Approval Probability
TA Base Rate
Adjusted LOA
ML Risk
tapentadol · 16 trials · 25 indications
A "responder" is a participant in the study that: 1. completed 28 days of the maintenance phase 2. had a numeric rating scale score below 5 on the 11 point scale (where 0 indicates no pain and 10 indicates worst possible pain. This twice daily current pain score was averaged over Day 18 to Day 43. 3. did not use more than 20 mg of rescue medication per day on average in the 28 day maintenance period (from Day 18 to Day 43). A participant that met all 3 of the above-mentioned criteria is counted as a responder, in other words the participant benefited from the assigned drug treatment. A participant that failed to meet only 1 of the 3 criteria is not counted as a responder.
For this twice daily pain assessment, the participants were required to indicate the level of pain experienced over the previous 12 hours on an 11-point Numeric Rating Scale (NRS) where a score of 0 indicated "no pain" and a score of 10 indicated "pain as bad as you can imagine". The lower the value the less pain in the treatment group. Negative values indicate a reduction in pain.
Pain control was considered to be achieved for participants who met both of the following criteria for any consecutive 3 days during the first week of treatment period: a) Change from baseline of mean 24 hour numerical rating scale (NRS) (an 11-point NRS is used to measure the pain level where 0=no pain to 10=pain as bad as you can imagine) score less than +1.5, and b) when the frequency of rescue medication was twice or less per day.
For this twice daily pain assessment, the patients were to indicate the level of pain experienced over the previous 12 hours on an 11-point Numerical Rating Scale (NRS) where a score of 0 indicated "no pain" and a score of 10 indicated "pain as bad as you can imagine".
SPID5 was calculated as the weighted (weights is taken as the number of hours elapsed since the previous measurement) sum of the PID collected up to 5 days. Pain intensity (PI) score is calculated as the average PI over the past 12 hours using an 11-point (0 to 10) numerical rating scale (NRS) where "0" is no pain and "10" is pain as bad as you can imagine. The difference between baseline PI at the qualifying period and current PI is pain intensity difference (PID).
The number of SBM over the 14-day IR treatment phase was determined from the Bowel Function Patient Diary and factored to enable a per week value to be used. An SBM is defined as any BM that has occurred without the use of a laxative, enema, suppository, or manual manipulation within the previous 24 hours.
The SPID score incorporates the cumulative analgesic effects of tapentadol IR on pain intensity over an extended period (48 hours) allowing for an evaluation of multiple doses of drug, even when dosing frequency may vary. Scoring is derived from the Numerical Rating Scale (NRS) from 0 = No pain to 11 = Pain as bad as you can imagine. A positive difference between the mean SPID48 for an active study drug and placebo would indicate a numerically larger analgesic effect for subjects dosed with active study drug than in the placebo group. A higher value in SPID indicates greater pain relief.
The number of subjects who reported a TEAE during the treatment period. TEAE was defined as any adverse event that started or worsened on or after the start of the study medication and up to 3 days after the discontinuation of the study medication.
For this twice daily pain assessment, the subjects were to indicate the level of pain experienced over the previous 12 hours on an 11-point Numerical Rating Scale (NRS) where a score of 0 indicated "no pain" and a score of 10 indicated "pain as bad as you can imagine".
For this twice daily pain assessment, the subjects were to indicate the level of pain experienced over the previous 12 hours on an 11-point Numerical Rating Scale (NRS) where a score of 0 indicated "no pain" and a score of 10 indicated "pain as bad as you can imagine".
The number of participants who reported a TEAE during the treatment period. TEAE was defined as any adverse event that started or worsened on or after the start of the study medication and up to 3 days after the discontinuation of the study medication.
Participants were asked to assess the average pain intensity on an 11-point NRS ranging from 0 (no pain) to 10 (maximum pain imaginable) by selecting a number on the scale applicable to their pain. Baseline pain score is defined as the average pain intensity score over the last 3 days prior to the randomization. Change from Baseline in NRS score is the mean NRS score at Week 12 minus mean NRS score at Baseline.
Participants were asked to assess the average pain intensity on a 11-point NRS ranging from 0 (no pain) to 10 (maximum pain imaginable) by selecting a number applicable to their pain on the scale. The mean pain intensity during the past 74 hours (3 days) was evaluated at Baseline and the mean pain intensity during the past 12 hours was evaluated at subsequent study visits.
The Cmax is the maximum plasma concentration.
The tmax is time to reach the maximum observed serum concentration.
The AUC (0-last) is the area under the serum concentration-time curve from time zero to last quantifiable time.
The AUC (0-infinity) is the area under the serum concentration-time curve from time zero to infinite time, calculated as the sum of AUC(last) and C(last)/lambda(z), wherein AUC(last) is area under the serum concentration-time curve from time zero to last quantifiable time; C(last) is the last observed quantifiable concentration; and lambda(z) is elimination rate constant.
