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    Clinical Trial Results:
    CONTROLLED, DOUBLE-BLIND, RANDOMIZED CLINICAL TRIAL FOR PROPHILAXIS OF POSOPERATIVE DELIRIUM IN HIGH RISK SURGICAL PATIENTS WITH QUETIAPINE.

    Summary
    EudraCT number
    2016-004117-27
    Trial protocol
    ES  
    Global end of trial date
    07 Jun 2022

    Results information
    Results version number
    v1(current)
    This version publication date
    01 Nov 2022
    First version publication date
    01 Nov 2022
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    QUEPRO
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT03739476
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Fundación IECSCYL-IBSAL.
    Sponsor organisation address
    Paseo de San Vicente, 58-182., Salamanca, Spain, 37007
    Public contact
    Unidad de gestión de ensayos clínicos, IBSAL, 34 923210960, ensayosclinicos@ibsal.es
    Scientific contact
    Unidad investigación clínica y ensayos clínicos, IBSAL, 696022264 923291100 ext 55779, uicec.gestion@ibsal.es
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    07 Oct 2022
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    30 Jun 2020
    Global end of trial reached?
    Yes
    Global end of trial date
    07 Jun 2022
    Was the trial ended prematurely?
    Yes
    General information about the trial
    Main objective of the trial
    To Know the incidence of postoperative delirium in patients at risk, over 65 years, treated early with prophylactic quetiapine versus placebo.
    Protection of trial subjects
    Adequate information of each patient and efficient monitoring of treatment safety through pharmacovigilance.
    Background therapy
    Postoperative delirium is a prevalent condition which worsens the outcomes of elderly patients at surgery. Nowadays there are not specifics treatments for this illness. For decades, antipsychotic medication has been used to control the symptoms.
    Evidence for comparator
    Quetiapine is a second-generation antipsychotic which has been used to control delirious symptoms, but there is not evidence about this use in prophylaxis of the disease.
    Actual start date of recruitment
    13 Mar 2019
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Spain: 54
    Worldwide total number of subjects
    54
    EEA total number of subjects
    54
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    0
    From 65 to 84 years
    44
    85 years and over
    10

    Subject disposition

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    Recruitment
    Recruitment details
    The subjects were recruited if they were greater than or equal to 65 years-old patients who will be undergoing major surgery (noncardiac-with a hospitalization more than three days) and having an equal or greater score of 5 on the scale Delphi. The patient had to be able to understand all the information provided and sing the informed consent.

    Pre-assignment
    Screening details
    With these criteria, 79 patients were evaluated from January 2019 until March 2020 and finally 54 were included in trial. There was a low recruitment rate because the number of patients available were lower than expected

    Period 1
    Period 1 title
    overall trial (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator, Monitor

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Active group
    Arm description
    Patients treated with the medicinal product
    Arm type
    Experimental

    Investigational medicinal product name
    Quetiapine
    Investigational medicinal product code
    N05AH04
    Other name
    Pharmaceutical forms
    Capsule
    Routes of administration
    Oral use
    Dosage and administration details
    A capsule with 25mg was administrated twice daily, starting after surgery for three days

    Arm title
    Placebo group
    Arm description
    Patients treated with the placebo
    Arm type
    Placebo

    Investigational medicinal product name
    Placebo
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Capsule
    Routes of administration
    Oral use
    Dosage and administration details
    A capsule with placebo was administrated twice daily, starting after surgery for three days

    Number of subjects in period 1
    Active group Placebo group
    Started
    31
    23
    Completed
    27
    21
    Not completed
    4
    2
         Consent withdrawn by subject
    3
    1
         Physician decision
    1
    1

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    overall trial
    Reporting group description
    -

    Reporting group values
    overall trial Total
    Number of subjects
    54 54
    Age categorical
    Units: Subjects
        In utero
    0 0
        Preterm newborn infants (gestational age < 37 wks)
    0 0
        Newborns (0-27 days)
    0 0
        Infants and toddlers (28 days-23 months)
    0 0
        Children (2-11 years)
    0 0
        Adolescents (12-17 years)
    0 0
        Adults (18-64 years)
    0 0
        From 65-84 years
    44 44
        85 years and over
    10 10
    Age continuous
    Units: years
        median (inter-quartile range (Q1-Q3))
    81 (75 to 83) -
    Gender categorical
    Units: Subjects
        Female
    14 14
        Male
    40 40

    End points

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    End points reporting groups
    Reporting group title
    Active group
    Reporting group description
    Patients treated with the medicinal product

    Reporting group title
    Placebo group
    Reporting group description
    Patients treated with the placebo

    Primary: Delirium incidence

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    End point title
    Delirium incidence [1]
    End point description
    Number of patients diagnosed with delirium within the first four days after taking medication.
    End point type
    Primary
    End point timeframe
    24h, 48h, 72h, 96h
    Notes
    [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: This trial, despite the huge efforts of the group of researchers had to be ended prematurely. In this situation, statistical analysis is not reliable due to the inability to reach the expected “n”. The number of patients recruited is not sufficient to perform a viable statistical analysis.
    End point values
    Active group Placebo group
    Number of subjects analysed
    31
    23
    Units: patients
        24h-1stvisit
    0
    0
        48h-2ndvisit
    3
    0
        72h-3rdvisit
    3
    1
        96h-4thvisit
    0
    1
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    28(±2) days since the beginning of treatment
    Adverse event reporting additional description
    All the severe adverse events were not related to the drug under study. The elevate age and mayor surgery of the selected cohort for this trial can be related to the number of adverse events detected.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    23
    Reporting groups
    Reporting group title
    Active group
    Reporting group description
    Patients treated with the medicinal product: quetiapine

    Reporting group title
    Placebo group
    Reporting group description
    Patients treated with the placebo

    Serious adverse events
    Active group Placebo group
    Total subjects affected by serious adverse events
         subjects affected / exposed
    3 / 31 (9.68%)
    5 / 23 (21.74%)
         number of deaths (all causes)
    0
    1
         number of deaths resulting from adverse events
    0
    Injury, poisoning and procedural complications
    Intestinal perforation
         subjects affected / exposed
    1 / 31 (3.23%)
    1 / 23 (4.35%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Intra-abdominal abscess
         subjects affected / exposed
    1 / 31 (3.23%)
    0 / 23 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cardiac disorders
    Non ST segment elevation acute coronary syndrome
         subjects affected / exposed
    0 / 31 (0.00%)
    1 / 23 (4.35%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gastrointestinal disorders
    Diarrhea clostridium
         subjects affected / exposed
    0 / 31 (0.00%)
    1 / 23 (4.35%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Wound evisceration
         subjects affected / exposed
    1 / 31 (3.23%)
    0 / 23 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Exacerbation of COPD
         subjects affected / exposed
    0 / 31 (0.00%)
    1 / 23 (4.35%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Seroma
         subjects affected / exposed
    0 / 31 (0.00%)
    1 / 23 (4.35%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Respiratory insufficiency
         subjects affected / exposed
    0 / 31 (0.00%)
    1 / 23 (4.35%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Infections and infestations
    Septic shock
         subjects affected / exposed
    1 / 31 (3.23%)
    1 / 23 (4.35%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    Sepsis secondary
         subjects affected / exposed
    1 / 31 (3.23%)
    0 / 23 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 0%
    Non-serious adverse events
    Active group Placebo group
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    11 / 31 (35.48%)
    5 / 23 (21.74%)
    Surgical and medical procedures
    Post procedural urine leak
         subjects affected / exposed
    1 / 31 (3.23%)
    0 / 23 (0.00%)
         occurrences all number
    1
    0
    Gastrointestinal disorders
    Paralytic ileus
         subjects affected / exposed
    3 / 31 (9.68%)
    0 / 23 (0.00%)
         occurrences all number
    3
    0
    Gastrointestinal bleeding
         subjects affected / exposed
    1 / 31 (3.23%)
    0 / 23 (0.00%)
         occurrences all number
    1
    0
    Postoperative wound complication
         subjects affected / exposed
    2 / 31 (6.45%)
    1 / 23 (4.35%)
         occurrences all number
    2
    1
    Gonarthritis
         subjects affected / exposed
    1 / 31 (3.23%)
    0 / 23 (0.00%)
         occurrences all number
    1
    0
    Diarrhea
         subjects affected / exposed
    1 / 31 (3.23%)
    0 / 23 (0.00%)
         occurrences all number
    1
    0
    Renal and urinary disorders
    Acute urine retention
         subjects affected / exposed
    2 / 31 (6.45%)
    1 / 23 (4.35%)
         occurrences all number
    2
    1
    Anaemia postoperative
         subjects affected / exposed
    3 / 31 (9.68%)
    1 / 23 (4.35%)
         occurrences all number
    3
    1
    Psychiatric disorders
    Agitation mental
         subjects affected / exposed
    1 / 31 (3.23%)
    1 / 23 (4.35%)
         occurrences all number
    1
    1
    Acute delirium
         subjects affected / exposed
    0 / 31 (0.00%)
    1 / 23 (4.35%)
         occurrences all number
    0
    1
    Infections and infestations
    Urinary tract infection
         subjects affected / exposed
    2 / 31 (6.45%)
    0 / 23 (0.00%)
         occurrences all number
    2
    0

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    03 Apr 2019
    To solve the problem of the low rate recruitment, the authors of the Delphi scale were contacted, requesting the complete data of the original work. After careful study, it was concluded that a lower cut-off point could allow an increase in the recruitment rate. After performing the relevant calculations, it was determined that a value of five on the Delphi scale allows to discriminate patients at risk against patients without risk with a sensitivity of 85% (95% CI: 78.49-93.23), a specificity of 80% (95% CI: 76.16-83.75) and an accuracy of 81%, with an area under the calculated curve of 0.83 (95% CI: 0,79-0,87)so it is still excellent, in addition to allowing to considerably increase the chances of recruiting patients within the target population. Therefore the proposed and accepted changes by Agencia Española de Medicamento y Productos Sanitarios ( AEMPS) in the new version of the protocol were: 1) Inclusion criteria: Version 1.7: Patients over or equal to 65 years of age who are undergoing major non-cardiac surgery and who have a score equal to or greater than 7 on the Delphi scale. Version 2.0: Patients over or over 65 years of age who are undergoing major non-cardiac surgery and who have a score equal to or greater than 5 on the Delphi scale. 2) Exclusion criterion: Version 1.7: Patients at risk of developing delirium on admission. Version 2.0: Patients with a score of less than 5 on the Delphi scale -Extension of the total time of the clinical trial based on the extension in the recruitment period of 18 months, until expiration of the medication (June 30, 2020). Medication undergoes a process to guarantee the blind, one of the pillars of the study. It is not possible to generate new medication due to lack of financial funds.

    Interruptions (globally)

    Were there any global interruptions to the trial? Yes
    Date
    Interruption
    Restart date
    30 Jun 2020
    It was impossible to continuate the trial because of the crisis SARS-COV-2 pandemic. This exceptional situation forced to suspend the non-essential scheduled surgical activity and recruitment was stopped. On June 30,2020 medication expired and there was no possible to get more medication (because of lack of economical support and the global pandemic). This trial, despite the huge efforts of the group of researchers had to be ended prematurely. In this situation, statistical analysis is not reliable due to the inability to reach the expected “n”.
    -

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    It was impossible to continuate the trial because of the crisis SARS-COV-2 pandemic. This exceptional situation forced to suspend the non-essential scheduled surgical activity and recruitment was stopped.
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