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Buprenorphine (CAM2038) in Subjects With a Recent History of Moderate to Severe Chronic Low Back Pain (CAM2038)

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ClinicalTrials.gov Identifier: NCT02946073
Recruitment Status : Active, not recruiting
First Posted : October 26, 2016
Last Update Posted : July 18, 2018
Sponsor:
Collaborators:
Medpace, Inc.
Camurus AB
Information provided by (Responsible Party):
Braeburn Pharmaceuticals

Brief Summary:
This is a Phase III, placebo-controlled, multicenter study with an enriched-enrollment withdrawal (EEW) design to evaluate the efficacy and safety of CAM2038 in opioid-experienced subjects with moderate to severe CLBP that requires continuous, around-the-clock (ATC) opioid treatment ≥ 40 mg morphine equivalent dose (MED). The study includes 5 phases: A Screening Phase (up to 2 weeks), a Transition Phase (up to 2 weeks), an Open-Label Titration Phase (up to 10 weeks), a Double-Blind Treatment Phase including a Final Study Visit (12 weeks), and a Follow-up Phase (4 weeks). The overall duration of participation in the core phase of the study (randomized Double-Blind Phase) is up to 30 weeks, from the Screening Phase through the Follow-up Phase. Subjects who complete the Double-Blind Treatment Study Phase will be offered an opportunity to continue treatment in an open label safety extension for up to 60 weeks. Additional subjects may be recruited to open label safety extension to meet the goal of 100 subjects with 60 weeks of treatment.

Condition or disease Intervention/treatment Phase
Chronic Lower Back Pain Chronic Pain Drug: buprenorphine Other: Placebo Phase 3

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 340 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: A Phase III, Randomized, Double-Blind, Placebo-Controlled, Enriched-Enrollment Withdrawal, Multicenter Study to Evaluate the Efficacy and Safety of a Long-Acting Subcutaneous Injectable Depot of Buprenorphine (CAM2038) in Subjects With Moderate to Severe Chronic Low Back Pain Currently Treated With Daily Opioids
Actual Study Start Date : September 2016
Actual Primary Completion Date : May 2018
Estimated Study Completion Date : January 2019

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Back Pain

Arm Intervention/treatment
Placebo Comparator: Placebo
CAM2038 placebo injections
Other: Placebo
Experimental: CAM2038
CAM2038 50 mg/mL q1w at doses of 8 mg, 12 mg, 16 mg, 24 mg, or 32 mg. CAM2038 356 mg/mL q4w at doses of 64 mg, 96 mg, or 128 mg.
Drug: buprenorphine
Other Name: CAM2038




Primary Outcome Measures :
  1. Change from baseline in Weekly Average of (Daily) Average Pain Intensity and the primary timepoint will be Week 12 of the Double-Blind Phase based on the 11-Point numerical rating scale with 10 being the worst pain. [ Time Frame: 12 weeks ]
    Change from baseline in WAAPI and the primary timepoint will be Week 12 of the Double-Blind Phase.


Secondary Outcome Measures :
  1. Change from baseline in the Weekly Average of (Daily) Worst Pain Intensity scores at Week 12 of the Double-Blind Phase based on 11-Point numerical rating scale with 10 being the worst pain. [ Time Frame: 12 weeks ]
  2. Percentage of subjects with a 30% or greater decrease in API from baseline to Week 12 of the Double-Blind Phase. [ Time Frame: 12 weeks ]
  3. Rescue medication usage (total dose) during the Double-Blind Phase. [ Time Frame: 12 weeks ]
  4. Rescue medication usage (number of days used) during the Double-Blind Phase. [ Time Frame: 12 weeks ]
  5. Change from baseline to Week 12 of the Double-Blind Phase in EuroQol Group 5-dimension 5-level self-report questionaire score. [ Time Frame: 12 weeks ]
  6. Change from baseline to Week 12 of the Double-Blind Phase in Work Productivity and Activity Impairment score with a range of 0-1 for 4 types of scores with higher scores indicating greater impairment. [ Time Frame: 12 weeks ]
  7. Time to loss of efficacy, defined as discontinuation of study drug for lack of efficacy. [ Time Frame: 12 weeks ]
  8. Summary of AEs and SAEs [ Time Frame: 60 weeks ]


