Effects of Intraarticular Botulinum Toxin A in Ankle Osteoarthritis

NCT ID: NCT01760577

Last Updated: 2013-01-04

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

70 participants

Study Classification

INTERVENTIONAL

Study Start Date

2010-05-31

Study Completion Date

2012-11-30

Brief Summary

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The purpose of this study is to compare the effects of intraarticular Botulinum Toxin A versus intraarticular hyaluronate plus rehabilitation exercise in patients with ankle osteoarthritis.

Detailed Description

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Recent pilot studies report that intraarticular injection of Botulinum Toxin A into painful joints of patients with various types of arthritis leads to significant and durable improvement in pain and function and is safe to use. To date, there is no published literature that evaluate the effects of intraarticular Botulinum Toxin A in the treatment of ankle OA. Sun el al reported that 3 or 5 weekly injection of hyaluronate may improve pain and physical function in patients with ankle OA and the treatment effects may last for 6 months. The effect of one injection of hyaluronate plus exercise had never been studied. The purpose of this study is to compare the effects of intraarticular Botulinum Toxin A versus intraarticular hyaluronate plus rehabilitation exercise for patients with ankle OA.

Conditions

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Ankle Osteoarthritis

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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The Botulinum Toxin A group

The Botulinum Toxin A group received intraarticular injections of 100 units of Botulinum Toxin A (Allergan, Inc, Irvine CA) reconstituted in 2 cc normal saline.

Group Type EXPERIMENTAL

Botulinum Toxin A (Allergan, Inc, Irvine CA)

Intervention Type DRUG

patients received intraarticular injections by the same experienced physician using aseptic procedures.

The hyaluronate group (Hyalgan, Italy)

The hyaluronate group received intraarticular injections of 2 ml sodium hyaluronate (Hyalgan, molecular weight 500-730kDa, Fidia Pharmaceutical Corporation, Abano Terme, Italy) and subsequent 6 sessions of rehabilitation exercise for 50 miniutes/day, 3 days per week for 2 weeks and home exercise for 2 weeks .

Group Type ACTIVE_COMPARATOR

Hyalgan (Hyalgan, Fidia , Italy)

Intervention Type DRUG

The rehabilitation program consists of 6 sessions of rehabilitation exercise for 50 miniutes/day, 3 days per week for 2 weeks and home exercise program for another 2 weeks.

Interventions

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Botulinum Toxin A (Allergan, Inc, Irvine CA)

patients received intraarticular injections by the same experienced physician using aseptic procedures.

Intervention Type DRUG

Hyalgan (Hyalgan, Fidia , Italy)

The rehabilitation program consists of 6 sessions of rehabilitation exercise for 50 miniutes/day, 3 days per week for 2 weeks and home exercise program for another 2 weeks.

Intervention Type DRUG

Other Intervention Names

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100 units of Botulinum Toxin A in 2 cc NS 2 ml Hyalgan, molecular weight 500-730kDa, Fidia , Italy

Eligibility Criteria

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Inclusion Criteria

* an age of 20-85 years with diagnosis of ankle osteoarthritis
* unilateral ankle pain that had lasted for at least 6 months, with no significant benefit from conservative treatment or with an inability to tolerate the side effects of medications
* ankle radiographs taken within 6 months equivalent to grade 2 on the Kellgren-Lawrence grading system
* a current total Ankle Osteoarthritis Scale (AOS) score of \>3 and \< 9 (possible range, 0-10)
* a normal activity level-i.e., not bedridden or confined to a wheelchair, and are able to walk 30 meters without the aid of a walker, crutches or cane
* no changes in shoes or orthotic devices during the study period.

Exclusion Criteria

* pregnancy or lactation in women
* lower leg trauma other than ankle trauma
* previous surgery involving the spine, hip or knee
* the presence of an active joint infections of foot or ankle
* previous surgery or arthroscopy on the ankle within 12 months
* history of chicken or egg allergy
* intraarticular steroid or hyaluronate injection in the treated ankle within the previous 6 months
* treatment with anticoagulants or immunosuppressives
* a history of rheumatoid arthritis, gout, or any other inflammatory arthropathy
* the presence of other comorbidity (such as neoplasms, diabetes mellitus, paresis or recent trauma) or poor health status that would interfere with the clinical assessments during the study.
Minimum Eligible Age

20 Years

Maximum Eligible Age

85 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Kaohsiung Veterans General Hospital.

