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    Clinical Trial Results:
    Use of drug therapy in the management of symptomatic ureteric stones in hospitalised adults: a multicentre placebo controlled randomised trial of a calcium channel blocker(nifedipine)and an alpha blocker(tamsulosin) - The SUSPEND trial

    Summary
    EudraCT number
    2010-019469-26
    Trial protocol
    GB  
    Global end of trial date
    24 Apr 2014

    Results information
    Results version number
    v1(current)
    This version publication date
    12 May 2018
    First version publication date
    12 May 2018
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    pRGF/016/09
    Additional study identifiers
    ISRCTN number
    ISRCTN69423238
    US NCT number
    -
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    NHS Grampian
    Sponsor organisation address
    Foresterhill House Annex, Foresterhill,, Aberdeen, United Kingdom, AB25 2ZD
    Public contact
    Professor Sam McClinton, NHS Grampian, smcclinton@abdn.ac.uk
    Scientific contact
    Professor Sam McClinton, NHS Grampian, smcclinton@abdn.ac.uk
    Sponsor organisation name
    University of Aberdeen
    Sponsor organisation address
    Research Governance, Foresterhill House Annex,, Aberdeen, United Kingdom, AB25 2ZD
    Public contact
    Professor Sam McClinton, University of Aberdeen, smcclinton@nhs.net
    Scientific contact
    Professor Sam McClinton, University of Aberdeen, smcclinton@nhs.net
    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
    14 Oct 2014
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    24 Apr 2014
    Global end of trial reached?
    Yes
    Global end of trial date
    24 Apr 2014
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    The aim of the project is to determine the clinical effectiveness and cost-effectiveness of the use of an alpha blocker(tamsulosin) and a calcium channel blocker (nifedipine) in the management of symptomatic urinary stones.
    Protection of trial subjects
    Fully informed consent. Oversight by Sponsor, Data Monitoring Committee and Trial Steering Committee who reviewed accruing data.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    11 Jan 2011
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    United Kingdom: 1167
    Worldwide total number of subjects
    1167
    EEA total number of subjects
    1167
    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)
    1154
    From 65 to 84 years
    13
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    Clinicians assessed patients presenting with suspected ureteric calculi against the eligibility criteria in accordance with standard practice. Eligible patients were approached and given a Patient Information Leaflet and given the opportunity to fully discuss the trial. All participants gave written consent.

    Pre-assignment
    Screening details
    Patients were identified by clinicians working in the urology or accident and emergency departments of participating sites, who were supported by local clinical research teams. Approved trial publicity material in he form of posters was used to help alert staff that the trial was taking place at specific sites.

    Period 1
    Period 1 title
    Overall trial (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
    Blinding implementation details
    At randomisation, the participant was allocated a unique participant study number and assigned a numbered participant pack. The packs were provided by an independent supplier containing the over-encapsulated trial medication to ensure that the participant, local investigator and trial personnel remained blinded to treatment allocation.

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Placebo
    Arm description
    Over-encapsulated lactose capsule
    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
    Lactose capsule, once daily

    Arm title
    Tamsulosin Hydrochloride
    Arm description
    Over-encapsulated capsule containing 400 ug tamsulosin (modified release)
    Arm type
    Active comparator

    Investigational medicinal product name
    Tamsulosin Hydrochloride
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Capsule
    Routes of administration
    Oral use
    Dosage and administration details
    400 ug, once daily up to 28 days

    Arm title
    Nifedipine
    Arm description
    Over-encapsulated nifedipine (30 mg MR capsule)
    Arm type
    Active comparator

    Investigational medicinal product name
    Nifedipine
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Capsule
    Routes of administration
    Oral use
    Dosage and administration details
    Nifedipine, 30mg, once daily

    Number of subjects in period 1 [1]
    Placebo Tamsulosin Hydrochloride Nifedipine
    Started
    384
    383
    383
    Completed
    379
    378
    379
    Not completed
    5
    5
    4
         Lost to follow-up
    5
    5
    4
    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: Number of subjects enrolled includes those later identified as post-randomisation exclusions. Number of subjects in the baseline period is the number enrolled minus those post-randomisation exclusions.

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Placebo
    Reporting group description
    Over-encapsulated lactose capsule

    Reporting group title
    Tamsulosin Hydrochloride
    Reporting group description
    Over-encapsulated capsule containing 400 ug tamsulosin (modified release)

    Reporting group title
    Nifedipine
    Reporting group description
    Over-encapsulated nifedipine (30 mg MR capsule)

    Reporting group values
    Placebo Tamsulosin Hydrochloride Nifedipine Total
    Number of subjects
    384 383 383 1150
    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: years
        arithmetic mean (standard deviation)
    42.8 ( 12.3 ) 43.1 ( 11.5 ) 42.3 ( 11.0 ) -
    Gender categorical
    Units: Subjects
        Female
    85 68 66 219
        Male
    299 315 317 931

    End points

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    End points reporting groups
    Reporting group title
    Placebo
    Reporting group description
    Over-encapsulated lactose capsule

    Reporting group title
    Tamsulosin Hydrochloride
    Reporting group description
    Over-encapsulated capsule containing 400 ug tamsulosin (modified release)

    Reporting group title
    Nifedipine
    Reporting group description
    Over-encapsulated nifedipine (30 mg MR capsule)

