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The purpose of this study is to assess the safety and tolerability of long term therapy with Sativex® and GW-2000-02.
Subjects who have previously participated in GWCA0101, a two week (two days baseline and two weeks treatment period), multicentre, double blind, randomised, placebo controlled, parallel group study to evaluate the efficacy of Sativex® (containing delta-9-tetrahydrocannabinol [THC] and cannabidiol [CBD]) and GW-2000-02 (containing THC alone) in subjects with cancer-related pain are screened, and if eligible begin dosing with open-label Sativex®. They are allowed to self-titrate their study medication to symptom resolution or maximum tolerated/allowable dose of 130 mg THC and 120 mg CBD and have the opportunity to request a change from Sativex® to GW-2000-02 if they or the investigator consider their response less than optimal. Subjects are reviewed for tolerability and evidence of clinical benefit at 7-10 days after Visit 1 and then every four weeks. Continuation within the study is conditional on satisfactory reports of tolerability, efficacy and dosing regime.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Sativex | Experimental | Active treatment |
|
| GW-2000-02 | Experimental | Active treatment |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Sativex | Drug | Containing delta-9-tetrahydrocannabinol (THC), 27 mg/ml: cannabidiol (CBD), 25 mg/ml; both as extract of Cannabis sativa L. Subjects received study medication delivered in 100 µl actuations by a pump action oromucosal spray. Maximum permitted dose was eight actuations in any three hour period and 48 actuations (THC 130 mg:CBD 120 mg) in 24 hours. |
| Measure | Description | Time Frame |
|---|---|---|
| The Incidence of Adverse Events as a Measure of Subject Safety | The number of subjects who experienced an adverse event in this study is presented. | 0 - 657 days |
| Measure | Description | Time Frame |
|---|---|---|
| Change From Baseline in the Mean Brief Pain Inventory (Short Form) - Pain Severity Score at the End of Treatment | The Brief Pain Inventory (Short Form) is a 14-item questionnaire that asks subjects to rate pain over the prior week and the degree to which it interferes with activities on a 0 to 10 scale, where 0=no pain and 10=pain as bad as you can imagine. Severity is measured as worst pain, least pain, average pain, and pain right now. The severity composite score was calculated as the arithmetic mean of the four severity items (range 0-10). The minimum value is zero and maximum is 10. A negative value indicates an improvement in score from baseline. The end of treatment was classed as study completion or withdrawal, if this occurred sooner. Calculation of the mean Brief Pain Inventory (Short Form) score was only carried out when data was available for 10 or more subjects at the relevant study visits. As such, no mean scores were calculated for subjects taking THC alone. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Jeremy R Johnson, MB ChB | Shropshire and Mid-Wales Hospice | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Shropshire and Mid-Wales Hospice | Shrewsbury | SY3 8HS | United Kingdom |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 23141881 | Result | Johnson JR, Lossignol D, Burnell-Nugent M, Fallon MT. An open-label extension study to investigate the long-term safety and tolerability of THC/CBD oromucosal spray and oromucosal THC spray in patients with terminal cancer-related pain refractory to strong opioid analgesics. J Pain Symptom Manage. 2013 Aug;46(2):207-18. doi: 10.1016/j.jpainsymman.2012.07.014. Epub 2012 Nov 8. |
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The first subject was recruited on the 30th April 2002
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| ID | Title | Description |
|---|---|---|
| FG000 | Sativex | Each 100 μl actuation of Sativex delivered a dose containing 2.7 mg THC and 2.5 mg CBD |
| FG001 | THC Alone | Each 100 μl actuation of THC alone delivered a dose containing 2.7 mg THC |
| Title | Milestones | Reasons Not Completed | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
|
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| ID | Title | Description |
|---|---|---|
| BG000 | Sativex | Each 100 μl actuation of Sativex delivered a dose containing 2.7 mg THC and 2.5 mg CBD |
| BG001 | THC Alone | Each 100 μl actuation of THC alone delivered a dose containing 2.7 mg THC |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Categorical | Count of Participants |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | The Incidence of Adverse Events as a Measure of Subject Safety | The number of subjects who experienced an adverse event in this study is presented. | All subjects who took at least one dose of study medication and yielded on-treatment efficacy data were classed as the safety population. | Posted | Number | participants | 0 - 657 days |
|
All adverse events (AEs) occurring from the time of consent to post study follow up (2 - 521 days) were collected. All deaths and serious adverse events (SAEs) occurring within 28 days of the final dose of study medication were also collected.
