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    Summary
    EudraCT Number:2020-002220-37
    Sponsor's Protocol Code Number:UP-CLI-2020-001
    National Competent Authority:Italy - Italian Medicines Agency
    Clinical Trial Type:EEA CTA
    Trial Status:Ongoing
    Date on which this record was first entered in the EudraCT database:2021-06-07
    Trial results
    Index
    A. PROTOCOL INFORMATION
    B. SPONSOR INFORMATION
    C. APPLICANT IDENTIFICATION
    D. IMP IDENTIFICATION
    D.8 INFORMATION ON PLACEBO
    E. GENERAL INFORMATION ON THE TRIAL
    F. POPULATION OF TRIAL SUBJECTS
    G. INVESTIGATOR NETWORKS TO BE INVOLVED IN THE TRIAL
    N. REVIEW BY THE COMPETENT AUTHORITY OR ETHICS COMMITTEE IN THE COUNTRY CONCERNED
    P. END OF TRIAL
    Expand All   Collapse All
    A. Protocol Information
    A.1Member State ConcernedItaly - Italian Medicines Agency
    A.2EudraCT number2020-002220-37
    A.3Full title of the trial
    Comparison of the analgesic effect of a new paracetamol formulation (paracetamol UNIFLASH) for buccal use and two different doses of an oral paracetamol form controlled versus placebo in patients suffering from moderate pain due to a tooth extraction.
    Studio di comparazione controllato con placebo dell’effetto analgesico di una nuova formulazione di paracetamolo (paracetamolo UNIFLASH) per via buccale rispetto a due diverse dosi di una forma orale di paracetamolo in pazienti con dolore moderato dovuto a estrazione dentale.
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    Evaluation of the efficacy of a new paracetamol formulation for buccal use after a single dose in patients with a moderate pain after a wisdom tooth extraction.
    Valutazione dell'efficacia di una nuova formulazione di paracetamolo per via buccale dopo somministrazione singola in pazienti con estrazione dentale.
    A.3.2Name or abbreviated title of the trial where available
    Paramouth
    Paramouth
    A.4.1Sponsor's protocol code numberUP-CLI-2020-001
    A.7Trial is part of a Paediatric Investigation Plan No
    A.8EMA Decision number of Paediatric Investigation Plan
    B. Sponsor Information
    B.Sponsor: 1
    B.1.1Name of SponsorUNITHER PHARMACEUTICALS
    B.1.3.4CountryFrance
    B.3.1 and B.3.2Status of the sponsorCommercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportUnither Pharmaceuticals
    B.4.2CountryFrance
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationUnither Pharmaceuticals
    B.5.2Functional name of contact pointInnovation and Development Director
    B.5.3 Address:
    B.5.3.1Street Address3-5 rue Saint Georges
    B.5.3.2Town/ cityParis
    B.5.3.3Post code75009
    B.5.3.4CountryFrance
    B.5.4Telephone number0033184825608
    B.5.5Fax number0033184825608
    B.5.6E-mailnathalie.masson@unither-pharma.com
    D. IMP Identification
    D.IMP: 1
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameParacetamol UNIFLASH
    D.3.2Product code [08P1703F0]
    D.3.4Pharmaceutical form Oromucosal/laryngopharyngeal solution
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPBuccal use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNPARACETAMOLO
    D.3.9.2Current sponsor codeNA
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number125
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 2
    D.1.2 and D.1.3IMP RoleComparator
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name Panadol
    D.2.1.1.2Name of the Marketing Authorisation holderGlaxo Smith Kline healthcare
    D.2.1.2Country which granted the Marketing AuthorisationBelgium
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product namePanadol
    D.3.2Product code [N02B01]
    D.3.4Pharmaceutical form Tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNPARACETAMOLO
    D.3.9.2Current sponsor codeNA
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number500
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.8 Information on Placebo
    D.8 Placebo: 1
    D.8.1Is a Placebo used in this Trial?Yes
    D.8.3Pharmaceutical form of the placeboOromucosal/laryngopharyngeal solution
    D.8.4Route of administration of the placeboBuccal use
    D.8 Placebo: 2
    D.8.1Is a Placebo used in this Trial?Yes
    D.8.3Pharmaceutical form of the placeboTablet
    D.8.4Route of administration of the placeboOral use
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Symptomatic short-term treatment of moderate pain
    Trattamento sintomatico a breve termine del dolore moderato
    E.1.1.1Medical condition in easily understood language
    Tooth pain post removal
    Dolore post-estrazione dentale
    E.1.1.2Therapeutic area Body processes [G] - Physiological processes [G07]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.0
    E.1.2Level LLT
    E.1.2Classification code 10036286
    E.1.2Term Post-operative pain
    E.1.2System Organ Class 100000004863
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.0
    E.1.2Level LLT
    E.1.2Classification code 10059723
    E.1.2Term Tooth pain
    E.1.2System Organ Class 100000004856
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    To evaluate the efficacy, after one single administration, of 125 mg of a new paracetamol form for buccal use (paracetamol UNIFLASH) in patients with a moderate pain after tooth extraction in terms of:
    1. Superiority on the pain intensity reduction (Sum of Pain Intensity Difference – SPID0-60min) at 1 hour versus placebo;
    2. Non-inferiority on the onset of pain relief versus 500 mg of the reference oral paracetamol (Panadol®);
    3. Non-inferiority on the number and proportion of responder patients at 1 hour versus 500 mg of the reference oral paracetamol (Panadol®);
    4. Non-inferiority on the Subject's global evaluation (Patient Global Impression of Change - PGIC) of the treatment at 1 hour versus 1000 mg of the reference oral paracetamol (Panadol®);
