NH600001, an etomidate analogue, provides gastrointestinal endoscopy sedation/anesthesia and reduces adrenocortical depression: two randomized controlled trials

To evaluate the efficacy and safety of NH600001, a novel etomidate derivative, in gastrointestinal endoscopy, as well as its impact on adrenocortical function, two multicenter, double-blind, randomized, controlled clinical trials(NH600001-21 [Phase II trial] and NH600001-31 [Phase III trial]) were conducted in China. In NH600001-21, 160 gastroscopy subjects were randomized 1:1:1:1 to receive NH600001 (0.20, 0.25, or 0.30 mg/kg) and etomidate (0.30 mg/kg). In NH600001-31, 344 gastroscopy or colonoscopy subjects were randomized in a 1:1 ratio to receive NH600001 (0.25 mg/kg) and etomidate (0.30 mg/kg). The primary efficacy outcome was the rate of endoscopic success. Additionally, Safety and effects on adrenocortical function were also assessed. In NH600001-21, the 0.25 mg/kg NH600001 showed non-inferiority to etomidate based on the prespecified non-inferiority margin of −8% (Rate Difference [95% confidence interval], 5.0[−4.49 to 14.49]), whereas the 0.20 mg/kg and 0.30 mg/kg NH600001 did not meet statistical non-inferiority criteria (0[−11.54 to 11.54]; 0[−11.54 to 11.54]). The area under curve (AUC) of plasma cortisol change values within 0-4 h (∆Cortisol AUC0-4h) were significantly higher in the NH600001 treatment groups than in the etomidate group (P < 0.01). In NH600001-31, NH600001 (0.25 mg/kg) showed non-inferiority to etomidate (1.16[−0.44 to 2.76]). ∆Cortisol AUC0-4h in the NH600001 group, versus the etomidate group, were significantly higher (P < 0.001). Furthermore, NH600001 had a safety profile comparable to etomidate and elicited fewer myoclonus adverse events. In Conclusions, NH600001 has a sedative/anesthetic effect comparable to etomidate while reducing the risk of adrenocortical depression with a favorable safety profile. Chictr.org.cn identifier: ChiCTR2300069841, ChiCTR2400084095. Clinical Trial Number and Registry URL: NH60001-21, Identifier, ChiCTR2300069841 (Changsha, China;, principal investigator: Wen Ouyang, first registration date: March 28, 2023), https://www.chictr.org.cn; NH60001-31, Identifier, ChiCTR2400084095 (Changsha, China, principal investigator: Wen Ouyang, first registration date: May 10, 2024), https://www.chictr.org.cn. The authors conducted two trials to evaluate the efficacy and safety of NH600001, an etomidate derivative, in gastrointestinal endoscopy. The results showed NH600001 has a sedative effect while reducing the risk of adrenocortical depression.