Relistor Injection for Chronic Pain in HIV

Recruiting at 1 trial location

Overseen By Saurabh Aggarwal, MD., PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Florida International University

Must be taking: Antiretroviral therapy

Must not be taking: Methadone, Buprenorphine

Disqualifiers: Anemia, Blood disorders, Infections, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 2 Jurisdictions This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 3

Duration: 2 visits

200 Participants Needed

Trial Summary

What is the purpose of this trial?

To determine if decreased production or release of endogenous opioid peptides by peripheral immune cells contributes to hypersensitivity in people with HIV

Will I have to stop taking my current medications?

The trial does not require participants to stop taking their current medications for pain management, as long as they have been stable on them for at least 60 days. However, medications like methadone or buprenorphine used for opioid addiction treatment may be exceptions.

What data supports the effectiveness of the drug Relistor Injection for chronic pain in HIV patients?

There is no direct evidence from the provided research articles about the effectiveness of Relistor Injection for chronic pain in HIV patients. However, the use of opioid treatments like buprenorphine has been shown to be effective and safe for pain management in HIV patients, suggesting that similar treatments might offer some benefits. ^{1 2 3 4 5}

How is the drug Relistor Injection unique for treating chronic pain in HIV?

Relistor Injection (Methylnaltrexone) is unique because it is specifically designed to treat opioid-induced constipation without affecting pain relief, which can be particularly beneficial for people with HIV who are on long-term opioid therapy for chronic pain. Unlike other treatments that may affect the central nervous system, Relistor works peripherally, meaning it targets the gut to relieve constipation without crossing into the brain, thus not interfering with pain management. ^{1 2 6 7 8}

Research Team

Saurabh Aggarwal, MD., PhD

Principal Investigator

Florida International University

Eligibility Criteria

This trial is for adults aged 19-65 with HIV and chronic widespread pain, receiving stable antiretroviral therapy at the UAB 1917 Clinic. HIV-negative individuals can join if they have chronic pain or no significant pain. Exclusions include anemia, blood disorders, uncontrolled diabetes, neurological diseases, severe psychiatric issues, active infections, certain medications (excluding stable pain management drugs), recent major surgery, cognitive impairment that affects understanding of the study procedures, pregnancy, systemic rheumatic disease, cachexia or severe frailty.

Inclusion Criteria

I am HIV negative and either experience pain more than once a week for 3 months or have little to no pain.

I am living with HIV and am on a stable ART regimen.

I am between 19 and 65 years old.

Exclusion Criteria

You have a serious mental illness that needed hospital treatment or have been thinking about hurting yourself.

I do not have high blood pressure or heart/blood vessel diseases.

Any participant deemed to be actively suicidal upon study screening will be escorted to the UAB emergency room and evaluated by the Psychiatry Service

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Baseline Assessment

Quantitative sensory testing (QST) and blood samples are collected to measure endogenous opioid peptides

1 day

1 visit (in-person)

Treatment

Participants are randomly administered saline or RELISTOR and undergo quantitative sensory testing

2 visits

2 visits (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

Treatment Details

Interventions

• Relistor Injectable Product

Trial Overview The trial tests Relistor Injectable Product to see if it helps reduce hypersensitivity in people with HIV by affecting opioid peptides released by immune cells. It aims to understand novel mechanisms behind chronic widespread pain in these patients.

Participant Groups

Group I: HIV positive without chronic widespread pain Experimental Treatment 1 Intervention

50 Participants will be randomly administered saline or RELISTOR (Individuals weighing 38-\<62 kg will receive an 8 mg dose; those weighing 62-114 kg will receive a 12 mg dose; Participants weighing more than 114 kg will receive 0.15 mg/kg) in counterbalance between visit 1 and visit 2.

Group II: HIV positive with chronic widespread pain Experimental Treatment 1 Intervention

50 Participants will be randomly administered saline or RELISTOR (Individuals weighing 38-\<62 kg will receive an 8 mg dose; those weighing 62-114 kg will receive a 12 mg dose; Participants weighing more than 114 kg will receive 0.15 mg/kg) in counterbalance between visit 1 and visit 2.

Group III: HIV negative without chronic widespread pain Experimental Treatment 1 Intervention

50 Participants will be randomly administered saline or RELISTOR (Individuals weighing 38-\<62 kg will receive an 8 mg dose; those weighing 62-114 kg will receive a 12 mg dose; Participants weighing more than 114 kg will receive 0.15 mg/kg) in counterbalance between visit 1 and visit 2.

Group IV: HIV negative with chronic widespread pain Experimental Treatment 1 Intervention

50 Participants will be randomly administered saline or RELISTOR (Individuals weighing 38-\<62 kg will receive an 8 mg dose; those weighing 62-114 kg will receive a 12 mg dose; Participants weighing more than 114 kg will receive 0.15 mg/kg) in counterbalance between visit 1 and visit 2.

Relistor Injectable Product is already approved in United States, Canada for the following indications:

Approved in United States as Relistor for:

• Opioid-induced constipation (OIC) in adults with chronic non-cancer pain
• OIC in adults with advanced illness or pain caused by active cancer

Approved in Canada as Relistor for:

• Opioid-induced constipation (OIC) in adults with chronic non-cancer pain
• OIC in adults with advanced illness or pain caused by active cancer

Who Is Running the Clinical Trial?

Florida International University

Lead Sponsor

Trials

114

Recruited

19,400+

University of Alabama at Birmingham

Lead Sponsor

Trials

1,677

Recruited

2,458,000+

Findings from Research

In a 48-week study involving 200 participants with opioid addiction and HIV, the naltrexone implant group showed a significant improvement in maintaining viral loads below 400 copies per mL at 48 weeks compared to the oral naltrexone group, suggesting that long-acting naltrexone may enhance HIV treatment outcomes.

Despite some serious adverse events, including deaths in both groups, the study indicates that longer opioid blockade from the implant may help protect against missed antiretroviral therapy doses and impulsive behaviors that could lead to relapse.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Slow-release naltrexone implant versus oral naltrexone for improving treatment outcomes in people with HIV who are addicted to opioids: a double-blind, placebo-controlled, randomised trial. Krupitsky, E., Blokhina, E., Zvartau, E., et al.[2020]

In a study of 2334 individuals living with HIV, chronic pain was found to significantly increase the risk of suboptimal retention in care and virologic failure, particularly in those not receiving long-term opioid therapy (LTOT).

Interestingly, among those with chronic pain, LTOT was associated with lower rates of virologic failure, suggesting that LTOT may have a protective effect on HIV outcomes that warrants further investigation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Brief Report: The Association of Chronic Pain and Long-Term Opioid Therapy With HIV Treatment Outcomes. Merlin, JS., Long, D., Becker, WC., et al.[2022]

In a study involving 40 advanced AIDS patients, both transdermal buprenorphine and fentanyl significantly reduced various types of neuropathic pain and improved overall patient performance, indicating their effectiveness as pain management options.

Both opioids were well tolerated and did not negatively impact immune function, with buprenorphine showing a tendency to stabilize CD4+ levels, making it a safer choice for patients with compromised immune systems.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Safety and efficacy of transdermal buprenorphine and transdermal fentanyl in the treatment of neuropathic pain in AIDS patients. Canneti, A., Luzi, M., Di Marco, P., et al.[2022]

In a survey of 148 ambulatory HIV patients, 82 reported experiencing pain, with 60-70% indicating that it significantly interfered with their daily lives.

Despite the high prevalence of pain, 40% of those suffering were not receiving any treatment, and those who were treated only achieved a mean pain relief of 65%, highlighting the need for better pain management strategies in this population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Inadequate treatment of pain in ambulatory HIV patients. McCormack, JP., Li, R., Zarowny, D., et al.[2019]

In a 12-week pilot study involving 16 HIV-positive, opioid-dependent patients, integrating buprenorphine/naloxone into HIV care showed high treatment retention, with 81% completing the study and significant reductions in opioid use, as evidenced by urine tests.

Patients also experienced improvements in HIV-related health markers, with a significant decline in HIV-1 RNA levels, indicating that buprenorphine treatment is not only feasible but also beneficial for managing both opioid dependence and HIV.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A trial of integrated buprenorphine/naloxone and HIV clinical care. Sullivan, LE., Barry, D., Moore, BA., et al.[2013]

In a phase III study involving 344 patients with osteoarthritis pain, morphine/naltrexone significantly improved pain management compared to placebo, demonstrating its efficacy in treating moderate to severe chronic pain.

In a 12-month safety study with 465 participants, morphine/naltrexone was well tolerated and provided effective pain relief, with significant improvements in pain scores observed from the first week of treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Morphine/naltrexone. Duggan, ST., Scott, LJ.[2021]

A survey of 3,255 patients indicated that transdermal buprenorphine is effective for managing chronic pain, with 81% of respondents reporting good or very good pain relief, especially beneficial for those with stable cancer and non-cancer pain.

Adverse effects were generally mild and similar to other opioids, with only 4% experiencing local erythema and 1% pruritus, suggesting that the buprenorphine patch may be a safer alternative for patients who have had side effects from oral pain medications.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Buprenorphine TDS: use in daily practice, benefits for patients. Radbruch, L.[2022]

Buprenorphine, especially in its transdermal patch form, is effective for managing chronic pain, including neuropathic pain, and has demonstrated both efficacy and safety in randomized trials and post-marketing studies.

The transdermal delivery system allows for continuous and stable drug levels, making it a suitable option for chronic pain management compared to on-demand administration, and buprenorphine's unique receptor activity as a partial agonist may contribute to its effectiveness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Transdermal buprenorphine: a current overview of pharmacological and clinical data]. Faymonville, ME., Libbrecht, D.[2015]

References

1. Netherlands pubmed.ncbi.nlm.nih.gov

Slow-release naltrexone implant versus oral naltrexone for improving treatment outcomes in people with HIV who are addicted to opioids: a double-blind, placebo-controlled, randomised trial. [2020]

2. United States pubmed.ncbi.nlm.nih.gov

Brief Report: The Association of Chronic Pain and Long-Term Opioid Therapy With HIV Treatment Outcomes. [2022]

3. Italy pubmed.ncbi.nlm.nih.gov

Safety and efficacy of transdermal buprenorphine and transdermal fentanyl in the treatment of neuropathic pain in AIDS patients. [2022]

4. United States pubmed.ncbi.nlm.nih.gov

Inadequate treatment of pain in ambulatory HIV patients. [2019]

5. United States pubmed.ncbi.nlm.nih.gov

A trial of integrated buprenorphine/naloxone and HIV clinical care. [2013]

6. New Zealand pubmed.ncbi.nlm.nih.gov

Morphine/naltrexone. [2021]

7. England pubmed.ncbi.nlm.nih.gov

Buprenorphine TDS: use in daily practice, benefits for patients. [2022]

8. Belgium pubmed.ncbi.nlm.nih.gov

[Transdermal buprenorphine: a current overview of pharmacological and clinical data]. [2015]