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NCT01122030

Study to Evaluate the Safety and Efficacy of Naldemedine (S-297995) for the Treatment of Opioid-Induced Bowel Dysfunction in Subjects With Chronic Pain

Completed Phase 2 Results posted Last updated 30 May 2017
What this trial tests

Phase 2 trial testing Naldemedine in Opioid Induced Bowel Dysfunction in 72 participants. Completed in 22 March 2011.

Timeline
19 May 2010
Primary endpoint
23 February 2011
22 March 2011

Quick facts

Lead sponsorShionogi
PhasePhase 2
StatusCompleted
Study typeINTERVENTIONAL
Allocationrandomized
Designsingle group
Maskingtriple
Primary purposetreatment
Enrollment72
Start date19 May 2010
Primary completion23 February 2011
Estimated completion22 March 2011
Sites1 location across United States

Drugs / interventions tested

Conditions studied

Sponsor

Shionogi — full company profile →

Who can join

Adults 18 to 65, any sex, with Opioid Induced Bowel Dysfunction. Patients with the condition only — healthy volunteers not accepted.

Results — posted to ClinicalTrials.gov

Per-arm endpoint measurements with 95% confidence intervals where reported. Source: trial results section.

Number of Participants With Adverse Events Primary · From the first dose of study drug on Day 15 up to Day 24.

Severity of adverse events (AEs) was graded according to the following definitions: * Mild: The subject experiences awareness of symptoms but these are easily tolerated or managed without specific treatment * Moderate: The subject experiences discomfort enough to cause interference with usual activity, and/or the condition requires specific treatment * Severe: The subject is incapacitated with inability to work or do usual activity, and/or the event requires significant treatment measures. The relationship of the event to the study drug was determined by the investigator. A serious adverse

Any adverse event
GroupValue95% CI
Pooled Placebo9
Naldemedine 0.01 mg6
Naldemedine 0.03 mg6
Naldemedine 0.1 mg5
Naldemedine 0.3 mg9
Naldemedine 1 mg9
Naldemedine 3 mg9
Mild adverse events
GroupValue95% CI
Pooled Placebo9
Naldemedine 0.01 mg6
Naldemedine 0.03 mg6
Naldemedine 0.1 mg4
Naldemedine 0.3 mg6
Naldemedine 1 mg5
Naldemedine 3 mg1
Moderate adverse events
GroupValue95% CI
Pooled Placebo0
Naldemedine 0.01 mg0
Naldemedine 0.03 mg0
Naldemedine 0.1 mg1
Naldemedine 0.3 mg3
Naldemedine 1 mg3
Naldemedine 3 mg2
Severe adverse events
GroupValue95% CI
Pooled Placebo0
Naldemedine 0.01 mg0
Naldemedine 0.03 mg0
Naldemedine 0.1 mg0
Naldemedine 0.3 mg0
Naldemedine 1 mg1
Naldemedine 3 mg6
Treatment-related adverse events
GroupValue95% CI
Pooled Placebo6
Naldemedine 0.01 mg5
Naldemedine 0.03 mg3
Naldemedine 0.1 mg1
Naldemedine 0.3 mg9
Naldemedine 1 mg8
Naldemedine 3 mg9
Deaths
GroupValue95% CI
Pooled Placebo0
Naldemedine 0.01 mg0
Naldemedine 0.03 mg0
Naldemedine 0.1 mg0
Naldemedine 0.3 mg0
Naldemedine 1 mg0
Naldemedine 3 mg0
Serious adverse events
GroupValue95% CI
Pooled Placebo0
Naldemedine 0.01 mg0
Naldemedine 0.03 mg0
Naldemedine 0.1 mg0
Naldemedine 0.3 mg0
Naldemedine 1 mg0
Naldemedine 3 mg0
Adverse events leading to discontinuation
GroupValue95% CI
Pooled Placebo0
Naldemedine 0.01 mg0
Naldemedine 0.03 mg0
Naldemedine 0.1 mg0
Naldemedine 0.3 mg0
Naldemedine 1 mg0
Naldemedine 3 mg0
Change From Baseline to 24 Hours Post-dose in Number of Spontaneous Bowel Movements (SBMs) Per Day Secondary · Baseline (Day 1 to Day 15) and Day 15 to 16 (0 to 24 hours post-dose)

Participants completed a bowel function assessment daily diary to record information about bowel movements and constipation. A spontaneous bowel movement was defined as a bowel movement where no laxative or enema was used in the 24 hours preceding the bowel movement. Baseline was defined as the average number of SBMs per day during the 2 weeks prior to receiving study drug (Day 1 to Day 15).

