title: Evaluation of an Extended-Release, Abuse-Deterrent, Microsphere-in-Capsule Analgesic for the Management of Patients with Chronic Pain With Dysphagia (CPD).
abstract: BACKGROUND
  Patients who have chronic pain with dysphagia (difficulty swallowing) (CPD) often have difficulty taking oral medication and, as such, alter their medications by crushing or chewing in an attempt to make it easier to swallow. Such manipulation of currently marketed, extended-release (ER) opioid analgesics can significantly alter the pharmacokinetic (PK) properties of the formulations, resulting in poor treatment outcome or serious adverse events. There is an unmet medical need for oral ER opioid formulations suitable for patients with CPD.
  
  
  OBJECTIVE
  The primary objectives of this study were to conduct in vitro studies to evaluate alternate means of administration of a new, extended-release (ER), abuse-deterrent, microsphere-in-capsule formulation of oxycodone for patients with CPD. Specifically, these studies investigated the in vitro equivalence of drug release rates from Oxycodone DETERx® ER intact capsules (control condition) and administration via alternate modes-opening the capsule and sprinkling the microspheres onto soft foods or administration through enteral tubes. Secondary objectives were to compare alternate modes of administration of Oxycodone DETERx® to a commercially available ER-morphine product.
  
  
  METHODS
  Soft food study: Oxycodone DETERx® microspheres were sprinkled onto and mixed with several soft foods (ie, applesauce, vanilla pudding, strawberry jam, yogurt, and vanilla ice cream); the effect of drug contact time (0, 30, and 60 minutes) on drug release was studied. Enteral tube study: Oxycodone DETERx® microspheres were administered through varying sizes of nasogastric (10 and 12 Fr.) tubes and a 16 Fr. gastrostomy tube using 5 different delivery vehicles (ie, water, liquid nutritional feeds [Jevity®, Ensure®], and milk [whole milk and 2% milk]). Drug release rate was characterized using a standard in vitro dissolution methodology; dissolution of intact Oxycodone DETERx® capsules served as the control for both the soft food and enteral tube studies. Oxycodone concentration was measured using a standardized high-performance liquid chromatography (HPLC) assay. Similarity factor (f2) analysis was used to compare similarity of the dissolution profiles of test and control conditions.
  
  
  RESULTS
  The mean dissolution profile of Oxycodone DETERx® microspheres sprinkled onto and mixed with each of the soft foods were similar (f2 > 50) to that of the control. Study drug-food contact time did not impact dissolution profiles. The dissolution data obtained from Oxycodone DETERx® microspheres passed through enteral feeding tubes of varying sizes were similar (f2 > 50) to that of the control. Unlike a marketed morphine sulfate ER pellet formulation, Oxycodone DETERx® did not clog any of the studied enteral tubes.
  
  
  CONCLUSIONS
  A new ER, abuse-deterrent, microsphere-in-capsule formulation of oxycodone can be administered by sprinkling onto soft food without affecting the drug release profile of the formulation. The formulation can also be administered directly via enteral tubes without affecting drug release and without clogging enteral tubes. Oxycodone DETERx® may offer physicians and patients with CPD an alternate treatment option, especially in those patients who have dysphagia or an aversion to swallowing monolithic tablet/capsule formulations and for whom analgesic patches or other opioid formulations are not a viable therapeutic option.
authors: Collegium Pharmaceutical, Inc., Canton, MA, U.S.A.
authors: Alison B
authors: AB
authors: Fleming
authors: Collegium Pharmaceutical, Inc., Canton, MA, U.S.A.
authors: Douglas R
authors: DR
authors: Carlson
authors: Collegium Pharmaceutical, Inc., Canton, MA, U.S.A.
authors: Ravi K
authors: RK
authors: Varanasi
authors: Collegium Pharmaceutical, Inc., Canton, MA, U.S.A.
authors: Michael
authors: M
authors: Grima
authors: Collegium Pharmaceutical, Inc., Canton, MA, U.S.A.
authors: Stephen P
authors: SP
authors: Mayock
authors: Collegium Pharmaceutical, Inc., Canton, MA, U.S.A.
authors: Said
authors: S
authors: Saim
authors: Collegium Pharmaceutical, Inc., Canton, MA, U.S.A.
authors: Ernest A
authors: EA
authors: Kopecky
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000493:pharmacokinetics / Q000627:therapeutic use*; D002214:Capsules; D002626:Chemistry, Pharmaceutical; D059350:Chronic Pain / Q000150:complications / Q000188:drug therapy*; D003679:Deglutition; D003680:Deglutition Disorders / Q000150:complications*; D003692:Delayed-Action Preparations; D005502:Food; D006801:Humans; D007441:Intubation, Gastrointestinal; D008863:Microspheres; D009293:Opioid-Related Disorders; D010098:Oxycodone / Q000008:administration & dosage* / Q000493:pharmacokinetics / Q000627:therapeutic use*; D059408:Pain Management / Q000379:methods*
chemical_list: D000701:Analgesics, Opioid; D002214:Capsules; D003692:Delayed-Action Preparations; D010098:Oxycodone
keywords: abuse-deterrent; chronic pain; dysphagia; extended-release; opioid; oxycodone