PainPhase 2NCT01926444
A Phase 2a, Proof-of-Concept Study of GIC-1001 in the Management of Visceral Pain During Sedation-Free, Full Colonoscopy
A Phase 2 study testing GIC-1001 in people with Pain and Cancer, run by gicare Pharma Inc. at 15 sites in 2 countries.
Trial summary
GIC-1001 is a novel, orally-administered, colonic analgesic drug developed as an alternative to i.v. sedation during full colonoscopy. It will be evaluated for efficacy and safety in a multi-center, randomized, double-blind, placebo controlled, dose-ranging, proof of concept Phase 2a trial. Read more about this study
- Who is it for?
- Ages 40 to 70 years
- Conditions the study is for
- Pain, Cancer, Colonic Diseases
- What is being tested?
- GIC-1001
- Type of treatment
- Pill or oral medicine
- Could I receive a placebo?
- Yes, some participants may receive a placebo
- How many people
- 308 participants
- Where
- 15 sitesin 2 countries
- Study dates
- Jul 2013to Mar 2014
- Phase
- Phase 2
- Are there results?
- Yes, posted in the registrySummary in the doctors' view
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 40 to 70 years
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Signed and dated written Informed Consent obtained.
- Males or females.
- Aged 40-75 years.
- Indication for full colonoscopy for colorectal cancer screening or investigation, including subjects presenting suggestive symptoms and who need a differential diagnosis.
- Colonoscopy naïve subjects, i.e. who never underwent colonoscopy before, will be eligible, as well as non-naïve subjects who have previously undergone unsedated colonoscopy , or who had sedated colonoscopy at least 10 years prior (i.e. ≥ 10 years) to enrolment
- Eligible for a procedure without sedation.
- Able to complete questionnaires and use a Visual Analog Scale (VAS), including sufficient English, French or Spanish speaking skills as well as adequate eyesight and hearing
- BMI ≥ 19, BMI ≤ 40 kg/m2.
Who cannot join
- Known allergy or intolerance to trimebutine (Modulon® or generic).
- Known allergy or intolerance to sulfur-containing drugs (e.g. N-acetylcysteine or captopril).
- Previous gastrointestinal or gynecologic surgery, e.g. ileostomy, pelvic surgery,; however, patients with an appendectomy are eligible.Patients who have had a tubal ligation at least 10 years prior (i.e. ≥ 10 years) to enrolment are also eligible.
- Diagnosed Inflammatory Bowel Disease (IBD).
- Visceral hypersensitivity conditions such as Irritable Bowel Syndrome (IBS).
- Clinically significant renal and/or hepatic impairment.
Show all 20Show fewer
- History of peritonitis.
- Known severe diverticular disease.
- Severe diverticulosis as documented by prior imaging series
- Known or suspected stenosis of the colon.
- Chronic pain syndrome such as fibromyalgia and endometriosis.
- Any clinically-relevant abnormality identified on the screening, history, physical examination, 12-lead ECG or laboratory examination, which would, in the Investigator's opinion, preclude the administration of investigational drug product, GIC1001
- Unexpected and significant visceral pain reported by subject prior to colonoscopy.
- Dementia.
- Diagnosed clinically significant psychiatric illness, including severe anxiety disorders that may affect the subject's perception of visceral pain or ability to participate in the study.
- Patient is a lactating female.
- Female is of childbearing potential sexually active who are unwilling or unable to use an acceptable method of contraception (which includes oral or implanted contraceptives, IUD, female condom, diaphragm with spermicide, cervical cap, use of a condom by the sexual partner or sterile sexual partner) throughout the duration of the study and 1 month following study completion.
- Female is of childbearing potential, sexually abstinent who does not agree to continue abstinence or to use one of the acceptable methods of birth control should sexual activity commence.
- Any serious medical condition that could increase the risk of adverse reactions with trimebutine.
- Participation in another experimental drug trial within 30 days of randomization.
Trial locations and contacts
15 sites in 2 countries.
