Efficacy of a Fixed-Dose Combination of Ibuprofen and Acetaminophen Compared With Individual Monocomponents in Adult Male Subjects With Endotoxin-Induced Fever: A Randomized Controlled Trial

• Published in: Clinical therapeutics Vol. 43; no. 7; pp. 1213 - 1227
• Main Authors: Smith, William, Leyva, Rina, Kellstein, David, Arthur, Edmund, Cruz-Rivera, Mario
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2021; Elsevier Limited
• Subjects: Acetaminophen; Acetaminophen - adverse effects; Adolescent; Adult; Adverse events; Analgesics; Analgesics, Non-Narcotic - adverse effects; antipyretic agent; Blood pressure; Double-Blind Method; Drug administration; Drug dosages; endotoxin; Endotoxins; Fever; fixed-dose combination, ibuprofen; Heart rate; Humans; Ibuprofen; Ibuprofen - adverse effects; Internal Medicine; Intravenous administration; Laboratories; Male; Middle Aged; Nervous system; Nonsteroidal anti-inflammatory drugs; Pain, Postoperative; Placebos; Statistical analysis; Young Adult; United States > US; fever; acetaminophen; fixed-dose combination, ibuprofen; antipyretic agent; endotoxin
• DOI: 10.1016/j.clinthera.2021.05.004
• ISSN: 0149-2918; 1879-114X

This study evaluated antipyretic efficacy and onset of a novel fixed-dose combination (FDC) of ibuprofen (IBU; 250 mg) and acetaminophen (APAP; 500 mg) compared with placebo and IBU or APAP monocomponents. This single-center, randomized, double-blind, placebo-controlled, full-factorial study was conducted in healthy males aged 18 to 55 years with pyrexia induced by intravenous administration of reference standard endotoxin (RSE). After attainment of an oral temperature ≥38.1°C, subjects were randomized 3:3:3:1 to a double-blind single oral dose of FDC IBU/APAP 250 mg/500 mg, APAP 500 mg, IBU 250 mg, or placebo. Oral temperature was measured every 10 minutes for 2 hours, then every 30 minutes until 8 hours postdose. Time-weighted sum of temperature differences from baseline to 8 hours (WSTD0–8) after study medication administration was the primary efficacy end point. Secondary end points included WSTD scores from 0 to 2 hours, 0 to 4 hours, 0 to 6 hours, and 6 to 8 hours; time to return to “normal” temperature; time to rescue medication use; and global drug evaluation. Safety was assessed via adverse events (AEs). Two hundred ninety subjects were randomized; 273 were included in the primary efficacy analysis. WSTD0–8 was significantly better for FDC IBU/APAP 250 mg/500 mg (P = 0.002), IBU 250 mg (P = 0.030), and APAP 500 mg (P = 0.023) versus placebo; there were no significant differences between active treatments. For WSTD0–2, only the FDC was statistically significant versus placebo (P = 0.004). All active treatments were significantly better (P < 0.05) for WSTD0–4 and WSTD0–6 versus placebo; there were no differences in WSTD6–8 between cohorts. Temperature returned to normal during the 8-hour treatment period in ∼50% of subjects in each cohort. Only 1 subject (IBU cohort) took rescue medication. Post hoc analyses at early time points revealed significant treatment differences favoring FDC versus placebo and IBU for the WSTD from baseline during the 50- to 110-minute posttreatment window; for WSTD from baseline during the 80- to 110-minute posttreatment window, FDC provided significant treatment differences versus placebo and both monocomponents. Overall, 223 (76.9%) of 290 subjects experienced AEs related to RSE; only 2 subjects experienced treatment-related AEs (FDC, rash; placebo, ear pain). Although the primary end point was not met, these results suggest that FDC IBU/APAP 250 mg/500 mg provides effective antipyresis with a faster onset versus equal doses of IBU and APAP alone. ClinicalTrials.gov identifier: NCT02761980.