The study aims to determine the pharmacokinetic (PK) profile of a single oromucosal dose of Sativex® (i.e. how the body absorbs, distributes, metabolises and excretes the drug) when subjects have severe renal impairment or end stage renal disease (ESRD), compared with subjects who have normal renal function. The primary clinical hypothesis is that there will be an effect from severe renal impairment on the PK of Sativex® when administered as a single oromucosal dose. The study additionally aims to evaluate the safety and tolerability of the same single oromucosal dose of Sativex® in subjects with severe renal impairment or ESRD.
This is a Phase I, open label, single-dose study to evaluate the effect of renal impairment on the PK of an oromucosal dose (four sprays) of Sativex® (containing 10.8 mg Δ9 tetrahydrocannabinol \[THC\] and 10 mg cannabidiol \[CBD\]) in subjects with severe renal impairment or ESRD (with a creatinine clearance \< 30 mL/min and not requiring dialysis) compared to matched subjects with normal renal function (with a creatinine clearance \> 80 mL/min). Eligible subjects will be given a single oromucosal dose (four sprays) of Sativex® on Dosing Day 1. Serial blood and urine samples for determination of concentrations of THC, 11-hydroxy- Δ9 - tetrahydrocannabinol (11-OH-THC), CBD, and 7-hydroxy-cannabidiol (7- OH-CBD) will be collected from subjects with severe renal impairment or ESRD, not requiring dialysis, and matched subjects with normal renal function before and up to 48 hours after dosing at selected time points. Pre-dose blood samples will also be collected for protein binding measurement. Safety and tolerability will be evaluated from Day -2 through to the post-study follow-up visit. The Follow-up Safety visit will be performed 7 days after Sativex® dosing (+ 2 days). The expected maximum duration for study participation (including Screening, Inpatient Period, and Follow-up) for each individual subject is a maximum of 24 days.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
BASIC_SCIENCE
Masking
NONE
Each 100 uL actuation (spray) of Sativex contains 27 mg/mL THC and 25 mg/mL CBD plus peppermint flavouring. The study dosage of 10.8 mg THC and 10 mg CBD is delivered as four sprays to the oral mucosa.
Pharmacokinetic parameters of THC: Cmax, AUC(0-t) and AUC(0-∞)
The following are presented for THC: * Mean maximum (peak) plasma concentration of the drug (Cmax) * Mean area under the concentration-time curve calculated to the last observable concentration at time t (AUC(0-t)) * Mean area under the concentration-time curve from time zero to infinity (AUC(0-∞))
Time frame: Pre-dose (t=0) and up to 48 hours post-dose
Pharmacokinetic parameters of 11-hydroxy-THC (11-OH-THC): Cmax, AUC(0-t) and AUC(0-∞)
The following are presented for 11-OH-THC: * Mean Cmax * Mean AUC(0-t) * Mean AUC(0-∞)
Time frame: Pre-dose (t=0) and up to 48 hours post-dose
Pharmacokinetic parameters of CBD: Cmax, AUC(0-t) and AUC(0-∞)
The following are presented for CBD: * Mean Cmax * Mean AUC(0-t) * Mean AUC(0-∞)
Time frame: Pre-dose (t=0) and up to 48 hours post-dose
Pharmacokinetic parameters of 7-hydroxy-CBD (7-OH-CBD): Cmax, AUC(0-t) and AUC(0-∞)
The following are presented for 7-OH-CBD: * Mean Cmax * Mean AUC(0-t) * Mean AUC(0-∞)
Time frame: Pre-dose (t=0) and up to 48 hours post-dose
Pharmacokinetic parameters of THC: t(1/2), tmax, CL/F, CLr and F(e,u)
The following are presented for THC; * Mean terminal-phase elimination half-life (t(1/2)) * Mean time to maximum (peak) plasma concentration (tmax) * Mean apparent clearance of drug from plasma (CL/F) * Mean renal clearance (CLr) * Mean fraction of the systemically available drug excreted into the urine (F(e,u))
Time frame: Pre-dose (t=0) and up to 48 hours post-dose
Pharmacokinetic parameters of 11-OH-THC: t(1/2), tmax, CLr and F(e,u)
