A Study to Evaluate the Safety and Efficacy of CNTX-6970 in Subjects With Knee Osteoarthritis Pain.

Summary

The primary objective of this study is to evaluate the safety and efficacy of CNTX-6970 for the treatment of pain related to OA of the knee compared to placebo. CNTX-6970 is being developed as a new treatment for chronic pain, including painful osteoarthritis of the knee.

Timeline

Start

2021-10-25

Primary completion

2024-06-11

Completion

2024-06-11

Outcome

Missed primary endpoint

paper trial participants reported slightly higher knee pain intensity when taking the novel chemokine antagonist CNTX-6970 than when taking placebo. PMID 41468282 ↗

paper pharmacologic blockade of specific chemokine receptors with this compound was not effective in reducing moderate-to-severe knee osteoarthritis pain. PMID 41468282 ↗

Publications

• Background Arnold SE, Betensky RA. Multicrossover Randomized Controlled Trial Designs in Alzheimer Disease. Ann Neurol. 2018 Aug;84(2):168-175. doi: 10.1002/ana.25280. Epub 2018 Aug 29.
• Background Arroll B, Goodyear-Smith F, Crengle S, Gunn J, Kerse N, Fishman T, Falloon K, Hatcher S. Validation of PHQ-2 and PHQ-9 to screen for major depression in the primary care population. Ann Fam Med. 2010 Jul-Aug;8(4):348-53. doi: 10.1370/afm.1139.
• Background Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988 Dec;15(12):1833-40.
• Background Bhangoo S, Ren D, Miller RJ, Henry KJ, Lineswala J, Hamdouchi C, Li B, Monahan PE, Chan DM, Ripsch MS, White FA. Delayed functional expression of neuronal chemokine receptors following focal nerve demyelination in the rat: a mechanism for the development of chronic sensitization of peripheral nociceptors. Mol Pain. 2007 Dec 12;3:38. doi: 10.1186/1744-8069-3-38.
• Background Boakye M, Harkema S, Ellaway PH, Skelly AC. Quantitative testing in spinal cord injury: overview of reliability and predictive validity. J Neurosurg Spine. 2012 Sep;17(1 Suppl):141-50. doi: 10.3171/2012.5.AOSPINE1296.
• Background Bruehl S, Liu X, Burns JW, Chont M, Jamison RN. Associations between daily chronic pain intensity, daily anger expression, and trait anger expressiveness: an ecological momentary assessment study. Pain. 2012 Dec;153(12):2352-2358. doi: 10.1016/j.pain.2012.08.001. Epub 2012 Aug 30.
• Background Buckner JD, Crosby RD, Silgado J, Wonderlich SA, Schmidt NB. Immediate antecedents of marijuana use: an analysis from ecological momentary assessment. J Behav Ther Exp Psychiatry. 2012 Mar;43(1):647-55. doi: 10.1016/j.jbtep.2011.09.010. Epub 2011 Sep 14.
• Background Chen X, Chen P. A comparison of four methods for the analysis of N-of-1 trials. PLoS One. 2014 Feb 4;9(2):e87752. doi: 10.1371/journal.pone.0087752. eCollection 2014.
• Background Centrexion Investigator's Brochure for CNTX-6970. Version 2, 21 February 2019.
• Background Ciarleglio A, Petkova E, Ogden T, Tarpey T. Constructing treatment decision rules based on scalar and functional predictors when moderators of treatment effect are unknown. J R Stat Soc Ser C Appl Stat. 2018 Nov;67(5):1331-1356. doi: 10.1111/rssc.12278. Epub 2018 Apr 16.
• Background Dunton GF. Ecological Momentary Assessment in Physical Activity Research. Exerc Sport Sci Rev. 2017 Jan;45(1):48-54. doi: 10.1249/JES.0000000000000092.
• Background Dworkin RH, Turk DC, Farrar JT, Haythornthwaite JA, Jensen MP, Katz NP, Kerns RD, Stucki G, Allen RR, Bellamy N, Carr DB, Chandler J, Cowan P, Dionne R, Galer BS, Hertz S, Jadad AR, Kramer LD, Manning DC, Martin S, McCormick CG, McDermott MP, McGrath P, Quessy S, Rappaport BA, Robbins W, Robinson JP, Rothman M, Royal MA, Simon L, Stauffer JW, Stein W, Tollett J, Wernicke J, Witter J; IMMPACT. Core outcome measures for chronic pain clinical trials: IMMPACT recommendations. Pain. 2005 Jan;113(1-2):9-19. doi: 10.1016/j.pain.2004.09.012. No abstract available.
