Opioid Analgesia
Conditions
Keywords
Pediatric, Post-operative, Nonsurgical, patients, Opioid
Brief summary
The purpose of this study is to characterize the pharmacokinetics (PK) of single-dose ORF tablets in pediatric patients aged 6 to 16 years, inclusive.
Interventions
DRUGOxycodone hydrochloride controlled-release (ORF) tablets
Oxycodone hydrochloride controlled-release (ORF) tablets (10 mg, 15 mg or 20 mg) taken every 12 hours
Sponsors
Purdue Pharma LP
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
6 Years to 16 Years
Healthy volunteers
No
Inclusion criteria
* Written informed consent provided by the parent or legal guardian and patient assent, when appropriate. * Children of either gender, aged 6 to 16 years, inclusive. * Have or are expected to have moderate to severe pain for an extended period of time requiring inpatient opioid analgesic treatment for at least 12 hours as this is the minimum duration of study period treatment. * In order to receive the first oral dose, patients must have respiratory stability, including a sustained SpO2 of at least 92% with or without supplemental oxygen during the 15 minute period just prior to dosing. * Must be inpatient for the treatment period of the study. * The patient's anticipated opioid analgesic requirement over the first 12 hours that will follow administration of ORF must be equivalent to at least 10 mg of intravenous (IV) morphine. * Have adequate pain control during the 6 hours prior to study drug administration, based on appropriate clinical assessment. * Must be sufficiently alert to communicate and complete the faces pain scales-revised (FPS-R) or 100-mm visual analogue scale (VAS). * Females who are of child bearing potential must be using an adequate and reliable method of contraception (e.g., barrier with additional spermicidal foam or jelly, intra-uterine device, hormonal contraception) or be abstinent. * If female, must have a negative pregnancy test and be non-lactating. * Must be able to swallow tablets whole. * Must have stable vital signs. * Must have vascular access to facilitate blood draws. * Must be willing and able to participate in all aspects of this study involving use of oral medications, patient evaluation, and phlebotomy, as evidenced by written informed consent from the parent or legal guardian and written patient assent when required by the local IRB/EC. * Must be willing to have up to 10 milliliters (mL) of blood collected for blood analysis (7 mL for primary PK and 3 mL for secondary PK analysis); and up to 10 mL of blood for pre-specified safety laboratory tests, without safety concerns. * Must be treated with an opioid for a minimum of 96 hours prior to first dose of ORF.
Exclusion criteria
* Any history of hypersensitivity or medical contraindication for the use of oxycodone (this does not exclude patients with a history of expected opioid-related adverse events (AEs), such as light-headedness, dizziness, sedation, nausea, or vomiting). * Any current history of medical or surgical conditions that might significantly interfere with the gastrointestinal absorption, distribution, metabolism, or excretion of oxycodone (this includes any history of serious disease+ of the gastrointestinal tract, liver, kidneys, and/or blood-forming organs). * Received oxycodone in the 24 hours prior to study drug administration. . * Received epidural (or regional) anesthesia \< 12 hours prior to the first oral dose of ORF. * A current history of malabsorption syndrome. * A current diagnosis of sleep apnea within the last year. * Reduced renal function (serum creatinine \> 1.8 X the upper limit of normal for age). * Hepatic impairment as evidenced by serum alanine amino transferase (ALT) or serum aspartate amino transferase (AST) \> 5 times the upper limit of normal (ULN) for age. * Currently taking any medications which are CYP3A4 inhibitors. * Impaired respiratory reserve including severe acute or chronic lung disease, or patients receiving mechanical respiratory support, including mechanical ventilation, BIPAP, or CPAP 6 hours prior to the first oral dose and during the entire oral treatment period. * Impaired cardiovascular stability (e.g., the day of surgery for cardiac surgery patients). * Participated in a clinical drug study within 30 days preceding the initial dose in this study. * Patients who have had surgery within 96 hours prior to the day of the first dose of study drug. * Deemed to be unsuitable by the investigator for reason(s) not specifically stated in the
