Trial Review

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Trial registered on ANZCTR


Registration number
ACTRN12616001104448
Ethics application status
Approved
Date submitted
3/08/2016
Date registered
16/08/2016
Date last updated
10/10/2017
Type of registration
Prospectively registered

Titles & IDs
Public title
Study of ZYN002 (transdermal gel) in Patients with Knee Pain due to Osteoarthritis
Scientific title
A Phase 2A, Randomized, Double-Blind, Placebo-Controlled, Multiple Center, Multiple-Dose Study to Assess the Efficacy and Safety of ZYN002 Administered as a Transdermal Gel to Patients with Knee Pain due to Osteoarthritis
Secondary ID [1] 289794 0
ZYN2-CL-005
Universal Trial Number (UTN)
Nil
Trial acronym
STOP 1
Linked study record

Health condition
Health condition(s) or problem(s) studied:
Osteoarthritis 299697 0
Condition category
Condition code
Musculoskeletal 299632 299632 0 0
Osteoarthritis

Intervention/exposure
Study type
Interventional
Description of intervention(s) / exposure
Participants will undergo a 1-week Washout Period to discontinue current anti-inflammatory agents (e.g., nonsteroidal anti-inflammatory drugs (NSAIDs)) and other analgesics (except acetaminophen) followed by a 1-week Baseline Period capturing daily pain ratings using a 0 to 10 numeric rating scale (NRS). After the washout and baseline periods, participants will receive one of three treatments as indicated below:
- Treatment A: ZYN002 – CBD 250 mg every 12 hours, or
- Treatment B: ZYN002 – CBD 125 mg every 12 hours, or
- Treatment C: placebo every 12 hours
for 12 weeks.

ZYN002 or placebo gel will be applied to the skin of both the right and left shoulder and/or upper arms.

Participants will bring used and unused sachets to each visit for site to check treatment compliance.
Intervention code [1] 295461 0
Treatment: Drugs
Comparator / control treatment
Placebo - matching gel with no active ingredient
Control group
Placebo

Outcomes
Primary outcome [1] 299097 0
To evaluate the efficacy of ZYN002 administered as a transdermal gel for 12 weeks as treatment for knee pain due to osteoarthritis (OA) of the knee.
Assessed by: change in weekly mean of the 24-hour average worst pain score, change in Western Ontario and McMaster Universities Index of Osteoarthritis (WOMAC) score, rescue pain medication usage,
Timepoint [1] 299097 0
Assessed at every study visit from Screening visit to End of study visit (baseline, Day 1, Weeks 4, 8 and 12).
Secondary outcome [1] 326124 0
To evaluate the safety of ZYN002 in osteoarthritis (OA) patients.
Assessed by: monitoring side effects, physical examinations, electrocardiogram and neurological exams.
Studies to date have demonstrated that ZYN002 is generally well tolerated with most common side effect is site application dryness. There have also been some reports of headache. Most side effects have been mild in nature and similar between placebo patients and those receiving ZYN002.
Timepoint [1] 326124 0
Safety will be assessed at every study visit from Screening visit to End of study visit (baseline, Day 1, Weeks 4, 8 and 12).
Secondary outcome [2] 326702 0
To evaluate the tolerability of ZYN002 in osteoarthritis (OA) patients.
Assessed by: skin assessment, blood and urine tests, measuring vital signs, completion of Columbia Suicidality Severity Rating Scale (C-SSRS) and presence of effusion in the knee.
Timepoint [2] 326702 0
Tolerability will be assessed at every study visit from Screening visit to End of study visit (baseline, Day 1, Weeks 4, 8 and 12).

Eligibility
Key inclusion criteria
- Eligible participants are those who are aged 40 to 75 years
- moderate to severe knee pain due to OA, are in general good health
- body mass index between 18-40 kg /m2
- able and willing to maintain daily pain and skin diaries, able to read, speak and understand English.
- Females of childbearing potential must have a negative serum pregnancy test and must agree to use an acceptable method of contraception. Males with a partner of childbearing potential must use an acceptable method of contraception.
Minimum age
40 Years
Maximum age
75 Years
Sex
Both males and females
Can healthy volunteers participate?
No
Key exclusion criteria
- participants who are allergic/hypersensitive to ZYN002 type products
- exposed to any investigational drug/device in the last 30 days
- used cannabis or any CBD or THC-containing products in last 4 weeks
- change in tobacco products in last 30 days
- used opioids more than half the days in the last month
- using any concomitant OA therapies, who have any diseases or conditions that are likely to require changes in drug therapy during the study or interfere with the objectives of the study; who are breastfeeding, who are at risk of suicide; who have Hepatitis or HIV; or who have a history of alcohol or drug abuse.
- Prohibited medications include: midazolam, oral ketoconazole, fluconazole, nefazadone, rifampin, alfentanil, alfuzosin, amiodarone, cyclosporine, dasatinib, docetaxol, eplerenone, ergotamine, everolimus, fentanyl, halofantrine, irinotecan, lapatinib, levomethadyl, lumefantrine, nilotinib, pimozide, quinidine, ranolazine, sirolimus, tacrolimus, temsirolimus, toremifene, tretinioin, vincristine, vinorelbine, St. John’s Wort, benzodiazepines, and any supplements with anti-inflammatory and/or analgesic properties.

