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The purpose of this study is to determine whether a new opioid molecule, NKTR-181, is effective for the relief of moderate to severe chronic low back pain as compared to a placebo.
This is an enriched enrollment, randomized withdrawal study with an open label, dose-titration period followed by a randomized, double-blind, placebo-control treatment of twelve weeks. During the double-blind treatment period, this study will evaluate the analgesic effect of NKTR-181 versus placebo in patients with moderate to severe chronic low back pain.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| NKTR-181 | Experimental | NKTR-181 twice daily (BID) tablets |
|
| Placebo | Placebo Comparator | Placebo to match NKTR-181 twice daily (BID) tablets |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| NKTR-181 BID tablets | Drug | NKTR-181 tablets 100-400 mg twice daily (BID) |
| |
| Measure | Description | Time Frame |
|---|---|---|
| The Change in Weekly (ie, 7-day Average) Pain Score at the End of Double-blind, Randomized Treatment Period, Relative to the Weekly Score at the End of Titration (Double-blind Baseline) | The daily pain intensity is an 11-point numerical rating scale ranging from 0 (no pain) to 10 (worst possible pain). | 12 Weeks of randomized double blinded period |
| Measure | Description | Time Frame |
|---|---|---|
| Responder Analysis Based on Percent Reduction in Pain Intensity | A responder is defined by the Sponsor as a randomized subject who completes the double-blind Randomized Treatment Period and experiences improvement in the Week 12 Weekly Pain Score from Screening Pain Score. This includes the proportion of responders with at least 30% and at least 50% reduction in pain intensity. | Screening Baseline through Week 12 |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Investigator Site - Saraland | Saraland | Alabama | 36571 | United States | ||
| Investigator Site - Phoenix |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 30747908 | Result | Markman J, Gudin J, Rauck R, Argoff C, Rowbotham M, Agaiby E, Gimbel J, Katz N, Doberstein SK, Tagliaferri M, Lu L, Siddhanti S, Hale M. SUMMIT-07: a randomized trial of NKTR-181, a new molecular entity, full mu-opioid receptor agonist for chronic low-back pain. Pain. 2019 Jun;160(6):1374-1382. doi: 10.1097/j.pain.0000000000001517. |
| Label | URL |
|---|---|
| Related Info | View source |
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The titration phase of the study was designed to titrate patients to a dose of NKTR-181 that provided adequate analgesia and acceptable side effects.
First subject screened: 11Mar2015; Last subject out: 28 Dec 2016. The study was conducted at 55 medical/research sites in the United States.
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| ID | Title | Description |
|---|---|---|
| FG000 | NKTR-181 (Open-label Titration Phase) | NKTR-181 100-400 mg twice daily tablets |
| FG001 | NKTR-181 (Double-blind Treatment Phase) | NKTR-181: 100-400 mg twice daily tablets |
| Title | Milestones | Reasons Not Completed | |||||
|---|---|---|---|---|---|---|---|
| Titration Phase |
|
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| Placebo to match NKTR-181 BID tablets |
| Drug |
Placebo to match NKTR-181 tablets 100-400 mg twice daily (BID) |
|
| Patient Global Impression of Change (PGIC): Number of Responders | The PGIC assesses the change in overall status relative to the initiation of the treatment. The scale measures global change of overall status on a 7-point scale (1 = No change (or condition has got worse), 2 = Almost the same, 3 = A little better, 4 = Somewhat better, 5 = Moderately better, 6 = Better, 7 = A great deal better). The proportion of subjects responding " A great deal better " and "better" was summarized by treatment group. | Screening Baseline through Week 12 |