• Background Edwards RR, Dworkin RH, Turk DC, Angst MS, Dionne R, Freeman R, Hansson P, Haroutounian S, Arendt-Nielsen L, Attal N, Baron R, Brell J, Bujanover S, Burke LB, Carr D, Chappell AS, Cowan P, Etropolski M, Fillingim RB, Gewandter JS, Katz NP, Kopecky EA, Markman JD, Nomikos G, Porter L, Rappaport BA, Rice ASC, Scavone JM, Scholz J, Simon LS, Smith SM, Tobias J, Tockarshewsky T, Veasley C, Versavel M, Wasan AD, Wen W, Yarnitsky D. Patient phenotyping in clinical trials of chronic pain treatments: IMMPACT recommendations. Pain. 2016 Sep;157(9):1851-1871. doi: 10.1097/j.pain.0000000000000602.
• Background Evans K, Romero H, Katz N. Qualitative evaluation and responsiveness of the staircase-evoked pain procedure (STEPP) in two clinical trials of treatments for knee osteoarthritis (OA). https://www.oarsijournal.com/article/S1063-4584(20)30302-2/abstract DOI:https://doi.org/10.1016/j.joca.2020.02.235.
• Background Farrar JT, Troxel AB, Haynes K, Gilron I, Kerns RD, Katz NP, Rappaport BA, Rowbotham MC, Tierney AM, Turk DC, Dworkin RH. Effect of variability in the 7-day baseline pain diary on the assay sensitivity of neuropathic pain randomized clinical trials: an ACTTION study. Pain. 2014 Aug;155(8):1622-1631. doi: 10.1016/j.pain.2014.05.009. Epub 2014 May 14.
• Background Gilron I, Ghasemlou N. Chronobiology of chronic pain: focus on diurnal rhythmicity of neuropathic pain. Curr Opin Support Palliat Care. 2014 Dec;8(4):429-36. doi: 10.1097/SPC.0000000000000085.
• Background Gryczynski J, McNeely J, Wu LT, Subramaniam GA, Svikis DS, Cathers LA, Sharma G, King J, Jelstrom E, Nordeck CD, Sharma A, Mitchell SG, O'Grady KE, Schwartz RP. Validation of the TAPS-1: A Four-Item Screening Tool to Identify Unhealthy Substance Use in Primary Care. J Gen Intern Med. 2017 Sep;32(9):990-996. doi: 10.1007/s11606-017-4079-x. Epub 2017 May 26.
• Background Garcia-Palacios A, Herrero R, Belmonte MA, Castilla D, Guixeres J, Molinari G, Banos RM. Ecological momentary assessment for chronic pain in fibromyalgia using a smartphone: a randomized crossover study. Eur J Pain. 2014 Jul;18(6):862-72. doi: 10.1002/j.1532-2149.2013.00425.x. Epub 2013 Nov 22.
• Background Hedeker D, Mermelstein RJ, Demirtas H. An application of a mixed-effects location scale model for analysis of Ecological Momentary Assessment (EMA) data. Biometrics. 2008 Jun;64(2):627-34. doi: 10.1111/j.1541-0420.2007.00924.x. Epub 2007 Oct 26.
• Background Hedeker D, Mermelstein RJ, Demirtas H. Modeling between-subject and within-subject variances in ecological momentary assessment data using mixed-effects location scale models. Stat Med. 2012 Nov 30;31(27):3328-36. doi: 10.1002/sim.5338. Epub 2012 Mar 15.
• Background Hughes CE, Nibbs RJB. A guide to chemokines and their receptors. FEBS J. 2018 Aug;285(16):2944-2971. doi: 10.1111/febs.14466. Epub 2018 Apr 24.
• Background Hunter DJ, Bierma-Zeinstra S. Osteoarthritis. Lancet. 2019 Apr 27;393(10182):1745-1759. doi: 10.1016/S0140-6736(19)30417-9.
• Background Jiang B, Petkova E, Tarpey T, Ogden RT. A Bayesian approach to joint modeling of matrix-valued imaging data and treatment outcome with applications to depression studies. Biometrics. 2020 Mar;76(1):87-97. doi: 10.1111/biom.13151. Epub 2019 Nov 14.
