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A Bioavailability Study With Alternate Methods of Administration of Naloxegol Tablets, and Solution

An Open-Label, Randomized, 4-Period, 4-Treatment, Crossover, Single-Center, Single-Dose Bioavailability Study With Alternate Methods of Administration of Crushed Naloxegol Tablets, 25 mg and of a Naloxegol Solution Formulation, 25 mg, Compared to Whole Naloxegol Tablets, 25 mg, in Healthy Subjects

Status
Completed
Phases
Phase 1
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT02446171
Enrollment
44
Registered
2015-05-18
Start date
2015-05-31
Completion date
2015-07-31
Last updated
2017-03-10

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

Conditions

Bioavailability, Healthy Subjects

Keywords

naloxegol tablet crushed, naloxegol oral solution, naloxegol whole tablet, relative bioavailability, Phase I, healthy subjects

Brief summary

This clinical study is an open-label, randomized, 4-period, 4-treatment, crossover, single-center, single-dose bioavailability study with alternate methods of administration of crushed naloxegol tablets, 25 mg and of a naloxegol solution formulation, 25 mg, compared to whole naloxegol tablets, 25 mg, in healthy subjects. The main objective of this study is to determine the bioavailability of each of three alternative methods of naloxegol administration compared to whole naloxegol tablets given orally by assessment of the primary pharmacokinetic (PK) parameters of naloxegol

Detailed description

This is an open-label, randomized, 4-period, 4-treatment, crossover, single-center, single-dose bioavailability study with alternate methods of administration of naloxegol: crushed and suspended in water and administered orally (Treatment A),crushed and suspended in water administered via nasogastric tube (Treatment B), solution administered orally (Treatment C) and tablet swallowed as a whole (Treatment D). Alternative ways of administering a tablet may be useful to help patients who, for different reasons, have difficulties with swallowing a whole tablet. Administration of dispersed (crushed) tablets suspended in water is a common way of administering drugs to these patients. A useful method in patients whose condition prevents swallowing is administration of dispersed tablets through nasogastric tubes. Additionally a solution formulation may be an attractive option for some patients including the pediatric population. The main aim in this clinical study is to investigate whether the blood concentrations of naloxegol (pharmacokinetic) after each treatment A, B and C is comparable to that after treatment D. Additionally, the safety and tolerability shall be assessed.

Interventions

DRUGNaloxegol 25 mg tablet, crushed, suspended in water, given orally

naloxegol 25 mg (1 tablet) crushed, suspended in water, given orally

DRUGNaloxegol 25mg tablet crushed, suspended in water, given via nasogastric tube

naloxegol 25 mg (1 tablet) crushed, suspended in water, given via nasogastric tube

DRUGNaloxegol 25 mg (10 mL oral solution)

naloxegol 25 mg (10 mL oral solution)

DRUGNaloxegol 25 mg tablet, given orally

naloxegol 25 mg (1 tablet) whole tablet, given orally

Sponsors

AstraZeneca
Lead SponsorINDUSTRY

Study design

Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
BASIC_SCIENCE
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
18 Years to 55 Years
Healthy volunteers
No

Inclusion criteria

* Healthy male and female subjects aged 18 to 55 years with suitable veins for cannulation or repeated venipuncture. * Females must have a negative pregnancy test at screening and on admission to the clinical unit, must not be lactating and must be of non childbearing potential, confirmed at screening by fulfilling one of the following criteria: * Post-menopausal defined as amenorrhea for at least 12 months or more following cessation of all exogenous hormonal treatments and follicle-stimulating hormone (FSH) levels in the post-menopausal range. * Documentation of irreversible surgical sterilization by hysterectomy, bilateral oophorectomy or bilateral salpingectomy; but not tubal ligation. * Have a body mass index (BMI) between 18.5 and 29.9 kg/m2 inclusive and weigh at least 50 kg and no more than 100 kg inclusive. * Able to understand, read and speak the German language.

Exclusion criteria

* History of any clinically significant disease or disorder which, in the opinion of the investigator, may either put the potential subject at risk because of participation in the study, or influence the results or the potential subject's ability to participate in the study. * Current smokers or those who have smoked or used nicotine products within the previous 3 months. * Use of drugs with enzyme-inducing properties such as St John's Wort within 3 weeks prior to the first administration of IMP. Drugs include known CYP3A4 and/or P-gp inhibitors and inducers, e.g., diltiazem, verapamil, and erythromycin \- Use of any prescribed or non-prescribed medication including antacids, analgesics (other than paracetamol/acetaminophen), herbal remedies, megadose vitamins (intake of 20 to 600 times the recommended daily dose) and minerals during 2 weeks prior to the first administration of IMP or longer if the medication has a long half-life. For females, hormonal replacement therapy is not allowed. * Subject with a relevant history of a suicide attempt or suicidal behavior. Any recent suicidal ideation within the last 6 months (a level of 4 or 5), or who are at significant risk to commit suicide, as judged by the investigator using the Columbia-Suicide Severity Rating Scale (C-SSRS). * Applicable to subjects willing to participate in genetic research: Non-leukocyte depleted whole blood transfusion within 120 days of the date of the genetic sample collection or previous bone marrow transplant.

