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Post-market, Randomized, Controlled, Prospective Study Evaluating Intrathecal Pain Medication (IT) Versus Conventional Medical Management (CMM) in the Non-cancer, Refractory, Chronic Pain Population (Prosper-001)

Primary Purpose

Chronic Nonmalignant Pain, Pain, Intractable, Pain, Chronic

Status
Completed
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Flowonix Prometra® II Programmable Infusion System
Pain Medicine
Sponsored by
Evolve Restorative Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional other trial for Chronic Nonmalignant Pain focused on measuring Truncal Pain, Lower Extremity Limb Pain, Refractory Pain

Eligibility Criteria

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

Inclusion Criteria:

  1. Subject must have signed and dated the IRB approved Informed Consent Form and HIPAA Authorization prior to any study procedures being performed
  2. Subject must be willing and able to complete study requirements including diaries, questionnaires and attend all visits, in the opinion of the investigator
  3. Subject must be male or female and at least 22 years of age
  4. Subjects who are female are non-lactating and if of childbearing potential have a negative urine pregnancy test at screening
  5. Subjects who are currently be receiving ≤ 90 mg/day morphine per day dose (or MME), with stable dose at equivalent of systemic opioids at Screening
  6. Subjects who are on a stable dose of opioids (no change in type or prescribed frequency or dose) for 30 days prior to the screening as documented in medical history;
  7. Subjects who have refractory pain despite failure of regional minimally invasive treatment options, including epidurals, facets, rhizotomies, direct or indirect spinal stenosis treatments, etc.
  8. Subjects who are a new candidate for chronic intrathecal drug therapy (including no prior intrathecal/epidural trial for pump infusion therapy)
  9. Subjects have not been implanted with a spinal cord stimulator for pain
  10. Subjects currently do not have an implanted spinal cord stimulator for pain
  11. Subjects who have a diagnosis of nonmalignant, chronic intractable pain as documented in the medical history
  12. Subjects who are medically stable and able to undergo surgery for implantation of the Prometra® II Infusion System
  13. Subject must have completed a psychological evaluation within 6 months prior to Screening
  14. Subject must complete an intrathecal trial resulting in candidacy for pump implantation during Screening

Exclusion Criteria:

A potential subject who has any contraindications listed in the Prometra® II labeling or any contraindications of intrathecal agents employed in the United States within the PACC, will be excluded. All subjects meeting any of the following criteria will also be excluded from this study:

  1. Subjects currently have a spinal cord stimulator implanted for pain
  2. Subjects previously had a spinal cord stimulator implanted for pain
  3. Subjects who have psychological or other health conditions, financial, and/or legal concerns (within 3 months prior to Screening) that would interfere with the subject's ability to fulfill the requirements of the protocol as per the investigator's opinion
  4. Subjects who have a history of alcohol abuse or illicit drug use within 2 years of screening
  5. Subjects who have an active malignancy or has been diagnosed with cancer and has not been in remission for at least 1 year prior to Screening
  6. Subjects who are female and who are pregnant, nursing or planning a pregnancy during the study or females of childbearing potential who are unable or unwilling to use a form of contraception during the study.
  7. Subjects who plan to enroll or is currently enrolled in another investigational drug or investigational medical device study or has participated in an investigational drug or medical device study within 30 days prior to Screening
  8. Subject has any condition or situation which, in the investigator's opinion, puts the patient at significant risk, could confound the study results, or may interfere significantly with the subject's participation in the study

    At the Baseline Visit or prior to Randomization, a subject will be excluded from continued participation if the subject has:

  9. Subjects that have a mean of the reported 12 hour "average" NPRS responses of < 6 on an eleven-point scale (0 to10) rated over the 5 days prior to the Baseline Visit (as recorded in the electronic Study Diary) in the absence of intolerable side effects as documented in the medical history
  10. Subjects with a negative urine test for opioids at Baseline
  11. Subjects with a positive Pregnancy test, if applicable
  12. Subjects that failed the intrathecal trial during Screening

Sites / Locations

  • Evolve Restorative Center

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Active Comparator

Arm Label

Intrathecal Drug Delivery System

Conventional Medical Management

Arm Description

Subjects randomized to the Intrathecal Drug Delivery System group will be implanted with the Prometra System under sterile technique in accordance with the Instructions for Use. The pump will be filled at the time of implantation with the prescribed medication.

