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Study to Assess the Effectiveness and Safety of FLECTOR Patch for Treatment of Acute Back Strain

Multicenter, Open-Label Study to Assess the Effectiveness and Safety of FLECTOR Patch for Treatment of Acute Back Strain

Status
Completed
Phases
Phase 4
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT01054820
Enrollment
123
Registered
2010-01-22
Start date
2010-01-31
Completion date
2010-03-31
Last updated
2012-08-16

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Acute Back Strain

Keywords

FLECTOR® Patch, acute back strain

Brief summary

Although approved for minor strains, sprains and contusions, FLECTOR Patch has not been studied extensively in the setting of acute back strain. This study is being conducted as an initial step in demonstrating the benefit of FLECTOR Patch specifically for back strain. In particular, this study is expected to provide information about the amount of improvement in back strain among subjects using the FLECTOR Patch, which may then be used to inform subsequent studies.

Interventions

DRUGFLECTOR® Patch (diclofenac epolamine topical patch) 1.3%

One FLECTOR Patch applied to the most painful area on the subject's back every 12 hours for up to 14 days.

Sponsors

Pfizer
Lead SponsorINDUSTRY

Study design

Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No

Inclusion criteria

Participants in the study must: 1. have acute, non-radicular back strain with onset up to 10 days before the first visit 2. have intact, non-damaged skin at the proposed patch application site 3. be untreated or unresponsive to conservative pain treatment regimens and/or opioids 4. have a minimum pain intensity score of four (4) or more on a scale of 1-10 (a rating of zero (0) being no pain and a rating of ten (10) being pain as bad as you can imagine) 5. have a normal neurologic examination

Exclusion criteria

Participants may not be in the study if they: 1. have had surgery or other chronic pain condition within 3 months before first treatment 2. have back pain radiating below the knee at time of enrollment 3. have neuropathic pain or have been treated with gabapentin or pregabalin for neuropathy 4. are being treated for or are known to currently have kidney or liver disease 5. have certain other diseases or are using certain types of other drugs.

Design outcomes

Primary

MeasureTime frameDescription
Mean Change From Baseline to End of Treatment (EOT) in Response to Modified Brief Pain Inventory (mBPI) Question 5: Average Pain Over the Last 24 HoursBaseline, End of Treatment (last visit up to Day 15)Participant-rated instrument to assess functional activities (general activity, mood, walking ability, relations with other people, sleep, normal work, and enjoyment of life) in past 24 hours. Question 5: Please rate your pain by marking the box beside the number that best describes your pain on the average (over the last 24 hours); rated on an 11 point Likert rating scale ranging from 0 (no pain) to 10 (pain as bad as you can imagine).

