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Safety and Effect on Pain and Function According to RAPID-3 of IHL-675A in Patients With Rheumatoid Arthritis (CHAPPII)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT05942911
Recruitment Status : Recruiting
First Posted : July 12, 2023
Last Update Posted : November 27, 2023
Sponsor:
Information provided by (Responsible Party):
Incannex Healthcare Ltd

Brief Summary:

The goal of this randomised, double-blind, placebo-controlled Phase II clinical trial is to assess the safety and effect of of IHL-675A in rheumatoid arthritis patients on pain, and function according to RAPID-3.

128 volunteers will be enrolled and randomised to one of four treatments (32 subjects per treatment). Each treatment will be self-administered twice daily for 24 weeks.

The four treatments are:

  • Treatment 1 - IHL-675A
  • Treatment 2 - CBD
  • Treatment 3 - HCQ
  • Treatment 4 - Placebo

Condition or disease Intervention/treatment Phase
Rheumatoid Arthritis Drug: IHL-675A Drug: Cannabidiol Drug: Hydroxychloroquine Drug: Placebo Phase 2

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 128 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double (Participant, Investigator)
Masking Description: Double-blind
Primary Purpose: Treatment
Official Title: A Phase II, Blinded, Randomised, Placebo Controlled Clinical Trial to Determine the Safety and Effect on Pain and Function According to RAPID-3 of IHL-675A in Patients With Rheumatoid Arthritis
Actual Study Start Date : November 22, 2023
Estimated Primary Completion Date : October 2024
Estimated Study Completion Date : December 2024

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: IHL-675A
150 mg CBD, 200 mg HCQ: two soft gel capsules each containing 75 mg CBD and 100 mg HCQ twice per day for a total daily dose of 300 mg CBD and 400 mg HCQ
Drug: IHL-675A
Combination product containing CBD and HCQ UniGel™ technology by ProCaps®. IHL-675A consists of a solid, film coated HCQ tablet that is contained within a CBD oil solution gel cap. Each IHL-675A gel cap contains 75 mg of CBD and 100 mg HCQ.

Active Comparator: Cannabidiol
150 mg: two capsules each containing 75 mg CBD twice per day for a total daily dose of 300 mg CBD
Drug: Cannabidiol
Formulated using UniGel™ technology by ProCaps®. The CBD soft gel capsules contain 75 mg CBD oil solution. These capsules look identical to the IHL-675A UniGel™ capsules, to aid double-blinding
Other Names:
  • CBD
  • Epidiolex
  • Epydiolex

Active Comparator: Hydroxychloroquine
200 mg: two capsules each containing 100 mg HCQ twice per day for a total daily dose of 400 mg HCQ
Drug: Hydroxychloroquine
Formulated using UniGel™ technology by ProCaps®. The soft gel capsules each contain a 100 mg HCQ tablet. These capsules look identical to the IHL-675A UniGel™ capsules to aid double-blinding.
Other Names:
  • HCQ
  • Plaquenil

Placebo Comparator: Placebo
Two capsules twice per day
Drug: Placebo
Formulated using UniGel™ technology by ProCaps®. The soft gel capsules contain the inactive ingredients of the IHL-675A capsules and no active ingredients. These capsules look identical to the IHL-675A UniGel™ capsules to aid double-blinding.




Primary Outcome Measures :
  1. Change in pain and function [ Time Frame: 24 weeks ]

    Routine Assessment of Patient Index Data 3 (RAPID-3) questionnaire to assess pain and function in arthritis patients.

    RAPID-3 is a pooled index of the 3 patient-reported American College of Rheumatology RA Core Data Set measures: function, pain, and patient global estimate of status. Each of the 3 individual measures is scored 0 to 10, for a total of 30. Disease severity may be classified on the basis of RAPID3 scores: >12 = high; 6.1-12 = moderate; 3.1-6 = low; < or =3 = remission



Secondary Outcome Measures :
  1. Safety and tolerability - Incidence of the use of concomitant medications for pain management [ Time Frame: 4, 8, 12, 16, 20 and 24 weeks ]
    Incidence of the use of concomitant pain medications for the treatment of arthritis related pain. Subjects will report the use of rescue pain medication for pain associated with arthritis using an electronic patient reported outcome (ePRO) on their personal device.

