E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
BPH (Benign prostatic hyperplasia |
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E.1.1.1 | Medical condition in easily understood language |
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E.1.1.2 | Therapeutic area | Diseases [C] - Male diseases of the urinary and reproductive systems [C12] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 17.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10004446 |
E.1.2 | Term | Benign prostatic hyperplasia |
E.1.2 | System Organ Class | 10038604 - Reproductive system and breast disorders |
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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 |
To assess the change in sexual function from baseline in sexually active men with at least moderate BPH (international prostate symptom score - IPSS = or > 12) who are treated with DUODART, compared to men treated with placebo at 1 year. Change in sexual function will be assessed by change in total score from the full men’s sexual health questionnaire (MSHQ) which has domains for erectile dysfunction, ejaculatory function and libido. |
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E.2.2 | Secondary objectives of the trial |
Changes in sexual function from baseline using the full Men’s Sexual Health Questionnaire (MSHQ).
Assess percentage of subjects reaching various thresholds of change in total MSHQ at 12 months.
Changes in erectile dysfunction (ED), ejaculatory dysfunction (EjD), and libido domains (of the MSHQ).
Assess changes in BPH symptoms, quality of life, perception of treatment benefit/satisfaction with treatment and relationship of these changes to sexual function.
Assess changes in MSHQ in subpopulations of men with good BPH symptomatic response that is subjects with IPSS improvement of ≥2 and ≥3 points from baseline and, separately to assess changes in MSHQ scores at 12 months in subpopulations of men with ≥25% improvement from baseline.
EXPLORATORY OBJECTIVE: assess the persistence of sexual adverse events by following up those men with sexual adverse events who withdraw from the study or men with sexual adverse events present at the last visit of the treatment phase.
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. Males aged ≥50 years.
2. Men must be sexually active.
3. A confirmed clinical diagnosis of BPH.
4. International Prostate Symptom Score (IPSS) > or = 12 at Visit 1 (screening), with bother score 4 or less (score from the IPSS Quality of Life question 8).
5. Prostate volume ≥30 cc (by transrectal ultrasonography; TRUS). Measurement should be available by the baseline visit and should have been made /arranged at the screening visit or within the previous 6 months.
6. Total serum prostate specific antigen (PSA) ≥1.5 ng/mL (but see exclusion criteria 1) at Visit 1 (screening).
7. Willing and able to give signed written informed consent and comply with study procedures, including the ability to participate in the study for the full 1 year (or 18 months if necessary because of a persistent sexual AE).
8. Fluent and literate in local language with the ability to read, comprehend and record information on the MSHQ, IPSS, PPSM, BPH Impact Index (BII) and C-SSRS questionnaires.
9. Able to swallow and retain oral medication.
10. Men with a female partner of childbearing potential must either agree to use effective contraception or have had a prior vasectomy. Contraception must be used from 2 weeks prior to administration of the first dose of study treatment until at least 5 half-lives for the drug (45 days) plus 3 months (i.e. a total of 4.5 months) to allow clearance of any altered sperm after the last dose of study treatment.
French subjects: In France, a subject will be eligible for inclusion in this study only if either affiliated to or a beneficiary of a social security category.
Specific information regarding warnings, precautions, contraindications, adverse events, and other pertinent information on the GSK investigational product or other study treatment that may impact subject eligibility is provided in the SmPC for DUODART. |
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E.4 | Principal exclusion criteria |
1. Total serum PSA >10.0 ng/mL at Visit 1 (screening).
2. History or evidence of prostate cancer. Subjects with suspicious ultrasound or DRE who have had a negative biopsy within the preceding 6 months and stable PSA are eligible for the study.
3. Current or prior use (within the periods given) of the following prohibited medications
i. Any prior use of a 5α-reductase inhibitor (finasteride or dutasteride),
ii. Anti-cholinergics (e.g. oxybutynin, propantheline, tolerodine, solifenacin or darifenacin) within 1 month prior to visit 2 (baseline)
iii. An alpha-adrenoreceptor blocker (i.e. indoramin, prazosin, terazosin, tamsulosin, alfuzosin and doxazosin) within 1 month prior to visit 2 (baseline)
iv. Use of any drugs with anti-androgenic properties (e.g. spironolactone, flutamide, bicalutamide, cimetidine, ketoconazole, progestational agents) within the 6 months prior to visit 1 (screening).
v. Use of any drugs noted for propensity to cause gynaecomastia, or which could affect prostate volume, within 6 months prior to Visit 1 (screening).
vi. Use of any investigational or marketed study drug within 30 days or 5 half-lives of the drug in question, (whichever is longer), preceding visit 2 (baseline).
4. Current use (at the baseline visit or within the prior 1month) of: PDE-5 inhibitors, Anabolic steroids, Drugs known or thought to have an interaction with tamsulosin, e.g. cimetidine and warfarin.