    5. Non-inferiority on the onset of pain relief versus 1000 mg of the reference oral paracetamol (Panadol®).
    Valutare l'efficacia, dopo una singola somministrazione, di 125 mg di una nuova formulazione di paracetamolo per uso buccale (paracetamolo UNIFLASH) in pazienti con dolore moderato a seguito di estrazione dentale in termini di:
    1. Superiorità nella riduzione dell’intensità del dolore (Somma della differenza dell’intensità del dolore – SPID0-60min) a 1 ora contro il placebo;
    2. Non inferiorità all’insorgenza del sollievo dal dolore contro 500 mg del paracetamolo orale di riferimento (Panadol®);
    3. Non inferiorità sul numero e percentuale di pazienti “responder” a 1 ora contro 500 mg del paracetamolo orale di riferimento (Panadol®);
    4. Non inferiorità sulla valutazione globale del trattamento da parte del soggetto (Valutazione globale del cambiamento da parte del paziente - PGIC) a 1 ora contro 1000 mg del paracetamolo orale di riferimento (Panadol®);
    5. Non inferiorità all’insorgenza del sollievo dal dolore contro 1000 mg del paracetamolo orale di riferimento (Panadol®).
    E.2.2Secondary objectives of the trial
    Evaluate the non-inferiority in term of efficacy after 1 single administration of 125 mg of a new paracetamol form for buccal use paracetamol UNIFLASH vs 2 oral paracetamol at different time-points in patients with a moderate pain after tooth extraction on:
    1) pain intensity reduction at 5,10,30,45mn, 1,2,4,6 h vs 500 & 1000 mg of oral paracetamol
    2) number and proportion of responder patients at 1 h vs 1000 mg of oral paracetamol
    3) number and proportion of responder patients at 5,10,30,45mn;2, 4,6h vs 500 & 1000 mg of oral paracetamol
    4) Pain Relief at 1,2,4,6h vs 500 mg and 1000 mg of oral paracetamol
    5) Duration of pain relief throughout 6 h vs 500 & 1000 mg of oral paracetamol
    6) Subject's global evaluation of the treatment at 1 h vs 500 mg of oral paracetamol
    7) Subject's global evaluation of the treatment at 6 h vs 500 mg and 1000mg of oral paracetamol
    Valutare la non inferiorità in termini di efficacia dopo singola somministrazione di 125 mg di nuova formulazione di paracetamolo per uso buccale (UNIFLASH) contro due concentrazioni del paracetamolo orale a diversi tempi in pazienti con dolore moderato dopo estrazione dentale su:
    1) riduzione dell’intensità del dolore a 5 min, 10 min, 30 min, 45 min, 1 ora, 2 ore, 4 ore e 6 ore contro 500 mg e 1000 mg paracetamolo;
    2) numero e percentuale di pazienti “responder” a 1 ora contro 1000 mg paracetamolo;
    3) Numero e percentuale di pazienti “responder” a 5 min, 10 min, 30 min, 45 min, 2 ore, 4 ore e quindi 6 ore contro 500 mg e 1000 mg paracetamolo;
    4) Sollievo dal dolore a 1 ora, 2 ore, 4 ore e 6 ore contro 500 mg e 1000 mg del paracetamolo;
    5) durata del sollievo dal dolore fino a 6 ore contro 500 mg e 1000 mg del paracetamolo;
    6) PGIC a 1 ora contro 500 mg del paracetamolo;
    7) PGIC a 6 ore contro 500 mg e 1000 mg del paracetamolo.