• Background Jung SY, Jang EJ, Nam SW, Kwon HH, Im SG, Kim D, Cho SK, Kim D, Sung YK. Comparative effectiveness of oral pharmacologic interventions for knee osteoarthritis: A network meta-analysis. Mod Rheumatol. 2018 Nov;28(6):1021-1028. doi: 10.1080/14397595.2018.1439694. Epub 2018 Mar 1.
• Background Kalliomaki J, Attal N, Jonzon B, Bach FW, Huizar K, Ratcliffe S, Eriksson B, Janecki M, Danilov A, Bouhassira D; AZD2423 PTN Study Group. A randomized, double-blind, placebo-controlled trial of a chemokine receptor 2 (CCR2) antagonist in posttraumatic neuralgia. Pain. 2013 May;154(5):761-767. doi: 10.1016/j.pain.2013.02.003. Epub 2013 Feb 13.
• Background Kalliomaki J, Jonzon B, Huizar K, O'Malley M, Andersson A, Simpson DM. Evaluation of a novel chemokine receptor 2 (CCR2)-antagonist in painful diabetic polyneuropathy. Scand J Pain. 2013 Apr 1;4(2):77-83. doi: 10.1016/j.sjpain.2012.10.003.
• Background Kan H, Arai Y, Kobayashi M, Nakagawa S, Inoue H, Hino M, Komaki S, Ikoma K, Ueshima K, Fujiwara H, Yokota I, Kubo T. Fixed-flexion view X-ray of the knee superior in detection and follow-up of knee osteoarthritis. Medicine (Baltimore). 2017 Dec;96(49):e9126. doi: 10.1097/MD.0000000000009126.
• Background Koelink PJ, Overbeek SA, Braber S, de Kruijf P, Folkerts G, Smit MJ, Kraneveld AD. Targeting chemokine receptors in chronic inflammatory diseases: an extensive review. Pharmacol Ther. 2012 Jan;133(1):1-18. doi: 10.1016/j.pharmthera.2011.06.008. Epub 2011 Aug 1.
• Background Kroenke K, Krebs EE, Turk D, Von Korff M, Bair MJ, Allen KD, Sandbrink F, Cheville AL, DeBar L, Lorenz KA, Kerns RD. Core Outcome Measures for Chronic Musculoskeletal Pain Research: Recommendations from a Veterans Health Administration Work Group. Pain Med. 2019 Aug 1;20(8):1500-1508. doi: 10.1093/pm/pny279.
• Background Kroenke K, Spitzer RL, Williams JB, Monahan PO, Lowe B. Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med. 2007 Mar 6;146(5):317-25. doi: 10.7326/0003-4819-146-5-200703060-00004.
• Background Li X, Hedeker D. A three-level mixed-effects location scale model with an application to ecological momentary assessment data. Stat Med. 2012 Nov 20;31(26):3192-210. doi: 10.1002/sim.5393. Epub 2012 Aug 3.
• Background Lin WC, Burke L, Schlenk EA, Yeh CH. Use of an Ecological Momentary Assessment Application to Assess the Effects of Auricular Point Acupressure for Chronic Low Back Pain. Comput Inform Nurs. 2019 May;37(5):276-282. doi: 10.1097/CIN.0000000000000478.
• Background Lundeen J, McCall WV, Looney S. Dealing with Methodological Issues in the Functional Data Analysis of Actigraphy Data. Journal of Biometrics & Biostatistics 2019; 10: 429.
• Background May M, Junghaenel DU, Ono M, Stone AA, Schneider S. Ecological Momentary Assessment Methodology in Chronic Pain Research: A Systematic Review. J Pain. 2018 Jul;19(7):699-716. doi: 10.1016/j.jpain.2018.01.006. Epub 2018 Jan 31.
• Background McWilliams LA, Kowal J, Wilson KG. Development and evaluation of short forms of the Pain Catastrophizing Scale and the Pain Self-efficacy Questionnaire. Eur J Pain. 2015 Oct;19(9):1342-9. doi: 10.1002/ejp.665. Epub 2015 Mar 11.
• Background MacDonald IJ, Liu SC, Su CM, Wang YH, Tsai CH, Tang CH. Implications of Angiogenesis Involvement in Arthritis. Int J Mol Sci. 2018 Jul 10;19(7):2012. doi: 10.3390/ijms19072012.
• Background Norton S, Cosco T, Doyle F, Done J, Sacker A. The Hospital Anxiety and Depression Scale: a meta confirmatory factor analysis. J Psychosom Res. 2013 Jan;74(1):74-81. doi: 10.1016/j.jpsychores.2012.10.010. Epub 2012 Nov 18.
