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Study to Assess Efficacy and Safety of BNX Sublingual Tablets for the Induction of Treatment of Opioid Dependence

Primary Purpose

Opioid-Related Disorders, Opiate Dependence

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

About this trial

This is an interventional treatment trial for Opioid-Related Disorders focused on measuring opioid dependence, buprenorphine/naloxone, sublingual

Eligibility Criteria

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

Inclusion Criteria:

  • Able to read, comprehend, and sign the informed consent form and willingly provide written informed consent
  • Prepared to engage in opioid replacement therapy and to abstain from opioid utilization other than the study drug, and from other illicit drugs
  • Male or female, 18 to 65 years of age (inclusive)
  • Met clinical criteria for opioid dependence in past 12 months based on DSM-IV-TR
  • Provided buprenorphine-negative urine drug screen prior to randomization
  • Provided negative urine pregnancy test
  • Females of childbearing potential were required to be using a reliable method of contraception (e.g., hormonal, condom with spermicide, intrauterine device [IUD]) after the screening visit and for the duration of the study
  • Participants receiving opioids for pain must receive clearance from their prescribing physician to be withdrawn from their prescribed opioids
  • Generally good health as determined by the investigator
  • Participants should demonstrate at least mild withdrawal symptoms (defined as a COWS score >9 at Day 1 predose)

Exclusion Criteria:

  • Females who are pregnant or lactating, or planning to be pregnant during study
  • Any previous prescribed treatment with buprenorphine monotherapy (e.g., generic buprenorphine sublingual tablets)
  • Prescribed treatment with buprenorphine or naloxone within 90 days prior to start of treatment
  • Methadone patients with any daily dose over 30 mg during the past week and who received the last dose of methadone less than 30 hours prior to start of treatment
  • Participants who are unwilling or unable to comply with the requirements of the protocol
  • Participants who are participating in any other clinical study in which medication(s) are being delivered or who have used an investigational drug or device within the last 30 days
  • Participants with any known allergy or sensitivity or intolerance to buprenorphine, naloxone, or any related drug
  • Participants who are on the staff, affiliated with, or a family member of the staff personnel directly involved with this study
  • Participants with serious untreated Axis I DSM-IV-TR psychiatric comorbidity
  • Tongue piercing or other piercings in the mouth, including lips and cheek
  • Participants with current or history of clinically significant medical disorder or condition
  • Participants who are human immunodeficiency virus (HIV)-seropositive with a CD4+ count <200 or active acquired immune deficiency syndrome (AIDS)
  • Participants who have any Class III or IV congestive heart failure, symptomatic myocardial ischemia, a history of long QT syndrome.
  • Participants who are currently taking Class 1A antiarrhythmic medications or Class III antiarrhythmic medications
  • Participants who have uncontrolled hypertension or clinically significant ECG abnormalities
  • Participants who have a pulse oximetry ≤93% at screening, due to any medical reason.
  • Individuals with AST or ALT levels ≥3 X the upper limit of normal or total bilirubin or creatinine ≥1.5 X ULN, on the screening laboratory assessments
  • Participants with known significant liver disease.
  • Participants who take any medication, nutraceutical, herbal product with known CYP3A4 inhibition or induction properties within 14 days of screening.
  • Participants who are at suicidal risk

Sites / Locations

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

BNX Sublingual Tablets Induction

Buprenorphine Induction

Arm Description

Day 1-2 (Blinded Induction): BNX sublingual tablets Day 3-28 (Open-label Maintenance): BNX sublingual tablets

Day 1-2 (Blinded Induction): Generic buprenorphine sublingual tablets Day 3-28 (Open-label Maintenance): BNX sublingual tablets

Outcomes

Primary Outcome Measures

Retention in Treatment in the Per Protocol Population
Retention in treatment at Day 3 in the per protocol population (n=256) was defined as the number of patients in each induction arm completing the induction phase and who received study medication on Day 3. Treatment with BNX sublingual tablets was considered non-inferior to generic buprenorphine if the lower limit of the 95% confidence interval for the difference between BNX and generic buprenorphine was ≥-10% in the number of patients retained in treatment on Day 3.

