Can we Use Estrogen-containing Therapy to Improve Pain in Women After Menopause With Hand Osteoarthritis?

Hand Osteoarthritis Clinical Trial

— HOPE-e  

Official title:

Hand Osteoarthritis: Investigating Pain Effects in a Randomised Placebo-controlled Feasibility Study of an Estrogen-containing Therapy

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT04036929
• Other study ID #: HOPE-e
• Status: Completed
• Phase: N/A
• Start date: May 9, 2019
• Est. completion date: December 10, 2021

Study information

• Verified date: April 2022
• Source: University of Oxford
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Post-menopausal women aged 40-65 with symptomatic hand osteoarthritis are invited to take part in this feasibility study. The study's aim is to investigate whether it is acceptable to women with painful hand OA to take an estrogen-containing therapy, and what is the best way of collecting some of the information in order to facilitate planning a full size trial. The investigator's long-term aim is to find out whether giving estrogen-containing therapy to women after the menopause improves hand OA symptoms.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 28
• Est. completion date: December 10, 2021
• Est. primary completion date: August 19, 2021
• Accepts healthy volunteers: No
• Gender: Female
• Age group: 40 Years to 65 Years

Eligibility

Inclusion Criteria:

• Able to give informed written consent

• Female, aged 40-65 years old

• In those with an intact uterus: At least 12 months of spontaneous amenorrhea (without any menstrual bleeding in last 12 months) and last menstrual period not more than 10 years ago

• In those who have undergone hysterectomy or are/were using an intrauterine contraceptive device with progesterone local therapy (such as Mirena): Follicle stimulating hormone (FSH) =30 milli-International Units per millilitre (mIU/ml) on screening blood test AND a history of menopausal symptoms in the last 1 to 10 years, in keeping with appropriate timing of menopausal status

• Hand pain, aching or stiffness on most days in the last 3 months

• At least 2, painful hand joints of any type (interphalangeal joints (IPJ) or base of thumbs)

• Fulfils American College of Rheumatology clinical diagnostic criteria for hand OA (3 or more of following):

1. Hard tissue enlargement of 2 or more of the following joints: 2nd or 3rd distal interphalangeal joints (DIPJ), 2nd or 3rd proximal interphalangeal joints (PIPJ), first carpometacarpal joints (CMCJ)

2. Hard tissue enlargement of 2 or more of the DIPJs

3. Less than 3 swollen metacarpophalangeal joints (MCPJ)

4. Deformity of at least one of the joints listed in first point

OR, for those with base of thumb osteoarthritis only not fulfilling these criteria, has clinical symptoms and examination findings consistent with base of thumb osteoarthritis.

• Hand pain has not responded adequately to National Institute for Health and Care Excellence core guidance for management of OA, including the use of paracetamol or non-steroidal anti-inflammatory drug (NSAID) gel, except where there is contraindication or intolerance

• Average hand pain is reported as typically more than 4 out of 10 in severity, or average hand pain in the last 7 days of 4/10 or more on a visual analogue scale

• In the Investigator's opinion, is able and willing to comply with all study requirements

Exclusion criteria

• Other cause of hand pain, including inflammatory arthritis, connective tissue disorder, chronic pain or alternative clinical diagnosis such as tenosynovitis or carpal tunnel syndrome

• Pregnancy or breast feeding, or risk of this during study

• Use of one or more prohibited treatments within specified timeframe, or not willing to avoid treatment for the duration of the study:

• Oral contraceptive pill, or systemic HRT within the last 6 months (Use of an intrauterine contraceptive device with progesterone local therapy (Mirena) or vaginal topical estrogen use (known low systemic absorption) are not exclusions to participation)

• Anti-estrogen medication within the last 6 months

• Oral, intramuscular or intraarticular steroid within the last 3 months

• Intraarticular hyaluronan to a hand joint within the last 6 months

• Initiation of new oral analgesia within the last 4 weeks

• Initiation of glucosamine, chondroitin, hand exercises or other relevant non- pharmacological therapy within the last 6 weeks

