Nicholas J Pastis1, Lonny B Yarmus2, Frank Schippers3, Randall Ostroff4, Alexander Chen5, Jason Akulian6, Momen Wahidi7, Samira Shojaee8, Nichole T Tanner9, Sean P Callahan10, Gregory Feldman11, Daniel G Lorch12, Ikeadi Ndukwu13, Michael A Pritchett14, Gerard A Silvestri9. 1. Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston, SC. Electronic address: pastisn@musc.edu. 2. Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore, MD. 3. PAION Deutschland GmbH, Aachen, Germany. 4. Chicago, IL. 5. Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, MO. 6. Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina, Chapel Hill, NC. 7. Pulmonary and Critical Care Medicine, Duke University Medical Center, Durham, NC. 8. Division of Pulmonary Disease and Critical Care Medicine, Virginia Commonwealth University, Richmond, VA. 9. Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston, SC. 10. Division of Pulmonary and Critical Care, Greenville Health System, Greenville, SC. 11. South Carolina Pharmaceutical Research, Spartanburg, SC. 12. Pulmonary Associates of Brandon Clinical Research, Brandon, FL. 13. LaPorte County Institute for Clinical Research, Michigan City, IN. 14. Pulmonary and Critical Care Medicine, FirstHealth Moore Regional Hospital, and Pinehurst Medical Clinic, Pinehurst, NC.
Abstract
BACKGROUND: While the complexity of flexible bronchoscopy has increased, standard options for moderate sedation medications have not changed in three decades. There is a need to improve moderate sedation while maintaining safety. Remimazolam was developed to address shortcomings of current sedation strategies. METHODS: A prospective, double-blind, randomized, multicenter, parallel group trial was performed at 30 US sites. The efficacy and safety of remimazolam for sedation during flexible bronchoscopy were compared with placebo and open-label midazolam. RESULTS: The success rates were 80.6% in the remimazolam arm, 4.8% in the placebo arm (P < .0001), and 32.9% in the midazolam arm. Bronchoscopy was started sooner in the remimazolam arm (mean, 6.4 ± 5.82 min) compared with placebo (17.2 ± 4.15 min; P < .0001) and midazolam (16.3 ± 8.60 min). Time to full alertness after the end of bronchoscopy was significantly shorter in patients treated with remimazolam (median, 6.0 min; 95% CI, 5.2-7.1) compared with those treated with placebo (13.6 min; 95% CI, 8.1-24.0; P = .0001) and midazolam (12.0 min; 95% CI, 5.0-15.0). Remimazolam registered superior restoration of neuropsychiatric function compared with placebo and midazolam. Safety was comparable among all three arms, and 5.6% of the patients in the remimazolam group had serious treatment-emergent adverse events as compared with 6.8% in the placebo group. CONCLUSIONS:Remimazolam administered under the supervision of a pulmonologist was effective and safe for moderate sedation during flexible bronchoscopy. In an exploratory analysis, it demonstrated a shorter onset of action and faster neuropsychiatric recovery than midazolam.
RCT Entities:
BACKGROUND: While the complexity of flexible bronchoscopy has increased, standard options for moderate sedation medications have not changed in three decades. There is a need to improve moderate sedation while maintaining safety. Remimazolam was developed to address shortcomings of current sedation strategies. METHODS: A prospective, double-blind, randomized, multicenter, parallel group trial was performed at 30 US sites. The efficacy and safety of remimazolam for sedation during flexible bronchoscopy were compared with placebo and open-label midazolam. RESULTS: The success rates were 80.6% in the remimazolam arm, 4.8% in the placebo arm (P < .0001), and 32.9% in the midazolam arm. Bronchoscopy was started sooner in the remimazolam arm (mean, 6.4 ± 5.82 min) compared with placebo (17.2 ± 4.15 min; P < .0001) and midazolam (16.3 ± 8.60 min). Time to full alertness after the end of bronchoscopy was significantly shorter in patients treated with remimazolam (median, 6.0 min; 95% CI, 5.2-7.1) compared with those treated with placebo (13.6 min; 95% CI, 8.1-24.0; P = .0001) and midazolam (12.0 min; 95% CI, 5.0-15.0). Remimazolam registered superior restoration of neuropsychiatric function compared with placebo and midazolam. Safety was comparable among all three arms, and 5.6% of the patients in the remimazolam group had serious treatment-emergent adverse events as compared with 6.8% in the placebo group. CONCLUSIONS:Remimazolam administered under the supervision of a pulmonologist was effective and safe for moderate sedation during flexible bronchoscopy. In an exploratory analysis, it demonstrated a shorter onset of action and faster neuropsychiatric recovery than midazolam.
Authors: Frank Schippers; Marija Pesic; Robert Saunders; Keith Borkett; Shawn Searle; Lynn Webster; Thomas Stoehr Journal: J Clin Pharmacol Date: 2020-06-03 Impact factor: 3.126