Alvimopan Use in Polytraumatized Patients

NCT ID: NCT03068975

Last Updated: 2020-02-05

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

TERMINATED

Clinical Phase

PHASE4

Total Enrollment

3 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-09-01

Study Completion Date

2019-11-19

Brief Summary

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To evaluate the efficacy and safety of Alvimopan(12 mg) in recovery of bowel function in an emergency trauma setting without the pre-operative dosage in patients that will receive abdominal surgery.

Detailed Description

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Conditions

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Post Operative Ileus

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Will create a double blind, randomized, parallel design study to evaluate the effectiveness of Alvimopan(post operative dose) in preventing post-operative ileus in poly-traumatized patients
Primary Study Purpose

PREVENTION

Blinding Strategy

TRIPLE

Participants Caregivers Investigators

Study Groups

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Alvimopan

Patients in the study group will be administered a post operative dose of Alvimopan

Group Type EXPERIMENTAL

Alvimopan

Intervention Type DRUG

Patients who sustained abdominal trauma with resection of bowel and anastomosis will receive Alvimopan ( post operative dose only) and will monitor for post operative ileus.

Placebo

Patients in the Placebo group will receive a placebo pill and will be compared with the study group

Group Type PLACEBO_COMPARATOR

Placebo

Intervention Type DRUG

Patients who sustained abdominal trauma with resection of bowel and anastomosis will receive the Placebo Pill (post operative dose only) and will monitor for post operative ileus.

Interventions

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Alvimopan

Patients who sustained abdominal trauma with resection of bowel and anastomosis will receive Alvimopan ( post operative dose only) and will monitor for post operative ileus.

Intervention Type DRUG

Placebo

Patients who sustained abdominal trauma with resection of bowel and anastomosis will receive the Placebo Pill (post operative dose only) and will monitor for post operative ileus.

Intervention Type DRUG

Other Intervention Names

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Entereg placebo pill

Eligibility Criteria

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Inclusion Criteria

* Ages 18 to 80
* Poly-traumatized patients
* Extubated patients after abdominal exploration
* Underwent Abdominal exploration, had colon resection with primary anastomosis with closure of abdomen

Exclusion Criteria

* Mechanically ventilated patients
* Patient not expected to survive Glasgow Coma Scale = 3
* Pregnant patients
* Apache score \> 40 (observed mortality 100%) Saas Ahmed Naved et al 2011
* Vasopressor therapy
* Septic patients
* Thoracotomy
* Bogota bag
* Intravenous Drug Abuser (IVDA) as evidenced by urine toxicology upon admission to the Trauma Unit
* Patients with prior history of gastric surgery and/or colonic surgery
* Medical History: of severe cardiovascular disease, Renal diseases, Hepatitis C or Hepatic failure, Autoimmune disease, Crohn and Ulcerative Colitis (In view of the inflammation in the intestinal mucosal which may decrease optimal absorption of the medication) and or bowel obstruction
* Prior pancreatic anastomosis or gastric anastomosis; ostomy formation
* Chronic use of nonsteroidal anti-inflammatory drugs
Minimum Eligible Age

18 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Merck Sharp & Dohme LLC

INDUSTRY

Sponsor Role collaborator

University of Puerto Rico

OTHER

Sponsor Role lead

Responsible Party

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Pablo Rodriguez Ortiz

MD

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Puerto Rico Trauma Hospital

San Juan, US, Puerto Rico

Site Status

Countries

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Puerto Rico

References

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Bragg D, El-Sharkawy AM, Psaltis E, Maxwell-Armstrong CA, Lobo DN. Postoperative ileus: Recent developments in pathophysiology and management. Clin Nutr. 2015 Jun;34(3):367-76. doi: 10.1016/j.clnu.2015.01.016. Epub 2015 Jan 31.

Reference Type BACKGROUND
PMID: 25819420 (View on PubMed)

Delaney CP, Weese JL, Hyman NH, Bauer J, Techner L, Gabriel K, Du W, Schmidt WK, Wallin BA; Alvimopan Postoperative Ileus Study Group. Phase III trial of alvimopan, a novel, peripherally acting, mu opioid antagonist, for postoperative ileus after major abdominal surgery. Dis Colon Rectum. 2005 Jun;48(6):1114-25; discussion 1125-6; author reply 1127-9. doi: 10.1007/s10350-005-0035-7.

Reference Type BACKGROUND
PMID: 15906123 (View on PubMed)

Delaney CP, Senagore AJ, Viscusi ER, Wolff BG, Fort J, Du W, Techner L, Wallin B. Postoperative upper and lower gastrointestinal recovery and gastrointestinal morbidity in patients undergoing bowel resection: pooled analysis of placebo data from 3 randomized controlled trials. Am J Surg. 2006 Mar;191(3):315-9. doi: 10.1016/j.amjsurg.2005.10.026.

Reference Type BACKGROUND
PMID: 16490538 (View on PubMed)

Earnshaw SR, Kauf TL, McDade C, Potashman MH, Pauyo C, Reese ES, Senagore A. Economic Impact of Alvimopan Considering Varying Definitions of Postoperative Ileus. J Am Coll Surg. 2015 Nov;221(5):941-50. doi: 10.1016/j.jamcollsurg.2015.08.004. Epub 2015 Aug 15.

