E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
BRAIN ISCHEMIC STROKE IN ACUTE PHASE |
INFARTO CEREBRAL ISQUÉMICO EN FASE AGUDA |
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E.1.1.1 | Medical condition in easily understood language |
BRAIN STROKE |
INFARTO CEREBRAL O ICTUS |
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E.1.1.2 | Therapeutic area | Diseases [C] - Nervous System Diseases [C10] |
MedDRA Classification |
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 |
To establish the viability and safety of this clinical-stage study in patients with cerebral infarction who underwent a peritoneal dialysis procedure in the acute phase (a conventional dialysis fluid enriched with phosphate will be used). This study is established as a preliminary step for a more extensive clinical trial that has as main objective efficacy parameters. |
Establecer la viabilidad y seguridad de este estudio en su fase clínica en pacientes con un infarto cerebral a los que se les realizará un procedimiento de diálisis peritoneal en la fase aguda (se utilizará un líquido de diálisis convencional enriquecido con fosfato). Se establece este estudio como etapa preliminar para un ensayo clínico de mayor extensión que tenga como objetivo principal parámetros de eficacia. |
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E.2.2 | Secondary objectives of the trial |
To determine the potential efficacy and clinical benefit as estimated by infarct volume, mortality and functional status of patients at 90 days by applying mRS scale.
To research the evolution of Glu levels in serum and peritoneal dialysis in patients with cerebral infarction in the acute phase. |
Determinar el beneficio clínico estimado por el volumen del infarto, la mortalidad y situación funcional de los pacientes a los 90 días, mediante la aplicación escala modificada de Rankin (mRS)
Investigar la evolución los niveles de glutamato, en suero y dializado peritoneal, en pacientes con infarto cerebral en la fase aguda |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
Patients 18 to 80 years-old with acute ischemic stroke in the territory of the middle cerebral artery, which can not be applied pharmacological thrombolysis or mechanical thrombectomy, with less than 12h duration and have given consent. |
pacientes de 18 a 80 años con ictus isquémico agudo del territorio de la arteria cerebral media, en los que no se pueda aplicar tratamiento trombolítico farmacológico o trombectomía mecánica, de menos de 12 h de evolución y que hayan otorgado su consentimiento. |
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E.4 | Principal exclusion criteria |
-Patients with previous functional dependency (mRS>2),
-presence of minor neurological deficit (NIHSS scale < 4 at the time of randomization) or rapid improvement during the process of inclusion,
-very severe neurological deficit (NIHSS>20),
-state of coma,
- posterior territory stroke;
- lacunar stroke with symptoms (pure hemiparesis, pure hemihypoestesia, dysarthria, clumsy hand, ataxia, hemiparesis),
-haematological diseases, infectious, inflammatory or neoplastic known at the time of treatment,
-pregnancy or lactation (urine analysis be performed prior to randomization in women of childbearing age),
-renal impairment (CLcr < 40 ml/h o Creat > 1.5 mg/dl) previously known;
- severe liver disease, any comorbility status at the discretion of the investigator may prevent the patient complete the study;