Information from the National Library of Medicine

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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. Written informed consent provided prior to the conduct of any study-related procedures.
  2. Male or non-pregnant, non-lactating female subject, greater than or equal to 18 years old.
  3. Body mass index (BMI) between 18 and 38 kg/m2, inclusive.
  4. Treated with daily opioids for moderate to severe CLBP for a minimum of 3 months prior to Screening.
  5. On a stable dose of ≥40 mg/day of oral morphine or MED during the 14 days prior to Screening.
  6. Systolic blood pressure ≥100 mmHg and diastolic blood pressure ≥60 mmHg.
  7. Female subject of childbearing potential who is willing to use a reliable method of contraception during the entire study (Screening Visit to final Follow-up). To be considered not of childbearing potential, female subjects must be surgically sterile (hysterectomy or bilateral oophorectomy, or bilateral tubal ligation with surgery at least 6 weeks before Screening).
  8. Male subject who is willing to use reliable contraception
  9. Willing and able to comply with all study procedures and requirements.

Exclusion Criteria:

  1. Positive for hepatitis B surface antigen, hepatitis C viral RNA, or antibodies to human immunodeficiency virus (HIV).
  2. Clinically significant symptoms, medical conditions, or other circumstances which, in the opinion of the investigator, would preclude compliance with the protocol, adequate cooperation in the study, or obtaining informed consent, or may prevent the subject from safely participating in the study, including the following:

    1. Severe respiratory insufficiency, respiratory depression, airway obstruction, gastrointestinal motility disorders, biliary tract disease, severe hepatic insufficiency, or planned surgery.
    2. Bipolar disorder
  3. Current diagnosis of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition-defined moderate to severe substance use disorder (including alcohol), other than caffeine or nicotine.
  4. Female subject planning to become pregnant during the study.
  5. Surgical procedure(s) for CLBP within 6 months prior to Screening.
  6. Concomitant disease(s) that could prolong the QTcF interval, such as autonomic neuropathy (caused by diabetes or Parkinson's disease), HIV, cirrhosis, Long QT Syndrome, or family history of Long QT Syndrome.
  7. QTcF >450 ms for males and >470 ms for females, or clinically significant electrocardiogram (ECG) abnormality at Screening, at the investigator's discretion.
  8. Currently taking medications that have the potential to prolong the QTcF interval or may require such medications during the course of the study (Appendix 1) and has clinically significant abnormalities on screening ECG readings, as determined by the investigator.
  9. A nerve or plexus block, including epidural steroid injections or facet blocks, within 1 month prior to Screening or botulinum toxin injection in the lower back region within 3 months of Screening.
  10. History of chemotherapy or confirmed malignancy (except basal cell carcinoma) within the past 2 years.
  11. Any other acute or chronic pain condition that could interfere with the subject's ability to report their CLBP accurately and consistently and/or interfere with the study staff's ability to assess the subjects CLBP.
  12. An active or pending workman's compensation, insurance claim, or litigation related to back pain (i.e., primary claim is back pain).
  13. Clinically significant history, in the opinion of the investigator, of suicidal ideation or current evidence that the subject is actively suicidal.
  14. Clinically significant history of major depressive disorder that is poorly controlled with medication, per investigator judgment.
  15. Hypersensitivity or allergy to BPN, other opioids, or excipients of CAM2038.
  16. Hypersensitivity or allergy to acetaminophen.
  17. Use of strong inhibitors or inducers of cytochrome P450 3A4 (CYP3A4), such as some azole antifungals (e.g., ketoconazole), macrolide antibiotics (e.g., clarithromycin), or protease inhibitors (e.g., ritonavir, indinavir, and saquinavir) within the 30 days prior to Screening,
  18. Use or planned use of natural supplements that can affect CYP3A4, such as St. John's Wort, throughout the study.
  19. Has a major bleeding disorder, such as hemophilia, or treated with high levels of anticoagulants per the investigator's discretion.
  20. Current or confirmed past diagnosis of Sphincter of Oddi dysfunction.
  21. Has a significant hepatic disease, as indicated by Screening clinical laboratory assessment results (aspartate aminotransferase, alanine aminotransferase, or lactate dehydrogenase values ≥3 × the upper limit of normal [ULN]) or has a creatinine value ≥1.5 × ULN).
  22. Is an employee of the investigator or the trial site, with direct involvement in the proposed trial or other studies under the direction of the investigator or trial site or is a family member of the investigator or of an employee of the investigator.
  23. Has any pending legal action that could prohibit participation or compliance in the study.

