A Study Comparing the Sodium Picosulfate, Magnesium Oxide and Anhydrous Citric Acid Oral Solution With PREPOPIK® for Colon Cleansing in Preparation for Colonoscopy

• ClinicalTrials.gov Identifier: NCT03017235
• Recruitment Status: Completed
• First Posted: January 11, 2017
• Results First Posted: November 14, 2018
• Last Update Posted: November 14, 2018
• Sponsor: Ferring Pharmaceuticals
• Information provided by (Responsible Party): Ferring Pharmaceuticals

Study Description

Brief Summary:

The purpose of this study is to compare the Sodium Picosulfate, Magnesium Oxide and Anhydrous Citric Acid Oral Solution with PREPOPIK® for colon cleansing in adult subjects undergoing colonoscopy.

Condition or disease	Intervention/treatment	Phase
Bowel Preparation	Drug: Sodium Picosulfate, Magnesium Oxide and Anhydrous Citric Acid Oral Solution; Drug: Sodium Picosulfate, Magnesium Oxide and Anhydrous Citric Powder	Phase 3

Study Design

• Study Type: Interventional (Clinical Trial)
• Actual Enrollment: 917 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Masking: Single (Outcomes Assessor)
• Primary Purpose: Other
• Official Title: A Randomized, Assessor-Blinded, Multi-Center Study Investigating the Efficacy, Safety, and Tolerability of Sodium Picosulfate, Magnesium Oxide and Anhydrous Citric Acid Oral Solution Versus Sodium Picosulfate, Magnesium Oxide and Anhydrous Citric Acid Powder for Oral Solution (PREPOPIK®) for Colon Cleansing in Preparation for Colonoscopy
• Actual Study Start Date: February 20, 2017
• Actual Primary Completion Date: September 15, 2017
• Actual Study Completion Date: October 12, 2017

Arms and Interventions

Arm	Intervention/treatment
Experimental: NaP/MC Oral Solution; Sodium Picosulfate, Magnesium Oxide and Anhydrous Citric Acid (NaP/MC) Oral Solution	Drug: Sodium Picosulfate, Magnesium Oxide and Anhydrous Citric Acid Oral Solution; Supplied as two 160 mL ready-to-drink bottles, per subject, without further reconstitution, before administration.
Active Comparator: PREPOPIK®	Drug: Sodium Picosulfate, Magnesium Oxide and Anhydrous Citric Powder; Supplied as two sachets per subject. Subjects will be instructed to reconstitute the medication by combining the contents of one packet with approximately five (5) ounces of cold water and stirring for two to three minutes.; Other Names: PREPOPIK®; PicoPrep®

Outcome Measures

Primary Outcome Measures :

1. Percentage of Subjects Classified as a Responder Defined by "Excellent" or "Good" [ Time Frame: During colonoscopy procedure (5-9 hours after completed treatment) ]
   The efficacy of overall colon cleansing in terms of responders was measured by a blinded endoscopist using the Modified Aronchick Scale. Modified Aronchick scale is a 4-point scale that grades colon cleansing as Excellent (>90% of mucosa seen, mostly liquid stool, minimal suctioning needed for adequate visualization), Good (>90% of mucosa seen, mostly liquid stool, significant suctioning needed for adequate visualization), Fair (>90% of mucosa seen, mixture of liquid and semisolid stool, could be suctioned and/or washed) or Inadequate (<90% of mucosa seen, mixture of semisolid and solid stool which could not be suctioned or washed).The participant is considered to be a responder if overall colon cleansing is "excellent" or "good" on this 4-point scale.

Secondary Outcome Measures :

1. Percentage of Subjects Classified as a Responder Defined by a Score ≥2 in the Right Segment of the Colon [ Time Frame: During colonoscopy procedure (5-9 hours after completed treatment) ]

   The percentage of subjects classified as responders, defined by a Boston Bowel Preparation Scale (BBPS) score ≥2 in the right segment of the colon was determined.

   The BBPS scale:

   0= Unprepared colon segment with mucosa not seen due to solid stool that cannot be cleared; 1= Portion of mucosa of the colon segment seen, but other areas of the colon segment not well seen due to staining, residual stool, and/or opaque liquid; 2= Minor amount of residual staining, small fragments of stool and/or opaque liquid, but mucosa of colon segment seen well; 3= Entire mucosa of colon segment seen well with no residual staining, small fragments of stool or opaque liquid.

