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CompletedNCT03497975PRISMUpdated Jun 24, 2025Results posted

PRISM Study-Pruritus Relief Through Itch Scratch Modulation

A Phase 2/3 interventional study of Nalbuphine ER Tablets and Placebo Tablets in Prurigo Nodularis, sponsored by Trevi Therapeutics. Completed at 70 sites in 5 countries. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2025-06-24.

Sponsored by Trevi Therapeutics · Phase 2/3, Interventional, and Treatment

Phase
Phase 2/3
Study type
Interventional
Enrollment
353
Allocation
Randomized
Ages
18 Years and older
Sex
All
01

Study summary

To investigate the anti-pruritic efficacy and safety of Nalbuphine Extended Release (ER) (NAL ER) tablets in Prurigo Nodularis. Participants were randomized to NAL ER (or matching placebo) with the primary endpoint evaluation at Week 14. During the open label extension, participants who received NAL ER were continued on NAL ER and participants who received placebo would then shift to NALER.

02

Conditions studied

  • Prurigo Nodularis

Browse trials for

03

In context

Prurigo

38 studies on the registry are indexed under Prurigo; 10 are open to participants now.

This study's enrollment of 353 is above the median of 135 across 31 interventional studies indexed under Prurigo.

Browse Prurigo studies →

Lead sponsor

Trevi Therapeutics is the lead sponsor of 17 studies on the registry; 3 are open to participants now.

Of its 9 completed or terminated interventional studies of FDA-regulated products, 6 (67%) have results posted.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

  • Individuals diagnosed with generalized nodular PN, covering 2 separate body parts, and 10 or more pruriginous nodules
  • Severe itch due to PN
  • Age 18 years and older at the time of consent, and a of at least 18 months.
  • Individuals using antidepressants must be on a stable dose for a minimum of 4 weeks prior to screening.
  • Participants with a history of acute secondary dermatoses within the preceding 6 months may enroll only if the dermatosis has resolved completely as follows per medical history or participant self-report and current clinical assessment: (a) Localized contact dermatitis, environmental exposures, superficial burns, or viral exanthems must have been resolved for at least 4 weeks prior to screening. (b) Skin or environmental infestations, such as scabies, lice, or bed bugs, must have been resolved for at least 8 weeks prior to screening.
  • Any identified systemic, non-dermatologic disease that could be a potential cause of concomitant pruritus (e.g., thyroid disease, celiac disease, virus [HCV]) must either have resolved, been successfully treated [i.e., HCV ribonucleic acid (RNA) negative], or must be successfully managed with stable, optimized treatment (e.g., thyroid replacement, dietary management with resolution of symptoms, respectively) for at least 3 months prior to screening.
  • Participants who are (HIV) positive may enroll if they meet the following criteria: (a) currently on a stable (> 6 months stable use) and well tolerated highly active antiretroviral therapy regimen; (b) cluster of differentiation 4 (CD4) count > 500 cells/mL; and (c) HIV ribonucleic acid (RNA) \< 50 copies/mL documented for at least 6 months prior to enrollment.

Exclusion criteria

Exclusion Criteria:

  • Pruritus due to localized PN (only one body part affected), or less than 10 nodules
  • Active, uncontrolled, pruritic dermatoses in need of treatment (such as atopic dermatitis or bullous pemphigoid for example).
  • History of a major psychiatric disorder such as bipolar disorder or schizophrenia. History of active substance abuse in the last 3 years.
  • Known intolerance [gastrointestinal (GI), central nervous system (CNS) symptoms] or /drug allergy to opioids.
  • Use of certain concomitant medications and treatments within a period prior to the study, or requirement for these medications during the study:

    • Potential participants taking opiates, gabapentin, pregabalin, calcineurin inhibitors, cannabinoid agonists, capsaicin, cryosurgery, topical doxepin, thalidomide or methotrexate, topical antihistamines or topical require a 14-day washout.
    • Within 4 weeks prior to screening: ultraviolet (UV)-therapy, exposure to any medication, including placebo
    • Within 3 months prior to screening: Non-insulin biologics (including monoclonal antibodies) that modify the immune system,
    • Individuals taking monoamine oxidase inhibitors are excluded, as concomitant opiate use may increase the risk for serotonin syndrome.
  • Myocardial infarction or acute coronary syndrome within the previous 3 months, as reported by the participant.
  • Individuals with prolonged corrected for heart rate using Fridericia's formula (QTcF).

Note: Other Inclusion/Exclusion criteria may apply.

Terms in these criteria, in plain language(7)

Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.

Life expectancy

The study doctor’s estimate of how long someone is likely to live. Criteria use it so that people can stay in the study long enough for it to answer its question.

Hepatitis C tests

Hepatitis C is a virus that infects the liver. An HCV antibody test can stay positive after an infection has cleared (and is occasionally positive without one); an HCV RNA test shows whether the virus is there now.

After treatment, hepatitis C counts as cured when HCV RNA is still undetectable 12 weeks or more after the treatment ended. Studies often accept people cured this way.

HIV

The human immunodeficiency virus, which weakens the immune system.

Many studies now accept people whose HIV is controlled on treatment, judged by the viral load and the CD4 count. Check the limits this study sets.

Hypersensitivity

An allergy, or another reaction of the immune system, to a substance. “Hypersensitivity to the study drug” means a known allergic reaction to it — not every side effect a medicine can have.

Corticosteroids (steroids)

Anti-inflammatory medicines such as prednisone, prednisolone and dexamethasone — not the anabolic steroids used for muscle.

Studies differ in what they allow: check which steroid medicines, routes (tablets, injections, creams, inhalers, eye drops) and doses this study accepts.

Investigational drug or device

A drug or device being studied in a clinical trial.

It may be new, or already approved and being studied for another use, dose or form. Criteria often leave out people who took part in another study of one within a recent period, commonly 30 days or five half-lives.

