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The purpose of this study is to determine the effectiveness and safety of single intravenous doses of the kappa opioid agonist CR845 in relieving pain in patients following laparoscopic-assisted hysterectomy surgery. The study protocol was divided into two parts with subjects either dosed with study drug the day following surgery (Cohort 1), or immediately after surgery (Cohort 2).
Currently, the most widely used drugs to treat pain after surgery are opiates, such as morphine. Morphine works mainly by activating one of several types of opiate receptors that control some of our pain sensation - the so-called mu opiate receptors. These receptors are located in many areas of the brain and also outside of the brain. By activating these receptors, morphine provides significant pain relief, but also causes side effects that limit its use. Some of these side effects include: respiratory depression or arrest (slowed or stopped breathing), sedation (a state of calmness or extreme relaxation), euphoria (an exaggerated feeling of physical and mental well-being), constipation, nausea, vomiting, and drug addiction.
In order to avoid the side effects of morphine and other mu opiates, the present experimental drug CR845 was designed to work at a different type of opiate receptor - called kappa - that can also provide pain relief, by acting on sensory nerves outside the brain. CR845 was designed to penetrate the brain much less than other opiate drugs, which should result in pain relief similar to that of morphine, but with fewer side effects. Because CR845 activates kappa receptors instead of mu receptors, the side effects are different than with a morphine-type drug. In particular, kappa opiates, such as CR845, do not cause respiratory depression or arrest, euphoria, constipation, drug tolerance, physical drug dependence or drug addiction. For these reasons, CR845 may present a distinct advantage over other opiates that are currently used for pain relief and post-operative pain in particular.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| CR845 | Experimental | CR845 administered as a single 15-min i.v. infusion at doses of 0.008 or 0.024 mg/kg on the day after surgery (Cohort 1), or at a dose of 0.040 mg/kg immediately after surgery (Cohort 2) |
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| Placebo | Placebo Comparator | Matched placebo administered as a single 15-min i.v. infusion on the day after surgery (Cohort 1), or the immediately after surgery (Cohort 2) |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| CR845 | Drug | CR845 (0.024 mg/kg) administered the day after surgery (Day 1) |
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| Measure | Description | Time Frame |
|---|---|---|
| Responders on Pain Intensity(PI) and Pain Relief (PR) Composite Endpoint | The primary efficacy endpoint was the percentage of treatment responders compared to placebo. A responder was defined as a subject who had at least a 40% reduction in their pain intensity score and a pain relief score of "some," "a lot," or "complete" at 15 and 30 min following the start of the study drug infusion. | 15 and 30 minutes after study drug administration |
| Measure | Description | Time Frame |
|---|---|---|
| Total PCA Morphine Consumption in the 0-16 Hour Period Following Postoperative Study Drug Treatment | 0 to 16 hours |
| Measure | Description | Time Frame |
|---|---|---|
| Total PCA Morphine Consumption in the 4-8 Hour Period Following Postoperative Study Drug Treatment | 4 to 8 hours | |
| Total PCA Morphine Consumption in the 8-16 Hour Period Following Postoperative Study Drug Treatment | 8 to 16 hours |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Frédérique Menzaghi, Ph.D. | Cara Therapeutics, Inc. | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Mobile Infirmary Medical Center | Mobile | Alabama | 36607 | United States | ||
| Springhill Medical Center |
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Two cohorts of patients were enrolled in this study in sequential order. Based on interim analysis of the results for Cohort 1 where study drug was administered 24 hours following surgery, the protocol was revised to administer the study drug immediately following surgery when patients were more likely to report a higher level of pain.
