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    Clinical Trial Results:
    A multicentre, double-blind, randomised, placebo controlled study to determine the efficacy and tolerability of OXN PR for the treatment of severe Parkinson's disease associated pain

    Summary
    EudraCT number
    2011-002901-31
    Trial protocol
    GB   ES   DE   CZ   HU  
    Global end of trial date
    05 Nov 2013

    Results information
    Results version number
    v1(current)
    This version publication date
    31 Mar 2016
    First version publication date
    31 Mar 2016
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    OXN2504
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT01439100
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Mundipharma Research GmbH & Co. KG
    Sponsor organisation address
    Höhenstraße 10, Limburg, Germany, D-65549
    Public contact
    European Medical Operations, Mundipharma Research Limited, +44 122342490, info@contact-clinical-trials.com
    Scientific contact
    European Medical Operations, Mundipharma Research Limited, +44 122342490, info@contact-clinical-trials.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 Nov 2013
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    05 Nov 2013
    Global end of trial reached?
    Yes
    Global end of trial date
    05 Nov 2013
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    To demonstrate superiority of OXN PR compared to placebo with respect to analgesic efficacy in subjects with chronic severe pain associated with Parkinson's disease (PD), as assessed by averaged 24 hour pain scores collected for 7 days prior to the clinic visits.
    Protection of trial subjects
    All subjects were provided with oral and written information describing the nature and duration of the study, its purpose, the procedures to be performed, the potential risks and benefits involved, and any potential discomfort. Each subject was given a copy of the patient information sheet (PIS) and informed consent form (ICF). The subject was asked to sign and date an ICF prior to any study-specific procedures being performed. Under a separate informed consent process, subjects were invited to consent to blood sampling for pharmacogenomic testing. The collected blood samples were anonymised and stored for future analysis. The consent to pharmacogenomic sampling was completely separate from the main study and subjects were able to take part in the main study without consenting to pharmacogenomic blood sampling. Blood sampling took place prior to receiving any dose of study medication.
    Background therapy
    In the Double Blind period, Levodopa and benserazide hydrochloride combination Tablets, 100/25 mg, PRN, oral were provided as rescue medication. In the Open Label period, Oxycodone immediate release (OxyIR) Capsules, 5 mg, PRN, oral were provided as rescue medication
    Evidence for comparator
    The comparator product was placebo oxycodone hydrochloride and naloxone hydrochloride dihydrate combined oral prolonged release tablets, OXN PR. Placebo was chosen as comparator in order to measure the pain relief provided by the investigational medicinal product. Rescue medication (described above) was provided.
    Actual start date of recruitment
    31 Oct 2011
    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
    Romania: 21
    Country: Number of subjects enrolled
    Spain: 15
    Country: Number of subjects enrolled
    United Kingdom: 21
    Country: Number of subjects enrolled
    Czech Republic: 33
    Country: Number of subjects enrolled
    Germany: 43
    Country: Number of subjects enrolled
    Hungary: 34
    Country: Number of subjects enrolled
    Poland: 35
    Worldwide total number of subjects
    202
    EEA total number of subjects
    202
    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)
    79
    From 65 to 84 years
    123
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    Subjects were recruited from 47 active centres in 7 countries: Czech Republic: 6 centres; Germany: 10 centres; Poland: 8 centres; Hungary: 7 centres; Romania: 3 centres; Spain: 7 centres; United Kingdom: 6 centres .

    Pre-assignment
    Screening details
    A total of 252 subjects provided written informed consent and were screened, 202 were randomized.

    Period 1
    Period 1 title
    Double-blind
    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
    Oxycodone Naloxone
    Arm description
    Oxycodone Naloxone Prolonged Release Tablets
    Arm type
    Experimental

    Investigational medicinal product name
    Oxycodone hydrochloride and naloxone hydrochloride dihydrate combined oral prolonged release tablets OXN PR-
    Investigational medicinal product code
    OXN
    Other name
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    OXN 5/2.5 mg PR; OXN 10/5 mg PR ; OXN 15/7.5 mg PR ; OXN 20/10 mg PR all taken q12h, Oral

    Arm title
    Placebo Oxycodone Naloxone
    Arm description
    Placebo Oxycodone Naloxone Prolonged Release Tablets
    Arm type
    Placebo