Secondary

MeasureTime frameDescription
Mean Change From Baseline to EOT in Response to Modified Brief Pain Inventory (mBPI) Question 3: Pain at Its Worst in the Last 24 HoursBaseline, End of Treatment (last visit up to Day 15)Participant-rated instrument to assess functional activities (general activity, mood, walking ability, relations with other people, sleep, normal work, and enjoyment of life) in past 24 hours. Question 3: Rate your pain at its worst in the last 24 hours; rated on an 11 point Likert rating scale ranging from 0 (no pain) to 10 (pain as bad as you can imagine).
Mean Change From Baseline to EOT in Response to Modified Brief Pain Inventory (mBPI) Question 4: Pain at Its Least in the Last 24 HoursBaseline, End of Treatment (last visit up to Day 15)Participant-rated instrument to assess functional activities (general activity, mood, walking ability, relations with other people, sleep, normal work, and enjoyment of life) in past 24 hours. Question 4: Rate your pain at its least in the last 24 hours; rated on an 11 point Likert rating scale ranging from 0 (no pain) to 10 (pain as bad as you can imagine).
Mean Change From Baseline to EOT in Response to Modified Brief Pain Inventory (mBPI) Question 6: Pain Right NowBaseline, End of Treatment (last visit up to Day 15)Participant-rated instrument to assess functional activities (general activity, mood, walking ability, relations with other people, sleep, normal work, and enjoyment of life) in past 24 hours. Question 6: Rate your pain right now; rated on an 11 point Likert rating scale ranging from 0 (no pain) to 10 (pain as bad as you can imagine).
Mean Change From Baseline to EOT in Response to Modified Brief Pain Inventory (mBPI) Question 8: Percent Reduction in Pain From BaselineBaseline, End of Treatment (last visit up to Day 15)Participant-rated instrument to assess functional activities (general activity, mood, walking ability, relations with other people, sleep, normal work, and enjoyment of life) in past 24 hours. Question 8: Rate your percent reduction in pain from Baseline (0% = no relief to 100% = complete relief).
Number of Participants With Change From Baseline (Bsl) to EOT in Response to Modified Brief Pain Inventory (mBPI) Question 1: Pain Other Than Everyday Kind of PainBaseline, End of Treatment (last visit up to Day 15)Participant-rated instrument to assess functional activities (general activity, mood, walking ability, relations with other people, sleep, normal work, and enjoyment of life) in past 24 hours. Question 1: Have you had pain other than everyday kinds of pain?; response = Yes or No.
Number of Participants Per Global Pain Relief Scores at the End of Treatment as Assessed by the InvestigatorEnd of Treatment (up to Day 15)Participants' global pain relief as assessed by investigator using a 5-point scale where 5 = complete relief, 4=a lot of improvement, 3=moderate improvement, 2=slight improvement, and 1=no change.
Mean Change From Baseline to EOT in Beck Depression Inventory® IlBaseline, End of Treatment (last visit up to Day 15)The Beck Depression Inventory® II consisted of 21 items, each with 4 categorical responses ranging from 0 (I do not feel sad) to 3 (I am so sad or unhappy that I can't stand it) with maximum possible score of 63; increase in the number reflected an increase in severity. Total Beck Depression Inventory® II scores classified as follows: 1 to 10=normal ups and downs; 11 to 16=mild mood disturbance; 17 to 20=borderline clinical depression; 21 to 30=moderate depression; 31 to 40=severe depression; and \>40=extreme depression.
Number of Participants Per Patch Satisfaction Response at the End of Treatment as Assessed by ParticipantEnd of Treatment (last visit up to Day 15)Participant satisfaction with the FLECTOR® Patch rated on a 5-point scale scored as 5=Very Satisfied, 4=Satisfied, 3=No Preference, 2=Dissatisfied, and 1=Very Dissatisfied.
Number of Participants Per Patch Satisfaction Response at the End of Treatment as Assessed by the InvestigatorEnd of Treatment (last visit up to Day 15)Investigator's assessment of participants' satisfaction with the FLECTOR® Patch rated on a 5-point scale scored as 5=Very Satisfied, 4=Satisfied, 3=No Preference, 2=Dissatisfied, and 1=Very Dissatisfied.
Number of Participants Per Global Pain Relief Scores at the End of Treatment as Assessed by the ParticipantEnd of Treatment (up to Day 15)Global pain relief as assessed by participant using a 5-point scale where 5 = complete relief, 4=a lot of improvement, 3=moderate improvement, 2=slight improvement, and 1=no change.

Participant flow

Participants by arm

ArmCount
FLECTOR® Patch (Diclofenac Epolamine Topical Patch) 1.3%.
One patch applied topically every 12 hours for up to 14 days. Patch was to be applied at approximately the same time every day upon arising in the morning and at bedtime. The patch was to be applied to the most painful area to cover as much of the painful region as possible.
123
Total123

Withdrawals & dropouts

PeriodReasonFG000
Overall StudyWithdrawal by Subject2

Baseline characteristics

CharacteristicFLECTOR® Patch (Diclofenac Epolamine Topical Patch) 1.3%.
Age Continuous38.8 years
STANDARD_DEVIATION 12.4
Sex: Female, Male
Female
60 Participants
Sex: Female, Male
Male
63 Participants

Adverse events

Event typeEG000
affected / at risk
deaths
Total, all-cause mortality
— / —
other
Total, other adverse events
15 / 123
serious
Total, serious adverse events
1 / 123

Outcome results

Primary

Mean Change From Baseline to End of Treatment (EOT) in Response to Modified Brief Pain Inventory (mBPI) Question 5: Average Pain Over the Last 24 Hours

Participant-rated instrument to assess functional activities (general activity, mood, walking ability, relations with other people, sleep, normal work, and enjoyment of life) in past 24 hours. Question 5: Please rate your pain by marking the box beside the number that best describes your pain on the average (over the last 24 hours); rated on an 11 point Likert rating scale ranging from 0 (no pain) to 10 (pain as bad as you can imagine).

