E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
moderate to severe localized chronic post-operative neuropathic pain |
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E.1.1.1 | Medical condition in easily understood language |
long-term local nerve pain |
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E.1.1.2 | Therapeutic area | Diseases [C] - Nervous System Diseases [C10] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 17.0 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10054095 |
E.1.2 | Term | Neuropathic pain |
E.1.2 | System Organ Class | 100000004852 |
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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 |
The primary objective is to assess the superiority of the analgesic efficacy of lidocaine 5% medicated plaster in comparison to placebo in subjects with moderate to severe localized chronic post-operative neuropathic pain (PoNP). |
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E.2.2 | Secondary objectives of the trial |
To evaluate the effect of lidocaine 5% medicated plaster on quality of life, allodynia, and other various symptoms of localized neuropathic pain in subjects suffering from moderate to severe localized chronic PoNP. To evaluate the safety and tolerability of lidocaine 5% medicated plaster in subjects suffering from moderate to severe localized chronic PoNP. |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
Male or female subjects aged >18 years at Visit 1.
Subjects having understood the nature of the trial and having given written informed consent.
Subjects able to communicate meaningfully with investigational site staff, to comply with investigational site staff instructions, to comply with the planned use of the IMPs, to complete the questionnaires, and to use the e-diaries.
For women of childbearing potential, a negative pregnancy test (sample taken at Visit 1).
Subjects suffering from moderate to severe localized chronic PoNP in the location of a surgical intervention with a presumed local pain generator. Localized chronic PoNP is defined as chronic neuropathic pain on the surface of a single cutaneous area neurologically related to the site of surgery and following surgery (e.g., thoracotomy, total/partial knee replacement, cholecystectomy, mastectomy, inguinal hernia repair, varicose vein stripping).
The surgery leading to PoNP was performed 3 to 36 months prior to Visit 1.
Pain intensity at Visit 1 (subject’s average pain during the last 24 hours before the Enrollment Visit) of ≥4 on the 11 point NRS.
Localized PoNP present for ≥3 months prior to Visit 1.
Douleur neuropathique 4 (DN4) questionnaire score ≥4/10 at Visit 1.
Size of the affected painful skin area is not larger than the size of 3 plasters.
Intact skin besides the scar of surgery (absence of skin disease, skin irritation, inflammation or injury, such as active herpes zoster lesions, atopic dermatitis, wounds) in the area where the plasters will be applied.
Adherence to the restricted use of concomitant treatments.
Compliance with the use of e-diaries; at least 75% of all NRS entries must be available since Visit 1 (assessed at Visit 2). The percentage refers to the maximum number of expected e-diary entries based on the time span between Visit 1 and Visit 2.
Baseline average pain intensity assessed at Visit 2 (mean of subject’s average pain intensities during the last 24 hours, calculated over the last 7 days of the Enrollment Period) of ≥4 on the 11 point NRS. |
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E.4 | Principal exclusion criteria |
Participation in another trial of IMPs or devices parallel to, or <30 days prior to Visit 1, or previous participation in this trial.
Any dependency of the subject to the investigator or the trial site, e.g., employees with direct involvement in the proposed trial or in other trials under the direction of this investigator or trial site, as well as family members of the employees or the investigator.
History of dependency or “active” drug abuse (alcohol, medication) during the 1 year prior to Visit 1.
Evidence or history (during the 3 years prior to Visit 1) of neurotic personality or psychiatric illness that in the investigator’s opinion may affect efficacy or safety assessments or may compromise the subject’s safety during trial participation.
Pregnant or breastfeeding women or women of childbearing potential who are sexually active without satisfactory contraception.
Any surgery performed in the 3 months prior to Visit 1, which may affect efficacy or safety assessment, or any surgery scheduled or expected during the trial.
Clinically significant disease (e.g., acquired immunodeficiency syndrome) or condition that may affect efficacy or safety assessments, or any other reason which, in investigator’s opinion, may preclude the subject’s participation in the trial.
Any painful procedure planned during the trial that may, in the opinion of the investigator, affect the efficacy or safety assessments.
History of malignancy (with the exception of neoplasia related to the trial indication) within 2 years prior to Visit 1.
Pending litigation due to chronic pain or disability.
Other painful conditions in the area of PoNP of infectious or non infectious, inflammatory, or neuropathic causes, or conditions representing a complication of the previous surgical procedure which may affect efficacy or safety assessments.
For subjects with PoNP related to a surgery due to neoplasia: suspected residual neoplasia or metastases.
