Clinical Trial Results:
A prospective, multi-center, open-label, single-arm, Phase 2 study to assess the efficacy and safety of clazosentan in reversing angiographically-confirmed cerebral vasospasm in adult subjects with aneurysmal subarachnoid hemorrhage (aSAH) treated by surgical clipping or endovascular coiling.
Summary
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EudraCT number |
2015-002721-18 |
Trial protocol |
FI |
Global end of trial date |
15 May 2017
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Results information
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Results version number |
v2(current) |
This version publication date |
07 Nov 2019
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First version publication date |
23 Jun 2018
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Other versions |
v1 |
Version creation reason |
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Trial Information
Subject Disposition
Baseline Characteristics
End Points
Adverse Events
More Information
Subject Disposition
Baseline Characteristics
End Points
Adverse Events
More Information
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Trial identification
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Sponsor protocol code |
AC-054-203
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Additional study identifiers
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ISRCTN number |
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US NCT number |
NCT02560532 | ||
WHO universal trial number (UTN) |
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Sponsors
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Sponsor organisation name |
Idorsia Pharmaceuticals Ltd
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Sponsor organisation address |
Hegenheimermattweg 91, Allschwil, Switzerland, 4123
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Public contact |
clinical trial disclosure desk, Idorsia Pharmaceuticals Ltd, clinical-trials-disclosure@idorsia.com
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Scientific contact |
clinical trial disclosure desk, Idorsia Pharmaceuticals Ltd, clinical-trials-disclosure@idorsia.com
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Paediatric regulatory details
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Is trial part of an agreed paediatric investigation plan (PIP) |
No
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Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial? |
No
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Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial? |
No
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Results analysis stage
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Analysis stage |
Final
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Date of interim/final analysis |
14 Jul 2017
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Is this the analysis of the primary completion data? |
No
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Global end of trial reached? |
Yes
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Global end of trial date |
15 May 2017
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Was the trial ended prematurely? |
Yes
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General information about the trial
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Main objective of the trial |
To evaluate whether clazosentan has an early effect in reversing angiographically-confirmed cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage treated by endovascular coiling or surgical clipping.
The study used a Simon 2-stage design. Stage 1 analysis was planned to be performed on the first 10 evaluable subjects, while stage 2 analysis was planned to be conducted, assuming positive stage 1 analysis, on the first 19 evaluable subjects.
Criterion to continue to stage 2 (positive stage 1 analysis) is met if > 2 subjects with successful reversal were observed.
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Protection of trial subjects |
Prior to the start of the study, each study site consulted an Independent Ethics Committee (IEC) or Institutional Review Board (IRB), i.e., a review panel that was responsible for ensuring the protection of the rights, safety, and well being of human subjects involved in a clinical investigation. The sponsor and the investigators ensured that the study was conducted in full compliance with International Council for Harmonisation (ICH)-Good Clinical Practice (GCP) Guidelines, the principles of the “Declaration of Helsinki” and with the laws and regulations of the countries in which the research was conducted.
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Background therapy |
- | ||
Evidence for comparator |
- | ||
Actual start date of recruitment |
04 Dec 2015
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Long term follow-up planned |
No
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Independent data monitoring committee (IDMC) involvement? |
No
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Population of trial subjects
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Number of subjects enrolled per country |
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Country: Number of subjects enrolled |
Finland: 1
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Country: Number of subjects enrolled |
France: 9
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Country: Number of subjects enrolled |
Switzerland: 4
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Worldwide total number of subjects |
14
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EEA total number of subjects |
10
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Number of subjects enrolled per age group |
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In utero |
0
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Preterm newborn - gestational age < 37 wk |
0
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Newborns (0-27 days) |
0
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Infants and toddlers (28 days-23 months) |
0
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Children (2-11 years) |
0
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Adolescents (12-17 years) |
0
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Adults (18-64 years) |
14
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From 65 to 84 years |
0
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85 years and over |
0
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Recruitment
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Recruitment details |
The study was conducted at 11 sites in 3 countries from 21 March 2016 to 2 May 2017. | ||||||
Pre-assignment
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Screening details |
The study included a screening period of variable duration, starting any time after the aneurysm securing procedure and lasting up to a maximum of 14 days from the occurrence of the aneurysm to enrollment into the study. At the time of study termination, 33 subjects had been screened and 14 subjects enrolled. | ||||||
Period 1
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Period 1 title |
Overall trial (overall period)
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Is this the baseline period? |
Yes | ||||||
Allocation method |
Not applicable
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Blinding used |
Not blinded | ||||||
Arms
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Arm title
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Clazosentan 15 mg/h | ||||||
Arm description |
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Arm type |
Experimental | ||||||
Investigational medicinal product name |
Clazosentan
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Investigational medicinal product code |
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Other name |
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Pharmaceutical forms |
Concentrate for solution for injection/infusion
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Routes of administration |
Intravenous use
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Dosage and administration details |
Clazosentan was supplied as a concentrated solution for i.v. administration after dilution. The diluted study drug solution was administered as a continuous i.v. infusion at the dose of 15 mg/h for up to a cumulative maximum of 10 days.
