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Long Term Safety of Sativex Oromucosal Spray (Sativex®; Nabiximols) as Adjunctive Therapy in Patients With Uncontrolled Persistent Chronic Cancer Related Pain

Primary Purpose

Pain, Advanced Cancer

Status
Completed
Phase
Phase 3
Locations
International
Study Type
Interventional
Intervention
Nabiximols
Sponsored by
Jazz Pharmaceuticals
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Pain focused on measuring Cancer pain, Opioid therapy, Inadequate analgesia, Optimized chronic opioid therapy

Eligibility Criteria

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

Inclusion Criteria:

  • Participant had completed the parent study within the last seven days
  • Willing and able to give written informed consent
  • Willing and able to comply with all study requirements

Exclusion Criteria:

  • The participant was using cannabis or cannabinoid based medications, other than the parent study investigational medicinal product (IMP), and was unwilling to abstain for the duration of the study
  • Any history or immediate family history of schizophrenia, other psychotic illness, severe personality disorder or other significant psychiatric disorder other than depression associated with their underlying condition
  • Any known or suspected history of a substance abuse/dependence disorder (including opiate abuse/dependence prior to the diagnosis of cancer), current heavy alcohol consumption (more than 60 grams [g] of pure alcohol per day for men, and more than 40 g of pure alcohol per day for women), current use of an illicit drug or current non-prescribed use of any prescription drug
  • Had poorly controlled epilepsy or recurrent seizures (for example, one or more seizure during the last year)
  • Had experienced myocardial infarction or clinically significant cardiac dysfunction within the last 12 months or had a cardiac disorder that, in the opinion of the investigator would have put the participant at risk of a clinically significant arrhythmia or myocardial infarction
  • Had significantly impaired renal function
  • Had significantly impaired hepatic function at the "end of treatment" visit of the parent study
  • Female participants of child-bearing potential and male participants whose partner was of child-bearing potential, unless willing to ensure that they or their partner used effective contraception, for example, oral contraception, double barrier, intra-uterine device, during the study and for 3 months thereafter (however, a male condom should not have been used in conjunction with a female condom as this may not have proven effective)

Sites / Locations

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Non-comparative, open-label Nabiximols

Arm Description

Nabiximols was self-administered by participants as a 100 microliter (μL) oromucosal spray, in the morning and evening, up to a maximum of 10 sprays per day for 6 months. Nabiximols oromucosal spray contained delta-9-tetrahydrocannabinol (THC) (27 milligrams [mg]/milliliter [mL]):cannabidiol (CBD) (25 mg/mL), in ethanol:propylene glycol (50:50) excipients, with peppermint oil (0.05%) flavoring. Each 100 μL actuation delivered 2.7 mg THC and 2.5 mg CBD.

Outcomes

Primary Outcome Measures

Percent Of Participants With Treatment-emergent Adverse Events
Treatment-emergent Adverse Events (TEAEs) were coded according to the Medical Dictionary for Regulatory Activities (MedDRA) dictionary version 17.0. A TEAE is defined as an adverse event with an onset after the start of study drug treatment. The percent of participants who experienced one or more TEAEs is reported.

Secondary Outcome Measures

Change From Baseline In Mean NRS Average Pain During The Last Period
Participants indicated the level of pain experienced in the last 24 hours on an 11-point Numerical Rating Scale (NRS), where a score of 0 indicated "no pain" and a score of 10 indicated "pain as bad as you can imagine." Change in mean NRS average pain was calculated as: Last Period NRS average pain score - Baseline NRS average pain score. A negative value indicates an improvement in average pain score from Baseline.
Change From Baseline In Mean Sleep Disruption NRS During The Last Period
Participants indicated the level of sleep disruption experienced in the last 24 hours on an 11-point NRS, where a score of 0 indicated "did not disrupt sleep" and a score of 10 indicated "completely disrupted (unable to sleep at all)." Change in mean sleep disruption NRS was calculated as: Last Period sleep disruption NRS score - Baseline sleep disruption NRS score. A negative value indicates an improvement in sleep disruption score from Baseline.
Patient Satisfaction Questionnaire At Last Visit (Up To Day 183)
The Patient Satisfaction Questionnaire (PSQ) was used to assess level of satisfaction of the participant with the study drug, with the markers "extremely satisfied, very satisfied, slightly satisfied, neutral, slightly dissatisfied, very dissatisfied, extremely dissatisfied". Last visit refers to the last visit that a participant completed the assessment.
Change From Baseline In NRS Constipation At Last Visit (Up To Day 183)
Participants indicated level of constipation on an 11-point NRS, where a score of 0 was "no constipation", and 10 was "constipation as bad as you can imagine." Last visit refers to the last visit that a participant completed the assessment. Change in NRS constipation score was calculated as: Last Visit NRS constipation score - Baseline NRS constipation score. A negative value indicates improvement in condition from Baseline.

