An Open-label Safety and Pharmacokinetic Study of INL-001 in Adults Following Various Open Soft-Tissue Surgeries

Pain, Postoperative Clinical Trial

Official title:

An Open-label Safety and Pharmacokinetic Study of INL-001 in Adults Following Open Ventral Hernia Repair, Abdominoplasty, Open Abdominal Hysterectomy, Laparoscopic-assisted Colectomy, and Reduction Mammoplasty

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT04785638
• Other study ID #: INN-CB-025
• Status: Completed
• Phase: Phase 3
• Start date: April 14, 2021
• Est. completion date: January 10, 2023

Study information

• Verified date: February 2023
• Source: Innocoll
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This is a multicenter, Phase 3, open-label, safety, tolerability, and characterization of pharmacokinetics study of the INL 001 (bupivacaine HCl) implant, at 300 mg, in patients following various soft-tissue surgeries: open ventral hernia repair, abdominoplasty, open abdominal hysterectomy, laparoscopic-assisted colectomy, and reduction mammoplasty.

Description:

This is a multicenter, Phase 3, open-label, safety, tolerability, and characterization of pharmacokinetics study of the INL-001 (bupivacaine HCl) implant, at 300 mg, in patients following various soft-tissue surgeries: open ventral hernia repair, abdominoplasty, open abdominal hysterectomy, laparoscopic-assisted colectomy, and reduction mammoplasty. After a screening period, eligible patients will undergo study surgery under general anesthesia and have INL-001 implanted intraoperatively. Efficacy is also an exploratory measure in this study. The study includes a screening period, an inpatient period (preoperative, intraoperative, postoperative) of approximately 5 days, and an outpatient follow-up period (up to 30 days after treatment). Posttreatment safety and/or efficacy assessments will be made throughout the study and as specifically scheduled through 96 hours posttreatment, on day 7 (telephone), on day 15 (clinic visit), and on day 30 (clinic visit). Unless the investigator determines further hospitalization is necessary, patients will be discharged approximately 96 hours posttreatment (inpatient day 5). During the screening period, all patients will undergo eligibility and other screening and safety assessments. In addition, the investigator will administer the Pain Catastrophizing Scale (screening only) as an exploratory measure and the 15-item Quality of Recovery (QoR-15) questionnaire (baseline). Adverse event and concomitant medication information, including use of rescue pain medication, will be collected throughout the study (inpatient and outpatient). Surgical wound healing/grading assessments and assessment for signs and symptoms potentially indicative of systemic bupivacaine toxicity will be made. Blood samples for pharmacokinetic assessments will be collected from patients at multiple time points for the measurement of concentrations of bupivacaine in plasma. After surgery, patient reports of pain intensity using an 11-point numeric pain rating scale (NPRS) will be recorded at multiple time points through 96 hours posttreatment. Patients will be permitted rescue medication (oral and/or intravenous) to manage breakthrough pain when it occurs. The QoR-15 questionnaire and Patient Global Assessment (for pain control) will be administered on an inpatient basis and on day 7. The Opioid Related Symptom Distress Scale will be administered on an inpatient basis.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 100
• Est. completion date: January 10, 2023
• Est. primary completion date: January 10, 2023
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 75 Years

Eligibility

Inclusion Criteria:

• Has a body mass index of 18-35 kg/m2.
• Has a planned (nonemergency) open ventral hernia repair, abdominoplasty (with rectus sheath plication, in the opinion of the surgeon), open abdominal hysterectomy, laparoscopic-assisted colectomy, or reduction mammoplasty to be conducted using standard surgical technique under general anesthesia.
• Has the ability and willingness to comply with all study procedures including being domiciled for at least 96 hours after surgery.
• Is willing to use opioid analgesia, if needed.

Exclusion Criteria:

• Has a known hypersensitivity to amide-type local anesthetics, fentanyl, morphine, oxycodone, acetaminophen, NSAIDs, or bovine products.
• Is scheduled for other significant concurrent surgical procedures (eg, cholecystectomy or additional cosmetic procedures concurrent with abdominoplasty).
• Has used an opioid analgesic on an extended daily basis (=5 mg oral morphine equivalents per day for 3 or more days a week) within 4 weeks before surgery and/or chronically uses pain medication.
• Has any chronic painful condition (eg, fibromyalgia), as determined by the investigator, that may confound the assessment of pain associated with the study surgery.
• For open hernia repair, has open ventral hernia with primary suture repair and mesh placement requiring an incisional length greater than 12 cm.

Related Conditions & MeSH terms

• Abdominoplasty
• Colectomy
• Hernia
• Hernia, Ventral
• Hysterectomy
• Pain, Postoperative
• Reduction Mammoplasty

Intervention

Combination Product:
• INL-001 (bupivacaine hydrochloride) implant
INL-001 (bupivacaine hydrochloride) implant

Locations

Country	Name	City	State
United States	Midwest Clinical Research	Dayton	Ohio
United States	North Alabama Medical Center	Florence	Alabama
United States	Baylor College of Medicine	Houston	Texas
United States	Daneshvari Solanki	Houston	Texas
United States	Memorial Hermann	Houston	Texas
United States	Lotus Clinical Research	Pasadena	California
United States	Endeavor Clinical Trials	San Antonio	Texas
United States	Helen Keller Hospital	Sheffield	Alabama

Sponsors (1)

Lead Sponsor	Collaborator
Innocoll

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	SPI24	Time-weighted sum of pain intensity from Time 0 through 24 hours (SPI24). Lower score has a better outcome. Pain Intensity was assessed by the subject using the 11-point NRS, where 0 indicated "no pain" and 10 indicated "worst pain possible". Minimum value would be "0" and Maximum value would be 240. Time-weighted SPI is calculated as the sum of the pain intensities between successive time points (i.e., if SPI24 = ?[PI x (time t - time t-1)], where "t" represents a given time point,"t-1" represents the previous time point, and time is expressed in hours). This represents the AUC (Area Under the Curve) of the pain intensities when calculated with the trapezoidal rule.	0 to 24 hours
Other	SPI48	Time-weighted sum of pain intensity from Time 0 through 48 hours (SPI48). Lower score has a better outcome. Pain Intensity was assessed by the subject using the 11-point NRS, where 0 indicated "no pain" and 10 indicated "worst pain possible". Minimum value would be "0" and Maximum value would be 480. Time-weighted SPI is calculated as the sum of the pain intensities between successive time points (i.e., if SPI48 = ?[PI x (time t - time t-1)], where "t" represents a given time point,"t-1" represents the previous time point, and time is expressed in hours). This represents the AUC (Area Under the Curve) of the pain intensities when calculated with the trapezoidal rule.	0 to 48 hours
Other	SPI72	Time-weighted sum of pain intensity from Time 0 through 72 hours (SPI72) A lower score is a better outcome. Pain Intensity was assessed by the subject using the 11-point NRS, where 0 indicated "no pain" and 10 indicated "worst pain possible" Minimum value would be "0" and Maximum value would be 720. Time-weighted SPI is calculated as the sum of the pain intensities between successive time points (i.e., if SPI72 = ?[PI x (time t - time t-1)], where "t" represents a given time point,"t-1" represents the previous time point, and time is expressed in hours). This represents the AUC (Area Under the Curve) of the pain intensities when calculated with the trapezoidal rule.	0 to 72 Hours
Other	Total use of opioid rescue analgesia	Total use of opioid rescue analgesia (mg equivalent) -higher score means more analgesia was needed and worse outcome	0 to 24 hours postoperatively
Other	Total use of opioid rescue analgesia	Total use of opioid rescue analgesia (mg equivalent) -higher score means more analgesia was needed and worse outcome	0 to 72 hours postoperatively
Other	Total use of opioid rescue analgesia	Total use of opioid rescue analgesia (mg equivalent) -higher score means more analgesia was needed and worse outcome	0 to 48 hours postoperatively
Other	Time to discharge from the postanesthesia care unit (PACU)	Time to discharge from the PACU	Immediately after the intervention/procedure/surgery
Other	Opioid-related Symptom Distress Scale (OR-SDS)	The OR-SDS is a measurement tool to assess patient experience following opioid use in the postoperative setting.	24, 48, 72, and 96 hours posttreatment
Other	15-item Quality of Recovery (QoR-15) Questionnaire	The 15-item Quality of Recovery (QoR-15) Questionnaire s a surgical recovery assessment tool. The QoR-15 assesses postsurgical recovery from the patient's perspective and incorporates all 5 dimensions of health patient support, comfort, emotions, physical independence, and pain. Investigator judgement will be used to determine if a positive finding on the QoR-15 is clinically significant and reportable as an adverse event.	24, 48, 72, and 96 hours, and day 7 posttreatment
Other	Patient Global Assessment (PGA) as Related to Postoperative Pain	The PGA will be administered by study staff who ask patients to rate "how well your pain has been controlled during the study" on a 5 point nominal scale: 0-poor, 1-fair, 2-good, 3-ery good, or 4-excellent.	24, 48, 72, and 96 hours, and day 7 posttreatment
Primary	Evaluate the safety and tolerability	The primary objective of the study is to evaluate the safety and tolerability of the INL-001 implant in patients. Measured by frequency and incidents of adverse events.	Day 1 through Day 30
Secondary	Cmax	Maximum (peak) plasma concentration	0.5, 1, 1.5, 2, 3, 4, 5, 6, 9, 12, 18, 24, 36, 48, 72 and 96 hours
Secondary	Tmax	Time to maximum (peak) plasma concentration	0.5, 1, 1.5, 2, 3, 4, 5, 6, 9, 12, 18, 24, 36, 48, 72 and 96 hours
Secondary	Tlag	Lag-time	0.5, 1, 1.5, 2, 3, 4, 5, 6, 9, 12, 18, 24, 36, 48, 72 and 96 hours
Secondary	t½ Terminal Half life	Terminal Half life	0.5, 1, 1.5, 2, 3, 4, 5, 6, 9, 12, 18, 24, 36, 48, 72 and 96 hours
Secondary	?z	Terminal phase rate constant	0.5, 1, 1.5, 2, 3, 4, 5, 6, 9, 12, 18, 24, 36, 48, 72 and 96 hours
Secondary	AUC	Area under the plasma concentration-time curve from Time 0 to last time of last quantifiable plasma concentration (AUC0-last)	0.5, 1, 1.5, 2, 3, 4, 5, 6, 9, 12, 18, 24, 36, 48, 72 and 96 hours
Secondary	AUC0-8	AUC from Time 0 to infinity	0.5, 1, 1.5, 2, 3, 4, 5, 6, 9, 12, 18, 24, 36, 48, 72 and 96 hours