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Baseline characteristics reporting groups
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Reporting group title |
Overall trial
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Reporting group description |
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End points reporting groups
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Reporting group title |
Clazosentan 15 mg/h
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Reporting group description |
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Subject analysis set title |
Evaluable set
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Subject analysis set type |
Sub-group analysis | ||
Subject analysis set description |
Used for the main analysis of the primary and secondary endpoints and included subjects with:
Absence of violation of exclusion criteria related to forbidden medications and procedures.
Presence of a DSA evaluable for global cerebral vasospasm at baseline and at 3h / 24 h post-study drug initiation.
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End point title |
Successful reversal of global cerebral vasospasm (GV) 3 h post study drug initiation [1] | ||||||||
End point description |
Successful reversal was defined as an improvement in at least one level of severity on the global vasospasm assessment (i.e., from severe to moderate, mild, or none, or from moderate to mild or none) evaluated on DSA. The presence/absence of vasospasm (vsp) was determined at the level of the following 15 proximal (vertebro basilar, left/right intradural ICA, left/right A1, left/right M1, left/right P1) and distal (left/right A2, left/right P2, left/right M2) brain vessels.
The severity of the vsp in each vessel segment was indicated as follows:
None: no vsp
Mild: up to 1/3 vessel narrowing
Moderate: more than 1/3 and up to 2/3 vessel narrowing
Severe: more than 2/3 vessel narrowing
The severity of global vsp was indicated as follows:
No significant vsp: ≤2 segments with mild vsp
Mild: >2 segments with mild and/or 1 segment with moderate vsp
Moderate: ≥2 segments with moderate and/or 1 segment with severe vsp
Severe: ≥2 segments with severe vsp
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End point type |
Primary
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End point timeframe |
3 hours post study-drug initiation
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Notes [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point. Justification: Not applicable. |
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No statistical analyses for this end point |
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End point title |
Successful reversal of global cerebral vasospasm 24 hours (+/– 6 h) post-study drug initiation | ||||||
End point description |
Successful reversal of global cerebral vasospasm was defined as described for the primary endpoint when a baseline DSA and a DSA at 24 h were both available
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End point type |
Secondary
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End point timeframe |
24 hours post-study drug initiation
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No statistical analyses for this end point |
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End point title |
Maximum change in angiographic cerebral circulation time from baseline to 3 hours | ||||||||
End point description |
The maximum change in CCT from baseline to 3 hours is the largest of the differences between CCTs at baseline and CCTs at 3 hours, and the maximum change in CCT from baseline to 24 hours is the largest of the differences between CCTs at baseline and CCTs at 24 hours. This endpoint has been chosen to take into account changes in diameter of small cerebral vessels, not measurable on angiography
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End point type |
Secondary
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End point timeframe |
From baseline to 3 hours
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No statistical analyses for this end point |
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End point title |
Maximum change in angiographic cerebral circulation time from baseline to 24 hours | ||||||||
End point description |
The maximum change in CCT from baseline to 3 hours is the largest of the differences between CCTs at baseline and CCTs at 3 hours, and the maximum change in CCT from baseline to 24 hours is the largest of the differences between CCTs at baseline and CCTs at 24 hours. This endpoint has been chosen to take into account changes in diameter of small cerebral vessels, not measurable on angiography
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End point type |
Secondary
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End point timeframe |
From baseline to 24 hours
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No statistical analyses for this end point |
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End point title |
Distribution of responding segments (i.e., score ≥ 2) by location at 3 h and 24 h | ||||||||||
End point description |
This endpoint was assessed post-hoc with the objective to better characterize the pharmacodynamic effect of clazosentan on the entire cerebral vasculature, including smaller distal vessel segments and the cerebellar arteries. This evaluation considered a larger number of vessel segments (29) than the primary endpoint evaluation (15 segments).
