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Acute PancreatitisPhase 2/3NCT04743570

Effects of Peripherally Acting µ-opioid Receptor Antagonists on Acute Pancreatitis

A Phase 2/3 study testing Methylnaltrexone treatment in people with Acute Pancreatitis, run by Asbjørn Mohr Drewes at 4 sites in Denmark.

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 study will investigate the effect of peripheral acting opioid antagonist (PAMORA) on the disease course of patients with acute inflammation of the pancreas (acute pancreatitis). The study will be conducted by treating hospitalized patients with acute pancreatitis with a PAMORA (methylnaltrexone). Read more about this study

Who is it for?
Ages 18 to 85 years
Conditions the study is for
Acute Pancreatitis
What is being tested?
Methylnaltrexone treatment
Type of treatment
Injection or infusion
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
105 participants
Where
4 sitesDenmark
Study dates
14 May 2021to 20 Apr 2023
Phase
Phase 2/3
Are there results?
None posted in the registry

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 to 85 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Signed informed consent before any study specific procedures
  • Able to read and understand Danish
  • Male or female age between 18 and 80 years
  • The researcher believes that the participant understands what the study entails, is capable of following instructions, can attend when needed, and is expected to complete the study
  • The investigator will ensure that fertile female participants have a negative pregnancy test before treatment initiation and use contraception during the study period. The following methods of contraception, if properly used, are generally considered reliable: oral contraceptives, patch contraceptives, injection contraceptives, vaginal contraceptive ring, intrauterine device, surgical sterilization (bilateral tubal ligation), vasectomized partner, double barrier (condom and pessary), or sexual abstinence. Methods of contraception will be documented in the source documents
  • At least two of the following criteria need to be fulfilled to establish a diagnosis of AP (according to the revised Atlanta criteria (16)): i) abdominal pain consistent with AP (acute onset of a persistent, severe, epigastric pain often radiating to the back); ii) serum amylase activity at least three times greater than the upper limit of normal; and iii) characteristic findings of AP on diagnostic imaging
  • Predicted moderate or severe AP based on 2 or more systemic inflammatory response syndrome criteria upon admission

Who cannot join

  • Definitive chronic pancreatitis according to the M-ANNHEIM criteria
  • Known allergy towards study medication
  • Known or suspected major stenosis or perforation of the intestines
  • Known or suspected abdominal cancer (incl. intestine, pancreas and the biliary tree)
  • Pre-existing renal insufficiency (defined as habitual estimated glomerular filtration rate below 45)
  • Severe pre-existing comorbidities (assessed by investigator upon inclusion)
Show all 9Show fewer
  • Severe non-pancreaticobiliary infections or sepsis caused by non-pancreaticobiliary disease
  • Child-Pugh class B or C liver cirrhosis
  • Females that are currently lactating

Trial locations and contacts

4 sites in 1 country.

Denmark4 sites
  • Mech-Sense, Department of Medical Gastroenterology, Aalborg University Hospital

    Aalborg, Jutland, 9000

  • Digestive Disease Center K, Bispebjerg University Hospital

    Bispebjerg

  • Gastrounit, Hvidovre University Hospital

    Hvidovre

  • Odense Pancreas Center

    Svendborg

Other trials in Denmark

About this study

Official title: Effects of Peripherally Acting µ-opioid Receptor Antagonists on Acute Pancreatitis - An Investigator-initiated, Randomized, Placebo-controlled, Double-blind Clinical Trial

This study will investigate the effect of peripheral acting opioid antagonist (PAMORA) on the disease course of patients with acute inflammation of the pancreas (acute pancreatitis). The study will be conducted by treating hospitalized patients with acute pancreatitis with a PAMORA (methylnaltrexone).

Read the detailed description

In this study, the effects of peripheral acting µ-opioid receptor antagonists (PAMORA) on disease development and progression in patients with acute pancreatitis (AP) will be investigated. Patients with AP will be administered Methylnaltrexone (Relistor®) intravenously. This medication is defined as the investigational product. Relistor® is approved and sold on the Danish marked for treatment of opioid-induced constipation. This PAMORA have not previously been investigated in patients with pancreatitis. The dose regimes for this study will be according to label. It has previously been shown, in patients with opioid-induced obstipation and healthy subjects, that opioid antagonism incl. PAMORA treatment increases gut motility, relaxes gastrointestinal sphincters, increases the intestinal water content and improves the immune response, without affecting analgesia. The affinity of PAMORAs to the µ-opioid receptors is much stronger than opioid analgesics. Therefore, they as antagonists have the potential to counteract the harmful effects of opioids on the gut mucosa, bacterial translocation and inflammation despite the high levels of exogenous opioids present in patients with pancreatitis. PAMORAs do not cross the blood-brain barrier and consequently do not interfere with analgesia or other central effects of opioids.

