• to assess opioid-induced constipation based on Complete Spontaneous Bowel Movement (CSBMs) recorded in the subject daily diaries during the first 4 weeks of the Double-blind Phase.• to assess the frequency of laxative use during the 12 weeks of…
ID
Source
Brief title
Condition
- Tendon, ligament and cartilage disorders
Synonym
Research involving
Sponsors and support
Intervention
Outcome measures
Primary outcome
• to demonstrate that the treatment with OXN PR tablets is non-inferior to the
treatment with OxyPR with regards to analgesic efficacy and locomotor function
as assessed by the Western Ontario and McMaster Universities Osteoarthritis
Composite Index (WOMAC VA3.1, visual analogue scale) in subjects with moderate
to severe OA pain.
• to demonstrate that subjects with moderate to severe OA pain taking
oxycodone/naloxone prolonged release tablets have improvement in symptoms of
constipation as measured by the bowel function index (BFI) compared to subjects
taking oxycodone prolonged release tablets alone.
Secondary outcome
• to estimate the subjects* average pain over the last 24 hours assessed at
each double-blind study visit during treatment with OXN PR compared with OxyPR.
• to assess subject assessment of opioid-induced constipation, constipation
symptom severity, impact and bothersomeness based on the PAC-SYM(b).
Background summary
OXN PR tablets are a combination product of prolonged release
oxycodone/prolonged release naloxone being developed for the treatment of
moderate to serve pain in Germany. The naloxone component in a fixed
compination with oxycodone is indicated for therapy of and/or prophylaxis of
opioid constipation
Study objective
• to assess opioid-induced constipation based on Complete Spontaneous Bowel
Movement (CSBMs) recorded in the subject daily diaries during the first 4 weeks
of the Double-blind Phase.
• to assess the frequency of laxative use during the 12 weeks of the
Double-blind Phase.
• to assess pain and interference of pain with activities during treatment with
OXN PR compared with OxyPR based on the modified Brief Pain Inventory- Short
Form (modified BPI-SF).
• to assess the frequency of pain rescue medication use during the 12 weeks of
the Double-blind Phase.
• to assess overall health based on the SF-36 v2.
Study design
Pre-randomisation Phase (up to 42 days):
Screening (up to 14 days): At Visit 1, after written informed consent is
obtained, subjects will undergo complete evaluation for study eligibility
(i.e., all inclusion/exclusion criteria). Subjects meeting the Prospective
Assessment Criteria may continue in the study.
Run-in (7 to 28 days): At Visit 2, subjects will have their opioid therapy
converted to open-label oxycodone prolonged release (OxyPR), which will be
titrated to an effective analgesic dose between 20 - 80 mg/day of OxyPR (20,
30, 40, 50, 60, 70 and 80 mg/d). Oxycodone immediate release (OxyIR) will be
available as rescue medication. Subjects will also have their pre-study
laxative therapy converted to the study laxative to be used per the study
routine for constipation during this period, no sooner than 72 hours after
their most recent bowel movement (BM) as rescue medication for constipation.
However, investigators will instruct their subjects that if they exhibit
discomfort during the 72 hours period they can take oral bisacodyl as a
laxative earlier than 72 hours after their most recent bowel movement as
required to treat constipation. The maximum allowed number of bisacodyl intakes
is 5 dosages bisacodyl 10mg/day within the last 7 days of the Run-in Period.
The 7-day baseline assessment in the Run-in Period will start no sooner than
the day of the initial dose conversion to OxyPR.
