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CataractPhase 2NCT05133518

A Study of MELT-300 (Midazolam and Ketamine Sublingual Tablets) for Sedation and Intraoperative Ocular Analgesia in Participants Undergoing Cataract Extraction With Lens Replacement (CELR)

A Phase 2 study testing MELT-300, Midazolam alone and Ketamine alone in people with Cataract, run by Melt Pharmaceuticals at 3 sites in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The primary purpose of the study is to evaluate the efficacy and safety of MELT-300 (Midazolam and Ketamine Sublingual Tablets) and the contribution of midazolam and ketamine components to sedation and during the surgery or ocular analgesia in participants undergoing cataract surgery with lens replacement. Read more about this study

Who is it for?
Ages 55 years and older
Conditions the study is for
Cataract
What is being tested?
MELT-300, Midazolam alone and Ketamine alone
Type of treatment
Pill or oral medicine
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
338 participants
Where
3 sitesUnited States
Study dates
20 Jul 2021to 3 Nov 2022
Phase
Phase 2
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 55 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • 1. Are to undergo unilateral primary uncomplicated CELR under topical anesthesia, with a phacoemulsification device and insertion of an intraocular lens.

Who cannot join

  • Participants scheduled for simultaneous bilateral or 2nd-eye cataract surgery (note, subjects scheduled for a future 2nd eye cataract study are eligible for the study).
  • Known sensitivity to benzodiazepines or ketamine.
  • Known sensitivity to -caines (including proparacaine), benzalkonium chloride (BAK).
  • Intraocular pressure (IOP) ≥ 23 mmHg in the study eye and/or ≥ 30 mmHg in the fellow eye at screening. This IOP exclusion requirement will only need to be re-confirmed on the day of surgery if it has been > 14 days since the screening visit.
  • History of iritis, or any ocular trauma with iris damage in the study eye.
  • Presence of active corneal pathology other than corneal pathology per slit lamp and an external eye exam at screening in either eye.
Show all 18Show fewer
  • Presence of extraocular/intraocular inflammation in either eye.
  • Presence of active bacterial and/or viral infection in either eye.
  • History of intraocular non-laser surgery in the study eye within the 3 months prior to day of surgery, or intraocular laser surgery in the study eye within 30 days prior to the day of surgery.
  • Require or are planning other additional ocular surgery during the cataract surgery.
  • 12. Have a history or clinical manifestations (e.g., signs, symptoms, laboratory values, diagnostic imaging, etc.) of significant gastrointestinal, cardiovascular, hepatic, renal, hematological, endocrine, neurological, psychiatric, respiratory, or other medical condition that in the opinion of the investigator might confound the study results or pose additional risk in administering the study procedures.
  • 13. History of or presence of any connective tissue disorder (i.e., lupus, rheumatoid arthritis, fibromyalgia).
  • 14. Use of disallowed medications, including the following:
  • Pain medication (opioids, non-steroidal anti-inflammatory drugs [NSAIDs], cyclooxygenase-2 [COX-2] inhibitors, tramadol, ketamine, clonidine, gabapentin, pregabalin, or cannabinoids) within 3 days prior to Day 1, or routine, daily opioid therapy within the past 30 days.
  • Central nervous system (CNS) active drugs such as benzodiazepines, tricyclic antidepressants, serotonin, and norepinephrine reuptake inhibitors (SNRIs), or selective serotonin reuptake inhibitors (SSRIs) for pain within 7 days prior to Day 1. These drugs are permitted for non-pain indications if the dose has been stable for at least 30 days prior to Day 1 and is planned to remain stable throughout the study. The use of lorazepam and other sleep medications, except those containing analgesic properties, is permitted.
  • Use of parenteral or oral corticosteroid(s) within 14 days prior to Day 1.
  • Antihypertensive agent or diabetic regimen at a dose that has not been stable for at least 30 days, or which is not expected to remain stable throughout the study.
  • 15. Chronic pain rated moderate to severe within the past week (4-pt categorical scale, 0=no pain, 1=mild pain, 2=moderate pain, 3=severe pain). 17. Hospital Depression and Anxiety Scale (HADS) score > 10

Trial locations and contacts

3 sites in 1 country.

