Central Neuropathic Pain, Chronic Pain, Chronic Pain Syndrome, Multiple Sclerosis, Neuropathic Pain, Pain, Pain, Chronic, Pain Syndrome, Paraplegia, Phantom Limb Syndrome With Pain, Phantom Pain, Stroke, Traumatic Brain Injury
Conditions
Keywords
Adezunap, Pain Therapy, Pain, Pain Syndrome, Chronic Pain, Chronic Pain Syndrome, Central Nervous System, CNS, Neuropathic Pain, Central Neuropathic Pain, Paraplegia, Multiple Sclerosis, Stroke, Phantom Limb Syndrome with Pain, Phantom Pain, Traumatic Brain Injury, THC, Tetrahydrocannabinol, Delta-9-Tetrahydrocannabinol, Cannabis, Cannabinoids
Brief summary
Over the last years a rising medical need for treatment of chronic pain was identified. Based on previous findings indicating the pain modulating effects of cannabinoids in chronic pain disorders, this clinical trial investigates the long term efficacy and tolerability of the THC-focused nano endocannabinoid system modulator AP707 in patients with chronic pain disorders due to central neuropathy of any genesis. Patients receive AP707 or placebo over the course of 14 weeks as an add-on to the standard of care. Changes in pain intensity, quality of life and sleep and others measures are monitored through different scales to assess the efficacy of AP707 in patients with chronic pain due to central neuropathy of any genesis.
Interventions
DRUGAdezunap (AP707)
Sublingual spray with maximum application of 16 actuations per day or a maximum daily dose of 17,6mg THC distributed over 4 daily intakes.
DRUGPlacebo
Sublingual spray with maximum application of 16 actuations per day distributed over 4 daily intakes.
Sponsors
Apurano Pharmaceuticals GmbH
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 No maximum
Healthy volunteers
No
Inclusion criteria
1. Signed and dated informed consent form 2. Patients with chronic pain due to central neuropathy of any genesis since at least 3 months 3. Female and male patients (\> 18 years) 4. Patients with more than 1 year life expectancy 5. Patients with optimized sCPT on study entry as defined in section 3.1.1 and section 3.1.3 of the study protocol 6. Willingness of study patients of both sexes to use reliable contraception during study participation and for three months after taking the last study medication 7. Good command of German language, in order to understand questionnaires in German 8. Current moderate to severe pain with pain intensity \> 5 on Numeric Rating Scale (NRS, 0 - 10) and thus an existing need for further pain therapy 9. Completed QUISS (Quantification Inventory for Somatoform Syndromes) questionnaire with 45 or less score points
Exclusion criteria
1. Medical history of hypersensitivity or intolerance to the investigational product or its ingredients or to ingredients of similar chemical structure 2. Known intolerance to cannabinoids or cannabis products. 3. Participation in another clinical trial within the last four weeks prior to inclusion. 4. Pregnant or nursing women (as excluded by pregnancy testing at visit 1). 5. Other medical conditions that do not allow the trial subject to appraise the nature, scope, and potential consequences of the clinical trial 6. Indications that the trial subject is unlikely to comply with the study protocol (e.g., unwillingness to cooperate) 7. Known use of medicinal cannabis products within the last 8 weeks 8. Active malignant tumor disease, tumor pain, or other dominant severe pain other than that of the study indication 9. Known history of severe liver or kidney diseases 10. Known history of severe cardiovascular disease 11. Known history of or acute mental illness such as severe depression, psychosis, bipolar disorder, mania, anxiety, or obsessive-compulsive disorder 12. Known history of addictive disease (e.g., alcohol, medication, drug addiction) 13. Answered during Screening less than 12 times of 18 the pain intensity (NRS) inquiry 14. Laboratory liver values: Alanine aminotransferase (ALT, GPT) \> 3 x ULN (Upper Limit of Normal range), Aspartate aminotransferase (AST, GOT) \> 3 x ULN, Alkaline phosphatase (AP) \> 2.5 x ULN, and for bilirubin \> 1.5 x ULN 15. Laboratory renal value: Serum creatinine \> 1.5 ULN
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Change in pain level on the Numeric Rating Scale (NRS, 0-10) between baseline and at treatment week 14 (end of first treatment phase) in comparison of study arm 1 (verum) and study arm 2 (placebo) | Once daily in week 4 and 14 |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in quality of life using the Veterans RAND (VR-12) questionnaire from start to week 14, 26, and 52 | Week 1, 14, 26 and 52 | — |
| Change in psychological distress using Depression Anxiety Stress Scales Short Form (DASS-21) questionnaire from start to week 14, 26, and 52 | Week 1, 14, 26 and 52 | — |
| Change in pain level on the Numeric Rating Scale (NRS, 0-10) between baseline and at treatment week 26 (end of second treatment phase) in comparison of study arm 1 (verum) and study arm 2 (placebo) | Once daily in week 4 and 26 | — |
| Change in pain level on the Numeric Rating Scale (NRS, 0-10) between baseline and at treatment week 52 (end of third treatment phase) in comparison of study arm 1 (verum) and study arm 2 (placebo) | Once daily in week 4 and 52 | — |
| Change in the pain score of the Neuropathic Pain Symptom Inventory (NPSI) questionnaire between baseline and at treatment week 14, treatment week 26 and treatment week 52 in comparison of study arm 1 (verum) and study arm 2 (placebo) | Once in week 1, 14, 26 and 52 | — |
| Change in pain level on the Numeric Rating Scale (0-10) between baseline and in treatment week 5, 11, 18, 22, 30, 34, 43, 47 in comparison of study arm 1 (verum) and study arm 2 (placebo) | Several times weekly in week 4, 5, 11, 18, 22, 30, 34, 43 and 47 | — |
| Change of Patient Global Impression of Change (PGIC) from start to week 14, 26, and 52 | Week 14, 26 and 52 | — |
| Change in sCPT (percentage of change in dosage and percentage of change in combination of analgesic measures) in both study arms from start to week 14 | Week 14 | — |
| Change in sleep quality using the Regensburg Insomnia Scale (RIS) from start to week 14, 26, and 52 | Week 1, 14, 26 and 52 | — |
| Change in pain score of the Brief Pain Inventory - Short Form (BPI-SF) questionnaire from start to week 14, 26, and 52 | Week 1, 14, 26 and 52 | — |
| Area under NRS-curve until treatment week 5, 11, 14, 18, 22, 26, 30, 34, 39, 43, 47, 52 | Week 5, 12, 18, 22, 26, 30, 34, 39, 43, 47 and 52 | — |
| Change in VR-12 components (physical component summary PCS, mental component summary MCS) from start to week 14, 26, and 52 | Week 1, 14, 26 and 52 | — |
| Number of patients with rescue medication over the course of the clinical trial and within periods: until treatment week ≤5, ≤11, ≤14, ≤18, ≤22, ≤26, ≤30, ≤34, ≤43, ≤47, ≤52 | Week 5, 11, 14, 18, 22, 26, 30, 34, 43, 47 and 52 | — |
| Responder analysis for endpoints 1), 2), 3) and 4) for treatment week 14, 26 and 52 | Week 14, 26 and 52 | 1. Proportion of patients who experienced \> 30 % improvement in pain score (Numeric Rating Scale) 2. Proportion of patients who experienced \> 40 % improvement in pain score (Numeric Rating Scale) 3. Proportion of patients who experienced \> 50 % improvement in pain score (Numeric Rating Scale) |
Other
| Measure | Time frame |
|---|---|
| Number and severity of adverse events (AE) | Week 1 to 52 |
Countries
Germany
Contacts
Primary ContactMarko Blisse
Outcome results
None listed