Baseline
GroupValue95% CI
Pooled Placebo0.15± 0.13
Naldemedine 0.01 mg0.20± 0.14
Naldemedine 0.03 mg0.24± 0.09
Naldemedine 0.1 mg0.13± 0.13
Naldemedine 0.3 mg0.17± 0.12
Naldemedine 1 mg0.13± 0.09
Naldemedine 3 mg0.23± 0.11
24 hours post-dose
GroupValue95% CI
Pooled Placebo0.44± 0.51
Naldemedine 0.01 mg0.11± 0.33
Naldemedine 0.03 mg0.67± 0.71
Naldemedine 0.1 mg0.56± 0.73
Naldemedine 0.3 mg2.00± 1.32
Naldemedine 1 mg3.89± 3.06
Naldemedine 3 mg5.00± 2.12
Change from Baseline to 24 hours post-dose
GroupValue95% CI
Pooled Placebo0.29± 0.48
Naldemedine 0.01 mg-0.09± 0.41
Naldemedine 0.03 mg0.42± 0.72
Naldemedine 0.1 mg0.43± 0.68
Naldemedine 0.3 mg1.83± 1.34
Naldemedine 1 mg3.76± 3.06
Naldemedine 3 mg4.77± 2.15
Change From Baseline to 48 Hours Post-dose in the Number of SBMs Per Day Secondary · Baseline (Day 1 to Day 15) and Day 15 to Day 17 (0 to 48 hours post-dose)

Participants completed a bowel function assessment daily diary to record information about bowel movements and constipation. A spontaneous bowel movement was defined as a bowel movement where no laxative or enema was used in the 24 hours preceding the bowel movement. Baseline was defined as the average number of SBMs per day during the 2 weeks prior to receiving study drug (Day 1 to Day 15). Forty-eight hours post-dose was defined as the average number of SBMs per day from 0 to 48 hours post-dose.

Baseline
GroupValue95% CI
Pooled Placebo0.15± 0.13
Naldemedine 0.01 mg0.20± 0.14
Naldemedine 0.03 mg0.24± 0.09
Naldemedine 0.1 mg0.13± 0.13
Naldemedine 0.3 mg0.17± 0.12
Naldemedine 1 mg0.13± 0.09
Naldemedine 3 mg0.23± 0.11
48 hours post-dose
GroupValue95% CI
Pooled Placebo0.36± 0.33
Naldemedine 0.01 mg0.44± 0.39
Naldemedine 0.03 mg0.67± 0.61
Naldemedine 0.1 mg0.39± 0.49
Naldemedine 0.3 mg1.06± 0.68
Naldemedine 1 mg2.28± 1.80
Naldemedine 3 mg2.67± 1.03
Change from Baseline to 48 hours post-dose
GroupValue95% CI
Pooled Placebo0.21± 0.32
Naldemedine 0.01 mg0.24± 0.39
Naldemedine 0.03 mg0.42± 0.65
Naldemedine 0.1 mg0.26± 0.45
Naldemedine 0.3 mg0.88± 0.68
Naldemedine 1 mg2.15± 1.81
Naldemedine 3 mg2.44± 1.05
Change From Baseline to 24 Hours Post-dose in Number of Bowel Movements (BM) Per Day Secondary · Baseline and 24 hours post-dose

Participants completed a bowel function assessment daily diary to record information about bowel movements and constipation. Baseline was defined as the average number of BMs per day during the 2 weeks prior to receiving study drug (Day 1 to Day 15).

