| Eligibility |
Inclusion Criteria:
1. Provide written informed consent and abide by the study restrictions.
2. Males and females between 40 and 75 years of age and body weight >40 kg and <150 kg
with a body mass index (BMI) between 20-35 kg/m2 inclusive
3. Patients with osteoarthritic knee based on disease diagnostic criteria as presented in
section; Inclusion Disease Criteria.
4. Self-reported pain intensities higher or equal to 5 cm on a 0-10 cm visual analog
scale when asked to assess the worst pain within the last 24 hours
5. Have agreed to maintain the same activity level throughout the course of the study.
6. Knee pain for at least 14 days per month for the last three months before study entry.
7. Osteophytes (with radiographic evidence).
8. At least 1 of the following 3 conditions: Age >50, or morning stiffness <30 minutes,
or crepitus.
9. Kellgren and Lawrence grade of I, II or III at the index knee. If the patient has had
X-rays of the knee joints within the last year, which can confirm the diagnosis, they
may be used. Otherwise, a new posterior-anterior view X-ray of both knees will be
conducted by CCBR Aalborg.
10. Worst pain within the last 24-hour must be 5.0cm to 10.0cm (assessed on a 0-10 cm VAS
scale anchored at 0cm: no pain and 10cm: worst pain imaginable) prior to enrolment.
11. Discontinued use of all analgesic medications (including over-the-counter [OTC]
analgesics/ Non-Steroidal Anti-Inflammatory Drug (NSAID) at least three days prior to
randomization (patients are allowed limited use of analgesic medications).
Exclusion Criteria:
1. Have a history of recurrent seizures other than febrile seizures.
2. Have a history of frequent and/or severe allergic reactions with multiple medications.
3. Patients with a current or recent history, as determined by the PI or his delegates,
of severe, progressive, and/or uncontrolled renal, hepatic, hematological,
gastrointestinal, endocrine, pulmonary, cardiac, neurological, psychiatric or cerebral
disease which could interfere with the patient's participation in the study.
4. Moderate or great hepatic impairment. Retest of abnormal lab values is allowed once.
If still abnormal, the patient will be excluded.
5. An alanine aminotransaminase (ALAT) higher than the Upper Limit of Normal (ULN) or
explain by obesity
6. Have prior renal transplant, current renal dialysis or severe renal insufficiency
(creatinine clearance of <30 mL/min), or serum creatinine laboratory value >1.5 times
ULN, based on the reference ranges of the central laboratory.
7. Have uncontrolled hypertension (systolic blood pressure over 160 and diastolic blood
pressure over 100)
8. Have active peptic ulcer, gastrointestinal (GI) bleeding or previous unexplained
bleeding episodes
9. Have known inflammatory intestinal disease or gastrointestinal disease which might
impact absorption
10. Patients with congestive heart failure (NYHA II-IV)
11. Bazett's corrected QT (QTcB) interval > 450 msec for men and > 470 msec for women
12. Patients with diabetes mellitus and documented atherosclerosis
13. Patients allergic to the active ingredient of duloxetine or one or more of the
excipients
14. Pregnancy and breast feeding
15. Non-postmenopausal (defined as the absence of menstruation for at least 12 months and
confirmed by assessing the follicle-stimulating hormone (FSH) level) and non-sterile
females patients not using fertility control such as either birth control pills,
hormonal or copper intrauterine device (IUD), vaginal ring, implant, transdermal
release patch, or birth control depot injections
16. Patients with an active malignancy of any type or a history of malignancy within the
last five years (except basal cell carcinoma of the skin that has been excised prior
to study start)
17. Are taking any excluded medications (analgesic medications) that cannot be
discontinued during the study period.
18. Patients in treatment with anticoagulants (with the exception of acetylsalicylic acid)
19. In treatment with a CYP1A2 inhibitors.
20. Have received treatment within the last 30 days with a drug that has not received
regulatory approval for any indication at Visit 1.
21. Have a history of substance abuse or dependence within the past year, excluding
nicotine and caffeine
22. Patients at a high risk of infection (e.g. leg ulcers, indwelling urinary catheter and
persistent or recurrent chest infections and patients who are permanently bed ridden
or wheelchair bound)
23. Patients with a history of, or suspected, demyelinating disease of the central nervous
system (e.g. multiple sclerosis or optic neuritis).
24. The investigator experiences that the volunteers do not fully understand the
experimental pain procedures.
25. Investigator site personnel directly affiliated with this study and/or their immediate
family. Immediate family is defined as a spouse, parent, child, or sibling, whether
biological or legally adopted.
26. Patients on monoamine oxidase inhibitors (MAOIs), dopamine-antagonists, tricyclic
antidepressants (TCAs), selective serotonin re-uptake inhibitors (SSRI)s or SNRIs, as
well as use of the supplement St. John's Wort
27. Psychiatric diagnosis or symptoms (e.g. depression or anxiety) that in the opinion of
the investigator could interfere with study procedures or participation evaluated
using the Mini International Neuropsychiatric Interview (M.I.N.I.).
28. Has answered "yes" in the Columbia-Suicide Severity Rating Scale (C-SSRS) to suicidal
ideation items 4 or 5, or any suicidal behaviour within six months before screening,
at screening or at randomization visit, or has been hospitalized or treated for
suicidal behaviour in the past five years before screening.
29. Patients are not allowed to donate blood or blood products during the study
30. Have secondary causes of arthritis of the knee including septic arthritis,
inflammatory joint disease, articular fracture, major dysplasia or congenital
abnormality, acromegaly, hemochromatosis, Wilson's disease, and primary
osteochondromatosis.
31. Have had lower extremity surgery (including arthroscopy of the index knee) within 3
months prior to Visit 1 or have surgery planned of the index knee at any time.
32. Have had significant prior injury to the index knee within 12 months prior to Visit 1.
33. Use of lower extremity assistive devices other than a cane or knee brace (use of a
'shoe lift' is permitted). Are non-ambulatory or require the use of crutches or a
walker. Use of a cane in the hand opposite the index knee is acceptable.
34. Has had a prior synovial fluid analysis showing a White Blood Cell (WBC) =2000mm3 that
is indicative of a diagnosis other than OA at the index knee.
35. Have a confounding painful condition that may interfere with assessment of the index
knee. (Knee pain should be the predominant pain. Mild OA of the hands is allowed, for
instance).
36. Have any other musculoskeletal or arthritic condition that may affect the
interpretation of the clinical efficacy and/or safety data or otherwise
contraindicates participation in this clinical study (i.e., currently symptomatic
fractures or any concurrent rheumatic diseases such as but not limited to
fibromyalgia, rheumatoid arthritis, gout, pseudo-gout or Paget's disease and Reiter's
syndrome are excluded).
37. Have used corticosteroids prior to baseline:
1. Intra-articular injection of steroids to the index knee or into any other site
than the index knee within the previous three months.
2. Intra-muscular corticosteroid injections within the previous three months.
3. Oral corticosteroids within the previous one month.
38. Have initiated or have changed to an established physiotherapy program within two
weeks prior to Visit 2 or during the study period. An established physiotherapy
program may be continued throughout the study period if unchanged in frequency and
intensity.
|
