Clinical Trial Results:
A double-blind, placebo controlled, parallel-group, randomised study of safety, tolerability and efficacy of AMAP102 in patients with osteoarthritis.
Summary
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EudraCT number |
2012-001769-34 |
Trial protocol |
SE DE |
Global end of trial date |
31 Jul 2014
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Results information
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Results version number |
v1(current) |
This version publication date |
18 Feb 2016
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First version publication date |
18 Feb 2016
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Other versions |
Trial Information
Subject Disposition
Baseline Characteristics
End Points
Adverse Events
More Information
Subject Disposition
Baseline Characteristics
End Points
Adverse Events
More Information
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Trial identification
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Sponsor protocol code |
102-240-02
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Additional study identifiers
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ISRCTN number |
- | ||
US NCT number |
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WHO universal trial number (UTN) |
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Sponsors
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Sponsor organisation name |
AnaMar AB
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Sponsor organisation address |
Medicon Village, Lund, Sweden, SE-223 81
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Public contact |
Helena Arozenius, AnaMar AB, helena.arozenius@anamar.com
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Scientific contact |
Helena Arozenius, AnaMar AB, helena.arozenius@anamar.com
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Paediatric regulatory details
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Is trial part of an agreed paediatric investigation plan (PIP) |
No
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Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial? |
No
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Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial? |
No
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Results analysis stage
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Analysis stage |
Final
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Date of interim/final analysis |
27 Mar 2015
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Is this the analysis of the primary completion data? |
Yes
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Primary completion date |
31 Jul 2014
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Global end of trial reached? |
Yes
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Global end of trial date |
31 Jul 2014
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Was the trial ended prematurely? |
No
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General information about the trial
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Main objective of the trial |
To assess the efficacy of AMAP102 in patients with pain secondary to osteoarthritis (OA) over 28 days of dosing
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Protection of trial subjects |
Rescue medication (paracetamol) was dispensed to the patient by the investigator. Daily use of rescue medication (paracetamol) was limited to 3 g. Rescue medication was replenished at each visit if required.
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Background therapy |
No background therapy was used as part of the clinical trial | ||
Evidence for comparator |
There were no active comparators included in the clinical trial. | ||
Actual start date of recruitment |
21 Jan 2013
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Long term follow-up planned |
No
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Independent data monitoring committee (IDMC) involvement? |
No
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Population of trial subjects
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Number of subjects enrolled per country |
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Country: Number of subjects enrolled |
Sweden: 21
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Country: Number of subjects enrolled |
Germany: 20
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Country: Number of subjects enrolled |
Poland: 75
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Worldwide total number of subjects |
116
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EEA total number of subjects |
116
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Number of subjects enrolled per age group |
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In utero |
0
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Preterm newborn - gestational age < 37 wk |
0
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Newborns (0-27 days) |
0
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Infants and toddlers (28 days-23 months) |
0
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Children (2-11 years) |
0
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Adolescents (12-17 years) |
0
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Adults (18-64 years) |
61
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From 65 to 84 years |
55
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85 years and over |
0
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Recruitment
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Recruitment details |
This was a multicentre study that included 16 sites across Germany, Poland and Sweden. Studied Period (Years): Approximately 1 year and 6 months Date of First Enrolment: 21-Jan-2013 Date of Last Completed: 31-Jul-2014 | |||||||||||||||||||||||||||
Pre-assignment
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Screening details |
Overall, 257 patients were screened and 116 patients were randomised to receive study drug. The number of patients randomised to receive AMAP102 or placebo was similar. Screening Period: Visit 1 (Days -12 to 1) The screening criteria included: Discontinuation of all pain medication (as specified in the Inclusion/Exclusion Criteria) | |||||||||||||||||||||||||||
Period 1
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Period 1 title |
Randomised Double-blind Treatment Period (overall period)
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Is this the baseline period? |
Yes | |||||||||||||||||||||||||||
Allocation method |
Randomised - controlled
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Blinding used |
Double blind | |||||||||||||||||||||||||||
Roles blinded |
Investigator, Monitor, Data analyst, Carer, Subject, Assessor | |||||||||||||||||||||||||||
Blinding implementation details |
This was a randomised, double-blind, placebo-controlled study with limited access to the randomisation code. Investigational medicinal product and placebo capsules were identical in physical appearance. The treatment each patient received was not be disclosed to the investigator, study centre personnel, patient, AnaMar AB, or their representatives. The treatment codes were held according to the interactive voice response system (IVRS).