15 sites in 2 countries
United States11 sites
Anaheim Clinical Trials
Anaheim, California, 92801
Precision Research Institute
Chula Vista, California, 91910
Avail Clinical Research LLC
DeLand, Florida, 32720
PharmaTrials
Hillsborough, New Jersey, 08844
The Center for GI Disorders
Hollywood, Florida, 33021
Mid-Atlantic Medical Research Centers
Hollywood, Maryland, 20636
Gastroenterology Associates of Orangeburg
Orangeburg, South Carolina, 29118
Mayo Clinic Rochester
Rochester, Minnesota, 55910
Precision Research Institute
San Diego, California, 92114
Mayo Clinic
Scottsdale, Arizona, 85259
Montefiore Medical Center
The Bronx, New York, 10467
Canada4 sites
Clinique 1037
Montreal, Quebec, H2X3H9
Spécialistes MD Specialists
Montreal, Quebec, H3Z 2P9
Toronto Digestive Disease Associates
Toronto, Ontario, L4L4Y7
GIRI (GI Research Institute)
Vancouver, British Columbia, V6Z 2K5
About this study
Official title: A Randomized, Double-Blind, Placebo-Controlled, Phase 2a Proof-of-Concept Study of GIC-1001 for the Management of Visceral Pain in Subjects Undergoing Sedation-Free, Full Colonoscopy
GIC-1001 is a novel, orally-administered, colonic analgesic drug developed as an alternative to i.v. sedation during full colonoscopy. It will be evaluated for efficacy and safety in a multi-center, randomized, double-blind, placebo controlled, dose-ranging, proof of concept Phase 2a trial. Up to 240 patients will receive one of 3 doses of GIC-1001 or its matching placebo. A pharmacokinetic evaluation will be carried out on a subset of patients (N: 24).
Read the detailed description
- Study Objectives 1.1 Primary objective: The primary objective of this Phase IIa study is to establish clinical Proof-of-Concept (POC) by providing clinically and statistically significant evidence that GIC-1001 is safe and effective in managing visceral pain in male and female patients who undergo sedation-free, full colonoscopy for preventive purposes. 1.2 Secondary objectives: Secondary objectives will include the selection of the optimal dose of GIC-1001 from a safety/efficacy ratio point of view, establish a preliminary safety profile of the drug in patients, and obtain a preliminary general efficacy profile of GIC-1001 by assessing various secondary endpoints
- Study Endpoints 2.1 Primary endpoints: Visceral pain will be assessed using a 100-mm VAS, measured at various times and anatomical segments (N: 8) throughout the colon, i.e.:
- Prior to intra-rectal insertion of the endoscope;
- After insertion through the anus;
- After passage through the rectosigmoid segment;
- Immediately after passage through the splenic flexure;
- Immediately after passage through the hepatic flexure;
- Once the caecum is reached;
- Immediately after passage through the splenic flexure during scope withdrawal; and
- At the end of the procedure, once the colonoscope has been completely removed. Any additional episodes of pain experienced by the patient will also be assessed using the 100-mm VAS scale. The area under the curve (AUC) calculated from all serial measurements made will be used for statistical purposes, where the length of inserted colonoscope determines the VAS measurement's location. 2.2 Secondary endpoints:
- Overall pain perception (100-mm VAS) at the end of the procedure;
- Time to reach the caecum with the endoscope (intubation time from rectum to caecum defined as time-to-caecum);
- Total examination time, defined at the time from introduction to removal of the colonoscope;
- Percentage of completed procedures;
- Endoscopist's perception of the adequacy of analgesia, difficulty of insertion, and amount of colonic spasm on insertion and withdrawal (five-point Likert scale);
- Use of rescue sedation (i.e. midazolam or midazolam followed by fentanyl)
- Safety as assessed by the incidence of treatment emergent adverse effects during the procedure and for 30 days after;
- Plasma determination of trimebutine and N-desmethyl-trimebutine moieties at GIC-1001 plasmatic steady state;
- Patient satisfaction with treatment (five-point Likert scale);
- Patient' willingness for repeat colonoscopy in the future (five-point Likert scale); and
- Safety of GIC-1001.
- Study Design This is a randomized, double-blind, placebo-controlled parallel design 4-treatment arms study. Eligible patients will be randomized in a 1:1:1:2 ratio to one of 4 treatment arms: low (250 mg), mid (375 mg) or high (500 mg) dose of GIC-1001, or matching placebo. All potential study subjects will be screened and assessed for eligibility within maximum two (2) weeks prior to randomization. Bowel preparation will be performed using a polyethylene glycol (PEG) based regimen the night before the actual procedure.
- Number of Clinical Sites: This trial will be conducted in both Canada and USA. Up to ten (10) clinical sites will participate in this trial. The lead Investigator for this trial is Dr Mark V. Larson MD, Head of Digestive Endoscopy, Mayo Clinic, Rochester MN, USA
- Study population and sample size: Approximately 240 patients will be randomized in this study. Male and female patients having an indication for full colonoscopy, mainly for colorectal cancer screening and surveillance. Only naïve subjects, i.e. who never underwent colonoscopy before, will be eligible.
