Trial Outcomes & Findings for Safety and Efficacy of Buprenorphine Transdermal System (BTDS) in Subjects With Chronic Nonmalignant Pain (NCT NCT00312195)

NCT ID: NCT00312195

Last Updated: 2012-09-10

Results Overview

Ineffective treatment was defined as: * Subject took \>1 gram of acetaminophen in a 24-hour period, or * Subject required a change in transdermal patch (TDS) dose, or * Subject had difficulty in keeping the TDS on, or * Subject discontinued due to ineffective treatment (but did not meet any of the above criteria). Note: some subjects may have had multiple reasons for ineffective treatment and are counted under each category. Therefore the sum of subjects across all criteria for ineffective treatment is greater than the total number of subjects with ineffective treatment.

Recruitment status

COMPLETED

Study phase

PHASE3

Target enrollment

267 participants

Primary outcome timeframe

Double-blind phase (14 days)

Results posted on

2012-09-10

Participant Flow

(First patient first visit) 19-Mar-2001 to (last patient last visit) 22-Jul-2001 at 42 centers: 21 in the UK and 21 in the US.

The Run-in period (N = 588 subjects started) consisted of titration from buprenorphine transdermal patch (BTDS) 5 to BTDS 10, or 20 mcg/h for tolerability. If BTDS was not tolerated or pain increased, the subject was discontinued. N = 267 subjects were randomized.

Participant milestones

Participant milestones
Measure
Double-blind Placebo Patch
Reference drug - Placebo transdermal patch to match BTDS 5, 10, or 20 mcg/h applied for 7-day wear.
Double-blind BTDS
Test drug - buprenorphine transdermal patch (BTDS) 5, 10, or 20 mcg/h applied for 7-day wear.
Overall Study
STARTED
138
129
Overall Study
COMPLETED
132
123
Overall Study
NOT COMPLETED
6
6

Reasons for withdrawal

Reasons for withdrawal
Measure
Double-blind Placebo Patch
Reference drug - Placebo transdermal patch to match BTDS 5, 10, or 20 mcg/h applied for 7-day wear.
Double-blind BTDS
Test drug - buprenorphine transdermal patch (BTDS) 5, 10, or 20 mcg/h applied for 7-day wear.
Overall Study
Adverse Event
4
6
Overall Study
Lost to Follow-up
1
0
Overall Study
Protocol Violation
1
0

Baseline Characteristics

Safety and Efficacy of Buprenorphine Transdermal System (BTDS) in Subjects With Chronic Nonmalignant Pain

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Double-blind Placebo Patch
n=138 Participants
Reference drug - Placebo transdermal patch to match BTDS 5, 10, or 20 mcg/h applied for 7-day wear.
Double-blind BTDS
n=129 Participants
Test drug - buprenorphine transdermal patch (BTDS) 5, 10, or 20 mcg/h applied for 7-day wear.
Total
n=267 Participants
Total of all reporting groups
Age Continuous
59.2 years
STANDARD_DEVIATION 11.48 • n=5 Participants
56.2 years
STANDARD_DEVIATION 13.34 • n=7 Participants
57.7 years
STANDARD_DEVIATION 12.48 • n=5 Participants
Sex: Female, Male
Female
88 Participants
n=5 Participants
79 Participants
n=7 Participants
167 Participants
n=5 Participants
Sex: Female, Male
Male
50 Participants
n=5 Participants
50 Participants
n=7 Participants
100 Participants
n=5 Participants
Region of Enrollment
United States
46 participants
n=5 Participants
42 participants
n=7 Participants
88 participants
n=5 Participants
Region of Enrollment
United Kingdom
92 participants
n=5 Participants
87 participants
n=7 Participants
179 participants
n=5 Participants

PRIMARY outcome

Timeframe: Double-blind phase (14 days)

Population: The Full Analysis Population (N = 266) for efficacy analyses included all subjects who were randomized and provided at least 1 efficacy assessment in the double-blind phase.

Ineffective treatment was defined as: * Subject took \>1 gram of acetaminophen in a 24-hour period, or * Subject required a change in transdermal patch (TDS) dose, or * Subject had difficulty in keeping the TDS on, or * Subject discontinued due to ineffective treatment (but did not meet any of the above criteria). Note: some subjects may have had multiple reasons for ineffective treatment and are counted under each category. Therefore the sum of subjects across all criteria for ineffective treatment is greater than the total number of subjects with ineffective treatment.