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The Number of Patients With Adverse Events as a Measure of Safety | Adverse events (AEs) & serious adverse events (SAEs) were reported from start of study participation through the period beyond study completion (AEs) & through 30 days following last study drug dose, or until last study visit, whichever was later (SAEs). | — |
| Single-dose PK Metric: Area Under the Plasma Concentration-time Curve From Hour 0 to the Last Measurable Plasma Concentration [AUCt] | Up to 24 hours | — |
| Single-dose PK Metric: Area Under the Plasma Concentration-time Curve Extrapolated to Infinity (AUCinf) | Up to 24 hours | Due to insufficient sampling, AUCinf was not estimated. |
| Single-dose PK Metric: Maximum Observed Plasma Concentration (Cmax) | Up to 24 hours | — |
| Single-dose PK Metric: Time to Maximum Plasma Concentration (Tmax) | Up to 24 hours | — |
| Single-dose PK Metric: Apparent Terminal Phase Rate Constant (Lamda z) | Up to 24 hours | Due to insufficient sampling, Lamda z was not estimated. |
| Single-dose PK Metric: Apparent Plasma Terminal Phase Half/Life (t1/2z) | Up to 24 hours | Due to insufficient sampling, t1/2z was not estimated. |
| Single-dose PK Metric: Lag Time Was Estimated as the Time Point Immediately Prior to the First Measurable Plasma Concentration Value (Tlag) | Up to 24 hours | Due to insufficient sampling, tlag was not estimated. |
| Single- and Multiple-dose PK Metric: Mean Area Under the Plasma Concentration During Each Dosing Interval-time Curve From Hour 0 to 12 Hours of the First Dose of ORF (AUC 0-12) | Up to 12 hours | — |
| Single- and Multiple-dose PK Metric: Maximum Observed Plasma Concentration From Hour 0 to 12 Hours of the First Dose of ORF (Cmax 0-12) | Up to 12 hours | — |
| Single- and Multiple-dose PK Metric: Time to Maximum Plasma Concentration From Hour 0 to 12 Hours of the First Dose of ORF (Tmax 0-12) | Up to 12 hours | — |
| Single- and Multiple-dose PK Metric: Lag Time Estimated as the Time Point Immediately Prior to the First Measurable Plasma Concentration Value From Hour 0 to 12 Hours of the First Dose of ORF (Tlag 0-12) | Up to 12 hours | Due to insufficient sampling, tlag 0-12 was not estimated. |
Secondary
| Measure | Time frame |
|---|---|
| Multiple-dose PK Metric: Minimum Observed Plasma Concentration Just Prior to the Next Dose (Cmin) | Up to 72 hours if all 5 doses were administered |
Countries
Australia, Finland, New Zealand, United States
Participant flow
Recruitment details
First Patient First Visit: 18-Aug-2010; Last Patient Last Visit: 16-Aug-2011. The study was conducted at 11 sites in the United States and Australia.
Pre-assignment details
Pediatric patients who were anticipated to have pain requiring opioid analgesia.
Participants by arm
| Arm | Count |
|---|---|
| 6 to < 12 Years Children aged 6 to \< 12 Years received ORF Tablets (10 mg, 15 mg or 20 mg taken every 12 hours). Study treatment could have lasted from 12 hours (single dose) to 72 hours (5 doses). | 5 |
| ≥ 12 to ≤ 16 Years Children aged ≥ 12 to ≤ 16 Years received ORF Tablets (10 mg, 15 mg or 20 mg taken every 12 hours). Study treatment could have lasted from 12 hours (single dose) to 72 hours (5 doses). | 25 |
| Total | 30 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Withdrawal by Subject | 0 | 2 |
Baseline characteristics
| Characteristic | ≥ 12 to ≤ 16 Years | Total | 6 to < 12 Years |
|---|---|---|---|
| Age Continuous | 14.1 Years STANDARD_DEVIATION 1.6 | 13.5 Years STANDARD_DEVIATION 2 | 10.6 Years STANDARD_DEVIATION 0.9 |
| Race (NIH/OMB) American Indian or Alaska Native | 1 Participants | 1 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 3 Participants | 4 Participants | 1 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 21 Participants | 25 Participants | 4 Participants |
| Sex: Female, Male Female | 14 Participants | 17 Participants | 3 Participants |
| Sex: Female, Male Male | 11 Participants | 13 Participants | 2 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 5 / 5 | 16 / 25 |
| serious Total, serious adverse events | 0 / 5 | 1 / 25 |
Outcome results
Primary
Single- and Multiple-dose PK Metric: Lag Time Estimated as the Time Point Immediately Prior to the First Measurable Plasma Concentration Value From Hour 0 to 12 Hours of the First Dose of ORF (Tlag 0-12)
Due to insufficient sampling, tlag 0-12 was not estimated.
