Title

SUBLOCADE Rapid Initiation Study
An Open-label, Rapid Initiation Study for Extended-Release Buprenorphine Subcutaneous Injection (SUBLOCADE)
  • Phase

    Phase 4
  • Study Type

    Interventional
  • Study Participants

    26
This study is to evaluate the safety and tolerability of initiating SUBLOCADE™ treatment following a shorter period of transmucosal (TM) buprenorphine treatment.
Currently patients who are appropriate candidates for SUBLOCADE™ injection for subcutaneous (SC) use must initiate treatment with TM buprenorphine for a minimum of 7 days before receiving their first injection. This study is to evaluate the safety and tolerability of starting SUBLOCADE treatment following a shorter period.

Adults with moderate to severe opioid use disorder (OUD) not currently receiving medication assisted treatment will be recruited to participate. Prior to receiving TM buprenorphine, subjects will report their last opioid use and be experiencing at least mild withdrawal. Subjects will receive at least one dose of TM buprenorphine to ensure tolerability and that they show no evidence of precipitated withdrawal. If no evidence of intolerability or no precipitated withdrawal occurs, subjects will receive a single injection of SUBLOCADE and remain in the clinic for approximately 48 hours after the injection to assess for safety and tolerability.
Study Started
Aug 29
2019
Primary Completion
Dec 26
2019
Study Completion
Dec 26
2019
Results Posted
Dec 09
2020
Last Update
Oct 03
2022

Drug TM buprenorphine

4mg TM buprenorphine, investigator choice as to brand

  • Other names: suboxone, subutex, belbuca, zubsolv, bunavail, generic buprenorphine

Drug SUBLOCADE

300mg subcutaneous injection

  • Other names: extended release buprenorphine

TM buprenorphine followed by SUBLOCADE 300 mg Experimental

Participants with a diagnosis of OUD stopped use of their current opioid prior to coming to the clinic to be assessed for withdrawal symptoms. If confirmed to be in withdrawal, participants were administered 4 mg transmucosal (TM) buprenorphine. If tolerated without sensitivity, clinical signs of sedation, or precipitated withdrawal, 300 mg SUBLOCADE was administered. Following SUBLOCADE administration, participants remained in the clinic for approximately 48 hours and were assessed for safety and tolerability, as well as for any signs of precipitated withdrawal. Participants returned to the clinic weekly, until the end-of-treatment (EOT) visit (28 days after SUBLOCADE administration).

Criteria

Inclusion Criteria:

Signed the informed consent form (ICF) and have the ability to comply with the requirements and restrictions listed therein.
Documented history of moderate or severe opioid use disorder (OUD) as defined by Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5).
Seeking buprenorphine-assisted treatment for OUD and is an appropriate candidate in the opinion of the Investigator or medically qualified sub-Investigator.
A female subject is eligible to participate if she is not pregnant (as confirmed by a negative urine human chorionic gonadotrophin test), is not lactating and, if of childbearing potential, agrees not to become pregnant while on the study and use medically acceptable means of contraception while on the study.

Exclusion Criteria:

Current diagnosis, other than OUD, requiring chronic opioid treatment.
Meet DSM-5 criteria for severe alcohol-use disorder.
Has received any medication assisted treatment within 2 weeks.
Concurrent or prior treatment with any long-acting depot form of buprenorphine containing products.
Concurrent treatment with another investigational agent or enrolment in another clinical study (except for an observational study) or treatment with another investigational agent within 30 days prior to screening.
Concurrent treatment with medications contraindicated for use with buprenorphine as per local prescribing information, including benzodiazepines or any other central nervous system depressants.
Significant traumatic injury, major surgical procedure (as defined by the Investigator) within 30 days prior to Day 1 or still recovering from prior surgery.
Any other active medical condition, organ disease or concurrent medication or treatment that may either compromise subject safety or interfere with study endpoints.
Congenital long QT syndrome, history of prolonged QT in the 3 months prior to screening, or a corrected QT interval (Fridericia's - QTcF) >450 msec (male) or >470 msec (female), or history of risk factors for Torsades de Pointes. Known personal and/or family history of congenital QT prolongation, or taking Class IA antiarrhythmic medications (e.g., quinidine, procainamide, disopyramide) or Class III antiarrhythmic medications (e.g., sotalol, amiodarone) or other mediations that prolong the QT interval. Known family history of sudden unexplained death.
Total bilirubin ≥1.5*upper limit of normal (ULN), alanine aminotransferase (ALT) ≥3*ULN, aspartate aminotransferase (AST) ≥5*ULN, serum creatinine >2*ULN at screening.
Abdominal area unsuitable for SC injections.
Uncontrolled intercurrent illness including, but not limited to, a medical or psychiatric illness/social situation that would limit compliance with study requirements or compromise the ability of the subject to provide written informed consent.
Known allergy or hypersensitivity to buprenorphine, ATRIGEL or their excipients.
Subject to court order requiring treatment for OUD.
Subjects who are unable, in the opinion of the Investigator or Indivior, to comply fully with the study requirements including those who are currently incarcerated or pending incarceration/legal action.
Clinic staff and/or subjects who have a financial interest in the study or who have an immediate family member of either the clinic staff and/or Indivior employees directly involved in the study.

