Constipation Predominant Irritable Bowel Syndrome
Conditions
Brief summary
This phase 3, 26-week, randomized, double-blind, placebo-controlled, multi-center study will evaluate the safety and efficacy of one dose of Tenapanor in subjects with constipation-predominant irritable bowel syndrome (IBS-C) as defined by the ROME III criteria and who have active disease as determined after a two-week screening period. Subjects who qualify and are randomized into the study will either receive 50mg BID of Tenapanor (1:1) for a 26 week treatment period.
Detailed description
During the 26-week double-blind treatment period, subjects will record daily assessments including: frequency and timing of bowel movements; sensation of complete bowel emptying; consistency of bowel movements; degree of straining, worst abdominal pain, abdominal discomfort, abdominal bloating, abdominal fullness and abdominal cramping; and use and timing of rescue medication. Subjects will also record weekly assessments including: adequate relief of IBS symptoms, degree of relief of IBS symptoms, IBS severity, and constipation severity.
Interventions
DRUGTenapanor
DRUGPlacebo
Sponsors
Ardelyx
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* Males or females aged 18 to 75 years, inclusive * Females must be of non-childbearing potential; If of child-bearing potential, must have negative pregnancy test and confirm the use of one of the appropriate means of contraception * Males must agree to use appropriate methods of barrier contraception or have documented surgical sterilization * Subject meets definition of IBS-C using Rome III Criteria for the Diagnosis of IBS * A colonoscopy based on AGA guidelines; every 10 years at ≥50 years old
Exclusion criteria
* Functional diarrhea as defined by Rome III criteria * IBS with diarrhea (IBS-D), mixed IBS (IBS-M), or unsubtyped IBS as defined by Rome III criteria * Diagnosis or treatment of any clinically symptomatic biochemical or structural abnormality of the GI tract within 6 months prior to screening, or active disease within 6 months prior to screening; including but not limited to cancer, inflammatory bowel disease, diverticulitis, duodenal ulcer, erosive esophagitis, gastric ulcer, pancreatitis (within 12 months of screening), cholelithiasis, amyloidosis, ileus, non-controlled GERD, gastrointestinal obstruction or carcinoid syndrome. * Potential CNS cause of constipation (e.g., Parkinson's disease, spinal cord injury, or multiple sclerosis) * Subject has a history or current evidence of laxative abuse (in the clinical judgment of physician) * Hepatic dysfunction (ALT \[SGPT\] or AST \[SGOT\] \>2.5 times the upper limit of normal) or renal impairment (serum creatinine \>2 mg/dL) * Any evidence of or treatment of malignancy (other than localized basal cell, squamous cell skin cancer or cancer in situ that has been resected) within the previous year * Any surgery on the stomach, small intestine or colon, excluding appendectomy and cholecystectomy (unless within 60 days of screening visit)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Subjects With Overall Response for 6 Out of 12 Weeks | First 12 weeks | An overall responder is defined as a weekly responder for the first 6/12 weeks where both CSBM and abdominal pain response criteria were met for the week. The CSBM response criteria are defined as an increase of one or more change in average weekly CSBMs from baseline. The definition of a CSBM is as follows: A CSBM is a spontaneous bowel movement (SBM) for which the subject responds yes to the following question; Did you feel like you completely emptied your bowels? The abdominal pain response criterion is defined as a decrease of 30% or more of percent change in average weekly worst abdominal pain from baseline. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Subjects With Overall Abdominal Pain Response for 6 Out of 12 Weeks | First 12 weeks | An overall abdominal pain responder is defined as a weekly responder for the first 6/12 weeks. The abdominal pain response criterion is defined as a decrease of 30% or more of percent change in average weekly worst abdominal pain from baseline. |
| Percentage of Subjects With Overall Response for 13 Out of 26 Weeks | 26 weeks | An overall responder is defined as a weekly responder for the first 13/26 weeks where both CSBM and abdominal pain response criteria were met for the week. The CSBM response criteria are defined as an increase of one or more change in average weekly CSBMs from baseline. The definition of a CSBM is as follows: A CSBM is a spontaneous bowel movement (SBM) for which the subject responds yes to the following question; Did you feel like you completely emptied your bowels? The abdominal pain response criterion is defined as a decrease of 30% or more of percent change in average weekly worst abdominal pain from baseline. |
| Percentage of Subjects With Overall Complete Spontaneous Bowel Movement (CSBM) Response for 13 Out of 26 Weeks | 26 weeks | An overall CSBM responder is defined as a weekly responder for the first 13/26 weeks. The CSBM response criteria are defined as an increase of one or more change in average weekly CSBMs from baseline. The definition of a CSBM is as follows: A CSBM is a spontaneous bowel movement (SBM) for which the subject responds yes to the following question; Did you feel like you completely emptied your bowels? |
