Open-Label, Extension Study to Evaluate the Safety of Hydrocodone Bitartrate Extended-Release Tablets
- Registration Number
- NCT01922739
- Lead Sponsor
- Teva Branded Pharmaceutical Products R&D, Inc.
- Brief Summary
This is a 6-month, nonrandomized, open-label extension study to assess the long-term safety of hydrocodone bitartrate extended-release (ER) tablets in patients with moderate to severe chronic low back pain who require continuous opioid treatment for an extended period of time.
To be eligible for Study 3104, patients were required to have completed the entire double blind treatment period on study drug (either placebo or hydrocodone bitartrate ER tablets) through week 12 of Study 3103 (NCT01789970) and to have met the entry criteria for Study 3104.
- Detailed Description
Eligible patients from Study 3103 (NCT01789970) were enrolled for participation in this extension study. For these patients, the final study visit in Study 3103 was visit 1 for this study (also referred to as the titration or adjustment baseline visit, depending on whether the patient was enrolled under the original or amended protocol, respectively). The original protocol was amended after 26 patients had been enrolled in the study. Those who were enrolled under the original protocol participated in a double-blind titration period of up to approximately 4 weeks followed by an open-label treatment period of 22 weeks. Those patients who were enrolled under the amended protocol participated in an open-label adjustment period of up to approximately 3 weeks followed by an open-label treatment period of 22 weeks.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 182
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Patients must have participated in and completed the entire double-blind treatment period on study drug through the final study visit (week 12) of study 3103.
NOTE: Patients who had a final on-treatment visit (i.e. prior to week 12) are not permitted to participate in study 3104.
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The patient is able to speak English and is willing to provide written informed consent for study 3104, including re-signing a written opioid agreement, to participate in this study.
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Women of childbearing potential (not surgically sterile or 2 years postmenopausal) must use a medically accepted method of contraception, agree to continue use of this method for the duration of the study and for 30 days after participation in the study, and have a negative pregnancy test at screening. Acceptable methods of contraception include barrier method with spermicide, intrauterine device (IUD), or steroidal contraceptive (oral, transdermal, implanted, and injected) in conjunction with a barrier method. 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.
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The patient must be willing and able to successfully self-administer the study drug, comply with study restrictions, and return to the study center for scheduled study visits, as specified in the protocol.
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The patient must not participate in any other study involving an investigational agent (excluding those who participated in study 3103) while enrolled in the present study.
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The patient's current source of pain is different from the low back pain the patient was experiencing at entry into study 3103. NOTE: Any additional source of pain for a patient must be discussed with the medical monitor.
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The patient has current evidence of alcohol or other substance abuse with the exception of nicotine or caffeine.
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The patient has developed, during study 3103, a medical or psychiatric disease (including suicidality) that, in the opinion of the investigator, would compromise collected data.
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The patient is expected to have surgery during the study.
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The patient is pregnant or lactating.
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The patient has developed an active malignancy (excluding basal cell carcinoma) during study 3103.
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The patient has known human immunodeficiency virus (HIV).
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In the judgment of the investigator, the patient has any clinically significant deviation from normal in the physical examination and/or clinical laboratory test values.
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The patient has developed cardiopulmonary disease that would, in the opinion of the investigator, significantly increase the risk of treatment with opioids.
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The patient is receiving a monoamine oxidase inhibitor (MAOI).
