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Evaluating PN 400 (VIMOVO) in Reducing Gastric Ulcers Compared to Non-steroidal Antiinflammatory Drug (NSAID) Naproxen

Primary Purpose

Gastric Ulcer

Status
Completed
Phase
Phase 3
Locations
Study Type
Interventional
Intervention
PN400 (VIMOVO)
Naproxen
Sponsored by
POZEN
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Gastric Ulcer focused on measuring NSAID, gastric ulcers, Vimovo, Esomeprazole, Naproxen

Eligibility Criteria

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

Inclusion Criteria

A subject was eligible for inclusion in this study if all of the following criteria applied:

  1. Male or non-pregnant, non-breastfeeding female subjects with a history of osteoarthritis, rheumatoid arthritis, ankylosing spondylitis or other medical conditions expected to require daily NSAID therapy for at least 6 months, who were

    • 18-49 years of age and had a history of a documented, uncomplicated gastric or duodenal ulcer (a mucosal break of at least 3 mm in diameter with depth, without any concurrent bleeding, clot or perforation) within the past 5 years OR, who were
    • 50 years of age and older (These subjects did not require a history of a documented, uncomplicated gastric or duodenal ulcer within the past 5 years.)
  2. Female subjects were eligible for participation in the study if they were of

    • non-childbearing potential (i.e., physiologically incapable of becoming pregnant);
    • childbearing potential, had a negative pregnancy test at Screening, and at least 1 of the following applied or was agreed to by the subject:
    • Female sterilization or sterilization of male partner
    • Hormonal contraception by oral route, implant, injectable, vaginal ring
    • Any intrauterine device with published data showing that the lowest expected failure rate is < 1% per year
    • Double barrier method (2 physical barriers or 1 physical barrier plus spermicide)
    • Any other method with published data showing that the lowest expected failure rate is < 1% per year
  3. Each subject was required to understand and comply with study procedures required of a subject and was able and willing to provide written informed consent prior to any study procedures being performed.

Exclusion Criteria

A subject was not eligible for this study if any 1 or more of the following criteria applied:

  1. History of hypersensitivity to esomeprazole or to another PPI
  2. History of allergic reaction or intolerance to any NSAID (including aspirin) and/or a history of NSAID-induced symptoms of asthma, rhinitis, and/or nasal polyps
  3. Participation in any study of an investigational treatment in the 4 weeks before Screening
  4. Presence of uncontrolled acute or chronic medical illness, e.g., GI disorder, hypertension, diabetes, thyroid disorder, depression and/or infection that would have endangered a subject if they were to have participated in the study
  5. GI disorder or surgery leading to impaired drug absorption
  6. Evidence of uncontrolled, or unstable cardio- or cerebrovascular disorder, which in the investigator's opinion would have endangered a subject if they were to have participated in the study
  7. Schizophrenia or bipolar disorder
  8. Use of any excluded concomitant medication (see Section 9.4.8)
  9. A recent history (in the past 3 months) suggestive of alcohol or drug abuse or dependence, including overuse/abuse of narcotics for management of pain
  10. Serious blood coagulation disorder, including use of systemic anticoagulants
  11. Positive test result for H. pylori at Screening
  12. Screening endoscopy showing any gastric or duodenal ulcer at least 3 mm in diameter with depth
  13. Screening laboratory alanine aminotransferase (ALT) or aspartate aminotransferase (AST) value > 2 times the upper limit of normal
  14. Estimated creatinine clearance < 30 ml/min
  15. Other than noted specifically, any screening laboratory value that was clinically significant in the investigator's opinion and would have endangered a subject if they were to have participated in the study
  16. History of malignancy, treated or untreated, within the past 5 years, with the exception of successfully treated basal cell or squamous cell carcinoma of the skin

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm Type

    Experimental

    Active Comparator

    Arm Label

    PN400

    Naproxen

    Arm Description

    Naproxen 500 mg/Immediate-Release Esomeprazole 20 mg dosed twice daily

    Naproxen 500 mg dosed twice daily

    Outcomes

    Primary Outcome Measures

    Number of Participants With Gastric Ulcer Confirmed by Endoscopy
    The primary efficacy endpoint was the number of subjects with gastric ulcers at any time throughout 6 months of treatment. An ulcer was defined as a mucosal break of at least 3 mm in diameter (measured by close application of open endoscopic biopsy forceps) with unequivocal crater depth. A subject is considered to have completed the study if all scheduled assessments up through the 6 month visit have been performed or if the endpoint of gastric ulcer confirmed by endoscopy has been reached.

