Trial Comparing Haloperidol, Quetiapine and Placebo in the Pharmacological Treatment of Delirium (Haloquet)

This study is currently recruiting participants. (see Contacts and Locations)
Verified February 2013 by Centre hospitalier de l'Université de Montréal (CHUM)
Sponsor:
Collaborator:
Fondation des pompiers du Québec pour les grands brûlés
Information provided by (Responsible Party):
Centre hospitalier de l'Université de Montréal (CHUM)
ClinicalTrials.gov Identifier:
NCT01811459
First received: March 12, 2013
Last updated: March 13, 2013
Last verified: February 2013
  Purpose

Background:

Delirium is an important problem in critical care. Its prevalence often reaches 75% in intensive care patients. Its occurrence is associated with numerous complications and deleterious consequences such as death, longer stay, higher cost, and long-term cognitive impairment. Delirium treatment entails correcting its underlying causes and usually initiating a pharmacological intervention with an antipsychotic. Typical antipsychotics, particularly haloperidol, are commonly used to treat delirium although few placebo-controlled trials of pharmacological treatments for delirium have been conducted. Furthermore, appropriate doses for delirium treatment have yet to be established. In critical care, two pilot studies provided the first randomized, placebo-controlled evidence for the pharmacologic treatment of ICU delirium. One found that neither haloperidol nor ziprasidone significantly reduced the incidence or duration of delirium compared with placebo whereas the other one found that quetiapine added to as-needed haloperidol resulted in faster delirium resolution.

Objective:

The goal of this study is to determine the effectiveness of antipsychotics in regular dosage regimen (quetiapine group and haloperidol group) compared to as-needed haloperidol (placebo group) in the pharmacological treatment of delirium. We will conduct a three-arm randomized controlled trial to achieve this goal.

Materials and Methods:

During one year, 45 delirious patients from three intensive care units will be recruited and randomized into one of three groups. Randomization will be performed in blocks of 9 by the pharmacy department, using a random numbers table.

Patients will be continuously screened for delirium using the Intensive Care Delirium Screening Checklist (ICDSC) as part of routine care. A positive screening score (≥4) will warrant confirmation of delirium diagnosis by the treating physician. Treatment will begin according to randomization group, provided that informed consent has been obtained. Delirium status will be monitored during the episode using the Nursing Delirium Screening Scale (Nu-DESC). When the Nu-DESC monitoring will become negative for delirium (total score below 2), the resolution of the episode will be confirmed by the treating physician. A clinical evaluation by a psychiatrist will be performed within 24-48 hours of each of the two evaluations made by the treating physician (beginning and end of the delirium episode).

The treating physician will initiate twice-daily treatment at the first of five levels for each of the three groups: 1) 1 mg of intravenous (IV) haloperidol + oral (PO) placebo, 2) 50 mg of PO quetiapine + IV placebo, or 3) IV + PO placebo. Therapy will be titrated upwards on a daily basis by increments of 1) 1 mg of IV haloperidol or 2) 50 mg of PO quetiapine, or 3) IV + PO placebo every 12 hrs, respectively, if the subject received at least two doses of as-needed haloperidol in the previous 24 hrs. As-needed (PRN) doses of 2 mg of IV haloperidol q 30 minutes will be available to patients from all three groups and administered by nurses until symptoms associated with delirium resolve. In case of unsuccessful as-needed treatment, rescue (STAT) doses of 5 mg of IV haloperidol q 30 minutes will be available to patients from all three groups and will be administered by nurses if agreement is reached with the treating physician that the situation indeed calls for it. The treatment level of patients requiring a STAT dose will immediately be raised to the above level. The treatment will stop when one of the following occurs: (1) the subject is deemed by the treating physicians, based on their clinical judgment, to no longer demonstrate signs of delirium and, therefore, to no longer require scheduled therapy with an antipsychotic agent; (2) 21 days of therapy has elapsed; (3) ICU discharge occurred; or (4) a life-threatening adverse event potentially attributable to the study drug occurred that warranted discontinuation of the study drug.

Adverse effects will be closely monitored: extrapyramidal reactions, neuroleptic malignant syndrome, drowsiness, hypotension, QTc prolongation. The treatment level of patients presenting a non life-threatening adverse event will immediately be lowered to the level directly below.

The sample size was calculated for a 2-tailed test with an alpha of .05 and a power of .80.

The primary statistical analysis will involve Cox proportional time to event analysis comparing the three groups. Secondary analysis will use T-test comparisons for continuous variables and chi square for proportional analysis.


Condition Intervention Phase
Delirium
Drug: Quetiapine
Drug: Haloperidol
Drug: Placebo
Phase 3

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Randomized Controlled Trial Comparing Haloperidol, Quetiapine and Placebo in the Pharmacological Treatment of Delirium : The Haloquet Trial

Resource links provided by NLM:


Further study details as provided by Centre hospitalier de l'Université de Montréal (CHUM):

