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Study to Evaluate the Safety and Efficacy of Oral CR845 (Difelikefalin) in Patients With Primary Biliary Cholangitis (PBC) and Moderate-to-Severe Pruritus

Primary Purpose

Cholestatic Pruritus

Status
Terminated
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
CR845 1.0 mg
Placebo
Sponsored by
Cara Therapeutics, Inc.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Cholestatic Pruritus focused on measuring Primary Biliary Cholangitis, Pruritus, CR845, Chronic Itch, difelikefalin, Itch, Itching, Generalized pruritus

Eligibility Criteria

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

Key Inclusion Criteria:

To be eligible for inclusion into the study, a patient must meet the following criteria:

  • Confirmed diagnosis of PBC;
  • If currently taking ursodeoxycholic acid (UDCA), should be on stable dose for >12 weeks prior to screening and plan on continuing to take UDCA throughout the study;
  • If previously taking UDCA, should have discontinued its use >12 weeks prior to screening;
  • Self-reports experiencing daily or near-daily pruritus during the month prior to screening;
  • Prior to randomization has a mean baseline WI-NRS score indicative of moderate to severe pruritus.

Key Exclusion Criteria:

A patient will be excluded from the study if any of the following criteria are met:

  • Presence of Child-Pugh Class C decompensated cirrhosis at screening;
  • Itching secondary to biliary obstruction;
  • History or presence of hepatocellular carcinoma, hepatic abscess, or acute portal vein thrombosis;
  • Current placement on liver transplantation list with anticipated liver transplant during the course of the study or current Model for End-stage Liver Disease (MELD) score ≥15;
  • Alanine aminotransferase or aspartate aminotransferase >5 × upper limit of normal at screening, or within 2 months prior to screening;
  • Anticipates receiving an opioid antagonist (eg, naloxone, naltrexone) or opioid-mixed agonist-antagonist (eg, buprenorphine, nalbuphine) from the start of screening through the end of the Treatment Period;
  • New or change of treatment with antihistamines and corticosteroids (oral, intravenous, or topical), opioids, gabapentin, pregabalin, cholestyramine, rifampicin or fibrates within 14 days prior to screening.

Sites / Locations

  • Cara Therapeutics Study Site
  • Cara Therapeutics Study Site
  • Cara Therapeutics Study Site
  • Cara Therapeutics Study Site
  • Cara Therapeutics Study Site
  • Cara Therapeutics Study Site
  • Cara Therapeutics Study Site
  • Cara Therapeutics Study Site 2
  • Cara Therapeutics Study Site
  • Cara Therapeutics Study Site
  • Cara Therapeutics Study Site
  • Cara Therapeutics Study Site
  • Cara Therapeutics Study Site
  • Cara Therapeutics Study Site

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Placebo Comparator

Arm Label

CR845 1.0 mg

Placebo

Arm Description

Oral CR845 1.0 mg tablet administered twice daily

Oral placebo tablet administered twice daily

Outcomes

Primary Outcome Measures

Change from baseline to Week 16 with respect to the weekly mean of the daily 24-hour Worst Itching Intensity Numeric Rating Scale (WI-NRS) score.
Intensity of itch will be measured using an NRS used to indicate the intensity of the worst itching over the past 24 hours using a 0 to 10 numeric rating scale, where "0" represents "no itching" and "10" represents "worst itching imaginable".

Secondary Outcome Measures

Improvement in itch-related quality of life as assessed by the change from baseline to Week 16 in total Skindex-10 Scale score
The Skindex-10 Scale is a multidimensional questionnaire which assesses itch-related quality of life over the past week. The questions cover 3 domains: disease, mood/emotional distress, and social functioning domain. A lower total score represents better quality of life.
Improvement in itch-related quality of life as assessed by the change from baseline to Week 16 in 5-D Itch Scale score
The 5-D Itch Scale is a multidimensional questionnaire which assesses itch-related quality of life over the past 2 weeks. The questions cover five dimensions of itch including the degree, duration of itch/day, direction (improvement/worsening), disability (impact on activities such as work), and body distribution of itch. A lower total score represents better quality of life.
Reduction of itch intensity as assessed by the proportion of patients achieving an improvement from baseline ≥3 points with respect to the weekly mean of the daily 24-hour WI-NRS score at Week 16
Intensity of itch will be measured using an NRS used to indicate the intensity of the worst itching over the past 24 hours using a 0 to 10 numeric rating scale, where "0" represents "no itching" and "10" represents "worst itching imaginable".

