The goal of this clinical trial is to evaluate the analgesic activity of PF614 (an oral oxycodone prodrug extended-release analgesic) for control of postsurgical pain in subjects scheduled for abdominoplasty surgery. The main question to be answered is: • To assess the analgesic efficacy of PF614 compared to placebo in subjects with moderate to severe pain following abdominoplasty. Participants will be asked to take oral blinded doses of study medication at about one hour before surgery starts, and then every 12 hours after surgery for up to 4 days. Participants will be asked to: * Rate their pain on a 0-10 numerical rating scale (NRS) at various timepoints up to 5 days following surgery; * Tell us about the need for rescue medication if they continue to have moderate-to-severe pain; * Tell us about any side effects or adverse effects that they may experience to help us understand the safety and tolerability of the test medications; * Provide periodic blood samples to help us understand how much study drug is in their system. Participants will stay in a clinic setting and be monitored for safety for 5 days following surgery. We anticipate that participants will be discharged on Day 5, pending medical review, and then keep a diary to record study-related pain and adverse effects for an additional 2-4 days after discharge.
This will be a Phase 3, multicenter, randomized, double-blind, placebo-controlled study to evaluate the efficacy and safety of PF614 in the treatment of moderate to severe acute postoperative pain following abdominoplasty. The study will be conducted in 4 phases: Screening, Treatment, Outpatient and Follow-up. Screening Phase Prospective participants will complete a standard medical screening within 28 days of the abdominoplasty procedure. At Screening, participants will provide written informed consent to participate in the study before any protocol-specified procedures or assessments are conducted. Treatment Phase The Treatment Phase will begin on the day of the abdominoplasty procedure (Day 1) and will end on postoperative Day 5. Participants will be admitted to the study center on the morning of the scheduled procedure and will be confined throughout the Treatment Phase (5 days, 4 nights). Days 1-4 (0-72 hours): Randomized Treatment Period Following admission to the study center, presurgical procedures will include participant training on pain intensity assessments, which will be administered as 11-point numerical rating scales (NRS). Participants who continue to meet all study entry criteria will be randomized prior to the abdominoplasty procedure in a 1:1:1:1 ratio to 1 of 4 treatment groups. Treatment groups will include the following doses: PF614 25 mg, PF614 37.5 mg, PF614 50 mg, and Placebo. The first dose of study drug will be administered 1 hour (±15 minutes) prior to the scheduled start time of the abdominoplasty procedure (i.e., prior to time of anesthetic induction). Time 0 is defined as the time of first study drug administration. Additional doses of study drug will be provided every 12 hours (BID) (±15 minutes), with the last scheduled study drug administration at 72 hours. Qualified medical personnel and/or investigators who are ACLS (Advanced Cardiovascular Life Support) certified will be present in the clinic during the inpatient treatment phase when participants are administered opioid medications. Participants will undergo a full abdominoplasty procedure without liposuction or other collateral procedures under a standardized anesthetic protocol. Prior to wound closure, the surgeon will perform a transversalis abdominal plane (TAP) block by infiltrating 1% lidocaine with epinephrine 7 mg/kg with a maximum dose of 500 mg. Participants may be administered supplemental oxygen for at least the first 2 hours postoperatively (end of surgery defined as time of extubation), and the participant will be weaned as clinically appropriate. Participants may receive hydrocodone/acetaminophen APAP (HC/APAP) 5 mg/325 mg every 6 hours as rescue medication, up to a maximum of 20 mg/1300 mg every 24 hours. If HC/APAP is administered, participants will not be eligible to receive additional HC/APAP for the following 6 hours. Pain intensity (11-point NRS) assessments at rest (NRS-R; minimum 3-minute rest) and then with movement (NRS-A, where movement is defined as moving from a semi-supine or supine to sitting position without assistance) will be recorded at scheduled times (if participants are asleep, they will be awoken for scheduled assessments) during the inpatient period, and NRS-R and NRS-A will be recorded immediately before each use of rescue medication. Study drug will be administered after assessment of pain at each time point when dosing and pain assessments overlap. Pain intensity will also be recorded before early study discontinuation. Blood will be collected for pharmacokinetic (PK) analysis; observer-rated assessments of sedation (using the Modified Observer's Assessment of Alertness/Sedation Scale \[MOAA/S\]) will be conducted at pre-specified time points. In the event of treatment discontinuation, participants will continue to be followed and will be encouraged, though not required, to complete any remaining study assessments to minimize the occurrence of missing data. Days 4-5 (72-96 hours): Predischarge Period Participants will remain inpatient for approximately 24 hours after the last scheduled study drug administration. Participants will complete a Patient Global Assessment (PGA) of satisfaction with study treatment at 84 (±2) hours or early discontinuation. During this period, participants may be administered standard of care to manage their pain, which will be recorded as concomitant medications. Pain intensity, PK, and safety assessments will be conducted at pre-specified time points until discharge on Day 5 (\~96 hours). Outpatient and Follow-up Phases Before discharge from the study center, study personnel will dispense a prescription for pain medication (if necessary) and an outpatient participant diary. Participants will be instructed to record use of any concomitant medications and adverse events (AEs) experienced after discharge in their outpatient participant diaries. Participants will also record their worst pain intensity in the last 24 hours at the end of each day and their current ("right now") pain intensity prior to use of any medication taken for pain. Participants will be instructed to return the outpatient participant diaries to study personnel at the follow-up visit, scheduled to occur 7 to 9 days after the abdominoplasty procedure.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
320
Experimental oxycodone prodrug
Inactive medication
CenExel / Atlanta Center for Medical Research (ACMR)
Atlanta, Georgia, United States
RECRUITINGHD Research - Memorial Hermann Surgery Center
Houston, Texas, United States
RECRUITINGCenExel / JBR
Salt Lake City, Utah, United States
RECRUITINGPain NRS-R area under the curve through 48 hours (AUC4-48)
Pain at rest
Time frame: 4-48 hours
Pain NRS-A area under the curve through 48 hours (AUC4-48)
Pain with activity
Time frame: 4-48 hours
Pain NRS-R and NRS-A
Partial AUCs (AUC4-12, AUC4-24, AUC4-36, AUC4-72, AUC12-24, AUC24-36, AUC36-48, AUC24 48, AUC48-72, AUC72-84, AUC72-96); AUC4-84; AUC4-96
Time frame: 4-96 hours
Time to first use of rescue opioid medication
Time to first use of rescue opioid medication through 96 hours
Time frame: 0-96 hours
Total rescue opioid consumption through 24, 48, and 72 hours
Use of rescue opioid medication for up to 72 hours after surgery
Time frame: 72 hours
Proportion of participants who take at least 1 dose of rescue opioid medication
Need for opioid rescue medication
Time frame: Up to 12, 24, 36, 48, and 72 hours
Total rescue opioid consumption 72 through 96 hours
Need for rescue opioid medication
Time frame: 0-96 hours
Proportion of participants who discontinue from the inpatient treatment period early for any reason
Discontinuations
Time frame: 5 days
Scores on PGA of satisfaction with study treatment
Patient Global Assessment (PGA) of study treatment
Time frame: 96 hours
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