    Investigational medicinal product name
    Placebo Oxycodone hydrochloride and naloxone hydrochloride dihydrate combined oral prolonged release tablets OXN PR-
    Investigational medicinal product code
    Placebo OXN
    Other name
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Placebo OXN 5/2.5 mg PR; Placebo OXN 10/5 mg PR ; Placebo OXN 15/7.5 mg PR ; Placebo OXN 20/10 mg PR all taken q12h, Oral

    Number of subjects in period 1
    Oxycodone Naloxone Placebo Oxycodone Naloxone
    Started
    93
    109
    Completed
    62
    77
    Not completed
    31
    32
         Consent withdrawn by subject
    6
    6
         Administrative
    5
    2
         Adverse event, non-fatal
    17
    10
         Lack of efficacy
    3
    14
    Period 2
    Period 2 title
    Open Label
    Is this the baseline period?
    No
    Allocation method
    Randomised - controlled
    Blinding used
    Not blinded
    Blinding implementation details
    Open label

    Arms
    Are arms mutually exclusive
    No

    Arm title
    Oxycodone Naloxone
    Arm description
    Oxycodone Naloxone Prolonged Release Tablets
    Arm type
    Experimental

    Investigational medicinal product name
    Oxycodone hydrochloride and naloxone hydrochloride dihydrate combined oral prolonged release tablets OXN PR-
    Investigational medicinal product code
    OXN
    Other name
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    OXN 5/2.5 mg PR; OXN 10/5 mg PR ; OXN 15/7.5 mg PR ; OXN 20/10 mg PR all taken q12h, Oral

    Arm title
    Placebo Oxycodone Naloxone
    Arm description
    Placebo Oxycodone Naloxone Prolonged Release Tablets
    Arm type
    Placebo

    Investigational medicinal product name
    Placebo Oxycodone hydrochloride and naloxone hydrochloride dihydrate combined oral prolonged release tablets OXN PR-
    Investigational medicinal product code
    Placebo OXN
    Other name
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Placebo OXN 5/2.5 mg PR; Placebo OXN 10/5 mg PR ; Placebo OXN 15/7.5 mg PR ; Placebo OXN 20/10 mg PR all taken q12h, Oral

    Number of subjects in period 2
    Oxycodone Naloxone Placebo Oxycodone Naloxone
    Started
    64
    87
    Completed
    63
    82
    Not completed
    1
    5
         Consent withdrawn by subject
    1
    -
         Adverse event, non-fatal
    -
    5

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Oxycodone Naloxone
    Reporting group description
    Oxycodone Naloxone Prolonged Release Tablets

    Reporting group title
    Placebo Oxycodone Naloxone
    Reporting group description
    Placebo Oxycodone Naloxone Prolonged Release Tablets

    Reporting group values
    Oxycodone Naloxone Placebo Oxycodone Naloxone Total
    Number of subjects
    93 109 202
    Age categorical
    Units: Subjects
        18 to 60 years
    20 20 40
        >= 60 years and < 70 years
    33 46 79
        >= 70 years
    40 43 83
    Age continuous
    Units: years
        median (full range (min-max))
    67 (46 to 83) 67.5 (49 to 85) -
    Gender categorical
    Units: Subjects
        Female
    49 51 100
        Male
    44 58 102

    End points

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    End points reporting groups
    Reporting group title
    Oxycodone Naloxone
    Reporting group description
    Oxycodone Naloxone Prolonged Release Tablets

    Reporting group title
    Placebo Oxycodone Naloxone
    Reporting group description
    Placebo Oxycodone Naloxone Prolonged Release Tablets
    Reporting group title
    Oxycodone Naloxone
    Reporting group description
    Oxycodone Naloxone Prolonged Release Tablets

    Reporting group title
    Placebo Oxycodone Naloxone
    Reporting group description
    Placebo Oxycodone Naloxone Prolonged Release Tablets

    Primary: To demonstrate superiority of OXN PR compared to placebo with respect to analgesic efficacy in subjects with chronic severe pain associated with Parkinson’s disease (PD), as assessed by averaged 24 hour pain scores collected for 7 days prior to the clinic