| Change in Sleep Quality in the Medical Outcome Study Sleep Scale - Revised (MOS Sleep-R) | The MOS Sleep Scale measure sleep parameters contains 12 items. Eleven of them scored using a 5-point response scale and across 5 dimensions of sleep, including disturbance (4 items), sleep problems index (9 items), somnolence (3 items), adequacy (2 items), and respiratory impairments (2 items). The original survey items are converted to a 0 to 100 range (by Converting 1 to 0, 2 to 25, 3 to 50, 4 to 75, and 5 to 100). Items in each dimension (disturbance, sleep problems index, somnolence, adequacy, respiratory impairments) of sleep are averaged together to create the score for the scale. The range of each sleep dimension is from 0 to 100. Higher score of sleep disturbance, somnolence, sleep indices, and respiratory impairments indicates relatively worse sleep problem, whereas lower scores for sleep adequacy indicate worse sleep problems. | Screening Baseline through Week 12 |
| Change in Sleep Quantity Measure in Hours in the Medical Outcome Study Sleep Scale - Revised (MOS Sleep-R) | The 12 items of the MOS Sleep Scale measure sleep parameters across 6 dimensions of sleep, including disturbance (4 items), sleep problems index (9 items), quantity (1 item), somnolence (3 items), adequacy (2 items), and respiratory impairments (2 items). One of the 12 items, Sleep quantity, records the actual number of hours slept. Reported here is the sleep quantity. | Screening Baseline through Week 12 |
| Change in Roland Morris Disability Questionnaire (RMDQ) | The RMDQ contains 24 items that is used to quantify the impact of low back pain on subject's ability to perform daily activities, mood and sleep. The questionnaire consists of 24 statements derived from the Sickness Impact Profile, with the addition of the phrase "because of my back." The questionnaire covers the areas of mobility, self-care, and sleeping. The RMDQ score is the total number of items checked which is from a minimum of 0 to a maximum of 24; the greater the score the grater the physical disability due to lower back pain. | Screening Baseline through Week 12 |
| Phoenix |
| Arizona |
| 85023 |
| United States |
| Investigator Site - Tempe | Tempe | Arizona | 85283 | United States |
| Investigator Site - Little Rock | Little Rock | Arkansas | 72211 | United States |
| Investigator Site - Stamford | Stamford | Connecticut | 06905 | United States |
| Investigator Site - Clearwater | Clearwater | Florida | 33765 | United States |
| Investigator Site - Fort Lauderdale | Fort Lauderdale | Florida | 33312 | United States |
| Investigator Site - Jacksonville | Jacksonville | Florida | 32257 | United States |
| Investigator Site - Orlando | Orlando | Florida | 32806 | United States |
| Investigator Site - Ormond Beach | Ormond Beach | Florida | 32174 | United States |
| Investigator Site - Plantation | Plantation | Florida | 33324 | United States |
| Investigator Site - Tampa | Tampa | Florida | 33603 | United States |
| Investigator Site - West Palm Beach | West Palm Beach | Florida | 33409 | United States |
| Investigator Site - Atlanta | Atlanta | Georgia | 30338 | United States |
| Investigator Site - Blue Ridge | Blue Ridge | Georgia | 30513 | United States |
| Investigator Site - Marietta | Marietta | Georgia | 30060 | United States |
| Investigator Site - Norcross | Norcross | Georgia | 30092 | United States |
| Investigator Site - Gurnee | Gurnee | Illinois | 60031 | United States |
| Investigator Site - West Des Moines | West Des Moines | Iowa | 50265 | United States |
| Investigator Site - Wichita | Wichita | Kansas | 67207 | United States |
| Investigator Site - Louisville | Louisville | Kentucky | 40213 | United States |
| Investigator Site - Bossier | Bossier City | Louisiana | 71111 | United States |
| Investigator Site - New Orleans | New Orleans | Louisiana | 70115 | United States |
| Investigator Site - Shreveport | Shreveport | Louisiana | 71105 | United States |
| Investigator Site - Bay City | Bay City | Michigan | 48706 | United States |
| Investigator Site - Pinconning | Pinconning | Michigan | 48706 | United States |
| Investigator Site - Biloxi | Biloxi | Mississippi | 39531 | United States |
| Investigator Site - Saint Louis 1 | St Louis | Missouri | 63141 | United States |
| Investigator Site - Saint Louis 2 | St Louis | Missouri | 63141 | United States |
| Investigator Site - Omaha | Omaha | Nebraska | 68134 | United States |