    Secondary Outcome Measures

    The Number of Participants With Pre-Specified NSAID-Associated Upper GI Adverse Events or Duodenal Ulcers
    The Number of Participants with Pre-Specified non-steroidal antiinflammatory drug (NSAID)-Associated Upper Gastrointestinal (UGI) Adverse Events or Duodenal Ulcers after 6 months of treatment. Pre-specified UGI adverse events typically associated with NSAID use include dyspepsia, abdominal pain, gastritis, erosive esophagitis, duodenitis, abdominal discomfort
    The Number of Participants Discontinuing From the Study Due to NSAID-Associated Upper GI Adverse Events or to Duodenal Ulcer
    The Number of Participants Discontinuing from the Study Due to non-steroidal antiinflammatory drug (NSAID)-Associated Upper GI Adverse Events or to Duodenal Ulcer during the treatment period
    The Number of Participants Developing Duodenal Ulcers Throughout 6 Months of Treatment
    The Number of Participants Developing Duodenal Ulcers at any time during the 6 Months of the treatment period
    Heartburn Symptom Resolution, ie no Heartburn Symptoms During the Last 7 Days Prior to the Visit
    Subjects were asked whether heartburn symptoms within the 7 days prior to the visit were: none: no symptoms mild: awareness of symptom, but easily tolerated moderate: discomforting symptom sufficient to cause interference with normal activities (including sleep) severe: incapacitating symptom, with inability to perform normal activities (including sleep) Heartburn was defined as a burning feeling rising from the stomach or lower part of the chest towards the neck.
    Improvement From Baseline in Upper Abdominal Pain and Discomfort Scores at 6 Months, Based on the Overall Treatment Evaluation for Dyspepsia Questionnaire
    Improvement from baseline in Upper Abdominal Pain and Discomfort scores at 6 months, based on the overall Treatment Evaluation for Dyspepsia Questionnaire. Subjects were asked: "since treatment started, has there been any change in your upper abdominal pain and/or discomfort?" Answers would be better/about the same/worse. Participants with the response "better" (instead of "about the same" or "worse"), are tabulated by treatment group.
    Mean Change From Baseline on Pain Intensity of the Severity of Dyspepsia Assessment (SODA) Subscales
    Mean Change from Baseline on Pain Intensity of the Severity of Dyspepsia Assessment (SODA) Subscales. There are 6 questions about abdominal pain during the past 7 days: q 1-5 on average: 1. rate with a number between 0 (no pain) and 100 (pain as bad as it could be), 2. rate with a number between 0 (no discomfort) and 10 (discomfort as bad as it can be), 3. on a scale of 5 (from none to excriciating), 4. on 100 mm VAS, 5. on a scale of 4 and 6. worst abdominal pain scale 0 (no discomfort) and 10 (discomfort as bad as it can be). Total composite possible range for "pain intensity" is: 2-47
    Mean Change From Baseline on Non-Pain Symptoms of the Severity of Dyspepsia Assessment (SODA) Subscales
    Change from Baseline of Non-Pain Symptoms on the SODA Assessment. There are 7 categories about the non-pain symptoms: burping/beching, heartburn, bloating, passing gas, sour taste, nausea and bad breath. For each of these categories, subjects were to rate during the past seven days, on average, the severity on a 5 point scale ranging from no problem to very severe problem. The scores are combined into a single composite score. The total possible range of the non-pain symptoms subscale is: 7-35.
    Mean Change From Baseline on Satisfaction of the Severity of Dyspepsia Assessment (SODA) Subscales
    Mean Change in Satisfaction on SODA Assessment. Questions/statements to rate about satisfaction/dissatisfaction with their present level of abdominal discomfort. Question 1: 4-point scale range 0 (extremely unhappy) to 4 (extremely happy), statement 2 (I feel satisfied with my health with regard to abdominal discomfort) & statement 3 (I am pleased because my abdominal discomfort seems under control) on a 5 point scale (definitely true to definitely false) & question 4 rated how pleased subjects were with abdominal discomfort on a 10 point scale. Total satisfaction composite range: 2-23

