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Acute Post-surgical PainPhase 3NCT03108482

Co-crystal E-58425 vs Tramadol and Celecoxib for Moderate to Severe Acute Pain After Bunionectomy. Phase III Clinical Trial.

A Phase 3 study testing Co-crystal E-58425 (Tramadol/Celecoxib), Tramadol (Ultram®) and Celecoxib (Celebrex®) in people with Acute Post-surgical Pain, run by Esteve Pharmaceuticals, S.A. at 5 sites in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

This is a Phase 3, randomized, double-blind, controlled, parallel-group, multicenter clinical trial with co-crystal E-58425 compared to tramadol, to celecoxib, and to placebo. The primary objective of the trial is to establish the analgesic efficacy of co-crystal E-58425 by demonstrating a superior effect compared to… Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Acute Post-surgical Pain
What is being tested?
Co-crystal E-58425 (Tramadol/Celecoxib), Tramadol (Ultram®) and Celecoxib (Celebrex®)
Type of treatment
Pill or oral medicine
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
637 participants
Where
5 sitesUnited States
Study dates
14 Mar 2017to 28 Nov 2017
Phase
Phase 3
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 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Subject must have signed consent before study entry.
  • Subject must be at least 18 years old, scheduled to undergo primary unilateral first metatarsal osteotomy with internal fixation with no additional collateral procedure.
  • Male and female subjects are eligible. If female, subject must be either not of childbearing potential (defined as postmenopausal for at least 1 year or surgically sterile [bilateral tubal ligation, bilateral oophorectomy, or hysterectomy]) or practicing 1 of the following effective methods of birth control:
  • Hormonal methods such as oral, implantable, injectable, vaginal ring, or transdermal contraceptives.
  • Total abstinence from sexual intercourse since the last menses before study medication administration.
  • Intrauterine device
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  • Double-barrier method (condoms, sponge, or diaphragm with spermicidal jellies or cream).
  • Women must use effective methods of birth control from 6 weeks before administration of study medication until 4 weeks after the last administration.
  • If female and of childbearing potential, subject must be non-lactating and non pregnant (has negative serum pregnancy test results at Screening and negative urine test on the day of surgery prior to surgery).
  • Subject must have a body weight of 45 kg or more and a body mass index (BMI) of 40 kg/m2 or less.
  • Subject must have a qualifying pain score of ≥5 and <9 on the 0-10 NPRS at rest as a result of turning off the popliteal sciatic block for bunionectomy to be eligible for randomization.
  • Subject must be in good physical health in the investigator's judgment.
  • Subject must be sufficiently alert to understand and communicate intelligibly with the study observer.

