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    Clinical Trial Results:
    A Multicenter, Open-label Study of SI-6603 in Patients with Lumbar Disc Herniation (Phase III)

    Summary
    EudraCT number
    2014-001449-26
    Trial protocol
    ES   DE  
    Global end of trial date
    21 Feb 2018

    Results information
    Results version number
    v1(current)
    This version publication date
    12 May 2019
    First version publication date
    12 May 2019
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    6603/1132
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT02421601
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Seikagaku Corporation
    Sponsor organisation address
    6-1, Marunouchi 1-chome, Chiyoda-ku, Tokyo , Japan, 100-0005
    Public contact
    Clinical Development Department, Seikagaku Corporation, +81 3-5220-8948,
    Scientific contact
    Clinical Development Department, Seikagaku Corporation, +81 3-5220-8948,
    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
    21 Jul 2017
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    21 Feb 2018
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    The primary study objective was to evaluate the safety of a single-dose intervertebral disc injection of SI-6603 at a dose of 1.25 U in subjects with lumbar disc herniation, for a 26-week follow-up period.
    Protection of trial subjects
    At each study center, the protocol and informed consent form (ICF) for this study were reviewed and approved by a duly constituted Institutional Review Board (IRB) or Independent Ethics Committee (IEC) before subjects were screened for entry. Amendments to the protocol were reviewed and approved in the same manner before being implemented. This study was designed and monitored in accordance with the CRO’s standard operating procedures, which comply with the ethical principles of Good Clinical Practice (GCP) as required by the major Regulatory Authorities, and in accordance with the Declaration of Helsinki as amended by the 52nd General Assembly in October 2013. Informed consent was obtained from each subject (or subject's legally authorized representative) before the subject was admitted to the study.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    19 Mar 2015
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Romania: 25
    Country: Number of subjects enrolled
    Spain: 75
    Country: Number of subjects enrolled
    Germany: 72
    Country: Number of subjects enrolled
    United States: 839
    Worldwide total number of subjects
    1011
    EEA total number of subjects
    172
    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)
    957
    From 65 to 84 years
    54
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    The study was planned to be conducted at approximately 80 study centers in the United States (US) and European Union (EU). In the US there were 39 study centers initiated and 33 enrolled subjects. In the EU there were 27 study centers initiated: 9 in Germany, 14 in Spain, and 4 in Romania, with 7, 10, and 4 centers enrolling subjects, respectively

    Pre-assignment
    Screening details
    The study consisted of a 4-week Screening period (Days -28 to -1). All other assessments were done at Screening as per the Schedule of Procedures and Assessments.

    Period 1
    Period 1 title
    Overall (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Not applicable
    Blinding used
    Not blinded

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    SI-6603 (US)
    Arm description
    Following a 4-week Screening period, on Day 0 all subjects in US received a single intradiscal injection of SI-6603 1.25 U.
    Arm type
    Experimental

    Investigational medicinal product name
    SI-6603
    Investigational medicinal product code
    SI-6603
    Other name
    Condoliase
    Pharmaceutical forms
    Concentrate and solvent for solution for injection
    Routes of administration
    Intradiscal use
    Dosage and administration details
    SI-6603 for injection is a lyophilized injectable containing SI-6603 as an active ingredient. An SI-6603 for injection vial was reconstituted with 1.2 mL of saline to prepare a 1.25 U/mL solution of SI-6603. A volume of 1.0 mL was administered into the intervertebral disc in a single-dose.

    Arm title
    SI-6603 (EU)
    Arm description
    Following a 4-week Screening period, on Day 0 all subjects in Germany, Spain and Romania received a single intradiscal injection of SI-6603 1.25 U.
    Arm type
    Experimental

    Investigational medicinal product name
    SI-6603
    Investigational medicinal product code
    SI-6603
    Other name
    Condoliase
    Pharmaceutical forms
    Concentrate and solvent for solution for injection
    Routes of administration
    Intradiscal use
    Dosage and administration details
    SI-6603 for injection is a lyophilized injectable containing SI-6603 as an active ingredient. An SI-6603 for injection vial was reconstituted with 1.2 mL of saline to prepare a 1.25 U/mL solution of SI-6603. A volume of 1.0 mL was administered into the intervertebral disc in a single-dose.

