Olanzapine Versus Haloperidol for Treatment of Delirium in Patients with Advanced Cancer: A Phase III Randomized Clinical Trial. (8th December 2019)

• Record Type: Journal Article
• Authors: van der Vorst, Maurice J.D.L.; Neefjes, Elisabeth C.W.; Boddaert, Manon S.A.; Verdegaal, Bea A.T.T.; Beeker, Aart; Teunissen, Saskia C.C.; Beekman, Aartjan T.F.; Wilschut, Janneke A.; Berkhof, Johannes; Zuurmond, Wouter W.A.; Verheul, Henk M.W.
• Is Part Of: Oncologist. Volume 25:Number 3(2020)
• Page Start: e570
• Page End: e577
• Publication Date: 2019-12-08
• Subjects: Delirium -- Advanced cancer -- Haloperidol -- Olanzapine -- Efficacy -- Safety -- Phase III; Oncology -- Periodicals; Tumors -- Periodicals; Cancérologie -- Périodiques; Tumeurs -- Périodiques; Oncology; Tumors; Neoplasms; Electronic journals; Periodicals; Periodicals; 616.994
• DOI: 10.1634/theoncologist.2019-0470
• Languages: English
• ISSNs: 1083-7159

Abstract

Abstract: Background: Treatment of delirium often includes haloperidol. Second‐generation antipsychotics like olanzapine have emerged as an alternative with possibly fewer side effects. The aim of this multicenter, phase III, randomized clinical trial was to compare the efficacy and tolerability of olanzapine with haloperidol for the treatment of delirium in hospitalized patients with advanced cancer. Materials and Methods: Eligible adult patients (≥18 years) with advanced cancer and delirium (Delirium Rating Scale‐Revised‐98 [DRS‐R‐98] total score ≥17.75) were randomized 1:1 to receive either haloperidol or olanzapine (age‐adjusted, titratable doses). Primary endpoint was delirium response rate (DRR), defined as number of patients with DRS‐R‐98 severity score <15.25 and ≥4.5 points reduction. Secondary endpoints included time to response (TTR), tolerability, and delirium‐related distress. Results: Between January 2011 and June 2016, 98 patients were included in the intention‐to‐treat analysis. DRR was 45% (95% confidence interval [CI], 31–59) for olanzapine and 57% (95% CI, 43–71) for haloperidol (Δ DRR −12%; odds ratio [OR], 0.61; 95% CI, 0.2–1.4; p = .23). Mean TTR was 4.5 days (95% CI, 3.2–5.9 days) for olanzapine and 2.8 days (95% CI, 1.9–3.7 days; p = .18) for haloperidol. Grade ≥3 treatment‐related adverse events occurred in 5 patients (10.2%) and 10 patients (20.4%) in the olanzapine and haloperidol arm, respectively. Distress rates were similar in both groups. The study was terminated early because of futility. Conclusion: Delirium treatment with olanzapine in hospitalized patients with advanced cancer did not result in improvement of DRR or TTR compared with haloperidol. Clinical trial identification number . NCT01539733. Dutch Trial Register . NTR2559. Abstract : Pharmacological interventions for the treatment of delirium in patients with cancer is controversial. This article compares olanzapine and haloperidol for the treatment of delirium in hospitalized patients with advanced cancer.