- Inclusion Criteria See Eligibility Section
- Exclusion Criteria See Eligibility Section
- Study Drugs Administration and Schedule: GIC-1001, or its matching placebo will be administered as follows:
- One tablet TID on an empty stomach for three (3) consecutive days prior to colonoscopy.
- Last dose taken at the clinical site at least one (1) hour prior to beginning of procedure (endoscope insertion).
- Bowel preparation to be performed using PEG based regimen the day before the actual procedure.
- Three (3) different GIC-1001 dose levels will be studied:
- 250 mg TID
- 375 mg TID
- 500 mg TID
- Matching placebo TID
- Concomitant Medications 9.1 Prior to colonoscopy, the following medication will be permitted: Aspirin (ASA) at low levels for cardiovascular health, if dose and regimen stable for the last 6 months prior to colonoscopy. 9.2 The following medications and foods will be prohibited:
- Any prescription chronic analgesic narcotic, anti-spasmodic, anti-inflammatory medications are forbidden for 30 days prior to screening. (i.e. Washout ≥ 30 days)
- Selective Serotonin Re-uptake Inhibitors (SSRIs) are forbidden for 30 days prior to screening, unless patient has been on a stable dose for 3 consecutive months prior to screening.
- Over-the-counter analgesics, or anti-inflammatory medication, oral or topical used for acute pain treatment must be washed out for ≥ 7days prior to screening.
- Acute or as needed prescription or non-prescription anti-inflammatory and/or analgesic treatment within one (1) week prior to colonoscopy.
- Use of bowel stimulant laxatives, such bisacodyl, within one (1) week preceding randomization.
- Use of antidiarrheic medication, such as diphenoxylate, loperamide, kaopectate or bismuth salts, within one (1) week preceding randomization.
- Administration of barium enema within two (2) weeks preceding randomization.
- Colonic irritant beverages or foods, such as caffeine-containing beverages (e.g. coffee, Coca-Cola), spices, as well as foods containing seeds (i.e. tomatoes, strawberries, kiwis, raspberries) within 24 hours preceding colonoscopy.
- Use of any other investigational drug is prohibited unless discontinued, within at least 30 days prior to randomization.
- Additionally, Prior and Concomitant Medications are to be recorded in the CRF starting 30 days prior to Screening Visit CLV1.
- Efficacy Evaluation: Colonic analgesic clinical efficacy of GIC-1001 will be measured using a continuous, horizontal 100-mm VAS, at pre-determined times and colonic anatomical segments. At least 8 measurements will be done by the participating patients themselves (see Primary Endpoint section). Subjects will receive proper instructions on the use of the VAS prior to colonoscopy. Overall experience of visceral pain (if any) will be evaluated using the AUC constructed from all calculated VAS self-measurements for each patient. Additional, secondary, efficacy endpoints will also be measured, including time-to-caecum, colonoscopy completion rate and antispasmodic activity.
- Safety Evaluation: Safety will be assessed using the performance of physical exams, ECG, various laboratory safety tests and the occurrence of adverse events. AEs will be mapped to MedDRA, version 16.
- Sample Size Considerations: It has been reported in the medical literature that a MCID range of 10-15 mm on the 100-mm VAS is clinical significant in the evaluation of colonoscopy-related visceral pain. Using this value, with an alpha of 0.05 and a beta of 0.9, about 50 patients would be needed in each active arm considering a 90-patient placebo arm. Total study sample size is then estimated at approximately 240 randomized patients.
- Statistical Analysis: The primary outcome measure will be the mean 100-mm VAS AUC in each treatment arm.
- Conditions
- Pain, Cancer, Colonic Diseases
- Being tested
- GIC-1001
- Keywords
- colonoscopy, sedation-free, colorectal cancer, CRC screening, prevention, analgesia, colonic, kappa, opioid agonist, pain management, oral, hydrogen sulfide, peripheral
- Medical subject headings
- Pain, Neoplasms, Colonic Diseases, Colorectal Neoplasms, Agnosia
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
GIC-1001Drug
Also called trimebutine 3-thiocarbamoylbenzenesulfonate, TB-905-02
GIC-1001 oral tablet, white-coated, to be taken with water
| Study group | Role | What they receive |
|---|---|---|
| GIC-1001 low dose | Experimental | GIC-1001 , 250 mg TID during 3 consecutive days + a last, 10th dose in the morning of Day 4 (colonoscopy day) Receives: Drug: GIC-1001 |
| GIC-1001 mid-dose | Experimental | GIC-1001 , 375 mg TID during 3 consecutive days + a 10th dose in the morning of day 4 (colonoscopy day) Receives: Drug: GIC-1001 |
| GIC-1001 , high dose | Experimental | GIC-1001 , 500 mg TID during 3 consecutive days + a 10th dose in the morning of day 4 (colonoscopy day) Receives: Drug: GIC-1001 |
| GIC-1001 matching placebo | Placebo comparator | Placebo, TID during 3 consecutive days, + a 10 th dose in the morning of day 4 (colonoscopy day) Receives: Drug: GIC-1001 |
What is being measured
The primary outcome is the main question the study is designed to answer.
Measurements of Visceral Pain, Using a 100-mm Visual Analog Scale (VAS)
The Primary Outcomes Measure was the pain VAS 100-mm AUC (0mm = no pain; 100mm = worst pain), constructed from serial pain VAS measurements performed during colonoscopy. At least 8 pain VAS measurements were made, and the length of the colonoscope inserted (or removed on the way out) was recorded at every measurement. The X-axis of the VAS versus anatomical locations was defined accordingly: each VAS value corresponded to a relative length of inserted colonoscope (d/2Lc) of the X axis, where d was the actual length of the inserted colonoscope and 2Lc represented twice the total length of the colon examined (Lc). Before scope insertion the X value equaled zero. Once the caecum was reached, the X value was 0.5. Upon complete removal of the endoscope, the X value was 1. This allowed standardization of colonic length between study subjects. Visceral pain AUC (mm) was calculated from all serial measurements, where the length of inserted colonoscope determined the VAS measurement's location
Measured: Assessed at different anatomical locations: (1) before colonoscopy, (2) insertion of scope in anus, (3) at rectosigmoid flexure, (4) at splenic flexure, (5) at hepatic flexure, (6) at caecum, (7) at splenic flexure on way back, (8) after colonoscopy.
Secondary outcomes (8)
Time to Caecum
Time to Caecum is the time taken by the physician to reach the caecum with the colonoscope, from the insertion in the anus. Time to Caecum was measured during colonoscopy, for which total duration of colonoscopy ranged between a minimum of 5.00 and a maximum of 50.10 minutes.
Measured: From the time of introduction of the colonoscope, to removal of colonoscope. Range of duration of colonoscopy 5.00- 50.10 minutes.
Colonoscopy Completion Rate (%)
Qualitative outcome: colonoscopy completion is defined as a procedure performed entirely, from initial anal insertion, reaching of caecum, and complete removal of the scope. Completion rate is then the number of patient (%) with a complete colonoscopy (up to the caecum) divided by the number of trial participants.
Measured: Number of patients during trial with a complete colonoscopy, where the scope has reached the caecum during the colonoscopy. Range of duration of colonoscopy 5.00- 50.10 minutes.
Safety-Plasma Concentrations of Trimebutine and N-Desmethyl-Trimebutine
A pharmacokinetic (PK) analysis was carried out on the first 24 patients randomized, equally distributed between treatment groups; 18 patients were assigned to active treatment
Measured: Day 4 prior to colonoscopy.
Total Examination Time (Colonoscopy)
Defined as the time from endoscope insertion to complete removal of the endoscope; measured in minutes
Measured: From the time of introduction of the colonoscope, to removal of colonoscope. Range of duration of colonoscopy 5.00- 50.10 minutes.
Endoscopist's Perception of Colonoscopy- Adequacy of Analgesia, Difficulty of Insertion and Withdrawal
Endoscopist's perception of the adequacy of analgesia, difficulty of insertion and withdrawal measured on a five-point Likert scale: Strongly Agree, Agree, Agree nor Disagree, Disagree, Strongly Disagree
Measured: From the time of introduction of the colonoscope, to removal of colonoscope. Range of duration of colonoscopy 5.00- 50.10 minutes.
Endoscopist's Perception of Colonoscopy- Amount of Colonic Spasm on Insertion and Withdrawal
Endoscopist's perception of the amount of colonic spasm on insertion and withdrawal measured on five-point Likert scale according to the following: Strongly Agree, Agree, Agree nor Disagree, Disagree, Strongly Disagree
Measured: From the time of introduction of the colonoscope, to removal of colonoscope. Range of duration of colonoscopy 5.00- 50.10 minutes.
Patient's Willingness to Repeat Experience
Patients' willingness for repeat colonoscopy, was assessed with the Patient Willingness to Repeat Experience (P.W.R.E.) questionnaire (1 question), asking patients to rate their willingness to repeat the procedure according to a 5-point Likert scale: Strongly Agree, Agree, Agree nor Disagree, Disagree, Strongly Disagree. The P.W.R.E was administered after the colonoscopy during subject recovery.
Measured: Post-colonoscopy- during subject recovery
Subject Satisfaction and Acceptability of the Colonic Analgesia - Patient's Global Impression of Abdominal Pain
Subject satisfaction and acceptability of the colonic analgesia modality offered by GIC-1001 was assessed with the Patient Global Impression of Abdominal Pain (P.G.I.A.P.) (1 question), asking patients to rate their pain during the procedure according to a 5-point Likert scale: Absent, Mild, Moderate, Severe, Intolerable. The P.G.I.A.P was administered after the colonoscopy during subject recovery.
Measured: Post-colonoscopy- during subject recovery
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted21 Aug 2013 (estimated)
- Study startJul 2013
- Primary completionMar 2014
- Study completionMar 2014
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Posted resultsParticipant flow, outcome measures and adverse events reported by the sponsor.
- Other trials for PainStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 2
- Primary purpose
- Prevention
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Quadruple blind
- Who is masked
- Participant, Care provider, Investigator, Outcomes assessor
- Enrolment
- 308 participants (actual)
Sponsor and investigators
- Lead sponsor
- gicare Pharma Inc.
- Sponsor type
- Industry (pharma, biotech, devices)
- Collaborators
- JSS Medical Research Inc., Algorithme Pharma Inc
- Responsible party
- Sponsor
- Investigators
- Mark V Larson, MD, Study chair, Mayo Clinic, Rochester, MN, USAMichael DeMicco, MD, Principal investigator, Anaheim Clinical Trials, Anaheim, CA, USAMark Lamet, MD, Principal investigator, The Center of GI Disorders, Hollwood, FL, USATaddese Desta, MD, Principal investigator, Precision Research Institute, San Diego, CA, USACynthia Schaeffer, MD, Principal investigator, Precision Research Institute, Chula Vista, CA, USAVivek Gumaste, MD, Principal investigator, Montefiore Medical Center, NY, USATheadore Ptak, MD, Principal investigator, Toronto Digestive Disease Associates, Toronto, ON, CanadaAnand Sahai, MD, Principal investigator, Clinique 1037, Montreal, QC, Canada
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT01926444
- Sponsor's protocol ID
- GIC13-01
- Status last verified
- May 2019
- First submitted
- 8 Aug 2013
- Last updated
- 8 May 2019
- Results posted
- Yes, on ClinicalTrials.gov
- Data monitoring committee
- Yes
Study at a glance
From the registry record, last updated by the sponsor on 8 May 2019. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- A Randomized, Double-Blind, Placebo-Controlled, Phase 2a Proof-of-Concept Study of GIC-1001 for the Management of Visceral Pain in Subjects Undergoing Sedation-Free, Full Colonoscopy
- ClinicalTrials.gov ID
- NCT01926444
- Acronym / sponsor ID
- GIC13-01
- Conditions
- Pain, Cancer, Colonic Diseases
- Keywords
- colonoscopy, sedation-free, colorectal cancer, CRC screening, prevention, analgesia, colonic, kappa
- Phase
- Phase 2
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 308 participants (actual)
- Lead sponsor
- gicare Pharma Inc.Industry (pharma, biotech, devices)
- Collaborators
- JSS Medical Research Inc., Algorithme Pharma Inc
- Study start
- Jul 2013
- Primary completion
- Mar 2014 (actual)
- Study completion
- Mar 2014 (actual)
- First posted
- 21 Aug 2013 (estimated)
- Results
- Posted 8 May 2019
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
GIC-1001 is a novel, orally-administered, colonic analgesic drug developed as an alternative to i.v. sedation during full colonoscopy. It will be evaluated for efficacy and safety in a multi-center, randomized, double-blind, placebo controlled, dose-ranging, proof of concept Phase 2a trial. Up to 240 patients will receive one of 3 doses of GIC-1001 or its matching placebo. A pharmacokinetic evaluation will be carried out on a subset of patients (N: 24).
