PROfylactic Haloperidol in Patients Defined as High Risk for DElirium With Delirium Risk mOdel

NCT ID: NCT03199950

Last Updated: 2017-06-27

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

UNKNOWN

Clinical Phase

PHASE4

Total Enrollment

1366 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-06-23

Study Completion Date

2018-11-23

Brief Summary

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The hospital pharmacy at the Zuyderland Medical Centre developed the DElirium MOdel (DEMO) to predict which patients are at risk of developing a delirium in patients aged 60 or older. With this delirium risk prediction model we aim to predict more accurately which patients are at high risk of developing a delirium and want to investigate if these patients can benefit from prophylactic haloperidol.

Detailed Description

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Intro: Delirium is a common postoperative complication within geriatric patients. It is described delirium as a very stressful experience for the patient which can lead to prolonged hospital stay, higher cost, additional morbidity and increased mortality.

In 2013 the hospital pharmacy at the Zuyderland Medical Center developed the delirium risk prediction model to determine the chance of development of a delirium in patients aged 60 or older. Electronically available data such as age, polypharmacy, use of anti-dementia drugs, anti-depressants, anti-parkinsonian drugs, anti-diabetics, analgesics and/or sleeping medication were used in the study. The delirium risk prediction model was validated prospectively after retrospective development. The model will be used in this study to predict the risk of developing delirium postoperatively.

We expect prophylactic haloperidol to be effective in patients with a high risk of developing a delirium according to the delirium risk prediction model.

Aim: The PRODEO-study aims to reduce the incidence of postoperative delirium by administering prophylactic haloperidol to patients with a high risk of developing delirium according to the delirium risk prediction model.

Methods: The study is a randomized and double blind single center study with two parallel groups. Subjects ≥60 years with increased risk of postoperative delirium according to the delirium risk prediction model undergoing elective chirurgical or elective orthopedic surgery are eligible. Subjects will be excluded if they already use anti-psychotic drugs, are not able to take oral medication or when there are contra-indications. Haloperidol (1mg) or placebo will be administered at set times postoperatively. Subjects receive haloperidol 2dd1mg or a placebo 2dd during a maximum of five days during admission. On day 3 blood samples will be obtained in order to determine the true concentration levels of haloperidol. The primary endpoint is delirium incidence within 5 days after surgery. Secondary endpoints are costs of treatment, number of admission days, adverse events, true concentration levels of haloperidol and duration and severity of delirium.

Results: The study will start in June 2017 with an inclusion rate of 20 patients per week. An incidence reduction of 30% in the intervention group is expected. To reach sufficient statistical power a study population of 1366 subjects is needed. Duration of the inclusion period is expected to be 18 months.

Conditions

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Delirium

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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Prophylactic Haloperidol arm

Patients will receive oral haloperidol 2dd1mg (08.00am \& 10.00pm)

Group Type EXPERIMENTAL

Haloperidol

Intervention Type DRUG

Haloperidol 2dd1mg (08.00am - 10.00pm)

No treatment

Patients will receive oral placebo 2dd (08.00am \& 10.00pm)

Group Type PLACEBO_COMPARATOR

Placebo Oral Tablet

Intervention Type DRUG

Placebo oral 2dd (08.00am - 10.00pm)

Interventions

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Haloperidol

Haloperidol 2dd1mg (08.00am - 10.00pm)

Intervention Type DRUG

Placebo Oral Tablet

Placebo oral 2dd (08.00am - 10.00pm)

Intervention Type DRUG

Other Intervention Names

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Haldol RVG 55776

Eligibility Criteria

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Inclusion Criteria

* Age \>60 years
* Planned elective surgery
* General surgery or orthopaedic surgery
* At least one night postsurgical admission
* High-risk developing delirium according to the DEMO-model
* Absence of delirium pre-operatively