Design outcomes

Primary

MeasureTime frameDescription
Area Under Plasma Concentration-time Curve From Time Zero Extrapolated to Infinity (AUC0-infinity).Pre-dose (0 hours [within 30 minutes prior to administration of the investigational medicinal product (IMP)]) and post-dose at 0.25 (15 minutes), 0.5 (30 minutes), 1, 1.5, 2, 3, 4, 5, 6, 8, 10, 12, 16, 24, 36, 48 and 72 hours in each treatment period.Area under plasma concentration-time curve from time zero extrapolated to infinity (AUC) is presented below. Blood was collected pre-dose and 0.25, 0.5, 1, 1.5, 2, 3, 4, 5, 6, 8, 10, 12, 16, 24, 36, 48 and 72 hours post-dose to determine naloxegol plasma concentrations.
Area Under the Plasma Concentration-time Curve From Time Zero to Time of Last Quantifiable Concentration (AUC 0-t).Pre-dose (0 hours [within 30 minutes prior to IMP administration]) and post-dose at 0.25 (15 minutes), 0.5 (30 minutes), 1, 1.5, 2, 3, 4, 5, 6, 8, 10, 12, 16, 24, 36, 48 and 72 hours in each treatment period.Area under the plasma concentration-time curve from time zero to time of last quantifiable concentration is presented below. Blood was collected pre-dose and 0.25, 0.5, 1, 1.5, 2, 3, 4, 5, 6, 8, 10, 12, 16, 24, 36, 48 and 72 hours post-dose to determine naloxegol plasma concentrations.
Observed Maximum Plasma Concentration (Cmax).Pre-dose (0 hours [within 30 minutes prior to IMP administration]) and post-dose at 0.25 (15 minutes), 0.5 (30 minutes), 1, 1.5, 2, 3, 4, 5, 6, 8, 10, 12, 16, 24, 36, 48 and 72 hours in each treatment period.Observed maximum plasma concentration (Cmax) is presented below. Blood was collected pre-dose and 0.25, 0.5, 1, 1.5, 2, 3, 4, 5, 6, 8, 10, 12, 16, 24, 36, 48 and 72 hours post-dose to determine naloxegol plasma concentrations.

Secondary

MeasureTime frameDescription
Mean Residence Time (MRT).Pre-dose (0 hours [within 30 minutes prior to IMP administration]) and post-dose at 0.25 (15 minutes), 0.5 (30 minutes), 1, 1.5, 2, 3, 4, 5, 6, 8, 10, 12, 16, 24, 36, 48 and 72 hours in each treatment period.This was one of the PK parameters to determine MRT. Blood was collected pre-dose and 0.25, 0.5, 1, 1.5, 2, 3, 4, 5, 6, 8, 10, 12, 16, 24, 36, 48 and 72 hours post-dose to determine naloxegol plasma concentrations.
Apparent Total Body Clearance After Extravascular Administration Estimated as Dose Divided by AUC (CL/F).Pre-dose (0 hours [within 30 minutes prior to IMP administration]) and post-dose at 0.25 (15 minutes), 0.5 (30 minutes), 1, 1.5, 2, 3, 4, 5, 6, 8, 10, 12, 16, 24, 36, 48 and 72 hours in each treatment period.This was one of the PK parameters to determine the apparent total body clearance after extravascular administration estimated as dose divided by AUC. Blood was collected pre-dose and 0.25, 0.5, 1, 1.5, 2, 3, 4, 5, 6, 8, 10, 12, 16, 24, 36, 48 and 72 hours post-dose to determine naloxegol plasma concentrations.
Apparent Volume of Distribution During the Terminal Phase After Extravascular Administration (Vz/F).Pre-dose (0 hours [within 30 minutes prior to IMP administration]) and post-dose at 0.25 (15 minutes), 0.5 (30 minutes), 1, 1.5, 2, 3, 4, 5, 6, 8, 10, 12, 16, 24, 36, 48 and 72 hours in each treatment period.This was one of the PK parameters to determine the apparent volume of distribution during the terminal phase after extravascular administration.
Percentage of Participants With Adverse Events (AE).For up to 9 weeks (starting with screening).An AE is the development of an undesirable medical condition or the deterioration of a pre-existing medical condition following or during exposure to a pharmaceutical product, whether or not considered causally related to the product.The term AE is used generally to include any AE whether serious or non-serious. An serious AE (SAE) is an AE that fulfills one or more of the following criteria: results in death, is immediately life-threatening; requires in-patient hospitalization or prolongation of existing hospitalization; results in persistent or significant disability or incapacity or substantial disruption of the ability to conduct normal life functions; is a congenital abnormality or birth defect; is an important medical event that may jeopardize the participant or may require medical intervention to prevent one of the outcomes listed above.
Mean Change From Baseline for Vital Signs of Supine Systolic and Diastolic Blood Pressure.Day 2 (24h post-dose), Day 3 (48h post-dose) and Day 4 (72h post-dose).The following variables were collected after the participants had rested in the supine position for at least 5 minutes: Systolic Blood Pressure (SBP) and Diastolic BP. The measurement of vital signs for SBP and DBP are presented in the below outcome table.
Time to Reach Maximum Plasma Concentration (Tmax).Pre-dose (0 hours [within 30 minutes prior to IMP administration]) and post-dose at 0.25 (15 minutes), 0.5 (30 minutes), 1, 1.5, 2, 3, 4, 5, 6, 8, 10, 12, 16, 24, 36, 48 and 72 hours in each treatment period.This was one of the PK parameters to determine the time to reach maximum plasma concentration (tmax). Blood was collected pre-dose and 0.25, 0.5, 1, 1.5, 2, 3, 4, 5, 6, 8, 10, 12, 16, 24, 36, 48 and 72 hours post-dose to determine naloxegol plasma concentrations.
Participants With Significant Findings in Physical Examination.A full physical examination at screening and the final follow-up visit (maximum 9 weeks apart). Abbreviated physical examination on admission (on Day -1 of each treatment period) and at 48-hours post-dose to each treatment period (for up to 4 weeks).A complete physical examination included an assessment of the general appearance, respiratory, cardiovascular, abdomen, skin, head, and neck (including ears, eyes, nose, mouth and throat), lymph nodes, thyroid, musculoskeletal and neurological systems. Physical examination was performed to check for any significant abnormality in participants.
Participants With Significant Findings in Columbia-Suicide Severity Rating Scale (C-SSRS).At Baseline and Days 1-4 of each treatment period.The C-SSRS is a unique, simple and short method of assessing both behavior and ideation that tracks all suicidal events, and provided a summary of suicidality. It assesses the lethality of attempts and other features of ideation (frequency, duration, controllability, reasons for ideation and deterrents), all of which are significantly predictive of completed suicide. The C-SSRS was performed to determine the presence of suicidality.
Participants With Significant Findings in 12-Lead Electrocardiography (ECG).At screening, first admission to the clinical unit (Visit 2, Day -1), 1.25 hours after each dose (Visits 2-5, Day 1), as well as at the final follow-up visit (up to 9 weeks).A 12-lead ECG was obtained after the participant rested in supine position for at least 10 minutes. The study physician was to judge the overall interpretation as normal or abnormal. If abnormal, it was decided as to whether or not the abnormality was clinically significant and the reason for the abnormality was recorded.
Participants With Significant Findings in Hematology, Clinical Chemistry and Urinalysis.At screening and at the final follow-up visit (maximum 9 weeks apart); in addition, for the first and third treatment period at pre-dose.Participants were assessed through each laboratory variables for any significant abnormalities. Hematology assessments included white blood cell count, red blood cell count, hemoglobin, hematocrit, mean corpuscular volume, mean corpuscular hemoglobin and others. Clinical chemistry assessment included testing levels of sodium, potassium, urea, creatinine, albumin, calcium, glucose (fasting) and others. Urinalysis assessment included glucose, protein, blood and microscopy (if positive for blood or protein).
Taste Test Assessment.Within 1 hour after dosing (Treatments A and C only).A standardized questionnaire was provided to participants and were asked to complete the questionnaire for the liquid formulations tested, i.e., Naloxegol crushed tablet, oral (Treatment A) and Naloxegol oral solution (Treatment C), without assistance or influence from site personnel. For each formulation, the questionnaire was identical and required the participant's opinion. Sweet, salty, sour, bitter, metallic, hot/spicy were rated on a scale of 0 to 10, where 0 means not at all and 10 means extreme. The overall rating of the taste was rated on a scale of 0 to 10, where 0 means I dislike it extremely much and 10 means I like it extremely much. The smell of the medicine was based on a scale of 0 to 10, where 0 means extremely bad and 10 means extremely nice. The question on whether the participants would consider ever taking the medicine again was based on a scale of 0 to 10, where 0 means Never - under no circumstances and 10 means Yes, definitely.
Mean Change From Baseline for Vital Signs in Supine Pulse Rate.Day 2 (24h post-dose), Day 3 (48h post-dose) and Day 4 (72h post-dose).Pulse rate: the measurement of vital signs for pulse rate is presented in the below outcome table.
Half-life Associated With Terminal Slope (λz) of a Semi-logarithmic Concentration-time Curve (t½λz).Pre-dose (0 hours [within 30 minutes prior to IMP administration]) and post-dose at 0.25 (15 minutes), 0.5 (30 minutes), 1, 1.5, 2, 3, 4, 5, 6, 8, 10, 12, 16, 24, 36, 48 and 72 hours in each treatment period.This was one of the PK parameters to determine λz of a t½λz. Blood was collected pre-dose and 0.25, 0.5, 1, 1.5, 2, 3, 4, 5, 6, 8, 10, 12, 16, 24, 36, 48 and 72 hours post-dose to determine naloxegol plasma concentrations.
Mean Dissolution Time (MDT).Pre-dose (0 hours [within 30 minutes prior to IMP administration]) and post-dose at 0.25 (15 minutes), 0.5 (30 minutes), 1, 1.5, 2, 3, 4, 5, 6, 8, 10, 12, 16, 24, 36, 48 and 72 hours in each treatment period.This was one of the PK parameters to determine MDT (whole tablet only) (calculated as MRT Treatment D \[Reference\] - MRT Treatment C \[Test\]). Blood was collected pre-dose and 0.25, 0.5, 1, 1.5, 2, 3, 4, 5, 6, 8, 10, 12, 16, 24, 36, 48 and 72 hours post-dose to determine naloxegol plasma concentrations.

