Assessment of Efficacy, Safety and Dosing of Clevidipine in Pediatric Participants Undergoing Surgery (PIONEER)

Chiesi

Status and phase: Terminated; Phase 4

Conditions: Pediatric Perioperative Blood Pressure Management

Treatments: Drug: clevidipine

Study type: Interventional

Funder types: Industry

Identifiers

NCT01938547

MDCO-CLV-12-01

Details and patient eligibility

About

Evaluate the efficacy, safety, and dosing of clevidipine as an intravenous (IV) infusion for blood pressure (BP) management in paediatric participants in the perioperative setting.

Full description

This was an open-label study to assess, in a stepwise approach across 4 age cohorts from oldest to youngest (birth to <age 18), the efficacy and safety of clevidipine exposure for a minimum of 30 minutes and up to a maximum of 96 hours in pediatric participants undergoing a surgical procedure with anesthesia for greater than or equal to 1 hour and for whom parenteral IV infusion of antihypertensive therapy for the management of blood pressure was expected.

The reason for initiating clevidipine administration was to keep blood pressure within a pre-specified range during surgery.

After the study completion for Cohort 1 (adolescent patients 12 to less than 18 years), the PIONEER study was placed on partial clinical hold by the FDA; later, the study was terminated by the sponsor. Enrolment of the subsequent cohorts did not take place; results are presented for Cohort 1 only.

Enrollment: 22 patients

Sex: All

Ages: Under 17 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Less than 18 years of age
• Written informed consent obtained before initiation of any study-related procedures
• The enrolling physician determines that the participant will likely require a 15% reduction in BP during the perioperative course
• Intra-arterial line is available for blood pressure monitoring
• Surgical procedure requiring a minimum of 1 hour of anesthesia, in which IV antihypertensive therapy to control BP for at least 30 minutes is anticipated

Exclusion criteria

• Administration of an IV or oral antihypertensive agent within 2 hours prior to study drug administration
• Congenital heart disease described as single ventricle
• Evidence of liver failure, severe liver disease, pulmonary disease (e.g. uncontrolled asthma), hyperlipidemia, lipoid nephrosis, lipid dysfunction or acute pancreatitis
• Allergy to soya bean oil or egg lecithin
• Known to be intolerant to calcium channel blockers
• Hemophilia or blood coagulation disorders
• Any serious medical condition which, in the opinion of the investigator, is likely to interfere with study procedures
• Clinically significant abnormal physical findings at the screening evaluation
• Any serious surgical or medical condition which, in the opinion of the investigator, is likely to interfere with study procedures or with the pharmacokinetics or pharmacodynamics of the study drug
• Participant is terminally ill (death likely to occur within 48 hours)
• Use of Methylphenidate, calcium channel blockers, Aripiprazole and other atypical anti- psychotics and antihypertensives used for BP control within 2 hours prior to study drug initiation
• Positive serum or urine pregnancy test for any female of child bearing potential
• Participation in other clinical research studies involving the evaluation of other investigational drugs or devices within 30 days of enrollment
• Participants who, for any reason, are deemed by the Investigator to be inappropriate for this study
• Participant is a relative of the Investigator or his/her deputy, research assistant, pharmacist, study coordinator, other staff directly involved in the conduct of the study

Trial design

Primary purpose: Treatment

Allocation: N/A

Interventional model: Single Group Assignment

Masking: None (Open label)

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22 participants in 1 patient group

clevidipine

Experimental group

Description:

An initial clevidipine IV infusion dose for the adolescent cohort has been specified per protocol. The initial dose for each of the subsequent age cohorts could be modified if necessary, based on the recommendation of the Data and Safety Monitoring Board (DSMB). Following the initial dose, clevidipine will be up-titrated every 1.5 minutes, according to participant need, to achieve a systolic blood pressure (SBP) within the pre-specified SBP target range. Doses may be increased by less than doubling, and the time between dose adjustments may be lengthened, as the target blood pressure is approached. The infusion rate may be maintained for up to 96 hours, once the participant's SBP is within the target range, and titrated as necessary to maintain blood pressure within the range.

Treatment:

Drug: clevidipine