  2. Safety and tolerability - Vital signs - Temperature [ Time Frame: 4, 8, 12, 16, 20 and 24 weeks ]
    Change from baseline in body temperature (°C)

  3. Safety and tolerability - Vital signs - Pulse Rate [ Time Frame: 4, 8, 12, 16, 20 and 24 weeks ]
    Change from baseline in pulse rate (BPM)

  4. Safety and tolerability - Vital signs - Respiratory Rate [ Time Frame: 4, 8, 12, 16, 20 and 24 weeks ]
    Change from baseline in respiratory rate (RPM)

  5. Safety and tolerability - Vital signs - Blood Pressure [ Time Frame: 4, 8, 12, 16, 20 and 24 weeks ]
    Change from baseline in systolic blood pressure (mmHg) and diastolic blood pressure (mmHg) to report change in blood pressure

  6. Safety and tolerability - 12-lead ECG [ Time Frame: 4, 8, 12, 16, 20 and 24 weeks ]
    Change from baseline in 12-lead ECG results: PR interval, QRS, QTcF

  7. Safety and tolerability - Adverse Events [ Time Frame: 4, 8, 12, 16, 20 and 24 weeks ]
    Assess the number of treatment emergent adverse events (TEAEs) and serious treatment emergent adverse events associated with the dosing of IHL-675A in comparison to the active comparators (CBD and HCQ), and placebo.

  8. Safety and tolerability - OCT Eye Exam [ Time Frame: 24 weeks ]
    Changes from baseline in retinopathy as assessed by Optical Coherence Tomography (OCT) eye exam

  9. Safety and tolerability - The Columbia Suicide Severity Rating Scale (C-SSRS) [ Time Frame: 24 weeks ]
    Change from baseline in suicidality assessed by The Columbia Suicide Severity Rating Scale (C-SSRS). The C-SSRS is an instrument that measures suicidal ideation and behaviour. The ideation subscale evaluates severity on a 5-point scale, ranging from "wish to be dead" to "active suicidal ideation with specific plan and intent." The behaviour subscale assesses various categories of suicidal behaviour. Higher scores on the C-SSRS represent more severe levels of suicidal ideation or behaviour. Lower scores, therefore, indicate a better outcome as it represents lower levels of suicidal ideation or behaviour.

  10. Change in pain - Routine Assessment of Patient Index Data 3 (RAPID-3) [ Time Frame: 4, 8, 12, 16 and 20 weeks ]
    Change in pain from baseline. Assessed by change in Routine Assessment of Patient Index Data 3 (RAPID-3) score relative to baseline. RAPID-3 is a composite score that measures physical function, pain, and patient global assessment on a scale from 0 to 30, with higher scores indicating worse outcomes (i.e., more pain and disability). A decrease in the RAPID-3 score from baseline represents an improvement.

  11. Change in fatigue - Functional Assessment of Chronic Illness Therapy - Fatigue (FACIT-F) [ Time Frame: 4, 8, 12, 16, 20 and 24 weeks ]
    Change in fatigue from baseline. Assessed by change in the Functional Assessment of Chronic Illness Therapy - Fatigue (FACIT-F) score. FACIT-F is a 40-item measure that assesses self-reported fatigue and its impact upon daily activities and function on a scale from 0 to 160. Higher scores indicate better outcomes (i.e., less fatigue). An increase in the FACIT-F score from baseline represents an improvement.

