E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Patients suffering from acute pulmonary embolism |
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E.1.1.1 | Medical condition in easily understood language |
Acute pulmonary embolism with blood clots plugging and obstructing a part of the pulmonary arteries. Patients with low or unstable blood pressure are excluded from the study. |
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E.1.1.2 | Therapeutic area | Diseases [C] - Cardiovascular Diseases [C14] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 14.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10014521 |
E.1.2 | Term | Embolism pulmonary |
E.1.2 | System Organ Class | 100000004855 |
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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 is to demonstrate the clinical benefits of tenecteplase over placebo in normotensive patients with acute pulmonary embolism and right ventricular dysfunction. |
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E.2.2 | Secondary objectives of the trial |
The secondary objective is to assess the safety after administration of tenecteplase in normotensive patients with acute pulmonary embolism and with echocardiographic and laboratory evidence of right ventricular dysfunction.
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
- Age 18 years or older
- acute PE (first symptoms occurring 15 days or less before randomization) confirmed by lung scan, or a positive spiral computed tomogram, or a positive pulmonary angiogram
- right ventricular dysfunction confirmed by echocardiography or spiral computed tomography of the chest and a positive troponin I or T test.
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E.4 | Principal exclusion criteria |
- Haemodynamic collapse at presentation as defined above
- Known significant bleeding risk
- Administration of thrombolytic agents within the previous 4 days
- Vena cava filter insertion or pulmonary thrombectomy within the previous 4 days
- Uncontrolled hypertension defined as systolic BP >180 mm Hg and/or diastolic BP >110 mm Hg at randomization
- Treatment with an investigational drug under another study protocol in the previous 7 days or greater, according to local requirements
- Previous enrollment in this study
- Known hypersensitivity to tenecteplase, alteplase, unfractionated heparin, or to any of the excipients
- Pregnancy, lactation or parturition within the previous 30 days. Women of childbearing age must have a negative pregnancy test or use a medically accepted method of birth control
- Known coagulation disorder (including vitamin K antagonists)
- Any other condition that the investigator feels would place the patient at increased risk if the investigational therapy is initiated. |
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E.5 End points |
E.5.1 | Primary end point(s) |
- Clinical composite endpoint of all-cause mortality or haemodynamic collapse within 7 days
Haemodynamic collapse is defined as:
- need for cardiopulmonary resuscitation; or
- systolic blood pressure < 90 mm Hg for at least 15 min or drop of systolic blood pressure by at least 40 mm Hg for at least 15 min with signs of end organ hypoperfusion (cold extremities or low urinary output < 30 mL/h or mental confusion); or
- the need for catecholamines to maintain adequate organ perfusion and a systolic blood pressure of >90 mm Hg (including dopamine at the rate of >5 micrograms / kg per minute). |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
Seven days after randomization |
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E.5.2 | Secondary end point(s) |
Secondary efficacy outcomes:
1) death from any cause within 7 days;
2) hemodynamic collapse (as defined above) within 7 days;
3) imaging-confirmed symptomatic recurrence of PE within 7 days;
4) death within 30 days;
5) death within 6 months.
Safety outcomes
1) ischemic or hemorrhagic stroke within 7 days;
2) other major (i.e., moderate or severe) bleeding within 7 days;
3) serious adverse events within 30 days. Moderate bleeding is defined as a bleeding episode requiring blood transfusion(s), but which is not considered life-threatening and does not lead to hemodynamic compromise requiring emergency fluid replacement, inotropic support, or interventional/surgical treatment. Severe bleeding is defined as an episode that leads to hemodynamic compromise requiring emergency intervention (as administration of fluids and/or blood products, inotropic support, or surgical treatment), or is life-threatening or fatal. |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
7 days, 30 days and 6 months. |
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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.8.2.4 | Number of treatment arms in the trial | 2 |
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.8.4.1 | Number of sites anticipated in Member State concerned | 16 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 88 |
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 | No |
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 |
Israel |
Serbia |
Switzerland |
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E.8.7 | Trial has a data monitoring committee | Yes |
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 (6-month) visit of the last subject enrolled. |
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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 | 3 |
E.8.9.1 | In the Member State concerned months | 6 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 3 |
E.8.9.2 | In all countries concerned by the trial months | 6 |
E.8.9.2 | In all countries concerned by the trial days | 0 |