Baseline
GroupValue95% CI
Pooled Placebo0.35± 0.18
Naldemedine 0.01 mg0.34± 0.10
Naldemedine 0.03 mg0.41± 0.22
Naldemedine 0.1 mg0.35± 0.17
Naldemedine 0.3 mg0.33± 0.12
Naldemedine 1 mg0.29± 0.09
Naldemedine 3 mg0.38± 0.19
24 hours post-dose
GroupValue95% CI
Pooled Placebo0.50± 0.62
Naldemedine 0.01 mg0.11± 0.33
Naldemedine 0.03 mg0.67± 0.71
Naldemedine 0.1 mg0.56± 0.73
Naldemedine 0.3 mg2.00± 1.32
Naldemedine 1 mg3.89± 3.06
Naldemedine 3 mg5.00± 2.12
Change from Baseline to 24 hours post-dose
GroupValue95% CI
Pooled Placebo0.15± 0.65
Naldemedine 0.01 mg-0.23± 0.36
Naldemedine 0.03 mg0.25± 0.75
Naldemedine 0.1 mg0.21± 0.76
Naldemedine 0.3 mg1.67± 1.35
Naldemedine 1 mg3.60± 3.10
Naldemedine 3 mg4.62± 2.06
Change From Baseline to 48 Hours Post-dose in Number of Bowel Movements Per Day Secondary · Baseline and 48 hours post-dose

Participants completed a bowel function assessment daily diary to record information about bowel movements and constipation. Baseline was defined as the average number of BMs per day during the 2 weeks prior to receiving study drug (Day 1 to Day 15). Forty-eight hours post-dose was defined as the average number of BMs per day from 0 to 48 hours post-dose.

Baseline
GroupValue95% CI
Pooled Placebo0.35± 0.18
Naldemedine 0.01 mg0.34± 0.10
Naldemedine 0.03 mg0.41± 0.22
Naldemedine 0.1 mg0.35± 0.17
Naldemedine 0.3 mg0.33± 0.12
Naldemedine 1 mg0.29± 0.09
Naldemedine 3 mg0.38± 0.19
48 hours post-dose
GroupValue95% CI
Pooled Placebo0.50± 0.51
Naldemedine 0.01 mg0.61± 0.49
Naldemedine 0.03 mg0.72± 0.71
Naldemedine 0.1 mg0.56± 0.46
Naldemedine 0.3 mg1.06± 0.68
Naldemedine 1 mg2.28± 1.80
Naldemedine 3 mg2.67± 1.03
Change from baseline to 48 hours post-dose
GroupValue95% CI
Pooled Placebo0.15± 0.53
Naldemedine 0.01 mg0.27± 0.51
Naldemedine 0.03 mg0.31± 0.67
Naldemedine 0.1 mg0.21± 0.52
Naldemedine 0.3 mg0.72± 0.70
Naldemedine 1 mg1.99± 1.82
Naldemedine 3 mg2.29± 0.98
Change From Baseline to 24 Hours Post-dose in Number of Complete Spontaneous Bowel Movements (CSBMs) Per Day Secondary · Baseline and 24 hours post-dose

Participants completed a bowel function assessment daily diary to record information about bowel movements and constipation. A complete spontaneous bowel movement was defined as a bowel movement where no laxative or enema was used and the bowel movement resulted in a sensation of complete evacuation (based on the question of "having a feeling of complete emptying after the bowel movement"). Baseline was defined as the average number of CSBMs per day during the 2 weeks prior to receiving study drug (Day 1 to Day 15).