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1. Male and female patient aged from 18 years of age at the time of signing the informed consent;
    2. Patient scheduled to undergo the removal of one third soft-tissue impacted or not-impacted mandibular molar (associated or not to an ipsilateral erupted maxillary molar) under short-acting local anaesthetic (e.g., mepivacaine or lidocaine) preoperatively;
    3. Patient weighing > 50 kg;
    4. Female patient of childbearing potential must be willing to use a highly efficient birth control method during the study;
    A woman is considered to be of childbearing potential if she is postmenarcheal, has not reached a postmenopausal state (= 12 continuous months of amenorrhea with no identified cause other than menopause), and has not undergone surgical sterilization (removal of ovaries and/or uterus).
    The following are considered as highly effective birth control methods:
    Established use of oral, intravaginal or transdermal combined (estrogen and progestogen containing) hormonal contraception associated with inhibition of ovulation - Established use of oral, injected, or implanted progestogen-only hormonal contraception associated with inhibition of ovulation – Intrauterine hormone-releasing system or placement of an intrauterine device – Bilateral tubal occlusion – Vasectomised partner - True abstinence [periodic abstinence (e.g., calendar, ovulation, symptothermal, postovulation methods) and withdrawal are not acceptable methods of contraception].
    5. Patient able to understand and comply with protocol requirements and instructions;
    6. Patient covered by national healthcare insurance system or similar system, if applicable by local regulations;
    7. Patient who has signed a written informed consent obtained prior to any study-related procedures.
    Un paziente sarà idoneo all’inclusione in questo studio se saranno applicabili tutti i criteri che seguono:
    1. Paziente di sesso maschile e femminile di età pari o superiore a 18 anni al momento della firma del consenso informato;
    2. Paziente con intervento programmato per l’estrazione di un molare mandibolare incluso o meno per un terzo nei tessuti molli (associato o meno a molare mascellare ipsilaterale erotto) in anestesia locale preoperatoria di breve durata (per es., mepivacaina o lidocaina);
    3. Paziente di peso > 50 kg;
    4. La paziente di sesso femminile in età fertile deve essere disposta a far uso di un metodo contraccettivo altamente efficaci durante lo studio;
    Una donna viene considerata in età fertile se è post-menarca, non ha raggiunto lo stato post-menopausale (= 12 mesi continuativi di amenorrea con causa non identificata diversa dalla menopausa), e non sottoposta a sterilizzazione chirurgica (rimozione di ovaie e/o utero).
    Quelli che seguono vengono considerati metodi anticoncezionali altamente efficaci: Uso consolidato di contraccezione orale, intravaginale o transdermica combinata (contenente estrogeno e progestinico) associata a inibizione dell’ovulazione - Uso consolidato di contraccezione orale a base del solo progesterone per via orale, per iniezione o impianto associata a inibizione dell’ovulazione – Sistema intrauterino a rilascio ormonale o posizionamento di dispositivo intrauterino – Legatura bilaterale delle tube – Partner vasectomizzato- Astinenza reale [astinenza periodica (per es., metodi del calendario, ovulazione, sintotermico, post-ovulazione) e coito interrotto non sono metodi contraccettivi accettabili].
