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This is a Phase 2a, randomized, double-blind, placebo-controlled, 14-day repeat oral, dose ranging study to determine the safety, pharmacokinetics (PK) and pharmacodynamics (PD) effects of SP-304 in patients with chronic idiopathic constipation.
This is a Phase 2a, randomized, double-blind, placebo-controlled, 14-day repeat oral, dose ranging study to determine the safety, PK and PD effects of SP-304 in patients with chronic idiopathic constipation. Patients diagnosed with chronic idiopathic constipation (CIC) will be screened for the anticipated 4 cohorts, to yield 80 randomized patients for enrollment. Four dose cohorts are planned (0.3 mg, 1.0 mg, 3.0mg, and 9.0 mg) with 20 patients per dose cohort [randomization ratio 3:1 (15 receive SP-304:5 receive placebo)]. Patients who continue to meet all the entry criteria and complete the pre-treatment bowel movement (BM) diary will receive, in a double-blind, randomized fashion, SP-304 or matching placebo. It is expected that each patient will complete all 14 days of dosing (including making accurate BM diary entries for all 14 days in the treatment period). All patients receiving at least one dose of SP-304 or matching placebo will be considered evaluable for the safety endpoints. If a patient receives at least 5 doses per treatment week (1 dose per day for 7 days) and has completed BM diary entries for those 5 dosing days in each corresponding treatment week, he/she will be considered evaluable.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| SP-304 0.3 mg | Experimental | SP-304 0.3 mg tablet by mouth once daily for 14 consecutive days. |
|
| SP-304 1.0 mg | Experimental | SP-304 1.0 mg tablet by mouth once daily for 14 consecutive days. |
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| SP-304 3.0 mg | Experimental | SP-304 3.0 mg tablet by mouth once daily for 14 consecutive days |
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| SP-304 9.0 mg | Experimental | SP-304 9.0 mg tablet by mouth once daily for 14 consecutive days. |
|
| Placebo | Placebo Comparator | Placebo tablet by mouth once daily for 14 consecutive days |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| SP-304 0.3 mg | Drug | SP-304 0.3 mg |
| |
| SP-304 1.0 mg |
| Measure | Description | Time Frame |
|---|---|---|
| Number of Participants With Adverse Events | Incidences of adverse events from Baseline through the end of the Follow-up period. | 21 days: Baseline through Follow-up (Treatment Days 14, 7 days post treatment) |
| Measure | Description | Time Frame |
|---|---|---|
| Change From Baseline Overall in Number of Complete Spontaneous Bowel Movements (CSBM) | Using a Daily Diary, patients recorded the number of spontaneous bowel movements having the sensation of complete evacuation (Complete Spontaneous Bowel Movement - CSBM). The total number of spontaneous bowel movements associated with a feeling of complete evacuation were summed and divided by 2 (the number of weeks in treatment). Change was calculated as the difference between the number of the CSBMs at the completion of the 2-week treatment period, versus the 14-day pretreatment baseline. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Gary S Jacob, Ph.D. | Synergy Pharmaceuticals Inc. | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Novara Clinical Research | Mesa | Arizona | 85206 | United States | ||
| Genova Clinical Research |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| Result | Shailubhai K, Talluto C, Comiskey S, Foss J, Joslyn A, Jacob G. Phase II Clinical Evaluation of SP-304, a Guanylate Cyclase-C Agonist, for Treatment of Chronic Constipation. Am J Gastroenterology 105 (Supp 1): S487, 2010 |
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During the pre-treatment period (Study Days -14 though -1), 84 eligible patients completed daily bowel movement diaries to obtain baseline data. Of these, 78 patients (58 and 20 patients for the SP-304 and placebo treatment groups, respectively) received at least one dose of study drug.
This study was conducted between 3 March 2010 and 26 August 2010 at 14 study centers in the United States. Four dose cohorts were planned (0.3 mg, 1.0 mg, 3.0 mg, and 9.0 mg with 20 patients per dose cohort randomized in a 3:1 ratio [15 pts receive SP-304, 5 pts receive placebo].
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| ID | Title | Description |
|---|---|---|
| FG000 | SP-304 0.3 mg | Subjects receiving SP-304 0.3 mg for 14 consecutive days. |
| FG001 | SP-304 1.0 mg | Subjects receiving SP-304 1.0 mg for 14 consecutive days |
| Title | Milestones | Reasons Not Completed | |||||
|---|---|---|---|---|---|---|---|
| Pretreatment Period |
|
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| Drug |
SP-304 1.0 mg |
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| SP-304 3.0 mg | Drug | SP-304 3.0 mg |
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| SP-304 9.0 mg | Drug | SP-304 9.0 mg |
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| Placebo | Drug | Placebo |
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| Study days 1 through 14 |
| Change From Baseline Overall in Number of Spontaneous Bowel Movements (SBM) | Using a Daily Diary, patients recorded the number of spontaneous bowel movements (SBM). The overall weekly frequency was calculated as the total number of SBMs divided by 2 (the number weeks of treatment). Change was calculated as the difference between the number of the SBMs at the completion of the 2-week treatment period, versus the 14-day pretreatment baseline. | Study Days 1 through 14 |
| Changes From Baseline Overall in Bristol Stool Form Scale (BSFS) | Using a Daily Diary, patients recorded Stool Consistency using the 7-point Bristol Stool Form Scale (BSFS) (1 = separate hard lumps, like nuts; 2 sausage shaped but lumpy; 3 = like a sausage but with cracks on surface; 4 = like a sausage or snake, smooth and soft; 5 = soft blobs with clear-cut edges; 6 = fluffy pieces with ragged edges, a mushy stool; 7 = watery, no solid pieces, entirely liquid). Changes in mean BSFS were assessed from the average 14-day pretreatment baseline to the average during the 2-week treatment period. | Study day 1 through 14 |
| Changes From Baseline Overall in Ease of Passage (Straining) | Using a Daily Diary, patients recorded Ease of Passage (Straining) using the 7-point Ease-of-Passage Scale (1 = manual disimpaction/enema needed, 2 = severe straining, 3 = moderate straining, 4 = mild straining, 5 = no straining, 6 = urgency, 7 = incontinent). Changes in overall ease of passage (Straining) were assessed from the average 14-day pretreatment baseline to average during the 2-week treatment period | Study Days 1 through 14 |
| Tucson |
| Arizona |
| 85741 |
| United States |
| Advanced Clinical Research | Anaheim | California | 92801 | United States |
| Advanced Clinical Research | Orange | California | 92869 | United States |
| A.G.A. Clinical Trials | Hialeah | Florida | 33012 | United States |
| Miami Ressearch and Associates | Miami | Florida | 33143 | United States |
| Lee Research Institute | Shawnee Mission | Kansas | 66218 | United States |
| Clinical Research Institute of Michigan, LLC | Chesterfield | Michigan | 48047 | United States |
| Universtiy of North Carolina at Chapel Hill | Chapel Hill | North Carolina | 27599 | United States |
| Wake Research Associates | Raleigh | North Carolina | 27612 | United States |
| Memphis Gastroenterology Group | Germantown | Tennessee | 38138 | United States |
| Nashville Medical Research Institute | Nashville | Tennessee | 37205 | United States |
| DCOL Center for Clinical Research | Longview | Texas | 75605 | United States |
| Pioneer Research Solutions | Sugar Land | Texas | 77479 | United States |
| FG002 | SP-304 3.0 mg | Subjects receiving SP-304 3.0 mg for 14 consecutive days |
| FG003 | SP-304 9.0 mg | Subjects receiving SP-304 9.0 mg for 14 consecutive days |
| FG004 | Placebo | Subjects receiving Placebo for 14 consecutive days |
| COMPLETED |
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| NOT COMPLETED |
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| Treatment Period |
|
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| Follow-up Period |
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Safety Population: patients who received at least one dose of study medication (population for primary endpoint).