We hypothesize that treatment with the PAMORA methylnaltrexone will antagonize the harmful effects of opioids without reducing analgesia in patients with AP and hence reduce disease severity and improve clinical outcomes. If successful, this sub-study will for the first time document the effects of a targeted pharmacotherapy in AP with the potential benefit of improved patient outcomes.

Being tested
Placebo treatment, Methylnaltrexone treatment
Medical subject headings
Pancreatitis

What participants receive

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

  • Placebo treatmentDrug

    Active drug/placebo is given for the first 5 days of admission.

  • Methylnaltrexone treatmentDrug

    Active drug/placebo is given for the first 5 days of admission.

Study groups in NCT04743570
Study groupRoleWhat they receive
Placebo treatmentPlacebo comparatorPlacebo consisting of Ringer's lactate in matched volume to active drug is added to 1000 mL Ringer's lactate solution and given as a continues infusion over 24 hours using an infusion pump.
Receives: Drug: Placebo treatment
Methylnaltrexone treatmentActive comparator0.15 mg/kg methylnaltrexone will be dissolved in 1000 mL Ringer's lactate solution and given as a continues infusion over 24 hours using an infusion pump.
Receives: Drug: Methylnaltrexone treatment

What is being measured

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

  1. Pancreatitis activity scoring system

    Difference in Pancreatitis activity scoring system (PASS) score between the methylnaltrexone group and the placebo group. The PASS-score is a weighted score of presence of organ failure, number of criterias of Systemic Inflammatory Response Syndrome fulfilled, abdominal pain (0-10), morphine equivalent dose (mg) and tolerance to solid food. Minimum value is 0 and higher score is equal to higher disease activity.

    Documentation for the PASS can be found on the following link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5519418/

    Measured: 48 hours after randomization

Secondary outcomes (16)
  1. Pancreatitis activity scoring system

    Difference PASS scores between subgroups

    Measured: 24 hours after randomization and every 24 hours untill end of study at day 5 (after 120 hours) and again at the day 14 follow-up visit

  2. Difference in assessments of circulating proinflammatory marker

    C-Reactive Protein (mg/L)

    Measured: 24 hours after randomization and every 24 hours untill end of study at day 5 (after 120 hours) and again at the day 14 follow-up visit

  3. Difference in assessments of circulating pro- and anti-inflammatory markers

    Interleukin-6, Interleukin-8, Interleukin-18, Tumor necrosis factor alpha, Cluster of Differentiation 163 (serum) (all measured in pg/mL)

    Measured: 24 hours after randomization and every 24 hours untill end of study at day 5 (after 120 hours) and again at the day 14 follow-up visit

  4. Intestinal permeability

    Difference in intestinal permeability between subgroups using the oral polyethylene glycol 400/4000 test

    Measured: From 48 to 72 hours after randomization

  5. Intestinal motility

    Difference in intestinal motility assessed by means of gut/colon transit using a CT-based radiopaque marker method between subgroups

    Measured: 5 (+/- 1 day) after randomization

  6. Pancreatic complications

    Difference in pancreatic complications (e.g. edema, fluid collections and necrosis) assessed and quantified with contrast-enhanced CT

    Measured: Day 5 (+/- 1 day) after randomization

  7. Pain intensity

    Difference between subgroups in pain intensity measured with the questionaire "modified Brief Pain Inventory short form" on visual analogue scale from 0-10 (0 is no pain and 10 is worst pain).

    Measured: 24 hours after randomization and every 24 hours untill end of study at day 5 (after 120 hours) and again at the day 14 follow-up visit

  8. Gut function (BSFS)

    Difference between subgroups in gut function assessed by The Bristol Stool Form Scale for assessment of stool frequency as well as stool consistency (scale from 1-7, where 1 is firmeste and 7 is softest)

    Measured: 24 hours after randomization and every 24 hours untill end of study at day 5 (after 120 hours) and again at the day 14 follow-up visit

  9. Gut function (GSRS)

    Difference between subgroups in gut function assessed by Gastrointestinal Symptom Rating Scale which is a disease-specific instrument of 15 items combined into five symptom clusters depicting reflux, abdominal pain, indigestion, diarrhea and constipation. The GSRS has a seven-point graded Likert-type scale, where 1 represents absence of troublesome symptoms and 7 represents very troublesome symptoms.

