Study of the Analgesic Efficacy and Safety of Subcutaneous Tanezumab in Subjects With Osteoarthritis of the Hip or Knee.

Phase 3

Completed

Conditions: Osteoarthritis, Hip
Osteoarthritis, Knee

Interventions: Drug: Tanezumab
Drug: Placebo

Registration Number: NCT02709486

Lead Sponsor: Pfizer

Brief Summary: Tanezumab is a monoclonal antibody that binds to and inhibits the actions of nerve growth factor (NGF). The Nerve Growth Factor Inhibitor (NGFI) class may offer an important breakthrough in the treatment of chronic pain and is under clinical investigation for the treatment of pain associated with osteoarthritis or other chronic pain conditions.

The primary objective of this study is to demonstrate superior efficacy of tanezumab 5 mg and 2.5 mg administered subcutaneously (SC) every 8 weeks versus placebo at Week 24 in subjects with osteoarthritis of the knee or hip. The 2.5 mg dose was shown to provide efficacy benefits with a favorable safety profile when administered intravenously in previous Phase 3 clinical trials. The 5 mg dose is expected to provide added efficacy benefit over the 2.5 mg dose based on data from previous studies.

Detailed Description: This is a randomized, double blind, placebo controlled, parallel group multicenter Phase 3 study of the efficacy and safety of tanezumab when administered by SC injection for 24 weeks compared to placebo in subjects with osteoarthritis of the knee or hip. A total of approximately 810 subjects will be randomized to 1 of 3 treatment groups in a 1:1:1 ratio (ie, 270/group). The randomization will be stratified by index joint (hip or knee), and most severe Kellgren-Lawrence grade (of any knee or hip joint) at study entry (grade 2, 3 or 4). Subjects will receive up to three SC doses of one of the following treatments at an 8-week interval between each injection:

1. tanezumab 2.5 mg;

2. tanezumab 5 mg;

3. Placebo to match tanezumab. The study is designed with a total (post-randomization) duration of 48 weeks and will consist of three periods: Screening (up to 37 days), Double-blind Treatment (24 weeks) and Safety Follow-up (24 weeks). The Screening Period (beginning up to 37 days prior to Randomization) includes a Washout Period (lasting a minimum of 2 days for all prohibited pain medications), if required, and an Initial Pain Assessment Period (the 7 days prior to Randomization/Baseline).

Week 24 is the landmark analysis in this study. Subjects who do not complete the Double-blind Treatment period will enter and complete the 24-week Early-termination follow-up period.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 849

Inclusion Criteria

A diagnosis of osteoarthritis of the index hip or knee based on American College of Rheumatology criteria with Kellgren Lawrence x-ray Grade of at least 2 as diagnosed by the Central Reader
A history of insufficient pain relief from acetaminophen along with a history of insufficient pain relief from, inability to tolerate or contraindication to taking NSAIDs, and tramadol or opioid treatments.
WOMAC Pain subscale score of at least 5 in the index hip or knee at Screening.
Be willing to discontinue all non study pain medications for osteoarthritis and not use prohibited pain medications throughout the duration of the study.
Female subjects of childbearing potential must agree to comply with protocol specified contraceptive requirements.

Exclusion Criteria

Subjects exceeding protocol defined BMI or body weight limits.
History of other diseases specified in the protocol (e.g. inflammatory joint diseases, crystalline diseases such as gout or pseudogout) that may involve the index joint and that could interfere with efficacy assessments.
Radiographic evidence of protocol specified bone or joint conditions in any screening radiograph as determined by the central radiology reviewer.
A history of osteonecrosis or osteoporotic fracture.
History of significant trauma or surgery to a knee, hip or shoulder within the previous year.
Planned surgical procedure during the duration of the study.
Presence of conditions (e.g. fibromyalgia, radiculopathy) associated with moderate to severe pain that may confound assessments or self evaluation of osteoarthritis pain.
Signs or symptoms of carpal tunnel syndrome in the year prior to Screening.
Considered unfit for surgery based upon American Society of Anesthesiologists physical classification system for surgery grading, or subjects who would not be willing to undergo joint replacement surgery if required.
History of intolerance or hypersensitivity to acetaminophen or any of its excipients or existence of a medical condition or use of concomitant medication for which the use of acetaminophen is contraindicated.
Use of prohibited medications without the appropriate washout period prior to Screening or Initial Pain Assessment Period.
History of cancer within 5 years of Screening, except for cutaneous basal cell or squamous cell cancer resolved by excision.
Subjects with signs and symptoms of clinically significant cardiac disease as described in the protocol.
Diagnosis of a transient ischemic attack in the 6 months prior to Screening, diagnosis of stroke with residual deficits that would preclude completion of required study activities.
History, diagnosis, or signs and symptoms of clinically significant neurological disease such as but not limited to peripheral or autonomic neuropathy.
History, diagnosis, signs or symptoms of any clinically significant psychiatric disorder.
History of known alcohol, analgesic or drug abuse within 2 years of Screening.
Previous exposure to exogenous NGF or to an anti-NGF antibody.
History of allergic or anaphylactic reaction to a therapeutic or diagnostic monoclonal antibody or IgG fusion protein.
Poorly controlled hypertension as defined in the protocol or taking an antihypertensive that has not been stable for at least 1 month prior to Screening.
Evidence of protocol defined orthostatic hypotension at Screening.
Disqualifying score on the Survey of Autonomic Symptoms questionnaire at Screening.
Screening AST, ALT, serum creatinine or HbA1c values that exceed protocol defined limits.
Presence of drugs of abuse in screening urine toxicology panel.
Positive hepatitis B, hepatitis C or HIV test results indicative of current infection.
Participation in other investigational drug studies within protocol defined time limits.
Pregnant, breastfeeding or female subjects of childbearing potential who are unwilling or unable to follow protocol required contraceptive requirements.
Other severe acute or chronic medical or psychiatric condition or laboratory abnormality that in the judgment of the investigator, would make the subject inappropriate for entry into this study.

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
High dose	Tanezumab	Investigational product
Placebo	Placebo	Investigational product
Low dose	Tanezumab	Investigational product

Primary Outcome Measures

Name	Time	Method
Change From Baseline in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain Subscale at Week 24	Baseline, Week 24	WOMAC: Self-administered, disease-specific questionnaire which assesses clinically important, participant-relevant symptoms for pain, stiffness and physical function in participants with osteoarthritis (OA). The WOMAC pain subscale is a 5-item questionnaire used to assess the amount of pain experienced due to OA of index joint (knee or hip) during past 48 hours. It was calculated as the mean of scores from 5 individual questions scored on a numerical rating scale (NRS). Scores for each question and WOMAC Pain subscale score on NRS ranged from 0 (no pain) to 10 (extreme pain), where higher scores indicated higher pain.
Change From Baseline in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Physical Function Subscale at Week 24	Baseline, Week 24	WOMAC: Self-administered, disease-specific questionnaire which assesses clinically important, participant-relevant symptoms for pain, stiffness and physical function in participants with OA. Physical function refers to participant's ability to move around and perform usual activities of daily living. The WOMAC physical function subscale is a 17-item questionnaire used to assess the degree of difficulty experienced due to OA in index joint (knee or hip) during past 48 hours. It was calculated as mean of the scores from 17 individual questions scored on a NRS. Scores for each question and WOMAC physical function subscale score on NRS ranged from 0 (no difficulty) to 10 (extreme difficulty), where higher scores indicated extreme difficulty/worse physical function.
Change From Baseline in the Patient's Global Assessment (PGA) of Osteoarthritis at Week 24	Baseline, Week 24	PGA of OA was assessed by asking a question from participants: "Considering all the ways your osteoarthritis in your knee or hip (index joint) affects you, how are you doing today?" Participants responded on a scale ranging from 1-5, where 1=very good (no symptom and no limitation of normal activities), 2= good (mild symptoms and no limitation of normal activities), 3= fair (moderate symptoms and limitation of some normal activities), 4= poor (severe symptoms and inability to carry out most normal activities), and 5= very poor (very severe symptoms and inability to carry out all normal activities). Higher scores indicated worsening of condition.