Countries

Germany

Participant flow

Recruitment details

This study was conducted at PAREXEL International, Early Phase Clinical Unit Berlin, Berlin, Germany.

Pre-assignment details

Participants were randomized in 4 sequence Williams design for 4 periods and 4 treatments: 25 mg naloxegol tablet crushed and suspended in water taken orally(Treatment A), 25 mg naloxegol tablet crushed and suspended in water via nasogastric tube (Treatment B), 2.5 mg/mL oral solution (Treatment C) and 25 mg naloxegol tablet swallowed(Treatment D).

Participants by arm

ArmCount
ADBC Sequence
Treatment A in Period 1, Treatment D in Period 2, Treatment B in Period 3 and Treatment C in Period 4.
11
BACD Sequence
Treatment B in Period 1, Treatment A in Period 2, Treatment C in Period 3 and Treatment D in Period 4.
11
CBDA Sequence
Treatment C in Period 1, Treatment B in Period 2, Treatment D in Period 3 and Treatment A in Period 4.
11
DCAB Sequence
Treatment D in Period 1, Treatment C in Period 2, Treatment A in Period 3 and Treatment B in Period 4.
11
Total44

Withdrawals & dropouts

PeriodReasonFG000FG001FG002FG003
Overall StudyWithdrawal by Subject0020

Baseline characteristics

CharacteristicTotalBACD SequenceADBC SequenceCBDA SequenceDCAB Sequence
Age, Continuous44 years
STANDARD_DEVIATION 10
42 years
STANDARD_DEVIATION 11
44 years
STANDARD_DEVIATION 12
45 years
STANDARD_DEVIATION 8
44 years
STANDARD_DEVIATION 8
Sex: Female, Male
Female
11 Participants2 Participants3 Participants3 Participants3 Participants
Sex: Female, Male
Male
33 Participants9 Participants8 Participants8 Participants8 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
EG002
affected / at risk
EG003
affected / at risk
deaths
Total, all-cause mortality
— / —— / —— / —— / —
other
Total, other adverse events
4 / 423 / 435 / 438 / 43
serious
Total, serious adverse events
0 / 420 / 430 / 430 / 43

Outcome results

Primary

Area Under Plasma Concentration-time Curve From Time Zero Extrapolated to Infinity (AUC0-infinity).

Area under plasma concentration-time curve from time zero extrapolated to infinity (AUC) is presented below. Blood was collected pre-dose and 0.25, 0.5, 1, 1.5, 2, 3, 4, 5, 6, 8, 10, 12, 16, 24, 36, 48 and 72 hours post-dose to determine naloxegol plasma concentrations.

