Safety and Efficacy of HSK3486 Compared to Propofol for Induction of General Anesthesia in Adults With Elective Surgery

General Anesthesia Clinical Trial

Official title:

A Global Multicenter, Randomized, Double-blinded, Propofol-controlled, Phase 3 Clinical Study to Evaluate the Efficacy and Safety of HSK3486 Injectable Emulsion for Induction of General Anesthesia in Adults Undergoing Elective Surgery

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT05486416
• Other study ID #: HSK3486-309
• Status: Recruiting
• Phase: Phase 3
• Start date: January 12, 2024
• Est. completion date: July 31, 2024

Study information

• Verified date: May 2024
• Source: Haisco-USA Pharmaceuticals, Inc.
• Contact: Yu-Ling Lai
• Phone: 732-266-4759
• Email: yuling.lai[@]haisco-usa.com
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

To demonstrate HSK3486 0.4/0.2 mg/kg (0.4 mg/kg intravenous [IV] slow injection over 30 [±5] seconds for the first dose, an additional 0.2 mg/kg if needed) is non-inferior to Propofol 2.0/1.0 mg/kg (2.0 mg/kg IV slow injection over 30 [±5] seconds for first dose, an additional 1.0 mg/kg if needed) in success of induction of general anesthesia in adults undergoing elective surgery.

Description:

This is a global multicenter, randomized, double-blinded, propofol-controlled, phase 3 clinical study to evaluate the efficacy and safety of HSK3486 for induction of general anesthesia in adults undergoing elective surgery with endotracheal intubation.

After screening, eligible subjects will be randomized in a 2:1 ratio to receive either HSK3486 0.4/0.2 mg/kg (i.e., 0.4 mg/kg IV slow injection over 30 [±5] seconds followed by an additional 0.2 mg/kg dose over 10 [±2] seconds if needed) or propofol 2.0/1.0 mg/kg (i.e., 2.0 mg/kg IV slow injection over 30 [±5] seconds followed by an additional 1.0 mg/kg dose over 10 [±2]seconds if needed) in a blinded manner. Enrolled subjects will be stratified by American Society of Anesthesiologists Physical Status (ASA-PS; I-II and III-IV), age (<65 and ≥65 years), and Body Mass Index (BMI <35 and ≥35 kg/m2). Endotracheal intubation will be performed after adequate anesthetic induction (Modified Observer's Assessment of Awareness/Sedation [MOAA/S] ≤1) (Appendix 1) has been achieved and administration of neuromuscular blocking agent.

Before surgery, premedication is allowed except for sedative-hypnotic or analgesic drugs. Premedication should be recorded if used.

Prior to administration of the study drug in the operating room, the preoperative readiness of each subject will be confirmed. Oxygen will be supplied through a facemask (oxygen flow rate: ≥4 L/min) at least 2 minutes before study drug administration. Subsequently, the investigator can adjust the oxygen flow according to the specific situation of the subject and maintenance IV solution (normal saline [NS], lactated ringer's [LR], or 5% dextrose) will be administrated through IV infusion. Throughout the pre-induction and induction periods, a timing device must be used to allow accuracy and sequencing of necessary assessments.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 399
• Est. completion date: July 31, 2024
• Est. primary completion date: July 31, 2024
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 18 Years to 99 Years

Eligibility

Inclusion Criteria:

• Subjects must satisfy all of the following criteria at the screening visit:

1. Subjects undergoing elective surgery (non-emergency, non-cardiothoracic, and non-intracranial surgery anticipated to last at least 1 hour) requiring endotracheal intubation and inhalation general anesthesia during the maintenance period. Duration of surgery is defined as time from study drug administration to time of transfer from operating room to recovery room or PACU.

2. Males or females, aged =18 years old, with ASA PS I to IV (Appendix 6). For ASA-PS IV subjects, clinical status must be optimized at time of preoperative anesthesia evaluation per judgement of the anesthesiologist.

3. BMI =18 kg/m2.

4. Vital signs at screening: RR =10 and =24 breaths/min; SpO2 =92% in ambient air; SBP =90 and =160 mmHg; DBP =55 and = 100 mmHg; HR =55 (or =50 if subjects are on beta blockers) and =100 beats/min.

5. For all women of childbearing potential, negative serum pregnancy test within the screening period and negative urine pregnancy test at baseline (Day 1). Additionally, women of childbearing potential* and male subjects with female partners of childbearing potential must agree to use contraception as defined in 7.3.4 from the time of consent until 30 days post study drug administration.

6. For subjects with known hypothyroidism and/or on thyroid-hormone replacement treatment (i.e., thyroxine), or subjects suspected to have thyroid dysfunction based on clinical laboratory and physical exam, a TSH must drawn and be within normal levels.

7. Capable of understanding the procedures and methods of this study, willing to sign an Informed Consent Form (ICF), and able to complete this study in strict compliance with the study protocol.

8. Willing to comply with the site's COVID guidelines and testing requirements as applicable.

9. Patients with psychiatric/mental disorders must be considered stable on treatment (e.g., SSRIs, SNRIs, TCAs, MAOIs, psychotherapy) per investigator judgement, and no hospitalizations and urgent care due to the underlying psychiatric pathology for at least 12 months.

• Women are considered of childbearing potential until becoming post-menopausal, unless she had a documented hysterectomy or bilateral oophorectomy / salpingo-oophorectomy. A woman is considered to be post-menopausal if she had no menses for at least 12 consecutive months (without an alternative medical cause).

Exclusion Criteria:

1. Contraindications to deep sedation/general anesthesia or a history of adverse reaction to sedation/general anesthesia.

2. Known to be allergic to eggs, soy products, opioids and their antidotes, or propofol; subjects having contraindications to propofol, opioids, and their antidotes. In cases where the only previous reaction to opioids was itching or nausea, subjects need not be excluded if the investigator believes the subject is not truly allergic to opioids.

3. Medical condition or evidence of increased sedation/general anesthesia risk as follows:

1. Cardiovascular disorder: uncontrolled hypertension (SBP >160 mmHg and/or DBP >100 mmHg) with or without antihypertensive therapy (antihypertensive therapy should be stable for 1 month prior to screening), serious arrhythmia (including the subjects with implanted pace makers), unstable heart failure, Adams-Stokes syndrome (i.e., syncope or near-syncope due to cardiac arrythmia), unstable angina, myocardial infarction occurring within 6 months prior to screening, history of tachycardia/bradycardia requiring medications, third degree atrioventricular block or QT interval corrected for HR using Fridericia's formula (QTcF) =450 ms for males and =470 ms for females.

2. History of severe obstructive lung disease (i.e., forced expiratory volume in 1 second [FEV1] <50% predicted), history of bronchospasm requiring treatment in a hospital emergency room or hospitalization occurring within 3 months prior to screening, developing acute respiratory tract infection within 2 weeks prior to baseline (such as symptoms of fever, shortness of breath, wheezing, nasal congestion, and cough).

3. Cerebrovascular disease: subject with a history of serious craniocerebral injury, convulsion, seizure disorder, intracranial hypertension, cerebral aneurysm, or stroke.

4. Patients with psychiatric/mental disorders who have not been on a stable treatment regimen (e.g., SSRIs, SNRIs, TCAs, MAOIs, psychotherapy) per investigator judgement, for at least 12 months or who have been hospitalized or had emergent/urgent care due to the underlying psychiatric pathology within the last 12 months.

5. Uncontrolled clinically significant conditions of liver (e.g., severe hepatic insufficiency defined as Childs-Pugh class C), kidney, gastrointestinal tract, blood system, nervous system, or metabolic system diseases, judged by the investigator to be unsuitable for involvement in the study.

6. History of uncontrolled diabetes in the opinion of the investigator.

7. History of alcohol abuse within 3 months prior to screening, where alcohol abuse refers to daily alcohol drinking >2 units of alcohol (1 unit = 360 mL of beer or 45 mL of spirit with a strength of 40% or 150 mL of wine).

8. History of drug abuse that, in the opinion of the investigator, may confound the interpretation of safety or efficacy in a study subject.

9. For subjects with known hypothyroidism and/or on thyroid-hormone replacement treatment (i.e., thyroxine), or subjects suspected to have thyroid dysfunction based on clinical laboratory and physical exam who has a TSH value outside the normal range.

4. Management risks of respiratory tract and judged by the investigator to be unsuitable for inclusion in the study as follows:

1. Asthma must be stable: stable doses of asthma medications for the past 6 months, no requirement for rescue inhalers or oral steroids within past 6 months, not evaluated in emergency department, urgent care, or hospitalized for an asthma attack within past 1 year.

2. History (or family history) of malignant hyperthermia.

3. Any previous failure of tracheal intubation.

4. Judged to have a difficult airway for endotracheal intubation in the opinion of the Investigator based on parameters such as modified Mallampati score (Grade III or IV [Appendix 7]), neck mobility, short thyromental distance, and/or history of difficult intubation).

5. Any medication that has the potential to interact synergistically with propofol or HSK3486, including but not limited to all sedatives and hypnotics (e.g., benzodiazepines and opioids), taken within 5 half-lives prior to Day 1.

6. Laboratory parameters measured at screening with the following levels:

1. Neutrophil count =1.5 x 109/L

2. Platelet count <80 x 109/L

3. Hemoglobin <90 g/L (without blood transfusion within 14 days)

4. Alanine transaminase and/or aspartate transaminase =2.0 x upper limit of normal (ULN)

5. Total bilirubin =2.0 x ULN

6. Severe renal impairment defined by creatinine clearance (CrCl) =30 mL/min

7. Female subjects with a positive pregnancy test at screening (serum) or baseline (urine); lactating subjects; any subject planning to get pregnant within 1 month after the study (including the male subject's partner).

8. Judged by the investigator to have any other factors that make the subject unsuitable for participation in the study.

Related Conditions & MeSH terms

• General Anesthesia

Intervention

Drug:
• HSK3486
HSK3486 for induction of general anesthesia
• Propofol
Propofol for induction of general anesthesia

Locations

Country	Name	City	State
Poland	Uniwersytecki Szpital Kliniczny W Opolu	Opole
Poland	Samodzielny Publiczny Szpital Kliniczny Nr 1 im. prof. Tadeusza Sokolowskiego Pomorskiego Uniwersytetu Medycznego w Szczecinie	Szczecin
Poland	Panstwowy Instytut Medyczny Mswia - Klinika Anestezjologii I Intensywnej Terapii	Warsaw
Poland	Spsk Nr 1 Im. Prof. S. Szyszko	Zabrze
Spain	Hospital Clinic De Barcelona	Barcelona
Spain	Hospital General Universitario De Ciudad Real	Ciudad Real
Spain	Universidad de Navarra - Clinica Universidad de Navarra en Pamplona	Pamplona
Spain	Hospital Clinico Universitario de Valencia (CHUV)	Valencia
United States	University of Michigan	Ann Arbor	Michigan
United States	Atlanta Center for Medical Research	Atlanta	Georgia
United States	HD Research	Bellaire	Texas
United States	Brigham and Women's Hospital	Boston	Massachusetts
United States	HD Research	Carrollton	Texas
United States	The Ohio State University Wexner Medical Center	Columbus	Ohio
United States	Duke University Hospital	Durham	North Carolina
United States	M3 Emerging Medical Research	Durham	North Carolina
United States	North Alabama Medical Center	Florence	Alabama
United States	HD Research	Houston	Texas
United States	The University of Texas - MD Anderson Cancer Center	Houston	Texas
United States	University of Iowa Healthcare	Iowa City	Iowa
United States	University of Louisville Hospital	Louisville	Kentucky
United States	University of Miami	Miami	Florida
United States	University of Minnesota / M Health Surgeries and Clinics Center	Minneapolis	Minnesota
United States	Clinical Trials of Texas	San Antonio	Texas
United States	Endeavor Clinical Trials	San Antonio	Texas
United States	Gulfcoast Research Institute	Sarasota	Florida
United States	Shoals Medical Trials, Inc	Sheffield	Alabama
United States	EBGS Clinical Research Center	Snellville	Georgia
United States	Phoenix Clinical Research	Tamarac	Florida
United States	ForCare Clinical Research	Tampa	Florida

Sponsors (1)

Lead Sponsor	Collaborator
Haisco-USA Pharmaceuticals, Inc.

Countries where clinical trial is conducted

United States,  Poland,  Spain, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Success rate of general anesthesia induction	Induction success (MOAA/S =1) after administration of the study drug, and; One or less top-up doses required without using any rescue drugs.	From the time of study drug administration to desired depth of anesthesia to MOAA/S=1( up to 5 minutes)
Secondary	Proportion of subjects with successful induction who maintain the desired depth of anesthesia for general elective surgery, AND without significant cardiac and respiratory depression		15 minutes from end of drug administration
Secondary	Proportion of subjects with any injection-site pain on Numeric Rating Scale		From start of the drug administration to MOAA/S =1 (up to 3 minutes)