- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT00740571
Amitriptyline or Pregabalin to Treat Neuropathic Pain in Incurable Cancer (Off-label)
A Randomised Controlled Trial in the Palliative Setting Regarding Off-Label Medication: Investigating the Efficiency of Amitriptyline Versus Pregabalin From a Societal Perspective
Rationale: Often, incurable cancer patients suffer from severe symptoms as (neuropathic) pain and fatigue with polypharmaceutic interventions as a consequence. Regarding neuropathic pain in incurable cancer patients, pregabalin has been registered for neuropathic non-cancer pain, and amitriptyline is not registered for neuropathic pain, but is recommended as the drug of first choice in the Dutch handbooks of palliative care. As a consequence of an adaptation of a Dutch law (July 2007) about off-label medication prescription, off-label medication is not allowed anymore unless a standard or protocol exists. No clinical trials for this patient group have been published before.
Objective: To compare efficacy, side effects and costs of a strategy with amitriptyline as drug of first choice versus a strategy with pregabalin as drug of first choice.
Study design: An open label, randomised non-inferiority trial Study population: Incurable cancer patients with neuropathic pain Intervention: When a patient decides to take part in the study, he will be allocated randomly to one of the two study groups. A minimisation algorithm will be used, that balances for the cause of neuropathic pain (tumour related versus treatment related), type of treatment (ongoing chemo- or radiotherapy versus not ongoing chemo- or radiotherapy) and institution. Each drug will be prescribed in a step up procedure. Patients will be followed during 8 weeks.
Main study parameters/endpoints: Neuropathic pain, as measured with the mean VAS and McGill questionnaire, strategy success, costs per strategy, side effects, quality of life and concomitant analgesic drugs.
Nature and extent of the burden and risks associated with participation, benefit and group relatedness: There are hardly any risks for the patients. The drugs in both arms already are usual care for the target population. If there is no or a too small effect, the drug of the other arm will be added, which strategy also is already usual care. All other medication, except for Tricyclic Antidepressants Drugs (TADs) and Anti Epileptic Drugs (AEDs), as well as radiotherapy and chemotherapy are allowed. The patient has to visit the hospital 2 times during the study period. The patient had to fill in a pain diary daily (5 min), cost diary and EQ-5D every other week (10 min), related questionnaires as HADS, McGill and EORTC-QLQ-C30 monthly (20 min).
Study Overview
Status
Intervention / Treatment
Study Type
Enrollment (Anticipated)
Phase
- Phase 3
Contacts and Locations
Study Contact
- Name: Yvonne Engels, PhD
- Phone Number: +31243616583
- Email: y.engels@anes.umcn.nl
Study Contact Backup
- Name: Annelies Schalkwijk, MSc
- Phone Number: +31243666254
- Email: a.schalkwijk@anes.umcn.nl
Study Locations
-
-
Noord-Holland
-
Amsterdam, Noord-Holland, Netherlands, 1007MB
- Recruiting
- VUMC
-
Contact:
- Roberto Perez, PhD
- Phone Number: +31204440029
- Email: rsgm.perez@vumc.nl
-
Principal Investigator:
- Roberto Perez, PhD
-
-
Zuid-Holland
-
Rotterdam, Zuid-Holland, Netherlands, 3000CA
- Recruiting
- Erasmus MC
-
Contact:
- Carin vd Rijt, MD, PhD
- Phone Number: +31104391906
- Email: c.vanderrijt@erasmusmc.nl
-
Principal Investigator:
- Carin vd Rijt, MD, PhD
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Age 18+
- Incurable cancer
- Life expectancy three months or longer
- NRS ≥ 4
- Neuropathic pain
- Adequate renal function with cockroft ≥ 60 ml/min
- Signed informed consent
- Expected adequacy of follow up
Exclusion Criteria:
- Previous use of TAD or AED for neuropathic pain within 30 days prior to screening
- Unstable regime of analgetica for 1 week prior to screening
- Use of cannabis
- Radiotherapy aimed at the source of the neuropathic pain 2 weeks before screening
- Chemotherapy with known neurotoxic effect (taxanes, thalidomide, vinca alkaloids, cytarabine,fluoropyrimidines, oxaliplatin) 2 weeks before screening
- Unstable regime of corticosteroids for 1 week prior to screening
- Pregnancy
- Any condition preventing the intake or absorption of oral drugs
- Participation in any other studies involving investigational products within the 30 days prior to screening
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: 1
Strategy in which patient starts with amitriptyline
|
strategy in which the patient starts with amitriptyline, during 8 weeks
Other Names:
|
Active Comparator: 2
Strategy in which patient starts with pregabalin
|
Strategy in which patient starts with pregabalin
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
VAS score
Time Frame: 8 weeks
|
8 weeks
|
Secondary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
EQ-5D, McGill, EORTC-C30, HADS
Time Frame: 8 weeks
|
8 weeks
|
Collaborators and Investigators
Investigators
- Study Director: Kris Vissers, MD PhD FIPP, Radboud university medical center
Study record dates
Study Major Dates
Study Start
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Nervous System Diseases
- Pain
- Neurologic Manifestations
- Neuromuscular Diseases
- Peripheral Nervous System Diseases
- Neuralgia
- Physiological Effects of Drugs
- Adrenergic Agents
- Neurotransmitter Agents
- Molecular Mechanisms of Pharmacological Action
- Central Nervous System Depressants
- Peripheral Nervous System Agents
- Analgesics
- Sensory System Agents
- Analgesics, Non-Narcotic
- Tranquilizing Agents
- Psychotropic Drugs
- Neurotransmitter Uptake Inhibitors
- Membrane Transport Modulators
- Antidepressive Agents
- Anti-Anxiety Agents
- Anticonvulsants
- Antidepressive Agents, Tricyclic
- Calcium-Regulating Hormones and Agents
- Calcium Channel Blockers
- Adrenergic Uptake Inhibitors
- Pregabalin
- Amitriptyline
Other Study ID Numbers
- 80-82310-98-8612
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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