| Investigator Site - Las Vegas 2 | Las Vegas | Nevada | 89102 | United States |
| Investigator Site - Las Vegas 1 | Las Vegas | Nevada | 89119 | United States |
| Investigator Site - Rochester | Rochester | New York | 14642 | United States |
| Investigator Site - Williamsville | Williamsville | New York | 14221 | United States |
| Investigator Site - Greensboro | Greensboro | North Carolina | 27410 | United States |
| Investigator Site - Winston Salem | Winston-Salem | North Carolina | 27103 | United States |
| Investigator Site - Fargo | Fargo | North Dakota | 58104 | United States |
| Investigator Site - Beavercreek | Beavercreek | Ohio | 45432 | United States |
| Investigator Site - Cincinnati 1 | Cincinnati | Ohio | 45219 | United States |
| Investigator Site - Cincinnati 2 | Cincinnati | Ohio | 45246 | United States |
| Investigator Site - Columbus | Columbus | Ohio | 43235 | United States |
| Investigator Site - Duncansville | Duncansville | Pennsylvania | 16635 | United States |
| Investigator Site - Jenkintown | Jenkintown | Pennsylvania | 19046 | United States |
| Investigator Site - Rapid City | Rapid City | South Dakota | 57702 | United States |
| Investigator Site - Memphis | Memphis | Tennessee | 38119 | United States |
| Investigator Site - Arlington | Arlington | Texas | 76012 | United States |
| Investigator Site - Austin | Austin | Texas | 78731 | United States |
| Investigator Site - Killeen | Killeen | Texas | 76543 | United States |
| Investigator Site - San Antonio | San Antonio | Texas | 78229 | United States |
| Investigator Site - Salt Lake City | Salt Lake City | Utah | 84124 | United States |
| Investigator Site - West Jordan | West Jordan | Utah | 84088 | United States |
| Investigator Site - Midlothian | Midlothian | Virginia | 23114 | United States |
| Investigator Site - Norfolk | Norfolk | Virginia | 23507 | United States |
| Investigator Site - Kenosha | Kenosha | Wisconsin | 53142 | United States |
| FG002 | Placebo (Double-blind Treatment Phase) | Placebo: Placebo, twice daily tablets |
| COMPLETED |
|
| NOT COMPLETED |
|
| Double-blind Maintenance Phase |
|
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| ID | Title | Description |
|---|---|---|
| BG000 | NKTR-181 | NKTR-181 (Double-blind Treatment Phase) |
| BG001 | Placebo | Placebo (Double-blind Treatment Phase) |
| BG002 | 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, Continuous | Mean | Standard Deviation | years |
| |||||||||||||||
| Sex: Female, Male | Count of Participants | Participants |
| ||||||||||||||||
| Race (NIH/OMB) | Count of Participants | Participants |
| ||||||||||||||||
| Screening Baseline Pain Intensity in Numeric Rating Scale (NRS) | The pain intensity in NRS is an 11-point numerical rating scale ranging from 0 (no pain) to 10 (worst possible pain). Screening baseline was the 7-day average immediately prior to the first dose of NKTR-181 | 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 | The Change in Weekly (ie, 7-day Average) Pain Score at the End of Double-blind, Randomized Treatment Period, Relative to the Weekly Score at the End of Titration (Double-blind Baseline) | The daily pain intensity is an 11-point numerical rating scale ranging from 0 (no pain) to 10 (worst possible pain). | The analysis set (N=610) is the intention-to-treat population, which was defined as all randomized subjects | Posted | Mean | Standard Error | units on a scale | 12 Weeks of randomized double blinded period |
|
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| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Secondary | Responder Analysis Based on Percent Reduction in Pain Intensity | A responder is defined by the Sponsor as a randomized subject who completes the double-blind Randomized Treatment Period and experiences improvement in the Week 12 Weekly Pain Score from Screening Pain Score. This includes the proportion of responders with at least 30% and at least 50% reduction in pain intensity. | Posted | Count of Participants | Participants | Screening Baseline through Week 12 |
|