- Other exclusion criteria apply.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SINGLE_GROUP
- Arm && Interventions
Group Intervention Description Hydrocodone ER Hydrocodone ER Participants were administered hydrocodone ER tablets orally at dosages of 15, 30, 45, 60, or 90 mg every 12 hours at the dosage deemed successful for managing their pain. If enrolled under the original protocol, there was a double-blind titration period of four weeks to adjust the dose taken in study 3103 (NCT01789970). If enrolled under the amended protocol, there was an open-label adjustment period of three weeks to adjust the dose taken in study 3103 (NCT01789970). Both versions of protocol 3104 followed the titration/adjustment period with a open-label treatment period of 22 weeks. Hydrocodone ER Placebo Participants were administered hydrocodone ER tablets orally at dosages of 15, 30, 45, 60, or 90 mg every 12 hours at the dosage deemed successful for managing their pain. If enrolled under the original protocol, there was a double-blind titration period of four weeks to adjust the dose taken in study 3103 (NCT01789970). If enrolled under the amended protocol, there was an open-label adjustment period of three weeks to adjust the dose taken in study 3103 (NCT01789970). Both versions of protocol 3104 followed the titration/adjustment period with a open-label treatment period of 22 weeks.
- Primary Outcome Measures
Name Time Method Participants With Adverse Events Day 1 of the Titration/Adjustment Period to Week 22 of the Treatment Period (total of 25-26 weeks) An adverse event (AE) was defined in the protocol as any untoward medical occurrence that develops or worsens in severity during the conduct of a clinical study and does not necessarily have a causal relationship to the study drug. Severity was rated by the investigator on a scale of mild, moderate and severe, with severe= an inability to carry out usual activities. Relation of AE to treatment was determined by the investigator. Serious AEs include death, a life-threatening adverse event, inpatient hospitalization or prolongation of existing hospitalization, persistent or significant disability or incapacity, a congenital anomaly or birth defect, OR an important medical event that jeopardized the patient and required medical intervention to prevent the previously listed serious outcomes.
Shifts From Baseline to Endpoint (Treatment Period) in Electrocardiogram (ECG) Findings Baseline (final visit for study 3103), End of trial visit (up to week 22 of Open-label Treatment Period which is up to week 26 including the titration/adjustment period) A 12-lead ECG was conducted at the final visit for study 3103 which is used as baseline for this study, and at week 22 of the treatment period \[or early termination\]). A qualified physician at the study center was responsible for providing interpretation of the ECG.
Endpoint refers to the last observation carried forward.Participants With Clinically Significant (CS) Hearing Changes From Baseline to the Final Visit in Pure Tone Audiometry Test Results Baseline was within two weeks of the final study visit in study 3103; during study exam was within two weeks of the end of trial visit for study 3104 (up to study week 26) Pure tone audiometry was performed by trained personnel. Hearing loss was classified in degrees of hearing from normal to profound. This classification was determined by the hearing threshold (or the softest sound detected at a specific frequency). The exact ranges that classified hearing loss depended on the exact technique used during testing and on the patient's age. These values were provided by each audiology laboratory that performed the test. For serial audiograms, the criteria for a clinically significant hearing change were based on guidance from the American Speech Language Hearing Association (ASHA 1994, cited in \[Konrad-Martin et al 2005\]). These criteria included the following: greater than 20 decibels (dB) pure tone threshold shift at 1 frequency; greater than 10 dB shift at 2 consecutive test frequencies; or threshold response shifting to "no response" at 3 consecutive test frequencies.
Participants With Potentially Clinically Significant Abnormal Laboratory Values End of trial visit (up to week 22 of Open-label Treatment Period which is up to week 26 including the titration/adjustment period) Data represents participants with potentially clinically significant abnormal serum chemistry, hematology and urinalysis values.
Significance criteria:
* Blood urea nitrogen: \>=10.71 mmol/L
* Creatinine: \>=177 μmol/L
* Uric acid: M\>=625, F\>=506 μmol/L
* Aspartate aminotransferase (AST): \>=3\* upper limit of normal (ULN)
* Alkaline phosphatase: \>=3\* upper limit of normal (ULN)
* Gamma-glutamyl transpeptidase (GGT): \>=3\* upper limit of normal (ULN)
* Serum white blood cells: \>=20 \* 10\^9/L
* Hemoglobin: M\<=115, F\<=95 g/dL
* Hematocrit: M\<0.37, F\<0.32 L/L
* Eosinophils: \>=10.0 %
* Platelets: \<=75 \* 10\^9/L
* Absolute neutrophils: \<=1.0 \* 10\^9/L
* Urinalysis: Glucose, Ketones, and Total Protein: \>=2 unit increase from baselineParticipants With Potentially Clinically Significant Abnormal Vital Signs Values Day 1 of the Titration/Adjustment Period to Week 22 of the Treatment Period (total of 25-26 weeks) Data represents participants with potentially clinically significant (PCS) vital sign values.