    Number of subjects in period 1
    SI-6603 (US) SI-6603 (EU)
    Started
    839
    172
    Completed
    753
    156
    Not completed
    86
    16
         Adverse event, serious fatal
    4
    -
         Consent withdrawn by subject
    29
    7
         Physician decision
    3
    1
         Adverse event, non-fatal
    1
    -
         Other
    45
    7
         Lack of efficacy
    4
    1

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    SI-6603 (US)
    Reporting group description
    Following a 4-week Screening period, on Day 0 all subjects in US received a single intradiscal injection of SI-6603 1.25 U.

    Reporting group title
    SI-6603 (EU)
    Reporting group description
    Following a 4-week Screening period, on Day 0 all subjects in Germany, Spain and Romania received a single intradiscal injection of SI-6603 1.25 U.

    Reporting group values
    SI-6603 (US) SI-6603 (EU) Total
    Number of subjects
    839 172 1011
    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 (inter-quartile range (Q1-Q3))
    49.7 (43.0 to 57.0) 46.1 (39.0 to 52.5) -
    Gender categorical
    Units: Subjects
        Female
    376 83 459
        Male
    463 89 552

    End points

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    End points reporting groups
    Reporting group title
    SI-6603 (US)
    Reporting group description
    Following a 4-week Screening period, on Day 0 all subjects in US received a single intradiscal injection of SI-6603 1.25 U.

    Reporting group title
    SI-6603 (EU)
    Reporting group description
    Following a 4-week Screening period, on Day 0 all subjects in Germany, Spain and Romania received a single intradiscal injection of SI-6603 1.25 U.

    Primary: Number of subjects with Adverse events (AEs)

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    End point title
    Number of subjects with Adverse events (AEs) [1]
    End point description
    The number of subjects with AEs was presented as a measure to evaluate the safety of a single-dose intervertebral disc injection of SI-6603 at a dose of 1.25 U in patients with lumbar disc herniation.
    End point type
    Primary
    End point timeframe
    From screening (Day -28) to follow-up period (week 26) or early discontinuation. Although AEs were collected from Day -28, only those AEs collected from Day 0 to week 26 or early discontinuation are presented in results.
    Notes
    [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: No statistical analysis is available for this primary endpoint
    End point values
    SI-6603 (US) SI-6603 (EU)
    Number of subjects analysed
    824
    167
    Units: Subjects
    number (not applicable)
        Any Treatment-Emergent Adverse Events (TEAE)
    497
    118
        Any treatment-related TEAE
    140
    39
        Any serious adverse event (SAE)
    31
    5
        Any treatment-related SAE
    0
    0
        TEAE with fatal outcome
    4
    0
        Severe TEAE
    31
    4
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    From screening (Day -28) to follow-up period (week 26) or early discontinuation. Although AEs were collected from Day -28, only those AEs collected from Day 0 to week 26 or early discontinuation are presented in results.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    19.1
    Reporting groups
    Reporting group title
    SI-6603 (US)
    Reporting group description
    Following a 4-week Screening period, on Day 0 all subjects in US received a single intradiscal injection of SI-6603 1.25 U.

    Reporting group title
    SI-6603 (EU)
    Reporting group description
    Following a 4-week Screening period, on Day 0 all subjects in Germany, Spain and Romania received a single intradiscal injection of SI-6603 1.25 U.

