E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Patients who present with high-risk non-ST-segment elevation acute coronary syndrome who are planned to undergo an invasive strategy no sooner than the next calendar day following randomization. |
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MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 6.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10051592 |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
The primary objective of this study is to demonstrate the superiority of early eptifibatide, administered as a double bolus plus infusion, compared to placebo (with provisional use of eptifibatide in the catheterisation laboratory) in reducing the composite of death, myocardial infarction (MI), recurrent ischemia requiring urgent revascularisation (RI-UR), and thrombotic bail-out (TBO) within 96 hours of randomisation in patients with high-risk non-ST-segment elevation acute coronary syndrome (NSTE ACS) who are planned to be managed with an invasive strategy after receiving study drug for 12 to 96 hours. |
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E.2.2 | Secondary objectives of the trial |
The secondary objectives are to demonstrate the superiority of early eptifibatide use compared to placebo (with provisional use of eptifibatide in the catherisation laboratory) in this setting, in reducing the following: - The composite of death and MI within 30 days - The composite of death, MI and RI-UR within 30 days - The composite of death and MI within 96 hours - The occurrence of MI within 96 hours - The occurrence of death within 30 days Additionally the occurrence of death at 6 months and 1 year will be examined. |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. 18 years of age or older. 2. Willing and able to give informed consent. The patient must be able to comply with study procedures and follow-up through 1 year 3. Experiencing symptoms of cardiac ischemia at rest (angina or anginal equivalent) with episode(s) lasting at least 10 minutes within 24 hours of randomisation and have at least 2 of the following: - Electrocardiogram (ECG) changes: • New or presumable new ST-segment depression > or =0.1 mV or transient (<30minutes) ST-segment elevation > or = 0.1mV in at least 2 contiguous leads - Elevated troponin I or T greater than the established criteria at site or creatine kinase-MB fraction (CK-MB) greater than the site's upper limit of normal (ULN) - 60 years of age or older. Or have all 3 of the following: o Prior history of cardiovascular disease (eg, prior MI, PCI, CABG, >50% coronary artery stenosis by angiography, ischemia present on exercisestress imaging or pharmacologic-stress imaging study, peripheral vascular disease [PVD] with symptoms and objective evidence [eg, ankle brachial index {ABI} ≥0.9], non-hemmorhagic CVA) o Elevated troponin I or T greater than the established criteria at each site or CK-MB greater than the site’s ULN o 50-59 years of age 4. Able to be randomised within 12 hours of presentation and plan to undergo an invasive strategy no sooner than the next calendar day following randomisation.
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E.4 | Principal exclusion criteria |
1. Pregnancy-known or suspected-premenopausal females must have a confirmed negative urine or serum pregnancy test before study enrolment 2. Renal dialysis within 30 days prior to randomisation 3. Other serious illness (eg, active cancer within 5 years, sepsis) or any condition that the investigator feels would pose a significiant hazard to the patient if the investigational therapy was to be initiated. 4. History of a hemorrhagic stroke at any time or non-hemorrhagic stroke of any etiology within 7 days; central nervous system structural damage (eg, neoplasm, aneurysm, intracranial surgery);any recent severe head or facial trauma. 5. History of a bleeding diathesis, including documented gastrointestinal (GI) bleeding or any history of clinically significant GI bleeding, or evidence of active abnormal bleeding within 30 days prior to randomisation or an international normalised ratio (INR) >1.8 due to treatment with an oral anticoagulant or underlying coagulopathy. 6. Major surgery, biopsy of a parenchymal organ, or significant trauma within 14 days prior to randomisation 7. History of heparin or eptifibatide induced thrombocytopenia or a platelet count of <100,000 mm3. Platelet count should be confirmed by drawing a second blood sample. 8. Intent to use a direct prothrombin inhibitor, factor Xa inhibitor, low molecular weight heparin other than enoxaparin, or any other anticoagulant other than UFH or enoxaparin. (Exception: warfarin after completion of study drug infusion is permitted in patients with an indication for oral anticoagulation. 9. Recent therapy with a GP IIB/IIIa inhibitor; abciximab within 24 hours prior to randomisation, or eptifibatide, tirofiban, or other agent within 4 hours prior to randomisation. 10 Known hypersensitivity to any component of the products evaluated in the study. |
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E.5 End points |
E.5.1 | Primary end point(s) |
Safety: All serious adverse events will be monitored from randomisation through the 30-day follow-up contact. In addition clinical events and 2 key safety endpoints (for the patients who undergo CABG surgery), post-operative bleeding volume and the occurrence of surgical re-exporation, will be assessed. Mortality will be monitored for one year after randomisation. Efficacy: The primary efficacy endpoint is the composite of death, MI RI-UR, and TBO within 96 hours. The key secondary endpoint is the composite of death and MI within 30 days. All components of the efficacy endpoints except death will be adjudicated by a Clinical Events Committee. |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | Yes |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | Yes |
E.8.1.5 | Parallel group | Yes |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | Yes |
E.8.2.3 | Other | No |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | Information not present in EudraCT |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
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E.8.7 | Trial has a data monitoring committee | Information not present in EudraCT |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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Last patient 1 year follow-up phone call |
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 5 |
E.8.9.1 | In the Member State concerned months | 0 |
E.8.9.1 | In the Member State concerned days | |
E.8.9.2 | In all countries concerned by the trial years | 5 |
E.8.9.2 | In all countries concerned by the trial months | 0 |