Clinical Trial Results:
CONTROLLED, DOUBLE-BLIND, RANDOMIZED CLINICAL TRIAL FOR PROPHILAXIS OF POSOPERATIVE DELIRIUM IN HIGH RISK SURGICAL PATIENTS WITH QUETIAPINE.
Summary
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EudraCT number |
2016-004117-27 |
Trial protocol |
ES |
Global end of trial date |
07 Jun 2022
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Results information
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Results version number |
v1(current) |
This version publication date |
01 Nov 2022
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First version publication date |
01 Nov 2022
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Other versions |
Trial Information
Subject Disposition
Baseline Characteristics
End Points
Adverse Events
More Information
Subject Disposition
Baseline Characteristics
End Points
Adverse Events
More Information
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Trial identification
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Sponsor protocol code |
QUEPRO
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Additional study identifiers
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ISRCTN number |
- | ||
US NCT number |
NCT03739476 | ||
WHO universal trial number (UTN) |
- | ||
Sponsors
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Sponsor organisation name |
Fundación IECSCYL-IBSAL.
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Sponsor organisation address |
Paseo de San Vicente, 58-182., Salamanca, Spain, 37007
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Public contact |
Unidad de gestión de ensayos clínicos, IBSAL, 34 923210960, ensayosclinicos@ibsal.es
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Scientific contact |
Unidad investigación clínica y ensayos clínicos, IBSAL, 696022264 923291100 ext 55779, uicec.gestion@ibsal.es
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Paediatric regulatory details
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Is trial part of an agreed paediatric investigation plan (PIP) |
No
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Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial? |
No
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Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial? |
No
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Results analysis stage
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Analysis stage |
Final
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Date of interim/final analysis |
07 Oct 2022
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Is this the analysis of the primary completion data? |
Yes
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Primary completion date |
30 Jun 2020
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Global end of trial reached? |
Yes
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Global end of trial date |
07 Jun 2022
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Was the trial ended prematurely? |
Yes
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General information about the trial
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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.
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Protection of trial subjects |
Adequate information of each patient and efficient monitoring of treatment safety through pharmacovigilance.
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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
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Long term follow-up planned |
No
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Independent data monitoring committee (IDMC) involvement? |
No
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Population of trial subjects
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Number of subjects enrolled per country |
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Country: Number of subjects enrolled |
Spain: 54
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Worldwide total number of subjects |
54
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EEA total number of subjects |
54
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Number of subjects enrolled per age group |
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In utero |
0
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Preterm newborn - gestational age < 37 wk |
0
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Newborns (0-27 days) |
0
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Infants and toddlers (28 days-23 months) |
0
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Children (2-11 years) |
0
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Adolescents (12-17 years) |
0
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Adults (18-64 years) |
0
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From 65 to 84 years |
44
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85 years and over |
10
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Recruitment
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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
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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
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Period 1 title |
overall trial (overall period)
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Is this the baseline period? |
Yes | ||||||||||||||||||
Allocation method |
Randomised - controlled
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Blinding used |
Double blind | ||||||||||||||||||
Roles blinded |
Subject, Investigator, Monitor | ||||||||||||||||||
Arms
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Are arms mutually exclusive |
Yes
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Arm title
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Active group | ||||||||||||||||||
Arm description |
Patients treated with the medicinal product | ||||||||||||||||||
Arm type |
Experimental | ||||||||||||||||||
Investigational medicinal product name |
Quetiapine
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Investigational medicinal product code |
N05AH04
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Other name |
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Pharmaceutical forms |
Capsule
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Routes of administration |
Oral use
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Dosage and administration details |
A capsule with 25mg was administrated twice daily, starting after surgery for three days
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Arm title
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Placebo group | ||||||||||||||||||
Arm description |
Patients treated with the placebo | ||||||||||||||||||
Arm type |
Placebo | ||||||||||||||||||
Investigational medicinal product name |
Placebo
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Investigational medicinal product code |
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Other name |
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Pharmaceutical forms |
Capsule
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Routes of administration |
Oral use
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Dosage and administration details |
A capsule with placebo was administrated twice daily, starting after surgery for three days
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Baseline characteristics reporting groups
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Reporting group title |
overall trial
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Reporting group description |
- | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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End points reporting groups
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Reporting group title |
Active group
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Reporting group description |
Patients treated with the medicinal product | ||
Reporting group title |
Placebo group
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Reporting group description |
Patients treated with the placebo |
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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.
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End point type |
Primary
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End point timeframe |
24h, 48h, 72h, 96h
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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. |
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No statistical analyses for this end point |
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Adverse events information
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Timeframe for reporting adverse events |
28(±2) days since the beginning of treatment
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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.
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Assessment type |
Systematic | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary used for adverse event reporting
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Dictionary name |
MedDRA | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary version |
23
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Reporting groups
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Reporting group title |
Active group
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Reporting group description |
Patients treated with the medicinal product: quetiapine | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reporting group title |
Placebo group
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Reporting group description |
Patients treated with the placebo | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Frequency threshold for reporting non-serious adverse events: 0% | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Substantial protocol amendments (globally) |
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Were there any global substantial amendments to the protocol? Yes | |||||||
Date |
Amendment |
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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.
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Interruptions (globally) |
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Were there any global interruptions to the trial? Yes | |||||||
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Limitations and caveats |
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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. |