Pilot and Feasibility Study of Intra-articular Anti-CD14 for the Treatment of Knee Osteoarthritis
VA Office of Research and Development
Summary
Knee osteoarthritis (KOA) is a leading cause of chronic pain and disability among Veterans, which contributes significantly to reduced mobility, impaired quality of life, and increased health care utilization. First-line therapies, including non-steroidal anti-inflammatory drugs, physical therapy, and intra-articular corticosteroids, provide modest and short-term relief, while being associated with other side effects (i.e., potential for hastened cartilage loss) and no disease-modifying potential. Total knee arthroplasty, although effective, is not suitable for all patients and carries surgical risks. There is an unmet need for effective, durable, and locally-targeted therapies that can alleviate pain and improve function. The development of new therapies for this condition is thus a priority for the VA. While the therapy has been used in humans in other contexts, to date there are no data on the safety, feasibility, and potential efficacy of intra-articular IC14 administration in patients with KOA. A small-scale, Phase I "first-in-joint" pilot and feasibility trial is therefore critical to inform the design and implementation of larger, definitive studies. Specifically, preliminary data are needed to (1) determine the appropriate inclusion/exclusion criteria, (2) solidify the study design and study processes,(3) assess patient tolerance and acceptability of i.a. mAb injection, (4) evaluate safety profiles of the localized biologic intervention. Participants will be randomized into one of three arms, (a placebo arm, a low-dose arm, and a high-dose arm) and will be followed to evaluate the safety and feasibility of this treatment.
Description
In recent years, pain in osteoarthritis has been tied to inflammation in the joint. For example, Philpott et al. found that, among 258 patients with KOA, moderate to severe synovitis on ultrasound was associated with a 2- to 4-fold increase in the risk of constant and intermittent pain. A prior study in 535 patients from the Multicenter Osteoarthritis Study (MOST) cohort found that the presence of synovitis on contrast-enhanced magnetic resonance imaging (MRI) was associated with a 9-fold increase in the risk of pain. Supporting these cross-sectional associations is the observation that cortic…
Eligibility
- Age range
- 50–80 years
- Sex
- All
- Healthy volunteers
- No
Inclusion Criteria: * ACR Classification Criteria for Knee Osteoarthritis * Pain \>=5 on Visual Analogue Scale * Kelgren-Lawrence Grade \>1 * Joint Effusion on Exam * Able to provide informed consent Exclusion Criteria: * Serious or hospitalized infection in last 1 year * Poorly controlled crystal arthritis in last 6 months * Pain Pressure Threshold (PPT) testing \<=3 * History of diagnosed fibromyalgia * Receipt of corticosteroid in affected knee within 3 months * Receipt of visco-supplementation or other intra-articular therapy (other than corticosteroid) within 6 months * Ongoing partici…
Interventions
- BiologicalAtibuclimab (intra-articular)
Intra-articular injection of Atibuclimab
- Othersaline placebo
2 mL
Location
- Corporal Michael J. Crescenz Veterans Affairs Medical CenterPhiladelphia, Pennsylvania