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Study of NGX-4010 for the Treatment of Postherpetic Neuralgia

Primary Purpose

Peripheral Nervous System Diseases, Pain, Neuralgia

Status
Completed
Phase
Phase 3
Locations
Study Type
Interventional
Intervention
NGX-4010
Sponsored by
NeurogesX
About
Eligibility
Locations
Outcomes
Full info

About this trial

This is an interventional treatment trial for Peripheral Nervous System Diseases focused on measuring dermal assessment, pain measurement, diary, PHN, shingles, neuropathy, analgesics, capsaicin, postherpetic neuralgia

Eligibility Criteria

18 Years - 90 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Diagnosis of PHN, with at least 6 months of pain since shingles vesicle crusting Average NPRS scores for PHN-associated pain during screening period of 3 to 9 Intact, unbroken skin over the painful area(s) to be treated If taking chronic pain medications, be on a stable (not PRN) regimen for at least 21 days prior to Study Patch Application Visit (Day 0) and willing to maintain medications at same stable dose(s) and schedule throughout study Female subjects with child-bearing potential must have a negative serum beta human chorionic gonadotropin (hCG) pregnancy test, within 7 days of Study Patch Application Visit All subjects must be willing to use effective methods of birth control and/or refrain from participating in a conception process during the study (or, in the event of early termination from the study, for 30 days following experimental drug exposure) Be willing and able to comply with protocol requirements for the duration of study participation. Subjects must sign an informed consent form for this study approved by the Investigator's Institutional Review Board/Independent Ethics Committee (IRB/IEC). Exclusion Criteria: Concomitant opioid medication, unless orally or transdermally administered and not exceeding a total daily dose of morphine 60 mg/day, or equivalent. Parenteral opioid use is excluded, regardless of dose. Unavailability of an effective rescue medication strategy for the subject, such as unwillingness to use opioid analgesics during study treatment, or high tolerance to opioids precluding the ability to relieve treatment-associated discomfort, as judged by Investigator. Active substance abuse or history of chronic substance abuse within the past year, or prior chronic substance abuse (including alcoholism) judged likely to recur during the study period by Investigator. Recent use (within 21 days preceding the Study Patch Application Visit [Day 0]) of any topically applied pain medication, such as non-steroidal anti-inflammatory drugs, menthol, methyl salicylate, local anesthetics including Lidoderm (lidocaine patch 5%), steroids or capsaicin products on the painful areas. Participation in a previous NeurogesX clinical trial in which subject received NGX-4010 (either blinded or open-label study treatment). Current use of any investigational agent, or Class 1 anti-arrhythmic drugs (such as tocainide and mexiletine). Diabetes mellitus, unless well-controlled as evidenced by an HbA1c level less than or equal to 9%. Hypertension, unless adequately controlled by medication. Significant pain of an etiology other than PHN. Subjects must not have significant ongoing pain from other cause(s) that may interfere with judging PHN-related pain. Painful PHN areas located only on the face, above the hairline of the scalp, and/or in proximity to mucous membranes. Any implanted medical device (spinal cord stimulator, intrathecal pump or peripheral nerve stimulator) for the treatment of neuropathic pain. Hypersensitivity to capsaicin (i.e., chili peppers or OTC capsaicin products), local anesthetics, oxycodone hydrochloride, hydrocodone bitartrate or adhesives. Significant ongoing or untreated abnormalities in cardiac, renal, hepatic, or pulmonary function that may interfere either with the ability to complete the study or the evaluation of adverse events. Recent history of a significant medical-surgical intervention in the judgment of the Investigator. Evidence of cognitive impairment including dementia that may interfere with subject's ability to complete daily pain diaries requiring subject's recall of average PHN pain level in the past 24 hours.