Secondary Outcome Measures

Area Under the Curve (AUC) in Clinical Opiate Withdrawal Scale (COWS) Total Score on Days 1 to 3 Inclusive
Least squares mean AUC in COWS total score on Days 1 to 3; COWS scores range from 0-48, with a lower score being more favorable
AUC in Subjective Opiate Withdrawal Scale (SOWS) Total Score on Days 1 to 3 Inclusive
Least squares mean AUC day 1 pre-dose through Day 3 in SOWS; SOWS scores range from 0-64, with a lower score being more favorable
AUC in Visual Analog Scale (VAS) Score for Craving on Days 1 to 3 Inclusive
Least squares mean AUC measurement in VAS score for cravings on Days 1 to 3; the VAS craving scores range from 0 ("no cravings") to 100 ("most intense craving I have ever had")
Mean Change From Baseline in COWS Total Score After Day 3 (Maintenance Phase)
Mean change from baseline in COWS total scores during the maintenance phase (Days 4, 8, 15, 22, and 29); COWS scores range from 0-48, with a lower score being more favorable
Mean Change From Baseline in SOWS Total Score After Day 3 (Maintenance Phase)
Mean change from baseline in SOWS total scores during the maintenance phase (Days 4, 8, 15, 22, and 29); SOWS scores range from 0-64, with a lower score being more favorable
Mean Change From Baseline in the VAS Score for Cravings After Day 3 (Maintenance Phase)
Mean change from baseline in VAS scores for cravings during the maintenance phase (Days 4, 8, 15, 22, and 29); the VAS craving scores range from 0 ("no cravings") to 100 ("most intense craving I have ever had")
Retention in Treatment in the Full Analysis Population
Retention in treatment at Day 3 in the full analysis population (N=310) was defined as the number of patients in each induction arm completing the induction phase and who received study medication on Day 3. Treatment with BNX sublingual tablets was considered non-inferior to generic buprenorphine if the lower limit of the 95% confidence interval for the difference between BNX and generic buprenorphine was ≥-10% in the number of patients retained in treatment on Day 3.

Full Information

First Posted
May 2, 2013
Last Updated
April 3, 2017
Sponsor
Orexo AB
Collaborators
Worldwide Clinical Trials
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1. Study Identification

Unique Protocol Identification Number
NCT01848054
Brief Title
Study to Assess Efficacy and Safety of BNX Sublingual Tablets for the Induction of Treatment of Opioid Dependence
Official Title
A Randomized, Blinded, Active-controlled Non-inferiority Study of the Efficacy and Safety of OX219 for the Induction of Treatment of Opioid Dependence
Study Type
Interventional

2. Study Status

Record Verification Date
April 2017
Overall Recruitment Status
Completed
Study Start Date
June 2013 (undefined)
Primary Completion Date
January 2014 (Actual)
Study Completion Date
January 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 the study was to assess the efficacy of induction treatment with buprenorphine/naloxone (BNX) sublingual tablet s compared with induction treatment with buprenorphine only. The hypothesis is that starting directly on OX219 works equally well (e.g. not significantly worse) as starting on buprenorphine only and switching to OX219 on Day 3.
Detailed Description
This was a prospective, randomized, multicenter, blinded, parallel-group, active-controlled, non-inferiority study conducted at 13 sites within the US. Eligible patients participated in 8 treatment visits on Days 1, 2, 3, 4, 8, 15, 22, and 29. Effectiveness of treatment was assessed as follows: Retention in treatment at Day 3 Clinician and patient assessments of opioid withdrawal symptoms Assessment opioid cravings

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Opioid-Related Disorders, Opiate Dependence
Keywords
opioid dependence, buprenorphine/naloxone, sublingual

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigator
Allocation
Randomized
Enrollment
313 (Actual)