Who cannot join

  • Subject's Baseline pain is <5 or >9 on a 0-10 NPRS.
  • Subject received any analgesic medication other than short-acting pre-operative or intra-operative anesthetic agents before the end of bunionectomy surgical procedure. Subjects who received any analgesic medication immediately after the bunionectomy surgical procedure was completed and before study medication is administered will also be excluded, with the exception of ketorolac 30 mg intravenously supplemental analgesia during the continuous infusion period and up until 1:00 A.M.
  • Subject has a history of seizures or alcohol abuse (eg, drinks >4 units of alcohol per day, a unit being equal to 8 oz. beer, 3 oz. wine, 1 oz. spirits) within the past 5 years, has a history of prescription/illicit drug abuse within 6 months before dosing with study medication, or has positive results on the urine drug screen or alcohol breath test indicative of illicit drug or alcohol abuse.
  • Subject has a history of or positive test results for human immunodeficiency virus or hepatitis B or C.
  • Subject has an active malignancy of any type, or has been diagnosed with cancer within 5 years before Screening (excluding successfully treated squamous or basal cell carcinoma of the skin).
  • Subject is currently receiving anticoagulants (eg, heparin or warfarin) or antiplatelets (except aspirin ≤325 mg/day).
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  • Subject has received a course of systemic (either oral or parenteral) or intra-articular corticosteroids within 3 months before Screening (inhaled nasal steroids and topical corticosteroids are allowed).
  • Subject has any ongoing condition, other than one associated with the current primary, unilateral, first metatarsal bunionectomy, that, in the investigator's opinion, could generate levels of pain sufficient to confound assessments of post-operative pain (eg, severe osteoarthritis of the target joint or extremity, fibromyalgia, rheumatoid arthritis, moderate to severe headache, diabetic foot pain or neuropathy).
  • Subject has been receiving or has received chronic (defined as daily use for >2 weeks) opioid (oral codeine, dextromoramide, dihydrocodeine, oxycodone, or morphine-like anti-tussive) therapy defined as >15 morphine equivalents units per day for more than 3 out of 7 days per week over a 1-month period within 12 months of surgery, or has been treated chronically with opioid analgesic (buprenorphine, nalbuphine, or pentazocine) or NSAIDs within 30 days before Screening.
  • Subject received a long-acting Non-Steroidal Anti-Inflammatory Drug (NSAID) within 4 days before initiation of study medication (except aspirin ≤325 mg/day), or a short-acting NSAID within 1 day.
  • Subject is under long-term treatment with opioid agonist-antagonists.
  • Subject has used drugs with enzyme-inducing properties, such as rifampicin and St. John's Wort, or any drug known to be a strong inhibitor or inducer of CYP3A4, CYP2C9, or CYP2D6 within 3 weeks before surgery.
  • Subject is pregnant or lactating.
  • Subject had any complication during primary bunionectomy surgery.
  • Subject has received monoamine oxidase inhibitors, tricyclic antidepressants, neuroleptics, or other drugs that reduce the seizure threshold within 4 weeks of study entry.
  • Subject has a history or evidence of a clinically significant (in the investigator's opinion) gastrointestinal (GI) event within 6 months before Screening or has any history of peptic or gastric ulcers or GI bleeding.
  • Subject has clinically significant renal or hepatic disease, as indicated by clinical laboratory assessment (results ≥3 times the upper limit of normal for any liver function test, including aspartate aminotransferase, alanine aminotransferase, bilirubin, and lactate dehydrogenase, or creatinine ≥1.5 times the upper limit of normal). Laboratory tests may be repeated once at Screening to rule out laboratory error.
  • Subject has any clinically significant laboratory or 12-lead electrocardiogram (ECG) finding at Screening that, in the opinion of the investigator, contraindicates study participation (eg, QTc >450 msec [male] or >470 msec [female]).
  • Subject has a known history of allergic reaction or clinically significant intolerance to acetaminophen, aspirin, opioids, or any NSAIDs; history of NSAID induced bronchospasm (subjects with the triad of asthma, nasal polyps, and chronic rhinitis are at greater risk for bronchospasm and should be considered carefully) or to the ingredients of the study medication, or any other drugs used in the study, including anesthetics and antibiotics that may be required on the day of surgery.
  • Subject has received anti-depressive medication with serotonin-norepinephrine reuptake inhibitors (SNRIs; milnacipran, duloxetine, venlafaxine), diet pills (including fenfluramine and phentermine) or methylphenidate (Ritalin®), or other similar medications for attention deficit hyperactivity disorder (ADHD) within 4 weeks of study entry. Subjects receiving selective serotonin reuptake inhibitors (SSRIs) may be included provided they have been on a stable dose for 60 days prior to study participation and plan to remain on that dose throughout the study.
  • Subject is at risk in terms of precautions, warnings, and contraindications in the package insert for Ultram® (tramadol hydrochloride) or Celebrex® (celecoxib).
  • Subject has a known coagulation disorder.
  • Subject has history of or current medical, surgical, post-surgical, or psychiatric condition that would confound interpretation of safety, tolerability, or efficacy, (eg, uncontrolled diabetes mellitus, uncontrolled hypertension, hemodynamic instability, or respiratory insufficiency, cancer or palliative care).
  • Subject received an experimental drug or used an experimental medical device within 30 days prior to Screening or has previously participated in this trial.
  • Subject is unable to comply with the requirements of the study or, in the investigator's opinion, should not participate in the study.

Trial locations and contacts

5 sites in 1 country.

5 sites in 1 country

United States5 sites
  • Anaheim Clinical Trials, LLC

    Anaheim, California, 92801

  • Optimal Research, LLC

    Austin, Texas, 78705

  • Chesapeake Research Group, LLC

    Pasadena, Maryland, 21122

  • Arizona Research Center

    Phoenix, Arizona, 85023

  • Jean Brown Research

    Salt Lake City, Utah, 84124

Other trials in United States

About this study

Official title: A Randomized, Double-blind, Active- (Tramadol and Celecoxib) and Placebo-controlled, Parallel Groups, Phase 3 Clinical Trial to Establish the Efficacy of Co-crystal E-58425 for the Management of Moderate to Severe Post-surgical Pain After Bunionectomy.

This is a Phase 3, randomized, double-blind, controlled, parallel-group, multicenter clinical trial with co-crystal E-58425 compared to tramadol, to celecoxib, and to placebo. The primary objective of the trial is to establish the analgesic efficacy of co-crystal E-58425 by demonstrating a superior effect compared to tramadol and to celecoxib for the management of moderate to severe acute post-operative pain for 48 hours after bunionectomy.

