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    Clinical Trial Results:
    A double-blind, placebo controlled, parallel-group, randomised study of safety, tolerability and efficacy of AMAP102 in patients with osteoarthritis.

    Summary
    EudraCT number
    2012-001769-34
    Trial protocol
    SE   DE  
    Global end of trial date
    31 Jul 2014

    Results information
    Results version number
    v1(current)
    This version publication date
    18 Feb 2016
    First version publication date
    18 Feb 2016
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    102-240-02
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    -
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    AnaMar AB
    Sponsor organisation address
    Medicon Village, Lund, Sweden, SE-223 81
    Public contact
    Helena Arozenius, AnaMar AB, helena.arozenius@anamar.com
    Scientific contact
    Helena Arozenius, AnaMar AB, helena.arozenius@anamar.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
    27 Mar 2015
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    31 Jul 2014
    Global end of trial reached?
    Yes
    Global end of trial date
    31 Jul 2014
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    To assess the efficacy of AMAP102 in patients with pain secondary to osteoarthritis (OA) over 28 days of dosing
    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.
    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
    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
    Sweden: 21
    Country: Number of subjects enrolled
    Germany: 20
    Country: Number of subjects enrolled
    Poland: 75
    Worldwide total number of subjects
    116
    EEA total number of subjects
    116
    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)
    61
    From 65 to 84 years
    55
    85 years and over
    0

    Subject disposition

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    Recruitment
    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
    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
    Period 1 title
    Randomised Double-blind Treatment Period (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
    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).

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    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
    Investigational medicinal product code
    AMAP102
    Other name
    Pharmaceutical forms
    Capsule
    Routes of administration
    Oral use
    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).

    Arm title
    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
    Investigational medicinal product code
    Placebo
    Other name
    Pharmaceutical forms
    Capsule
    Routes of administration
    Oral use
    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).

    Number of subjects in period 1
    AMAP102 Placebo
    Started
    59
    57
    Completed
    42
    51
    Not completed
    17
    6
         Consent withdrawn by subject
    3
    4
         Physician decision
    1
    -
         not defined
    1
    -
         Adverse event, non-fatal
    10
    2
         Protocol deviation
    2
    -

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Randomised Double-blind Treatment Period
    Reporting group description
    -

    Reporting group values
    Randomised Double-blind Treatment Period Total
    Number of subjects
    116 116
    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)
    65.3 ( 8.51 ) -
    Gender categorical
    Units: Subjects
        Female
    84 84
        Male
    32 32
    Identification of Target Knee
    Patients who had arthritis flare in either the left or right knee were selected at baseline.
    Units: Subjects
        Left
    55 55
        Right
    61 61
    Subject analysis sets

    Subject analysis set title
    Intention to Treat
    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.

    Subject analysis set title
    Safety Population
    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.

    Subject analysis set title
    Per Protocol Population
    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.

    Subject analysis sets values
    Intention to Treat Safety Population Per Protocol Population
    Number of subjects
    104
    115
    88
    Age categorical
    Units: Subjects
        In utero
        Preterm newborn infants (gestational age < 37 wks)
        Newborns (0-27 days)
        Infants and toddlers (28 days-23 months)
        Children (2-11 years)
        Adolescents (12-17 years)
        Adults (18-64 years)
        From 65-84 years
        85 years and over
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    65.5 ( 8.52 )
    65.3 ( 8.51 )
    65 ( 8.44 )
    Gender categorical
    Units: Subjects
        Female
    27
    31
    25
        Male
    77
    84
    63
    Identification of Target Knee
    Patients who had arthritis flare in either the left or right knee were selected at baseline.
    Units: Subjects
        Left
    51
    55
    43
        Right
    53
    60
    45

    End points

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    End points reporting groups
    Reporting group title
    AMAP102
    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
    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
    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.

    Subject analysis set title
    Safety Population
    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.

    Subject analysis set title
    Per Protocol Population
    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.

