the current standard treatment with corticosteroids and an air injection placebo. Read more about this study

Who is it for?
Ages 18 to 80 years
Conditions the study is for
Symptomatic Osteoarthritis of the Knee
What is being tested?
40 mg Depo-Medrol in 1 ml, 9 ml of 1% lidocaine, Normal Saline 10 ml and Air 10 ml
Type of treatment
Injection or infusion
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
0 participants
Where
No sites listed yet
Study dates
Jun 2017to Jan 2018
Phase
Early Phase 1
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 80 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • The patient must be between the ages of 18 and 80
  • Informed consent has been obtained from the patient
  • The patient must have diagnosed symptomatic osteoarthritis of the tibio-femoral or patello-femoral compartment of the target knee for at least 1 month
  • The patient has moderate-to-severe knee pain reflected by an average visual analogue scale (VAS) score of 4 or greater (out of a possible 10) over the previous 7 days.
  • Radiographic imaging must show grade II-III osteoarthritis on the Kellgren \& Lawrence Scale.
  • Patients may have bilateral osteoarthritis but only patients with unilateral symptoms may be included.

Who cannot join

  • Knee instability
  • A score less than 4 (out of a possible 10) on their intake VAS
  • Major axial deviation (>5º valgus or varus deviation as evidenced on a standard of care x-ray.
  • Previous surgery at the target knee < 6 months.
  • Symptomatic osteoarthritis of the contralateral knee or any other joint.
  • Systemic or intra articular injection to any joint with corticosteroids within 6 months prior to screening
Show all 12Show fewer
  • Previous joint injection of any type in the past 6 months
  • Systemic conditions that could interfere with outcome such as Rheumatoid arthritis, coagulopathy, and anemia.
  • Allergy to any of the injected substances.
  • Any patient unable to cease NSAID usage (other than low dose aspirin) due to unrelated condition.
  • Cognitive impairment or unable to provide informed consent
  • Recent knee trauma with violation of the intra-articular bone.

About this study

Official title: Corticosteriods vs. Saline vs. Air Placebo Intra-articular Injections for Knee Osteoarthritis: A Single Blinded Prospective Randomized Trial

To investigate the clinical benefit of intra-articular injections of saline in patients with symptomatic osteoarthritis of the knee and compare the clinical response of saline to the current standard treatment with corticosteroids and an air injection placebo.

Read the detailed description

As non-surgical treatments of OA are essential, multiple trials have been done to compare standard of care IA injection therapies to more novel injection treatments, with many of these trials using saline as the control arm. The purpose of using a control arm is to attempt to eliminate placebo effect and help distinguish the true effectiveness of a therapy. There has been controversy over the clinical effect of saline in treating OA with some arguing that saline may have some clinical benefit. If this is true, it could allow for the true effect of standard of care therapies to appear diminished when compared to saline as a placebo. A recent meta analysis looked at the use of saline as a placebo in 38 randomized control trials to determine if intra-articular saline injections for knee OA had a clinical effect. The study found that IA injections of saline significantly improved short-term knee pain in 32 of the studies which involved 1705 patients, p <0.001, and long-term pain was significantly decreased in 19 of the studies involving 1445 patients, p <0.001. It is essential to empirically determine if saline has a clinical effect due to the role it plays as a placebo in many clinical studies of the management of OA with intra-articular injections.

Objective: To investigate the clinical benefit of intra-articular injections of saline in patients with symptomatic osteoarthritis of the knee and compare the clinical response of saline to the current standard treatment with corticosteroids and an air injection placebo.

Study Design: Prospective, single-blinded, randomized, clinical study. Patients will be randomized into three treatment arms in a 1:1:1 fashion with approximately 50 patients in the saline arm, 50 patients in the corticosteroid arm, and 50 patients in the placebo arm.

Null Hypothesis: Clinical knee outcomes of subjects following one intra-articular knee injection of air will be similar to one intra-articular knee injection of saline or corticosteroid for symptomatic patients diagnosed with knee OA.

