E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Cancer-related breakthrough pain |
|
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 9.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10064556 |
E.1.2 | Term | Breakthrough pain |
|
E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
to demonstrate non-inferiority of Nasal Transmucosal Fentanyl Citrate (NFTC) compared to Oral Morphine Sulphate (OMS) administered as immediate release tablets for treatment of cancer-related breakthrough pain considering pain intensity difference; If non-inferiority can be demonstrated subsequently also superiority shall be demonstrated |
|
E.2.2 | Secondary objectives of the trial |
efficacy of Nasal Transmucosal Fentanyl Citrate (NFTC) shall be characterised in comparison to Oral Morphine Sulphate (OMS) considering pain relief, satisfaction of the patients, and failure / rescue medication rate Furthermore, the safety and tolerability of NFTC and OMS will be compared
|
|
E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. Males or females (aged at least 18 years, at the time of screening); 2. Patients with cancer related breakthrough pain 3. Being on stable transdermal fentanyl therapy equal to 25 – 200 µg/h or alternatively stable oral morphine therapy equal to 60 – 600 mg/day, or oral oxycodone therapy equal to 30 – 300 mg/day, or oral hydromorphone therapy equal to 8 – 80 mg/day for the treatment of chronic pain; 4. Breakthrough pain in general of such severe pain intensity that the patients needs additional analgesics (apart from persistent pain medication) 5. Experiencing at least 3 target breakthrough pain episodes per week 6. Achieving at least partial relief of the target breakthrough pains by oral opioid medication; 7. Patients able to use intranasal sprays; 8. Life expectancy of at least 3 month; 9. Written informed consent. 10. Safe contraception in women of childbearing potential throughout the entire study, which is defined as the use of effective birth-control methods such as condoms, diaphragms or intra-uterine devices, which are thought to be medically acceptable forms of birth control, or established treatment with hormonal contraceptives for at least 2 months prior to the first intake of study medication; 11. Women without childbearing potential such as women with hysterectomy or tubal ligation and post-menopausal women, the latter is defined as women who have had no menstruation for at least 2 years.
|
|
E.4 | Principal exclusion criteria |
12. Hypersensitivities, allergies or contraindications to any compound in the present study medications or allergies to constituents of the pharmaceutical preparations; 13. Clinically relevant cardiopulmonary diseases that would increase the risk of taking potent opioids; 14. Evidence of clinically relevant increased intracranial pressure (e.g. brain metastases, head injuries) or impaired consciousness; 15. Current therapy with monoamine oxidase (MAO)-Inhibitors, or therapy with MAO-Inhibitors within the last 14 days 16. History of clinically relevant chronic obstructive pulmonary disease (COPD) or clinically relevant asthma bronchiale; 17. History of severe hepatic impairment that affects the safety of investigational products 18. Radionucleid therapy within the last 14 days; 19. Current radiotherapy or planned radiotherapy within the next 2 months; 20. Moderate or severe oronasal mucositis; 21. Clinically relevant brady-arrhythmias. 22. Malignant hypertension; 23. History of drug or alcohol abuse within the past 2 years; 24. Pregnant or nursing women or women of childbearing potential without an effective method of birth control (effective birth control methods are: intra-uterine device, surgical sterilisation, hysterectomy, oral contraceptive) 25. Frequent use of intranasal drugs that affects absorption 26. Participation in a clinical study during the last 6 weeks prior to the start of the study; 27. Uncontrolled or rapidly escalating pain; 28. Clinically relevant neurological or psychiatric disease that would compromise data collection; 29. Nasal obstruction or acute and chronic diseases of the nose or paranasal sinuses; 30. Nose and throat tumours that may alter the absorption of nasally applied fentanyl, the assessment of local tolerability or that may prevent from swallowing the capsules; 31. Clinically relevant allergic and non-allergic rhinitis; Administrative reasons: 32. Lack of ability or willingness to give informed consent; 33. Anticipated non-availability for study visits/procedures; 34. Vulnerable patients (e.g. person kept in detention)
|
|
E.5 End points |
E.5.1 | Primary end point(s) |
The two primary endpoints are the pain intensity differences versus baseline at 15 (PID15) and 30 minutes (PID30) after study drug intake. In case of multiple target breakthrough pain episodes the intraindividual average will be determined for each period. The primary analysis will be performed in the PP analysis data set using a type I error level of alpha=0.025 (one-sided). Multiplicity will be controlled by a-priori ordering of hypotheses (non-inferiority for PID30 will only be tested after non-inferiority for PID15 has been demonstrated). After demonstrating non-inferiority superiority of NTFC over OMS will be investigated. Analysis of variance models will be used. There will be no missing data imputation. |
|
E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | Information not present in EudraCT |
E.6.2 | Prophylaxis | Information not present in EudraCT |
E.6.3 | Therapy | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | Information not present in EudraCT |
E.6.7 | Pharmacodynamic | Information not present in EudraCT |
E.6.8 | Bioequivalence | Information not present in EudraCT |
E.6.9 | Dose response | Information not present in EudraCT |
E.6.10 | Pharmacogenetic | Information not present in EudraCT |
E.6.11 | Pharmacogenomic | Information not present in EudraCT |
E.6.12 | Pharmacoeconomic | Information not present in EudraCT |
E.6.13 | Others | Information not present in EudraCT |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | Yes |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | Yes |
E.8.1.5 | Parallel group | No |
E.8.1.6 | Cross over | Yes |
E.8.1.7 | Other | Yes |
E.8.1.7.1 | Other trial design description |
|
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | Yes |
E.8.2.2 | Placebo | Yes |
E.8.2.3 | Other | No |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 7 |
E.8.5 | The trial involves multiple Member States | No |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | No |
E.8.6.2 | Trial being conducted completely outside of the EEA | Information not present in EudraCT |
E.8.7 | Trial has a data monitoring committee | Information not present in EudraCT |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
|
End of the study is defined as the day of shipment of the last CRF to the department responsible for clinical biometrics. |
|
E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | |
E.8.9.1 | In the Member State concerned months | 10 |
E.8.9.1 | In the Member State concerned days | |