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    Clinical Trial Results:
    Superficial vein thrombosis (SVT) treated for forty-five days with Rivaroxaban versus Fondaparinux

    Summary
    EudraCT number
    2011-005158-73
    Trial protocol
    DE  
    Global end of trial date
    31 Jul 2016

    Results information
    Results version number
    v1(current)
    This version publication date
    06 Jun 2022
    First version publication date
    06 Jun 2022
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    SURPRISE-2011
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT01499953
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    GWT-TUD GmbH
    Sponsor organisation address
    Freiberger Str. 33, Dresden, Germany, 01067
    Public contact
    Medical Consulting, GWT-TUD GmbH, 0049 35125933100,
    Scientific contact
    Medical Consulting, GWT-TUD GmbH, 0049 35125933190,
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    10 May 2017
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    11 May 2016
    Global end of trial reached?
    Yes
    Global end of trial date
    31 Jul 2016
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    Evaluation of efficacy and safety of 45 days of rivaroxaban 10 mg vs. fondaparinux 2.5 mg in the treatment of superficial vein thrombosis of risk patients for major VTE complications to prove non-inferiority of oral rivaroxaban treatment
    Protection of trial subjects
    The conduct of this study was in compliance with the Good Clinical Practice Guidelines and under the guiding principles detailed in the Declaration of Helsinki. The study was also be carried out in keeping with applicable local law(s) and regulation(s). No specific measures had to be put in place as both substances (Rivaroxaban and Fondaparinux) have a wide therapeutic window. Therefore, in case of asymptomatic overdosing without overt bleeding complications, no specific treatment actions were required and the patient should have been kept under surveillance. For rivaroxaban, gastrointestinal uptake might have been reduced by activated carbon application within 3 hours after intake of rivaroxaban. In case of bleeding complications, study treatment with rivaroxaban and fondaparinux should have been interrupted or discontinued and symptomatic therapy (mechanical compression, surgical intervention, hemodynamic stabilization with fluids or whole-blood transfusions) should have been initiated as indicated.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    25 Apr 2012
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Germany: 472
    Worldwide total number of subjects
    472
    EEA total number of subjects
    472
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    282
    From 65 to 84 years
    168
    85 years and over
    22

    Subject disposition

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    Recruitment
    Recruitment details
    From 25/04/2012 until 18/02/2016, a total of 485 patients were screened at 23 study sites in Germany. Of them, 9 patients did not meet the eligibility criteria. For another 4 subjects, signatures either on informed consent form or data protection waiver were not provided and therefore, these 4 subjects were not included in the study.

    Pre-assignment
    Screening details
    472 patients were randomized to one of the two treatment groups. One patient withdrew consent after randomization but before the first study drug administration. 448 subjects completed the study (222 rivaroxaban and 226 fondaparinux ).

    Period 1
    Period 1 title
    overall trial (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Not blinded

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Rivaroxaban
    Arm description
    -
    Arm type
    Experimental

    Investigational medicinal product name
    Rivaroxaban
    Investigational medicinal product code
    Other name
    Xarelto®
    Pharmaceutical forms
    Film-coated tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Patients taken rivaroxaban 10 mg once daily for 45 (±5) days at the same time.

    Arm title
    Fondaparinux
    Arm description
    -
    Arm type
    Active comparator

    Investigational medicinal product name
    Fondaparinux
    Investigational medicinal product code
    Other name
    Arixtra®
    Pharmaceutical forms
    Injection
    Routes of administration
    Subcutaneous use
    Dosage and administration details
    Patients taken fondaparinux 2.5 mg once daily for 45 (±5) days at the same time.

    Number of subjects in period 1
    Rivaroxaban Fondaparinux
    Started
    236
    236
    Completed
    222
    226
    Not completed
    14
    10
         Consent withdrawn by subject
    3
    1
         Adverse event, non-fatal
    7
    6
         Lost to follow-up
    3
    1
         not specified
    1
    2

    Baseline characteristics

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    End points

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    End points reporting groups
    Reporting group title
    Rivaroxaban
    Reporting group description
    -

    Reporting group title
    Fondaparinux
    Reporting group description
    -

    Primary: Rate of objectively confirmed VTE (venous thromboembolism) complications

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    End point title
    Rate of objectively confirmed VTE (venous thromboembolism) complications
    End point description
    The primary efficacy outcome was the composite of death from any cause, symptomatic pulmonary embolism (PE), symptomatic deep vein thrombosis (DVT), or symptomatic extension towards the saphenofemoral junction, or symptomatic recurrence of superficial vein thrombosis (SVT) up to day 45.
    End point type
    Primary
    End point timeframe
    day 45
    End point values
    Rivaroxaban Fondaparinux
    Number of subjects analysed
    211
    224
    Units: Number of patients
        number (confidence interval 95%)
    3.32 (1.62 to 6.69)
    1.79 (0.70 to 4.50)
    Statistical analysis title
    Full Analysis
    Comparison groups
    Rivaroxaban v Fondaparinux
    Number of subjects included in analysis
    435
    Analysis specification
    Pre-specified
    Analysis type
    non-inferiority
    P-value
    = 0.0252
    Method
    Regression, Cox
    Confidence interval

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    day 0 (randomization) until day 90 (follow up)
    Adverse event reporting additional description
    Patients were asked at each visit whether they have experienced adverse events (AEs) or serious adverse events (SAEs). AEs were documented from the time of first IMP application until 5 days after the last application of study treatment. AEs and SAEs were listed by primary SOC (System Organ Class).
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    23.1
    Reporting groups
    Reporting group title
    Overall
    Reporting group description
    -

