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AsthmaPhase 2IMPACT-EDNCT05166811

Timely Intravenous Magnesium for Asthma in Children

A Phase 2 study testing Magnesium Sulfate, Heptahydrate and 0.9% saline in people with Asthma, run by University of Utah 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

Many children currently being hospitalized with severe asthma could potentially avoid hospitalization and be sent home if their treatment in the emergency department was more effective. Read more about this study

Who is it for?
Ages 2 to 17 years
Conditions the study is for
Asthma
What is being tested?
Magnesium Sulfate, Heptahydrate and 0.9% saline
Type of treatment
Injection or infusion
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
52 participants
Where
3 sitesUnited States
Study dates
12 Sep 2022to 31 Jul 2023
Phase
Phase 2
Are there results?
Yes, posted in the registrySummary in the doctors' view

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 2 to 17 years
  • All sexes
  • No healthy volunteers
  • Child

Who may be able to join

  • A prior physician diagnosis of asthma confirmed by a treating physician in the ED who has spoken with the patient and family and reviewed the medical record (ED attending or fellow physician)
  • Severe acute asthma, defined as a Pediatric Respiratory Assessment Measure (PRAM) score of 7 or greater as assessed by a treating physician at the time of screening using the study scoring instrument, which takes 60 seconds to complete
  • Children 2-17 years of age

Who cannot join

  • Known pregnancy (by patient or parent report) or positive pregnancy test on females 12 years of age and older
  • Age-adjusted hypotension at presentation using age-based Pediatric Advanced Life Support parameters (children >1 year to 10 years, systolic blood pressure (SBP)<(70 + 2 x age in years); >10 years, SBP < 90 mmHg)71
  • Known severe renal impairment (by parent or patient report)
  • Application of assisted ventilation before enrollment assessment (intubated, bi-level positive airway pressure, continuous positive airway pressure)
  • Received IVMg within 24 hours prior to screening (by parent or patient report or medical record review)
  • Enrollment assessment is 60 minutes after the start of ED treatment (start of first albuterol treatment)
  • Previous enrollment in the same trial (by research coordinator review of trial records)

Trial locations and contacts

3 sites in 1 country.

United States3 sites
  • Nationwide Children's Hospital

    Columbus, Ohio, 43205

  • Children's Hospital of Philadelphia

    Philadelphia, Pennsylvania, 19104

  • Primary Children's Hospital

    Salt Lake City, Utah, 84010

Other trials in United States

About this study

Official title: Intravenous Magnesium: Prompt Use for Asthma in Children Treated in the Emergency Department

Many children currently being hospitalized with severe asthma could potentially avoid hospitalization and be sent home if their treatment in the emergency department was more effective. The investigators will conduct a pilot trial that will lead to a larger study to conclusively answer whether a simple and inexpensive medicine, intravenous magnesium sulfate, can be used in the emergency department to prevent hospitalization for these children.

Read the detailed description

5.4.1 Acquisition The specific study agent to be used in this pilot trial is Magnesium Sulfate in Water for Injection, a sterile, nonpyrogenic solution of magnesium sulfate heptahydrate in water. Study agent will be acquired by each hospital's research pharmacy from Pfizer, Inc as a solution of magnesium sulfate in water at 80 mg/mL. Agent will be shipped directly from Pfizer to each study hospital pharmacy.

5.4.2 Preparation, Storage \& Labeling Doses for each IVMg arm will be prepared in identical manner, by drawing a specified volume of Intravenous Magnesium Sulfate (IVMg) from the commercial container using sterile technique and mixing in a polyvinylchloride container with a specified volume of sterile water. For the 50 mg/kg arm, this will be accomplished by mixing 25 mL of IVMg (80 mg/mL) with 15 mL of sterile water for a final concentration of 50 mg/mL and volume of 40 mL. For the 75 mg/kg arm, this will be accomplished by mixing 37.5 mL of IVMg (80 mg/mL) with 2.5 mL of sterile water for a final concentration of 75 mg/mL and volume of 40 mL. For the placebo arm, 40 mL of 0.9% sodium chloride solution will be drawn into a polyvinylchloride container identical in appearance to the containers used for the IVMg arms. Each prepared dose will be labeled according to the sequential randomization scheme and stored according to local pharmacy procedure. Unused doses prepared locally will be replaced after one week of storage.