5. Use of phytotherapy for BPH within 2 weeks prior to Visit 1 (screening) and/or predicted to need phytotherapy during the study.
6. History of a known (immediate or delayed) hypersensitivity reaction or idiosyncratic reaction to drugs chemically related to the study medication or excipients that, in the opinion of the Investigator or GSK, contraindicate their participation.
7. Previous prostatic surgery (including TURP, balloon dilatation, thermotherapy and stent replacement) or other invasive or minimally invasive procedures to treat BPH.
8. History of flexible/rigid cystoscopy or other instrumentation of the urethra within 7 days prior to Visit 1 (screening). Catheterisation (<10F) is acceptable with no time restriction.
9. Presence of structural abnormalities in the LUT or sexual organs (e.g. urethral stricture, Peyronie's Disease etc) that may cause LUT symptoms or sexual dysfunction.
10. History of AUR.
11. Post-void residual volume >100 mL (suprapubic ultrasound) at Visit 1 (screening) or a recorded PVR above this level on any previous examination. Measurement should be available by the baseline visit and should have been made /arranged at the screening visit or within the previous 6 months.
12. Any causes other than BPH, which may in the judgement of the investigator, result in urinary symptoms (e.g. neurogenic bladder, bladder neck contracture, urethral stricture, bladder malignancy, acute or chronic prostatitis, or acute or chronic urinary tract infections).
13. History of ‘first dose’ hypotensive episode on initiation of alpha-1-adrenoreceptor antagonist therapy.
14. History of postural hypotension, dizziness, vertigo or any other signs and symptoms of orthostasis, which in the opinion of the investigator could be exacerbated by tamsulosin and result in putting the subject at risk of injury.
15. History of breast cancer or clinical breast examination finding of unclear origin or suggestive of malignancy.
16. Prior history of malignancies (other than basal cell carcinoma or squamous cell carcinoma of the skin) within the past 5 years. Subjects with an earlier history of malignancy who have had no evidence of disease for at least the past 5 years are eligible.
17. History of hepatic impairment or abnormal liver function tests at Visit 1 (screening) (defined as ALT, AST or alkaline phosphatase >2 times the ULN, or total bilirubin >1.5 times the ULN (unless associated with predominantly indirect bilirubin elevation or Gilbert's syndrome).
18. History of renal insufficiency, or serum creatinine >1.5 times the upper limit of normal at Visit 1 (screening).
19. Any unstable, serious co-existing medical condition(s) including, but not limited to, myocardial infarction, coronary bypass surgery, unstable angina, cardiac arrhythmias, clinically evident congestive heart failure, or cerebrovascular accident within 6 months prior to the Screening visit; uncontrolled diabetes or peptic ulcer disease which is uncontrolled by medical management.
20. History or current evidence of drug or alcohol abuse within the previous 12 months.
21. History or presence of any serious and/or unstable pre-existing psychiatric disorder or other conditions that in the opinion of the Investigator or GSK Medical Monitor, could interfere with subject’s safety, obtaining informed consent, compliance to the study procedures, or confound the results of the study.
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E.5 End points |
E.5.1 | Primary end point(s) |
Change in sexual function will be assessed by change in total score from the full men’s sexual health questionnaire (MSHQ) which has domains for erectile dysfunction, ejaculatory function and libido. |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
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E.5.2 | Secondary end point(s) |
Changes in sexual function from baseline using the full Men’s Sexual Health Questionnaire (MSHQ).
Assess percentage of subjects reaching various thresholds of change in total MSHQ at 12 months.
Changes in erectile dysfunction (ED), ejaculatory dysfunction (EjD), and libido domains (of the MSHQ).
Assess changes in BPH symptoms, quality of life, perception of treatment benefit/satisfaction with treatment and relationship of these changes to sexual function.
Assess changes in MSHQ in subpopulations of men with good BPH symptomatic response that is subjects with IPSS improvement of ≥2 and ≥3 points from baseline and, separately to assess changes in MSHQ scores at 12 months in subpopulations of men with ≥25% improvement from baseline.
EXPLORATORY OBJECTIVE: assess the persistence of sexual adverse events by following up those men with sexual adverse events who withdraw from the study or men with sexual adverse events present at the last visit of the treatment phase.
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E.5.2.1 | Timepoint(s) of evaluation of this 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 | Yes |
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) | No |
E.7.4 | Therapeutic use (Phase IV) | Yes |
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 | 10 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 46 |
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 |
Australia |
France |
Germany |
Greece |
Hungary |
Italy |
Netherlands |
Spain |
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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 | 2 |
E.8.9.1 | In the Member State concerned months | 6 |
E.8.9.1 | In the Member State concerned days | |
E.8.9.2 | In all countries concerned by the trial years | 2 |
E.8.9.2 | In all countries concerned by the trial months | 6 |