  12. Change in quality of life - Health Assessment Questionnaire - Disability Index (HAQ-DI) [ Time Frame: 4, 8, 12, 16, 20 and 24 weeks ]
    Change in quality of life from baseline. Assessed by change in Health Assessment Questionnaire - Disability Index (HAQ-DI) score. The HAQ-DI assesses a patient's level of functional ability on a scale from 0 to 3. Higher scores indicate worse outcomes (i.e., greater disability). A decrease in the HAQ-DI score from baseline represents an improvement.

  13. Change in disease activity - ACR20 [ Time Frame: 4, 8, 12, 16, 20 and 24 weeks ]
    Change in disease activity from baseline. Assessed by change in American College of Rheumatology-20 (ACR20) response rate. The ACR response is scored as a percentage improvement, comparing disease activity at two discrete time points (usually baseline and post-baseline comparison). ACR20 is ≥ 20% improvement

  14. Change in disease activity - JC66/68 [ Time Frame: 4, 8, 12, 16, 20 and 24 weeks ]
    Change in disease activity from baseline. Assessed by change in joint swelling/tenderness count 66/68 (JC66/68). The 66/68 Joint Count evaluates 66 joints for swelling and 68 joints for tenderness and pain with movement. Note that the hip joints can be evaluated for tenderness only-not for swelling. The total score is composed of points that are based on the presence of pain and/or swelling in a joint

  15. Change in disease activity - CDAI-RA [ Time Frame: 4, 8, 12, 16, 20 and 24 weeks ]
    Change in disease activity from baseline. Assessed by change in clinical disease activity index for rheumatoid arthritis (CDAI-RA) score. CDAI is based on the simple summation of the count of swollen/tender joint count of 28 joints along with patient and physician global assessment on VAS (0-10 cm) Scale for estimating disease activity. The CDAI has range from 0 to 76.

  16. Change in inflammatory serology - C-Reactive Protein (CRP) [ Time Frame: 4, 8, 12, 16, 20 and 24 weeks ]
    Change in CRP levels from baseline. Assessed by the change in blood C-reactive protein (CRP) levels relative to baseline. CRP is a systemic marker of inflammation. The measurement is reported in milligrams per litre (mg/L). Higher levels of CRP typically indicate a higher level of systemic inflammation, so a decrease in CRP levels from baseline would generally indicate an improvement.

  17. Change in inflammatory serology - Erythrocyte sedimentation rate (ESR) [ Time Frame: 4, 8, 12, 16, 20 and 24 weeks ]
    Change in ESR levels from baseline. This outcome is assessed by the change in blood erythrocyte sedimentation rate (ESR) levels relative to baseline. ESR is a systemic marker of inflammation. The measurement is reported in millimetres per hour (mm/hr). Higher ESR levels typically indicate a higher level of systemic inflammation, so a decrease in ESR levels from baseline would generally indicate an improvement.

  18. Change in tiredness [ Time Frame: 24 weeks ]
    Change in tiredness from baseline. Assessed by an electronic patient reported outcome (ePRO). Subjects will be prompted daily to answer a set of 5 questions that will ask the patient about their pain, joint stiffness duration and severity, and tiredness, and to record the use of any concomitant medication for pain associated with arthritis.

  19. Change in pain (daily) [ Time Frame: 24 weeks ]
    Change in pain from baseline. Assessed by an electronic patient reported outcome (ePRO). Subjects will be prompted daily to answer a set of 5 questions that will ask the patient about their pain, joint stiffness duration and severity, and tiredness, and to record the use of any concomitant medication for pain associated with arthritis.

  20. Change in joint stiffness duration [ Time Frame: 24 weeks ]
    Change in joint stiffness duration from baseline. Assessed by an electronic patient reported outcome (ePRO). Subjects will be prompted daily to answer a set of 5 questions that will ask the patient about their pain, joint stiffness duration and severity, and tiredness, and to record the use of any concomitant medication for pain associated with arthritis.

