Study to Evaluate a Preop Dose of Brivoligide Injection for Pain After Knee Replacement in Patients With High PCS Scores

The objective of this study is to evaluate the safety and postoperative pain reducing
efficacy of a single preoperative intrathecal administration of brivoligide injection in
patients with a Pain Catastrophizing Scale (PCS) score ≥16 undergoing unilateral total knee
arthroplasty.

Potential subjects will be prescreened for PCS scores of 16 or greater in advance;
pre-qualified patients will be invited to the investigative site for informed consent and
full screening within 30 days of randomization. Patients providing informed consent and
meeting all study eligibility criteria will be enrolled in the study on the day of surgery
(Day 1). Safety assessments will be performed through Day 28; efficacy assessments will be
conducted at the follow-up visits and daily via electronic diary by subjects through Day 42.
Follow up visits will occur on Days 7, 14, 21, 28, and 42.

Inclusion Criteria:

- Score of 16 or greater on the PCS scale

- Scheduled for primary unilateral TKA with spinal anesthesia as the primary anesthetic
for painful osteoarthritis without congenital knee pathology

- American Society of Anesthesiologists Physical Status Classification System ≤ 3

- Medically stable for elective surgery with spinal anesthetic as determined by the
Investigator

- Body mass index of 18-45 kg/m2

- Stable medical regimen at least 1 week before randomization

- Able to read and understand study instructions in English or Spanish, and willing to
comply with all study procedures

Exclusion Criteria:

- Target knee > 20 degrees valgus or varus deformity, evidence of significant bone loss
or ligamentous laxity, or existing major hardware that requires removal during TKA

- Inflammatory arthridities (e.g., rheumatoid arthritis, lupus, ankylosing spondylitis,
psoriatic arthritis), with the exception of clinically stable/non-active gout

- Undergoing concomitant surgical procedures or non-elective TKA, or contralateral knee
is likely to require TKA within 6 weeks (or would interfere with study assessments)

- Use of cryoneurolysis (including Iovera) on the current operative knee region within 6
months prior to randomization and/or at any time through the duration of the study

- Planned use of general anesthesia as the primary anesthetic; planned use of neuroaxial
(intrathecal or epidural) opioids, or any use of extended release/long acting opioids
or ketamine preoperatively and/or at any time through the duration of the study

- Use of more than 40 mg per day (on average) of oral morphine or its equivalent within
1 month prior to randomization

- Current neurologic disorder, which could confound the assessment of pain (e.g.,
Parkinson's, Multiple Sclerosis)

- Unstable mental condition and/or evidence of an uncooperative attitude in the opinion
of the Investigator; subjects diagnosed with schizophrenia, prescribed antipsychotic
medications or MAOIs

- Women who are pregnant or nursing

- Subjects engaged in pending or active litigation, or seeking disability compensation;
subjects whose cases have been settled or finally decided are not excluded

- Participation in a clinical trial with the last dose or intervention within 1 month of
randomization, or planned participation in a clinical trial during this study

- Previous participation in any study involving brivoligide injection