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Efficacy of BNX Sublingual Tablets Versus BNX Sublingual Film for Treatment of Opioid-Dependent Adults (ISTART)

Primary Purpose

Opioid Dependence, on Agonist Therapy

Status
Completed
Phase
Phase 3
Locations
United States
Study Type
Interventional
Intervention
BNX sublingual tablets
BNX sublingual film
Buprenorphine
Sponsored by
Orexo AB
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Opioid Dependence, on Agonist Therapy focused on measuring Opioid, Dependence, agonist, buprenorphine, naloxone, BUP/NAL

Eligibility Criteria

18 Years - 65 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Male/female 18-65 years old
  2. Able to read, comprehend & sign the informed consent form
  3. Meet opioid dependence criteria in DSM-IV-TR the past 12 months
  4. Have a buprenorphine-negative UDS &/or urine dipstick
  5. Prepared to abstain from opioids other than the study drug & from other addictive drugs
  6. Negative urine pregnancy test
  7. Females of childbearing potential who use a reliable method of contraception. Females of non-childbearing potential; surgically sterile or post-menopausal as defined by being at least 50 years of age & having an absence of menses for at least 2 years
  8. Clearance from the prescribing MD to be withdrawn from their prescribed opioids for subjects receiving opioids for pain
  9. Lack of clinically significant abnormalities in health assessments performed at screening. Unclear cases should be approved by the medical monitor
  10. At least mild withdrawal symptoms (COWS ≥9)

Exclusion Criteria:

  1. Pregnant, lactating or planning to be pregnant during study
  2. Unwilling/unable to comply with the requirements of the protocol (e.g., pending incarceration) are in a situation/condition that may interfere with participation in the study
  3. Prescribed treatment with generic buprenorphine monotherapy within 90 days prior start of treatment
  4. Daily dose of methadone over 30 mg during the past week or who received the last dose of methadone less than 30 hours prior to treatment
  5. Participating in other clinical studies in which medications is delivered or who have used an investigational drug/device within the last 30 days
  6. Allergy, sensitivity or intolerance to BUP, NAL or any related drug; history of drug hypersensitivity or intolerance which, in the opinion of the investigator, would compromise the safety of the subject/study
  7. Staff, affiliated with, or family member of the staff directly involved with this study
  8. Serious untreated Axis I DSM-IV-TR psychiatric comorbidity (actively suicidal or homicidal, have untreated schizophrenia)
  9. Tongue/oral deformities that may affect the absorption of the drug products
  10. Current/history of clinically significant medical disorder or condition which would jeopardize the safety or impact the validity of the results. Unclear cases should be discussed with & approved by the medical monitor
  11. HIV-seropositive with a CD4+ count <200, active AIDS defining infection in the last 120 days
  12. Have Class III/IV congestive heart failure, symptomatic myocardial ischemia or history of long QT syndrome (or an immediate family member with this condition)
  13. Currently taking Class 1A antiarrhythmic medications (e.g., quinidine, procainamide, & disopyramide) or Class III antiarrhythmic medications (e.g., sotalol, amiodarone, & dofetilide)
  14. Have uncontrolled hypertension, pulse oximetry ≤92%or clinically significant abnormality on 12-lead ECG, including a corrected QT (QTc) interval >450 ms
  15. Severe liver disease

Sites / Locations

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Experimental

Arm Label

Buprenorphine; then OL BNX film, then BNX tablets

BNX tablets, then OL BNX tablets, then BNX film

Arm Description

Days 1-2: Generic buprenorphine sublingual tablets (blinded); Days 3 to 14: Buprenorphine/naloxone sublingual film (open-label); Days 15-21: BNX sublingual tablets (open-label); Day 22: Offered option in continuing in open-label follow-up study of BNX sublingual tablets

Days 1-2: BNX sublingual tablets (blinded); Days 3 to 14: BNX sublingual tablets (open-label); Days 15-21: Buprenorphine/naloxone sublingual film (open-label); Day 22: Offered option in continuing in open-label follow-up study of BNX sublingual tablets

Outcomes

Primary Outcome Measures

Primary Endpoints of Retention in Treatment at Days 3 and 15
Retention rates (number of patients retained) for the primary efficacy endpoints of retention in treatment at Days 3 and 15, which was defined as the number of patients who received treatment on Days 3 and 15.