All AEs occurring during the study were reported on the running logs at the back of the study case report form.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Sativex | Each 100 μl actuation of Sativex delivered a dose containing 2.7 mg THC and 2.5 mg CBD |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Anaemia NOS aggravated | Blood and lymphatic system disorders | MedDRA 5.1 | Systematic Assessment |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Nausea | Gastrointestinal disorders | MedDRA 5.1 | Systematic Assessment |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Mr Richard Potts, Clinical Operations Director | GW Pharma LTD. | 00 44 1223 266 800 | rp@gwpharm.com |
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| ID | Term |
|---|---|
| D010146 | Pain |
| D009369 | Neoplasms |
| ID | Term |
|---|---|
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
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| ID | Term |
|---|---|
| C587251 | nabiximols |
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|
|
| GW-2000-02 | Drug | Containing THC, 27 mg/ml, as extract of Cannabis sativa L. Subjects received study medication delivered in 100 µl actuations by a pump action oromucosal spray. Maximum permitted dose was eight actuations in any three hour period and 48 actuations (THC 130 mg) in 24 hours. |
|
| 0 - 657 days |
| Change From Baseline in the Mean EORTC Quality of Life-C30 Questionnaire - Global Health Status Score at the End of Treatment | The EORTC Quality of Life-C30 Health Status visual analogue scale was a self-reported score where subjects rated their health state from: 0 = worst health state imaginable to 100 = best health state imaginable. An increase in score from baseline indicates an improvement in condition. The end of treatment was classed as study completion or withdrawal, if this occurred sooner. Calculation of mean EORTC Quality of Life-C30 Health Status scores was only produced when data was available for 10 or more subjects at the relevant study visits. As such, no mean scores were calculated for subjects taking THC alone. | 0 - 657 days |
| Withdrawal by Subject |
|
| Lost to Follow-up |
|
| Protocol Violation |
|
| Pain under control |
|
| Sponsor decision |
|
| Patient died |
|
| Patient unable to comply with diaries |
|
| Patient feels unable to take medication |
|
| BG002 | Total | Total of all reporting groups |
| Participants |
|
| Age, Continuous | Mean | Standard Deviation | years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Region of Enrollment | Number | participants |
|
|
|
| Secondary | Change From Baseline in the Mean Brief Pain Inventory (Short Form) - Pain Severity Score at the End of Treatment | The Brief Pain Inventory (Short Form) is a 14-item questionnaire that asks subjects to rate pain over the prior week and the degree to which it interferes with activities on a 0 to 10 scale, where 0=no pain and 10=pain as bad as you can imagine. Severity is measured as worst pain, least pain, average pain, and pain right now. The severity composite score was calculated as the arithmetic mean of the four severity items (range 0-10). The minimum value is zero and maximum is 10. A negative value indicates an improvement in score from baseline. The end of treatment was classed as study completion or withdrawal, if this occurred sooner. Calculation of the mean Brief Pain Inventory (Short Form) score was only carried out when data was available for 10 or more subjects at the relevant study visits. As such, no mean scores were calculated for subjects taking THC alone. | The efficacy analyses were conducted on data from all subjects who entered the study, who were randomised, who received at least one dose of study medication and who yielded on-treatment efficacy data | Posted | Mean | Standard Deviation | units on a scale | 0 - 657 days |
|
|
|