Time frame: Pre-dose (0 hours [within 30 minutes prior to administration of the investigational medicinal product (IMP)]) and post-dose at 0.25 (15 minutes), 0.5 (30 minutes), 1, 1.5, 2, 3, 4, 5, 6, 8, 10, 12, 16, 24, 36, 48 and 72 hours in each treatment period.

Population: The Pharmacokinetic (PK) analysis set was a subset of those participants in the safety analysis set and included participants who had received at least 1 dose of study medication and had at least 1 post-dose plasma concentration measurement at a scheduled time point.

ArmMeasureValue (GEOMETRIC_MEAN)Dispersion
Treatment AArea Under Plasma Concentration-time Curve From Time Zero Extrapolated to Infinity (AUC0-infinity).191 h*ng/mLGeometric Coefficient of Variation 54.2
Treatment BArea Under Plasma Concentration-time Curve From Time Zero Extrapolated to Infinity (AUC0-infinity).192 h*ng/mLGeometric Coefficient of Variation 48
Treatment CArea Under Plasma Concentration-time Curve From Time Zero Extrapolated to Infinity (AUC0-infinity).179 h*ng/mLGeometric Coefficient of Variation 54
Treatment DArea Under Plasma Concentration-time Curve From Time Zero Extrapolated to Infinity (AUC0-infinity).191 h*ng/mLGeometric Coefficient of Variation 47.2
90% CI: [92.4, 105.84]ANOVA
90% CI: [93.17, 107.43]ANOVA
90% CI: [88.7, 100.4]ANOVA
Primary

Area Under the Plasma Concentration-time Curve From Time Zero to Time of Last Quantifiable Concentration (AUC 0-t).

Area under the plasma concentration-time curve from time zero to time of last quantifiable concentration is presented below. Blood was collected pre-dose and 0.25, 0.5, 1, 1.5, 2, 3, 4, 5, 6, 8, 10, 12, 16, 24, 36, 48 and 72 hours post-dose to determine naloxegol plasma concentrations.

Time frame: Pre-dose (0 hours [within 30 minutes prior to IMP administration]) and post-dose at 0.25 (15 minutes), 0.5 (30 minutes), 1, 1.5, 2, 3, 4, 5, 6, 8, 10, 12, 16, 24, 36, 48 and 72 hours in each treatment period.

Population: The PK analysis set was a subset of those participants in the safety analysis set and included participants who had received at least 1 dose of study medication and had at least 1 post-dose plasma concentration measurement at a scheduled time point.

ArmMeasureValue (GEOMETRIC_MEAN)Dispersion
Treatment AArea Under the Plasma Concentration-time Curve From Time Zero to Time of Last Quantifiable Concentration (AUC 0-t).188 h*ng/mLGeometric Coefficient of Variation 54.4
Treatment BArea Under the Plasma Concentration-time Curve From Time Zero to Time of Last Quantifiable Concentration (AUC 0-t).190 h*ng/mLGeometric Coefficient of Variation 47.8
Treatment CArea Under the Plasma Concentration-time Curve From Time Zero to Time of Last Quantifiable Concentration (AUC 0-t).178 h*ng/mLGeometric Coefficient of Variation 53.7
Treatment DArea Under the Plasma Concentration-time Curve From Time Zero to Time of Last Quantifiable Concentration (AUC 0-t).188 h*ng/mLGeometric Coefficient of Variation 47.4
90% CI: [92.24, 105.8]ANOVA
90% CI: [93.65, 107.72]ANOVA
90% CI: [89.2, 100.82]ANOVA
Primary

Observed Maximum Plasma Concentration (Cmax).

Observed maximum plasma concentration (Cmax) is presented below. Blood was collected pre-dose and 0.25, 0.5, 1, 1.5, 2, 3, 4, 5, 6, 8, 10, 12, 16, 24, 36, 48 and 72 hours post-dose to determine naloxegol plasma concentrations.

Time frame: Pre-dose (0 hours [within 30 minutes prior to IMP administration]) and post-dose at 0.25 (15 minutes), 0.5 (30 minutes), 1, 1.5, 2, 3, 4, 5, 6, 8, 10, 12, 16, 24, 36, 48 and 72 hours in each treatment period.

Population: The PK analysis set was a subset of those participants in the safety analysis set and included participants who had received at least 1 dose of study medication and had at least 1 post-dose plasma concentration measurement at a scheduled time point.

ArmMeasureValue (GEOMETRIC_MEAN)Dispersion
Treatment AObserved Maximum Plasma Concentration (Cmax).39.2 ng/mLGeometric Coefficient of Variation 44.1
Treatment BObserved Maximum Plasma Concentration (Cmax).40.1 ng/mLGeometric Coefficient of Variation 45.1
Treatment CObserved Maximum Plasma Concentration (Cmax).40.2 ng/mLGeometric Coefficient of Variation 45.7
Treatment DObserved Maximum Plasma Concentration (Cmax).39.7 ng/mLGeometric Coefficient of Variation 51.8
90% CI: [88.09, 106.92]ANOVA
90% CI: [91.8, 110.16]ANOVA
90% CI: [93.13, 111.82]ANOVA
Secondary

Apparent Total Body Clearance After Extravascular Administration Estimated as Dose Divided by AUC (CL/F).

This was one of the PK parameters to determine the apparent total body clearance after extravascular administration estimated as dose divided by AUC. Blood was collected pre-dose and 0.25, 0.5, 1, 1.5, 2, 3, 4, 5, 6, 8, 10, 12, 16, 24, 36, 48 and 72 hours post-dose to determine naloxegol plasma concentrations.

Time frame: Pre-dose (0 hours [within 30 minutes prior to IMP administration]) and post-dose at 0.25 (15 minutes), 0.5 (30 minutes), 1, 1.5, 2, 3, 4, 5, 6, 8, 10, 12, 16, 24, 36, 48 and 72 hours in each treatment period.

Population: The PK analysis set was a subset of those participants in the safety analysis set and included participants who had received at least 1 dose of study medication and had at least 1 post-dose plasma concentration measurement at a scheduled time point.

ArmMeasureValue (GEOMETRIC_MEAN)Dispersion
Treatment AApparent Total Body Clearance After Extravascular Administration Estimated as Dose Divided by AUC (CL/F).131 L/hGeometric Coefficient of Variation 54.2
Treatment BApparent Total Body Clearance After Extravascular Administration Estimated as Dose Divided by AUC (CL/F).130 L/hGeometric Coefficient of Variation 48
Treatment CApparent Total Body Clearance After Extravascular Administration Estimated as Dose Divided by AUC (CL/F).140 L/hGeometric Coefficient of Variation 54
Treatment DApparent Total Body Clearance After Extravascular Administration Estimated as Dose Divided by AUC (CL/F).131 L/hGeometric Coefficient of Variation 47.2
Secondary

Apparent Volume of Distribution During the Terminal Phase After Extravascular Administration (Vz/F).

This was one of the PK parameters to determine the apparent volume of distribution during the terminal phase after extravascular administration.

Time frame: Pre-dose (0 hours [within 30 minutes prior to IMP administration]) and post-dose at 0.25 (15 minutes), 0.5 (30 minutes), 1, 1.5, 2, 3, 4, 5, 6, 8, 10, 12, 16, 24, 36, 48 and 72 hours in each treatment period.

Population: The PK analysis set was a subset of those participants in the safety analysis set and included participants who had received at least 1 dose of study medication and had at least 1 post-dose plasma concentration measurement at a scheduled time point.

ArmMeasureValue (GEOMETRIC_MEAN)Dispersion
Treatment AApparent Volume of Distribution During the Terminal Phase After Extravascular Administration (Vz/F).1738 LGeometric Coefficient of Variation 55.3
Treatment BApparent Volume of Distribution During the Terminal Phase After Extravascular Administration (Vz/F).1513 LGeometric Coefficient of Variation 55.4
Treatment CApparent Volume of Distribution During the Terminal Phase After Extravascular Administration (Vz/F).1731 LGeometric Coefficient of Variation 58.5
Treatment DApparent Volume of Distribution During the Terminal Phase After Extravascular Administration (Vz/F).1640 LGeometric Coefficient of Variation 54.7
Secondary

Half-life Associated With Terminal Slope (λz) of a Semi-logarithmic Concentration-time Curve (t½λz).

This was one of the PK parameters to determine λz of a t½λz. Blood was collected pre-dose and 0.25, 0.5, 1, 1.5, 2, 3, 4, 5, 6, 8, 10, 12, 16, 24, 36, 48 and 72 hours post-dose to determine naloxegol plasma concentrations.

Time frame: Pre-dose (0 hours [within 30 minutes prior to IMP administration]) and post-dose at 0.25 (15 minutes), 0.5 (30 minutes), 1, 1.5, 2, 3, 4, 5, 6, 8, 10, 12, 16, 24, 36, 48 and 72 hours in each treatment period.

Population: The PK analysis set was a subset of those participants in the safety analysis set and included participants who had received at least 1 dose of study medication and had at least 1 post-dose plasma concentration measurement at a scheduled time point.

ArmMeasureValue (MEAN)Dispersion
Treatment AHalf-life Associated With Terminal Slope (λz) of a Semi-logarithmic Concentration-time Curve (t½λz).9.92 hStandard Deviation 3.92
Treatment BHalf-life Associated With Terminal Slope (λz) of a Semi-logarithmic Concentration-time Curve (t½λz).8.78 hStandard Deviation 4.22
Treatment CHalf-life Associated With Terminal Slope (λz) of a Semi-logarithmic Concentration-time Curve (t½λz).9.28 hStandard Deviation 3.4
Treatment DHalf-life Associated With Terminal Slope (λz) of a Semi-logarithmic Concentration-time Curve (t½λz).9.22 hStandard Deviation 3.13
Secondary

Mean Change From Baseline for Vital Signs in Supine Pulse Rate.

Pulse rate: the measurement of vital signs for pulse rate is presented in the below outcome table.

Time frame: Day 2 (24h post-dose), Day 3 (48h post-dose) and Day 4 (72h post-dose).

Population: The safety analysis set included all participants who had received at least one dose of Naloxegol and for whom any safety post-dose data were available.

ArmMeasureGroupValue (MEAN)Dispersion
Treatment AMean Change From Baseline for Vital Signs in Supine Pulse Rate.Day 2/24h Post-dose (N= 42, 43, 43, 43)1 beats per minute (bpm)Standard Deviation 5
Treatment AMean Change From Baseline for Vital Signs in Supine Pulse Rate.Day 4/72h Post-dose (N= 9, 11, 11, 12)8 beats per minute (bpm)Standard Deviation 9
Treatment AMean Change From Baseline for Vital Signs in Supine Pulse Rate.Day 3/48h Post-dose (N= 42, 43, 43, 42)5 beats per minute (bpm)Standard Deviation 6
Treatment BMean Change From Baseline for Vital Signs in Supine Pulse Rate.Day 2/24h Post-dose (N= 42, 43, 43, 43)0 beats per minute (bpm)Standard Deviation 6
Treatment BMean Change From Baseline for Vital Signs in Supine Pulse Rate.Day 4/72h Post-dose (N= 9, 11, 11, 12)4 beats per minute (bpm)Standard Deviation 9
Treatment BMean Change From Baseline for Vital Signs in Supine Pulse Rate.Day 3/48h Post-dose (N= 42, 43, 43, 42)4 beats per minute (bpm)Standard Deviation 7
Treatment CMean Change From Baseline for Vital Signs in Supine Pulse Rate.Day 3/48h Post-dose (N= 42, 43, 43, 42)5 beats per minute (bpm)Standard Deviation 8
Treatment CMean Change From Baseline for Vital Signs in Supine Pulse Rate.Day 2/24h Post-dose (N= 42, 43, 43, 43)1 beats per minute (bpm)Standard Deviation 6
Treatment CMean Change From Baseline for Vital Signs in Supine Pulse Rate.Day 4/72h Post-dose (N= 9, 11, 11, 12)8 beats per minute (bpm)Standard Deviation 5
Treatment DMean Change From Baseline for Vital Signs in Supine Pulse Rate.Day 2/24h Post-dose (N= 42, 43, 43, 43)2 beats per minute (bpm)Standard Deviation 6
Treatment DMean Change From Baseline for Vital Signs in Supine Pulse Rate.Day 4/72h Post-dose (N= 9, 11, 11, 12)12 beats per minute (bpm)Standard Deviation 5
Treatment DMean Change From Baseline for Vital Signs in Supine Pulse Rate.Day 3/48h Post-dose (N= 42, 43, 43, 42)5 beats per minute (bpm)Standard Deviation 6
Secondary

Mean Change From Baseline for Vital Signs of Supine Systolic and Diastolic Blood Pressure.

