This is a non-randomised, single arm, open-label study of medical cannabis, Cybis™ 10:25, in participants with chronic back or neck pain in which participants receive escalating doses of Cybis™ 10:25.
This is a non-randomised, single arm, open-label study of Cybis™ 10:25 in participants with chronic back or neck pain in which participants receive escalating doses of Cybis™ 10:25. The purpose of the study is to demonstrate the safety and tolerability of Cybis™ 10:25 in participants with moderate to severe chronic back or neck pain that is unresponsive to over-the-counter non-opioid analgesics. Participants will undergo a screening visit, then seven clinic visits (Day 1, 2, 8, 15, 22, 29, and 35). Cybis™ 10:25 will be administered oromucosally at doses varying from 0.5 mL once daily to 1.5 mL twice daily. Total duration of dosing is 28 days.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
28
Cybis™ 10:25 containing 10 mg/mL of D9-THC and 25 mg/mL of CBD, formulated in medium chain triglycerides (MCT)
ACRN - Australian Clinical Research Network
Maroubra, New South Wales, Australia
Holdsworth House Medical Practice
Sydney, New South Wales, Australia
Number (and percentage) of participants with one or more adverse event
To assess the safety and tolerability of Cybis™ 10:25 at low (0.5 mL qd), medium-low (0.5 mL bd), medium (1.0 mL bd) and high (1.5 mL bd) doses.
Time frame: Safety and tolerability will be assessed throughout the trial. Up to 35 days.
Number (and percentage) of participants with one or more adverse event of special interest
To assess the safety and tolerability of Cybis™ 10:25 at low (0.5 mL qd), medium-low (0.5 mL bd), medium (1.0 mL bd) and high (1.5 mL bd) doses.
Time frame: Safety and tolerability will be assessed throughout the trial. Up to 35 days.
Number (and percentage) of participants with one or more serious adverse events
To assess the safety and tolerability of Cybis™ 10:25 at low (0.5 mL qd), medium-low (0.5 mL bd), medium (1.0 mL bd) and high (1.5 mL bd) doses.
Time frame: Safety and tolerability will be assessed throughout the trial. Up to 35 days.
Adverse events, adverse events of special interest, serious adverse events will be summarised descriptively with the number of participants experiencing the event and the percentages of participants experiencing the event.
To assess the safety and tolerability of Cybis™ 10:25 at low (0.5 mL qd), medium-low (0.5 mL bd), medium (1.0 mL bd) and high (1.5 mL bd) doses.
Time frame: Safety and tolerability will be assessed throughout the trial. Up to 35 days.
Number (and percentage) of participants with changes in vital signs
To assess the safety and tolerability of Cybis™ 10:25 at low (0.5 mL qd), medium-low (0.5 mL bd), medium (1.0 mL bd) and high (1.5 mL bd) doses.
Time frame: Safety and tolerability will be assessed throughout the trial. Up to 35 days.
Number (and percentage) of participants with clinically relevant changes in physical examination
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
To assess the safety and tolerability of Cybis™ 10:25 at low (0.5 mL qd), medium-low (0.5 mL bd), medium (1.0 mL bd) and high (1.5 mL bd) doses.
Time frame: Safety and tolerability will be assessed throughout the trial. Up to 35 days.
Number (and percentage) of participants with clinically relevant changes in clinical chemistry
To assess the safety and tolerability of Cybis™ 10:25 at low (0.5 mL qd), medium-low (0.5 mL bd), medium (1.0 mL bd) and high (1.5 mL bd) doses.
Time frame: Safety and tolerability will be assessed throughout the trial. Up to 35 days.
Number (and percentage) of participants who drop-out
To assess the safety and tolerability of Cybis™ 10:25 at low (0.5 mL qd), medium-low (0.5 mL bd), medium (1.0 mL bd) and high (1.5 mL bd) doses.
Time frame: Safety and tolerability will be assessed throughout the trial. Up to 35 days.
Number (and percentage) of participants who withdraw due to adverse events
To assess the safety and tolerability of Cybis™ 10:25 at low (0.5 mL qd), medium-low (0.5 mL bd), medium (1.0 mL bd) and high (1.5 mL bd) doses.
Time frame: Safety and tolerability will be assessed throughout the trial. Up to 35 days.
To investigate the pharmacokinetics of Cybis™ 10:25 in participants with chronic back and neck pain following single and repeated doses. Peak plasma concentration (Cmax) of THC in plasma.
To investigate the pharmacokinetics of Cybis™ 10:25 in participants with chronic back and neck pain following single and repeated doses. The concentration at peak (Cmax) will be calculated for THC. Pharmacokinetic calculations will be conducted for each dose level individually.
Time frame: Up to 29 days. Samples collected at baseline 0 (pre-dose), 0.25, 0.5, 1.0, 1.5, 2.0, 2.5, 3.0, 3.5, 4.0, 5.0, 6.0, 9.0, 12.0, and 24.0 hours post dosing. Day 8, 15, 22 and 29 trough levels.
To investigate the pharmacokinetics of Cybis™ 10:25 in participants with chronic back and neck pain following single and repeated doses. Time to maximum concentration (tmax) of THC in plasma.
To investigate the pharmacokinetics of Cybis™ 10:25 in participants with chronic back and neck pain following single and repeated doses. The time to reach peak (tmax) will be calculated for THC. Pharmacokinetic calculations will be conducted for each dose level individually.
Time frame: Up to 29 days. Samples collected at baseline 0 (pre-dose), 0.25, 0.5, 1.0, 1.5, 2.0, 2.5, 3.0, 3.5, 4.0, 5.0, 6.0, 9.0, 12.0, and 24.0 hours post dosing. Day 8, 15, 22 and 29 trough levels.
To investigate the pharmacokinetics of Cybis™ 10:25 in participants with chronic back and neck pain following single and repeated doses. Area under the concentration/time curve (AUC) will be calculated for THC.
To investigate the pharmacokinetics of Cybis™ 10:25 in participants with chronic back and neck pain following single and repeated doses. The area under the concentration/time curve (AUC) will be calculated for THC. Pharmacokinetic calculations will be conducted for each dose level individually.
Time frame: Up to 29 days. Samples collected at baseline 0 (pre-dose), 0.25, 0.5, 1.0, 1.5, 2.0, 2.5, 3.0, 3.5, 4.0, 5.0, 6.0, 9.0, 12.0, and 24.0 hours post dosing. Day 8, 15, 22 and 29 trough levels.
To investigate the pharmacokinetics of Cybis™ 10:25 in participants with chronic back and neck pain following single and repeated doses. The elimination half-life (t1/2) will be calculated for THC.
To investigate the pharmacokinetics of Cybis™ 10:25 in participants with chronic back and neck pain following single and repeated doses. The elimination half-life (t1/2) will be calculated for THC. Pharmacokinetic calculations will be conducted for each dose level individually.
Time frame: Up to 29 days. Samples collected at baseline 0 (pre-dose), 0.25, 0.5, 1.0, 1.5, 2.0, 2.5, 3.0, 3.5, 4.0, 5.0, 6.0, 9.0, 12.0, and 24.0 hours post dosing. Day 8, 15, 22 and 29 trough levels.
To investigate the pharmacokinetics of Cybis™ 10:25 in participants with chronic back and neck pain following single and repeated doses. Peak plasma concentration (Cmax) of CBD in plasma.
To investigate the pharmacokinetics of Cybis™ 10:25 in participants with chronic back and neck pain following single and repeated doses. The concentration at peak (Cmax) will be calculated for CBD. Pharmacokinetic calculations will be conducted for each dose level individually.
Time frame: Up to 29 days. Samples collected at baseline 0 (pre-dose), 0.25, 0.5, 1.0, 1.5, 2.0, 2.5, 3.0, 3.5, 4.0, 5.0, 6.0, 9.0, 12.0, and 24.0 hours post dosing. Day 8, 15, 22 and 29 trough levels.
To investigate the pharmacokinetics of Cybis™ 10:25 in participants with chronic back and neck pain following single and repeated doses. Time to maximum concentration (tmax) of CBD in plasma.
To investigate the pharmacokinetics of Cybis™ 10:25 in participants with chronic back and neck pain following single and repeated doses. The Time to maximum concentration (tmax) will be calculated for CBD. Pharmacokinetic calculations will be conducted for each dose level individually.
Time frame: Up to 29 days. Samples collected at baseline 0 (pre-dose), 0.25, 0.5, 1.0, 1.5, 2.0, 2.5, 3.0, 3.5, 4.0, 5.0, 6.0, 9.0, 12.0, and 24.0 hours post dosing. Day 8, 15, 22 and 29 trough levels.
To investigate the pharmacokinetics of Cybis™ 10:25 in participants with chronic back and neck pain following single and repeated doses. The area under the concentration/time curve (AUC) will be calculated for CBD.
To investigate the pharmacokinetics of Cybis™ 10:25 in participants with chronic back and neck pain following single and repeated doses. The area under the concentration/time curve (AUC) will be calculated for CBD. Pharmacokinetic calculations will be conducted for each dose level individually.
Time frame: Up to 29 days. Samples collected at baseline 0 (pre-dose), 0.25, 0.5, 1.0, 1.5, 2.0, 2.5, 3.0, 3.5, 4.0, 5.0, 6.0, 9.0, 12.0, and 24.0 hours post dosing. Day 8, 15, 22 and 29 trough levels.
To investigate the pharmacokinetics of Cybis™ 10:25 in participants with chronic back and neck pain following single and repeated doses. The elimination half-life (t1/2) will be calculated for CBD.
To investigate the pharmacokinetics of Cybis™ 10:25 in participants with chronic back and neck pain following single and repeated doses. The elimination half-life (t1/2) will be calculated for CBD. Pharmacokinetic calculations will be conducted for each dose level individually.
