A Phase 2 interventional study of Dexamethasone Sodium Phosphate and Iontophoresis in Apophysitis; Juvenile, sponsored by Children's Health System, Inc.. Terminated at 5 sites in United States. Open to participants aged 7 Years to 18 Years. Per ClinicalTrials.gov, last updated 2024-03-06.
Sponsored by Children's Health System, Inc. · Phase 2, Interventional, and Treatment
The goal of this clinical research study is to determine if there is a difference in time to meet return to sport criteria for Pediatric patients with apophysitis of the knee who receive iontophoresis with Dexamethasone Sodium Phosphate (DSP) and Physical Therapy (PT) as those who receive iontophoresis with placebo and PT or PT alone.
Approximately 147 patients will be enrolled in this study.
Iontophoresis is a treatment that allows medication to be delivered across your skin to the painful area without having to have an injection into your muscle or soft tissue, through a vein in your arm, or taking a pill. Instead, liquid medication is placed on a patch (like a large Band-Aid) and then placed on your knee over the location where it hurts. A plastic device, like a battery, is then attached to the patch for three minutes. During this time, this device begins to deliver the medication through your skin and into the area that hurts, and also charges the patch so it can continue to deliver the medication for two hours once the device is removed. The medication is delivered by a mild electrical current. The most common drug used with iontophoresis for pain caused by such things as apophysitis of the knee is dexamethasone sodium phosphate (dexamethasone).
This is an investigational study. Dexamethasone is a steroid medication that has been approved by the U.S Food and Drug Administration (FDA) to treat many types of problems (such as joint problems, skin and allergy problems, eye, stomach, and lung problems), but has not been approved to treat apophysitis of the knee using iontophoresis. In this study, it is an experimental drug.
Participants will be randomized to one of three treatment groups:
Participants will be asked to attend study visits twice/week for up to 8 weeks or until they are able to pass the Return To Sport Checklist, whichever is sooner. Participants will the receive a 30-Day Follow Up phone call and complete a survey at the 90-Day mark, making each participant's study duration approximately five (5) months.
Females 7 to 14 years of age who have not reached skeletal maturity (skeletal maturity based on referring physician's clinical judgement or as demonstrated via radiograph images taken within 90 days of enrollment) and who meet one of the following criteria:
Exclusion Criteria:
Iontophoresis is a non-invasive delivery mechanism for transmitting a medication to a local area of the body. The I-Bresis™ System and I-Bresis™ Patch will be the delivery system used for this study. The I-Bresis™ Patch is an adhesive patch. 1.5 ml of the dexamethasone sodium phosphate (4ml/1mL) will be placed on one side and 1.5 ml of 0.9% sodium chloride (saline) solution will be placed on the other. Duration of exposure: 123 minutes. Frequency of exposure: twice per week for a total of 12 sessions over a maximum of 8 weeks or until Return to Sport Criteria are met, whichever is sooner. Participants will also receive the standard PT protocol for apophysitis of the knee. This will involve up to 20 visits.
Drug: Dexamethasone Sodium Phosphate · Procedure: Iontophoresis · Procedure: Physical Therapy
Iontophoresis is a non-invasive delivery mechanism for transmitting a medication to a local area of the body. The I-Bresis™ System and I-Bresis™ Patch will be the delivery system used for this study. The I-Bresis™ Patch is an adhesive patch. 1.5 ml of 0.9% sodium chloride (saline) solution will be placed on one side and 1.5 ml of 0.9% saline solution will be placed on the other. Duration of exposure: 123 minutes. Frequency of exposure: twice per week for a total of 12 sessions over a maximum of 8 weeks or until Return to Sport Criteria are met, whichever is sooner. Participants will also receive the standard PT protocol for apophysitis of the knee. This will involve up to 20 visits.
Procedure: Iontophoresis · Procedure: Physical Therapy
Participants will only receive the standard PT protocol for apophysitis of the knee. This will involve up to 20 visits.
Procedure: Physical Therapy
Dexamethasone sodium phosphate administered via iontophoresis
Iontophoresis on affected knee
Physical therapy of affected knee
Functional Outcome as Measured in Length of Time to Meet Return To Sport Criteria (Measured in Days)
The Return To Sport Criteria is met when all items on the Return To Sport Checklist can be successfully achieved. There are no units of measure for any of the criteria listed as they are either achieved/passed or not achieved/failed based on the criteria listed. Once all criteria can be passed, this date is noted. The number of days from Visit 1 to the date when all criteria are achieved is calculated. This outcome is measured in days.