    Serious adverse events
    SI-6603 (US) SI-6603 (EU)
    Total subjects affected by serious adverse events
         subjects affected / exposed
    31 / 824 (3.76%)
    5 / 167 (2.99%)
         number of deaths (all causes)
    4
    0
         number of deaths resulting from adverse events
    0
    0
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Bladder cancer
         subjects affected / exposed
    1 / 824 (0.12%)
    0 / 167 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Breast cancer
         subjects affected / exposed
    1 / 824 (0.12%)
    0 / 167 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Hodgkin's disease recurrent
         subjects affected / exposed
    1 / 824 (0.12%)
    0 / 167 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Small intestine adenocarcinoma
         subjects affected / exposed
    0 / 824 (0.00%)
    1 / 167 (0.60%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Vascular disorders
    Hypertensive crisis
         subjects affected / exposed
    0 / 824 (0.00%)
    1 / 167 (0.60%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    General disorders and administration site conditions
    Non-cardiac chest pain
         subjects affected / exposed
    2 / 824 (0.24%)
    0 / 167 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pain
         subjects affected / exposed
    0 / 824 (0.00%)
    1 / 167 (0.60%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Reproductive system and breast disorders
    Uterine haemorrhage
         subjects affected / exposed
    1 / 824 (0.12%)
    0 / 167 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Asthma
         subjects affected / exposed
    2 / 824 (0.24%)
    0 / 167 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Chronic obstructive pulmonary disease
         subjects affected / exposed
    1 / 824 (0.12%)
    0 / 167 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Psychiatric disorders
    Drug dependence
         subjects affected / exposed
    1 / 824 (0.12%)
    0 / 167 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Panic attack
         subjects affected / exposed
    1 / 824 (0.12%)
    0 / 167 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Investigations
    Nuclear magnetic resonance imaging abnormal
         subjects affected / exposed
    1 / 824 (0.12%)
    0 / 167 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Injury, poisoning and procedural complications
    Ankle fracture
         subjects affected / exposed
    2 / 824 (0.24%)
    0 / 167 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Road traffic accident
         subjects affected / exposed
    2 / 824 (0.24%)
    0 / 167 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 2
    0 / 0
    Spinal compression fracture
         subjects affected / exposed
    1 / 824 (0.12%)
    0 / 167 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Toxicity to various agents
         subjects affected / exposed
    1 / 824 (0.12%)
    0 / 167 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    Wound dehiscence
         subjects affected / exposed
    1 / 824 (0.12%)
    0 / 167 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cardiac disorders
    Acute myocardial infarction
         subjects affected / exposed
    1 / 824 (0.12%)
    0 / 167 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cardio-respiratory arrest
         subjects affected / exposed
    1 / 824 (0.12%)
    0 / 167 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    Nervous system disorders
    Cerebral ischaemia
         subjects affected / exposed
    0 / 824 (0.00%)
    1 / 167 (0.60%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Sciatica
         subjects affected / exposed
    1 / 824 (0.12%)
    0 / 167 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Syncope
         subjects affected / exposed
    1 / 824 (0.12%)
    0 / 167 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Transient ischaemic attack
         subjects affected / exposed
    2 / 824 (0.24%)
    0 / 167 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gastrointestinal disorders
    Ascites
         subjects affected / exposed
    1 / 824 (0.12%)
    0 / 167 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Colitis
         subjects affected / exposed
    1 / 824 (0.12%)
    0 / 167 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Hepatobiliary disorders
    Cholecystitis
         subjects affected / exposed
