Subacromial Bursitis Clinical Trial
Official title:
Rilonacept (Arcalyst ®) in the Treatment of Subacromial Bursitis
To date no trials have been performed looking at whether or not intra-bursal injection of an IL-1 antagonist provides pain relief similar to that of a corticosteroid injection. The subcutaneous injection of anakinra, an IL-1 receptor antagonist, in patients with shoulder pain due to rotator cuff tendonitis and subacromial bursitis was efficacious in relieving pain but this information was presented as a case series in a letter to the editor format, so the validity of these results would require additional testing [Omoigui S, et al. 2004]. Based mainly on the data from the intra-articular administration of anakinra, there have not been any adverse trends in outcomes or safety to suggest that intra-bursal injection of rilonacept will carry an increase risk of adverse events. The purpose of this trial is to compare the improvement in pain and function of patients with clinical symptoms and signs of subacromial bursitis of rilonacept vs. corticosteroid injection (standard of care).
Background: Subacromial bursitis is an inflammatory condition which is typically triggered
by altered rotator cuff mechanics. One of the mainstays of therapy is corticosteroid
injection. Given the inflammatory nature of subacromial bursitis coupled with prominence of
interleukin-1 (IL-1) beta on histopathologic assessment of resected subacromial bursa,
targeted anti-IL-1 therapy would be an attractive alternative to corticosteroid injection.
Hypothesis: One intra-bursal injection of the IL-1 trap rilonacept (Arcalyst ®), currently
FDA approved for the treatment of cryopyrin associated periodic syndrome (CAPS), is
non-inferior to intra-bursal corticosteroid injection at 4 weeks post-procedure.
Methods: This study is a prospective trial lasting a total of 4 weeks. Patients with typical
symptoms and signs of subacromial bursitis are randomized to either corticosteroid injection
prepared in the usual fashion in clinic vs. injection of rilonacept. Prior to injection of
either medication patients will complete a QuickDASH Questionnaire and provide a verbal pain
score from 0 to 10. The Quick DASH Questionnaire and verbal pain score are then completed
within 2 duty days of injection, 2 weeks after injection, and 4 weeks after injection by
phone.
Primary Outcome: Primary outcome is improvement in QuickDASH. Secondary outcomes are
improvement in the verbal pain score and monitoring for infection or other complications
from rilonacept administration.
;
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
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