• Background Osani MC, Vaysbrot EE, Zhou M, McAlindon TE, Bannuru RR. Duration of Symptom Relief and Early Trajectory of Adverse Events for Oral Nonsteroidal Antiinflammatory Drugs in Knee Osteoarthritis: A Systematic Review and Meta-Analysis. Arthritis Care Res (Hoboken). 2020 May;72(5):641-651. doi: 10.1002/acr.23884. Epub 2020 Apr 14.
• Background Park H, Petkova E, Tarpey T, Ogden RT. A single-index model with multiple-links. J Stat Plan Inference. 2020 Mar;205:115-128. doi: 10.1016/j.jspi.2019.05.008. Epub 2019 Jul 4.
• Background Park H, Petkova E, Tarpey T, Ogden RT. A constrained single-index regression for estimating interactions between a treatment and covariates. Biometrics. 2021 Jun;77(2):506-518. doi: 10.1111/biom.13320. Epub 2020 Jul 3.
• Background Parry EL, Thomas MJ, Peat G. Defining acute flares in knee osteoarthritis: a systematic review. BMJ Open. 2018 Jul 19;8(7):e019804. doi: 10.1136/bmjopen-2017-019804.
• Background Perrot S, Lanteri-Minet M. Patients' Global Impression of Change in the management of peripheral neuropathic pain: Clinical relevance and correlations in daily practice. Eur J Pain. 2019 Jul;23(6):1117-1128. doi: 10.1002/ejp.1378. Epub 2019 Mar 18.
• Background Petkova E, Park H, Ciarleglio A, Todd Ogden R, Tarpey T. Optimising treatment decision rules through generated effect modifiers: a precision medicine tutorial. BJPsych Open. 2019 Dec 3;6(1):e2. doi: 10.1192/bjo.2019.85.
• Background Plummer F, Manea L, Trepel D, McMillan D. Screening for anxiety disorders with the GAD-7 and GAD-2: a systematic review and diagnostic metaanalysis. Gen Hosp Psychiatry. 2016 Mar-Apr;39:24-31. doi: 10.1016/j.genhosppsych.2015.11.005. Epub 2015 Nov 18.
• Background Pocock SJ, Simon R. Sequential treatment assignment with balancing for prognostic factors in the controlled clinical trial. Biometrics. 1975 Mar;31(1):103-15.
• Background Reginster JY, Reiter-Niesert S, Bruyere O, Berenbaum F, Brandi ML, Branco J, Devogelaer JP, Herrero-Beaumont G, Kanis J, Maggi S, Maheu E, Richette P, Rizzoli R, Cooper C. Recommendations for an update of the 2010 European regulatory guideline on clinical investigation of medicinal products used in the treatment of osteoarthritis and reflections about related clinically relevant outcomes: expert consensus statement. Osteoarthritis Cartilage. 2015 Dec;23(12):2086-2093. doi: 10.1016/j.joca.2015.07.001. Epub 2015 Jul 14.
• Background Puljak L, Marin A, Vrdoljak D, Markotic F, Utrobicic A, Tugwell P. Celecoxib for osteoarthritis. Cochrane Database Syst Rev. 2017 May 22;5(5):CD009865. doi: 10.1002/14651858.CD009865.pub2.
• Background Read SJ, Dray A. Osteoarthritic pain: a review of current, theoretical and emerging therapeutics. Expert Opin Investig Drugs. 2008 May;17(5):619-40. doi: 10.1517/13543784.17.5.619.
• Background Salaffi F, Leardini G, Canesi B, Mannoni A, Fioravanti A, Caporali R, Lapadula G, Punzi L; GOnorthrosis and Quality Of Life Assessment (GOQOLA). Reliability and validity of the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index in Italian patients with osteoarthritis of the knee. Osteoarthritis Cartilage. 2003 Aug;11(8):551-60. doi: 10.1016/s1063-4584(03)00089-x.
• Background Salaffi F, Stancati A, Silvestri CA, Ciapetti A, Grassi W. Minimal clinically important changes in chronic musculoskeletal pain intensity measured on a numerical rating scale. Eur J Pain. 2004 Aug;8(4):283-91. doi: 10.1016/j.ejpain.2003.09.004.
• Background Serbina NV, Jia T, Hohl TM, Pamer EG. Monocyte-mediated defense against microbial pathogens. Annu Rev Immunol. 2008;26:421-52. doi: 10.1146/annurev.immunol.26.021607.090326.