Sites / Locations

    Outcomes

    Primary Outcome Measures

    Percent change from baseline in "average pain for the past 24 hours" Numeric Pain Rating Scale (NPRS) score (i.e., average of scores during Weeks 2 to 8, compared to baseline) in the active group compared to the control group

    Secondary Outcome Measures

    Percent change from baseline in "average pain for the past 24 hours" NPRS score (i.e., average of scores during Weeks 2 to 4 and 2 to 12, respectively, compared to baseline) in the active group compared to the control group
    Proportion of subjects reaching 30% and 50% decrease, respectively, from baseline in "average pain for the past 24 hours" NPRS scores on average during Weeks 2 to 8
    Proportion of subjects reaching 30% and 50% decrease, respectively, from baseline in "average pain for the past 24 hours" NPRS scores on average during Weeks 2 to 4 and 2 to 12, respectively
    Median onset and mean duration of efficacy in days in the active group
    Proportion of subjects with significant changes in concomitant pain medication usage during Weeks 2 to 8, compared to baseline
    Brief Pain Inventory (BPI)
    Short-Form McGill Pain Questionnaire (SF-MPQ)
    Subject Global Impression of Change (PGIC)
    Self-Assessment of Treatment (SAT)
    Short-Form 36v2 Health Survey (SF-36v2™)

    Full Information

    First Posted
    June 21, 2005
    Last Updated
    March 4, 2008
    Sponsor
    NeurogesX
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    1. Study Identification

    Unique Protocol Identification Number
    NCT00115310
    Brief Title
    Study of NGX-4010 for the Treatment of Postherpetic Neuralgia
    Official Title
    A Randomized, Double-Blind, Controlled Study of NGX-4010 for the Treatment of Postherpetic Neuralgia
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    March 2008
    Overall Recruitment Status
    Completed
    Study Start Date
    June 2005 (undefined)
    Primary Completion Date
    undefined (undefined)
    Study Completion Date
    October 2006 (Actual)

    3. Sponsor/Collaborators

    Name of the Sponsor
    NeurogesX

    4. Oversight

    5. Study Description

    Brief Summary
    The purpose of the study is to assess the efficacy and safety of NGX-4010 applied for 60 minutes for the treatment of postherpetic neuralgia (PHN).
    Detailed Description
    This study is a 12-week randomized, double-blind, controlled multi-center evaluation of the efficacy, safety and tolerability of NGX-4010 for the treatment of PHN. Eligible subjects will have moderate to severe pain from PHN, with average NPRS scores during screening of 3 to 9 (inclusive). Painful areas of up to 1000 square centimeters will be treated during a single treatment administration in this study. Subjects will be randomly assigned to receive active NGX-4010 patches or low-concentration control patches that are identical in appearance, according to a 1:1 allocation scheme. Subjects may be on stable chronic oral pain medication regimens, but currently will not be using any topical pain medications on the affected areas. NPRS scores for the average pain in the past 24 hours will be recorded daily in the evening, beginning on the day of the Screening Visit (usually on Day -14). Subjects will continue to record NPRS scores in a take-home diary from the evening on the day of treatment through the evening before the Termination Visit at Week 12. Subjects will return for interim follow-up visits at Weeks 4 and 8 following study treatment.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Peripheral Nervous System Diseases, Pain, Neuralgia, Herpes Zoster, Shingles
    Keywords
    dermal assessment, pain measurement, diary, PHN, shingles, neuropathy, analgesics, capsaicin, postherpetic neuralgia

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Phase 3
    Interventional Study Model
    Parallel Assignment
    Masking
    Double
    Allocation
    Randomized
    Enrollment
    400 (false)

    8. Arms, Groups, and Interventions

    Intervention Type
    Drug
    Intervention Name(s)
    NGX-4010
    Primary Outcome Measure Information:
    Title
    Percent change from baseline in "average pain for the past 24 hours" Numeric Pain Rating Scale (NPRS) score (i.e., average of scores during Weeks 2 to 8, compared to baseline) in the active group compared to the control group
    Secondary Outcome Measure Information:
    Title
    Percent change from baseline in "average pain for the past 24 hours" NPRS score (i.e., average of scores during Weeks 2 to 4 and 2 to 12, respectively, compared to baseline) in the active group compared to the control group
    Title
    Proportion of subjects reaching 30% and 50% decrease, respectively, from baseline in "average pain for the past 24 hours" NPRS scores on average during Weeks 2 to 8
    Title
    Proportion of subjects reaching 30% and 50% decrease, respectively, from baseline in "average pain for the past 24 hours" NPRS scores on average during Weeks 2 to 4 and 2 to 12, respectively
    Title
    Median onset and mean duration of efficacy in days in the active group
    Title
    Proportion of subjects with significant changes in concomitant pain medication usage during Weeks 2 to 8, compared to baseline
    Title
    Brief Pain Inventory (BPI)
    Title
    Short-Form McGill Pain Questionnaire (SF-MPQ)
    Title
    Subject Global Impression of Change (PGIC)
    Title
    Self-Assessment of Treatment (SAT)
    Title
    Short-Form 36v2 Health Survey (SF-36v2™)