    Serious adverse events
    Overall
    Total subjects affected by serious adverse events
         subjects affected / exposed
    19 / 471 (4.03%)
         number of deaths (all causes)
    1
         number of deaths resulting from adverse events
    0
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
         subjects affected / exposed
    2 / 471 (0.42%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Vascular disorders
    Vascular disorders
         subjects affected / exposed
    4 / 471 (0.85%)
         occurrences causally related to treatment / all
    0 / 4
         deaths causally related to treatment / all
    0 / 0
    Cardiac disorders
    Cardiac disorders
         subjects affected / exposed
    3 / 471 (0.64%)
         occurrences causally related to treatment / all
    0 / 3
         deaths causally related to treatment / all
    0 / 1
    Surgical and medical procedures
    Surgical and medical procedures
         subjects affected / exposed
    2 / 471 (0.42%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Nervous system disorders
    Nervous system disorders
         subjects affected / exposed
    2 / 471 (0.42%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Immune system disorders
    Immune system disorders
         subjects affected / exposed
    1 / 471 (0.21%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Eye disorders
    Eye disorders
         subjects affected / exposed
    1 / 471 (0.21%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Respiratory, thoracic and mediastinal disorders
         subjects affected / exposed
    1 / 471 (0.21%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Skin and subcutaneous tissue disorders
    Skin and subcutaneous tissue disorders
         subjects affected / exposed
    1 / 471 (0.21%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Psychiatric disorders
    Psychiatric disorders
         subjects affected / exposed
    2 / 471 (0.42%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Musculoskeletal and connective tissue disorders
    Musculoskeletal and connective tissue disorders
         subjects affected / exposed
    1 / 471 (0.21%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Infections and infestations
    Infections and infestations
         subjects affected / exposed
    1 / 471 (0.21%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Overall
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    178 / 471 (37.79%)
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
         subjects affected / exposed
    5 / 471 (1.06%)
         occurrences all number
    5
    Vascular disorders
    Vascular disorders
         subjects affected / exposed
    43 / 471 (9.13%)
         occurrences all number
    45
    Surgical and medical procedures
    Surgical and medical procedures
         subjects affected / exposed
    7 / 471 (1.49%)
         occurrences all number
    7
    General disorders and administration site conditions
    General disorders and administration site conditions
         subjects affected / exposed
    44 / 471 (9.34%)
         occurrences all number
    48
    Immune system disorders
    Immune system disorders
         subjects affected / exposed
    3 / 471 (0.64%)
         occurrences all number
    3
    Reproductive system and breast disorders
    Reproductive system and breast disorders
         subjects affected / exposed
    7 / 471 (1.49%)
         occurrences all number
    8
    Respiratory, thoracic and mediastinal disorders
    Respiratory, thoracic and mediastinal disorders
         subjects affected / exposed
    11 / 471 (2.34%)
         occurrences all number
    12
    Psychiatric disorders
    Psychiatric disorders
         subjects affected / exposed
    5 / 471 (1.06%)
         occurrences all number
    5
    Investigations
    Investigations
         subjects affected / exposed
    8 / 471 (1.70%)
         occurrences all number
    10
    Injury, poisoning and procedural complications
    Injury, poisoning and procedural complications
         subjects affected / exposed
    8 / 471 (1.70%)
         occurrences all number
    8
    Cardiac disorders
    Cardiac disorders
         subjects affected / exposed
    13 / 471 (2.76%)
         occurrences all number
    14
    Nervous system disorders
    Nervous system disorders
         subjects affected / exposed
    17 / 471 (3.61%)
         occurrences all number
    20
    Blood and lymphatic system disorders
    Blood and lymphatic system disorders
         subjects affected / exposed
    1 / 471 (0.21%)
         occurrences all number
    1
    Ear and labyrinth disorders
    Ear and labyrinth disorders
         subjects affected / exposed
    1 / 471 (0.21%)
         occurrences all number
    1
    Eye disorders
    Eye disorders
         subjects affected / exposed
    4 / 471 (0.85%)
         occurrences all number
    4
    Gastrointestinal disorders
    Gastrointestinal disorders
         subjects affected / exposed
    35 / 471 (7.43%)
         occurrences all number
    41
    Hepatobiliary disorders
    Hepatobiliary disorders
         subjects affected / exposed
    3 / 471 (0.64%)
         occurrences all number
    3
    Skin and subcutaneous tissue disorders
    Skin and subcutaneous tissue disorders
         subjects affected / exposed
    14 / 471 (2.97%)
         occurrences all number
    14
    Renal and urinary disorders
    Renal and urinary disorders
         subjects affected / exposed
    3 / 471 (0.64%)
         occurrences all number
    5
    Musculoskeletal and connective tissue disorders
    Musculoskeletal and connective tissue disorders
         subjects affected / exposed
    33 / 471 (7.01%)
         occurrences all number
    39
    Infections and infestations
    Infections and infestations
         subjects affected / exposed
    28 / 471 (5.94%)
         occurrences all number
    32
    Metabolism and nutrition disorders
    Metabolism and nutritional disorders
         subjects affected / exposed
    3 / 471 (0.64%)
         occurrences all number
    3

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    02 Mar 2012
    Protocol 2.6 dated 10 Feb 2012: Change in labelling of the primary and secondary packaging; addition of composition of the DSMB

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported
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