Secondary Outcome Measures

Name	Time	Method
Change From Baseline in Patient's Global Assessment (PGA) of Osteoarthritis at Weeks 2, 4, 8, 12 and 16	Baseline, Weeks 2, 4, 8, 12 and 16	PGA of OA was assessed by asking a question from participants: "Considering all the ways your osteoarthritis in your knee or hip (index joint) affects you, how are you doing today?" Participants responded on a scale ranging from 1-5, where 1=very good (no symptom and no limitation of normal activities), 2= good (mild symptoms and no limitation of normal activities), 3= fair (moderate symptoms and limitation of some normal activities), 4= poor (severe symptoms and inability to carry out most normal activities), and 5 = very poor (very severe symptoms and inability to carry out all normal activities).
Percentage of Participants Meeting Outcomes Measures in Arthritis Clinical Trials-Osteoarthritis Research Society International (OMERACT-OARSI) Responder Index	Weeks 2, 4, 8, 12, 16, 24 and 32	Participants were considered as OMERACT-OARSI responders: if the change (improvement) from baseline to week of interest was greater than or equal to (\>=) 50 percent and \>= 2 units in either WOMAC pain subscale or physical function subscale score; if change (improvement) from baseline to week of interest was \>=20 percent and \>=1 unit in at least 2 of the following: 1) WOMAC pain subscale score, 2) WOMAC physical function subscale score, 3) PGA of osteoarthritis. WOMAC pain subscale assess amount of pain experienced (score: 0 \[no pain\] to 10 \[extreme pain\], higher score = more pain), WOMAC physical function subscale assess degree of difficulty experienced (score: 0 \[minimum difficulty\] to 10 \[extreme difficulty\], higher score = worse physical function) and PGA of OA (score: 1 \[very good\] to 5 \[very poor\], higher score = worse condition). Missing data was imputed using mixed baseline/last observation carried forward (BOCF/LOCF).
Change From Baseline in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Average Score at Week 32	Baseline, Week 32	WOMAC: self-administered, disease-specific questionnaire which assesses clinically important, participant-relevant symptoms for pain, stiffness and physical function in participants with OA of index joint (knee or hip). WOMAC pain subscale assess amount of pain experienced (score: 0 \[no pain\] to 10 \[extreme pain\], higher score = more pain), WOMAC physical function subscale assess degree of difficulty experienced (score: 0 \[no difficulty\] to 10 \[extreme difficulty\], higher score = worse physical function) and WOMAC stiffness subscale assess the amount of stiffness experienced (score: 0 \[no stiffness\] to 10 \[extreme stiffness\], higher score = higher stiffness). WOMAC average score was the mean of WOMAC pain, physical function and stiffness subscale scores and ranges from 0 to 10, where higher scores indicated worse response.
Change From Baseline in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain Subscale at Weeks 2, 4, 8, 12 and 16	Baseline, Weeks 2, 4, 8, 12 and 16	WOMAC: Self-administered, disease-specific questionnaire which assesses clinically important, participant-relevant symptoms for pain, stiffness and physical function in participants with OA. The WOMAC pain subscale is a 5-item questionnaire used to assess the amount of pain experienced due to osteoarthritis of index joint (knee or hip) during past 48 hours. It was calculated as the mean of scores from 5 individual questions scored on a numerical rating scale (NRS). Scores for each question and WOMAC Pain subscale score on NRS ranged from 0 (no pain) to 10 (extreme pain), where higher scores indicated higher pain.
Change From Baseline in Patient's Global Assessment (PGA) of Osteoarthritis at Week 32	Baseline, Week 32	PGA of OA was assessed by asking a question from participants: "Considering all the ways your osteoarthritis in your knee or hip (index joint) affects you, how are you doing today?" Participants responded on a scale ranging from 1-5, where 1=very good (no symptom and no limitation of normal activities), 2= good (mild symptoms and no limitation of normal activities), 3= fair (moderate symptoms and limitation of some normal activities), 4= poor (severe symptoms and inability to carry out most normal activities), and 5 = very poor (very severe symptoms and inability to carry out all normal activities). Higher scores indicated worse condition.
Percentage of Participants With Cumulative Percent Change From Baseline in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain Subscale at Weeks 16 and 24	Baseline, Weeks 16 and 24	WOMAC: Self-administered, disease-specific questionnaire which assesses clinically important, participant-relevant symptoms for pain, stiffness and physical function in participants with OA. The WOMAC pain subscale is a 5-item questionnaire used to assess the amount of pain experienced due to OA of index joint during past 48 hours. It was calculated as the mean of scores from 5 individual questions scored on a NRS. Scores for each question and WOMAC Pain subscale score on NRS ranged from 0 (no pain) to 10 (extreme pain), where higher scores indicated higher pain. Percentage of participants with cumulative reduction (as percent) (greater than 0% ; \>= 10, 20, 30, 40, 50, 60, 70, 80 and 90%; = 100 %) in WOMAC pain subscale from Baseline to Weeks 16 and 24 were reported, participants (%) are reported more than once in categories specified. Missing data was imputed using mixed BOCF/LOCF.
Percentage of Participants Achieving Improvement of >=2 Points in Patient's Global Assessment (PGA) of Osteoarthritis	Weeks 2, 4, 8, 12, 16, 24 and 32	PGA of OA was assessed by asking a question from participants: "Considering all the ways your osteoarthritis in your knee or hip affects you, how are you doing today?" Participants responded on a scale ranging from 1-5, where, 1=very good (no symptom and no limitation of normal activities), 2= good (mild symptoms and no limitation of normal activities), 3= fair (moderate symptoms and limitation of some normal activities), 4= poor (severe symptoms and inability to carry out most normal activities), and 5 = very poor (very severe symptoms and inability to carry out all normal activities). Higher scores indicated worse condition. Percentage of participants with improvement of at least 2 points from Baseline in PGA of OA were reported. Missing data was imputed using mixed BOCF/LOCF.
Change From Baseline in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Stiffness Subscale at Week 32	Baseline, Week 32	WOMAC: self-administered, disease-specific questionnaire which assesses clinically important, participant-relevant symptoms for pain, stiffness and physical function in participants with OA. Stiffness was defined as a sensation of decreased ease of movement in the index joint (knee or hip). The WOMAC stiffness subscale is a 2-item questionnaire used to assess the amount of stiffness experienced due to OA in the index joint (knee or hip) during the past 48 hours. It was calculated as the mean of scores from 2 individual questions scored on a NRS. Scores for each question and WOMAC stiffness subscale score on NRS ranged from 0 (no stiffness) to 10 (extreme stiffness), where higher scores indicated higher stiffness.
Change From Baseline in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain Subscale at Week 32	Baseline, Week 32	WOMAC: Self-administered, disease-specific questionnaire which assesses clinically important, participant-relevant symptoms for pain, stiffness and physical function in participants with OA. The WOMAC pain subscale is a 5-item questionnaire used to assess the amount of pain experienced due to osteoarthritis of index joint (knee or hip) during past 48 hours. It was calculated as the mean of scores from 5 individual questions scored on a numerical rating scale (NRS). Scores for each question and WOMAC Pain subscale score on NRS ranged from 0 (no pain) to 10 (extreme pain), where higher scores indicated higher pain.