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| Secondary | Patient Global Impression of Change (PGIC): Number of Responders | The PGIC assesses the change in overall status relative to the initiation of the treatment. The scale measures global change of overall status on a 7-point scale (1 = No change (or condition has got worse), 2 = Almost the same, 3 = A little better, 4 = Somewhat better, 5 = Moderately better, 6 = Better, 7 = A great deal better). The proportion of subjects responding " A great deal better " and "better" was summarized by treatment group. | Posted | Count of Participants | Participants | Screening Baseline through Week 12 |
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| Secondary | Change in Sleep Quality in the Medical Outcome Study Sleep Scale - Revised (MOS Sleep-R) | The MOS Sleep Scale measure sleep parameters contains 12 items. Eleven of them scored using a 5-point response scale and across 5 dimensions of sleep, including disturbance (4 items), sleep problems index (9 items), somnolence (3 items), adequacy (2 items), and respiratory impairments (2 items). The original survey items are converted to a 0 to 100 range (by Converting 1 to 0, 2 to 25, 3 to 50, 4 to 75, and 5 to 100). Items in each dimension (disturbance, sleep problems index, somnolence, adequacy, respiratory impairments) of sleep are averaged together to create the score for the scale. The range of each sleep dimension is from 0 to 100. Higher score of sleep disturbance, somnolence, sleep indices, and respiratory impairments indicates relatively worse sleep problem, whereas lower scores for sleep adequacy indicate worse sleep problems. | The MOS Sleep-R was analyzed and presented as a change from Screening Baseline to Week 12 in double blinded treatment period. Subjects who discontinued from treatment early were not included in this analysis. | Posted | Mean | Standard Deviation | units on a scale | Screening Baseline through Week 12 |
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| Secondary | Change in Sleep Quantity Measure in Hours in the Medical Outcome Study Sleep Scale - Revised (MOS Sleep-R) | The 12 items of the MOS Sleep Scale measure sleep parameters across 6 dimensions of sleep, including disturbance (4 items), sleep problems index (9 items), quantity (1 item), somnolence (3 items), adequacy (2 items), and respiratory impairments (2 items). One of the 12 items, Sleep quantity, records the actual number of hours slept. Reported here is the sleep quantity. | Posted | Mean | Standard Deviation | hours | Screening Baseline through Week 12 |
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| Secondary | Change in Roland Morris Disability Questionnaire (RMDQ) | The RMDQ contains 24 items that is used to quantify the impact of low back pain on subject's ability to perform daily activities, mood and sleep. The questionnaire consists of 24 statements derived from the Sickness Impact Profile, with the addition of the phrase "because of my back." The questionnaire covers the areas of mobility, self-care, and sleeping. The RMDQ score is the total number of items checked which is from a minimum of 0 to a maximum of 24; the greater the score the grater the physical disability due to lower back pain. | The RMDQ was analyzed and presented as a change from Screening Baseline to Week 12 in double blinded treatment period. Subjects who discontinued from treatment early were not included in this analysis. | Posted | Mean | Standard Deviation | units on a scale | Screening Baseline through Week 12 |
|
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Adverse events were reported starting immediately after the subject provided written informed consent through the end of study, which is approximately 20 to 25 weeks for each subject.
Adverse events were collected after the subject provided written informed consent till the end of study through spontaneous reports or were observed during other assessments. All ongoing AEs were followed until resolution or for 14 days after the subject's last visit, whichever came first. All SAEs were followed until resolution, stabilization of condition, return to baseline, or until follow-up is no longer possible.
