E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Pain due to Osteoarthritis |
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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 | 10031161 |
E.1.2 | Term | Osteoarthritis |
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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 evaluate the effectiveness, tolerability, and safety of tapentadol hydrochloride PR in subjects with chronic pain due to OA of the knee taking either WHO Step I or Step II analgesics or no regular analgesics and showing lack of efficacy |
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E.2.2 | Secondary objectives of the trial |
Demonstrate that tapentadol hydrochloride PR produces a better analgesia than previous Step I and Step II analgesics. Evaluate the conversion of subjects from previous WHO Step II analgesics to tapentadol hydrochloride PR. Evaluate the titration of tapentadol hydrochloride PR in clinical practice. Evaluate whether the treatment with tapentadol hydrochloride PR can produce a reduction in the need for WHO Step I analgesics and co analgesics (sparing effect). Evaluate whether the treatment with tapentadol hydrochloride PR can produce a reduction in the need for medications (antiemetics and laxatives) to treat opioid-related adverse events in subjects previously on WHO Step II opioid analgesics. Evaluate the impact of tapentadol hydrochloride PR on function and quality of life parameters (subject-reported outcomes) in subjects with pain due to OA of the knee.
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E.2.3 | Trial contains a sub-study | Yes |
E.2.3.1 | Full title, date and version of each sub-study and their related objectives |
Substudy A: Tapering of WHO Step I analgesics and co-analgesics Evaluate whether the treatment with tapentadol hydrochloride PR can produce a reduction in the need for WHO Step I analgesics and co analgesics (sparing effect). Substudy B: Tapering of concomitant medications to alleviate adverse events of previous opioid therapy Evaluate whether the treatment with tapentadol hydrochloride PR can produce a reduction in the need for medications (antiemetics and laxatives) to treat opioid-related adverse events in subjects previously treated with WHO Step III opioid analgesics.
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E.3 | Principal inclusion criteria |
Key inclusion criteria (general) Subjects have signed an Informed Consent Form indicating that they understand the purpose of and the procedures required for the trial and are willing to participate in it. Subjects are men or non-pregnant, non-lactating women. Sexually active women must be postmenopausal, surgically sterile, or practicing an effective method of birth control (e.g., prescription oral contraceptives, contraceptive injections, intrauterine device, double barrier method, contraceptive patch, male partner sterilization) before entry and throughout the trial. Women of childbearing potential must have a negative pregnancy test at screening. Subjects must be appropriately communicative to verbalize and to differentiate with regard to location and intensity of the pain.
Key inclusion criteria (trial specific) - at the Screening Visit Subjects must be at least 40 years of age. Subjects must have a diagnosis of osteoarthritis of the knee based on the American College of Rheumatology (ACR) classification criteria: Knee pain and Radiographic osteophytes or Knee pain and Aged 40 years or above, and Morning stiffness of 30 minutes of duration or more, and Crepitus on motion. Subjects must have pain at the reference joint which has been present for at least 3 months. Subject’s pain must require a strong analgesic (defined as WHO Step III) as judged by the Investigator. Subjects must report a rate of satisfaction with their previous analgesic regimen not exceeding “fair” on a subject satisfaction with treatment scale (5-point VRS). If under regular, daily pretreatment: • Subjects must be taking a WHO Step I or Step II analgesic medication for osteoarthritis of the knee on a daily basis for at least 2 weeks prior to the Screening Visit. • The Investigator considers dose increase of WHO Step I analgesics (as mono- or combination therapy) and/or continuation with or dose increase of WHO Step II analgesics inadequate for the individual subject, whatever applicable. • Subjects must have an average pain intensity score (NRS 3) greater than 5 points during the last 3 days prior to the Screening Visit. or If no regular analgesic pretreatment is reported: Subjects must have an average pain intensity score (NRS-3) greater than 6 points in the last 3 days prior to the Screening Visit and related to osteoarthritis.
