Pivotal Study to Evaluate Efficacy and Safety of SP5M002 Inj. as Compared to Synovian Inj. in Patients With Mild to Moderate Knee Osteoarthritis

Phase 3

Active, not recruiting

• Conditions: Osteoarthritis
• Interventions: Device: Synovian inj; Device: SP5M002 inj

• Registration Number: NCT06399042
• Lead Sponsor: Shin Poong Pharmaceutical Co. Ltd.

Brief Summary

This is a randomized, double-blind, multicenter, Active Controlled, pivotal clinical trial to assess the efficacy and safety of the novel hexamethylenediamine (HMDA) cross-linked hyaluronate intra-articular injection (SP5M002) compared with an active comparator, the 1,4-butanediol diglycidyl ether (BDDE) cross-linked hyaluronate (Synovian) in patients with knee osteoarthritis.

Detailed Description

Not available

Study Timeline

• Study Start: 2023-06-14
• Status Verified: 2024-04
• Study First Submitted: 2024-04-30
• Study First Submitted QC: 2024-04-30
• Last Update Submitted: 2024-04-30
• Study First Posted: 2024-05-03
• Last Update Posted: 2024-05-03
• Primary Completion: 2024-06
• Study Completion: 2024-09

Recruitment & Eligibility

• Status: ACTIVE_NOT_RECRUITING
• Sex: All
• Target Recruitment: 297

Inclusion Criteria

1. Adult males and females aged 40 years or older as of the date of written consent

2. Subject with knee osteoarthritis whose X-ray test results within 6 months from the screening or at the screening visit correspond to grades I - III of the Kellgren & Lawrence scale

3. Subject diagnosed with unilateral or bilateral knee osteoarthritis according to the clinical diagnostic criteria of the American College of Rheumatology (ACR) at screening who have knee joint pain and meet three or more of the following conditions

   • Over 50 years of age

     • Less than 30 minutes of morning stiffness ③ Crepitus on active motion ④ Bony tenderness ⑤ Bony enlargement ⑥ No palpable warmth of synovium

4. Weight bearing pain (WBP) of at least one of both knee joints on 100 mm-VAS ≥ 40 mm when measured at screening and baseline [However, if both sides have symptoms, the knee joint with the higher WBP becomes the joint for evaluation, and the selected joint cannot be changed during the study period.]

5. Walk without relying on a walking aid such as a walker or cane (patients who have been using a walking aid every day since 6 months prior to the screening visit can use the walking aid, and must use the walking aid in the same way throughout the study period.)

6. Ability to fully understand and complete the safety and efficacy measurement questionnaire

7. Voluntary decision for participation and provision of written consent to comply with the precautions after hearing and fully understanding the detailed explanation of the purpose, method, and effects of this study

Exclusion Criteria

1. Body mass index (BMI) ≥ 35 kg/m2 at screening

2. Hip osteoarthritis or osteoarthritis of another joint that is severe enough to preclude evaluation of knee osteoarthritis at the time of screening

3. Having the following diseases that may affect the efficacy and safety evaluation but not being limited to the following

   • Septic arthritis, rheumatoid arthritis, gout, recurrent pseudogout arthritis, trauma that may damage joint cartilage, congenital abnormalities, calcium deposition disease, diabetes, ochronosis, hemochromatosis, acromegaly, Wilson's disease, primary osteochondrosis, genetic diseases (e.g., hyperkinesis), secondary osteoarthritis caused by collagen gene abnormalities, etc.
   • Sudek's atrophy or severe painful diseases such as Paget's disease

4. Infection or skin disease in the joint area that is unsuitable for injection at the time of screening

5. Active or suspected knee joint infection at the time of screening

6. Complete loss of the Patello-femoral joint space

7. Received the following treatments within 14 days of the screening visit (except those who have passed a 14-day wash-out) or scheduled to be administered during the study period

   • Taking medicines containing ingredients such as glucosamine, chondroitin sulfate, and diacerhein
   • Taking herbal medicines and herbal medicines for osteoarthritis
   • Taking anti-inflammatory painkillers, non-steroidal anti-inflammatory drugs (NSAIDs, prescription/non-prescription drugs), etc. (administration of acetaminophen allowed if passing a 3 day wash-out)
   • Taking oral steroids
   • Hospital physical therapy or oriental medicine treatment (cupping, acupuncture, moxibustion, etc.)

