Study of AA4500 in the Treatment of Peyronie's Disease

Peyronie's Disease Clinical Trial

Official title:

A Phase 3, Double-blind, Randomized, Placebo-controlled Study of the Safety and Effectiveness of AA4500 Administered Twice Per Treatment Cycle for up to Four Treatment Cycles (2 x 4) in Men With Peyronie's Disease

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT01221597
• Other study ID #: AUX-CC-803
• Status: Completed
• Phase: Phase 3
• First received: October 8, 2010
• Last updated: September 7, 2017
• Start date: September 2010
• Est. completion date: April 2012

Study information

• Verified date: September 2017
• Source: Endo Pharmaceuticals
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This study is a Phase 3, double-blind, randomized, placebo-controlled study of the safety and efficacy of AA4500 0.58 mg in subjects with Peyronie's disease. Approximately 400 (267 AA4500 and 133 placebo) men will be randomized. Subjects will be screened for study eligibility within 21 days before the initial injection of study drug in the first treatment cycle.

Before dosing, subjects will be stratified by degree of penile curvature deformity (ie, 30º to 60º or 61º to 90º) and then randomized into two treatment groups to receive in a 2:1 ratio either AA4500 0.58 mg or placebo.

In this study, qualified subjects may receive up to four treatment cycles; each cycle will be separated by a period of 42 days (± 5 days). During each treatment cycle, subjects will receive two injections of study drug with at least 24 hours but not more than 72 hours between injections. After the final injection of each treatment cycle, the investigator or qualified designee will model the penile plaque in an attempt to stretch or elongate the plaque. If the subject's penile curvature is reduced to <15 degrees after the first, second, or third cycle of injections or if further treatment is not clinically indicated, subsequent treatment cycles will not be administered.

Following the maximum of four treatment cycles, each subject will be followed for additional safety and efficacy assessments on Days 169 (± 7 days), 232 (± 7 days), 295 (± 7 days), 365 (± 7 days) (nominal weeks 24, 33, 42 and 52). Subjects randomized to placebo may receive open-label AA4500 treatment after completing this study as part of another protocol.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 418
• Est. completion date: April 2012
• Est. primary completion date: April 2012
• Accepts healthy volunteers: No
• Gender: Male
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

1. Be a male and be = 18 years of age

2. Be in a stable relationship with a female partner/spouse for at least 3 months before screening and be willing to have vaginal intercourse with that partner/spouse

3. Have symptom(s) of Peyronie's disease for at least 12 months before the first dose of study drug and have evidence of stable disease as determined by the investigator

4. Have curvature deformity of at least 30° in the dorsal, lateral, or dorsal/lateral plane at screening. It must be possible to delineate the single plane of maximal curvature for evaluation during the study

5. Be judged to be in good health, based upon the results of a medical history, physical examination, and laboratory profile

6. Voluntarily sign and date an informed consent agreement approved by the Institutional Review Board/Independent Ethics Committee (IRB/IEC). The subject must also sign an authorization form to allow disclosure of his protected health information (PHI). The PHI authorization form and informed consent form may be an integrated form or may be separate forms depending on the institution

7. Be able to read, complete and understand the various rating instruments in English

Exclusion criteria

1. Has a penile curvature of less than 30° or greater than 90° at the screening visit

2. Has any of the following conditions:

• Chordee in the presence or absence of hypospadias

• Thrombosis of the dorsal penile artery and/or vein

• Infiltration by a benign or malignant mass resulting in curvature deformity

• Infiltration by an infectious agent, such as lymphogranuloma venereum

• Ventral curvature from any cause

• Presence of an active sexually transmitted disease

• Known active hepatitis B or C

• Known immune deficiency disease or be positive for human immunodeficiency virus (HIV)

3. Has previously undergone surgery for Peyronie's disease

4. Fails to have an erection which in the opinion of the investigator is sufficient to accurately measure the subject's penile deformity after administration of prostaglandin E1 (PGE1) or trimix

5. Has a calcified plaque as evident by appropriate radiographic evaluation, penile x-ray or penile ultrasound that would prevent proper injection of study medication. Non-contiguous stippling of calcium is acceptable for inclusion provided the calcium deposit does not interfere with the injection of AA4500 into the plaque