Time frame: Up to 12 hours
Primary
Single- and Multiple-dose PK Metric: Maximum Observed Plasma Concentration From Hour 0 to 12 Hours of the First Dose of ORF (Cmax 0-12)
Time frame: Up to 12 hours
Population: The full analysis population for PK (N = 30) was defined as patients who received at least 1 dose of oral study drug and had at least 1 valid quantifiable PK metric
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| 6 to < 12 Years (10 mg ORF) | Single- and Multiple-dose PK Metric: Maximum Observed Plasma Concentration From Hour 0 to 12 Hours of the First Dose of ORF (Cmax 0-12) | 9.4 ng/mL | Standard Deviation 4.2 |
| 6 to < 12 Years (15 mg ORF) | Single- and Multiple-dose PK Metric: Maximum Observed Plasma Concentration From Hour 0 to 12 Hours of the First Dose of ORF (Cmax 0-12) | 23.5 ng/mL | Standard Deviation 9.8 |
| 6 to < 12 Years (20 mg ORF) | Single- and Multiple-dose PK Metric: Maximum Observed Plasma Concentration From Hour 0 to 12 Hours of the First Dose of ORF (Cmax 0-12) | 21.9 ng/mL | — |
| ≥ 12 to ≤ 16 Years (10 mg ORF) | Single- and Multiple-dose PK Metric: Maximum Observed Plasma Concentration From Hour 0 to 12 Hours of the First Dose of ORF (Cmax 0-12) | 10.0 ng/mL | Standard Deviation 2.3 |
| ≥ 12 to ≤ 16 Years (15 mg ORF) | Single- and Multiple-dose PK Metric: Maximum Observed Plasma Concentration From Hour 0 to 12 Hours of the First Dose of ORF (Cmax 0-12) | 21.8 ng/mL | Standard Deviation 14.2 |
| ≥ 12 to ≤ 16 Years (20 mg ORF) | Single- and Multiple-dose PK Metric: Maximum Observed Plasma Concentration From Hour 0 to 12 Hours of the First Dose of ORF (Cmax 0-12) | 25.1 ng/mL | Standard Deviation 14.2 |
Primary
Single- and Multiple-dose PK Metric: Mean Area Under the Plasma Concentration During Each Dosing Interval-time Curve From Hour 0 to 12 Hours of the First Dose of ORF (AUC 0-12)
Time frame: Up to 12 hours
Population: The full analysis population for PK (N = 30) was defined as patients who received at least 1 dose of oral study drug and had at least 1 valid quantifiable PK metric
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| 6 to < 12 Years (10 mg ORF) | Single- and Multiple-dose PK Metric: Mean Area Under the Plasma Concentration During Each Dosing Interval-time Curve From Hour 0 to 12 Hours of the First Dose of ORF (AUC 0-12) | 67.5 ng*h/mL | Standard Deviation 29.1 |
| 6 to < 12 Years (15 mg ORF) | Single- and Multiple-dose PK Metric: Mean Area Under the Plasma Concentration During Each Dosing Interval-time Curve From Hour 0 to 12 Hours of the First Dose of ORF (AUC 0-12) | 114.5 ng*h/mL | Standard Deviation 9.4 |
| 6 to < 12 Years (20 mg ORF) | Single- and Multiple-dose PK Metric: Mean Area Under the Plasma Concentration During Each Dosing Interval-time Curve From Hour 0 to 12 Hours of the First Dose of ORF (AUC 0-12) | 112.8 ng*h/mL | — |