    5. Paziente in grado di comprendere e rispettare i requisiti e le istruzioni del protocollo;
    6. Paziente coperto dal sistema sanitario nazionale o sistema simile, se applicabile secondo le normative locali;
    7. Paziente che ha firmato un consenso informato scritto ottenuto prima di qualsiasi procedura correlata allo studio.
    E.4Principal exclusion criteria
    1. Patient who undergoes an extraction of contralateral molar in the same procedure or a bony-impacted molar;
    2. Patient treated by analgesics or nonsteroidal anti-inflammatory drugs (NSAIDs) within the 3 days prior to the day of randomization (or within 5 times the elimination half-life whichever the longest);
    3. Patient who received other analgesic than short-acting preoperative or intraoperative local anaesthetic agents within 12 hours before the start of the surgery or peri-operatively until randomization;
    4. Patient with any known hypersensitivity to paracetamol, ibuprofen or ingredients contained in Investigational Medicinal Products (IMP) and Non-Investigational Medicinal Products (NIMP);
    5. Patient with contra-indication to the alcoholic solution for medical reason (alcoholic weaning or abuse, epilepsy);
    6. Women with positive results on a urine pregnancy test or breastfeeding women or women of childbearing potential without an effective contraception;
    7. Patient with current or chronic history of liver disease, or known hepatic or biliary abnormalities;
    8. Patient with a current or chronic history of severe renal impairment;
    9. Patient with severe heart failure (New York Heart Association (NYHA) Class IV);
    10. Patient with history of gastrointestinal bleeding or perforation, related to previous NSAIDs therapy;
    11. Patient with gastrointestinal haemorrhage, cerebrovascular haemorrhage or of other evolving haemorrhage;
    12. Patient with an active, or history of recurrent peptic ulcer/haemorrhage (two or more distinct episodes of proven ulceration or bleeding);
    13. Patient with inflammation or ulcerative disease of the oral mucosa (i.e., aphthae…);
    14. Patient with known systemic lupus erythematosus;
    15. Patient having developed hypersensitivity reactions, including symptoms of asthma, rhinitis, angioedema or urticaria after taking acetylsalicylic acid or other NSAIDs;
    16. Patient with drug or alcohol abuse within 6 months before dosing with study medication; Alcohol abuse is defined as the consumption of more than 90 mL of liquor or spirits or 530 mL of beer per day, for 5 consecutive days during the 6-month period. Drug abuse is defined as the use of any recreational drug for 5 consecutive days during the 6-month period.
    17. Patient having participated in any clinical research study within the previous 30 days or 5 half-lives duration of the biological effect of the investigational product (whichever is longer);
    18. Patient having any current dental or medical condition that could prevent safe participation in this study;
    19. Unwillingness or inability to follow the procedures outlined in the protocol.
    Il paziente che rispetta uno solo dei criteri che seguono non sarà considerato idoneo allo studio:
    1. Paziente sottoposto a estrazione di molare controlaterale nello stesso intervento o molare incluso nell’osso;
    2. Paziente trattato con analgesici o farmaci antinfiammatori non steroidei (FANS) entro i 3 giorni precedenti il giorno della randomizzazione (o entro 5 volte l'emivita di eliminazione, qualunque sia il periodo più lungo);
    3. Paziente che ha ricevuto analgesici diversi dai farmaci anestetici locali a breve durata d’azione preoperatori o intraoperatori entro 12 ore prima dell’inizio dell’intervento o peri-operatori fino alla randomizzazione;
    4. Paziente con qualsiasi ipersensibilità nota a paracetamolo, ibuprofene o agli ingredienti contenuti nei prodotti in sperimentazione Investigational Medicinal Products (IMP) e nel Medicinale Non Sperimentale (Non-Investigational Medicinal Product (NIMP));
    5. Paziente con controindicazioni alla soluzione alcolica per motivi medici (disintossicazione o abuso di alcool, epilessia);
    6. Paziente di sesso femminile con risultati positivi a un test di gravidanza urinario, o in allattamento, o donna in età fertile senza contraccezione efficace;
    7. Paziente con anamnesi attuale o cronica di patologia epatica, o anomalie epatiche o biliari note;
    8. Paziente con anamnesi attuale o cronica di compromissione renale grave;
    9. Paziente con grave scompenso cardiaco (Classe IV secondo la New York Heart Association [NYHA]);
    10. Paziente con anamnesi di sanguinamento o perforazione gastrointestinale correlata a precedente terapia con FANS;
    11. Paziente con emorragia gastrointestinale, emorragia cerebrovascolare o altra emorragia in corso di evoluzione;
    12. Paziente con ulcera/emorragia peptica ricorrente attuale o passata (due o più episodi distinti di ulcera o sanguinamento dimostrati)
    13. Paziente con malattia infiammatoria o ulcerativa della mucosa orale (per es., afte…);
    14. Paziente con lupus eritematoso sistemico noto;
    15. Paziente che ha sviluppato reazioni di ipersensibilità, tra cui sintomi di asma, rinite, angioedema od orticaria dopo aver assunto acido acetilsalicilico o altri FANS;
    16. Paziente con abuso di droga o alcool entro i 6 mesi precedenti la somministrazione del farmaco di studio;
    L'abuso di alcool viene definito come il consumo di più di 90 ml di liquori o superalcolici o 530 ml di birra al giorno, per 5 giorni consecutivi durante un periodo di 6 mesi. L’abuso di droga viene definito come il consumo di qualsiasi sostanza stupefacente per 5 giorni consecutivi durante un periodo di 6 mesi.
