Clinical trial NCT01378988: Phase II Pharmacokinetic and Pharmacodynamic Study of DEX in Subjects Aged 12 Months Through <24 Months
Official title: A Phase II, Randomized, Open-Label, Single Center, Pharmacokinetic and Pharmacodynamic Study of Dexmedetomidine in Pediatric Subjects Aged 12 Months Through <24 Months
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE2
Conditions: Sedation
Pain
Lead sponsor: Hospira, now a wholly owned subsidiary of Pfizer
Sponsor class: INDUSTRY
First posted: 2011-06-23
Enrollment: 5
Sex: ALL
Minimum age (years): 12
Maximum age (years): 23
Standard ages: CHILD
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: The purpose of this study is to investigate the pharmacokinetic, pharmacodynamic, and safety of dexmedetomidine at 2 different dose levels in pediatric subjects, aged 12 months through \<24 months, administered as an intravenous loading dose followed by continuous infusion for a minimum of 6 hours and up to 24 hours in an intensive care setting.

Detailed description: Phase II, randomized, open-label, single-center, study evaluating the pharmacokinetics and pharmacodynamics of dexmedetomidine in pediatric subjects across two dose levels (Dose Level 1 consists of a 0.7 mcg/kg loading dose immediately followed by a 0.5 mcg/kg/hr maintenance infusion; Dose Level 2 consists of a 1.0 mcg/kg loading dose immediately followed by a 0.75 mcg/kg/hr maintenance infusion). The study population will consist of intubated and mechanically ventilated pediatric subjects who require sedation in an intensive care setting for a minimum of 6 hours but not to exceed 24 hours. Subjects eligible for enrollment are 12 months to \<24 months of age.

Eligibility criteria: Inclusion Criteria:

1. Subject is 12 months to \<24 months of age at screening.
2. Subject is intubated and mechanically ventilated in an intensive care setting and is anticipated to require a minimum of 6 hours of continuous IV sedation.
3. Subject has adequate renal function, defined as: Serum creatinine ≤1.0 mg/dL.
4. The subject's parent(s) or legal guardian(s) must voluntarily sign and date the informed consent document approved by the Institutional Review Board.

Exclusion Criteria:

1. Pediatric subjects with neurological conditions that prohibit an evaluation of sedation such as:

   * Diminished consciousness from increased intracranial pressure
   * Extensive brain surgery (surgery requiring intracranial pressure monitor)
   * Diminished cognitive function per Principal Investigator (PI) discretion
   * Subjects with immobility from neuromuscular disease or continuous infusion of neuromuscular blocking agents.
2. Subjects with second degree or third degree heart block unless subject has a permanent pacemaker or pacing wires are in situ.
3. Subjects who have hepatic impairment as defined by a serum glutamic-pyruvic transaminase/alanine aminotransferase (SGPT/ALT) \>90 U/L at the time of screening.
4. Subjects who have hypotension, based on repeat assessments within 15 minutes preceding the start of study drug, defined as: Systolic blood pressure (SBP) \<70 mmHg.
5. Pre-existing bradycardia based on repeated assessments within 15 minutes preceding the start of study drug, defined as: Heart rate (HR) \<70 bpm.
6. Subject who have acute thermal burns involving more than 15 percent total body surface area.
7. Subjects who have a known allergy to dexmedetomidine, midazolam or fentanyl.
8. Subject who has received dexmedetomidine within 15 hours prior to the start of study drug.
9. Subjects with a life expectancy that is \<72 hours.
10. Subjects that are expected to have hemodialysis (continuous hemofiltration), peritoneal dialysis or extracorporeal membrane oxygenation (ECMO) treatments within 48 hours prior to the start of study drug or during the duration of the study.
11. Subjects who have been treated with α-2 agonists/antagonists within 2 weeks.
12. Subjects with a spinal cord injury above T5 (5th Thoracic Vertebra).
13. Subjects who have received another investigational drug as part of an investigational drug study within the past 30 days.
14. Subjects who, in the opinion of the investigator, may not be able to comply with the safety monitoring requirements of this clinical study.

Primary outcomes:
measure: Area Under the Plasma Concentration-time Curve (AUC0-∞)
timeFrame: 30 minutes prior to loading dose (LD); 5 minutes before finishing LD; 0.5, 1, 2 and 4-6 hours during maintenance infusion (MI); 30 minutes prior (within 24 hours of start of MI) and 10 minutes, 0.5, 1, 2, 4 and 10 hours end of MI
measure: Observed Peak Plasma Concentration (Cmax)
timeFrame: 30 minutes prior to loading dose (LD); 5 minutes before finishing LD; 0.5, 1, 2 and 4-6 hours during maintenance infusion (MI); 30 minutes prior (within 24 hours of start of MI) and 10 minutes, 0.5, 1, 2, 4 and 10 hours end of MI
measure: Steady State Concentration (Css)
timeFrame: 30 minutes prior to loading dose (LD); 5 minutes before finishing LD; 0.5, 1, 2 and 4-6 hours during maintenance infusion (MI); 30 minutes prior (within 24 hours of start of MI) and 10 minutes, 0.5, 1, 2, 4 and 10 hours end of MI
measure: Terminal Elimination Half-life (t1/2)
timeFrame: 30 minutes prior to loading dose (LD); 5 minutes before finishing LD; 0.5, 1, 2 and 4-6 hours during maintenance infusion (MI); 30 minutes prior (within 24 hours of start of MI) and 10 minutes, 0.5, 1, 2, 4 and 10 hours end of MI
measure: Time to Reach Maximum Plasma Concentration (Tmax)
timeFrame: 30 minutes prior to loading dose (LD); 5 minutes before finishing LD; 0.5, 1, 2 and 4-6 hours during maintenance infusion (MI); 30 minutes prior (within 24 hours of start of MI) and 10 minutes, 0.5, 1, 2, 4 and 10 hours end of MI
measure: Weight-Adjusted Plasma Clearance (CLw)
timeFrame: 30 minutes prior to loading dose (LD); 5 minutes before finishing LD; 0.5, 1, 2 and 4-6 hours during maintenance infusion (MI); 30 minutes prior (within 24 hours of start of MI) and 10 minutes, 0.5, 1, 2, 4 and 10 hours end of MI
measure: Plasma Clearance (CL)
timeFrame: 30 minutes prior to loading dose (LD); 5 minutes before finishing LD; 0.5, 1, 2 and 4-6 hours during maintenance infusion (MI); 30 minutes prior (within 24 hours of start of MI) and 10 minutes, 0.5, 1, 2, 4 and 10 hours end of MI
measure: Volume of Distribution (Vd)
timeFrame: 30 minutes prior to loading dose (LD); 5 minutes before finishing LD; 0.5, 1, 2 and 4-6 hours during maintenance infusion (MI); 30 minutes prior (within 24 hours of start of MI) and 10 minutes, 0.5, 1, 2, 4 and 10 hours end of MI
measure: Weight-Adjusted Volume of Distribution (Vdw)
timeFrame: 30 minutes prior to loading dose (LD); 5 minutes before finishing LD; 0.5, 1, 2 and 4-6 hours during maintenance infusion (MI); 30 minutes prior (within 24 hours of start of MI) and 10 minutes, 0.5, 1, 2, 4 and 10 hours end of MI
measure: Average Total Faces, Legs, Activity, Cry, and Consolability (FLACC) Score
timeFrame: Prior to loading dose and every hour during the maintenance infusion; within 5 minutes after any fentanyl administration during DEX infusion or every 4 hours in case of continuous fentanyl infusion; within 5 minutes prior and after titration of fentanyl
measure: Absolute Time That Subject is in UMSS Range 2-4 During Treatment Period
timeFrame: During the treatment (6 to 24 hours)
measure: Number of Subjects Who Received Rescue Medication for Sedation and Analgesic
timeFrame: During the treatment (6 to 24 hours)
Secondary outcomes:
Other outcomes:
Locations:
city: Pittsburgh
country: United States
facility: Children's Hospital of Pittusburgh of UPMC
state: Pennsylvania
Study officials:
affiliation: Children's Hospital of Pittusburgh of UPMC
name: Constantinos Chrysostomou, MD
role: PRINCIPAL_INVESTIGATOR
References: