- ICH GCP
- Registr klinických studií v USA
- Klinická studie NCT02615340
Melatonin for Prevention of Delirium in Critically Ill Patients (MELLOW-1)
Feasibility of Melatonin for Prevention of Delirium in Critically Ill Patients: a Multi-centre, Randomized, Placebo-controlled Study.
Přehled studie
Detailní popis
The available evidence indicates melatonin may decrease the incidence of delirium in non-critically ill patient populations; however, trials in the critically ill are lacking. The investigators hypothesize that melatonin, administered on a scheduled nightly basis during ICU admission, will be efficacious and safe for the prevention of delirium in critically ill adults. The null hypothesis is that there is no difference in delirium incidence between placebo and melatonin. Prior to conducting an adequately powered multi-centre, blinded randomized, placebo-controlled trial in critically ill patients, there is a need for a better understanding of melatonin pharmacokinetics (PK) in critically ill patients. This will help to determine appropriate dosing, drug administration issues (specifically protocol adherence), adverse drug effects, and recruitment rates based on inclusion and exclusion criteria.
The specific aim is to conduct a phase II triple blind, placebo-controlled randomized trial comparing two doses of melatonin (low dose = 0.5 mg and high dose = 2.0 mg) to assess the feasibility of a future full-scale RCT. Feasibility of the larger trial will be based on protocol adherence and participant recruitment rates. Data on PK properties of melatonin will be assessed to determine dosing for future studies of melatonin for delirium prevention in the critically ill.
Typ studie
Zápis (Očekávaný)
Fáze
- Fáze 2
Kontakty a umístění
Studijní kontakt
- Jméno: Lisa Burry, PharmD
- Telefonní číslo: 4820 4165864800
- E-mail: lisa.burry@sinaihealthsystem.ca
Studijní záloha kontaktů
- Jméno: Louise Rose
- Telefonní číslo: 416978-3492
- E-mail: louise.rose@utoronto.ca
Studijní místa
-
-
Ontario
-
Toronto, Ontario, Kanada, M5G1X5
- Nábor
- Mount Sinai Hospital
-
Kontakt:
- Lisa Burry, PharmD
- E-mail: lisa.burry@sinaihealthsystem.ca
-
Vrchní vyšetřovatel:
- Lisa Burry
-
Toronto, Ontario, Kanada
- Nábor
- Sunnybrook Health Sciences Centre
-
Kontakt:
- Damon Scales
- E-mail: damon.scales@sunnybrook.ca
-
Vrchní vyšetřovatel:
- Damon Scales, MD PhD
-
Vrchní vyšetřovatel:
- Louise Rose, PhD
-
-
Quebec
-
Montréal, Quebec, Kanada
- Zatím nenabíráme
- Hopital du Sacre-Coeur
-
Kontakt:
- David Williamson
- E-mail: david.williamson@umontreal.ca
-
Vrchní vyšetřovatel:
- David Williamson, PhD
-
Vrchní vyšetřovatel:
- Francis Bernard, MD
-
-
Kritéria účasti
Kritéria způsobilosti
Věk způsobilý ke studiu
Přijímá zdravé dobrovolníky
Pohlaví způsobilá ke studiu
Popis
Inclusion Criteria:
- Critically ill patients ≥18 years of age
- Anticipated ICU stay of >48 hours
- Able to receive enteral administration of study drug (i.e. by mouth or any feeding tube = naso- or oro- or percutaneous gastric or post-pyloric feeding tube)
- Consent to participate.
Exclusion Criteria:
- ICU admission of >48 hours prior to screening
- Unable to assess for delirium (e.g. comatose defined as SAS 1 or 2 or either 'No Response' Score A or B on ICDSC, chemically paralyzed with neuromuscular blocking drugs)
- Screened delirium positive prior to randomization (ICDSC score ≥4 out of 8)
- Anticipated withdrawal in next 48 hours
- Known history of severe cognitive or neurodegenerative disease (e.g. dementia, Parkinson's disease) or severe structural brain injury (e.g. traumatic brain injury, intracranial hemorrhage) as the ICDSC assessment tool has not been validated in these patient populations
- Unable to communicate in English or French (Montreal site)
- Contraindications to receiving any enteral medication (defined as absolute contraindication to enteral nutrition such as gastrointestinal obstruction, perforation, recent upper GI surgery, no enteral access)
- Active seizures
- Known pregnancy
- Legal blindness
- Known allergy to melatonin
Studijní plán
Jak je studie koncipována?
