long term safety of sativex oromucosal spray (sativex®; nabiximols) as adjunctive therapy in patients with uncontrolled persistent chronic cancer related pain

Conditions: Pain; Advanced Cancer

Summary: this was a six-month open-label extension (ole) study to evaluate the safety of long-term nabiximols (sativex®) therapy when used as an adjunctive treatment in participants with advanced cancer. the study provided continued availability of nabiximols to participants who completed a preceding phase 3 study and new (de novo) participants.

this was a 6-month, multicenter, non-comparative, ole study to evaluate the safety of long-term nabiximols use as an adjunctive measure in participants with advanced cancer. the study provided continued availability of nabiximols to participants who completed a preceding double-blind phase 3 study and de novo participants. consenting eligible participants entered the extension study (day 1) on the same day as the "end of treatment" visit of a parent study or within 7 days of the "end of treatment" visit or on the day of the "safety follow-up visit" of the parent study. the "safety follow-up" visit of a parent study was performed on the same day as day 1, if the participant did not enter the ole study on the same day as the "end of treatment" visit of a parent study. de novo participants attended a screening visit 3 to 14 days prior to enrollment (day 1). all participants commenced dosing on day 1. further study visits took place after 2 weeks (day 15), and every 4 weeks thereafter until the end of treatment period on day 183 or earlier if the participant withdrew from the study. treatment was started as a single spray in the evening on the first day (day 1). participants then gradually titrated by 1 additional spray per day to an individualized dose, balancing efficacy and tolerability. participants had to complete titration within 14 days of their first dose of study drug and then continue at the same dose for the remainder of the study.

Eligibility criteria:
inclusion criteria: * participant had completed the parent study within the last seven days * willing and able to give written informed consent * willing and able to comply with all study requirements exclusion criteria: * the participant was using cannabis or cannabinoid based medications, other than the parent study investigational medicinal product (imp), and was unwilling to abstain for the duration of the study * any history or immediate family history of schizophrenia, other psychotic illness, severe personality disorder or other significant psychiatric disorder other than depression associated with their underlying condition * any known or suspected history of a substance abuse/dependence disorder (including opiate abuse/dependence prior to the diagnosis of cancer), current heavy alcohol consumption (more than 60 grams \[g\] of pure alcohol per day for men, and more than 40 g of pure alcohol per day for women), current use of an illicit drug or current non-prescribed use of any prescription drug * had poorly controlled epilepsy or recurrent seizures (for example, one or more seizure during the last year) * had experienced myocardial infarction or clinically significant cardiac dysfunction within the last 12 months or had a cardiac disorder that, in the opinion of the investigator would have put the participant at risk of a clinically significant arrhythmia or myocardial infarction * had significantly impaired renal function * had significantly impaired hepatic function at the "end of treatment" visit of the parent study * female participants of child-bearing potential and male participants whose partner was of child-bearing potential, unless willing to ensure that they or their partner used effective contraception, for example, oral contraception, double barrier, intra-uterine device, during the study and for 3 months thereafter (however, a male condom should not have been used in conjunction with a female condom as this may not have proven effective)

Keywords: cancer pain opioid therapy inadequate analgesia optimized chronic opioid therapy