QT and QTc

On an ECG, the QT interval is the time the heart’s lower chambers take to activate electrically and recover in each beat. QTc is that time adjusted for heart rate (QTcF by Fridericia’s formula, QTcB by Bazett’s). Some medicines lengthen it, and a long QTc can raise the risk of a dangerous heart rhythm.

The study may name a correction formula and a limit in milliseconds, often around 450–480.

05

Study design

Phase
Phase 2 / Phase 3
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Quadruple (Participant, Care provider, Investigator, Outcomes assessor)
Enrollment
353 participants (actual)

Study arms

  • Experimental
    NAL ER

    During the double-blind (DB) period, participants were titrated over 2 weeks to NAL ER 162 mg, orally, twice daily (BID), followed by 162 mg, orally, BID, for 12 weeks. During the open label extension (OLE) period, participants perceived a titration period of 2 weeks, and continued to receive NAL ER 162 mg, orally, BID, for 38 weeks in total.

    Drug: Nalbuphine ER Tablets

  • Placebo comparator
    Placebo

    During the DB period, participants perceived a titration period of 2 weeks during which they received placebo to match the active titration period, followed by placebo, orally, BID, for 12 weeks. During the OLE period, participants were titrated over 2 weeks to NAL ER 162 mg, orally, BID, which they received for 38 weeks (including titration).

    Drug: Nalbuphine ER Tablets · Drug: Placebo Tablets

Interventions

  • Active Nalbuphine ER Tablets

    Also known as: NAL ER Tablets

  • DrugPlacebo Tablets

    Placebo matching NAL ER with no active substance

06

What researchers measure

Primary outcomes

  1. Percentage of Participants With ≥ 4- Point Decrease in 7-day Average Worst Itch - Numerical Rating Scale (WI-NRS) up to Week 14

    The NRS is a patient related outcome (PRO) instrument, designed to quantify the intensity of worst itching experienced during a 24-hour period, and can be applied and validated either with reference to the average itch or to the absolute worst itch (WI-NRS) over that 24-hour period. WI-NRS is a set of boxes, one for each number, from 0 (no itching) to 10 (worst possible itching). Higher scores indicate worst itching experience. Responder was defined as a participant with a ≥4-point decrease in the 7-day average WI-NRS from baseline to Week 14.

    Time frame: Baseline up to Week 14

Secondary outcomes

  1. Change From Baseline in Itch-related Quality of Life (ItchyQoL) Total Score at Week 14

    The ItchyQoL consists of 22 pruritus-specific items measuring how pruritus affects participant's QoL in the area of symptoms related to the itch condition (6 questions), functional limitations (7 questions), and emotions (9 questions). The participant scored each question never = 1, rarely = 2, sometimes = 3, often = 4, all the time = 5. The ItchyQoL total score were obtained as the sum of the 22 items ranging from 22 to 110, with higher score indicating worsening of pruritus. A negative change from baseline indicated improvement in the pruritus-related difficulties.

    Time frame: Baseline, Week 14

  2. Change From Baseline in Prurigo Activity Score (PAS) Assessed by the Percentage of Participants With 1-Category Improvement in the Percentage of Pruriginous Lesions With Excoriations/Crusts (Item 5a) at Week 14

    PAS consists of 5 quantitative/qualitative measurements related to examination of skin: Type; number;distribution;quantitative number of lesions in a body part;activity. Prurigo lesion activity is recorded as a stage (0 to 4), based on percentage of overall lesions with relevant characteristic. Three types of PAS responders defined one for each of the following items: Pruriginous lesions with excoriations/crusts (item 5a);Healed lesions (item 5b);Number of lesions (item 2). Pruriginous lesions with excoriations/crusts (item 5a) was recorded from 0 to 4;where 0 = 0-25%1 = 26-50%,2 = 51-75%,3 = 76-90%,4 = 91-100%. Higher score=a greater number of pruriginous lesions with excoriations/crusts. A responder was defined as a participant who has at least 1-category improvement in the relevant item from baseline to Week 14. Baseline is defined as the last non-missing evaluation (including repeated and unscheduled assessments) taken prior to or on the date of first dose of study medication.

    Time frame: Baseline, Week 14

  3. Change From Baseline in Patient-Reported Outcomes Measurement Information System (PROMIS) Sleep Disturbance Short Form 8a at Week 14

    PROMIS Sleep Disturbance Short Form 8a questionnaire is a tool for assessing sleep. It has 8 questions which measures sleep in the past 7 days.There is 1 broad sleep quality question with options:"very poor","poor","fair","good",and "very good".Remaining 7 questions are answered with:"not at all","a little bit","somewhat","quite a bit",and "very much".Lowest possible raw score=8; highest possible raw score=40. The T-score rescales raw score into a standardized score with a mean of 50 and an standard deviation of 10 derived from general population.Lowest possible T-score=28.9;highest possible T-score=76.6.Higher T-score shows more of the concept measured,higher the T-Score worse the sleep disturbance.Scores \<55=normal limits, 55-60=mild, 61-70=moderate,and \>70=severe sleep disturbance.Baseline=last non-missing evaluation (including repeated and unscheduled assessments) taken prior to or on the date of first dose of study medication.Negative change from baseline indicated better sleep.

    Time frame: Baseline, Week 14

  4. Change From Baseline in 7-Day Average WI-NRS to Week 14

    The NRS is a PRO instrument, designed to quantify the intensity of worst itching experienced during a 24-hour period, and can be applied and validated either with reference to the average itch or to the absolute worst itch (WI-NRS) over that 24-hour period. WI-NRS is a set of boxes, one for each number, from 0 (no itching) to 10 (worst possible itching). Higher scores indicate worst itching experience. Baseline WI-NRS value was calculated as the arithmetic mean of the WI-NRS values (minimum of 5 required) taken for eligibility review by site at the time of randomization. A negative change from baseline indicates improvement in symptoms.