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| ID | Title | Description |
|---|---|---|
| FG000 | Cohort 1: Placebo | Matched Placebo administered 24 hours post-surgery (Day 1) |
| FG001 | Cohort 1: CR845 0.008 mg/kg | CR845 (0.008 mg/kg) single i.v. dose administered 24 hours post-surgery (Day 1) |
| Title | Milestones | Reasons Not Completed | |||||
|---|---|---|---|---|---|---|---|
| Cohort 1: 24 Hours After Surgery (Day 1) |
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| CR845 | Drug | CR845 (0.008 mg/kg) administered the day after surgery (Day 1) |
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| CR845 | Drug | CR845 (0.040 mg/kg) administered immediately after surgery (Day 0) |
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| Placebo | Drug | Matched placebo administered the day after surgery (Day 1) |
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| Placebo | Drug | Matched placebo administered immediately after surgery (Day 0) |
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| Mobile |
| Alabama |
| 36608 |
| United States |
| Helen Keller Hospital | Sheffield | Alabama | 35660 | United States |
| Paradise Valley Hospital | Phoenix | Arizona | 85032 | United States |
| Adventist Medical Center | Glendale | California | 91206 | United States |
| Saddleback Memorial Hospital | Laguna Hills | California | 92653 | United States |
| Huntington Memorial Hospital | Pasadena | California | 91105 | United States |
| Palms West Hospital | Loxahatchee Groves | Florida | 33472 | United States |
| University of Miami/Jackson Memorial Hospital | Miami | Florida | 33136 | United States |
| The Ohio State University Medical Center | Columbus | Ohio | 43210 | United States |
| Memorial Hermann - Memorial City Medical Center | Houston | Texas | 77024 | United States |
| The Woman's Hospital of Texas | Houston | Texas | 77054 | United States |
| FG002 | Cohort 1: CR845 0.024 mg/kg | CR845 (0.024 mg/kg) single i.v. dose administered 24 hours post-surgery (Day 1) |
| FG003 | Cohort 2: Placebo | Matched Placebo administered within 3 hours after surgery (Day 0) |
| FG004 | Cohort 2: CR845 0.040 mg/kg | CR845 (0.040 mg/kg) single i.v. dose administered within 3 hours after surgery (Day 0) |
| COMPLETED |
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| NOT COMPLETED |
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| Cohort 2: Immediately Post-op (Day 0) |
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| ID | Title | Description |
|---|---|---|
| BG000 | Cohort 1: Placebo | Matched placebo administered 24 hours post-surgery (Day 1) |
| BG001 | Cohort 1: CR845 0.008 mg/kg | CR845 (0.008 mg/kg) single i.v. dose administered 24 hours post-surgery (Day 1) |
| BG002 | Cohort 1: CR845 0.024 mg/kg | CR845 (0.024 mg/kg) single i.v. dose administered 24 hours post-surgery (Day 1) |
| BG003 | Cohort 2: Placebo | Matched placebo administered within 3 hours post-surgery (Day 0) |
| BG004 | Cohort 2: CR845 0.040 mg/kg | CR845 (0.040 mg/kg) single i.v. dose administered within 3 hours post-surgery (Day 0) |
| BG005 | Total | Total of all reporting groups |
| Units | Counts |
|---|---|
| Participants |
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| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Age, Categorical | Count of Participants | Participants |
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| Sex: Female, Male | Count of Participants | Participants |
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| Region of Enrollment | Number | participants |
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| 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 | Responders on Pain Intensity(PI) and Pain Relief (PR) Composite Endpoint | The primary efficacy endpoint was the percentage of treatment responders compared to placebo. A responder was defined as a subject who had at least a 40% reduction in their pain intensity score and a pain relief score of "some," "a lot," or "complete" at 15 and 30 min following the start of the study drug infusion. | Results are for Cohort 2 (study drug administered within 3 hours after surgery), ITT population. | Posted | Number | responders | 15 and 30 minutes after study drug administration |
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| Secondary | Total PCA Morphine Consumption in the 0-16 Hour Period Following Postoperative Study Drug Treatment | Results are for Cohort 2 (study drug administered within 3 hours after surgery), ITT population. | Posted | Mean | Standard Deviation | mg | 0 to 16 hours |
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| Other Pre-specified | Total PCA Morphine Consumption in the 4-8 Hour Period Following Postoperative Study Drug Treatment | Results are for Cohort 2 (study drug administered within 3 hours after surgery), ITT population, based on the number of evaluable patients over the 4-8 hour time interval. | Posted | Mean | Standard Deviation | mg | 4 to 8 hours |
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| Other Pre-specified | Total PCA Morphine Consumption in the 8-16 Hour Period Following Postoperative Study Drug Treatment | Results are for Cohort 2 (study drug administered within 3 hours after surgery), ITT population, based on the number of evaluable patients over the 8-16 hour time interval. | Posted | Mean | Standard Deviation | mg | 8 to 16 hours |
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Treatment-emergent adverse events were collected from the time the patient received her first dose of study drug through the Follow-up Visit.