The following variables were collected after the participants had rested in the supine position for at least 5 minutes: Systolic Blood Pressure (SBP) and Diastolic BP. The measurement of vital signs for SBP and DBP are presented in the below outcome table.

Time frame: Day 2 (24h post-dose), Day 3 (48h post-dose) and Day 4 (72h post-dose).

Population: The safety analysis set included all participants who had received at least one dose of Naloxegol and for whom any safety post-dose data were available.

ArmMeasureGroupValue (MEAN)Dispersion
Treatment AMean Change From Baseline for Vital Signs of Supine Systolic and Diastolic Blood Pressure.Day 2/24h Post-dose (SBP) (N= 42, 43, 43, 43)-2 mmHgStandard Deviation 9
Treatment AMean Change From Baseline for Vital Signs of Supine Systolic and Diastolic Blood Pressure.Day 3/48h Post-dose (SBP) (N= 42, 43, 43, 42)4 mmHgStandard Deviation 9
Treatment AMean Change From Baseline for Vital Signs of Supine Systolic and Diastolic Blood Pressure.Day 4/72h Post-dose (SBP) (N= 9, 11, 11, 12)7 mmHgStandard Deviation 9
Treatment AMean Change From Baseline for Vital Signs of Supine Systolic and Diastolic Blood Pressure.Day 2/24h Post-dose (DBP) (N= 42, 43, 43, 43)-2 mmHgStandard Deviation 6
Treatment AMean Change From Baseline for Vital Signs of Supine Systolic and Diastolic Blood Pressure.Day 3/48h Post-dose (DBP) (N= 42, 43, 43, 42)0 mmHgStandard Deviation 6
Treatment AMean Change From Baseline for Vital Signs of Supine Systolic and Diastolic Blood Pressure.Day 4/72h Post-dose (DBP) (N= 9, 11, 11, 12)5 mmHgStandard Deviation 7
Treatment BMean Change From Baseline for Vital Signs of Supine Systolic and Diastolic Blood Pressure.Day 4/72h Post-dose (DBP) (N= 9, 11, 11, 12)0 mmHgStandard Deviation 6
Treatment BMean Change From Baseline for Vital Signs of Supine Systolic and Diastolic Blood Pressure.Day 2/24h Post-dose (DBP) (N= 42, 43, 43, 43)-4 mmHgStandard Deviation 7
Treatment BMean Change From Baseline for Vital Signs of Supine Systolic and Diastolic Blood Pressure.Day 2/24h Post-dose (SBP) (N= 42, 43, 43, 43)-4 mmHgStandard Deviation 11
Treatment BMean Change From Baseline for Vital Signs of Supine Systolic and Diastolic Blood Pressure.Day 4/72h Post-dose (SBP) (N= 9, 11, 11, 12)0 mmHgStandard Deviation 9
Treatment BMean Change From Baseline for Vital Signs of Supine Systolic and Diastolic Blood Pressure.Day 3/48h Post-dose (SBP) (N= 42, 43, 43, 42)-2 mmHgStandard Deviation 10
Treatment BMean Change From Baseline for Vital Signs of Supine Systolic and Diastolic Blood Pressure.Day 3/48h Post-dose (DBP) (N= 42, 43, 43, 42)-2 mmHgStandard Deviation 7
Treatment CMean Change From Baseline for Vital Signs of Supine Systolic and Diastolic Blood Pressure.Day 3/48h Post-dose (SBP) (N= 42, 43, 43, 42)2 mmHgStandard Deviation 8
Treatment CMean Change From Baseline for Vital Signs of Supine Systolic and Diastolic Blood Pressure.Day 4/72h Post-dose (SBP) (N= 9, 11, 11, 12)1 mmHgStandard Deviation 11
Treatment CMean Change From Baseline for Vital Signs of Supine Systolic and Diastolic Blood Pressure.Day 2/24h Post-dose (DBP) (N= 42, 43, 43, 43)-1 mmHgStandard Deviation 5
Treatment CMean Change From Baseline for Vital Signs of Supine Systolic and Diastolic Blood Pressure.Day 4/72h Post-dose (DBP) (N= 9, 11, 11, 12)4 mmHgStandard Deviation 3
Treatment CMean Change From Baseline for Vital Signs of Supine Systolic and Diastolic Blood Pressure.Day 3/48h Post-dose (DBP) (N= 42, 43, 43, 42)0 mmHgStandard Deviation 6
Treatment CMean Change From Baseline for Vital Signs of Supine Systolic and Diastolic Blood Pressure.Day 2/24h Post-dose (SBP) (N= 42, 43, 43, 43)-1 mmHgStandard Deviation 8
Treatment DMean Change From Baseline for Vital Signs of Supine Systolic and Diastolic Blood Pressure.Day 3/48h Post-dose (DBP) (N= 42, 43, 43, 42)1 mmHgStandard Deviation 5
Treatment DMean Change From Baseline for Vital Signs of Supine Systolic and Diastolic Blood Pressure.Day 4/72h Post-dose (DBP) (N= 9, 11, 11, 12)4 mmHgStandard Deviation 6
Treatment DMean Change From Baseline for Vital Signs of Supine Systolic and Diastolic Blood Pressure.Day 3/48h Post-dose (SBP) (N= 42, 43, 43, 42)2 mmHgStandard Deviation 8
Treatment DMean Change From Baseline for Vital Signs of Supine Systolic and Diastolic Blood Pressure.Day 2/24h Post-dose (DBP) (N= 42, 43, 43, 43)0 mmHgStandard Deviation 6
Treatment DMean Change From Baseline for Vital Signs of Supine Systolic and Diastolic Blood Pressure.Day 2/24h Post-dose (SBP) (N= 42, 43, 43, 43)0 mmHgStandard Deviation 8
Treatment DMean Change From Baseline for Vital Signs of Supine Systolic and Diastolic Blood Pressure.Day 4/72h Post-dose (SBP) (N= 9, 11, 11, 12)7 mmHgStandard Deviation 13
Secondary

Mean Dissolution Time (MDT).