Time frame: Baseline, End of Treatment (last visit up to Day 15)

Population: Intent to Treat (ITT) population: had at least one application of FLECTOR® Patch, pain survey data at Baseline, and at least 1 follow-up visit. EOT score calculated by taking average of any non-missing scores recorded last 3 days of treatment; if no score on those days, EOT was single, most recent non-missing score recorded on a treatment day.

ArmMeasureGroupValue (MEAN)Dispersion
FLECTOR® Patch (Diclofenac Epolamine Topical Patch) 1.3%.Mean Change From Baseline to End of Treatment (EOT) in Response to Modified Brief Pain Inventory (mBPI) Question 5: Average Pain Over the Last 24 HoursBaseline6.46 scores on a scaleStandard Deviation 1.3
FLECTOR® Patch (Diclofenac Epolamine Topical Patch) 1.3%.Mean Change From Baseline to End of Treatment (EOT) in Response to Modified Brief Pain Inventory (mBPI) Question 5: Average Pain Over the Last 24 HoursChange from baseline to EOT-3.95 scores on a scaleStandard Deviation 2.51
Comparison: Null hypothesis: no change from baseline. Study powered at 95 percent (%) to detect a mean change of at least 1.2 units, with assumed standard deviation of at most 3.2 units.p-value: <0.0001t-test, 2 sided
Secondary

Mean Change From Baseline to EOT in Beck Depression Inventory® Il

The Beck Depression Inventory® II consisted of 21 items, each with 4 categorical responses ranging from 0 (I do not feel sad) to 3 (I am so sad or unhappy that I can't stand it) with maximum possible score of 63; increase in the number reflected an increase in severity. Total Beck Depression Inventory® II scores classified as follows: 1 to 10=normal ups and downs; 11 to 16=mild mood disturbance; 17 to 20=borderline clinical depression; 21 to 30=moderate depression; 31 to 40=severe depression; and \>40=extreme depression.

Time frame: Baseline, End of Treatment (last visit up to Day 15)

Population: ITT population; End-of-Treatment score was the most recent non-missing value.

ArmMeasureGroupValue (MEAN)Dispersion
FLECTOR® Patch (Diclofenac Epolamine Topical Patch) 1.3%.Mean Change From Baseline to EOT in Beck Depression Inventory® IlBaseline3.44 scores on a scaleStandard Deviation 5.47
FLECTOR® Patch (Diclofenac Epolamine Topical Patch) 1.3%.Mean Change From Baseline to EOT in Beck Depression Inventory® IlChange from baseline to EOT-1.54 scores on a scaleStandard Deviation 3.05
p-value: <0.0001t-test, 2 sided
Secondary

Mean Change From Baseline to EOT in Response to Modified Brief Pain Inventory (mBPI) Question 3: Pain at Its Worst in the Last 24 Hours

Participant-rated instrument to assess functional activities (general activity, mood, walking ability, relations with other people, sleep, normal work, and enjoyment of life) in past 24 hours. Question 3: Rate your pain at its worst in the last 24 hours; rated on an 11 point Likert rating scale ranging from 0 (no pain) to 10 (pain as bad as you can imagine).

Time frame: Baseline, End of Treatment (last visit up to Day 15)

Population: ITT population; EOT score calculated by taking average of any non-missing scores recorded last 3 days of treatment; if no score on those days, EOT was single, most recent non-missing score recorded on a treatment day.