Subjects randomized to the Conventional Medical Management group will continue with the standard of care procedures.

Outcomes

Primary Outcome Measures

Compare the change in Numeric Pain Rating Scale between the IDDS group and the CMM group
The Numeric Pain Rating Scale (NPRS) is a 0-10 numeric pain rating scale (11 point scale), where a higher scores equates to more pain. The primary endpoint for this post-marketing study is the comparison of the NPRS between the IDDS group and the CMM group collected in the Study Diary at various time points.

Secondary Outcome Measures

Compare the change in PROMIS 29 scores between the IDDS group and CMM group
Compare the subject reported Patient-Reported Outcomes Measurement Information System (PROMIS) 29 between the IDDS group and CMM group. PROMIS 29 assesses pain intensity using a 0-10 numeric rating scale (11 point scale), where a higher score equates to more pain. Other health domains are scored using a Likert scale, where higher scores represent more of the specific domain being measured. The other health domains that are scored are: depression; anxiety; physical function; pain interference; fatigue; sleep disturbance; and ability to participate in social roles and activities.
Comparison of the accrued cost of therapy for pain
Compare the accrued cost of therapy for pain control including those related to adverse events, ED visits, cost of medications between the IDDS group and CMM group.
Comparison of other concurrent treatments
Compare the number of other concurrent treatments performed on each subject between the IDDS group and CMM group.

Full Information

First Posted
September 12, 2019
Last Updated
May 16, 2022
Sponsor
Evolve Restorative Center
Collaborators
Flowonix Medical, Celéri Health, Inc., Advanced Infusion Solutions
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1. Study Identification

Unique Protocol Identification Number
NCT04096391
Brief Title
Post-market, Randomized, Controlled, Prospective Study Evaluating Intrathecal Pain Medication (IT) Versus Conventional Medical Management (CMM) in the Non-cancer, Refractory, Chronic Pain Population
Acronym
Prosper-001
Official Title
Post-market, Randomized, Controlled, Prospective Study Evaluating Intrathecal Pain Medication (IT) Versus Conventional Medical Management (CMM) in the Non-cancer, Refractory, Chronic Pain Population (PROSPER)
Study Type
Interventional

2. Study Status

Record Verification Date
May 2022
Overall Recruitment Status
Completed
Study Start Date
June 5, 2019 (Actual)
Primary Completion Date
April 11, 2022 (Actual)
Study Completion Date
April 11, 2022 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Evolve Restorative Center
Collaborators
Flowonix Medical, Celéri Health, Inc., Advanced Infusion Solutions

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
Yes
Product Manufactured in and Exported from the U.S.
Yes
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This study is being conducted to compare intrathecal morphine using the commercially available intrathecal drug delivery systems (IDDS), and conventional medical management (CMM) in subjects with non-cancer, refractory chronic pain.
Detailed Description
This study will evaluate the following objectives: Primary objective: 1. To compare the change in pain intensity from baseline based on the Numeric Rating Scale [NRS] between subjects randomized to the IDDS group and subjects randomized to the CMM group.The comparison will be conducted at 3, 6, 9 and 12 months following enrollment. The evaluation at 6 months will be considered the primary time point for evaluation. Secondary objectives: For each of the following secondary objectives, the comparisons between the IDDS group and CMM group will be made using the intra-subject change from baseline as the dependent variable. Compare the subject reported PROMIS 29 between the IDDS group and CMM group. Individual subject scores recorded at baseline and months 3, 6, 9 and 12. Compare the accrued cost of therapy for pain control including those related to adverse events, ED visits, cost of medications between the IDDS group and CMM group Compare the number of other concurrent treatments performed on each subject between the IDDS group and CMM group. Individual subject counts recorded at months 3, 6, 9 and 12 will be compared. Additional safety objective: 1. To characterize pain and device related adverse events for all subjects throughout the study through completion of 12 month follow-up or subject exit.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Chronic Nonmalignant Pain, Pain, Intractable, Pain, Chronic
Keywords
Truncal Pain, Lower Extremity Limb Pain, Refractory Pain