Full Information

First Posted
June 19, 2019
Last Updated
June 28, 2023
Sponsor
Cara Therapeutics, Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT03995212
Brief Title
Study to Evaluate the Safety and Efficacy of Oral CR845 (Difelikefalin) in Patients With Primary Biliary Cholangitis (PBC) and Moderate-to-Severe Pruritus
Official Title
A Multicenter, Double-blind, Randomized, Placebo-controlled Study to Evaluate the Safety and Efficacy of Oral CR845 in Patients With Primary Biliary Cholangitis (PBC) and Moderate-to-Severe Pruritus
Study Type
Interventional

2. Study Status

Record Verification Date
June 2023
Overall Recruitment Status
Terminated
Why Stopped
Slow enrollment due primarily to Covid-19
Study Start Date
June 25, 2019 (Actual)
Primary Completion Date
June 29, 2022 (Actual)
Study Completion Date
June 29, 2022 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Cara Therapeutics, Inc.

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
This is a multicenter, randomized, double-blind, placebo-controlled study to evaluate the safety and efficacy of twice-daily (BID) oral CR845 1.0 mg in patients with PBC with moderate-to-severe pruritus. The study includes a 16-week Treatment Period.
Detailed Description
This study will consist of a Screening Visit, a 7-day Run-in Period, a 16-week Treatment Period, and a Follow-up Visit (approximately 7-10 days after the last dose of study drug). Informed consent will be obtained prior to performing any study-specific procedures. The Screening Visit will occur within 7 to 28 days prior to randomization to assess eligibility. Day 1 of the Treatment Period will be defined as the day of the administration of the first dose of study drug. If patients continue to meet all inclusion and no exclusion criteria at the end of the 7-day Run-in Period, they will be randomized in a 1:1 ratio to receive either placebo or CR845 tablets at a dose of 1.0 mg orally BID for 16 weeks.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Cholestatic Pruritus
Keywords
Primary Biliary Cholangitis, Pruritus, CR845, Chronic Itch, difelikefalin, Itch, Itching, Generalized pruritus

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigator
Allocation
Randomized
Enrollment
14 (Actual)

8. Arms, Groups, and Interventions

Arm Title
CR845 1.0 mg
Arm Type
Active Comparator
Arm Description
Oral CR845 1.0 mg tablet administered twice daily
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Oral placebo tablet administered twice daily
Intervention Type
Drug
Intervention Name(s)
CR845 1.0 mg
Other Intervention Name(s)
CR845, Difelikefalin
Intervention Description
Oral CR845 1.0 mg administered twice daily
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Oral Placebo administered twice daily
Primary Outcome Measure Information:
Title
Change from baseline to Week 16 with respect to the weekly mean of the daily 24-hour Worst Itching Intensity Numeric Rating Scale (WI-NRS) score.
Description
Intensity of itch will be measured using an NRS used to indicate the intensity of the worst itching over the past 24 hours using a 0 to 10 numeric rating scale, where "0" represents "no itching" and "10" represents "worst itching imaginable".
Time Frame
Baseline, Week 16
Secondary Outcome Measure Information:
Title
Improvement in itch-related quality of life as assessed by the change from baseline to Week 16 in total Skindex-10 Scale score
Description
The Skindex-10 Scale is a multidimensional questionnaire which assesses itch-related quality of life over the past week. The questions cover 3 domains: disease, mood/emotional distress, and social functioning domain. A lower total score represents better quality of life.
Time Frame
Baseline, Week 16
Title
Improvement in itch-related quality of life as assessed by the change from baseline to Week 16 in 5-D Itch Scale score
Description
The 5-D Itch Scale is a multidimensional questionnaire which assesses itch-related quality of life over the past 2 weeks. The questions cover five dimensions of itch including the degree, duration of itch/day, direction (improvement/worsening), disability (impact on activities such as work), and body distribution of itch. A lower total score represents better quality of life.
Time Frame
Baseline, Week 16
Title
Reduction of itch intensity as assessed by the proportion of patients achieving an improvement from baseline ≥3 points with respect to the weekly mean of the daily 24-hour WI-NRS score at Week 16
Description
Intensity of itch will be measured using an NRS used to indicate the intensity of the worst itching over the past 24 hours using a 0 to 10 numeric rating scale, where "0" represents "no itching" and "10" represents "worst itching imaginable".
Time Frame
Week 16

