Lidocaine Patch 1.8% for Moderate to Severe Pain From Carpal Tunnel Syndrome

NCT ID: NCT04245371

Last Updated: 2023-06-08

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE4

Total Enrollment

45 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-02-24

Study Completion Date

2023-05-07

Brief Summary

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The primary objective is to determine the efficacy of Lidocaine Patch 1.8% in reducing the severity of symptoms in participants with moderate-to-severe pain from Carpal Tunnel Syndrome.

Detailed Description

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This is a prospective, randomized, double-blind, cross-over study. Following informed consent, participants fulfilling entry criteria will be randomly assigned into one of two treatment cohorts. Cohort 1 will be treated with active lidocaine study patch for 1 week following FDA approved dosing recommendations, i.e. 12 hours during each 24-hour daily cycle. Following a 1-week washout period, provided participants continue to meet criteria to proceed, they will then be treated with a placebo topical patch for 1 week. A final visit after another 1-week washout period will complete the study. Participants assigned to the Cohort 2 will be evaluated in the same way except they will enter the placebo arm first and then, after 1-week washout, they will enter the active treatment arm, provided to continue to meet criteria to proceed.

For all measures, participants will serve as their own matched control. Comparisons will be made between significant improvements on active versus placebo treatment arms. The first two-week treatment period is Arm 1; the second two-week period is considered the cross-over arm.

Participants failing treatment will be offered standard of care treatment of steroid injection. All participants will wear a brace for the duration of the study per standard clinical practice.

Conditions

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Carpal Tunnel Syndrome

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

CROSSOVER

Participants will serve as their own control
Primary Study Purpose

TREATMENT

Blinding Strategy

TRIPLE

Participants Investigators Outcome Assessors
Double-Blind

Study Groups

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Active

Lidocaine Patch 1.8% applied to affected hand at night for 2 weeks following FDA approved dosing recommendations, i.e. 12 hours during each 24-hour daily cycle.

Group Type ACTIVE_COMPARATOR

Lidocaine 1.8%

Intervention Type DRUG

Topical Patch

Placebo

Placebo Patch applied to affected hand at night for 2 weeks for 12 hours during each 24-hour daily cycle.

Group Type PLACEBO_COMPARATOR

Placebo

Intervention Type DRUG

Matching Placebo Patch

Interventions

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Lidocaine 1.8%

Topical Patch

Intervention Type DRUG

Placebo

Matching Placebo Patch

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Male and female participants, 18 years or older at Screening;
* Participants with Carpal Tunnel Syndrome, confirmed by CT6;
* Pain score of at least 4, based on an 11-point numeric rating scale (NRS) (scale of 0-10), at the screening (baseline) visit;
* Able and willing to provide a written informed consent;
* Able and willing to follow study instructions;
* Able and willing to return to clinic for follow-up visits;
* Able and willing to complete a daily diary;
* Intact skin over the affected wrist;
* Woman of childbearing age agreeing to use 2 forms of contraception.

Exclusion Criteria

* Participants must NOT have had prior steroid injection for CTS, CTS surgery, or other intervention/injury to the wrist that might interfere with assessments in the previous 30 days;
* Participants must not have pain at other sites that interfere with their ability to report site-specific pain related to the study (bilateral CT is an exclusion);
* Participants must NOT have cognitive or psychological impairment that interferes with the ability to complete study related assessments;
* Participants with mild (NRS less than 4) or no pain (only numbness) at baseline prior to randomization;
* Opioid tolerance (receiving at least 1 week of oral morphine 60 mg/day OR transdermal fentanyl 25 mcg/hour OR oral oxycodone 30 mg/day OR oral hydromorphone 8 mg/day OR an equianalgesic dose of any other opioid);
* History of sensitivity or allergy to lidocaine or ZTLIDO;
* Irritated, abraded, or otherwise non-intact skin over the affected wrist;
* Concurrently taking tocainide, mexiletine, or local anesthetics;
* Participants with history of or at significant risk for methemoglobinemia;
* Participation in another study of investigational drugs or devices within 30 days before screening, or previous participation in a Lidocaine Patch study;
* Known to or suspected of not being able to comply with the study protocol;
* Any clinically significant condition that would, in the investigator's opinion, preclude study participation for instance alcohol, medication or drug dependency, neurotic personality, psychiatric illness, epilepsy or suicide risk;
* Pregnancy or nursing mother;
* Woman in childbearing age without satisfactory contraception;
* Presence of possible other cause/s for hand pain (i.e., radicular pain, arthritis, injury, surgery) that could confound assessment or self-evaluation of the pain due to Carpal Tunnel Syndrome;
* Participants using topically applied analgesic compounds on the affected area;
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Scilex Ltd.

INDUSTRY

Sponsor Role collaborator

John Papakonstantinou, MD

OTHER

Sponsor Role lead

Responsible Party

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John Papakonstantinou, MD

Orthopaedic Surgeon, Hand and Upper Extremity Surgeon

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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John Papakonstantinou, MD

Role: PRINCIPAL_INVESTIGATOR

Michigan Orthopaedic & Spine Surgeons

Locations

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Michigan Orthopaedic & Spine Surgeons

Rochester Hills, Michigan, United States

Site Status

Countries

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United States

References

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Chung SY, Kwak JM, Kang S, Son SH, Kim JD, Yoon JS. Predictive Variables for Sonographically Guided Corticosteroid Injection in Mild-to-Moderate Carpal Tunnel Syndrome. Ann Rehabil Med. 2018 Apr;42(2):213-221. doi: 10.5535/arm.2018.42.2.213. Epub 2018 Apr 30.

Reference Type BACKGROUND
PMID: 29765874 (View on PubMed)

Chesterton LS, Blagojevic-Bucknall M, Burton C, Dziedzic KS, Davenport G, Jowett SM, Myers HL, Oppong R, Rathod-Mistry T, van der Windt DA, Hay EM, Roddy E. The clinical and cost-effectiveness of corticosteroid injection versus night splints for carpal tunnel syndrome (INSTINCTS trial): an open-label, parallel group, randomised controlled trial. Lancet. 2018 Oct 20;392(10156):1423-1433. doi: 10.1016/S0140-6736(18)31572-1.

Reference Type BACKGROUND
PMID: 30343858 (View on PubMed)

Moghtaderi AR, Jazayeri SM, Azizi S. EMLA cream for carpal tunnel syndrome: how it compares with steroid injection. Electromyogr Clin Neurophysiol. 2009 Sep-Oct;49(6-7):287-9.

Reference Type BACKGROUND
PMID: 19845100 (View on PubMed)

Leppert W, Malec-Milewska M, Zajaczkowska R, Wordliczek J. Transdermal and Topical Drug Administration in the Treatment of Pain. Molecules. 2018 Mar 17;23(3):681. doi: 10.3390/molecules23030681.

Reference Type BACKGROUND
PMID: 29562618 (View on PubMed)

Sears ED, Meerwijk EL, Schmidt EM, Kerr EA, Chung KC, Kamal RN, Harris AHS. Variation in Nonsurgical Services for Carpal Tunnel Syndrome Across a Large Integrated Health Care System. J Hand Surg Am. 2019 Feb;44(2):85-92.e1. doi: 10.1016/j.jhsa.2018.11.002. Epub 2018 Dec 20.

Reference Type BACKGROUND
PMID: 30579690 (View on PubMed)

Okamura A, Guidetti BC, Caselli R, Borracini JA, Moraes VY, Belloti JC. HOW DO BOARD-CERTIFIED HAND SURGEONS MANAGE CARPAL TUNNEL SYNDROME? A NATIONAL SURVEY. Acta Ortop Bras. 2018 Jan-Feb;26(1):48-53. doi: 10.1590/1413-785220182601181880.

Reference Type BACKGROUND
PMID: 29977145 (View on PubMed)

Graham B. The value added by electrodiagnostic testing in the diagnosis of carpal tunnel syndrome. J Bone Joint Surg Am. 2008 Dec;90(12):2587-93. doi: 10.2106/JBJS.G.01362.

Reference Type BACKGROUND
PMID: 19047703 (View on PubMed)

Aroori S, Spence RA. Carpal tunnel syndrome. Ulster Med J. 2008 Jan;77(1):6-17.

Reference Type BACKGROUND
PMID: 18269111 (View on PubMed)

Related Links

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https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/207962s000lbl.pdf

FULL PRESCRIBING INFORMATION of ZTLIDO (lidocaine topical system) 1.8%

Other Identifiers

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CTS2020

Identifier Type: -

Identifier Source: org_study_id

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