    Time frame: Baseline, Week 14

  5. Change From Baseline in PAS Assessed by the Percentage of Participants With 1-Category Improvement in the Percentage of Healed Lesions (Item 5b) at Week 14

    PAS consists of 5 quantitative/qualitative measurements related to skin-Type; number; distribution; quantitative number of lesions in body part; activity. Prurigo lesion activity is recorded as stage (0 to 4), based on percentage of overall lesions with relevant characteristic. Three types of PAS responders are defined: Pruriginous lesions with excoriations/crusts (item 5a); Healed lesions (item 5b); Number of lesions (item 2). Prurigo lesions (item 5b), where 0 = 100%,1 = 75-99%,2 = 50-74%,3 = 25-49%,4 = 0-24% healed pruriginous lesions. Lower score=more number of healed pruriginous lesions. A responder was defined as a participant who has at least 1-category improvement in the relevant item from baseline to Week 14. Baseline was defined as the last non-missing evaluation (including repeated and unscheduled assessments) taken prior to or on the date of first dose of treatment. A negative change from baseline would indicate higher number of healed lesions.

    Time frame: Baseline, Week 14

  6. Change From Baseline in PAS Assessed by the Percentage of Participants With 1-Category Improvement in the Percentage of Lesions (Item 2) at Week 14

    PAS consists of 5 quantitative/qualitative measurements of skin- Type; number; distribution; quantitative number of lesions in body part; activity. Prurigo lesion activity is recorded as stage (0 to 4) based on percentage of overall lesions with relevant characteristic. Three types of PAS responders are defined: Pruriginous lesions with excoriations/crusts (item 5a); Healed lesions (item 5b); Number of lesions (item 2). Prurigo lesion activity is recorded as a stage (0 to 4), based on the percentage of overall lesions with the relevant characteristic. A lower score indicates less number of pruriginous lesions. A responder was defined as a participant who has at least 1-category improvement in the relevant item from baseline to Week 14. Baseline was defined as the last non-missing evaluation (including repeated and unscheduled assessments) taken prior to or on the date of first dose of study medication. A negative change from baseline would indicate lower number of lesions.

    Time frame: Baseline, Week 14

  7. Change From Baseline in Investigator Global Assessment-Prurigo Nodularis (IGA-PN) Assessed by the Percentage of Participants With 1-Category Improvement in Activity at Week 14

    The IGA-PN collects an investigator global assessment of status of PN skin lesions. The IGA-PN uses a 5-category scale (scoring 0 to 4) to describe the status of 2 aspects of disease: The Activity (amount of excoriation and crusting associated with the prurigo lesions), and the Stage (the quantitative presence and proportion of flattening of the lesions). The excoriation/crusting activity on the surface (PN-Activity) where it considers number of PN lesion with excoriations and crusts on the top, 0=clear (No nodules), 1 =small number, 2=minority of nodules, 3=most nodules, 4=severe (vast majority of nodules). A higher number indicates severe status of PN skin lesions. An IGA-PN responder for activity was defined as participants who has at a least 1-category improvement in the respective score from baseline to Week 14. Baseline was defined as the last non-missing evaluation (including repeated and unscheduled assessments) taken prior to or on the date of first dose of study medication.

    Time frame: Baseline, Week 14

  8. Change From Baseline in IGA-PN Assessed by the Percentage of Participants With 1-Category Improvement in Stage at Week 14

    The IGA-PN collects an investigator global assessment of status of PN skin lesions. The IGA-PN uses a 5-category scale(scoring 0 to 4) to describe 2 aspects of disease. The Activity(amount of excoriation and crusting of prurigo lesions) and the Stage(the quantitative presence and proportion of flattening of lesions),where 0=clear(No nodules),1=Rare, flattened lesions, with no more than single dome-shaped palpable nodules(1-5 nodules), 2=Few,mostly flattened lesions, with small number of dome-shaped palpable nodules(6-19 nodules,3=Many lesions, partially flattened and dome-shaped palpable nodules (20-100 nodules),4=Abundant lesions, majority are dome-shaped palpable nodules (over 100 nodules).Higher number= presence of abundant lesions.Responder as defined as participants who has at a least 1-category improvement from baseline to Week 14.Baseline was defined as the last non-missing evaluation(repeated and unscheduled assessments)taken prior to or on the date of first dose of treatment.

    Time frame: Baseline, Week 14

  9. Percentage of Participants Having a Patient Benefit Index, Pruritus Version (PBI-P) Score of ≥1 at Week 14

    PBI-P is an instrument that measures participant-defined treatment objectives and benefits acquired during the course of treatment.During and after therapy, the participant completes a matched "on-treatment" Treatment Benefits questionnaire and rates the extent to which the treatment objectives have been achieved.It consists of 27 multiple choice questions that can be answered "not at all","somewhat","moderately","quite","very".PBI-P global score is computed according to the score obtained for patient needs questionnaire (PNQ) and patient benefit questionnaire (PBQ).Score may only be computed if the participant has provided valid data on importance (PNQ) and benefit (PBQ) for at least 75% of the respective treatment goals,i.e., for at least 21 of the 27 items. Total score ranges from 0-135. Higher scores=more benefit received from the study to the participant.Responses "does/did not apply","question answered" are considered valid values when counting number of non-missing responses.

    Time frame: At Week 14

  10. Number of Participants Who Experienced Treatment Emergent Adverse Events (TEAEs), Serious TEAEs, and Discontinued From Study Drug Due to TEAEs in DB Period

    An AE is any untoward medical occurrence in a participant who administered a pharmaceutical product, and which does not necessarily have to have a causal relationship with the study drug. An AE can, therefore, be any unfavorable and unintended sign (including an abnormal laboratory finding, for example), symptom, or disease temporally associated with the use of a medicinal product, whether or not considered related to the medicinal product. A serious adverse event (SAE) is any untoward medical occurrence that resulted in any of the following outcomes: death; life threatening; persistent/significant disability/incapacity; initial or prolonged inpatient hospitalization; congenital anomaly/birth defect or was otherwise considered medically important. DB period TEAEs are defined as AEs that either start or worsen in severity on or after the first DB dose and prior to the first extension titration dose of study medication in the OLE period. TEAEs included both serious \& non-serious TEAEs.