Exclusion Criteria

* Less than 1-day postoperative admission in hospital
* Hypersensitivity to butyrophenone derivates
* Use of antipsychotics
* Not being able to take oral medication
* Presence of contraindications (lesions of basal ganglia, clinical significant heart disease (eg. recent acute myocardial infarction, non-compensated heart failure, arrythmias treated with drugs out of the NYHA(New York Heart Association)-class Ia and II anti-arrythmics), known prolongation of the QT interval, history of ventricular arrythmia and torsades de pointes, uncorrected hypokalemia.
Minimum Eligible Age

60 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Zuyderland Medisch Centrum

OTHER

Sponsor Role lead

Responsible Party

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Hugo Van der Kuy

Principle Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Hugo van der Kuy

Role: PRINCIPAL_INVESTIGATOR

Zuyderland MC

Locations

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Zuyderland Medisch Centrum

Sittard, Limburg, Netherlands

Site Status RECRUITING

Countries

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Netherlands

Central Contacts

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Hugo van der Kuy

Role: CONTACT

088 4595945 ext. 0031

Facility Contacts

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Site sub-investigator

Role: primary

088-4595947

References

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Inouye SK, Studenski S, Tinetti ME, Kuchel GA. Geriatric syndromes: clinical, research, and policy implications of a core geriatric concept. J Am Geriatr Soc. 2007 May;55(5):780-91. doi: 10.1111/j.1532-5415.2007.01156.x.

Reference Type BACKGROUND
PMID: 17493201 (View on PubMed)

Demeure MJ, Fain MJ. The elderly surgical patient and postoperative delirium. J Am Coll Surg. 2006 Nov;203(5):752-7. doi: 10.1016/j.jamcollsurg.2006.07.032. Epub 2006 Sep 26. No abstract available.

Reference Type BACKGROUND
PMID: 17084339 (View on PubMed)

Salluh JI, Wang H, Schneider EB, Nagaraja N, Yenokyan G, Damluji A, Serafim RB, Stevens RD. Outcome of delirium in critically ill patients: systematic review and meta-analysis. BMJ. 2015 Jun 3;350:h2538. doi: 10.1136/bmj.h2538.

Reference Type BACKGROUND
PMID: 26041151 (View on PubMed)

Leslie DL, Marcantonio ER, Zhang Y, Leo-Summers L, Inouye SK. One-year health care costs associated with delirium in the elderly population. Arch Intern Med. 2008 Jan 14;168(1):27-32. doi: 10.1001/archinternmed.2007.4.

Reference Type BACKGROUND
PMID: 18195192 (View on PubMed)

Fukata S, Kawabata Y, Fujisiro K, Katagawa Y, Kuroiwa K, Akiyama H, Terabe Y, Ando M, Kawamura T, Hattori H. Haloperidol prophylaxis does not prevent postoperative delirium in elderly patients: a randomized, open-label prospective trial. Surg Today. 2014 Dec;44(12):2305-13. doi: 10.1007/s00595-014-0859-7. Epub 2014 Feb 16.

Reference Type BACKGROUND
PMID: 24532143 (View on PubMed)

Wang W, Li HL, Wang DX, Zhu X, Li SL, Yao GQ, Chen KS, Gu XE, Zhu SN. Haloperidol prophylaxis decreases delirium incidence in elderly patients after noncardiac surgery: a randomized controlled trial*. Crit Care Med. 2012 Mar;40(3):731-9. doi: 10.1097/CCM.0b013e3182376e4f.

Reference Type BACKGROUND
PMID: 22067628 (View on PubMed)

de Wit HA, Winkens B, Mestres Gonzalvo C, Hurkens KP, Mulder WJ, Janknegt R, Verhey FR, van der Kuy PH, Schols JM. The development of an automated ward independent delirium risk prediction model. Int J Clin Pharm. 2016 Aug;38(4):915-23. doi: 10.1007/s11096-016-0312-7. Epub 2016 May 13.

Reference Type BACKGROUND
PMID: 27177868 (View on PubMed)

Other Identifiers

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2017-001260-37

Identifier Type: EUDRACT_NUMBER

Identifier Source: secondary_id

17-T-31

Identifier Type: -

Identifier Source: org_study_id

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