Double-blind Phase (12 weeks):
At Visit 3, subjects who qualify for entry into the Double-blind Phase of the
study will be randomised to OXN PR or OxyPR in a 1:1 ratio. Subjects will
receive double-blind study medication for up to 12 weeks. The switch to the
study medication will be done in a stepwise manner over a period of 4 days
regarding the naloxone dose within the first week of Double-blind Phase for the
60, 70 and 80 mg/day doses. For subjects on the 20-50 mg/day doses the study
medication will be switched directly. During the Double-blind Phase the
subjects will continue to use study laxatives as described above. Subjects will
be asked not to take any laxative for the first 3 days after the randomisation
visit (V3). However, investigators will instruct their subjects that if they
exhibit discomfort during this period they can take oral bisacodyl as a
laxative earlier as required to treat constipation. OxyIR will be prescribed as
rescue medication up to 6 times a day at a dose of approximately 1/6 of total
daily study medication dose.
During the Double-blind Phase the dose range based on OxyPR will be 20 - 80
mg/day, which refers to the effective, stable analgesic dose established in the
Run-In period. If a dose above 80 mg oxycodone/day is needed, an uptitration to
120 mg/day oxycodone during the Double-blind Phase is permitted (100 and 120
mg/d).
According to the Protocol Amendment No1, Final, dated 07 Jan 09 the 12-lead ECG
assessment will be performed at every visit including screening one and except
Visit No9. As well as the Vigilance procedure will take place at the 2nd - 8th
Visits.
Vital Signs Measurements are going to be performed at every Study Visit.
Study burden and risks
Physician Exam: 4
Vital signs Measurement:8
Vigiliance:7
Visits: 9
the diary have to be filled in every day
12-lead EKG: 8
pregnancy test: 2
It is possible that patient may not receive the same level of pain control when
his current medication is switched to subject`s study medication (at visit 2),
until doctor has increased the dose of study medication to a dose that does
control subject`s pain. If subject is currently taking a laxative for the
treatment of his constipation patient may notice his constipation worsens
during the first few days of the study as subject will be required to stop his
laxative for 3 days after visit 3.
It is possible that if the treatment is given to a pregnant woman it could harm
the unborn child. Therefore pregnant women must not take part in this study;
neither should women who plan to become pregnant during the study. Women who
are at risk of pregnancy will be asked to have a pregnancy test prior to taking
part to exclude this possibility. Women who could become pregnant must use an
effective contraceptive during the course of this study. Any woman who finds
that she has become pregnant while taking part in the study should immediately
tell her study doctor.
The blood samples that subject provide may cause some discomfort and/or
bruising.
ECG examinations may lead to local irritations etc.
Hoehenstrasse 10, Limburg (Lahn)
65549
Germany
Hoehenstrasse 10, Limburg (Lahn)
65549
Germany
Listed location countries
Age
Inclusion criteria
1. Male or female subjects at least 18 years or older.
2. Female subjects less than one year post-menopausal must have a negative pregnancy test recorded prior to the first dose of study medication, be non-lactating, and willing to use adequate and highly effective methods of contraception throughout the study. A highly effective method of birth control is defined as those which result in a low failure rate (i.e. less than 1% per year) when used consistently and correctly such as sterilization, implants, injectables, combined oral contraceptives, some IUDs (Intrauterine Device, hormonal), sexual abstinence or vasoectomised partner.
3. Moderate to severe chronic nonmalignant OA, whose primary pain site is of the hip(s) and/or knee(s) and that require around-the-clock opioid therapy (oxycodone equivalent of 20-80 mg/day).
4. Subjects who require continuation of daily opioid treatment and are likely to benefit from WHO step III opioid therapy at least for the duration of the study.
5. Subjects with a clinical diagnosis of degenerative or primary osteoarthritis, supported by evidence from one of the following: magnetic resonance imaging (MRI), computerized axial tomography (CAT), arthroscopy or x-ray. The clinical imaging of osteoarthritis may include one or more of the following features: joint space narrowing, degenerative changes, osteophyte formation or subchondral cysts. Subjects will identify the most painful joint (hip or knee) for documentation of OA. Pain measurement will be done at this joint only.
6. Subject and investigator confirm that the subjects constipation is induced, or worsened by the subjects pre study opioid medication (present at Screening) and needs medical treatment.
