Senolytic Drugs Attenuate Osteoarthritis-Related Articular Cartilage Degeneration: A Clinical Trial
Thos Evans, MD
This is a prospective randomized controlled trial evaluating the therapeutic efficacy of Fisetin (a dietary supplement) for the treatment of knee osteoarthritis symptoms. This clinical trial will be conducted at The Steadman Clinic and Steadman Philippon Research Institute. This study is supported by The United States Department of Defense: Office of Naval Research.
For additional information, please visit www.clinicaltrials.gov
and search for: NCT04210986
Subjects will be included if all the following criteria are met:
- Determine if oral Fisetin treatment reduces pro-inflammatory and cartilage degenerating systemic senescence-associate secretory phenotype markers in patients with moderate to severe knee osteoarthritis.
- Determine if Fisetin treatment results in greater improvements in functional performance and physical function compared to the placebo group.
- Evaluate, quantify and validate a non-invasive magnetic resonance imaging (MRI) methodology to measure cartilage and subchondral bone health compared to the placebo group.
- Determine if Fisetin treatment groups result in greater improvements in self-reported outcomes compared to the placebo group.
Subjects will be excluded if any of the following criteria are met:
- Are male or female, ages 40-80;
- Are willing to comply with all study related procedures and assessments;
- Are ambulatory as defined by ability to complete functional performance testing;
- Radiographic evidence of Kellgren-Lawrence grade II-IV osteoarthritis in one or both knees;
- Scores 4-10 on the Numerical Rating Scale (NRS) for pain;
- Patients are permitted but not required to use the following drugs ONLY IF they have been taking a stable dose and regimen of the medication for at least 4 weeks prior to date of the signing of informed consent and will continue throughout the study: Oral or topical analgesics or anti-inflammatory drugs including NSAIDs, acetaminophen (Tylenol), CBD (or related cannabinoids), joint health supplements such as glucosamine, turmeric or curcumin, and chondroitin sulfate.
- Females who are nursing, pregnant or planning to become pregnant during the duration of study drug dosing;
- Males who do not wish to abstain from sex or use contraceptive protection;
- Subjects who do not have the capacity to consent themselves;
- Subjects who are unable to tolerate oral medication;
- Subjects having previously undergone any of the following treatments in the stated time window.
- Surgery on the Study Knee in the past 6 months;
- Partial or complete joint replacement in either knee;
- Patients who have undergone arthroscopic surgery (including microfracture and meniscectomy) on the Study Knee in the last 2 years prior to the Screening visit or are anticipated to have arthroscopic surgery on either knee at any time during the study period;
- Steroid injection, including extended-release corticosteroid (e.g., Zilretta®) within the last 5 months;
- Biologic (platelet-rich plasma, bone marrow, adipose tissue/cells) or hyaluronic acid injection into the Study Knee in the past 6 months;
- Subjects with any of the following drug/medication statuses:
- Opioid analgesics taken in the past 8 weeks and are not willing to discontinue these medications through the duration of the study;
- Senolytic agents taken within the past 6 months and are not willing to discontinue these medications through the duration of the study, including: Fisetin, Quercetin, Luteolin, Dasatinib, Piperlongumine, or Navitoclax;
- Drugs that induce significant cellular stress and are not willing to discontinue these medications through the duration of the study, including alkylating agents, anthracyclines, platins, other chemotherapy drugs;
- Subjects taking the following other drugs if they cannot be held (per the Principal Investigator) for at least 2 days before and during administration of Fisetin: Medications that are substrates with a narrow therapeutic range for CYP2C9, CYP2C19, CYP3A4 or CYP1A2 such as anticoagulants (warfarin, heparin, low molecular weight heparin, factor Xa inhibitors etc.); the following antimicrobial agents: Aminoglycosides, Azole antifungals (fluconazole, miconazole, voriconazole, itraconazole), Macrolides (clarithromycin, erythromycin), Antivirals (nelfinavir, indinavir, saquinavir, ritonavir, elbasvir/grazoprevir), Rifampin; Subjects taking proton pump inhibitors (iansoprazole etc.); all statins; immunosuppressive drugs (cyclosporine, tacrolimus, sirolimus); or therapeutic doses of any of the following drugs (digoxin, lithium, repaglinide, bosentan, gemfibrozil, olmesartan, enalapril, valsartan, methotrexate, corticosteroids, eluxadoline, eltrombopag, nitroglycerin, pioglitazone, glyburide, enzalutamide, ezetimibe, colchicine, imatinib, carbamazepine, flecainide, phenytoin, phenobarbital, theophylline, clopidogrel, celecoxib, desipramine, thioridazine, venlafaxine, tizanidine, atomoxetine, citalopram, Dilantin (phenytoin), diazepam, escitalopram, propranolol, clozapine, cyclobenzaprine, mexiletine, olanzapine, ondansetron, riluzole.
- Subjects with any of the following disease statuses:
- Significant liver disease (i.e. greater than or equal to 2x the upper limit of normal bilirubin levels) or as in the opinion of the Principal Investigator;
- Significant renal disease (eGFR of <60 ml/min/1.73m2) or as in the opinion of the Principal Investigator;
- History of other formally diagnosed joint diseases including, osteonecrosis, acromegaly, Paget's disease, Ehlers-Danlos Syndrome, Gaucher's disease, Cushing’s syndrome, Stickler's syndrome, joint infection, hemophilia, hemochromatosis, or neuropathic arthropathy of any cause;
- Any active systemic autoimmune disease with musculoskeletal involvement or any history of systemic inflammatory arthritis;
- Patients with type 1 or 2 diabetes (HbA1c > 6.5%) and/or taking medications that affect insulin levels, including: Metformin (within the last week), Glucocorticoids (within the last month), Acarbose (within the last week).
- Subjects unable to safely practically undergo an MRI (BMI > 40 kg/m2) or size exceeding limits of MRI equipment, implanted metal in study knee near joint surface, incompatible implant/device, severe claustrophobia;
- Subjects that have any medical condition, including laboratory findings and findings in the medical history or in the pre-study assessments, that in the opinion of the Investigator constitutes a risk or contraindication for participation in the study or that could interfere with the study objectives, conduct or evaluation or prevent the patient from fully participating in all aspects of the study.
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