This was one of the PK parameters to determine MDT (whole tablet only) (calculated as MRT Treatment D \[Reference\] - MRT Treatment C \[Test\]). Blood was collected pre-dose and 0.25, 0.5, 1, 1.5, 2, 3, 4, 5, 6, 8, 10, 12, 16, 24, 36, 48 and 72 hours post-dose to determine naloxegol plasma concentrations.

Time frame: Pre-dose (0 hours [within 30 minutes prior to IMP administration]) and post-dose at 0.25 (15 minutes), 0.5 (30 minutes), 1, 1.5, 2, 3, 4, 5, 6, 8, 10, 12, 16, 24, 36, 48 and 72 hours in each treatment period.

Population: The PK analysis set was a subset of those participants in the safety analysis set and included participants who had received at least 1 dose of study medication and had at least 1 post-dose plasma concentration measurement at a scheduled time point. There were zero participants analyzed in Treatment A, B and C, hence data was not determined.

ArmMeasureValue (MEAN)Dispersion
Treatment AMean Dissolution Time (MDT).1.29 hStandard Deviation 0.951
Secondary

Mean Residence Time (MRT).

This was one of the PK parameters to determine MRT. Blood was collected pre-dose and 0.25, 0.5, 1, 1.5, 2, 3, 4, 5, 6, 8, 10, 12, 16, 24, 36, 48 and 72 hours post-dose to determine naloxegol plasma concentrations.

Time frame: Pre-dose (0 hours [within 30 minutes prior to IMP administration]) and post-dose at 0.25 (15 minutes), 0.5 (30 minutes), 1, 1.5, 2, 3, 4, 5, 6, 8, 10, 12, 16, 24, 36, 48 and 72 hours in each treatment period.

Population: The PK analysis set was a subset of those participants in the safety analysis set and included participants who had received at least 1 dose of study medication and had at least 1 post-dose plasma concentration measurement at a scheduled time point.

ArmMeasureValue (MEAN)Dispersion
Treatment AMean Residence Time (MRT).6.94 hStandard Deviation 2
Treatment BMean Residence Time (MRT).6.54 hStandard Deviation 1.92
Treatment CMean Residence Time (MRT).6.21 hStandard Deviation 1.42
Treatment DMean Residence Time (MRT).6.72 hStandard Deviation 1.68
Secondary

Participants With Significant Findings in 12-Lead Electrocardiography (ECG).

A 12-lead ECG was obtained after the participant rested in supine position for at least 10 minutes. The study physician was to judge the overall interpretation as normal or abnormal. If abnormal, it was decided as to whether or not the abnormality was clinically significant and the reason for the abnormality was recorded.

Time frame: At screening, first admission to the clinical unit (Visit 2, Day -1), 1.25 hours after each dose (Visits 2-5, Day 1), as well as at the final follow-up visit (up to 9 weeks).

Population: The safety analysis set included all participants who had received at least one dose of Naloxegol and for whom any safety post-dose data were available.

ArmMeasureValue (NUMBER)
Treatment AParticipants With Significant Findings in 12-Lead Electrocardiography (ECG).0 participants
Treatment BParticipants With Significant Findings in 12-Lead Electrocardiography (ECG).0 participants
Treatment CParticipants With Significant Findings in 12-Lead Electrocardiography (ECG).0 participants
Treatment DParticipants With Significant Findings in 12-Lead Electrocardiography (ECG).0 participants
Secondary

Participants With Significant Findings in Columbia-Suicide Severity Rating Scale (C-SSRS).

The C-SSRS is a unique, simple and short method of assessing both behavior and ideation that tracks all suicidal events, and provided a summary of suicidality. It assesses the lethality of attempts and other features of ideation (frequency, duration, controllability, reasons for ideation and deterrents), all of which are significantly predictive of completed suicide. The C-SSRS was performed to determine the presence of suicidality.

Time frame: At Baseline and Days 1-4 of each treatment period.

Population: The safety analysis set included all participants who had received at least one dose of Naloxegol and for whom any safety post-dose data were available.

ArmMeasureValue (NUMBER)
Treatment AParticipants With Significant Findings in Columbia-Suicide Severity Rating Scale (C-SSRS).0 participants
Treatment BParticipants With Significant Findings in Columbia-Suicide Severity Rating Scale (C-SSRS).0 participants
Treatment CParticipants With Significant Findings in Columbia-Suicide Severity Rating Scale (C-SSRS).0 participants
Treatment DParticipants With Significant Findings in Columbia-Suicide Severity Rating Scale (C-SSRS).0 participants
Secondary

Participants With Significant Findings in Hematology, Clinical Chemistry and Urinalysis.

Participants were assessed through each laboratory variables for any significant abnormalities. Hematology assessments included white blood cell count, red blood cell count, hemoglobin, hematocrit, mean corpuscular volume, mean corpuscular hemoglobin and others. Clinical chemistry assessment included testing levels of sodium, potassium, urea, creatinine, albumin, calcium, glucose (fasting) and others. Urinalysis assessment included glucose, protein, blood and microscopy (if positive for blood or protein).

Time frame: At screening and at the final follow-up visit (maximum 9 weeks apart); in addition, for the first and third treatment period at pre-dose.

Population: The safety analysis set included all participants who had received at least one dose of Naloxegol and for whom any safety post-dose data were available.

ArmMeasureValue (NUMBER)
Treatment AParticipants With Significant Findings in Hematology, Clinical Chemistry and Urinalysis.0 participants
Treatment BParticipants With Significant Findings in Hematology, Clinical Chemistry and Urinalysis.0 participants
Treatment CParticipants With Significant Findings in Hematology, Clinical Chemistry and Urinalysis.0 participants
Treatment DParticipants With Significant Findings in Hematology, Clinical Chemistry and Urinalysis.0 participants
Secondary

Participants With Significant Findings in Physical Examination.

