Study to Evaluate the Analgesic Efficacy and Safety of Hydrocodone Bitartrate/Acetaminophen Immediate-Release Tablets in Participants With Moderate to Severe Pain Following Bunionectomy

• ClinicalTrials.gov Identifier: NCT02487108
• Recruitment Status: Completed
• First Posted: July 1, 2015
• Last Update Posted: February 14, 2022
• Sponsor: Teva Branded Pharmaceutical Products R&D, Inc.
• Collaborator: Syneos Health
• Information provided by (Responsible Party): Teva Branded Pharmaceutical Products R&D, Inc.

Study Description

Brief Summary:

The primary objective of this study is to evaluate the analgesic efficacy of hydrocodone bitartrate/acetaminophen immediate-release tablets at doses of 5.0 milligrams (mg)/325 mg, 7.5 mg/325 mg, and 10 mg/325 mg every 4 to 6 hours compared with placebo in treating participants with moderate to severe pain following bunionectomy.

Condition or disease	Intervention/treatment	Phase
Pain	Drug: TV-46763; Drug: Placebo	Phase 3

Study Design

• Study Type: Interventional (Clinical Trial)
• Actual Enrollment: 569 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
• Primary Purpose: Treatment
• Official Title: A Multicenter, Randomized, Double-blind, Placebo-controlled, Phase 3 Study to Evaluate the Analgesic Efficacy and Safety of Hydrocodone Bitartrate/Acetaminophen Immediate-Release Tablets (TV-46763) at Doses of 5.0 mg/325 mg, 7.5 mg/325 mg, and 10 mg/325 mg Every 4 to 6 Hours in Patients With Moderate to Severe Pain Following Bunionectomy
• Actual Study Start Date: August 11, 2015
• Actual Primary Completion Date: March 30, 2016
• Actual Study Completion Date: March 30, 2016

Arms and Interventions

Arm	Intervention/treatment
Placebo Comparator: Placebo; Participants will receive placebo matching to TV46763 (hydrocodone bitartrate/acetaminophen) immediate release (IR) tablets for 48 hours (every 4 to 6 hours) on Days 1, 2, and 3 during the inpatient treatment period. Participants will continue to take the same treatment daily, every 4 to 6 hours after discharge on Day 3, over a 10-day (±1 day) outpatient treatment period.	Drug: Placebo; Placebo matching to TV-46763 will be administered per schedule specified in the arm description.
Experimental: TV-46763 5.0 mg/325 mg; Participants will receive TV46763 (hydrocodone bitartrate/acetaminophen) 5.0 mg/325 mg IR tablets for 48 hours (every 4 to 6 hours) on Days 1, 2, and 3 during the inpatient treatment period. Participants will continue to take the same treatment daily, every 4 to 6 hours after discharge on Day 3, over a 10-day (±1 day) outpatient treatment period.	Drug: TV-46763; TV-46763 will be administered per dose and schedule specified in the arm description.; Other Name: Hydrocodone bitartrate/acetaminophen IR tablets
Experimental: TV-46763 7.5 mg/325 mg; Participants will receive TV46763 (hydrocodone bitartrate/acetaminophen) 7.5 mg/325 mg IR tablets for 48 hours (every 4 to 6 hours) on Days 1, 2, and 3 during the inpatient treatment period. Participants will continue to take the same treatment daily, every 4 to 6 hours after discharge on Day 3, over a 10-day (±1 day) outpatient treatment period.	Drug: TV-46763; TV-46763 will be administered per dose and schedule specified in the arm description.; Other Name: Hydrocodone bitartrate/acetaminophen IR tablets
Experimental: TV-46763 10.0 mg/325 mg; Participants will receive TV46763 (hydrocodone bitartrate/acetaminophen) 10.0 mg/325 mg IR tablets for 48 hours (every 4 to 6 hours) on Days 1, 2, and 3 during the inpatient treatment period. Participants will continue to take the same treatment daily, every 4 to 6 hours after discharge on Day 3, over a 10-day (±1 day) outpatient treatment period.	Drug: TV-46763; TV-46763 will be administered per dose and schedule specified in the arm description.; Other Name: Hydrocodone bitartrate/acetaminophen IR tablets

Outcome Measures

Primary Outcome Measures :

1. Summed Pain Intensity Difference (SPID) Calculated Over the First 48 Hours (SPID48) After the First Dose of Study Drug on an 11-Point Numerical Pain Rating Scale (NPRS-11) [ Time Frame: 48 Hours ]

