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Multicenter Randomized Parallel Group Phase III Study Comparing the Bowel Cleansing Efficacy, Safety and Tolerability of NER1006 Versus a Sodium Picosulfate and Magnesium Salt Solution Using Day Before-Only Dosing Regimen in Adults.

Primary Purpose

Colorectal Cancer, Colorectal Carcinoma, Colon Cleansing

Status
Completed
Phase
Phase 3
Locations
International
Study Type
Interventional
Intervention
NER1006, Day Before-Only Dosing
SP+MS, Day Before-Only Dosing
Sponsored by
Norgine
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional screening trial for Colorectal Cancer

Eligibility Criteria

18 Years - 85 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Patients must provide written informed consent.
  • Male and female outpatients and inpatients aged: ≥18 to ≤85 years undergoing a screening, surveillance or diagnostic colonoscopy.
  • Females of child-bearing potential must have a negative pregnancy test at Screening and at Visit 2 and must be practising one of the following methods of birth control and agree to continue with the regimen throughout the study period (unless postmenopausal or surgically sterile, or whose sole sexual partner has had a successful vasectomy):

    • Oral, implantable, or injectable contraceptives (for a minimum of three months before study entry) in combination with a condom;
    • Intrauterine device in combination with a condom;
    • Double barrier method (condom* and occlusive cap [diaphragm or cervical/vault caps] with spermicidal foam/gel/film/cream/suppository).
  • Willing, able and competent to complete the entire study and to comply with instructions.

Exclusion Criteria:

  • Patients with past history within last 12 months or current episode of severe constipation (requiring repeated use of laxatives/enema or physical intervention before resolution), known or suspected ileus, gastrointestinal obstruction, gastric retention, bowel perforation, toxic colitis or megacolon.
  • Patients with ongoing severe acute Inflammatory Bowel Disease.
  • Patients who have had previous significant gastrointestinal surgeries, including colonic resection, sub-total colectomy, abdomino-perineal resection, de-functioning colostomy, Hartmann's procedure and de-functioning ileostomy or other similar surgeries involving structure and function of the small or large colon.
  • Regular use of laxatives or colon motility altering drugs in the last month (i.e. more than 2-3 times per week) and/or laxative use within 72 hours prior to administration of the preparation.
  • Patients with active intestinal bleeding episodes or with a clinically significant low hemoglobin level <9 g/dL for women and <11 g/dL for men at screening.
  • Known glucose-6-phosphate dehydrogenase (G6PD) deficiency.
  • Known phenylketonuria.
  • Known hypersensitivity to polyethylene glycols, ascorbic acid and sulfates (not including sulfa-based products), sodium picosulfate and magnesium salt compounds, or any other component of the study drug or comparator
  • Past history within the last 12 months or evidence of any on-going clinically relevant electrocardiogram abnormalities (e.g. arrhythmias).
  • History of uncontrolled hypertension with systolic blood pressure >170 mmHg and diastolic blood pressure >100 mmHg.
  • Patients with cardiac insufficiency NYHA grades III or IV.
  • Patients with moderate to severe renal insufficiency (i.e. with GFR, <60 mL/min/1.73m2).
  • Patient with serum albumin <3.4 g/dL.
  • Patients with liver disease of grades B and C according to the Child Pugh classification.
  • Patients suffering from dehydration at screening as evaluated by the Investigator from physical examination and laboratory investigations.
  • Patients with clinically significant electrolyte abnormalities, whether pre-existing or noted at screening, such as hypernatremia, hyponatremia, hyperphosphatemia, hypermagnesemia, hypokalemia, hypocalcaemia, dehydration, or those secondary to the use of diuretics or angiotensin converting enzyme (ACE) inhibitors.
  • Patients with any other clinically significant hematological parameters including coagulation profile at screening.
  • Patients with impaired consciousness that might predispose them to pulmonary aspiration.
  • Patients undergoing colonoscopy for foreign body removal and/or decompression.
  • Patients who are pregnant or lactating, or intending to become pregnant during the study.
  • Clinically relevant findings on physical examination based on the Investigator's judgment.
  • History of drug or alcohol abuse within the 12 months prior to dosing.
  • Concurrent participation in an investigational drug or device study or participation within three months of study entry.
  • Patients who are ordered to live in an institution on court or authority order.
  • Patients with history of rhabdomyolysis

Sites / Locations

  • Charité - Campus Virchow Klinikum
  • University Hospital Schleswig-Holstein
  • An der Germania Brauerei 6
  • An der Germania Brauerei 6
  • Osp.San Raffaele U.O. Gastroenterologia
  • P.T.P.Nuovo Regina Margherita
  • Onze Lieve Vrouwe Gashuis
  • Albert Schweitzer Ziekenhuis
  • Radboud UMC
  • Orbis Medisch Centrum
  • Centrum Medyczne sw. Lukasza
  • Instytut Medycyny Wsi im. Witolda Chodzki w
  • Specjalistyczna Praktyka Lekarska dr med. Marek Horynski
  • SPSK Nr 1 im. Prof. Tadeusza Sokolowskiego
  • Hospital de Vinalopó, Unidad de Endoscopia Digestiva
  • Hospital Universitario de la Princesa
  • Hospital Universitario La Paz, Unidad Enfermedad Intestinal
  • Department of Surgery, Raigmore Hospital
  • Derriford Hospital

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

NER1006, Day Before-Only Dosing

SP+MS, Day Before-Only Dosing

Arm Description

NER1006 1-Day Day Before-Only Split-Dosing Regimen (to commence on the evening of the day before colonoscopy).

SP+MS 1-Day Day Before-Only Split-Dosing Regimen (to commence on the morning of the day before colonoscopy).

Outcomes

Primary Outcome Measures

Number of Patients With Successful Bowel Cleansing (Overall Colon)
The overall quality of bowel cleansing was assessed by a blinded central reader (an experienced and trained colonoscopist) using the segmental scores of the Harefield Cleansing Scale (HCS). A final HCS grading of A, B, C or D was derived. Grades A and B are classified as successful (i.e. all mucosa could be visualized) and C and D are classified as unsuccessful. Comparison of overall success of cleansing with NER1006 versus SP+MS was evaluated using a non-inferiority study design.
Number of Patients With 'Excellent Plus Good' (Highly Effective) Bowel Cleansing (Colon Ascendens)
The overall quality of bowel cleansing was assessed by a blinded central reader (an experienced and trained colonoscopist) using the segmental scores of the Harefield Cleansing Scale (HCS). Highly effective cleansing in the colon ascendens corresponded to scores 3 (Good) or 4 (Excellent) of the HCS. Adequate plus failure of cleansing corresponded to score 0-2. Comparison of 'Excellent plus good' cleansing of the colon ascendens using NER1006 versus SP+MS was evaluated using a non-inferiority study design.

Secondary Outcome Measures

Adenoma Detection Rate (Colon Ascendens)
Comparison of the number of patients with at least one adenoma detected in the colon ascendens when NER1006 is used for bowel cleansing versus SP+MS. Adenoma detection rate (ADR) defined as the number of patients with at least one adenoma in the colon ascendens.
Adenoma Detection Rate (Overall Colon)
Comparison of the number of patients with at least one adenoma detected in the overall colon when NER1006 is used for bowel cleansing versus SP+MS. Adenoma detection rate (ADR) defined as the number of patients with at least one adenoma in the overall colon.
Polyp Detection Rate (Colon Ascendens)
Comparison of the number of patients with at least one polyp detected in the colon ascendens when NER1006 is used for bowel cleansing versus SP+MS. Polyp detection rate (PDR) defined as the number of patients with at least one polyp in the colon ascendens.
Polyp Detection Rate (Overall Colon)
Comparison of the number of patients with at least one polyp detected in the overall colon when NER1006 is used for bowel cleansing versus SP+MS. Polyp detection rate (PDR) defined as the number of patients with at least one polyp in the overall colon.