Detailed description
- Study Objectives 1.1 Primary objective: The primary objective of this Phase IIa study is to establish clinical Proof-of-Concept (POC) by providing clinically and statistically significant evidence that GIC-1001 is safe and effective in managing visceral pain in male and female patients who undergo sedation-free, full colonoscopy for preventive purposes. 1.2 Secondary objectives: Secondary objectives will include the selection of the optimal dose of GIC-1001 from a safety/efficacy ratio point of view, establish a preliminary safety profile of the drug in patients, and obtain a preliminary general efficacy profile of GIC-1001 by assessing various secondary endpoints
- Study Endpoints 2.1 Primary endpoints: Visceral pain will be assessed using a 100-mm VAS, measured at various times and anatomical segments (N: 8) throughout the colon, i.e.:
- Prior to intra-rectal insertion of the endoscope;
- After insertion through the anus;
- After passage through the rectosigmoid segment;
- Immediately after passage through the splenic flexure;
- Immediately after passage through the hepatic flexure;
- Once the caecum is reached;
- Immediately after passage through the splenic flexure during scope withdrawal; and
- At the end of the procedure, once the colonoscope has been completely removed. Any additional episodes of pain experienced by the patient will also be assessed using the 100-mm VAS scale. The area under the curve (AUC) calculated from all serial measurements made will be used for statistical purposes, where the length of inserted colonoscope determines the VAS measurement's location. 2.2 Secondary endpoints:
- Overall pain perception (100-mm VAS) at the end of the procedure;
- Time to reach the caecum with the endoscope (intubation time from rectum to caecum defined as time-to-caecum);
- Total examination time, defined at the time from introduction to removal of the colonoscope;
- Percentage of completed procedures;
- Endoscopist's perception of the adequacy of analgesia, difficulty of insertion, and amount of colonic spasm on insertion and withdrawal (five-point Likert scale);
- Use of rescue sedation (i.e. midazolam or midazolam followed by fentanyl)
- Safety as assessed by the incidence of treatment emergent adverse effects during the procedure and for 30 days after;
- Plasma determination of trimebutine and N-desmethyl-trimebutine moieties at GIC-1001 plasmatic steady state;
- Patient satisfaction with treatment (five-point Likert scale);
- Patient' willingness for repeat colonoscopy in the future (five-point Likert scale); and
- Safety of GIC-1001.
- Study Design This is a randomized, double-blind, placebo-controlled parallel design 4-treatment arms study. Eligible patients will be randomized in a 1:1:1:2 ratio to one of 4 treatment arms: low (250 mg), mid (375 mg) or high (500 mg) dose of GIC-1001, or matching placebo. All potential study subjects will be screened and assessed for eligibility within maximum two (2) weeks prior to randomization. Bowel preparation will be performed using a polyethylene glycol (PEG) based regimen the night before the actual procedure.
- Number of Clinical Sites: This trial will be conducted in both Canada and USA. Up to ten (10) clinical sites will participate in this trial. The lead Investigator for this trial is Dr Mark V. Larson MD, Head of Digestive Endoscopy, Mayo Clinic, Rochester MN, USA
- Study population and sample size: Approximately 240 patients will be randomized in this study. Male and female patients having an indication for full colonoscopy, mainly for colorectal cancer screening and surveillance. Only naïve subjects, i.e. who never underwent colonoscopy before, will be eligible.
- Inclusion Criteria See Eligibility Section
- Exclusion Criteria See Eligibility Section
- Study Drugs Administration and Schedule: GIC-1001, or its matching placebo will be administered as follows:
- One tablet TID on an empty stomach for three (3) consecutive days prior to colonoscopy.
- Last dose taken at the clinical site at least one (1) hour prior to beginning of procedure (endoscope insertion).
- Bowel preparation to be performed using PEG based regimen the day before the actual procedure.
- Three (3) different GIC-1001 dose levels will be studied:
- 250 mg TID
- 375 mg TID
- 500 mg TID
- Matching placebo TID
- Concomitant Medications 9.1 Prior to colonoscopy, the following medication will be permitted: Aspirin (ASA) at low levels for cardiovascular health, if dose and regimen stable for the last 6 months prior to colonoscopy. 9.2 The following medications and foods will be prohibited:
- Any prescription chronic analgesic narcotic, anti-spasmodic, anti-inflammatory medications are forbidden for 30 days prior to screening. (i.e. Washout ≥ 30 days)
- Selective Serotonin Re-uptake Inhibitors (SSRIs) are forbidden for 30 days prior to screening, unless patient has been on a stable dose for 3 consecutive months prior to screening.