| Percentage of Subjects With Overall Complete Spontaneous Bowel Movement (CSBM) Response for 6 Out of 12 Weeks | First 12 weeks | An overall CSBM responder is defined as a weekly responder for the first 6/12 weeks. The CSBM response criteria are defined as an increase of one or more change in average weekly CSBMs from baseline. The definition of a CSBM is as follows: A CSBM is a spontaneous bowel movement (SBM) for which the subject responds yes to the following question; Did you feel like you completely emptied your bowels? |
| Percentage of Subjects With Overall Response for 9 Out of 12 Weeks | First 12 weeks | An overall responder is defined as a weekly responder for the first 9/12 weeks where both CSBM and abdominal pain response criteria were met for the week. The CSBM response criteria are defined as an increase of one or more change in average weekly CSBMs from baseline and a minimum of at least 3 CSBMs that same week. The definition of a CSBM is as follows: A CSBM is a spontaneous bowel movement (SBM) for which the subject responds yes to the following question; Did you feel like you completely emptied your bowels? The abdominal pain response criterion is defined as a decrease of 30% or more of percent change in average weekly worst abdominal pain from baseline. |
| Percentage of Subjects With Overall Complete Spontaneous Bowel Movement (CSBM) Response for 9 Out of 12 Weeks | First 12 weeks | An overall CSBM responder is defined as a weekly responder for the first 9/12 weeks. The CSBM response criteria are defined as an increase of one or more change in average weekly CSBMs from baseline and a minimum of at least 3 CSBMs that same week. The definition of a CSBM is as follows: A CSBM is a spontaneous bowel movement (SBM) for which the subject responds yes to the following question; Did you feel like you completely emptied your bowels? |
| Percentage of Subjects With Overall Abdominal Pain Response for 9 Out of 12 Weeks | First 12 weeks | An overall abdominal pain responder is defined as a weekly responder for the first 9/12 weeks. The abdominal pain response criterion is defined as a decrease of 30% or more of percent change in average weekly worst abdominal pain from baseline. |
| Percentage of Subjects With Overall Abdominal Pain Response for 13 Out of 26 Weeks | 26 weeks | An overall abdominal pain responder is defined as a weekly responder for the first 13/26 weeks. The abdominal pain response criterion is defined as a decrease of 30% or more of percent change in average weekly worst abdominal pain from baseline. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| 50mg BID Tenapanor, 50mg BID (100mg total)
Tenapanor | 293 |
| Placebo Placebo
Placebo | 300 |
| Total | 593 |
Baseline characteristics
| Characteristic | 50mg BID | Placebo | Total |
|---|---|---|---|
| Age, Continuous | 46.1 years STANDARD_DEVIATION 13.1 | 44.8 years STANDARD_DEVIATION 13.8 | 45.4 years STANDARD_DEVIATION 13.46 |
| Body Mass Index (BMI) | 30.50 kg/m^2 STANDARD_DEVIATION 7.18 | 30.88 kg/m^2 STANDARD_DEVIATION 7.27 | 30.69 kg/m^2 STANDARD_DEVIATION 7.22 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 77 Participants | 78 Participants | 155 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 216 Participants | 222 Participants | 438 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 1 Participants | 0 Participants | 1 Participants |
| Race (NIH/OMB) Asian | 12 Participants | 9 Participants | 21 Participants |
| Race (NIH/OMB) Black or African American | 92 Participants | 92 Participants | 184 Participants |
| Race (NIH/OMB) More than one race | 1 Participants | 3 Participants | 4 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 2 Participants | 4 Participants | 6 Participants |
| Race (NIH/OMB) White | 185 Participants | 192 Participants | 377 Participants |
| Sex: Female, Male Female | 240 Participants | 247 Participants | 487 Participants |
| Sex: Female, Male Male | 53 Participants | 53 Participants | 106 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 293 | 0 / 300 |
| other Total, other adverse events | 47 / 293 | 11 / 300 |
| serious Total, serious adverse events | 4 / 293 | 8 / 300 |
Outcome results
Primary
Percentage of Subjects With Overall Response for 6 Out of 12 Weeks
An overall responder is defined as a weekly responder for the first 6/12 weeks where both CSBM and abdominal pain response criteria were met for the week. The CSBM response criteria are defined as an increase of one or more change in average weekly CSBMs from baseline. The definition of a CSBM is as follows: A CSBM is a spontaneous bowel movement (SBM) for which the subject responds yes to the following question; Did you feel like you completely emptied your bowels? The abdominal pain response criterion is defined as a decrease of 30% or more of percent change in average weekly worst abdominal pain from baseline.