5.4.3 Dosing Schedule

After randomization the institutional pharmacist will draw equivolumetric dosages (1 mL/kg, with max of 40 mL) from previously prepared vials. Enrolled subjects will be randomized to one of three arms:

  • IVMg 75 mg/kg arm: 75 mg/kg (max 3 gm) infused over 20 minutes through a peripheral IV catheter
  • IVMg 50 mg/kg arm: 50 mg/kg (max 2 gm) infused over 20 minutes through a peripheral IV catheter
  • Placebo arm: 1 mL/kg (max 40 ml) of normal saline over 20 minutes through a peripheral IV catheter 5.4.4 Dose Modification for Potential Toxicity Clinicians will not administer IVMg to enrolled subjects outside of the study protocol until study outcomes have been determined 2 hours after the start of the infusion. The half-life of IVMg is approximately 2 hours.49 Repeated-dose protocols in an ICU setting that gave as much as 125 mg/kg IVMg to children with asthma over two hours produced no hypotension or other serious adverse effects.47 Because of this margin of safety, open-label IVMg 50 mg/kg can be administered safely 2 hours after the study infusion under strict study monitoring protocols without need for unblinding.
Conditions
Asthma
Being tested
Magnesium Sulfate, Heptahydrate, 0.9% saline
Keywords
asthma, IV Magnesium
Medical subject headings
Asthma

What participants receive

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

  • Magnesium Sulfate, HeptahydrateDrug

    Also called Intravenous magnesium sulfate

    A single dose of intravenous magnesium sulfate given over 20 minutes through a peripheral intravenous line. Two arms of the study will deliver intravenous magnesium, one at a dose of 50 mg/kg, and the other at a dose of 75 mg/kg.

  • 0.9% salineDrug

    Also called normal saline, 0.9% sodium chloride

    A single dose of intravenous 0.9% sodium chloride given over 20 minutes through a peripheral intravenous line as the placebo arm of the study.

Study groups in NCT05166811
Study groupRoleWhat they receive
75 mg/kgActive comparatorDoses for each IVMg arm will be prepared in identical manner, by drawing a specified volume of IVMg from the commercial container using sterile technique and mixing in a polyvinylchloride container with a specified volume of sterile water. For the 75 mg/kg arm, this will be accomplished by mixing 37.5 mL of IVMg (80 mg/mL) with 2.5 mL of sterile water for a final concentration of 75 mg/mL and volume of 40 mL. After randomization the institutional pharmacist will draw dosages (1 mL/kg, with max of 40 mL) from previously prepared vials. The dose will be delivered by the clinical nurse over 20 minutes through a peripheral IV.
Receives: Drug: Magnesium Sulfate, Heptahydrate
50 mg/kgActive comparatorDoses for each IVMg arm will be prepared in identical manner, by drawing a specified volume of IVMg from the commercial container using sterile technique and mixing in a polyvinylchloride container with a specified volume of sterile water. For the 50 mg/kg arm, this will be accomplished by mixing 25 mL of IVMg (80 mg/mL) with 15 mL of sterile water for a final concentration of 50 mg/mL and volume of 40 mL. After randomization the institutional pharmacist will draw dosages (1 mL/kg, with max of 40 mL) from previously prepared vials. The dose will be delivered by the clinical nurse over 20 minutes through a peripheral IV.
Receives: Drug: Magnesium Sulfate, Heptahydrate
PlaceboPlacebo comparatorFor the placebo arm, 40 mL of 0.9% sodium chloride solution will be drawn into a polyvinylchloride container identical in appearance to the containers used for the IVMg arms. After randomization the institutional pharmacist will draw dosages (1 mL/kg, with max of 40 mL) from previously prepared vials. The dose will be delivered by the clinical nurse over 20 minutes through a peripheral IV.
Receives: Drug: 0.9% saline

What is being measured

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

  1. Enrollment

    The primary outcome in this pilot trial is demonstration of the ability to enroll severely ill children with asthma in a randomized trial requiring timely delivery of IVMg or placebo. The investigators anticipate that the primary outcome of the future large trial will be the proportion of children hospitalized at the index visit in each arm.

    Measured: 7 months of enrollment.

Secondary outcomes (24)
  1. Hospitalization

    Actual patient disposition from medical record review after completion of ED treatment. Hospitalization will be defined as any outcome other than discharge from the ED, including hospitalization in an ICU, hospital unit, or observation area.

    Measured: Actual disposition from chart review 1 week after enrollment.

  2. Hospitalization Anticipated by Treating Physician 2 Hours After Start of Study Infusion

    The treating clinician's stated disposition two hours after the start of study infusion.

    Measured: Physician-anticipated hospitalization 2 hours after the start of study drug infusion

  3. Adverse Events and Safety Profiles - Hypotension and Perfusion

    Decrease in blood pressure was categorized based on degree of associated symptoms and defined as occurring less than 2 hours after the start of study drug infusion or 2 hours and later. Hypotension is defined by age-based Pediatric Advanced Life Support guidelines.

    Measured: 2 hours after study drug infusion.

  4. Rescue Therapies Used During ED Care - SQ or IM Epinephrine

    Count of the number of participants that were administered subcutaneous (SQ) or intramuscular (IM) epinephrine while in the ED during the index visit, recorded by chart review approximately one week after enrollment.

    Measured: One week after enrollment

  5. Return ED Visit

    In patients discharged from the ED, any ED visit and/or hospitalization following discharge.

