Study of AQUAVAN® Injection (AQUAVAN; Fospropofol Disodium) for Sedation During Colonoscopy

Condition(s) targeted: Colonoscopy; Colonic Polyps

Intervention: AQUAVAN® (fospropofol disodium) Injection (Drug); Midazolam HCl (Drug)

Phase: Phase 2/Phase 3

Status: Active, not recruiting

Sponsored by: Guilford Pharmaceuticals

Official(s) and/or principal investigator(s):
James Jones, PharmD, MD, Study Director, Affiliation: Guilford Pharmaceuticals

Very often, patients receive sedative medication before a diagnostic, therapeutic, or surgical procedure to help them relax, keep them calm, and to relieve them from pain. This is called procedural sedation. During procedural (mild to moderate) sedation, a patient is first given a pain-relief medication (analgesic) and then a medication to help him/her relax and keep him/her calm (sedative). Propofol is the drug commonly used for sedation because it releases immediately into the blood stream and causes fast sedation. AQUAVAN (fospropofol disodium) is made as a slow release version of propofol, allowing for fast sedation and possibly faster recovery and discharge. This study is intended to compare several different doses of AQUAVAN in patients having a colonoscopy in order to find the right dose that will get patients to a level of mild to moderate (procedural) sedation.

Official title: A Randomized, Double-Blind, Dose-Response Study to Assess the Efficacy and Safety of AQUAVAN® Injection for Procedural Sedation in Patients Undergoing Colonoscopy

Study design: Treatment, Randomized, Double-Blind, Active Control, Parallel Assignment, Safety/Efficacy Study

Primary outcome: Three consecutive MOAA/S scores ≤4 after administration of sedative medication AND completing the procedure without requiring the use of alternative sedative medication AND without requiring manual or mechanical ventilation

Secondary outcome:

Patient's rating of experience after ready for discharge

Principal Investigator's (PI’s) rating at end of procedure

Percentage of patients requiring alternative sedative medication

Number of doses/amount of fentanyl administered

Number of doses of study medication administered

Time to sedation, digital rectal examination, start of procedure, reach splenic flexure, hepatic flexure, cecum, end of procedure, and ready for discharge

Percentage of patients requiring repositioning

Percentage of patients whose procedures are interrupted due to inadequate sedation

Time to ready for discharge from end of procedure

Change from baseline DSST score over time during recovery period

Patient's rating at 24 hour post discharge telephone survey

Duration and percent of time when a patient's MOAA/S score is at each level between the first dose of study medications and fully alert and during the procedure

PI’s rating of level of sedation prior to initiation of the procedure

Percentage of patients with a mean MOAA/S of 2 to 4 and 0 to 1 during the procedure

MOAA/S over time

Detailed description: This is a randomized, double-blind study designed to evaluate the dose-response in the sedation success rate for 4 different initial bolus doses of AQUAVAN following pretreatment with an analgesic, fentanyl, in patients undergoing a colonoscopy. A group of patients will receive midazolam as a reference therapy. Following completion of pre-procedure assessments, patients will be randomly assigned to 1 of 5 IV treatment groups at an equal allocation ratio (25 patients per arm) on the day of the scheduled procedure. Randomization will be stratified by age and ASA status: AQUAVAN initial bolus dose 1: 8 mg/kg AQUAVAN initial bolus dose 2: 6. 5 mg/kg AQUAVAN initial bolus dose 3: 5 mg/kg AQUAVAN initial bolus dose 4: 2 mg/kg Midazolam initial bolus dose: 0. 02 mg/kg A person skilled in airway management and authorized by the facility in which the colonoscopy is performed (such as a respiratory therapist, a study nurse, or a clinician) must be immediately available during the conduct of the study. All patients will be placed on supplemental oxygen via nasal cannula (4 L/min), and a 12-lead electrocardiogram (ECG), pulse oximeter, and blood pressure monitor prior to administration of study medication. All patients will receive an injection of analgesic pretreatment followed by the administration of sedative medication, as described below. This protocol recognizes 2 distinct phases of sedation: Sedation Initiation and Sedation Maintenance. Assessments will be made to evaluate the patients for levels of sedation, clinical benefit, and adverse events as detailed in the protocol. Blood samples will be collected for pharmacokinetic (PK) analysis, also detailed in the protocol.

Minimum age: 18 Years. Maximum age: N/A. Gender(s): Both.

Criteria:

Number of Patients/Site: Approximately 125 patients, 25 per arm, at up to 25 sites will be randomized into this study. Study Country Location: United States Study Population: Male and female patients aged 18 years and older and undergoing elective colonoscopy will be enrolled in the study. Inclusion Criteria: Patient provides signed/dated informed consent and Health Insurance Portability and Accountability Act of 1996 (HIPAA) authorization after receiving a full explanation of the extent and nature of the study Patient must be at least 18 years of age at the time of screening If female, patient must be surgically sterile, postmenopausal, or not pregnant or lactating and has been using an acceptable method of birth control for at least 1 month prior to dosing, with a negative urine pregnancy test result at screening and pre-dose Patient meets American Society of Anesthesiologists (ASA) Physical Classification System status of P1 to P4 Exclusion Criteria: Patient has a history of allergic reaction or hypersensitivity to any anesthetic agent, narcotic, or benzodiazepine Patient does not meet nils per os (NPO) status per ASA guidelines or institution’s guidelines Patient has a Mallampati classification score of 4; OR a Mallampati classification score of 3 AND a thyromental distance <= 4 cm, or for any other reason has a difficult airway, in the opinion of the Investigator Patient has an abnormal, clinically significant 12-lead ECG finding at predosing period Day 0 Patient has participated in an investigational drug study within 1 month prior to study start Patient is unwilling to adhere to pre- and post-procedural instructions Patient for whom the use of fentanyl is contraindicated Patient for whom the use of Midazolam HCl injection (Midazolam) is contraindicated

Clinical Research Associates, Huntsville, Alabama 35801, United States

Arizona Research Center, Phoenix, Arizona 85023, United States

Atlanta Gastroenterology Associates, Atlanta, Georgia 30342, United States

Rockford Gastroenterology Associates Ltd., Rockford, Illinois 61107, United States

Welborn Clinic, Evansville, Indiana 47713, United States

Gastroenterology Clinic, Monroe, Louisiana 71201, United States

Gulf Coast Research Associates, Inc., Baton Rouge, Louisiana 70808, United States

Chevy Chase Clinical Research, Chevy Chase, Maryland 20815, United States

Endoscopic Microsurgery Associates, PA, Towson, Maryland 21204, United States

Gastrointestinal Associates, PA, Jackson, Mississippi 39202, United States

Research Associates of New York, New York, New York 10021, United States

Winthrop-University Hospital, Mineola, New York 11501, United States

Asheville Gastroenterology Associates/The Endoscopy Center, Asheville, North Carolina 28801, United States

Oklahoma Gastroenterology Associates, Tulsa, Oklahoma 74104, United States

St. Thomas Medical Group, P.C., Nashville, Tennessee 37205, United States

Gastrointestinal Institute, Nashville, Tennessee 37203, United States

Memphis Gastroenterology Group, PC, Memphis, Tennessee 38120, United States

Alamo Research Center, San Antonio, Texas 78215, United States

Spokane Digestive Diseases Center, Spokane, Washington 99207, United States

Wisconsin Center for Advance Research, Milwaukee, Wisconsin 53215, United States

Starting date: July 2005
Ending date: September 2005
Last updated: March 9, 2006