Percentage of AUC (0-infinity) will be obtained by extrapolation and calculated as: difference between AUC (0-infinity) and AUC (0-last)/AUC (0-infinity) multiplied by 100.
Elimination half-life (t \[1/2\] Lambda) is associated with the terminal slope (lambda \[z\]) of the semi logarithmic drug concentration-time curve, calculated as 0.693/lambda(z).
Lambda(z) is first-order rate constant associated with the terminal portion of the curve, determined as the negative slope of the terminal log-linear phase of the drug concentration-time curve .
The t (last) is the time to last quantifiable serum concentration.
The Cmax,ss is the observed maximum serum concentration during a dosing interval at steady-state (time at which serum concentration does not change with time).
The C trough is the trough serum concentration before each dose of the multiple-dose treatment.
The Tmax,ss is the time to reach the maximum serum concentration after the fifth dose of the multiple-dose treatment.
The AUC (0-tau) is the area under the serum concentration-time curve during a dosing interval (tau).
The Cavg,ss is the average serum concentration at steady-state, calculated as AUC (tau) divided by tau.
The FI is percentage fluctuation that is, variation between peak and trough at steady-state, calculated as difference between Cmax and Ctrough divided by Cavg,ss and multiplied by 100.
Accumulation Ratio calculated for AUC as AUC (x, ss) divided by AUC (x, sd) and for Cmax as C(max,ss) divided by C(max,sd).
| Arm | Type | Description |
|---|---|---|
| Matching Placebo after Tapentadol in Titration Phase | PLACEBO_COMPARATOR | Oral Tapentadol 100 mg to 250 mg twice daily. Participants randomized to placebo in the maintenance phase received 100 mg tapentadol prolonged release twice daily for 3 days to taper them off the tapentadol dose they had received in the Titration Phase. From the 4th day (Day 18) all participants received matching placebo in the maintenance (i.e. randomized withdrawal) phase. |
| Morphine Controlled Release | ACTIVE_COMPARATOR | Oral Morphine 40 mg to 100 mg twice daily. Capsule taken orally, twice daily, morning \& evening with preferably 12 hours (not less than 6 hours) between doses. Maintenance phase: continuing on dose level established in titration phase. |
| Tapentadol Prolonged Release | EXPERIMENTAL | Oral Tapentadol 100 mg to 250 mg twice daily. Tablet taken orally, twice daily, morning \& evening with preferably 12 hours (not less than 6 hours) between doses. |
| Matching Placebo (twice daily) | PLACEBO_COMPARATOR | The starting dose of placebo was matched with the active treatment arms taken twice daily for the first 3 days. The dose was then increased to match the active treatments for at least 4 days. Thereafter, during the titration and maintenance phase participants were allowed to increase the dose every 3 days as in the active treatment arms. Dose decreases were allowed without time restrictions. |
| Tapentadol ER (100 to 250 mg twice daily) | EXPERIMENTAL | The starting dose was tapentadol ER 50 mg twice daily for 3 days. The dose was then increased to 100 mg tapentadol ER twice daily for at least 4 days. Thereafter, during the titration and maintenance phase participants were allowed to increase the dose every 3 days. Dose decreases were allowed without time restrictions. |
| Oxycodone CR (20 to 50 mg twice daily) | ACTIVE_COMPARATOR | The starting dose was oxycodone CR 10 mg twice daily for 3 days. The dose was then increased to 20 mg oxycodone CR twice daily for at least 4 days. Thereafter, during the titration and maintenance phase participants were allowed to increase the dose every 3 days. Dose decreases were allowed without time restrictions. |
| Tapentadol ER | EXPERIMENTAL | Tapentadol extended-release (ER) (JNS024ER) oral tablets 100 to 400 milligram (mg) daily for 8 weeks (maximum dose could be up to 500 mg daily), as per Investigator's discretion. |
| Morphine SR | ACTIVE_COMPARATOR | Morphine sustained-release (SR) oral tablets 30 to 120 mg daily for 8 weeks (maximum dose could be up to 140 mg daily), as per Investigator's discretion. |
| Tapentadol Extended Release (ER) | EXPERIMENTAL | - |
| Placebo | PLACEBO_COMPARATOR | - |
| 001 | EXPERIMENTAL | Tapentadol IR (CG5503) 50mg for 14 days |
| 002 | EXPERIMENTAL | Tapentadol IR (CG5503) 75mg for 14 days |
| 003 | ACTIVE_COMPARATOR | oxycodone IR 10mg for 14 days |
| 004 | PLACEBO_COMPARATOR | placebo 1 capsule for 14 days |
| 005 | EXPERIMENTAL | Tapentadol ER (CG5503) flexible dose tablets and capsules 2 x a day for 28 days (100-500mg/day) |
| 006 | ACTIVE_COMPARATOR | oxycodone CR flexible dose tablets and capsules 2 x a day for 28 days (20-60mg/day) |
| 007 | PLACEBO_COMPARATOR | placebo Tablets and capsules 2 x a day for 28 days |
| Tapentadol (CG5503) | EXPERIMENTAL | Tapentadol (CG5503) extended release (ER) 100 to 250 mg twice daily (BID) for up to one year. |
| Oxycodone | ACTIVE_COMPARATOR | Oxycodone controlled release (CR) 20 to 50 mg twice daily (BID) for up to one year. |
| Tapentadol Oral Solution (OS) | EXPERIMENTAL | - |
| Tapentadol | EXPERIMENTAL | Tapentadol hydrochloride extended-release(ER) will be administered as oral tablet at dose ranging from 25 milligram (mg) to 250 mg twice daily for 12 weeks. |
| Tapentadol Hydrochloride | EXPERIMENTAL | - |
| Name | Type | Description |
|---|---|---|
| Tapentadol Extended Release | DRUG | Tablet taken orally, twice daily, morning \& evening with preferably 12 hours (not less than 6 hours) between doses. Titration phase: Starting at 100 mg, increasing at a minimum of 3 day intervals by 50 mg, with a maximum dose of 250 mg. |
| Matching Placebo after Tapentadol in the Titration Phase. | DRUG | Tablet taken orally, twice daily, morning \& evening with preferably 12 hours (not less than 6 hours) between doses. In the maintenance phase only to participants that were randomized to tapentadol in the titration phase. |
| Morphine Sulphate Controlled Release | DRUG | Capsule taken orally, twice daily, morning \& evening with preferably 12 hours (not less than 6 hours) between doses. Titration phase: Starting at 40 mg, increasing at a minimum of 3 days intervals by 20 mg, with a maximum dose of 100 mg. Maintenance phase: continuing on dose level established in titration phase. |
| Tapentadol ER (100 to 250 mg twice daily) | DRUG | 50, 100, 150, 200, 250 mg twice a day (BID) during 15 weeks (3 weeks titration and 12 weeks maintenance) |
| Matching Placebo (twice daily) | DRUG | Matching Placebo during 15 weeks (3 weeks titration and 12 weeks maintenance) |
| Oxycodone CR (20 to 50 mg twice daily) | DRUG | 10, 20, 30, 40, 50 mg twice a day (BID) during 15 weeks (3 weeks titration and 12 weeks maintenance) |
| Tapentadol ER | DRUG | Tapentadol ER 100 to 400 milligram (mg) orally daily for 8 weeks (maximum up to 500 mg daily), as per Investigator's discretion. |
| Morphine SR | DRUG | Morphine SR 30 to 120 mg orally daily for 8 weeks (maximum up to 140 mg daily), as per Investigator's discretion. |
| Tapentadol extended release (ER) | DRUG | Type= range, unit= mg, number= 100 to 250, form= tablet, route= oral use. Tapentadol ER optimal dose ranging between 100 mg and 250 mg twice daily for 15 weeks. |
| Placebo | DRUG | Form= tablet, route= oral use. Matching placebo twice daily. |
| oxycodone CR | DRUG | flexible dose tablets and capsules 2 x a day for 28 days (20-60mg/day) |
| oxycodone IR | DRUG | 10mg for 14 days |
| Tapentadol ER (CG5503) | DRUG | flexible dose tablets and capsules 2 x a day for 28 days (100-500mg/day) |
| Tapentadol IR (CG5503) | DRUG | 50mg for 14 days |
| Tapentadol (CG5503) | DRUG | 50mg capsule q4-6 hrs for 3 days |
| oxycodone | DRUG | 10mg capsule q4-6 hrs for 3 days |
| Tapentadol (CG5503) Extended Release (ER) | DRUG | 100, 150, 200, 250 mg oral tablet twice daily for 52 weeks |
| tapentadol (CG5503) ER | DRUG | 50, 100, 150, 200, 250 mg twice daily for 15 weeks |
| Tapentadol (OS) Oral Solution | DRUG | Tapentadol OS Bodyweight \<20 kg: Type=4 unit=mg/mL form=oral solution route=oral use or Tapentadol OS Bodyweight \>=20 kg: Type=20 unit=mg/mL form=oral solution route=oral use. Single oral dose administered once. |
| Tapentadol | DRUG | Tapentadol hydrochloride extended-release(ER) will be administered as oral tablet at dose ranging from 25 milligram (mg) to 250 mg twice daily for 12 weeks. |
| Tapentadol Hydrochloride | DRUG | Tapentadol hydrochloride extended release (ER) tablets 25 to 250 milligram (mg) will be administered orally twice daily for 12 weeks. Dose will be adjusted as per Investigator's discretion. |
| tapentadol HCl | DRUG | - |
Inclusion Criteria * Male and non-pregnant, non-lactating female subjects. * Of at least 18 years of age with chronic malignant tumor-related pain with a mean pain intensity (NRS) of 5 points or higher. * Subjects who are opioid-naïve or pretreated with an equianalgesic dose range equivalent of up ...