Time frame: Measured at each Study Treatment Visit for a maximum of 12 Study Treatment Visits over a maximum of 8 weeks or until Return to Sport Criteria are met, whichever is sooner
Patient Reported Outcome - Percent Difficulty With Activities as Measured by the Lower Extremity Function Scale (LEFS)
The LEFS is a patient reported questionnaire that measures difficult of completing 20 activities. The maximum possible score of the LEFS is 80 points, indicating very high function. The minimum possible score is 0 points, indicating very low function. The LEFS data is reported as a percentage, calculated as XX points/80 \* 100.
Time frame: Collected at final visit, which is at Visit 12, maximum of 8 weeks, or when Return to Sport Criteria are met, whichever is sooner
Patient Reported Outcome - Activity Level as Measured by the Godin Leisure-Time Activity Questionnaire
The Godin Leisure-Time Activity Questionnaire measures physical activity. Scores of 24 and above indicate the individual is "Active", scores of 14-23 indicate the individual is "Moderately Active", and scores of 14 and below indicate the individual is insufficiently active/sedentary. A higher score indicates higher levels of physical activity at baseline, thus would be considered a better outcome. The minimum possible score is 0, and there is no defined maximum score, as scores are based on patient's self-reported quantitative activity level, but scores of 24 and above indicate the highest levels of physical activity.
Time frame: Measured at Study Treatment Visit 1 to establish baseline activity level (prior to onset of injury/pain)
Patient Reported Outcome - Pain as Measured by the Wong-Baker FACES Pain Rating Scale
This scale was created for children to help them communicate their pain. The scale shows a series of faces ranging from a happy face at 0, "No hurt" to a crying face at 10 "Hurts worst".
Time frame: Collected at final visit, which is at Visit 12, maximum of 8 weeks, or when Return to Sport Criteria are met, whichever is sooner
Number of Participants With Adverse Events
All adverse events that occur during participation in this research study, whether or not considered intervention-related, will be collected.
Time frame: Measured at each Study Treatment Visit (up to 12 Study Treatment Visits over a maximum of 8 weeks or until Return to Sport Criteria are met, whichever is sooner), then again 2 - 3 days, 30 days, and 90 days after Return To Sport Criteria are met.
| Milestone | Iontophoresis With Dexamethasone | Iontophoresis With Sodium Chloride | Physical Therapy Alone |
|---|---|---|---|
| Started | 16 | 15 | 14 |
| Completed | 12 | 13 | 7 |
| Not completed | 4 | 2 | 7 |
| Withdrew: Lost to follow-up | 3 | 2 | 3 |
| Withdrew: Withdrawal by subject | 1 | 0 | 4 |
The Return To Sport Criteria is met when all items on the Return To Sport Checklist can be successfully achieved. There are no units of measure for any of the criteria listed as they are either achieved/passed or not achieved/failed based on the criteria listed. Once all criteria can be passed, this date is noted. The number of days from Visit 1 to the date when all criteria are achieved is calculated. This outcome is measured in days.
| days to meet return to sport criteria | Iontophoresis With Dexamethasone | Iontophoresis With Sodium Chloride | Physical Therapy Alone |
|---|---|---|---|
| Functional Outcome as Measured in Length of Time to Meet Return To Sport Criteria (Measured in Days) | 38.1 ± 9.48 | 30.2 ± 6.8 | 37.25 ± 3.86 |
The LEFS is a patient reported questionnaire that measures difficult of completing 20 activities. The maximum possible score of the LEFS is 80 points, indicating very high function. The minimum possible score is 0 points, indicating very low function. The LEFS data is reported as a percentage, calculated as XX points/80 \* 100.
| percent | Iontophoresis With Dexamethasone | Iontophoresis With Sodium Chloride | Physical Therapy Alone |
|---|---|---|---|
| Patient Reported Outcome - Percent Difficulty With Activities as Measured by the Lower Extremity Function Scale (LEFS) | 84.66 ± 17.50 | 86.42 ± 12.89 | 81.98 ± 23.38 |
The Godin Leisure-Time Activity Questionnaire measures physical activity. Scores of 24 and above indicate the individual is "Active", scores of 14-23 indicate the individual is "Moderately Active", and scores of 14 and below indicate the individual is insufficiently active/sedentary. A higher score indicates higher levels of physical activity at baseline, thus would be considered a better outcome. The minimum possible score is 0, and there is no defined maximum score, as scores are based on patient's self-reported quantitative activity level, but scores of 24 and above indicate the highest levels of physical activity.