Full Information

First Posted
April 12, 2011
Last Updated
April 7, 2023
Sponsor
Jazz Pharmaceuticals
Collaborators
Otsuka Pharmaceutical Development & Commercialization, Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT01337089
Brief Title
Long Term Safety of Sativex Oromucosal Spray (Sativex®; Nabiximols) as Adjunctive Therapy in Patients With Uncontrolled Persistent Chronic Cancer Related Pain
Official Title
A Multicenter, Non-comparative, Open-label Extension Study to Assess the Long Term Safety of Sativex® Oromucosal Spray (Sativex®; Nabiximols) as Adjunctive Therapy in Patients With Uncontrolled Persistent Chronic Cancer Related Pain
Study Type
Interventional

2. Study Status

Record Verification Date
April 2023
Overall Recruitment Status
Completed
Study Start Date
January 19, 2011 (Actual)
Primary Completion Date
January 27, 2016 (Actual)
Study Completion Date
January 27, 2016 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Jazz Pharmaceuticals
Collaborators
Otsuka Pharmaceutical Development & Commercialization, Inc.

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This was a six-month open-label extension (OLE) study to evaluate the safety of long-term nabiximols (Sativex®) therapy when used as an adjunctive treatment in participants with advanced cancer. The study provided continued availability of nabiximols to participants who completed a preceding Phase 3 study and new (de novo) participants.
Detailed Description
This was a 6-month, multicenter, non-comparative, OLE study to evaluate the safety of long-term nabiximols use as an adjunctive measure in participants with advanced cancer. The study provided continued availability of nabiximols to participants who completed a preceding double-blind phase 3 study and de novo participants. Consenting eligible participants entered the extension study (Day 1) on the same day as the "end of treatment" visit of a parent study or within 7 days of the "end of treatment" visit or on the day of the "safety follow-up visit" of the parent study. The "safety follow-up" visit of a parent study was performed on the same day as Day 1, if the participant did not enter the OLE study on the same day as the "end of treatment" visit of a parent study. De novo participants attended a screening visit 3 to 14 days prior to enrollment (Day 1). All participants commenced dosing on Day 1. Further study visits took place after 2 weeks (Day 15), and every 4 weeks thereafter until the end of treatment period on Day 183 or earlier if the participant withdrew from the study. Treatment was started as a single spray in the evening on the first day (Day 1). Participants then gradually titrated by 1 additional spray per day to an individualized dose, balancing efficacy and tolerability. Participants had to complete titration within 14 days of their first dose of study drug and then continue at the same dose for the remainder of the study.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Pain, Advanced Cancer
Keywords
Cancer pain, Opioid therapy, Inadequate analgesia, Optimized chronic opioid therapy