| ≥ 12 to ≤ 16 Years (10 mg ORF) | Single- and Multiple-dose PK Metric: Mean Area Under the Plasma Concentration During Each Dosing Interval-time Curve From Hour 0 to 12 Hours of the First Dose of ORF (AUC 0-12) | 82.5 ng*h/mL | Standard Deviation 13.4 |
| ≥ 12 to ≤ 16 Years (15 mg ORF) | Single- and Multiple-dose PK Metric: Mean Area Under the Plasma Concentration During Each Dosing Interval-time Curve From Hour 0 to 12 Hours of the First Dose of ORF (AUC 0-12) | 139.0 ng*h/mL | Standard Deviation 105.2 |
| ≥ 12 to ≤ 16 Years (20 mg ORF) | Single- and Multiple-dose PK Metric: Mean Area Under the Plasma Concentration During Each Dosing Interval-time Curve From Hour 0 to 12 Hours of the First Dose of ORF (AUC 0-12) | 174.2 ng*h/mL | Standard Deviation 112.7 |
Primary
Single- and Multiple-dose PK Metric: Time to Maximum Plasma Concentration From Hour 0 to 12 Hours of the First Dose of ORF (Tmax 0-12)
Time frame: Up to 12 hours
Population: The full analysis population for PK (N = 30) was defined as patients who received at least 1 dose of oral study drug and had at least 1 valid quantifiable PK metric
| Arm | Measure | Value (MEDIAN) | Dispersion |
|---|---|---|---|
| 6 to < 12 Years (10 mg ORF) | Single- and Multiple-dose PK Metric: Time to Maximum Plasma Concentration From Hour 0 to 12 Hours of the First Dose of ORF (Tmax 0-12) | 9 h | Full Range 4.243 |
| 6 to < 12 Years (15 mg ORF) | Single- and Multiple-dose PK Metric: Time to Maximum Plasma Concentration From Hour 0 to 12 Hours of the First Dose of ORF (Tmax 0-12) | 7.3 h | Full Range 6.131 |
| 6 to < 12 Years (20 mg ORF) | Single- and Multiple-dose PK Metric: Time to Maximum Plasma Concentration From Hour 0 to 12 Hours of the First Dose of ORF (Tmax 0-12) | 12 h | — |
| ≥ 12 to ≤ 16 Years (10 mg ORF) | Single- and Multiple-dose PK Metric: Time to Maximum Plasma Concentration From Hour 0 to 12 Hours of the First Dose of ORF (Tmax 0-12) | 4.6 h | Full Range 3.526 |
| ≥ 12 to ≤ 16 Years (15 mg ORF) | Single- and Multiple-dose PK Metric: Time to Maximum Plasma Concentration From Hour 0 to 12 Hours of the First Dose of ORF (Tmax 0-12) | 4.5 h | Full Range 3.036 |
| ≥ 12 to ≤ 16 Years (20 mg ORF) | Single- and Multiple-dose PK Metric: Time to Maximum Plasma Concentration From Hour 0 to 12 Hours of the First Dose of ORF (Tmax 0-12) | 6 h | Full Range 2.931 |
Primary
Single-dose PK Metric: Apparent Plasma Terminal Phase Half/Life (t1/2z)
Due to insufficient sampling, t1/2z was not estimated.
Time frame: Up to 24 hours
Primary
Single-dose PK Metric: Apparent Terminal Phase Rate Constant (Lamda z)
Due to insufficient sampling, Lamda z was not estimated.
Time frame: Up to 24 hours
Primary
Single-dose PK Metric: Area Under the Plasma Concentration-time Curve Extrapolated to Infinity (AUCinf)
Due to insufficient sampling, AUCinf was not estimated.