    Time frame: Baseline up to Week 14

  11. Number of Participants Who Experienced TEAEs, Serious TEAEs, and Discontinued From Study Drug Due to TEAEs in OLE Period

    An AE is any untoward medical occurrence in a participant or clinical investigation participant administered a pharmaceutical product and which does not necessarily have to have a causal relationship with the study drug. An AE can, therefore, be any unfavorable and unintended sign (including an abnormal laboratory finding, for example), symptom, or disease temporally associated with the use of a medicinal product, whether or not considered related to the medicinal product. A serious adverse event (SAE) was any untoward medical occurrence that resulted in any of the following outcomes: death; life threatening; persistent/significant disability/incapacity; initial or prolonged inpatient hospitalization; congenital anomaly/birth defect or was otherwise considered medically important. OLE period TEAEs are defined as AEs that either start or worsen in severity on or after the first extension titration dose of study medication. TEAEs included both serious \& non-serious TEAEs.

    Time frame: From Week 14 up to Week 56

07

Results

Posted Jun 24, 2025

Participant flow

Participants were enrolled at 70 sites in Germany, Poland, Austria, France and the United States from 07 August 2018 to 24 February 2023.

Participant flow — Overall Study
MilestoneNAL ERPlacebo
Started173180
Modified intent-to-treat (mitt) analysis set168176
Participants who entered the ole period107144
Completed7180
Not completed102100
Withdrew: Withdrew consent3435
Withdrew: Lost to follow-up77
Withdrew: Physician decision45
Withdrew: Discontinued4239
Withdrew: Reason not specified1514

Outcome measures

PrimaryPercentage of Participants With ≥ 4- Point Decrease in 7-day Average Worst Itch - Numerical Rating Scale (WI-NRS) up to Week 14

The NRS is a patient related outcome (PRO) instrument, designed to quantify the intensity of worst itching experienced during a 24-hour period, and can be applied and validated either with reference to the average itch or to the absolute worst itch (WI-NRS) over that 24-hour period. WI-NRS is a set of boxes, one for each number, from 0 (no itching) to 10 (worst possible itching). Higher scores indicate worst itching experience. Responder was defined as a participant with a ≥4-point decrease in the 7-day average WI-NRS from baseline to Week 14.

Time frame:
Baseline up to Week 14
Reported as:
Number · percentage of participants
Percentage of Participants With ≥ 4- Point Decrease in 7-day Average Worst Itch - Numerical Rating Scale (WI-NRS) up to Week 14
percentage of participantsNAL ERPlacebo
Percentage of Participants With ≥ 4- Point Decrease in 7-day Average Worst Itch - Numerical Rating Scale (WI-NRS) up to Week 1424.2414.50
Statistical analysis
  • NAL ER vs Placebo · Regression, Logistic · p = 0.0309 (Logistic regression model includes WI-NRS baseline score as a covariate, treatment and the study site (with pooling) as a fixed effect.) · Odds ratio (or): 2.10 · 95% CI 1.07 to 4.13
SecondaryChange From Baseline in Itch-related Quality of Life (ItchyQoL) Total Score at Week 14

The ItchyQoL consists of 22 pruritus-specific items measuring how pruritus affects participant's QoL in the area of symptoms related to the itch condition (6 questions), functional limitations (7 questions), and emotions (9 questions). The participant scored each question never = 1, rarely = 2, sometimes = 3, often = 4, all the time = 5. The ItchyQoL total score were obtained as the sum of the 22 items ranging from 22 to 110, with higher score indicating worsening of pruritus. A negative change from baseline indicated improvement in the pruritus-related difficulties.

Time frame:
Baseline, Week 14
Reported as:
Mean · score on a scale
Change From Baseline in Itch-related Quality of Life (ItchyQoL) Total Score at Week 14
score on a scaleNAL ERPlacebo
Change From Baseline in Itch-related Quality of Life (ItchyQoL) Total Score at Week 14-17.4 ± 18.01-8.8 ± 17.15
Statistical analysis
  • NAL ER vs Placebo · Mixed Model for Repeated Measurements · p = 0.0002 (Repeated measures model with the fixed effects of treatment, visit, treatment by visit interaction and baseline ItchyQoL value. An unstructured covariance matrix is used.) · Difference in ls mean: -7.06 · 95% CI -10.82 to -3.30
SecondaryChange From Baseline in Prurigo Activity Score (PAS) Assessed by the Percentage of Participants With 1-Category Improvement in the Percentage of Pruriginous Lesions With Excoriations/Crusts (Item 5a) at Week 14

PAS consists of 5 quantitative/qualitative measurements related to examination of skin: Type; number;distribution;quantitative number of lesions in a body part;activity. Prurigo lesion activity is recorded as a stage (0 to 4), based on percentage of overall lesions with relevant characteristic. Three types of PAS responders defined one for each of the following items: Pruriginous lesions with excoriations/crusts (item 5a);Healed lesions (item 5b);Number of lesions (item 2). Pruriginous lesions with excoriations/crusts (item 5a) was recorded from 0 to 4;where 0 = 0-25%1 = 26-50%,2 = 51-75%,3 = 76-90%,4 = 91-100%. Higher score=a greater number of pruriginous lesions with excoriations/crusts. A responder was defined as a participant who has at least 1-category improvement in the relevant item from baseline to Week 14. Baseline is defined as the last non-missing evaluation (including repeated and unscheduled assessments) taken prior to or on the date of first dose of study medication.

Time frame:
Baseline, Week 14
Reported as:
Number · percentage of participants
Change From Baseline in Prurigo Activity Score (PAS) Assessed by the Percentage of Participants With 1-Category Improvement in the Percentage of Pruriginous Lesions With Excoriations/Crusts (Item 5a) at Week 14
percentage of participantsNAL ERPlacebo
Change From Baseline in Prurigo Activity Score (PAS) Assessed by the Percentage of Participants With 1-Category Improvement in the Percentage of Pruriginous Lesions With Excoriations/Crusts (Item 5a) at Week 1454.541.1
Statistical analysis
  • NAL ER vs Placebo · Regression, Logistic · p = 0.0179 (Logistic regression model includes PAS (Item 5a) baseline score as a covariate, treatment as a fixed effect and the study site (with pooling) as a fixed effect.) · Odds ratio (or): 1.85 · 95% CI 1.11 to 3.07
SecondaryChange From Baseline in Patient-Reported Outcomes Measurement Information System (PROMIS) Sleep Disturbance Short Form 8a at Week 14

PROMIS Sleep Disturbance Short Form 8a questionnaire is a tool for assessing sleep. It has 8 questions which measures sleep in the past 7 days.There is 1 broad sleep quality question with options:"very poor","poor","fair","good",and "very good".Remaining 7 questions are answered with:"not at all","a little bit","somewhat","quite a bit",and "very much".Lowest possible raw score=8; highest possible raw score=40. The T-score rescales raw score into a standardized score with a mean of 50 and an standard deviation of 10 derived from general population.Lowest possible T-score=28.9;highest possible T-score=76.6.Higher T-score shows more of the concept measured,higher the T-Score worse the sleep disturbance.Scores \<55=normal limits, 55-60=mild, 61-70=moderate,and \>70=severe sleep disturbance.Baseline=last non-missing evaluation (including repeated and unscheduled assessments) taken prior to or on the date of first dose of study medication.Negative change from baseline indicated better sleep.

Time frame:
Baseline, Week 14
Reported as:
Mean · T-score
Change From Baseline in Patient-Reported Outcomes Measurement Information System (PROMIS) Sleep Disturbance Short Form 8a at Week 14
T-scoreNAL ERPlacebo
Change From Baseline in Patient-Reported Outcomes Measurement Information System (PROMIS) Sleep Disturbance Short Form 8a at Week 14-9.5 ± 10.01-4.5 ± 8.44
Statistical analysis
  • NAL ER vs Placebo · Mixed Model for Repeated Measurements · p = <0.0001 (Repeated measures model with the fixed effects of treatment, visit, treatment by visit interaction and baseline PROMIS value. An unstructured covariance matrix is used.) · Difference in ls mean: -4.43 · 95% CI -6.55 to -2.31
SecondaryChange From Baseline in 7-Day Average WI-NRS to Week 14

The NRS is a PRO instrument, designed to quantify the intensity of worst itching experienced during a 24-hour period, and can be applied and validated either with reference to the average itch or to the absolute worst itch (WI-NRS) over that 24-hour period. WI-NRS is a set of boxes, one for each number, from 0 (no itching) to 10 (worst possible itching). Higher scores indicate worst itching experience. Baseline WI-NRS value was calculated as the arithmetic mean of the WI-NRS values (minimum of 5 required) taken for eligibility review by site at the time of randomization. A negative change from baseline indicates improvement in symptoms.

Time frame:
Baseline, Week 14
Reported as:
Mean · score on a scale
Change From Baseline in 7-Day Average WI-NRS to Week 14
score on a scaleNAL ERPlacebo
Change From Baseline in 7-Day Average WI-NRS to Week 14-2.5 ± 2.36-1.6 ± 2.14
SecondaryChange From Baseline in PAS Assessed by the Percentage of Participants With 1-Category Improvement in the Percentage of Healed Lesions (Item 5b) at Week 14

PAS consists of 5 quantitative/qualitative measurements related to skin-Type; number; distribution; quantitative number of lesions in body part; activity. Prurigo lesion activity is recorded as stage (0 to 4), based on percentage of overall lesions with relevant characteristic. Three types of PAS responders are defined: Pruriginous lesions with excoriations/crusts (item 5a); Healed lesions (item 5b); Number of lesions (item 2). Prurigo lesions (item 5b), where 0 = 100%,1 = 75-99%,2 = 50-74%,3 = 25-49%,4 = 0-24% healed pruriginous lesions. Lower score=more number of healed pruriginous lesions. A responder was defined as a participant who has at least 1-category improvement in the relevant item from baseline to Week 14. Baseline was defined as the last non-missing evaluation (including repeated and unscheduled assessments) taken prior to or on the date of first dose of treatment. A negative change from baseline would indicate higher number of healed lesions.

Time frame:
Baseline, Week 14
Reported as:
Number · percentage of participants
Change From Baseline in PAS Assessed by the Percentage of Participants With 1-Category Improvement in the Percentage of Healed Lesions (Item 5b) at Week 14
percentage of participantsNAL ERPlacebo
Change From Baseline in PAS Assessed by the Percentage of Participants With 1-Category Improvement in the Percentage of Healed Lesions (Item 5b) at Week 1439.334.7
SecondaryChange From Baseline in PAS Assessed by the Percentage of Participants With 1-Category Improvement in the Percentage of Lesions (Item 2) at Week 14

PAS consists of 5 quantitative/qualitative measurements of skin- Type; number; distribution; quantitative number of lesions in body part; activity. Prurigo lesion activity is recorded as stage (0 to 4) based on percentage of overall lesions with relevant characteristic. Three types of PAS responders are defined: Pruriginous lesions with excoriations/crusts (item 5a); Healed lesions (item 5b); Number of lesions (item 2). Prurigo lesion activity is recorded as a stage (0 to 4), based on the percentage of overall lesions with the relevant characteristic. A lower score indicates less number of pruriginous lesions. A responder was defined as a participant who has at least 1-category improvement in the relevant item from baseline to Week 14. Baseline was defined as the last non-missing evaluation (including repeated and unscheduled assessments) taken prior to or on the date of first dose of study medication. A negative change from baseline would indicate lower number of lesions.

Time frame:
Baseline, Week 14
Reported as:
Number · percentage of participants
Change From Baseline in PAS Assessed by the Percentage of Participants With 1-Category Improvement in the Percentage of Lesions (Item 2) at Week 14
percentage of participantsNAL ERPlacebo
Change From Baseline in PAS Assessed by the Percentage of Participants With 1-Category Improvement in the Percentage of Lesions (Item 2) at Week 1425.018.8
SecondaryChange From Baseline in Investigator Global Assessment-Prurigo Nodularis (IGA-PN) Assessed by the Percentage of Participants With 1-Category Improvement in Activity at Week 14

The IGA-PN collects an investigator global assessment of status of PN skin lesions. The IGA-PN uses a 5-category scale (scoring 0 to 4) to describe the status of 2 aspects of disease: The Activity (amount of excoriation and crusting associated with the prurigo lesions), and the Stage (the quantitative presence and proportion of flattening of the lesions). The excoriation/crusting activity on the surface (PN-Activity) where it considers number of PN lesion with excoriations and crusts on the top, 0=clear (No nodules), 1 =small number, 2=minority of nodules, 3=most nodules, 4=severe (vast majority of nodules). A higher number indicates severe status of PN skin lesions. An IGA-PN responder for activity was defined as participants who has at a least 1-category improvement in the respective score from baseline to Week 14. Baseline was defined as the last non-missing evaluation (including repeated and unscheduled assessments) taken prior to or on the date of first dose of study medication.

Time frame:
Baseline, Week 14
Reported as:
Number · percentage of participants
Change From Baseline in Investigator Global Assessment-Prurigo Nodularis (IGA-PN) Assessed by the Percentage of Participants With 1-Category Improvement in Activity at Week 14
percentage of participantsNAL ERPlacebo
Change From Baseline in Investigator Global Assessment-Prurigo Nodularis (IGA-PN) Assessed by the Percentage of Participants With 1-Category Improvement in Activity at Week 1457.141.1
SecondaryChange From Baseline in IGA-PN Assessed by the Percentage of Participants With 1-Category Improvement in Stage at Week 14

The IGA-PN collects an investigator global assessment of status of PN skin lesions. The IGA-PN uses a 5-category scale(scoring 0 to 4) to describe 2 aspects of disease. The Activity(amount of excoriation and crusting of prurigo lesions) and the Stage(the quantitative presence and proportion of flattening of lesions),where 0=clear(No nodules),1=Rare, flattened lesions, with no more than single dome-shaped palpable nodules(1-5 nodules), 2=Few,mostly flattened lesions, with small number of dome-shaped palpable nodules(6-19 nodules,3=Many lesions, partially flattened and dome-shaped palpable nodules (20-100 nodules),4=Abundant lesions, majority are dome-shaped palpable nodules (over 100 nodules).Higher number= presence of abundant lesions.Responder as defined as participants who has at a least 1-category improvement from baseline to Week 14.Baseline was defined as the last non-missing evaluation(repeated and unscheduled assessments)taken prior to or on the date of first dose of treatment.

Time frame:
Baseline, Week 14
Reported as:
Number · percentage of participants
Change From Baseline in IGA-PN Assessed by the Percentage of Participants With 1-Category Improvement in Stage at Week 14
percentage of participantsNAL ERPlacebo
Change From Baseline in IGA-PN Assessed by the Percentage of Participants With 1-Category Improvement in Stage at Week 1443.832.9
SecondaryPercentage of Participants Having a Patient Benefit Index, Pruritus Version (PBI-P) Score of ≥1 at Week 14

PBI-P is an instrument that measures participant-defined treatment objectives and benefits acquired during the course of treatment.During and after therapy, the participant completes a matched "on-treatment" Treatment Benefits questionnaire and rates the extent to which the treatment objectives have been achieved.It consists of 27 multiple choice questions that can be answered "not at all","somewhat","moderately","quite","very".PBI-P global score is computed according to the score obtained for patient needs questionnaire (PNQ) and patient benefit questionnaire (PBQ).Score may only be computed if the participant has provided valid data on importance (PNQ) and benefit (PBQ) for at least 75% of the respective treatment goals,i.e., for at least 21 of the 27 items. Total score ranges from 0-135. Higher scores=more benefit received from the study to the participant.Responses "does/did not apply","question answered" are considered valid values when counting number of non-missing responses.

Time frame:
At Week 14
Reported as:
Number · percentage of participants
Percentage of Participants Having a Patient Benefit Index, Pruritus Version (PBI-P) Score of ≥1 at Week 14
percentage of participantsNAL ERPlacebo
Percentage of Participants Having a Patient Benefit Index, Pruritus Version (PBI-P) Score of ≥1 at Week 14100.0100.0
SecondaryNumber of Participants Who Experienced Treatment Emergent Adverse Events (TEAEs), Serious TEAEs, and Discontinued From Study Drug Due to TEAEs in DB Period

An AE is any untoward medical occurrence in a participant who administered a pharmaceutical product, and which does not necessarily have to have a causal relationship with the study drug. An AE can, therefore, be any unfavorable and unintended sign (including an abnormal laboratory finding, for example), symptom, or disease temporally associated with the use of a medicinal product, whether or not considered related to the medicinal product. A serious adverse event (SAE) is any untoward medical occurrence that resulted in any of the following outcomes: death; life threatening; persistent/significant disability/incapacity; initial or prolonged inpatient hospitalization; congenital anomaly/birth defect or was otherwise considered medically important. DB period TEAEs are defined as AEs that either start or worsen in severity on or after the first DB dose and prior to the first extension titration dose of study medication in the OLE period. TEAEs included both serious \& non-serious TEAEs.

Time frame:
Baseline up to Week 14
Reported as:
Count of participants · Participants
Number of Participants Who Experienced Treatment Emergent Adverse Events (TEAEs), Serious TEAEs, and Discontinued From Study Drug Due to TEAEs in DB Period
ParticipantsNAL ERPlacebo
Participants with TEAEs136106
Participants with Serious TEAEs98
Participants with Study Drug Discontinuation Due to TEAEs5313
SecondaryNumber of Participants Who Experienced TEAEs, Serious TEAEs, and Discontinued From Study Drug Due to TEAEs in OLE Period

An AE is any untoward medical occurrence in a participant or clinical investigation participant administered a pharmaceutical product and which does not necessarily have to have a causal relationship with the study drug. An AE can, therefore, be any unfavorable and unintended sign (including an abnormal laboratory finding, for example), symptom, or disease temporally associated with the use of a medicinal product, whether or not considered related to the medicinal product. A serious adverse event (SAE) was any untoward medical occurrence that resulted in any of the following outcomes: death; life threatening; persistent/significant disability/incapacity; initial or prolonged inpatient hospitalization; congenital anomaly/birth defect or was otherwise considered medically important. OLE period TEAEs are defined as AEs that either start or worsen in severity on or after the first extension titration dose of study medication. TEAEs included both serious \& non-serious TEAEs.

Time frame:
From Week 14 up to Week 56
Reported as:
Count of participants · Participants
Number of Participants Who Experienced TEAEs, Serious TEAEs, and Discontinued From Study Drug Due to TEAEs in OLE Period
ParticipantsPrior NAL ER (OLE Period)Prior Placebo (OLE Period)
Participants with TEAEs84116
Participants with Serious TEAEs77
Participants with Study Drug Discontinuation Due to TEAEs830

Adverse events

Collected over DB Period: Baseline up to Week 14; OLE Period: From Week 14 to Week 56. Non-serious events are listed at a 5% frequency threshold.

Adverse event summary by group
GroupDeathsSeriousOther
NAL ER (DB Period)0/168 (0%)9/168 (5.4%)112/168 (66.7%)
Placebo (DB Period)0/176 (0%)8/176 (4.5%)58/176 (33%)
Prior NAL ER (OLE Period)0/107 (0%)7/107 (6.5%)49/107 (45.8%)
Prior Placebo (OLE Period)0/144 (0%)7/144 (4.9%)95/144 (66%)
Most frequent serious events
Showing 10 of 39
Most frequent serious events
EventNAL ER (DB Period)Placebo (DB Period)Prior NAL ER (OLE Period)Prior Placebo (OLE Period)
NeurodermatitisSkin and subcutaneous tissue disorders1/1681/1761/1070/144
Spinal compression fractureInjury, poisoning and procedural complications0/1680/1761/1070/144
Clear cell renal cell carcinomaNeoplasms benign, malignant and unspecified (incl cysts and polyps)0/1680/1761/1070/144
Migraine with auraNervous system disorders0/1680/1761/1070/144
NephrolithiasisRenal and urinary disorders0/1680/1761/1070/144
Interstitial lung diseaseRespiratory, thoracic and mediastinal disorders0/1680/1761/1070/144
VertigoEar and labyrinth disorders0/1680/1761/1071/144
DermatitisSkin and subcutaneous tissue disorders0/1680/1760/1071/144
Hypertensive heart diseaseCardiac disorders0/1680/1760/1071/144
Vision blurredEye disorders0/1680/1760/1071/144
Most frequent other events
Showing 10 of 13
Most frequent other events
EventNAL ER (DB Period)Placebo (DB Period)Prior NAL ER (OLE Period)Prior Placebo (OLE Period)
DizzinessNervous system disorders53/1686/1765/10730/144
NauseaGastrointestinal disorders52/16816/17613/10744/144
ConstipationGastrointestinal disorders26/1687/1764/10711/144
HeadacheNervous system disorders26/16814/1768/10722/144
SomnolenceNervous system disorders25/1686/1763/10719/144
VomitingGastrointestinal disorders19/1686/1763/10720/144
FatigueGeneral disorders23/16810/1765/10718/144
DiarrhoeaGastrointestinal disorders7/1685/17610/10715/144
Medication errorInjury, poisoning and procedural complications4/1686/17611/10714/144
Treatment noncomplianceGeneral disorders4/1683/1768/1078/144

Baseline characteristics

The mITT population included all randomized participants who received at least a single dose of IP.

Age, Continuous
Age, Continuous(years)NAL ERPlaceboTotal
Mean59.6 ± 13.2555.9 ± 14.3257.7 ± 13.91
Sex: Female, Male
Sex: Female, Male(Participants)NAL ERPlaceboTotal
Female100112212
Male6864132
Ethnicity (NIH/OMB)
Ethnicity (NIH/OMB)(Participants)NAL ERPlaceboTotal
Hispanic or Latino6713
Not Hispanic or Latino6366129
Unknown or Not Reported99103202
Race (NIH/OMB)
Race (NIH/OMB)(Participants)NAL ERPlaceboTotal
American Indian or Alaska Native000
Asian6713
Native Hawaiian or Other Pacific Islander61117
Black or African American242347
White132134266
More than one race011
Unknown or Not Reported000
Worst Itch - Numerical Rating Scale (WI-NRS) Score
Worst Itch - Numerical Rating Scale (WI-NRS) Score(score on scale)NAL ERPlaceboTotal
Mean8.637 ± 0.91158.650 ± 0.89028.643 ± 0.8993
08

Study locations

70 sites
  • Study Site 151
    Phoenix, Arizona 85006, United States
  • Study Site 121
    Fremont, California 94538, United States
  • Study Site 157
    Laguna Niguel, California 92677, United States
  • Study Site 141
    North Hollywood, California 91606, United States
  • Study Site 130
    San Francisco, California 94115, United States
  • Study Site 128
    Washington D.C., District of Columbia 20037, United States
  • Study Site 138
    Boca Raton, Florida 33433, United States
  • Study Site 158
    Orlando, Florida 32819, United States
  • Study Site 108
    South Miami, Florida 33143, United States
  • Study Site 142
    Tampa, Florida 33615, United States
  • Study Site 102
    Rockville, Maryland 20850, United States
  • Study Site 136
    Boston, Massachusetts 02114, United States
  • Study Site 153
    Brighton, Massachusetts 02135, United States
  • Study Site 143
    Ann Arbor, Michigan 48103, United States
  • Study Site 139
    Troy, Michigan 48084, United States
  • Study Site 118
    Saint Joseph, Missouri 64506, United States
  • Study Site 144
    Henderson, Nevada 89052, United States
  • Study Site 146
    Las Vegas, Nevada 89119, United States
  • Study Site 109
    Portsmouth, New Hampshire 03801, United States
  • Study Site 159
    Hackensack, New Jersey 07601, United States
  • Study Site 134
    Stony Brook, New York 11794, United States
  • Study Site 101
    Wilmington, North Carolina 28411, United States
  • Study Site 122
    Cincinnati, Ohio 45219, United States
  • Study Site 120
    Cleveland, Ohio 44106, United States
  • Study Site 132
    Hershey, Pennsylvania 17033, United States
  • Study Site 106
    Philadelphia, Pennsylvania 19103, United States
  • Study Site 131
    Johnston, Rhode Island 02919, United States
  • Study Site 147
    Charleston, South Carolina 29407, United States
  • Study Site 107
    Charleston, South Carolina 29425-8908, United States
  • Study Site 140
    Chattanooga, Tennessee 37421, United States
  • Study Site 145
    Knoxville, Tennessee 37917, United States
  • Study Site 137
    Austin, Texas 78705, United States
  • Study Site 103
    Webster, Texas 77598, United States
  • Study Site 150
    West Jordan, Utah 84088, United States
  • Study Site 135
    Spokane, Washington 99202, United States
  • Study Site 148
    Morgantown, West Virginia 26505, United States
  • Study Site 401
    Graz, 8036, Austria
  • Study Site 402
    Linz, 4020, Austria
  • Study Site 501
    Brest, 29609, France
  • Study Site 502
    Paris, 75010, France
  • Study Site 204
    Frankfurt am Main, Hesse 60590, Germany
  • Study Site 202
    Münster, North Rhine-Westphal 48149, Germany
  • Study Site 201
    Mainz, Rhineland-Palatinate 55131, Germany
  • Study Site 213
    Dresden, Saxony 01307, Germany
  • Study Site 205
    Bad Bentheim, 48455, Germany
  • Study Site 216
    Berlin, 10117, Germany
  • Study Site 209
    Berlin, 10247, Germany
  • Study Site 208
    Berlin, 10789, Germany
  • Study Site 219
    Cologne, 50937, Germany
  • Study Site 221
    Düsseldorf, 40225, Germany
  • Study Site 215
    Hamburg, 20246, Germany
  • Study Site 222
    Hamburg, 22391, Germany
  • Study Site 212
    Heidelberg, 69115, Germany
  • Study Site 214
    Kiel, 24105, Germany
  • Study Site 220
    München, 80802, Germany
  • Study Site 206
    Stuttgart, 70178, Germany
  • Study Site 304
    Bialystok, 15-453, Poland
  • Study Site 306
    Katowice, 40-648, Poland
  • Study Site 308
    Krakow, 31-302, Poland
  • Study Site 316
    Krakow, 31-559, Poland
  • Study Site 309
    Lodz, 90-265, Poland
  • Study Site 314
    Lublin, 20-406, Poland
  • Study Site 305
    Ostrowiec Świętokrzyski, 27-400, Poland
  • Study Site 313
    Poznan, 60-529, Poland
  • Study Site 315
    Poznan, 60-848, Poland
  • Study Site 303
    Rzeszów, 35055, Poland
  • Study Site 310
    Warsaw, 01-142, Poland
  • Study Site 301
    Warsaw, 01-817, Poland
  • Study Site 312
    Warsaw, 02-962, Poland
  • Study Site 302
    Wroclaw, 50566, Poland
09

References and documents

Study documents

PDFs hosted by the registry, ClinicalTrials.gov.

Individual participant data

Plan to share: No

10

Timeline

Tracking since Sep 25, 2026
ElapsedEstimatedEstimated, not yet reached

Ran from Aug 2018 to primary completion in May 2022, 45 months.

Results were first posted in Jun 2025, 3 years 1 month after primary completion. A results delay was requested in Apr 2023.

How these figures are worked out, and which studies are left out of them.

Registered
Mar 22, 2018
First posted
Apr 13, 2018
StartActual
Aug 7, 2018
Primary completionActual
May 10, 2022
CompletionActual
Feb 24, 2023
Results delay requested
Apr 25, 2023
Results first posted
Jun 24, 2025
Last update
Jun 24, 2025
What these dates mean
Start.
When the first participant enrolled; while estimated, when the study expects to open to recruitment.
Primary completion.
When the last participant was examined or treated to collect data for the study's main question, its primary outcome. A study that stopped early gives the date its data collection stopped.
Completion.
When the last participant's last visit took place, for every outcome, secondary ones and side effects included: the end of the study. Often later than primary completion, sometimes the same day.
Actual and Est.
Actual means the registry says the date has happened. Est. (estimated) is a date the sponsor plans or expects. It can still move, and the sponsor is expected to change it to actual once it has passed.
No changes since tracking began. The registry record was last updated on Jun 24, 2025, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
11

Registry details

Key details

Study ID
NCT03497975
Lead sponsor
Trevi Therapeutics
Responsible party
Sponsor
First posted
Apr 13, 2018
Start date
Aug 7, 2018
Primary completion
May 10, 2022
Completion
Feb 24, 2023
Results posted
Jun 24, 2025
Last update
Jun 24, 2025

Study contacts

Chief Development Officer
study director · Trevi Therapeutics

Oversight

Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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Studies of the drug tested here: Nalbuphine

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