    Full Information

    First Posted
    May 20, 2010
    Last Updated
    November 29, 2010
    Sponsor
    POZEN
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    1. Study Identification

    Unique Protocol Identification Number
    NCT01129011
    Brief Title
    Evaluating PN 400 (VIMOVO) in Reducing Gastric Ulcers Compared to Non-steroidal Antiinflammatory Drug (NSAID) Naproxen
    Official Title
    6-Month, Phase 3, Randomized, Double-blind, Parallel-group, Controlled, Multi-center Study Evaluate Gastric Ulcer Incidence Following Administration of PN400 or Naproxen in Subjects Who Are at Risk for Developing NSAID-associated Ulcers
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    November 2010
    Overall Recruitment Status
    Completed
    Study Start Date
    September 2007 (undefined)
    Primary Completion Date
    September 2008 (Actual)
    Study Completion Date
    October 2008 (Actual)

    3. Sponsor/Collaborators

    Name of the Sponsor
    POZEN

    4. Oversight

    Data Monitoring Committee
    Yes

    5. Study Description

    Brief Summary
    This study uses a randomized, double-blind, controlled design to demonstrate that PN400 (esomeprazole and naproxen) is more effective in reducing the occurrence of gastroduodenal ulcers, dyspepsia, and heartburn in subjects at risk for developing NSAID-associated gastric ulcers compared to naproxen alone.
    Detailed Description
    Objectives: Primary: To demonstrate that PN400 is effective in reducing the risk of gastric ulcers in subjects at risk for developing NSAID-associated gastric ulcers. Secondary: To determine if PN400 is effective in reducing the risk of duodenal ulcers in subjects at risk for developing NSAID-associated ulcers To compare upper gastrointestinal symptoms in subjects treated with PN400 versus naproxen as measured by scores on the Severity of Dyspepsia Assessment (SODA) instrument and the Overall Treatment Evaluation - Dyspepsia (OTE-DP) To compare heartburn symptoms in subjects treated with PN400 versus naproxen To evaluate the safety and tolerability of PN400 and naproxen

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Gastric Ulcer
    Keywords
    NSAID, gastric ulcers, Vimovo, Esomeprazole, Naproxen

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Phase 3
    Interventional Study Model
    Parallel Assignment
    Masking
    ParticipantInvestigator
    Allocation
    Randomized
    Enrollment
    420 (Actual)