2. Percentage of Subjects Classified as a Responder Defined by a Score ≥2 in the Transverse Segment of the Colon [ Time Frame: During colonoscopy procedure (5-9 hours after completed treatment) ]

   The percentage of subjects classified as responders, defined by a Boston Bowel Preparation Scale (BBPS) score ≥2 in the transverse segment of the colon was determined.

   The BBPS scale:

   0= Unprepared colon segment with mucosa not seen due to solid stool that cannot be cleared; 1= Portion of mucosa of the colon segment seen, but other areas of the colon segment not well seen due to staining, residual stool, and/or opaque liquid; 2= Minor amount of residual staining, small fragments of stool and/or opaque liquid, but mucosa of colon segment seen well; 3= Entire mucosa of colon segment seen well with no residual staining, small fragments of stool or opaque liquid.

3. Percentage of Subjects Classified as a Responder Defined by a Score ≥2 in the Left Segment of the Colon [ Time Frame: During colonoscopy procedure (5-9 hours after completed treatment) ]

   The percentage of subjects classified as responders, defined by a Boston Bowel Preparation Scale (BBPS) score ≥2 in the left segment of the colon was determined.

   The BBPS scale:

   0= Unprepared colon segment with mucosa not seen due to solid stool that cannot be cleared; 1= Portion of mucosa of the colon segment seen, but other areas of the colon segment not well seen due to staining, residual stool, and/or opaque liquid; 2= Minor amount of residual staining, small fragments of stool and/or opaque liquid, but mucosa of colon segment seen well; 3= Entire mucosa of colon segment seen well with no residual staining, small fragments of stool or opaque liquid.