Full Information

First Posted
October 16, 2014
Last Updated
April 12, 2018
Sponsor
Norgine
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1. Study Identification

Unique Protocol Identification Number
NCT02273141
Brief Title
Multicenter Randomized Parallel Group Phase III Study Comparing the Bowel Cleansing Efficacy, Safety and Tolerability of NER1006 Versus a Sodium Picosulfate and Magnesium Salt Solution Using Day Before-Only Dosing Regimen in Adults.
Official Title
A Multicenter Randomized Parallel Group Phase III Study Comparing the Bowel Cleansing Efficacy, Safety and Tolerability of NER1006 (a Low Volume Bowel Cleansing Solution) Versus Sodium Picosulfate and Magnesium Salt (SP+MS) Solution Using Day Before-Only Dosing Regimen in Adults.
Study Type
Interventional

2. Study Status

Record Verification Date
April 2018
Overall Recruitment Status
Completed
Study Start Date
November 2014 (undefined)
Primary Completion Date
August 2015 (Actual)
Study Completion Date
August 2015 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Norgine

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
This study evaluates the efficacy, safety and tolerability of NER1006 versus a sodium picosulfate and magnesium salt solution (SP + MS) in adult patients requiring bowel cleansing prior to any procedure that requires a clean bowel, using a Day Before Only Dosing regimen. Approximately 484 patients will be randomised with the aim of achieving a minimum of 220 patients in each of the 2 groups.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Colorectal Cancer, Colorectal Carcinoma, Colon Cleansing

7. Study Design

Primary Purpose
Screening
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
Investigator
Allocation
Randomized
Enrollment
515 (Actual)

8. Arms, Groups, and Interventions

Arm Title
NER1006, Day Before-Only Dosing
Arm Type
Experimental
Arm Description
NER1006 1-Day Day Before-Only Split-Dosing Regimen (to commence on the evening of the day before colonoscopy).
Arm Title
SP+MS, Day Before-Only Dosing
Arm Type
Active Comparator
Arm Description
SP+MS 1-Day Day Before-Only Split-Dosing Regimen (to commence on the morning of the day before colonoscopy).
Intervention Type
Drug
Intervention Name(s)
NER1006, Day Before-Only Dosing
Intervention Description
The subject will self-administer both doses of NER1006 in the evening of Day 1 with 1-2 hours interval. Subject will take mandatory additional clear fluid after each dose.
Intervention Type
Drug
Intervention Name(s)
SP+MS, Day Before-Only Dosing
Intervention Description
The subject will self-administer SP+MS in the morning of Day 1 and afternoon of Day 1. Subject will take mandatory additional clear fluid after each dose.
Primary Outcome Measure Information:
Title
Number of Patients With Successful Bowel Cleansing (Overall Colon)
Description
The overall quality of bowel cleansing was assessed by a blinded central reader (an experienced and trained colonoscopist) using the segmental scores of the Harefield Cleansing Scale (HCS). A final HCS grading of A, B, C or D was derived. Grades A and B are classified as successful (i.e. all mucosa could be visualized) and C and D are classified as unsuccessful. Comparison of overall success of cleansing with NER1006 versus SP+MS was evaluated using a non-inferiority study design.
Time Frame
One day (day before colonoscopy)
Title
Number of Patients With 'Excellent Plus Good' (Highly Effective) Bowel Cleansing (Colon Ascendens)
Description
The overall quality of bowel cleansing was assessed by a blinded central reader (an experienced and trained colonoscopist) using the segmental scores of the Harefield Cleansing Scale (HCS). Highly effective cleansing in the colon ascendens corresponded to scores 3 (Good) or 4 (Excellent) of the HCS. Adequate plus failure of cleansing corresponded to score 0-2. Comparison of 'Excellent plus good' cleansing of the colon ascendens using NER1006 versus SP+MS was evaluated using a non-inferiority study design.
Time Frame
One day (day before colonoscopy)
Secondary Outcome Measure Information:
Title
Adenoma Detection Rate (Colon Ascendens)
Description
Comparison of the number of patients with at least one adenoma detected in the colon ascendens when NER1006 is used for bowel cleansing versus SP+MS. Adenoma detection rate (ADR) defined as the number of patients with at least one adenoma in the colon ascendens.
Time Frame
One day (day before colonoscopy).
Title
Adenoma Detection Rate (Overall Colon)
Description
Comparison of the number of patients with at least one adenoma detected in the overall colon when NER1006 is used for bowel cleansing versus SP+MS. Adenoma detection rate (ADR) defined as the number of patients with at least one adenoma in the overall colon.
Time Frame
One day (day before colonoscopy)
Title
Polyp Detection Rate (Colon Ascendens)
Description
Comparison of the number of patients with at least one polyp detected in the colon ascendens when NER1006 is used for bowel cleansing versus SP+MS. Polyp detection rate (PDR) defined as the number of patients with at least one polyp in the colon ascendens.
Time Frame
One day (day before colonoscopy)
Title
Polyp Detection Rate (Overall Colon)
Description
Comparison of the number of patients with at least one polyp detected in the overall colon when NER1006 is used for bowel cleansing versus SP+MS. Polyp detection rate (PDR) defined as the number of patients with at least one polyp in the overall colon.
Time Frame
One day (day before colonoscopy)