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
660 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Non-comparative, open-label Nabiximols
Arm Type
Experimental
Arm Description
Nabiximols was self-administered by participants as a 100 microliter (μL) oromucosal spray, in the morning and evening, up to a maximum of 10 sprays per day for 6 months. Nabiximols oromucosal spray contained delta-9-tetrahydrocannabinol (THC) (27 milligrams [mg]/milliliter [mL]):cannabidiol (CBD) (25 mg/mL), in ethanol:propylene glycol (50:50) excipients, with peppermint oil (0.05%) flavoring. Each 100 μL actuation delivered 2.7 mg THC and 2.5 mg CBD.
Intervention Type
Drug
Intervention Name(s)
Nabiximols
Other Intervention Name(s)
Sativex®
Primary Outcome Measure Information:
Title
Percent Of Participants With Treatment-emergent Adverse Events
Description
Treatment-emergent Adverse Events (TEAEs) were coded according to the Medical Dictionary for Regulatory Activities (MedDRA) dictionary version 17.0. A TEAE is defined as an adverse event with an onset after the start of study drug treatment. The percent of participants who experienced one or more TEAEs is reported.
Time Frame
Baseline, Day 183
Secondary Outcome Measure Information:
Title
Change From Baseline In Mean NRS Average Pain During The Last Period
Description
Participants indicated the level of pain experienced in the last 24 hours on an 11-point Numerical Rating Scale (NRS), where a score of 0 indicated "no pain" and a score of 10 indicated "pain as bad as you can imagine." Change in mean NRS average pain was calculated as: Last Period NRS average pain score - Baseline NRS average pain score. A negative value indicates an improvement in average pain score from Baseline.
Time Frame
Baseline, Last Period (Days 156-183) or last 27 days of treatment
Title
Change From Baseline In Mean Sleep Disruption NRS During The Last Period
Description
Participants indicated the level of sleep disruption experienced in the last 24 hours on an 11-point NRS, where a score of 0 indicated "did not disrupt sleep" and a score of 10 indicated "completely disrupted (unable to sleep at all)." Change in mean sleep disruption NRS was calculated as: Last Period sleep disruption NRS score - Baseline sleep disruption NRS score. A negative value indicates an improvement in sleep disruption score from Baseline.
Time Frame
Baseline, Last Period (Days 156-183) or last 27 days of treatment
Title
Patient Satisfaction Questionnaire At Last Visit (Up To Day 183)
Description
The Patient Satisfaction Questionnaire (PSQ) was used to assess level of satisfaction of the participant with the study drug, with the markers "extremely satisfied, very satisfied, slightly satisfied, neutral, slightly dissatisfied, very dissatisfied, extremely dissatisfied". Last visit refers to the last visit that a participant completed the assessment.
Time Frame
Last Visit (up to Day 183)
Title
Change From Baseline In NRS Constipation At Last Visit (Up To Day 183)
Description
Participants indicated level of constipation on an 11-point NRS, where a score of 0 was "no constipation", and 10 was "constipation as bad as you can imagine." Last visit refers to the last visit that a participant completed the assessment. Change in NRS constipation score was calculated as: Last Visit NRS constipation score - Baseline NRS constipation score. A negative value indicates improvement in condition from Baseline.
Time Frame
Baseline, Last Visit (up to Day 183)