Significance criteria
* Pulse - high: \>=120 and increase of \>= 15 beats/minute from baseline
* Pulse - low: \<=50 and decrease of \>=15 beats/minute
* Systolic blood pressure - high: \>=180 and increase \>=20 mmHg
* Systolic blood pressure - low: \<=90 and decrease \>=20 mmHg
* Diastolic blood pressure - high: \>=105 and increase of \>=15 mmHg
* Diastolic blood pressure - low: \<=50 and decrease of \>=15 mmHgParticipants With Shifts From Normal to Abnormal in Physical Examination Findings End of trial visit (up to week 22 of Open-label Treatment Period which is up to week 26 including the titration/adjustment period) The endpoint visit or early termination visit was an abbreviated exam. Endpoint refers to the last observation carried forward.
- Secondary Outcome Measures
Name Time Method Change From Baseline to Weeks 2, 6, 10, 14, 18, 22 and Endpoint of the Treatment Period in Daily Worst Pain Intensity (WPI) Scores During the Previous 24 Hours for Each Visit Baseline (Day 0 of Treatment Period), Weeks 2, 6, 10, 14, 18, 22 and Endpoint during the Open-Label Treatment Period The WPI was recorded daily by participants in an electronic diary using an 11-point numerical rating scale (NRS-11), a Likert-type scale in which 0=no pain and 10=the worst pain imaginable. At each visit, participants selected the number that best described their worst pain intensity over the last 24 hours. Negative change from baseline scores indicate improvement in pain control.
Endpoint refers to the last observation carried forward.Change From Baseline to Weeks 2, 6, 10, 14, 18, 22 and Endpoint of the Treatment Period in Daily Average Pain Intensity (API) Scores During the Previous 24 Hours for Each Visit Baseline (Day 0 of Treatment Period), Weeks 2, 6, 10, 14, 18, 22 and Endpoint during the Open-Label Treatment Period The API was recorded daily by participants in an electronic diary using an 11-point numerical rating scale (NRS-11), a Likert-type scale in which 0=no pain and 10=the worst pain imaginable. Participants selected the number that best described their average pain intensity over the last 24 hours. Negative change from baseline scores indicate improvement in pain control.
Endpoint refers to the last observation carried forward.Percentage of Participants Withdrawn From the Study For Lack of Efficacy Day 1 of the Titration/Adjustment Period to Week 22 of the Treatment Period (total of 25-26 weeks) Percentage of patients who withdrew from the study for lack of efficacy, as indicated on the early termination form of the case report form (CRF).