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E.4 | Principal exclusion criteria |
Key exclusion criteria (general) Presence of a clinically significant disease or laboratory findings that in the Investigator’s opinion may affect efficacy or safety assessments. Presence of active systemic or local infection, that may, in the opinion of the Investigator, affect the efficacy, quality of life/function or safety assessments. History of alcohol or drug abuse, or suspicion thereof in the Investigator’s judgment. Presence of concomitant autoimmune inflammatory conditions. Known history of or laboratory values reflecting severe renal impairment. Known history of moderately or severely impaired hepatic function. History of or active hepatitis B or C within the past 3 months or history of HIV infection. History of seizure disorder or epilepsy. Any of the following within 1 year: mild/moderate traumatic brain injury, stroke, transient ischemic attack, or brain neoplasm. Severe traumatic brain injury within 15 years (consisting of 1 or more of the following: brain contusion, intracranial hematoma, either unconsciousness or post-traumatic amnesia lasting more than 24 h) or residual sequelae suggesting transient changes in consciousness. Pregnant or breast-feeding. History of allergy to, or hypersensitivity to tapentadol hydrochloride or its excipients, or contraindications related to tapentadol hydrochloride including: Subjects with acute or severe bronchial asthma or hypercapnia. Subjects who have or are suspected of having paralytic ileus. Employees of the Investigator or trial site, with direct involvement in this trial or other trials under the direction of the Investigator or trial site, as well as family members of employees of the Investigator. Participation in another trial concurrently or within 4 weeks prior to the Screening Visit. Known to or suspected of not being able to comply with the protocol and the use of the IMPs. Use of monoamine oxidase inhibitors within 14 days before the Screening Visit. Non-stable dosing of selective serotonin reuptake inhibitors within 30 days before the Screening Visit (Doses must remain stable during the trial). Key exclusion criteria (trial specific) Osteoarthritis in a flare state. Use of intra-articular injections of hyaluronic acid in the reference joint within 3 months before the Screening Visit. Presence of conditions other than osteoarthritis of the reference joint that could confound the assessment or self-evaluation of pain, e.g., anatomical deformities, significant skin conditions such as abscess or syndromes with widespread pain such as fibromyalgia. Subjects with osteoarthritis at joints other than the reference joint will not be excluded as long as the reference joint is the source of main pain and disability. History and clinical signs at the reference joint of crystal-induced (e.g., gout, pseudo-gout), metabolic, infectious and autoimmune disease. Any concomitant painful condition that could interfere with the subjects’ trial assessments or with their ability to differentiate the current joint pain from other painful conditions. Any painful procedures during the trial (e.g., major surgery, including the reference joint) that may, in the opinion of the Investigator, affect the efficacy or safety assessments. Pending litigation due to chronic pain or disability. Intake of Step III analgesics within the 30 days prior to the Screening Visit.
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E.5 End points |
E.5.1 | Primary end point(s) |
The primary endpoint is defined as the change from Week 1 of the average pain intensity score on an 11-point NRS-3 at Week 6 |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | No |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | Information not present in EudraCT |
E.7.1.2 | Bioequivalence study | Information not present in EudraCT |
E.7.1.3 | Other | Information not present in EudraCT |
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 | No |
E.8.1.1 | Randomised | Information not present in EudraCT |
E.8.1.2 | Open | Information not present in EudraCT |
E.8.1.3 | Single blind | Information not present in EudraCT |
E.8.1.4 | Double blind | Information not present in EudraCT |
E.8.1.5 | Parallel group | Information not present in EudraCT |
E.8.1.6 | Cross over | Information not present in EudraCT |
E.8.1.7 | Other | Information not present in EudraCT |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | Information not present in EudraCT |
E.8.2.2 | Placebo | Information not present in EudraCT |
E.8.2.3 | Other | Information not present in EudraCT |
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.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 36 |
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 | No |
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
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 0 |
E.8.9.1 | In the Member State concerned months | 8 |
E.8.9.1 | In the Member State concerned days | 5 |
E.8.9.2 | In all countries concerned by the trial years | 0 |
E.8.9.2 | In all countries concerned by the trial months | 8 |
E.8.9.2 | In all countries concerned by the trial days | 5 |