Clinical trial NCT05079035: Lyophilized and Micronized Particulate Human Amniotic and Umbilical Cord (TTAX03) for KL Grade 3-4 Knee OA
Official title: A Phase 2, 52-Week Trial of TTAX03 vs. Saline as a Single Intra-articular Injection in Kellgren-Lawrence Grade 3-4 Knee OA
Study type: INTERVENTIONAL
Overall status: ACTIVE_NOT_RECRUITING
Phase: PHASE2
Conditions: Knee Osteoarthritis
Knee Pain Chronic
Knee Arthritis
Lead sponsor: BioTissue Holdings, Inc
Sponsor class: INDUSTRY
First posted: 2021-10-15
Enrollment: 90
Sex: ALL
Minimum age (years): 35
Maximum age (years): 85
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: It is hypothesized that a single Intra-articular Injection of TTAX03, 100mg in 2mL of saline, will have more benefit with respect to the proportion of responders 12 weeks post-injection than an equal volume of saline, based on the OMERACT-OARSI responder criteria.

Detailed description: This trial is designed as a Phase 2 randomized, placebo controlled, double-blinded parallel design to be conducted at multiple sites throughout North America. One dose level of TTAX03 (100 mg) will be tested against an equal volume of saline, which is the suspension vehicle (i.e., excipient). Each subject will receive a single IA injection into the knee under local anesthesia, with two safety follow-up visits in the first eight days and a third at the end of two weeks post injection. Subsequent visits will occur at the end of 6 and 12 weeks for evaluation of response, with the end of 12 weeks being the primary endpoint. Additional visits will occur at 6, 9 and 12 months (end of weeks 26, 39, 52) to evaluate duration of benefit and overall impression of change from baseline, as well as safety. The primary endpoint will be assessed at 12 weeks post receiving the assigned Intra-articular injection.

Eligibility criteria: Inclusion Criteria:

* Able and willing to provide written informed consent
* ≥ 35 and ≤ 85 years of age (until a cap of 30 subjects \< 50 years of age is reached, at which point this will convert to ≥ 50 and ≤ 85 years of age)
* Able to reliably complete the KOOS self-administered questionnaire
* Clinical diagnosis of OA of the index knee, with pain onset more than one year prior to screening according to subject recall
* KL grade 3 or 4 in the index knee
* Pain score (KOOS) over the past week ≥ 70 in the index knee at Screening (the index knee will be the more painful knee by ≥ 20 in the case of bilateral disease)
* A ≥ 3 months history of insufficient pain relief from IA hyaluronic acid or a ≥ 3 months history of insufficient pain relief from IA corticosteroids, unless they are medically contraindicated for the subject
* A ≥ 3 months history of insufficient pain relief from other currently recommended treatments, including weight loss and physical therapy
* Any two of the following:

  * Severe knee pain or stiffness that limits everyday activities, including walking, climbing stairs, and getting in and out of chairs. Finding it hard to walk more than a few blocks without significant pain and need to use a cane or walker
  * Moderate or severe knee pain while resting, either day or night
  * Chronic knee inflammation and swelling that does not improve with rest or medications
* BMI ≤ 40 kg/m2
* Adequate bone marrow function (ANC \> 1000 × 109 /L, platelets ≥ 100,000 × 109 /L, Hgb ≥ 10 g/dL)
* Adequate hepatic function (AST/ALT ≤ 1.5 × ULN, total bilirubin ≤ 1.2 × ULN)
* Adequate renal function (creatinine ≤ 1.2 × ULN)
* Negative urine test for opioids (including synthetic opioids)
* If female and of child-bearing potential, willingness to use effective birth control during the study.