Change From Baseline in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Physical Function Subscale at Week 32	Baseline, Week 32	WOMAC: Self-administered, disease-specific questionnaire which assesses clinically important, participant-relevant symptoms for pain, stiffness and physical function in participants with OA. Physical function refers to participant's ability to move around and perform usual activities of daily living. The WOMAC physical function subscale is a 17-item questionnaire used to assess the degree of difficulty experienced due to OA in index joint (knee or hip) during past 48 hours. It was calculated as mean of the scores from 17 individual questions scored on a NRS. Scores for each question and WOMAC physical function subscale score on NRS ranged from 0 (no difficulty) to 10 (extreme difficulty), where higher scores indicated extreme difficulty/worse physical function.
Health Care Resource Utilization (HCRU): Number of Visits of Services Directly Related to Osteoarthritis	Baseline, Weeks 32 and 48	Osteoarthritis HCRU assessed healthcare usage during last 3 months (for Baseline and Week 48) and past 8 weeks (for Week 32). Visits of services directly related to osteoarthritis evaluated were: visits to primary care physician, neurologist, rheumatologist, physician assistant or nurse practitioner, pain specialist, orthopedist, physical therapist, chiropractor, alternative medicine or therapy, podiatrist, nutritionist/dietitian, radiologist, home healthcare services and other practitioner.
Percentage of Participants With Adjudicated Joint Safety Outcomes	Baseline up to Week 48	Incidence of participants with any of the joint safety adjudication outcomes of primary osteonecrosis, rapidly progressive OA (type 1 and type 2), subchondral insufficiency fracture (or SPONK), or pathological fracture.
Change From Baseline in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Physical Function Subscale at Weeks 2, 4, 8, 12 and 16	Baseline, Weeks 2, 4, 8, 12 and 16	WOMAC: Self-administered, disease-specific questionnaire which assesses clinically important, participant-relevant symptoms for pain, stiffness and physical function in participants with OA. Physical function refers to participant's ability to move around and perform usual activities of daily living. The WOMAC physical function subscale is a 17-item questionnaire used to assess the degree of difficulty experienced due to OA in index joint (knee or hip) during past 48 hours. It was calculated as mean of the scores from 17 individual questions scored on a NRS. Scores for each question and WOMAC physical function subscale score on NRS ranged from 0 (no difficulty) to 10 (extreme difficulty), where higher scores indicated extreme difficulty/worse physical function.
Percentage of Participants Achieving Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Physical Function Subscale Reduction >=30%, >=50%, >=70% and >=90% Response	Weeks 2, 4, 8, 12, 16, 24 and 32	Percentage of participants with reduction in WOMAC physical function of at least (\>=)30%,50%,70% and 90% at weeks 2,4,8,12,16,24 and 32 compared to baseline were classified as responders to WOMAC physical function subscale. WOMAC: Self-administered, disease-specific questionnaire which assesses clinically important, participant-relevant symptoms for pain, stiffness and physical function in participants with OA. Physical function:Participant's ability to move around and perform usual activities of daily living. WOMAC physical function subscale17-item questionnaire used to assess the degree of difficulty experienced due to OA in index joint (knee/hip) during past 48 hours, calculated as mean of the scores from 17 individual questions scored on a NRS. Scores for each question and WOMAC physical subscale on NRS ranged from 0 (no difficulty) to 10 (extreme difficulty), where higher scores indicated extreme difficulty/worse physical function. Missing data was imputed using mixed BOCF/LOCF.
Change From Baseline in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Average Score at Weeks 2, 4, 8, 12, 16 and 24	Baseline, Weeks 2, 4, 8, 12, 16 and 24	WOMAC: self-administered, disease-specific questionnaire which assesses clinically important, participant-relevant symptoms for pain, stiffness and physical function in participants with OA of index joint (knee or hip). WOMAC pain subscale assess amount of pain experienced (score: 0 \[no pain\] to 10 \[extreme pain\], higher score = more pain), WOMAC physical function subscale assess degree of difficulty experienced (score: 0 \[no difficulty\] to 10 \[extreme difficulty\], higher score = worse physical function) and WOMAC stiffness subscale assess the amount of stiffness experienced (score: 0 \[no stiffness\] to 10 \[extreme stiffness\], higher score = higher stiffness). WOMAC average score was the mean of WOMAC pain, physical function and stiffness subscale scores and ranges from 0 to 10, where higher scores indicated worse response.
Work Productivity and Activity Impairment Questionnaire for Osteoarthritis (WPAI:OA) Scores at Baseline	Baseline	WPAI is 6-question participant rated questionnaire to determine the impact of OA on absenteeism, presenteeism, work productivity, and daily activity impairment for a period of 7 days prior to a visit. It yields 4 sub-scores: work time missed (absenteeism), impairment while working (presenteeism), overall work impairment (work productivity) and activity impairment (daily activity impairment). These sub-scores are expressed as an impairment percentage (range from 0 to 100), with higher numbers indicating greater impairment and less productivity.
Number of Days of Rescue Medication Used at Week 32	Week 32	In case of inadequate pain relief, after Week 24, acetaminophen/paracetamol up to 4000 mg per day up to 7 days in a week could be taken as rescue medication and use was reported weekly via diary. Number of days per week the participants used the rescue medication during the 4 weeks up to and including the particular study week were summarized.
Percentage of Participants Achieving Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain Subscale Reduction >=30 Percent (%), >=50%, >=70% and >=90% Response	Week 2, 4, 8, 12, 16, 24 and 32	Percentage of participants with reduction in WOMAC pain intensity of at least (\>=) 30%, 50%, 70% and 90% at Weeks 2, 4, 8, 12, 16, 24 and 32 compared to baseline were classified as responders to WOMAC pain subscale and are reported here. WOMAC: Self-administered, disease-specific questionnaire which assesses clinically important, participant-relevant symptoms for pain, stiffness and physical function in participants with OA. The WOMAC pain subscale is a 5-item questionnaire used to assess the amount of pain experienced due to OA of index joint (knee or hip) during past 48 hours. It was calculated as the mean of scores from 5 individual questions scored on a NRS. Scores for each question and WOMAC Pain subscale score on NRS ranged from 0 (no pain) to 10 (extreme pain), where higher scores indicated higher pain. Missing data was imputed using mixed BOCF/LOCF.
