Dehydration
Conditions
Keywords
dehydration, fluid therapy, pediatrics, emergency medicine, hyaluronoglucosaminidase, hyaluronidase, hypodermoclysis, clysis, subcutaneous hydration, subcutaneous rehydration, hyaluronan, rHuPH20
Brief summary
The aim of the study is to evaluate the safety, effectiveness and ease of use of subcutaneous (SC) rehydration using HYLENEX-augmented SC infusion of fluids and electrolytes for the rehydration of pediatric patients with mild to moderate dehydration.
Detailed description
Pediatric patients (2 months to 10 years of age), presenting to the emergency department (ED) with mild to moderate dehydration and requiring parenteral rehydration, were treated with HYLENEX-augmented subcutaneous (SC) rehydration. An initial volume of 20 mL/kg of isotonic fluid was to be administered by continuous SC infusion over the first hour, and additional SC rehydration could be continued as clinically indicated. The preferred anatomic site for the SC infusion was the anterior thigh, unless there was an overriding preference for an alternate site. The duration of HYLENEX-augmented SC rehydration was to be a minimum of 1 hour and a maximum of 72 hours. The investigator or designee performed a clinical assessment of the subject's hydration status at baseline and at the end of SC infusion or at discharge from the ED. Other assessments of effectiveness and safety were made directly during the rehydration period and ED stay, and by telephone on Days 3 and 7 after discharge from the ED.
Interventions
DRUGhyaluronidase (human recombinant)/rehydration fluid
Single 150 U subcutaneous (SC) HYLENEX dose administered immediately prior to start of SC infusion of rehydration fluid. Additional 150 U HYLENEX dose to be administered prior to any additional fluid infusion beyond 24 hours.
Sponsors
Halozyme Therapeutics
PPD Development, LP
Baxter Healthcare Corporation
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
2 Months to 10 Years
Healthy volunteers
No
Inclusion criteria
* Child, 2 months to 10 years of age * Body weight less than 42 kg * Presenting at emergency department with mild to moderate dehydration (Gorelick dehydration classification: presence of 1 to 6 \[of possible 10\] moderate or severe signs and symptoms) requiring parenteral rehydration
Exclusion criteria
* In shock or life-threatening situation (other than dehydration) * Severe dehydration * Requires intravenous (IV) therapy for another indication * Indwelling IV catheter (excepting one intended strictly for clinical laboratory sample collection) * Already received rehydration therapy IV within prior 48 hours or substantial oral fluid immediately before enrollment * Condition precluding subcutaneous injection or infusion site evaluation in anterior thigh or other elected infusion site * Reason for hospital admission or extended emergency department stay other than dehydration * Known hypersensitivity to hyaluronidase or another ingredient in HYLENEX * Hyponatremia or hypernatremia * Hypokalemia * Medical condition likely to interfere with ability to fully complete study or have protocol-specified assessments * Medical history, screening examination finding or historical clinical laboratory result precluding safe participation in study or which might adversely effect interpretation of study results * Participated in study of any investigational drug or device within 30 days prior to this study
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| HYLENEX-facilitated Subcutaneous (SC) Rehydration Success | At emergency department discharge (mean time to discharge = 7.03 ± 7.57 hr) | Successfully rehydrated (as medically judged by treating physician) without rescue therapy (ie, without receiving fluids via an alternate route), and discharged to home |
| Modified HYLENEX-facilitated Subcutaneous (SC) Rehydration Success | At emergency department discharge (mean time to discharge = 7.03 ± 7.57 hr) | Successfully rehydrated (as medically judged by treating physician) without rescue therapy (ie, without receiving fluids via an alternate route), regardless of emergency department discharge destination |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of Attempts Needed to Successfully Place Subcutaneous (SC) Catheter | At end of placement of SC catheter | — |