    Primary: Primary outcome - no further intervention

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    End point title
    Primary outcome - no further intervention
    End point description
    End point type
    Primary
    End point timeframe
    Four weeks
    End point values
    Placebo Tamsulosin Hydrochloride Nifedipine
    Number of subjects analysed
    379
    378
    379
    Units: Number participants
        number (not applicable)
    303
    307
    304
    Statistical analysis title
    Primary Outcome
    Statistical analysis description
    MET (Tamsulosin & Nifedipine) vs Placebo
    Comparison groups
    Tamsulosin Hydrochloride v Nifedipine v Placebo
    Number of subjects included in analysis
    1136
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.05
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    1.06
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.77
         upper limit
    1.43
    Statistical analysis title
    Primary outcome
    Statistical analysis description
    Tamsulosin vs. Nifedipine
    Comparison groups
    Tamsulosin Hydrochloride v Nifedipine
    Number of subjects included in analysis
    757
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.05
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    1.06
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.73
         upper limit
    1.53
    Statistical analysis title
    Primary outcome
    Statistical analysis description
    Tamsulosin vs. placebo
    Comparison groups
    Placebo v Tamsulosin Hydrochloride
    Number of subjects included in analysis
    757
    Analysis specification
    Post-hoc
    Analysis type
    superiority
    P-value
    < 0.05
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    1.09
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.67
         upper limit
    1.78
    Statistical analysis title
    Primary Outcome
    Comparison groups
    Nifedipine v Placebo
    Number of subjects included in analysis
    758
    Analysis specification
    Post-hoc
    Analysis type
    superiority
    P-value
    < 0.05
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    1.03
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.68
         upper limit
    1.56

    Adverse events

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    Adverse events information [1]
    Timeframe for reporting adverse events
    Sixteen weeks
    Assessment type
    Non-systematic
    Dictionary used for adverse event reporting
    Dictionary name
    None
    Dictionary version
    0
    Reporting groups
    Reporting group title
    Nifedipine
    Reporting group description
    -

    Reporting group title
    Placebo
    Reporting group description
    -

    Reporting group title
    Tamsulosin
    Reporting group description
    -

    Notes
    [1] - There are no non-serious adverse events recorded for these results. It is expected that there will be at least one non-serious adverse event reported.
    Justification: Non-serious adverse events were not collected for the study as both IMPs were established, marketed products with a known safety profile
    Serious adverse events
    Nifedipine Placebo Tamsulosin
    Total subjects affected by serious adverse events
         subjects affected / exposed
    12 / 383 (3.13%)
    6 / 384 (1.56%)
    9 / 383 (2.35%)
         number of deaths (all causes)
    0
    0
    0
         number of deaths resulting from adverse events
    0
    0
    0
    Vascular disorders
    Hypotension
         subjects affected / exposed
    0 / 383 (0.00%)
    0 / 384 (0.00%)
    1 / 383 (0.26%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Cardiac disorders
    Chest pain
         subjects affected / exposed
    2 / 383 (0.52%)
    0 / 384 (0.00%)
    0 / 383 (0.00%)
         occurrences causally related to treatment / all
    2 / 2
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Nervous system disorders
    Headache
         subjects affected / exposed
    1 / 383 (0.26%)
    0 / 384 (0.00%)
    0 / 383 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Gastrointestinal disorders
    Crohn's disease
         subjects affected / exposed
    0 / 383 (0.00%)
    0 / 384 (0.00%)
    1 / 383 (0.26%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Diarrhoea
         subjects affected / exposed
    0 / 383 (0.00%)
    0 / 384 (0.00%)
    1 / 383 (0.26%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Shortness of breath
         subjects affected / exposed
    1 / 383 (0.26%)
    0 / 384 (0.00%)
    0 / 383 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Renal and urinary disorders
    Right loin pain
         subjects affected / exposed
    1 / 383 (0.26%)
    0 / 384 (0.00%)
    0 / 383 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Renal colic
         subjects affected / exposed
    8 / 383 (2.09%)
    4 / 384 (1.04%)
    6 / 383 (1.57%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Infections and infestations
    Sepsis
         subjects affected / exposed
    0 / 383 (0.00%)
    1 / 384 (0.26%)
    0 / 383 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 0%
    Non-serious adverse events
    Nifedipine Placebo Tamsulosin
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    0 / 383 (0.00%)
    0 / 384 (0.00%)
    0 / 383 (0.00%)

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    18 May 2011
    During the initial stages of the trial, a number of SAEs were reported and recorded which, on investigation, were found to be a result of readmissions for continuing treatment of the participant’s ureteric stone (i.e. the primary outcome). These were, therefore, being recorded as a SAE as well as an outcome. To ensure that such events were recorded only as an outcome, the wording regarding the collection of these events was clarified to state: Hospital admissions (planned or unplanned) associated with the treatment of the ureteric stone diagnosed at the time of entry to the trial are expected. These will be recorded as an outcome measure, but will not be recorded or reported as serious adverse events.

    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

    Online references

    http://www.ncbi.nlm.nih.gov/pubmed/26244520
    http://www.ncbi.nlm.nih.gov/pubmed/25998582
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    The status and protocol content of GB trials is no longer updated since 1 January 2021. For the UK, as of 31 January 2021, EU Law applies only to the territory of Northern Ireland (NI) to the extent foreseen in the Protocol on Ireland/NI. Legal notice
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