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
80 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Key Inclusion Criteria: To be eligible for inclusion into the study, a patient must meet the following criteria: Confirmed diagnosis of PBC; If currently taking ursodeoxycholic acid (UDCA), should be on stable dose for >12 weeks prior to screening and plan on continuing to take UDCA throughout the study; If previously taking UDCA, should have discontinued its use >12 weeks prior to screening; Self-reports experiencing daily or near-daily pruritus during the month prior to screening; Prior to randomization has a mean baseline WI-NRS score indicative of moderate to severe pruritus. Key Exclusion Criteria: A patient will be excluded from the study if any of the following criteria are met: Presence of Child-Pugh Class C decompensated cirrhosis at screening; Itching secondary to biliary obstruction; History or presence of hepatocellular carcinoma, hepatic abscess, or acute portal vein thrombosis; Current placement on liver transplantation list with anticipated liver transplant during the course of the study or current Model for End-stage Liver Disease (MELD) score ≥15; Alanine aminotransferase or aspartate aminotransferase >5 × upper limit of normal at screening, or within 2 months prior to screening; Anticipates receiving an opioid antagonist (eg, naloxone, naltrexone) or opioid-mixed agonist-antagonist (eg, buprenorphine, nalbuphine) from the start of screening through the end of the Treatment Period; New or change of treatment with antihistamines and corticosteroids (oral, intravenous, or topical), opioids, gabapentin, pregabalin, cholestyramine, rifampicin or fibrates within 14 days prior to screening.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Frédérique Menzaghi, PhD
Organizational Affiliation
Cara Therapeutics
Official's Role
Study Director
Facility Information:
Facility Name
Cara Therapeutics Study Site
City
Coronado
State/Province
California
ZIP/Postal Code
92118
Country
United States
Facility Name
Cara Therapeutics Study Site
City
Rialto
State/Province
California
ZIP/Postal Code
92377
Country
United States
Facility Name
Cara Therapeutics Study Site
City
San Francisco
State/Province
California
ZIP/Postal Code
94114
Country
United States
Facility Name
Cara Therapeutics Study Site
City
Colorado Springs
State/Province
Colorado
ZIP/Postal Code
80907
Country
United States
Facility Name
Cara Therapeutics Study Site
City
Miami
State/Province
Florida
ZIP/Postal Code
33136
Country
United States
Facility Name
Cara Therapeutics Study Site
City
Plantation
State/Province
Florida
ZIP/Postal Code
33322
Country
United States
Facility Name
Cara Therapeutics Study Site
City
Indianapolis
State/Province
Indiana
ZIP/Postal Code
46202
Country
United States
Facility Name
Cara Therapeutics Study Site 2
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02114
Country
United States
Facility Name
Cara Therapeutics Study Site
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02215
Country
United States
Facility Name
Cara Therapeutics Study Site
City
New York
State/Province
New York
ZIP/Postal Code
10065
Country
United States
Facility Name
Cara Therapeutics Study Site
City
Nashville
State/Province
Tennessee
ZIP/Postal Code
37232
Country
United States
Facility Name
Cara Therapeutics Study Site
City
Arlington
State/Province
Texas
ZIP/Postal Code
76012
Country
United States
Facility Name
Cara Therapeutics Study Site
City
Newport News
State/Province
Virginia
ZIP/Postal Code
23606
Country
United States
Facility Name
Cara Therapeutics Study Site
City
Morgantown
State/Province
West Virginia
ZIP/Postal Code
26506
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

Study to Evaluate the Safety and Efficacy of Oral CR845 (Difelikefalin) in Patients With Primary Biliary Cholangitis (PBC) and Moderate-to-Severe Pruritus

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