Study design
Purpose of the study
Treatment
Allocation to intervention
Randomised controlled trial
Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
On Day 1, participants with knee pain due to OA of the knee will be randomized in a 1:1:1 ratio to receive either Treatment A ZYN002 – CBD 250 mg Q12 H, Treatment B ZYN002 - CBD 125 mg Q12 H or Treatment C placebo Q12 H for 12 weeks.
Once a participant qualifies to participate in the study, the respective site will receive the randomization number for the participant.
The un-blinded randomization schedule will be maintained within the interactive web response system (IWRS).
Methods used to generate the sequence in which subjects will be randomised (sequence generation)
A randomization schedule has been prepared by a statistician. The software application SAS was used to generate the randomization codes. A series unique code has been issued on a per protocol allocation ratio of 1:1:1.
Masking / blinding
Blinded (masking used)
Who is / are masked / blinded?
The people receiving the treatment/s
The people administering the treatment/s
The people assessing the outcomes
The people analysing the results/data
Intervention assignment
Parallel
Other design features
Phase
Phase 2
Type of endpoint/s
Efficacy
Statistical methods / analysis
Primary Efficacy Analysis
The primary efficacy analysis will be a mixed-model repeated measures (MMRM) model on the change from baseline (ChgPAIN). The model will include terms for treatment group, site, week and treatment-by-week interaction, and Baseline Period pain score a) PAIN(Baseline) and b) baseline-by-week interaction. The contrast at Week 12 comparing each active dose against placebo will be used to test the significance of treatment effect.
To assess the impact of missing data, an analysis of covariance (ANCOVA) will be conducted at Week 12 with PAIN(Baseline) as the covariate using last observation carried forward (LOCF), baseline observation carried forward (BOCF) and a modified BOCF (mBOCF) imputation strategies. In the mBOCF approach, a BOCF strategy will be used to impute missing data from dropouts due to lack of efficacy (LOE) or AE and an LOCF strategy will be used to impute missing data from dropouts due to other reasons.

Secondary Efficacy Analysis
The secondary analyses will include:
a) 30% and 50% responder rate: Logistic regression with factors for treatment and center will be used to compare the active treatment group to placebo at Weeks 4, 8, and 12.
b) Percent change from Baseline in weekly mean pain: %ChgPAIN. Descriptive statistics including number (N), mean, median, standard deviation (SD), minimum, and maximum will be presented by treatment group. Graphs of cumulative distribution functions for %ChgPAIN will be presented by treatment group.
c) Change from Baseline (ChgPAIN) in the weekly mean of the 24-hour average worst pain score at Weeks 4 and 8. Descriptive statistics including N, mean, median, SD, minimum, and maximum will be presented by treatment group.
d) Change from Baseline in the WOMAC Pain, Stiffness and Physical Function Subscales at Weeks 4, 8, and 12. ANCOVA will be used to compare each active treatment group to placebo at each time point (Week 4, Week 8, and Week 12) with factors for treatment and Baseline PAIN scores.
e) Percentage of patients using rescue pain medication weekly during the 12-week treatment period. Descriptive statistics will be presented by treatment group.
f) Physician assessment of presence of joint effusion. Descriptive statistics will be presented by treatment group

The sample size of 100 patients per treatment group is sufficient to have a power of 80% to detect a difference of 1.0 between the change from Baseline for active and placebo with a standard deviation (SD) of 2.5. To account for a possible screening failure rate of approximately 8%, a total of 320 patients should be enrolled to ensure there will be 300 patients to randomize.

Recruitment
Recruitment status
Completed
Date of first participant enrolment
Anticipated
22/08/2016
Actual
30/08/2016
Date of last participant enrolment
Anticipated
27/01/2017
Actual
24/03/2017
Date of last data collection
Anticipated
19/07/2017
Actual
28/07/2017
Sample size
Target
320
Accrual to date
Final
320
Recruitment in Australia
Recruitment state(s)
NSW,QLD,VIC
Recruitment hospital [1] 6311 0
Royal North Shore Hospital - St Leonards
Recruitment hospital [2] 6313 0
Holdsworth House Medical Practice - Sydney
Recruitment hospital [3] 6314 0
University of Sunshine Coast Health Clinics - Sippy Downs
Recruitment postcode(s) [1] 13881 0
2010 - Darlinghurst
Recruitment postcode(s) [2] 13848 0
2065 - St Leonards
Recruitment postcode(s) [3] 13880 0
2289 - Kotara
Recruitment postcode(s) [4] 13878 0
2292 - Broadmeadow
Recruitment postcode(s) [5] 13883 0
3121 - Richmond
Recruitment postcode(s) [6] 13879 0
3145 - Malvern East
Recruitment postcode(s) [7] 13877 0
4075 - Oxley
Recruitment postcode(s) [8] 13882 0
4215 - Australia Fair
Recruitment postcode(s) [9] 13851 0
4556 - Sippy Downs
Recruitment postcode(s) [10] 13884 0
4558 - Cotton Tree