Outcome measures

Outcome measures
Measure
Double-blind Placebo Patch
n=137 Participants
Reference drug - Placebo transdermal patch to match BTDS 5, 10, or 20 mcg/h applied for 7-day wear.
Double-blind BTDS
n=129 Participants
Test drug - buprenorphine transdermal patch 5, 10 or 20 mcg/h applied for 7-day wear.
Total
n=266 Participants
Placebo and BTDS combined.
The Number of Subjects With Ineffective Treatment During the Double-blind Evaluation Phase.
Subjects With Ineffective Treatment
89 participants
66 participants
155 participants
The Number of Subjects With Ineffective Treatment During the Double-blind Evaluation Phase.
Reason: took more than 1 gram of acetaminophen/day
81 participants
59 participants
140 participants
The Number of Subjects With Ineffective Treatment During the Double-blind Evaluation Phase.
Reason: required a change in TDS dose
34 participants
25 participants
59 participants
The Number of Subjects With Ineffective Treatment During the Double-blind Evaluation Phase.
Reason: difficulty keeping patch on
6 participants
1 participants
7 participants
The Number of Subjects With Ineffective Treatment During the Double-blind Evaluation Phase.
Reason: discontinued due to ineffective treatment
2 participants
3 participants
5 participants

SECONDARY outcome

Timeframe: 14 days

Population: Full Analysis (N = 266) consisted of subjects who were randomized into the double-blind evaluation phase, were exposed to study drug, and provided at least 1 efficacy assessment during the double-blind evaluation phase.

The time of ineffective treatment was calculated as the earliest of the following: * The date the subject first took \>1 gram of acetaminophen, * The visit date when ineffective treatment was first determined, or * The date the last patch was removed.

Outcome measures

Outcome measures
Measure
Double-blind Placebo Patch
n=137 Participants
Reference drug - Placebo transdermal patch to match BTDS 5, 10, or 20 mcg/h applied for 7-day wear.
Double-blind BTDS
n=129 Participants
Test drug - buprenorphine transdermal patch 5, 10 or 20 mcg/h applied for 7-day wear.
Total
Placebo and BTDS combined.
Time (Days) From the Initial Dose of Study Drug in the Double-blind Evaluation Phase to Ineffective Treatment
5.6 Days
Standard Error 0.44
7.4 Days
Standard Error 0.45

SECONDARY outcome

Timeframe: 14 days

Population: Full Analysis (N = 266) consisted of subjects who were randomized into the double-blind evaluation phase, were exposed to study drug, and provided at least 1 efficacy assessment during the double-blind evaluation phase.

Note: The total numbers of "Subjects w/ineffective treatment or who discont'd" for placebo and BTDS are 1 less because there were reasons other than lack of efficacy that made up this total: adverse event, death, lost to follow- up, protocol violation, and other. Example for placebo 89+5=94; however, 93 is indicated for the total because there is 1 subject in the placebo group who was counted under ineffective treatment and discontinued due to reasons other than lack of efficacy. The same is true for 1 subject in BTDS.

Outcome measures

Outcome measures
Measure
Double-blind Placebo Patch
n=137 Participants
Reference drug - Placebo transdermal patch to match BTDS 5, 10, or 20 mcg/h applied for 7-day wear.
Double-blind BTDS
n=129 Participants
Test drug - buprenorphine transdermal patch 5, 10 or 20 mcg/h applied for 7-day wear.
Total
Placebo and BTDS combined.
The Number of Subjects Who Had Ineffective Treatment or Who Discontinued Due to Reasons Other Than Ineffective Treatment in the Double-blind Phase
Subjects w/ineffective treatment or who discont'd
93 participants
71 participants
The Number of Subjects Who Had Ineffective Treatment or Who Discontinued Due to Reasons Other Than Ineffective Treatment in the Double-blind Phase
Ineffective Treatment
89 participants
66 participants
The Number of Subjects Who Had Ineffective Treatment or Who Discontinued Due to Reasons Other Than Ineffective Treatment in the Double-blind Phase
Discontinued due to other reasons
5 participants
6 participants

SECONDARY outcome

Timeframe: 14 days

Population: Full Analysis (N = 266) consisted of subjects who were randomized into the double-blind evaluation phase, were exposed to study drug, and provided at least 1 efficacy assessment during the double-blind evaluation phase.

