Zhao et al. reported on a phase IIa, single-center, randomized, open-label, and dose-finding study that enrolled 35 patients under general anesthesia who received the neuromuscular blocking agent rocuronium for induction and maintenance of neuromuscular blockade. The subjects were randomized to one of the five adamgammadex dose groups (2, 4, 6, 8, and 10mg kg−1) and to the 4mg kg−1 sugammadex group. Pharmacological efficacy was the recovery time from the start of adamgammadex or sugammadex administration to train-of-four (TOF) ratio 0.9, 0.8, and 0.7 among the different dose groups. Adverse events were recorded throughout the study.
The efficacy in reversing deep neuromuscular block was the same between 4mg kg−1 sugammadex and adamgammadex. However, in the lowest dose groups of 2 and 4mg kg−1 adamgammadex, adequate reversal could not be achieved in all subjects.
The recovery time of TOF ratio to 0.9, 0.8, and 0.7 was shorter in the adamgammadex 10mg kg−1 group than in the sugammadex 4mg kg−1 group. The average values of the TOF ratio after 3min of administration of adamgammadex 8 and 10mg kg−1 and sugammadex 4mg kg−1 were >90%. There were no serious adverse events after the use of adamgammadex, and no subjects had to be withdrawn from the trial.
Adamgammadex enabled quick, predictable, and tolerable reversion of rocuronium-induced deep neuromuscular block in a dose-dependent manner. Adamgammadex doses of 6–10mg kg−1 might be the recommended dose range for further exploration of efficacy.
Zhao Y, Chen S, Huai X, Yu Z, Qi Y, Qing J, Yu W and Su D (2021) Efficiency and Safety of the Selective
Relaxant Binding Agent Adamgammadex Sodium for Reversing Rocuronium-Induced Deep Neuromuscular Block: A Single-Center, Open-Label, Dose-Finding, and Phase IIa Study. Front. Med. 8:697395. doi: 10.3389/fmed.2021.697395