    8. Arms, Groups, and Interventions

    Arm Title
    PN400
    Arm Type
    Experimental
    Arm Description
    Naproxen 500 mg/Immediate-Release Esomeprazole 20 mg dosed twice daily
    Arm Title
    Naproxen
    Arm Type
    Active Comparator
    Arm Description
    Naproxen 500 mg dosed twice daily
    Intervention Type
    Drug
    Intervention Name(s)
    PN400 (VIMOVO)
    Other Intervention Name(s)
    Vimovo
    Intervention Description
    PN400 tablets (Naproxen 500 mg and Esomeprazole 20 mg) twice daily (bid) taken orally.
    Intervention Type
    Drug
    Intervention Name(s)
    Naproxen
    Other Intervention Name(s)
    Naprosyn
    Intervention Description
    Naproxen 500 mg dosed twice daily (bid) orally
    Primary Outcome Measure Information:
    Title
    Number of Participants With Gastric Ulcer Confirmed by Endoscopy
    Description
    The primary efficacy endpoint was the number of subjects with gastric ulcers at any time throughout 6 months of treatment. An ulcer was defined as a mucosal break of at least 3 mm in diameter (measured by close application of open endoscopic biopsy forceps) with unequivocal crater depth. A subject is considered to have completed the study if all scheduled assessments up through the 6 month visit have been performed or if the endpoint of gastric ulcer confirmed by endoscopy has been reached.
    Time Frame
    6 months
    Secondary Outcome Measure Information:
    Title
    The Number of Participants With Pre-Specified NSAID-Associated Upper GI Adverse Events or Duodenal Ulcers
    Description
    The Number of Participants with Pre-Specified non-steroidal antiinflammatory drug (NSAID)-Associated Upper Gastrointestinal (UGI) Adverse Events or Duodenal Ulcers after 6 months of treatment. Pre-specified UGI adverse events typically associated with NSAID use include dyspepsia, abdominal pain, gastritis, erosive esophagitis, duodenitis, abdominal discomfort
    Time Frame
    6 months
    Title
    The Number of Participants Discontinuing From the Study Due to NSAID-Associated Upper GI Adverse Events or to Duodenal Ulcer
    Description
    The Number of Participants Discontinuing from the Study Due to non-steroidal antiinflammatory drug (NSAID)-Associated Upper GI Adverse Events or to Duodenal Ulcer during the treatment period
    Time Frame
    6 Months
    Title
    The Number of Participants Developing Duodenal Ulcers Throughout 6 Months of Treatment
    Description
    The Number of Participants Developing Duodenal Ulcers at any time during the 6 Months of the treatment period
    Time Frame
    6 months
    Title
    Heartburn Symptom Resolution, ie no Heartburn Symptoms During the Last 7 Days Prior to the Visit
    Description
    Subjects were asked whether heartburn symptoms within the 7 days prior to the visit were: none: no symptoms mild: awareness of symptom, but easily tolerated moderate: discomforting symptom sufficient to cause interference with normal activities (including sleep) severe: incapacitating symptom, with inability to perform normal activities (including sleep) Heartburn was defined as a burning feeling rising from the stomach or lower part of the chest towards the neck.
    Time Frame
    6 months
    Title
    Improvement From Baseline in Upper Abdominal Pain and Discomfort Scores at 6 Months, Based on the Overall Treatment Evaluation for Dyspepsia Questionnaire
    Description
    Improvement from baseline in Upper Abdominal Pain and Discomfort scores at 6 months, based on the overall Treatment Evaluation for Dyspepsia Questionnaire. Subjects were asked: "since treatment started, has there been any change in your upper abdominal pain and/or discomfort?" Answers would be better/about the same/worse. Participants with the response "better" (instead of "about the same" or "worse"), are tabulated by treatment group.
    Time Frame
    change from baseline at 6 Months
    Title
    Mean Change From Baseline on Pain Intensity of the Severity of Dyspepsia Assessment (SODA) Subscales
    Description
    Mean Change from Baseline on Pain Intensity of the Severity of Dyspepsia Assessment (SODA) Subscales. There are 6 questions about abdominal pain during the past 7 days: q 1-5 on average: 1. rate with a number between 0 (no pain) and 100 (pain as bad as it could be), 2. rate with a number between 0 (no discomfort) and 10 (discomfort as bad as it can be), 3. on a scale of 5 (from none to excriciating), 4. on 100 mm VAS, 5. on a scale of 4 and 6. worst abdominal pain scale 0 (no discomfort) and 10 (discomfort as bad as it can be). Total composite possible range for "pain intensity" is: 2-47
    Time Frame
    Baseline to 6 Months
    Title
    Mean Change From Baseline on Non-Pain Symptoms of the Severity of Dyspepsia Assessment (SODA) Subscales
    Description
    Change from Baseline of Non-Pain Symptoms on the SODA Assessment. There are 7 categories about the non-pain symptoms: burping/beching, heartburn, bloating, passing gas, sour taste, nausea and bad breath. For each of these categories, subjects were to rate during the past seven days, on average, the severity on a 5 point scale ranging from no problem to very severe problem. The scores are combined into a single composite score. The total possible range of the non-pain symptoms subscale is: 7-35.
    Time Frame
    baseline to 6 Months
    Title
    Mean Change From Baseline on Satisfaction of the Severity of Dyspepsia Assessment (SODA) Subscales
    Description
    Mean Change in Satisfaction on SODA Assessment. Questions/statements to rate about satisfaction/dissatisfaction with their present level of abdominal discomfort. Question 1: 4-point scale range 0 (extremely unhappy) to 4 (extremely happy), statement 2 (I feel satisfied with my health with regard to abdominal discomfort) & statement 3 (I am pleased because my abdominal discomfort seems under control) on a 5 point scale (definitely true to definitely false) & question 4 rated how pleased subjects were with abdominal discomfort on a 10 point scale. Total satisfaction composite range: 2-23
    Time Frame
    baseline to 6 Months