Trial Locations
- Locations (61)
Teva Investigational Site 10426
🇺🇸Mobile, Alabama, United States
Teva Investigational Site 10425
🇺🇸Carmichael, California, United States
Teva Investigational Site 10370
🇺🇸Los Angeles, California, United States
Teva Investigational Site 10428
🇺🇸Torrance, California, United States
Teva Investigational Site 10379
🇺🇸Fort Lauderdale, Florida, United States
Teva Investigational Site 10357
🇺🇸Plantation, Florida, United States
Teva Investigational Site 10385
🇺🇸Marietta, Georgia, United States
Teva Investigational Site 10411
🇺🇸Chicago, Illinois, United States
Teva Investigational Site 10389
🇺🇸Fall River, Massachusetts, United States
Teva Investigational Site 10364
🇺🇸Dallas, Texas, United States
Teva Investigational Site 10372
🇺🇸Dallas, Texas, United States
Teva Investigational Site 10371
🇺🇸Houston, Texas, United States
Teva Investigational Site 10363
🇺🇸Phoenix, Arizona, United States
Teva Investigational Site 10431
🇺🇸Meridian, Idaho, United States
Teva Investigational Site 10419
🇺🇸New Orleans, Louisiana, United States
Teva Investigational Site 10359
🇺🇸Shreveport, Louisiana, United States
Teva Investigational Site 10437
🇺🇸Tucson, Arizona, United States
Teva Investigational Site 10743
🇺🇸Meridian, Idaho, United States
Teva Investigational Site 10366
🇺🇸Phoenix, Arizona, United States
Teva Investigational Site 10376
🇺🇸Omaha, Nebraska, United States
Teva Investigational Site 10373
🇺🇸Tipton, Pennsylvania, United States
Teva Investigational Site 10399
🇺🇸Las Vegas, Nevada, United States
Teva Investigational Site 10414
🇺🇸Winston-Salem, North Carolina, United States
Teva Investigational Site 10409
🇺🇸Berlin, New Jersey, United States
Teva Investigational Site 10439
🇺🇸Buffalo, New York, United States
Teva Investigational Site 10374
🇺🇸Plano, Texas, United States
Teva Investigational Site 10446
🇺🇸Oklahoma City, Oklahoma, United States
Teva Investigational Site 10405
🇺🇸Austin, Texas, United States
Teva Investigational Site 10386
🇺🇸Mechanicsburg, Pennsylvania, United States
Teva Investigational Site 10430
🇺🇸Duncansville, Pennsylvania, United States
Teva Investigational Site 10433
🇺🇸Everett, Washington, United States
Teva Investigational Site 10378
🇺🇸San Antonio, Texas, United States
Teva Investigational Site 10402
🇺🇸Salt Lake City, Utah, United States
Teva Investigational Site 10410
🇺🇸New York, New York, United States
Teva Investigational Site 10436
🇺🇸Montgomery, Alabama, United States
Teva Investigational Site 10412
🇺🇸Birmingham, Alabama, United States
Teva Investigational Site 10358
🇺🇸Anaheim, California, United States
Teva Investigational Site 10408
🇺🇸Bell Gardens, California, United States
Teva Investigational Site 10429
🇺🇸El Cajon, California, United States
Teva Investigational Site 10391
🇺🇸Huntington Park, California, United States
Teva Investigational Site 10390
🇺🇸Cerritos, California, United States
Teva Investigational Site 10423
🇺🇸Escondido, California, United States
Teva Investigational Site 10392
🇺🇸Sherman Oaks, California, United States
Teva Investigational Site 10398
🇺🇸Thousand Oaks, California, United States
Teva Investigational Site 10369
🇺🇸DeLand, Florida, United States
Teva Investigational Site 10361
🇺🇸Walnut Creek, California, United States
Teva Investigational Site 10365
🇺🇸Jacksonville, Florida, United States
Teva Investigational Site 10445
🇺🇸Leesburg, Florida, United States
Teva Investigational Site 10381
🇺🇸Ormond Beach, Florida, United States
Teva Investigational Site 10362
🇺🇸Orlando, Florida, United States
Teva Investigational Site 10435
🇺🇸Royal Palm Beach, Florida, United States
Teva Investigational Site 10383
🇺🇸Marietta, Georgia, United States
Teva Investigational Site 10432
🇺🇸Columbus, Georgia, United States
Teva Investigational Site 10444
🇺🇸Newnan, Georgia, United States
Teva Investigational Site 10440
🇺🇸Newburgh, Indiana, United States
Teva Investigational Site 10388
🇺🇸Bay City, Michigan, United States
Teva Investigational Site 10397
🇺🇸Biloxi, Mississippi, United States
Teva Investigational Site 10406
🇺🇸Hazelwood, Missouri, United States
Teva Investigational Site 10401
🇺🇸Saint Louis, Missouri, United States
Teva Investigational Site 10377
🇺🇸Lake Jackson, Texas, United States
Teva Investigational Site 10420
🇺🇸Bellevue, Washington, United States