United States3 sites
  • Levenson Eye Associates

    Jacksonville, Florida, 32204

  • Martel Eye Medical Group

    Rancho Cordova, California, 95670

  • Vance Thompson Vision

    West Fargo, North Dakota, 58078

Other trials in United States

About this study

Official title: A Phase 2, Factorial-Designed, Randomized, Double-Blind, Placebo-Controlled, Parallel- Cohort Study to Evaluate Efficacy and Safety of MELT-300 and the Contribution of Midazolam and Ketamine Components to Sedation and Intraoperative Ocular Analgesia in Subjects Undergoing Cataract Extraction With Lens Replacement (CELR)

The primary purpose of the study is to evaluate the efficacy and safety of MELT-300 (Midazolam and Ketamine Sublingual Tablets) and the contribution of midazolam and ketamine components to sedation and during the surgery or ocular analgesia in participants undergoing cataract surgery with lens replacement.

Read the detailed description

This is a Phase 2, factorial-designed, randomized, double-blind, placebo-controlled, parallel-cohort study to be conducted in 324 adult male and female participants who are ≥ 55 years of age and undergoing cataract extraction with lens replacement. An additional 3 participants per site (first 3 participants enrolled per site) will be considered sentinel participants for the purpose of ensuring safety and that logistical and operational challenges that may occur during the study are identified and mitigated. Sentinel participants will be evaluated for safety but not for efficacy. The study aims to evaluate the efficacy and safety of MELT-300 and the contribution of midazolam and ketamine components for procedural sedation prior to cataract surgery. In the study, eligible study participants will be randomly assigned (1:1:1:1 ratio) to one of the following treatments: MELT-300 (3 mg/50 mg), midazolam 3 mg, ketamine 50 mg, and placebo sublingual tablet 30 (± 5) minutes prior to the anticipated start of surgery (defined as instillation of topical ocular anesthetic drops [i.e., proparacaine]) without food or water in the operating room. At the time of dosing, participants will be instructed to hold the tablet under their tongue until it is completely dissolved and to not swallow or chew the tablets. The study duration will be up to 35 days, including 28 days for screening and 7 ± 2 days after surgery.

Efficacy assessments will be performed after study medication administration before surgery, intraoperatively, and postoperatively on Day 1 (end of surgery defined as drape removal). Efficacy assessments will include assessments of sedation and intraoperative pain, the need for rescue medication for sedation or pain, and the ability to complete the surgery. Safety will be monitored at baseline, intraoperatively, postoperatively on Day 1, on the day after surgery (Day 2, via a phone call), and at 1 week (Day 8 ± 2 days) after dosing of study medication. Safety assessments will include monitoring of AEs, vital sign measurements, physical examinations, and 12-lead ECGs. Exploratory endpoints are postoperative pain as measured by the NPRS prior to discharge, 6 hours +/- 30 minutes after the end of surgery on Day 1 and on Days 2 (the day after surgery), the percentage of participants with concomitant medication opioid use, and average opioid consumption on Day 2 and participant likelihood of wanting study drug again for second cataract surgery as measured by an 11-point Likert scale on Day 2.

Conditions
Cataract
Being tested
MELT-300, Midazolam alone, Ketamine alone, Placebo
Keywords
Cataract surgery, Intraocular pressure, Intraoperative ocular pain, Sedation, Lens replacement, MELT-300, Cataract extraction
Medical subject headings
Cataract

