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Flurbiprofen Tape for Treatment of Chronic Low Back Pain (LBP)

Primary Purpose

Chronic Low Back Pain

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Placebo Tape (Arm 1)
Flurbiprofen Tape (Arm 2)
Placebo Tape (Arm 3)
Flurbiprofen Tape (Arm 4)
Sponsored by
Teikoku Pharma USA, Inc.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Chronic Low Back Pain focused on measuring Flurbiprofen, low back pain, chronic low back pain

Eligibility Criteria

18 Years - 80 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • male or female 18 to 80 years;
  • signed an informed consent;
  • daily LBP below the 12th thoracic vertebra of greater than 3 months' duration;
  • able to ambulate at least 100 meters;
  • in stable general health with laboratory values within normal limits
  • no evidence of drug abuse or residual opiates; determined by urine drug screening;
  • diagnosis of chronic LBP verified by medical records;
  • female patients must be postmenopausal (defined as 1 year without menses), physically incapable of becoming pregnant, or using an acceptable birth control method. Non-postmenopausal patients must have confirmation of a negative urine pregnancy test;
  • must read and speak English;
  • must be reliable and mentally competent to complete study measurements;
  • must be available for the study visits and telephone checks from study entry to study completion.
  • male patients must use an acceptable method of birth control with their female partners;
  • rates their pain at 3 or higher on an 11-point Categorical Pain Scale for LBP over the prior week (7 days) of Visit 1.
  • over the last 3 days of the Baseline Phase, had a computed average pain score of 4 or greater on an 11-point Categorical Pain Scale
  • discontinued the use of any topical pain medications, salves, anticonvulsants, oral NSAIDs, muscle relaxants, opioids, or anti-inflammatory steroids during the Baseline Phase. Acetaminophen, at a dose of ≤ 1000 mg per day is acceptable;
  • able to discontinue the use of therapy defined as ice, heat, chiropractic care, physical therapy, acupuncture and acupressure on their lower back area during the Baseline Phase.

Exclusion Criteria:

  • open skin lesion within the painful area;
  • experiencing LBP for less than 3 months;
  • undergone back surgery within the past 3 months or has plans for back surgery within 30 days post-study;
  • participated in clinical treatment studies within 30 days of study entry;
  • chronic back pain which is due to fibromyalgia or connective tissue disorder (lupus, rheumatoid arthritis, ankylosing spondylitis, Reiter's syndrome, etc.);
  • LBP due to malignancy, vertebral fracture, or infection;
  • used opioids (including low potency/low dose opioid combinations and tramadol) more than 2 times per week within 30 days of study entry. Opioids and tramadol must not have been taken at least 4 days prior to study entry;
  • had injection therapy within 30 days of study entry, including corticosteroids;
  • a clinically significant psychiatric disorder (severe depression, other Axis I or Axis II disorders as defined in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV);
  • taking lithium, furosemide, and/or thiazides;
  • considered unreliable as to medication compliance (if any medication other than 1000 mg or less of acetaminophen a day was taken for any type of pain, the patient was discontinued) or adherence to scheduled appointments as determined by the investigators;
  • a prior history of GI bleeds/ulcers or clinically significant liver/kidney disease;
  • known hypersensitivity to flurbiprofen or other NSAIDs;
  • has a coagulation disorder or is taking warfarin or other anticoagulants (aspirin at a dose of [≤ 81 mg] is acceptable);
  • clinically significant fluid retention, cardiovascular disease (CVD), hypertension, or heart failure;
  • had coronary artery bypass graft surgery (CABG), cardiovascular thrombotic event, myocardial infarction (MI) and/or stroke within 1 year of Visit 1;
  • had unresolved litigation related to back injury or other pain complaints; settled disability claims/payments (Worker's Compensation, state/federal/private disability plans) were allowed.

Sites / Locations

  • Redpoint Research
  • Diablo Clinical Research, Inc.
  • University Foundation for Education and Research, Inc.
  • Palm Beach Research Center
  • Internal Medicine Associates of Cordova
  • Sarah Cannon Research Institute
  • Senior Adults Specialty Research
  • Charolettesville Medical Research
  • Rainier Clinical Research Center, Inc.
  • Aurora Advanced Healthcare, Inc.

