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Hand OsteoarthritisHOPE-eNCT04036929

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

A study testing Estrogen-bazedoxifene in people with Hand Osteoarthritis, run by University of Oxford at 3 sites in United Kingdom.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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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… Read more about this study

Who is it for?
Ages 40 to 65 years, women only
Conditions the study is for
Hand Osteoarthritis
What is being tested?
Estrogen-bazedoxifene
Type of treatment
Pill or oral medicine
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
28 participants
Where
3 sitesUnited Kingdom
Study dates
9 May 2019to 10 Dec 2021
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 40 to 65 years
  • Women only
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • 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)
Show all 15Show fewer
  • Fulfils American College of Rheumatology clinical diagnostic criteria for hand OA (3 or more of following):
  • 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)
  • Hard tissue enlargement of 2 or more of the DIPJs
  • Less than 3 swollen metacarpophalangeal joints (MCPJ)
  • 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

Who cannot join

  • 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
Show all 34Show fewer
  • 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

Trial locations and contacts

3 sites in 1 country.

United Kingdom3 sites
  • White Horse Medical Practice, Faringdon Medical Centre

    Faringdon, Oxfordshire, SN7 7YU

  • Charing Cross Hospital, Imperial College Healthcare NHS Trust

    London, W6 8RF

  • Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust

    Oxford, OX3 7HE

Other trials in United Kingdom

About this study

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

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.

Being tested
Estrogen-bazedoxifene, Placebo oral tablet
Keywords
Osteoarthritis, Hand, Hormone, Pain, Estrogen
Medical subject headings
Osteoarthritis, Pain

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Estrogen-bazedoxifeneDrug

    Also called Duavive

    Conjugated estrogens 0.45 mg-bazedoxifene acetate 20 mg.

  • Placebo oral tabletDrug

    Placebo oral tablet

Study groups in NCT04036929
Study groupRoleWhat they receive
Estrogen-bazedoxifeneExperimentalTablet, once daily for 6 months.
Receives: Drug: Estrogen-bazedoxifene
PlaceboPlacebo comparatorClosely matched tablet, once daily for 6 months.
Receives: Drug: Placebo oral tablet

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Feasibility: Rates of eligible participant identification, rates of recruitment/randomisation from different sources, retention rates

    Measured: From the date of recruitment opening until the date of recruitment closing, 1 year

  2. Feasibility: Frequency of adverse events related to the active study medication

    Measured: Through study completion, 7 months

  3. Feasibility: Bang's Blinding Index (likelihood of unblinding)

    Self-complete questionnaire which assesses likelihood that participant or Investigator have become unblinded

    Measured: Week 24

  4. 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.

    Measured: From randomisation to end of treatment at Week 24

Secondary outcomes (12)
  1. 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"

    Measured: Collected at: Baseline, Week 4, Week 12, Week 24

  2. 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"

    Measured: Collected at: Baseline, Week 4, Week 12, Week 24

  3. Pain and function: Prevalence of joint pain elsewhere (pain manikin)

    Prevalence of joint pain elsewhere in the 4 weeks preceding the study visit

    Measured: Collected at: Baseline, Week 12, Week 24

  4. 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).

    Measured: Collected at: Baseline, Week 12, Week 24

  5. 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.

    Measured: Collected at: Baseline, Week 12, Week 24

  6. 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.

    Measured: Collected at: Baseline, Week 12, Week 24

  7. 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.

    Measured: Collected at: Baseline, Week 12, Week 24

  8. 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.

    Measured: Collected at: Baseline, Week 12, Week 24

  9. Joint appearance: Investigator-recorded tender and swollen joint counts

    Investigator examination of tender and swollen hand joints, binary recording (1 swollen, 0 not swollen).

    Measured: Collected at: Baseline, Week 12, Week 24

  10. Joint appearance: Photographic recording of swollen hand joints

    Standardised digital photography of hands

    Measured: Collected at: Baseline, Week 12, Week 24

  11. 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.

    Measured: Collected at: Baseline, Week 12, Week 24

  12. End of Treatment questionnaire (study-specific)

    A study specific end of treatment questionnaire will be designed to include items on acceptability.

    Measured: Week 24

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted30 Jul 2019
  2. Study start9 May 2019
  3. Primary completion19 Aug 2021
  4. Study completion10 Dec 2021

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Other
Allocation
Randomised
Intervention model
Parallel groups
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
28 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04036929
Sponsor's protocol ID
HOPE-e
Acronym
HOPE-e
Status last verified
Apr 2022
First submitted
21 Jun 2019
Last updated
21 Apr 2022
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No: Access to the de-identified dataset for purposes of research other than this study, would be at the discretion of the Chief Investigator, Dr Fiona Watt and OCTRU. All participants have consented to the information collected about them from the study may be used in a de-identified form to support other research on hand osteoarthritis in the future and may in certain circumstances be passed on to other collaborators of the research team in organisations other than the University of Oxford, which may include those outside the EU and commercial organisations. Requests for the de-identified dataset generated during the current study should be made to the Chief Investigator, Dr Fiona Watt (fiona.watt@kennedy.ox.ac.uk) or OCTRU (octrutrialshub@ndorms.ox.ac.uk). Dr Fiona Watt and OCTRU will consider requests once the main results from the study have been published up until 10 Dec 2036 . All requests must relate to bone fide research into hand osteoarthritis research.

Publications

  • 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.

    PubMed 34167594

Questions about this trial

What is this clinical trial studying?

A study testing Estrogen-bazedoxifene in people with Hand Osteoarthritis, run by University of Oxford at 3 sites in United Kingdom.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 15 inclusion and 34 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 21 Apr 2022. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 3 sites in United Kingdom. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Feasibility: Rates of eligible participant identification, rates of recruitment/randomisation from different sources, retention rates (time frame: From the date of recruitment opening until the date of recruitment closing, 1 year). The study lists 4 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04036929, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 21 Apr 2022.

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