Clinical Outcomes From Nalmefene

Opioid Overdose Clinical Trial

— COINED  

Official title:

Clinical Outcomes From Injectable Nalmefene in the Emergency Department (COINED)

Clinical Trial Details — Status: Withdrawn

Administrative data

• NCT number: NCT05808881
• Other study ID #: NAL4001
• Status: Withdrawn
• Phase: Phase 4
• Start date: June 2023
• Est. completion date: May 2024

Study information

• Verified date: July 2023
• Source: Purdue Pharma LP
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The purpose of this study is to assess the effectiveness of nalmefene relative to naloxone for the reversal of opioid intoxication in emergency department (ED) settings.

Recruitment information / eligibility

• Status: Withdrawn
• Enrollment: 0
• Est. completion date: May 2024
• Est. primary completion date: May 2024
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

1. Presumed or known opioid overdose in community settings.

2. Experiencing clinically significant respiratory depression based on appropriate medical judgement.

3. Patient airway is open and unobstructed at the time of enrollment. (Utilization of oral pharyngeal or nasal pharyngeal airway is allowed.)

4. Pre-hospital naloxone administration is allowed.

Exclusion Criteria:

1. Patient age known or estimated to be less than 18 years.

2. Patient has one or more additional documented acute medical, traumatic, toxicologic, or psychiatric conditions that would extend length of treatment or adversely alter the clinical outcome.

3. Cardiac arrest, secondary to opioid intoxication.

4. Arrested, jailed, or imprisoned patients.

5. Inappropriate for the study per judgement of research team.

Related Conditions & MeSH terms

• Opiate Overdose
• Opioid Overdose

Intervention

Drug:
• Nalmefene Hydrochloride Injection
for intravenous/intramuscular/subcutaneous (IV/IM/SC) administration
• Naloxone Hydrochloride Injection
for intravenous/intramuscular/subcutaneous (IV/IM/SC) administration

Locations

Country	Name	City	State
n/a

Sponsors (1)

Lead Sponsor	Collaborator
Purdue Pharma LP

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Reversal of Respiratory Depression	Normalization of the end tidal carbon dioxide value (if measured) to between 35 and 45 mmHg; and/or; =5 breaths per minute increase in respiratory rate from baseline (pre-dose) measurement, with rate of at least 12 breaths per minute.	Up to 3 hours
Secondary	Time to Reversal from administration of opioid antagonist		Up to 3 hours
Secondary	Recurrence of Respiratory Depression	Increased end tidal carbon dioxide value (if measured) above 45 mmHg when previously within the normal range; and/or; =5 breaths per minute decrease in respiratory rate from maximum post-reversal measurement, with a rate of at most 12 breaths per minute.	Up to 3 hours
Secondary	ED Disposition	One of the following will apply: ED Discharge; Hospital Admission; ICU Admission; Left against medical advice; Transfer to another facility; Death.	Up to 3 hours
Secondary	Drug Dosing	Dose administered for each opioid antagonist given to patients during their ED encounter -; Individual dose amount and frequency; Cumulative dose; Any pre-hospital naloxone given prior to ED arrival -; Dose amount, route	Up to 3 hours
Secondary	Richmond-Agitation Sedation Scale (RASS) Score	This is a single-item instrument used to quickly assess the degree of patient alertness and agitation in emergency and critical care settings. It is an observational assessment conducted by healthcare providers, and it can be completed in seconds. The scale uses integers from -5 to +4, each with its own clear anchor. A score of 0 means that the patient is alert and calm. Negative integers indicate diminished responsiveness and consciousness, with -1 indicating that a patient will open their eyes or make eye contact for 10 or more seconds when awakened by voice, and -5 meaning that the patient is unarousable by voice or physical stimulation. Positive integers indicate an increased level of arousal or agitation. The positive end of the scale spans from +1 (anxious, apprehensive, but not aggressive) to +4 (combative, violent, danger to staff).	Up to 3 hours
Secondary	Clinical Opioid Withdrawal Scale (COWS) Score	This is an observational assessment performed by a clinician to diagnose and assess the severity of opioid withdrawal symptoms. Eleven different opioid withdrawal symptoms are included in the COWS. The clinician will score the presence and severity of each symptom, with 0 indicating that the symptom is absent and more severe symptoms warranting a higher score. Individual symptom scores are then added to determine the overall severity of the patient's withdrawal. Total scores range from 5 to 48 where 5 - 12 = mild; 13 - 24 = moderate; 25 - 36 moderately severe; and greater than 36 = severe withdrawal.	Up to 3 hours
Secondary	Oxygen saturation level	Pulse oximetry monitoring will be used to assess the patient's oxygen saturation level (SpO2), expressed as a percentage from 0 to 100.	Up to 3 hours
Secondary	Length of time during ED encounter	Defined as the difference between time at Triage to time at ED Disposition	Up to 3 hours