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    Clinical Trial Results:
    Double-blind, randomised, placebo-controlled, parallel group study to evaluate the efficacy and safety of oral administration of Nepadutant in infant colic

    Summary
    EudraCT number
    2009-018218-21
    Trial protocol
    DE   SE  
    Global end of trial date
    28 Dec 2013

    Results information
    Results version number
    v1(current)
    This version publication date
    04 Nov 2018
    First version publication date
    04 Nov 2018
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    NIC-03
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT01258153
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Menarini Ricerche S.p.A.
    Sponsor organisation address
    Via Sette Santi 1, Florence, Italy, 50131
    Public contact
    Angela Capriati, Menarini Ricerche S.p.A., +39 05556809990, acapriati@menarini-ricerche.it
    Scientific contact
    Angela Capriati, Menarini Ricerche S.p.A., +39 05556809990, acapriati@menarini-ricerche.it
    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
    31 Oct 2014
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    28 Dec 2013
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    Efficacy of oral Nepadutant treatment given once daily at two doses in comparison to placebo
    Protection of trial subjects
    Parents could withdraw consent for their baby participation in the study at any time without prejudice. The investigator could withdraw a subject if, in his/her clinical judgment, it was in the best interest of the subject or if the subject could not comply with the protocol. The subject underwent to a final study visit (FU visit) after withdrawal, the cause of which had to be recorded in detail on the CRF/eCRF. If the withdrawal of a subject resulted from an adverse event, this was documented in accordance with procedures described under section “Adverse Event”.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    04 Nov 2010
    Long term follow-up planned
    Yes
    Long term follow-up rationale
    Safety
    Long term follow-up duration
    1 Months
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Poland: 2
    Country: Number of subjects enrolled
    Sweden: 1
    Country: Number of subjects enrolled
    Germany: 1
    Country: Number of subjects enrolled
    United States: 2
    Country: Number of subjects enrolled
    Russian Federation: 109
    Worldwide total number of subjects
    115
    EEA total number of subjects
    4
    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)
    115
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    0
    From 65 to 84 years
    0
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    Screened patients were 130, of these, 15 were screening failures. Subjects randomised therefore were 115. Two patients were excluded from ITT population (n=113) due to: withdrawal of consent after 1st intake (1) and after 1 day with 0 intake.

    Pre-assignment
    Screening details
    Healthy infants(age >4 weeks and <20 weeks),breast-fed,mixed fed or formula fed with a stable dietary regimen,normal growth,infant colic as per modified Wessel criteria.At randomization,eligibility was confirmed by total of crying and/or fussing time lasting at least 6h during the last 3days screening SF:15;Main SF reason: I/E criteria not met(10)

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

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Nepadutant low dose
    Arm description
    Nepadutant oral solution 0.1 mg/kg for oral administration once daily for 7 days
    Arm type
    Experimental

    Investigational medicinal product name
    Nepadutant
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Oral solution
    Routes of administration
    Oral use
    Dosage and administration details
    Nepadutant oral solution 0.1 mg/kg for oral administration once daily for 7 days

    Arm title
    Nepadutant high dose
    Arm description
    Nepadutant oral solution 0.5 mg/kg for oral administration once daily for 7 days
    Arm type
    Experimental

    Investigational medicinal product name
    Nepadutant oral solution 0.5 mg/kg
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Oral solution
    Routes of administration
    Oral use
    Dosage and administration details
    Nepadutant oral solution 0.5 mg/kg for oral administration once daily for 7 days

    Arm title
    Placebo
    Arm description
    Placebo matching Nepadutant oral solution for oral administration once daily for 7 days
    Arm type
    Placebo

    Investigational medicinal product name
    placebo
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Oral solution
    Routes of administration
    Oral use
    Dosage and administration details
    once daily for 7 days

    Number of subjects in period 1 [1]
    Nepadutant low dose Nepadutant high dose Placebo
    Started
    39
    38
    36
    Completed
    39
    38
    36
    Notes
    [1] - The number of subjects reported to be in the baseline period are not the same as the worldwide number enrolled in the trial. It is expected that these numbers will be the same.
    Justification: Two patients withdraw the consent: a total of 113 patients were considered in the ITT population and 114 for the safety population. For the efficacy analysis 112 patients were considered, as one patient had no baseline recorded data.

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Nepadutant low dose
    Reporting group description
    Nepadutant oral solution 0.1 mg/kg for oral administration once daily for 7 days

    Reporting group title
    Nepadutant high dose
    Reporting group description
    Nepadutant oral solution 0.5 mg/kg for oral administration once daily for 7 days

    Reporting group title
    Placebo
    Reporting group description
    Placebo matching Nepadutant oral solution for oral administration once daily for 7 days

    Reporting group values
    Nepadutant low dose Nepadutant high dose Placebo Total
    Number of subjects
    39 38 36 113
    Age categorical
    Units: Subjects
        In utero
    0
        Preterm newborn infants (gestational age < 37 wks)
    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)
    0
        From 65-84 years
    0
        85 years and over
    0
    Age continuous
    Units: weeks
        arithmetic mean (standard deviation)
    11.03 ± 4.909 11.34 ± 5.147 10.92 ± 4.686 -
    Gender categorical
    Units: Subjects
        Female
    21 13 17 51
        Male
    18 25 19 62
        not recorded
    0 0 0 0

    End points

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    End points reporting groups
    Reporting group title
    Nepadutant low dose
    Reporting group description
    Nepadutant oral solution 0.1 mg/kg for oral administration once daily for 7 days

    Reporting group title
    Nepadutant high dose
    Reporting group description
    Nepadutant oral solution 0.5 mg/kg for oral administration once daily for 7 days

    Reporting group title
    Placebo
    Reporting group description
    Placebo matching Nepadutant oral solution for oral administration once daily for 7 days

    Primary: Absolute Change of the Mean Daily Crying and Fussing Time for Three Consecutive Days While on Treatment Versus Baseline.

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    End point title
    Absolute Change of the Mean Daily Crying and Fussing Time for Three Consecutive Days While on Treatment Versus Baseline.
    End point description
    Efficacy assessment to be measured through “baby’s day” diary recorded for three consecutive days while on treatment (i.e. starting from 6 pm on Day 4 and continued for 72 hours) vs baseline (i.e. starting from 6 pm on Day -4 until 1st treatment administration). Analysis population: 112 instead of 113, because 1 subject had no records at baseline and therefore the outcome could not be measured
    End point type
    Primary
    End point timeframe
    Baseline and one week
    End point values
    Nepadutant low dose Nepadutant high dose Placebo
    Number of subjects analysed
    38
    38
    36
    Units: minute
        arithmetic mean (standard deviation)
    -96.9 ± 75.12
    -119.2 ± 97.13
    -91.2 ± 76.2
    Statistical analysis title
    ANCOVA
    Comparison groups
    Nepadutant high dose v Placebo v Nepadutant low dose
    Number of subjects included in analysis
    112
    Analysis specification
    Pre-specified
    Analysis type
    other
    P-value
    = 0.04
    Method
    ANCOVA
    Confidence interval

    Secondary: Absolute Change in the Overall Parental Judgment After the First Dose of Treatment Versus Baseline

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    End point title
    Absolute Change in the Overall Parental Judgment After the First Dose of Treatment Versus Baseline
    End point description
    On a daily basis parents expressed an overall judgement on the study treatment effect based on a 6 rate categorical scale from 0 to 5 (where 0 is for "Not at all" and 5 is "Extremely". The question was "How frustrating to you was your baby's crying today?"
    End point type
    Secondary
    End point timeframe
    1 day
    End point values
    Nepadutant low dose Nepadutant high dose Placebo
    Number of subjects analysed
    39
    38
    36
    Units: score range 0-5
        median (standard deviation)
    -0.38 ± 0.771
    -068 ± 0.884
    -0.34 ± 0.596
    No statistical analyses for this end point

    Secondary: Absolute Change in the Overall Parental Judgment at the End of Treatment Versus Baseline

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    End point title
    Absolute Change in the Overall Parental Judgment at the End of Treatment Versus Baseline
    End point description
    On a daily basis parents expressed an overall judgement on the study treatment effect based on a 6 rate categorical scale from 0 to 5 (where 0 is for "Not at all" and 5 is "Extremely". The question was "How frustrating to you was your baby's crying today?"
    End point type
    Secondary
    End point timeframe
    1 week
    End point values
    Nepadutant low dose Nepadutant high dose Placebo
    Number of subjects analysed
    39
    38
    36
    Units: score 0-5
        median (standard deviation)
    -1.24 ± 0.909
    -1.75 ± 1.186
    -1.23 ± 1.044
    No statistical analyses for this end point