ArmMeasureGroupValue (MEAN)Dispersion
FLECTOR® Patch (Diclofenac Epolamine Topical Patch) 1.3%.Mean Change From Baseline to EOT in Response to Modified Brief Pain Inventory (mBPI) Question 3: Pain at Its Worst in the Last 24 HoursBaseline7.59 scores on a scaleStandard Deviation 1.19
FLECTOR® Patch (Diclofenac Epolamine Topical Patch) 1.3%.Mean Change From Baseline to EOT in Response to Modified Brief Pain Inventory (mBPI) Question 3: Pain at Its Worst in the Last 24 HoursChange from baseline to EOT-4.50 scores on a scaleStandard Deviation 2.48
p-value: <0.0001t-test, 2 sided
Secondary

Mean Change From Baseline to EOT in Response to Modified Brief Pain Inventory (mBPI) Question 4: Pain at Its Least in the Last 24 Hours

Participant-rated instrument to assess functional activities (general activity, mood, walking ability, relations with other people, sleep, normal work, and enjoyment of life) in past 24 hours. Question 4: Rate your pain at its least in the last 24 hours; rated on an 11 point Likert rating scale ranging from 0 (no pain) to 10 (pain as bad as you can imagine).

Time frame: Baseline, End of Treatment (last visit up to Day 15)

Population: ITT population; EOT score calculated by taking average of any non-missing scores recorded last 3 days of treatment; if no score on those days, EOT was single, most recent non-missing score recorded on a treatment day.

ArmMeasureGroupValue (MEAN)Dispersion
FLECTOR® Patch (Diclofenac Epolamine Topical Patch) 1.3%.Mean Change From Baseline to EOT in Response to Modified Brief Pain Inventory (mBPI) Question 4: Pain at Its Least in the Last 24 HoursBaseline5.46 scores on a scaleStandard Deviation 1.84
FLECTOR® Patch (Diclofenac Epolamine Topical Patch) 1.3%.Mean Change From Baseline to EOT in Response to Modified Brief Pain Inventory (mBPI) Question 4: Pain at Its Least in the Last 24 HoursChange from baseline to EOT-3.50 scores on a scaleStandard Deviation 2.3
p-value: <0.0001t-test, 2 sided
Secondary

Mean Change From Baseline to EOT in Response to Modified Brief Pain Inventory (mBPI) Question 6: Pain Right Now

Participant-rated instrument to assess functional activities (general activity, mood, walking ability, relations with other people, sleep, normal work, and enjoyment of life) in past 24 hours. Question 6: Rate your pain right now; rated on an 11 point Likert rating scale ranging from 0 (no pain) to 10 (pain as bad as you can imagine).

Time frame: Baseline, End of Treatment (last visit up to Day 15)

Population: ITT population; EOT score calculated by taking average of any non-missing scores recorded last 3 days of treatment; if no score on those days, EOT was single, most recent non-missing score recorded on a treatment day.

ArmMeasureGroupValue (MEAN)Dispersion
FLECTOR® Patch (Diclofenac Epolamine Topical Patch) 1.3%.Mean Change From Baseline to EOT in Response to Modified Brief Pain Inventory (mBPI) Question 6: Pain Right NowBaseline6.49 scores on a scaleStandard Deviation 1.76
FLECTOR® Patch (Diclofenac Epolamine Topical Patch) 1.3%.Mean Change From Baseline to EOT in Response to Modified Brief Pain Inventory (mBPI) Question 6: Pain Right NowChange from baseline to EOT-4.28 scores on a scaleStandard Deviation 2.28
p-value: <0.0001t-test, 2 sided
Secondary

Mean Change From Baseline to EOT in Response to Modified Brief Pain Inventory (mBPI) Question 8: Percent Reduction in Pain From Baseline

Participant-rated instrument to assess functional activities (general activity, mood, walking ability, relations with other people, sleep, normal work, and enjoyment of life) in past 24 hours. Question 8: Rate your percent reduction in pain from Baseline (0% = no relief to 100% = complete relief).

Time frame: Baseline, End of Treatment (last visit up to Day 15)

Population: ITT population; EOT score calculated by taking average of any non-missing scores recorded last 3 days of treatment; if no score on those days, EOT was single, most recent non-missing score recorded on a treatment day. N=number of participants with analyzable data for Question 8 at observation.

ArmMeasureGroupValue (MEAN)Dispersion
FLECTOR® Patch (Diclofenac Epolamine Topical Patch) 1.3%.Mean Change From Baseline to EOT in Response to Modified Brief Pain Inventory (mBPI) Question 8: Percent Reduction in Pain From BaselineBaseline2.94 percentStandard Deviation 11.23
FLECTOR® Patch (Diclofenac Epolamine Topical Patch) 1.3%.Mean Change From Baseline to EOT in Response to Modified Brief Pain Inventory (mBPI) Question 8: Percent Reduction in Pain From BaselineChange from baseline to EOT67.30 percentStandard Deviation 30.58
p-value: <0.0001t-test, 2 sided
Secondary

Number of Participants Per Global Pain Relief Scores at the End of Treatment as Assessed by the Investigator

Participants' global pain relief as assessed by investigator using a 5-point scale where 5 = complete relief, 4=a lot of improvement, 3=moderate improvement, 2=slight improvement, and 1=no change.

Time frame: End of Treatment (up to Day 15)

Population: ITT population

ArmMeasureGroupValue (NUMBER)
FLECTOR® Patch (Diclofenac Epolamine Topical Patch) 1.3%.Number of Participants Per Global Pain Relief Scores at the End of Treatment as Assessed by the Investigator3=Moderate Improvement8 participants
FLECTOR® Patch (Diclofenac Epolamine Topical Patch) 1.3%.Number of Participants Per Global Pain Relief Scores at the End of Treatment as Assessed by the Investigator2=Slight Improvement10 participants
FLECTOR® Patch (Diclofenac Epolamine Topical Patch) 1.3%.Number of Participants Per Global Pain Relief Scores at the End of Treatment as Assessed by the Investigator5=Complete Relief58 participants
FLECTOR® Patch (Diclofenac Epolamine Topical Patch) 1.3%.Number of Participants Per Global Pain Relief Scores at the End of Treatment as Assessed by the Investigator4=A Lot Of Improvement42 participants
FLECTOR® Patch (Diclofenac Epolamine Topical Patch) 1.3%.Number of Participants Per Global Pain Relief Scores at the End of Treatment as Assessed by the Investigator1=No Change5 participants
Secondary

Number of Participants Per Global Pain Relief Scores at the End of Treatment as Assessed by the Participant

Global pain relief as assessed by participant using a 5-point scale where 5 = complete relief, 4=a lot of improvement, 3=moderate improvement, 2=slight improvement, and 1=no change.

Time frame: End of Treatment (up to Day 15)

Population: ITT population

ArmMeasureGroupValue (NUMBER)
FLECTOR® Patch (Diclofenac Epolamine Topical Patch) 1.3%.Number of Participants Per Global Pain Relief Scores at the End of Treatment as Assessed by the Participant5=Complete Relief53 participants
FLECTOR® Patch (Diclofenac Epolamine Topical Patch) 1.3%.Number of Participants Per Global Pain Relief Scores at the End of Treatment as Assessed by the Participant4=A Lot Of Improvement42 participants
FLECTOR® Patch (Diclofenac Epolamine Topical Patch) 1.3%.Number of Participants Per Global Pain Relief Scores at the End of Treatment as Assessed by the Participant3=Moderate Improvement12 participants
FLECTOR® Patch (Diclofenac Epolamine Topical Patch) 1.3%.Number of Participants Per Global Pain Relief Scores at the End of Treatment as Assessed by the Participant2=Slight Improvement12 participants
FLECTOR® Patch (Diclofenac Epolamine Topical Patch) 1.3%.Number of Participants Per Global Pain Relief Scores at the End of Treatment as Assessed by the Participant1=No Change4 participants
Secondary

Number of Participants Per Patch Satisfaction Response at the End of Treatment as Assessed by Participant

Participant satisfaction with the FLECTOR® Patch rated on a 5-point scale scored as 5=Very Satisfied, 4=Satisfied, 3=No Preference, 2=Dissatisfied, and 1=Very Dissatisfied.

Time frame: End of Treatment (last visit up to Day 15)

Population: ITT; End-of-Treatment score for patch satisfaction consisted of the last value recorded.

