A single intra-articular injection of JTA-004, a combination of human plasma, hyaluronic acid, and clonidine, versus placebo in symptomatic knee osteoarthritis: A Phase 3 trial

Abstract

Objectives: Intra-articular treatments for osteoarthritis (OA) are limited by their efficacy, safety, or duration of response. JTA-004 is a potential novel treatment for OA for intra-articular (IA) injection, combining hyaluronic acid (HA) and clonidine with human plasma to enhance the effects of HA. The objectives of the trial were to evaluate the efficacy and safety of JTA-004 in participants with symptomatic knee OA, where the primary objective was evaluating the efficacy of JTA-004 in terms of WOMAC pain, compared to placebo.

Design: The trial was a multicenter, Phase 3, randomized, double-blind, placebo- and active-controlled clinical trial, evaluating the efficacy and safety of a single IA injection of JTA-004, compared to saline (primary hypothesis) and an HA-comparator (Synvisc-One®) (secondary hypothesis) in knee OA with a Kellgren-Lawrence grade of 2 or 3. For the secondary hypothesis, non-inferiority of JTA-004 to active comparator by comparing the 2 treatment groups on the mean differences in WOMAC pain with a non-inferiority margin of Δ = 10 mm. Primary efficacy endpoint was the change from baseline in WOMAC pain to Month 3. The main secondary efficacy endpoints included changes from baseline in WOMAC function and stiffness at Months 3 and 6, OMERACT-OARSI responder rates, global assessments, and use of rescue medication. Safety assessments were based on adverse events (AE) reporting, and post-injection vital signs.

Results: A total of 746 participants were randomized, of which 687 (92.1%) completed the trial. The results indicated no significant differences in the primary endpoint between JTA-004 and placebo (LSmean difference: -1.50 mm, 95%CI 5.12; 2.12, p= 0.42) or Synvisc-One® (LSmean difference: 2.40, 95% CI: -1.22; 6.02, p=0.20) nor in either of the efficacy outcomes of the main study population. The safety and tolerability of JTA-004 was good, and there were no differences in the frequency of any of the reported AEs or trial discontinuations between the study groups.

Conclusions: A single IA injection of JTA-004 was not superior to a saline solution (LSmean difference: -1.50 mm, 95%CI 5.12; 2.12, p= 0.42) or Synvisc-One® (LSmean difference: 2.40, 95% CI: -1.22; 6.02, p=0.20) for the treatment of OA symptoms in the overall study population.

Keywords: Clonidine; Hyaluronic acid; Inflammation; Knee osteoarthritis; Randomized controlled trials; Viscosupplement.