    Secondary: Absolute Change in the Overall Parental Judgment After Treatment Discontinuation Versus Baseline

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    End point title
    Absolute Change in the Overall Parental Judgment After Treatment Discontinuation Versus Baseline
    End point description
    On a daily basis parents expressed an overall judgement on the study treatment effect based on a 6 rate categorical scale from 0 to 5 (where 0 is for "Not at all" and 5 is "Extremely". The question was "How frustrating to you was your baby's crying today?"
    End point type
    Secondary
    End point timeframe
    10 days
    End point values
    Nepadutant low dose Nepadutant high dose Placebo
    Number of subjects analysed
    39
    38
    36
    Units: score 0-5
        median (standard deviation)
    -1.35 ± 0.857
    -1.78 ± 1.176
    -1.39 ± 0.896
    No statistical analyses for this end point

    Secondary: Percentage of 'Responder' Babies at the End of Treatment Period.

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    End point title
    Percentage of 'Responder' Babies at the End of Treatment Period.
    End point description
    Response is defined as a decrease of at least 50% of crying and fussing time during the last 3 days on treatment vs baseline. Analysis population: 112 instead of 113, because 1 subject had no records at baseline and therefore the outcome could not be measured
    End point type
    Secondary
    End point timeframe
    baseline and one week
    End point values
    Nepadutant low dose Nepadutant high dose Placebo
    Number of subjects analysed
    38
    38
    36
    Units: patient
    14
    21
    7
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    up to 4 weeks after the first drug intake
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    14.1
    Reporting groups
    Reporting group title
    Nepadutant low dose
    Reporting group description
    Nepadutant oral solution 0.1 mg/kg for oral administration once daily for 7 days

    Reporting group title
    Nepadutant high dose
    Reporting group description
    Nepadutant oral solution 0.5 mg/kg for oral administration once daily for 7 days

    Reporting group title
    Placebo
    Reporting group description
    Placebo matching Nepadutant oral solution for oral administration once daily for 7 days

    Serious adverse events
    Nepadutant low dose Nepadutant high dose Placebo
    Total subjects affected by serious adverse events
         subjects affected / exposed
    0 / 40 (0.00%)
    1 / 38 (2.63%)
    0 / 36 (0.00%)
         number of deaths (all causes)
    0
    0
    0
         number of deaths resulting from adverse events
    0
    0
    0
    Respiratory, thoracic and mediastinal disorders
    Bronchitis bacterial
         subjects affected / exposed
    0 / 40 (0.00%)
    1 / 38 (2.63%)
    0 / 36 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 2%
    Non-serious adverse events
    Nepadutant low dose Nepadutant high dose Placebo
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    9 / 40 (22.50%)
    7 / 38 (18.42%)
    5 / 36 (13.89%)
    Investigations
    Body temperature increased
         subjects affected / exposed
    0 / 40 (0.00%)
    1 / 38 (2.63%)
    0 / 36 (0.00%)
         occurrences all number
    0
    1
    0
    Gamma-glutamyltransferase abnormal
         subjects affected / exposed
    1 / 40 (2.50%)
    0 / 38 (0.00%)
    0 / 36 (0.00%)
         occurrences all number
    1
    0
    0
    Nervous system disorders
    Crying
         subjects affected / exposed
    0 / 40 (0.00%)
    0 / 38 (0.00%)
    1 / 36 (2.78%)
         occurrences all number
    0
    0
    1
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    1 / 40 (2.50%)
    0 / 38 (0.00%)
    0 / 36 (0.00%)
         occurrences all number
    1
    0
    0
    General disorders and administration site conditions
    Pyrexia
         subjects affected / exposed
    0 / 40 (0.00%)
    1 / 38 (2.63%)
    0 / 36 (0.00%)
         occurrences all number
    0
    1
    0
    Gastrointestinal disorders
    Diarrhoea
         subjects affected / exposed
    0 / 40 (0.00%)
    0 / 38 (0.00%)
    1 / 36 (2.78%)
         occurrences all number
    0
    0
    1
    Frequent bowel movements
         subjects affected / exposed
    1 / 40 (2.50%)
    0 / 38 (0.00%)
    0 / 36 (0.00%)
         occurrences all number
    1
    0
    0
    Infrequent bowel movements
         subjects affected / exposed
    1 / 40 (2.50%)
    0 / 38 (0.00%)
    0 / 36 (0.00%)
         occurrences all number
    1
    0
    0
    Regurgitation
         subjects affected / exposed
    1 / 40 (2.50%)
    0 / 38 (0.00%)
    0 / 36 (0.00%)
         occurrences all number
    1
    0
    0
    Vomiting
         subjects affected / exposed
    1 / 40 (2.50%)
    0 / 38 (0.00%)
    1 / 36 (2.78%)
         occurrences all number
    1
    0
    1
    Salivary hypersecretion
         subjects affected / exposed
    0 / 40 (0.00%)
    1 / 38 (2.63%)
    0 / 36 (0.00%)
         occurrences all number
    0
    1
    0
    Aphthous ulcer
         subjects affected / exposed
    1 / 40 (2.50%)
    0 / 38 (0.00%)
    0 / 36 (0.00%)
         occurrences all number
    1
    0
    0
    Hepatobiliary disorders
    Hyperbilirubinaemia
         subjects affected / exposed
    0 / 40 (0.00%)
    0 / 38 (0.00%)
    1 / 36 (2.78%)
         occurrences all number
    0
    0
    1
    Respiratory, thoracic and mediastinal disorders
    Apnoea
         subjects affected / exposed
    1 / 40 (2.50%)
    0 / 38 (0.00%)
    0 / 36 (0.00%)
         occurrences all number
    1
    0
    0
    Skin and subcutaneous tissue disorders
    Rash
         subjects affected / exposed
    1 / 40 (2.50%)
    0 / 38 (0.00%)
    1 / 36 (2.78%)
         occurrences all number
    1
    0
    1
    Skin lesion
         subjects affected / exposed
    0 / 40 (0.00%)
    1 / 38 (2.63%)
    0 / 36 (0.00%)
         occurrences all number
    0
    1
    0