The average daily acetaminophen (Panadol) use (1 tablet = 500 mg) during the double-blind phase was compared between the treatment groups using ANCOVA methodology with terms for country and treatment. The average escape medication used in the last 4 days prior to randomization was included as a covariate.

Outcome measures

Outcome measures
Measure
Double-blind Placebo Patch
n=137 Participants
Reference drug - Placebo transdermal patch to match BTDS 5, 10, or 20 mcg/h applied for 7-day wear.
Double-blind BTDS
n=129 Participants
Test drug - buprenorphine transdermal patch 5, 10 or 20 mcg/h applied for 7-day wear.
Total
Placebo and BTDS combined.
The Amount of Rescue Medication Used for Pain (Average Daily Number of Acetaminophen Tablets).
2.2 Tablets
Standard Error 0.15
1.8 Tablets
Standard Error 0.14

Adverse Events

Double-blind Placebo Patch

Serious events: 0 serious events
Other events: 21 other events
Deaths: 0 deaths

Double-blind BTDS

Serious events: 0 serious events
Other events: 25 other events
Deaths: 0 deaths

Open-label Run-in Period BTDS 5, 10 or 20

Serious events: 7 serious events
Other events: 245 other events
Deaths: 0 deaths

Serious adverse events

Serious adverse events
Measure
Double-blind Placebo Patch
n=138 participants at risk
Reference drug - Placebo transdermal patch to match BTDS 5, 10, or 20 mcg/h applied for 7-day wear.
Double-blind BTDS
n=129 participants at risk
Test drug - buprenorphine transdermal patch (BTDS) 5, 10, or 20 mcg/h applied for 7-day wear.
Open-label Run-in Period BTDS 5, 10 or 20
n=588 participants at risk
Buprenorphine transdermal patch (BTDS) 5, 10, or 20 mcg/h applied for 7-day wear.
General disorders
Pain abdominal
0.00%
0/138 • Adverse Events (AEs)that occurred after the signing of the informed consent up to end of study, discontinuation, or Serious AE occurring up to 30 days following the last study visit were followed until the AE resolved.
Adverse Events were learned of through spontaneous reports and subject interview.
0.00%
0/129 • Adverse Events (AEs)that occurred after the signing of the informed consent up to end of study, discontinuation, or Serious AE occurring up to 30 days following the last study visit were followed until the AE resolved.
Adverse Events were learned of through spontaneous reports and subject interview.
0.17%
1/588 • Number of events 1 • Adverse Events (AEs)that occurred after the signing of the informed consent up to end of study, discontinuation, or Serious AE occurring up to 30 days following the last study visit were followed until the AE resolved.
Adverse Events were learned of through spontaneous reports and subject interview.
General disorders
Abscess
0.00%
0/138 • Adverse Events (AEs)that occurred after the signing of the informed consent up to end of study, discontinuation, or Serious AE occurring up to 30 days following the last study visit were followed until the AE resolved.
Adverse Events were learned of through spontaneous reports and subject interview.
0.00%
0/129 • Adverse Events (AEs)that occurred after the signing of the informed consent up to end of study, discontinuation, or Serious AE occurring up to 30 days following the last study visit were followed until the AE resolved.
Adverse Events were learned of through spontaneous reports and subject interview.
0.17%
1/588 • Number of events 1 • Adverse Events (AEs)that occurred after the signing of the informed consent up to end of study, discontinuation, or Serious AE occurring up to 30 days following the last study visit were followed until the AE resolved.
Adverse Events were learned of through spontaneous reports and subject interview.
General disorders
Injury accidental
0.00%
0/138 • Adverse Events (AEs)that occurred after the signing of the informed consent up to end of study, discontinuation, or Serious AE occurring up to 30 days following the last study visit were followed until the AE resolved.
Adverse Events were learned of through spontaneous reports and subject interview.
0.00%
0/129 • Adverse Events (AEs)that occurred after the signing of the informed consent up to end of study, discontinuation, or Serious AE occurring up to 30 days following the last study visit were followed until the AE resolved.
Adverse Events were learned of through spontaneous reports and subject interview.
0.17%
1/588 • Number of events 1 • Adverse Events (AEs)that occurred after the signing of the informed consent up to end of study, discontinuation, or Serious AE occurring up to 30 days following the last study visit were followed until the AE resolved.
Adverse Events were learned of through spontaneous reports and subject interview.
General disorders
Cellulitis
0.00%
0/138 • Adverse Events (AEs)that occurred after the signing of the informed consent up to end of study, discontinuation, or Serious AE occurring up to 30 days following the last study visit were followed until the AE resolved.
Adverse Events were learned of through spontaneous reports and subject interview.
0.00%
0/129 • Adverse Events (AEs)that occurred after the signing of the informed consent up to end of study, discontinuation, or Serious AE occurring up to 30 days following the last study visit were followed until the AE resolved.
Adverse Events were learned of through spontaneous reports and subject interview.
0.17%