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
85 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients must provide written informed consent. Male and female outpatients and inpatients aged: ≥18 to ≤85 years undergoing a screening, surveillance or diagnostic colonoscopy. Females of child-bearing potential must have a negative pregnancy test at Screening and at Visit 2 and must be practising one of the following methods of birth control and agree to continue with the regimen throughout the study period (unless postmenopausal or surgically sterile, or whose sole sexual partner has had a successful vasectomy): Oral, implantable, or injectable contraceptives (for a minimum of three months before study entry) in combination with a condom; Intrauterine device in combination with a condom; Double barrier method (condom* and occlusive cap [diaphragm or cervical/vault caps] with spermicidal foam/gel/film/cream/suppository). Willing, able and competent to complete the entire study and to comply with instructions. Exclusion Criteria: Patients with past history within last 12 months or current episode of severe constipation (requiring repeated use of laxatives/enema or physical intervention before resolution), known or suspected ileus, gastrointestinal obstruction, gastric retention, bowel perforation, toxic colitis or megacolon. Patients with ongoing severe acute Inflammatory Bowel Disease. Patients who have had previous significant gastrointestinal surgeries, including colonic resection, sub-total colectomy, abdomino-perineal resection, de-functioning colostomy, Hartmann's procedure and de-functioning ileostomy or other similar surgeries involving structure and function of the small or large colon. Regular use of laxatives or colon motility altering drugs in the last month (i.e. more than 2-3 times per week) and/or laxative use within 72 hours prior to administration of the preparation. Patients with active intestinal bleeding episodes or with a clinically significant low hemoglobin level <9 g/dL for women and <11 g/dL for men at screening. Known glucose-6-phosphate dehydrogenase (G6PD) deficiency. Known phenylketonuria. Known hypersensitivity to polyethylene glycols, ascorbic acid and sulfates (not including sulfa-based products), sodium picosulfate and magnesium salt compounds, or any other component of the study drug or comparator Past history within the last 12 months or evidence of any on-going clinically relevant electrocardiogram abnormalities (e.g. arrhythmias). History of uncontrolled hypertension with systolic blood pressure >170 mmHg and diastolic blood pressure >100 mmHg. Patients with cardiac insufficiency NYHA grades III or IV. Patients with moderate to severe renal insufficiency (i.e. with GFR, <60 mL/min/1.73m2). Patient with serum albumin <3.4 g/dL. Patients with liver disease of grades B and C according to the Child Pugh classification. Patients suffering from dehydration at screening as evaluated by the Investigator from physical examination and laboratory investigations. Patients with clinically significant electrolyte abnormalities, whether pre-existing or noted at screening, such as hypernatremia, hyponatremia, hyperphosphatemia, hypermagnesemia, hypokalemia, hypocalcaemia, dehydration, or