8. Intra-articular injection, such as intra-articular corticosteroid, at the injection site within 6 months from the time of screening

9. Systemic use of steroids within 3 months from the time of screening (including inhalants, however, topical application is permitted only on the upper body)

10. Surgical operations such as knee joint replacement, including arthroscopic surgery, at the administration site within 6 months from the time of screening; or expecting surgery within 6 months

11. Moderate or severe joint effusion by Patella tap test at the screening visit

12. History of hypersensitivity to ingredients of the IP or active control drug

13. Antiplatelet agents (excluding aspirin of 300 mg/day or less), heparin, oral anticoagulants (coumarin anticoagulants, thrombin inhibitors, Factor Xa inhibitors, etc.), and thrombolytics must be used during the study

14. Clinically significant abnormalities in liver function (3 times or more than the upper limit of normal for ALT/AST) or abnormalities in renal function (3 times or more than the upper limit of normal for serum creatinine), or severe liver or renal disease at the discretion of the investigator which is judged to have an impact on the effectiveness and safety evaluation of the study

15. The following clinically significant diseases in the past or present

    • Diagnosis of malignancy within 5 years prior to screening or currently
    • Cardiac disorders (myocardial infarction, coronary artery bypass surgery, arrhythmia, and other serious Cardiac disorders, etc.)
    • Uncontrolled hypertension (systolic blood pressure greater than 160 mmHg or diastolic blood pressure greater than 100 mmHg)
    • Severe endocrine diseases (diabetes insipidus, Cushing's disease, etc.) which is judged to have an impact on the efficacy and safety evaluation of the study

16. Currently pregnant or lactating; or planning to become pregnant/lactating during this study

17. Women of childbearing age who have not undergone sterilization surgery, women less than 1 year after menopause, or men who do not agree to avoid pregnancy or use appropriate contraceptive methods during the study period

18. Planned to participate in another study during the study period or having administered (applied) other investigational product (investigational device) within 3 months prior to the screening visit

19. Difficult to conduct the study as judged by the investigator due to other reasons

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Synovian inj	Synovian inj	Synovian inj 3 ml pre-filled syringe into Knee joint cavity of osteoarthritis patients
SP5M002 inj	SP5M002 inj	SP5M002 inj 3 ml pre-filled syringe into Knee joint cavity of osteoarthritis patients

Primary Outcome Measures

Name	Time	Method
Change in [Weight-Bearing Pain (WBP)-100mm-visual analogue scale (VAS)] at Week 12 from baseline (visit 2)	12 weeks	\* Weight Bearing Pain (WBP) - 100mm-visual analogue scale (VAS)
Change in [Weight-Bearing Pain (WBP)-100mm-visual analogue scale (VAS)] at Week 6 from baseline (visit 2)	6 weeks	\* Weight Bearing Pain (WBP) - 100mm-visual analogue scale (VAS)