-hours of stroke onset unknown (in stroke upon awakening is taken as the start time of the last time the patient was seen asymptomatic);
-contraindication to standard procedure of peritoneal dialysis,
-haemorrhagic stroke in the imaging scan performed at baseline,
-stroke or myocardial infarction within the previous 90days,
-platelet count<100.000/mm3,
-treatment with anticoagulants
- INR < 1.4 or Time cephalin > 1.3 times the control group,
-participation in another clinical trial within the previous 90 days. |
-Pacientes con dependencia funcional previa (mRS>2);
-presencia de un déficit neurológico menor (escala NIHSS<4 en el momento de la aleatorización) o rápida mejoría durante el proceso de inclusión;
-déficit neurológico muy grave (NIHSS>20),
-estado de coma;
- ictus de territorio posterior ;
-ictus con sintomatología lacunar (hemiparesia pura, hemihipoestesia pura, hemiparesia hemihipoestesia, disartria mano torpe, ataxia hemiparesia);
-enfermedades hematológicas, infecciosas, inflamatorias o neoplásicas conocidas en el momento del tratamiento;
-embarazo o lactancia (se realizará análisis en orina previo a la aleatorización en mujeres en edad fértil);
- insuficiencia renal (Clcr < 40 ml/h o Creat > 1,5 mg/dl) previa conocida;
enfermedad hepática grave;
- cualquier situación de comorbilidad que a criterio del investigador pueda impedir que el paciente complete el estudio;
- hora de comienzo del ictus desconocida (en el ictus al despertar se tomará como hora de inicio la de la última vez que el paciente fue visto asintomático);
- contraindicación para realizar un procedimiento estándar de diálisis peritoneal;
- ictus hemorrágico en la prueba de neuroimagen realizada al inicio;
- ictus o infarto de miocardio en los 90 días previos;
- recuento plaquetar <100.000/mm3;
- tratamiento con anticoagulantes
- INR > 1,4 ó Tiempo de cefalina > 1,3 veces el control;
- participación en otro ensayo clínico en los 90 días previos. |
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E.5 End points |
E.5.1 | Primary end point(s) |
SAFETY AND VIABILITY |
SEGURIDAD Y VIABILIDAD |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
CLINICAL PRESENCE OF SIDE EFFECTS (HYPOTENSION, CARDIOVASCULAR AND HEMODYNAMIC, DIGESTIVE, ABDOMINAL-SPECIAL WATCH OR INCIDENTS OF BLEEDING-VISCERA PERFORATION, INFECTION, NEUROLOGICAL DETERIORATION DUE TO INTRACRANIAL HYPERTENSION OR HEMORRHAGIC TRANSFORMATION.
ANALYTICAL CONTROLS OF HEMATOCRIT, HEMOGLOBIN, LEUKOCYTES, ESR, PLATELETS, FIBRINOGEN, T.QUICK, APTT, ION, BLOOD GLUCOSE, LIVER FUNCTION AND RENAL FUNCTION AT BASELINE AND 24 AND 72H AND 7 DAYS.
VOLUME OF HYPODENSITY, HEMORRHAGIC TRANSFORMATION ON CT 24H AND 72H, EARLY NEUROLOGICAL DETERIORATION (INCREASE OF 4 OR MORE POINTS IN THE NIHSS SCALE FOR THE FIRST 24H) AND MORTALITY TO 3 MONTHS.
MEDICAL COMPLICATIONS AND SERIOUS ADVERSE EVENTS |
PRESENCIA DE EFECTOS ADVERSOS CLÍNICOS (HIPOTENSIÓN, COMPLICACIONES CARDIOVASCULARES Y HEMODINÁMICAS, DIGESTIVAS, ABDOMINALES -ESPECIAL VIGILANCIA DE INCIDENCIAS DE SANGRADO O PERFORACIÓN DE VÍSCERA HUECA-, INFECCIONES, DETERIORO NEUROLÓGICO POR HIPERTENSIÓN INTRACRANEAL O TRANSFORMACIÓN HEMORRÁGICA SINTOMÁTICA.
CONTROLES ANALÍTICOS SERIADOS DE HEMATOCRITO, HEMOGLOBINA, LEUCOCITOS, VSG, PLAQUETAS, FIBRINÓGENO, T.QUICK, TTPA, IONES, GLUCEMIA, FUNCIÓN HEPÁTICA Y FUNCIÓN RENAL BASALES Y A LAS 24 Y 72H Y 7 DÍAS.
VOLUMEN DE HIPODENSIDAD, LA TRANSFORMACIÓN HEMORRÁGICA EN LA TC A 24H Y 72H, EL DETERIORO NEUROLÓGICO PRECOZ (INCREMENTO DE 4 O MÁS PUNTOS EN LA ESCALA NIHSS DURANTE LAS PRIMERAS 24H) Y LA MORTALIDAD A 3 MESES.
