The purpose of the study is to determine the clinical efficacy and safety of Maxigesic IV, acetaminophen IV, Ibuprofen IV versus placebo IV for the treatment of acute postoperative pain after bunionectomy
AFT Pharmaceuticals Ltd. has been developing a fixed-dose combination of acetaminophen 1000mg and ibuprofen 300mg/100mL solution for infusion (Maxigesic IV) for the temporary relief of postoperative pain, when administration by intravenous route is clinically justified by an urgent need to treat pain or hyperthermia and/or when other routes of administration not possible. A phase 3 efficacy study (AFT-MXIV-07) is proposed to determine the analgesic effects of the fixed dose combination product Maxigesic IV versus its individual components (acetaminophen IV and ibuprofen IV) and placebo in participants with acute post-operative pain after bunionectomy. The primary efficacy objective is to determine the efficacy of Maxigesic IV, acetaminophen IV, Ibuprofen IV versus placebo IV as measured by the summed pain intensity difference (SPID) (calculated as a time-weighted average) over 0-48 hours (SPID-48) after time 0. Other secondary efficacy endpoints are: VAS Pain intensity difference (PID) at each scheduled assessment time point after Time 0 VAS Pain intensity score at each scheduled assessment time point VAS SPID over 0 to 6 hours (SPID-6), over 0 to 12 hours (SPID-12), and over 0 to 24 hours (SPID-24) after Time 0 Summed pain relief (TOTPAR) (calculated as a time-weighted average) over 0 to 6 hours (TOTPAR-6), over 0 to 12 hours (TOTPAR-12), over 0 to 24 hours (TOTPAR-24) after Time 0, and over 0 to 48 hours (TOTPAR-48) after Time 0 Time to onset of analgesia (measured as time to perceptible pain relief confirmed by meaningful pain relief) using the two-stopwatch method Pain relief score on a 5-point categorical scale at each scheduled time point after Time 0 Peak pain relief Time to peak pain relief Time to first perceptible pain relief Time to meaningful pain relief Proportion of subjects using rescue medication Time to first use of rescue medication (duration of analgesia) Total use of rescue analgesia over 0 to 24 hours and over 0 to 48 hours Patient's global evaluation of study drug
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
276
IV acetaminophen 1000 mg and IV ibuprofen 300 mg /100 mL solution for infusion, 100mL, every 6 hours for 48 hours
IV Acetaminophen 1000 mg/100 mL solution for infusion, 100mL, every 6 hours for 48 hours
IV Ibuprofen 300 mg/100 mL solution for infusion, 100mL, every 6 hours for 48 hours
Chesapeake Reserach Group
Pasadena, Maryland, United States
Optimal Research
Austin, Texas, United States
Summed Pain Intensity Difference (SPID)-Calculated From the Pain Intensity Scores Recorded on a 100mm Long Scale With Anchors for "no Pain" (0 mm) and "Worst Pain Imaginable" (100 mm).
A Pain Intensity Difference (PID) is the difference between the Visual Analogue Scale (VAS) pain intensity score recorded at baseline and a score recorded at any time after the first dose of study medication. Taken together, a patient's PID scores capture the pain relief profile attributable to the assigned study medication. A high PID score indicates a better pain relief experienced. The extent of pain relief can then be calculated by the Area Under the Curve the PID scores (also referred to as the Sum of Pain Intensity Differences \[SPID\]). SPID48 scores were adjusted by the time interval from baseline to the final VAS score used in the SPID, using the following formula: Time-adjusted SPID48 (mm) = SPID (mm\*hr) / Time (hr) In the event that a patient required rescue medication, the SPID was calculated up until the first Pre-Rescue VAS pain assessment (inclusive).
Time frame: 48 hours after the first dose
VAS Pain Intensity Difference (PID)-Calculated From the Pain Intensity Scores Recorded on a 100mm Long VAS Scale With Anchors for "no Pain" (0 mm) and "Worst Pain Imaginable" (100 mm).
VAS Pain intensity difference (PID) at each scheduled assessment time point after Time 0. A Pain Intensity Difference (PID) is the difference between the Visual Analogue Scale (VAS) pain intensity score recorded at baseline and a score recorded at any time after the first dose of study medication. Taken together, a patient's PID scores capture the pain relief profile attributable to the assigned study medication. A high PID score indicates a better pain relief experienced.
Time frame: 48 hours after the first dose
VAS Pain Intensity Score-marking on a 100 mm VAS Scale With Anchors for "no Pain" (0 mm) and "Worst Pain Imaginable" (100 mm). A High VAS Score Indicates a More Intensive Pain Level Experienced.
VAS Pain intensity score at each scheduled assessment time point VAS pain intensity score-marking on a 100 mm VAS scale with anchors for "no pain" (0 mm) and "worst pain imaginable" (100 mm). A high VAS score indicates a more intensive pain level experienced.
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Placebo IV- 100 mL intravenous saline for infusion, 100mL, every 6 hours for 48 hours
Time frame: 48 hours after the first dose
SPID-6, SPID-12, SPID-24-VAS SPID Over 0 to 6 Hours (SPID-6), Over 0 to 12 Hours (SPID-12), and Over 0 to 24 Hours (SPID-24) After Time 0 (=the First Dose)
Time adjusted SPID-6, SPID-12, SPID-24 were derived in a similar manner to the Time-adjusted SPID-48 (i.e. up until the first Pre-Rescue VAS inclusive). Please see the primary outcome measure descriptions. Each of these variables were derived from VAS (Visual Analogue Scale) scores recorded prior to the first dose of rescue medication in the first 6 (to calculate SPID6), 12 (to calculate SPID12) or 24 hours (to calculate SPID24) of the study. VAS pain intensity scores were obtained by marking on a 100 mm VAS scale with anchors for "no pain" (0 mm) and "worst pain imaginable" (100 mm). The VAS was completed at rest.