Secondary Outcome Measures

Name	Time	Method
Changes in the following at each visit: Weight Bearing pain (WBP) (Weeks 2, 24, and 36) from baseline (Visit 2)	week 2, 24, 36	Outcome Measurement of Weight Bearing pain(WBP): 100mm-visual analogue scale (VAS)
Changes in the following at each visit: Rest pain (RP) (Weeks 2, 6, 12, 24, and 36) from baseline (Visit 2)	week 2,6,12, 24, 36	Outcome Measurement of Rest pain (RP): 100mm-visual analogue scale (VAS)
Changes in the following at each visit: Night pain (NP) (Weeks 2, 6, 12, 24, and 36) from baseline (Visit 2)	week 2,6,12, 24, 36	Outcome Measurement of Night pain (NP): 100mm-visual analogue scale (VAS)
Changes in the following at each visit: Motion pain (MP) (Weeks 2, 6, 12, 24, and 36) from baseline (Visit 2)	week 2,6,12, 24, 36	Outcome Measurement of Motion pain (MP): 100mm-visual analogue scale (VAS)
Changes in the following at each visit: Investigator Global Assessment (IGA) (Weeks 2, 6, 12, 24, and 36) from baseline (Visit 2)	week 2,6,12, 24, 36	Outcome Measurement of Investigator Global Assessment (IGA) : 100mm-visual analogue scale (VAS)
Changes in the following at each visit: Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score and individual score evaluation (Pain, function, stiffness) (Weeks 2, 6, 12, 24, and 36) from baseline (Visit 2)	week 2,6,12, 24, 36	Outcome Measurement of Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score and individual score evaluation (Pain, function, stiffness) : WOMAC-Likert Assessment (5-point Likert scale)
Physical assessments at each post-administration visit: joint-line tenderness on pressure (Weeks 2, 6, 12, 24, and 36)	week 2,6,12, 24, 36	Outcome Measurement of joint-line tenderness on pressure : 4-point scale; \*4-point scale: 0(none)/1(mild)/2(moderate)/3(severe)
Post-administration response rate A. Proportion at which WBP decreases by at least 20 mm or improves by at least 40% from baseline at the time of evaluation (B section-Description)	week 2,6,12, 24, 36	\*B. Response rate of OMERACT-OARSI (Outcome Measures in Rheumatology-Osteoarthritis Research Society International) I. At least 50% improvement in WOMAC pain or function at the time of evaluation; or at least a 20 point improvement from baseline; or II. meeting 2 of the 3 conditions below; At least 20% improvement in WOMAC pain, at least a 10 point improvement from each baseline At least 20% improvement in WOMAC function, at least a 10 point improvement from each baseline At least 20% improvement in patient's global assessment (100 mm-VAS) and at least a 10 point improvement from each baseline
Changes in the following at each visit: Patient Global Assessment(PGA) (Weeks 2, 6, 12, 24, and 36) from baseline (Visit 2)	week 2,6,12, 24, 36	Outcome Measurement of Patient Global Assessment(PGA): 100mm-visual analogue scale (VAS)
Physical assessments at each post-administration visit: range of motion (Weeks 2, 6, 12, 24, and 36)	week 2,6,12, 24, 36	The angle was recorded as is for the range of motion.
Proportion (%) of participants who took rescue medication at each post-administration visit and dose of rescue medication (Weeks 2, 6, 12, 24, and 36)	week 2,6,12, 24, 36
Physical assessments at each post-administration visit: Swelling (Weeks 2, 6, 12, 24, and 36)	week 2,6,12, 24, 36	Outcome Measurement of Swelling : 4-point scale; \*4-point scale: 0(none)/1(mild)/2(moderate)/3(severe)

Trial Locations

Locations (16)

Kyung Hee University Hospital at Gangdong; 🇰🇷 Seoul, Korea, Republic of

The Catholic University of Korea, Seoul St. Mary's Hospital; 🇰🇷 Seoul, Korea, Republic of

Kyungpook National University Hospital; 🇰🇷 Daegu, Korea, Republic of

Kyunghee University Hospital; 🇰🇷 Seoul, Korea, Republic of

Yeungnam University Medical Center; 🇰🇷 Daegu, Korea, Republic of

Chungnam National University Hospital; 🇰🇷 Sejong, Korea, Republic of

Gangnam Severance Hospita; 🇰🇷 Seoul, Korea, Republic of

Gachon University Gil Medical Center; 🇰🇷 Incheon, Korea, Republic of

Seoul National University Boramae Medical Center; 🇰🇷 Seoul, Korea, Republic of

CHA University Bundang Medical Center; 🇰🇷 Seongnam, Korea, Republic of

Chonnam National University Bitgoeul Hospital; 🇰🇷 Gwangju, Korea, Republic of

Jeonbuk National University Hospital; 🇰🇷 Jeonju, Korea, Republic of

Gyeongsang National University Hospital; 🇰🇷 Jinju, Korea, Republic of

EWHA Womans University Mokdong Hospital; 🇰🇷 Seoul, Korea, Republic of

Samsung Medical Center; 🇰🇷 Seoul, Korea, Republic of

Seoul National University Hospital; 🇰🇷 Seoul, Korea, Republic of