- Over-the-counter analgesics, or anti-inflammatory medication, oral or topical used for acute pain treatment must be washed out for ≥ 7days prior to screening.
- Acute or as needed prescription or non-prescription anti-inflammatory and/or analgesic treatment within one (1) week prior to colonoscopy.
- Use of bowel stimulant laxatives, such bisacodyl, within one (1) week preceding randomization.
- Use of antidiarrheic medication, such as diphenoxylate, loperamide, kaopectate or bismuth salts, within one (1) week preceding randomization.
- Administration of barium enema within two (2) weeks preceding randomization.
- Colonic irritant beverages or foods, such as caffeine-containing beverages (e.g. coffee, Coca-Cola), spices, as well as foods containing seeds (i.e. tomatoes, strawberries, kiwis, raspberries) within 24 hours preceding colonoscopy.
- Use of any other investigational drug is prohibited unless discontinued, within at least 30 days prior to randomization.
- Additionally, Prior and Concomitant Medications are to be recorded in the CRF starting 30 days prior to Screening Visit CLV1.
- Efficacy Evaluation: Colonic analgesic clinical efficacy of GIC-1001 will be measured using a continuous, horizontal 100-mm VAS, at pre-determined times and colonic anatomical segments. At least 8 measurements will be done by the participating patients themselves (see Primary Endpoint section). Subjects will receive proper instructions on the use of the VAS prior to colonoscopy. Overall experience of visceral pain (if any) will be evaluated using the AUC constructed from all calculated VAS self-measurements for each patient. Additional, secondary, efficacy endpoints will also be measured, including time-to-caecum, colonoscopy completion rate and antispasmodic activity.
- Safety Evaluation: Safety will be assessed using the performance of physical exams, ECG, various laboratory safety tests and the occurrence of adverse events. AEs will be mapped to MedDRA, version 16.
- Sample Size Considerations: It has been reported in the medical literature that a MCID range of 10-15 mm on the 100-mm VAS is clinical significant in the evaluation of colonoscopy-related visceral pain. Using this value, with an alpha of 0.05 and a beta of 0.9, about 50 patients would be needed in each active arm considering a 90-patient placebo arm. Total study sample size is then estimated at approximately 240 randomized patients.
- Statistical Analysis: The primary outcome measure will be the mean 100-mm VAS AUC in each treatment arm.
Study design
- Primary purpose
- Prevention
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Quadruple blind (participant, care provider, investigator, outcomes assessor)
- Number of arms
- 4
| Arm | Type | Receives |
|---|---|---|
| GIC-1001 low dose | Experimental | Drug: GIC-1001GIC-1001 , 250 mg TID during 3 consecutive days + a last, 10th dose in the morning of Day 4 (colonoscopy day) |
| GIC-1001 mid-dose | Experimental | Drug: GIC-1001GIC-1001 , 375 mg TID during 3 consecutive days + a 10th dose in the morning of day 4 (colonoscopy day) |
| GIC-1001 , high dose | Experimental | Drug: GIC-1001GIC-1001 , 500 mg TID during 3 consecutive days + a 10th dose in the morning of day 4 (colonoscopy day) |
| GIC-1001 matching placebo | Placebo comparator | Drug: GIC-1001Placebo, TID during 3 consecutive days, + a 10 th dose in the morning of day 4 (colonoscopy day) |
Who may qualify
- Ages
- 40 to 70 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (8 listed)
- Signed and dated written Informed Consent obtained.
- Males or females.
- Aged 40-75 years.
- Indication for full colonoscopy for colorectal cancer screening or investigation, including subjects presenting suggestive symptoms and who need a differential diagnosis.
- Colonoscopy naïve subjects, i.e. who never underwent colonoscopy before, will be eligible, as well as non-naïve subjects who have previously undergone unsedated colonoscopy , or who had sedated colonoscopy at least 10 years prior (i.e. ≥ 10 years) to enrolment
Key exclusion criteria (20 listed)
- Known allergy or intolerance to trimebutine (Modulon® or generic).
- Known allergy or intolerance to sulfur-containing drugs (e.g. N-acetylcysteine or captopril).
- Previous gastrointestinal or gynecologic surgery, e.g. ileostomy, pelvic surgery,; however, patients with an appendectomy are eligible.Patients who have had a tubal ligation at least 10 years prior (i.e. ≥ 10 years) to enrolment are also eligible.
