title: A first-in-human, double-blind, randomised, placebo-controlled, dose ascending study of intra-articular rhFGF18 (sprifermin) in patients with advanced knee osteoarthritis.
abstract: OBJECTIVE
  To evaluate the safety of intra-articular sprifermin (primary), and to evaluate systemic exposure, biomarkers, histology, and other cartilage parameters in patients with advanced osteoarthritis (OA).
  
  
  METHODS
  This was a first-in-human, double-blind, randomised, placebo-controlled trial of single and multiple ascending doses of sprifermin from 3-300 μg in knee OA patients scheduled for total knee replacement. Patients were randomised 3:1 to sprifermin or placebo, injected into the target knee once or once weekly for 3 weeks, and followed-up for 24 weeks.
  
  
  RESULTS
  Fifty-five patients were treated with sprifermin, 25 with single and 30 with multiple doses, 18 received placebo. There was no clear difference between the active and placebo groups in incidence, severity, and nature of reported treatment emergent adverse events. Acute inflammatory reactions were slightly more common with sprifermin 300 μg, but none led to discontinuation. No clear difference was seen between placebo and sprifermin in physician-assessed local tolerability, pain, or swelling in the knee. No meaningful changes over time, or differences between treatment groups, were observed for safety laboratory parameters or ECG. Although individual abnormalities were observed, no patterns were evident suggesting a relation to treatment or potential safety concern. No systemic sprifermin exposure, anti-FGF18 antibodies, or clear-cut effects on systemic biomarkers were detected.
  
  
  CONCLUSIONS
  This first clinical trial of sprifermin revealed no serious safety concerns, although larger studies are needed. The possibility of positive effects of intra-articular sprifermin on histological and other cartilage parameters in knee OA also warrant further investigation.
authors.affiliation: Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden. leif.dahlberg@med.lu.se.
authors.forename: Leif E
authors.initials: LE
authors.lastname: Dahlberg
authors.affiliation: EMD Serono Research and Development Institute, Billerica, MA, USA.
authors.forename: Aida
authors.initials: A
authors.lastname: Aydemir
authors.affiliation: EMD Serono Research and Development Institute, Billerica, MA, USA.
authors.forename: Norma
authors.initials: N
authors.lastname: Muurahainen
authors.affiliation: Global Research and Development, Merck KGaA, Darmstadt, Germany.
authors.forename: Hans
authors.initials: H
authors.lastname: Gühring
authors.affiliation: Department of Orthopaedics/Surgery, Kungälv Sjukhus, Kungälv, Sweden.
authors.forename: Helena
authors.initials: H
authors.lastname: Fredberg Edebo
authors.affiliation: Department of Orthopaedic Surgery, Regionshospitalet Viborg, Viborg, Denmark.
authors.forename: Niels
authors.initials: N
authors.lastname: Krarup-Jensen
authors.affiliation: Global Research and Development, Merck KGaA, Darmstadt, Germany.
authors.forename: Christoph H
authors.initials: CH
authors.lastname: Ladel
authors.affiliation: Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.
authors.forename: Jukka S
authors.initials: JS
authors.lastname: Jurvelin
mesh_terms: D000328:Adult; D000368:Aged; D002358:Cartilage, Articular / Q000187:drug effects / Q000473:pathology; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D016903:Drug Monitoring / Q000379:methods; D005260:Female; D005346:Fibroblast Growth Factors / Q000008:administration & dosage / Q000009:adverse effects; D006133:Growth Substances; D006801:Humans; D007270:Injections, Intra-Articular; D007719:Knee Joint / Q000473:pathology; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D062072:Patient Acuity; D016896:Treatment Outcome
chemical_list: D006133:Growth Substances; C113569:fibroblast growth factor 18; D005346:Fibroblast Growth Factors