Degenerative Disc Disease
Conditions
Brief summary
Study to show the safety and tolerability of Intradiscal rhGDF-5 in subjects with early lumbar disc degeneration
Interventions
The API is recombinant human growth and differentiation factor-5 (rhGDF-5), a recombinant version of human GDF-5. GDF-5 is a member of the transforming growth factor-b (TGF-b) superfamily and the bone morphogenetic protein (BMP) subfamily, and is known to influence the growth and differentiation of various tissues, including the intervertebral disc. In vitro experiments have shown that rhGDF-5 can stimulate gene expression and synthesis of the extracellular matrix proteins type II collagen and aggrecan. In vivo experiments in rabbit models of disc degeneration have shown that intradiscal injections of rhGDF-5 can stimulate an increase in disc height and hydration.
OTHERWater for injection
Sterile water for injection
Sponsors
DePuy Spine
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Investigator)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Persistent low back pain with at least 3 months of non-surgical therapy at one suspected symptomatic lumbar level (L3/L4 to L5/S1) as confirmed using a standardized provocative discography protocol. The required discography protocol will be provided by the sponsor. Subjects with multilevel disease must have a provocative discogram confirming that only 1 level is symptomatic at least 2 weeks prior to administration. Historical provocative discograms may be used for screening purposes, with an expiry of 12 calendar months from the date performed. If the study treatment is not performed within those 12 calendar months, a new discogram will be required. 2. Oswestry Disability Index (ODI) for low back pain of 30 or greater 3. Low Back Pain score greater than or equal to 4 cm as measured by Visual Analog Scale (VAS) at Visit 1 Baseline
Exclusion criteria
1. Persons unable to have a discogram, CT, or MRI 2. Abnormal neurological exam at baseline (e.g., chronic radiculopathy) 3. Active radicular pain due to anatomical compression such as stenosis or disc herniation (radicular pain is defined as pain below the knee) 4. Extravasation of contrast agent during the discogram, into the epidural space (does not include leakage of contrast agent along the needle track or leakage to the outer annular ring at the posterior longitudinal ligament vicinity) 5. Suspected symptomatic facet joints and/or severe facet joint degeneration at the index level or adjacent segments
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Neurological Assessment for Motor Function and Reflexes/Sensory | 12 months | Neurological Assessment for Motor Function and Reflexes/Sensory- Number of patients with Clinically Significant Abnormal results at 12 months. For Motor Function, Clinically Significant Abnormal results are determined by the surgeon investigator and are further classified by grade: 0= No Movement, 1= Flicker/trace of contraction, 2=Active movement when gravity removed, 3= Active movement against gravity, 4= Active Movement against gravity and resistance. For Reflexes/Sensory, Clinically Significant Abnormal results are determined by the surgeon investigator and are based on exams of the Knee, Ankle, L3-L5 Dermatone, and S1 Dermatome. Tension signs are evaluated with a straight leg raise to determine at which point, if any, sciatic pain occurs. |
| Treatment Emergent Adverse Events- Relationship to Study Drug | Through a 12 month period and annual telephone contact at 24 and 36 months for subject health status follow-up. | Number of patients with Treatment Emergent Adverse Events that were designated as Definitely Related to Study Drug. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Function Assessed by Oswestry Disability Index Change at 12 Months From Baseline. | 12-month | The Oswestry Disability Index (ODI) is a 10-category (Pain Intensity, Personal Care, Lifting, Walking, Sitting, Standing, Sleeping, Sex Life, Social Life, Traveling) disability measurement scale with a graded response from 0 to 5, with 0 being the best score (no impairment) to 5 being the worst score (significant impairment). ODI score for a subject is calculated by adding the scores and converting the score to a 100 point scale. |
| Change in Pain Visual Analogue Scale (VAS) at 12 Months From Baseline. | 12 months | The Visual Analogue Scale (VAS) pain score asks the subject to place a vertical mark on a horizontal line ( that is approximately 10cm long) with 'No Pain' (score of 0=0cm) listed on the left and 'Very severe pain' (score of 10=10cm) labeled on the right. The subject is instructed to indicate the amount of pain they feel in their back. |
| Change in Physical Component Summary of Quality of Life Measure Assessed by Short-Form 36 at 12 Months From Baseline. | 12 months | The 36-item Short Form Health Survey (SF-36) is a patient reported outcome survey that evaluates functional health and well-being. The survey is converted into two summary measures (the Physical Component- PCS and Mental Component- MCS) that are scored from 0 to 100 (where 100 indicates the highest level of health) |