7. Subjects willing and able to participate in all aspects of the core study, including use of oral medication, completion of subjective evaluations, attending scheduled clinic visits, completing telephone contacts, and compliance with protocol requirements as evidenced by providing written, informed consent and willing to discontinue their current opioid analgesic routine, laxative regimen, and comply with the use of oral bisacodyl as laxative rescue medication.
8. Subjects taking daily fibre supplementation or bulking agents are eligible if they can be maintained on a stable dose and regimen throughout the study, and in the investigator*s opinion are willing and able to maintain adequate hydration.
9. Subjects taking pre-study, non-opioid analgesics, and all other concomitant medications, including those medications for the treatment of depression and non-medical treatment, that are thought to be stable, and are considered necessary for the subject*s welfare, and are anticipated to remain stable throughout the Double-blind Period of the study, and are to be continued under the supervision of the investigator, are eligible.
Exclusion criteria
1. Females who are pregnant (positive β-hCG test) or lactating.
2. Subjects with any contraindication or any history of hypersensitivity to bisacodyl, oxycodone, naloxone, related products or other ingredients.
3. Subjects with secondary osteoarthritis (e.g. fracture, septic, agromegaly).
4. Subjects with a replacement of the most painful joint (knee or hip).
5. Subjects with evidence of significant structural abnormalities of the gastrointestinal tract (e.g., bowel obstruction, strictures) or any diseases/conditions that affect bowel transit (e.g. ileus, hypothyroidism).
6. Subjects who require treatment for the diagnosis of irritable bowel syndrome (IBS); Surgery within 2 months prior to the start of the Screening Period, or planned surgery during the 12-week Double-blind Phase that may affect GI motility or pain.
7. Subjects with cancer associated pain.
8. Subjects with chronic disease of the joints of a relapsing/remitting nature or any other chronic condition causing pain likely to warrant the persistent use of escape analgesic (e.g. gout, Rheumatoid Arthritis (RA)).
9. Evidence of clinically significant cardiovascular, renal, hepatic or psychiatric disease, as determined by medical history, clinical laboratory tests, ECG results, and physical examination, that would place the subject at risk upon exposure to the study medication or that may confound the analysis and/or interpretation of the study results.
10. Subjects with evidence of impaired liver/kidney function upon entry into the study defined as aspartate aminotransferase (AST; SGOT), alanine aminotransferase (ALT; SGPT), or alkaline phosphatase levels >3 times the upper limit of normal; gamma glutamyl transpeptidase (GGT or GGTP) >=5 times the upper limit of normal; total bilirubin level outside of the reference range; and/or creatinine level outside of the reference range, or in the investigator*s opinion, liver and/or kidney impairment to the extent that the subject should not participate in this study.
11. Subjects presently taking, or who have taken naloxone or naltrexone within 30 days of study entry (defined as the start of the Screening Period).
12. Subjects receiving hypnotics or other central nervous system (CNS) depressants that, in the investigator*s opinion, may pose a risk of additional CNS depression with opioids study medication.
13. Subjects receiving opioid substitution therapy for opioid addiction (e.g. methadone or buprenorphine).
14. Subjects with active alcohol or drug abuse and/or history of opioid abuse.
15. Subjects who have received a new chemical entity or an experimental drug within 30 days of study entry (defined as the start of the Screening Period).
16. Subjects with any situation in which opioids are contraindicated, severe respiratory depression with hypoxia and/or hypercapnia, severe chronic obstructive lung disease, cor pulmonale, severe bronchial asthma, paralytic ileus.
17. Subjects with myxoedema;18. Subjects presently taking, or who have taken tramadol as primary opioid anagesic for chronic pain within 30 days of study entry (defined as the start of the Screening Period)
Design
Recruitment
Followed up by the following (possibly more current) registration
No registrations found.
Other (possibly less up-to-date) registrations in this register
No registrations found.
In other registers
Register | ID |
---|---|
EudraCT | EUCTR2008-002670-36-NL |
CCMO | NL26311.040.08 |