Presence of total anesthesia in the cutaneous area neurologically related to the location of surgical intervention (test performed at Visit 1).
Hypersensitivity to the IMP, its excipients, or anesthetics of the amide type.
Severe cardiac impairment, e.g., New York Heart Association Class ≥III, myocardial infarction in the 6 months prior to Visit 1, and/or unstable angina pectoris.
Any former use of topical lidocaine in the area of localized chronic PoNP.
Any use of Class I anti arrhythmic medicinal products (e.g., tocainide, mexiletine, flecainide, and intravenous lidocaine), or local anesthetics containing lidocaine or ketamine in the 3 days prior to Visit 1 or planned during the trial.
Known severe renal impairment or a glomerular filtration rate/creatinine clearance <30 mL/min. The Cockroft and Gault formula will be used to calculate the creatinine clearance (sample taken at Visit 1).
Known severe hepatocellular insufficiency. |
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E.5 End points |
E.5.1 | Primary end point(s) |
The primary efficacy endpoint is the change from baseline of recorded average pain intensity values during the last 24 hours, averaged over the 7 days of Week 12 of the Double-blind Treatment Period. |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
7 days of Week 12 of the Double-blind Treatment Period |
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E.5.2 | Secondary end point(s) |
1) Mean pain intensity and mean pain intensity change from baseline based on the average pain intensity during the last 24 hours, calculated over the last 28 days (4 weeks) and 84 days (12 weeks) of the Double blind Treatment Period.
Timepoint(s) of evaluation of this endpoint: last 28 days (4 weeks) and 84 days (12 weeks) of the Double blind Treatment Period
2) Mean pain intensity and mean pain intensity change from baseline based on the current pain intensity before plaster removal, calculated over the last 7 days, 28 days (4 weeks), and 84 days (12 weeks) of the Double blind Treatment Period.
Timepoint(s) of evaluation of this endpoint: last 7 days, 28 days (4 weeks), and 84 days (12 weeks) of the Double blind Treatment Period
3) Weekly mean pain intensities and weekly mean pain intensity change from baseline based on average pain intensity during the last 24 hours, and current pain intensity before plaster removal, respectively, calculated for each of the 12 weeks of the Double blind Treatment Period.
Timepoint(s) of evaluation of this endpoint: each of the 12 weeks of the Double blind Treatment Period
4) Responder rates (thresholds of 30% and 50% improvement compared to baseline) based on average pain intensity values during the last 24 hours at the end of the Double blind Treatment Period. All discontinued subjects will be considered non-responders except for those who do not require pain treatment any more due to absence of pain.
Timepoint(s) of evaluation of this endpoint: the last 24 hours at the end of the Double blind Treatment Period
5) Final score of the painDETECT Pain Questionnaire and the changes from baseline during the Double-blind Treatment Period.
Timepoint(s) of evaluation of this endpoint: Visit 3, 4 and 5 of the Double blind Treatment Period.
6) Pain intensity from mechanical dynamic allodynia (brush) testing and change from baseline.
Timepoint(s) of evaluation of this endpoint: Visit 3, 4 and 5 of the Double blind Treatment Period
7) Anxiety and depression scores of HADS and changes from baseline.
Timepoint(s) of evaluation of this endpoint: Visit 5 of the Double blind Treatment Period
8) Rating of global improvement and satisfaction with treatment according to PGIC using a 7 point verbal rating scale.
Timepoint(s) of evaluation of this endpoint: Visit 5 of the Double blind Treatment Period
9) The weighted Health Status Index of quality of life by means of EQ-5D and change from baseline.
Timepoint(s) of evaluation of this endpoint: Visit 5 of the Double blind Treatment Period
10) Total score in quality of sleep using CPSI and change from baseline.
Timepoint(s) of evaluation of this endpoint: Visit 5 of the Double blind Treatment Period |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
Please see section E.5.2 (timepoint is given under listed secondary end point). |
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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 | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
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 | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | Yes |
E.8.1.5 | Parallel group | Yes |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | Yes |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 2 |
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.8.4.1 | Number of sites anticipated in Member State concerned | 5 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 50 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
Brazil |
Chile |
Colombia |
Croatia |
Russian Federation |
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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 | 3 |
E.8.9.1 | In the Member State concerned months | 9 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 3 |
E.8.9.2 | In all countries concerned by the trial months | 9 |
E.8.9.2 | In all countries concerned by the trial days | 0 |