Summary

Induction Phase

Safety Population (Post -SUBLOCADE)

All Events

Event Type Organ System Event Term Induction Phase Safety Population (Post -SUBLOCADE)

Participants Who Experienced Any Precipitated Withdrawal Within One Hour After SUBLOCADE Administration

Clinical Opiate Withdrawal Scale (COWS) is an 11-item instrument used to assess signs and symptoms of opioid withdrawal. The score is the sum of the responses for a total range of 0-48. The COWS is commonly used by clinicians treating patients with buprenorphine to monitor the severity of withdrawal. COWS scores below 5 are considered not indicative of withdrawal. Scores from 5 to 12 are considered mild withdrawal; from 13 to 24 moderate withdrawal; 25 to 36 moderately severe withdrawal, and 37-48 severe withdrawal. Precipitated withdrawal was defined as in increase in Clinical Opioid Withdrawal Scale (COWS) score by ≥6 from the pre-SUBLOCADE value within 1 hour SUBLOCADE injection.

TM Buprenorphine Followed by SUBLOCADE 300 mg

Participants With Treatment-Emergent Adverse Events (TEAE)

A TEAE was an AE that started after the administration of TM buprenorphine for induction on Day 1. TEAE=any untoward medical occurrence that develops or worsens in severity after dispensation of the study drug and does not necessarily have a causal relationship to the study drug. Severity was rated by the investigator as mild, moderate and severe, with severe= a marked limitation in activity. Relation of AE to treatment was determined by the investigator. Serious AEs include death, a life-threatening AE, inpatient hospitalization or prolongation of existing hospitalization, persistent or significant disability or incapacity, a congenital anomaly or birth defect, OR an important medical event that jeopardized the patient and required medical or surgical intervention to prevent one of the outcomes listed in this definition. AEs of special interest include SUBOCADE depot removal, occurrences of alanine aminotransferase (ALT) >3*upper limit of normal (ULN) and bilirubin >2*ULN.

TM Buprenorphine Followed by SUBLOCADE 300 mg

AE of Special Interest

Any TEAE

Related and Serious TEAE

Serious TEAE

Serious TEAEs - discontinuation of drug

Serious TEAEs - interruption of drug

Severe TEAE

Study Drug-related TEAE

TEAE leading to death

TEAE leading to discontinuation of drug

TEAE leading to interruption of drug

Participants With Treatment-Emergent Adverse Events (TEAE) Within 48 Hours Post-SUBLOCADE Injection

A TEAE was an AE that started after the administration of TM buprenorphine for induction on Day 1. TEAE=any untoward medical occurrence that develops or worsens in severity after dispensation of the study drug and does not necessarily have a causal relationship to the study drug. Severity was rated by the investigator as mild, moderate and severe, with severe= a marked limitation in activity. Relation of AE to treatment was determined by the investigator. Serious AEs include death, a life-threatening AE, inpatient hospitalization or prolongation of existing hospitalization, persistent or significant disability or incapacity, a congenital anomaly or birth defect, OR an important medical event that jeopardized the patient and required medical or surgical intervention to prevent one of the outcomes listed in this definition. AEs of special interest include SUBOCADE depot removal, occurrences of alanine aminotransferase (ALT) >3*upper limit of normal (ULN) and bilirubin >2*ULN.