Reference Type BACKGROUND
PMID: 26353904 (View on PubMed)

Hilton WM, Lotan Y, Parekh DJ, Basler JW, Svatek RS. Alvimopan for prevention of postoperative paralytic ileus in radical cystectomy patients: a cost-effectiveness analysis. BJU Int. 2013 Jun;111(7):1054-60. doi: 10.1111/j.1464-410X.2012.11499.x. Epub 2012 Nov 21.

Reference Type BACKGROUND
PMID: 23171223 (View on PubMed)

Herzog TJ, Coleman RL, Guerrieri JP Jr, Gabriel K, Du W, Techner L, Fort JG, Wallin B. A double-blind, randomized, placebo-controlled phase III study of the safety of alvimopan in patients who undergo simple total abdominal hysterectomy. Am J Obstet Gynecol. 2006 Aug;195(2):445-53. doi: 10.1016/j.ajog.2006.01.039. Epub 2006 Apr 19.

Reference Type BACKGROUND
PMID: 16626607 (View on PubMed)

Holte K, Kehlet H. Postoperative ileus: a preventable event. Br J Surg. 2000 Nov;87(11):1480-93. doi: 10.1046/j.1365-2168.2000.01595.x.

Reference Type BACKGROUND
PMID: 11091234 (View on PubMed)

Kalff JC, Schraut WH, Simmons RL, Bauer AJ. Surgical manipulation of the gut elicits an intestinal muscularis inflammatory response resulting in postsurgical ileus. Ann Surg. 1998 Nov;228(5):652-63. doi: 10.1097/00000658-199811000-00004.

Reference Type BACKGROUND
PMID: 9833803 (View on PubMed)

Ludwig K, Viscusi ER, Wolff BG, Delaney CP, Senagore A, Techner L. Alvimopan for the management of postoperative ileus after bowel resection: characterization of clinical benefit by pooled responder analysis. World J Surg. 2010 Sep;34(9):2185-90. doi: 10.1007/s00268-010-0635-9.

Reference Type BACKGROUND
PMID: 20526599 (View on PubMed)

Ludwig K, Enker WE, Delaney CP, Wolff BG, Du W, Fort JG, Cherubini M, Cucinotta J, Techner L. Gastrointestinal tract recovery in patients undergoing bowel resection: results of a randomized trial of alvimopan and placebo with a standardized accelerated postoperative care pathway. Arch Surg. 2008 Nov;143(11):1098-105. doi: 10.1001/archsurg.143.11.1098.

Reference Type BACKGROUND
PMID: 19015469 (View on PubMed)

Manger JP, Nelson M, Blanchard S, Helo S, Conaway M, Krupski TL. Alvimopan: A cost-effective tool to decrease cystectomy length of stay. Cent European J Urol. 2014;67(4):335-41. doi: 10.5173/ceju.2014.04.art4. Epub 2014 Dec 5.

Reference Type BACKGROUND
PMID: 25667750 (View on PubMed)

Miedema BW, Johnson JO. Methods for decreasing postoperative gut dysmotility. Lancet Oncol. 2003 Jun;4(6):365-72. doi: 10.1016/s1470-2045(03)01118-5.

Reference Type BACKGROUND
PMID: 12788410 (View on PubMed)

Naved SA, Siddiqui S, Khan FH. APACHE-II score correlation with mortality and length of stay in an intensive care unit. J Coll Physicians Surg Pak. 2011 Jan;21(1):4-8.

Reference Type BACKGROUND
PMID: 21276376 (View on PubMed)

Simorov A, Thompson J, Oleynikov D. Alvimopan reduces length of stay and costs in patients undergoing segmental colonic resections: results from multicenter national administrative database. Am J Surg. 2014 Dec;208(6):919-25; discussion 925. doi: 10.1016/j.amjsurg.2014.08.011. Epub 2014 Sep 22.

Reference Type BACKGROUND
PMID: 25440479 (View on PubMed)

Thompson M, Magnuson B. Management of postoperative ileus. Orthopedics. 2012 Mar;35(3):213-7. doi: 10.3928/01477447-20120222-08.

Reference Type BACKGROUND
PMID: 22385598 (View on PubMed)

Vaughan-Shaw PG, Fecher IC, Harris S, Knight JS. A meta-analysis of the effectiveness of the opioid receptor antagonist alvimopan in reducing hospital length of stay and time to GI recovery in patients enrolled in a standardized accelerated recovery program after abdominal surgery. Dis Colon Rectum. 2012 May;55(5):611-20. doi: 10.1097/DCR.0b013e318249fc78.

Reference Type BACKGROUND
PMID: 22513441 (View on PubMed)

Winegar B, Cox M, Truelove D, Brock G, Scherrer N, Pass LA. Efficacy of alvimopan following bowel resection: a comparison of two dosing strategies. Ann Pharmacother. 2013 Nov;47(11):1406-13. doi: 10.1177/1060028013504289.

Reference Type BACKGROUND
PMID: 24285757 (View on PubMed)

Wolff BG, Michelassi F, Gerkin TM, Techner L, Gabriel K, Du W, Wallin BA; Alvimopan Postoperative Ileus Study Group. Alvimopan, a novel, peripherally acting mu opioid antagonist: results of a multicenter, randomized, double-blind, placebo-controlled, phase III trial of major abdominal surgery and postoperative ileus. Ann Surg. 2004 Oct;240(4):728-34; discussion 734-5. doi: 10.1097/01.sla.0000141158.27977.66.

Reference Type BACKGROUND
PMID: 15383800 (View on PubMed)

Other Identifiers

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55238

Identifier Type: -

Identifier Source: org_study_id

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