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Arms
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Are arms mutually exclusive |
Yes
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Arm title
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AMAP102 | |||||||||||||||||||||||||||
Arm description |
Following the confirmation of eligibility to the study, the patients were randomised in a 1:1 ratio to AMAP102 or placebo. | |||||||||||||||||||||||||||
Arm type |
Experimental | |||||||||||||||||||||||||||
Investigational medicinal product name |
AMAP102
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Investigational medicinal product code |
AMAP102
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Other name |
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Pharmaceutical forms |
Capsule
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Routes of administration |
Oral use
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Dosage and administration details |
For protocol versions 1 to 3, treatment comprised of oral AMAP102 75 mg or placebo b.i.d for 28 days. After the issue of protocol version 4, treatment comprised of oral AMAP102 or placebo b.i.d for 28 days, AMAP102 25 mg b.i.d or placebo b.i.d between Days 1 and 6
and AMAP102 50 mg b.i.d or placebo b.i.d between Days 7 and 28 (for those patients who reported clinically significant AEs or any tolerability issues between Days 7 and 28, the study drug dose could be down-titrated).
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Arm title
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Placebo | |||||||||||||||||||||||||||
Arm description |
Following the confirmation of eligibility to the study, the patients were randomised in a 1:1 ratio to AMAP102 or placebo. | |||||||||||||||||||||||||||
Arm type |
Placebo | |||||||||||||||||||||||||||
Investigational medicinal product name |
Placebo
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Investigational medicinal product code |
Placebo
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Other name |
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Pharmaceutical forms |
Capsule
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Routes of administration |
Oral use
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Dosage and administration details |
For protocol versions 1 to 3, treatment comprised of oral AMAP102 75 mg or placebo b.i.d for 28 days. After the issue of protocol version 4, treatment comprised of oral AMAP102 or placebo b.i.d for 28 days, AMAP102 25 mg b.i.d or placebo b.i.d between Days 1 and 6
and AMAP102 50 mg b.i.d or placebo b.i.d between Days 7 and 28 (for those patients who reported clinically significant AEs or any tolerability issues between Days 7 and 28, the study drug dose could be down-titrated).
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Baseline characteristics reporting groups
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Reporting group title |
Randomised Double-blind Treatment Period
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Reporting group description |
- | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Subject analysis sets
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Subject analysis set title |
Intention to Treat
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Subject analysis set type |
Intention-to-treat | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Subject analysis set description |
The intent-to-treat (ITT) population (full analysis set) comprised of all patients who were correctly included (implying that they fulfilled all entry criteria), randomised and had taken at least 1 dose of the study drug. The ITT population was used to perform confirmatory analyses of the primary efficacy evaluation only. Missing data were imputed using the Last Observation Carried Forward (LOCF) principle.
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Subject analysis set title |
Safety Population
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Subject analysis set type |
Safety analysis | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Subject analysis set description |
The safety population included all patients who were randomised and received at least 1 dose of study drug. This population was used to assess comparative safety information.
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Subject analysis set title |
Per Protocol Population
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Subject analysis set type |
Per protocol | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Subject analysis set description |
The per protocol (PP) population included all patients in the ITT population who did not have major deviations from the protocol that could have affected the primary (and secondary) endpoints. The PP population was the main analysis set from which conclusions on efficacy were drawn.