Time frame: 6, 12, 24 hours after the first dose
TOTPAR-6, TOTPAR-12, TOTPAR-24, TOTPAR-48
Total Pain Relief (TOTPAR) is a measure of total Area Under the Curve of Pain Relief scores. In the event that a patient required rescue medication, the TOTPAR endpoints were calculated using Pain Relief Assessments recorded prior to the first dose of rescue (i.e. inclusive of the first pre-rescue Pain Relief score). Pain relief scores were obtained by marking on a 5-point categorical rating at scheduled time points. The high score means more pain relief experienced: 0 = No pain relief (the pain is the same, or worse, than the starting pain) 1. = A little pain relief (the pain is less than half gone) 2. = some pain relief (the pain is about half gone) 3. = A lot pain relief (the pain is more than half gone) 4. = Complete pain relief (the pain is completely gone) Each of these variables were derived from pain relief scores recorded prior to the first dose of rescue medication in the first 6 (0-48), 12 (0-48), 24 (0-48) or 48 (0-48) hours of the study.
Time frame: 6, 12, 24, 48 hours after the first dose
Time to the Onset of Analgesia-Time to Onset of Analgesia (Measured as Time to Perceptible Pain Relief Confirmed by Meaningful Pain Relief) Using the Two-stopwatch Method
Two-stopwatch method 1. Start two stopwatches ('Stopwatch A' and 'Stopwatch B') at the same time that the infusion of study drug is initiated. This is Time 0. 2. The participant is given 'Stopwatch A' and instructed to "Stop 'Stopwatch A' when you first feel any pain relief whatsoever. This does not mean you feel completely better, although you might, but when you first feel any relief in the pain you have now." (Perceptible Pain Relief) 3. When the participant stops the 'Stopwatch A', the participant then was asked "Do you consider the pain relief you experienced meaningful?" 4. If the participant answered "No", then the participant was given the "Stopwatch B" and instructed to "Stop 'Stopwatch B' when you feel the pain relief is meaningful to you" (Meaningful Pain Relief) 5. If the subject did not experience "perceptible pain relief, they would retain 'Stopwatch A' for the entire 6 hour evaluation period.
Time frame: 6 hours
Percentage of Participants With Complete Pain Relief
Pain relief score was assessed on a 5-point categorical scale at each scheduled time point after Time 0: 0 = No pain relief (the pain is the same, or worse, than the starting pain) 1. = A little pain relief (the pain is less than half gone) 2. = some pain relief (the pain is about half gone) 3. = A lot pain relief (the pain is more than half gone) 4. = Complete pain relief (the pain is completely gone) Assessed at scheduled time points: * 5, 10, 15, 30, 45 minutes, 1, 1.5, 2, 3, 4, 5, 6 hours after the first dose of the study drug * Immediately before and 2 hours after each subsequent dose (doses 2-8) of the study drug while awake * At the end of 48 hours of double-blind treatment period * Immediately before taking each dose of the rescue medication if additional analgesia is required. * At the time of withdrawal (if applicable)
Time frame: 48 hours after the first dose
Percentage of Participants Who Obtained a Peak Pain Relief -Value of 3 ('A Lot of Relief') or 4 ('Complete Relief') Prior to the First Dose of Rescue
Peak Pain Relief was assessed on Pain Relief scores (on a 5 point categorical rating-please see outcome measure description No. 7) recorded up until the first dose of rescue (First Pre-Rescue Pain Relief score inclusive). The percentage of participants who achieve the peak pain relief was summarized.
Time frame: 48 hours after the first dose
Time to Peak Pain Relief
Time to peak pain relief-Peak Pain Relief was assessed on Pain Relief scores recorded up until the first dose of rescue (First Pre-Rescue Pain Relief score inclusive). Time for participants who experienced peak pain relief was summarized. Note: For the reader to interpret this outcome measure, a very short Time to Peak Pain Relief indicates the absence of analgesic effect for a treatment because peak pain relief was determined prior to the first dose of rescue medication (or 48 hours if no rescue medication was used).
Time frame: 48 hrs after the first dose
Percentage of Subjects Using Rescue Medication
The percentage of participants who used at lease one dose of rescue medication was summarized in each treatment group
Time frame: 48 hrs after the first dose
Time to the First Dose of Rescue Medication
Time to first use of rescue medication (duration of analgesia)
Time frame: 48 hrs
Total Use of Rescue Medication
Total use of rescue analgesia over 0 to 24 hours and over 0 to 48 hours
Time frame: 24, 48 hrs after the first dose
The Percentage of Participants Who Evaluated Their Study Drug as " Excellent" on a 5-point Categorical Scale Global Evaluation of Study Drug
At the end of 48 hours study period, participants will be asked to " How do you rate the study medication?" on a 5 point categorical scale: 1. Poor 2. Fair 3. Good 4. Very Good 5. Excellent The high score means the participants believed that a better treatment for pain relief received.
Time frame: 48 hrs after the first dose
Number of Participants With Treatment Emergent Adverse Events (AEs)
Treatment-emergent Adverse events coded to MedDRA v 20.0 Preferred Term and System Organ Class Code were tabulated as the counts and percentages by treatment group.
Time frame: Day 7