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Naloxone SR Capsules in Patients With Opioid Induced Constipation

Primary Purpose

Chronic Pain, Opioid Induced Constipation

Status
Completed
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
Naloxone SR 5 mg capsules
Placebo
Naloxone SR 10 mg capsules
Naloxone SR 20mg capsules
Naloxone SR 2.5 mg capsules
Sponsored by
S.L.A. Pharma AG
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Chronic Pain focused on measuring pain, opioid, constipation, Subjects taking opioids for chronic non-cancer pain, who, experience symptoms of opioid induced constipation

Eligibility Criteria

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

Inclusion Criteria:

  • All subjects must give written informed consent
  • Male or female subjects greater than 18 years of age
  • Taking opioid full agonist therapy(oral or transdermal) for persistent non-cancer pain, for at least 4 weeks prior to baseline visit
  • Subjects with at least a 3 week history of OIC prior to baseline; where bowel dysfunction is predominantly due to opioids and started following commencement of opioid therapy
  • Subjects with <3 SBMs a week and experiencing one or more bowel symptoms (incomplete evacuation, straining, hard/small pellets) for 25% or more of bowel movements during the screening period
  • Subjects must be willing to discontinue all current laxative (constipation) therapy. Bisacodyl will be provided and taken as required

Exclusion Criteria:

  • Women of childbearing potential, unless surgically sterile or using adequate contraception (either IUD, oral or depot contraceptive, or barrier plus spermicide). Women using oral contraception must have started using it at least 2 months prior to enrolment
  • Women who are pregnant or breastfeeding
  • Symptoms suggestive of non-opioid related bowel dysfunction (e.g. IBS - intermittent constipation or diarrhoea) or have diarrhoea or loose stools in the 4 weeks prior to baseline
  • History of chronic constipation prior to commencing opioid therapy
  • Gastrointestinal disorders known to affect bowel transit, or contribute to bowel dysfunction (other than OIC)
  • Chronic faecal incontinence
  • Subjects who have a colostomy, ileostomy, or colectomy with ileorectal anastomosis
  • Subjects with a history of neoplastic disease within 5 years (except for basal cell carcinoma or non-metastatic squamous cell carcinoma of the skin)
  • Subjects taking opioids for the management of drug addiction Subjects who do not meet any of the following criteria regarding baseline medications. Analgesia (including opioids and NSAIDs) should be stable throughout the trial.

    • Any baseline analgesia must have been administered at a stable dose for a minimum of 4 weeks. If non-opioid analgesia recently discontinued, must have stopped at least 4 weeks prior to baseline
    • Laxatives (outside that allowed by the protocol) are not permitted; these agents must have been discontinued at the screening visit.
    • Use of drugs known to affect gut transit time (other than opioids) are not permitted (see Section 6.9 for exceptions)
    • Use of mixed agonist/antagonist, or partial agonist opioids are not permitted (e.g. buprenorphine, pentazocine, cyclazocine, nalbuphine, nalorphine)
    • Experimental agents must have been discontinued at least 8 weeks prior to screening, or for a period equivalent to 5 half-lives (t½) of the agent (whichever is longer)
    • Subjects with a history of clinically significant and/or persistent disorder that, in the investigators opinion, may affect the clinical trial assessments
    • Subjects with any laboratory tests considered clinically significant at screening.
    • Subjects not ambulatory i.e. bedridden or require use of a commode
    • Subjects who will be unavailable for the duration of the trial, likely to be non-compliant with the protocol, or who are felt to be unsuitable by the Investigator for any other reason

Sites / Locations

  • Schmerzzentrum Berlin
  • Schmerzzentrum Frankfurt
  • Gemeinschaftspraxis Tamm-Albert-Schroter-Uhmann
  • Gemeinschaftspraxis Loewenstein-Hesselbarth
  • Regionales Schmerzzentrum Wuppertal
  • St Jame's Hospital Leeds
  • Norfolk & Norwich Hospital
  • Department of Pain Management, York Hospital

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm 5

Arm Type

Placebo Comparator

Active Comparator

Experimental

Experimental

Experimental

Arm Label

Capsules with no active drug

Naloxone SR 2.5 mg capsules

Naloxone SR 10mg capsules

Naloxone SR 20 mg capsules

Naloxone SR 5mg capsules

Arm Description

Placebo capsules once daily for three weeks then twice daily for three weeks.