- Diagnosed Inflammatory Bowel Disease (IBD).
- Visceral hypersensitivity conditions such as Irritable Bowel Syndrome (IBS).
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| GIC-1001Also: trimebutine 3-thiocarbamoylbenzenesulfonate, TB-905-02GIC-1001 oral tablet, white-coated, to be taken with water | Drug | GIC-1001 , high dose, GIC-1001 low dose, GIC-1001 matching placebo, GIC-1001 mid-dose |
Primary outcome
Measurements of Visceral Pain, Using a 100-mm Visual Analog Scale (VAS)
Time frame: Assessed at different anatomical locations: (1) before colonoscopy, (2) insertion of scope in anus, (3) at rectosigmoid flexure, (4) at splenic flexure, (5) at hepatic flexure, (6) at caecum, (7) at splenic flexure on way back, (8) after colonoscopy.
The Primary Outcomes Measure was the pain VAS 100-mm AUC (0mm = no pain; 100mm = worst pain), constructed from serial pain VAS measurements performed during colonoscopy. At least 8 pain VAS measurements were made, and the length of the colonoscope inserted (or removed on the way out) was recorded at every measurement. The X-axis of the VAS versus anatomical locations was defined accordingly: each VAS value corresponded to a relative length of inserted colonoscope (d/2Lc) of the X axis, where d was the actual length of the inserted colonoscope and 2Lc represented twice the total length of the colon examined (Lc). Before scope insertion the X value equaled zero. Once the caecum was reached, the X value was 0.5. Upon complete removal of the endoscope, the X value was 1. This allowed standardization of colonic length between study subjects. Visceral pain AUC (mm) was calculated from all serial measurements, where the length of inserted colonoscope determined the VAS measurement's location
8 secondary outcomes
Time to Caecum
Time frame: From the time of introduction of the colonoscope, to removal of colonoscope. Range of duration of colonoscopy 5.00- 50.10 minutes.
Colonoscopy Completion Rate (%)
Time frame: Number of patients during trial with a complete colonoscopy, where the scope has reached the caecum during the colonoscopy. Range of duration of colonoscopy 5.00- 50.10 minutes.
Safety-Plasma Concentrations of Trimebutine and N-Desmethyl-Trimebutine
Time frame: Day 4 prior to colonoscopy.
Total Examination Time (Colonoscopy)
Time frame: From the time of introduction of the colonoscope, to removal of colonoscope. Range of duration of colonoscopy 5.00- 50.10 minutes.
Endoscopist's Perception of Colonoscopy- Adequacy of Analgesia, Difficulty of Insertion and Withdrawal
Time frame: From the time of introduction of the colonoscope, to removal of colonoscope. Range of duration of colonoscopy 5.00- 50.10 minutes.
Endoscopist's Perception of Colonoscopy- Amount of Colonic Spasm on Insertion and Withdrawal
Time frame: From the time of introduction of the colonoscope, to removal of colonoscope. Range of duration of colonoscopy 5.00- 50.10 minutes.
Patient's Willingness to Repeat Experience
Time frame: Post-colonoscopy- during subject recovery
Subject Satisfaction and Acceptability of the Colonic Analgesia - Patient's Global Impression of Abdominal Pain
Time frame: Post-colonoscopy- during subject recovery
Results and safety
Loading the posted results from ClinicalTrials.gov…
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 8 May 2019.
- Posted resultsParticipant flow, baseline, all outcome measures and adverse events.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Mark V Larson, MD study chair
Mayo Clinic, Rochester, MN, USA
Michael DeMicco, MD principal investigator
Anaheim Clinical Trials, Anaheim, CA, USA
Mark Lamet, MD principal investigator
The Center of GI Disorders, Hollwood, FL, USA
15 sites in 2 countries: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 2 study testing GIC-1001 in people with Pain and Cancer, run by gicare Pharma Inc. at 15 sites in 2 countries.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 8 inclusion and 20 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 8 May 2019. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 15 sites in United States, Canada. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this phase mean?
Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
Yes. Results are posted in the registry (first posted 8 May 2019). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Measurements of Visceral Pain, Using a 100-mm Visual Analog Scale (VAS) (time frame: Assessed at different anatomical locations: (1) before colonoscopy, (2) insertion of scope in anus, (3) at rectosigmoid flexure, (4) at splenic flexure, (5) at hepatic flexure, (6) at caecum, (7) at splenic flexure on way back, (8) after colonoscopy.). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 8 May 2019.