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NAL

Phase 3

Idiopathic Pulmonary Fibrosis | Small molecule | Respiratory |Trevi Therapeutics, Inc.|Last Updated: Jul 10, 2026

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Trial Design
RandomizedDouble-BlindCONTROLLEDDMC
Total Trials4
Total Enrollment523
FDA Designations
No designations recorded
Clinical trial landscape

NAL · 8 trials · 3 indications

Phase 3 1Phase 2 4Phase 1 3
NCT07671911Idiopathic Pulmonary Fibrosis (IPF)-Related Chronic Cough Reduction With Nalbuphine Extended-Release (NAL ER) TabletsIdiopathic Pulmonary Fibrosis
RECRUITING306 Analytics
PHASE3RECRUITING
Idiopathic Pulmonary Fibrosis (IPF)-Related Chronic Cough Reduction With Nalbuphine Extended-Release (NAL ER) Tablets
Idiopathic Pulmonary FibrosisUnlock trial analytics
Study Endpoints
Primary Endpoints
Relative Change from Baseline in 24-hour Cough Frequency at Week 26
Baseline, Week 26
Relative Change From Baseline in 24-hour Cough Frequency at Week 6
Baseline, Week 6
Relative Change From Baseline in 24-hour Cough Frequency at Day 21
Baseline, Day 21

Relative change in 24-hour (combined daytime and nighttime) cough frequency (coughs per hour) from baseline was assessed. Assessment was done using objective digital cough monitoring. Baseline was defined as the last non-missing assessment, prior to the first dose of study drug.

Number of Participants Who Experienced at Least One Treatment Emergent Adverse Events (TEAEs)
Up to Day 72

An AE was defined as any untoward medical occurrence in a participant or clinical investigation participant administered a pharmaceutical product and which does not necessarily have to have a causal relationship with the treatment. An AE can therefore be any unfavorable and unintended sign (including an abnormal laboratory finding, for example), symptom, or disease temporally associated with the use of a medicinal product, whether or not considered related to the medicinal product. A TEAE was defined as any AE that occurs after the first dose of study drug. TEAEs included both serious and non-serious TEAEs.

Number of Participants With Clinically Significant Abnormalities in Laboratory Parameters
Up to Day 72

The clinical laboratory parameters included the urinalysis, hematology, serum chemistry, coagulation and liver function parameters. Clinical significance was determined by the investigator.

Number of Participants With Clinically Significant Changes in Vital Sign Parameters
Up to Day 72

Vital signs measurements included blood pressure, heart rate, and respiration rate, body temperature, pulse oximetry, and weight. Clinical significance was determined by the investigator.

Number of Participants With Clinically Significant Changes in Physical Examination Parameters
Up to Day 72

Physical examination included examination of the following body systems: general appearance, eyes, ears, nose, throat, head and neck, chest and lungs, cardiovascular, abdomen, musculoskeletal, lymphatic, dermatological, neurological, and extremities. Clinical significance was determined by the investigator.

Number of Participants With Clinically Significant Abnormalities in 12-Lead Electrocardiogram (ECG)
Up to Day 72

Changes in ECG data such as heart rate, rhythm, and other clinically significant abnormalities (left ventricular hypertrophy, pathological Q-waves) were measured. Clinical significance was determined by the investigator.

Change From Baseline in Forced Vital Capacity (FVC) at Day 21
Baseline, Day 21

Spirometry was used to assess FVC. It was used to assess pulmonary breathing mechanics.

Subjective Opiate Withdrawal (SOWS) Total Raw Score
Up to Day 72

The SOWS is a self-administered scale for grading opioid withdrawal symptoms and was collected via the study issued e-diary. It consisted of 16 symptoms related to how the participant felt. Each symptom was scored between 0 to 4. The total score ranges between 0 to 64, higher score indicates more severe symptoms.

Daytime Cough Frequency at Baseline
At Baseline

Daytime cough was defined as cough that occurs between the time that the participant is a wake in the 24 hours after the digital cough monitor was applied for use. Assessment was done using objective digital cough monitoring. Baseline was defined as the last available assessment prior to the first Treatment Period 1 IP intake.

Percent Change From Baseline in Daytime Cough Frequency at Day 22
Baseline, Day 22

Daytime cough was defined as cough that occurs between the time that the participant is a wake in the 24 hours after the digital cough monitor was applied for use. Assessment was done using objective digital cough monitoring. Percent change in daytime cough frequency (coughs per hour) from baseline was assessed. Baseline was defined as the last available assessment prior to the first Treatment Period 1 IP intake.

Relative Bioavailability of NAL ER
Predose and at multiple timepoints postdose (from Day 1 to Day 8)
Respiratory Function and Safety Assessed by Number of Participants With Increase in End Tidal Partial Pressure of Carbon Dioxide by Capnography (PetCO2) of at Least 10 Millimetres of Mercury (mmHg) From Baseline, or PetCO2>55 mmHg, for at Least 1 Minute
Up to Day 6
Respiratory Function and Safety as Assessed by Number of Participants With a Decrease in Blood Oxygen Saturation (SpO2) to <88% for at Least 1 Minute
Up to Day 6
Respiratory Function and Safety as Assessed by Number of Participants With a Decrease in Respiratory Rate (RR) to <6 Breaths per Minute
Up to Day 6
Safety and Tolerability as Assessed by Number of Participants With Treatment Emergent Adverse Events (TEAEs)
Up to Day 51
Maximum Plasma Concentration (Cmax) of NAL ER, Pirfenidone, and Nintedanib
Pre-dose and at multiple timepoints post-dose on Days 1 and 6 for Cohorts A1 and B1; on Days 1 and 8 for Cohort A2; on Days 1 and 7 for Cohort B2
Time to Reach Maximum Observed Concentration (Tmax) of NAL ER, Pirfenidone, and Nintedanib
Pre-dose and at multiple timepoints post-dose on Days 1 and 6 for Cohorts A1 and B1; on Days 1 and 8 for Cohort A2; on Days 1 and 7 for Cohort B2
Area Under the Concentration-Time Curve From Time Zero to Time of Last Measurable Concentration (AUC0-Tlast) of NAL ER, Pirfenidone, and Nintedanib
Pre-dose and at multiple timepoints post-dose on Days 1 and 6 for Cohorts A1 and B1; on Days 1 and 8 for Cohort A2; on Days 1 and 7 for Cohort B2
Area Under the Concentration-Time Curve From Time Zero Extrapolated to Infinity (AUC0-inf) of NAL ER, Pirfenidone, and Nintedanib
Pre-dose and at multiple timepoints post-dose on Days 1 and 6 for Cohorts A1 and B1; on Days 1 and 8 for Cohort A2; on Days 1 and 7 for Cohort B2
Apparent Terminal Rate Constant (λz) of NAL ER, Pirfenidone, and Nintedanib
Pre-dose and at multiple timepoints post-dose on Days 1 and 6 for Cohorts A1 and B1; on Days 1 and 8 for Cohort A2; on Days 1 and 7 for Cohort B2
Apparent Terminal Half-Life (t1/2) of NAL ER, Pirfenidone, and Nintedanib
Pre-dose and at multiple timepoints post-dose on Days 1 and 6 for Cohorts A1 and B1; on Days 1 and 8 for Cohort A2; on Days 1 and 7 for Cohort B2
Apparent Clearance (CL/F) of NAL ER, Pirfenidone, and Nintedanib
Pre-dose and at multiple timepoints post-dose on Days 1 and 6 for Cohorts A1 and B1; on Days 1 and 8 for Cohort A2; on Days 1 and 7 for Cohort B2
Apparent Volume of Distribution (Vz/F) of NAL ER, Pirfenidone, and Nintedanib
Pre-dose and at multiple timepoints post-dose on Days 1 and 6 for Cohorts A1 and B1; on Days 1 and 8 for Cohort A2; on Days 1 and 7 for Cohort B2
Secondary Endpoints
Absolute Change from Baseline in the Cough Severity Numerical Rating Scale (CS-NRS) at Week 26
Baseline, Week 26
Relative Change from Baseline in 24-hour Cough Frequency at Week 6
Baseline, Week 6
Percentage of Participants Achieving ≥50% Reduction from Baseline in 24-hour Cough Frequency at Week 26
Baseline, Week 26
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Study Design & Arms
AllocationRANDOMIZED
MaskingDOUBLE
ModelPARALLEL
PurposeTREATMENT
Treatment Arms
ArmTypeDescription
NAL ER 54 mgEXPERIMENTALParticipants will undergo a 2-week blinded titration period followed by a fixed dose treatment period receiving NAL ER 54 milligrams (mg) twice daily (BID) for 52 weeks.
PlaceboPLACEBO_COMPARATORParticipants will undergo a 2-week blinded titration period followed by a fixed dose treatment period receiving a matching placebo BID for 52 weeks.
NAL ER 54 mg BIDEXPERIMENTALParticipants will receive NAL ER during the titration period, with dose titration starting at 27 milligrams (mg) once daily (QD) and increasing up to 54 mg twice daily (BID) from Day 1 to Day 14. Participants will receive NAL ER 54 mg BID during the fixed-dose treatment period from Day 15 to Day 42.
NAL ER 27 mg BIDEXPERIMENTALParticipants will receive NAL ER during the titration period, starting at 27 mg QD to 27 mg BID from Day 1 to Day 14. Participants will receive NAL ER 27 mg BID during the fixed-dose treatment period from Day 15 to Day 42.
NAL ER 27 mg QDEXPERIMENTALParticipants will receive NAL ER 27 mg QD during the titration period from Day 1 to Day 14. Participants will continue to receive NAL ER 27 mg QD during the fixed-dose treatment period from Day 15 to Day 42.
NAL ER 27 mgEXPERIMENTALParticipants were titrated over 2 weeks to NAL ER 27 mg BID, then maintained at the fixed dose for 4 weeks (total 6 weeks of treatment).
NAL ER 108 mgEXPERIMENTALParticipants were titrated over 2 weeks to NAL ER 108 mg BID, then maintained at the fixed dose for 4 weeks (total 6 weeks of treatment).
First NAL ER, then PlaceboEXPERIMENTALParticipants received NAL ER at escalating doses (27 mg QD to BID, 54 mg BID, and 108 mg BID) in Treatment Period 1, followed by placebo matched to NAL ER in Treatment Period 2.
First Placebo then NAL EREXPERIMENTALParticipants received placebo matched to NAL ER in Treatment Period 1, followed by NAL ER at escalating doses (27 mg QD to BID, 54 mg BID, and 108 mg BID) in Treatment Period 2.
NAL ER then placeboEXPERIMENTALParticipants received NAL ER in treatment period 1 at dose 27 mg once daily (QD) to 54 mg twice daily (BID) over a 5-day period and then maintained at 54 mg BID for 4 days. Dose was increased to 108 mg BID for 1 week then to 162 mg BID for 6 days, followed by placebo matching NAL ER for 3 weeks in treatment period 2. Both the treatment periods were separated by 2 weeks of washout period.
Placebo then NAL EREXPERIMENTALParticipants received placebo matching NAL ER for 3 weeks in treatment period 1 followed by NAL ER in treatment period 2 at dose 27 mg QD to 54 mg BID over a 5-day period and then maintained at 54 mg BID for 4 days. Dose was increased to 108 mg BID for 1 week then to 162 mg BID for 6 days. Both the treatment periods were separated by 2 weeks of washout period.
Cohort 1: NAL ER Dose AEXPERIMENTALParticipants will receive NAL ER Dose A on Day 1 in the fasted state, followed by dosing on Day 5 in the fed state in the first sequence, and vice versa in the second sequence, with a 3-day washout maintained between sequences.
Cohort 2: NAL ER Dose BEXPERIMENTALParticipants will receive NAL ER Dose B on Day 1 in the fasted state, followed by dosing on Day 5 in the fed state in the first sequence, and vice versa in the second sequence, with a 3-day washout maintained between sequences.
NAL EREXPERIMENTALParticipants will receive 2 doses of placebo (placebo matching NAL ER) over 2 days followed by increasing doses of NAL ER tablets twice daily (BID) over 6 days.
Cohort A1 - NAL ER + PirfenidoneEXPERIMENTALParticipants will receive NAL ER followed by NAL ER co-administered with pirfenidone.
Cohort A2 - NAL ER + NintedanibEXPERIMENTALParticipants will receive NAL ER followed by NAL ER co-administered with nintedanib.
Cohort B1 - Pirfenidone + NAL EREXPERIMENTALParticipants will receive pirfenidone followed by pirfenidone co-administered with NAL ER.
Cohort B2 - Nintedanib + NAL EREXPERIMENTALParticipants will receive nintedanib followed by nintedanib co-administered with NAL ER.
Interventions
NameTypeDescription
NAL ERDRUGOral tablets
PlaceboDRUGOral tablets
PirfenidoneDRUGOral tablets
NintedanibDRUGOral capsules
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Eligibility Criteria
Age Range40 Years to N/A
SexALL
Healthy VolunteersNo
Study Sites5