Secondary Outcome Measures :

1. SPID Scores Over the Intervals During the First 36 Hours Following the First Dose of Study Drug [ Time Frame: 0-6, 0-12, 0-24, and 0-36 hours ]
2. Pain Intensity Difference (PID) Scores [ Time Frame: 0.25, 0.5, 0.75, 1, 1.5, 2, 3, 4, 5, and 6 hours ]
3. Time to Peak PID [ Time Frame: Within 6 hours ]
4. Number of Participants With a 30% Reduction in Pain Intensity Measured Using NPRS-11 Scores [ Time Frame: 6, 12, 24, and 48 hours ]
5. Number of Participants With a 50% Reduction in Pain Intensity Measured Using NPRS-11 Scores [ Time Frame: 6, 12, 24, and 48 hours ]
6. Time to Onset of Perceptible Pain Relief [ Time Frame: Day 1 ]
7. Time to Onset of Meaningful Pain Relief [ Time Frame: Day 1 ]
8. Total Rescue Medication Use (Number of Tablets Used) [ Time Frame: 6, 12, 24, and 48 hours ]
9. Number of Participants Taking Rescue Medication [ Time Frame: 6, 12, 24, and 48 hours ]
10. Number of Participants With Adverse Events [ Time Frame: Day 1 up to Day 13 ]

Eligibility Criteria

• Ages Eligible for Study: 18 Years to 75 Years (Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

1. Men and women aged 18 to 75 years, inclusive.
2. Participants who are scheduled to undergo a primary unilateral first metatarsal Austin bunionectomy with distal osteotomy and internal fixation without any collateral procedures (ie, uncomplicated procedure).
3. Participants who according to the American Society of Anesthesiologists Physical Status (PS) classification system are classified PS-1 (normal, healthy participant) or PS-2 (mild systemic disease).
4. The participant is able to speak English and is willing to provide written informed consent, including a written opioid agreement, to participate in the study.
5. The participant has a body mass index (BMI) between 18.0 and 33.0 kg/m2 (inclusive) at the time of screening.
6. The participant is in generally good health as determined by a medical history, medical examination, ECG, serum chemistry, hematology, urinalysis, and serology.

7. Women of childbearing potential (not surgically sterile or 2 years postmenopausal) must use a medically acceptable method of contraception and must agree to continue use of this method for the duration of the study and for 30 days after discontinuation of the study drug, unless they have exclusively same-sex partners. Acceptable methods of contraception include intrauterine device (IUD) known to have a failure rate of less than 1% per year, hormonal contraceptive (oral, implanted, transdermal, or injected), and barrier method with spermicide, abstinence, and partner vasectomy.

   NOTE: A woman will be considered surgically sterile if she has had a tubal ligation, hysterectomy, bilateral salpingo-oophorectomy or bilateral oophorectomy, or hysterectomy with bilateral salpingo-oophorectomy.

8. The participant, if a man, is surgically sterile, or, if capable of producing offspring, is currently using a medically acceptable method of contraception and agrees to continue use of this method for the duration of the study (and for 90 days after taking the last dose of the study drug because of the possible effects on spermatogenesis), unless he has exclusively same-sex partners. Acceptable methods of contraception include abstinence, barrier method with spermicide, female partner's use of steroidal hormonal contraceptive (oral, implanted, transdermal, or injected) in conjunction with a barrier method, female partner's use of an IUD known to have a failure rate of less than 1% per year, or if his female partner is surgically sterile or 2 years postmenopausal. In addition, male participants may not donate sperm for the duration of the study and for 90 days after taking study drug.
9. The participant must be willing and able to comply with study restrictions and to remain at the clinic for the required duration during the study, and willing to return to the clinic for the follow-up evaluation as specified in this protocol.
10. The participant must not participate in any other study involving an investigational agent while enrolled in the present study.
11. The participant must report a pain intensity score of ≥4 on an 11-point NPRS-11 within 9 hours after stopping postsurgical analgesia and immediately before randomization.
12. The participant should be free of any surgical or anesthetic complications after the surgery, which is to be performed using the intraoperative anesthetic regimen and the postoperative analgesic regimen that was followed appropriately without deviations that would confound analgesic assessments after receipt of the investigational product.

