Clinical Trial Results:
A randomised, double blind, placebo controlled crossover study of the influence of the HCN channel blocker ivabradine in a healthy volunteer pain model - an enriched population study
Summary
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EudraCT number |
2012-005627-32 |
Trial protocol |
GB |
Global end of trial date |
07 Mar 2016
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Results information
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Results version number |
v1 |
This version publication date |
02 Apr 2017
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First version publication date |
02 Apr 2017
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Other versions |
v2 |
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 |
IIVoP
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Additional study identifiers
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ISRCTN number |
- | ||
US NCT number |
- | ||
WHO universal trial number (UTN) |
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Sponsors
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Sponsor organisation name |
Cambridge University Hospitals NHS Foundation Trust & University of Cambridge
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Sponsor organisation address |
Addenbrookes Hospital, Hills Road, Cambridge, United Kingdom, CB2 0QQ
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Public contact |
Carrie Bayliss, CCTU Cambridge University Hospitals NHS Foundation Trust, 44 1223348158, cctu@addenbrookes.nhs.uk
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Scientific contact |
Carrie Bayliss, CCTU Cambridge University Hospitals NHS Foundation Trust, 44 1223348158, cctu@addenbrookes.nhs.uk
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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 |
01 Mar 2017
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Is this the analysis of the primary completion data? |
Yes
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Primary completion date |
07 Mar 2016
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Global end of trial reached? |
Yes
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Global end of trial date |
07 Mar 2016
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Was the trial ended prematurely? |
Yes
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General information about the trial
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Main objective of the trial |
We examined whether ivabradine reduces the intensity of sensitisation induced by capsaicin. Application of capsaicin cream to the skin causes a reddening of the skin, and an increased sensitivity within the area the cream is applied (the primary hyperalgesia area) and in surrounding areas (the secondary hyperalgesia area). Changes in sensitivity can be assessed using quantitative sensory testing (QST). This will be an enriched population study, meaning that we will only include participants who respond to capsaicin. This was determined at the screening visit.
The principle research objective was to investigate whether ivabradine reduces the area of secondary punctate mechanical hyperalgesia induced by capsaicin (a change in normal sensation to a von Frey hair or pin prick stimulator).
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Protection of trial subjects |
Blood pressure and heart rate monitoring was carried out during each visit and reviewed for safety before subjects were discharged from the clinical environment.
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Background therapy |
Capsaicin 0.5% cream; approximately 0.5 –1ml applied topically to alternating forearms | ||
Evidence for comparator |
The non-selective HCN channel blocking drug ivabradine is licensed for the symptomatic treatment of stable angina pectoris in patients with coronary artery disease and the treatment of heart failure. We recently investigated its effects on the symptoms of neuropathic pain in a smaller scale clinical trial (IISNeP) in 12 healthy volunteers (data not yet published). Results from this previous trial suggested that ivabradine may influence capsaicin-induced thermal and mechanical hyperalgesia, but this effect was of borderline statistical significance. However, in this initial trial there was variability in the size of the area of hyperalgesia that developed on the forearm between volunteers. The effect of ivabradine was greater in those participants who developed a large area of hyperalgesia (i.e. responded to capsaicin), providing strong justification for an enriched population trial of the influence of ivabradine on hyperalgesia in a group of capsaicin responders. This method of recruitment for experimental clinical studies using capsaicin has been previously reported due to the occurrence of capsaicin-responders and non-responders. | ||
Actual start date of recruitment |
01 Jun 2014
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Long term follow-up planned |
No
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Independent data monitoring committee (IDMC) involvement? |
Yes
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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 |
United Kingdom: 55
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Worldwide total number of subjects |
55
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EEA total number of subjects |
55
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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) |
55
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From 65 to 84 years |
0
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85 years and over |
0
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Recruitment
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Recruitment details |
All subjects were recruited within the UK. | ||||||||||||||||||
Pre-assignment
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Screening details |
Area of capsaicin induced hyperalgesia on the screening visit was calculated to determine capsaicin-responders who proceed into the treatment phase of the trial. A capsaicin-responder was defined as someone who has an area of punctate hyperalgesia on the forearm equal to or greater than 20 cm(2), rounded to the nearest cm(2), at at 75 minutes. | ||||||||||||||||||
Pre-assignment period milestones
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Number of subjects started |
55 | ||||||||||||||||||
Number of subjects completed |
27 | ||||||||||||||||||
Pre-assignment subject non-completion reasons
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Reason: Number of subjects |
Did not fulfill screening criteria: 28 | ||||||||||||||||||
Period 1
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Period 1 title |
Post Screening @ 0 mins (Baseline)
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Is this the baseline period? |
Yes | ||||||||||||||||||
Allocation method |
Randomised - controlled
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Blinding used |
Double blind | ||||||||||||||||||
Roles blinded |
Subject, Investigator, Monitor, Data analyst, Assessor | ||||||||||||||||||
Blinding implementation details |
Subjects, researchers & statisticians were blinded to allocation to Investigational Medicinal Product (IMP). Placebo and active medication comparator were designed and manufactured to be visually indistinguishable.