Baseline
GroupValue95% CI
Pooled Placebo0.03± 0.06
Naldemedine 0.01 mg0.07± 0.09
Naldemedine 0.03 mg0.07± 0.08
Naldemedine 0.1 mg0.06± 0.10
Naldemedine 0.3 mg0.01± 0.03
Naldemedine 1 mg0.03± 0.04
Naldemedine 3 mg0.10± 0.07
24 hours post-dose
GroupValue95% CI
Pooled Placebo0.06± 0.24
Naldemedine 0.01 mg0.00± 0.00
Naldemedine 0.03 mg0.11± 0.33
Naldemedine 0.1 mg0.22± 0.44
Naldemedine 0.3 mg0.11± 0.33
Naldemedine 1 mg2.44± 2.55
Naldemedine 3 mg3.00± 3.20
Change from Baseline to 24 hours post-dose
GroupValue95% CI
Pooled Placebo0.02± 0.25
Naldemedine 0.01 mg-0.07± 0.09
Naldemedine 0.03 mg0.04± 0.29
Naldemedine 0.1 mg0.16± 0.44
Naldemedine 0.3 mg0.10± 0.34
Naldemedine 1 mg2.42± 2.55
Naldemedine 3 mg2.90± 3.24
Change From Baseline to 48 Hours Post-dose in Number of Complete Spontaneous Bowel Movements (CSBMs) Per Day Secondary · Baseline and 48 hours post-dose

Participants completed a bowel function assessment daily diary to record information about bowel movements and constipation. A complete spontaneous bowel movement was defined as a bowel movement where no laxative or enema was used and the bowel movement resulted in a sensation of complete evacuation (based on the question of "having a feeling of complete emptying after the bowel movement"). Baseline was defined as the average number of CSBMs per day during the 2 weeks prior to receiving study drug (Day 1 to Day 15). Forty-eight hours post-dose was defined as the average number of CSBMs per da

Baseline
GroupValue95% CI
Pooled Placebo0.03± 0.06
Naldemedine 0.01 mg0.07± 0.09
Naldemedine 0.03 mg0.07± 0.08
Naldemedine 0.1 mg0.06± 0.10
Naldemedine 0.3 mg0.01± 0.03
Naldemedine 1 mg0.03± 0.04
Naldemedine 3 mg0.10± 0.07
48 hours post-dose
GroupValue95% CI
Pooled Placebo0.08± 0.19
Naldemedine 0.01 mg0.17± 0.25
Naldemedine 0.03 mg0.17± 0.25
Naldemedine 0.1 mg0.17± 0.35
Naldemedine 0.3 mg0.06± 0.17
Naldemedine 1 mg1.39± 1.34
Naldemedine 3 mg1.61± 1.52
Change from baseline to 48 hours post-dose
GroupValue95% CI
Pooled Placebo0.05± 0.16
Naldemedine 0.01 mg0.10± 0.18
Naldemedine 0.03 mg0.10± 0.25
Naldemedine 0.1 mg0.10± 0.34
Naldemedine 0.3 mg0.04± 0.17
Naldemedine 1 mg1.36± 1.34
Naldemedine 3 mg1.51± 1.56
Time to First Spontaneous Bowel Movement Secondary · From first dose on Day 15 through Day 17

The time to first SBM during the Study Drug Administration Period was summarized using Kaplan-Meier estimates. Each participant's first SBM was counted as an event and the time to first SBM after dosing was calculated from the date and time of first dosing until the date and time of first SBM. Participants who dropped out or were lost to follow-up before the first SBM were censored.

GroupValue95% CI
Pooled Placebo27.212.4 – NA
Naldemedine 0.01 mg37.025.8 – NA
Naldemedine 0.03 mg13.98.2 – NA
Naldemedine 0.1 mgNA3.3 – NA
Naldemedine 0.3 mg4.72.8 – 6.2
Naldemedine 1 mg1.41.0 – 2.3
Naldemedine 3 mg0.70.6 – 0.8
Time to First Bowel Movement Secondary · From first dose on Day 15 through Day 17

The time to first BM during the Study Drug Administration Period was summarized using Kaplan-Meier estimates. Each participant's first BM was counted as an event and the time to first BM after dosing was calculated from the date and time of first dosing until the date and time of first BM. Participants who dropped out or were lost to follow-up before the first BM were censored.

