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    Clinical Trial Results:
    Prospective Randomised 12-Week Controlled Study of Visual Field Change in Subjects With Partial Seizures Receiving Pregabalin or Placebo

    Summary
    EudraCT number
    2009-014269-25
    Trial protocol
    HU   CZ   PL   BG  
    Global end of trial date
    04 Feb 2020

    Results information
    Results version number
    v1(current)
    This version publication date
    17 Feb 2021
    First version publication date
    17 Feb 2021
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    A0081096
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT00351611
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Pfizer Inc.
    Sponsor organisation address
    235 E 42nd Street, New York, United States, NY 10017
    Public contact
    Pfizer ClinicalTrials.gov Call Center, Pfizer Inc., 001 8007181021, ClinicalTrials.gov_Inquiries@pfizer.com
    Scientific contact
    Pfizer ClinicalTrials.gov Call Center, Pfizer Inc., 001 8007181021, ClinicalTrials.gov_Inquiries@pfizer.com
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    05 Oct 2020
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    04 Feb 2020
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    To evaluate visual fields in subjects with partial epilepsy receiving 12 weeks treatment of pregabalin compared to placebo.
    Protection of trial subjects
    The study was in compliance with the ethical principles derived from the Declaration of Helsinki and in compliance with all International Conference for Harmonization (ICH) Good Clinical Practice (GCP) Guidelines. All the local regulatory requirements pertinent to safety of trials subjects were followed.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    26 Jul 2006
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Bulgaria: 10
    Country: Number of subjects enrolled
    Hungary: 7
    Country: Number of subjects enrolled
    India: 30
    Country: Number of subjects enrolled
    Korea, Republic of: 33
    Country: Number of subjects enrolled
    Mexico: 3
    Country: Number of subjects enrolled
    Poland: 7
    Country: Number of subjects enrolled
    Thailand: 11
    Country: Number of subjects enrolled
    United States: 86
    Worldwide total number of subjects
    187
    EEA total number of subjects
    24
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    186
    From 65 to 84 years
    1
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    -

    Pre-assignment
    Screening details
    This study was conducted in multiple sites from 26-Jul-2006 to 04-Feb-2020. This study used an Internal Review Committee (IRC).

    Period 1
    Period 1 title
    Overall Study (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Investigator, Carer, Subject

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Pregabalin
    Arm description
    Subjects were randomised to receive pregabalin. In Week 1 (titration), subjects received pregabalin 150 milligram (mg) per day (mg/day) as 75 mg oral capsules twice daily. From Week 2 to 12, subjects received pregabalin 300 mg/day as 150 mg oral capsules twice daily. In Week 13 (tapering), subjects received 150 mg/day as 75 mg oral capsules twice daily. Subjects were followed up from Week 14 to 15. If subjects not tolerated 300 mg/day dose, they were discontinued from the study.
    Arm type
    Experimental

    Investigational medicinal product name
    Pregabalin
    Investigational medicinal product code
    PD-0144723
    Other name
    CI-1008
    Pharmaceutical forms
    Capsule
    Routes of administration
    Oral use
    Dosage and administration details
    In Week 1, subjects received pregabalin 150 mg/day as 75 mg oral capsules twice daily. From Week 2 to 12, subjects received pregabalin 300 mg/day as 150 mg oral capsules twice daily. In Week 13, subjects received 150 mg/day as 75 mg oral capsules twice daily.

    Arm title
    Placebo
    Arm description
    Subjects with were randomised to receive placebo matched to pregabalin for Week 1 to 13 and were followed up from Week 14 to 15.
    Arm type
    Placebo

    Investigational medicinal product name
    Placebo
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Capsule
    Routes of administration
    Oral use
    Dosage and administration details
    Subjects received placebo matched to pregabalin from Week 1 to 13.

    Number of subjects in period 1
    Pregabalin Placebo
    Started
    89
    98
    Completed
    75
    88
    Not completed
    14
    10
         Adverse event, serious fatal
    1
    -
         Adverse event, non-fatal
    11
    3
         No Longer Willing to Participate in Study
    -
    5
         Unspecified
    1
    -
         Lost to follow-up
    1
    -
         Protocol deviation
    -
    2

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Pregabalin
    Reporting group description
    Subjects were randomised to receive pregabalin. In Week 1 (titration), subjects received pregabalin 150 milligram (mg) per day (mg/day) as 75 mg oral capsules twice daily. From Week 2 to 12, subjects received pregabalin 300 mg/day as 150 mg oral capsules twice daily. In Week 13 (tapering), subjects received 150 mg/day as 75 mg oral capsules twice daily. Subjects were followed up from Week 14 to 15. If subjects not tolerated 300 mg/day dose, they were discontinued from the study.

    Reporting group title
    Placebo
    Reporting group description
    Subjects with were randomised to receive placebo matched to pregabalin for Week 1 to 13 and were followed up from Week 14 to 15.

    Reporting group values
    Pregabalin Placebo Total
    Number of subjects
    89 98 187
    Age categorical
    Units: Subjects
        In utero
    0 0 0
        Preterm newborn infants (gestational age < 37 wks)
    0 0 0
        Newborns (0-27 days)
    0 0 0
        Infants and toddlers (28 days-23 months)
    0 0 0
        Children (2-11 years)
    0 0 0
        Adolescents (12-17 years)
    0 0 0
        Adults (18-64 years)
    88 98 186
        From 65-84 years
    1 0 1
        85 years and over
    0 0 0
    Age Continuous
    Units: Years
        arithmetic mean (standard deviation)
    38.1 ± 12.1 39.1 ± 11.6 -
    Sex: Female, Male
    Units: Subjects
        Female
    44 46 90
        Male
    45 52 97
    Race/Ethnicity, Customised
    Units: Subjects
        White
    47 51 98
        Black
    4 5 9
        Asian
    34 40 74
        Others
    4 2 6

    End points

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    End points reporting groups
    Reporting group title
    Pregabalin
    Reporting group description
    Subjects were randomised to receive pregabalin. In Week 1 (titration), subjects received pregabalin 150 milligram (mg) per day (mg/day) as 75 mg oral capsules twice daily. From Week 2 to 12, subjects received pregabalin 300 mg/day as 150 mg oral capsules twice daily. In Week 13 (tapering), subjects received 150 mg/day as 75 mg oral capsules twice daily. Subjects were followed up from Week 14 to 15. If subjects not tolerated 300 mg/day dose, they were discontinued from the study.

    Reporting group title
    Placebo
    Reporting group description
    Subjects with were randomised to receive placebo matched to pregabalin for Week 1 to 13 and were followed up from Week 14 to 15.

    Primary: Percentage of Subjects With a Decrease (p<0.05) From Baseline in Threshold Value in any 5 or More Points in Humphrey 24-2 Swedish Interactive Threshold Algorithm (SITA) Standard Testing at Week 12 or Early Termination

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    End point title
    Percentage of Subjects With a Decrease (p<0.05) From Baseline in Threshold Value in any 5 or More Points in Humphrey 24-2 Swedish Interactive Threshold Algorithm (SITA) Standard Testing at Week 12 or Early Termination
    End point description
    Percentage of subjects is reported, with a decrease in threshold value from baseline to Week 12 or termination in any 5 or more points (in either eye) at the p<0.05 level repeated in same 5 points on subsequent computerized automated perimetry testing. It was derived from Humphrey 24-2 SITA standard visual field analyzer. For each eye there were 52 test points. For each test point, Humphrey analyzer determined threshold value for sensitivity to light by subject. In addition, for each points, test provided probabilities (p<0.05, p<0.02, etc) that a subject with normal vision of same age would have same result, i.e., that measured value at that point was at or below respective percentile of age-specific empiric distribution at that position of field for normal subjects. Per protocol population: all subjects randomized to treatment who received at least 1 dose of study medication and excluded subjects with decrease in at least 5 points at termination but did not return for repeat test.
    End point type
    Primary
    End point timeframe
    Baseline, Week 12 or Early Termination (any time up to Week 12)
    End point values
    Pregabalin Placebo
    Number of subjects analysed
    78
    90
    Units: Percentage of subjects
        number (not applicable)
    3.8
    5.6
    Statistical analysis title
    Pregabalin versus Placebo
    Statistical analysis description
    A 2-sided 95 percent (%) confidence interval (CI) on the difference in percentage of subjects, between pregabalin and placebo was constructed using unconditional exact methods.
    Comparison groups
    Pregabalin v Placebo
    Number of subjects included in analysis
    168
    Analysis specification
    Pre-specified
    Analysis type
    non-inferiority [1]
    Method
    Parameter type
    Difference in percentage of subjects
    Point estimate
    -1.7094
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -9.1751
         upper limit
    5.9784
    Notes
    [1] - Non-inferiority was demonstrated if the upper CI bound was less than 0.10 (10%).