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Participant had completed the parent study within the last seven days Willing and able to give written informed consent Willing and able to comply with all study requirements Exclusion Criteria: The participant was using cannabis or cannabinoid based medications, other than the parent study investigational medicinal product (IMP), and was unwilling to abstain for the duration of the study Any history or immediate family history of schizophrenia, other psychotic illness, severe personality disorder or other significant psychiatric disorder other than depression associated with their underlying condition Any known or suspected history of a substance abuse/dependence disorder (including opiate abuse/dependence prior to the diagnosis of cancer), current heavy alcohol consumption (more than 60 grams [g] of pure alcohol per day for men, and more than 40 g of pure alcohol per day for women), current use of an illicit drug or current non-prescribed use of any prescription drug Had poorly controlled epilepsy or recurrent seizures (for example, one or more seizure during the last year) Had experienced myocardial infarction or clinically significant cardiac dysfunction within the last 12 months or had a cardiac disorder that, in the opinion of the investigator would have put the participant at risk of a clinically significant arrhythmia or myocardial infarction Had significantly impaired renal function Had significantly impaired hepatic function at the "end of treatment" visit of the parent study Female participants of child-bearing potential and male participants whose partner was of child-bearing potential, unless willing to ensure that they or their partner used effective contraception, for example, oral contraception, double barrier, intra-uterine device, during the study and for 3 months thereafter (however, a male condom should not have been used in conjunction with a female condom as this may not have proven effective)
Facility Information:
City
Phoenix
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Arizona
ZIP/Postal Code
85018
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United States
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Phoenix
State/Province
Arizona
ZIP/Postal Code
85028
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United States
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El Cajon
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California
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92020
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Gilroy
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California
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95020
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Glendale
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California
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91204
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Santa Rosa
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California
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95403
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Clearwater
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Florida
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33756
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Daytona Beach
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Florida
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32117
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Holiday
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Florida
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34691
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United States
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Jacksonville
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Florida
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32257
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Lynn Haven
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Florida
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32444
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Miami
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Florida
ZIP/Postal Code
33136
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Stuart
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Florida
ZIP/Postal Code
34994
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United States
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Tampa
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Florida
ZIP/Postal Code
33609
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United States
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Winter Park
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Florida
ZIP/Postal Code
32789
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United States
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Marietta
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Georgia
ZIP/Postal Code
30060
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United States
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Newnan
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Georgia
ZIP/Postal Code
30265
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United States
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Stockbridge
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Georgia
ZIP/Postal Code
30281
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United States
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Woodlawn
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Illinois
ZIP/Postal Code
62898
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United States
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Ashland
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Kentucky
ZIP/Postal Code
41101
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United States
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Bossier City
State/Province
Louisiana
ZIP/Postal Code
71111
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United States
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Shreveport
State/Province
Louisiana
ZIP/Postal Code
71105
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United States
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Saint Louis Park
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Minnesota
ZIP/Postal Code
55426
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United States
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Kansas City
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Missouri
ZIP/Postal Code
64132
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United States
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Missoula
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Montana
ZIP/Postal Code
59802
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United States