    Primary: The primary efficacy endpoint was the Western Ontario and McMaster Universities Osteoarthritis Index® (WOMAC®) Pain Subscale Score for the target knee

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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)
    End point type
    Primary
    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)
    End point values
    AMAP102 Placebo Per Protocol Population
    Number of subjects analysed
    40
    48
    88
    Units: Pain Subscale Score
    arithmetic mean (standard deviation)
        Change from baseline to day 7 (mean)
    -3.7 ( 6.11 )
    -4 ( 6.32 )
    -3.85 ( 6.21 )
        Change from baseline to day 14 (mean)
    -5.8 ( 7.44 )
    -7 ( 7.27 )
    -6.4 ( 7.34 )
        Change from baseline to day 28 (mean)
    -8.5 ( 7.98 )
    -8.2 ( 8.53 )
    -8.35 ( 7.27 )
    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.
    Comparison groups
    Placebo v AMAP102
    Number of subjects included in analysis
    88
    Analysis specification
    Pre-specified
    Analysis type
    other [1]
    P-value
    = 0.669 [2]
    Method
    Wilcoxon (Mann-Whitney)
    Confidence interval
    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)
    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.
    Comparison groups
    Placebo v AMAP102
    Number of subjects included in analysis
    88
    Analysis specification
    Pre-specified
    Analysis type
    other [3]
    P-value
    = 0.397 [4]
    Method
    Wilcoxon (Mann-Whitney)
    Confidence interval
    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)
    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.
    Comparison groups
    Placebo v AMAP102
    Number of subjects included in analysis
    88
    Analysis specification
    Pre-specified
    Analysis type
    other [5]
    P-value
    = 0.784 [6]
    Method
    Wilcoxon (Mann-Whitney)
    Confidence interval
    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)

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Treatment-emergent adverse events
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    15.1
    Reporting groups
    Reporting group title
    AMAP102
    Reporting group description
    AMAP102 - dose 25 mg b.i.d. to 75 mg b.i.d.

    Reporting group title
    Placebo
    Reporting group description
    -

    Serious adverse events
    AMAP102 Placebo
    Total subjects affected by serious adverse events
         subjects affected / exposed
    1 / 59 (1.69%)
    1 / 56 (1.79%)
         number of deaths (all causes)
    0
    0
         number of deaths resulting from adverse events
    0
    0
    Nervous system disorders
    Migraine
         subjects affected / exposed
    1 / 59 (1.69%)
    0 / 56 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Psychiatric disorders
    Suicidal ideation
         subjects affected / exposed
    0 / 59 (0.00%)
    1 / 56 (1.79%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 0.05%
    Non-serious adverse events
    AMAP102 Placebo
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    31 / 59 (52.54%)
    19 / 56 (33.93%)
    Nervous system disorders
    Headache
         subjects affected / exposed
    5 / 59 (8.47%)
    2 / 56 (3.57%)
         occurrences all number
    5
    2
    General disorders and administration site conditions
    Fatigue
         subjects affected / exposed
    3 / 59 (5.08%)
    1 / 56 (1.79%)
         occurrences all number
    3
    1
    Eye disorders
    Photopsia
         subjects affected / exposed
    7 / 59 (11.86%)
    0 / 56 (0.00%)
         occurrences all number
    7
    0
    Vision blurred
         subjects affected / exposed
    3 / 59 (5.08%)
    0 / 56 (0.00%)
         occurrences all number
    3
    0
    Gastrointestinal disorders
    Diarrhoea
         subjects affected / exposed
    1 / 59 (1.69%)
    3 / 56 (5.36%)
         occurrences all number
    1
    3
    Nausea
         subjects affected / exposed
    8 / 59 (13.56%)
    3 / 56 (5.36%)
         occurrences all number
    8
    3
    Psychiatric disorders
    Anxiety
         subjects affected / exposed
    3 / 59 (5.08%)
    0 / 56 (0.00%)
         occurrences all number
    3
    0

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    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.
    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.
    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.
    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.

    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.
    There were no statistical differences on the primary, secondary or exploratory efficacy endpoints between AMAP102 and placebo.
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