Time frame: First 12 weeks
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| 50mg BID | Percentage of Subjects With Overall Response for 6 Out of 12 Weeks | 107 Participants |
| Placebo | Percentage of Subjects With Overall Response for 6 Out of 12 Weeks | 71 Participants |
p-value: <0.001Cochran-Mantel-Haenszel
Secondary
Percentage of Subjects With Overall Abdominal Pain Response for 13 Out of 26 Weeks
An overall abdominal pain responder is defined as a weekly responder for the first 13/26 weeks. The abdominal pain response criterion is defined as a decrease of 30% or more of percent change in average weekly worst abdominal pain from baseline.
Time frame: 26 weeks
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| 50mg BID | Percentage of Subjects With Overall Abdominal Pain Response for 13 Out of 26 Weeks | 147 Participants |
| Placebo | Percentage of Subjects With Overall Abdominal Pain Response for 13 Out of 26 Weeks | 120 Participants |
p-value: 0.013Cochran-Mantel-Haenszel
Secondary
Percentage of Subjects With Overall Abdominal Pain Response for 6 Out of 12 Weeks
An overall abdominal pain responder is defined as a weekly responder for the first 6/12 weeks. The abdominal pain response criterion is defined as a decrease of 30% or more of percent change in average weekly worst abdominal pain from baseline.
Time frame: First 12 weeks
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| 50mg BID | Percentage of Subjects With Overall Abdominal Pain Response for 6 Out of 12 Weeks | 146 Participants |
| Placebo | Percentage of Subjects With Overall Abdominal Pain Response for 6 Out of 12 Weeks | 115 Participants |
p-value: 0.004Cochran-Mantel-Haenszel
Secondary
Percentage of Subjects With Overall Abdominal Pain Response for 9 Out of 12 Weeks
An overall abdominal pain responder is defined as a weekly responder for the first 9/12 weeks. The abdominal pain response criterion is defined as a decrease of 30% or more of percent change in average weekly worst abdominal pain from baseline.
Time frame: First 12 weeks
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| 50mg BID | Percentage of Subjects With Overall Abdominal Pain Response for 9 Out of 12 Weeks | 105 Participants |
| Placebo | Percentage of Subjects With Overall Abdominal Pain Response for 9 Out of 12 Weeks | 80 Participants |
p-value: 0.015Cochran-Mantel-Haenszel
Secondary
Percentage of Subjects With Overall Complete Spontaneous Bowel Movement (CSBM) Response for 13 Out of 26 Weeks
An overall CSBM responder is defined as a weekly responder for the first 13/26 weeks. The CSBM response criteria are defined as an increase of one or more change in average weekly CSBMs from baseline. The definition of a CSBM is as follows: A CSBM is a spontaneous bowel movement (SBM) for which the subject responds yes to the following question; Did you feel like you completely emptied your bowels?