    17. Paziente che ha partecipato a qualsiasi studio clinico entro i precedenti 30 giorni o 5 emivite dell'effetto biologico del prodotto medicinale sperimentale (qualunque sia il periodo più lungo);
    18. Paziente attualmente affetto da qualsiasi condizione odontoiatrica o medica che potrebbe impedire la partecipazione in sicurezza a questo studio;
    19. Mancata disponibilità o incapacità di seguire le procedure delineate nel protocollo.
    E.5 End points
    E.5.1Primary end point(s)
    1. Sum of Pain Intensity Difference (SPID0-60min) over 60 minutes (1 hour) post-IMP intake.
    SPID0-60min: Time-weighted summary measure of the total area under the pain intensity difference (PID) curve that integrates serial assessments of pain during the first hour after IMP intake
    PID will be calculated using the scores of pain intensity assessed by the patient at defined time-points (T5, T10, T15, T20, T30, T45, T60 min) after the IMP intake and/or right before first intake of rescue medication using a 100-mm VAS (0= no pain and 100= worst imaginable pain; see Appendix 17.1 ) compared to baseline.
    2. Onset of pain relief (versus 500 mg of the reference oral paracetamol (Panadol®) Defined as the period for the patient to reach a meaningful pain relief during the first 60 min post-IMP intake. After completion of the 5-point verbal rating scale (VRS) (0- no relief, 1-little relief, 2- some relief, 3- a lot of relief, 4- complete relief of pain; see Appendix 17.2) at T5, T10, T15, T20,T30, T45, T60 min post-IMP intake assessment time-points, the patient will have to answer this question "Do you consider this level of pain relief as meaningful - Yes or No?"
    3. Number and proportion of responder patients at 60 minutes (versus 500 mg of the reference oral paracetamol (Panadol®)). A responder patient is defined as a subject who achieves a reduction of 50 % of pain intensity compared to baseline.
    4. Patient Global Impression of Change (PGIC) versus 1000 mg of the reference oral paracetamol (Panadol®): assessed at T60 min post-IMP intake or at time of rescue medication (whichever happens first).
    5. Onset of pain relief (versus 1000 mg of the reference oral paracetamol (Panadol®)). Defined as the period.for the patient to reach a meaningful pain relief during the first 60 min post-IMP intake. After completion of the a 5-point verbal rating scale (0- no relief, 1- little relief, 2- some relief, 3- a lot of relief, 4- complete relief of pain; see Appendix 17.2) at T5, T10, T15, T20, T30, T45, T60 min post-IMP intake assessment timepoints, the patient will have to answer this question "Do you consider this level of pain relief as meaningful - Yes or No?"
    1. Somma della differenza dell’intensità del dolore (SPID0-60min) nel corso di 60 minuti (1 ora) post-assunzione dell’IMP.
    SPID0-60min: Misura di sintesi ponderata nel tempo dell’area totale sotto la curva della differenza di intensità del dolore (PID) che integra valutazioni seriali del dolore durante la prima ora dopo l’assunzione dell’IMP.
    La PID sarà calcolata usando i punteggi di intensità del dolore valutati dal paziente a time points definiti (T5, T10, T15, T20, T30, T45, T60 minuti) dopo l'assunzione dell’IMP e/o immediatamente prima della prima assunzione del farmaco di salvataggio usando una VAS da 100-mm (0 = nessun dolore e 100 = peggior dolore immaginabile; vedere l’Appendice del protocollo) rispetto al basale.
    2. Insorgenza del sollievo dal dolore (contro 500 mg del paracetamolo orale di riferimento (Panadol®). Definita come il periodo che il paziente impiega a raggiungere un sollievo significativo dal dolore durante i primi 60 minuti dopo l’assunzione dell’IMP. Dopo il completamento della scala verbale di valutazione in 5 punti (VRS) (0- nessun sollievo, 1- poco sollievo, 2- abbastanza sollievo, 3- molto sollievo, 4- totale sollievo dal dolore; vedere Appendice del protocollo) a T5, T10, T15, T20, T30, T45, T60 minuti di time-points di valutazione post-assunzione dell’IMP, il paziente dovrà rispondere alla domanda, “Considera significativo questo livello di sollievo dal dolore - Sì o No?”
    3. Numero e percentuale di pazienti “responder” a 60 minuti (contro 500 mg del paracetamolo orale di riferimento (Panadol®)). Un paziente “responder” viene definito come un soggetto che raggiunge una riduzione dell’intensità del dolore del 50% rispetto al basale.
    4. Valutazione globale del cambiamento da parte del paziente (PGIC) contro 1000 mg del paracetamolo orale di riferimento (Panadol®): valutata a T60 minuti post-assunzione dell’IMP o al momento dell'assunzione del farmaco di salvataggio (qualunque di essi compaia per primo).