OTHER

Sponsor Role lead

Responsible Party

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Shu-Fen Sun

MD

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Shu-Fen Sun, MD

Role: PRINCIPAL_INVESTIGATOR

Kaohsiung Veterans General Hospital, Taiwan

Locations

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Kaohsiung Veterans General Hospital, No 386, Ta-Chung 1st Road

Kaohsiung City, , Taiwan

Site Status

Countries

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Taiwan

References

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Sun SF, Chou YJ, Hsu CW, Hwang CW, Hsu PT, Wang JL, Hsu YW, Chou MC. Efficacy of intra-articular hyaluronic acid in patients with osteoarthritis of the ankle: a prospective study. Osteoarthritis Cartilage. 2006 Sep;14(9):867-74. doi: 10.1016/j.joca.2006.03.003. Epub 2006 Apr 24.

Reference Type BACKGROUND
PMID: 16635582 (View on PubMed)

Sun SF, Hsu CW, Sun HP, Chou YJ, Li HJ, Wang JL. The effect of three weekly intra-articular injections of hyaluronate on pain, function, and balance in patients with unilateral ankle arthritis. J Bone Joint Surg Am. 2011 Sep 21;93(18):1720-6. doi: 10.2106/JBJS.J.00315.

Reference Type BACKGROUND
PMID: 21938376 (View on PubMed)

Mahowald ML, Singh JA, Dykstra D. Long term effects of intra-articular botulinum toxin A for refractory joint pain. Neurotox Res. 2006 Apr;9(2-3):179-88. doi: 10.1007/BF03033937.

Reference Type BACKGROUND
PMID: 16785116 (View on PubMed)

Singh JA, Mahowald ML, Kushnaryov A, Goelz E, Dykstra D. Repeat injections of intra-articular botulinum toxin a for the treatment of chronic arthritis joint pain. J Clin Rheumatol. 2009 Feb;15(1):35-8. doi: 10.1097/RHU.0b013e3181953b14. No abstract available.

Reference Type BACKGROUND
PMID: 19131763 (View on PubMed)

Singh JA, Mahowald ML, Noorbaloochi S. Intra-articular botulinum toxin A for refractory shoulder pain: a randomized, double-blinded, placebo-controlled trial. Transl Res. 2009 May;153(5):205-16. doi: 10.1016/j.trsl.2009.02.004. Epub 2009 Mar 13.

Reference Type BACKGROUND
PMID: 19375681 (View on PubMed)

Mahowald ML, Krug HE, Singh JA, Dykstra D. Intra-articular Botulinum Toxin Type A: a new approach to treat arthritis joint pain. Toxicon. 2009 Oct;54(5):658-67. doi: 10.1016/j.toxicon.2009.03.028. Epub 2009 Apr 5.

Reference Type BACKGROUND
PMID: 19351542 (View on PubMed)

Aoki KR. Evidence for antinociceptive activity of botulinum toxin type A in pain management. Headache. 2003 Jul-Aug;43 Suppl 1:S9-15. doi: 10.1046/j.1526-4610.43.7s.3.x.

Reference Type BACKGROUND
PMID: 12887389 (View on PubMed)

Sun SF, Chou YJ, Hsu CW, Chen WL. Hyaluronic acid as a treatment for ankle osteoarthritis. Curr Rev Musculoskelet Med. 2009 Jun;2(2):78-82. doi: 10.1007/s12178-009-9048-5. Epub 2009 Mar 13.

Reference Type BACKGROUND
PMID: 19468874 (View on PubMed)

Konttinen YT, Kemppinen P, Segerberg M, Hukkanen M, Rees R, Santavirta S, Sorsa T, Pertovaara A, Polak JM. Peripheral and spinal neural mechanisms in arthritis, with particular reference to treatment of inflammation and pain. Arthritis Rheum. 1994 Jul;37(7):965-82. doi: 10.1002/art.1780370701. No abstract available.

Reference Type BACKGROUND
PMID: 8024624 (View on PubMed)

Sun SF, Hsu CW, Lin HS, Chou YJ, Chen JY, Wang JL. Efficacy of intraarticular botulinum toxin A and intraarticular hyaluronate plus rehabilitation exercise in patients with unilateral ankle osteoarthritis: a randomized controlled trial. J Foot Ankle Res. 2014 Feb 6;7(1):9. doi: 10.1186/1757-1146-7-9.

Reference Type DERIVED
PMID: 24502534 (View on PubMed)

Other Identifiers

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VGHKS100-061

Identifier Type: -

Identifier Source: org_study_id

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