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End points reporting groups
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Reporting group title |
AMAP102
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Reporting group description |
Following the confirmation of eligibility to the study, the patients were randomised in a 1:1 ratio to AMAP102 or placebo. | ||
Reporting group title |
Placebo
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Reporting group description |
Following the confirmation of eligibility to the study, the patients were randomised in a 1:1 ratio to AMAP102 or placebo. | ||
Subject analysis set title |
Intention to Treat
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Subject analysis set type |
Intention-to-treat | ||
Subject analysis set description |
The intent-to-treat (ITT) population (full analysis set) comprised of all patients who were correctly included (implying that they fulfilled all entry criteria), randomised and had taken at least 1 dose of the study drug. The ITT population was used to perform confirmatory analyses of the primary efficacy evaluation only. Missing data were imputed using the Last Observation Carried Forward (LOCF) principle.
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Subject analysis set title |
Safety Population
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Subject analysis set type |
Safety analysis | ||
Subject analysis set description |
The safety population included all patients who were randomised and received at least 1 dose of study drug. This population was used to assess comparative safety information.
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Subject analysis set title |
Per Protocol Population
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Subject analysis set type |
Per protocol | ||
Subject analysis set description |
The per protocol (PP) population included all patients in the ITT population who did not have major deviations from the protocol that could have affected the primary (and secondary) endpoints. The PP population was the main analysis set from which conclusions on efficacy were drawn.
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End point title |
The primary efficacy endpoint was the Western Ontario and McMaster Universities Osteoarthritis Index® (WOMAC®) Pain Subscale Score for the target knee | ||||||||||||||||||||||||||||
End point description |
Mean change from Baseline in WOMAC® Pain Subscale Score on the Target Knee at Visits 3 (Day 7), 4 (Day 14) and 5 (Day 28) (PP Population)
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End point type |
Primary
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End point timeframe |
Change from Baseline in WOMAC® Pain Subscale Score on the Target Knee at Visits 3 (Day 7), 4 (Day 14) and 5 (Day 28) (PP Population)
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Statistical analysis title |
Wilcoxon Rank-Sum test | ||||||||||||||||||||||||||||
Statistical analysis description |
Both groups recorded a similar decrease in the mean change from baseline throughout the treatment period.
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Comparison groups |
Placebo v AMAP102
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Number of subjects included in analysis |
88
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Analysis specification |
Pre-specified
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Analysis type |
other [1] | ||||||||||||||||||||||||||||
P-value |
= 0.669 [2] | ||||||||||||||||||||||||||||
Method |
Wilcoxon (Mann-Whitney) | ||||||||||||||||||||||||||||
Confidence interval |
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Notes [1] - Wilcoxon Rank-Sum test [2] - The decrease from baseline was not statistically significantly different between the AMAP102 group and the placebo group for Visit 3 (Day 7) |
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Statistical analysis title |
Wilcoxon Rank-Sum test | ||||||||||||||||||||||||||||
Statistical analysis description |
Both groups recorded a similar decrease in the mean change from baseline throughout the treatment period.
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Comparison groups |
Placebo v AMAP102
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Number of subjects included in analysis |
88
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Analysis specification |
Pre-specified
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Analysis type |
other [3] | ||||||||||||||||||||||||||||
P-value |
= 0.397 [4] | ||||||||||||||||||||||||||||
Method |
Wilcoxon (Mann-Whitney) | ||||||||||||||||||||||||||||
Confidence interval |
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Notes [3] - Wilcoxon Rank-Sum test [4] - The decrease from baseline was not statistically significantly different between the AMAP102 group and the placebo group for Visit 4 (Day 14) |
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Statistical analysis title |
Wilcoxon Rank-Sum test | ||||||||||||||||||||||||||||
Statistical analysis description |
Both groups recorded a similar decrease in the mean change from baseline throughout the treatment period.