7. Study Design

Primary Purpose
Other
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Model Description
Subjects will be randomized in a 1:1 ratio to one of two groups
Masking
None (Open Label)
Allocation
Randomized
Enrollment
73 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Intrathecal Drug Delivery System
Arm Type
Active Comparator
Arm Description
Subjects randomized to the Intrathecal Drug Delivery System group will be implanted with the Prometra System under sterile technique in accordance with the Instructions for Use. The pump will be filled at the time of implantation with the prescribed medication.
Arm Title
Conventional Medical Management
Arm Type
Active Comparator
Arm Description
Subjects randomized to the Conventional Medical Management group will continue with the standard of care procedures.
Intervention Type
Device
Intervention Name(s)
Flowonix Prometra® II Programmable Infusion System
Intervention Description
The Flowonix Prometra® II Programmable Infusion System consists of an implanted infusion pump and catheter, and external components including a clinician programmer, refill and catheter access port kits, the PTC™(a subject operated controller).
Intervention Type
Drug
Intervention Name(s)
Pain Medicine
Other Intervention Name(s)
Systemic opioid therapy
Intervention Description
Injections, spinal cord stimulation, peripheral nerve stimulation, pain medication, etc.
Primary Outcome Measure Information:
Title
Compare the change in Numeric Pain Rating Scale between the IDDS group and the CMM group
Description
The Numeric Pain Rating Scale (NPRS) is a 0-10 numeric pain rating scale (11 point scale), where a higher scores equates to more pain. The primary endpoint for this post-marketing study is the comparison of the NPRS between the IDDS group and the CMM group collected in the Study Diary at various time points.
Time Frame
Comparisons will be done prior to baseline visit and at 3, 6, 9 and 12 month visits.
Secondary Outcome Measure Information:
Title
Compare the change in PROMIS 29 scores between the IDDS group and CMM group
Description
Compare the subject reported Patient-Reported Outcomes Measurement Information System (PROMIS) 29 between the IDDS group and CMM group. PROMIS 29 assesses pain intensity using a 0-10 numeric rating scale (11 point scale), where a higher score equates to more pain. Other health domains are scored using a Likert scale, where higher scores represent more of the specific domain being measured. The other health domains that are scored are: depression; anxiety; physical function; pain interference; fatigue; sleep disturbance; and ability to participate in social roles and activities.
Time Frame
Individual subject scores recorded at baseline visit and at 3, 6, 9 and 12 month visits.
Title
Comparison of the accrued cost of therapy for pain
Description
Compare the accrued cost of therapy for pain control including those related to adverse events, ED visits, cost of medications between the IDDS group and CMM group.
Time Frame
Cost of therapy will be obtained at 3, 6, 9 and 12 month visits.
Title
Comparison of other concurrent treatments
Description
Compare the number of other concurrent treatments performed on each subject between the IDDS group and CMM group.
Time Frame
Individual subject counts recorded at 3, 6, 9 and 12 month visits will be compared.