Percentage of Participants With Cumulative Percent Change From Baseline Reduction in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Physical Function Subscale at Weeks 16 and 24	Baseline, Weeks 16 and 24	Percentage of participants with cumulative reduction (as percent) (greater than 0 %; \>= 10 %, 20 %, 30 %, 40 %, 50 %, 60 %, 70 %, 80 % and 90%; =100 %) in WOMAC physical function subscale from Baseline to Weeks 16 and 24 were reported. WOMAC:Self-administered, disease-specific questionnaire which assesses clinically important, participant-relevant symptoms for pain, stiffness and physical function in participants with OA. Physical function: participant's ability to move around and perform usual activities of daily living. WOMAC physical function subscale:17-item questionnaire to assess the degree of difficulty experienced due to OA in index joint (knee or hip) during past 48 hours, calculated as mean of the scores from 17 individual questions scored on a NRS. Scores for each question and WOMAC Pain subscale on NRS ranged from 0 (no difficulty) to 10 (extreme difficulty), higher scores indicate extreme difficulty/worse physical function. Missing data was imputed using mixed BOCF/LOCF.
Change From Baseline for Average Pain Score in the Index Joint at Weeks 1, 2, 3, 4, 6, 8, 10, 12, 16, 20 and 24	Baseline, Weeks 1, 2, 3, 4, 6, 8, 10, 12, 16, 20 and 24	Participants assessed their average pain in the index hip/knee in the past 24 hours using a scale ranging from 0 (no pain) to 10 (worst possible pain). Higher scores indicated higher pain. Data represents averages of the values reported during the 8-week interval up to and including the given week. Change from baseline was calculated using the difference between each post-baseline weekly mean and the baseline mean score.
Change From Baseline for Average Pain Score in the Index Joint at Weeks 28 and 32	Baseline, Weeks 28 and 32	Participants assessed their average pain in the index hip/knee in the past 24 hours using a scale ranging from 0 (no pain) to 10 (worst possible pain). Higher scores indicated higher pain. Data represents averages of the values reported during the 8-week interval up to and including the given week. Change from baseline was calculated using the difference between each post-baseline weekly mean and the baseline mean score.
Change From Baseline in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Stiffness Subscale at Weeks 2, 4, 8, 12, 16 and 24	Baseline, Weeks 2, 4, 8, 12, 16 and 24	WOMAC: self-administered, disease-specific questionnaire which assesses clinically important, participant-relevant symptoms for pain, stiffness and physical function in participants with OA. Stiffness was defined as a sensation of decreased ease of movement in the index joint (knee or hip). The WOMAC stiffness subscale is a 2-item questionnaire used to assess the amount of stiffness experienced due to OA in the index joint (knee or hip) during the past 48 hours. It was calculated as the mean of scores from 2 individual questions scored on NRS. Scores for each question and WOMAC stiffness subscale score on NRS ranged from 0 (no stiffness) to 10 (extreme stiffness), where higher scores indicated higher stiffness.
Change From Baseline in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain Subscale Item (Pain When Going Up or Downstairs) at Weeks 2, 4, 8, 12, 16 and 24	Baseline, Weeks 2, 4, 8, 12, 16 and 24	WOMAC: self-administered, disease-specific questionnaire which assesses clinically important, participant-relevant symptoms for pain, stiffness and physical function in participants with OA in index joint (knee or hip). Participants answered a question: "How much pain have you had when going up or down the stairs?" Participants responded about the amount of pain they experienced when going up or down stairs by using a NRS of 0 (no pain) to 10 (extreme pain), where higher scores indicated higher pain.
Change From Baseline in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain Subscale Item (Pain When Going Up or Downstairs) at Week 32	Baseline, Week 32	WOMAC: self-administered, disease-specific questionnaire which assesses clinically important, participant-relevant symptoms for pain, stiffness and physical function in participants with OA in index joint (knee or hip). Participants answered a question: "How much pain have you had when going up or down the stairs?" Participants responded about the amount of pain they experienced when going up or down stairs by using a NRS of 0 (no pain) to 10 (extreme pain), where higher scores indicated higher pain.
Patient Reported Treatment Impact Assessment-Modified (mPRTI) Score at Weeks 16 and 24: Participant Reported Treatment Impact Assessment-Overall, How Satisfied Are You With The Drug That You Received in This Study?	Weeks 16 and 24	The mPRTI is a self-administered questionnaire containing participant reported treatment impact assessment (to assess participant satisfaction), participant global preference assessment (to assess previous treatment and preference to continue using the investigational product) and participant willingness to use drug again assessment. For participant satisfaction, participants responded using interactive response technology (IRT) on a 5 point likert scale from 1-5, where 1=extremely dissatisfied, 2=dissatisfied, 3=neither satisfied nor dissatisfied, 4=satisfied and 5=extremely satisfied. Higher scores indicated greater satisfaction.
Change From Baseline in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain Subscale Item (Pain When Walking on a Flat Surface) at Weeks 2, 4, 8, 12, 16 and 24	Baseline, Weeks 2, 4, 8, 12, 16 and 24	WOMAC: self-administered, disease-specific questionnaire which assesses clinically important, participant-relevant symptoms for pain, stiffness and physical function in participants with OA in index joint (knee or hip). Participants answered a question: "How much pain have you had when walking on a flat surface?". Participants responded about the amount of pain they experienced when walking on a flat surface by using a NRS of 0 (no pain) to 10 (extreme pain), where higher scores indicated higher pain.
Change From Baseline in Work Productivity and Activity Impairment Questionnaire for Osteoarthritis (WPAI:OA) Impairment Scores at Weeks 8, 16 and 24	Baseline, Weeks 8, 16 and 24	WPAI is 6-question participant rated questionnaire to determine the impact of OA on absenteeism, presenteeism, work productivity, and daily activity impairment for a period of 7 days prior to a visit. It yields 4 sub-scores: work time missed (absenteeism), impairment while working (presenteeism), overall work impairment (work productivity) and activity impairment (daily activity impairment). These sub-scores are expressed as an impairment percentage (range from 0 to 100), with higher numbers indicating greater impairment and less productivity.
European Quality of Life- 5 Dimension-5 Levels (EQ-5D-5L) Overall Health Utility Score/ Index Value	Baseline, Weeks 8, 16 and 24	EQ-5D-5L: standardized participant completed questionnaire that measures health-related quality of life and translates that score into an index value or utility score. EQ-5D-5L consists of two components: a health state profile and an optional VAS. EQ-5D health state profile comprises of 5 dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each dimension has 5 levels: 1=no problems, 2=slight problems, 3=moderate problems, 4=severe problems, and 5=extreme problems. Responses from the five domains were used to calculate a single utility index (the Overall health utility score) where values are less than equal to (\<=) 1. The Overall health utility score for a participant with no problems in all 5 items is 1 for all countries (except for Zimbabwe where it is 0.9), and is reduced where a participant reports greater levels of problems across the five dimensions.