A complete physical examination included an assessment of the general appearance, respiratory, cardiovascular, abdomen, skin, head, and neck (including ears, eyes, nose, mouth and throat), lymph nodes, thyroid, musculoskeletal and neurological systems. Physical examination was performed to check for any significant abnormality in participants.

Time frame: A full physical examination at screening and the final follow-up visit (maximum 9 weeks apart). Abbreviated physical examination on admission (on Day -1 of each treatment period) and at 48-hours post-dose to each treatment period (for up to 4 weeks).

Population: The safety analysis set included all participants who had received at least one dose of Naloxegol and for whom any safety post-dose data were available.

ArmMeasureValue (NUMBER)
Treatment AParticipants With Significant Findings in Physical Examination.0 participants
Treatment BParticipants With Significant Findings in Physical Examination.0 participants
Treatment CParticipants With Significant Findings in Physical Examination.0 participants
Treatment DParticipants With Significant Findings in Physical Examination.0 participants
Secondary

Percentage of Participants With Adverse Events (AE).

An AE is the development of an undesirable medical condition or the deterioration of a pre-existing medical condition following or during exposure to a pharmaceutical product, whether or not considered causally related to the product.The term AE is used generally to include any AE whether serious or non-serious. An serious AE (SAE) is an AE that fulfills one or more of the following criteria: results in death, is immediately life-threatening; requires in-patient hospitalization or prolongation of existing hospitalization; results in persistent or significant disability or incapacity or substantial disruption of the ability to conduct normal life functions; is a congenital abnormality or birth defect; is an important medical event that may jeopardize the participant or may require medical intervention to prevent one of the outcomes listed above.

Time frame: For up to 9 weeks (starting with screening).

Population: The safety analysis set included all participants who had received at least one dose of Naloxegol and for whom any safety post-dose data were available.

ArmMeasureValue (NUMBER)
Treatment APercentage of Participants With Adverse Events (AE).9.5 percentage of participants
Treatment BPercentage of Participants With Adverse Events (AE).7.0 percentage of participants
Treatment CPercentage of Participants With Adverse Events (AE).11.6 percentage of participants
Treatment DPercentage of Participants With Adverse Events (AE).18.6 percentage of participants
Secondary

Taste Test Assessment.

A standardized questionnaire was provided to participants and were asked to complete the questionnaire for the liquid formulations tested, i.e., Naloxegol crushed tablet, oral (Treatment A) and Naloxegol oral solution (Treatment C), without assistance or influence from site personnel. For each formulation, the questionnaire was identical and required the participant's opinion. Sweet, salty, sour, bitter, metallic, hot/spicy were rated on a scale of 0 to 10, where 0 means not at all and 10 means extreme. The overall rating of the taste was rated on a scale of 0 to 10, where 0 means I dislike it extremely much and 10 means I like it extremely much. The smell of the medicine was based on a scale of 0 to 10, where 0 means extremely bad and 10 means extremely nice. The question on whether the participants would consider ever taking the medicine again was based on a scale of 0 to 10, where 0 means Never - under no circumstances and 10 means Yes, definitely.

Time frame: Within 1 hour after dosing (Treatments A and C only).

Population: The safety analysis set included all participants who had received at least one dose of Naloxegol and for whom any safety post-dose data were available.

ArmMeasureGroupValue (MEDIAN)Dispersion
Treatment ATaste Test Assessment.Salty0.0 units on a scale
Treatment ATaste Test Assessment.Hot/Spicy0.0 units on a scale
Treatment ATaste Test Assessment.Bitter3.0 units on a scale
Treatment ATaste Test Assessment.How would you rate the taste of this medicine?4.0 units on a scale
Treatment ATaste Test Assessment.Sour0.0 units on a scale
Treatment ATaste Test Assessment.If the medicine smells, how does it smell?4.0 units on a scale
Treatment ATaste Test Assessment.Metallic1.0 units on a scale
Treatment ATaste Test Assessment.Would you consider taking this medicine again?8.0 units on a scale
Treatment ATaste Test Assessment.Sweet0.0 units on a scaleFull Range 0
Treatment BTaste Test Assessment.Would you consider taking this medicine again?9.0 units on a scale
Treatment BTaste Test Assessment.Sweet7.0 units on a scale
Treatment BTaste Test Assessment.Salty0.0 units on a scale
Treatment BTaste Test Assessment.Sour0.0 units on a scale
Treatment BTaste Test Assessment.Bitter0.0 units on a scale
Treatment BTaste Test Assessment.Metallic0.0 units on a scale
Treatment BTaste Test Assessment.Hot/Spicy0.0 units on a scale
Treatment BTaste Test Assessment.How would you rate the taste of this medicine?7.0 units on a scale
Treatment BTaste Test Assessment.If the medicine smells, how does it smell?7.0 units on a scale
Secondary

Time to Reach Maximum Plasma Concentration (Tmax).

This was one of the PK parameters to determine the time to reach maximum plasma concentration (tmax). Blood was collected pre-dose and 0.25, 0.5, 1, 1.5, 2, 3, 4, 5, 6, 8, 10, 12, 16, 24, 36, 48 and 72 hours post-dose to determine naloxegol plasma concentrations.

Time frame: Pre-dose (0 hours [within 30 minutes prior to IMP administration]) and post-dose at 0.25 (15 minutes), 0.5 (30 minutes), 1, 1.5, 2, 3, 4, 5, 6, 8, 10, 12, 16, 24, 36, 48 and 72 hours in each treatment period.

Population: The PK analysis set was a subset of those participants in the safety analysis set and included participants who had received at least 1 dose of study medication and had at least 1 post-dose plasma concentration measurement at a scheduled time point.

ArmMeasureValue (MEDIAN)
Treatment ATime to Reach Maximum Plasma Concentration (Tmax).0.75 h
Treatment BTime to Reach Maximum Plasma Concentration (Tmax).1.50 h
Treatment CTime to Reach Maximum Plasma Concentration (Tmax).0.50 h
Treatment DTime to Reach Maximum Plasma Concentration (Tmax).1.00 h

Source: ClinicalTrials.gov · Data processed: Feb 27, 2026