Detaily designu
- Primární účel: Prevence
- Přidělení: Randomizované
- Intervenční model: Paralelní přiřazení
- Maskování: Čtyřnásobek
Zbraně a zásahy
Skupina účastníků / Arm |
Intervence / Léčba |
---|---|
Aktivní komparátor: Enteral melatonin 0.5 mg
Melatonin 0.5 mg from the 1mg/mL oral suspension qs to 5 mL with Oral Mix SF (sugar-free flavoured suspending vehicle) (final concentration of 0.1 mg/mL; final volume in the oral syringe will be 5 mL)
|
Study drug will be given at 21:00 - 23:59 daily, starting on the day of enrolment until ICU discharge, death, or up to 14 days, as most critically ill patients are at greatest risk of delirium in the first two weeks of admission.
The study medication will be given by mouth (PO or per os) or if needed, via the feeding tube followed by a flush with 20mL water.
Doses can be given up to midnight if administration needs to be delayed for procedures or investigations.
Ostatní jména:
|
Aktivní komparátor: Enteral melatonin 2 mg
Melatonin 2 mg from the 1mg/mL oral suspension qs to 5 mL with Oral Mix SF (sugar-free flavoured suspending vehicle) (final concentration 0.4 mg/mL; final volume in the oral syringe will be 5 mL)
|
Study drug will be given at 21:00 - 23:59 daily, starting on the day of enrolment until ICU discharge, death, or up to 14 days, as most critically ill patients are at greatest risk of delirium in the first two weeks of admission.
The study medication will be given by mouth (PO or per os) or if needed, via the feeding tube followed by a flush with 20mL water.
Doses can be given up to midnight if administration needs to be delayed for procedures or investigations.
Ostatní jména:
|
Komparátor placeba: Enteral matched placebo
Melatonin 0 mg qs to 5 mL with Oral Mix SF (sugar-free flavoured suspending vehicle) (final concentration 0 mg/mL; final volume in the oral syringe will be 5 mL)
|
Study drug will be given at 21:00 - 23:59 daily, starting on the day of enrolment until ICU discharge, death, or up to 14 days, as most critically ill patients are at greatest risk of delirium in the first two weeks of admission.
The study medication will be given by mouth (PO or per os) or if needed, via the feeding tube followed by a flush with 20mL water.
Doses can be given up to midnight if administration needs to be delayed for procedures or investigations.
|
Co je měření studie?
Primární výstupní opatření
Měření výsledku |
Popis opatření |
Časové okno |
---|---|---|
Feasibility: Study adherence
Časové okno: 1 year
|
Investigators will calculate protocol adherence as the overall proportion of administered doses in the prescribed dose administration window (between 21:00 and to 23:59 hours) divided by total number of eligible study days.
|
1 year
|
Sekundární výstupní opatření
Měření výsledku |
Popis opatření |
Časové okno |
---|---|---|
Feasibility: Trial recruitment
Časové okno: 1 year
|
Proportion of ICU patients screened that meet study inclusion criteria, the number of patients excluded and reasons for exclusion, and the consent rate of eligible participants.
|
1 year
|
Feasibility: Time in motion (minutes)
Časové okno: 1 year
|
Research coordinators at each site will capture the amount of time (minutes) taken to screen, consent, and enrol patients, complete study procedures, and collect data.
|
1 year
|
Pharmacokinetic: Peak melatonin concentration (Cmax)
Časové okno: 24 hours
|
Peak melatonin concentration. Plasma melatonin concentrations measured by mass spectrometry. N=5 from each study arm of Mount Sinai Hospital site. On study day 1, eight blood samples (4 mL each) will be collected at the following intervals, from the time of first study drug dose to the following morning (time 0, 0.5, 1, 2, 4, 6, 8, 12 hours). |
24 hours
|
Pharmacokinetic: Time of peak melatonin concentration (Tmax)
Časové okno: 24 hours
|
Time of peak melatonin concentration (Tmax). Plasma melatonin concentrations measured by mass spectrometry. N=5 from each study arm of Mount Sinai Hospital site. On study day 1, eight blood samples (4 mL each) will be collected at the following intervals, from the time of first study drug dose to the following morning (time 0, 0.5, 1, 2, 4, 6, 8, 12 hours). |
24 hours
|
Pharmacokinetic: Morning melatonin concentration (C9AM)
Časové okno: 24 hours
|
Morning melatonin concentration (C9AM). Plasma melatonin concentrations measured by mass spectrometry. N=5 from each study arm of Mount Sinai Hospital site. On study day 1, eight blood samples (4 mL each) will be collected at the following intervals, from the time of first study drug dose to the following morning (time 0, 0.5, 1, 2, 4, 6, 8, 12 hours). |
24 hours
|
Pharmacokinetic: Melatonin half-life (T½)
Časové okno: 24 hours
|
Melatonin half-life (T½). Plasma melatonin concentrations measured by mass spectrometry. N=5 from each study arm of Mount Sinai Hospital site. On study day 1, eight blood samples (4 mL each) will be collected at the following intervals, from the time of first study drug dose to the following morning (time 0, 0.5, 1, 2, 4, 6, 8, 12 hours). |
24 hours
|
Pharmacokinetic: Mean apparent clearance (CL/F)
Časové okno: 24 hours
|
Mean apparent clearance (CL/F). Plasma melatonin concentrations measured by mass spectrometry. N=5 from each study arm of Mount Sinai Hospital site. On study day 1, eight blood samples (4 mL each) will be collected at the following intervals, from the time of first study drug dose to the following morning (time 0, 0.5, 1, 2, 4, 6, 8, 12 hours). |
24 hours
|
Pharmacokinetic: Mean apparent volume distribution (V/F)
Časové okno: 24 hours
|
Mean apparent volume distribution (V/F). Plasma melatonin concentrations measured by mass spectrometry. N=5 from each study arm of Mount Sinai Hospital site. On study day 1, eight blood samples (4 mL each) will be collected at the following intervals, from the time of first study drug dose to the following morning (time 0, 0.5, 1, 2, 4, 6, 8, 12 hours). |
24 hours
|
Pharmacokinetic: Area under the concentration-time curve (AUC)
Časové okno: 24 hours
|
Area under the concentration-time curve (AUC). Plasma melatonin concentrations measured by mass spectrometry. N=5 from each study arm of Mount Sinai Hospital site. On study day 1, eight blood samples (4 mL each) will be collected at the following intervals, from the time of first study drug dose to the following morning (time 0, 0.5, 1, 2, 4, 6, 8, 12 hours). |
24 hours
|
Clinical: Adverse events
Časové okno: 14 days
|
Adverse events reported by the participant, family, or treating team.
The following potential adverse effects will be collected: morning drowsiness (Sedation Agitation Scale (SAS) score <3 or patient's self report of drowsiness between 07:00h and 12:00h), headache, and vivid dreams.
|
14 days
|
Clinical: Delirium incidence
Časové okno: 14 days
|
Intensive Care Delirium Screening Checklist (ICDSC) administered daily.
Delirium defined as an ICDSC score ≥4.
|
14 days
|
Clinical: Delirium time to onset and duration (days)
Časové okno: 14 days
|
Time to onset of first ICDSC score ≥4, and number of days with ICDSC score ≥4.
|
14 days
|
Clinical: Sleep
Časové okno: 14 days
|
Richards Campbell Sleep Questionnaire (RCSQ) administered daily, where possible.
Patients with or without the assistance of their nurse will be asked to complete the questions of the RCSQ each morning.
Nurses will not complete the RCSQ if the patient is unable to verbalize, as poor correlation has been shown between patient and nursing scores.
|
14 days
|
Clinical: Duration of mechanical ventilation
Časové okno: ICU admission
|
Duration of mechanical ventilation (days)
|
ICU admission
|
Clinical: ICU length of stay
Časové okno: ICU admission
|
Duration of stay for index ICU admission (days)
|
ICU admission
|
Clinical: Hospital length of stay
Časové okno: 1 year
|
Duration of stay for admission involving trial enrolment (days)
|
1 year
|
Clinical: ICU mortality
Časové okno: 1 year
|
Number of deaths during index ICU admission
|
1 year
|
Clinical: Hospital mortality
Časové okno: 1 year
|
Number of deaths during hospital admission
|
1 year
|
Spolupracovníci a vyšetřovatelé
Sponzor
Vyšetřovatelé
- Vrchní vyšetřovatel: Lisa Burry, PharmD, Mount Sinai Hospital
Publikace a užitečné odkazy
Termíny studijních záznamů
Hlavní termíny studia
Začátek studia (Aktuální)
Primární dokončení (Očekávaný)
Dokončení studie (Očekávaný)
Termíny zápisu do studia
První předloženo
První předloženo, které splnilo kritéria kontroly kvality
První zveřejněno (Odhad)
Aktualizace studijních záznamů
Poslední zveřejněná aktualizace (Aktuální)
Odeslaná poslední aktualizace, která splnila kritéria kontroly kvality
Naposledy ověřeno
Více informací
Termíny související s touto studií
Klíčová slova
Další relevantní podmínky MeSH
Další identifikační čísla studie
- 4000145150
Informace o lécích a zařízeních, studijní dokumenty
Studuje lékový produkt regulovaný americkým FDA
Studuje produkt zařízení regulovaný americkým úřadem FDA
Tyto informace byly beze změn načteny přímo z webu clinicaltrials.gov. Máte-li jakékoli požadavky na změnu, odstranění nebo aktualizaci podrobností studie, kontaktujte prosím register@clinicaltrials.gov. Jakmile bude změna implementována na clinicaltrials.gov, bude automaticky aktualizována i na našem webu .
Klinické studie na Delirium
-
Efficacy Care R&D LtdHadassah Medical OrganizationNeznámýDelirium | Delirium, příčina neznámá | Delirium smíšeného původu | Delirium Zmatený stav | Delirium vyvolané lékyIzrael
-
Oslo University HospitalUniversity of Melbourne; Norwegian Academy of MusicDokončenoDelirium ve stáří | Delirium smíšeného původu | Delirium superponované na demenci | Delirium Zmatený stavNorsko
-
Universidad de SantanderNeznámýDelirium smíšeného původu | Hypoaktivní delirium | Hyperaktivní deliriumKolumbie
-
Chinese PLA General HospitalBeijing Tiantan HospitalNábor
-
Charite University, Berlin, GermanyBARMERNáborDelirium ve stáříNěmecko
-
Johns Hopkins UniversityNational Institute on Aging (NIA)Aktivní, ne náborDelirium | Delirium při vynoření | Ztráta sluchu | Ztráta sluchu, vysoká frekvence | Ztráta sluchu, senzorineurální | Delirium, příčina neznámá | Ztráta sluchu, oboustranná | Sluchové postižení | Delirium ve stáří | Delirium smíšeného původu | Delirium superponované na demenci | Delirium Zmatený stav | Delirium s demencí a další podmínkySpojené státy
-
Qin ZhangNational Natural Science Foundation of ChinaNábor
-
Qin ZhangNational Natural Science Foundation of ChinaNábor
-
University Hospital, Basel, SwitzerlandInnosuisse - Swiss Innovation AgencyNáborPooperační delirium (POD)Švýcarsko
-
Indiana UniversityNational Institute on Aging (NIA)Zatím nenabíráme