Clinical trial NCT06367283: Metformin Treatment of Patients with Hand Osteoarthritis
Official title: Metformin Treatment of Patients with Hand Osteoarthritis: a Randomised, Placebo-controlled Trial
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: PHASE3
Conditions: Hand Osteoarthritis
Lead sponsor: Frederiksberg University Hospital
Sponsor class: OTHER
First posted: 2024-04-16
Enrollment: 150
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: To compare metformin (2 g daily), or maximum tolerated dose, for 16 weeks with placebo as a treatment of hand osteoarthritis symptoms.


Eligibility criteria: Inclusion Criteria:

1. Age ≥18 years
2. Hand OA according to the ACR criteria
3. Average finger (2 to 5) pain ≥4 on a 0-10 numeric rating scale (NRS where 10 is worst pain) over the past 30 days
4. Metformin naive

Exclusion Criteria:

Comorbidities

1. History of, or current signs of medical disease that may affect joints, e.g. rheumatoid arthritis, gout, psoriatic arthritis
2. Psoriasis
3. Known malignancy (except successfully treated squamous or basal cell skin carcinoma)
4. Drug or alcohol abuse in the last year
5. Existing nerve entrapment syndromes (e.g. carpal tunnel syndrome)
6. Known diabetes
7. Generalised pain syndromes such as fibromyalgia
8. Known peripheral neuropathies
9. Known allergies towards the interventions
10. Gastric bypass or other malabsorption syndrome
11. In case of pharmacological weight loss medication (e.g. glucagon like peptide-1 (GLP-1) analogues) or pharmacological osteoporosis medication, dosage must have been stable for 3 months without any plan of up-titration during the study period
12. Any other condition or impairment that, in the opinion of the investigator, makes a potential participant unsuitable for participation or obstructs participation e.g. psychiatric disorders.

    Surgical history
13. History of hand surgery in the target hand within 12 months prior to enrolment
14. History of arthroplasty, arthrodesis or surgical treatment of thumb base osteoarthritis in the target hand

    Management strategies
15. Use of systemic corticosteroids equivalent of ≥ 7.5 mg prednisolone daily within 3 months
16. Treatment with denosumab (Prolia/Xgeva)
17. Participation in experimental device or experimental drug study 3 months prior to enrolment
18. Intra-articular treatments of any kind of any joint of the target hand 3 months before inclusion
19. Current use of synthetic or non-synthetic opioids
20. Planning to start other treatment for hand OA in the study participation period
21. Planned CT scan with iodine contrast
22. Scheduled surgery on upper extremity of the target hand during study participation
23. Scheduled surgery requiring pause of metformin, e.g. surgery in general anaesthesia, during study participation

    Reproductive system
24. Pregnancy
25. Planned pregnancy within the study period, 3 months after end of study treatment for female fertile participant and 6 months after end of study treatment for male participant
26. Insufficient anti-conception therapy for female fertile participants within the study period and 3 months after end of study treatment

    * Sufficient anti-conception therapy consists of intra-uterine device (coil), hormonal anti-conception (birth control pills, implant, intra-uterine system, dermal patch, vaginal ring, or injections) or sexual abstinence
    * Female participants are considered infertile if they are postmenopausal or if they have undergone surgical sterilisation (bilateral salpingectomy, hysterectomy or bilateral oophorectomy)
    * Postmenopausal state is defined as no menses for 12 months without alternative medical cause before inclusion in the study
27. Insufficient anti-conception therapy for male participants within the study period and 6 months after end of study treatment

    * Sufficient anti-conception therapy consists of condom or sexual abstinence
    * Male participants are considered sterile if they have undergone surgical sterilisation (vasectomy)
28. Breast-feeding

    Blood analysis
29. Positive anti-cyclic citrullinated peptide (\>10 kU/L)
30. eGFR \<60 ml/min/1.73 m2
31. Vitamin B12 deficiency \< 200 pmol/L
32. Hba1c ≥ 48 mmol/mol

Primary outcomes:
measure: Finger pain
timeFrame: Week 16
Secondary outcomes:
measure: Function
timeFrame: Week 16
measure: Thumb base pain
timeFrame: Week 16
measure: Hand pain
timeFrame: Week 16
measure: Physician tender joint count
timeFrame: Week 16
measure: Patient global assessment
timeFrame: Week 16
measure: Quality of life assessed by the European Quality of life - 5 dimensions (EQ-5D) scale
timeFrame: Week 16
measure: Hand strength
timeFrame: Week 16
measure: Number of treatment responders
timeFrame: Week 16
Other outcomes:
measure: Stiffness of both hands
timeFrame: Week 16
measure: Composite of pain, function and stiffness
timeFrame: Week 16
measure: Physical function
timeFrame: Week 16
measure: Physician global assessment
timeFrame: Week 16
measure: Swollen joint count
timeFrame: Week 16
measure: Fatigue
timeFrame: Week 16
measure: Sleep quality
timeFrame: Week 16
measure: Absence or presence of inflammation of target hand
timeFrame: Week 16
measure: Change in use of analgesics
timeFrame: Week 16
measure: Inflammatory biomarker
timeFrame: Week 16
measure: Metabolic outcomes
timeFrame: Week 16
measure: Metabolic outcomes
timeFrame: Week 16
measure: Vitamin K
timeFrame: Week 16
measure: Proteomics
timeFrame: Week 16
Locations:
city: Copenhagen
country: Denmark
facility: The Parker Institute, Bispebjerg and Frederiksberg hospital
state: Frederiksberg
Study officials:
References: