Safety of remimazolam in comparison with midazolam for colonoscopy: A systematic review and meta-analysis

Background Remimazolam is an ester-based ultra-short-acting benzodiazepine that efficiently achieves sedation within a short period and is now being assessed as a suitable alternative to midazolam. This meta-analysis aims to pool the available data assessing and focusing on the safety aspect of remimazolam compared with midazolam. Methods A multi-center randomized control trial for patients undergoing endoscopic procedures like colonoscopy was conducted, comparing remimazolam to placebo for the midazolam group as the intervention group. The safety of remimazolam was the primary endpoint of this meta-analysis. Results A total of 3 studies were included. The total study population was 697, including the placebo, remimazolam, and midazolam groups. The types of studies included are i. randomized, double-blind, parallel-group, active-controlled clinical trial ii. prospective, randomized, parallel-group study comparing remimazolam to placebo (blindly), RCT, and iii. prospective, double-blind, randomized, parallel-group study RCT.; Treatment-emergent adverse effects included vascular disorders (P=0.42), cardiac disorders (p=0.06), respiratory, thoracic, and mediastinal disorders (p=0.26), infections and infestations (0.88), hematologic abnormalities such as anemia (p=0.63), and derangements in Blood pressure (systolic p=0.47 and diastolic p=0.68 and respiratory parameters (p=0.34). Analysis of the reported data suggests that the remimazolam group had a significantly higher incidence of treatment-emergent adverse effects compared to the midazolam group (RR: 0.84; 95% CI [0.78, 0.91]; P <0.00001; I2 = 5%). Conclusions In conclusion, this meta-analysis of three randomized controlled trials showed outcomes favoring both remimazolam and midazolam as successful sedatives, yet the higher requirement of top-up dosage and rescue sedatives in the midazolam group indicates that remimazolam can be used as its replacement, especially in colonoscopy procedures.