TM Buprenorphine Followed by SUBLOCADE 300 mg

AE of Special Interest

Any TEAE

Related and Serious TEAE

Serious TEAE

Serious TEAEs - discontinuation of drug

Serious TEAEs - interruption of drug

Severe TEAE

Study Drug-related TEAE

TEAE leading to death

TEAE leading to discontinuation of drug

TEAE leading to interruption of drug

Cumulative Number of Participants Who Experienced a >=6 Point Clinical Opiate Withdrawal Scale (COWS) Total Score Increase After SUBLOCADE Administration From the Pre-SUBLOCADE Value at Key Timepoints

COWS is an 11-item instrument used to assess signs and symptoms of opioid withdrawal. The score is the sum of the responses for a total range of 0-48. The COWS is commonly used by clinicians treating patients with buprenorphine to monitor the severity of withdrawal. COWS scores below 5 are considered not indicative of withdrawal. Scores from 5 to 12 are considered mild withdrawal; from 13 to 24 moderate withdrawal; 25 to 36 moderately severe withdrawal, and 37-48 severe withdrawal. Cumulative number of participants in key timepoints who had a COWS total score increase of ≥6 points from the pre-SUBLOCADE value.

TM Buprenorphine Followed by SUBLOCADE 300 mg

>0 to 1 hour

>12 to 24 hours

> 1 to 6 hours

>24 to 48 hours

>6 to 12 hours

COWS Total Score Normalized Area Under the Curve (AUC) Through Key Timepoints Post SUBLOCADE Injection

The area under the curve (AUC) for COWS total score from the pre-SUBLOCADE value to a later time point were calculated using the linear trapezoidal method. For each analysis time interval (AUC0-1hr, AUC0-6hrs, AUC0-12hrs, AUC0-24hrs, AUC0-48hrs) the AUC value was normalized across participants for the actual duration (in hours) of the time interval. The normalized AUC for COWS can be interpreted as the averaged AUC per hour or the averaged COWS over a time interval, as if the COWS was measured hourly during that time interval. Participants were included in a given interval if they had a pre-SUBLOCADE COWS assessment and a COWS assessment at the terminal timepoint for the interval.

TM Buprenorphine Followed by SUBLOCADE 300 mg

Through 12 hours post SUBLOCADE

7.91
hours*units on a scale (Mean)
Standard Deviation: 3.772

Through 1 hour post SUBLOCADE

11.91
hours*units on a scale (Mean)
Standard Deviation: 3.700

Through 24 hours post SUBLOCADE

6.59
hours*units on a scale (Mean)
Standard Deviation: 3.021

Through 48 hours post SUBLOCADE

5.03
hours*units on a scale (Mean)
Standard Deviation: 2.566

Through 6 hours post SUBLOCADE

9.27
hours*units on a scale (Mean)
Standard Deviation: 3.939

Total Score on COWS At Timepoints During the Treatment Period

Clinical Opiate Withdrawal Scale (COWS) is an 11-item instrument used to assess signs and symptoms of opioid withdrawal. The score is the sum of the responses for a total range of 0-48. The COWS is commonly used by clinicians treating patients with buprenorphine to monitor the severity of withdrawal. COWS scores below 5 are considered not indicative of withdrawal. Scores from 5 to 12 are considered mild withdrawal; from 13 to 24 moderate withdrawal; 25 to 36 moderately severe withdrawal, and 37-48 severe withdrawal.

