The goal of this clinical trial is to learn if MELT-300 works on procedural sedation in adult participants undergoing cataract extraction with lens replacement (CELR). It will also learn about the safety of MELT-300. Researchers will compare MELT-300 to a placebo (a look-alike substance that contains no drug) to see if MELT-300 works on procedural sedation in adult participants undergoing CELR. Researchers will also include a comparator SL midazolam to confirm the benefit of inclusion of ketamine in the combined drug product. The main questions it aims to answer are: 1. Does MELT-300 is effective in comparison to placebo on procedural sedation for cataract surgery? 2. To determine the effectiveness of MELT-300 compared with midazolam on procedural sedation (to determine the contribution of ketamine component and inform the risk of ketamine in MELT-300) 3. To determine the time to achieve preoperative target sedation level with MELT-300 4. What medical problems do participants have when taking MELT-300 vs placebo Eligible participants will admitted to the study unit on Day 1. Participants will be randomized prior to surgery 4:1:1 to 1. MELT-300 (i.e. 1 MELT-300 sublingual tablet which contains 3 mg midazolam and 50 mg of ketamine) 2. Midazolam (i.e. 1 matching midazolam sublingual tablet which contains 3 mg midazolam) 3. Placebo (i.e. 1 matching placebo sublingual tablet) Participants will receive study medication 30 (± 5) minutes, without food or water, before planned surgery start (defined as instillation of topical ocular anesthetic gel \[i.e.. 3 drops of chloroprocaine hydrochloride ophthalmic gel)\]. The effectiveness of MELT-300 will be performed after study medication is administered before surgery, in the course of surgery, and postoperative on Day 1 (end of surgery defined as just prior to drape removal). The safety of MELT-300 will be performed at baseline, in the course of surgery, postoperatively on Day 1, and on Day 3 ± 1 day post dose of study medication.
This is a Phase 3, randomized, double-masked, placebo-controlled, parallel-cohort, multicenter study to evaluate the efficacy and safety of MELT-300 compared with placebo on procedural sedation in adult participants undergoing CELR. An active comparator, SL midazolam, is also included in the trial, in part, to confirm the benefit of inclusion of ketamine in the combined drug product. Approximately 528 participants will be enrolled in 3 parallel treatment arms to assess efficacy endpoints. Eligible participants will be admitted to the study unit on Day 1. Participants will be randomized prior to surgery 4:1:1 to 1. MELT-300 (i.e. 1 MELT-300 sublingual tablet which contains 3 mg midazolam and 50 mg of ketamine) 2. Midazolam (i.e. 1 matching midazolam sublingual tablet which contains 3 mg midazolam) 3. Placebo (i.e. 1 matching placebo sublingual tablet) Participants will receive study medication 30 (± 5) minutes, without food or water, before planned surgery start (defined as instillation of topical ocular anesthetic gel \[i.e.. 3 drops of chloroprocaine hydrochloride ophthalmic gel)\]. Efficacy assessments will be performed after study medication administration before surgery, intraoperatively, and postoperative on Day 1 (end of surgery defined as just prior to drape removal). Efficacy assessments will include assessments of sedation, need for rescue medication for sedation, need for rescue medication for pain, and the ability to complete the surgery. Safety will be monitored at baseline, intraoperatively, postoperatively on Day 1, and on Day 3 ± 1 day post dose of study medication. Safety assessment will include monitoring of AEs, vital sign measurements, and physical examinations.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
528
Each dose of MELT-300 will be provided as a single sublingual tablet, containing 3 mg midazolam and 50 mg ketamine. Participants will receive 1 sublingual tablet of study medication 30 (± 5) minutes prior to planned surgery start, without food or water.
Each dose of midazolam will be provided as a single sublingual tablet, containing 3 mg midazolam. Participants will receive 1 sublingual tablet of study medication 30 (± 5) minutes prior to planned surgery start, without food or water.
Each dose of placebo will be provided as a matching sublingual tablet, containing placebo. Participants will receive 1 sublingual tablet of study medication 30 (± 5) minutes prior to planned surgery start, without food or water.
Ridge Eye Care, Inc.
Chico, California, United States
RECRUITINGIcon Eye Care
Grand Junction, Colorado, United States
RECRUITINGLevenson Eye Associates
Jacksonville, Florida, United States
RECRUITINGMaryland Vision Institute
Hagerstown, Maryland, United States
RECRUITINGVance Thompson Vision- Alexandria
Alexandria, Minnesota, United States
RECRUITINGTekwani Vision Center
Bay Saint Louis, Mississippi, United States
RECRUITINGBergstrom Eye Research
Fargo, North Dakota, United States
RECRUITINGVance Thompson Vision, ND
West Fargo, North Dakota, United States
RECRUITINGNortheastern Eye Institute
Scranton, Pennsylvania, United States
RECRUITINGConway Ophthalmology
Conway, South Carolina, United States
RECRUITING...and 2 more locations
Percentage of Participants Achieving Successful Procedural Sedation
Successful procedural sedation is defined as achieving target sedation level (Ramsay Sedation Scale \[RSS\] level 2 or 3) by the start of surgery without need for rescue sedation medication, no requirement for intraoperative sedation medication, and able to complete the surgery (i.e. procedural sedation responder). The Ramsay Sedation Scale (RSS) was the first scale to be defined for the sedated participants and was designed as a test of arousability. The Ramsay Scale provides three levels of 'awake' states (score 1-3) and three levels of 'asleep' states (score 4-6). A score of 2 (participant is cooperative, orientated, and tranquil) best fits an optimum sedation level based on the criteria of calm, comfortable, communicative, and cooperative participants.
Time frame: Preoperative (Day 1), Intraoperative (Day 1), and Postoperative (Day 1)
Percentage of Participants Requiring Rescue Sedation Medication
Rescue sedation medication (i.e., intravenous midazolam) at a dose determined by Investigator or anesthesiologist may be given. Use of rescue sedation medication during surgery will be allowed if a participant's RSS score is \< 2.
Time frame: Preoperative (Day 1) and Intraoperative (Day 1)
Percentage of Participants Achieving Preoperative Procedural Sedation Without Need For Rescue Sedation Medication
Participants achieving target sedation level RSS level 2 or 3 by the start of surgery without need for rescue sedation medication.
Time frame: Preoperative (Day 1)
Percentage of Participants Requiring Rescue Sedation Medication Preoperatively
Rescue sedation medication (i.e., intravenous midazolam) at a dose determined by Investigator or anesthesiologist may be given. Use of rescue sedation medication during surgery will be allowed if a participant's RSS score is \< 2.
Time frame: Preoperative (Day 1)
Percentage of Participants Requiring Rescue Sedation Medication Intraoperatively
Rescue sedation medication (i.e., intravenous midazolam) at a dose determined by Investigator or anesthesiologist may be given. Use of rescue sedation medication during surgery will be allowed if a participant's RSS score is \< 2.
Time frame: Intraoperative (Day 1)
Assessment of Sedation Scores in Participants Without Requiring Rescue Sedation Medication
Target sedation level (RSS level 2 or 3) by the start of surgery without need for rescue sedation medication, no requirement for intraoperative sedation medication, and able to complete the surgery (i.e. procedural sedation responder).
Time frame: Preoperative (Day 1), Intraoperative (Day 1), and Postoperative (Day 1)
Percentage of Participants Able to Complete the Surgery
Participants achieving the target sedation level (RSS level 2 or 3) by the start of surgery without need for rescue sedation medication, no requirement for intraoperative sedation medication.
Time frame: Postoperative (Day 1)
Percentage of Participants Able to Complete the Surgery Without Intervention (Other Than Rescue Sedation Medication)
Time frame: Postoperative (Day 1)
Duration to Achieve Preoperative Target Sedation (RSS level 2 or 3)
Measurement of duration (time taken) to achieve target sedation level (RSS level 2 or 3) by the start of surgery.
Time frame: Preoperative (Day 1)
Percentage of Participants Reporting Treatment Emergent Adverse Events (TEAEs)
An adverse event is any untoward medical occurrence in a participant or clinical study participant, temporally associated with the use of study intervention, whether or not considered related to the study intervention.
Time frame: Baseline, Preoperative (Day 1), Intraoperative (Day 1), Postoperative (Day 1), and Day 3 ± 1 post dose of study medication
Percentage of Participants Reporting Adverse Events Special Interest (AESIs)
The prespecified AESI include: 1. AEs representing ketamine emergence delirium (i.e.., hallucinations, unpleasant/bad dreams, vivid imagery, confusional state, excitement, behavior abnormal, agitation), 2. Respiratory AEs (i.e.., respiratory depression, hypoventilation, dyspnea, oxygen desaturation, respiratory arrest, airway obstruction), 3. Cardiovascular AEs (i.e.., hypotension, blood pressure increased, hypertension \[new onset or worsened\], bradycardia/tachycardia, cardiac arrest, cardiac decompensation), 4. Neurocognitive AEs (i.e.., confusional state, amnesia, memory impairment, attention impaired, disorientation, delirium). 5. Abuse-related AEs 6. Oversedation (i.e.. sedation excessive) requiring the use of flumazenil 7. Oral/pharyngeal AEs (i.e.. changes to tongue, oral cavity \[active infection, mucositis, cold sores, canker sores, vesicles, viral lesions, stomatitis, periodontal disease\], and/or oral/pharyngeal function \[hypoesthesia, taste disorders, dysphagia\])
Time frame: Baseline, Preoperative (Day 1), Intraoperative (Day 1), Postoperative (Day 1), and Day 3 ± 1 post dose of study medication
Mean Change from Baseline in Blood Pressure (mmHg)
Time frame: Baseline, Preoperative (Day 1), Intraoperative (Day 1), Postoperative (Day 1), and Day 3 ± 1 post dose of study medication
Mean Change from Baseline in Heart Rate [beats per minute (bpm)]
Time frame: Baseline, Preoperative (Day 1), Intraoperative (Day 1), Postoperative (Day 1), and Day 3 ± 1 post dose of study medication
Mean Change from Baseline in Respiratory Rate (breath per minute)
Time frame: Baseline, Preoperative (Day 1), Intraoperative (Day 1), Postoperative (Day 1), and Day 3 ± 1 post dose of study medication
Mean Change from Baseline in Body Temperature (degrees Fahrenheit)
Time frame: Baseline, Preoperative (Day 1), Intraoperative (Day 1), Postoperative (Day 1), and Day 3 ± 1 post dose of study medication
Mean Change from Baseline in Pulse Oximetry (%)
Time frame: Baseline, Preoperative (Day 1), Intraoperative (Day 1), Postoperative (Day 1), and Day 3 ± 1 post dose of study medication
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.