Time frame: Up to 29 days. Samples collected at baseline 0 (pre-dose), 0.25, 0.5, 1.0, 1.5, 2.0, 2.5, 3.0, 3.5, 4.0, 5.0, 6.0, 9.0, 12.0, and 24.0 hours post dosing. Day 8, 15, 22 and 29 trough levels.
To investigate the dose-response relationship between Cybis™ 10:25 and pain response, as measured by the change from baseline in Numerical Pain Rating Scale (NPRS)
To investigate the dose-response relationship between Cybis™ 10:25 and pain response as measured by the change from baseline in Numerical Pain Rating Scale (NPRS). The NPRS is an 11-point scale between 0 (no pain) and 10 (worst pain ever possible). The minimum clinically significant change in NPRS is two points. The NPRS has been validated for use in participant with low back pain. Baseline pain levels are considered the NPRS at Day 1, irrespective of dose cohort. Change from baseline will be calculated as the pain level at the end of a dose cohort (Day 8 for 0.5 mL once daily; Day 15 for 0.5 mL bd; Day 22 for 1.0 mL bd; or Day 29 for 1.5 mL bd) minus the Day 1 value.
Time frame: Baseline (pre-dose), Day 1, 8, 15, 22, 29 and 35
To investigate the dose-response relationship between Cybis™ 10:25 and pain response, as measured by the change from baseline in Brief Pain Inventory - Short Form.
To investigate the dose-response relationship between Cybis™ 10:25 and pain response as measured by the change from baseline in Brief Pain Inventory - Short Form. The Brief Pain Inventory-Short Form is a questionnaire that assesses worst pain in the last 24 hours, least pain in the last 24 hours, average pain, and pain 'right now' along with the interference the pain causes on general activity, mood, walking ability, normal work, relations with others, sleep and enjoyment of life. It will be scored according to its scoring manual \[24\]. Scores will be summarised at baseline, Day 8, 15, 22, 29 and 35.
Time frame: Baseline (pre-dose), Day 1, 8, 15, 22, 29 and 35
To investigate the dose-response relationship between Cybis™ 10:25 and quality of life as measured by the change from baseline in Depression Anxiety Stress Scale.
To investigate the dose-response relationship between Cybis™ 10:25 and quality of life as measured by the change from baseline in Depression Anxiety Stress Scale. The Depression Anxiety Stress Scale (DASS) is a 21-item self-report instrument used to measure depression, anxiety and stress. The DASS will be scored according to its scoring manual. Participants will be categorised as having normal, mild, moderate, severe, or extremely severe symptoms. Lower scores indicate normal symptoms, whereas higher scores indicate severe symptoms. Changes from baseline in DASS subscale scores will be used to investigate the dose-response relationship.
Time frame: Baseline (pre-dose), Day 1, 8, 15, 22, 29 and 35
To investigate the dose-response relationship between Cybis™ 10:25 and quality of life as measured by the change from baseline in Medical Outcomes Sleep Survey.
To investigate the dose-response relationship between Cybis™ 10:25 and quality of life as measured by the change from baseline in Medical Outcomes Sleep Survey. The Medical Outcomes Sleep Scale is a 12-item scale that assesses sleep disturbance, sleep adequacy, somnolence, quantity of sleep, snoring, and awakening short of breath or with a headache. It will be scored according to its scoring manual. The change in MOS Sleep Problems Index will be used to investigate the dose-response relationship.
Time frame: Baseline (pre-dose), Day 1, 8, 15, 22, 29 and 35
To investigate the dose-response relationship between Cybis™ 10:25 and quality of life as measured by the change from baseline in Self-Assessment of Treatment (SAT-II) scale.
To investigate the dose-response relationship between Cybis™ 10:25 and quality of life as measured by the change from baseline in in Self-Assessment of Treatment (SAT-II) scale. The Self-Assessment of Treatment is a 9-item scale that measures treatment satisfaction in the previous seven days. It assesses pain, self-care activities, daily activities, physical activities, emotional well-being, sleep and social functioning, all assessed on a 5-point Likert scale. It also captures how likely the respondent would be willing to receive the study treatment again, and how study treatment compares to other treatments. The SAT-II has been validated, and is considered an acceptable endpoint for pain studies. The change in Self-Assessment of Treatment score will be used to investigate the dose-response relationship.
Time frame: Baseline (pre-dose), Day 1, 8, 15, 22, 29 and 35
To investigate rescue medication use in participants prescribed Cybis™ 10:25 (proportion of patients requiring rescue medication, the number of doses of rescue medication required, the time to rescue medication).
To investigate rescue medication use in participants prescribed Cybis™ 10:25 for chronic back and neck pain. The proportion of patients requiring rescue medication and the number of doses of rescue medication required will be analysed descriptively. The time to first dose of rescue medication will be calculated using Kaplan-Meier methods.
Time frame: Day 1, 8, 15, 22, 29 and 35