| Change in Mental Component Summary Quality of Life Measure Assessed by Short Form SF-36 at 12 Months From Baseline. | 12 months | The 36-item Short Form Health Survey (SF-36) is a patient reported outcome survey that evaluates functional health and well-being. The survey is converted into two summary measures (the Physical Component- PCS and Mental Component- MCS) that are scored from 0 to 100 (where 100 indicates the highest level of health) |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Intradiscal rhGDF-5 (1.0mg) The API is recombinant human growth and differentiation factor-5 (rhGDF-5), a recombinant version of human GDF-5. GDF-5 is a member of the transforming growth factor-b (TGF-b) superfamily and the bone morphogenetic protein (BMP) subfamily, and is known to influence the growth and differentiation of various tissues, including the intervertebral disc. | 10 |
| Placebo Excipients in Intradiscal rhGDF-5, to include Trehalose, Glycine, HCl, and Water for Injection | 10 |
| Intradiscal rhGDF-5 (2.0mg) The API is recombinant human growth and differentiation factor-5 (rhGDF-5), a recombinant version of human GDF-5. GDF-5 is a member of the transforming growth factor-b (TGF-b) superfamily and the bone morphogenetic protein (BMP) subfamily, and is known to influence the growth and differentiation of various tissues, including the intervertebral disc. | 4 |
| Total | 24 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 |
|---|---|---|---|---|
| Overall Study | Lost to Follow-up | 1 | 0 | 1 |
| Overall Study | Other | 0 | 0 | 1 |
| Overall Study | Withdrawal by Subject | 2 | 2 | 0 |
Baseline characteristics
| Characteristic | Intradiscal rhGDF-5 (1.0mg) | Placebo | Intradiscal rhGDF-5 (2.0mg) | Total |
|---|---|---|---|---|
| Age, Continuous | 39.7 years STANDARD_DEVIATION 9.56 | 44.7 years STANDARD_DEVIATION 7.86 | 42.4 years STANDARD_DEVIATION 6.38 | 42.2 years STANDARD_DEVIATION 8.4 |
| Region of Enrollment United States | 10 participants | 10 participants | 4 participants | 24 participants |
| Sex: Female, Male Female | 4 Participants | 3 Participants | 1 Participants | 8 Participants |
| Sex: Female, Male Male | 6 Participants | 7 Participants | 3 Participants | 16 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — |
| other Total, other adverse events | 9 / 10 | 10 / 10 | 4 / 4 |
| serious Total, serious adverse events | 0 / 10 | 0 / 10 | 2 / 4 |
Outcome results
Primary
Neurological Assessment for Motor Function and Reflexes/Sensory
Neurological Assessment for Motor Function and Reflexes/Sensory- Number of patients with Clinically Significant Abnormal results at 12 months. For Motor Function, Clinically Significant Abnormal results are determined by the surgeon investigator and are further classified by grade: 0= No Movement, 1= Flicker/trace of contraction, 2=Active movement when gravity removed, 3= Active movement against gravity, 4= Active Movement against gravity and resistance. For Reflexes/Sensory, Clinically Significant Abnormal results are determined by the surgeon investigator and are based on exams of the Knee, Ankle, L3-L5 Dermatone, and S1 Dermatome. Tension signs are evaluated with a straight leg raise to determine at which point, if any, sciatic pain occurs.
Time frame: 12 months
Population: Safety Population~For the Neurological Assessment at 12 months, only 8 subjects from the rhGDF-5 1.0mg group (out of 10 subjects total) completed the assessment, only 3 subjects from the rhGDF-5 2.0mg group (out of 4 subjects total) completed the assessment, and none of the placebo subjects (out of 10 total subjects) completed the assessment.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Intradiscal rhGDF-5 (1.0mg) | Neurological Assessment for Motor Function and Reflexes/Sensory | 0 participants |
| Intradiscal rhGDF-5 (2.0mg) | Neurological Assessment for Motor Function and Reflexes/Sensory | 0 participants |
Primary
Treatment Emergent Adverse Events- Relationship to Study Drug
Number of patients with Treatment Emergent Adverse Events that were designated as Possibly or Probably Related to Study Drug.
Time frame: 12 month period and annual telephone contact at 24 and 36 months for subject health status follow-up
Population: Safety Population
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Intradiscal rhGDF-5 (1.0mg) | Treatment Emergent Adverse Events- Relationship to Study Drug | 4 participants |
| Placebo | Treatment Emergent Adverse Events- Relationship to Study Drug | 1 participants |
| Intradiscal rhGDF-5 (2.0mg) | Treatment Emergent Adverse Events- Relationship to Study Drug | 0 participants |
Primary
Treatment Emergent Adverse Events- Relationship to Study Drug
Number of patients with Treatment Emergent Adverse Events that were designated as Definitely Related to Study Drug.
Time frame: Through a 12 month period and annual telephone contact at 24 and 36 months for subject health status follow-up.
Population: Safety Population
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Intradiscal rhGDF-5 (1.0mg) | Treatment Emergent Adverse Events- Relationship to Study Drug | 0 participants |
| Placebo | Treatment Emergent Adverse Events- Relationship to Study Drug | 0 participants |
| Intradiscal rhGDF-5 (2.0mg) | Treatment Emergent Adverse Events- Relationship to Study Drug | 0 participants |
Secondary
Change in Function Assessed by Oswestry Disability Index Change at 12 Months From Baseline.
The Oswestry Disability Index (ODI) is a 10-category (Pain Intensity, Personal Care, Lifting, Walking, Sitting, Standing, Sleeping, Sex Life, Social Life, Traveling) disability measurement scale with a graded response from 0 to 5, with 0 being the best score (no impairment) to 5 being the worst score (significant impairment). ODI score for a subject is calculated by adding the scores and converting the score to a 100 point scale.
Time frame: 12-month
Population: FAS Population
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Intradiscal rhGDF-5 (1.0mg) | Change in Function Assessed by Oswestry Disability Index Change at 12 Months From Baseline. | -19.8 units on a scale | Standard Deviation 21.22 |
| Placebo | Change in Function Assessed by Oswestry Disability Index Change at 12 Months From Baseline. | -18.8 units on a scale | Standard Deviation 22.43 |
| Intradiscal rhGDF-5 (2.0mg) | Change in Function Assessed by Oswestry Disability Index Change at 12 Months From Baseline. | -6.0 units on a scale | Standard Deviation 29.98 |
Secondary
Change in Mental Component Summary Quality of Life Measure Assessed by Short Form SF-36 at 12 Months From Baseline.
The 36-item Short Form Health Survey (SF-36) is a patient reported outcome survey that evaluates functional health and well-being. The survey is converted into two summary measures (the Physical Component- PCS and Mental Component- MCS) that are scored from 0 to 100 (where 100 indicates the highest level of health)
Time frame: 12 months
Population: FAS Population~One subject from the rhGDF-5 1.0mg group (out of 10 subjects total) did not complete the MCS, SF-36 at Baseline.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Intradiscal rhGDF-5 (1.0mg) | Change in Mental Component Summary Quality of Life Measure Assessed by Short Form SF-36 at 12 Months From Baseline. | 2.86 units on a scale | Standard Deviation 11.142 |
| Placebo | Change in Mental Component Summary Quality of Life Measure Assessed by Short Form SF-36 at 12 Months From Baseline. | -0.92 units on a scale | Standard Deviation 9.163 |
| Intradiscal rhGDF-5 (2.0mg) | Change in Mental Component Summary Quality of Life Measure Assessed by Short Form SF-36 at 12 Months From Baseline. | 1.31 units on a scale | Standard Deviation 20.276 |
Secondary
Change in Pain Visual Analogue Scale (VAS) at 12 Months From Baseline.
The Visual Analogue Scale (VAS) pain score asks the subject to place a vertical mark on a horizontal line ( that is approximately 10cm long) with 'No Pain' (score of 0=0cm) listed on the left and 'Very severe pain' (score of 10=10cm) labeled on the right. The subject is instructed to indicate the amount of pain they feel in their back.
Time frame: 12 months
Population: FAS Population
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Intradiscal rhGDF-5 (1.0mg) | Change in Pain Visual Analogue Scale (VAS) at 12 Months From Baseline. | -2.33 units on a scale | Standard Deviation 3.645 |
| Placebo | Change in Pain Visual Analogue Scale (VAS) at 12 Months From Baseline. | -2.78 units on a scale | Standard Deviation 3.751 |
| Intradiscal rhGDF-5 (2.0mg) | Change in Pain Visual Analogue Scale (VAS) at 12 Months From Baseline. | -1.10 units on a scale | Standard Deviation 3.336 |
Secondary
Change in Physical Component Summary of Quality of Life Measure Assessed by Short-Form 36 at 12 Months From Baseline.
The 36-item Short Form Health Survey (SF-36) is a patient reported outcome survey that evaluates functional health and well-being. The survey is converted into two summary measures (the Physical Component- PCS and Mental Component- MCS) that are scored from 0 to 100 (where 100 indicates the highest level of health)
Time frame: 12 months
Population: FAS Population~One subject from the rhGDF-5 1.0mg group (out of 10 subjects total) did not complete the PCS, SF-36 at Baseline.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Intradiscal rhGDF-5 (1.0mg) | Change in Physical Component Summary of Quality of Life Measure Assessed by Short-Form 36 at 12 Months From Baseline. | 7.22 units on a scale | Standard Deviation 9.728 |
| Placebo | Change in Physical Component Summary of Quality of Life Measure Assessed by Short-Form 36 at 12 Months From Baseline. | 8.61 units on a scale | Standard Deviation 14.213 |
| Intradiscal rhGDF-5 (2.0mg) | Change in Physical Component Summary of Quality of Life Measure Assessed by Short-Form 36 at 12 Months From Baseline. | 6.21 units on a scale | Standard Deviation 8.245 |