  21. Change in joint stiffness severity [ Time Frame: 24 weeks ]
    Change in joint stiffness severity from baseline. Assessed by an electronic patient reported outcome (ePRO). Subjects will be prompted daily to answer a set of 5 questions that will ask the patient about their pain, joint stiffness duration and severity, and tiredness, and to record the use of any concomitant medication for pain associated with arthritis.

  22. Effect of IHL-675A on cytokines [ Time Frame: 12 and 24 weeks ]
    Change in cytokines IL-1β, IL-6, TNF levels compared to pre-dose levels.


Other Outcome Measures:
  1. Structural effects of IHL-675A [ Time Frame: 24 weeks ]
    Change in Rheumatoid Arthritis Magnetic Resonance Imaging Score (RAMRIS) at 24 weeks (visit week 25) compared to baseline in a sub-study of subjects who have affected wrist and metacarpophalangeal joints (applicable to sub-study only).



Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

Subjects will be included in the study if they satisfy all the following criteria:

  1. Must have given written informed consent, before any study-related activities are carried out and must be able to understand the full nature and purpose of the trial, including possible risks and adverse effects
  2. Has been diagnosed with RA and on stable treatment for RA for at least 3 months prior to the screening visit
  3. Subject has a RAPID-3 score of >4.5 at screening
  4. Male or female, aged 18 or older inclusive at the screening visit
  5. Body mass index (BMI) of 18 to 32 kg/m2, inclusive, at screening
  6. Has at least two swollen or tender joints on the JC 66/68 at screening
  7. Subject is otherwise medically healthy (in the opinion of the investigator), as determined by pre-study medical history and without clinically significant abnormalities including:

    1. Physical examination at screening without any additional clinically relevant findings apart from those consistent with RA in the opinion of the investigator.
    2. Systolic blood pressure at screening in the range of 90 to 160 mmHg and diastolic blood pressure in the range of 50 to 95 mmHg after 5 minutes in supine or semi-supine position.
    3. Pulse rate at screening in the range of 45 to 100 beats/minute after 5 minutes rest in supine or semi-supine position.
    4. Body temperature (tympanic) at screening between 35.5°C and 37.5°C.
    5. Electrocardiogram (ECG) at screening without clinically significant abnormal findings including QT interval corrected for Fredericia (QTcF) ≤470msec for females and ≤450msec for males.
  8. Physically well, in the opinion of the investigator, with no severe psychiatric, cardiac, renal, endocrine, gastrointestinal, bleeding, thyroid, cholesterol, or hypertension disorders
  9. Male subjects must:

    1. Agree not to donate sperm from the time of signing consent until at least 340 days (t1/2 *5 +90 days) after the last dose of study drug
    2. If engaging in sexual intercourse with a female partner who could become pregnant, must agree to use adequate contraception (defined as use of a condom plus a highly effective method of contraception (Appendix 10) from the time of signing consent until at least 340 days after the last dose of study drug).
    3. If engaging in sexual intercourse with a female partner who is not of childbearing potential or a same-sex partner, must agree to use a condom from the time of signing consent until at least 340 days after the last dose of study drug.
  10. Female subjects must be of non-childbearing potential i.e., surgically sterilised (hysterectomy, bilateral salpingectomy, bilateral oophorectomy at least 6 weeks before screening) or postmenopausal (where postmenopausal is defined as no menses for 12 months without an alternative medical cause and a follicle-stimulating hormone (FSH) level consistent with postmenopausal status, per local laboratory guidelines), or, if of childbearing potential (Women who have been surgically sterilised through tubal ligation are permitted to participate, if they agree to use an additional barrier method of contraception from one month prior to the first dose of study drug, until at least 280 days (t1/2 * 5 +30 days) after the last dose of study drug.):

