Managing Avascular Necrosis Treatments: an Investigational Study (MANTIS)

ISRCTN ISRCTN14015902
DOI https://doi.org/10.1186/ISRCTN14015902
EudraCT/CTIS number 2017-002798-21
Secondary identifying numbers 37920
Submission date
11/06/2018
Registration date
12/06/2018
Last edited
03/11/2022
Recruitment status
No longer recruiting
Overall study status
Completed
Condition category
Musculoskeletal Diseases
Prospectively registered
Protocol
Statistical analysis plan
Results
Individual participant data

Plain English Summary

Background and study aims
Avascular necrosis (AVN) is death of bone tissue due to interruption of the blood supply. The aim of this study is to assess the effect of a bisphosphonate drug treatment (Alendronate) on AVN of the hip.

Who can participate?
Patients aged 18 and over with AVN of the hip

What does the study involve?
Participants are randomly allocated to receive either a 12 month course of oral alendronate (70 mg taken weekly), or a matched placebo (dummy drug). This is in addition to standard care for the condition which includes non-weight bearing periods and over the counter pain medication. Participants are followed up for 3 years with follow-up assessments at 6, 12, 24 and 36 months and compliance assessments at 1, 2, 3, 6, 9 and 12 months: patients complete these assessments via questionnaires either in a paper format or through a secure online portal (the electronic data capture is planned to improve completion rates for the younger and more geographically mobile population). An x-ray is taken at 1 year and 3 years as part of standard routine care of patients with AVN, and the notes and images from these scans are collected. Those that haven’t had any surgery also have an MRI scan at 3 years of which the images and notes are collected. The study includes a pilot study, which progresses to the definitive trial if predefined criteria regarding recruitment are met. In the initial pilot study, a minimum of 50 patients are randomly allocated over 12 months from at least 10 sites, with a target recruitment rate of 1-2 patients per site per month. AVN is an uncommon condition, therefore the aim of the pilot study is to maximise recruitment, and ensure that outcomes can be collected reliably and remotely in all patients. It will also provide information on site feasibility.

What are the possible benefits and risks of participating?
The results of this study will improve understanding of how Alendronate works which may help to improve the treatment for future patients with AVN. Alendronate is routinely used as osteoporosis treatment and therefore has a highly reviewed safety profile. As with any medication there are risks involved and recent evidence indicates the following side effects occurred in less than 10% of patients: headache, dizziness, vertigo, abdominal pain, indigestion, constipation, diarrhoea, abdominal swelling, acid reflux, alopecia, itching, joint swelling, physical weakness or lack of energy and a build-up of fluid. Bone, muscle or joint pain is also a very common side effect occurring in more than 1 in 10 patients. There is limited information available regarding the effect of alendronate on pregnancy therefore highly effective contraceptive methods are required for all participants (regardless of sex or gender) for the duration of the study treatment and for a year after completing the treatment.

Where is the study run from?
Nuffield Orthopaedic Centre (UK)

When is the study starting and how long is it expected to run for?
June 2017 to December 2022

Who is funding the study?
National Institute for Health Research (NIHR) (UK)

Who is the main contact?
Miss Gemma Greenall
mantis@ndorms.ox.ac.uk

Study website

Contact information

Miss Gemma Greenall
Scientific

Surgical Intervention Trials Unit
Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences (NDORMS)
University of Oxford
Botnar Research Centre
Oxford
OX3 7LD
United Kingdom

Phone +44 (0)1865 223665
Email mantis@ndorms.ox.ac.uk

Study information

Study designRandomised; Interventional; Design type: Treatment, Drug
Primary study designInterventional
Secondary study designRandomised controlled trial
Study setting(s)Hospital
Study typeTreatment
Participant information sheet Not available in web format, please use the contact details below to request a patient information sheet
Scientific titleA multi-centre, blinded, randomised, placebo-controlled trial assessing the clinical and cost effectiveness of a 12 month course of oral alendronate (70 mg weekly) in patients presenting with avascular necrosis of the hip - Managing Avascular Necrosis Treatments: an Interventional Study (MANTIS)
Study acronymMANTIS
Study hypothesisTo assess the effect of bisphosphonate treatment (alendronate) on avascular necrosis (AVN) of the hip.
Ethics approval(s)South Central – Oxford A Research Ethics Committee, 29/05/2018, ref: 18/SC/0247
ConditionAvascular necrosis of the hip
InterventionRandomisation will be performed using a minimisation algorithm including random elements to ensure balanced allocation of participants across the two treatment groups stratified by:
1. Randomising site
2. FICAT stage (1 or 2)
3. Main AVN risk factors (steroid/alcohol/other) obtained from clinical notes
4. Bilateral vs unilateral AVN

Patients will be randomised on a 1:1 basis to receive either a 12 month course of oral alendronate (one 70mg tablet taken weekly), or a matched placebo. This will be in addition to standard care for the condition which includes non-weight bearing periods and over the counter pain medication.

Patients, clinicians and assessors will be blinded to the treatment allocation. Patients will be followed up for 3 years with follow up assessments at 6, 12, 24 and 36 months and compliance assessments at 1, 2, 3, 6, 9 and 12 months: patients will complete these assessments via questionnaires either in a paper format or through a secure online portal (the electronic data capture is planned to improve completion rates for the younger and more geographically mobile population).

