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Use of Tapentadol Oral Solution for Pain After Surgery in Children From Newborn to Less Than 2 Years Old

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ClinicalTrials.gov Identifier: NCT02221674
Recruitment Status : Terminated
First Posted : August 20, 2014
Results First Posted : December 12, 2017
Last Update Posted : January 29, 2018
Sponsor:
Collaborator:
Depomed
Information provided by (Responsible Party):
Grünenthal GmbH

Brief Summary:

This is a multicenter, open-label (all people involved know the identity of the intervention), single dose trial to evaluate the pharmacokinetic (PK) profile (how drugs are absorbed in the body, how are they distributed within the body and how are they removed from the body over time) in children aged from birth to less than 2 years after a surgical procedure that routinely produces moderate to severe acute post-surgical pain.

The trial will also evaluate the safety and tolerability of tapentadol oral solution in the population studied and the effect of tapentadol oral solution on pain.


Condition or disease Intervention/treatment Phase
Moderate to Severe Acute Postoperative Pain Drug: Tapentadol Phase 2

Detailed Description:

This clinical trial has 3 phases: enrollment, treatment (15 hours) and follow up.

During the enrolment phase consent and eligibility will be determined. After surgery, the participant will be given routine pain medication as per standard of care in the hospital.

Treatment phase: When the participant has a functioning gastrointestinal tract after surgery, can tolerate medication administered orally or via a feeding tube, meets the inclusion criteria, and does not meet any exclusion criterion, the participant will be allocated to the investigational medicinal product (IMP). Evaluations will be performed over the next 15 hours, including the assessment of the amount of pain. During this time, 2 blood samples will be taken for testing of the amount of tapentadol and its main metabolites in the participant's blood.

A final follow-up visit is planned to take place up to 2 weeks after taking the trial medication.


Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 40 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Open-label Evaluation of the Population Pharmacokinetic Profile, Safety, Tolerability, and Efficacy of Tapentadol Oral Solution for the Treatment of Post-surgical Pain in Children Aged From Birth to Less Than 2 Years
Actual Study Start Date : November 5, 2014
Primary Completion Date : October 14, 2016
Study Completion Date : November 3, 2016

Resource links provided by the National Library of Medicine

U.S. FDA Resources

Arm Intervention/treatment
Experimental: Tapentadol
Tapentadol 4 mg/mL immediate release oral solution, single dose post-operatively.
Drug: Tapentadol
Other Names:
  • Palexia®
  • Nucynta®
  • Yantil®



Primary Outcome Measures :
  1. Pharmacokinetic Evaluation Based on Serum Concentrations of Tapentadol After a Single Dose of Tapentadol Oral Solution in Participants Aged 6 Months to Less Than 2 Years [ Time Frame: Up to 8 hours after IMP administration ]

    The pharmacokinetic profile of Tapentadol and its major metabolite tapentadol-O-glucuronide was evaluated to enable data based recommendations for the use of Tapentadol in children of different ages.

    Each participant had a single pharmacokinetic sample taken at up to 2 different pre-defined time points.

    Serum was analyzed using liquid chromatography-tandem mass spectrometry. Mean and Standard Deviation of Serum Concentrations of Tapentadol were calculated.

    Summary statistics at a given time point were only determined if at least 2 participants had observations above the lower limit of quantification (LLOQ).

    If overall only a single sample was available at one of the pre-defined time points, the measured value is presented and the standard deviation is given as N/A.


  2. Pharmacokinetic Evaluation Based on Serum Concentrations of Tapentadol After a Single Dose of Tapentadol Oral Solution in Participants Aged 1 Month to Less Than 6 Months [ Time Frame: Up to 8 hours after IMP administration ]

    The pharmacokinetic profile of Tapentadol and its major metabolite tapentadol-O-glucuronide was evaluated to enable data based recommendations for the use of Tapentadol in children of different ages.

    Each participant had a single pharmacokinetic sample taken at up to 2 different pre-defined time points.

    Serum was analyzed using liquid chromatography-tandem mass spectrometry. Mean and Standard Deviation of Serum Concentrations of Tapentadol were calculated.

    Summary statistics at a given time point were only determined if at least 2 participants had observations above the lower limit of quantification (LLOQ).

    If overall only a single sample was available at one of the pre-defined time points, the measured value is presented and the standard deviation is given as N/A.


  3. Pharmacokinetic Evaluation Based on Serum Concentrations of Tapentadol After a Single Dose of Tapentadol Oral Solution in Participants Aged From Birth to Less Than 1 Month [ Time Frame: Up to 8 hours after IMP ]

    The pharmacokinetic profile of Tapentadol and its major metabolite tapentadol-O-glucuronide was evaluated to enable data based recommendations for the use of Tapentadol in children of different ages.

    Each participant had a single pharmacokinetic sample taken at up to 2 different pre-defined time points.

    Serum was analyzed using liquid chromatography-tandem mass spectrometry. Mean and Standard Deviation of Serum Concentrations of Tapentadol were calculated.

    Summary statistics at a given time point were only determined if at least 2 participants had observations above the lower limit of quantification (LLOQ).

    If overall only a single sample was available at one of the pre-defined time points, the measured value is presented and the standard deviation is given as N/A.


  4. Pharmacokinetic Profile of Serum Concentrations of Tapentadol-O-glucuronide After a Single Dose of Tapentadol Oral Solution in Participants Aged 6 Months to Less Than 2 Years [ Time Frame: Up to 8 hours after IMP ]

    The pharmacokinetic profile of Tapentadol and its major metabolite tapentadol-O-glucuronide was evaluated to enable data based recommendations for the use of Tapentadol in children of different ages.

    Each participant had a single pharmacokinetic sample taken at up to 2 different pre-defined time points.

    Serum was analyzed using liquid chromatography-tandem mass spectrometry. Mean and Standard Deviation of Serum Concentrations of tapentadol-O-glucuronide were calculated.

    Summary statistics at a given time point were only determined if at least 2 participants had observations above the lower limit of quantification (LLOQ).

    If overall only a single sample was available at one of the pre-defined time points, the measured value is presented and the standard deviation is given as N/A.


  5. Pharmacokinetic Profile of Serum Concentrations of Tapentadol-O-glucuronide After a Single Dose of Tapentadol Oral Solution in Participants Aged 1 Month to Less Than 6 Months [ Time Frame: Up to 8 hours after IMP ]

    The pharmacokinetic profile of Tapentadol and its major metabolite tapentadol-O-glucuronide was evaluated to enable data based recommendations for the use of Tapentadol in children of different ages.

    Each participant had a single pharmacokinetic sample taken at up to 2 different pre-defined time points.

    Serum was analyzed using liquid chromatography-tandem mass spectrometry. Mean and Standard Deviation of Serum Concentrations of tapentadol-O-glucuronide were calculated.

    Summary statistics at a given time point were only determined if at least 2 participants had observations above the lower limit of quantification (LLOQ).

    If overall only a single sample was available at one of the pre-defined time points, the measured value is presented and the standard deviation is given as N/A.


  6. Pharmacokinetic Profile of Serum Concentrations of Tapentadol-O-glucuronide After a Single Dose of Tapentadol Oral Solution in Participants Aged From Birth to Less Than 1 Month [ Time Frame: Up to 8 hours after IMP ]

    The pharmacokinetic profile of Tapentadol and its major metabolite tapentadol-O-glucuronide was evaluated to enable data based recommendations for the use of Tapentadol in children of different ages.

    Each participant had a single pharmacokinetic sample taken at up to 2 different pre-defined time points.

    Serum was analyzed using liquid chromatography-tandem mass spectrometry. Mean and Standard Deviation of Serum Concentrations of tapentadol-O-glucuronide were calculated.

    Summary statistics at a given time point were only determined if at least 2 participants had observations above the lower limit of quantification (LLOQ).

    If overall only a single sample was available at one of the pre-defined time points, the measured value is presented and the standard deviation is given as N/A.