Being tested
Co-crystal E-58425 (Tramadol/Celecoxib), Tramadol (Ultram®), Celecoxib (Celebrex®), Placebo
Keywords
Acute Pain, Post-surgical Pain, Bunionectomy, Co-crystal, Tramadol, Celecoxib
Medical subject headings
Acute Pain, Pain, Postoperative

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Co-crystal E-58425 (Tramadol/Celecoxib)Drug

    Co-crystal E-58425 (Tramadol/Celecoxib): Two immediate release oral over-encapsulated tablets of 100 mg, every 12 hours for 48 hours.

  • Tramadol (Ultram®)Drug

    Tramadol: One immediate release oral over-encapsulated tablet of 50 mg, every 6 hours for 48 hours.

  • Celecoxib (Celebrex®)Drug

    Celecoxib: One immediate release oral over-encapsulated capsule of 100 mg, every 12 hours for 48 hours.

  • PlaceboDrug

    Placebo 100 mg or 200 mg oral over-encapsulated tablets every 6 hours for 48 hours.

Study groups in NCT03108482
Study groupRoleWhat they receive
Co-crystal E-58425 (Tramadol/Celecoxib)ExperimentalCo-crystal E-58425 (Tramadol/Celecoxib): Two tablets of 100 mg every 12 hours. The total daily dose will be 400 mg of Co-crystal E-58425.
Receives: Drug: Co-crystal E-58425 (Tramadol/Celecoxib)
Tramadol (Ultram®)Active comparatorTramadol: One tablet of 50 mg every 6 hours. The total daily dose will be 200 mg of tramadol.
Receives: Drug: Tramadol (Ultram®)
Celecoxib (Celebrex®)Active comparatorCelecoxib: One capsule of 100 mg every 12 hours. The total daily dose will be 200 mg of celecoxib.
Receives: Drug: Celecoxib (Celebrex®)
PlaceboPlacebo comparatorPlacebo: One or two tablets of 100 mg every 6 hours.
Receives: Drug: Placebo

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Sum of Pain Intensity Differences (SPID)

    The primary efficacy variable was the Pain Intensity (PI) measured by the Numerical Pain Rating Scale (NPRS); a scale from zero to 10 on which subjects circled a single number to indicate current pain level, with zero representing "No Pain" and 10 representing "Worst Possible Pain". The primary analysis endpoint was the Sum of Pain Intensity Differences (SPID) from 0 to 48 hours. Pain Intensity Differences (PID) was the difference between current PI at assessment minus baseline PI (prior to the first dose). Baseline PI ranged from 5 to 9. SPID was calculated as a time-weighted Sum of PID scores over 48 hours. Negative differences correspond to an amelioration of pain, while positive differences correspond to recrudescence of pain. The total scale ranged from -480 (best) to +480 (worst). A higher negative value of SPID indicates greater pain relief.

    Measured: Assessments was recorded from time 0 to 48 hours.

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted11 Apr 2017
  2. Study start14 Mar 2017
  3. Primary completion9 Nov 2017
  4. Study completion28 Nov 2017

Resources

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 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Triple blind
Who is masked
Participant, Care provider, Investigator
Enrolment
637 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03108482
Sponsor's protocol ID
ESTEVE-SUSA-301
Status last verified
Jan 2019
First submitted
30 Mar 2017
Last updated
24 Jan 2019
Data monitoring committee
No
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
No

Publications

  • Morte A, Sust M, Vaque A, Cebrecos J, Gimenez-Arnau JM. Adverse Reactions Following First-Dose Administration of Co-Crystal of Tramadol-Celecoxib Versus Tramadol Alone for Moderate-To-Severe Acute Pain. Pain Ther. 2025 Jun;14(3):1147-1154. doi: 10.1007/s40122-025-00730-w. Epub 2025 May 2.

    PubMed 40314885
  • Viscusi ER, Langford R, Morte A, Vaque A, Cebrecos J, Sust M, Gimenez-Arnau JM, de Leon-Casasola O. Safety of Co-Crystal of Tramadol-Celecoxib (CTC) in Patients with Acute Moderate-to-Severe Pain: Pooled Analysis of Three Phase 3 Randomized Trials. Pain Ther. 2024 Dec;13(6):1617-1631. doi: 10.1007/s40122-024-00655-w. Epub 2024 Sep 24.

    PubMed 39316284

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Co-crystal E-58425 (Tramadol/Celecoxib), Tramadol (Ultram®) and Celecoxib (Celebrex®) in people with Acute Post-surgical Pain, run by Esteve Pharmaceuticals, S.A. at 5 sites in United States.

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 13 inclusion and 25 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 24 Jan 2019. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 5 sites in United States. 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 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

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 9 Jan 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?

Sum of Pain Intensity Differences (SPID) (time frame: Assessments was recorded from time 0 to 48 hours.). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03108482, which also lists 2 linked publications.

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 24 Jan 2019.

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