Criteria for Entry into the Titration Phase:

  1. After at least a 12-hour washout from the last IR morphine dose, subject must have a COWS ≥5 and an API pain score over the past 24 hours ≥5 in order to receive a test dose of Buprenex.
  2. Passed all baseline criteria, including a normal QTcF, had no change in QTcF >30 ms at 1 hour after the test dose with Buprenex, and had a COWS score <5 after the test dose with Buprenex.

Note:

  • Subjects on BPN at Screening are required to participate in the down titration and will undergo a washout period prior to the test dose and first on-study treatment. Subjects entering the study on BPN will not transition to IR Morphine, but will refrain from taking their BPN for 12 -24 hours prior to the test dose to achieve the desired washout period.
  • Subjects on BPN at Screening are still required to follow the same Day 1 procedures (e.g., confirmation of pain scores, COWS assessment and Buprenex test dose) as non-BPN subjects.

Criteria for Randomization into the Double-Blind Phase:

  1. Been on a stable dose of CAM2038 q1w for at least 2 consecutive weeks.
  2. CAM2038 titrated to a dose that provides analgesia (i.e., 7-day API score of ≤4 and at least 2 points below the value at the start of Titration Phase) and is well tolerated for 7 days before randomization.
  3. Requires no more than an average of one hydrocodone/acetaminophen 5 mg/325 mg/day during the last 7 days prior to randomization.
  4. Demonstrated study medication (CAM2038) compliance ≥80% during the previous 14 days.
  5. Demonstrated daily compliance with pain intensity scoring for ≥11 of the previous 14 days, including the last 3 days prior to randomization.

Inclusion Criteria for Open Label Extension For Subjects Continuing from The Randomized Double-Blind Phase.

Subjects must have:

  1. Completed Double Blind Phase of the study
  2. Signed Informed Consent for Safety Extension

Subjects completing the double-blind phase will be enrolled directly into the open label extension at their respective dose level of CAM2038. They will not be required to participate in a Buprenex treatment test dosing or participate in a titration phase.

For De Novo Subjects (New Subjects Recruited Directly into The Open Label Extension)

Subjects who are not participating in the Double-Blind Phase of the Study must meet all of the following inclusion criteria in order to be eligible for participation in the study:

  1. Written informed consent provided prior to the conduct of any study-related procedures.
  2. Male or non-pregnant and non-lactating female subject, greater than or equal to 18 years old.
  3. BMI between 18 and 38 kg/m2, inclusive.
  4. Treated with daily opioids for moderate to severe chronic pain disorder such as CLBP or osteoarthritis for a minimum of 3 months prior to Screening.
  5. On a stable dose of >40 mg/day of oral morphine or MED during the 14 days prior to Screening.
  6. Systolic blood pressure ≥100 mmHg and diastolic blood pressure ≥60 mmHg.
  7. Female subject of childbearing potential who is willing to use a reliable method of contraception during the entire study (Screening Visit to final Follow-up). To be considered not of childbearing potential, female subjects must be surgically sterile (hysterectomy or bilateral oophorectomy, or bilateral tubal ligation with surgery at least 6 weeks before Screening).
  8. Male subject who is willing to use reliable contraception
  9. Willing and able to comply with all study procedures and requirements.

Exclusion Criteria for Subjects Continuing from The Randomized Double-Blind Phase

1. Clinically significant symptoms, medical conditions, or other circumstances which, in the opinion of the investigator, would preclude compliance with the protocol, adequate cooperation in the study, or obtaining informed consent, or may prevent the subject from safely participating in the study.