Inclusion Criteria: * Diagnosis of IPF as determined by the Investigator based on American Thoracic Society (ATS)/European Respiratory Society (ERS)/Japanese Respiratory Society (JRS)/Latin American Thoracic Society (ALAT) clinical practice guidelines. * Chronic cough for ≥8 weeks prior to Screenin...

Countries:United StatesCanadaAustraliaChileGermanyItalyNetherlandsPolandSpainTurkey (Türkiye)United Kingdom
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Recent Changes (Last 90 Days)
MEDIUMJul 27, 2026NCT05964335TRIAL_REMOVED: changed
MEDIUMJul 27, 2026NCT05964335TRIAL_REMOVED: changed
MEDIUMJul 27, 2026NCT05964335TRIAL_REMOVED: changed
MEDIUMJul 27, 2026NCT05964335TRIAL_REMOVED: changed
LOWJul 10, 2026NCT07671911Status: NOT_YET_RECRUITING → RECRUITING
LOWJul 10, 2026NCT07671924Status: NOT_YET_RECRUITING → RECRUITING
LOWJul 10, 2026NCT07671911Status: NOT_YET_RECRUITING → RECRUITING
LOWJul 10, 2026NCT07671924Status: NOT_YET_RECRUITING → RECRUITING
LOWJun 26, 2026NCT07671911NEW_TRIAL: changed
LOWJun 26, 2026NCT07671924NEW_TRIAL: changed
LOWJun 26, 2026NCT07671911NEW_TRIAL: changed
LOWJun 26, 2026NCT07671924NEW_TRIAL: changed
LOWMay 26, 2026NCT07487740primaryCompletionDate: changed
LOWMay 26, 2026NCT07036029primaryCompletionDate: changed
LOWMay 24, 2026NCT07487740studyFirstPostDate: changed
LOWMay 24, 2026NCT07036029studyFirstPostDate: changed