This is a randomized, double-blind, placebo-controlled dose-escalation study designed to evaluate the safety, tolerability, pharmacokinetics (PK), and preliminary efficacy of intra-articular injection of RAB001 in participants with knee osteoarthritis (KOA). The study consists of five dose groups: 1.5 mg, 4.5 mg, 9 mg, 18 mg and 27 mg. A total of 12 participants with knee osteoarthritis will be enrolled per dose group (9 receiving investigational product and 3 receiving placebo), for an overall total enrollment of 60 subjects. The 27 mg cohort serves as an optional escalation group, whose initiation is contingent upon assessment by the Safety Review Committee (SRC). Eligible participants will first receive a single-dose administration followed by a 14-day observation period, during which safety, tolerability, PK and preliminary efficacy data will be collected. In the multiple-dose phase, study treatment will be administered once every 4 weeks for a total of 2 injections, on Week 4 (Day 29) and Week 8 (Day 57), respectively. After the last administration, subjects will enter the follow-up period and return to the study site for safety and efficacy assessments at Weeks 12, 16 and 24. A staggered dose-escalation design will be implemented. Escalation to the next higher dose level may proceed only after completion of the 14-day safety and tolerability evaluation for all subjects in the current dose cohort and subsequent approval from the SRC. Each participant will receive only one assigned dose level throughout the trial.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
60
Treatment period: 8 weeks, with study medication administered once every 4 weeks for a total of 3 administrations. All injections shall be performed under full aseptic technique. In case of joint effusion, arthrocentesis shall be conducted prior to study drug administration. The study drug will be injected over approximately 30 to 60 seconds. Subjects shall be monitored for 15 to 30 minutes after injection.
Peking Union Medical College Hospital, Chinese Academy of Medical Sciences
Beijin, Beijin, China
The Third Hospital of Hebei Medical University
Shijiazhuang, Hebei, China
Efficacy Endpoints-(WOMAC A1)
Changes from baseline in the walking pain score of target knee (WOMAC A1). WOMAC=Western Ontario and McMaster Universities Osteoarthritis Index
Time frame: Weeks 4, 8, 12, 16 and 24
Efficacy Endpoints-WOMAC Scale A (Pain)
Change from baseline in target knee WOMAC Scale A (Pain) score at Weeks 4, 8, 12, 16 and 24
Time frame: Weeks 4, 8, 12, 16 and 24
Efficacy Endpoints-WOMAC subscale B (stiffness)
Change from baseline in target knee WOMAC subscale B (stiffness) score at Weeks 4, 8, 12, 16 and 24. WOMAC=Western Ontario and McMaster Universities Osteoarthritis Index
Time frame: Weeks 4, 8, 12, 16 and 24
Efficacy Endpoints-WOMAC subscale C (physical function)
Change from baseline in target knee WOMAC subscale C (physical function) score at Weeks 4, 8, 12, 16 and 24. WOMAC=Western Ontario and McMaster Universities Osteoarthritis Index
Time frame: Weeks 4, 8, 12, 16 and 24
Efficacy Endpoints-WOMAC subscale C (physical function)
Change from baseline in target knee total WOMAC score at Weeks 4, 8, 12, 16 and 24. WOMAC=Western Ontario and McMaster Universities Osteoarthritis Index
Time frame: Weeks 4, 8, 12, 16 and 24
Efficacy Endpoints
Percentage of responders per( OMERACT-OARSI )response criteria at Weeks 4, 8, 12, 16 and 24
Time frame: Weeks 4, 8, 12, 16 and 24
Efficacy Endpoints
Changes from baseline in the five KOOS subdomain scores (pain, symptoms, activities of daily living, sport and recreation function, knee-related quality of life) for the target knee at Weeks 4, 8, 12, 16 and 24. KOOS =Knee injury and Osteoarthritis Outcome Score
Time frame: Weeks 4, 8, 12, 16 and 24
Efficacy Endpoints
Changes from baseline in Patient Global Assessment (PGA) score at Weeks 4, 8, 12, 16 and 24
Time frame: Weeks 4, 8, 12, 16 and 24
Efficacy Endpoints
Changes from baseline in Clinician's Global Assessment (COGA) score at Weeks 4, 8, 12, 16 and 24
Time frame: Weeks 4, 8, 12, 16 and 24
Efficacy Endpoints
Cumulative intake of rescue medication (paracetamol / acetaminophen) throughout the study period.