| score on a scale | Iontophoresis With Dexamethasone | Iontophoresis With Sodium Chloride | Physical Therapy Alone |
|---|---|---|---|
| Patient Reported Outcome - Activity Level as Measured by the Godin Leisure-Time Activity Questionnaire | 71.81 ± 23.61 | 58.07 ± 24.86 | 65.43 ± 18.54 |
This scale was created for children to help them communicate their pain. The scale shows a series of faces ranging from a happy face at 0, "No hurt" to a crying face at 10 "Hurts worst".
| score on a scale of 0-10 | Iontophoresis With Dexamethasone | Iontophoresis With Sodium Chloride | Physical Therapy Alone |
|---|---|---|---|
| Patient Reported Outcome - Pain as Measured by the Wong-Baker FACES Pain Rating Scale | 1.33 ± 0.65 | 1.85 ± 1.07 | 2.13 ± 1.36 |
All adverse events that occur during participation in this research study, whether or not considered intervention-related, will be collected.
| Participants | Iontophoresis With Dexamethasone | Iontophoresis With Sodium Chloride | Physical Therapy Alone |
|---|---|---|---|
| Mild AE | 8 | 5 | 4 |
| Moderate | 4 | 5 | 5 |
| Severe | 2 | 0 | 0 |
Collected over Adverse events were tracked throughout the study duration for each participant, i.e. approximately 5 months.. Non-serious events are listed at a 0% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Iontophoresis With Dexamethasone | 0/16 (0%) | 0/16 (0%) | 14/16 (87.5%) |
| Iontophoresis With Sodium Chloride | 0/15 (0%) | 0/15 (0%) | 10/15 (66.7%) |
| Physical Therapy Alone | 0/14 (0%) | 0/14 (0%) | 9/14 (64.3%) |
| Event | Iontophoresis With Dexamethasone | Iontophoresis With Sodium Chloride | Physical Therapy Alone |
|---|---|---|---|
| redness at patch siteSkin and subcutaneous tissue disorders | 2/16 | 0/15 | 0/14 |
| dryness over tibial tubercleSkin and subcutaneous tissue disorders | 2/16 | 0/15 | 0/14 |
| abrasionSkin and subcutaneous tissue disorders | 0/16 | 0/15 | 1/14 |
| bruised elbowSkin and subcutaneous tissue disorders | 0/16 | 0/15 | 1/14 |
| common coldInfections and infestations | 1/16 | 0/15 | 1/14 |
| constipationGastrointestinal disorders | 0/16 | 0/15 | 1/14 |
| coughRespiratory, thoracic and mediastinal disorders | 0/16 | 0/15 | 1/14 |
| influenzaInfections and infestations | 0/16 | 0/15 | 1/14 |
| migraineNervous system disorders | 0/16 | 1/15 | 1/14 |
| tibial tubercle painMusculoskeletal and connective tissue disorders | 0/16 | 0/15 | 1/14 |
| Age, Categorical(Participants) | Iontophoresis With Dexamethasone | Iontophoresis With Sodium Chloride | Physical Therapy Alone | Total |
|---|---|---|---|---|
| <=18 years | 16 | 15 | 14 | 45 |
| Between 18 and 65 years | 0 | 0 | 0 | 0 |
| >=65 years | 0 | 0 | 0 | 0 |
| Sex: Female, Male(Participants) | Iontophoresis With Dexamethasone | Iontophoresis With Sodium Chloride | Physical Therapy Alone | Total |
|---|---|---|---|---|
| Female | 9 | 4 | 6 | 19 |
| Male | 7 | 11 | 8 | 26 |
| Race and Ethnicity Not Collected(Participants) | Iontophoresis With Dexamethasone | Iontophoresis With Sodium Chloride | Physical Therapy Alone | Total |
|---|---|---|---|---|
| Count of participants | — | — | — | 0 |
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Children's Health System, Inc.