Statistical Assumptions: Power Analysis

Investigational Arm: 10 ml Saline (Normal Saline)

Control Arm: 1 ml of 40 mg corticosteroid in 9 ml 1% lidocaine (Depo-medrol, Pfizer, New York, New York), 10 ml air (placebo)

Primary Efficacy Endpoint: The primary efficacy endpoint is the mean change in the WOMAC Index score 12 weeks after first injection with regards to baseline score.

Secondary Efficacy Secondary efficacy endpoints include the change in the full Endpoints: WOMAC Index, KOOS, Lysholm, IKDC, VAS, SF-12 and use of rescue medication (steroid at 12 weeks).

Enrollment: Prospective, randomized, clinical study designed to evaluate 150 subjects. All enrolled subjects will have a pre-procedure visit, one treatment visit, and follow-up visits at week 6 and week 12 if they require a rescue injection and will fill out patient reported outcome measures at 1, 6, 12, and 24 weeks.

Being tested
40 mg Depo-Medrol in 1 ml, 9 ml of 1% lidocaine, Normal Saline 10 ml, Air 10 ml
Keywords
osteoarthritis
Medical subject headings
Osteoarthritis

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • 40 mg Depo-Medrol in 1 ml, 9 ml of 1% lidocaineDrug

    Also called Corticosteroid

    Patients will receive an ultrasound guided intra-articular injection of 40 mg Depo-Medrol in 1 ml, 9 ml of 1% lidocaine

  • Normal Saline 10 mlDrug

    Also called Saline

    Patients will receive an ultrasound guided intra-articular injection of Normal Saline 10 ml

  • Air 10 mlDrug

    Also called Air

    Patients will receive an ultrasound guided intra-articular injection of Air 10 ml

Study groups in NCT02995083
Study groupRoleWhat they receive
Knee injection with corticosteroidsActive comparatorUsing clinically accepted methods, subjects will undergo a palpation guided injection of corticosteroids into the knee joint. Subjects will then return for follow-up visit at 12 weeks for a physical exam of the knee. Patients will fill out questionnaires online at 1, 6, 12 and 24 weeks.
Receives: Drug: 40 mg Depo-Medrol in 1 ml, 9 ml of 1% lidocaine
Knee injection with salinePlacebo comparatorUsing clinically accepted methods, subjects will undergo a palpation guided injection of saline into the knee joint. Subjects will then return for follow-up visit at 12 weeks for a physical exam of the knee. Patients will fill out questionnaires online at 1, 6, 12 and 24 weeks.
Receives: Drug: Normal Saline 10 ml
Knee injection with airSham comparatorUsing clinically accepted methods, subjects will undergo a palpation guided injection of air into the knee joint. Subjects will then return for follow-up visit at 12 weeks for a physical exam of the knee. Patients will fill out questionnaires online at 1, 6, 12 and 24 weeks.
Receives: Drug: Air 10 ml

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Mean change in Western Ontario and McMaster Universities Arthritis Index score (WOMAC)

    Mean change in the WOMAC Index score from baseline score

    Measured: 12 weeks after injection

Secondary outcomes (6)
  1. Mean change in Knee injury and Osteoarthritis Outcome Score (KOOS)

    Mean change in the KOOS from baseline score

    Measured: 12 weeks after injection

  2. Mean change in International Knee Documentation Committee (IKDC) score

    Mean change in IKDC from baseline score

    Measured: 12 weeks after injection

  3. Mean change in Visual Analogue Scale (VAS)

    Mean change in VAS from baseline score

    Measured: 12 weeks after injection

  4. Mean change in Short Form 12 (SF-12) score

    Mean change in SF-12 from baseline score

    Measured: 12 weeks after injection

  5. Mean change in The Lysholm Knee score

    Mean change in The Lysholm Knee score from baseline score

    Measured: 12 weeks after injection

  6. Mean change in use of rescue medication

    Use of anti-inflammatory, analgesics, and rescue corticosteroid injection. Number of pills taken each day. This will be collected via survey. If the medical examiner feels that the patient is continuing to do poorly and they did not receive the steroid injection intervention, then they will be offered a rescue corticosteroid injection at 12 weeks. The number of patients who do not initially receive a corticosteroid injection and require a rescue corticosteroid injection at 12 weeks will be recorded.