Patient Reported Treatment Impact Assessment-Modified (mPRTI) Score at Weeks 16 and 24: Participant Global Preference Assessment- What is The Current or Most Recent Treatment You Were Receiving For Osteoarthritis Pain Before Enrolling?	Weeks 16 and 24	The mPRTI is a self-administered questionnaire containing participant reported treatment impact assessment (to assess participant satisfaction), participant global preference assessment (to assess previous treatment and preference to continue using the investigational product) and participant willingness to use drug again assessment. To assess previous treatment, participants responded for, 1=injectable prescription medicines, 2=prescription medicines taken by mouth, 3=surgery, 4=prescription medicines and surgery and 5=no treatment.
Patient Reported Treatment Impact Assessment-Modified (mPRTI) Score at Weeks 16 and 24: Participant Global Preference Assessment- Overall, do You Prefer The Drug That You Received in This Study to Previous Treatment?	Weeks 16 and 24	The mPRTI is a self-administered questionnaire containing participant reported treatment impact assessment (to assess participant satisfaction), participant global preference assessment (to assess previous treatment and preference to continue using the investigational product) and participant willingness to use drug again assessment. To assess preference to continue using the investigational product, participants responded using interactive response technology (IRT) on a 5 point likert scale from 1-5, where, 1= yes, I definitely prefer the drug that I am receiving now, 2= I have a slight preference for the drug that I am receiving now, 3= I have no preference either way, 4= I have a slight preference for my previous treatment, 5= No, I definitely prefer my previous treatment. Higher scores indicate lesser preference to use the investigational product.
Health Care Resource Utilization (HCRU): Number of Nights Stayed in the Hospital Due to Osteoarthritis	Baseline, Weeks 32 and 48	Osteoarthritis HCRU assessed healthcare usage during last 3 months (for Baseline and Week 48) and past 8 weeks (for Week 32). Domain evaluated was number of nights stayed in the hospital due to OA.
Health Care Resource Utilization (HCRU): Number of Participants Who Used Any Aids/Devices for Doing Things	Baseline, Weeks 32 and 48	Osteoarthritis HCRU assessed healthcare usage during last 3 months (for Baseline and Week 48) and past 8 weeks (for Week 32). Domain evaluated was number of participants who used any aids/devices for doing things. Aids such as walking aid, wheelchair, device or utensil for dress/bathe/eat and any other aids/devices.
Health Care Resource Utilization (HCRU): Number of Participants Who Quit Job Due to Osteoarthritis	Baseline, Weeks 32 and 48	Osteoarthritis HCRU assessed healthcare usage (during 3 months prior to baseline) at baseline, Week 32 and Week 48. Domain evaluated was number of participants who quit job due to OA.
Number of Participants Who Took Rescue Medication During Week 32	Week 32	In case of inadequate pain relief, after Week 24, acetaminophen/paracetamol up to 4000 mg per day up to 5 days in a week could be taken as rescue medication and use was reported weekly via diary. Number of participants with any use of rescue medication during the 4 weeks up to and including the particular study week were summarized.
Change From Baseline in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain Subscale Item (Pain When Walking on a Flat Surface) at Week 32	Baseline, Week 32	WOMAC: self-administered, disease-specific questionnaire which assesses clinically important, participant-relevant symptoms for pain, stiffness and physical function in participants with OA in index joint (knee or hip). Participants answered a question: "How much pain have you had when walking on a flat surface?". Participants responded about the amount of pain they experienced when walking on a flat surface by using a NRS of 0 (no pain) to 10 (extreme pain), where higher scores indicated higher pain.
Patient Reported Treatment Impact Assessment-Modified (mPRTI) Score at Weeks 16 and 24: Participant Willingness to Use Drug Again Assessment- Willing to Use The Same Drug That You Have Received in This Study For Your Osteoarthritis Pain?	Weeks 16 and 24	The mPRTI is a self-administered questionnaire containing participant reported treatment impact assessment (to assess participant satisfaction), participant global preference assessment (to assess previous treatment and preference to continue using the investigational product) and participant willingness to use drug again assessment. To assess Patient willingness to use drug again, participants responded using interactive response technology (IRT) on a 5 point likert scale from 1-5, where, 1= yes, I would definitely want to use the same drug again, 2= I might want to use the same drug again, 3= I am not sure, 4= I might not want to use the same drug again, 5= no, I definitely would not want to use the same drug again. Higher scores indicate lesser willingness to use the investigational product.
Number of Participants Who Withdrew Due to Lack of Efficacy	Baseline up to Week 24	Number of participants who withdrew from treatment due to lack of efficacy have been reported here.
Number of Participants Who Took Rescue Medication During Weeks 2, 4, 8, 12, 16 and 24	Weeks 2, 4, 8, 12, 16 and 24	In case of inadequate pain relief, acetaminophen/paracetamol up to 4000 mg per day up to 5 days in a week could be taken as rescue medication between day 1 and week 24. Number of participants with any use of rescue medication during the particular study week were summarized.
Number of Participants With Laboratory Test Abnormalities With Regard to Abnormal Baseline	Baseline up to Week 48	Primary Abnormality criteria: hemoglobin; hematocrit; RBC count \< 0.8\LLN; Ery. mean corpuscular volume/ hemoglobin/ HGB concentration, erythrocytes distribution width \<0.9\LLN, \>1.1\ULN; platelets \<0.5\LLN,\>1.75\upper limit of normal (ULN); white blood cell count\<0.6\LLN, \>1.5\ULN; Lymphocytes, Leukocytes, Neutrophils \<0.8\LLN, \>1.2\ULN; Basophils, Eosinophils, Monocytes \>1.2\ULN; total bilirubin\>1.5\ULN; aspartate aminotransferase, alanine aminotransferase, gamma GT,LDH, alkaline phosphatase \>3.0\ULN; total protein; albumin\<0.8\LLN, \>1.2\ULN; blood urea nitrogen, creatinine, Cholesterol, triglycerides \>1.3\ULN; Urate \>1.2\ULN; sodium \<0.95\LLN,\>1.05\ULN; potassium, chloride, calcium, magnesium, bicarbonate \<0.9\LLN, \>1.1\ULN; phosphate \<0.8\LLN, \>1.2\ULN; glucose \<0.6\LLN, \>1.5\ULN; Hemoglobin A1C \>1.3\ULN; creatine kinase \>2.0\ULN; Nitrite \>=1.
European Quality of Life- 5 Dimension-5 Levels (EQ-5D-5L) Dimensions Score	Baseline, Weeks 8, 16 and 24	EQ-5D-5L is a standardized participant completed questionnaire that measures health-related quality of life and translates that score into an index value or utility score. EQ-5D-5L consists of two components: a health state profile and an optional visual analogue scale (VAS). EQ-5D health state profile is comprised of 5 dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each dimension has 5 levels: 1=no problems, 2=slight problems, 3=moderate problems, 4=severe problems, and 5=extreme problems. The health utility score for a participant with no problems in all 5 items is 1 for all countries (except for Zimbabwe where it is 0.9), and is reduced where a participant reports greater levels of problems across the five dimensions.
Time to Discontinuation Due to Lack of Efficacy	Baseline up to Week 24	Time to discontinuation due to lack of efficacy was defined as the time interval from the date of first study drug administration up to the date of discontinuation of participant from treatment due to lack of efficacy.
Number of Days of Rescue Medication Used at Weeks 2, 4, 8, 12, 16 and 24	Weeks 2, 4, 8, 12, 16 and 24	In case of inadequate pain relief during the treatment period, acetaminophen/paracetamol up to 4000 mg per day up to 5 days in a week a could be taken as rescue medication. Number of days the participants used the rescue medication during the particular study weeks were summarized.