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • MELT-300Drug

    Sublingual tablet

  • Midazolam aloneDrug

    Sublingual tablet

  • Ketamine aloneDrug

    Sublingual tablet

  • PlaceboDrug

    Sublingual tablet

Study groups in NCT05133518
Study groupRoleWhat they receive
MELT-300Active comparatorParticipants will receive a single dose of MELT-300 sublingual, rapidly dissolving tablet containing 3 mg of midazolam and 50 mg of ketamine.
Receives: Drug: MELT-300
Midazolam aloneActive comparatorParticipants will receive a single dose of midazolam 3 mg sublingual tablet.
Receives: Drug: Midazolam alone
Ketamine aloneActive comparatorParticipants will receive a single dose of ketamine 50 mg sublingual tablet.
Receives: Drug: Ketamine alone
PlaceboPlacebo comparatorParticipants will receive a single dose of a matching placebo sublingual tablet.
Receives: Drug: Placebo

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Percentage of Participants with Success for Procedural Sedation by Using Ramsay Sedation Scale

    The Ramsay Sedation Scale (RSS) was the first scale to be defined for the sedated participants and was designed as a test of arousability. The Ramsay Scale provides three levels of 'awake' states (score 1-3) and three levels of 'asleep' states (score 4-6). A score of 2 (participant is cooperative, orientated, and tranquil) best fits an optimum sedation level based on the criteria of calm, comfortable, communicative, and cooperative participants.

    Ramsay Sedation Scale

    1. =Participant is anxious and agitated or restless, or both
    2. =Participant is cooperative, oriented, and tranquil
    3. =Participant responds to commands only
    4. =Participant exhibits brisk response to a light glabellar tap or loud auditory stimulus
    5. =Participant exhibits a sluggish response to a light glabellar tap or loud auditory stimulus
    6. =Participants exhibits no response RSS score will be assessed pre-operatively, intra-operatively, and post-operatively on Day 1

    Measured: Day 1

  2. Mean Intraoperative Analgesia as Measured by the Numeric Pain Rating Scale

    The Numeric Pain Rating Scale (NPRS) is a segmented numeric version of the visual analog scale (VAS) in which a respondent selects a whole number (0-10 integers) that best reflects the intensity of his/her pain. The 11-point numeric scale ranges from '0' representing one pain extreme (e.g. "no pain") to '10' representing the other pain extreme (e.g. "pain as bad as you can imagine" or "worst pain imaginable")

    Measured: Intraoperatively on Day 1

Secondary outcomes (10)
  1. Percentage of Pre-operative Target Sedation Responders by Ramsay Sedation Scale (level 2 or 3)

    The Ramsay Sedation Scale (RSS) was the first scale to be defined for the sedated participants and was designed as a test of arousability. The Ramsay Scale provides three levels of 'awake' states (score 1-3) and three levels of 'asleep' states (score 4-6). A score of 2 (participant is cooperative, orientated, and tranquil) best fits an optimum sedation level based on the criteria of calm, comfortable, communicative, and cooperative participants.

    Ramsay Sedation Scale

    1. =Participant is anxious and agitated or restless, or both
    2. =Participant is cooperative, oriented, and tranquil
    3. =Participant responds to commands only
    4. =Participant exhibits brisk response to a light glabellar tap or loud auditory stimulus
    5. =Participant exhibits a sluggish response to a light glabellar tap or loud auditory stimulus
    6. =Participants exhibits no response

    Measured: Pre-operatively (at baseline), intra-operatively and post-operatively on Day 1

  2. Percentage of Analgesia Responders Using Numeric Pain Rating Scale

    The Numeric Pain Rating Scale (NPRS) is a segmented numeric version of the visual analog scale (VAS) in which a respondent selects a whole number (0-10 integers) that best reflects the intensity of his/her pain. The 11-point numeric scale ranges from '0' representing one pain extreme (e.g. "no pain") to '10' representing the other pain extreme (e.g. "pain as bad as you can imagine" or "worst pain imaginable").

    Measured: Pre-operatively (at baseline), intra-operatively and post-operatively on Day 1

  3. Number of Participants with Sedation Scores

    The Ramsay Sedation Scale (RSS) was the first scale to be defined for the sedated participants and was designed as a test of arousability. The Ramsay Scale provides three levels of 'awake' states (score 1-3) and three levels of 'asleep' states (score 4-6). A score of 2 (participant is cooperative, orientated, and tranquil) best fits an optimum sedation level based on the criteria of calm, comfortable, communicative, and cooperative participants.