COMPLICACIONES MÉDICAS Y ACONTECIMIENTOS ADVERSOS GRAVES |
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E.5.2 | Secondary end point(s) |
efficacy (potential efficacy and clinical benefit) |
EFICACIA (EFICACIA POTENCIAL Y BENEFICIO CLÍNICO) |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
THE POTENTIAL EFFICACY AND CLINICAL BENEFIT WILL BE ESTIMATED A) QUANTIFYING THE VOLUME OF INFARCTED TISSUE (CONSIDER A REDUCTION IN INFARCTED TISSUE 20% VS CONTROL) AND B) NEUROLOGICAL STATUS-A FAVORABLE OUTCOME IN NEUROLOGICAL DEFICIT (NIHSS 0.1 OR IMPROVEMENT ? 10 POINTS) AND FUNCTIONAL STATUS (MODIFIED RANKIN SCALE (MRS) ? 2, ASSESSED WITH STRUCTURED INTERVIEW) TO 7 DAYS, OR AT THE TIME OF HIGH IF BEFORE, AND 3 MONTHS.
DETERMINATION OF THE CONCENTRATION OF GLUTAMATE IN THE SERUM AND LIQUID DIALYSATE OF PATIENTS AND THEIR CORRELATION WITH INFARCT SIZE AND NEUROLOGICAL DEFICITS. |
LA EFICACIA POTENCIAL Y BENEFICIO CLÍNICO SE ESTIMARÁN A) CUANTIFICANDO EL VOLUMEN DE TEJIDO INFARTADO (ESTIMAMOS UNA REDUCCIÓN DEL TEJIDO INFARTADO EN UN 20% VS CONTROL) Y B) EL STATUS NEUROLÓGICO -UNA EVOLUCIÓN FAVORABLE EN EL DÉFICIT NEUROLÓGICO (NIHSS 0,1 O MEJORÍA ? 10 PUNTOS) Y EN EL ESTADO FUNCIONAL (ESCALA MODIFICADA DE RANKIN (MRS) ? 2, EVALUADA CON UNA ENTREVISTA ESTRUCTURADA) A LOS 7 DÍAS, O EN EL MOMENTO DEL ALTA SI ES ANTES, Y A LOS 3 MESES-.
DETERMINACIÓN DE LA CONCENTRACIÓN DE GLUTAMATO EN EL SUERO Y LÍQUIDO DE DIALIZADO DE LOS PACIENTES Y SU CORRELACIÓN CON EL TAMAÑO DEL INFARTO Y LOS DÉFICITS NEUROLÓGICOS. |
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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 | No |
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) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
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 | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | No |
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 | No |
E.8.2.3 | Other | Yes |
E.8.2.3.1 | Comparator description |
PACIENTES CON ICTUS SOMETIDOS A TRATAMIENTO CONVENCIONAL EN UNA UNIDAD DE ICTUS |
PATIENTS WITH ACUTE ISCHEMIC STROKE SUBJECTED TO CONVENTIONAL TREATMENT IN AN STROKE UNIT |
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E.8.2.4 | Number of treatment arms in the trial | 1 |
E.8.3 |
The trial involves single site in the Member State concerned
| Yes |
E.8.4 | The trial involves multiple sites in the Member State concerned | No |
E.8.5 | The trial involves multiple Member States | No |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | No |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.7 | Trial has a data monitoring committee | No |
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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ON WHICH THE LAST SUBJECT COMPLETED THE STUDY FOLLOW-UP VISITBJECT COMPLETED |
FECHA EN LA QUE EL ÚLTIMO SUJETO COMPLETA LA VISITA DE SEGUIMIENTO DEL ESTUDIO |
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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 | 1 |
E.8.9.1 | In the Member State concerned months | 0 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 1 |
E.8.9.2 | In all countries concerned by the trial months | 0 |
E.8.9.2 | In all countries concerned by the trial days | 0 |