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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 | NKTR-181 (Titration Phase) | NKTR-181 100-400 mg twice daily tablets | 9 | 1,189 | 803 | 1,189 | ||
| EG001 | NKTR-181 (Double-blind Treatment Phase) | NKTR-181 100-400 mg twice daily tablets | 5 | 309 | 111 | 309 | ||
| EG002 | Placebo (Double-blind Treatment Phase) | Placebo, twice daily tablets | 6 | 301 | 66 | 301 |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Atrial Fibrillation | Cardiac disorders | MedDRA 17.1 | Systematic Assessment |
| |
| Blindness transient | Eye disorders | MedDRA 17.1 | Systematic Assessment |
| |
| Large intestine perforation | Gastrointestinal disorders | MedDRA 17.1 | Systematic Assessment |
| |
| Diverticulum intestinal | Gastrointestinal disorders | MedDRA 17.1 | Systematic Assessment |
| |
| Chest Pain | General disorders | MedDRA 17.1 | Systematic Assessment |
| |
| Cellulitis | Infections and infestations | MedDRA 17.1 | Systematic Assessment |
| |
| Gastrointestinal infection | Infections and infestations | MedDRA 17.1 | Systematic Assessment |
| |
| Herpes virus infection | Infections and infestations | MedDRA 17.1 | Systematic Assessment |
| |
| Infective exacerbation of chronic obstructive airways | Infections and infestations | MedDRA 17.1 | Systematic Assessment |
| |
| Pneumonia | Infections and infestations | MedDRA 17.1 | Systematic Assessment |
| |
| Diverticulitis | Infections and infestations | MedDRA 17.1 | Systematic Assessment |
| |
| Bacterial infection | Infections and infestations | MedDRA 17.1 | Systematic Assessment |
| |
| Gastroenteritis | Infections and infestations | MedDRA 17.1 | Systematic Assessment |
| |
| Rib fracture | Injury, poisoning and procedural complications | MedDRA 17.1 | Systematic Assessment |
| |
| Skin abrasions | Injury, poisoning and procedural complications | MedDRA 17.1 | Systematic Assessment |
| |
| Bladder cancer | Neoplasms benign, malignant and unspecified (incl cysts and polyps) | MedDRA 17.1 | Systematic Assessment |
| |
| Cerebrovascular accident | Nervous system disorders | MedDRA 17.1 | Systematic Assessment |
| |
| Dysarthria | Neoplasms benign, malignant and unspecified (incl cysts and polyps) | MedDRA 17.1 | Systematic Assessment |
| |
| Pulmonary Embolism | Respiratory, thoracic and mediastinal disorders | MedDRA 17.1 | Systematic Assessment |
| |
| Renal failure | Renal and urinary disorders | MedDRA 17.1 | Systematic Assessment |
| |
| Angiodema | Skin and subcutaneous tissue disorders | MedDRA 17.1 | Systematic Assessment |
| |
| Hypertension | Vascular disorders | MedDRA 17.1 | Systematic Assessment |
| |
| Malignant hypertension | Vascular disorders | MedDRA 17.1 | Systematic Assessment |
|
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Constipation | Gastrointestinal disorders | MedDRA 17.1 | Systematic Assessment |
| |
| Nausea | Gastrointestinal disorders | MedDRA 17.1 | Systematic Assessment |
| |
| Vomiting | Gastrointestinal disorders | MedDRA 17.1 | Systematic Assessment |
| |
| Dry mouth | Gastrointestinal disorders | MedDRA 17.1 | Systematic Assessment |
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| Diarrhoea | Gastrointestinal disorders | MedDRA 17.1 | Systematic Assessment |
| |
| Fatigue | General disorders | MedDRA 17.1 | Systematic Assessment |
| |
| Somnolence | Nervous system disorders | MedDRA 17.1 | Systematic Assessment |
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| Headache | Nervous system disorders | MedDRA 17.1 | Systematic Assessment |
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If a joint manuscript has not been submitted for publication within twelve (12) months of completion or termination of the study, the PI is free to publish separately, upon provision of any proposed publication or manuscript to the Sponsor at least sixty (60) days before it is submitted or otherwise disclosed.
| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Medical Affairs | Nektar Therapeutics | StudyInquiry@nektar.com |
| ID | Term |
|---|---|
| D017116 | Low Back Pain |
| D059350 | Chronic Pain |
| ID | Term |
|---|---|
| D001416 | Back Pain |
| D010146 | Pain |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
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| Male |
|
| Asian |
|
| Native Hawaiian or Other Pacific Islander |
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| Black or African American |
|
| White |
|
| More than one race |
|
| Unknown or Not Reported |
|
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| Units | Counts |
|---|---|
| Participants |
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