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| ID | Title | Description |
|---|---|---|
| BG000 | SP-304 1.0 mg | Subjects receiving SP-304 1.0 mg for 14 consecutive days |
| BG001 | SP-304 3.0 mg | Subjects receiving SP-304 3.0 mg for 14 consecutive days |
| BG002 | SP-304 9.0 mg | Subjects receiving SP-304 9.0 mg for 14 consecutive days |
| BG003 | Placebo | Subjects receiving Placebo for 14 consecutive days |
| BG004 | SP-304 0.3 mg | Subjects receiving SP-304 0.3 mg for 14 consecutive days. |
| BG005 | Total | Total of all reporting groups |
| 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 | Participants |
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| Age, Continuous | Mean | Standard Deviation | years |
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| Sex: Female, Male | Count of Participants | Participants |
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| Region of Enrollment | Number | participants |
| ||||||||||||||||
| Complete Spontaneous Bowel Movement Frequency | On daily basis during the 14-day pre-treatment period, patients recorded the number of spontaneous bowel movements having the sensation of complete evacuation (Complete Spontaneous Bowel Movement - CSBM). The Baseline Weekly Frequency of CSBMs during the pre-treatment period was calculated total number of CSBMs divided by 2 (the number of weeks in the pre-treatment period). | Mean | Standard Deviation | CSBMs per week |
| ||||||||||||||
| Spontaneous Bowel Movement Frequency | On daily basis during the 14-day pre-treatment period, patients recorded the number of spontaneous bowel movements (SBM). The Baseline Weekly Frequency of SBMs during the pre-treatment period was calculated total number of SBMs divided by 2 (the number of weeks in the pre-treatment period). | Mean | Standard Deviation | events per week |
| ||||||||||||||
| Stool Consistency (Bristol Stool Form Scale) | Using a Daily Diary, patients recorded Stool Consistency using the 7-point Bristol Stool Form Scale (BSFS) (1 = separate hard lumps, like nuts; 2 sausage shaped but lumpy; 3 = like a sausage but with cracks on surface; 4 = like a sausage or snake, smooth and soft; 5 = soft blobs with clear-cut edges; 6 = fluffy pieces with ragged edges, a mushy stool; 7 = watery, no solid pieces, entirely liquid). | Mean | Standard Deviation | units on a scale |
| ||||||||||||||
| Ease of Passage (Straining) | Using a Daily Diary, patients recorded Ease of Passage (Straining) using the 7-point Ease-of-Passage Scale (1 = manual disimpaction/enema needed, 2 = severe straining, 3 = moderate straining, 4 = mild straining, 5 = no straining, 6 = urgency, 7 = incontinent). | Mean | Standard Deviation | units on a scale |
|
| 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 | Number of Participants With Adverse Events | Incidences of adverse events from Baseline through the end of the Follow-up period. | Safety Population: all patients who received at least one dose of the study medication. | Posted | Count of Participants | Participants | 21 days: Baseline through Follow-up (Treatment Days 14, 7 days post treatment) |
|
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| Secondary | Change From Baseline Overall in Number of Complete Spontaneous Bowel Movements (CSBM) | Using a Daily Diary, patients recorded the number of spontaneous bowel movements having the sensation of complete evacuation (Complete Spontaneous Bowel Movement - CSBM). The total number of spontaneous bowel movements associated with a feeling of complete evacuation were summed and divided by 2 (the number of weeks in treatment). Change was calculated as the difference between the number of the CSBMs at the completion of the 2-week treatment period, versus the 14-day pretreatment baseline. | Modified-Intent-to-Treat population: All patients who received at least one dose of study medication and had at least one post-baseline diary assessment. One participant in the SP-304 0.3 mg group did not have information about complete evacuation post-baseline. | Posted | Mean | Standard Deviation | CSBMs per week | Study days 1 through 14 |
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| Secondary | Change From Baseline Overall in Number of Spontaneous Bowel Movements (SBM) | Using a Daily Diary, patients recorded the number of spontaneous bowel movements (SBM). The overall weekly frequency was calculated as the total number of SBMs divided by 2 (the number weeks of treatment). Change was calculated as the difference between the number of the SBMs at the completion of the 2-week treatment period, versus the 14-day pretreatment baseline. | Modified-Intent-to-Treat population: All patients who received at least one dose of study medication and had at least one post-baseline diary assessment. | Posted | Mean | Standard Deviation | SBMs per week | Study Days 1 through 14 |
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| Secondary | Changes From Baseline Overall in Bristol Stool Form Scale (BSFS) | Using a Daily Diary, patients recorded Stool Consistency using the 7-point Bristol Stool Form Scale (BSFS) (1 = separate hard lumps, like nuts; 2 sausage shaped but lumpy; 3 = like a sausage but with cracks on surface; 4 = like a sausage or snake, smooth and soft; 5 = soft blobs with clear-cut edges; 6 = fluffy pieces with ragged edges, a mushy stool; 7 = watery, no solid pieces, entirely liquid). Changes in mean BSFS were assessed from the average 14-day pretreatment baseline to the average during the 2-week treatment period. | Modified-Intent-to-Treat population: All patients who received at least one dose of study medication and had at least one post-baseline diary assessment. One participant in the SP-304 0.3 mg group did not have post-baseline results. | Posted | Mean | Standard Deviation | units on a scale | Study day 1 through 14 |
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| Secondary | Changes From Baseline Overall in Ease of Passage (Straining) | Using a Daily Diary, patients recorded Ease of Passage (Straining) using the 7-point Ease-of-Passage Scale (1 = manual disimpaction/enema needed, 2 = severe straining, 3 = moderate straining, 4 = mild straining, 5 = no straining, 6 = urgency, 7 = incontinent). Changes in overall ease of passage (Straining) were assessed from the average 14-day pretreatment baseline to average during the 2-week treatment period | Modified-Intent-to-Treat population: All patients who received at least one dose of study medication and had at least one post-baseline diary assessment. One participant in the SP-304 0.3 mg group did not have post-baseline results. | Posted | Mean | Standard Deviation | units on a scale | Study Days 1 through 14 |
|
21 Days
Baseline through 14 consecutive days of treatment plus 7 post-treatment days
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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 | SP-304 0.3 mg | Subjects receiving SP-304 0.3 mg for 14 consecutive days. | 0 | 14 | 3 | 14 | ||
| EG001 | SP-304 1.0 mg | Subjects receiving SP-304 1.0 mg for 14 consecutive days | 0 | 14 | 6 | 14 | ||
| EG002 | SP-304 3.0 mg | Subjects receiving SP-304 3.0 mg for 14 consecutive days | 0 | 15 | 2 | 15 | ||
| EG003 | SP-304 9.0 mg | Subjects receiving SP-304 9.0 mg for 14 consecutive days | 0 | 15 | 6 | 15 | ||
| EG004 | Placebo | Subjects receiving Placebo for 14 consecutive days | 1 | 20 | 4 | 20 |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Pyelonephritis | Renal and urinary disorders | MedDRA 12.1 | Systematic Assessment |
|
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Headache | Nervous system disorders | MedDRA 12.1 | Systematic Assessment |
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| Hyperglycemia | Endocrine disorders | MedDRA 12.1 | Systematic Assessment |
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| Bloating | Gastrointestinal disorders | MedDRA 12.1 | Systematic Assessment |
| |
| Gastritis | Gastrointestinal disorders | MedDRA 12.1 | Systematic Assessment |
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| Hiatus Hernia | Gastrointestinal disorders | MedDRA 12.1 | Systematic Assessment |
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| Nausea | Gastrointestinal disorders | MedDRA 12.1 | Systematic Assessment |
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| Tingling Feeling in Mouth | Gastrointestinal disorders | MedDRA 12.1 | Systematic Assessment |
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| Upset Stomach | Gastrointestinal disorders | MedDRA 12.1 | Systematic Assessment |
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| Tiredness | General disorders | MedDRA 12.1 | Systematic Assessment |
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| Bronchitis | Infections and infestations | MedDRA 12.1 | Systematic Assessment |
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| Elevated Amylase | Investigations | MedDRA 12.1 | Systematic Assessment |
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| Elevated Lipase | Investigations | MedDRA 12.1 | Systematic Assessment |
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| Weight Loss | Investigations | MedDRA 12.1 | Systematic Assessment |
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| Back Pain | Musculoskeletal and connective tissue disorders | MedDRA 12.1 | Systematic Assessment |
