what about the imp? imp handling for the trial site pharmacy
TRANSCRIPT
WHAT
ABOUT
THE IM
P?
IMP
HANDLING F
OR THE T
RIAL S
ITE P
HARMACY
CONTENTS
Study outline and objectivesWhat are the IMPs?How are they being used?Where do they come from?How do we get them?What do we do with them? Advice to participants?What about unblinding?What questions do you have?
STUDY OUTLINE AND OBJECTIVES
OUTLINE:
PHASE 3, RANDOMISED, DOUBLE-BLIND, PLACEBO-CONTROLLED 2X2 FACTORIAL TRIAL
PRIMARY OBJECTIVE
To determine whether the naturally-occurring omega -3 polyunsaturated fatty acid eicosapentaenoic acid (EPA) prevents colorectal adenomas, either alone or in combination with aspirin
SECONDARY OBJECTIVE
To assess the tolerability and safety of EPA in the free fatty acid form (EPA-FFA) alone, and in combination with aspirin, in elderly (60-73) years participants
1o endpoint – number of patients with a polyp(s) at one year
2o endpoints – polyp number, ‘advanced’ lesions, location, AEs
STUDY OUTLINE AND OBJECTIVES
INCLUSION:
60-73 Yrs BCSP Patients
Classified as High Risk following a Single Clearance Colonoscopy within past 4 weeks
nb high risk = 5 or more small adenomas or 3 or more adenomas with at least one being ≥10mm diameter
STUDY OUTLINE AND OBJECTIVESEXCLUSION CRITERIA: main ones listed here (see protocol for extensive list)
Need for a repeat colonoscopy of flexible sigmoidoscopy within a 3 month windowMalignant change in an adenoma requiring colorectal cancer MDT managementRegular (>3 doses/week) prescribed or OTC aspirin or prescribed or OTC non-aspirin NSAID useAspirin intolerance, hypersensitivity including aspirin-sensitive asthmaActive peptic ulcer disease within past 3 months or any previous peptic ulcer (not on PPI therapy)Fish or seafood allergyCurrent or planned regular(>3 doses/week) use of fish oil supplementsKnown clinical diagnosis or gene carrier of a hereditary CRC predisposition,(Familial Adenomatous Polyposis) or Hereditary Non Polyposis Colorectal CancerPrevious or newly diagnosed Inflammatory Bowel Disease or colorectal resectionKnown bleeding diathesis or concomitant warfarin therapy or any other anti-coagulant or anti-platelet therapySevere liver impairmentSevere renal failure (creatinine clearance <10ml/min)Current Methotrexate use at a weekly dose of 15 mg or moreInvolved in another interventional clinical trialFailure to give Informed Consent
WHAT ARE THE IMPS?Eicosapentaenoic acid in free fatty acid form (EPA-FFA) • a Fish Oil• naturally-occurring, ω-3 PUFA • provided in gastro-resistant capsules of 500mg designed to release
the contents of the capsules in the small intestine to reduce GI side effects and enable improved absorption• principal undesirable effects are expressed through the
gastrointestinal tract with diarrhoea, abdominal pain, nausea and vomiting• These are normally relatively mild in severity and can be minimised
or removed by dosing with food or dose reduction to 1g daily• EPA-FFA has not yet received marketing approval
EPA-FFA placebo consists of gastro-resistant capsules of capric and capryllic acid triglycerides
WHAT ARE THE IMPS?
Aspirin (acetylsalicylic acid) • supplied as enteric-coated 300mg tablets • see aspirin SPC in Pharmacy File for additional information • Aspirin EC 300mg tablets have marketing approval in the
EU
Aspirin placebo consists of the same excipients as in the active formulation of the drug minus the active ingredient.
HOW ARE THEY BEING USED? - DOSES
Two 500mg gastro-resistant capsules of EPA-FFA (or placebo) will be taken orally twice daily with food giving a total daily dose of 2g.
One 300mg enteric-coated aspirin tablet (or placebo) will be taken orally once a day with food.
The Trial treatment is taken daily from the date randomisation to the day before the surveillance colonoscopy, between 350-360 days.