Primary Outcome Measures:
  • Time to first resolution of delirium [ Time Frame: 21 days ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Days in delirium during the study [ Time Frame: 21 days ] [ Designated as safety issue: No ]
  • Duration of delirium [ Time Frame: 21 days ] [ Designated as safety issue: No ]
  • Severity of delirium (highest Nu-DESC score, mean episode Nu-DESC score) [ Time Frame: 21 days ] [ Designated as safety issue: No ]
  • ICU and hospital mortality [ Time Frame: 21 days ] [ Designated as safety issue: No ]
  • ICU and hospital length of stay [ Time Frame: 21 days ] [ Designated as safety issue: No ]
  • Length of mechanical ventilation [ Time Frame: 21 days ] [ Designated as safety issue: No ]
  • Time spent deeply sedated (RASS <3) [ Time Frame: 21 days ] [ Designated as safety issue: No ]
  • Episodes of subject-initiated device removal [ Time Frame: 21 days ] [ Designated as safety issue: No ]
  • Use of haloperidol therapy (including total dose in haloperidol equivalents during the study, number of doses, number of days of therapy, use of rescue IV haloperidol) [ Time Frame: 21 days ] [ Designated as safety issue: No ]
  • Average daily and maximum total antipsychotic drug dose in haloperidol equivalents [ Time Frame: 21 days ] [ Designated as safety issue: No ]
  • Duration of study drug administration [ Time Frame: 21 days ] [ Designated as safety issue: No ]
  • Use of benzodiazepines [ Time Frame: 21 days ] [ Designated as safety issue: No ]
  • Use of opioids [ Time Frame: 21 days ] [ Designated as safety issue: No ]
  • QTc prolongation [ Time Frame: 21 days ] [ Designated as safety issue: Yes ]
  • Extrapyramidal symptoms [ Time Frame: 21 days ] [ Designated as safety issue: Yes ]
  • Neuroleptic malignant syndrome [ Time Frame: 21 days ] [ Designated as safety issue: No ]

Estimated Enrollment: 45
Study Start Date: February 2013
Estimated Study Completion Date: March 2014
Estimated Primary Completion Date: March 2014 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Quetiapine
Drug: Quetiapine 50-250 mg PO BID (5 levels of treatment) + IV Placebo Rescue IV haloperidol available.
Drug: Quetiapine
Experimental: Haloperidol
Drug: Haloperidol 1-5 mg BID (5 levels of treatment) + PO placebo Rescue IV haloperidol available.
Drug: Haloperidol
Placebo Comparator: Placebo
IV placebo + PO placebo Rescue IV haloperidol available.
Drug: Placebo

Detailed Description:

Primary Outcome Measures:

•Time to first resolution of delirium.

Secondary Outcome Measures:

  • Days in delirium during the study
  • Duration of delirium
  • Severity of delirium (highest Nu-DESC score, mean episode Nu-DESC score)
  • ICU and hospital mortality
  • ICU and hospital length of stay
  • Length of mechanical ventilation
  • Time spent deeply sedated (RASS <3)
  • Episodes of subject-initiated device removal
  • Use of haloperidol therapy (including total dose in haloperidol equivalents during the study, number of doses, number of days of therapy, use of rescue IV haloperidol)
  • Average daily and maximum total antipsychotic drug dose in haloperidol equivalents
  • Duration of study drug administration
  • Use of benzodiazepines (converted to lorazepam equivalents)
  • Use of opioids (converted to morphine equivalents)
  • QTc prolongation
  • Extrapyramidal symptoms
  • Neuroleptic malignant syndrome
  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Patients aged 18 years or older.
  • Patients with a diagnosis of delirium made by a psychiatrist.

Exclusion Criteria:

  • Patients with active schizophrenia or bipolar disorder.
  • Patients with Parkinson disease.
  • Patients with severe liver failure.
  • Patients with alcohol or sedative/hypnotics dependence.
  • Patients with QTc interval above 500 msec.
  • Pregnant patients.
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01811459

Contacts
Contact: Nicolas Bergeron, MD (514) 890-8000 ext 36155 nbergeron@yahoo.com
Contact: Marie-Pierre Leduc, M.A. (514) 890-8000 ext 16807 marie-pierre.leduc.chum@ssss.gouv.qc.ca

Locations
Canada, Quebec
Centre hospitalier de l'Université de Montréal (CHUM) Recruiting
Montreal, Quebec, Canada, H2W 1T8
Sub-Investigator: Jean-David Gaudreau, MD, Ph.D         
Sub-Investigator: Marc-Jacques Dubois, MD         
Sponsors and Collaborators
Centre hospitalier de l'Université de Montréal (CHUM)
Fondation des pompiers du Québec pour les grands brûlés
  More Information

No publications provided

Responsible Party: Centre hospitalier de l'Université de Montréal (CHUM)
ClinicalTrials.gov Identifier: NCT01811459     History of Changes
Other Study ID Numbers: CE12.189
Study First Received: March 12, 2013
Last Updated: March 13, 2013
Health Authority: Canada: Health Canada

Keywords provided by Centre hospitalier de l'Université de Montréal (CHUM):
Delirium
ICU
Burn patients
Antipsychotics
Haloperidol
Quetiapine

Additional relevant MeSH terms:
Pharmacologic Actions
Molecular Mechanisms of Pharmacological Action
Delirium
Confusion
Neurobehavioral Manifestations
Neurologic Manifestations
Nervous System Diseases
Signs and Symptoms
Delirium, Dementia, Amnestic, Cognitive Disorders
Mental Disorders
Quetiapine
Haloperidol
Haloperidol decanoate
Antipsychotic Agents
Tranquilizing Agents
Central Nervous System Depressants
Physiological Effects of Drugs
Central Nervous System Agents
Therapeutic Uses
Psychotropic Drugs
Antiemetics
Autonomic Agents
Peripheral Nervous System Agents
Gastrointestinal Agents
Dopamine Antagonists
Dopamine Agents
Neurotransmitter Agents
Anti-Dyskinesia Agents

ClinicalTrials.gov processed this record on September 18, 2014