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    End point title
    To demonstrate superiority of OXN PR compared to placebo with respect to analgesic efficacy in subjects with chronic severe pain associated with Parkinson’s disease (PD), as assessed by averaged 24 hour pain scores collected for 7 days prior to the clinic
    End point description
    There were no plans to make adjustments for multiplicity for the primary endpoint. There was only one primary endpoint for this study, the averaged 24 hour pain scores collected for 7 days prior to the study clinical visit at Week 16. All other analyses on the primary endpoint for different populations and methods of handling missing data are conducted as sensitivity analyses.
    End point type
    Primary
    End point timeframe
    The averaged 24 hour pain scores collected for 7 days prior to the study clinical visit at Week 16
    End point values
    Oxycodone Naloxone Placebo Oxycodone Naloxone
    Number of subjects analysed
    61
    73
    Units: Pain Scale
        number (confidence interval 95%)
    5 (4.48 to 5.45)
    5.6 (5.14 to 6.03)
    Statistical analysis title
    Superiority of OXN PR vs Placebo (ave 24h pain)
    Statistical analysis description
    The primary analysis to assess the statistical hypothesis was via a Mixed Model for Repeated Measures (MMRM) analysis. The comparison was used to test, in a confirmatory manner, the hypothesis that OXN PR was superior to placebo with respect to the averaged 24 hour pain scores following at Week 16 i.e. to test the following 2-sided hypothesis: Null hypothesis: OXN PR = Placebo in averaged 24 hour pain scores at Week 16 Alternative: OXN PR ≠ Placebo in averaged 24 hour pain scores at Week 16
    Comparison groups
    Oxycodone Naloxone v Placebo Oxycodone Naloxone
    Number of subjects included in analysis
    134
    Analysis specification
    Pre-specified
    Analysis type
    superiority [1]
    P-value
    = 0.058
    Method
    Mixed Model for Repeated Measure
    Parameter type
    Mean difference (final values)
    Point estimate
    -0.6
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -1.26
         upper limit
    0.02
    Variability estimate
    Standard error of the mean
    Dispersion value
    0.33
    Notes
    [1] - Superiority was demonstrated if the primary comparison of OXN PR versus Placebo was significant at the 5% level.

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    In the Double-blind period the OXN PR group mean exposure was 90.8 days, as compared with 93.1 days in the placebo group. In the Open Label period the mean exposure was 28.7 days
    Assessment type
    Non-systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    15.0
    Reporting groups
    Reporting group title
    Oxycodone Naloxone
    Reporting group description
    Oxycodone Naloxone Prolonged Release Tablets - Double Blind Period

    Reporting group title
    Placebo Oxycodone Naloxone
    Reporting group description
    Placebo Oxycodone Naloxone Prolonged Release Tablets - Double blind period