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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 | Cohort 1: Placebo | Matched placebo administered 24 hours after surgery (Day 1) | 2 | 25 | 17 | 25 | ||
| EG001 | Cohort 1: CR845 0.008 mg/kg | CR845 (0.008 mg/kg) administered 24 hours after surgery (Day 1) | 1 | 22 | 14 | 22 | ||
| EG002 | Cohort 1: CR845 0.024 mg/kg | CR845 (0.024 mg/kg) administered 24 hours after surgery (Day 1) | 2 | 21 | 18 | 21 | ||
| EG003 | Cohort 2: Placebo | Matched Placebo administered within 3 hours after surgery (Day 0) | 1 | 26 | 14 | 26 | ||
| EG004 | Cohort 2: CR845 0.040 mg/kg | Cohort 2: CR845 (0.040 mg/kg) administered within 3 hours after surgery (Day 0) | 3 | 20 | 12 | 20 |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Pneumonia | Infections and infestations | MedDRA (Unspecified) | Systematic Assessment |
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| Peritoneal Hemorrhage | Gastrointestinal disorders | MedDRA (Unspecified) | Systematic Assessment |
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| Pleural Effusion | Respiratory, thoracic and mediastinal disorders | MedDRA (Unspecified) | Systematic Assessment |
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| Cerebral Infarction | Nervous system disorders | MedDRA (Unspecified) | Systematic Assessment |
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| Pelvic Abscess | Infections and infestations | MedDRA (Unspecified) | Systematic Assessment |
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| Gastrointestinal Inflammation | Gastrointestinal disorders | MedDRA (Unspecified) | Systematic Assessment |
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| Hypernatremia | Metabolism and nutrition disorders | MedDRA (Unspecified) | Systematic Assessment |
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| Postoperative Ileus | Injury, poisoning and procedural complications | MedDRA (Unspecified) | Systematic Assessment |
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| Sedation | Nervous system disorders | MedDRA (Unspecified) | Systematic Assessment |
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| Pyrexia | General disorders | MedDRA (Unspecified) | Systematic Assessment |
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| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Constipation | Gastrointestinal disorders | MedDRA (Unspecified) | Non-systematic Assessment |
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| Flatulence | Gastrointestinal disorders | MedDRA (Unspecified) | Non-systematic Assessment |
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| Nausea | Gastrointestinal disorders | MedDRA (Unspecified) | Non-systematic Assessment |
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| Pyrexia | General disorders | MedDRA (Unspecified) | Non-systematic Assessment |
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| Urinary Tract Infection | Infections and infestations | MedDRA (Unspecified) | Non-systematic Assessment |
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| Musculoskeletal | Musculoskeletal and connective tissue disorders | MedDRA (Unspecified) | Non-systematic Assessment |
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| Dizziness | Nervous system disorders | MedDRA (Unspecified) | Non-systematic Assessment |
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| Headache | Nervous system disorders | MedDRA (Unspecified) | Non-systematic Assessment |
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| Paraesthesia | Nervous system disorders | MedDRA (Unspecified) | Non-systematic Assessment |
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| Urinary Retention | Renal and urinary disorders | MedDRA (Unspecified) | Non-systematic Assessment |
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| Pruritis | Skin and subcutaneous tissue disorders | MedDRA (Unspecified) | Non-systematic Assessment |
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| Vomiting | Gastrointestinal disorders | MedDRA (Unspecified) | Non-systematic Assessment |
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| Musculoskeletal pain | Musculoskeletal and connective tissue disorders | MedDRA (Unspecified) | Non-systematic Assessment |
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| Hypotension | Vascular disorders | MedDRA (Unspecified) | Non-systematic Assessment |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Frédérique Menzaghi, PhD, Vice President Research & Development | Cara Therapeutics Inc. | 203-567-1502 | fmenzaghi@caratherapeutics.com |
| ID | Term |
|---|---|
| D059787 | Acute Pain |
| D010146 | Pain |
| D059265 | Visceral Pain |
| ID | Term |
|---|---|
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D059226 | Nociceptive Pain |
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| Lost to Follow-up |
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| Between 18 and 65 years |
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| >=65 years |
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| Male |
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