Naloxone SR 2.5 mg capsules once daily for three weeks then twice daily for three weeks.

Naloxone SR 10 mg capsules once daily for three weeks then twice daily for three weeks.

Two Naloxone SR 10 mg capsules once daily for three weeks then twice daily for three weeks.

Naloxone SR 5 mg capsules once daily for three weeks then twice daily for three weeks.

Outcomes

Primary Outcome Measures

Incidence and Severity of Treatment Emergent Adverse Events on Single Dosing.
Incidence and severity of treatment emergent adverse events on single dosing.

Secondary Outcome Measures

Full Information

First Posted
September 24, 2009
Last Updated
November 7, 2013
Sponsor
S.L.A. Pharma AG
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1. Study Identification

Unique Protocol Identification Number
NCT00984334
Brief Title
Naloxone SR Capsules in Patients With Opioid Induced Constipation
Official Title
A Multicentre, Randomised, Double-Blind, Placebo-Controlled, Multiple Ascending Dose Study Evaluating the Safety, Tolerability and Efficacy of Naloxone SR Capsules in Subjects With Constipation Due to Opioids, Taken for Persistent Non-Cancer Pain
Study Type
Interventional

2. Study Status

Record Verification Date
November 2013
Overall Recruitment Status
Completed
Study Start Date
October 2009 (undefined)
Primary Completion Date
January 2012 (Actual)
Study Completion Date
April 2012 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
S.L.A. Pharma AG

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
For many patients taking opioids for pain relief one of the most distressing side effects is constipation. Naloxone is effective in the reversal of the effects of opioids and is used following opioid overdose. If naloxone is given by mouth it would relieve the effects of constipation but as it goes into the blood stream very quickly, it would also reverse the effects of the opioid and therefore stop the pain relief. The aim of this study is to examine a slow release formulation of naloxone to see if is can reduce constipation without reducing the pain relieving effects of the opioid.
Detailed Description
Naloxone has been used for many years as an IV or IM injection for the reversal of opioid effects (following opioid overdose) and has been evaluated as an oral formulation to manage opioid-induced constipation. Immediate release oral naloxone preparations have however led to reversal of opioid effects and withdrawal. This has initiated the development of prolonged (slow release) naloxone preparations which prevent the systemic levels of naloxone reaching levels where the central opioid effects may be reversed. Naloxone has a high first pass metabolism (98%) and short half life (~1hr). The objectives of this trial are to identify the optimum dosage regime of Naloxone SR capsules based on tolerability level, to improve spontaneous bowel movement frequency, and relieve GI symptoms, in patients suffering with opioid induced constipation.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Chronic Pain, Opioid Induced Constipation
Keywords
pain, opioid, constipation, Subjects taking opioids for chronic non-cancer pain, who, experience symptoms of opioid induced constipation