4. Frequency of Each Category on the Subject Tolerability Questionnaire (How Many Bowel Movements Did You Have in the Week Prior to Starting Colon Preparation?) [ Time Frame: During colonoscopy procedure (5-9 hours after completed treatment) ]
   Subject tolerability and satisfaction with the bowel cleansing preparation were assessed by the validated Mayo Clinic Bowel Prep Tolerability Questionnaire. This simple, comprehensive questionnaire, developed to evaluate the tolerability of various types of bowel preparations, was administered to the subject at Visit 3 prior to the colonoscopy procedure.
5. Frequency of Each Category on the Subject Tolerability Questionnaire (How Much Bowel Preparation Was Left in Bottle After Drinking it?) [ Time Frame: During colonoscopy procedure (5-9 hours after completed treatment) ]
   Subject tolerability and satisfaction with the bowel cleansing preparation were assessed by the validated Mayo Clinic Bowel Prep Tolerability Questionnaire. This simple, comprehensive questionnaire, developed to evaluate the tolerability of various types of bowel preparations, was administered to the subject at Visit 3 prior to the colonoscopy procedure.
6. Frequency of Each Category on the Subject Tolerability Questionnaire (Was the Bowel Preparation Tolerable?) [ Time Frame: During colonoscopy procedure (5-9 hours after completed treatment) ]
   Subject tolerability and satisfaction with the bowel cleansing preparation were assessed by the validated Mayo Clinic Bowel Prep Tolerability Questionnaire. This simple, comprehensive questionnaire, developed to evaluate the tolerability of various types of bowel preparations, was administered to the subject at Visit 3 prior to the colonoscopy procedure.
7. Frequency of Each Category on the Subject Tolerability Questionnaire (How Willing Are You to Use This Preparation in the Future?) [ Time Frame: During colonoscopy procedure (5-9 hours after completed treatment) ]
   Subject tolerability and satisfaction with the bowel cleansing preparation were assessed by the validated Mayo Clinic Bowel Prep Tolerability Questionnaire. This simple, comprehensive questionnaire, developed to evaluate the tolerability of various types of bowel preparations, was administered to the subject at Visit 3 prior to the colonoscopy procedure.
8. Frequency of Each Category on the Subject Tolerability Questionnaire (If Difficulties Existed, Were They Due to Your Current Health Status?) [ Time Frame: During colonoscopy procedure (5-9 hours after completed treatment) ]
   Subject tolerability and satisfaction with the bowel cleansing preparation were assessed by the validated Mayo Clinic Bowel Prep Tolerability Questionnaire. This simple, comprehensive questionnaire, developed to evaluate the tolerability of various types of bowel preparations, was administered to the subject at Visit 3 prior to the colonoscopy procedure. Subjects in response to questions could provide multiple response if applicable.
9. Frequency of Each Category on the Subject Tolerability Questionnaire (How Bothered Were You During Bowel Prep by Bad Taste in Mouth?) [ Time Frame: During colonoscopy procedure (5-9 hours after completed treatment) ]
   Subject tolerability and satisfaction with the bowel cleansing preparation were assessed by the validated Mayo Clinic Bowel Prep Tolerability Questionnaire. This simple, comprehensive questionnaire, developed to evaluate the tolerability of various types of bowel preparations, was administered to the subject at Visit 3 prior to the colonoscopy procedure.
10. Frequency of Each Category on the Subject Tolerability Questionnaire (How Bothered Were You During Bowel Prep by Gastric Fullness?) [ Time Frame: During colonoscopy procedure (5-9 hours after completed treatment) ]
    Subject tolerability and satisfaction with the bowel cleansing preparation were assessed by the validated Mayo Clinic Bowel Prep Tolerability Questionnaire. This simple, comprehensive questionnaire, developed to evaluate the tolerability of various types of bowel preparations, was administered to the subject at Visit 3 prior to the colonoscopy procedure.
11. Frequency of Each Category on the Subject Tolerability Questionnaire (How Bothered Were You During Bowel Prep by Lack of Sleep From Excessive Bathroom Trips?) [ Time Frame: During colonoscopy procedure (5-9 hours after completed treatment) ]
    Subject tolerability and satisfaction with the bowel cleansing preparation were assessed by the validated Mayo Clinic Bowel Prep Tolerability Questionnaire. This simple, comprehensive questionnaire, developed to evaluate the tolerability of various types of bowel preparations, was administered to the subject at Visit 3 prior to the colonoscopy procedure.
12. Frequency of Each Category on the Subject Tolerability Questionnaire (How Bothered Were You During Bowel Prep by Nausea, Vomiting?) [ Time Frame: During colonoscopy procedure (5-9 hours after completed treatment) ]
    Subject tolerability and satisfaction with the bowel cleansing preparation were assessed by the validated Mayo Clinic Bowel Prep Tolerability Questionnaire. This simple, comprehensive questionnaire, developed to evaluate the tolerability of various types of bowel preparations, was administered to the subject at Visit 3 prior to the colonoscopy procedure.
13. Frequency of Each Category on the Subject Tolerability Questionnaire (How Bothered Were You During Bowel Prep by Bloating/Abdominal Distension/Gas?) [ Time Frame: During colonoscopy procedure (5-9 hours after completed treatment) ]
    Subject tolerability and satisfaction with the bowel cleansing preparation were assessed by the validated Mayo Clinic Bowel Prep Tolerability Questionnaire. This simple, comprehensive questionnaire, developed to evaluate the tolerability of various types of bowel preparations, was administered to the subject at Visit 3 prior to the colonoscopy procedure.
14. Frequency of Each Category on the Subject Tolerability Questionnaire (How Bothered Were You During Bowel Prep by Abdominal Pain/Cramps?) [ Time Frame: During colonoscopy procedure (5-9 hours after completed treatment) ]
    Subject tolerability and satisfaction with the bowel cleansing preparation were assessed by the validated Mayo Clinic Bowel Prep Tolerability Questionnaire. This simple, comprehensive questionnaire, developed to evaluate the tolerability of various types of bowel preparations, was administered to the subject at Visit 3 prior to the colonoscopy procedure.
15. Frequency of Each Category on the Subject Tolerability Questionnaire (How Bothered Were You During Bowel Prep by Headache?) [ Time Frame: During colonoscopy procedure (5-9 hours after completed treatment) ]
    Subject tolerability and satisfaction with the bowel cleansing preparation were assessed by the validated Mayo Clinic Bowel Prep Tolerability Questionnaire. This simple, comprehensive questionnaire, developed to evaluate the tolerability of various types of bowel preparations, was administered to the subject at Visit 3 prior to the colonoscopy procedure.
16. Frequency of Each Category on the Subject Tolerability Questionnaire (Was This Your First Colonoscopy?) [ Time Frame: During colonoscopy procedure (5-9 hours after completed treatment) ]
    Subject tolerability and satisfaction with the bowel cleansing preparation were assessed by the validated Mayo Clinic Bowel Prep Tolerability Questionnaire. This simple, comprehensive questionnaire, developed to evaluate the tolerability of various types of bowel preparations, was administered to the subject at Visit 3 prior to the colonoscopy procedure.
17. Frequency of Each Category on the Subject Tolerability Questionnaire (Previous Bowel Preparation) [ Time Frame: During colonoscopy procedure (5-9 hours after completed treatment) ]
    Subject tolerability and satisfaction with the bowel cleansing preparation were assessed by the validated Mayo Clinic Bowel Prep Tolerability Questionnaire. This simple, comprehensive questionnaire, developed to evaluate the tolerability of various types of bowel preparations, was administered to the subject at Visit 3 prior to the colonoscopy procedure.
18. Frequency of Each Category on the Subject Tolerability Questionnaire (Tolerability Compared to Previous Bowel Prepreparations) [ Time Frame: During colonoscopy procedure (5-9 hours after completed treatment) ]
    Subject tolerability and satisfaction with the bowel cleansing preparation were assessed by the validated Mayo Clinic Bowel Prep Tolerability Questionnaire. This simple, comprehensive questionnaire, developed to evaluate the tolerability of various types of bowel preparations, was administered to the subject at Visit 3 prior to the colonoscopy procedure.
19. Percentage of Treatment-emergent Adverse Events(AEs) [ Time Frame: From baseline (screening) up to day 28 after colonoscopy ]
    Collected as any AE that begins during the treatment period defined as the period during which a subject receives IMP. All endoscopy findings were reported as AEs while cancers/malignancies detected on endoscopy were reported as SAEs.
20. Clinically Significant Changes in Vital Signs [ Time Frame: From baseline (screening) up to day 28 after colonoscopy ]
    Blood pressure and pulse will be measured after at least 5 minutes of rest in supine position and after 3 minutes in standing position
21. Clinically Significant Changes in Electrocardiogram (ECG) [ Time Frame: At baseline (screening), on the day of colonoscopy, 1-2 days after colonoscopy, 7 days after colonoscopy and 28 days after colonoscopy ]
    Measured by standard 12-lead ECG. At each visit when an ECG was done, the investigator reviewed and initialed the tracing, which was then stored with the subject's source documents. The baseline ECG performed at the Screening Visit was reviewed for major abnormalities before dosing.
22. Clinically Significant Changes in Laboratory Values [ Time Frame: At baseline (screening), on the day of colonoscopy, 1-2 days after colonoscopy, 7 days after colonoscopy and 28 days after colonoscopy ]
    Rated by the investigator based on out of range laboratory values