• Hand surgery within the last 6 months, or planned within the next 6 months

• Medications likely to increase hepatic metabolism of study medication, including:

• St. John's Wort

• Anti-convulsants (phenobarbital, phenytoin, carbamazepine, lamotrigine)

• Some anti-infectives (rifampicin, rifabutin, nevirapine, efavirenz, ritonavir and nelfinavir)

• Presence of one or more medical contraindications to the use of systemic hormonal replacement therapy:

• In those aged 40-45 years, FSH <30 mIU/ml on screening blood test, i.e. non- confirmatory of menopausal status

• Any history of breast, endometrial, ovarian or skin cancer

• Any other history of other cancer within 5 years (except treated Basal Cell Carcinoma, BCC)

• Relevant breast issue on routine national breast screening in prior 3 years

• Undiagnosed genital bleeding, or untreated endometrial hyperplasia, active uterine fibroids or endometriosis

• Active or past history of venous thromboembolism (VTE) (including deep venous thrombosis, pulmonary embolism and retinal vein thrombosis), or at high risk of VTE (such as known thrombophilic disorders (such as Protein C, S or anti-thrombin deficiency) or presence of a strong family history of VTE). Women with a first degree relative with a history of VTE, or other strong family history of VTE at the Investigators' discretion.

• Active or past history of arterial thrombo-embolic disease (such as myocardial infarction, angina or stroke) or strong family history of stroke)

• Clinically significant immobility

• Migraine or active epilepsy

• Uncontrolled hypertension (or diastolic pressure greater than 90 mmHg or systolic pressure greater than 145 mmHg at screening visit)

• Uncontrolled diabetes mellitus or uncontrolled hypertriglyceridaemia

• Body Mass Index (BMI) greater than 30

• Active malabsorption syndrome or clinically significant small bowel disease

• Acute liver disease, clinically significant abnormal liver function, active gallbladder disease or porphyria

• Clinically significant renal impairment

• Intolerance to lactose, fructose or glucose (including galactose intolerance, lactase deficiency, fructose intolerance, glucose-galactose malabsorption or sucrase- isomaltase insufficiency)

• Known sensitivity to either conjugated equine estrogens, bazedoxifene or the combination

• Any other significant or uncontrolled disease or disorder which, in the opinion of the Investigator, may either put the participants at risk because of participation in the study, or may influence the result of the study, or the participant's ability to participate in the study

• Participants who have participated in another research trial involving an investigational product in the past 8 weeks

Related Conditions & MeSH terms

• Hand Osteoarthritis
• Osteoarthritis

Intervention

Drug:
• Estrogen-bazedoxifene
Conjugated estrogens 0.45 mg-bazedoxifene acetate 20 mg.
• Placebo oral tablet
Placebo oral tablet

Locations

Country	Name	City	State
United Kingdom	White Horse Medical Practice, Faringdon Medical Centre	Faringdon	Oxfordshire
United Kingdom	Charing Cross Hospital, Imperial College Healthcare NHS Trust	London
United Kingdom	Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust	Oxford

Sponsors (3)

Lead Sponsor	Collaborator
University of Oxford	National Institute for Health Research, United Kingdom, Oxford Clinical Trials Research Unit

Country where clinical trial is conducted

United Kingdom, 

References & Publications (1)