GroupValue95% CI
Pooled Placebo27.212.4 – NA
Naldemedine 0.01 mg28.425.8 – 43.0
Naldemedine 0.03 mg13.98.2 – NA
Naldemedine 0.1 mg25.13.3 – 57.3
Naldemedine 0.3 mg4.72.8 – 6.2
Naldemedine 1 mg1.41.0 – 2.3
Naldemedine 3 mg0.70.6 – 0.8
Time to First Complete Spontaneous Bowel Movement Secondary · From first dose on Day 15 through Day 17

The time to first CSBM during the Study Drug Administration Period was summarized using Kaplan-Meier estimates. Each participant's first CSBM was counted as an event and the time to first CSBM after dosing was calculated from the date and time of first dosing until the date and time of first CSBM. Participants who dropped out or were lost to follow-up before the first CSBM were censored.

GroupValue95% CI
Pooled PlaceboNANA – NA
Naldemedine 0.01 mgNA37.0 – NA
Naldemedine 0.03 mgNA37.7 – NA
Naldemedine 0.1 mgNANA – NA
Naldemedine 0.3 mgNANA – NA
Naldemedine 1 mg1.71.3 – 2.3
Naldemedine 3 mg0.80.6 – 25.8
Change From Baseline in Straining During Bowel Movements Secondary · Baseline, 24 hours post-dose and 48 hours post-dose

Straining during BMs was graded using the following scale: 0 = Absent; 1 = Mild; 2 = Moderate; 3 = Severe; 4 = Very Severe. Baseline was defined as the average straining score of all BMs prior to receiving study drug (Day 1 to Day 15). The straining score at 24 and 48 hours post-dose was calculated as the average straining score from all bowel movements from 0 to 24 and 0 to 48 hours post-dose, respectively.

Baseline
GroupValue95% CI
Pooled Placebo2.2± 0.71
Naldemedine 0.01 mg2.0± 0.78
Naldemedine 0.03 mg2.2± 0.68
Naldemedine 0.1 mg1.9± 0.90
Naldemedine 0.3 mg2.0± 1.08
Naldemedine 1 mg2.5± 0.97
Naldemedine 3 mg1.7± 0.99
Change from Baseline to 24 hours post-dose
GroupValue95% CI
Pooled Placebo0.8± 0.76
Naldemedine 0.01 mg-0.8± NA
Naldemedine 0.03 mg-0.2± 0.88
Naldemedine 0.1 mg-0.7± 0.43
Naldemedine 0.3 mg-0.1± 0.89
Naldemedine 1 mg-0.5± 1.37
Naldemedine 3 mg-0.9± 1.64
Change from Baseline to 48 hours post-dose
GroupValue95% CI
Pooled Placebo0.5± 0.87
Naldemedine 0.01 mg0.2± 0.74
Naldemedine 0.03 mg0.4± 0.80
Naldemedine 0.1 mg-0.6± 0.67
Naldemedine 0.3 mg0.1± NA
Naldemedine 1 mg-0.4± 0.42
Naldemedine 3 mg-1.4± 1.40
Change From Baseline to 24 Hours Post-dose in Number of Complete Bowel Movements Per Day Secondary · Baseline and 24 hours post-dose

A complete bowel movement (CBM) was defined as a bowel movement that resulted in a sensation of complete evacuation based on the question "Did you have a feeling of complete emptying after the bowel movement?" Baseline was defined as the average number of CBMs per day prior to receiving study drug (Day 1 to Day 15).

Baseline
GroupValue95% CI
Pooled Placebo0.13± 0.16
Naldemedine 0.01 mg0.13± 0.14
Naldemedine 0.03 mg0.11± 0.09
Naldemedine 0.1 mg0.14± 0.12
Naldemedine 0.3 mg0.04± 0.06
Naldemedine 1 mg0.12± 0.15
Naldemedine 3 mg0.19± 0.15
24 hours post-dose
GroupValue95% CI
Pooled Placebo0.06± 0.24
Naldemedine 0.01 mg0.00± 0.00
Naldemedine 0.03 mg0.11± 0.33
Naldemedine 0.1 mg0.22± 0.44
Naldemedine 0.3 mg0.11± 0.33
Naldemedine 1 mg2.44± 2.55
Naldemedine 3 mg3.00± 3.20
Change from baseline to 24 hours post-dose
GroupValue95% CI
Pooled Placebo-0.07± 0.20
Naldemedine 0.01 mg-0.13± 0.14
Naldemedine 0.03 mg0.01± 0.31
Naldemedine 0.1 mg0.09± 0.45
Naldemedine 0.3 mg0.07± 0.35
Naldemedine 1 mg2.32± 2.61
Naldemedine 3 mg2.81± 3.21

