Hao Wang1, Gary Romano2, Mary Ellen Frustaci2, Norm Bohidar2, Huizhong Ma2, Panna Sanga2, Seth Ness2, Lucille J Russell2, Margaret Fedgchin2, Kathleen M Kelly2, John Thipphawong2. 1. From the National Institute of Neurological Disorders and Stroke (H.W.), Bethesda, MD; and Janssen Research & Development, LLC (G.R., M.E.F., N.B., H.M., P.S., S.N., L.J.R., M.F., K.M.K., J.T.), NJ. wangh16@ninds.nih.gov. 2. From the National Institute of Neurological Disorders and Stroke (H.W.), Bethesda, MD; and Janssen Research & Development, LLC (G.R., M.E.F., N.B., H.M., P.S., S.N., L.J.R., M.F., K.M.K., J.T.), NJ.
Abstract
OBJECTIVE: To assess efficacy and safety of fulranumab, a fully human monoclonal antibody against nerve growth factor, in patients with diabetic peripheral neuropathic pain (DPNP). METHODS: In this phase II, double-blind, placebo-controlled trial, patients with moderate to severe DPNP were randomized to treatments with fulranumab (1, 3, or 10 mg) or placebo administered subcutaneously every 4 weeks. RESULTS: Because of early study termination (clinical hold) by the US Food and Drug Administration, 77 (intent-to-treat) of the planned 200 patients were enrolled. The primary endpoint, the mean reduction of average daily pain at week 12 compared with baseline, showed a positive dose-response relationship (p = 0.014, 1-sided); the pair-wise comparison between the 10-mg group and placebo was significant (unadjusted p = 0.040, 2-sided). An exploratory responder analysis revealed that a greater proportion of patients in the 10-mg group reported ≥30% reduction in the average DPNP intensity compared with placebo at week 12 (p = 0.006). Although not statistically significant, several secondary endpoints showed directionally similar results to the primary efficacy dose-response relationship. During the combined efficacy and safety extension phases, the top 3 treatment-emergent adverse events in the combined fulranumab group were arthralgia (11%), edema peripheral (11%), and diarrhea (9%). No cases of joint replacement or death were reported. CONCLUSION: Despite early study termination, fulranumab treatment resulted in dose-dependent efficacy and was generally well tolerated. CLASSIFICATION OF EVIDENCE: This study provides Class I evidence that in patients with DPNP, fulranumab 10 mg reduces pain by 1.2 points on an 11-point scale compared with placebo.
RCT Entities:
OBJECTIVE: To assess efficacy and safety of fulranumab, a fully human monoclonal antibody against nerve growth factor, in patients with diabetic peripheral neuropathic pain (DPNP). METHODS: In this phase II, double-blind, placebo-controlled trial, patients with moderate to severe DPNP were randomized to treatments with fulranumab (1, 3, or 10 mg) or placebo administered subcutaneously every 4 weeks. RESULTS: Because of early study termination (clinical hold) by the US Food and Drug Administration, 77 (intent-to-treat) of the planned 200 patients were enrolled. The primary endpoint, the mean reduction of average daily pain at week 12 compared with baseline, showed a positive dose-response relationship (p = 0.014, 1-sided); the pair-wise comparison between the 10-mg group and placebo was significant (unadjusted p = 0.040, 2-sided). An exploratory responder analysis revealed that a greater proportion of patients in the 10-mg group reported ≥30% reduction in the average DPNP intensity compared with placebo at week 12 (p = 0.006). Although not statistically significant, several secondary endpoints showed directionally similar results to the primary efficacy dose-response relationship. During the combined efficacy and safety extension phases, the top 3 treatment-emergent adverse events in the combined fulranumab group were arthralgia (11%), edema peripheral (11%), and diarrhea (9%). No cases of joint replacement or death were reported. CONCLUSION: Despite early study termination, fulranumab treatment resulted in dose-dependent efficacy and was generally well tolerated. CLASSIFICATION OF EVIDENCE: This study provides Class I evidence that in patients with DPNP, fulranumab 10 mg reduces pain by 1.2 points on an 11-point scale compared with placebo.
Authors: Panna Sanga; Nathaniel Katz; Elena Polverejan; Steven Wang; Kathleen M Kelly; Juergen Haeussler; John Thipphawong Journal: Pain Date: 2013-06-05 Impact factor: 6.961
Authors: Hao Wang; Gary Romano; Margaret Fedgchin; Lucille Russell; Panna Sanga; Kathleen M Kelly; Mary Ellen Frustaci; John Thipphawong Journal: Clin J Pain Date: 2017-02 Impact factor: 3.442