A Study to Evaluate the Efficacy and Safety of X0002 Spray in Subjects With Osteoarthritis

This is a phase 2, multicenter, randomized, double blind (with dose), placebo controlled,
parallel group, proof of concept, and dose range finding study to evaluate the efficacy,
safety, and PK of X0002 spray in adult subjects with clinically symptomatic mild to moderate
OA of the knee.

After a screening period of up to 3 weeks and radiographic evaluation of the target knee
joint space, 225 subjects will be randomly assigned to 1 of 3 treatment groups in a 1:1:1
ratio with a 2:1 ratio of active:placebo within each treatment group in a 1:1:1 ratio with a
2:1 ratio of active:placebo within each treatment group (i.e., 2 subjects to active treatment
and 1 subject to placebo):

Group A: low dose of X0002, twice daily (BID, approximately every 12 hours; n=50) or placebo
(low dose), BID (approximately every 12 hours; n=25); Group B: middle dose of X0002, BID
(approximately every 12 hours; n=50) or placebo , BID (approximately every 12 hours; n=25) ;
Group C: High dose of X0002, BID (approximately every 12 hours; n=50) or placebo, BID
(approximately every 12 hours; n=25) .

Safety and efficacy assessments will be performed at at 2, 4, 8, and 12 weeks of treatment.

Inclusion Criteria:

- A subject must be a male or female between 35 and 85 years of age, inclusive.

- A subject must have a body mass index (BMI) between 18.5 and 39.9 kg/m2, inclusive.

- A subject must have a diagnosis of idiopathic OA according to the American College of
Rheumatology (ACR) clinical and radiographic criteria (knee pain, osteophytes, and at
least one of the following: >50 years of age, morning stiffness lasting <30 minutes
after getting up in the morning, or crepitus).

- A subject must have a Kellgren Lawrence Grade of 1 or 2 as determined by the
Investigator or a local radiologist at Screening.

- A subject must have a history of clinically symptomatic mild to moderate OA of the
knee for ≥6 months.

- A subject must have had knee pain while standing, walking, and/or on motion for at
least 14 days during the month prior to Screening.

- A subject must have a knee pain score ≥40 mm and <90 mm on a 100 mm VAS (with or
without analgesic medication) on at least 10 of the 14 days prior to randomization.

- A subject must be willing to discontinue any NSAIDs or other analgesic (eg, aspirin,
acetaminophen) or potentially confounding concomitant treatments (eg, physiotherapy,
acupuncture) starting 4 days before the administration of the first dose of study
medication until completing participation in the study. (The use of ≤325 mg
acetylsalicylic acid per day as cardiac prophylaxis is permitted.) The subject will be
allowed to take rescue medication (acetaminophen) for pain during the study except
during the 24 hours prior to Baseline (Day1), Week 2, Week 4, Week 8, Week 12/EOS, and
Follow-up assessments.

- A subject must be willing to avoid unaccustomed physical activity (eg, starting a new
weight lifting routine) for the duration of the study.

Exclusion Criteria:

- A subject who has secondary OA of the knee or OA of lower limb joints other than the
knee that, in the opinion of the Investigator, could interfere with pain and
functional assessments related to the knee

- A subject who has OA of the knee with a Kellgren Lawrence Grade ≥3 as determined by
the Investigator or a local radiologist at Screening

- A subject who has a history of total or partial knee replacement, arthroplasty, or
other knee surgery on either knee

- A subject who has had significant injury, as judged by the Investigator, involving the
target knee within the 6 months before Screening.

- A subject who has skin lesions or wounds on or near the knees to be treated at
Screening or on Day 1 prior to the first administration of study medication

- A subject who has used opiates or corticosteroids within 30 days before Screening or
who requires treatment with chronic opiates or corticosteroids

- A subject who has had intra articular injections of corticosteroids, hyaluronic acid,
or viscosupplements (eg, Synvisc®) to a knee to be treated within the 3 months before
Screening.

- A subject who has a history of significant hypersensitivity, intolerance, or allergy
to ibuprofen, any NSAIDs, aspirin, or acetaminophen

- A subject who has had an active peptic ulceration in the 12 months prior to Screening
or a history of gastrointestinal (GI) bleeding within 5 years of Screening

- A subject who has used an anticoagulant (except aspirin up to 325 mg/day for cardiac
prophylaxis) in the month prior to Screening

- A subject who has positive results on fecal occult blood testing at Screening or on
Day 1 prior to the first administration of study medication

- A subject who has a history of chronic inflammatory disease (such as rheumatoid
arthritis, psoriatic arthritis, gouty arthritis), fibromyalgia, conditions that may
affect the target joint (eg, osteonecrosis, chondrocalcinosis), or asthma.