Exclusion Criteria for De Novo Subjects only:

Same exclusion criteria as for subjects participating in the Randomized Double-Blind Treatment Phase.

Criteria for Entry into the Titration Phase (for De novo subjects):

  1. After at least a 12-hour washout from the last IR morphine dose, subject should have a COWS ≥5 and an API pain score over the past 24 hours ≥5 in order to receive a test dose of Buprenex.
  2. Passed all baseline criteria, including a normal QTcF, had no change in QTcF >30 ms at 1 hour after the test dose with Buprenex, and had a COWS score <5 after the test dose with Buprenex.

Note:

  • Subjects on BPN at Screening are required to participate in the down titration and will undergo a washout period prior to the test dose and first on-study treatment. Subjects entering the study on BPN will not transition to IR Morphine, but will refrain from taking their BPN for 12 -24 hours prior to the test dose to achieve the desired washout period.
  • However, subjects on BPN at Screening are still required to follow the same Day 1 procedures (e.g., confirmation of pain scores, COWS assessment and Buprenex test dose) as non-BPN subjects.

Criteria for Enrolment into the Open Label Treatment Phase (for de Novo subjects):

  1. Been on a stable dose of CAM2038 q1w for at least 2 consecutive weeks.
  2. CAM2038 titrated to a dose that provides analgesia (i.e., 7-day API score of ≤4 and at least 2 points below the value at the start of Titration Phase) and is well tolerated for 7 days before randomization.
  3. Requires no more than an average of one hydrocodone/acetaminophen 5 mg/325 mg/day during the last 7 days prior to randomization