6. Has an isolated hourglass deformity of the penis

7. Has the plaque causing curvature of the penis located proximal to the base of the penis, so that the injection of the local anesthetic would interfere with the injection of AA4500 into the plaque

8. Has previously received alternative medical therapies for Peyronie's disease administered by the intralesional route (including, but not limited to, steroids, verapamil, and the naturally occurring low molecular weight protein, interferon-a2b) within 3 months before the first dose of study drug or plans to use any of these medical therapies at any time during the study

9. Has received alternative medical therapies for Peyronie's disease administered by the oral (including, but not limited to, vitamin E [> 500 U], potassium aminobenzoate [Potaba], tamoxifen, colchicine, pentoxifylline, over-the-counter erectile dysfunction medications, or steroidal anti-inflammatory drugs) or topical routes (including, but not limited to, verapamil applied as a cream) within 3 months before the first dose of study drug or plans to use any of these medical therapies at any time during the study

10. Has had extracorporeal shock wave therapy (ESWT) for correction of Peyronie's disease within the 6-month period before screening or plans to have ESWT at any time during the study

11. Has used any mechanical type device for correction of Peyronie's disease within the 2-week period before screening or plans to use any these devices at any time during the study

12. Has used a mechanical device to induce a passive erection within the 2-week period before screening or plans to use any of these devices at any time during the study

13. Has significant erectile dysfunction that has failed to respond to oral treatment with phosphodiesterase type 5 (PDE5) inhibitors

14. Has a penile Duplex Doppler ultrasound evaluation at screening that shows compromised penile hemodynamics that in the opinion of the investigator is clinically significant

15. Has uncontrolled hypertension, as determined by the investigator

16. Has a known recent history of stroke, bleeding, or other significant medical condition, which in the investigator's opinion would make the subject unsuitable for enrollment in the study

17. Is unwilling or unable to cooperate with the requirements of the study including completion of all scheduled study visits

18. Has received an investigational drug or treatment within 30 days before the first dose of study drug

19. Has a known systemic allergy to collagenase or any other excipient of AA4500

20. Has a known allergy to any concomitant medication required as per the protocol

21. Has received anticoagulant medication (except for = 165 mg aspirin daily or = 800 mg of over-the-counter non-steroidal anti-inflammatory drugs [NSAIDS] daily) during the 7 days before each dose of study drug

22. Has received any collagenase treatments within 30 days of the first dose of study drug

23. Has, at any time, received AA4500 for the treatment of Peyronie's disease

Related Conditions & MeSH terms

• Penile Induration
• Peyronie's Disease

Intervention

Biological:
• AA4500
2 injections separated by at least 24 hours but not more than 72 hours. At least 24 hours but not more than 72 hours after the 2nd injection of the treatment cycle, the investigator will model the plaque (ie, gradual, gentle stretching of the flaccid penis in the direction opposite to the curvature). Treatment may be repeated after 42 days (± 5 days) for up to 4 treatment cycles.
• Placebo
2 injections separated by at least 24 hours but not more than 72 hours. At least 24 hours but not more than 72 hours after the 2nd injection of the treatment cycle, the investigator will model the plaque (ie, gradual, gentle stretching of the flaccid penis in the direction opposite to the curvature). Treatment may be repeated after 42 days (± 5 days) for up to 4 treatment cycles.