Eligibility Criteria

• Ages Eligible for Study: 18 Years to 80 Years (Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

• Male or non-pregnant female subjects aged 18 to 80 years, inclusive, being scheduled to undergo elective colonoscopy
• Females of childbearing potential must agree to use an adequate contraception during the course of the trial. Accepted forms of contraception are: i.e., implants, injectables, hormonal intrauterine device, combined hormonal contraceptives, sexual abstinence, and vasectomized sexual partner. Premenopausal women who are of childbearing potential must have a negative serum pregnancy test result at screening and a negative urine pregnancy test result at randomization prior to colonoscopy. In the case of oral contraceptive use, women should have been taking the same pill consistently for a minimum of twelve (12) weeks before taking study medication. Sterilized or postmenopausal women may also participate. Women are considered to be postmenopausal and are not considered to be of childbearing potential if they have had twelve (12) months of natural (spontaneous) amenorrhea with an appropriate clinical profile (e.g. age appropriate, history of vasomotor symptoms) or have had surgical bilateral oophorectomy (with or without hysterectomy) or tubal ligation.
• An average of at least 3 spontaneous bowel movements per week for one month prior to the colonoscopy

Exclusion Criteria:

• Known or suspected gastrointestinal obstruction, perforation, ileus, or gastric retention
• Acute intestinal or gastric ulceration
• Severe acute inflammatory bowel disease (IBD), toxic colitis, or toxic megacolon
• Undergoing colonoscopy for foreign body removal or decompression
• Reduced level of consciousness or inability to swallow without aspiration
• Any prior colorectal surgery, excluding appendectomy, hemorrhoid surgery, or prior endoscopic procedures
• Upper gastrointestinal surgery (gastrectomy, gastric banding, gastric by-pass)
• Uncontrolled angina and/or myocardial infarction (MI) within last three months, congestive heart failure (CHF), uncontrolled hypertension, or ascites
• Severely reduced renal function (<30 mL/min/1.73 m2)
• Pregnant or lactating women
• Any clinically relevant abnormal findings in medical history, physical examination, vital signs, ECG, clinical chemistry, hematology, coagulation, or urinalysis at Screening Visit 1
• Rhabdomyolysis
• Chronic nausea and vomiting
• Hypermagnesemia
• Undergoing treatment with Lithium

