Evaluation of the Efficacy and Safety of Locally Administered HTX-011 for Postoperative Analgesia Following Bunionectomy

Phase 2

Completed

• Conditions: Postoperative Pain; Bunions
• Interventions: Drug: HTX-002; Biological: Saline Placebo; Drug: HTX-011A; Drug: HTX-011B; Drug: Bupivacaine HCl; Drug: HTX-009

• Registration Number: NCT02762929
• Lead Sponsor: Heron Therapeutics

Brief Summary

A Phase 2, Randomized, Controlled, Multicenter, Evaluation of the Efficacy and Safety of Locally Administered HTX-011 for Postoperative Analgesia Following Bunionectomy

Detailed Description

This study includes multiple formulations for formulation selection of the fixed-combination product and for the factorial design assessment of the contribution of each component. HTX-011A is the second formulation studied (HTX-011-49). HTX-011B is the final formulation studied (HTX-011-56), which was also included in subsequent Phase 2b and Phase 3 studies. For the factorial design assessment, HTX-002, a bupivacaine-only formulation in the same HTX-011 proprietary polymer, and HTX-009, a meloxicam-only formulation in the same HTX-011 proprietary polymer, were evaluated.

Study Timeline

• Study Start: 2016-05
• Study First Submitted: 2016-05-02
• Study First Submitted QC: 2016-05-04
• Study First Posted: 2016-05-05
• Primary Completion: 2017-02
• Study Completion: 2017-03
• Disposition First Submitted: 2018-06-08
• Disposition First Submitted QC: 2018-06-08
• Disposition First Posted: 2018-06-12
• Results First Submitted: 2021-06-14
• Status Verified: 2023-09
• Results First Submitted QC: 2023-09-13
• Last Update Submitted: 2023-09-13
• Results First Posted: 2023-10-04
• Last Update Posted: 2023-10-04

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 430

Inclusion Criteria

1. Be male or female 18 years of age or older

2. Female subjects are eligible only if all of the following apply:

   1. Not pregnant (female subject of child bearing potential must have a negative serum pregnancy test at screening and negative urine pregnancy test before surgery)
   2. Not lactating
   3. Not planning to become pregnant while participating in the study
   4. Be surgically sterile; or be at least two years post-menopausal; or have a monogamous partner who is surgically sterile; or be practicing double-barrier contraception; or practicing abstinence (must agree to use double-barrier contraception in the event of sexual activity); or using an insertable, injectable, transdermal, or combination oral contraceptive approved by the FDA for greater than 2 months prior to screening visits and commits to the use of an acceptable form of birth control for the duration of the study and for 30 days from completion of the study

3. Male subjects must be surgically sterile (biologically or surgically) or commit to the use of a reliable method of birth control for the duration of the study until at least 1 week after the administration of study medication

4. Be scheduled to undergo a primary unilateral first metatarsal bunionectomy repair, without collateral procedures, under regional anesthesia

5. Subject has not had a contralateral bunionectomy in the non-study foot in the past 3 months

6. Have the ability and be willing to comply with the study procedures.

7. Must be able to understand study procedures and give informed consent for the conduct for all study procedures, using an IRB approved consent form

Exclusion Criteria

1. Unwilling to sign informed consent or not willing or able to complete all study procedures
2. Have a contraindication or be allergic to any medication to be used during the trial period
3. Have clinically significant cardiac abnormalities that, in the opinion of the investigator, would pose a health risk to the subject
4. Have American Society of Anesthesiologists (ASA) Physical Status classification system category ≥4
5. Have clinically significant renal or hepatic abnormalities: for example, AST or ALT > 3x ULN, creatinine > 2x ULN
6. Have another pre-existing painful condition that may confound pain assessments
7. Have another surgery planned within 30 days of procedure
8. Have a known or suspected history of alcohol or drug abuse, or a positive drug screen
9. Currently taking analgesics for a chronically painful condition, or has taken long acting opioids within 3 days of surgery, or taken any opioids within 24 hours of scheduled surgery for this study
10. Subjects with documented sleep apnea or are on home continuous positive airway pressure (CPAP)
11. Subjects who are receiving oxygen therapy at the time of screening
12. Have participated in a clinical trial within 30 days of planned surgery

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
HTX-002, 120 mg	HTX-002	HTX-002, 120 mg via injection.
HTX-002, 60 mg	HTX-002	HTX- 002, 60 mg via injection.
Saline Placebo	Saline Placebo	Saline placebo via injection.
HTX-011A: 200 mg	HTX-011A	HTX-011A (bupivacaine/meloxicam), 200 mg/6 mg via injection.
HTX-011B: 30 mg	HTX-011B	HTX 011B (bupivacaine/meloxicam), 30 mg/0.9 mg via injection.
Bupivacaine HCI	Bupivacaine HCl	Bupivacaine HCI, 50 mg via injection.
HTX-002, 200 mg	HTX-002	HTX-002, 200 mg via injection.
HTX-009	HTX-009	HTX-009, 3.6 mg via injection.
HTX-011B : 60 mg	HTX-011B	HTX-011B (bupivacaine/meloxicam) 60 mg/1.8 mg via injection or instillation.
HTX-011B: 120 mg	HTX-011B	HTX- 011B (bupivacaine/meloxicam), 120 mg/3.6 mg via injection or instillation.
HTX-011B: 200 mg	HTX-011B	HTX- 011B (bupivacaine/meloxicam), 200 mg/6 mg via injection.

Primary Outcome Measures

Name	Time	Method
Mean Summed Pain Intensity (SPI) Score Over 24 Hours	0-24 hours	The SPI is derived by summing the pain intensity score weighted by the scheduled time duration. SPI0-24 will be calculated by summing the Pain intensity (PI) score at the relevant time points weighted by the scheduled time duration since the prior PI assessment as follows: SPI0-24= PI1+PI2+2\*PI4+2\*PI6+2\*PI8+2\*PI10+2\*PI12+2\*PI14+4\*PI18+6\*PI24. Min = 0 (if PI=0 at every time) and Max = 240 (if PI=10 at every time).