The Anti-Freaze-F Study- "Anti-TNF for Treatment of Frozen Shoulder - a Feasibility Study"

NCT05299242 | Completed Phase 2 Results DMC

• 1 other identifier: 15701
• Study Type: interventional
• Target: 9
• Locations: 1 country
• Sites: 4

Brief Summary

Frozen shoulder is a common condition affecting approximately 9% of people aged 25-64 years. During the early phase the pain is usually unbearable and the later restriction in movement is severely limiting. It occurs when the flexible tissue (capsule) that surrounds the shoulder joint becomes inflamed, thickened and tight. The pain can be very severe and lasts 3-9 months, followed by a 4-12 month period of increasing stiffness, after which the condition usually improves. Frozen shoulder often affects a person's ability to sleep, carry out everyday activities, and work. Current treatments include rest, painkillers, anti-inflammatories, physiotherapy and steroid injections. If stiffness persists, surgery is sometimes recommended. However, there is no evidence that any of these treatments lead to significant benefit in the long term, with many being ineffective. The aim of this study is to find out if it is possible to run a larger trial to test whether an injection of adalimumab can reduce pain and prevent the disease from getting worse, if given during the early painful phase of frozen shoulder. The investigators need to conduct this smaller study first to be sure it's possible to identify and treat people with early stage frozen shoulder, before they conduct a much larger trial to find out if this treatment works. In this study the investigators will include 84 adults from 5 sites with painful early stage frozen shoulder who have not yet received treatment. People will be randomised to receive either an injection of the drug adalimumab or a dummy injection of saline (placebo) directly into the shoulder joint, both guided by ultrasound. All participants will also receive standardized advice on how to manage their shoulder pain. The investigators will assess participants before treatment and three months later. Adalimumab has been used very successfully to treat other inflammatory diseases such as rheumatoid arthritis. This study has been funded by the NIHR RfPB programme and 180 Life Sciences.

Conditions

Frozen Shoulder

Keywords

Adhesive capsulitis

Outcome Measures

Primary Outcomes (5)

• Number of Participants Eligible With Pain Predominant Frozen Shoulder

  Ability to screen and identify potential participants with pain-predominant early stage frozen shoulder (i.e. within approximately 3 months of onset of symptoms).

  3 Months

• Number of Participants Consenting to be Included in the Trial

  Willingness of eligible participants to consent and be randomised to intervention.

  3 Months

• Time From Randomisation to First Injection

  Practicalities of delivering the intervention, including time to first injection (within 2 weeks of randomisation).

  2 weeks

• Time From First Injection to Second Injection

  Practicalities of delivering the intervention, including time between first injection and second injection (within 4-6 weeks of randomisation).

  6 weeks

• Shoulder Pain and Disability Index (SPADI) Score

  Score ranges from 0 to 100, lower scores indicate better outcome.

  Baseline and 3 months

Secondary Outcomes (10)

• Pain (Shoulder Pain And Disability Index, 5-item Subscale)

  Baseline and 3 months

• Function (Shoulder Pain And Disability Index, 8-item Subscale)

  Baseline and 3 months

• Fear Avoidance Belief Questionnaire

  Baseline and 3 months

• Pain Self Efficacy Questionnaire

  Baseline and 3 months

• Insomnia Severity Index

  Baseline and 3 months

Study Arms (2)

Arm A

ACTIVE COMPARATOR

Participants will receive 2 injections of adalimumab. First injection: 160mg in 3.2ml Second injection approximately 2-3 weeks later 80mg in 1.6ml

Drug: Adalimumab Injection

Arm B

PLACEBO COMPARATOR

Participants will receive 2 injections of placebo First injection: 3.2ml Second injection approximately 2-3 weeks later 1.6ml

Drug: Placebo

Interventions

Adalimumab Injection DRUG

40mg in 0.8ml preparation in vials from Fresenius Kabi Ltd

Arm A

Placebo DRUG

Saline \[0.9% NaCl\]

Arm B

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Men and women aged 18 years and above.
• With a new episode of shoulder pain attributable to pain-predominant stage of frozen shoulder (i.e. within approximately 3 months of onset of symptoms) diagnosed using criteria set out in the BESS guidelines (33) (Appendix 1);
• Who are not being considered for surgery;
• Able to understand spoken and written English;
• Willing and able to give informed consent for trial participation and comply with all study requirements and time line;
• Willing to allow his or her General Practitioner be notified of participation in the trial.
• If female and of child-bearing potential OR if male and their partner is of child-bearing potential - willing to use effective contraception throughout the treatment period and for 5 months after the last injection.-

You may not qualify if:

• Those with frozen shoulder secondary to significant shoulder trauma (e.g., dislocation, fracture or full thickness tear requiring surgery) or other causes (e.g. recent breast cancer surgery or radiotherapy);
• Those with a neurological disease affecting the shoulder;
• Those with bilateral concurrent frozen shoulder;
• Those with other shoulder disorders (e.g., inflammatory arthritis, rotator cuff disorders, glenohumeral joint instability) or with red flags consistent with the criteria set out in the BESS guidelines (33);
• Those who have received corticosteroid injection for shoulder pain in the last 12 weeks to either shoulder;
• Those currently taking any anti-TNF drug;
• Those being treated with coumarin anticoagulants, such as warfarin;
• Those who have participated in another research study involving an investigational medicinal product in the past 12 weeks;
• Those with significant renal or hepatic impairment;
• Those with contra-indications to anti-TNF injection:
• Known allergy to any anti-TNF agent or any of the excipients; 10.2 Known Active tuberculosis (TB) or history of TB. 10.3 Known Active infection (chronic or localised) or known history of recurring infections or condition which may predispose patients to infection, including the use of concomitant immunosuppressive medications; 10.4 Known Moderate to severe heart failure (NYHA class III/IV); 10.5 Those known to have HIV, Hepatitis B or C; 10.6 Those at risk of Hepatitis B infection; 10.7 Those diagnosed with Multiple Sclerosis (MS) or other central or peripheral nervous system demyelinating disorders; 10.8 Those who have ever been diagnosed with cancer, except basal cell carcinoma (BCC); 10.9 Those requiring live vaccination prior to within 12 weeks after of the last trial injection or within the 4 weeks prior to randomisation; 10.10 Those taking biologic DMARDS; 10.11 Any other significant 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

Sponsors & Collaborators

• University of Oxford: lead
• National Institute for Health Research, United Kingdom: collaborator
• 180 Life Sciences: collaborator

Study Sites (4)

Good Hope Hospital

Sutton Coldfield, Birmingham, B75 7RR, United Kingdom

Location

Conquest Hospital

Saint Leonards-on-Sea, Hastings, TN37 7RD, United Kingdom

Location

Grantham & District Hospital, United Lincolnshire Hospitals

Grantham, Lincolnshire, NG31 8DG, United Kingdom

Location

Sandwell General Hospital

West Bromwich, West Midlands, B71 4HJ, United Kingdom

Location

Related Publications (2)

• Hopewell S, Kenealy N, Knight R, Rangan A, Dutton S, Srikesavan C, Feldmann M, Lamb S, Nanchahal J. Anti-TNF (adalimumab) injection for the treatment of adults with frozen shoulder during the pain predominant stage protocol for a multi-centre, randomised, double blind, parallel group, feasibility trial. NIHR Open Res. 2023 Apr 24;2:28. doi: 10.3310/nihropenres.13275.2. eCollection 2022.

  PMID: 37881307 BACKGROUND

• Hopewell S, Srikesavan C, Evans A, Er F, Rangan A, Preece J, Francis A, Massa MS, Feldmann M, Lamb S, Nanchahal J. Anti-TNF (adalimumab) injection for the treatment of pain-predominant early-stage frozen shoulder: the Anti-Freaze-Feasibility randomised controlled trial. BMJ Open. 2024 May 1;14(5):e078273. doi: 10.1136/bmjopen-2023-078273.

  PMID: 38692727 DERIVED

Related Links

• Results Paper (BMJ Open)
• Protocol Paper (NIHR Open Research)

MeSH Terms

Conditions

Bursitis

Interventions

Adalimumab

Condition Hierarchy (Ancestors)

Joint Diseases; Musculoskeletal Diseases

Intervention Hierarchy (Ancestors)

Antibodies, Monoclonal, Humanized; Antibodies, Monoclonal; Antibodies; Immunoglobulins; Immunoproteins; Blood Proteins; Proteins; Amino Acids, Peptides, and Proteins; Serum Globulins; Globulins

Limitations and Caveats

This study demonstrated that current NHS musculoskeletal physiotherapy settings yielded only small numbers of participants, too few to make a trial viable. This was because many patients had passed the early stage of frozen shoulder or had already formulated a preference for treatment.

Results Point of Contact

• Title: Prof. Sally Hopewell
• Organization: University of Oxford

sally.hopewell@csm.ox.ac.uk

+441865223458

Study Officials

• Jagdeep Nanchahal

  University of Oxford

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: No
• Restrictive Agreement: No

Study Design

• Study Type: interventional
• Phase: phase 2
• Allocation: RANDOMIZED
• Masking: TRIPLE
• Who Masked: PARTICIPANT, INVESTIGATOR, OUTCOMES ASSESSOR
• Masking Details: The participant will be blinded along with the assessor and other site staff. The injector and pharmacy will not be blinded.
• Purpose: TREATMENT
• Intervention Model: SEQUENTIAL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: Participants will be randomised to either receive Adalimumab or Placebo.

Study Record Dates

• First Submitted: February 17, 2022
• First Posted: March 28, 2022
• Study Start: July 21, 2022
• Primary Completion: May 9, 2023
• Study Completion: June 12, 2023
• Last Updated: January 27, 2025
• Results First Posted: January 27, 2025

Record last verified: 2022-11

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL
• Access Criteria: Available on request

Locations

GB (4)