8. Arms, Groups, and Interventions

Arm Title
BNX Sublingual Tablets Induction
Arm Type
Experimental
Arm Description
Day 1-2 (Blinded Induction): BNX sublingual tablets Day 3-28 (Open-label Maintenance): BNX sublingual tablets
Arm Title
Buprenorphine Induction
Arm Type
Active Comparator
Arm Description
Day 1-2 (Blinded Induction): Generic buprenorphine sublingual tablets Day 3-28 (Open-label Maintenance): BNX sublingual tablets
Intervention Type
Drug
Intervention Name(s)
Buprenorphine/naloxone sublingual tablets
Other Intervention Name(s)
Zubsolv, OX219
Intervention Description
Advanced-formulation buprenorphine/naloxone sublingual tablets
Intervention Type
Drug
Intervention Name(s)
Buprenorphine
Other Intervention Name(s)
Generic buprenorphine
Intervention Description
Buprenorphine sublingual tablets
Primary Outcome Measure Information:
Title
Retention in Treatment in the Per Protocol Population
Description
Retention in treatment at Day 3 in the per protocol population (n=256) was defined as the number of patients in each induction arm completing the induction phase and who received study medication on Day 3. Treatment with BNX sublingual tablets was considered non-inferior to generic buprenorphine if the lower limit of the 95% confidence interval for the difference between BNX and generic buprenorphine was ≥-10% in the number of patients retained in treatment on Day 3.
Time Frame
Day 3
Secondary Outcome Measure Information:
Title
Area Under the Curve (AUC) in Clinical Opiate Withdrawal Scale (COWS) Total Score on Days 1 to 3 Inclusive
Description
Least squares mean AUC in COWS total score on Days 1 to 3; COWS scores range from 0-48, with a lower score being more favorable
Time Frame
Pre-dose on Days 1-3 and 0.5, 1, 1.5, 3, and 6 hours post-dose on Day 1
Title
AUC in Subjective Opiate Withdrawal Scale (SOWS) Total Score on Days 1 to 3 Inclusive
Description
Least squares mean AUC day 1 pre-dose through Day 3 in SOWS; SOWS scores range from 0-64, with a lower score being more favorable
Time Frame
Pre-dose on Days 1-3 and 0.5, 1, 1.5, 3, and 6 hours post-dose on Day 1
Title
AUC in Visual Analog Scale (VAS) Score for Craving on Days 1 to 3 Inclusive
Description
Least squares mean AUC measurement in VAS score for cravings on Days 1 to 3; the VAS craving scores range from 0 ("no cravings") to 100 ("most intense craving I have ever had")
Time Frame
Pre-dose on Days 1-3 and 0.5, 1, 1.5, 3, and 6 hours post-dose on Day 1
Title
Mean Change From Baseline in COWS Total Score After Day 3 (Maintenance Phase)
Description
Mean change from baseline in COWS total scores during the maintenance phase (Days 4, 8, 15, 22, and 29); COWS scores range from 0-48, with a lower score being more favorable
Time Frame
Predose on Days 4, 8, 15, 22, and 29
Title
Mean Change From Baseline in SOWS Total Score After Day 3 (Maintenance Phase)
Description
Mean change from baseline in SOWS total scores during the maintenance phase (Days 4, 8, 15, 22, and 29); SOWS scores range from 0-64, with a lower score being more favorable
Time Frame
Pre-dose on Days 4, 8, 15, 22, and 29
Title
Mean Change From Baseline in the VAS Score for Cravings After Day 3 (Maintenance Phase)
Description
Mean change from baseline in VAS scores for cravings during the maintenance phase (Days 4, 8, 15, 22, and 29); the VAS craving scores range from 0 ("no cravings") to 100 ("most intense craving I have ever had")
Time Frame
Pre-dose on Days 4, 8, 15, 22, and 29
Title
Retention in Treatment in the Full Analysis Population
Description
Retention in treatment at Day 3 in the full analysis population (N=310) was defined as the number of patients in each induction arm completing the induction phase and who received study medication on Day 3. Treatment with BNX sublingual tablets was considered non-inferior to generic buprenorphine if the lower limit of the 95% confidence interval for the difference between BNX and generic buprenorphine was ≥-10% in the number of patients retained in treatment on Day 3.
Time Frame
Day 3

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: Able to read, comprehend, and sign the informed consent form and willingly provide written informed consent Prepared to engage in opioid replacement therapy and to abstain from opioid utilization other than the study drug, and from other illicit drugs Male or female, 18 to 65 years of age (inclusive) Met clinical criteria for opioid dependence in past 12 months based on DSM-IV-TR Provided buprenorphine-negative urine drug screen prior to randomization Provided negative urine pregnancy test Females of childbearing potential were required to be using a reliable method of contraception (e.g., hormonal, condom with spermicide, intrauterine device [IUD]) after the screening visit and for the duration of the study Participants receiving opioids for pain must receive clearance from their prescribing physician to be withdrawn from their prescribed opioids Generally good health as determined by the investigator Participants should demonstrate at least mild withdrawal symptoms (defined as a COWS score >9 at Day 1 predose) Exclusion Criteria: Females who are pregnant or lactating, or planning to be pregnant during study Any previous prescribed treatment with buprenorphine monotherapy (e.g., generic buprenorphine sublingual tablets) Prescribed treatment with buprenorphine or naloxone within 90 days prior to start of treatment Methadone patients with any daily dose over 30 mg during the past week and who received the last dose of methadone less than 30 hours prior to start of treatment Participants who are unwilling or unable to comply with the requirements of the protocol Participants who are participating in any other clinical study in which medication(s) are being delivered or who have used an investigational drug or device within the last 30 days Participants with any known allergy or sensitivity or intolerance to buprenorphine, naloxone, or any related drug Participants who are on the staff, affiliated with, or a family member of the staff personnel directly involved with this study Participants with serious untreated Axis I DSM-IV-TR psychiatric comorbidity Tongue piercing or other piercings in the mouth, including lips and cheek Participants with current or history of clinically significant medical disorder or condition Participants who are human immunodeficiency virus (HIV)-seropositive with a CD4+ count <200 or active acquired immune deficiency syndrome (AIDS) Participants who have any Class III or IV congestive heart failure, symptomatic myocardial ischemia, a history of long QT syndrome. Participants who are currently taking Class 1A antiarrhythmic medications or Class III antiarrhythmic medications Participants who have uncontrolled hypertension or clinically significant ECG abnormalities Participants who have a pulse oximetry ≤93% at screening, due to any medical reason. Individuals with AST or ALT levels ≥3 X the upper limit of normal or total bilirubin or creatinine ≥1.5 X ULN, on the screening laboratory assessments Participants with known significant liver disease. Participants who take any medication, nutraceutical, herbal product with known CYP3A4 inhibition or induction properties within 14 days of screening. Participants who are at suicidal risk
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Lynn Webster
Organizational Affiliation
Life Tree Pain Clinic, 3838 S 700 E Suite 200, Salt Lake City, UT 84106
Official's Role
Principal Investigator
Facility Information:
City
Birmingham
State/Province
Alabama
Country
United States
City
Haleyville
State/Province
Alabama
Country
United States
City
National City
State/Province
California
Country
United States
City
Oceanside
State/Province
California
Country
United States
City
Jacksonville
State/Province
Florida
Country
United States
City
Maitland
State/Province
Florida
Country
United States
City
North Miami
State/Province
Florida
Country
United States
City
Baltimore
State/Province
Maryland
Country
United States
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Fall River
State/Province
Massachusetts
Country
United States
City
Flowood
State/Province
Mississippi
Country
United States
City
Philadelphia
State/Province
Pennsylvania
Country
United States
City
Charleston
State/Province
South Carolina
Country
United States
City
Houston
State/Province
Texas
Country
United States
City
Salt Lake City
State/Province
Utah
Country
United States

12. IPD Sharing Statement

Learn more about this trial

Study to Assess Efficacy and Safety of BNX Sublingual Tablets for the Induction of Treatment of Opioid Dependence

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