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The following are presented for 11-OH-THC; * Mean t(1/2) * Mean tmax * Mean CLr * Mean F(e,u)
Time frame: Pre-dose (t=0) and up to 48 hours post-dose
Pharmacokinetic parameters of CBD: t(1/2), tmax, CL/F, CLr and F(e,u)
The following are presented for CBD; * Mean t(1/2) * Mean tmax * Mean CL/F * Mean CLr * Mean F(e,u)
Time frame: Pre-dose (t=0) and up to 48 hours post-dose
Pharmacokinetic parameters of 7-OH-CBD: t(1/2), tmax, CLr and F(e,u)
The following are presented for 7-OH-CBD; * Mean t(1/2) * Mean tmax * Mean CLr * Mean F(e,u)
Time frame: Pre-dose (t=0) and up to 48 hours post-dose
Pharmacokinetic parameters of THC: Cmax(u), AUC(0-t(u)), AUC(0-∞(u)) and CLu/F
The following are presented for THC: * Mean unbound maximum (peak) plasma concentration of the drug (Cmax(u)) * Mean unbound area under the concentration-time curve calculated to the last observable concentration at time t (AUC(0-t(u))) * Mean unbound area under the concentration-time curve from time zero to infinity (AUC(0-∞(u))) * Mean apparent unbound clearance of drug from plasma (CLu/F)
Time frame: Pre-dose (t=0) and up to 48 hours post-dose
Pharmacokinetic parameters of 11-OH-THC: Cmax(u), AUC(0-t(u)) and AUC(0-∞(u))
The following are presented for 11-OH-THC: * Mean Cmax(u) * Mean AUC(0-t(u)) * Mean AUC(0-∞(u))
Time frame: Pre-dose (t=0) and up to 48 hours post-dose
Pharmacokinetic parameters of CBD: Cmax(u), AUC(0-t(u)), AUC(0-∞(u)) and CLuF
The following are presented for CBD: * Mean Cmax(u) * Mean AUC(0-t(u)) * Mean AUC(0-∞(u)) * Mean CLu/F
Time frame: Pre-dose (t=0) and up to 48 hours post-dose
Pharmacokinetic parameters of 7-OH-CBD: Cmax(u), AUC(0-t(u)) and AUC(0-∞(u))
The following are presented for 11-OH-THC: * Mean Cmax(u) * Mean AUC(0-t(u)) * Mean AUC(0-∞(u))
Time frame: Pre-dose (t=0) and up to 48 hours post-dose
The incidence of adverse events as a measure of subject safety
The number of subjects who experienced an adverse event during the study is presented. The time-frame for adverse event reporting was from screening to the follow-up visit.
Time frame: From screening to follow-up (a maximum of 24 days)
The number of subjects with a clinically significant change in physical and oral examination results, relative to pre-treatment baseline
The number of subjects with a change in physical and oral examination results indicative of an adverse event, relative to the pre-treatment baseline, is presented.
Time frame: From screening to follow-up (a maximum of 24 days)
The number of subjects with a clinically significant change in 12-lead electrocardiogram (ECG) results, relative to pre-treatment baseline
The number of subjects with a change in ECG results indicative of an adverse event, relative to the pre-treatment baseline, is presented.
Time frame: From screening to follow-up (a maximum of 24 days)
The number of subjects with clinically significant changes in laboratory test parameters, relative to pre-treatment baseline
The number of subjects with clinically significant changes in serum biochemistry, hematology and urinalysis, relative to the pretreatment baseline, is presented.
Time frame: From screening to follow-up (a maximum of 24 days)
The number of subjects with a clinically significant change in vital signs, relative to pre-treatment baseline
The number of subjects with a clinically significant change in vital signs (systolic blood pressure, diastolic blood pressure, pulse rate) indicative of an adverse event, relative to the pre-treatment baseline, is presented. A clinically significant drop in blood pressure is defined as a 20 mmHg drop in systolic or 10 mmHg drop in diastolic blood pressure associated with a clinical manifestation of postural hypotension after two minutes standing.
Time frame: From screening to follow-up (a maximum of 24 days)