An x-ray will be collected at 1 year and 3 years as part of standard routine care of patients with AVN, and the notes and images from these scans will be collected. Those that haven’t had any surgery will also have an MRI scan at 3 years of which the images and notes will be collected.

The study will include a pilot study, which will progress to the definitive trial if predefined criteria regarding recruitment are met. In the initial pilot study, a minimum of 50 patients will be randomised over 12 months from at least 10 sites, with a target recruitment rate of 1-2 patients per site per month. AVN is an uncommon condition, therefore the aim of the pilot study is to maximise recruitment, and ensure that outcomes can be collected reliably and remotely in all patients. It will also provide information on site feasibility.
Intervention typeDrug
Pharmaceutical study type(s)
PhaseNot Applicable
Drug / device / biological / vaccine name(s)Alendronate
Primary outcome measureHip function measured using Oxford Hip Score (OHS) at 12 months
Secondary outcome measures1. Hip function and quality of life (QoL) measured using Oxford Hip Score (OHS), iHOT-33, Hospital Anxiety and Depression Score (HADS) and EQ-5D-5L at baseline, 6, 12, 24 and 36 months
2. Radiological progression measured using x-ray at 12 and 36 months and MRI at 36 months
3. Treatment compliance measured using bespoke compliance questionnaires at 1, 2, 3, 6, 9, and 12 months
4. Cost effectiveness measured using healthcare resource use questionnaires at 6, 12, 24 and 36 months
Overall study start date01/06/2017
Overall study end date31/08/2020

Eligibility

Participant type(s)Patient
Age groupAdult
Lower age limit18 Years
SexBoth
Target number of participantsPlanned Sample Size: 280; UK Sample Size: 280
Total final enrolment21
Participant inclusion criteria1. Early, symptomatic, atraumatic AVN of the hip (Ficat score 1 or 2 using MRI)
2. Aged 18 years or over
Participant exclusion criteria1. Diagnosis not confirmed their diagnosis (Ficat 1 or 2), using MRI, within the last 12 months
2. Renal function (creatinine clearance) of < 30 ml/min (tested within the last 3 months)
3. Adjusted serum calcium levels outside local reference range (tested within the last 3 months)
4. Established osteoarthritis (Kellgren-Lawrence >=2)
5. Previous AVN, femoral head deformity, prior hip surgery or hip fracture in the index hip
6. Current pathology (e.g. osteoporosis) that requires treatment with bisphosphonates
7. Received previous anti-osteoporosis therapy (excluding calcium or vitamin D supplements) that lasted more than 4 weeks for oral treatment or any length of parenteral treatment
8. Contraindications to MRI
9. Contraindications to alendronate therapy (including hypocalcaemia) as listed in the SmPC
10. Planning a pregnancy in the next 12 months or are currently pregnant or breastfeeding
11. Not using appropriate contraception and of child bearing age
12. Have a planned joint preserving surgical procedure of the hip
13. Unable to provide informed consent
14. Unable to commit to follow-up regime
15. Already enrolled in an interventional clinical trial
Recruitment start date15/07/2018
Recruitment end date17/11/2019

Locations

Countries of recruitment

  • England
  • United Kingdom

Study participating centre

Nuffield Orthopaedic Centre (lead site)
Windmill Road
Headington
Oxford
OX3 7HE
United Kingdom

Sponsor information

University of Oxford
University/education

Clinical Trials and Research Governance
Joint Research Office
Block 60
Churchill Hospital
Old Road
Headington
Oxford
OX3 7LE
England
United Kingdom

Phone +44 (0)1865 289885
Email ctrg@admin.ox.ac.uk
ROR logo "ROR" https://ror.org/052gg0110

Funders

Funder type

Government

NIHR Evaluation, Trials and Studies Co-ordinating Centre (NETSCC); Grant Codes: 15/39/06

No information available

Results and Publications

Intention to publish date01/08/2021
Individual participant data (IPD) Intention to shareNo
IPD sharing plan summaryData sharing statement to be made available at a later date
Publication and dissemination planResults of this trial will be submitted for publication in a peer‐reviewed journal. All presentations and publications will be pre‐agreed by the Trial Steering Committee (TSC).
IPD sharing planThe data sharing plans for the current study are unknown and will be made available at a later date.

Study outputs

Output type Details Date created Date added Peer reviewed? Patient-facing?
Results article 01/10/2022 03/11/2022 Yes No
HRA research summary 28/06/2023 No No

Editorial Notes

03/11/2022: Publication reference added.
29/09/2020: The following changes have been made:
1. The recruitment end date has been changed from 01/12/2020 to 17/11/2019.
2. The overall trial end date has been changed from 01/12/2022 to 31/08/2020.
3. The intention to publish date has been changed from 01/12/2023 to 01/08/2021.
4. The final enrolment number has been added.
22/03/2019: The condition was updated from "Specialty: Musculoskeletal Disorders, Primary sub-specialty: Other; UKCRC code/ Disease: Musculoskeletal/ Other osteopathies" to "Avascular necrosis of the hip" following a request from the NIHR.