Amount of Rescue Medication Used at Weeks 2, 4, 8, 12, 16 and 24	Weeks 2, 4, 8, 12, 16 and 24	In case of inadequate pain relief, acetaminophen/paracetamol up to 4000 mg per day up to 5 days in a week could be taken as rescue medication. The total dosage of acetaminophen in milligrams used during the specified week were summarized.
Number of Participants With Treatment-Emergent Treatment-Related Adverse Events (AEs) and Serious Adverse Events (SAEs) up to End of Study	Baseline up to Week 48	Treatment-related AE was any untoward medical occurrence attributed to study drug in a participant who received study drug. SAE was an AE resulting in any of the following outcomes or deemed significant for any other reason: death; initial or prolonged inpatient hospitalization; life-threatening experience (immediate risk of dying); persistent or significant disability/incapacity; congenital anomaly. Treatment-emergent were events between first dose of study drug and up to week 48 that were absent before treatment or that worsened relative to pre-treatment state. Relatedness to study drug was assessed by the investigator.
Change From Baseline in Blood Pressure (BP) at Weeks 2, 4, 8, 12, 16, 24, 32 and 48	Baseline, Weeks 2, 4, 8, 12, 16, 24, 32 and 48	Measurement of BP included sitting systolic blood pressure (SBP) and diastolic blood pressure (DBP).
Change From Baseline in Electrocardiogram (ECG) Parameters at Weeks 24 and 48	Baseline, Weeks 24 and 48	A 12-lead ECG was recorded after participants had rested for at least 5 minutes in the supine position in a quiet environment. All standard intervals (PR, QRS, QT, QTcF, QTcB, QTcF, RR intervals) were collected.
Number of Participants With Confirmed Orthostatic Hypotension	Baseline, Weeks 2, 4, 8, 12, 16, 24, 32 and 48	Orthostatic hypotension was defined as postural change (supine to standing) that met the following criteria: For systolic BP \<=150 mmHg (mean supine): Reduction in systolic BP\>=20 mmHg or reduction in diastolic BP\>=10 mmHg at the 1 and/or 3 minute standing BP measurements. For systolic BP \>150 mmHg (mean supine): Reduction in systolic BP\>=30 mmHg or reduction in diastolic BP\>=15 mmHg at the 1 and/or 3 minute standing BP measurements. If the 1 minute or 3 minute standing BP in a sequence met the orthostatic hypotension criteria, then that sequence was considered positive. If 2 of 2 or 2 of 3 sequences were positive, then orthostatic hypotension was considered confirmed.
Number of Participants With Anti Tanezumab Antibodies	Baseline, Weeks 8,16, 24, 32 and 48	Human serum ADA samples were analyzed for the presence or absence of anti-tanezumab antibodies by using a semi quantitative enzyme linked immunosorbent assay (ELISA). Participants listed as having anti-tanezumab antibodies had ADA titer level \>=3.32. Less than 3.32 was considered below the limit of quantitation.
Health Care Resource Utilization (HCRU): Number of Participants Who Visited the Emergency Room Due to Osteoarthritis	Baseline, Weeks 32 and 48	Osteoarthritis HCRU assessed healthcare usage during last 3 months (for Baseline and Week 48) and past 8 weeks (for Week 32). Domain evaluated was number of participants who visited the emergency room due to osteoarthritis.
Health Care Resource Utilization (HCRU): Number of Visits to the Emergency Room Due to Osteoarthritis	Baseline, Weeks 32 and 48	Osteoarthritis HCRU assessed healthcare usage during last 3 months (for Baseline and Week 48) and past 8 weeks (for Week 32). Domain evaluated was number of visits to the emergency room due to OA.
Health Care Resource Utilization (HCRU): Number of Participants Hospitalized Due to Osteoarthritis	Baseline, Weeks 32 and 48	Osteoarthritis HCRU assessed healthcare usage during last 3 months (for Baseline and Week 48) and past 8 weeks (for Week 32). Domain evaluated was number of participants who were hospitalized due to OA.
Health Care Resource Utilization (HCRU): Duration Since Quitting Job Due to Osteoarthritis	Baseline, Weeks 32 and 48	Osteoarthritis HCRU assessed healthcare usage (during 3 months prior to baseline) at baseline, Week 32 and Week 48. Domain evaluated was duration since quitting job due to OA.
Number of Participants With Laboratory Test Abnormalities With Regard to Normal Baseline	Baseline up to Week 48	Primary Abnormality criteria: HGB, hematocrit, RBC count \<0.8\* lower limit of normal(LLN); Ery. mean corpuscular volume/hemoglobin/ HGB concentration, RBCs distribution width \<0.9\LLN, \>1.1\upper limit of normal(ULN); platelets \<0.5\LLN,\>1.75\ULN; WBC count\<0.6\LLN, \>1.5\ULN; Lymphocytes,Leukocytes,Neutrophils \<0.8\LLN, \>1.2\ULN; Basophils,Eosinophils,Monocytes\>1.2\ULN; Prothrombin time/Intl. normalized ratio\>1.1\ULN; total bilirubin\>1.5\ULN; aspartate aminotransferase,alanine aminotransferase,gamma GT,LDH,alkaline phosphatase \>3.0\ULN; total protein; albumin\<0.8\LLN, \>1.2\ULN; blood urea nitrogen,creatinine,Cholesterol,triglycerides \>1.3\ULN; Urate\>1.2\ULN; sodium\<0.95\LLN,\>1.05\ULN; potassium,chloride,calcium,magnesium,bicarbonate \<0.9\LLN, \>1.1\ULN; phosphate\<0.8\LLN, \>1.2\ULN; glucose\<0.6\LLN, \>1.5\ULN; HGB A1C \>1.3\ULN; creatine kinase\>2.0\ULN, specific gravity\<1.003, \>1.030; pH\<4.5, \>8; Urine Glucose, protein,HGB,bilirubin \>=1; Ketones\>=1;Urine erythrocytes,Leukocytes\>=20.
Change From Baseline in Heart Rate (as Assessed by ECG) at Weeks 24 and 48	Baseline, Weeks 24 and 48	Heart rate was measured at sitting position.
Percentage of Participants With Total Joint Replacements	Baseline up to Week 48	Percentage of participants who underwent at least one total knee, hip or shoulder joint replacement surgery.
Change From Baseline in Neuropathy Impairment Score (NIS) at Weeks 2, 4, 8, 12, 16, 24, 32 and 48	Baseline, Weeks 2, 4, 8, 12, 16, 24, 32 and 48	NIS is a standardized instrument used to evaluate participant for signs of peripheral neuropathy. NIS is the sum of scores of 37 items, from both the left and right side, where 24 items scored from 0 (normal) to 4 (paralysis), higher score indicated higher abnormality/impairment and 13 items scored from 0 (normal), 1 (decreased) and 2 (absent), higher score indicated higher impairment. NIS possible overall score ranged from 0 (no impairment) to 244 (maximum impairment), higher scores indicated increased impairment.
Number of Participants With Treatment-Emergent Adverse Events (AEs) and Serious Adverse Events (SAEs) up to End of Study	Baseline up to Week 48	An AE was any untoward medical occurrence in a participant who received study drug without regard to possibility of causal relationship. SAE was an AE resulting in any of the following outcomes or deemed significant for any other reason: death; initial or prolonged inpatient hospitalization; life-threatening experience (immediate risk of dying); persistent or significant disability/incapacity; congenital anomaly. Treatment-emergent were events between first dose of study drug and up to week 48 that were absent before treatment or that worsened relative to pretreatment state. AEs included both serious and non-serious AEs.
Change From Baseline in Heart Rate at Weeks 2, 4, 8, 12, 16, 24, 32 and 48	Baseline, Weeks 2, 4, 8, 12,16, 24, 32 and 48	Heart rate was measured at sitting position.
Change From Baseline in Survey of Autonomic Symptom (SAS) Scores at Week 24	Baseline, Week 24	The SAS is a 12 item (11 for females) questionnaire, from which the total number of symptoms (0-12 for males and 0-11 for females) is calculated. Each positive symptom is rated from 1 (not at all) to 5 (a lot). The total impact score was the sum of all symptom rating scores, with 0 assigned where the participant did not have the particular symptom. The range for the total impact score is 0-60 for males and 0-55 for females, higher scores indicating higher impact.