ArmMeasureGroupValue (NUMBER)
FLECTOR® Patch (Diclofenac Epolamine Topical Patch) 1.3%.Number of Participants Per Patch Satisfaction Response at the End of Treatment as Assessed by Participant5=Very Satisfied63 participants
FLECTOR® Patch (Diclofenac Epolamine Topical Patch) 1.3%.Number of Participants Per Patch Satisfaction Response at the End of Treatment as Assessed by Participant4=Satisfied45 participants
FLECTOR® Patch (Diclofenac Epolamine Topical Patch) 1.3%.Number of Participants Per Patch Satisfaction Response at the End of Treatment as Assessed by Participant3=No Preference6 participants
FLECTOR® Patch (Diclofenac Epolamine Topical Patch) 1.3%.Number of Participants Per Patch Satisfaction Response at the End of Treatment as Assessed by Participant2=Dissatisfied8 participants
FLECTOR® Patch (Diclofenac Epolamine Topical Patch) 1.3%.Number of Participants Per Patch Satisfaction Response at the End of Treatment as Assessed by Participant1=Very Dissatisfied1 participants
Secondary

Number of Participants Per Patch Satisfaction Response at the End of Treatment as Assessed by the Investigator

Investigator's assessment of participants' satisfaction with the FLECTOR® Patch rated on a 5-point scale scored as 5=Very Satisfied, 4=Satisfied, 3=No Preference, 2=Dissatisfied, and 1=Very Dissatisfied.

Time frame: End of Treatment (last visit up to Day 15)

Population: ITT; End-of-Treatment score for patch satisfaction consisted of the last value recorded.

ArmMeasureGroupValue (NUMBER)
FLECTOR® Patch (Diclofenac Epolamine Topical Patch) 1.3%.Number of Participants Per Patch Satisfaction Response at the End of Treatment as Assessed by the Investigator5=Very Satisfied66 participants
FLECTOR® Patch (Diclofenac Epolamine Topical Patch) 1.3%.Number of Participants Per Patch Satisfaction Response at the End of Treatment as Assessed by the Investigator4=Satisfied39 participants
FLECTOR® Patch (Diclofenac Epolamine Topical Patch) 1.3%.Number of Participants Per Patch Satisfaction Response at the End of Treatment as Assessed by the Investigator3=No Preference9 participants
FLECTOR® Patch (Diclofenac Epolamine Topical Patch) 1.3%.Number of Participants Per Patch Satisfaction Response at the End of Treatment as Assessed by the Investigator2=Dissatisfied8 participants
FLECTOR® Patch (Diclofenac Epolamine Topical Patch) 1.3%.Number of Participants Per Patch Satisfaction Response at the End of Treatment as Assessed by the Investigator1=Very Dissatisfied1 participants
Secondary

Number of Participants With Change From Baseline (Bsl) to EOT in Response to Modified Brief Pain Inventory (mBPI) Question 1: Pain Other Than Everyday Kind of Pain

Participant-rated instrument to assess functional activities (general activity, mood, walking ability, relations with other people, sleep, normal work, and enjoyment of life) in past 24 hours. Question 1: Have you had pain other than everyday kinds of pain?; response = Yes or No.

Time frame: Baseline, End of Treatment (last visit up to Day 15)

Population: ITT population; EOT score was the last non-missing score obtained on a treatment day, including the final treatment visit.

ArmMeasureGroupValue (NUMBER)
FLECTOR® Patch (Diclofenac Epolamine Topical Patch) 1.3%.Number of Participants With Change From Baseline (Bsl) to EOT in Response to Modified Brief Pain Inventory (mBPI) Question 1: Pain Other Than Everyday Kind of PainChange at EOT: Bsl=Yes, EOT=Yes93 participants
FLECTOR® Patch (Diclofenac Epolamine Topical Patch) 1.3%.Number of Participants With Change From Baseline (Bsl) to EOT in Response to Modified Brief Pain Inventory (mBPI) Question 1: Pain Other Than Everyday Kind of PainChange at EOT: Bsl=Yes, EOT=No21 participants
FLECTOR® Patch (Diclofenac Epolamine Topical Patch) 1.3%.Number of Participants With Change From Baseline (Bsl) to EOT in Response to Modified Brief Pain Inventory (mBPI) Question 1: Pain Other Than Everyday Kind of PainChange at EOT: Bsl=No, EOT=Yes0 participants
FLECTOR® Patch (Diclofenac Epolamine Topical Patch) 1.3%.Number of Participants With Change From Baseline (Bsl) to EOT in Response to Modified Brief Pain Inventory (mBPI) Question 1: Pain Other Than Everyday Kind of PainChange at EOT: Bsl=No, EOT=No9 participants
p-value: <0.0001McNemar

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026