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm Type

Placebo Comparator

Experimental

Placebo Comparator

Experimental

Arm Label

Placebo Tape (Arm 1)

Flurbiprofen Tape (Arm 2)

Placebo Tape (Arm 3)

Flurbiprofen Tape (Arm 4)

Arm Description

Placebo tape remained on for 12 hours of continuous treatment per day.

Flurbiprofen tape remained on for 12 hours of continuous treatment per day.

Placebo tape remained on for 24 hours of continuous treatment per day.

Flurbiprofen tape remained on for 24 hours of continuous treatment per day.

Outcomes

Primary Outcome Measures

Cumulative Summed Pain Intensity Difference (SPID+)
The primary efficacy endpoint was the cumulative summed pain intensity difference (SPID+) at Days 4 and 7 of the tape treatment phase as computed from the daily categorical pain scale score reported on the patient's daily diary during the tape treatment phase; pain was rated on an 11-point scale, where: 0 = no pain, 10 = worst pain imaginable. Summed pain intensity difference is the sum of the pain intensity differences (PID). PID at each post-baseline evaluation was computed as the average baseline categorical pain scale score minus the post-baseline categorical pain scale score from the daily dairy. For patients with multiple pain scores reported on a given post-baseline study day, the PID scores were averaged to compute one daily PID score for each patient.

Secondary Outcome Measures

Pain Intensity Difference (PID+)
+PID = pre-treatment value at baseline - post-treatment value at day of evaluation, where: pre-treatment value at baseline = average daily pain over the last 3 days of the baseline phase (ie, average of daily averages of the categorical pain scale scores for the last 3 days of the baseline phase). Pain was rated on an 11-point scale, where: 0 = no pain, 10 = worst pain imaginable. A positive PID indicates a reduction in pain.
Average Daily Categorical Pain Scale Scores
Patients rated their lower back pain, caused by normal activity and movement, on an 11-point categorical pain scale, where: 0 = no pain, and 10 = worst pain imaginable. Patients rated their lower back pain every 12 hours, at any time they took medication including rescue medication for any type of pain, and if they applied or removed their treatment tapes at a time other than the scheduled time. Data are reported as the daily average categorical pain scale score by treatment group.
Percent Change From Baseline in Total Functional Rating Index (FRI)
Patients completed the FRI, a 10-item back pain-specific measure of function questionnaire describing the condition at the time the questionnaire was completed; each item (pain intensity, sleeping, personal care, travel, etc.) was rated on a 5-point scale, where 0 = best outcome, 4 = worst outcome. FRI was reported as the percent change from baseline at Day 7 of the tape treatment phase, where: Total FRI score = sum of the 10 questions. The total FRI score ranged from 0 (best outcome) to 40 (worst outcome). Percent change = ([baseline - Day 7]/baseline)*100. A positive percent change indicates a favorable treatment effect.
Change From Baseline in Total Tender Point Examination Score
At baseline and Day 7 of the tape treatment phase, patients had an assessment of tenderness bilaterally at the sacroiliac joint, greater trochanter of the hip, gluteus medius and minimus, and paraspinal muscles at L3-L4, L4-L5, and L5-S1. The investigator or research nurse pressed 12 specific areas of the body (6 locations, left and right sides), and patients were asked to rate the intensity of their pain at those 12 areas using an 11-point scale, where: 0 = no pain, 10 = the worst pain the patient has ever experienced. The total tender point examination score ranged from 0 (best outcome) to 120 (worst outcome). Change from baseline = baseline - Day 7. A positive change indicates a favorable treatment effect.
Patient Global Impression of Change (PGIC)
At Day 7, patients provided their PGIC with regard to lower back pain response to treatment, using a 7-point scale, where: 1 = very much improved, 7 = very much worse.
Acetaminophen Used During the Tape Treatment Phase
The percentage of patients who used rescue medication during the tape treatment phase.
Acetaminophen Used During the Tape Treatment Phase
The total amount (mg) of rescue medication used during the tape treatment phase.
Percentage of Patients Who Discontinued
The percentage of patients who discontinued the study during the tape treatment phase due to lack of efficacy.
Patient Assessment of Wearability of Therapy
At Day 7, patients assessed the wearability of their treatment tape (ease of application, stays in place, comfortable to wear) using a 4-point scale, where: 1 = Excellent, 4 = Poor.

Full Information

First Posted
September 24, 2008
Last Updated
August 12, 2016
Sponsor
Teikoku Pharma USA, Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT00759330
Brief Title
Flurbiprofen Tape for Treatment of Chronic Low Back Pain
Acronym
LBP
Official Title
A Multi-Center, Randomized, Double-Blind, Placebo-Controlled Trial of Flurbiprofen Tape for Treatment of Chronic Low Back Pain
Study Type
Interventional

2. Study Status

Record Verification Date
June 2016
Overall Recruitment Status
Completed
Study Start Date
October 2007 (undefined)
Primary Completion Date
July 2008 (Actual)
Study Completion Date
July 2008 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Teikoku Pharma USA, Inc.

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
The purpose of this trial is to evaluate the analgesic efficacy and safety of flurbiprofen tape for chronic low back pain (lasting greater than 3 months).
Detailed Description
This study is a multi-center, randomized, double-blind, placebo-controlled study in patients with daily low back pain below the 12th thoracic vertebra of greater than 3 months duration. Patients also had an average daily pain score of 4 or greater on an 11-point categorical pain scale for the last 3 days of the baseline phase. The study began with a 14-day washout period of previously used pain medications. At the end of the 14-day baseline phase, patients were randomized to 1 of 4 treatments: Flurbiprofen tape applied once daily for 12 hours, Flurbiprofen tape applied once daily for 24 hours, placebo tape applied once daily for 12 hours, or placebo tape applied once daily for 24 hours. During the 7-day treatment phase, patients applied 2 treatment tapes once daily for 7 days. The tapes remained on for 12 or 24 hours of continuous treatment, depending on the treatment to which they were randomized. Patients were provided with rescue medication. After 7 days of tape treatment, patients returned to the clinic for a study exit visit.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Chronic Low Back Pain
Keywords
Flurbiprofen, low back pain, chronic low back pain

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
127 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Placebo Tape (Arm 1)
Arm Type
Placebo Comparator
Arm Description
Placebo tape remained on for 12 hours of continuous treatment per day.
Arm Title
Flurbiprofen Tape (Arm 2)
Arm Type
Experimental
Arm Description
Flurbiprofen tape remained on for 12 hours of continuous treatment per day.
Arm Title
Placebo Tape (Arm 3)
Arm Type
Placebo Comparator
Arm Description
Placebo tape remained on for 24 hours of continuous treatment per day.
Arm Title
Flurbiprofen Tape (Arm 4)
Arm Type
Experimental
Arm Description
Flurbiprofen tape remained on for 24 hours of continuous treatment per day.
Intervention Type
Drug
Intervention Name(s)
Placebo Tape (Arm 1)
Intervention Description
Two placebo tapes (one on each side of the spine) were applied on the lower back area once daily for 7 days.
Intervention Type
Drug
Intervention Name(s)
Flurbiprofen Tape (Arm 2)
Intervention Description
Two flurbiprofen tapes (one on each side of the spine) were applied on the lower back area once daily for 7 days. Each tape contained 31.5 mg flurbiprofen for a total daily dose of 63 mg.
Intervention Type
Drug
Intervention Name(s)
Placebo Tape (Arm 3)
Intervention Description
Two placebo tapes (one on each side of the spine) were applied on the lower back area once daily for 7 days.
Intervention Type
Drug
Intervention Name(s)
Flurbiprofen Tape (Arm 4)
Intervention Description
Two flurbiprofen tapes (one on each side of the spine) were applied on the lower back area once daily for 7 days. Each tape contained 31.5 mg flurbiprofen for a total daily dose of 63 mg.
Primary Outcome Measure Information:
Title
Cumulative Summed Pain Intensity Difference (SPID+)
Description
The primary efficacy endpoint was the cumulative summed pain intensity difference (SPID+) at Days 4 and 7 of the tape treatment phase as computed from the daily categorical pain scale score reported on the patient's daily diary during the tape treatment phase; pain was rated on an 11-point scale, where: 0 = no pain, 10 = worst pain imaginable. Summed pain intensity difference is the sum of the pain intensity differences (PID). PID at each post-baseline evaluation was computed as the average baseline categorical pain scale score minus the post-baseline categorical pain scale score from the daily dairy. For patients with multiple pain scores reported on a given post-baseline study day, the PID scores were averaged to compute one daily PID score for each patient.
Time Frame
Days 4 and 7 of tape treatment phase
Secondary Outcome Measure Information:
Title
Pain Intensity Difference (PID+)
Description
+PID = pre-treatment value at baseline - post-treatment value at day of evaluation, where: pre-treatment value at baseline = average daily pain over the last 3 days of the baseline phase (ie, average of daily averages of the categorical pain scale scores for the last 3 days of the baseline phase). Pain was rated on an 11-point scale, where: 0 = no pain, 10 = worst pain imaginable. A positive PID indicates a reduction in pain.
Time Frame
Days 1 through 7 of tape treatment phase
Title
Average Daily Categorical Pain Scale Scores
Description
Patients rated their lower back pain, caused by normal activity and movement, on an 11-point categorical pain scale, where: 0 = no pain, and 10 = worst pain imaginable. Patients rated their lower back pain every 12 hours, at any time they took medication including rescue medication for any type of pain, and if they applied or removed their treatment tapes at a time other than the scheduled time. Data are reported as the daily average categorical pain scale score by treatment group.
Time Frame
Days 1 through 7 of tape treatment phase
Title
Percent Change From Baseline in Total Functional Rating Index (FRI)
Description
Patients completed the FRI, a 10-item back pain-specific measure of function questionnaire describing the condition at the time the questionnaire was completed; each item (pain intensity, sleeping, personal care, travel, etc.) was rated on a 5-point scale, where 0 = best outcome, 4 = worst outcome. FRI was reported as the percent change from baseline at Day 7 of the tape treatment phase, where: Total FRI score = sum of the 10 questions. The total FRI score ranged from 0 (best outcome) to 40 (worst outcome). Percent change = ([baseline - Day 7]/baseline)*100. A positive percent change indicates a favorable treatment effect.
Time Frame
baseline to Day 7 of tape treatment phase
Title
Change From Baseline in Total Tender Point Examination Score
Description
At baseline and Day 7 of the tape treatment phase, patients had an assessment of tenderness bilaterally at the sacroiliac joint, greater trochanter of the hip, gluteus medius and minimus, and paraspinal muscles at L3-L4, L4-L5, and L5-S1. The investigator or research nurse pressed 12 specific areas of the body (6 locations, left and right sides), and patients were asked to rate the intensity of their pain at those 12 areas using an 11-point scale, where: 0 = no pain, 10 = the worst pain the patient has ever experienced. The total tender point examination score ranged from 0 (best outcome) to 120 (worst outcome). Change from baseline = baseline - Day 7. A positive change indicates a favorable treatment effect.
Time Frame
Baseline to Day 7 of tape treatment phase
Title
Patient Global Impression of Change (PGIC)
Description
At Day 7, patients provided their PGIC with regard to lower back pain response to treatment, using a 7-point scale, where: 1 = very much improved, 7 = very much worse.
Time Frame
Day 7
Title
Acetaminophen Used During the Tape Treatment Phase
Description
The percentage of patients who used rescue medication during the tape treatment phase.
Time Frame
Day 1 through Day 7 of the tape treatment phase
Title
Acetaminophen Used During the Tape Treatment Phase
Description
The total amount (mg) of rescue medication used during the tape treatment phase.
Time Frame
Day 1 through Day 7 of the tape treatment phase
Title
Percentage of Patients Who Discontinued
Description
The percentage of patients who discontinued the study during the tape treatment phase due to lack of efficacy.
Time Frame
Days 1 through Day 7 of tape treatment phase
Title
Patient Assessment of Wearability of Therapy
Description
At Day 7, patients assessed the wearability of their treatment tape (ease of application, stays in place, comfortable to wear) using a 4-point scale, where: 1 = Excellent, 4 = Poor.
Time Frame
Day 7

