Intravenous Exenatide (Byetta) During Surgery

Thomas Jefferson University

Status and phase: Completed; Phase 2; Phase 1

Conditions: Hypoglycemia; Hyperglycemia; Euglycemia

Treatments: Drug: Exenatide 0.41 ng/kg/min; Drug: Placebo; Drug: Exenatide 0.27 ng/kg/min

Study type: Interventional

Funder types: Other; Industry

Identifiers

NCT00882050

808104

Details and patient eligibility

About

The purpose of this project is to study if intravenous Exenatide is effective at maintaining normal blood glucose levels and preventing low blood glucose levels during surgery.

Full description

This is a single-center, block randomized, double-blind, placebo-controlled, dose-ranging study. Subjects will be randomized in equal proportions to one of three treatment arms: placebo of normal saline solution, 0.27 ng/kg/min (0.066 pmol/kg/min) IV Exenatide, and 0.41 ng/kg/min (0.099 pmol/kg/min) IV Exenatide. We will use a block number of 30 (please see power analysis) so that balance between each of the three groups will be maintained over the enrollment period. We will stratify the randomization scheme to ensure balance of diabetics and non-diabetics within the groups.

Enrollment: 104 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Age (>18 years)
• Weight of > 50 kg and < 150 kg
• Ability to provide informed consent
• Elective surgery including:
• Cardiac surgery to include elective CABG with or without single or multivalve repair or replacement and/or single or multivalve repair/replacement requiring CPB and sternotomy (to include subjects who are undergoing first time or redo cardiac surgery)
• Abdominal aortic aneurysm repair
• Carotid endarterectomy
• Esophagectomy
• Cystectomy
• Nephrectomy
• If female, subject must be non-lactating, and, if of childbearing potential, must have a negative urine pregnancy test within 24 hours prior to receiving study drug

Exclusion criteria

• Age (<18 years)
• Inability to provide informed consent
• History or risk of pancreatitis (e.g. ethanol abuse, gall stones)
• Receipt of an investigational drug or device with 30 days prior to surgery
• Use of any concomitant medication listed above on the day of surgery
• Known allergy to Exenatide, fentanyl, midazolam, isoflurane, propofol, heparin or neuromuscular blockers
• Known substance abuse
• Surgical procedure other than:

Cardiac surgery to include elective CABG with or without single or multivalve repair or replacement and/or single or multivalve repair/ replacement requiring CPB and sternotomy (to include subjects who are undergoing first time or redo cardiac surgery)

• Abdominal aortic aneurysm repair

• Carotid endarterectomy

• Esophagectomy

• Cystectomy

• Nephrectomy

  • Insulin dependent diabetes mellitis
  • Anticipated administration of intraoperative steroids
  • Major end organ dysfunction, defined as:

• Current intravenous inotropic agents

• Preoperative use of intra-aortic balloon pump (IABP), left ventricular assist device (LVAD), or extracorporeal membrane oxygenation (ECMO)

• Renal

• Preoperative serum Creatinine > 2.0 mg/dL

• Hepatic

• History of abnormal hepatic function in the past

• Hematologic

• Preoperative hematocrit (HCT) < 30%

• Platelet count < 100,000/mm3

• History of bleeding or clotting disorder

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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104 participants in 3 patient groups, including a placebo group

Exentatide 0.27 ng/kg/min

Experimental group

Description:

Exenatide to be infused by intravenous method at 0.27 ng/kg/min (0.066 pmol/kg/min) over 3-6 hours. * Induction of anesthesia will be equal to Intubation time. Infusion will begin at this time point (+ or - 3 minutes). * Blood samples will be obtained prior to intubation and then 10 and 30 minutes after drug initiation and every 30 minutes (+ or - 2 minutes) thereafter until the infusion is stopped. The drug infusion will be stopped at extubation. Blood will then be sampled every 30 minutes (+ or - 2 minutes) post extubation for 2 hours, and once 24 hours after extubation. * Blood plasma levels will be collected (8-10 mls) for analysis of GLP-1, Glucose, Potassium, Insulin, Glucagon, Epinephrine, Norepinephrine, Cortisol, and free fatty acids (FFA).

Treatment:

Drug: Exenatide 0.27 ng/kg/min

Exentatide 0.41 ng/kg/min

Experimental group

Description:

Experimental: IV Exenatide to be infused by intravenous method at 0.41 ng/kg/min (0.099 pmol/kg/min) over 3 to 6 hours. * Induction of anesthesia will be equal to Intubation time. Infusion will begin at this time point (+ or - 3 minutes). * Blood samples will be obtained prior to intubation and then 10 and 30 minutes after drug initiation and every 30 minutes (+ or - 2 minutes) thereafter until the infusion is stopped. The drug infusion will be stopped at extubation. Blood will then be sampled every 30 minutes (+ or - 2 minutes) post extubation for 2 hours, and once 24 hours after extubation. * Blood plasma levels will be collected (8-10 mls) for analysis of GLP-1, Glucose, Potassium, Insulin,Glucagon, Epinephrine, Norepinephrine, Cortisol, and free fatty acids (FFA).

Treatment:

Drug: Exenatide 0.41 ng/kg/min

Placebo IV NSS

Placebo Comparator group

Description:

Placebo of IV normal saline solution as comparator. * Induction of anesthesia will be equal to Intubation time. Infusion will begin at this time point (+ or - 3 minutes). * Blood samples will be obtained prior to intubation and then 10 and 30 minutes after drug initiation and every 30 minutes (+ or - 2 minutes) thereafter until the infusion is stopped. The drug infusion will be stopped at extubation. Blood will then be sampled every 30 minutes (+ or - 2 minutes) post extubation for 2 hours, and once 24 hours after extubation. * Blood plasma levels will be collected (8-10 mls) for analysis of GLP-1, Glucose, Potassium, Insulin, Glucagon, Epinephrine, Norepinephrine, Cortisol, and free fatty acids (FFA).

Treatment:

Drug: Placebo