Adverse events — posted to ClinicalTrials.gov

Time frame: From first dose of study drug on Day 15 up to Day 24 (10 days).. Reporting threshold: 0%. Adverse-event reports describe events observed during the trial — not all are caused by the drug.

Pooled Placebo
Serious: 0/18 (0%)
Deaths:
Naldemedine 0.01 mg
Serious: 0/9 (0%)
Deaths:
Naldemedine 0.03 mg
Serious: 0/9 (0%)
Deaths:
Naldemedine 0.1 mg
Serious: 0/9 (0%)
Deaths:
Naldemedine 0.3 mg
Serious: 0/9 (0%)
Deaths:
Naldemedine 1 mg
Serious: 0/9 (0%)
Deaths:
Naldemedine 3 mg
Serious: 0/9 (0%)
Deaths:
Other adverse events (53 terms — click to expand)

ReactionSystemPooled PlaceboNaldemedine 0.01 mgNaldemedine 0.03 mgNaldemedine 0.1 mgNaldemedine 0.3 mgNaldemedine 1 mgNaldemedine 3 mg
Abdominal painGastrointestinal disorders
DiarrhoeaGastrointestinal disorders
NauseaGastrointestinal disorders
VomitingGastrointestinal disorders
ChillsGeneral disorders
HyperhidrosisSkin and subcutaneous tissue disorders
Oxygen saturation decreasedInvestigations
DizzinessNervous system disorders
HeadacheNervous system disorders
FlatulenceGastrointestinal disorders
Abdominal pain upperGastrointestinal disorders
RetchingGastrointestinal disorders
Cardiac murmurInvestigations
PallorVascular disorders
Abdominal discomfortGastrointestinal disorders
Abdominal distensionGastrointestinal disorders
DyspepsiaGastrointestinal disorders
Abdominal tendernessGastrointestinal disorders
EructationGastrointestinal disorders
Tongue discolourationGastrointestinal disorders
ProctalgiaGastrointestinal disorders
Oedema peripheralGeneral disorders
Drug withdrawal syndromeGeneral disorders
FatigueGeneral disorders
PyrexiaGeneral disorders
Venipuncture site thrombosisGeneral disorders
Infusion site rashGeneral disorders
Cold sweatSkin and subcutaneous tissue disorders
RashSkin and subcutaneous tissue disorders
LethargyNervous system disorders
HypoaesthesiaNervous system disorders
MigraineNervous system disorders
ParaesthesiaNervous system disorders
SomnolenceNervous system disorders
Blood glucose decreasedInvestigations
Blood prolactin increasedInvestigations
Heart rate irregularInvestigations
Weight decreasedInvestigations
DyspnoeaRespiratory, thoracic and mediastinal disorders
Oropharyngeal painRespiratory, thoracic and mediastinal disorders

Data from ClinicalTrials.gov NCT01122030 adverse events section.

Sponsor's own description

The primary objective of the study is to evaluate the safety of single doses of oral naldemedine in adults physically dependent on opioids.

Publications & conference data

2 peer-reviewed publications reference this trial (live from Europe PMC):

  1. Opioid-induced constipation: advances and clinical guidance.
    Nelson AD, Camilleri M. · · 2016 · cited 70× · PMID 26977281 · DOI 10.1177/2040622315627801
  2. Naldemedine (Symproic) for the Treatment Of Opioid-Induced Constipation.
    Hu K, Bridgeman MB. · · 2018 · cited 11× · PMID 30271103

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