EU-project Pain treatment in children GAbapentin in Paediatric Pain (GAPP) Patty Brouwer 7th European CCI meeting, Belgrade 22 April 2016
EU-projectPain treatment in childrenGAbapentin in Paediatric Pain (GAPP)
Patty Brouwer7th European CCI meeting, Belgrade
22 April 2016
Background: Why this study?
Suffering from (chronic) pain can limit a child’s ability to attend school, socialize and participate in physical activity.
Studies suggest that many children do not receive appropriate help or pain treatment, and are often undertreated(Goodman JE and McGrath PJ, 1991; Perquin CW et al., 2000; Schanberg LE et al., 2003).
Background: Why this study?Pain is one of the most frequent and serious symptoms experienced by patients in need of palliative care
80% of the world’s population lack adequate access to medication need for palliative care
Pain treatment in children
WHO guidelines on the pharmacological treatment of persisting pain in children with medical illnesses (including cancer), 2012:1. mild pain:
paracetamol/acetaminophen and ibuprofen (non opioids)
2. moderate to severe pain: morphine
WHO1st priority is to find strong opioids as an alternative for morphine or as a complimentary drug to morphine
2nd priority is the search for drugs to reduce neuropathic pain. Among these drugs, gabapentin is specifically listed.
GABAPENTIN• anti epileptic• used in adults for neuropathic pain
treatment• for adults proven to bring great
benefit, good results• expected to bring great benefit to
children for whom very few approved medication are available for the treatment of pain
Why is CCI involved?Pain is one of the most common symptoms in children with cancer.
About 40% of cancer-related pain is neuropathic pain.
A Parent’s Guide to Enhancing the Quality of Life in Children with Cancer, Chapter 4 Pain in Children with Cancer,2014 by Ruth I Hoffman MPH and Sandra E Smith
Why is CCI involved?Most of the included children in this trial will be oncology patients.
For many parents pain isone of the most concerning and frightening aspects of the journey.
One of CCI’s visions
CCI wants to ensure that children receive the best possible care (pain treatment) wherever they are in the world at the time of diagnosis and beyond
Final Goal of GAPPTo propose a treatment of chronic pain with a neuropathic component in children with gabapentin both as monotherapy and as additional therapy to morphine
To assess the safety of gabapentin in children
CCI’s participation in GAPP
Complicated trials• Children need to be woken up every 4 hours:
burden on child and parent during 17-21 weeks
• Large quantities of liquids of a nasty tasting substance
• Challenge to include enough children
• Possibly high withdrawal rates for inefficacy or adverse drug events
CCI’s participation in GAPP• Ethic committee:
Anouk Nijenhuis: CCI and VOKK
2 Study Protocols, Information Document, Annex on side effects of drugs, Consent form, Letter for the primary care doctor/paediatrician for informing the parents and patients.
CCI’s participation in GAPP• Scientific committee:
Marcela Zubieta: CCI board member
• Patient Advisory Board (PAB): to provide input with attention to patient perspective on GAPP project
Anouk Nijenhuis: CCI and VOKKPatty Brouwer: CCI and VOKK
GAPP Patient Advisory Board (PAB)The PAB aims to assess all relevant aspects of the GAPP project from the patient perspective, including patient information material for both GABA-1 (WP 7) and GABA-2 (WP 8) trials• Booklets: to help children to decide in
participation• Video: explanation of trials in general• Patient diary: children at home and record
pain scores
Focus Groups used for patients perspective
• Children 6-11 and 12-17 years old (<6 not included)
• 3 booklets for 3 age groups• 2 countries: Italy and the
Netherlands• Italy: children's hospital Padova• The Netherlands: pain department
Rotterdam and VOKK
Patient information bookletsFOCUS GROUP KEY QUESTIONS• General question on what each page
depicts• Specific questions regarding key
information– Purpose of study: well understood– Chronic vs. acute pain: in general well
understood but 9-11 struggled
Focus group key questions– Study stages and procedures:12-17: too busy, too much information
Focus group key questions– Disadvantages, possible side effects:
concept very clear, too many pages, disturbing drawings
Focus group key questions• Reasons to participate: well understood,
also that it might not help them• Withdrawal from study
Emphasize ability to withdraw at any time and how
• Privacy and consent Appreciate that data will be kept
private. Understand that only doctor and parents will know if a child participates.
Resulting revisions to booklets• 12-17 year old booklet– Change “Generation GAPP” in title
Overall conclusions• Patient information booklets clear and
enjoyable to read for the children
• Helpful minor revisions suggested
• Important themes identified for further discussion with treating physician:– Blood draws (frequency, how long)– Randomization, blinding, placebo– Urine test/pregnancy– Study withdrawal procedures
Next step• Including children in trials in:
AlbaniaEstoniaFranceGreece GermanyItalythe NetherlandsUnited Kingdom
• Hand out of information booklets
ContactsFor more information contact:
Coordinator: Dr. Donato Bonifazi of the Consorzio per Valutazioni Biologiche e Farmacologiche (CVBF) [email protected]
Patty [email protected]