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Berlin
State/Province
New Jersey
ZIP/Postal Code
08009
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United States
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New York
State/Province
New York
ZIP/Postal Code
10003
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United States
City
New York
State/Province
New York
ZIP/Postal Code
10010
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United States
City
Flat Rock
State/Province
North Carolina
ZIP/Postal Code
28731
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United States
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Winston-Salem
State/Province
North Carolina
ZIP/Postal Code
27103
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United States
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Cleveland
State/Province
Ohio
ZIP/Postal Code
44119
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United States
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Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19146
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United States
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Houston
State/Province
Texas
ZIP/Postal Code
77089
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United States
City
Laredo
State/Province
Texas
ZIP/Postal Code
78041
Country
United States
City
Salt Lake City
State/Province
Utah
ZIP/Postal Code
84112
Country
United States
City
Salt Lake City
State/Province
Utah
ZIP/Postal Code
84124
Country
United States
City
Lacey
State/Province
Washington
ZIP/Postal Code
98503
Country
United States
City
Parkville
ZIP/Postal Code
3050
Country
Australia
City
Bruxelles
ZIP/Postal Code
1000
Country
Belgium
City
Gabrovo
ZIP/Postal Code
5300
Country
Bulgaria
City
Varna
ZIP/Postal Code
9010
Country
Bulgaria
City
Vratsa
ZIP/Postal Code
3000
Country
Bulgaria
City
Benešov
ZIP/Postal Code
25601
Country
Czechia
City
Jablonec Nad Nisou
ZIP/Postal Code
46601
Country
Czechia
City
Most
ZIP/Postal Code
434 64
Country
Czechia
City
Nová Ves Pod Pleší
ZIP/Postal Code
262 04
Country
Czechia
City
Ostrava
ZIP/Postal Code
708 52
Country
Czechia
City
Plzen
ZIP/Postal Code
304 60
Country
Czechia
City
Sokolov
ZIP/Postal Code
356 01
Country
Czechia
City
Teplice
ZIP/Postal Code
415 01
Country
Czechia
City
České Budějovice
ZIP/Postal Code
370 01
Country
Czechia
City
České Budějovice
ZIP/Postal Code
370 87
Country
Czechia
City
Berlin
ZIP/Postal Code
10435
Country
Germany
City
Frankfurt
ZIP/Postal Code
60311
Country
Germany
City
Jena
ZIP/Postal Code
07747
Country
Germany
City
Lunen
ZIP/Postal Code
44534
Country
Germany
City
Stadtroda
ZIP/Postal Code
07646
Country
Germany
City
Wetzlar
ZIP/Postal Code
35578
Country
Germany
City
Wiesbaden
ZIP/Postal Code
65189
Country
Germany
City
Deszk
ZIP/Postal Code
6772
Country
Hungary
City
Komarom
ZIP/Postal Code
2900
Country
Hungary
City
Miskolc
ZIP/Postal Code
3501
Country
Hungary
City
Nyíregyháza
ZIP/Postal Code
4412
Country
Hungary
City
Szekszard
ZIP/Postal Code
7100
Country
Hungary
City
Szikszo
ZIP/Postal Code
3800
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Hungary
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Beer Sheva
ZIP/Postal Code
84101
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Israel
City
Haifa
ZIP/Postal Code
31096
Country
Israel
City
Ramat Gan
ZIP/Postal Code
52621
Country
Israel
City
Zerifin
ZIP/Postal Code
60930
Country
Israel
City
Garbagnate Milanese
ZIP/Postal Code
20024
Country
Italy
City
Piacenza
ZIP/Postal Code
29100
Country
Italy
City
Torino
ZIP/Postal Code
10126
Country
Italy
City
Riga
ZIP/Postal Code
1038
Country
Latvia
City
Rēzekne
ZIP/Postal Code
4600
Country
Latvia
City
Klaipeda
ZIP/Postal Code
92288
Country
Lithuania
City
Siauliai
ZIP/Postal Code
76307
Country
Lithuania
City
Vilnius
ZIP/Postal Code
08660
Country
Lithuania
City
Chihuahua
ZIP/Postal Code
31238
Country
Mexico
City
Distrito Federal
ZIP/Postal Code
10700
Country
Mexico
City
Białystok
ZIP/Postal Code
15-250
Country
Poland
City
Bielsko-Biala
ZIP/Postal Code
43-300
Country
Poland
City
Bydgoszcz
ZIP/Postal Code
85-796
Country
Poland
City
Czeladz
ZIP/Postal Code
41-250
Country
Poland
City
Częstochowa
ZIP/Postal Code
42-200
Country
Poland
City
Częstochowa
ZIP/Postal Code
42-217
Country
Poland
City
Działdowo
ZIP/Postal Code
13-200
Country
Poland
City
Gdansk
ZIP/Postal Code
80-208
Country
Poland
City
Gliwice
ZIP/Postal Code
44-101
Country
Poland
City
Klodzko
ZIP/Postal Code
57-300
Country
Poland
City
Opole
ZIP/Postal Code
45-272
Country
Poland
City
Ostrowiec Swietokrzyski
ZIP/Postal Code
27-400
Country
Poland
City
Poznan
ZIP/Postal Code
61-245
Country
Poland
City
Warszawa
ZIP/Postal Code
02-781
Country
Poland
City
Warszawa
ZIP/Postal Code
02-793
Country
Poland
City
Wloclawek
ZIP/Postal Code
87-800
Country
Poland
City
Ponce
ZIP/Postal Code
00717
Country
Puerto Rico
City
San Juan
ZIP/Postal Code
00927
Country
Puerto Rico
City
Baia Mare
ZIP/Postal Code
430031
Country
Romania
City
Baia Mare
ZIP/Postal Code
430241
Country
Romania
City
Braila
ZIP/Postal Code
810325
Country
Romania
City
Bucuresti
ZIP/Postal Code
010976
Country
Romania
City
Bucuresti
ZIP/Postal Code
011461
Country
Romania
City
Cluj-Napoca
ZIP/Postal Code
400015
Country
Romania
City
Constanţa
ZIP/Postal Code
900591
Country
Romania
City
Craiova
ZIP/Postal Code
200385
Country
Romania
City
Focsani
ZIP/Postal Code
620165
Country
Romania
City
Iaşi
ZIP/Postal Code
700106
Country
Romania
City
Oradea
ZIP/Postal Code
410469
Country
Romania
City
Satu Mare
ZIP/Postal Code
440055
Country
Romania
City
Sibiu
ZIP/Postal Code
550245
Country
Romania
City
Suceava
ZIP/Postal Code
720237
Country
Romania
City
Târgovişte
ZIP/Postal Code
130095
Country
Romania
City
Granada
ZIP/Postal Code
18014
Country
Spain
City
Taichung
ZIP/Postal Code
404
Country
Taiwan
City
Tainan City
ZIP/Postal Code
73657
Country
Taiwan
City
Bury Saint Edmunds
ZIP/Postal Code
IP33 2QZ
Country
United Kingdom
City
Bury
ZIP/Postal Code
BL9 7TD
Country
United Kingdom
City
Cheltenham
ZIP/Postal Code
GL53 0QJ
Country
United Kingdom
City
Crumpsall
ZIP/Postal Code
M8 5RB
Country
United Kingdom
City
Edinburgh
ZIP/Postal Code
EH4 2XR
Country
United Kingdom
City
Edinburgh
Country
United Kingdom
City
Gorleston-on-Sea
ZIP/Postal Code
NR31 6LA
Country
United Kingdom
City
Leeds
ZIP/Postal Code
LS17 6QD
Country
United Kingdom
City
Manchester
ZIP/Postal Code
M20 4BX
Country
United Kingdom
City
Norwich
ZIP/Postal Code
NR4 7UY
Country
United Kingdom
City
Plymouth
ZIP/Postal Code
PL6 8DH
Country
United Kingdom
City
Weston-super-Mare
ZIP/Postal Code
BS23 4TQ
Country
United Kingdom
City
Withington
ZIP/Postal Code
M20 4BX
Country
United Kingdom

12. IPD Sharing Statement

Learn more about this trial

Long Term Safety of Sativex Oromucosal Spray (Sativex®; Nabiximols) as Adjunctive Therapy in Patients With Uncontrolled Persistent Chronic Cancer Related Pain

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