| Post-treatment Gorelick Dehydration Score | At baseline and at either the end of subcutaneous infusion (mean duration = 5.73 ± 9.15 hr) or emergency department discharge (mean time to discharge = 7.03 ± 7.57 hr) | Score indicates the number of moderate-to-severe signs/symptoms of dehydration, based on assessment of each of the following 10 patient parameters: general condition, quality of radial pulse, quality of respiration, skin elasticity, eyes, tears, mucous membranes, urine output, heart rate and fingertip capillary refill time. Minimum score = 0; maximum score = 10. |
Participant flow
Recruitment details
Subjects recruited in emergency department after presenting with signs of mild to moderate dehydration
Participants by arm
| Arm | Count |
|---|---|
| HYLENEX-augmented Subcutaneous (SC) Rehydration Single 150 U subcutaneous (SC) HYLENEX dose administered immediately prior to start of SC infusion of rehydration fluid. Additional 150 U HYLENEX dose to be administered prior to any additional fluid infusion beyond 24 hours. | 51 |
| Total | 51 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Adverse Event | 1 |
| Overall Study | Parent withdrew consent | 2 |
Baseline characteristics
| Characteristic | HYLENEX-augmented Subcutaneous (SC) Rehydration |
|---|---|
| Age Categorical >= 2 months to < 3 years | 43 participants |
| Age Categorical >= 3 years to <= 10 years | 8 participants |
| Age Continuous | 1.91 years STANDARD_DEVIATION 1.949 |
| Gorelick Dehydration Score | 3.5 Number of moderate/severe symptoms STANDARD_DEVIATION 1.19 |
| Region of Enrollment United States | 51 participants |
| Sex: Female, Male Female | 22 Participants |
| Sex: Female, Male Male | 29 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 51 / 51 |
| serious Total, serious adverse events | 1 / 51 |
Outcome results
Primary
HYLENEX-facilitated Subcutaneous (SC) Rehydration Success
Successfully rehydrated (as medically judged by treating physician) without rescue therapy (ie, without receiving fluids via an alternate route), and discharged to home
Time frame: At emergency department discharge (mean time to discharge = 7.03 ± 7.57 hr)
Population: ITT (all treated patients)
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| HYLENEX-augmented Subcutaneous (SC) Rehydration | HYLENEX-facilitated Subcutaneous (SC) Rehydration Success | 43 participants |
Primary
Modified HYLENEX-facilitated Subcutaneous (SC) Rehydration Success
Successfully rehydrated (as medically judged by treating physician) without rescue therapy (ie, without receiving fluids via an alternate route), regardless of emergency department discharge destination
Time frame: At emergency department discharge (mean time to discharge = 7.03 ± 7.57 hr)
Population: ITT (all treated patients)
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| HYLENEX-augmented Subcutaneous (SC) Rehydration | Modified HYLENEX-facilitated Subcutaneous (SC) Rehydration Success | 48 participants |
Secondary
Number of Attempts Needed to Successfully Place Subcutaneous (SC) Catheter
Time frame: At end of placement of SC catheter
Population: ITT (all treated patients)
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| HYLENEX-augmented Subcutaneous (SC) Rehydration | Number of Attempts Needed to Successfully Place Subcutaneous (SC) Catheter | 1 attempt | 46 participants |
| HYLENEX-augmented Subcutaneous (SC) Rehydration | Number of Attempts Needed to Successfully Place Subcutaneous (SC) Catheter | 2 attempts | 5 participants |
Secondary
Post-treatment Gorelick Dehydration Score
Score indicates the number of moderate-to-severe signs/symptoms of dehydration, based on assessment of each of the following 10 patient parameters: general condition, quality of radial pulse, quality of respiration, skin elasticity, eyes, tears, mucous membranes, urine output, heart rate and fingertip capillary refill time. Minimum score = 0; maximum score = 10.
Time frame: At baseline and at either the end of subcutaneous infusion (mean duration = 5.73 ± 9.15 hr) or emergency department discharge (mean time to discharge = 7.03 ± 7.57 hr)
Population: ITT (all treated patients)
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| HYLENEX-augmented Subcutaneous (SC) Rehydration | Post-treatment Gorelick Dehydration Score | Actual Score | 0.5 No. moderate/severe symptoms (max = 10) | Standard Deviation 0.9 |
| HYLENEX-augmented Subcutaneous (SC) Rehydration | Post-treatment Gorelick Dehydration Score | Change from Baseline | -3.0 No. moderate/severe symptoms (max = 10) | Standard Deviation 1.2 |