A Randomised Placebo Controlled Trial. The Effect of Spironolactone on Pain in Older People With Osteoarthritis
试验速览
- 阶段
- 4 期
- 状态
- 已完成
- 入组人数
- 86
- 试验地点
- 2
- 主要终点
- Between group difference in change in WOMAC pain subscale (5 items)
研究概览
简要总结
This pilot study will obtain preliminary evidence on which to base sample size calculations for a future trial of whether spironolactone (an aldosterone blocker) reduces knee pain in older people with symptomatic OA knee when given in addition to usual analgesia. Aldosterone is known to be pro-inflammatory, and spironolactone suppresses cytokine production in chronic arthritis. This application builds on previous work by the applicants showing that spironolactone significantly improved quality of life (particularly pain) in frail older people. The investigators will recruit 86 people (aged 70 years or over) with well-defined OA knee to 25mg spironolactone daily or to matching placebo for 12 weeks. The primary outcome is the between group difference in change in WOMAC pain sub-score at 12 weeks. Secondary outcomes are the WOMAC stiffness and physical function subscales and health related quality of life (EQ-5D). Morning cortisol levels will be measured to assess the effect of mineralocorticoid receptor blockade on glucocorticoid levels, which may mediate the anti-inflammatory effect of spironolactone; and urinary CTX-II, and serum matrix metalloproteinase-3 (MMP-3) will be measured as biomarkers as both are sensitive to the effects of pharmacological interventions for osteoarthritis.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Triple (Participant, Investigator, Outcomes Assessor)
入排标准
- 年龄范围
- 70 Years 至 —（Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Participant is willing and able to give informed consent
- •Community dwelling
- •Aged 70 years and over
- •Symptomatic idiopathic OA knee according to American College of Rheumatology clinical and radiographic criteria (ie Knee pain - with or without crepitus and presence of osteophytes on x ray)
- •To avoid floor effects, participants will require to have moderate (or more severe) pain at screening in at least 2 out of 5 WOMAC pain score items
- •To have been in receipt (prescription or/and over the counter) of one or more analgesic agents at a therapeutic dose for at least 2 months
- •Willing to have knee x-ray if one has not been taken in preceding 12 months
排除标准
- •Clinical diagnosis of symptomatic heart failure
- •History of inflammatory arthritis
- •Already taking spironolactone
- •Previous intolerance to spironolactone
- •Known allergies to spironolactone or lactose
- •Objection to taking capsules made from animal sourced gelatine
- •Taking oral NSAIDs (because of the increased risk of renal impairment when combined with spironolactone)
- •Taking ACE inhibitors or ARBs (angiotensin II receptor antagonists). ARBs have many properties similar to those of ACE inhibitors. Both will be exclusion because of the increased risk of acute kidney injury and hyperkalaemia, and because our previous study also excluded those on ACE inhibitors (and ARBs) and treatment was safe and well tolerated.
- •Supine hypotension (supine systolic blood pressure <100mmHg at screening)
- •Significant chronic kidney disease (eGFR<40ml/min)
- •Serum sodium<130mmol/l
- •Serum potassium>5.0mmol/l
- •Symptomatic orthostatic hypotension (measured at screening)
- •Nursing home resident
- •Wheelchair bound
- •Participating in another clinical trial (other than observational trials and registries) concurrently or within 30 days prior to screening for entry into this study
- •Known contraindication to spironolactone therapy
- •Participant who is terminally ill, defined as less than 3 months expected survival
研究组 & 干预措施
spironolactone
25mg spironolactone daily
干预措施: spironolactone (Drug)
Placebo
Matched Placebo
干预措施: spironolactone (Drug)
结局指标
主要结局
Between group difference in change in WOMAC pain subscale (5 items)
时间窗: 12 weeks
次要结局
- Between group difference in change in WOMAC stiffness subscale.(12 weeks)