Time frame: Day 1 to Week 24
Pharmacokinetic (PK) Endpoints Cmax
Maximum observed plasma concentration
Time frame: Single-dose Administration Phase: Within 1 hour prior to injection on Day 1 (0 hour), and at 5 , 10 , 15 , 30 minutes, 1 , 2 , 4 , 8 , 12 and 24 hours after injection initiation. A total of 11 blood collection time points are included.
Pharmacokinetic (PK) Endpoints-AUC₀-ₜ
Area under the concentration-time curve from time 0 to last measurable time point
Time frame: Single-dose Administration Phase: Within 1 hour prior to injection on Day 1 (0 hour), and at 5 , 10 , 15 , 30 minutes, 1 , 2 , 4 , 8 , 12 and 24 hours after injection initiation. A total of 11 blood collection time points are included.
Pharmacokinetic (PK) Endpoints-AUC₀-∞
Area under the concentration-time curve from time 0 to infinity
Time frame: Single-dose Administration Phase: Within 1 hour prior to injection on Day 1 (0 hour), and at 5 , 10 , 15 , 30 minutes, 1 , 2 , 4 , 8 , 12 and 24 hours after injection initiation. A total of 11 blood collection time points are included.
Pharmacokinetic (PK) Endpoints-AUC_%Extrap
Percentage of AUC extrapolation
Time frame: Single-dose Administration Phase: Within 1 hour prior to injection on Day 1 (0 hour), and at 5 , 10 , 15 , 30 minutes, 1 , 2 , 4 , 8 , 12 and 24 hours after injection initiation. A total of 11 blood collection time points are included.
Pharmacokinetic (PK) Endpoints-Tmax
Time to reach maximum concentration
Time frame: Single-dose Administration Phase: Within 1 hour prior to injection on Day 1 (0 hour), and at 5 , 10 , 15 , 30 minutes, 1 , 2 , 4 , 8 , 12 and 24 hours after injection initiation. A total of 11 blood collection time points are included.
Pharmacokinetic (PK) Endpoints-t₁/₂z
Terminal elimination half-life
Time frame: Single-dose Administration Phase: Within 1 hour prior to injection on Day 1 (0 hour), and at 5 , 10 , 15 , 30 minutes, 1 , 2 , 4 , 8 , 12 and 24 hours after injection initiation. A total of 11 blood collection time points are included.
Pharmacokinetic (PK) Endpoints-Vz/F
Apparent volume of distribution (terminal phase, extravascular route)
Time frame: Single-dose Administration Phase: Within 1 hour prior to injection on Day 1 (0 hour), and at 5 , 10 , 15 , 30 minutes, 1 , 2 , 4 , 8 , 12 and 24 hours after injection initiation. A total of 11 blood collection time points are included.
Pharmacokinetic (PK) Endpoints-CLz/F
Apparent total clearance (terminal phase, extravascular route)
Time frame: Single-dose Administration Phase: Within 1 hour prior to injection on Day 1 (0 hour), and at 5 , 10 , 15 , 30 minutes, 1 , 2 , 4 , 8 , 12 and 24 hours after injection initiation. A total of 11 blood collection time points are included.
Pharmacokinetic (PK) Endpoints-λz
Terminal elimination rate constant
Time frame: Single-dose Administration Phase: Within 1 hour prior to injection on Day 1 (0 hour), and at 5 , 10 , 15 , 30 minutes, 1 , 2 , 4 , 8 , 12 and 24 hours after injection initiation. A total of 11 blood collection time points are included.
