Indigotindisulfonate Sodium Injection, USP as an Aid in the Determination of Ureteral Patency in Pediatric Patients

Ureter Injury Clinical Trial

Official title:

An Open-Label, Multicenter Study to Evaluate the Safety, Pharmacokinetics and Conspicuity of Bludigo® When Used as an Aid in the Determination of Ureteral Patency in Pediatric Patients

Clinical Trial Details — Status: Not yet recruiting

Administrative data

• NCT number: NCT06448143
• Other study ID #: PVP-21IC03
• Status: Not yet recruiting
• Phase: Phase 3
• Start date: June 2024
• Est. completion date: February 2025

Study information

• Verified date: June 2024
• Source: Prove pharm
• Contact: Michelle Boytim, Ph.D.
• Phone: 610-850-7115
• Email: michelle.boytim[@]provepharm.com
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This is an open-label, multicenter study to evaluate the safety, pharmacokinetics, and conspicuity of a weight-based Bludigo® dose (0.05 mL/kg rounded up (if necessary) to a minimum of 0.5 mL and not to exceed 2.5 mL) when used as an aid in the determination of ureteral patency in pediatric patients. The study will enroll approximately 18 pediatric patients from approximately 2-3 study centers in the United States. Patients scheduled for urological or gynecological surgical procedures who are < 17 years will be screened for participation. A minimum of 6 patients will be enrolled in each of the following three age groups: birth to <6-years old, 6 to < 12 years old, 12 to < 17 years old. Screening will occur within 30 days before study drug administration (Day of Surgery). After signing the informed consent, review of inclusion and exclusion criteria will be performed. The collection of medical history and concomitant medications, the completion of a physical examination including vital signs measurement, ECG, and the collection of baseline laboratory testing (samples must be collected within 14 days of day 1) will be completed during the screening period. On the Day of Surgery (Day 1) patients will be evaluated for eligibility for treatment. To evaluate the efficacy outcomes, each patient will be injected with a weight-based dose of Bludigo® (0.05 mL/kg rounded up (if necessary) to a minimum of 0.5 mL) the maximum dose to be injected is not to exceed 2.5 mL. The ureteral orifices / urine jet will be observed, and a video will be recorded for 10 minutes. The time that will be captured on video is from the time of Bludigo® injection to 10 minutes post injection. If both ureters cannot be visualized simultaneously, then alternating 15-30 second images of each ureter or ureteral orifice will be obtained. The surgeon should note the time blue color is visualized in each ureter jet stream. Blood samples for PK analysis Urine samples will be collected at 0-30 minutes and 30 minutes- 2 hours post Bludigo® injection. All treated patients will have a follow-up visit 14 (± 3) days after the procedure. A final telephone call to assess adverse events (AEs) will occur at Day 30 (±2 days). Safety assessments will include monitoring of vital signs, AEs and laboratory testing post the procedure.

Recruitment information / eligibility

• Status: Not yet recruiting
• Enrollment: 18
• Est. completion date: February 2025
• Est. primary completion date: February 2025
• Accepts healthy volunteers: No
• Gender: All
• Age group: N/A to 17 Years

Eligibility

Inclusion Criteria:

I01. Patients from birth to < 17 years I02. Patients whose Parents or Legal Authorized Representative (LAR) have signed a written, IRB approved, informed consent form (ICF) and applicable assent obtained. I03. Patients scheduled for urological or gynecological surgical procedures in which the patency of the ureters must be assessed by the surgeon during the surgery. Exclusion Criteria: E01. For patients = 1 year of age, Stage 5 Chronic Kidney Failure (defined as an eGFR (estimated glomerular filtration rate) = 15mL/min/1.73 m2). (Calculated using the revised "Bedside Schwartz" equation (Schwartz et al. 2009) ). The revised "Bedside Schwartz" for eGFR is calculated as follows. eGFR (mL/min/1.73m2) = 0.413 * height/Scr, where height is baseline height measured in cm and Scr is baseline serum creatine measured in mg/dL; For patients less than 1 year of age, measured serum creatinine greater than 1.5-times the upper limit of normal (>97.5 percentile) based on the reference table in Boer et al., 2010. E02. Patients weighing less than 5 kgs. E03. Patients with known severe hypersensitivity reactions to Bludigo® or other dyes including contrast agents. E04. Patients with a history of, or being evaluated or treated for, gynecologic, renal, or urogenital (ureteral or bladder) cancer. E05. Patients with known congenital cardiac conditions or who have a history of arrythmia, hypotension, hypertension, bradycardia or tachycardia. E06. Patients, as assessed by the Investigator, with other conditions / concomitant diseases precluding their safe participation in this study (e.g., major systemic diseases). E07. Unable to meet specific protocol requirements (e.g., scheduled visits), or has a condition that could lead to non-compliance with the study procedures or patient/parent/LAR uncooperative. E08. Patient is the child of Investigator or any Sub-Investigator, research assistant, pharmacist, study coordinator, other staff or relative thereof directly involved in the conduct of the protocol. E09. Patients with a life expectancy = 6 months. E10. Requirement for concomitant treatment with renal tubule transport inhibitors or with any treatment that could potentially discolor urine (see section 6.6) E11. Patients who are pregnant or breast feeding.

Related Conditions & MeSH terms

• Ureter Injury

Intervention

Drug:
• Indigotindisulfonate sodium 0.8% injection
Experimental contrast dye for diagnostic procedures, commonly used as a visualization aid in pelvic and abdominal surgeries, as well as for evaluating ureteral patency.

Locations

Country	Name	City	State
n/a

Sponsors (1)

Lead Sponsor	Collaborator
Prove pharm

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Responders to Bludigo®	Urine jet conspicuity scores based on the 5-point conspicuity score utilized in study PVP-19IC01 in adults. The 5-point scale is defined as: No jet observed; Weak jet, little color contrast; Color contrast or significant jet flow; Strong jet flow with good color contrast; Strong jet flow with striking contrast in color	10 minutes post study drug administration
Secondary	Time to visualization	Time to visualization of blue color at each ureteral orifice following administration of Bludigo®.	10 minutes post drug administration
Secondary	Pharmacokinetics parameters	Amount of Bludigo® excreted in urine.	2 hours post study drug administration
Secondary	Pharmacokinetics parameters	Area under the curve up to the last quantifiable time-point (AUC 0-t)	40 minutes post study drug administration
Secondary	Pharmacokinetics parameters	Area under the curve to infinity (AUC 0-8)	40 minutes post study drug administration
Secondary	Pharmacokinetics parameters	Maximum plasma concentration (C max)	40 minutes post study drug administration
Secondary	Pharmacokinetics parameters	Time to reach maximum plasma concentration (T max)	40 minutes post study drug administration