Trial Locations

Locations (146): CHR Orleans La Source
🇫🇷
Orleans, France
Rheumazentrum Prof. Dr. med Gunther Neeck
🇩🇪
Bad Doberan, Germany
Hospital La Esperanza
🇪🇸
A Coruña, Spain
Corporacio Sanitaria Parc Tauli de Sabadell
🇪🇸
Sabadell, Barcelona, Spain
Corporació Sanitaria Parc Taulí de Sabadell
🇪🇸
Sabadell, Barcelona, Spain
Hospital CIMA Sanitas
🇪🇸
Barcelona, Spain
Hopital Saint-Antoine
🇫🇷
Paris cedex 12, France
Rheumapraxis
🇩🇪
Aachen, Germany
Kerckhoff Klinik GmbH
🇩🇪
Bad Nauheim, Germany
Hopital Lariboisiere
🇫🇷
Paris cedex 10, France
Farmacia AOUC Settore Sperimentazione Farmaci
🇮🇹
Firenze, FI, Italy
AZ OSPEDALIERO - UNIVERSITARIA CAREGGI-SOD Reumatologia - Dip. Medicina Sperimentale e Clinica
🇮🇹
Firenze, Italy
U.O.C. Farmacia - Gestione medicinali per la sperimentazione clinica
🇮🇹
Siena, Italy
Avdelningen for kliniska provningar, S-huset
🇸🇪
Orebro, Sweden
Hospital Universitario La Princesa
🇪🇸
Madrid, Spain
Charite Universitaetsmedizin Berlin
🇩🇪
Berlin, Germany
Hospital Universitario La Paz
🇪🇸
Madrid, Spain
Dipartimento Immagini Radiologia
🇮🇹
Novara, Italy
Hospital Universitario Marqués de Valdecilla
🇪🇸
Santander, Cantabria, Spain
Hospital del Mar
🇪🇸
Barcelona, Spain
Centrul Medical SANA S.R.L.
🇷🇴
Bucuresti, Sector 1, Romania
MUDr. Viliam Cibik, PhD, s.r.o.
🇸🇰
Pruske, Slovakia
Hospital Universitario de Getafe
🇪🇸
Getafe, Madrid, Spain
Hospital Regional Universitario de Malaga. Farmacia del Hospital Civil
🇪🇸
Malaga, Spain
Instituto de Ciencias Medicas
🇪🇸
Alicante, Spain
Spitalul Clinic Judetean de Urgenta Sibiu
🇷🇴
Sibiu, Romania
Clinical Trials, Bradford on Avon Health Centre
🇬🇧
Bradford on Avon, United Kingdom
Instituto de Ciencias Médicas
🇪🇸
Alicante, Spain
Karolinska Trial Alliance, KTA.
🇸🇪
Stockholm, Sweden
St George's University Hospitals NHS Foundation Trust
🇬🇧
London, United Kingdom
Hospital General Universitario de Guadalajara
🇪🇸
Guadalajara, Spain
Hospital Universitario La Paz Servicio de Farmacia
🇪🇸
Madrid, Spain
Hospital Regional Universitario de Malaga
🇪🇸
Malaga, Spain
Hospital Universitario La Princesa Farmacia - Ensayos Clinicos
🇪🇸
Madrid, Spain
Nuffield Department of Orthopaedics
🇬🇧
Oxford, United Kingdom
Diagnostic Consultative Center XIV- Sofia EOOD
🇧🇬
Sofia, Bulgaria
UMHAT Sveti Ivan Rilski - EAD
🇧🇬
Sofia, Bulgaria
Unite Clinique Therapeutique des Maladies Osteoarticulaires
🇫🇷
Montpellier Cedex 5, France
Obudai Egeszsegugyi Centrum Kft
🇭🇺
Budapest, Hungary
AOU Maggiore della Carita di Novara - S.C. Medicina Fisica e Riabilitativa
🇮🇹
Novara, Italy
Sato Orthopedic Clinic
🇯🇵
Ichikawa, Chiba, Japan
Kobe Konan Yamate clinic
🇯🇵
Kobe, Hyogo, Japan
Medical Corporation Association Sankikai, Yokohama Shinmidori General Hospital
🇯🇵
Yokohama, Kanagawa, Japan
Kompan, s.r.o
🇸🇰
Dolny Kubín, Slovakia
Complejo Hospital Universitario A Coruna (CHUAC)
🇪🇸
A Coruna, Spain
Hospital Universitario Reina Sofia.
🇪🇸
Cordoba, Spain
Hospital Universitario Reina Sofia
🇪🇸
Cordoba, Spain
Hospital Infanta Luisa
🇪🇸
Sevilla, Spain
PharmaSite
🇸🇪
Malmo, Sweden
ProbarE i Lund AB
🇸🇪
Lund, Sweden
Oxford University Hospitals NHS Foundation Trust
🇬🇧
Headington, Oxford, United Kingdom
Ladulaas Kliniska Studier
🇸🇪
Boras, Sweden
CTC (Clinical Trial Center), Sahlgrenska University Hospital
🇸🇪
Gothenburg, Sweden
ProbarE
🇸🇪
Stockholm, Sweden
Karolinska Trial Alliance, Fas 1
🇸🇪
Stockholm, Sweden
Istituto Clinico Humanitas Unita Operativa di Medicina Generale e Reumatologia -
🇮🇹
Rozzano, Milan, Italy
Azienda Ospedaliera-Universitaria S.Orsola-Malpighi
🇮🇹
Bologna, Italy
Farmacia Clinica Puggioli
🇮🇹
Bologna, Italy
Dipartmento di diagnostica per immagini
🇮🇹
Firenze, Italy
Farmacia Ospedaliera
🇮🇹
Novara, Italy
Azienda Ospedaliero-Universitaria E Policlinico Umberto I
🇮🇹
Rome, Italy
Azienda Ospedaliera Universitaria Senese - UOC Reumatologia,
🇮🇹
Siena, Italy
Ospedale Civile Maggiore Borgo Trento
🇮🇹
Verona, Italy
Hôpital Cochin
🇫🇷
Paris cedex 14, France
Hopital Cochin
🇫🇷
Paris cedex 14, France
Hôpital Edouard Herriot
🇫🇷
Lyon, France
Health Centre, Bradford on Avon & Melksham Health Partnership
🇬🇧
Bradford on Avon, United Kingdom
DCC St. Pantaleimon OOD
🇧🇬
Pleven, Bulgaria
Medical Center BLAGOEVGRAD 2009, EOOD
🇧🇬
Blagoevgrad, Bulgaria
Clinexpert Egeszsegugyi Szolgaltato es Kereskedelmi Kft.
🇭🇺
Budapest, Hungary
Nuhr Medical Center
🇦🇹
Senftenberg, Austria