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    26 Apr 2011
    Harmonisation of the slightly different protocol versions which are in force in three participating Countries as consequence of the country specific Amendments implemented in response to Regulatory Authorities (RAs), Ethical Committees (ECs) and Institutional Review Boards. Enlargement of the inclusion to infants who are fed with mixed milk or formula milk, provided that the following specifications on infant’s dietary regimen are met: a) stable and well tolerated dietary regimen b) no change in the dietary regimen until the end of the 7 day treatment period c) cow milk allergy must be excluded d) complementary food not allowed • Deletion of faecal analysis which was intended to be performed as sub-study in Finnish sites, no longer participating to the study. • Update on the Project Responsible Person appointed by the CRO.
    21 Dec 2011
    Main changes: The age range of eligible patients has been extended by increasing the age upper limit to < 20 weeks at screening visit. The allowed PCA (post-conceptual age) at screening visit has been decreased from >44 to >40 weeks. • Revision of the inclusion criteria specifically pertaining the diagnosis of colic has been made so that a total of 6 hours crying and/or fussing time over a three days screening period is now considered adequate to reflect the Wessel criteria based on a weekly observation time (“paroxysm of irritability, fussing or crying that start and stop without obvious cause for >3h/day, >3 days/week for at least one week”). • Study procedures have been reviewed to avoid unnecessary restriction and therefore to facilitate the inclusion of patients. In particular: - the start of the wash-out period for the exclusion of any pharmacological treatment has been shortened to 24 h before starting the “baby’s day” diary recording at screening (i.e. the day before Day -4) instead of 1 week prior randomisation. As the minimum screening period is 4 days, the wash-out period was at least of 5 days before starting the study treatment. - no change in probiotics and herbal tea intake is required, from 24 h before starting recording the “baby’s day” diary up to completion of post treatment period. • to remove the PK sampling scheduled at visit 3 in order to further reduce any patient discomfort. The “baby’s day” diary has been simplified Administrative changes: number of sites, CRO name,
    29 Oct 2012
    New sites in Asia and Australia have been included and ClinActis Ltd is the CRO in charge to manage the Asian and Australian sites. The contact details of the CRO have been added to the protocol. • The “Study Responsibility” section has been updated. • Exclusion criterion 5 clarifies that the daily infant’s habits should not be changed during the study conduct, including the use of probiotics, herbal tea and other home remedy. • Paper CRF was replaced by electronic CRF. • Other minor rewording and typos have been included in the protocol review

    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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