    Serious adverse events
    Oxycodone Naloxone Placebo Oxycodone Naloxone
    Total subjects affected by serious adverse events
         subjects affected / exposed
    5 / 92 (5.43%)
    7 / 109 (6.42%)
         number of deaths (all causes)
    0
    0
         number of deaths resulting from adverse events
    0
    0
    Injury, poisoning and procedural complications
    Rib fracture
         subjects affected / exposed
    1 / 92 (1.09%)
    0 / 109 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cardiac disorders
    Atrial fibrillation
         subjects affected / exposed
    0 / 92 (0.00%)
    1 / 109 (0.92%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Nervous system disorders
    Loss of consciousness
         subjects affected / exposed
    1 / 92 (1.09%)
    0 / 109 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    General disorders and administration site conditions
    Oedema peripheral
         subjects affected / exposed
    0 / 92 (0.00%)
    1 / 109 (0.92%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gastrointestinal disorders
    Melaena
         subjects affected / exposed
    1 / 92 (1.09%)
    0 / 109 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pancreatitis acute
         subjects affected / exposed
    1 / 92 (1.09%)
    0 / 109 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Diarrhoea
         subjects affected / exposed
    0 / 92 (0.00%)
    1 / 109 (0.92%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Reproductive system and breast disorders
    Endometrial hypertrophy
         subjects affected / exposed
    0 / 92 (0.00%)
    1 / 109 (0.92%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Benign prostatic hyperplasia
         subjects affected / exposed
    0 / 92 (0.00%)
    1 / 109 (0.92%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Hepatobiliary disorders
    Cholelithiasis
         subjects affected / exposed
    1 / 92 (1.09%)
    0 / 109 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Renal and urinary disorders
    Pyelocaliectasis
         subjects affected / exposed
    1 / 92 (1.09%)
    0 / 109 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Urinary retention
         subjects affected / exposed
    1 / 92 (1.09%)
    0 / 109 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Musculoskeletal and connective tissue disorders
    Osteoarthritis
         subjects affected / exposed
    0 / 92 (0.00%)
    1 / 109 (0.92%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Spondylolisthesis
         subjects affected / exposed
    0 / 92 (0.00%)
    1 / 109 (0.92%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Lumbar spinal stenosis
         subjects affected / exposed
    0 / 92 (0.00%)
    1 / 109 (0.92%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pain in extremity
         subjects affected / exposed
    0 / 92 (0.00%)
    1 / 109 (0.92%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Infections and infestations
    Pyelonephritis
         subjects affected / exposed
    1 / 92 (1.09%)
    0 / 109 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cystitis
         subjects affected / exposed
    1 / 92 (1.09%)
    0 / 109 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pneumonia
         subjects affected / exposed
    0 / 92 (0.00%)
    1 / 109 (0.92%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Oxycodone Naloxone Placebo Oxycodone Naloxone
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    60 / 92 (65.22%)
    76 / 109 (69.72%)
    Injury, poisoning and procedural complications
    Fall
         subjects affected / exposed
    5 / 92 (5.43%)
    3 / 109 (2.75%)
         occurrences all number
    6
    3
    Nervous system disorders
    Somnolence
         subjects affected / exposed
    12 / 92 (13.04%)
    15 / 109 (13.76%)
         occurrences all number
    18
    16
    Dizziness
         subjects affected / exposed
    12 / 92 (13.04%)
    12 / 109 (11.01%)
         occurrences all number
    18
    21
    Headache
         subjects affected / exposed
    6 / 92 (6.52%)
    9 / 109 (8.26%)
         occurrences all number
    7
    10
    General disorders and administration site conditions
    Fatigue
         subjects affected / exposed
    7 / 92 (7.61%)
    10 / 109 (9.17%)
         occurrences all number
    8
    13
    Ear and labyrinth disorders
    Vertigo
         subjects affected / exposed
    6 / 92 (6.52%)
    4 / 109 (3.67%)
         occurrences all number
    6
    7
    Gastrointestinal disorders
    Nausea
         subjects affected / exposed
    18 / 92 (19.57%)
    13 / 109 (11.93%)
         occurrences all number
    30
    19
    Constipation
         subjects affected / exposed
    16 / 92 (17.39%)
    6 / 109 (5.50%)
         occurrences all number
    20
    6
    Dry mouth
         subjects affected / exposed
    5 / 92 (5.43%)
    5 / 109 (4.59%)
         occurrences all number
    6
    6
    Vomiting
         subjects affected / exposed
    7 / 92 (7.61%)
    3 / 109 (2.75%)
         occurrences all number
    11
    3
    Diarrhoea
         subjects affected / exposed
    2 / 92 (2.17%)
    7 / 109 (6.42%)
         occurrences all number
    2
    7
    Skin and subcutaneous tissue disorders
    Hyperhidrosis
         subjects affected / exposed
    7 / 92 (7.61%)
    2 / 109 (1.83%)
         occurrences all number
    8
    4

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    13 Jan 2012
    In Section 8.3.2 ‘Secondary Efficacy Variable(s)’ a bullet point was added between bullet 1 and 3 that the percentage of responders (defined as a ≥30% reduction from baseline) in averaged 24 hour pain scores collected for 7 days preceding the study clinic visit at Week 16 was also tested in a hierarchical testing strategy. In Section 14.2 ‘Statistical Considerations’, the percentage of responders in averaged 24 hour pain scores at Week 16 was added to the key secondary endpoints which were tested for confirmatory statistical significance under a hierarchical testing strategy. In Section 14.7 ‘Secondary Outcome/Efficacy Variables, it was added that in the case the analyses described before in this section yielded statistically significant differences at each time point, the percentage of responders in averaged 24 hour pain scores at Week 16 were analysed in a formal, confirmatory manner to test for superiority. Logistic regression analysis was used to determine the odds ratio and 95% confidence interval of OXN PR relative to placebo. The statistical model included terms for treatment and centre as factors, and baseline averaged pain score as a covariate. LOCF was used for this analysis. A supportive analysis was performed on the PP Population. A sensitivity analysis on the FAP was also applied to the analysis of the key secondary endpoint of the percentage of responders in averaged 24 hour pain scores, implementing the same logistic regression model, using OC data at the 16-week time point. The analysis of the key secondary endpoint, CGI-I (as assessed by the Investigator), were conducted in a formal manner in the event that the hierarchical testing structure yielded statistically significant differences at each time point. A statistically significant difference in the percentage of responders in averaged 24 hour pain scores at Week 16 was added as a criterion.

    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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    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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