Funding & Sponsors
Funding source category [1] 294174 0
Commercial sector/Industry
Name [1] 294174 0
Zynerba Pharmaceuticals Inc.
Country [1] 294174 0
United States of America
Primary sponsor type
Commercial sector/Industry
Name
Zynerba Pharmaceuticals Pty Ltd
Address
At the office of PricewaterhouseCoopers, Level 27
Freshwater Place, 2 Southbank Boulevard,
Southbank, VIC 3006
Country
Australia
Secondary sponsor category [1] 293004 0
Commercial sector/Industry
Name [1] 293004 0
Novotech (Australia) Pty Limited
Address [1] 293004 0
Level 3, 235 Pyrmont St
Pyrmont NSW 2009
Country [1] 293004 0
Australia

Ethics approval
Ethics application status
Approved
Ethics committee name [1] 295580 0
Bellberry Limited
Ethics committee address [1] 295580 0
129 Glen Osmond Rd, Eastwood, SA 5063
Ethics committee country [1] 295580 0
Australia
Date submitted for ethics approval [1] 295580 0
Approval date [1] 295580 0
25/07/2016
Ethics approval number [1] 295580 0
2016-06-471

Summary
Brief summary
This study aims to investigate the effectiveness and safety of twice daily ZYN002, for 12 weeks in 320 (300 randomized) adults with knee pain due to osteoarthritis of the knee. This will be done by analysing a daily pain score and skin check, knee pain and rescue medication diary, and side effects. Safety will be monitored during the treatment visits using standard measures, including physical and neurological exams, vital signs (including oral temperature), 12-lead ECGs, clinical laboratory tests and side effect monitoring. Skin at the application sites will be checked to see if there is any irritation or reactions present after applications.

Who is if for? You may be eligible to join this study if you are aged between 40 and 75 years, have knee pain due to osteoarthritis of the knee and are in otherwise general good health.

Study details: This study will investigate two doses of ZYN002 compared to a placebo gel (a treatment with no active ingredients which looks like the real thing but it is not). This study is ‘double-blind’ which means you and your study doctor, together with the study staff will not know whether you are receiving ZYN002 or placebo gel.

What does study participation involve? Your participation in the study includes a screening visit; a 1 week washout period, a 1 week baseline period; a 12 week study treatment period; and an end of study (EOS) visit at Week 12.

During the washout period, participants will be asked to discontinue their anti-inflammatory agents (e.g., NSAIDs) and other analgesics prior to the Baseline Period. Only paracetemol (not more than 3 grams per day) will be allowed as rescue medication.
During the Baseline Period, participants will use a 0 to 10 point numeric rating scale to capture their worst pain severity every day. Only paracetemol (not more than 3 grams per day) will be allowed as rescue medication. Participants will record rescue pain medication in a daily diary (Skin Check, Knee Pain, Rescue Medication Diary.

During the treatment period four clinic visits are required for: blood sampling; review of daily diary, medications, AEs and skin irritation; measurement of blood pressure, heart rate, breathing rate and temperature ; suicide risk; and possibly, a brief physical and neurological exam, pregnancy tests (females only, if applicable) and an ECG. Participants will record rescue pain medication in a daily diary (Skin Check, Knee Pain, Rescue Medication Diary.
Participants will apply all study drug to clean, dry, intact skin, thoroughly massaging it into both the right and left shoulders and/or upper arms until the area is dry.
Trial website
Trial related presentations / publications
Public notes

Contacts
Principal investigator
Name 67842 0
Prof David Hunter
Address 67842 0
Royal North Shore Hospital
Rheumatology Department,
Pacific Highway, St Leonards NSW 2065
Country 67842 0
Australia
Phone 67842 0
+61 2 9463 1887
Fax 67842 0
Email 67842 0
david.hunter@sydney.edu.au
Contact person for public queries
Name 67843 0
Dr Nancy Tich
Address 67843 0
Zynerba Pharmaceuticals, Inc.
80 West Lancaster Avenue
Devon, PA 19333
Country 67843 0
United States of America
Phone 67843 0
+1 973-727-4117
Fax 67843 0
Email 67843 0
tichn@zynerba.com
Contact person for scientific queries
Name 67844 0
Dr Donna Gutterman
Address 67844 0
Zynerba Pharmaceuticals, Inc.
80 West Lancaster Avenue
Devon, PA 19333
Country 67844 0
United States of America
Phone 67844 0
+1 919-522-8828
Fax 67844 0
Email 67844 0
guttermand@zynerba.com

No information has been provided regarding IPD availability


What supporting documents are/will be available?

No Supporting Document Provided


Results publications and other study-related documents

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