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
80 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: male or female 18 to 80 years; signed an informed consent; daily LBP below the 12th thoracic vertebra of greater than 3 months' duration; able to ambulate at least 100 meters; in stable general health with laboratory values within normal limits no evidence of drug abuse or residual opiates; determined by urine drug screening; diagnosis of chronic LBP verified by medical records; female patients must be postmenopausal (defined as 1 year without menses), physically incapable of becoming pregnant, or using an acceptable birth control method. Non-postmenopausal patients must have confirmation of a negative urine pregnancy test; must read and speak English; must be reliable and mentally competent to complete study measurements; must be available for the study visits and telephone checks from study entry to study completion. male patients must use an acceptable method of birth control with their female partners; rates their pain at 3 or higher on an 11-point Categorical Pain Scale for LBP over the prior week (7 days) of Visit 1. over the last 3 days of the Baseline Phase, had a computed average pain score of 4 or greater on an 11-point Categorical Pain Scale discontinued the use of any topical pain medications, salves, anticonvulsants, oral NSAIDs, muscle relaxants, opioids, or anti-inflammatory steroids during the Baseline Phase. Acetaminophen, at a dose of ≤ 1000 mg per day is acceptable; able to discontinue the use of therapy defined as ice, heat, chiropractic care, physical therapy, acupuncture and acupressure on their lower back area during the Baseline Phase. Exclusion Criteria: open skin lesion within the painful area; experiencing LBP for less than 3 months; undergone back surgery within the past 3 months or has plans for back surgery within 30 days post-study; participated in clinical treatment studies within 30 days of study entry; chronic back pain which is due to fibromyalgia or connective tissue disorder (lupus, rheumatoid arthritis, ankylosing spondylitis, Reiter's syndrome, etc.); LBP due to malignancy, vertebral fracture, or infection; used opioids (including low potency/low dose opioid combinations and tramadol) more than 2 times per week within 30 days of study entry. Opioids and tramadol must not have been taken at least 4 days prior to study entry; had injection therapy within 30 days of study entry, including corticosteroids; a clinically significant psychiatric disorder (severe depression, other Axis I or Axis II disorders as defined in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV); taking lithium, furosemide, and/or thiazides; considered unreliable as to medication compliance (if any medication other than 1000 mg or less of acetaminophen a day was taken for any type of pain, the patient was discontinued) or adherence to scheduled appointments as determined by the investigators; a prior history of GI bleeds/ulcers or clinically significant liver/kidney disease; known hypersensitivity to flurbiprofen or other NSAIDs; has a coagulation disorder or is taking warfarin or other anticoagulants (aspirin at a dose of [≤ 81 mg] is acceptable); clinically significant fluid retention, cardiovascular disease (CVD), hypertension, or heart failure; had coronary artery bypass graft surgery (CABG), cardiovascular thrombotic event, myocardial infarction (MI) and/or stroke within 1 year of Visit 1; had unresolved litigation related to back injury or other pain complaints; settled disability claims/payments (Worker's Compensation, state/federal/private disability plans) were allowed.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
James Song
Organizational Affiliation
Teikoku Pharma USA, Inc.
Official's Role
Study Director
Facility Information:
Facility Name
Redpoint Research
City
Phoenix
State/Province
Arizona
ZIP/Postal Code
85029
Country
United States
Facility Name
Diablo Clinical Research, Inc.
City
Walnut Creek
State/Province
California
ZIP/Postal Code
94598
Country
United States
Facility Name
University Foundation for Education and Research, Inc.
City
Tampa
State/Province
Florida
ZIP/Postal Code
33606
Country
United States
Facility Name
Palm Beach Research Center
City
West Palm Beach
State/Province
Florida
ZIP/Postal Code
33409
Country
United States
Facility Name
Internal Medicine Associates of Cordova
City
Cordova
State/Province
Tennessee
ZIP/Postal Code
38018
Country
United States
Facility Name
Sarah Cannon Research Institute
City
Memphis
State/Province
Tennessee
ZIP/Postal Code
38119
Country
United States
Facility Name
Senior Adults Specialty Research
City
Austin
State/Province
Texas
ZIP/Postal Code
78757
Country
United States
Facility Name
Charolettesville Medical Research
City
Charlottesville
State/Province
Virginia
ZIP/Postal Code
22911
Country
United States
Facility Name
Rainier Clinical Research Center, Inc.
City
Renton
State/Province
Washington
ZIP/Postal Code
98057
Country
United States
Facility Name
Aurora Advanced Healthcare, Inc.
City
Milwaukee
State/Province
Wisconsin
ZIP/Postal Code
53209
Country
United States

12. IPD Sharing Statement

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Flurbiprofen Tape for Treatment of Chronic Low Back Pain

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