Locations

Country	Name	City	State
Australia	Repatriation General Hospital	Daws Park	South Australia
Australia	AusTrials	Kipparing	Queensland
Australia	Australian Urology Associates Pty Ltd	Malvern	Victoria
Australia	Australian Centre for Sexual Health	St. Leonards	New South Wales
Australia	Western Urology	Westmead	New South Wales
United States	Urology Associates of North Texas	Arlington	Texas
United States	Urology of Indiana LLC	Avon	Indiana
United States	Chesapeake Urology Research Associates	Baltimore	Maryland
United States	Johns Hopkins Hospital	Baltimore	Maryland
United States	Mens Health Boston	Brookline	Massachusetts
United States	Division of Urology at Maimonides Medical Center	Brooklyn	New York
United States	Urology Health Specialists,LLC	Bryn Mawr	Pennsylvania
United States	Urology Associates Medical Group	Burbank	California
United States	DCT-Celebration, LLC dba Discovery Clinical Trials	Celebration	Florida
United States	Tristate Urologic Services PSC Inc. dba TUG Research	Cincinnati	Ohio
United States	Alpha Clinical Research, LLC	Clarksville	Tennessee
United States	Southeastern Medical Research Institute	Columbus	Georgia
United States	DuPage Medical Group	Downers Grove	Illinois
United States	Alliance Urology Specialists, PA	Greensboro	North Carolina
United States	Center for Reproductive Medicine	Hackensack	New Jersey
United States	Urology Centers of Alabama, PC	Homewood	Alabama
United States	Baylor College of Medicine, Department of Urology	Houston	Texas
United States	Urological Associates of Lancaster	Lancaster	Pennsylvania
United States	Medical College of Wisconsin, Department of Urology	Milwaukee	Wisconsin
United States	Grove Hill Clinical Research, Grove Hill Medical Center	New Britain	Connecticut
United States	The Urology Center, PC	New Haven	Connecticut
United States	California Professional Research	Newport Beach	California
United States	Urology of Virginia - Sentara Medical Group	Norfolk	Virginia
United States	HOPE Research Institute, LLC	Phoenix	Arizona
United States	Wake Urological Associates	Raleigh	North Carolina
United States	Mayo Clinic at Rochester, Dept. of Urology	Rochester	Minnesota
United States	Salt Lake Research, PLLC	Salt Lake City	Utah
United States	San Diego Sexual Medicine	San Diego	California
United States	Palm Beach Urology Associates	Wellington	Florida

Sponsors (1)

Lead Sponsor	Collaborator
Endo Pharmaceuticals

Countries where clinical trial is conducted

United States,  Australia, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Percentage Change From Baseline in Penile Curvature	A negative value in the percentage change from baseline in penile curvature deformity (angle measured in degrees) indicates less curvature.	Baseline and Week 52
Primary	Change From Baseline in the Peyronie's Disease Bother Domain of the Peyronie's Disease Questionnaire (PDQ)	Peyronie's disease bother score range 0 (no issue or not at all bothered) to 4 (extremely bothered) on 4 questions; total score range 0 to 16. A decrease in the change from baseline total score in the Peyronie's disease bother domain of the PDQ is indicated by a negative number.	Baseline and Week 52
Secondary	A Responder Analysis Based on Subject Overall Global Assessment of Peyronie's Disease	A responder was defined as a subject who recorded his Peyronie's disease had either improved in a small but important way, moderately improved, or much improved in overall global assessment question.	Week 52
Secondary	Change From Baseline in the Severity of Peyronie's Disease Physical and Psychological Symptoms	Peyronie's disease symptoms (physical and psychological) severity score range 0 (none) to 4 (very severe) on 6 questions; total score range 0 to 24. A decrease in the change from baseline total score in the Peyronie's disease symptoms domain of the PDQ is indicated by a negative number.	Baseline and Week 52
Secondary	Change in the Overall Satisfaction Domain of the International Index of Erectile Function (IIEF)	Overall satisfaction domain of the IIEF score range 0 to 5 on 2 questions where higher scores indicate improved function or satisfaction; total score range 0 to 10.	Baseline and Week 52
Secondary	Change From Baseline in Penile Plaque Consistency	Penile plaque consistency score range 1 (non-palpable) to 5 (hard). A decrease in the change from baseline score in penile plaque consistency is indicated by a negative number.	Baseline and Week 52
Secondary	Change From Baseline in Penile Length	A negative value represents a reduction in measurement from baseline.	Baseline and Week 52
Secondary	Change From Baseline in the Penile Pain Domain of the PDQ in Subjects With Baseline Penile Pain Score =4	Penile pain scale range 0 (no pain) to 10 (extreme pain) on 3 questions; total score range 0 to 30. A decrease in the change from baseline total score in the penile pain domain of the PDQ is indicated by a negative number. Subjects were required to have a penile pain score of 4 or greater at baseline.	Baseline and Week 52
Secondary	Composite Responder Based on Change in Curvature Deformity and Change in Peyronie's Disease Bother Score	A responder was defined as a subject who satisfied the following 2 criteria at that visit: a) percent reduction from baseline in curvature deformity was =20% and b) reduction from baseline in PDQ Peyronie's disease bother score was =1, or had a change from reporting no sexual activity at screening to reporting sexual activity.	Week 52