Marian IR, Goff M, Williams JAE, Gulati M, Chester-Jones M, Francis A, Watson M, Vincent TL, Woollacott S, Mackworth-Young C, Glover V, Furniss D, Gardiner M, Lamb SE, Vincent K, Barber VS, Black J, Dutton SJ, Watt FE. Hand Osteoarthritis: investigating Pain Effects of estrogen-containing therapy (HOPE-e): a protocol for a feasibility randomised placebo-controlled trial. Pilot Feasibility Stud. 2021 Jun 24;7(1):133. doi: 10.1186/s40814-021-00869-1. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Feasibility: Rates of eligible participant identification, rates of recruitment/randomisation from different sources, retention rates		From the date of recruitment opening until the date of recruitment closing, 1 year
Primary	Feasibility: Frequency of adverse events related to the active study medication		Through study completion, 7 months
Primary	Feasibility: Bang's Blinding Index (likelihood of unblinding)	Self-complete questionnaire which assesses likelihood that participant or Investigator have become unblinded	Week 24
Primary	Feasibility: Monitoring study medication compliance (via diaries)	Participants will be asked to record any missed doses of study medication on a paper diary which will be provided at each visit. We will ask participants to bring the diary to each study visit and any missed doses will be recorded in the Case Report Form.	From randomisation to end of treatment at Week 24
Secondary	Pain and function: Average hand pain over last 14 days (NRS 0-10)	Numerical Rating Scale 0-to-10, where 0 is "no pain" and 10 is "pain as bad as you can imagine"	Collected at: Baseline, Week 4, Week 12, Week 24
Secondary	Pain and function: Remote pain-rating prior to a visit (NRS 0-10)	Numerical Rating Scale 0-to-10, where 0 is "no pain" and 10 is "pain as bad as you can imagine"	Collected at: Baseline, Week 4, Week 12, Week 24
Secondary	Pain and function: Prevalence of joint pain elsewhere (pain manikin)	Prevalence of joint pain elsewhere in the 4 weeks preceding the study visit	Collected at: Baseline, Week 12, Week 24
Secondary	Pain and function: Functional Index for Hand OA (FIHOA)	Validated measurement of hand OA-related functional impairment. It includes 10 questions scored according to a 4-grade scale. The score ranges from 0 (no functional impairment) to 30 points (maximal impairment).	Collected at: Baseline, Week 12, Week 24
Secondary	Pain and function: EQ-5D-5L	Validated measurement of quality of life across five dimensions and their associated levels of severity on a 1 (no problems) to 5 (extreme problems) scale.	Collected at: Baseline, Week 12, Week 24
Secondary	Menopause symptoms: The Menopause Specific Quality of Life Questionnaire (MENQOL)	Validated measurement of menopausal symptoms and their associated degree of severity; 30 items in a Likert-scale format. Items are rated as present or not present and if present how bothersome, on a 0 (not bothersome) to 6 (extremely bothersome) scale.; The interventional version is being used here, which includes an additional 3 questions relevant to Hormonal Replacement Therapy (HRT) use which has been used in a trials setting.	Collected at: Baseline, Week 12, Week 24
Secondary	Menopause symptoms: Greene Climacteric Scale	A 21-item validated questionnaire that measures a variety of menopausal symptoms on a 4-point Likert scale (0 = "not at all" to 3 = "extremely"), plus one sexual function probe.	Collected at: Baseline, Week 12, Week 24
Secondary	Joint appearance: Cosmesis score of Michigan Hand Questionnaire (4 questions, questions 28-31)	Subdomain of hand-specific outcomes instrument that measures outcomes of patients with conditions of, or injury to, the hand or wrist.	Collected at: Baseline, Week 12, Week 24
Secondary	Joint appearance: Investigator-recorded tender and swollen joint counts	Investigator examination of tender and swollen hand joints, binary recording (1 swollen, 0 not swollen).	Collected at: Baseline, Week 12, Week 24
Secondary	Joint appearance: Photographic recording of swollen hand joints	Standardised digital photography of hands	Collected at: Baseline, Week 12, Week 24
Secondary	Joint function: Jamar grip strength - average of 3 measurements	Handgrip strength will be measured in kilograms to the nearest hundred grams in both hands using a Jamar dynamometer.; Both hands will be alternately assessed three times and the average score recorded.	Collected at: Baseline, Week 12, Week 24
Secondary	End of Treatment questionnaire (study-specific)	A study specific end of treatment questionnaire will be designed to include items on acceptability.	Week 24

External Links

•   HOPE-e study website