    1. Must have a negative serum pregnancy test at screening and a negative urine pregnancy test prior to administration of the first dose of study drug. Note: subjects must also have a negative urine pregnancy test at each clinic visit.
    2. Must agree not to donate ova or attempt to become pregnant from the time of signing consent until at least 280 days after the last dose of study drug.
    3. If not exclusively in a same-sex relationship, must agree to use adequate contraception (which is defined as use of a condom by the male partner combined with use of a highly effective method of contraception (Appendix 10) from one month prior the first dose of study drug until at least 280 days after the last dose of study drug).
  11. Able to avoid strenuous exercise from 72 hours prior to each visit to the clinical unit
  12. Fluent in written and spoken English
  13. Willing and able to comply with all study required tasks, including the completion of questionnaires, and to adhere to the study schedule and restrictions, as instructed by the protocol.

Exclusion Criteria:

Subjects will be excluded from the study if there is evidence of any of the following at screening.

Subjects will be excluded from the study if there is evidence of any of the following at screening.

  1. Known hypersensitivity to any of the study drug ingredients (cannabis products, sesame oil, hydroxychloroquine or chloroquine)
  2. History of any clinically significant (in the opinion of the investigator) disorder within the last 3 months including cardiovascular (cardiac disease or arrythmias), haematologic, pulmonary, hepatic, renal, or gastrointestinal (such as cholecystitis, Gilbert's syndrome) disorders, or connective tissue, uncontrolled endocrine/metabolic, oncologic (within the last 5 years), neurologic, or any disorder within the last 3 months that may prevent the successful completion of the study or influence the absorption, distribution, metabolism, excretion or action of the study drug (in the opinion of the investigator). Note: a history of fully resolved childhood asthma is not exclusionary; a history of cholecystectomy is not exclusionary
  3. Family history of QT issues
  4. Currently taking or have taken hydroxychloroquine, chloroquine or any drugs containing HCQ or chloroquine within 3 months of screening
  5. Taking more than 10 mg prednisone per day
  6. Pregnant, lactating, planning to become pregnant
  7. Known substance abuse or medical, psychological, or social conditions or significant psychiatric illness (defined as hospitalisation), suicidal ideation, or suicidal attempts that, in the opinion of the investigator, may interfere with the subjects inclusion in the clinical study or evaluation of the clinical study results
  8. Regular consumption of >10 standard alcoholic drinks/week where 1 standard drink is 10 g of pure alcohol and is equivalent to 285 mL beer [4.9% Alc/Vol], 100 mL wine [12% Alc/Vol], 30 mL spirit [40% Alc/Vol])
  9. Positive urine illicit drug test at screening
  10. C-SSRS score ≥4 OR reported suicidal behaviour within the past 3 months
  11. Hepatic or renal impairment or disease defined as aspartate aminotransferase (AST)/ alanine aminotransferase (ALT) >1.5 x upper limit of normal (ULN), estimated glomerular filtration rate (eGFR) <60 at screening
  12. Subject has retinopathy or history thereof (as determined by the OCT eye examination at screening)
  13. A positive test result for active human immunodeficiency virus (HIV-1 or HIV-2), hepatitis B antigen (HBsAg) or hepatitis C virus (HCV) antibodies at the screening visit.
  14. History of gastrointestinal disorders which may impact absorption, distribution, metabolism and/or excretion of the IP (such as cholecystitis, cholecystectomy, Gilbert's syndrome)
  15. Participation in another clinical trial of an investigational drug within 30 Days or 5 half-lives of the investigational drug (whichever is longer) prior to screening
  16. Any other condition or prior therapy that in the opinion of the Investigator (or delegate) would make the subject unsuitable for this study, including inability to cooperate fully with the requirements of the study protocol or likelihood of noncompliance with any study requirements.

MRI Sub-Study Inclusion Criteria:

Subjects may also participate in the MRI Sub-Study based on the below inclusion criteria.