Contacts and Locations

Locations

United States, Alabama

Clinical Research Associates

Huntsville, Alabama, United States, 35801

United States, California

Associated Gastroenterology Medical Group

Anaheim, California, United States, 92801

GW Research, Inc.

Chula Vista, California, United States, 91910

Precision Research Institute

San Diego, California, United States, 92114

United States, Connecticut

Connecticut Clinical Research Foundation

Bristol, Connecticut, United States, 06010

United States, Florida

Florida Clinical Research Group

Clearwater, Florida, United States, 33759

Nature Coast Clinical Research

Inverness, Florida, United States, 34452

United States, New York

Long Island Gastrointestinal Research Group LLC

Great Neck, New York, United States, 11023

United States, North Carolina

Kinston Medical Specialists, PA

Kinston, North Carolina, United States, 28501

Wake Research Associates, LLC

Raleigh, North Carolina, United States, 27612

United States, Pennsylvania

Hillmont GI

Flourtown, Pennsylvania, United States, 19031

United States, Utah

Advanced Research Institute

Ogden, Utah, United States, 84405

Canada

Hotel Dieu Hospital

Kingston, Canada, K7L 5G2

Canadian Phase Onward, Inc.

Toronto, Canada, M3J 2C5

Sponsors and Collaborators

Ferring Pharmaceuticals

Investigators

• Study Director: Clinical Development Support; Ferring Pharmaceuticals

  Study Documents (Full-Text)

Documents provided by Ferring Pharmaceuticals:

Study Protocol  [PDF] January 25, 2017

Statistical Analysis Plan  [PDF] December 1, 2017

More Information

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Mankaney GN, Ando M, Dahdal DN, Burke CA. Safety and efficacy of sodium picosulfate, magnesium oxide, and citric acid bowel preparation in patients with baseline renal impairment or diabetes: subanalysis of a randomized, controlled trial. Therap Adv Gastroenterol. 2021 Jun 28;14:17562848211024458. doi: 10.1177/17562848211024458. eCollection 2021.

Hookey L, Bertiger G, Johnson KL 2nd, Boules M, Ando M, Dahdal DN. Efficacy, safety, and tolerability of a ready-to-drink bowel preparation in overweight and obese adults: subanalysis by body mass index from a phase III, assessor-blinded study. Therap Adv Gastroenterol. 2020 Apr 9;13:1756284820910050. doi: 10.1177/1756284820910050. eCollection 2020.

Hookey L, Bertiger G, Johnson KL, Boules M, Ando M, Dahdal DN. Efficacy, safety, and tolerability of a ready-to-drink bowel preparation: subanalysis by age from a phase III, assessor-blinded study. Therap Adv Gastroenterol. 2020 Feb 7;13:1756284820902878. doi: 10.1177/1756284820902878. eCollection 2020.

Hookey L, Bertiger G, Lee Johnson K 2nd, Ayala J, Seifu Y, Brogadir SP. Efficacy and safety of a ready-to-drink bowel preparation for colonoscopy: a randomized, controlled, non-inferiority trial. Therap Adv Gastroenterol. 2019 May 19;12:1756284819851510. doi: 10.1177/1756284819851510. eCollection 2019.

• Responsible Party: Ferring Pharmaceuticals
• ClinicalTrials.gov Identifier: NCT03017235
• Other Study ID Numbers: 000253
• First Posted: January 11, 2017
• Results First Posted: November 14, 2018
• Last Update Posted: November 14, 2018
• Last Verified: October 2018

• Studies a U.S. FDA-regulated Drug Product: Yes
• Studies a U.S. FDA-regulated Device Product: No

Additional relevant MeSH terms:

Picosulfate sodium; Magnesium Oxide; Sodium Citrate; Citric Acid; Anticoagulants; Calcium Chelating Agents; Chelating Agents; Sequestering Agents; Molecular Mechanisms of Pharmacological Action; Cathartics; Gastrointestinal Agents; Antacids