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
40 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Capsules with no active drug
Arm Type
Placebo Comparator
Arm Description
Placebo capsules once daily for three weeks then twice daily for three weeks.
Arm Title
Naloxone SR 2.5 mg capsules
Arm Type
Active Comparator
Arm Description
Naloxone SR 2.5 mg capsules once daily for three weeks then twice daily for three weeks.
Arm Title
Naloxone SR 10mg capsules
Arm Type
Experimental
Arm Description
Naloxone SR 10 mg capsules once daily for three weeks then twice daily for three weeks.
Arm Title
Naloxone SR 20 mg capsules
Arm Type
Experimental
Arm Description
Two Naloxone SR 10 mg capsules once daily for three weeks then twice daily for three weeks.
Arm Title
Naloxone SR 5mg capsules
Arm Type
Experimental
Arm Description
Naloxone SR 5 mg capsules once daily for three weeks then twice daily for three weeks.
Intervention Type
Drug
Intervention Name(s)
Naloxone SR 5 mg capsules
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Type
Drug
Intervention Name(s)
Naloxone SR 10 mg capsules
Intervention Type
Drug
Intervention Name(s)
Naloxone SR 20mg capsules
Intervention Type
Drug
Intervention Name(s)
Naloxone SR 2.5 mg capsules
Primary Outcome Measure Information:
Title
Incidence and Severity of Treatment Emergent Adverse Events on Single Dosing.
Description
Incidence and severity of treatment emergent adverse events on single dosing.
Time Frame
3 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: All subjects must give written informed consent Male or female subjects greater than 18 years of age Taking opioid full agonist therapy(oral or transdermal) for persistent non-cancer pain, for at least 4 weeks prior to baseline visit Subjects with at least a 3 week history of OIC prior to baseline; where bowel dysfunction is predominantly due to opioids and started following commencement of opioid therapy Subjects with <3 SBMs a week and experiencing one or more bowel symptoms (incomplete evacuation, straining, hard/small pellets) for 25% or more of bowel movements during the screening period Subjects must be willing to discontinue all current laxative (constipation) therapy. Bisacodyl will be provided and taken as required Exclusion Criteria: Women of childbearing potential, unless surgically sterile or using adequate contraception (either IUD, oral or depot contraceptive, or barrier plus spermicide). Women using oral contraception must have started using it at least 2 months prior to enrolment Women who are pregnant or breastfeeding Symptoms suggestive of non-opioid related bowel dysfunction (e.g. IBS - intermittent constipation or diarrhoea) or have diarrhoea or loose stools in the 4 weeks prior to baseline History of chronic constipation prior to commencing opioid therapy Gastrointestinal disorders known to affect bowel transit, or contribute to bowel dysfunction (other than OIC) Chronic faecal incontinence Subjects who have a colostomy, ileostomy, or colectomy with ileorectal anastomosis Subjects with a history of neoplastic disease within 5 years (except for basal cell carcinoma or non-metastatic squamous cell carcinoma of the skin) Subjects taking opioids for the management of drug addiction Subjects who do not meet any of the following criteria regarding baseline medications. Analgesia (including opioids and NSAIDs) should be stable throughout the trial. Any baseline analgesia must have been administered at a stable dose for a minimum of 4 weeks. If non-opioid analgesia recently discontinued, must have stopped at least 4 weeks prior to baseline Laxatives (outside that allowed by the protocol) are not permitted; these agents must have been discontinued at the screening visit. Use of drugs known to affect gut transit time (other than opioids) are not permitted (see Section 6.9 for exceptions) Use of mixed agonist/antagonist, or partial agonist opioids are not permitted (e.g. buprenorphine, pentazocine, cyclazocine, nalbuphine, nalorphine) Experimental agents must have been discontinued at least 8 weeks prior to screening, or for a period equivalent to 5 half-lives (t½) of the agent (whichever is longer) Subjects with a history of clinically significant and/or persistent disorder that, in the investigators opinion, may affect the clinical trial assessments Subjects with any laboratory tests considered clinically significant at screening. Subjects not ambulatory i.e. bedridden or require use of a commode Subjects who will be unavailable for the duration of the trial, likely to be non-compliant with the protocol, or who are felt to be unsuitable by the Investigator for any other reason
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Karen Simpson, MD
Organizational Affiliation
St James University Hospital, Leeds, UK
Official's Role
Principal Investigator
Facility Information:
Facility Name
Schmerzzentrum Berlin
City
Berlin
ZIP/Postal Code
10435
Country
Germany
Facility Name
Schmerzzentrum Frankfurt
City
Frankfurt
ZIP/Postal Code
60311
Country
Germany
Facility Name
Gemeinschaftspraxis Tamm-Albert-Schroter-Uhmann
City
Hannover
ZIP/Postal Code
30167
Country
Germany
Facility Name
Gemeinschaftspraxis Loewenstein-Hesselbarth
City
Mainz
ZIP/Postal Code
55116
Country
Germany
Facility Name
Regionales Schmerzzentrum Wuppertal
City
Wuppertal
ZIP/Postal Code
42105
Country
Germany
Facility Name
St Jame's Hospital Leeds
City
Leeds
ZIP/Postal Code
LS9 7TF
Country
United Kingdom
Facility Name
Norfolk & Norwich Hospital
City
Norwich
ZIP/Postal Code
NR4 7UY
Country
United Kingdom
Facility Name
Department of Pain Management, York Hospital
City
York
ZIP/Postal Code
LS14 6UH
Country
United Kingdom

12. IPD Sharing Statement

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Naloxone SR Capsules in Patients With Opioid Induced Constipation

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