  1. Must have given written informed consent to participate in the MRI sub-study
  2. Able and willing to undergo an MRI
  3. Have at least 1 swollen and/or tender joint in left or right wrist or hand
  4. Have a RAMRIS synovitis score of at least 1

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT05942911


Contacts
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Contact: Mark Bleackley, PhD -61 (0) 400 423 364 mark@incannex.com.au
Contact: Pia Kroner, BMedSci Hons +61 (0) 420 933 630 pia@incannex.com.au

Locations
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Australia, Australian Capital Territory
Paratus Clinical (Woden Dermatology) Not yet recruiting
Phillip, Australian Capital Territory, Australia, 2606
Contact: Anna Dorai Raj, Dr    1300742326      
Principal Investigator: Anna' Dorai Raj, Dr         
Australia, New South Wales
Genesis Research Services Not yet recruiting
Broadmeadow, New South Wales, Australia, 2292
Contact: Paul Mansfield, Dr    +61249851860      
Principal Investigator: Paul Mansfield, Dr         
Royal Prince Alfred Hospital Not yet recruiting
Camperdown, New South Wales, Australia, 2050
Contact: Peter Youssef, Prof    +61295156111      
Principal Investigator: Peter Youssef, Prof         
Novatrials Not yet recruiting
Kotara, New South Wales, Australia, 2289
Contact: Oscar Cumming, Dr    +61240893744      
Principal Investigator: Oscar Cumming, Dr         
Emeritus Research Recruiting
Sydney, New South Wales, Australia, 2019
Contact: Paul Bird, Prof    +61289648186      
Principal Investigator: Paul Bird, Prof         
Australia, Queensland
Coast Joint Care Not yet recruiting
Maroochydore, Queensland, Australia, 4558
Contact: Dave Nicholls, Dr    +61754431033      
Principal Investigator: Dave Nicholls, Dr         
AusTrials Westside (Taringa) Not yet recruiting
Taringa, Queensland, Australia, 4068
Contact: Florence Tiong, Dr    +61732785255      
Principal Investigator: Florence Tiong, Dr         
AusTrials Wellers Hill Not yet recruiting
Wellers Hill, Queensland, Australia, 4121
Contact: Ferdinandus de Looze, Dr    +61735170520      
Principal Investigator: Ferdinandus de Looze, Dr         
Australia, Victoria
Emeritus Research Melbourne Not yet recruiting
Camberwell, Victoria, Australia, 3124
Contact: Stephen Hall, Professor    +61395096166    stephenhall@emeritusresearch.com   
Contact: Cheryl-Ann Hawkins    +61395096166      
Australia, Western Australia
Captain Sterling Medical Centre Not yet recruiting
Nedlands, Western Australia, Australia, 6009
Contact: Michael Benson, Dr    +61893861858      
Principal Investigator: Michael Benson, Dr         
Sponsors and Collaborators
Incannex Healthcare Ltd
Investigators
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Principal Investigator: Stephen Hall, Prof. Emeritus Research
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Responsible Party: Incannex Healthcare Ltd
ClinicalTrials.gov Identifier: NCT05942911    
Other Study ID Numbers: IHL675ARAPhII
First Posted: July 12, 2023    Key Record Dates
Last Update Posted: November 27, 2023
Last Verified: November 2023

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Product Manufactured in and Exported from the U.S.: No
Keywords provided by Incannex Healthcare Ltd:
Arthritis
MRI
RA
Rheumatoid Arthritis
Pain
Fatigue
RAMRIS
RAPID-3
Cannabidiol
CBD
Hydroxychloroquine
HCQ
Placebo
IHL-67A
Incannex
Joint pain
Stiffness
Additional relevant MeSH terms:
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Arthritis
Arthritis, Rheumatoid
Joint Diseases
Musculoskeletal Diseases
Rheumatic Diseases
Connective Tissue Diseases
Autoimmune Diseases
Immune System Diseases
Hydroxychloroquine
Cannabidiol
Antimalarials
Antiprotozoal Agents
Antiparasitic Agents
Anti-Infective Agents
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Antirheumatic Agents
Anticonvulsants