Secondary Outcome Measures

Clinical Opiate Withdrawal Scale (COWS) Scores: Induction
Absolute ± mean standard deviation values for COWS total scores at baseline; 0.5 h, 1.5 h, 3 h, and 6 h post dose on Day 1, and Day 2; COWS scores range from 0-48, with a lower score being more favorable
COWS Total Scores: Stabilization/Maintenance
Absolute ± mean standard deviation values for COWS total scores at Days 3, 4, 8, 15, and 22; COWS scores range from 0-48, with a lower score being more favorable
Subjective Opiate Withdrawal Scale (SOWS) Scores: Induction
Absolute ± mean standard deviation values for SOWS total scores at baseline, 0.5 h, 1.5 h, 3 h, and 6 h post dose on Day 1, and Day 2; SOWS score ranges from 0-64, with a lower score being more favorable
SOWS Total Scores: Stabilization/Maintenance
Absolute ± mean standard deviation values for SOWS total scores on Days 2, 3, 4, 8, 15, and 22; SOWS scores ranged from 0-64, with a lower score being more favorable
Visual Analog Scale (VAS) Cravings: Induction
Absolute mean ± standard deviation values for VAS cravings at baseline, 0.5 h, 1.5 h, 3 h, and 6 post dose on Day 1, and Day 2; the VAS craving scores range from 0 ("no cravings") to 100 ("most intense craving I have ever had")
VAS Craving Scores: Stabilization/Maintenance
Absolute mean ± standard deviation values for VAS cravings scores on Days 3, 4, 8, 15, and 22; the VAS craving scores range from 0 ("no cravings") to 100 ("most intense craving I have ever had")

Full Information

First Posted
July 19, 2013
Last Updated
April 3, 2017
Sponsor
Orexo AB
Collaborators
Worldwide Clinical Trials
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1. Study Identification

Unique Protocol Identification Number
NCT01908842
Brief Title
Efficacy of BNX Sublingual Tablets Versus BNX Sublingual Film for Treatment of Opioid-Dependent Adults
Acronym
ISTART
Official Title
Induction, STabilization, Adherence, and Retention Trial (ISTART) - A Randomized, Non-inferiority, Multicenter Study to Assess Early Treatment Efficacy of OX219 Versus SUBOXONE Film and to Explore Switching Between Treatments
Study Type
Interventional

2. Study Status

Record Verification Date
April 2017
Overall Recruitment Status
Completed
Study Start Date
August 2013 (undefined)
Primary Completion Date
April 2014 (Actual)
Study Completion Date
April 2014 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Orexo AB
Collaborators
Worldwide Clinical Trials

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
The purpose of this study was to assess retention in treatment after induction with buprenorphine/naloxone (BNX) sublingual tablets compared with generic buprenorphine and after stabilization with BNX sublingual tablets compared with BNX film. Secondary objectives included assessment of treatment effects on opioid withdrawal symptoms, opioid cravings, and safety.
Detailed Description
This prospective, randomized, multicenter, parallel-group, non-inferiority study was conducted at 43 centers in the United States from August 2013 to April 2014. A non-inferior design was used because both products contain the same active components, and it was considered unethical to include a placebo arm. The study comprised an induction phase of 2 days and a stabilization phase of 20 days, with study visits scheduled on Days 1, 2, 3, 4, 8, 15, and 22. Eligible opioid-dependent patients were randomly assigned within 14 days of screening to induction with either the BNX sublingual tablets or generic buprenorphine tablets for 2 days. On Day 3, patients initially allocated to buprenorphine were switched to BNX film, whereas those allocated to BNX sublingual tablets continued on the same treatment. On Day 15, patients receiving BNX film were switched to BNX sublingual tablets, and those on BNX sublingual tablets were switched to BNX film. At the final study visit on Day 22, patients were offered the option of continuing in an open-label follow-up study of BNX sublingual tablets.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Opioid Dependence, on Agonist Therapy
Keywords
Opioid, Dependence, agonist, buprenorphine, naloxone, BUP/NAL

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
759 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Buprenorphine; then OL BNX film, then BNX tablets
Arm Type
Active Comparator
Arm Description
Days 1-2: Generic buprenorphine sublingual tablets (blinded); Days 3 to 14: Buprenorphine/naloxone sublingual film (open-label); Days 15-21: BNX sublingual tablets (open-label); Day 22: Offered option in continuing in open-label follow-up study of BNX sublingual tablets
Arm Title
BNX tablets, then OL BNX tablets, then BNX film
Arm Type
Experimental
Arm Description
Days 1-2: BNX sublingual tablets (blinded); Days 3 to 14: BNX sublingual tablets (open-label); Days 15-21: Buprenorphine/naloxone sublingual film (open-label); Day 22: Offered option in continuing in open-label follow-up study of BNX sublingual tablets
Intervention Type
Drug
Intervention Name(s)
BNX sublingual tablets
Other Intervention Name(s)
OX219, Zubsolv
Intervention Description
Buprenorphine/naloxone sublingual tablets
Intervention Type
Drug
Intervention Name(s)
BNX sublingual film
Other Intervention Name(s)
Suboxone film
Intervention Description
Buprenorphine/naloxone sublingual film
Intervention Type
Drug
Intervention Name(s)
Buprenorphine
Other Intervention Name(s)
Generic buprenorphine
Intervention Description
Buprenorphine sublingual tablets
Primary Outcome Measure Information:
Title
Primary Endpoints of Retention in Treatment at Days 3 and 15
Description
Retention rates (number of patients retained) for the primary efficacy endpoints of retention in treatment at Days 3 and 15, which was defined as the number of patients who received treatment on Days 3 and 15.
Time Frame
Day 3 and Day 15
Secondary Outcome Measure Information:
Title
Clinical Opiate Withdrawal Scale (COWS) Scores: Induction
Description
Absolute ± mean standard deviation values for COWS total scores at baseline; 0.5 h, 1.5 h, 3 h, and 6 h post dose on Day 1, and Day 2; COWS scores range from 0-48, with a lower score being more favorable
Time Frame
Days 1 and 2
Title
COWS Total Scores: Stabilization/Maintenance
Description
Absolute ± mean standard deviation values for COWS total scores at Days 3, 4, 8, 15, and 22; COWS scores range from 0-48, with a lower score being more favorable
Time Frame
Days 3 through 22
Title
Subjective Opiate Withdrawal Scale (SOWS) Scores: Induction
Description
Absolute ± mean standard deviation values for SOWS total scores at baseline, 0.5 h, 1.5 h, 3 h, and 6 h post dose on Day 1, and Day 2; SOWS score ranges from 0-64, with a lower score being more favorable
Time Frame
Days 1 and 2
Title
SOWS Total Scores: Stabilization/Maintenance
Description
Absolute ± mean standard deviation values for SOWS total scores on Days 2, 3, 4, 8, 15, and 22; SOWS scores ranged from 0-64, with a lower score being more favorable
Time Frame
Days 3 through 22
Title
Visual Analog Scale (VAS) Cravings: Induction
Description
Absolute mean ± standard deviation values for VAS cravings at baseline, 0.5 h, 1.5 h, 3 h, and 6 post dose on Day 1, and Day 2; the VAS craving scores range from 0 ("no cravings") to 100 ("most intense craving I have ever had")
Time Frame
Days 1 and 2
Title
VAS Craving Scores: Stabilization/Maintenance
Description
Absolute mean ± standard deviation values for VAS cravings scores on Days 3, 4, 8, 15, and 22; the VAS craving scores range from 0 ("no cravings") to 100 ("most intense craving I have ever had")
Time Frame
Days 3 through 22