    Measured: 12 weeks after injection

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted16 Dec 2016 (estimated)
  2. Study startJun 2017 (estimated)
  3. Primary completionJan 2018 (estimated)
  4. Study completionJan 2018 (estimated)

Why it stopped: Study deemed not feasible

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Early Phase 1
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Participant
Enrolment
0 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02995083
Sponsor's protocol ID
16090902
Status last verified
Dec 2017
First submitted
14 Dec 2016
Last updated
18 Dec 2017
Results posted
No
Data monitoring committee
No
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
No

Publications

  • Murphy L, Schwartz TA, Helmick CG, Renner JB, Tudor G, Koch G, Dragomir A, Kalsbeek WD, Luta G, Jordan JM. Lifetime risk of symptomatic knee osteoarthritis. Arthritis Rheum. 2008 Sep 15;59(9):1207-13. doi: 10.1002/art.24021.

    PubMed 18759314
  • Altman RD, Devji T, Bhandari M, Fierlinger A, Niazi F, Christensen R. Clinical benefit of intra-articular saline as a comparator in clinical trials of knee osteoarthritis treatments: A systematic review and meta-analysis of randomized trials. Semin Arthritis Rheum. 2016 Oct;46(2):151-159. doi: 10.1016/j.semarthrit.2016.04.003. Epub 2016 Apr 27.

    PubMed 27238876
  • Williams VJ, Piva SR, Irrgang JJ, Crossley C, Fitzgerald GK. Comparison of reliability and responsiveness of patient-reported clinical outcome measures in knee osteoarthritis rehabilitation. J Orthop Sports Phys Ther. 2012 Aug;42(8):716-23. doi: 10.2519/jospt.2012.4038. Epub 2012 Mar 8.

    PubMed 22402677
  • Kim J, Seo BS. How to calculate sample size and why. Clin Orthop Surg. 2013 Sep;5(3):235-42. doi: 10.4055/cios.2013.5.3.235. Epub 2013 Aug 20.

    PubMed 24009911
  • Zhang W, Robertson J, Jones AC, Dieppe PA, Doherty M. The placebo effect and its determinants in osteoarthritis: meta-analysis of randomised controlled trials. Ann Rheum Dis. 2008 Dec;67(12):1716-23. doi: 10.1136/ard.2008.092015. Epub 2008 Jun 9.

    PubMed 18541604
  • Eker HE, Cok OY, Aribogan A, Arslan G. The efficacy of intra-articular lidocaine administration in chronic knee pain due to osteoarthritis: A randomized, double-blind, controlled study. Anaesth Crit Care Pain Med. 2017 Apr;36(2):109-114. doi: 10.1016/j.accpm.2016.05.003. Epub 2016 Jul 30.

    PubMed 27485803

Questions about this trial

What is this clinical trial studying?

A Early Phase 1 study testing 40 mg Depo-Medrol in 1 ml, 9 ml of 1% lidocaine, Normal Saline 10 ml and Air 10 ml in people with Symptomatic Osteoarthritis of the Knee, run by Rush University Medical Center.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 6 inclusion and 12 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: withdrawn, as of the sponsor's last update on 18 Dec 2017. Status can change between updates, so confirm with the study contact before making plans.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Early Phase 1 (sometimes called Phase 0) studies give a very small amount of a treatment to a few people, mainly to see how the body handles it.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study was withdrawn before enrolling participants, so there are no results.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Mean change in Western Ontario and McMaster Universities Arthritis Index score (WOMAC) (time frame: 12 weeks after injection). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02995083, which also lists 6 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 18 Dec 2017; AzTrials last refreshed its copy on 7 Nov 2026.

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