AA4500 for the Treatment of Adhesive Capsulitis of the Shoulder

Study Overview
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Brief Summary
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The objectives of this study are to assess the safety, effectiveness, and immunogenicity of AA4500 in the treatment of adhesive capsulitis.

Detailed Description
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This study is a Phase 2a, open-label, dose-ranging study of the safety and effectiveness of AA4500 for the treatment of adhesive capsulitis of the shoulder. To be eligible for treatment, a subject must have unilateral idiopathic adhesive capsulitis of the shoulder with restricted range of motion in the affected shoulder for at least 3 months but not more than 12 months. Subjects will be screened for study eligibility within 30 days before injection of study drug. Approximately 50 adult women and men are to be enrolled in this study. Following screening and determination of study eligibility, Assignment to Cohorts 1-4 is sequential. Subjects assigned to Cohorts 1 through 4 may receive up to 3 injections of AA4500 according to cohort assignment. Each injection will be separated by a minimum of 21 days. Subjects assigned to Cohort 5 will receive home shoulder exercises only, while subjects assigned to Cohorts 1-4 will receive AA4500 and home shoulder exercises. Subjects in Cohort 5 will be offered physical therapy sessions for a period of 2 months following completion of the study. Dosing will range from 0.29 mg to 0.58 mg with varying volumes.

Official Title
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A Phase 2a, Open-label, Dose-ranging Study of the Safety and Effectiveness of AA4500 for the Treatment of Adhesive Capsulitis of the Shoulder

Conditions
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Frozen Shoulder, Adhesive Capsulitis

Intervention / Treatment
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* Biological: AA4500 0.29 mg/1 mL
* Biological: AA4500 0.58 mg/2 mL
* Biological: AA4500 0.58 mg/1 mL
* Biological: AA4500 0.58 mg/0.5 mL
* Other: Shoulder exercises