| Secondary | Change From Baseline in the Mean EORTC Quality of Life-C30 Questionnaire - Global Health Status Score at the End of Treatment | The EORTC Quality of Life-C30 Health Status visual analogue scale was a self-reported score where subjects rated their health state from: 0 = worst health state imaginable to 100 = best health state imaginable. An increase in score from baseline indicates an improvement in condition. The end of treatment was classed as study completion or withdrawal, if this occurred sooner. Calculation of mean EORTC Quality of Life-C30 Health Status scores was only produced when data was available for 10 or more subjects at the relevant study visits. As such, no mean scores were calculated for subjects taking THC alone. | The efficacy analyses were conducted on data from all randomised subjects who received at least one dose of study medication and who yielded on-treatment efficacy data. | Posted | Mean | Standard Deviation | units on a scale | 0 - 657 days |
|
|
|
| 20 |
| 39 |
| 37 |
| 39 |
| EG001 | THC Alone | Each 100 μl actuation of THC alone delivered a dose containing 2.7 mg THC | 1 | 4 | 4 | 4 |
| Atrial fibrillation | Cardiac disorders | MedDRA 5.1 | Systematic Assessment |
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| Haematemesis | Gastrointestinal disorders | MedDRA 5.1 | Systematic Assessment |
|
| Diarrhoea NOS | Gastrointestinal disorders | MedDRA 5.1 | Systematic Assessment |
|
| Intestinal obstruction NOS | Gastrointestinal disorders | MedDRA 5.1 | Systematic Assessment |
|
| Nausea | Gastrointestinal disorders | MedDRA 5.1 | Systematic Assessment |
|
| Vomiting NOS | Gastrointestinal disorders | MedDRA 5.1 | Systematic Assessment |
|
| General physical health deterioration | General disorders | MedDRA 5.1 | Systematic Assessment |
|
| Weakness | General disorders | MedDRA 5.1 | Systematic Assessment |
|
| Pneumonia | Infections and infestations | MedDRA 5.1 | Systematic Assessment |
|
| Pyelonephritis NOS | Infections and infestations | MedDRA 5.1 | Systematic Assessment |
|
| Sepsis NOS | Infections and infestations | MedDRA 5.1 | Systematic Assessment |
|
| Urinary tract infection NOS | Infections and infestations | MedDRA 5.1 | Systematic Assessment |
|
| Accident NOS | Injury, poisoning and procedural complications | MedDRA 5.1 | Systematic Assessment |
|
| Blood creatinine increased | Investigations | MedDRA 5.1 | Systematic Assessment |
|
| Blood potassium increased | Investigations | MedDRA 5.1 | Systematic Assessment |
|
| Blood urea increased | Investigations | MedDRA 5.1 | Systematic Assessment |
|
| Gamma-glutamyltransferase increased | Investigations | MedDRA 5.1 | Systematic Assessment |
|
| Dehydration | Metabolism and nutrition disorders | MedDRA 5.1 | Systematic Assessment |
|
| Back pain | Musculoskeletal and connective tissue disorders | MedDRA 5.1 | Systematic Assessment |
|
| Pain in limb | Musculoskeletal and connective tissue disorders | MedDRA 5.1 | Systematic Assessment |
|
| Malignant neoplasm progression | Neoplasms benign, malignant and unspecified (incl cysts and polyps) | MedDRA 5.1 | Systematic Assessment |
|
| Metastases to brain | Neoplasms benign, malignant and unspecified (incl cysts and polyps) | MedDRA 5.1 | Systematic Assessment |
|
| Non-small cell lung cancer NOS | Neoplasms benign, malignant and unspecified (incl cysts and polyps) | MedDRA 5.1 | Systematic Assessment |
|
| Tumour pain | Neoplasms benign, malignant and unspecified (incl cysts and polyps) | MedDRA 5.1 | Systematic Assessment |
|
| Loss of consciousness | Nervous system disorders | MedDRA 5.1 | Systematic Assessment |
|
| Neuropathic pain | Nervous system disorders | MedDRA 5.1 | Systematic Assessment |
|
| Somnolence | Nervous system disorders | MedDRA 5.1 | Systematic Assessment |
|
| Confusion | Psychiatric disorders | MedDRA 5.1 | Systematic Assessment |
|
| Dysuria | Renal and urinary disorders | MedDRA 5.1 | Systematic Assessment |
|
| Renal Failure NOS | Renal and urinary disorders | MedDRA 5.1 | Systematic Assessment |
|
| Urinary incontinence | Renal and urinary disorders | MedDRA 5.1 | Systematic Assessment |
|
| Urinary retention | Renal and urinary disorders | MedDRA 5.1 | Systematic Assessment |
|
| Respiratory depression | Respiratory, thoracic and mediastinal disorders | MedDRA 5.1 | Systematic Assessment |
|
| Vomiting | Gastrointestinal disorders | MedDRA 5.1 | Systematic Assessment |
|
| Dry mouth | Gastrointestinal disorders | MedDRA 5.1 | Systematic Assessment |
|
| Diarrhoea | Gastrointestinal disorders | MedDRA 5.1 | Systematic Assessment |
|
| Dizziness | Nervous system disorders | MedDRA 5.1 | Systematic Assessment |
|
| Somnolence | Nervous system disorders | MedDRA 5.1 | Systematic Assessment |
|