• Background Schalet BD, Hays RD, Jensen SE, Beaumont JL, Fries JF, Cella D. Validity of PROMIS physical function measured in diverse clinical samples. J Clin Epidemiol. 2016 May;73:112-8. doi: 10.1016/j.jclinepi.2015.08.039. Epub 2016 Mar 9.
• Background Schmid CH, Duan N. Statistical design and analytic considerations for N-of-1 trials. Design and Implementation of N-of-1 Trials: A User's Guide Rockville, MD: Agency for Healthcare Research and Quality; 2014. p. 33-52.
• Background Sullivan MJL, Bishop S, Pivik J. The pain catastrophizing scale: development and validation. Psychol Assess 1995; 7: 432-524.
• Background Timmermans EJ, de Koning EJ, van Schoor NM, van der Pas S, Denkinger MD, Dennison EM, Maggi S, Pedersen NL, Otero A, Peter R, Cooper C, Siviero P, Castell MV, Herbolsheimer F, Edwards M, Limongi F, Deeg DJH, Schaap LA. Within-person pain variability and physical activity in older adults with osteoarthritis from six European countries. BMC Musculoskelet Disord. 2019 Jan 5;20(1):12. doi: 10.1186/s12891-018-2392-0.
• Background Treister R, Honigman L, Lawal OD, Lanier RK, Katz NP. A deeper look at pain variability and its relationship with the placebo response: results from a randomized, double-blind, placebo-controlled clinical trial of naproxen in osteoarthritis of the knee. Pain. 2019 Jul;160(7):1522-1528. doi: 10.1097/j.pain.0000000000001538.
• Background Treister R, Suzan E, Lawal OD, Katz NP. Staircase-evoked Pain May be More Sensitive Than Traditional Pain Assessments in Discriminating Analgesic Effects: A Randomized, Placebo-controlled Trial of Naproxen in Patients With Osteoarthritis of the Knee. Clin J Pain. 2019 Jan;35(1):50-55. doi: 10.1097/AJP.0000000000000651.
• Background van Buuren S, Groothuis-Oudshoorn K. Multivariate Imputation by Chained Equations in R. Journal of Statistical Software, 2011, 45(3), 1-67.
• Background Wasan AD, Alter BJ, Edwards RR, Argoff CE, Sehgal N, Walk D, Moeller-Bertram T, Wallace MS, Backonja M. Test-Retest and Inter-Examiner Reliability of a Novel Bedside Quantitative Sensory Testing Battery in Postherpetic Neuralgia Patients. J Pain. 2020 Jul-Aug;21(7-8):858-868. doi: 10.1016/j.jpain.2019.11.013. Epub 2019 Dec 11.
• Background White FA, Feldman P, Miller RJ. Chemokine signaling and the management of neuropathic pain. Mol Interv. 2009 Aug;9(4):188-95. doi: 10.1124/mi.9.4.7.
• Background Yu L, Buysse DJ, Germain A, Moul DE, Stover A, Dodds NE, Johnston KL, Pilkonis PA. Development of short forms from the PROMIS sleep disturbance and Sleep-Related Impairment item banks. Behav Sleep Med. 2011 Dec 28;10(1):6-24. doi: 10.1080/15402002.2012.636266.
• Background Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983 Jun;67(6):361-70. doi: 10.1111/j.1600-0447.1983.tb09716.x.
• Background Zucker DR, Schmid CH, McIntosh MW, D'Agostino RB, Selker HP, Lau J. Combining single patient (N-of-1) trials to estimate population treatment effects and to evaluate individual patient responses to treatment. J Clin Epidemiol. 1997 Apr;50(4):401-10. doi: 10.1016/s0895-4356(96)00429-5.
• Edwards RR, Tarpey T, Ashburn M, Baer C, Campbell A, Dworkin RH, Gaspard G, Flynn M, Hade E, Jain N, Judge H, Kamp C, Li Y, Meropol S, Petkova E, Philip A, Przkora R, Rathmell JP, Robinson-Papp J, Samuels J, Sehgal N, Sienty J, Stacey B, Wallace M, Wasan AD, Wise B, Yu C, Fava M, Troxel AB. A double-blind, placebo-controlled, multi-crossover trial of treatment with a chemokine antagonist for knee osteoarthritis pain. Pain. 2026 May 1;167(5):1137-1145. doi: 10.1097/j.pain.0000000000003904. Epub 2026 Jan 6.

Drugs

Evaluation	Drug	Modality	Dose	Route
Subject	CNTX-6970	Small molecule	300 mg	Oral

Indications