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    18 Years
    Maximum Age & Unit of Time
    90 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: Diagnosis of PHN, with at least 6 months of pain since shingles vesicle crusting Average NPRS scores for PHN-associated pain during screening period of 3 to 9 Intact, unbroken skin over the painful area(s) to be treated If taking chronic pain medications, be on a stable (not PRN) regimen for at least 21 days prior to Study Patch Application Visit (Day 0) and willing to maintain medications at same stable dose(s) and schedule throughout study Female subjects with child-bearing potential must have a negative serum beta human chorionic gonadotropin (hCG) pregnancy test, within 7 days of Study Patch Application Visit All subjects must be willing to use effective methods of birth control and/or refrain from participating in a conception process during the study (or, in the event of early termination from the study, for 30 days following experimental drug exposure) Be willing and able to comply with protocol requirements for the duration of study participation. Subjects must sign an informed consent form for this study approved by the Investigator's Institutional Review Board/Independent Ethics Committee (IRB/IEC). Exclusion Criteria: Concomitant opioid medication, unless orally or transdermally administered and not exceeding a total daily dose of morphine 60 mg/day, or equivalent. Parenteral opioid use is excluded, regardless of dose. Unavailability of an effective rescue medication strategy for the subject, such as unwillingness to use opioid analgesics during study treatment, or high tolerance to opioids precluding the ability to relieve treatment-associated discomfort, as judged by Investigator. Active substance abuse or history of chronic substance abuse within the past year, or prior chronic substance abuse (including alcoholism) judged likely to recur during the study period by Investigator. Recent use (within 21 days preceding the Study Patch Application Visit [Day 0]) of any topically applied pain medication, such as non-steroidal anti-inflammatory drugs, menthol, methyl salicylate, local anesthetics including Lidoderm (lidocaine patch 5%), steroids or capsaicin products on the painful areas. Participation in a previous NeurogesX clinical trial in which subject received NGX-4010 (either blinded or open-label study treatment). Current use of any investigational agent, or Class 1 anti-arrhythmic drugs (such as tocainide and mexiletine). Diabetes mellitus, unless well-controlled as evidenced by an HbA1c level less than or equal to 9%. Hypertension, unless adequately controlled by medication. Significant pain of an etiology other than PHN. Subjects must not have significant ongoing pain from other cause(s) that may interfere with judging PHN-related pain. Painful PHN areas located only on the face, above the hairline of the scalp, and/or in proximity to mucous membranes. Any implanted medical device (spinal cord stimulator, intrathecal pump or peripheral nerve stimulator) for the treatment of neuropathic pain. Hypersensitivity to capsaicin (i.e., chili peppers or OTC capsaicin products), local anesthetics, oxycodone hydrochloride, hydrocodone bitartrate or adhesives. Significant ongoing or untreated abnormalities in cardiac, renal, hepatic, or pulmonary function that may interfere either with the ability to complete the study or the evaluation of adverse events. Recent history of a significant medical-surgical intervention in the judgment of the Investigator. Evidence of cognitive impairment including dementia that may interfere with subject's ability to complete daily pain diaries requiring subject's recall of average PHN pain level in the past 24 hours.
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    Jeffrey Tobias, MD
    Organizational Affiliation
    NeurogesX
    Official's Role
    Study Director

    12. IPD Sharing Statement

    Citations:
    PubMed Identifier
    18977178
    Citation
    Backonja M, Wallace MS, Blonsky ER, Cutler BJ, Malan P Jr, Rauck R, Tobias J; NGX-4010 C116 Study Group. NGX-4010, a high-concentration capsaicin patch, for the treatment of postherpetic neuralgia: a randomised, double-blind study. Lancet Neurol. 2008 Dec;7(12):1106-12. doi: 10.1016/S1474-4422(08)70228-X. Epub 2008 Oct 30. Erratum In: Lancet Neurol. 2009 Jan;8(1):31.
    Results Reference
    derived

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    Study of NGX-4010 for the Treatment of Postherpetic Neuralgia

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