| Headache | Nervous system disorders | MedDRA 5.1 | Systematic Assessment |
|
| Memory impairment | Nervous system disorders | MedDRA 5.1 | Systematic Assessment |
|
| Confusion | Psychiatric disorders | MedDRA 5.1 | Systematic Assessment |
|
| Pain in limb | Musculoskeletal and connective tissue disorders | MedDRA 5.1 | Systematic Assessment |
|
| Arthralgia | Musculoskeletal and connective tissue disorders | MedDRA 5.1 | Systematic Assessment |
|
| Dyspnoea NOS | Respiratory, thoracic and mediastinal disorders | MedDRA 5.1 | Systematic Assessment |
|
| Anaemia | Blood and lymphatic system disorders | MedDRA 5.1 | Systematic Assessment |
|
| Cholelithiasis | Hepatobiliary disorders | MedDRA 5.1 | Systematic Assessment |
|
| Atrial fibrillation | Cardiac disorders | MedDRA 5.1 | Systematic Assessment |
|
| Dyspepsia | Gastrointestinal disorders | MedDRA 5.1 | Systematic Assessment |
|
| Gastritis NOS | Gastrointestinal disorders | MedDRA 5.1 | Systematic Assessment |
|
| Haematemesis | Gastrointestinal disorders | MedDRA 5.1 | Systematic Assessment |
|
| Fatigue | General disorders | MedDRA 5.1 | Systematic Assessment |
|
| Thirst | General disorders | MedDRA 5.1 | Systematic Assessment |
|
| Weakness | General disorders | MedDRA 5.1 | Systematic Assessment |
|
| Lower respiratory tract infection NOS | Infections and infestations | MedDRA 5.1 | Systematic Assessment |
|
| Oral candidiasis | Infections and infestations | MedDRA 5.1 | Systematic Assessment |
|
| Cellulitis | Infections and infestations | MedDRA 5.1 | Systematic Assessment |
|
| Therapeutic agent toxicity | Injury, poisoning and procedural complications | MedDRA 5.1 | Systematic Assessment |
|
| Liver function tests abnormal | Investigations | MedDRA 5.1 | Systematic Assessment |
|
| Anorexia | Metabolism and nutrition disorders | MedDRA 5.1 | Systematic Assessment |
|
| Pain in back | Musculoskeletal and connective tissue disorders | MedDRA 5.1 | Systematic Assessment |
|
| Muscle spasms | Musculoskeletal and connective tissue disorders | MedDRA 5.1 | Systematic Assessment |
|
| Peripheral swelling | Musculoskeletal and connective tissue disorders | MedDRA 5.1 | Systematic Assessment |
|
| Malignant neoplasm progression | Neoplasms benign, malignant and unspecified (incl cysts and polyps) | MedDRA 5.1 | Systematic Assessment |
|
| Metastasis to bone | Neoplasms benign, malignant and unspecified (incl cysts and polyps) | MedDRA 5.1 | Systematic Assessment |
|
| Jerky movement | Nervous system disorders | MedDRA 5.1 | Systematic Assessment |
|
| Clonic convulsions | Nervous system disorders | MedDRA 5.1 | Systematic Assessment |
|
| Anxiety | Psychiatric disorders | MedDRA 5.1 | Systematic Assessment |
|
| Confusional state | Psychiatric disorders | MedDRA 5.1 | Systematic Assessment |
|
| Depression | Psychiatric disorders | MedDRA 5.1 | Systematic Assessment |
|
| Disorientation | Psychiatric disorders | MedDRA 5.1 | Systematic Assessment |
|
| Hallucination NOS | Psychiatric disorders | MedDRA 5.1 | Systematic Assessment |
|
| Affect lability | Psychiatric disorders | MedDRA 5.1 | Systematic Assessment |
|
| Haematuria | Renal and urinary disorders | MedDRA 5.1 | Systematic Assessment |
|
| Urinary incontinence | Renal and urinary disorders | MedDRA 5.1 | Systematic Assessment |
|
| Renal failure NOS | Renal and urinary disorders | MedDRA 5.1 | Systematic Assessment |
|
| Renal Impairment NOS | Renal and urinary disorders | MedDRA 5.1 | Systematic Assessment |
|
| Rash NOS | Skin and subcutaneous tissue disorders | MedDRA 5.1 | Systematic Assessment |
|
| Skin lesion NOS | Vascular disorders | MedDRA 5.1 | Systematic Assessment |
|
| Hypotension NOS | Vascular disorders | MedDRA 5.1 | Systematic Assessment |
|
| Hot flushes NOS | Skin and subcutaneous tissue disorders | MedDRA 5.1 | Systematic Assessment |
|
| Urinary tract infection | Infections and infestations | MedDRA 5.1 | Systematic Assessment |
|
| Joint swelling | Musculoskeletal and connective tissue disorders | MedDRA 5.1 | Systematic Assessment |
|
Publication Policy:
GW will coordinate the dissemination of data from this study and may solicit input and assistance from the principal investigator. All publications for example, manuscripts, abstracts, oral/slide presentations or book chapters based on this study, must be submitted to GW for corporate review before release.