Exclusion Criteria:

* Cognitive impairment, mental illness, neuroses or untreated depression that would preclude understanding or reliably completing the patient reported outcome measures
* Non-ambulatory, bedridden, or with active fibromyalgia, radiculopathy, painful peripheral neuropathy, vascular insufficiency, hip OA or other joint disease severe enough to prevent assessment of knee pain or causing functional impairment
* Current use of opioid analgesics, or positive urine laboratory test for opiates during the screening period
* Hyaluronic acid, corticosteroid, platelet rich plasma or stem cells IA knee injections within the prior 3 months, oral or intramuscular corticosteroids within the prior 2 months
* Scheduled knee arthroscopy or knee surgery in either knee within 12 weeks from enrollment
* Known or suspected joint infection of either knee
* History of knee ligament surgery in the past 12 months
* Acute injury to the knee in the past 3 months resulting in difficulty walking for more than 24 hours
* History of inflammatory joint diseases, crystalline diseases such as gout or pseudogout, systemic lupus, rheumatoid arthritis, autoimmune disease or Crohn's disease
* Previous repair of a cruciate ligament, osteochondral autograft transfer, mosaicplasty, subchondral surgery (subchondroplasty) or previously diagnosed subchondral insufficiency fracture
* Comorbid conditions that include the following: known other causes of arthritis (infectious arthritis, or psoriatic arthritis), osteomyelitis, cardiopulmonary disease that limits walking more than knee pain, bone metastases or Paget's disease involving the lower extremities.
* Psoriasis or other acute or chronic inflammatory conditions or infection affecting the skin over the index knee
* Symptoms of locking, intermittent block to range of motion or loose body sensation which could indicate meniscal displacement or an intraarticular loose body in the index knee
* Use of anticoagulants (except for ≤ 81 mg of aspirin per day) or a history of any coagulopathy or bleeding disorder, sickle cell disease
* History of substance abuse in the past 2 years
* Prior or current use of systemic immunosuppressive medications (other than corticosteroids for arthritis), chemotherapy, or history of organ transplant (kidney, heart, lung)
* Prior radiation therapy to the index knee
* Prior treatment with CLARIX FLO, NEOX FLO, or injectable birth tissue products for any indication
* Concurrent treatment, or treatment in the past 90 days, with any investigational agent
* Severe concurrent illness which, in the view of the investigator, would interfere with this 52 week study
* Any condition which, in the opinion of the investigator, would make a patient a poor candidate for this study
* Positive blood pregnancy test or known pregnancy

Primary outcomes:
measure: Pain Relief and/or Functional Improvement
timeFrame: 12-weeks post Intra-articular Injection
Secondary outcomes:
measure: KOOS Knee Symptoms Subscale
timeFrame: 6,12, 26, 39 & 52 weeks from Baseline versus Saline
measure: KOOS Knee Pain Subscale
timeFrame: 6,12, 26, 39 & 52 weeks from Baseline versus Saline
measure: KOOS Physical Function Subscale
timeFrame: 6,12, 26, 39 & 52 weeks from Baseline versus Saline
measure: KOOS Sports and Recreation Subscale
timeFrame: 6,12, 26, 39 & 52 weeks from Baseline versus Saline
measure: KOOS Quality of Life Subscale
timeFrame: 6,12, 26, 39 & 52 weeks from Baseline versus Saline
measure: Patient Global Impression of Change Questionnaire
timeFrame: 12, 26, 39 & 52 weeks from Baseline versus Saline
measure: Overall Change in Pain Relief Medication Use from Baseline
timeFrame: Over the 52 weeks from Baseline versus Saline
Other outcomes:
Locations:
city: Birmingham
country: United States
facility: UAB Orthopaedic Surgery
state: Alabama
city: Birmingham
country: United States
facility: Alabama Orthopaedic Center
state: Alabama
city: Tucson
country: United States
facility: Tuscon Orthopedic Institute
state: Arizona
city: La Mesa
country: United States
facility: Horizon Clinical Research
state: California
city: Sarasota
country: United States
facility: Gulfcoast Research Institute
state: Florida
city: Sunrise
country: United States
facility: Precision Clinical Research
state: Florida
city: Atlanta
country: United States
facility: Paragon Sports Medicine
state: Georgia
city: Jefferson
country: United States
facility: Ochsner Health Center
state: Louisiana
city: Columbus
country: United States
facility: Manage Sites/The Ohio State University Wexner Medical Center, Sports Medicine The Ohio State University Wexner Medical Center, Sports Medicine
state: Ohio
city: Media
country: United States
facility: Rothman Orthopaedic Institute
state: Pennsylvania
Study officials:
References: