Time‐to‐Event Modeling for Remimazolam for the Indication of Induction and Maintenance of General Anesthesia
| Autor: | Thomas Stoehr, Frank Schippers, Lauren R. L. Lohmer, Karl Uwe Petersen, Virginia D. Schmith |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Sedation Kaplan-Meier Estimate Anesthesia General anesthesia Models Biological 030226 pharmacology & pharmacy Drug Administration Schedule Time Benzodiazepines 03 medical and health sciences Clinical Trials Phase II as Topic 0302 clinical medicine medicine Humans Hypnotics and Sedatives Pharmacology (medical) Dosing Aged Probability Pharmacology Dose-Response Relationship Drug Proportional hazards model Cumulative dose business.industry remimazolam Middle Aged dose‐response Clinical Trials Phase III as Topic Pharmacodynamics sedation 030220 oncology & carcinogenesis Bispectral index Anesthesia Linear Models time‐to‐event analysis medicine.symptom Remimazolam business Body mass index |
| Zdroj: | Journal of Clinical Pharmacology |
| ISSN: | 1552-4604 0091-2700 |
| DOI: | 10.1002/jcph.1552 |
| Popis: | Remimazolam is an ultra‐short‐acting benzodiazepine being investigated for induction and maintenance of general anesthesia and for procedural sedation. This dose‐response analysis of 4 phase 2‐3 studies evaluated covariates that may impact the pharmacodynamic profile (based on theoretical pharmacokinetic principles) and require dose adjustments in subpopulations, particularly elderly, and if remimazolam has cumulative properties. Covariates affecting the time to loss of consciousness and time to extubation were evaluated using Cox proportional hazards models. Factors affecting steady‐state infusion rate required to produce adequate sedation were evaluated using linear regression. Variability in time to loss of consciousness was explained by induction dose, age, body mass index, and time from initiation of opioids to initiation of remimazolam. The steady‐state infusion rate producing adequate sedation was higher in European than Japanese subjects due to differences in study design. American Society of Anesthesiologists physical status class 3 subjects had a 28% lower maintenance infusion rate than class 1 subjects. Other statistically significant covariates (American Society of Anesthesiologists class 2, estimated glomerular filtration rate, and sex) resulted in small (≤14%), non–clinically relevant differences. Factors affecting time to extubation included the last infusion rate (ie, tapering), the bispectral index score at the end of infusion, and sex. The time to extubation after remimazolam did not increase with increased cumulative dose of remimazolam or duration of surgery. This evaluation of remimazolam's pharmacodynamic profile, in the absence of pharmacokinetic data, informed dosing recommendations and showed that remimazolam does not have cumulative properties in the general anesthesia setting. |
| Databáze: | OpenAIRE |
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