Time frame: Up to 24 hours
Primary
Single-dose PK Metric: Area Under the Plasma Concentration-time Curve From Hour 0 to the Last Measurable Plasma Concentration [AUCt]
Time frame: Up to 24 hours
Population: The full analysis population for PK (N = 30) was defined as patients who received at least 1 dose of oral study drug and had at least 1 valid quantifiable PK metric
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| 6 to < 12 Years (10 mg ORF) | Single-dose PK Metric: Area Under the Plasma Concentration-time Curve From Hour 0 to the Last Measurable Plasma Concentration [AUCt] | 129.2 ng*h/mL | — |
| 6 to < 12 Years (15 mg ORF) | Single-dose PK Metric: Area Under the Plasma Concentration-time Curve From Hour 0 to the Last Measurable Plasma Concentration [AUCt] | 121.1 ng*h/mL | — |
| 6 to < 12 Years (20 mg ORF) | Single-dose PK Metric: Area Under the Plasma Concentration-time Curve From Hour 0 to the Last Measurable Plasma Concentration [AUCt] | 272.2 ng*h/mL | — |
| ≥ 12 to ≤ 16 Years (10 mg ORF) | Single-dose PK Metric: Area Under the Plasma Concentration-time Curve From Hour 0 to the Last Measurable Plasma Concentration [AUCt] | 85.5 ng*h/mL | Standard Deviation 39.3 |
| ≥ 12 to ≤ 16 Years (15 mg ORF) | Single-dose PK Metric: Area Under the Plasma Concentration-time Curve From Hour 0 to the Last Measurable Plasma Concentration [AUCt] | 193.0 ng*h/mL | Standard Deviation 149.4 |
| ≥ 12 to ≤ 16 Years (20 mg ORF) | Single-dose PK Metric: Area Under the Plasma Concentration-time Curve From Hour 0 to the Last Measurable Plasma Concentration [AUCt] | 264.4 ng*h/mL | Standard Deviation 128.1 |
Primary
Single-dose PK Metric: Lag Time Was Estimated as the Time Point Immediately Prior to the First Measurable Plasma Concentration Value (Tlag)
Due to insufficient sampling, tlag was not estimated.
Time frame: Up to 24 hours
Primary
Single-dose PK Metric: Maximum Observed Plasma Concentration (Cmax)
Time frame: Up to 24 hours
Population: The full analysis population for PK (N = 30) was defined as patients who received at least 1 dose of oral study drug and had at least 1 valid quantifiable PK metric
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| 6 to < 12 Years (10 mg ORF) | Single-dose PK Metric: Maximum Observed Plasma Concentration (Cmax) | 12.3 ng/mL | — |
| 6 to < 12 Years (15 mg ORF) | Single-dose PK Metric: Maximum Observed Plasma Concentration (Cmax) | 16.6 ng/mL | — |
| 6 to < 12 Years (20 mg ORF) | Single-dose PK Metric: Maximum Observed Plasma Concentration (Cmax) | 21.9 ng/mL | — |
| ≥ 12 to ≤ 16 Years (10 mg ORF) | Single-dose PK Metric: Maximum Observed Plasma Concentration (Cmax) | 8.3 ng/mL | Standard Deviation 1.9 |
| ≥ 12 to ≤ 16 Years (15 mg ORF) | Single-dose PK Metric: Maximum Observed Plasma Concentration (Cmax) | 26.6 ng/mL | Standard Deviation 16 |
| ≥ 12 to ≤ 16 Years (20 mg ORF) | Single-dose PK Metric: Maximum Observed Plasma Concentration (Cmax) | 26.2 ng/mL | Standard Deviation 7.9 |
Primary
Single-dose PK Metric: Time to Maximum Plasma Concentration (Tmax)
Time frame: Up to 24 hours
Population: The full analysis population for PK (N = 30) was defined as patients who received at least 1 dose of oral study drug and had at least 1 valid quantifiable PK metric
| Arm | Measure | Value (MEDIAN) | Dispersion |
|---|---|---|---|