    Ramsay Sedation Scale

    1. =Participant is anxious and agitated or restless, or both
    2. =Participant is cooperative, oriented, and tranquil
    3. =Participant responds to commands only
    4. =Participant exhibits brisk response to a light glabellar tap or loud auditory stimulus
    5. =Participant exhibits a sluggish response to a light glabellar tap or loud auditory stimulus
    6. =Participants exhibits no response

    Measured: After study medication administration before surgery (baseline), intraoperatively, and postoperatively on Day 1 (end of surgery defined as drape removal)

  4. Number of Participants with Pain Scores

    Measured: Before dosing on the day of surgery (Day 1)

  5. Number of Participants-rated Worst Pain Following Completion of Surgery

    Measured: Pre-operatively (at baseline), intra-operatively, and post-operatively on Day 1

  6. Percentage of Participants Able to Complete Surgery

    Measured: Pre-operatively (at baseline), intra-operatively and post-operatively on Day 1

  7. Percentage of Participants Without Interruption of Surgery for Intervention (Other Than Rescue Medication) Due to Pain or Anxiety

    Measured: Pre-operatively (at baseline), intra-operatively, and post-operatively on Day 1

  8. Percentage of Participants Requiring Rescue Sedative Medication

    The preoperative target level of sedation for this trial is Ramsay Sedation Scale (RSS) 2 or 3. If a participant does not achieve this level of sedation prior to the start of surgery (administration of topical local anesthesia), rescue sedation medication (i.e., intravenous midazolam only, at a dose determined by Investigator or anesthesiologist) may be given. Use of rescue sedation medication during surgery will be allowed if a participant's RSS score is <2.

    Measured: Pre-operatively (at baseline) and Intra-operatively on Day 1

  9. Percentage of Participants Requiring Rescue Analgesic Medication

    Intraoperative pain assessments using the Numeric Pain Rating Scale (NPRS) scale, from 0 (no pain) to 10 (extreme pain), will be assessed.

    The NPRS is a segmented numeric version of the visual analog scale (VAS) in which a respondent selects a whole number (0-10 integers) that best reflects the intensity of his/her pain. The 11-point numeric scale ranges from '0' representing one pain extreme (e.g. "no pain") to '10' representing the other pain extreme (e.g. "pain as bad as you can imagine" or "worst pain imaginable").

    Measured: After study medication administration before surgery (baseline) and intraoperatively

  10. Number of Participants Reported with At least One Treatment Emergent Adverse Event (TEAE)

    A treatment-emergent adverse event is defined as any event not present prior to the initiation of the drug treatment or any event already present that worsens in either intensity or frequency following exposure to the drug treatment.

    Measured: Pre-operatively (at baseline), intra-operatively post-operatively on Day 1, on the day after surgery (Day 2, via a phone call), and at 1 week (Day 8 ± 2 days) after dose of study medication

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted24 Nov 2021
  2. Study start20 Jul 2021
  3. Primary completion26 Oct 2022
  4. Study completion3 Nov 2022

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Model description
Factorial-designed, randomized, double-blind, placebo-controlled, parallel-cohort safety and efficacy study.
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
338 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05133518
Sponsor's protocol ID
MELT-2-001
Status last verified
Dec 2022
First submitted
12 Nov 2021
Last updated
19 Dec 2022
Results posted
No
Data monitoring committee
No
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing MELT-300, Midazolam alone and Ketamine alone in people with Cataract, run by Melt Pharmaceuticals at 3 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 1 inclusion and 18 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 19 Dec 2022. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 3 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Percentage of Participants with Success for Procedural Sedation by Using Ramsay Sedation Scale (time frame: Day 1). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 19 Dec 2022.

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