The Trial treatment will not be available to the patients via the seAFOod Polyp Prevention Trial team when they have finished the Trial.
HOW ARE THEY BEING USED - DOSE MODIFICATIONS
Doses of EPA-FFA can be modified if side-effects occur which the Investigator suspects to be related to EPA-FFA• Dose modifications of EPA-FFA are advised by the SSP during
clinic or telephone visits following a defined flow chart• Dose modification are be recorded by the SSP in the medical
notes and adverse event section of the CRF • Dose modification of EPA-FFA does not alter the number of
capsules dispensed for a trial participant
Aspirin dose cannot be modified
WHERE DO THEY COME FROM?
Gastro-resistant Eicosapentaenoic Acid in free fatty acid form (EPA-FFA) 500mg capsules and matching placebo are supplied in bulk by SLA Pharma AG.
Aspirin 300mg E/C tablets and matching placebo are supplied in bulk by Bayer-Schering Pharma AG.
Packaging, labelling and release of blinded trial treatment containers, is carried out by Stockport Pharmaceuticals, Stepping Hill Hospital.
Supplies are delivered to the study sites from Stockport Pharmaceuticals, Stepping Hill Hospital.
HOW DO WE GET THEM?
Initial supply and resupply from Stockport Pharmaceuticals is at the request of the Trial Manager.
IMPs are supplied in outer boxes of 32 containers consisting of:
20 cartons of 150 x capsules EPA-FFA 500mg or placebo and 12 bottles of 62 Aspirin 300mg E/C or placebo tablets.
IMPs deliveries must be booked into the on-line stock control system without delay
https://ctu4.nottingham.ac.uk/0921_stock/login.asp
Issues concerning stock levels should be reported to the Trial Manager as soon as possible.
WHAT DO WE DO WITH THEM?
Storage
below 25oC
report temperature excursions to the co-ordinating centre as soon as possible
Documentation
Complete
IMP Inventories and
Participant IMP Accountability Document
PRESCRIBING AND DISPENSING
• Prescription is generated from the web-based randomisation system and completed by the prescribing physicianNote: EPA-FFA is a fish oil and allergy to fish oil is part of the
exclusion criteria.• It defines which container numbers should be dispensed
for the participant.• The container numbers specified will have been
delivered to your hospital
• Confirm local logistics regarding prescribing and dispensing
Dispensing is at week 0 and week 25Each participant has 5 packs of these at each dispensing(EPA-FFA 500mg or Placebo capsules 150 capsules per container)
And 3 packs of theseat each dispensing(Aspirin 300mg E/C or Placebo 62 tablets per container)
Container Number
Complete these boxes:
Participant IDVisit Number
Dispensing DateParticipant Name
The IMP Label looks like this:
ADVICE TO PARTICIPANTS?
It would be helpful if Pharmacy could remind the participants to:
•Complete one pack before starting the next• Take both the capsules and the tablets with food•Do not take aspirin containing products•Do not take Fish oil/omega 3 supplements
RETURNS
There is no requirement for Pharmacy to count returns except for destruction
Participant returns are counted in Clinic and recorded on the CRF
Returns should be collected in Pharmacy and
• date returned recorded on Participant IMP Accountability Log• stored until authorised to destroy by Sponsor
WHAT ABOUT UNBLINDING?
“For the majority of cases, unblinding will not be required because there is no antidote to the investigational treatments, and the medical care and usually the management of the patient would not be any different even if the treatment group assignment of the patient were known.”
Protocol
UNBLINDING PROCEDURE
• Local pharmacy contact(s) will have access to the emergency unblinding web-based system during office hours should it be required in a Medical Emergencyhttps://ctu4.nottingham.ac.uk/0921_unblind/login.asp
• Leeds Pharmacy are providing emergency blind breaks outside office hours• Contact details are in the pharmacy file
If it not a medical emergency refer the person requesting unblinding to the local PI
PHARMACY FILE
Your Pharmacy file contains further information
and
Contact details
Please complete the site specific information on the contact details in section 1.
WHAT QUESTIONS DO YOU HAVE?