| 6 to < 12 Years (10 mg ORF) | Single-dose PK Metric: Time to Maximum Plasma Concentration (Tmax) | 6 hour (h) | — |
| 6 to < 12 Years (15 mg ORF) | Single-dose PK Metric: Time to Maximum Plasma Concentration (Tmax) | 3 hour (h) | — |
| 6 to < 12 Years (20 mg ORF) | Single-dose PK Metric: Time to Maximum Plasma Concentration (Tmax) | 12 hour (h) | — |
| ≥ 12 to ≤ 16 Years (10 mg ORF) | Single-dose PK Metric: Time to Maximum Plasma Concentration (Tmax) | 5.3 hour (h) | Full Range 1.011 |
| ≥ 12 to ≤ 16 Years (15 mg ORF) | Single-dose PK Metric: Time to Maximum Plasma Concentration (Tmax) | 3 hour (h) | Full Range 1.26 |
| ≥ 12 to ≤ 16 Years (20 mg ORF) | Single-dose PK Metric: Time to Maximum Plasma Concentration (Tmax) | 6 hour (h) | Full Range 6.663 |
Primary
The Number of Patients With Adverse Events as a Measure of Safety
Time frame: Adverse events (AEs) & serious adverse events (SAEs) were reported from start of study participation through the period beyond study completion (AEs) & through 30 days following last study drug dose, or until last study visit, whichever was later (SAEs).
Population: The safety population (N = 30) was defined as the group of patients who received study drug
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| 6 to < 12 Years (10 mg ORF) | The Number of Patients With Adverse Events as a Measure of Safety | Serious Adverse Event (SAE) | 0 participants |
| 6 to < 12 Years (10 mg ORF) | The Number of Patients With Adverse Events as a Measure of Safety | Death | 0 participants |
| 6 to < 12 Years (10 mg ORF) | The Number of Patients With Adverse Events as a Measure of Safety | Any TEAE reported in ≥ 5% of participants | 5 participants |
| 6 to < 12 Years (15 mg ORF) | The Number of Patients With Adverse Events as a Measure of Safety | Serious Adverse Event (SAE) | 1 participants |
| 6 to < 12 Years (15 mg ORF) | The Number of Patients With Adverse Events as a Measure of Safety | Death | 0 participants |
| 6 to < 12 Years (15 mg ORF) | The Number of Patients With Adverse Events as a Measure of Safety | Any TEAE reported in ≥ 5% of participants | 16 participants |
Secondary
Multiple-dose PK Metric: Minimum Observed Plasma Concentration Just Prior to the Next Dose (Cmin)
Time frame: Up to 72 hours if all 5 doses were administered
Population: The full analysis population for PK (N = 30) was defined as patients who received at least 1 dose of oral study drug and had at least 1 valid quantifiable PK metric
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| 6 to < 12 Years (10 mg ORF) | Multiple-dose PK Metric: Minimum Observed Plasma Concentration Just Prior to the Next Dose (Cmin) | 15.5 ng/mL | — |
| 6 to < 12 Years (15 mg ORF) | Multiple-dose PK Metric: Minimum Observed Plasma Concentration Just Prior to the Next Dose (Cmin) | 17.3 ng/mL | — |
| ≥ 12 to ≤ 16 Years (10 mg ORF) | Multiple-dose PK Metric: Minimum Observed Plasma Concentration Just Prior to the Next Dose (Cmin) | 4.8 ng/mL | Standard Deviation 1.9 |
| ≥ 12 to ≤ 16 Years (15 mg ORF) | Multiple-dose PK Metric: Minimum Observed Plasma Concentration Just Prior to the Next Dose (Cmin) | 11.9 ng/mL | Standard Deviation 6.9 |
| ≥ 12 to ≤ 16 Years (20 mg ORF) | Multiple-dose PK Metric: Minimum Observed Plasma Concentration Just Prior to the Next Dose (Cmin) | 19.1 ng/mL | Standard Deviation 2.7 |