1/588 • Number of events 1 • Adverse Events (AEs)that occurred after the signing of the informed consent up to end of study, discontinuation, or Serious AE occurring up to 30 days following the last study visit were followed until the AE resolved.
Adverse Events were learned of through spontaneous reports and subject interview.
General disorders
Pain, chest
0.00%
0/138 • Adverse Events (AEs)that occurred after the signing of the informed consent up to end of study, discontinuation, or Serious AE occurring up to 30 days following the last study visit were followed until the AE resolved.
Adverse Events were learned of through spontaneous reports and subject interview.
0.00%
0/129 • Adverse Events (AEs)that occurred after the signing of the informed consent up to end of study, discontinuation, or Serious AE occurring up to 30 days following the last study visit were followed until the AE resolved.
Adverse Events were learned of through spontaneous reports and subject interview.
0.17%
1/588 • Number of events 1 • Adverse Events (AEs)that occurred after the signing of the informed consent up to end of study, discontinuation, or Serious AE occurring up to 30 days following the last study visit were followed until the AE resolved.
Adverse Events were learned of through spontaneous reports and subject interview.
Cardiac disorders
Fibrillation, atrial
0.00%
0/138 • Adverse Events (AEs)that occurred after the signing of the informed consent up to end of study, discontinuation, or Serious AE occurring up to 30 days following the last study visit were followed until the AE resolved.
Adverse Events were learned of through spontaneous reports and subject interview.
0.00%
0/129 • Adverse Events (AEs)that occurred after the signing of the informed consent up to end of study, discontinuation, or Serious AE occurring up to 30 days following the last study visit were followed until the AE resolved.
Adverse Events were learned of through spontaneous reports and subject interview.
0.17%
1/588 • Number of events 1 • Adverse Events (AEs)that occurred after the signing of the informed consent up to end of study, discontinuation, or Serious AE occurring up to 30 days following the last study visit were followed until the AE resolved.
Adverse Events were learned of through spontaneous reports and subject interview.
Immune system disorders
Gastroenteritis
0.00%
0/138 • Adverse Events (AEs)that occurred after the signing of the informed consent up to end of study, discontinuation, or Serious AE occurring up to 30 days following the last study visit were followed until the AE resolved.
Adverse Events were learned of through spontaneous reports and subject interview.
0.00%
0/129 • Adverse Events (AEs)that occurred after the signing of the informed consent up to end of study, discontinuation, or Serious AE occurring up to 30 days following the last study visit were followed until the AE resolved.
Adverse Events were learned of through spontaneous reports and subject interview.
0.17%
1/588 • Number of events 1 • Adverse Events (AEs)that occurred after the signing of the informed consent up to end of study, discontinuation, or Serious AE occurring up to 30 days following the last study visit were followed until the AE resolved.
Adverse Events were learned of through spontaneous reports and subject interview.
Metabolism and nutrition disorders
Dehydration
0.00%
0/138 • Adverse Events (AEs)that occurred after the signing of the informed consent up to end of study, discontinuation, or Serious AE occurring up to 30 days following the last study visit were followed until the AE resolved.
Adverse Events were learned of through spontaneous reports and subject interview.
0.00%
0/129 • Adverse Events (AEs)that occurred after the signing of the informed consent up to end of study, discontinuation, or Serious AE occurring up to 30 days following the last study visit were followed until the AE resolved.
Adverse Events were learned of through spontaneous reports and subject interview.
0.34%
2/588 • Number of events 2 • Adverse Events (AEs)that occurred after the signing of the informed consent up to end of study, discontinuation, or Serious AE occurring up to 30 days following the last study visit were followed until the AE resolved.
Adverse Events were learned of through spontaneous reports and subject interview.
Nervous system disorders
Depression
0.00%
0/138 • Adverse Events (AEs)that occurred after the signing of the informed consent up to end of study, discontinuation, or Serious AE occurring up to 30 days following the last study visit were followed until the AE resolved.
Adverse Events were learned of through spontaneous reports and subject interview.
0.00%
0/129 • Adverse Events (AEs)that occurred after the signing of the informed consent up to end of study, discontinuation, or Serious AE occurring up to 30 days following the last study visit were followed until the AE resolved.
Adverse Events were learned of through spontaneous reports and subject interview.
0.17%
1/588 • Number of events 1 • Adverse Events (AEs)that occurred after the signing of the informed consent up to end of study, discontinuation, or Serious AE occurring up to 30 days following the last study visit were followed until the AE resolved.
Adverse Events were learned of through spontaneous reports and subject interview.

Other adverse events

Other adverse events
Measure
Double-blind Placebo Patch
n=138 participants at risk
Reference drug - Placebo transdermal patch to match BTDS 5, 10, or 20 mcg/h applied for 7-day wear.
Double-blind BTDS
n=129 participants at risk
Test drug - buprenorphine transdermal patch (BTDS) 5, 10, or 20 mcg/h applied for 7-day wear.
Open-label Run-in Period BTDS 5, 10 or 20
n=588 participants at risk
Buprenorphine transdermal patch (BTDS) 5, 10, or 20 mcg/h applied for 7-day wear.
General disorders
Headache
2.2%
3/138 • Adverse Events (AEs)that occurred after the signing of the informed consent up to end of study, discontinuation, or Serious AE occurring up to 30 days following the last study visit were followed until the AE resolved.
Adverse Events were learned of through spontaneous reports and subject interview.
3.9%
5/129 • Adverse Events (AEs)that occurred after the signing of the informed consent up to end of study, discontinuation, or Serious AE occurring up to 30 days following the last study visit were followed until the AE resolved.
Adverse Events were learned of through spontaneous reports and subject interview.
7.5%
44/588 • Adverse Events (AEs)that occurred after the signing of the informed consent up to end of study, discontinuation, or Serious AE occurring up to 30 days following the last study visit were followed until the AE resolved.
Adverse Events were learned of through spontaneous reports and subject interview.
General disorders
Asthenia
2.2%
3/138 • Adverse Events (AEs)that occurred after the signing of the informed consent up to end of study, discontinuation, or Serious AE occurring up to 30 days following the last study visit were followed until the AE resolved.
Adverse Events were learned of through spontaneous reports and subject interview.
1.6%
2/129 • Adverse Events (AEs)that occurred after the signing of the informed consent up to end of study, discontinuation, or Serious AE occurring up to 30 days following the last study visit were followed until the AE resolved.
Adverse Events were learned of through spontaneous reports and subject interview.
6.1%
36/588 • Adverse Events (AEs)that occurred after the signing of the informed consent up to end of study, discontinuation, or Serious AE occurring up to 30 days following the last study visit were followed until the AE resolved.
Adverse Events were learned of through spontaneous reports and subject interview.
Gastrointestinal disorders
Nausea
3.6%
5/138 • Adverse Events (AEs)that occurred after the signing of the informed consent up to end of study, discontinuation, or Serious AE occurring up to 30 days following the last study visit were followed until the AE resolved.
Adverse Events were learned of through spontaneous reports and subject interview.
3.1%
4/129 • Adverse Events (AEs)that occurred after the signing of the informed consent up to end of study, discontinuation, or Serious AE occurring up to 30 days following the last study visit were followed until the AE resolved.
Adverse Events were learned of through spontaneous reports and subject interview.
19.0%
112/588 • Adverse Events (AEs)that occurred after the signing of the informed consent up to end of study, discontinuation, or Serious AE occurring up to 30 days following the last study visit were followed until the AE resolved.
Adverse Events were learned of through spontaneous reports and subject interview.
Gastrointestinal disorders
Vomit
0.00%
0/138 • Adverse Events (AEs)that occurred after the signing of the informed consent up to end of study, discontinuation, or Serious AE occurring up to 30 days following the last study visit were followed until the AE resolved.
Adverse Events were learned of through spontaneous reports and subject interview.
0.78%
1/129 • Adverse Events (AEs)that occurred after the signing of the informed consent up to end of study, discontinuation, or Serious AE occurring up to 30 days following the last study visit were followed until the AE resolved.
Adverse Events were learned of through spontaneous reports and subject interview.
6.1%
36/588 • Adverse Events (AEs)that occurred after the signing of the informed consent up to end of study, discontinuation, or Serious AE occurring up to 30 days following the last study visit were followed until the AE resolved.
Adverse Events were learned of through spontaneous reports and subject interview.
Nervous system disorders
Dizziness
0.00%
0/138 • Adverse Events (AEs)that occurred after the signing of the informed consent up to end of study, discontinuation, or Serious AE occurring up to 30 days following the last study visit were followed until the AE resolved.
Adverse Events were learned of through spontaneous reports and subject interview.
0.00%
0/129 • Adverse Events (AEs)that occurred after the signing of the informed consent up to end of study, discontinuation, or Serious AE occurring up to 30 days following the last study visit were followed until the AE resolved.
Adverse Events were learned of through spontaneous reports and subject interview.
12.4%
73/588 • Adverse Events (AEs)that occurred after the signing of the informed consent up to end of study, discontinuation, or Serious AE occurring up to 30 days following the last study visit were followed until the AE resolved.
Adverse Events were learned of through spontaneous reports and subject interview.
Nervous system disorders
Somnolence
0.72%
1/138 • Adverse Events (AEs)that occurred after the signing of the informed consent up to end of study, discontinuation, or Serious AE occurring up to 30 days following the last study visit were followed until the AE resolved.
Adverse Events were learned of through spontaneous reports and subject interview.
2.3%
3/129 • Adverse Events (AEs)that occurred after the signing of the informed consent up to end of study, discontinuation, or Serious AE occurring up to 30 days following the last study visit were followed until the AE resolved.
Adverse Events were learned of through spontaneous reports and subject interview.
7.0%
41/588 • Adverse Events (AEs)that occurred after the signing of the informed consent up to end of study, discontinuation, or Serious AE occurring up to 30 days following the last study visit were followed until the AE resolved.
Adverse Events were learned of through spontaneous reports and subject interview.
Skin and subcutaneous tissue disorders
Erythema at site
13.0%
18/138 • Adverse Events (AEs)that occurred after the signing of the informed consent up to end of study, discontinuation, or Serious AE occurring up to 30 days following the last study visit were followed until the AE resolved.
Adverse Events were learned of through spontaneous reports and subject interview.
13.2%
17/129 • Adverse Events (AEs)that occurred after the signing of the informed consent up to end of study, discontinuation, or Serious AE occurring up to 30 days following the last study visit were followed until the AE resolved.
Adverse Events were learned of through spontaneous reports and subject interview.
7.3%
43/588 • Adverse Events (AEs)that occurred after the signing of the informed consent up to end of study, discontinuation, or Serious AE occurring up to 30 days following the last study visit were followed until the AE resolved.
Adverse Events were learned of through spontaneous reports and subject interview.
Skin and subcutaneous tissue disorders
Pruritus at site
5.1%
7/138 • Adverse Events (AEs)that occurred after the signing of the informed consent up to end of study, discontinuation, or Serious AE occurring up to 30 days following the last study visit were followed until the AE resolved.
Adverse Events were learned of through spontaneous reports and subject interview.
9.3%
12/129 • Adverse Events (AEs)that occurred after the signing of the informed consent up to end of study, discontinuation, or Serious AE occurring up to 30 days following the last study visit were followed until the AE resolved.
Adverse Events were learned of through spontaneous reports and subject interview.
9.9%
58/588 • Adverse Events (AEs)that occurred after the signing of the informed consent up to end of study, discontinuation, or Serious AE occurring up to 30 days following the last study visit were followed until the AE resolved.
Adverse Events were learned of through spontaneous reports and subject interview.

Additional Information

Clinical Leader, Executive Medical Director

Purdue Pharma L.P.

Phone: 800-733-1333

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place

Restriction type: GT60