    5. Insorgenza del sollievo dal dolore (contro 1000 mg del paracetamolo orale di riferimento (Panadol®)). Definita come il periodo che il paziente impiega a raggiungere un sollievo significativo dal dolore durante i primi 60 minuti dopo l’assunzione dell’IMP. Dopo il completamento della scala verbale di valutazione in 5 punti (0- nessun sollievo, 1- poco sollievo, 2- abbastanza sollievo, 3- molto sollievo, 4- totale sollievo dal dolore; vedere Appendice del protocollo) a T5, T10, T15, T20, T30, T45, T60 minuti di time-point di valutazione post-assunzione dell’IMP, il paziente dovrà rispondere alla domanda, “Considera significativo questo livello di sollievo dal dolore - Sì o No?”
    E.5.1.1Timepoint(s) of evaluation of this end point
    (SPID0-60min) over 60 minutes (1 hour) post-IMP intake((T5, T10, T15, T20, T30, T45, T60 min)
    Onset of pain relief versus 500 mg of the reference oral paracetamol (PanadolR) at T5, T10, T15, T20,T30, T45, T60 min
    Number and proportion of responder patients at 60 minutes
    PGIC at T60 min
    Onset of pain relief (versus 1000 mg of the reference oral paracetamol(PanadolR)) at T5, T10, T15, T20, T30,T45, T60 min
    (SPID0-60min) su 60 minuti (1 ora) dopo l'assunzione dell'IMP (T5, T10, T15, T20, T30, T45, T60 min)
    Inizio della scomparsa del dolore vs. 500 mg del paracetamolo orale di riferimento (PanadolR) a T5, T10, T15, T20,T30, T45, T60 min
    Numero e percentuale di pazienti "responder" a 60 minuti
    PGIC a T60 min
    Inizio della scomparsa del dolore (vs. 1000 mg del paracetamolo orale di riferimento (PanadolR)) a T5, T10, T15, T20, T30,T45, T60 min
    E.5.2Secondary end point(s)
    Sum of Pain Intensity Difference at 5 min (SPID0-5min), 10 min (SPID0-10min), 30 min (SPID0-30min), 45 min (SPID0-45min), 1 hour (SPID0-1h), 2 hour (SPID0-2h), 4 hour (SPID0-4h), and 6 hours (SPID0-6h).
    SPID: time-weighted summary measure of the total area under the pain intensity difference (PID) curve that integrates serial assessments of pain during the first 5 min, 10 min, 30 min, 45 min, 1 hour, 2 hours, 4 hours and then 6 hours after the IMP intake.
    PID will be calculated using the score of pain intensity assessed by the patient at defined time-points (T5, T10, T15, T20, T30, T45, T90, T120, T180, T240, T300 and T360 min) after IMP intake or right before first intake of rescue medication using a 100-
    mm VAS compared to baseline.
    Number and proportion of responders at 60 minutes (versus 1000 mg of the reference oral paracetamol (Panadol®)). A responder patient is defined as a subject who achieves a reduction of 50 % of pain intensity compared to baseline.
    Number and proportion of responders at 5 min, 10 min, 30 min, 45 minutes, 2 hours, 4 hours and then 6 hours. A responder patient is defined as a subject who achieves a reduction of 50 % of pain intensity compared to baseline at each time point of the study.
    Total Pain Relief at 1 hour (TOTPAR0-1h), 2 hours (TOTPAR0-2h), 4 hours (TOTPAR0-4h) and 6 hours (TOTPAR0-6h), measured with a 5-point verbal rating scale (none – a little – some – lot – complete pain relief; see Appendix 2).
    TOTPAR: time-weighted summed measure of the total area under the pain relief (PAR) curve that integrates serial assessments of pain during the first 1 hour, 2 hours, 4 hours and then 6 hours after the IMP intake.
    Pain relief (PAR) will be assessed by the patient at defined time points (T5, T10, T15, T20,T30, T45, T60, T90, T120, T180, T240, T300 and T360 min) after IMP intake and/or right before first intake of rescue medication using a 5-point verbal rating scale (0- no relief, 1-
    little relief, 2- some relief, 3- a lot of relief, 4- complete relief of pain; see Appendix 17.2).
    Period of time before taking rescue analgesic treatment intake.
    Number and proportion of patients taking a rescue analgesic treatment throughout 6 hours following IMP administration.
    Patient Global Impression of Change (PGIC) versus 500 mg of the reference oral paracetamol (Panadol®): assessed at T60 min post-IMP intake or at time of rescue medication (whichever happens first).