    1 / 824 (0.12%)
    0 / 167 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cholelithiasis
         subjects affected / exposed
    0 / 824 (0.00%)
    1 / 167 (0.60%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Musculoskeletal and connective tissue disorders
    Arthralgia
         subjects affected / exposed
    1 / 824 (0.12%)
    0 / 167 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Back pain
         subjects affected / exposed
    1 / 824 (0.12%)
    0 / 167 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Intervertebral disc protrusion
         subjects affected / exposed
    2 / 824 (0.24%)
    1 / 167 (0.60%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Osteoarthritis
         subjects affected / exposed
    1 / 824 (0.12%)
    0 / 167 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pain in extremity
         subjects affected / exposed
    1 / 824 (0.12%)
    0 / 167 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Paraspinal abscess
         subjects affected / exposed
    1 / 824 (0.12%)
    0 / 167 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Infections and infestations
    Pneumonia
         subjects affected / exposed
    1 / 824 (0.12%)
    0 / 167 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Urinary tract infection bacterial
         subjects affected / exposed
    1 / 824 (0.12%)
    0 / 167 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Urosepsis
         subjects affected / exposed
    1 / 824 (0.12%)
    0 / 167 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Wound infection
         subjects affected / exposed
    1 / 824 (0.12%)
    0 / 167 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Metabolism and nutrition disorders
    Hyponatraemia
         subjects affected / exposed
    1 / 824 (0.12%)
    0 / 167 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 1%
    Non-serious adverse events
    SI-6603 (US) SI-6603 (EU)
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    493 / 824 (59.83%)
    117 / 167 (70.06%)
    Investigations
    Alanine aminotransferase increased
         subjects affected / exposed
    7 / 824 (0.85%)
    2 / 167 (1.20%)
         occurrences all number
    8
    2
    Blood alkaline phosphatase increased
         subjects affected / exposed
    9 / 824 (1.09%)
    0 / 167 (0.00%)
         occurrences all number
    9
    0
    Blood cholesterol increased
         subjects affected / exposed
    4 / 824 (0.49%)
    2 / 167 (1.20%)
         occurrences all number
    4
    2
    Blood triglycerides increased
         subjects affected / exposed
    10 / 824 (1.21%)
    0 / 167 (0.00%)
         occurrences all number
    11
    0
    C-reactive protein increased
         subjects affected / exposed
    37 / 824 (4.49%)
    3 / 167 (1.80%)
         occurrences all number
    40
    3
    Nuclear magnetic resonance imaging spinal abnormal
         subjects affected / exposed
    158 / 824 (19.17%)
    48 / 167 (28.74%)
         occurrences all number
    158
    49
    Spinal X-ray abnormal
         subjects affected / exposed
    64 / 824 (7.77%)
    12 / 167 (7.19%)
         occurrences all number
    71
    14
    White blood cell count increased
         subjects affected / exposed
    12 / 824 (1.46%)
    0 / 167 (0.00%)
         occurrences all number
    13
    0
    Injury, poisoning and procedural complications
    Contusion
         subjects affected / exposed
    2 / 824 (0.24%)
    2 / 167 (1.20%)
         occurrences all number
    2
    2
    Hand fracture
         subjects affected / exposed
    0 / 824 (0.00%)
    2 / 167 (1.20%)
         occurrences all number
    0
    2
    Vascular disorders
    Hypertension
         subjects affected / exposed
    9 / 824 (1.09%)
    0 / 167 (0.00%)
         occurrences all number
    9
    0
    Nervous system disorders
    Dizziness
         subjects affected / exposed
    2 / 824 (0.24%)
    2 / 167 (1.20%)
         occurrences all number
    2
    2
    Headache
         subjects affected / exposed
    8 / 824 (0.97%)
    6 / 167 (3.59%)
         occurrences all number
    8
    6
    Hypoaesthesia
         subjects affected / exposed
    6 / 824 (0.73%)
    3 / 167 (1.80%)
         occurrences all number
    8
    4
    Paraesthesia
         subjects affected / exposed
    1 / 824 (0.12%)
    6 / 167 (3.59%)
         occurrences all number
    1
    6
    Sciatica
         subjects affected / exposed