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Arms
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Are arms mutually exclusive |
Yes
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Arm title
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Ivabradine First | ||||||||||||||||||
Arm description |
Subjects were randomised to Ivabradine first and Placebo second or to Placebo first and Ivabradine second in a cross over study. | ||||||||||||||||||
Arm type |
Crossover | ||||||||||||||||||
Investigational medicinal product name |
Ivabradine
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Investigational medicinal product code |
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Other name |
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Pharmaceutical forms |
Film-coated tablet
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Routes of administration |
Oral use
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Dosage and administration details |
7.5 mg oral administration
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Investigational medicinal product name |
Placebo
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Investigational medicinal product code |
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Other name |
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Pharmaceutical forms |
Tablet
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Routes of administration |
Oral use
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Dosage and administration details |
placebo containing only excipients for oral administration (indistinguishable visually from ivabradine 7.5 mg film coated tablets for oral administration).
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Arm title
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Placebo First | ||||||||||||||||||
Arm description |
Subjects were randomised to either Ivabradine first or Placebo First in a cross over design study | ||||||||||||||||||
Arm type |
Crossover | ||||||||||||||||||
Investigational medicinal product name |
Ivabradine
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Investigational medicinal product code |
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Other name |
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Pharmaceutical forms |
Film-coated tablet
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Routes of administration |
Oral use
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Dosage and administration details |
7.5 mg oral administration
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Investigational medicinal product name |
Placebo
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Investigational medicinal product code |
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Other name |
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Pharmaceutical forms |
Tablet
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Routes of administration |
Oral use
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Dosage and administration details |
placebo containing only excipients for oral administration (indistinguishable visually from ivabradine 7.5 mg film coated tablets for oral administration).
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Notes [1] - The number of subjects reported to be in the baseline period are not the same as the worldwide number enrolled in the trial. It is expected that these numbers will be the same. Justification: The number enrolled included those subjects who were not randomised because they failed to fulfill the criteria for medical screening or were not capsaicin responders. This is a cross over study and the numbers that enter each period are not reportable in a design that inflexibly requests inputs as though this were a parallel arm study. |
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Period 2
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Period 2 title |
Post Screening @15, 30, 45, 60 & 75 mins
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Is this the baseline period? |
No | ||||||||||||||||||
Allocation method |
Randomised - controlled
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Blinding used |
Double blind | ||||||||||||||||||
Roles blinded |
Subject, Investigator, Monitor, Data analyst, Assessor | ||||||||||||||||||
Blinding implementation details |
Ivabradine and Placebo tablets were formulated to be visually identically and indistinguishable.
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Arms
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Are arms mutually exclusive |
Yes
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Arm title
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Ivabardine first | ||||||||||||||||||
Arm description |
Subjects were randomised to either Ivabradine first or placebo first sequences of IMP administration | ||||||||||||||||||
Arm type |
Experimental | ||||||||||||||||||
Investigational medicinal product name |
Ivabradine
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Investigational medicinal product code |
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Other name |
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Pharmaceutical forms |
Film-coated tablet
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Routes of administration |
Oral use
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Dosage and administration details |
7.5 mg oral administration
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Investigational medicinal product name |
Placebo
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Investigational medicinal product code |
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Other name |
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Pharmaceutical forms |
Tablet
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Routes of administration |
Oral use
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Dosage and administration details |
placebo containing only excipients for oral administration (indistinguishable visually from ivabradine 7.5 mg film coated tablets for oral administration).
