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Chen SH, Yuan TM, Zhang J, Bai H, Tian M, Pan CX, Bao HG, Jin XJ, Ji FH, Zhong TD, Wang Q, Lv JR, Wang S, Li YJ, Yu YH, Luo AL, Li XK, Min S, Li L, Zou XH, Huang YG. Remimazolam tosilate in upper gastrointestinal endoscopy: A multicenter, randomized, non-inferiority, phase III trial. J Gastroenterol Hepatol 2021; 36:474-481. [PMID: 32677707 DOI: 10.1111/jgh.15188] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/10/2020] [Accepted: 07/12/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM Remimazolam tosilate (RT) is a new short-acting GABA(A) receptor agonist, having potential to be an effective option for procedural sedation. Here, we aimed to compare the efficacy and safety of RT with propofol in patients undergoing upper gastrointestinal endoscopy. METHODS This positive-controlled, non-inferiority, phase III trial recruited patients at 17 centers, between September 2017 and November 2017. A total of 384 patients scheduled to undergo upper gastrointestinal endoscopy were randomly assigned to receive RT or propofol. Primary endpoint was the success rate of sedation. Adverse events (AEs) were recorded to evaluate safety. RESULTS The success rate of sedation in the RT group was non-inferior to that in the propofol group (97.34% vs 100.00%; difference in rate -2.66%, 95% CI -4.96 to -0.36, meeting criteria for non-inferiority). Patients in the RT group had longer time to adequate sedation (P < 0.0001) but shorter time to fully alert (P < 0.0001) than that in the propofol group. The incidences of hypotension (13.04% vs 42.86%, P < 0.0001), treatment-related hypotension (0.54% vs 5.82%, P < 0.0001), and respiratory depression (1.09% vs 6.88%, P = 0.0064) were significantly lower in the RT group. AEs were reported in 74 (39.15%) patients in the RT group and 114 (60.32%) patients in the propofol group, with significant difference (P < 0.0001). CONCLUSION This trial established non-inferior sedation success rate of RT compared with propofol. RT allows faster recovery from sedation compared with propofol. The safety profile is favorable and appears to be superior to propofol, indicating that it was feasible and well tolerated for patients.
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Affiliation(s)
- Shao-Hui Chen
- Department of Anesthesiology, Chinese Academy of Medical College and Peking Union Medical College Hospital, Beijing, China
| | - Tang-Mi Yuan
- Department of Anesthesiology, Chinese Academy of Medical College and Peking Union Medical College Hospital, Beijing, China
| | - Jiao Zhang
- Department of Anesthesiology, Chinese Academy of Medical College and Peking Union Medical College Hospital, Beijing, China
| | - Hua Bai
- Clinical Pharmacology Research Center, Chinese Academy of Medical College and Peking Union Medical College Hospital, Beijing, China
| | - Ming Tian
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Chu-Xiong Pan
- Department of Anesthesiology, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Hong-Guang Bao
- Department of Anesthesiology, Nanjing First Hospital, Nanjing, China
| | - Xiao-Ju Jin
- Department of Anesthesiology, Yijishan Hospital of Wannan Medical College, Wuhu, China
| | - Fu-Hai Ji
- Department of Anesthesiology, The First Hospital of Soochow University, Suzhou, China
| | - Tai-Di Zhong
- Department of Anesthesiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qiang Wang
- Department of Anesthesiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jian-Rui Lv
- Department of Anesthesiology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Sheng Wang
- Department of Anesthesiology, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Yu-Juan Li
- Department of Anesthesiology, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yong-Hao Yu
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Ai-Lin Luo
- Department of Anesthesiology, Tongji Hospital, Wuhan, China
| | - Xiang-Kui Li
- Department of Anesthesiology, Sichuan Provincial People's Hospital, Chengdu, China
| | - Su Min
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lin Li
- Department of Anesthesiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Xiao-Hua Zou
- Department of Anesthesiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Yu-Guang Huang
- Department of Anesthesiology, Chinese Academy of Medical College and Peking Union Medical College Hospital, Beijing, China
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