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): NCT02946073


  Hide Study Locations
Locations
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United States, Alabama
Parkway Medical Center
Birmingham, Alabama, United States, 35215
Boyett Health Services Inc
Hamilton, Alabama, United States, 35570
National Centers for Pain Management and Research
Vestavia Hills, Alabama, United States, 35243
United States, Arizona
Elite Clinical Studies
Phoenix, Arizona, United States, 85018
Phoenix Clinical
Phoenix, Arizona, United States, 85021
Noesis Pharma
Phoenix, Arizona, United States, 85032
Arizona Research Center
Phoenix, Arizona, United States, 85053
United States, California
MD Studies, Inc.
Fountain Valley, California, United States, 92708
Neuro-Pain Medical Center
Fresno, California, United States, 93710
Alliance Research Centers
Laguna Hills, California, United States, 92653
Clinical Trials Research
Lincoln, California, United States, 95648
Catalina Research Institute, LLC
Montclair, California, United States, 91763
Allied Clinical Research, LLC
Sacramento, California, United States, 95842
Care Practice
San Francisco, California, United States, 94708
Syrentis Clinical Research
Santa Ana, California, United States, 92705
Universal Pain Management Group
Valencia, California, United States, 91355
United States, Florida
Tampa Pain Relief Center-Brandon
Brandon, Florida, United States, 33511
International Research Partners
Doral, Florida, United States, 33122
Dr. Vijapura and Associates
Jacksonville, Florida, United States, 32256
Florida Institute of Medical Research
Jacksonville, Florida, United States, 32257
Lake Howell Health Center
Maitland, Florida, United States, 32751
Ocean Blue Medical Research Center, Inc.
Miami Springs, Florida, United States, 33166
Scientific Clinical Research, Inc.
North Miami, Florida, United States, 33161
Gold Coast Research, LLC
Plantation, Florida, United States, 33317
FMPM Research
Saint Petersburg, Florida, United States, 33709
Clinical Research of West Florida-Tampa
Tampa, Florida, United States, 33603
Tampa Pain Relief Centers-Hillsborough
Tampa, Florida, United States, 33603
Palm Beach Research Center
West Palm Beach, Florida, United States, 33409
United States, Georgia
River Birch Research Alliance LLC
Blue Ridge, Georgia, United States, 30513
Columbus Regional Research Institute
Knoxville, Georgia, United States, 37909
Drug Studies America
Marietta, Georgia, United States, 30060
Non-Surgical Orthopedics, P.C.
Marietta, Georgia, United States, 30060
United States, Idaho
Injury Care Research, LLC
Boise, Idaho, United States, 83713
United States, Illinois
Millennium Pain Center
Bloomington, Illinois, United States, 61701
Clinical Investigation Specialists, Inc.-Gurnee
Gurnee, Illinois, United States, 60031
United States, Indiana
Medisphere Medical Research Center
Evansville, Indiana, United States, 47714
United States, Kansas
International Clinical Research Institute Inc.
Overland Park, Kansas, United States, 66210
Phoenix Medical Research
Prairie Village, Kansas, United States, 66208
United States, Kentucky
Otrimed
Edgewood, Kentucky, United States, 41017
United States, Louisiana
River Cities Clinical Research Center
Shreveport, Louisiana, United States, 71105
United States, Massachusetts
Boston Paincare
Waltham, Massachusetts, United States, 02451
MedVadis Research Corporation
Watertown, Massachusetts, United States, 02472
United States, Missouri
Amicis Trials
Festus, Missouri, United States, 63028
United States, New Jersey
Hassman Research Institute
Berlin, New Jersey, United States, 08009
United States, New York
New York Clinical Trials, Inc
New York, New York, United States, 10022
MedEx Healthcare Research, Inc-NY
New York, New York, United States, 10036
Upstate Clinical Research Associates
Williamsville, New York, United States, 14221
United States, North Carolina
Rapha Institute for Clinical Research
Fayetteville, North Carolina, United States, 28314
OnSite Clinical Solutions, LLC-Hickory
Hickory, North Carolina, United States, 28602
Center for Clinical Research, LLC-Winston-Salem
Winston-Salem, North Carolina, United States, 27103
United States, Ohio
Aventiv Research, Inc.
Columbus, Ohio, United States, 43213
Dayton Outpatient Center (DOC) Clinical Research
Dayton, Ohio, United States, 45432
Providence Health Partners-Center for Clinical Research
Dayton, Ohio, United States, 45439
United States, Oklahoma
Medical Research Internationl
Oklahoma City, Oklahoma, United States, 73109
SP Research, PLLC
Oklahoma City, Oklahoma, United States, 73112
United States, Pennsylvania
Frost Medical Group, LLC
Conshohocken, Pennsylvania, United States, 19428
Suburban Research Associates
Media, Pennsylvania, United States, 19063
United States, South Carolina
Coastal Carolina Research Center
Charleston, South Carolina, United States, 29406
Medical Research South, LLC
Charleston, South Carolina, United States, 29407
United States, Tennessee
New Phase Research & Development
Knoxville, Tennessee, United States, 37909
United States, Texas
FutureSearch Trials of Dallas, LP
Dallas, Texas, United States, 75231
Renaissance Clinical Research and Hypertension Clinic
Dallas, Texas, United States, 75234
Research Concepts GP, LLC-Houstion
Houston, Texas, United States, 77004
Pioneer Research Solutions Inc.
Houston, Texas, United States, 77099
The Pain Relief Center
Plano, Texas, United States, 75024
United States, Utah
The SMART Clinic/Physicians Research Options LLC
Draper, Utah, United States, 84020
EPIC Medical Research
Murray, Utah, United States, 84123
Aspen Clinical Research
Orem, Utah, United States, 84058
United States, Washington
Mid Columbia Research
Richland, Washington, United States, 99352
Sponsors and Collaborators
Braeburn Pharmaceuticals
Medpace, Inc.
Camurus AB

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Responsible Party: Braeburn Pharmaceuticals
ClinicalTrials.gov Identifier: NCT02946073     History of Changes
Other Study ID Numbers: HS-16-555
First Posted: October 26, 2016    Key Record Dates
Last Update Posted: July 18, 2018
Last Verified: July 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

Additional relevant MeSH terms:
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Back Pain
Low Back Pain
Chronic Pain
Pain
Neurologic Manifestations
Signs and Symptoms
Buprenorphine
Analgesics, Opioid
Narcotics
Central Nervous System Depressants
Physiological Effects of Drugs
Analgesics
Sensory System Agents
Peripheral Nervous System Agents
Narcotic Antagonists