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Arm title
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Placebo first | ||||||||||||||||||
Arm description |
Subjects were randomised to receive Ivabradine or Placebo first in a double blind randomised cross-over study design | ||||||||||||||||||
Arm type |
Active comparator | ||||||||||||||||||
Investigational medicinal product name |
Ivabradine
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Investigational medicinal product code |
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Other name |
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Pharmaceutical forms |
Film-coated tablet
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Routes of administration |
Oral use
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Dosage and administration details |
7.5 mg oral administration
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Investigational medicinal product name |
Placebo
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Investigational medicinal product code |
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Other name |
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Pharmaceutical forms |
Tablet
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Routes of administration |
Oral use
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Dosage and administration details |
placebo containing only excipients for oral administration (indistinguishable visually from ivabradine 7.5 mg film coated tablets for oral administration).
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Baseline characteristics reporting groups
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Reporting group title |
Ivabradine First
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Reporting group description |
Subjects were randomised to Ivabradine first and Placebo second or to Placebo first and Ivabradine second in a cross over study. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reporting group title |
Placebo First
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Reporting group description |
Subjects were randomised to either Ivabradine first or Placebo First in a cross over design study | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Subject analysis sets
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Subject analysis set title |
Primary Endpoint - Punctate Hyperalgesia
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Subject analysis set type |
Intention-to-treat | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Subject analysis set description |
All subjects who passed the screening parts of the study and were randomised (regardless of contactability post randomisation).
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End points reporting groups
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Reporting group title |
Ivabradine First
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Reporting group description |
Subjects were randomised to Ivabradine first and Placebo second or to Placebo first and Ivabradine second in a cross over study. | ||
Reporting group title |
Placebo First
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Reporting group description |
Subjects were randomised to either Ivabradine first or Placebo First in a cross over design study | ||
Reporting group title |
Ivabardine first
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Reporting group description |
Subjects were randomised to either Ivabradine first or placebo first sequences of IMP administration | ||
Reporting group title |
Placebo first
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Reporting group description |
Subjects were randomised to receive Ivabradine or Placebo first in a double blind randomised cross-over study design | ||
Subject analysis set title |
Primary Endpoint - Punctate Hyperalgesia
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Subject analysis set type |
Intention-to-treat | ||
Subject analysis set description |
All subjects who passed the screening parts of the study and were randomised (regardless of contactability post randomisation).
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End point title |
Area of Punctate Hyperalgesia | ||||||||||||
End point description |
Area of punctate hyperalgesia 75 minutes post application of capsaisin cream
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End point type |
Primary
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End point timeframe |
Outcome at 75 minutes
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Statistical analysis title |
Hierarchical analysis | ||||||||||||
Statistical analysis description |
Hierarchical analysis was carried out for this endpoint to account for intra subject correlation (repeated measures) and to provide for Ivabradine versus Placebo contrasts. Restricted Maximum Likelihood was used for purposes of inferences. Where models did not converge the baseline values (invariably invariantly zero) were removed.
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Comparison groups |
Placebo first v Ivabardine first
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Number of subjects included in analysis |
24
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Analysis specification |
Pre-specified
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Analysis type |
equivalence | ||||||||||||
P-value |
= 0.8263 | ||||||||||||
Method |
Mixed models analysis | ||||||||||||
Parameter type |
Adjusted mean difference fixed effects | ||||||||||||
Point estimate |
1.6187
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Confidence interval |
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level |
95% | ||||||||||||
sides |
2-sided
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lower limit |
-13.08 | ||||||||||||
upper limit |
16.32 | ||||||||||||
Variability estimate |
Standard error of the mean
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Dispersion value |
7.3413
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Adverse events information
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Timeframe for reporting adverse events |
From the onset of screening to last patient last visit
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Adverse event reporting additional description |
Information about adverse events were collected both during routinely scheduled visits as well when subjects opportunistically contacted the researchers.
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Assessment type |
Non-systematic | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary used for adverse event reporting
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Dictionary name |
MedDRA | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary version |
19.1
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Reporting groups
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Reporting group title |
IIVoP Safety Population
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Reporting group description |
This population comprises all subjects who were exposed to any IMP | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Frequency threshold for reporting non-serious adverse events: 5% | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Substantial protocol amendments (globally) |
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Were there any global substantial amendments to the protocol? No | |||
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. | |||
NONE |