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| Intermittent Right Hand Pain | Musculoskeletal and connective tissue disorders | MedDRA 12.1 | Systematic Assessment |
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| Neck Pain | Musculoskeletal and connective tissue disorders | MedDRA 12.1 | Systematic Assessment |
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| One Episode of Neck Muscle Spasm Left Side | Musculoskeletal and connective tissue disorders | MedDRA 12.1 | Systematic Assessment |
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| Head Pressure | Nervous system disorders | MedDRA 12.1 | Systematic Assessment |
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| Intermittent Headache | Nervous system disorders | MedDRA 12.1 | Systematic Assessment |
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| Dizziness | Vascular disorders | MedDRA 12.1 | Systematic Assessment |
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| Abdominal Cramping | Gastrointestinal disorders | MedDRA 12.1 | Systematic Assessment |
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| Abdominal Pain | Gastrointestinal disorders | MedDRA 12.1 | Systematic Assessment |
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| Diarrhea | Gastrointestinal disorders | MedDRA 12.1 | Systematic Assessment |
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| Excessive Flatulence | Gastrointestinal disorders | MedDRA 12.1 | Systematic Assessment |
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| Flatulence | Gastrointestinal disorders | MedDRA 12.1 | Systematic Assessment |
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| Malaise | General disorders | MedDRA 12.1 | Systematic Assessment |
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| Rhinitis (Due To Pollen) | Immune system disorders | MedDRA 12.1 | Systematic Assessment |
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| Urinary Tract Infection | Infections and infestations | MedDRA 12.1 | Systematic Assessment |
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| Low Back Strain | Injury, poisoning and procedural complications | MedDRA 12.1 | Systematic Assessment |
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| Hydronephrosis | Renal and urinary disorders | MedDRA 12.1 | Systematic Assessment |
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This Phase 2a study was not sized to evaluate efficacy.
Any publication of the results, either in part or in total (e.g., articles in journals or newspapers, oral presentations, abstracts) by the Investigator(s) or their representative(s), shall require prior notification, review, within a reasonable time frame, and written approval by the Sponsor. Additionally such publications cannot be made in violation of the Sponsor's confidentiality restrictions or to the detriment of the Sponsor's intellectual property rights.
| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr. Laura Barrow/Senior Vice President Clinical Development | Synergy Pharmaceuticals Inc | 212-297-0020 | lbarrow@synergypharma.com |
| ID | Term |
|---|---|
| D003248 | Constipation |
| D043183 | Irritable Bowel Syndrome |
| ID | Term |
|---|---|
| D012817 | Signs and Symptoms, Digestive |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D003109 | Colonic Diseases, Functional |
| D003108 | Colonic Diseases |
| D007410 | Intestinal Diseases |
| D005767 | Gastrointestinal Diseases |
| D004066 | Digestive System Diseases |
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| ID | Term |
|---|---|
| C584575 | plecanatide |
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| Adverse Event |
|
| Withdrawal by Subject |
|
| Noncompliance with protocol |
|
| Between 18 and 65 years |
|
| >=65 years |
|
| Male |
|
Subjects receiving SP-304 3.0 mg for 14 consecutive days SP-304: Subjects receiving SP-304 3.0 mg for 14 consecutive days |
| OG003 | SP-304 9.0 mg | Subjects receiving SP-304 9.0 mg for 14 consecutive days SP-304: Subjects receiving SP-304 9.0 mg for 14 consecutive days |
| OG004 | Placebo | Subjects receiving Placebo for 14 consecutive days Placebo: Subjects receiving Placebo for 14 consecutive days |
|
|
Subjects receiving SP-304 9.0 mg for 14 consecutive days
| OG004 | Placebo | Subjects receiving Placebo for 14 consecutive days |
|
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| OG003 | SP-304 9.0 mg | Subjects receiving SP-304 9.0 mg for 14 consecutive days |
| OG004 | Placebo | Subjects receiving Placebo for 14 consecutive days |
|
|
| SP-304 9.0 mg |
Subjects receiving SP-304 9.0 mg for 14 consecutive days |
| OG004 | Placebo | Subjects receiving Placebo for 14 consecutive days |
|
|