    Measured: 24 hours after randomization and every 24 hours untill end of study at day 5 (after 120 hours) and again at the day 14 follow-up visit

  10. Quantification of analgesics

    Difference between subgroups in given dose of analgesics (separated into opioids and non-opioids) based on name, administration route and dose

    Measured: 24 hours after randomization and every 24 hours untill end of study at day 5 (after 120 hours) and again at the day 14 follow-up visit

  11. Use of nutritional support

    Difference between subgroups in the use of nutritional support with registration of the used of either oral nutrition, enteral or parenteral nutrition.

    Measured: 24 hours after randomization and every 24 hours untill end of study at day 5 (after 120 hours) and again at the day 14 follow-up visit

  12. Days of hospitalization

    Difference between subgroups in days of hospitalization and days on intensive ward

    Measured: Observation period starts from day of randomization and ends after 12 months or on the day of discharge which ever comes first

  13. Use of invasive treatment

    Difference between subgroups in use of invasive treatment (e.g. use of drain or surgery) measured in type and frequency of use

    Measured: Observation period starts from day of randomization and ends after 12 months or on the day of discharge whichever comes first

  14. Mortality

    Difference between subgroups in mortality rate

    Measured: Observation period starts from day of randomization and ends after 12 months or on the day of discharge whichever comes first

  15. Health resource utilization

    Difference in health resource utilization (measured in frequency and type of health services used (e.g. blood sample, MRI etc.) that can be converted into danish currency for economic analyses) between subgroups based on service codes (all services have unique service codes stored digitally).

    Measured: Observation period starts from day of randomization and ends after 12 months or on the day of discharge whichever comes first

  16. Disease severity

    Disease severity classified by the revised Atlanta classification system in 3 levels; Mild, Moderate or Severe acute pancreatitis. (Mild acute pancreatitis, with no organ failure, local or systemic complications, Moderately severe acute pancreatitis is with presence of transient organ failure, local complications or exacerbation of co-morbid disease. Severe acute pancreatitis with persistent organ failure (>48 h).

    Measured: Observation period starts from day of randomization and ends after 12 months or on the day of discharge whichever comes first

Timeline

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

  1. First posted8 Feb 2021
  2. Study start14 May 2021
  3. Primary completion9 Apr 2023
  4. Study completion20 Apr 2023

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 2/3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
105 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04743570
Sponsor's protocol ID
PAMORA_AP, PAMORA-1
Other IDs
2020-002313-18, N-20200060
Status last verified
Apr 2023
First submitted
28 Jan 2021
Last updated
21 Apr 2023
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes

Publications

  • Knoph CS, Cook ME, Novovic S, Hansen MB, Mortensen MB, Nielsen LBJ, Hogsberg IM, Salomon C, Neergaard CEL, Aajwad AJ, Pandanaboyana S, Sorensen LS, Thorlacius-Ussing O, Frokjaer JB, Olesen SS, Drewes AM. No Effect of Methylnaltrexone on Acute Pancreatitis Severity: A Multicenter Randomized Controlled Trial. Am J Gastroenterol. 2024 Nov 1;119(11):2307-2316. doi: 10.14309/ajg.0000000000002904. Epub 2024 Jun 25.

    PubMed 38916223
  • Knoph CS, Cook ME, Fjelsted CA, Novovic S, Mortensen MB, Nielsen LBJ, Hansen MB, Frokjaer JB, Olesen SS, Drewes AM. Effects of the peripherally acting mu-opioid receptor antagonist methylnaltrexone on acute pancreatitis severity: study protocol for a multicentre double-blind randomised placebo-controlled interventional trial, the PAMORA-AP trial. Trials. 2021 Dec 19;22(1):940. doi: 10.1186/s13063-021-05885-3.

    PubMed 34924020

Questions about this trial

What is this clinical trial studying?

A Phase 2/3 study testing Methylnaltrexone treatment in people with Acute Pancreatitis, run by Asbjørn Mohr Drewes at 4 sites in Denmark.

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 7 inclusion and 9 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 21 Apr 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 4 sites in Denmark. 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 combined 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.

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?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

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?

Pancreatitis activity scoring system (time frame: 48 hours after randomization). 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 NCT04743570, 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 21 Apr 2023.

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