Time frame: 26 weeks
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| 50mg BID | Percentage of Subjects With Overall Complete Spontaneous Bowel Movement (CSBM) Response for 13 Out of 26 Weeks | 121 Participants |
| Placebo | Percentage of Subjects With Overall Complete Spontaneous Bowel Movement (CSBM) Response for 13 Out of 26 Weeks | 93 Participants |
p-value: 0.01Cochran-Mantel-Haenszel
Secondary
Percentage of Subjects With Overall Complete Spontaneous Bowel Movement (CSBM) Response for 6 Out of 12 Weeks
An overall CSBM responder is defined as a weekly responder for the first 6/12 weeks. The CSBM response criteria are defined as an increase of one or more change in average weekly CSBMs from baseline. The definition of a CSBM is as follows: A CSBM is a spontaneous bowel movement (SBM) for which the subject responds yes to the following question; Did you feel like you completely emptied your bowels?
Time frame: First 12 weeks
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| 50mg BID | Percentage of Subjects With Overall Complete Spontaneous Bowel Movement (CSBM) Response for 6 Out of 12 Weeks | 139 Participants |
| Placebo | Percentage of Subjects With Overall Complete Spontaneous Bowel Movement (CSBM) Response for 6 Out of 12 Weeks | 100 Participants |
p-value: <0.001Cochran-Mantel-Haenszel
Secondary
Percentage of Subjects With Overall Complete Spontaneous Bowel Movement (CSBM) Response for 9 Out of 12 Weeks
An overall CSBM responder is defined as a weekly responder for the first 9/12 weeks. The CSBM response criteria are defined as an increase of one or more change in average weekly CSBMs from baseline and a minimum of at least 3 CSBMs that same week. The definition of a CSBM is as follows: A CSBM is a spontaneous bowel movement (SBM) for which the subject responds yes to the following question; Did you feel like you completely emptied your bowels?
Time frame: First 12 weeks
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| 50mg BID | Percentage of Subjects With Overall Complete Spontaneous Bowel Movement (CSBM) Response for 9 Out of 12 Weeks | 65 Participants |
| Placebo | Percentage of Subjects With Overall Complete Spontaneous Bowel Movement (CSBM) Response for 9 Out of 12 Weeks | 18 Participants |
p-value: <0.001Cochran-Mantel-Haenszel
Secondary
Percentage of Subjects With Overall Response for 13 Out of 26 Weeks
An overall responder is defined as a weekly responder for the first 13/26 weeks where both CSBM and abdominal pain response criteria were met for the week. The CSBM response criteria are defined as an increase of one or more change in average weekly CSBMs from baseline. The definition of a CSBM is as follows: A CSBM is a spontaneous bowel movement (SBM) for which the subject responds yes to the following question; Did you feel like you completely emptied your bowels? The abdominal pain response criterion is defined as a decrease of 30% or more of percent change in average weekly worst abdominal pain from baseline.
Time frame: 26 weeks
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| 50mg BID | Percentage of Subjects With Overall Response for 13 Out of 26 Weeks | 104 Participants |
| Placebo | Percentage of Subjects With Overall Response for 13 Out of 26 Weeks | 73 Participants |
p-value: 0.003Cochran-Mantel-Haenszel
Secondary
Percentage of Subjects With Overall Response for 9 Out of 12 Weeks
An overall responder is defined as a weekly responder for the first 9/12 weeks where both CSBM and abdominal pain response criteria were met for the week. The CSBM response criteria are defined as an increase of one or more change in average weekly CSBMs from baseline and a minimum of at least 3 CSBMs that same week. The definition of a CSBM is as follows: A CSBM is a spontaneous bowel movement (SBM) for which the subject responds yes to the following question; Did you feel like you completely emptied your bowels? The abdominal pain response criterion is defined as a decrease of 30% or more of percent change in average weekly worst abdominal pain from baseline.
Time frame: First 12 weeks
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| 50mg BID | Percentage of Subjects With Overall Response for 9 Out of 12 Weeks | 54 Participants |
| Placebo | Percentage of Subjects With Overall Response for 9 Out of 12 Weeks | 16 Participants |
p-value: <0.001Cochran-Mantel-Haenszel