To assess the efficacy of intravenous remimazolam in inducing and maintaining suitable sedation levels for paediatric patients undergoing diagnostic and/or therapeutic procedures
This trial is part of the European Paediatric Investigational Plan and the US Pediatric Study Plan and has been developed in line with guidance from the EMA Paediatric Committee and the US FDA. The trial will commence with cohort 1 (aged ≥6 and \<18 years) and proceed to lower age groups: cohort 2 (≥3 and \<6 years); and, in European sites only, cohort 3 (full-term birth to \<3 years). The Data Monitoring committee (DMC) may convene any time after at least half of the subjects in cohort 1 or 2 have completed the study, to review PK,safety and efficacy data. If there are no concerns, the DMC may recommend to initiate concurrent dosing in the next younger cohort (cohort 2 or 3) in parallel to dosing the remaining subjects in cohort 1 or 2 Dosing for cohort 3 will be predicted based on PK modelling as well as efficacy and safety outcomes of the older age groups. Enrolment of patients aged \<2 years will not be permitted until supported by adequate juvenile toxicity data. The trial will consist of three visits: Screening (Day -21 to day 1),Treatment (Day 1), and Follow-up (Day 4 \[+3/-1 days\]).
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
SUPPORTIVE_CARE
Masking
NONE
Enrollment
100
Remimazolam for intravenous sedation
Stanford University
Palo Alto, California, United States
University of California Davis Children's Hospital
Sacramento, California, United States
Boston Children's Hospital
Boston, Massachusetts, United States
University of Minnesota Masonic Children's Hospital
Success of the procedure
Success of the procedure defined as: Completion of the procedure AND no requirement for rescue sedative medication AND no requirement for more than the permitted bolus or infusion regimen
Time frame: 2 hours
Target depth of sedation achieved
Proportion of patients achieving predefined target depth of sedation (assessed using University of Michigan Sedation Score \[UMSS\]) during procedure
Time frame: 2 hours
Target range of sedation achieved during 80% of procedure duration
Proportion of patients in whom predefined target range of sedation (assessed using University of Michigan Sedation Score \[UMSS\]) was achieved during at least 80% of procedure duration
Time frame: 2 hours
Percentage of time within target range of sedation
Percentage of time spent by patients within predefined target range of sedation (assessed using University of Michigan Sedation Score \[UMSS\]) during procedure
Time frame: 2 hours
Adequacy of sedation
Depth of sedation (assessed using Nurse Interpretation of Sedation Scale \[NISS\]) of patients over time
Time frame: 2 hours
Time to start of procedure
Time between initial administration of study drug and start of procedure
Time frame: 2 hours
Time to fully alert
Time between last dose of study drug, end of procedure and full alertness, defined as the first of three consecutive sedation scores showing no sedation
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Minneapolis, Minnesota, United States
University of Pittsburgh Medical Center - Children's Hospital of Pittsburgh
Pittsburgh, Pennsylvania, United States
Texas Children's Hospital
Houston, Texas, United States
Rigshospitalet
Copenhagen, Denmark
Odense Universitetshospital
Odense, Denmark
Time frame: 2 hours
Time to ready for discharge
Time between last dose of study drug, end of procedure and discharge readiness
Time frame: 2 hours
Signs of re-sedation
Occurrence, after reaching a University of Michigan Sedation Score (UMSS) of 0 after end of procedure, of a UMSS greater than zero
Time frame: 2 hours
Procedure success excluding cases where the procedure could not be completed for non sedative reasons
Success of the procedure defined as: Completion of the procedure AND no requirement for rescue sedative medication AND no requirement for more than the permitted bolus or infusion regimen; excluding any patients where procedure was not completed for reasons other than failure of sedation
Time frame: 2 hours
Safety: AEs
Incidence of treatment-emergent adverse events
Time frame: 4 days
Safety: emergence of delirium
Incidence of paediatric anaesthesia emergence delirium between end of procedure until fit for discharge
Time frame: 2 hours
Safety: need for ventilation
Incidence of use of any manual or mechanical ventilation
Time frame: 2 hours
Safety: need for reversal
Incidence of use of flumazenil for reversal of benzodiazepine effect
Time frame: 2 hours
PK: assessment of plasma concentration-time relationship
Graphical description of plasma concentration over time and comparison to predicted concentration-time relationship as calculated from existing pharmacokinetic/pharmacodynamic model
Time frame: 3.5 hours