10. Eligibility

Sex
All
Minimum Age & Unit of Time
22 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Subject must have signed and dated the IRB approved Informed Consent Form and HIPAA Authorization prior to any study procedures being performed Subject must be willing and able to complete study requirements including diaries, questionnaires and attend all visits, in the opinion of the investigator Subject must be male or female and at least 22 years of age Subjects who are female are non-lactating and if of childbearing potential have a negative urine pregnancy test at screening Subjects who are currently be receiving ≤ 90 mg/day morphine per day dose (or MME), with stable dose at equivalent of systemic opioids at Screening Subjects who are on a stable dose of opioids (no change in type or prescribed frequency or dose) for 30 days prior to the screening as documented in medical history; Subjects who have refractory pain despite failure of regional minimally invasive treatment options, including epidurals, facets, rhizotomies, direct or indirect spinal stenosis treatments, etc. Subjects who are a new candidate for chronic intrathecal drug therapy (including no prior intrathecal/epidural trial for pump infusion therapy) Subjects have not been implanted with a spinal cord stimulator for pain Subjects currently do not have an implanted spinal cord stimulator for pain Subjects who have a diagnosis of nonmalignant, chronic intractable pain as documented in the medical history Subjects who are medically stable and able to undergo surgery for implantation of the Prometra® II Infusion System Subject must have completed a psychological evaluation within 6 months prior to Screening Subject must complete an intrathecal trial resulting in candidacy for pump implantation during Screening Exclusion Criteria: A potential subject who has any contraindications listed in the Prometra® II labeling or any contraindications of intrathecal agents employed in the United States within the PACC, will be excluded. All subjects meeting any of the following criteria will also be excluded from this study: Subjects currently have a spinal cord stimulator implanted for pain Subjects previously had a spinal cord stimulator implanted for pain Subjects who have psychological or other health conditions, financial, and/or legal concerns (within 3 months prior to Screening) that would interfere with the subject's ability to fulfill the requirements of the protocol as per the investigator's opinion Subjects who have a history of alcohol abuse or illicit drug use within 2 years of screening Subjects who have an active malignancy or has been diagnosed with cancer and has not been in remission for at least 1 year prior to Screening Subjects who are female and who are pregnant, nursing or planning a pregnancy during the study or females of childbearing potential who are unable or unwilling to use a form of contraception during the study. Subjects who plan to enroll or is currently enrolled in another investigational drug or investigational medical device study or has participated in an investigational drug or medical device study within 30 days prior to Screening Subject has any condition or situation which, in the investigator's opinion, puts the patient at significant risk, could confound the study results, or may interfere significantly with the subject's participation in the study At the Baseline Visit or prior to Randomization, a subject will be excluded from continued participation if the subject has: Subjects that have a mean of the reported 12 hour "average" NPRS responses of < 6 on an eleven-point scale (0 to10) rated over the 5 days prior to the Baseline Visit (as recorded in the electronic Study Diary) in the absence of intolerable side effects as documented in the medical history Subjects with a negative urine test for opioids at Baseline Subjects with a positive Pregnancy test, if applicable Subjects that failed the intrathecal trial during Screening
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Jason E Pope, MD
Organizational Affiliation
Evolve Restorative Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
Evolve Restorative Center
City
Santa Rosa
State/Province
California
ZIP/Postal Code
95403
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
28042914
Citation
Deer TR, Pope JE, Hayek SM, Lamer TJ, Veizi IE, Erdek M, Wallace MS, Grider JS, Levy RM, Prager J, Rosen SM, Saulino M, Yaksh TL, De Andres JA, Abejon Gonzalez D, Vesper J, Schu S, Simpson B, Mekhail N. The Polyanalgesic Consensus Conference (PACC): Recommendations for Intrathecal Drug Delivery: Guidance for Improving Safety and Mitigating Risks. Neuromodulation. 2017 Feb;20(2):155-176. doi: 10.1111/ner.12579. Epub 2017 Jan 2.
Results Reference
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PubMed Identifier
28042906
Citation
Deer TR, Hayek SM, Pope JE, Lamer TJ, Hamza M, Grider JS, Rosen SM, Narouze S, Perruchoud C, Thomson S, Russo M, Grigsby E, Doleys DM, Jacobs MS, Saulino M, Christo P, Kim P, Huntoon EM, Krames E, Mekhail N. The Polyanalgesic Consensus Conference (PACC): Recommendations for Trialing of Intrathecal Drug Delivery Infusion Therapy. Neuromodulation. 2017 Feb;20(2):133-154. doi: 10.1111/ner.12543. Epub 2017 Jan 2.
Results Reference
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PubMed Identifier
28042904
Citation
Deer TR, Pope JE, Hayek SM, Bux A, Buchser E, Eldabe S, De Andres JA, Erdek M, Patin D, Grider JS, Doleys DM, Jacobs MS, Yaksh TL, Poree L, Wallace MS, Prager J, Rauck R, DeLeon O, Diwan S, Falowski SM, Gazelka HM, Kim P, Leong M, Levy RM, McDowell G II, McRoberts P, Naidu R, Narouze S, Perruchoud C, Rosen SM, Rosenberg WS, Saulino M, Staats P, Stearns LJ, Willis D, Krames E, Huntoon M, Mekhail N. The Polyanalgesic Consensus Conference (PACC): Recommendations on Intrathecal Drug Infusion Systems Best Practices and Guidelines. Neuromodulation. 2017 Feb;20(2):96-132. doi: 10.1111/ner.12538. Epub 2017 Jan 2. Erratum In: Neuromodulation. 2017 Jun;20(4):405-406.
Results Reference
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Learn more about this trial

Post-market, Randomized, Controlled, Prospective Study Evaluating Intrathecal Pain Medication (IT) Versus Conventional Medical Management (CMM) in the Non-cancer, Refractory, Chronic Pain Population

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