    Secondary: Change From Baseline in Mean Deviation Score From Humphrey Threshold Test at Week 12 or Early Termination

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    End point title
    Change From Baseline in Mean Deviation Score From Humphrey Threshold Test at Week 12 or Early Termination
    End point description
    Mean Deviation (MD) is a global index of visual field depression. The MD ranges from 0 decibels (dB) (no defect) to about -32 dB (end-stage damage), higher scores indicate worse condition. It is derived from Humphrey 24-2 SITA Standard visual field analyzer. Change in mean deviation from baseline to Week 12 or termination was computed for each subject. As planned, for each subject, the worst eye (eye with the greatest decrease in mean deviation) was used in the analysis and data is reported for same. ITT population included all subjects randomised to treatment, who received at least 1 dose of study medication. Here, “Number of Subjects Analysed” refers to those subjects who were evaluable for this endpoint.
    End point type
    Secondary
    End point timeframe
    Baseline, Week 12 or Early Termination (any time up to Week 12)
    End point values
    Pregabalin Placebo
    Number of subjects analysed
    83
    96
    Units: Decibels
        least squares mean (standard error)
    -0.339 ± 0.1467
    -0.214 ± 0.1321
    Statistical analysis title
    Pregabalin versus Placebo
    Statistical analysis description
    Analysis of covariance (ANCOVA) with treatment and center in the model and the baseline mean deviation as the covariate was used to construct a 2-sided 95% CI on the difference in least squares (LS) means between pregabalin and placebo.
    Comparison groups
    Pregabalin v Placebo
    Number of subjects included in analysis
    179
    Analysis specification
    Pre-specified
    Analysis type
    non-inferiority [2]
    P-value
    = 0.4414
    Method
    ANCOVA
    Parameter type
    Difference in LS mean
    Point estimate
    -0.125
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -0.443
         upper limit
    0.194
    Notes
    [2] - Non-inferiority with respect to mean deviation was demonstrated if the lower bound of the CI is greater than –2.0 decibels.

    Secondary: Change From Baseline in Visual Acuity at Week 12 or Early Termination

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    End point title
    Change From Baseline in Visual Acuity at Week 12 or Early Termination
    End point description
    Visual acuity best-corrected (with glasses or best possible glasses prescription) was measured using early treatment diabetic retinopathy study (ETDRS) charts. There were 2 ETDRS charts. The letters on chart A were read using the right eye and on chart B using the left eye. The subjects started from the top of the chart to down. The subjects read down the chart until they reached a row where a minimum of 3 letters on a line could not be read. The subjects were scored by number of letters identified correctly. Range was from 0 to 70, with higher scores indicate better visual acuity. As planned, for each subject, the worst eye (eye with the greatest decrease in visual acuity) was used in the analysis and data is reported for same. ITT population included all subjects randomised to treatment, who received at least 1 dose of study medication. Here, “Number of Subjects Analysed” refers to those subjects who were evaluable for this endpoint.
    End point type
    Secondary
    End point timeframe
    Baseline, Week 12 or Early Termination (any time up to Week 12)
    End point values
    Pregabalin Placebo
    Number of subjects analysed
    83
    94
    Units: Letters identified correctly
        least squares mean (standard error)
    -1.890 ± 0.5515
    -0.990 ± 0.5057
    Statistical analysis title
    Pregabalin versus Placebo
    Statistical analysis description
    ANCOVA with treatment and center in the model and the baseline visual acuity as the covariate was used to construct a 2-sided 95% confidence interval on the difference in LS means between pregabalin and placebo.
    Comparison groups
    Pregabalin v Placebo
    Number of subjects included in analysis
    177
    Analysis specification
    Pre-specified
    Analysis type
    other
    P-value
    = 0.1346
    Method
    ANCOVA
    Parameter type
    Difference in LS mean
    Point estimate
    -0.9
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -2.083
         upper limit
    0.283

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Baseline up to Week 15
    Adverse event reporting additional description
    Same event may appear as both an adverse event and serious adverse event. However, what is presented are distinct events. An event may be categorised as serious in 1 subject and as non-serious in another, or a subject may have experienced both a serious and non-serious event. Safety was evaluated on safety analysis set.
    Assessment type
    Non-systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    23.1
    Reporting groups
    Reporting group title
    Pregabalin
    Reporting group description
    Subjects were randomised to receive pregabalin. In Week 1 (titration), subjects received pregabalin 150 mg/day as 75 mg oral capsules twice daily. From Week 2 to 12, subjects received target dose of pregabalin, 300 mg/day as 150 mg oral capsules twice. In Week 13 (tapering), subjects again received 150 mg/day as 75 mg oral capsules twice daily. If subjects could not tolerate 300 mg/day dose, they were discontinued from the study. Subjects were followed up from Week 14 to 15.

    Reporting group title
    Placebo
    Reporting group description
    Subjects were randomised to receive placebo matched to pregabalin for Week 1 to 13 and were followed up from Week 14 to 15.

