E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Acute Ischemic Stroke
Stroke is the most common neurologic disorder and is the third leading
cause of death in developed countries, after myocardial infarction and
cancer. Stroke is the second leading cause of neurological morbidity in
the United States, Europe, and Japan. 67%- 81% of all stroke cases are
ischemic strokes.
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E.1.1.2 | Therapeutic area | Diseases [C] - Nervous System Diseases [C10] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 14.0 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10055221 |
E.1.2 | Term | Ischemic stroke |
E.1.2 | System Organ Class | 10029205 - Nervous system disorders |
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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 compare the clinical therapeutic
effects of intravenous DP-b99 at a dose of 1.0 mg/kg initiated within
nine hours of stroke onset and administered daily over 2 hours for 4
consecutive days versus placebo in subjects with moderately severe,
likely hemispheric, acute ischemic stroke. The clinical outcome will be
measured by the modified Rankin Scale at day 90.
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E.2.2 | Secondary objectives of the trial |
The secondary objectives of this study are to compare the safety and
tolerability, as well as post-stroke recovery at Day 90, in subjects
treated with DP-b99 versus placebo
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
event, which must include at least one of the following components (as
reflected by at least 1 point on any of the corresponding items of the
NIHSS: 3, 9 or 11):
- Visual
- Best Language
- Extinction and Inattention (formerly Neglect)
3. Have suffered the onset of an acute ischemic stroke that can be
evaluated and treatment initiated within 9 hours after the onset of acute
was last seen in a normal state, or bedtime for unwitnessed strokes
occurring during sleep.)
4. Have at screening a NIHSS score of 10 to 16, inclusive
5. Have readily accessible peripheral venous access for clinical trial
material (CTM) administration and blood sampling
6. Have the ability to understand the requirements of the study and be
willing to provide written informed consent (IC) (as evidenced by
signature on an informed consent document approved by an independent
ethics committee (IEC), and agree to abide by the study restrictions and
return for the required assessments. (In the event of incapacitated
subjects, informed consent will be sought from a legally acceptable
representative or by any other means as approved by the IRB or IEC).
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E.4 | Principal exclusion criteria |
1. Have an intracerebral or subarachnoid hemorrhage per
screening/baseline computerized tomography (CT) scan or
susceptibility-weighted magnetic resonance imaging (MRI)
2. Be a candidate for either:
a. thrombolytic therapy, or have been treated with thrombolytic therapy
for the current stroke
b. mechanical thromboembolectomy, or have been treated with
mechanical thromboembolectomy for the current stroke
3. Be delirious, comatose or stuporous (a score of ≥2 on item 1.a of the
NIHSS) or demented, or having a mental impairment that in the
investigator's opinion renders the subject incapable to participate in the
study
4. Have seizure(s) anytime from stroke onset to screening/baseline
NIHSS evaluation
5. Have neurological or non-neurological comorbidities that in the
investigator's opinion may lead, independent of the current stroke, to
further deterioration in the subject's neurological status during the trial
period, or may render the study's neurological assessments inconclusive
for the purpose of evaluating solely the stroke's effects (e.g., metabolic
encephalopathies, hemiplegic migraine, multiple sclerosis, central
nervous system tumor, convulsive disorder, monocular blindness)
6. Be likely to undergo a procedure involving cardiopulmonary bypass
during the study period
7. Have suffered a myocardial infarction in the last 90 days
8. Have any medical condition that in the investigator's opinion may
threaten the subject's ability to complete the study (e.g., concurrent
significant or life-threatening diseases, such as malignancies or end
stage organ failure)
9. Have rapid spontaneous improvement of neurological signs during
screening/baseline assessments
10. Have premorbid neurological deficits and functional limitations
assessed by a pre-stroke Modified Rankin Scale score of > 1
11. Have suffered a stroke within 90 days of the screening/baseline
assessments that is either diagnostically confirmed or assumed to be in
the same cerebral territory as is the current acute stroke
12. Have either severe hypertension (systolic blood pressure (BP) >220
mm Hg or diastolic BP >120 mm Hg) or hypotension (systolic BP <90
mm Hg), as measured by at least 2 consecutive supine measurements
taken 10 minutes apart prior to randomization.
13. Have significant current renal or hepatic disease(s): a serum
creatinine concentration of >2.5 mg/dL; alanine aminotransferase (ALT),
aspartate aminotransferase (AST), or gamma-glutamyl transferase
(GGT) values that are three times greater than the upper limit of normal
(ULN) (or, if GGT cannot be evaluated, direct bilirubin must not be
greater than 1.5 times the ULN).
14. Have a platelet count of <100,000/mm3 or for patients on oral
anticoagulants at study entry, INR of >4
15. Be a female of childbearing potential (less than 2 years'
postmenopausal or not surgically sterilized) who is not willing to use
adequate and effective birth control measures for the duration of the
trial. Effective birth control measures include hormonal contraception, a
barrier method such as a diaphragm, intrauterine device (IUD) and/or
condom with spermicide (IUD, diaphragm, condoms alone or the rhythm
method are not considered reliable methods)
16. Have a positive urine pregnancy test at screening/baseline or be a
lactating female
17. Be currently dependent on, or abusing, alcohol or one or more of the
following: sympathomimetic amines (amphetamine-like), cannabis,
cocaine, hallucinogens, inhalants, opioids, phencyclidine, sedatives and
hypnotics
18. Have received an investigational drug or product or participated in
an investigational drug study within a period of 30 days prior to
receiving study medication or have previously participated in a clinical
trial involving DP-b99
19. Have severe anemia as measured by a hemoglobin value of < 7 g/dl.
20. Being in a dependent relationship with the physician or the study
21. Known hypersensitivity to any component of the investigational
product
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E.5 End points |
E.5.1 | Primary end point(s) |
The primary efficacy endpoint is the mRS score at 90 days (or on last
rating) following stroke onset as analyzed across the whole distribution
of scores ("shift analysis").
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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.8.4.1 | Number of sites anticipated in Member State concerned | 8 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 50 |
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 | 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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End of the trial will be when a total of 770 subjects have been
randomized.
Since this study is monitored by a data safety monitoring board
(DSMB), this board may stop the trial early for the following reasons:
A. Exposure to DP-b99 proves to be unsafe after weighing the
predetermined
safety factors as detailed in the DSMB charter
or
B. The futility analysis reached its pre-specified futility threshold
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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 | 2 |
E.8.9.1 | In the Member State concerned months | 5 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 2 |
E.8.9.2 | In all countries concerned by the trial months | 5 |
E.8.9.2 | In all countries concerned by the trial days | 0 |