    Patient Global Impression of Change (PGIC) versus 500 mg and 1000 mg of the reference oral paracetamol (Panadol®): assessed at T360 min post-IMP intake or at time of rescue medication (whichever happens first).
    Safety endpoints. Safety will be assessed by:
    Occurrence and severity of serious and non-serious Adverse Events (AEs).
    Number of patients withdrawn from the study due to an AE occurrence.
    The safety profile: serious and non-serious AEs will be collected during the whole duration of study. Clinical examination of the buccal mucosa will be performed at 1 hour,before patients go back home.
    Others Exploratory endpoint
    The test volume formulation acceptability will be assessed at 6 hours or right before taking the first rescue medication (whichever happens first). Patients will answer a questionenquiring about the satisfaction with the new oromucosal solution in terms of solution volume
    Obiettivi esplorativi di efficacia
    • Somma della differenza dell’intensità del dolore a 5 min (SPID0-5min), 10 min (SPID0-10min), 30 min (SPID0-30min), 45 min (SPID0-45min), 1 ora (SPID0-1h), 2 ore (SPID0-2h), 4 ore (SPID0-4h), e 6 ore (SPID0-6h). SPID: Misura di sintesi ponderata nel tempo dell’area totale sotto la curva della differenza di intensità del dolore (PID) che integra valutazioni seriali del dolore durante i primi 5 min, 10 min, 30 min, 45 min, 1 ora, 2 ore, 4 ore e quindi 6 ore dopo l’assunzione dell’IMP. La PID sarà calcolata usando il punteggio di intensità del dolore valutata dal paziente a time points definiti (T5, T10, T15, T20, T30, T45, T90, T120, T180, T240, T300 e T360 min) dopo l’assunzione dell’IMP o immediatamente prima della prima assunzione del farmaco di salvataggio usando una scala VAS a 100-mm rispetto al basale.
    • Numero e percentuale di “responder” a 60 minuti (contro 1000 mg del paracetamolo orale di riferimento (Panadol®)).
    Un paziente “responder” viene definito come un soggetto che raggiunge una riduzione dell’intensità del dolore del 50% rispetto al basale.
    • Numero e percentuale di “responder” a 5 min, 10 min, 30 min, 45 min, 2 ore, 4 ore e infine 6 ore.
    Un paziente “responder” viene definito come un soggetto che raggiunge una riduzione dell’intensità del dolore del 50% rispetto al basale a ogni time point dello studio.
    • Sollievo totale dal dolore a 1 ora (TOTPAR0-1h), 2 ore (TOTPAR0-2h), 4 ore (TOTPAR0-4h) e 6 ore (TOTPAR0-6h), misurato con una scala verbale di valutazione
    a 5 punti (nessuno – poco – abbastanza – molto – totale sollievo dal dolore; vedere Appendice del protocollo).
    TOTPAR: Misura di sintesi ponderata nel tempo dell’area totale sotto la curva della differenza di sollievo dal dolore (PAR) che integra valutazioni seriali del dolore durante i primi 1 ora, 2 ore, 4 ore e quindi 6 ore dopo l’assunzione dell’IMP.
    Il sollievo dal dolore (PAR) sarà valutato dal paziente a time points definiti (T5, T10, T15, T20, T30, T45, T60, T90, T120, T180, T240, T300 e T360 min) dopo l’assunzione dell’IMP e/o immediatamente prima della prima assunzione del farmaco di salvataggio, usando una scala verbale di valutazione a 5 punti (0- nessun sollievo, 1- poco sollievo, 2- abbastanza sollievo, 3- molto sollievo, 4- totale sollievo dal dolore; vedere Appendice del protocollo).
    • Periodo di tempo prima dell’assunzione del farmaco analgesico di salvataggio.
    • Numero e percentuale di pazienti che ha assunto un trattamento analgesico di salvataggio per tutte le 6 ore dopo la somministrazione dell’IMP.
    • Valutazione globale del cambiamento da parte del paziente (PGIC) contro 500 mg del paracetamolo orale di riferimento (Panadol®): valutata a T60 minuti post-assunzione dell’IMP o al momento dell'assunzione del farmaco di salvataggio (qualunque di essi compaia per primo).
    • Valutazione globale del cambiamento da parte del paziente (PGIC) contro 500 mg e 1000 mg del paracetamolo orale di riferimento (Panadol®): valutata a T360 minuti post-assunzione dell’IMP o al momento dell'assunzione del farmaco di salvataggio (qualunque di essi compaia per primo).
    E.5.2.1Timepoint(s) of evaluation of this end point
    SPID at 5 min , 10 min , 30 min ), 45 min ), 1 hour , 2 hour ), 4 hour ), and 6 hours .
    PID T5, T10, T15, T20, T30, T45, T90, T120, T180, T240, T300 and T360 min).
    Number and proportion of responders at 60 minutes (versus 1000 mg of Panadol®).
    Number and proportion of responders at 5 min, 10 min, 30 min, 45 minutes,2 hours, 4 hours and then 6 hours.
    Total Pain Relief at 1 hour (TOTPAR0-1h), 2 hours (TOTPAR0-2h), 4 hours(TOTPAR0-4h) and 6 hours (TOTPAR0-6h),
    PAR at: T5, T10, T15, T20, T30, T45, T60, T90, T120, T180, T240, T300 and T360 min
    Period of time before taking rescue analgesic treatment intake.
    Number and proportion of patients taking a rescue analgesic treatment throughout 6 hours following IMP administration.
    SPID a 5 min, 10 min, 30 min, 45 min, 1 ora, 2 ore, 4 ore e 6 ore.
    PID T5, T10, T15, T20, T30, T45, T90, T120, T180, T240, T300 e T360 min).
    Numero e percentuale dei "responders" a 60 minuti (vs. 1000 mg Panadol®).
    Numero e percentuale dei "responders" a 5 min, 10 min, 30 min, 45 min, 2 ore, 4 ore e 6 ore.
    Total Pain Relief a 1 ora (TOTPAR0-1h), 2 ore (TOTPAR0-2h), 4 ore (TOTPAR0-4h) e 6 ore (TOTPAR0-6h),
    PAR a: T5, T10, T15, T20, T30, T45, T60, T90, T120, T180, T240, T300 e T360 min
    Period of time before taking rescue analgesic treatment intake.
    Number and proportion of patients taking a rescue analgesic treatment throughout 6 hours following IMP administration.
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy Yes
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic No
    E.6.7Pharmacodynamic No
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others No
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) No
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other No
    E.7.1.3.1Other trial type description
    E.7.2Therapeutic exploratory (Phase II) No
    E.7.3Therapeutic confirmatory (Phase III) Yes
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled Yes
    E.8.1.1Randomised Yes
    E.8.1.2Open No
    E.8.1.3Single blind No
    E.8.1.4Double blind Yes
    E.8.1.5Parallel group Yes
    E.8.1.6Cross over No
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) Yes
    E.8.2.2Placebo Yes
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial4
    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.8.4.1Number of sites anticipated in Member State concerned4
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA20
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA No
    E.8.6.2Trial being conducted completely outside of the EEA Information not present in EudraCT
    E.8.7Trial 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
    LVLP (Last patient last visit)
    LVLP (Ultima visita dell'ultimo paziente)
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years0
    E.8.9.1In the Member State concerned months9
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years0
    E.8.9.2In all countries concerned by the trial months9
    E.8.9.2In all countries concerned by the trial days0
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 No
    F.1.1.1In Utero No
    F.1.1.2Preterm newborn infants (up to gestational age < 37 weeks) No
    F.1.1.3Newborns (0-27 days) No
    F.1.1.4Infants and toddlers (28 days-23 months) No
    F.1.1.5Children (2-11years) No
    F.1.1.6Adolescents (12-17 years) No
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 400
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 4
    F.2 Gender
    F.2.1Female Yes
    F.2.2Male Yes
    F.3 Group of trial subjects
    F.3.1Healthy volunteers No
    F.3.2Patients Yes
    F.3.3Specific vulnerable populations Yes
    F.3.3.1Women of childbearing potential not using contraception No
    F.3.3.2Women of child-bearing potential using contraception Yes
    F.3.3.3Pregnant women No
    F.3.3.4Nursing women No
    F.3.3.5Emergency situation No
    F.3.3.6Subjects incapable of giving consent personally No
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state101
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 404
    F.4.2.2In the whole clinical trial 404
    F.5 Plans for treatment or care after the subject has ended the participation in the trial (if it is different from the expected normal treatment of that condition)
    At the end of the follow-up period, patients will undergo an end of study (EOS) call. Duration of the follow-up period: 24 hours (+/-12 hours).
    Alla fine del periodo di follow-up, i pazienti effettueranno una visita telefonica di fine studio (EOS). Durata del periodo di follow-up: 24 ore (+/-12 ore).
    G. Investigator Networks to be involved in the Trial
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2021-04-16
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2021-07-07
    P. End of Trial
    P.End of Trial StatusOngoing
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