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    18 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria A subject was eligible for inclusion in this study if all of the following criteria applied: Male or non-pregnant, non-breastfeeding female subjects with a history of osteoarthritis, rheumatoid arthritis, ankylosing spondylitis or other medical conditions expected to require daily NSAID therapy for at least 6 months, who were 18-49 years of age and had a history of a documented, uncomplicated gastric or duodenal ulcer (a mucosal break of at least 3 mm in diameter with depth, without any concurrent bleeding, clot or perforation) within the past 5 years OR, who were 50 years of age and older (These subjects did not require a history of a documented, uncomplicated gastric or duodenal ulcer within the past 5 years.) Female subjects were eligible for participation in the study if they were of non-childbearing potential (i.e., physiologically incapable of becoming pregnant); childbearing potential, had a negative pregnancy test at Screening, and at least 1 of the following applied or was agreed to by the subject: Female sterilization or sterilization of male partner Hormonal contraception by oral route, implant, injectable, vaginal ring Any intrauterine device with published data showing that the lowest expected failure rate is < 1% per year Double barrier method (2 physical barriers or 1 physical barrier plus spermicide) Any other method with published data showing that the lowest expected failure rate is < 1% per year Each subject was required to understand and comply with study procedures required of a subject and was able and willing to provide written informed consent prior to any study procedures being performed. Exclusion Criteria A subject was not eligible for this study if any 1 or more of the following criteria applied: History of hypersensitivity to esomeprazole or to another PPI History of allergic reaction or intolerance to any NSAID (including aspirin) and/or a history of NSAID-induced symptoms of asthma, rhinitis, and/or nasal polyps Participation in any study of an investigational treatment in the 4 weeks before Screening Presence of uncontrolled acute or chronic medical illness, e.g., GI disorder, hypertension, diabetes, thyroid disorder, depression and/or infection that would have endangered a subject if they were to have participated in the study GI disorder or surgery leading to impaired drug absorption Evidence of uncontrolled, or unstable cardio- or cerebrovascular disorder, which in the investigator's opinion would have endangered a subject if they were to have participated in the study Schizophrenia or bipolar disorder Use of any excluded concomitant medication (see Section 9.4.8) A recent history (in the past 3 months) suggestive of alcohol or drug abuse or dependence, including overuse/abuse of narcotics for management of pain Serious blood coagulation disorder, including use of systemic anticoagulants Positive test result for H. pylori at Screening Screening endoscopy showing any gastric or duodenal ulcer at least 3 mm in diameter with depth Screening laboratory alanine aminotransferase (ALT) or aspartate aminotransferase (AST) value > 2 times the upper limit of normal Estimated creatinine clearance < 30 ml/min Other than noted specifically, any screening laboratory value that was clinically significant in the investigator's opinion and would have endangered a subject if they were to have participated in the study History of malignancy, treated or untreated, within the past 5 years, with the exception of successfully treated basal cell or squamous cell carcinoma of the skin
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    Everardus Orlemans, PhD
    Organizational Affiliation
    POZEN
    Official's Role
    Study Chair

    12. IPD Sharing Statement

    Learn more about this trial

    Evaluating PN 400 (VIMOVO) in Reducing Gastric Ulcers Compared to Non-steroidal Antiinflammatory Drug (NSAID) Naproxen

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