Clinical trial NCT01780389: Open-label Milnacipran for Persistent Knee Pain One Year After Total Knee Arthroplasty (TKA)
Official title: Open-label Milnacipran for Persistent Knee Pain One Year After Total Knee Arthroplasty (TKA)
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE4
Conditions: Knee Pain After Total Knee Arthroplasty
Osteoarthritis Pain
Keywords: Knee
Pain
Osteoarthritis
Lead sponsor: Duke University
Sponsor class: OTHER
First posted: 2013-01-31
Enrollment: 5
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Primary purpose: TREATMENT

Brief summary: The current study examines the effects of milnacipran in patients who have chronic persistent knee pain one year or longer after total knee arthroplasty (TKA) to evaluate for a pain-relieving effect.

Detailed description: The current study proposes to collect pilot data on the utility of open-label milnacipran for the treatment of pain and other outcomes in this unfortunate group of patients with chronic persistent pain after TKA. Among marketed serotonin norepinephrine reuptake inhibitors (SNRIs), milnacipran has a unique property in that it blocks serotonin and norepinephrine reuptake equally. It is plausible that equipotent reuptake inhibition may confer greater analgesic benefit compared to other agents, and in preclinical animal models milnacipran has shown superior effects of ameliorating hyperalgesia and allodynia compared to some other antidepressant drugs. Additionally, milnacipran does not have inhibitory effects on cytochrome P (CYP) 450 enzymes, no binding affinity to neurotransmitter receptors liable to cause adverse events, and simple pharmacokinetics.

Eligibility criteria: Inclusion Criteria:

1. Subject is a male or female adult outpatient age 18 or older at the time of consent.
2. Subject has chronic persistent pain 1 year after TKA without history of new injury, infection, or implant failure.
3. Subject has VAS \> or = 40 mm at screen and baseline visits.
4. Subject has an understanding, ability and willingness to fully comply with study procedures and restrictions.
5. Subject has the ability to provide written, personally signed and dated informed consent to participate in the study, in accordance with the International Conference on Harmonisation (ICH) Good Clinical Practice (GCP) Guideline E6 and applicable regulations, before completing any study-related procedures.

Exclusion Criteria:

1. Subjects unable to complete assessments due to language or cognitive impairment
2. Subjects with a history of bipolar disorder or psychosis as confirmed by the Mini International Neuropsychiatric Interview (MINI).
3. Subject currently has (or had a history within the last 6 months of) a drug dependence or substance abuse disorder according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision (DSM-IV-TR) criteria (excluding nicotine).
4. Subjects who are currently considered a suicide risk, any subject who has previously made a suicide attempt or who has a prior history of or are currently demonstrating active suicidal ideation.
5. Subject has any clinically significant ECG or clinically significant laboratory abnormality (including a positive urine drug screen) at Screening.
6. Subject has a concurrent chronic or acute illness, disability, or other condition that might confound the results of safety assessments administered in the study or that might increase risk to the subject. Similarly, the subject will be excluded if he or she has any additional condition(s) that in the Investigator's opinion would prohibit the subject from completing the study or would not be in the best interest of the subject. This would include any significant illness or unstable medical condition that could lead to difficulty complying with the protocol.
7. Subjects who do not agree to use adequate and reliable contraception throughout the study.
8. Subject previously completed, discontinued or was withdrawn from this study.
9. Subject has taken an investigational drug or taken part in a clinical trial within 30 days prior to Screening.
10. Subjects treated with antidepressant medication within 4 weeks of screening visit (6 weeks for fluoxetine).
11. Subjects with known sensitivity to milnacipran.
12. Subjects with liver disease or reduced liver function
13. Subjects with obstructive uropathies
14. Subjects who consume alcohol in amounts viewed by the Investigator to be contraindicated
15. Subjects taking monoamine oxidase inhibitors
16. Subjects with uncontrolled narrow angle glaucoma
17. Subjects who are pregnant, may become pregnant, or who are nursing
18. Subjects with seizure disorders
19. Subjects with bleeding disorders or use of other medications that may cause bleeding.

Primary outcomes:
measure: Change in Pain Visual Analogue Scale(VAS).
timeFrame: baseline and endpoint 12 weeks
Secondary outcomes:
measure: Change in Knee Society Score (KSS).
timeFrame: between baseline and endpoint (12 weeks or early termination)
measure: Global Rating of Change
timeFrame: Endpoint (12 weeks or early termination)
measure: Change in Total Score of Multidimensional Fatigue Inventory (MFI-20)
timeFrame: Baseline to endpoint (12 weeks or early termination)
measure: Change in the Beck Depression Inventory (BDI-II)
timeFrame: Baseline to endpoint (12 weeks or early termination)
measure: Change in the Montgomery Asberg Depression Rating Scale
timeFrame: Between baseline and endpoint (12 weeks or early termination)
measure: Change in Total Score of State Trait Anxiety Inventory (STAI)
timeFrame: baseline and endpoint (12 weeks or early termination)
measure: Change in Total Score of Short Form-36 (SF-36), Measuring Perceived Quality of Life
timeFrame: baseline and endpoint (12 weeks or early termination)
Other outcomes:
Locations:
city: Durham
country: United States
facility: Duke University Medical Center
state: North Carolina
Study officials:
affiliation: Duke University
name: Davi M Marks, MD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Marks DM, Bolognesi MP. Open-label milnacipran for patients with persistent knee pain 1 year or longer after total knee arthroplasty: a pilot study. Prim Care Companion CNS Disord. 2013;15(4):PCC.12m01496. doi: 10.4088/PCC.12m01496. Epub 2013 Jul 11.