    Serious adverse events
    Pregabalin Placebo
    Total subjects affected by serious adverse events
         subjects affected / exposed
    4 / 89 (4.49%)
    1 / 98 (1.02%)
         number of deaths (all causes)
    1
    0
         number of deaths resulting from adverse events
    Nervous system disorders
    Generalised tonic-clonic seizure
         subjects affected / exposed
    1 / 89 (1.12%)
    0 / 98 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Postictal state
         subjects affected / exposed
    1 / 89 (1.12%)
    0 / 98 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Status epilepticus
         subjects affected / exposed
    1 / 89 (1.12%)
    0 / 98 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pregnancy, puerperium and perinatal conditions
    Ectopic pregnancy
         subjects affected / exposed
    0 / 89 (0.00%)
    1 / 98 (1.02%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Acute respiratory distress syndrome
         subjects affected / exposed
    1 / 89 (1.12%)
    0 / 98 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    Psychiatric disorders
    Major depression
         subjects affected / exposed
    1 / 89 (1.12%)
    0 / 98 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Suicidal ideation
         subjects affected / exposed
    1 / 89 (1.12%)
    0 / 98 (0.00%)
         occurrences causally related to treatment / all
    0 / 3
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Infections and infestations
    Pneumonia
         subjects affected / exposed
    1 / 89 (1.12%)
    0 / 98 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 4%
    Non-serious adverse events
    Pregabalin Placebo
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    33 / 89 (37.08%)
    13 / 98 (13.27%)
    Investigations
    Weight increased
         subjects affected / exposed
    5 / 89 (5.62%)
    2 / 98 (2.04%)
         occurrences all number
    5
    2
    Nervous system disorders
    Dizziness
         subjects affected / exposed
    20 / 89 (22.47%)
    3 / 98 (3.06%)
         occurrences all number
    25
    3
    Headache
         subjects affected / exposed
    3 / 89 (3.37%)
    5 / 98 (5.10%)
         occurrences all number
    4
    6
    Somnolence
         subjects affected / exposed
    7 / 89 (7.87%)
    3 / 98 (3.06%)
         occurrences all number
    7
    3
    General disorders and administration site conditions
    Fatigue
         subjects affected / exposed
    6 / 89 (6.74%)
    3 / 98 (3.06%)
         occurrences all number
    6
    3

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    17 Oct 2006
    Increase in the number of centers participating from 10 to 15. Eliminate weight restriction enrollment criteria. Increase the screening period from 1 week to 21 days.
    12 Aug 2009
    Protocol template language updated to current SOP protocol template. Increase in the number of centers participating from 15 to 60. Removal of exclusion of subjects with prior treatment with pregabalin. Exclusion of subjects with history of pregabalin intolerance and subjects with a history of intolerability to pregabalin, or with a history of insufficient response in the treatment of epilepsy. Change of concomitant medication exclusion from exclusion of CNS active medications to exclusion of psychotropic compounds. Addition of safety assessments using the Sheehan-Suicidality Tracking Scale and the Patient Health Questionnaire-8.
    12 Dec 2011
    To add new safety wording. To allow for rescreening of subjects. To add clarification around the timing of the visual field testing (VFT) and handling of the primary endpoint as an AE. Also clarification of prohibited and allowed concomitant medications; and documentation of adverse events related to changes from entry in vital signs, weight and on the physical exam. PASS language added, Subject Selection, Compliance, DMC text added.
    15 Dec 2015
    Single Reference Safety Document (SRSD) for this study was changed from the Core Data Sheet (CDS) to the Investigators Brochure (IB). The following changes were made to comply with FDA and Neuropsychiatric and Abuse Potential Advisory Council (NAPAC) Guidance: • Suicidality assessment: the Columbia-Suicide Severity Rating Scale (C-SSRS) will be performed instead of the Sheehan-Suicidality Tracking Scale (S-STS) for subjects screened following approval/initiation of Amendment 4. Subjects who are randomized under Amendment 3 will not switch to the C-SSRS. • Suicidal Behaviors Questionnaire–Revised (SBQ-R) will be performed at screening. • Scoring instructions for the PHQ8 have been inserted as well as a reference to the Instruction Manual. The following protocol exclusion has been inserted to increase subject safety: • Any subject at risk of suicide or self-harm based on investigator judgment and/or details of a mental health risk assessment (MHRA) by a qualified mental health professional. • The number of sites to participate in the study has been deleted. The following changes were made to comply with the current protocol template and required language/wording: • Abbreviation list moved to an Appendix. • Updated terms study drug and study medication to investigational product for • consistency. • Inserted Lifestyle Guidelines which includes template contraception language. • Inserted Sponsors Medically Qualified Personnel. • Updated Trial Treatments including insertion of new sections for Investigational Product Storage, Investigational Product Accountability and Destruction of • Investigational Product Supplies. • Updated Drug Supplies. • Updated Investigational Product Storage. • Updated Quality Control and Quality Assurance. • Inserted Medication Errors. • Updated Exposure During Pregnancy. • Inserted Occupational Exposure. • Updated Publication of Results.

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported
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