"Medical Center Teodora" EOOD
🇧🇬
Ruse, Bulgaria
Multiprofile Hospital for Active Treatment-Silistra AD
🇧🇬
Silistra, Bulgaria
Rheuma Zentrum Favoriten
🇦🇹
Wien, Austria
Medical Center " Health for all" EOOD
🇧🇬
Plovdiv, Bulgaria
"Medical Center- Smolyan" OOD
🇧🇬
Smolyan, Bulgaria
Multiprofile hospital for active treatment - "Lyulin" EAD
🇧🇬
Sofia, Bulgaria
Medical Center-Avicena EOOD
🇧🇬
Sofia, Bulgaria
UMHAT "Prof. Dr. Stoyan Kirkovich" AD
🇧🇬
Stara Zagora, Bulgaria
Dextra Oy/Pihlajalinna Ite Kuopio
🇫🇮
Kuopio, Finland
Obase Hospital
🇯🇵
Miyako-gun, Fukuoka, Japan
Qualiclinic Kft.
🇭🇺
Budapest, Hungary
UMHAT Kaspela
🇧🇬
Plovdiv, Bulgaria
Jutrix Kft
🇭🇺
Kecskemét, Hungary
Kamagaya General Hospital
🇯🇵
Kamagaya, Chiba, Japan
NMTH 'Tsar Boris III". Clinic of Internal Diseases
🇧🇬
Sofia, Bulgaria
"Medical Center - Dr. Hayvazov" EOOD
🇧🇬
Sofia, Bulgaria
Oulu Deaconess Institute
🇫🇮
Oulu, Finland
Tolna Megyei Balassa Janos Korhaz, Ortopediai osztaly
🇭🇺
Szekszard, Hungary
UMHAT "Sofiamed" OOD, Block 2
🇧🇬
Sofia, Bulgaria
Praxis Dr. Kronung
🇩🇪
Offenbach, Hesse, Germany
Multiprofile Hospital for active treatment "SVETA PETKA" AD
🇧🇬
Vidin, Bulgaria
Bekes Megyei Központi Korhaz Dr Rethy Pal Tagkorhaz, Reumatologia Szakrendeles
🇭🇺
Bekescsaba, Hungary
Shinkokura Hospital
🇯🇵
Kitakyushu, Fukuoka, Japan
Fukuoka Mirai Hospital
🇯🇵
Higashi-ku,Fukuoka, Fukuoka, Japan
Takagi Hospital
🇯🇵
Okawa, Fukuoka, Japan
Himeno Hospital
🇯🇵
Yamegun, Fukuoka, Japan
Takahashi Orthopedics Clinic
🇯🇵
Chitose, Hokkaido, Japan
Hakodate Ohmura Orthopedic Hospital
🇯🇵
Hakodate, Hokkaido, Japan
Obihiro Orthopaedic Hospital
🇯🇵
Obihiro, Hokkaido, Japan
Marunouchi Hospital
🇯🇵
Matsumoto, Nagano, Japan
Ohimachi Orthopaedic Clinic
🇯🇵
Shinagawa-ku, Tokyo, Japan
Hakodate Central General Hospital
🇯🇵
Hakodate, Hokkaido, Japan
National Hospital Organization Nagasaki Medical Center
🇯🇵
Omura, Nagasaki, Japan
Hamamatsu Medical Center
🇯🇵
Hamamatsu, Shizuoka, Japan
Nagayoshi General Hospital
🇯🇵
Osaka, Japan
REUMATIKA - Centrum Reumatologii NZOZ
🇵🇱
Warszawa, Poland
AB-BA ambulancia s.r.o.
🇸🇰
Bratislava, Slovakia
ALGMED s.r.o.
🇸🇰
Kosice, Slovakia
Okubo Hospital
🇯🇵
Akashi, Hyogo, Japan
Kobe Kaisei Hospital
🇯🇵
Kobe, Hyogo, Japan
Akita City Hospital
🇯🇵
Akita, Japan
National Hospital Organization Sagamihara National Hospital
🇯🇵
Sagamihara, Kanagawa, Japan
Sobajima Clinic/Orthopedics
🇯🇵
Higashiosaka, Osaka, Japan
Malopolskie Centrum Medyczne S.C
🇵🇱
Krakow, Poland
Hospital Egas Moniz
🇵🇹
Lisboa, Portugal
Spitalul Clinic Judetean de Urgenta Sf. Apostol Andrei Constanta
🇷🇴
Constanta, Romania
Kitasato University Kitasato Institute Hospital
🇯🇵
Minato-ku, Tokyo, Japan
Hospital Conde de Bertiandos
🇵🇹
Ponte De Lima, Viana DO Castelo, Portugal
National Hospital Organization Osaka Minami Medical Center
🇯🇵
Kawachinagano, Osaka, Japan
National Hospital Organization Utsunomiya national Hospital
🇯🇵
Utsunomiya, Tochigi, Japan
Sonodakai Joint Replacement Center Hospital
🇯🇵
Adachi-ku, Tokyo, Japan
Jujo Takeda Rehabilitation Hospital
🇯🇵
Kyoto, Japan
Kyushu Central Hospital
🇯🇵
Fukuoka, Japan
ClinicMed Daniluk, Nowak Społka Jawna
🇵🇱
Bialystok, Poland
Centrum Medyczne Pratia Gdynia
🇵🇱
Gdynia, Poland
Centro Hospitalar Lisboa Ocidental, E.P.E., Hospital Egas Moniz
🇵🇹
Lisboa, Portugal
Spitalul Judetean de Urgenta Bacau
🇷🇴
Bacau, Romania
Spitalul Clinic "Sf. Maria"
🇷🇴
Bucuresti, Romania
Hiroshima Clinic
🇯🇵
Hiroshima, Japan
NZOZ OSTEO-MEDIC s.c. A. Racewicz, J. Supronik
🇵🇱
Bialystok, Poland
Centrum Terapii Wspolczesnej J.M Jasnorzewska
🇵🇱
Lodz, Poland
Centrum Kliniczno - Badawcze J. Brzezicki, B. Gornikiewicz - Brzezicka Lekarze Spolka Partnerska
🇵🇱
Elblag, Poland
Centrum Medyczne Pratia Krakow
🇵🇱
Krakow, Poland
MTZ Clinical Research Sp. z o.o.
🇵🇱
Warszawa, Poland
SC Duo Medical SRL
🇷🇴
Bucuresti, Sector 1, Romania
The Alverton Practice
🇬🇧
Penzance, Cornwall, United Kingdom
ROMJAN s.r.o.
🇸🇰
Bratislava, Slovakia
Reumex s.r.o
🇸🇰
Rimavska Sobota, Slovakia
Medipa s.r.o.
🇸🇰
Piestany, Slovakia
Brannel Surgery
🇬🇧
St. Austell, Cornwall, United Kingdom
Reum. hapi s.r.o.
🇸🇰
Nove Mesto nad Vahom, Slovakia
Knowle House Surgery
🇬🇧
Plymouth, Devon, United Kingdom
Western General Hospital
🇬🇧
Edinburgh, Midlothian, United Kingdom
CIRI GmbH
🇩🇪
Frankfurt am Main, Germany
Northumbria Healthcare NHS Foundation Trust
🇬🇧
North Shields, United Kingdom