    Measured: Within 10 days after ED discharge

  6. Baseline Serum Magnesium

    Measured: At IV placement before infusion of study drug

  7. Baseline Ionized Magnesium

    Measured: At IV placement before infusion of study drug

  8. Post-infusion Serum Magnesium 1

    Measured: 20-40 minutes after the start of study drug infusion

  9. Post-infusion Ionized Magnesium 1

    Measured: 20-40 minutes after the start of study drug infusion

  10. Post-infusion Serum Magnesium 2

    Measured: 90-150 minutes after the start of study drug infusion

  11. Post-infusion Ionized Magnesium 2

    Measured: 90-150 minutes after the start of study drug infusion

  12. Rescue Therapies Used During ED Care - IV Epinephrine

    Count of the number of participants that were administered intravenous (IV) epinephrine while in the ED during the index visit, recorded by chart review approximately one week after enrollment.

    Measured: One week after enrollment

  13. Rescue Therapies Used During ED Care - IV Terbutaline

    Count of the number of participants that were administered intravenous (IV) terbutaline while in the ED during the index visit, recorded by chart review approximately one week after enrollment.

    Measured: One week after enrollment

  14. Rescue Therapies Used During ED Care - IV Magnesium

    Count of the number of participants that were administered intravenous (IV) magnesium while in the ED during the index visit aside from any study infusion administered, recorded by chart review approximately one week after enrollment.

    Measured: One week after enrollment

  15. Adverse Events and Safety Profiles - Supraventricular Tachycardia

    Adverse events were assessed through chart review and phone call with the parent of the participant one week after enrollment. Timing after start of study infusion was not recorded.

    Measured: 1 week

  16. Adverse Events and Safety Profiles - Abdominal Discomfort

    Adverse events were assessed through chart review and phone call with the parent of the participant one week after enrollment. Timing after start of study infusion was not recorded.

    Measured: 1 week

  17. Adverse Events and Safety Profiles - Vomiting

    Adverse events were assessed through chart review and phone call with the parent of the participant one week after enrollment. Timing after start of study infusion was not recorded.

    Measured: 1 week

  18. Adverse Events and Safety Profiles - Fatigue

    Adverse events were assessed through chart review and phone call with the parent of the participant one week after enrollment. Timing after start of study infusion was not recorded.

    Measured: 1 week

  19. Adverse Events and Safety Profiles - Hypokalemia

    Adverse events were assessed through chart review and phone call with the parent of the participant one week after enrollment. Timing after start of study infusion was not recorded.

    Measured: 1 week

  20. Adverse Events and Safety Profiles - Delirium

    Adverse events were assessed through chart review and phone call with the parent of the participant one week after enrollment. Timing after start of study infusion was not recorded.

    Measured: 1 week

  21. Adverse Events and Safety Profiles - Hypoxia

    Adverse events were assessed through chart review and phone call with the parent of the participant one week after enrollment. Timing after start of study infusion was not recorded.

    Measured: 1 week

  22. Adverse Events and Safety Profiles - Respiratory Distress

    Adverse events were assessed through chart review and phone call with the parent of the participant one week after enrollment. Timing after start of study infusion was not recorded.

    Measured: 1 week

  23. Adverse Events and Safety Profiles - Metabolic Acidosis

    Adverse events were assessed through chart review and phone call with the parent of the participant one week after enrollment. Timing after start of study infusion was not recorded.

    Measured: 1 week

  24. Adverse Events and Safety Profiles - Duodenal Ulcer Perforation

    Adverse events were assessed through chart review and phone call with the parent of the participant one week after enrollment. Timing after start of study infusion was not recorded.

    Measured: 1 week

Timeline

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

  1. First posted22 Dec 2021
  2. Study start12 Sep 2022
  3. Primary completion31 May 2023
  4. Study completion31 Jul 2023

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
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
Randomized, double-blind, placebo-controlled trial
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
52 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05166811
Sponsor's protocol ID
IRB 104082
Other IDs
1R34HL152047-01A1
Acronym
IMPACT-ED
Status last verified
Dec 2024
First submitted
23 Nov 2021
Last updated
18 Dec 2024
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No

Publications

  • Johnson MD, Barney BJ, Rower JE, Finkelstein Y, Zorc JJ. Intravenous Magnesium: Prompt Use for Asthma in Children Treated in the Emergency Department (IMPACT-ED): Protocol for a Multicenter Pilot Randomized Controlled Trial. JMIR Res Protoc. 2023 Jul 17;12:e48302. doi: 10.2196/48302.

    PubMed 37459153

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Magnesium Sulfate, Heptahydrate and 0.9% saline in people with Asthma, run by University of Utah 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 3 inclusion and 7 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 18 Dec 2024. 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?

Yes. Results are posted in the registry (first posted 18 Dec 2024). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

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?

Enrollment (time frame: 7 months of enrollment.). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05166811, which also lists 1 linked publication.

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 18 Dec 2024.

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