Other Outcome Measures:
  1. Change From Baseline (Visit 1, After Surgery) in Pain Intensity [ Time Frame: Baseline; up to 15 hours after study medication ]

    The change from baseline in pain intensity using the Face, Legs, Activity, Cry, Consolability Scale (FLACC Scale) at 15 minutes, 30 minutes, 1 hour, 2 hours, 4 hours, 6 hours, 8 hours, 12 hours, and 15 hours after a single dose of tapentadol.

    The FLACC Scale is a behavioral scale for scoring postoperative pain in young children. It includes five categories of pain behaviors, including facial expression, leg movement, activity, cry, and consolability. The scale is scored in a range of 0-10 with 0 representing no pain.

    The pain intensity scores were summarized descriptively per scheduled time point.




Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


Ages Eligible for Study:   up to 23 Months   (Child)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • The participant's parent(s) or legal guardian(s) have given written informed consent to participate.
  • Participant is not obese (e.g., a body weight above the 97th percentile for children based on the World Health Organization weight charts) with a minimum body weight of 2.5 kg.
  • Physical status rated not higher than P3 on the American Society of Anesthesiologists physical status classification in participants aged from 1 month to less than 2 years.
  • Participant has undergone surgery that, in the investigator's opinion, would reliably produce moderate to severe pain requiring opioid treatment.
  • At the time of allocation to IMP, participant has a sedation score that is not higher than 2 (moderately sedated) on the University of Michigan Sedation Scale with the exception of participants who are mechanically ventilated in age subgroup 3, has a functioning gastrointestinal tract after surgery, and can tolerate medication administered orally or via a feeding tube at the time of allocation to IMP.
  • Participant has a reliable venous vascular access for pharmacokinetic blood sampling.

Exclusion Criteria:

  • The participant's parent(s) or legal guardian(s) is an employee of the investigator or trial site, with direct involvement in this trial or other trials under the direction of that investigator or trial site, or the participant, or participant's parent(s), or legal guardian(s) is a family member of the employees or the investigator.
  • Participant has been previously exposed to tapentadol.
  • Participant has received an experimental drug or used an experimental medical device within 28 days before allocation to study medication, or within a period less than 10 times the drug's half-life, whichever is longer.
  • Concomitant participation in another interventional clinical trial for the duration of this trial.
  • Participant has undergone brain surgery.
  • Participant has undergone a surgery that is expected to affect the absorption of tapentadol (e.g., to the gastrointestinal tract).
  • Participant has a history or current condition of any one of the following:

    • Seizure disorder.
    • Traumatic or hypoxic brain injury, i.e. brain contusion, stroke, transient ischemic attack, intracranial bleeding or hematoma, brain neoplasm.
  • Participant has a history or current condition of any one of the following:

    • Moderate to severe renal impairment.
    • Moderate to severe hepatic impairment, congestive hepatopathy, or hepatic portosystemic shunting.
    • Clinically relevant abnormal pulmonary function or clinically relevant respiratory disease that in the opinion of the investigator would put the participant at risk for developing respiratory depression, unless the participant is mechanically ventilated in age subgroup 3.
  • Participant has signs or symptoms of congestive heart failure (e.g., requiring more than minimal inotropic support, an abnormal lactic acid value greater than 2-times upper limit of normal), or hemorrhagic disorder following surgery.
  • Minimal inotropic medication is defined as:

    • Dopamine less or equal to 5 microgram/kg per minute.
    • Epinephrine less or equal to 0.03 microgram/kg per minute (but not both dopamine and epinephrine).
    • Milrinone less or equal to 0.5 microgram/kg per minute or less.
  • Participant has a concomitant disease or disorder (e.g., endocrine, metabolic, neurological, or psychiatric disorder, or a febrile seizure or paralytic ileus) that in the opinion of the investigator may affect or compromise participant's safety during the trial participation.
  • Participant has cognitive or developmental impairment such that trial participation may affect or compromise the participant's safety, or the participant's ability to comply with the protocol requirements (as appropriate for the participant's age), in the investigator's judgment. Otherwise, participant's with cognitive or developmental impairment may be enrolled in the trial.
  • Participant has a clinically relevant history of hypersensitivity, allergy, or contraindication to tapentadol (or ingredients).
  • Participant has:

    • Clinically relevant abnormal 12-lead ECG in the investigator's judgment.
    • Signs of pre-excitation syndrome.
    • Corrected QT (QTcF) interval greater than 460 ms. Participant may be allocated to Investigational Medicinal Product with values greater than 460 ms if, in the investigator's opinion, the value is a consequence of cardiac surgery and is not considered clinically significant.
  • Participant has clinically relevant abnormal lab values from a sample obtained postoperatively and prior to allocation to study medication. The following specifications will apply:

    • Aspartate transaminase or alanine transaminase is greater than 2.5-times upper limit of normal.
    • Total bilirubin is greater than 2-times upper limit of normal and direct bilirubin is greater than 20% of the total bilirubin, and for participants in age subgroup 3, the presence of pathological jaundice in the opinion of the investigator.
    • Glomerular filtration rate (calculated according to Schwartz et al. 1984):

      • less than 20 mL/min/1.73 m2 for participants less than 1 week old.
      • less than 30 mL/min/1.73 m2 for participants 1 week to 8 weeks old.
      • less than 50 mL/min/1.73 m2 for participants more than 8 weeks old.
    • Other parameters (in the investigator's judgment).
  • Signs or symptoms indicative of a systemic infection within 24 hours prior to allocation to study medication.
  • Participant has been administered a prohibited medication.
  • The mother of a newborn or the breastfeeding mother of a participant was administered a prohibited medication.
  • At the time of dosing, in the investigator's judgment, the participant has either of the following:

    • Clinically unstable upper or lower airway conditions or respiratory depression (unless the participant is mechanically ventilated in age subgroup 3).
    • Clinically unstable systolic or diastolic blood pressure, heart rate, or respiratory rate.
  • Participant has a peripheral oxygen saturation (SpO2) <92% for acyanotic participant, or <75% for cyanotic participant, with or without supplemental oxygen via nasal cannula or high flow nasal cannula, at the time of allocation to Investigational Medicinal Product.
  • For age subgroup 1 and age subgroup 2, participant requires continuous positive airway pressure or mechanical ventilation, at the time of allocation to Investigational Medicinal Product.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02221674


Locations
United States, California
US001
Palo Alto, California, United States, 94305
United States, Kentucky
US002
Louisville, Kentucky, United States, 40202
United States, North Carolina
US006
Durham, North Carolina, United States, 27710
United States, Pennsylvania
US004
Philadelphia, Pennsylvania, United States, 19104
Poland
PL004
Toruń, Poland, 87-100
PL001
Łódź, Poland, 93-338
United Kingdom
GB001
Sheffield, United Kingdom, S10 2TH
Sponsors and Collaborators
Grünenthal GmbH
Depomed
Investigators
Study Director: Clinical Trial Director Grünenthal GmbH

Responsible Party: Grünenthal GmbH
ClinicalTrials.gov Identifier: NCT02221674     History of Changes
Other Study ID Numbers: KF5503-72
2014-000623-24 ( EudraCT Number )
U1111-1153-1662 ( Other Identifier: WHO UTN )
R331333PAI2007 ( Other Identifier: Depomed Inc. )
First Posted: August 20, 2014    Key Record Dates
Results First Posted: December 12, 2017
Last Update Posted: January 29, 2018
Last Verified: January 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Yes
Plan Description: Information available on the Grünenthal Group Web Site (see URL below for details); according to the European Federation of Pharmaceutical Industries and Associations (EFPIA) Data Sharing Principles.
URL: http://www.grunenthal.com/grt-web/Grunenthal_Group/Research_Development/Grunenthal_Clinical_Trials/Data_Sharing/296200025.jsp

Keywords provided by Grünenthal GmbH:
Post-surgical pain
Opioid

Additional relevant MeSH terms:
Pain, Postoperative
Pain
Neurologic Manifestations
Nervous System Diseases
Postoperative Complications
Pathologic Processes
Signs and Symptoms