Exclusion Criteria:

1. The participant has a chronic pain condition, excluding bunion pain that requires taking opioid analgesics within 30 days prior to surgery or use of non-opioid analgesics (acetylsalicylic acid, acetaminophen, nonsteroidal anti-inflammatory drugs) within 24 hours prior to surgery. Stable therapy of >30 days for acetylsalicylic acid (up to 81 mg/day) is allowed as cardiovascular prophylaxis.
2. Use of glucocorticoids (except nasal corticosteroid sprays and/or topical corticosteroids) for any condition within 6 months before study drug administration.
3. The participant uses any nonpharmacologic pain management techniques (eg, physical techniques, physiotherapy, massage therapy, acupuncture, biofeedback, and/or psychological support) and is unable or unwilling to discontinue prior to randomization (or study start).
4. The participant has any other medical or psychiatric condition or is receiving concomitant medication/therapy that would, in the opinion of the investigator, compromise the participant's safety, compliance with the study protocol procedures, or collection of data.
5. The participant has a clinically significant abnormality in the physical examination and/or clinical laboratory test values.
6. The participant is a pregnant or lactating woman. (Any woman becoming pregnant during the study will be withdrawn from the study.)
7. The participant has used an investigational drug within 1 month before the screening visit.
8. The participant is participating any currently ongoing research study.
9. The participant has any disorder that may interfere with gastrointestinal (GI) drug absorption (eg, gastric bypass surgery, lap band, malabsorption syndrome, and inflammatory bowel disease) or other condition that may have an effect on participant safety or efficacy aspects of participation in the opinion of the investigator.
10. The participant is allergic to or has had a serious reaction to hydrocodone or other opioids, acetaminophen, ropivacaine, lidocaine, ketorolac, ibuprofen, propofol, or any of the drugs required by the study protocol.
11. The participant has a recent history (within 5 years) or current evidence of alcohol or other substance abuse, with the exception of nicotine.
12. The participant has a positive urine drug screen (UDS) for cocaine, marijuana, opioids, amphetamines, methamphetamines, benzodiazepines, barbiturates, and/or methadone, unless explained by the use of prescription medication.
13. The participant has a history of suicidality as assessed by participant medical history and/or the C-SSRS.
14. The participant is expected to have elective surgery during the study other than a bunionectomy.
15. The participant has a history of malignancy within 5 years (except for treated basal cell carcinoma).
16. The participant has a positive test result for hepatitis B surface antigen or antibodies to hepatitis C, or known or tested positive for human immunodeficiency virus.
17. The participant has received a monoamine oxidase inhibitor (MAOI) within 14 days before the first dose of study drug.
18. The investigator believes that the participant is not suitable for the study for any reason.

Contacts and Locations

Locations

United States, Arizona

Teva Investigational Site 13510

Phoenix, Arizona, United States, 85023

United States, California

Teva Investigational Site 13173

Anaheim, California, United States, 92801

Teva Investigational Site 13174

Bakersfield, California, United States, 93311

Teva Investigational Site 13170

Pasadena, California, United States, 91105

United States, Maryland

Teva Investigational Site 13169

Pasadena, Maryland, United States, 21122

United States, Texas

Teva Investigational Site 13172

San Antonio, Texas, United States, 78229

United States, Utah

Teva Investigational Site 13511

Saint George, Utah, United States, 84790

Teva Investigational Site 13171

Salt Lake City, Utah, United States, 84124

Sponsors and Collaborators

Teva Branded Pharmaceutical Products R&D, Inc.

Syneos Health

Investigators

• Study Director: Teva Medical Expert, MD; Teva Branded Pharmaceutical Products R&D, Inc.

More Information

• Responsible Party: Teva Branded Pharmaceutical Products R&D, Inc.
• ClinicalTrials.gov Identifier: NCT02487108
• Other Study ID Numbers: TV46763-CNS-30031
• First Posted: July 1, 2015
• Last Update Posted: February 14, 2022
• Last Verified: February 2022

Additional relevant MeSH terms:

Acetaminophen; Acetaminophen, hydrocodone drug combination; Hydrocodone; Analgesics, Non-Narcotic; Analgesics; Sensory System Agents; Peripheral Nervous System Agents; Physiological Effects of Drugs; Antipyretics; Analgesics, Opioid; Narcotics; Central Nervous System Depressants; Antitussive Agents; Respiratory System Agents; Anti-Inflammatory Agents, Non-Steroidal; Anti-Inflammatory Agents; Antirheumatic Agents