Segments were defined as proximal (ICA, A1, M1, vertebral artery, basilar artery, P1) or distal (A2, A3/A4, M2, M3/M4, P2, P3/P4, anterior inferior cerebellar artery, posterior inferior cerebellar artery, superior cerebellar artery). Each evaluable segment with significant vasospasm on the baseline angiogram was graded at 3 h and 24 h post initiation of clazosentan with a 7-level scoring system ranging from −3 for severe worsening to +3 for improvement back to admission state. A segment with a score ≥ 2 (corresponding to at least a significant improvement) was considered as responding.
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End point type |
Post-hoc
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End point timeframe |
3 and 24 hours post study-drug initiation
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Attachments |
Untitled (Filename: Number of evaluated segments.JPG) |
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No statistical analyses for this end point |
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End point title |
Distribution of responding subjects ( ≥ 50% of segments with score ≥ 2) by location and time point | ||||||||||
End point description |
This endpoint was assessed post-hoc with the objective to better characterize the pharmacodynamic effect of clazosentan on the entire cerebral vasculature, including smaller distal vessel segments and the cerebellar arteries. This evaluation considered a larger number of vessel segments (29) than the primary endpoint evaluation (15 segments).
Segments were defined as proximal (ICA, A1, M1, vertebral artery, basilar artery, P1) or distal (A2, A3/A4, M2, M3/M4, P2, P3/P4, anterior inferior cerebellar artery, posterior inferior cerebellar artery, superior cerebellar artery). Each evaluable segment with significant vasospasm on the baseline angiogram was graded at 3 h and 24 h post initiation of clazosentan with a 7-level scoring system ranging from −3 for severe worsening to +3 for improvement back to admission state. A segment with a score ≥ 2 (corresponding to at least a significant improvement) was considered as responding.
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End point type |
Post-hoc
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End point timeframe |
3 and 24 hours post-study drug initiation
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Attachments |
Untitled (Filename: Number of evaluated subjects.JPG) |
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No statistical analyses for this end point |
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Adverse events information
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Timeframe for reporting adverse events |
Enter description here
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Adverse event reporting additional description |
Enter description here
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Assessment type |
Systematic | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary used for adverse event reporting
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Dictionary name |
MedDRA | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary version |
19.0
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Reporting groups
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Reporting group title |
Clazosentan 15mg/h
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Reporting group description |
Clazosentan | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Frequency threshold for reporting non-serious adverse events: 5% | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Substantial protocol amendments (globally) |
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Were there any global substantial amendments to the protocol? Yes | |||||||
Date |
Amendment |
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17 Jun 2016 |
Summary of most relevant changes:
Modified entry criteria:
- The CT scan at 24‑48 h post aneurysm-securing procedure was removed since any procedure-related injury would have been detected on the CT scan performed just prior to study enrollment.
- The definition of severe hypoxemia was modified from PaO2/FiO2 < 300 to PaO2/FiO2 < 250, which was a more realistic definition of severe hypoxemia.
- Upon sponsor approval at site level, a CTA could replace a missing or incomplete DSA, at hospital admission.
definition of CCT secondary endpoint and how it was to be derived were made:
CCT secondary endpoint definition:
- The endpoint was modified from ʻchange in angiographic CCTʼ to ʻmaximum change in angiographic CCTʼ.
The recommendation to perform the TCD at 3 h post study drug initiation was waived. Also, it was acceptable to perform the hourly TCD assessments only in the vessel that showed the highest mean flow velocity at baseline
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Interruptions (globally) |
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Were there any global interruptions to the trial? Yes | |||||||
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Limitations and caveats |
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Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data. | |||||||
None reported |