    22 / 824 (2.67%)
    4 / 167 (2.40%)
         occurrences all number
    23
    4
    General disorders and administration site conditions
    Fatigue
         subjects affected / exposed
    0 / 824 (0.00%)
    2 / 167 (1.20%)
         occurrences all number
    0
    2
    Gastrointestinal disorders
    Diarrhoea
         subjects affected / exposed
    7 / 824 (0.85%)
    2 / 167 (1.20%)
         occurrences all number
    7
    2
    Nausea
         subjects affected / exposed
    12 / 824 (1.46%)
    3 / 167 (1.80%)
         occurrences all number
    12
    3
    Vomiting
         subjects affected / exposed
    5 / 824 (0.61%)
    2 / 167 (1.20%)
         occurrences all number
    6
    2
    Respiratory, thoracic and mediastinal disorders
    Asthma
         subjects affected / exposed
    3 / 824 (0.36%)
    2 / 167 (1.20%)
         occurrences all number
    3
    2
    Skin and subcutaneous tissue disorders
    Hyperhidrosis
         subjects affected / exposed
    3 / 824 (0.36%)
    2 / 167 (1.20%)
         occurrences all number
    3
    2
    Pruritus
         subjects affected / exposed
    3 / 824 (0.36%)
    2 / 167 (1.20%)
         occurrences all number
    3
    2
    Rash
         subjects affected / exposed
    11 / 824 (1.33%)
    0 / 167 (0.00%)
         occurrences all number
    12
    0
    Musculoskeletal and connective tissue disorders
    Arthralgia
         subjects affected / exposed
    18 / 824 (2.18%)
    6 / 167 (3.59%)
         occurrences all number
    18
    6
    Back pain
         subjects affected / exposed
    128 / 824 (15.53%)
    29 / 167 (17.37%)
         occurrences all number
    136
    32
    Intervertebral disc protrusion
         subjects affected / exposed
    3 / 824 (0.36%)
    2 / 167 (1.20%)
         occurrences all number
    3
    2
    Muscle spasms
         subjects affected / exposed
    16 / 824 (1.94%)
    1 / 167 (0.60%)
         occurrences all number
    19
    1
    Neck pain
         subjects affected / exposed
    3 / 824 (0.36%)
    2 / 167 (1.20%)
         occurrences all number
    3
    3
    Pain in extremity
         subjects affected / exposed
    42 / 824 (5.10%)
    11 / 167 (6.59%)
         occurrences all number
    42
    11
    Infections and infestations
    Influenza
         subjects affected / exposed
    6 / 824 (0.73%)
    4 / 167 (2.40%)
         occurrences all number
    6
    4
    Nasopharyngitis
         subjects affected / exposed
    9 / 824 (1.09%)
    11 / 167 (6.59%)
         occurrences all number
    9
    13
    Sinusitis
         subjects affected / exposed
    12 / 824 (1.46%)
    1 / 167 (0.60%)
         occurrences all number
    13
    1
    Tonsillitis
         subjects affected / exposed
    0 / 824 (0.00%)
    3 / 167 (1.80%)
         occurrences all number
    0
    3
    Upper respiratory tract infection
         subjects affected / exposed
    9 / 824 (1.09%)
    1 / 167 (0.60%)
         occurrences all number
    9
    1
    Metabolism and nutrition disorders
    Hypertriglyceridaemia
         subjects affected / exposed
    13 / 824 (1.58%)
    1 / 167 (0.60%)
         occurrences all number
    14
    1

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    15 Apr 2015
    Amendment 1 included the following changes to the protocol: •Change in administrative details: new General Manager at Seikagaku and a change in the name of the company used for imaging •Per-protocol population was removed, as there was no primary efficacy analysis •Clarification was added to an exclusion criterion •Criteria were modified for subject withdrawal, to allow a more appropriate evaluation of safety •The definition of permitted concomitant medications and previous and concomitant therapies were clarified •Notes for precaution on intradiscal injection was added •Subject demographic parameters were clarified
    09 Sep 2015
    Amendment 2 included the following changes to the protocol: •Planned number of study centers were modified •Follow-up period increased from 13 to 26 weeks •Clarification was added to the exclusion criteria •A Data Safety Monitoring Board was established
    24 Jun 2016
    Amendment 3 included the following changes to the protocol: •Changes in measuring method and research center of a laboratory assessment •The SAE reporting contact was changed

    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.
    None reported
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