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A Randomized Withdrawal, Active- and Placebo-controlled, Double-blind, Multi-center Phase III Trial Assessing Safety and Efficacy of Oral CG5503 (Tapentadol) Prolonged Release (PR*) in Subjects With Moderate to Severe Chronic Malignant Tumor-related Pain. *Prolonged Release and is the Recommended Nomenclature for Use in the European Union (EU). ER Means Extended Release and is the Recommended Nomenclature for Use in the United States of America (USA). "PR" is Synonymous With "ER" and is Interchangeable.


Phase 3
18 Years
N/A
Not Enrolling
Both
Tumors, Pain

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Trial Information

A Randomized Withdrawal, Active- and Placebo-controlled, Double-blind, Multi-center Phase III Trial Assessing Safety and Efficacy of Oral CG5503 (Tapentadol) Prolonged Release (PR*) in Subjects With Moderate to Severe Chronic Malignant Tumor-related Pain. *Prolonged Release and is the Recommended Nomenclature for Use in the European Union (EU). ER Means Extended Release and is the Recommended Nomenclature for Use in the United States of America (USA). "PR" is Synonymous With "ER" and is Interchangeable.


Normally chronic tumor related pain is controlled when subjects receive repeated doses of
opioid analgesics. However, opioid therapy is commonly associated with side effects such as
nausea, vomiting, sedation, constipation, addiction, tolerance, and respiratory depression.
Tapentadol, a newly synthesized drug with an Prolonged Release (ER) formulation, also acts
as a centrally acting pain reliever but has a dual mode of action.

The aim of this trial is to investigate the effectiveness (level of pain control) and safety
(side effects) of Tapentadol Prolonged Release (ER) compared to a tablet with no active
ingredient drug (placebo) and a corresponding dose of Morphine (an opioid commonly used to
treat tumor related pain). This trial is a randomized, double-blind (neither investigator
nor patient will know which treatment was received), active- and placebo-controlled,
parallel-group, multicenter trial.

The trial includes a 2 week titration phase starting with either 45 mg Morphine Sulfate
Controlled Release (CR) twice daily or 100 mg Tapentadol ER taken twice daily (bid). Based
on effectiveness and side effects subjects can up-titrate in steps of 50 mg Tapentadol ER or
15 mg Morphine Sulfate CR to a maximal dose of 250 mg Tapentadol ER bid or 90 mg Morphine
Sulfate CR twice daily respectively. If subjects meet the stabilization criteria at the end
of the titration phase they will be re-randomized to either placebo or active treatment and
will continue 4 weeks at the last dose level in the maintenance phase.

Assessments of pain relief, defined as a responder include the pain intensity numeric rating
scale (NRS). The Patient Global Impression of Change scale (PGIC) will also be used as a
secondary efficacy endpoint. Safety evaluations include monitoring of adverse events,
physical examinations, and clinical laboratory tests. Venous blood samples will be collected
for the determination of serum concentrations of tapentadol.


Inclusion Criteria:



- A signed informed consent document.

- Male and non-pregnant, non-lactating female subjects.

- Female subjects must be post menopausal, surgically sterile, or practicing an
effective method of birth control and continue to do so throughout the trial.

- At least 18 years of age.

- Have chronic malignant tumor-related pain

- Are opioid-naïve or have been pretreated with an equianalgesic dose range equivalent
of up to 160 mg oral morphine per day and are dissatisfied with prior treatment.

- Have a mean pain intensity of at least 5 points on an 11-point Numeric Rating Scale
(where 0 indicates no pain and 10 indicates worst possible pain).

- Have an expected course of the disease such that the pain that will permit compliance
with the trial protocol over the entire trial period.

Exclusion Criteria:

- Have a life-long history of seizure disorder or epilepsy.

- Have had any of the following within one year: mild/moderate traumatic brain injury,
stroke, and transient ischemic attack.

- Have had severe traumatic brain injury within 15 years (consisting of ≥ 1 of the
following: brain contusion, intracranial hematoma, and either unconsciousness or
post-traumatic amnesia lasting for more than 24 hours) or residual sequelae
suggesting transient changes in consciousness.

- Have a known history and/or presence of cerebral metastases.

- Have moderately or severely impaired hepatic function.

- Have laboratory values reflecting inadequate hepatic function.

- Have thrombopenia, leucopenia or hypercalcemia

- Have severely impaired renal function.

- Having uncontrolled hypertension

- Having clinically relevant history of hypersensitivity, allergy or contraindications
to morphine or any of the excipients.

- Have chronic hepatitis B or hepatitis C, or Human Immunodeficiency Virus (HIV).

- Subjects currently undergoing the following concomitant therapy: radiotherapy, pain
inducing chemotherapy, anti-parkinsonian drugs, neuroleptics, monoamine oxidase
inhibitors, serotonin norepinephrine re-uptake inhibitors (SNRI) or any other
analgesic therapy than investigational medication or rescue medication during the
trial. Selective serotonin re-uptake inhibitor (SSRI) treatments are allowed if taken
for at least 30 days before the screening period of the trial at an unchanged dose.

Type of Study:

Interventional

Study Design:

Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor), Primary Purpose: Treatment

Outcome Measure:

Responder

Outcome Description:

A "responder" is a participant in the study that: completed 28 days of the maintenance phase had a numeric rating scale score below 5 on the 11 point scale (where 0 indicates no pain and 10 indicates worst possible pain) did not use more than 30 mg of rescue medication per day on average in the 28 day maintenance period. A participant that met all 3 of the above-mentioned criteria is counted as a responder, in other words the participant benefited from the assigned drug treatment. A participant that fails to meet only 1 of the 3 criteria is not counted as a responder.

Outcome Time Frame:

completed 28 days in the maintenance phase

Safety Issue:

No

Principal Investigator

P. Poulain, Dr.

Investigator Role:

Principal Investigator

Investigator Affiliation:

Gustave Roussy, Cancer Campus, Grand Paris

Authority:

United States: Food and Drug Administration

Study ID:

672519

NCT ID:

NCT00505414

Start Date:

June 2007

Completion Date:

August 2009

Related Keywords:

  • Tumors
  • Pain
  • Opioid
  • Centrally acting analgesic
  • CG5503 IR
  • Tumor related pain
  • Cancer related pain
  • Morphine sulfate CR
  • Pain assessment
  • Placebo

Name

Location

Investigator 13 St. Petersburg, Florida  
Investigator 2 Elkhart, Indiana  
Investigator 1 Shreveport, Louisiana  
Investigator 10 Cedarhurst, New York  
Investigator 3 Glen Falls, New York  
Investigator 4 Winston-Salem, North Carolina  
Investigator 15 Canton, Ohio