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Comparison groups |
Placebo v AMAP102
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Number of subjects included in analysis |
88
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Analysis specification |
Pre-specified
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Analysis type |
other [5] | ||||||||||||||||||||||||||||
P-value |
= 0.784 [6] | ||||||||||||||||||||||||||||
Method |
Wilcoxon (Mann-Whitney) | ||||||||||||||||||||||||||||
Confidence interval |
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Notes [5] - Wilcoxon Rank-Sum test [6] - The decrease from baseline was not statistically significantly different between the AMAP102 group and the placebo group for Visit 5 (Day 28) |
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Adverse events information
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Timeframe for reporting adverse events |
Treatment-emergent adverse events
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Assessment type |
Systematic | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary used for adverse event reporting
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Dictionary name |
MedDRA | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary version |
15.1
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Reporting groups
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Reporting group title |
AMAP102
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Reporting group description |
AMAP102 - dose 25 mg b.i.d. to 75 mg b.i.d. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reporting group title |
Placebo
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Reporting group description |
- | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Frequency threshold for reporting non-serious adverse events: 0.05% | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Substantial protocol amendments (globally) |
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Were there any global substantial amendments to the protocol? Yes | |||
Date |
Amendment |
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12 Jul 2012 |
Protocol Amendment 1, Version 2 (24-Aug-2012)
The amendment was issued following objections raised to the submitted protocol version 1.1 (12-Jul-2012) by the Läkemedelsverket/Swedish Medical Products Agency (MPA). In addition, updates were made to improve the clarity of the protocol and the procedures to be used for some
assessments. |
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03 Oct 2012 |
Protocol Amendment 2, Version 3 (03-Oct-2012)
The amendment was issued following objections raised to the submitted protocol version 2.0 (24-Aug-2012) by the MPA and to the submitted protocol version 1.1 (12-Jul-2012) by the Berlin State Ethics Committee (State Office of Health and Social Affairs). Changes that were made included
the exclusion of patients with significant cardiovascular complications and patients who were taking potent inhibitors of CYP3A4 and CYP1A2. Furthermore, updates were made to improve the clarity of the protocol and the procedures to be used for some assessments. |
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31 Oct 2012 |
Non-Substantial Protocol Amendment 3, Version 3.1 (31-Oct-2012)
The amendment was issued to ensure consistency between both the protocol and the patient’s eDiary. |
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23 Oct 2013 |
Protocol Amendment 4, Version 4 (23-Oct-2013)
The amendment was issued to adjust the eligibility criteria for patients entering the study in order to aid recruitment, as it was proving more challenging than anticipated for the study investigators to find patients that met the entry criteria of the protocol. In addition, there had been a higher frequency of anticipated AEs, which had resulted in early discontinuations. For better tolerability to the study drug, the therapeutic dose was reduced from 75 mg b.i.d to 50 mg b.i.d. Specifically, the following changes were made:
For a better tolerability to the study drug, AMAP102 dosage was reduced from 75 mg b.i.d to 50 mg b.i.d
AMAP102 50 mg b.i.d was selected following the results obtained from the Phase I study that showed 50 mg b.i.d was safe and well tolerated and the observations from the initial blinded safety review on the patients receiving AMAP102 75 mg or placebo b.i.d
A titration step was introduced to allow the patient to become accustomed to the study drug prior to administering the proposed therapeutic dose of AMAP102.
The brief physical examination on Day 7 was amended to complete physical examination prior to the up-titration of the study drug.
The brief physical examination on Day 28 was amended to complete physical examination as this is the Early Discontinuation Visit and in case patients do not return to the follow-up visit on Day 35. The complete physical examination on Day 35
was amended to brief physical examination.
The introduction of a blinded interim analysis and a safety review, to be performed in parallel, after the first 60 randomised patients. The blinded interim analysis was to determine the need for a sample size increase and the safety review involved reviewing all reported AEs, SAEs
and patient withdrawals due to an AE.
The inclusion and exclusion criteria were amended in order to remove the requirement for OA
The requirement for the X-rays at screening were clarified. |
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Interruptions (globally) |
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Were there any global interruptions to the trial? No | |||
Limitations and caveats |
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Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data. | |||
There were no statistical differences on the primary, secondary or exploratory efficacy endpoints between AMAP102 and placebo. |