TM Buprenorphine Followed by SUBLOCADE 300 mg

12 hours post-SUBLOCADE dose

6.6
units on a scale (Mean)
Standard Deviation: 3.69

16 hours post-SUBLOCADE dose

6.0
units on a scale (Mean)
Standard Deviation: 2.65

1 hour post-SUBLOCADE dose

11.1
units on a scale (Mean)
Standard Deviation: 4.51

20 hours post-SUBLOCADE dose

5.0
units on a scale (Mean)
Standard Deviation: 2.90

24 hours post-SUBLOCADE dose

4.2
units on a scale (Mean)
Standard Deviation: 3.16

2 hours post-SUBLOCADE dose

10.1
units on a scale (Mean)
Standard Deviation: 4.99

30 hours post-SUBLOCADE dose

3.9
units on a scale (Mean)
Standard Deviation: 3.00

36 hours post-SUBLOCADE dose

3.5
units on a scale (Mean)
Standard Deviation: 2.65

3 hours post-SUBLOCADE dose

9.1
units on a scale (Mean)
Standard Deviation: 5.32

48 hours post-SUBLOCADE dose

2.8
units on a scale (Mean)
Standard Deviation: 2.54

4 hours post-SUBLOCADE dose

8.0
units on a scale (Mean)
Standard Deviation: 3.93

6 hours post-SUBLOCADE dose

6.9
units on a scale (Mean)
Standard Deviation: 4.06

8 hours post-SUBLOCADE dose

6.6
units on a scale (Mean)
Standard Deviation: 3.83

Day 15

2.0
units on a scale (Mean)
Standard Deviation: 1.99

Day 1 Check-in

12.5
units on a scale (Mean)
Standard Deviation: 3.74

Day 22

2.0
units on a scale (Mean)
Standard Deviation: 2.58

Day 8

1.9
units on a scale (Mean)
Standard Deviation: 1.64

End of Treatment Day 29

1.8
units on a scale (Mean)
Standard Deviation: 2.12

Pre-SUBLOCADE

12.6
units on a scale (Mean)
Standard Deviation: 4.05

Pre TM Buprenephrine

14.6
units on a scale (Mean)
Standard Deviation: 4.13

Total Score on Opioid Craving Visual Analogue Scale (OC-VAS) At Timepoints During the Treatment Period

Participants indicated their level of craving for opioids by marking a 100mm visual analogue scale where 0 = no craving and 100 = maximal craving.

TM Buprenorphine Followed by SUBLOCADE 300 mg

12 hours post-SUBLOCADE dose

39.3
units on a scale (Mean)
Standard Deviation: 31.19

16 hours post-SUBLOCADE dose

29.7
units on a scale (Mean)
Standard Deviation: 38.48

1 hour post-SUBLOCADE dose

56.5
units on a scale (Mean)
Standard Deviation: 26.52

20 hours post-SUBLOCADE dose

33.5
units on a scale (Mean)
Standard Deviation: 20.79

24 hours post-SUBLOCADE dose

27.3
units on a scale (Mean)
Standard Deviation: 20.77

2 hours post-SUBLOCADE dose

52.8
units on a scale (Mean)
Standard Deviation: 29.99

30 hours post-SUBLOCADE dose

16.7
units on a scale (Mean)
Standard Deviation: 12.37

36 hours post-SUBLOCADE dose

13.8
units on a scale (Mean)
Standard Deviation: 13.74

3 hours post-SUBLOCADE dose

53.9
units on a scale (Mean)
Standard Deviation: 30.22

48 hours post-SUBLOCADE dose

12.1
units on a scale (Mean)
Standard Deviation: 12.09

4 hours post-SUBLOCADE dose

44.5
units on a scale (Mean)
Standard Deviation: 29.75

6 hours post-SUBLOCADE dose

42.6
units on a scale (Mean)
Standard Deviation: 26.98

8 hours post-SUBLOCADE dose

43.1
units on a scale (Mean)
Standard Deviation: 27.20

Day 15

6.4
units on a scale (Mean)
Standard Deviation: 9.54

Day 1 Check-in

66.0
units on a scale (Mean)
Standard Deviation: 22.03

Day 22

13.1
units on a scale (Mean)
Standard Deviation: 20.32

Day 8

7.6
units on a scale (Mean)
Standard Deviation: 11.00

End of Treatment Day 29

7.3
units on a scale (Mean)
Standard Deviation: 9.24

Pre-SUBLOCADE

57.0
units on a scale (Mean)
Standard Deviation: 28.91

Pre TM Buprenephrine

65.0
units on a scale (Mean)
Standard Deviation: 31.06

Age, Continuous

40.0
years (Mean)
Standard Deviation: 13.45

Clinical Opiate Withdrawal Scale (COWS) Total Score at Screening

4.7
units on a scale (Mean)
Standard Deviation: 4.63

Opioid Craving Visual Analog Scale (OC-VAS) at Screening

58.3
units on a scale (Mean)
Standard Deviation: 23.97

Opioid Drug Use History - Last 30 Days Use

28.88
days (Mean)
Standard Deviation: 3.837

Opioid Drug Use History - Lifetime Use

13.88
years (Mean)
Standard Deviation: 13.542

Opioid Drug Use History - Participants Use Intravenously in Last 30 Days

6
Participants

Screening Body Mass Index (BMI)

22.60
kg/m^2 (Mean)
Standard Deviation: 4.058

Age Group

Caffeine Use

Day 1 Urine Drug Screen: Participants with Positive Opioid Tests

Ethnicity

Race/Ethnicity, Customized

Screening BMI Group

Sex: Female, Male

Tobacco Use

Urine Drug Screen (UDS) for Opioids at Screening

Overall Study

TM Buprenorphine Followed by SUBLOCADE 300 mg

Drop/Withdrawal Reasons

TM Buprenorphine Followed by SUBLOCADE 300 mg