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Be a male or female and be greater than or equal to 18 years of age If a female of childbearing potential, have a negative urine pregnancy test and be using an effective contraception method (ie, abstinence, intrauterine device (IUD), hormonal (estrogen/progestin) contraceptives, or barrier control) for at least one menstrual cycle prior to study enrollment and for one menstrual cycle following end of study, or be surgically sterile Have unilateral idiopathic adhesive capsulitis of one shoulder for at least 3 months but not more than 12 months before the screening visit and be in Stage 2 (frozen or adhesive stage), as determined by the investigator Have normal range of motion in the contralateral shoulder, as determined by the investigator Have restricted active range of motion (AROM) in the affected shoulder defined as: a deficit of at least 60 degrees in total AROM in the affected shoulder as compared with the total AROM in the contralateral shoulder and a deficit of at least 30 degrees in AROM in at least one of the following planes as compared with the contralateral shoulder: Forward flexion Abduction External rotation with the elbow up to 90 degrees abduction Internal rotation with the elbow up to 90 degrees abduction Voluntarily sign and date an informed consent agreement approved by the Institutional Review Board/Independent Ethics Committee (IRB/IEC). The subject must also sign an authorization form to allow disclosure of his protected health information (PHI). The PHI authorization form and informed consent form may be an integrated form or may be separate forms depending on the institution. Be able to complete and understand the various rating instruments in English. Exclusion Criteria: Is a pregnant or lactating female or female intending to become pregnant during the study Is a male who intends to father a child during the study Has received treatment for adhesive capsulitis or is planning to receive treatment for adhesive capsulitis at any time during the study including but not limited to: physical therapy or acupuncture within 2 weeks before the first injection of AA4500 intra-articular or intrabursal injection(s) of lidocaine; suprascapular nerve blocks; corticosteroids; electroanalgesic and/or thermoanalgesic modalities within 1 month before the screening visit intra-articular or intrabursal injection(s) of sodium hyaluronate within 3 months before the screening visit glenohumeral distension arthrography and/or surgical intervention (including shoulder manipulation under anesthesia) at any time Has any of the following conditions, as determined by the investigator: Adhesive capsulitis as a result of traumatic injury Pain in the affected shoulder at rest that is greater than or equal to 4 on the 11-point pain scale Active subacromial impingement in the affected shoulder Calcified tendonitis in the affected shoulder Glenohumeral joint arthritis in the affected shoulder Arthrosis of the affected shoulder Chondrolysis of the affected shoulder Subscapularis tendon rupture of the affected shoulder Other rotator cuff injuries of the affected shoulder Uncontrolled hypertension Uncontrolled diabetes Uncontrolled thyroid disease History of thrombosis or post-thrombosis syndrome Physical impairment that would preclude performing the protocol defined exercises Active infection in area to be treated Clinically significant neurological disease Coagulation disorder, using anticoagulant (except for less than or equal to 150 mg aspirin) within 7 days prior to each injection day Known active hepatitis B or C (history of hepatitis A permitted) Other significant medical condition (eg, morbid obesity, cervical disc disease), which in the investigator's opinion would make the subject unsuitable for enrollment in the study Is unwilling or unable to cooperate with the requirements of the study including completion of all scheduled study visits. Has received oral or intravenous steroids for any reason within 3 weeks before the screening visit Has received an investigational drug or treatment within 30 days before the first dose of study drug. Has a known systemic allergy to collagenase or any other excipient of AA4500 or any other procedural medication. Has, at any time, received collagenase for the treatment of adhesive capsulitis. Is unable to undergo an x-ray or MRI (contraindication) evaluation of the affected shoulder. Is planning to be treated with commercial Xiaflex at any time during the study.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: AA4500 0.29 mg/1 mL<br>Up to three injections | Biological: AA4500 0.29 mg/1 mL<br>* treatment of adhesive capsulitis<br>* Other names: XIAPEX;Other: Shoulder exercises<br>* Home shoulder exercises, minimum of 3 times per day<br>|
| Experimental: AA4500 0.58 mg/2 mL<br>Up to three injections | Biological: AA4500 0.58 mg/2 mL<br>* treatment of adhesive capsulitis<br>* Other names: XIAPEX;Other: Shoulder exercises<br>* Home shoulder exercises, minimum of 3 times per day<br>|
| Experimental: AA4500 0.58 mg/1 mL<br>Up to three injections | Biological: AA4500 0.58 mg/1 mL<br>* treatment of adhesive capsulitis<br>* Other names: XIAPEX;Other: Shoulder exercises<br>* Home shoulder exercises, minimum of 3 times per day<br>|
| Experimental: AA4500 0.58 mg/0.5 mL<br>Up to three injections | Biological: AA4500 0.58 mg/0.5 mL<br>* treatment of adhesive capsulitis<br>* Other names: XIAPEX;Other: Shoulder exercises<br>* Home shoulder exercises, minimum of 3 times per day<br>|
| Other: Shoulder exercises<br>Home shoulder exercises for 64 days | Other: Shoulder exercises<br>* Home shoulder exercises, minimum of 3 times per day<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change From Baseline to Day 92 in Active Forward Flexion | Active range of motion (AROM) measurement using a goniometer to assess forward flexion in the affected shoulder | Baseline, Day 92 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change From Baseline to Day 92 in Passive Forward Flexion | Passive range of motion (PROM) measurement using a goniometer to assess forward flexion in the affected shoulder | Baseline, Day 92 | 
| Change From Baseline to Day 92 in Active Abduction | AROM measurement using a goniometer to assess abduction in the affected shoulder | Baseline, Day 92 | 
| Change From Baseline to Day 92 in Passive Abduction | PROM measurement using a goniometer to assess abduction in the affected shoulder | Baseline, Day 92 | 
| Change From Baseline to Day 92 in Active External Rotation | AROM measurement using a goniometer to assess external rotation in the affected shoulder | Baseline, Day 92 | 
| Change From Baseline to Day 92 in Passive External Rotation | PROM measurement using a goniometer to assess external rotation in the affected shoulder | Baseline, Day 92 | 
| Change From Baseline to Day 92 in Active Internal Rotation | AROM measurement using a goniometer to assess internal rotation with the elbow up to 90° abduction in the affected shoulder | Baseline, Day 92 | 
| Change From Baseline to Day 92 in Passive Internal Rotation | PROM measurement using a goniometer to assess internal rotation with the elbow up to 90° abduction in the affected shoulder | Baseline, Day 92 | 
| Change From Baseline to Day 92 in American Shoulder and Elbow Surgeons (ASES) Composite Score | Composite score ranging from 0-100, with 0 being worst pain and function loss, derived from the sum of the scores from pain subscale (11-point NRS where 0=no pain at all and 10=pain) and function subscale (activity questionnaire where 0=unable to do to, 1=very difficult to do, 2=somewhat difficult, and 3=not difficult); adapted from ASES Standardized Shoulder Assessment Form, Patient Self-Evaluation | Baseline, Day 92 | 
| Change From Baseline to Day 92 in ASES Pain Subscale | Pain subscale score ranging from 0-50, with 0 being greatest pain, derived from participant assessment of pain in response to How bad is the pain in your affected shoulder today? on an 11-point numerical rating scale (NRS) where 0=no pain at all and 10=pain as bad as it can be and calculated as (10 - NRS score) x 5); adapted from ASES Standardized Shoulder Assessment Form, Patient Self-Evaluation | Baseline, Day 92 | 
| Change From Baseline to Day 92 in ASES Function Subscale | Function subscale score ranging from 0-50, with 0 being most dysfunctional, derived from participant assessment of ability to do 10 activities with affected shoulder/arm where 0=unable to do to, 1=very difficult to do, 2=somewhat difficult, and 3=not difficult, and calculated as (cumulative total score for the 10 activity items) × (5/3); adapted from ASES Standardized Shoulder Assessment Form, Patient Self-Evaluation | Baseline, Day 92 | 
| Subject Satisfaction With Treatment at Day 92 | Participant assessment of satisfaction with treatment rated as very satisfied, quite satisfied, neither satisfied nor dissatisfied, quite dissatisfied, or very dissatisfied. | Day 92 | 
| Investigator Assessment of Improvement With Treatment at Day 92 | Investigator assessment of degree of improvement in severity of the participant's treated shoulder compared with screening rated as very much improved, much improved, minimally improved, no change, minimally worse, much worse, or very much worse. | Day 92 |