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male/female 18-65 years old Able to read, comprehend & sign the informed consent form Meet opioid dependence criteria in DSM-IV-TR the past 12 months Have a buprenorphine-negative UDS &/or urine dipstick Prepared to abstain from opioids other than the study drug & from other addictive drugs Negative urine pregnancy test Females of childbearing potential who use a reliable method of contraception. Females of non-childbearing potential; surgically sterile or post-menopausal as defined by being at least 50 years of age & having an absence of menses for at least 2 years Clearance from the prescribing MD to be withdrawn from their prescribed opioids for subjects receiving opioids for pain Lack of clinically significant abnormalities in health assessments performed at screening. Unclear cases should be approved by the medical monitor At least mild withdrawal symptoms (COWS ≥9) Exclusion Criteria: Pregnant, lactating or planning to be pregnant during study Unwilling/unable to comply with the requirements of the protocol (e.g., pending incarceration) are in a situation/condition that may interfere with participation in the study Prescribed treatment with generic buprenorphine monotherapy within 90 days prior start of treatment Daily dose of methadone over 30 mg during the past week or who received the last dose of methadone less than 30 hours prior to treatment Participating in other clinical studies in which medications is delivered or who have used an investigational drug/device within the last 30 days Allergy, sensitivity or intolerance to BUP, NAL or any related drug; history of drug hypersensitivity or intolerance which, in the opinion of the investigator, would compromise the safety of the subject/study Staff, affiliated with, or family member of the staff directly involved with this study Serious untreated Axis I DSM-IV-TR psychiatric comorbidity (actively suicidal or homicidal, have untreated schizophrenia) Tongue/oral deformities that may affect the absorption of the drug products Current/history of clinically significant medical disorder or condition which would jeopardize the safety or impact the validity of the results. Unclear cases should be discussed with & approved by the medical monitor HIV-seropositive with a CD4+ count <200, active AIDS defining infection in the last 120 days Have Class III/IV congestive heart failure, symptomatic myocardial ischemia or history of long QT syndrome (or an immediate family member with this condition) Currently taking Class 1A antiarrhythmic medications (e.g., quinidine, procainamide, & disopyramide) or Class III antiarrhythmic medications (e.g., sotalol, amiodarone, & dofetilide) Have uncontrolled hypertension, pulse oximetry ≤92%or clinically significant abnormality on 12-lead ECG, including a corrected QT (QTc) interval >450 ms Severe liver disease
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Erik Gunderson
Organizational Affiliation
University of Virginia, PO Box 800623, Charlottesville, VA 22911
Official's Role
Principal Investigator
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12. IPD Sharing Statement

Citations:
PubMed Identifier
26412801
Citation
Gunderson EW, Hjelmstrom P, Sumner M; 006 Study Investigators. Effects of a higher-bioavailability buprenorphine/naloxone sublingual tablet versus buprenorphine/naloxone film for the treatment of opioid dependence during induction and stabilization: a multicenter, randomized trial. Clin Ther. 2015 Oct 1;37(10):2244-55. doi: 10.1016/j.clinthera.2015.08.025. Epub 2015 Sep 26.
Results Reference
derived

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Efficacy of BNX Sublingual Tablets Versus BNX Sublingual Film for Treatment of Opioid-Dependent Adults

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