Pharmacokinetic (PK) Endpoints-Css,max
Steady-state maximum concentration
Time frame: Multiple-dose Administration Phase: Within 1 hour prior to injection initiation on Day 29 (0 hour), within 1 hour prior to injection initiation on Day 57 (0 hour), and at 5, 10, 15, 30 minutes, 1, 2, 4, 8, 12 and 24 hours after injection initiation.
Pharmacokinetic (PK) Endpoints-Css,min
Steady-state minimum concentration
Time frame: Multiple-dose Administration Phase: Within 1 hour prior to injection initiation on Day 29 (0 hour), within 1 hour prior to injection initiation on Day 57 (0 hour), and at 5, 10, 15, 30 minutes, 1, 2, 4, 8, 12 and 24 hours after injection initiation.
Pharmacokinetic (PK) Endpoints-Css,av
Average steady-state concentration
Time frame: Multiple-dose Administration Phase: Within 1 hour prior to injection initiation on Day 29 (0 hour), within 1 hour prior to injection initiation on Day 57 (0 hour), and at 5, 10, 15, 30 minutes, 1, 2, 4, 8, 12 and 24 hours after injection initiation.
Pharmacokinetic (PK) Endpoints-AUC₀-τ
Area under the curve over one dosing interval
Time frame: Multiple-dose Administration Phase: Within 1 hour prior to injection initiation on Day 29 (0 hour), within 1 hour prior to injection initiation on Day 57 (0 hour), and at 5, 10, 15, 30 minutes, 1, 2, 4, 8, 12 and 24 hours after injection initiation.
Pharmacokinetic (PK) Endpoints-CLss/F
Apparent total clearance at steady state
Time frame: Multiple-dose Administration Phase: Within 1 hour prior to injection initiation on Day 29 (0 hour), within 1 hour prior to injection initiation on Day 57 (0 hour), and at 5, 10, 15, 30 minutes, 1, 2, 4, 8, 12 and 24 hours after injection initiation.
Pharmacokinetic (PK) Endpoints-Vz,ss/F
Apparent volume of distribution at steady state
Time frame: Multiple-dose Administration Phase: Within 1 hour prior to injection initiation on Day 29 (0 hour), within 1 hour prior to injection initiation on Day 57 (0 hour), and at 5, 10, 15, 30 minutes, 1, 2, 4, 8, 12 and 24 hours after injection initiation.
Pharmacokinetic (PK) Endpoints-Ra(Cmax)
Accumulation ratio of maximum concentration
Time frame: Multiple-dose Administration Phase: Within 1 hour prior to injection initiation on Day 29 (0 hour), within 1 hour prior to injection initiation on Day 57 (0 hour), and at 5, 10, 15, 30 minutes, 1, 2, 4, 8, 12 and 24 hours after injection initiation.
Pharmacokinetic (PK) Endpoints-Ra(AUC)
Accumulation ratio of AUC
Time frame: Multiple-dose Administration Phase: Within 1 hour prior to injection initiation on Day 29 (0 hour), within 1 hour prior to injection initiation on Day 57 (0 hour), and at 5, 10, 15, 30 minutes, 1, 2, 4, 8, 12 and 24 hours after injection initiation.
Pharmacokinetic (PK) Endpoints-DF
Fluctuation degree / Degree of fluctuation
Time frame: Multiple-dose Administration Phase: Within 1 hour prior to injection initiation on Day 29 (0 hour), within 1 hour prior to injection initiation on Day 57 (0 hour), and at 5, 10, 15, 30 minutes, 1, 2, 4, 8, 12 and 24 hours after injection initiation.
Safety Endpoints-AE(adverse events)
Safety assessments and grading of adverse events (AEs) occurring throughout the study period were performed in accordance with NCI-CTCAE Version 5.0.
Time frame: Day 1 to Week 24
Safety Endpoints-SAE(Serious adverse events)
Safety assessed by CTCAE v5.0 of the SAE(Serious adverse events) during the study.
Time frame: Day 1 to Week 24
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