those secondary to the use of diuretics or angiotensin converting enzyme (ACE) inhibitors. Patients with any other clinically significant hematological parameters including coagulation profile at screening. Patients with impaired consciousness that might predispose them to pulmonary aspiration. Patients undergoing colonoscopy for foreign body removal and/or decompression. Patients who are pregnant or lactating, or intending to become pregnant during the study. Clinically relevant findings on physical examination based on the Investigator's judgment. History of drug or alcohol abuse within the 12 months prior to dosing. Concurrent participation in an investigational drug or device study or participation within three months of study entry. Patients who are ordered to live in an institution on court or authority order. Patients with history of rhabdomyolysis
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Stefan Schreiber
Organizational Affiliation
University Hospital Schleswig-Holstein
Official's Role
Principal Investigator
Facility Information:
Facility Name
Charité - Campus Virchow Klinikum
City
Berlin
Country
Germany
Facility Name
University Hospital Schleswig-Holstein
City
Kiel
ZIP/Postal Code
24105
Country
Germany
Facility Name
An der Germania Brauerei 6
City
Münster
Country
Germany
Facility Name
An der Germania Brauerei 6
City
Milan
Country
Italy
Facility Name
Osp.San Raffaele U.O. Gastroenterologia
City
Milan
Country
Italy
Facility Name
P.T.P.Nuovo Regina Margherita
City
Rome
Country
Italy
Facility Name
Onze Lieve Vrouwe Gashuis
City
Amsterdam
Country
Netherlands
Facility Name
Albert Schweitzer Ziekenhuis
City
Dordrecht
Country
Netherlands
Facility Name
Radboud UMC
City
Nijmegen
Country
Netherlands
Facility Name
Orbis Medisch Centrum
City
Sittard
Country
Netherlands
Facility Name
Centrum Medyczne sw. Lukasza
City
Czestochowa
Country
Poland
Facility Name
Instytut Medycyny Wsi im. Witolda Chodzki w
City
Lubliniec
Country
Poland
Facility Name
Specjalistyczna Praktyka Lekarska dr med. Marek Horynski
City
Sopot
Country
Poland
Facility Name
SPSK Nr 1 im. Prof. Tadeusza Sokolowskiego
City
Szczecin
Country
Poland
Facility Name
Hospital de Vinalopó, Unidad de Endoscopia Digestiva
City
Elche
Country
Spain
Facility Name
Hospital Universitario de la Princesa
City
Madrid
Country
Spain
Facility Name
Hospital Universitario La Paz, Unidad Enfermedad Intestinal
City
Madrid
Country
Spain
Facility Name
Department of Surgery, Raigmore Hospital
City
Inverness
Country
United Kingdom
Facility Name
Derriford Hospital
City
Plymouth
Country
United Kingdom

12. IPD Sharing Statement

Citations:
PubMed Identifier
36064325
Citation
Cash BD, Allen C, Poppers DM. Transient alterations in plasma sodium concentrations with NER1006 bowel preparation: an analysis of three phase III, randomized clinical trials. BMC Gastroenterol. 2022 Sep 5;22(1):412. doi: 10.1186/s12876-022-02484-7.
Results Reference
derived

Learn more about this trial

Multicenter Randomized Parallel Group Phase III Study Comparing the Bowel Cleansing Efficacy, Safety and Tolerability of NER1006 Versus a Sodium Picosulfate and Magnesium Salt Solution Using Day Before-Only Dosing Regimen in Adults.

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