E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Central retinal artery occlusion |
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E.1.1.1 | Medical condition in easily understood language |
Central retinal artery occlusion (CRAO) is an ophthalmologic emergency that, without prompt revascularization, bears high risk of permanent blindness. |
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E.1.1.2 | Therapeutic area | Diseases [C] - Eye Diseases [C11] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 20.0 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10007971 |
E.1.2 | Term | Central retinal artery occlusion |
E.1.2 | System Organ Class | 100000004853 |
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E.1.3 | Condition being studied is a rare disease | Yes |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
To assess the effect of systemic tenecteplase within 4.5 hours onset of CRAO. |
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E.2.2 | Secondary objectives of the trial |
1. To assess the mean improvement in logMAR visual acuity from baseline to 6 weeks after treatment 2. To assess the effect of systemic tenecteplase within 3 hours onset of CRAO in a large multi-site trial involving leading clinical research centres across the Scandinavian countries. 3. To assess the mean deviation (dB) in central 30º visual field on threshold perimetry 6 weeks after treatment 4. To assess the proportion of patients with complications such as systemic bleeding 5. To assess the proportion of patients with symptomatic intracranial haemorrhage at 24 hours 6. To assess the mean score on National Eye Institute Visual Function Questionnaire (NEI-VFQ 25) at 6 weeks (1) 7. To assess the case fatality at 24 hours and 6 weeks To assess the safety of systemic tenecteplase within 4.5 hours onset of CRAO.
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. Non-arteritic central retinal artery occlusion with ≥ 1.0 logMAR visual acuitiy and symptoms lasting less than 4.5 hours. 2. Ability to administer the Investigator Medicinal Product (IMP) within 4.5 hours of symptom onset. 3. Age ≥18 years. 4. Informed written consent of the patient. 5. A woman of childbearing potential (WOCBP) must confirm that in her opinion, she cannot be pregnant, OR if there is a possibility that she is pregnant, a negative pregnancy test must be confirmed before any IMP is given.
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E.4 | Principal exclusion criteria |
1. Branch retinal artery occlusion, cilioretinal artery supplying the macula, combined arterial-venous occlusion, proliferative diabetic retinopathy, or elevated intraocular pressure (> 30 mmHg). 2. Systemic diseases; severe general diseases, systemic arterial hypertension (blood pressure >185/110 mmHg), despite medical therapy, or clinical suspicion of acute systemic inflammation. 3. Presence of intracranial haemorrhage on brain MRI/CT. 4. Medical history: heart attack within the last 6 weeks, intracerebral bleeding or neurosurgical operation within the last 4 weeks, therapy with anticoagulation, allergic reaction to contrast agent, haemorrhagic diathesis, aneurysms, inflammatory vascular diseases (eg, giant cell arteritis, granulomatosis with polyangitis), endocarditis, or gastric ulcer. 5. No willingness and ability of the patient to participate in all follow-up examinations. 6. Pregnancy (if suspicion of pregnancy s-hCG or u-hCG must be negative). 7. Allergy or intolerance to any ingredients of IMP or placebo or gentamicin. 8. Other conditions / circumstances likely to lead to poor treatment adherence (eg, history of poor compliance, alcohol or drug dependency, no fixed abode). 9. Significant bleeding disorder either at present or within the past 6 months. 10. Effective oral anticoagulant treatment, eg, warfarin sodium (INR >1.3). 11. Effective anticoagulant treatment with heparin or low molecular weight heparin the last 48 hours.
12. Any history of central nervous system damage (ie, neoplasm, aneurysm, intracranial or spinal surgery). 13. Known hemorrhagic diathesis. 14. Major surgery, biopsy of a parenchymal organ, or significant trauma within the past 2 months (this includes any trauma associated with acute myocardial infarction). 15. Recent non-compressible vessel puncture within 2 weeks. 16. Recent trauma to the head or cranium. 17. Prolonged cardiopulmonary resuscitation (>2 minutes) within the past 2 weeks. 18. Acute pericarditis and/or subacute bacterial endocarditis. 19. Acute pancreatitis. 20. Severe hepatic dysfunction, including hepatic failure, cirrhosis, portal hypertension (oesophageal varices) and active hepatitis. 21. Active peptic ulceration. 22. Arterial aneurysm and known arterial/venous malformation. 23. Neoplasm with increased bleeding risk. 24. Any known history of hemorrhagic stroke or stroke of unknown origin. 25. Known history of ischemic stroke or transient ischemic attack in the preceding 3 months. 26. Dementia.
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E.5 End points |
E.5.1 | Primary end point(s) |
Primary endpoint: Proportion of patients with ≤ 0.7 logMAR visual acuity in the affected eye at 30 (±5) days after treatment, representing an improvement in visual acuity of at least 0.3 logMAR (intention-to-treat (ITT) analysis).
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
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E.5.2 | Secondary end point(s) |
Secondary endpoints: 1. Proportion of patients with ≤ 0.5 logMAR visual acuity in the affected eye at 30 (±5) and 90 (±15) days. 2. Mean improvement in logMAR visual acuity in the affected eye from baseline to 30 (±5) and 90 (±15 ) days. 3. Proportion of patients with visual recovery (logMAR ≤ 0.7) and (logMAR ≤ 0.5) in the affected eye 30 (±5) and 90 (±15) days in patients who were treated with tenecteplace within 3 hours of onset. 4. Number of test points seen (of 100) on monocular Esterman perimetry at 30 (±5) days. 5. Acute ischemic lesions on follow-up on diffusion-weighted (DWI) MRI or on brain CT at baseline and 24hrs. 6. National Institutes of Health Stroke Scale score (NIHSS) at 24hrs and discharge. 7. Modified Rankin Scale score (mRS) at discharge, 30 (±5) and 90 days (±15) days. 8. Mean score on National Eye Institute Visual Function Questionnaire (NEI-VFQ 25) at 30 (±5) days (1). 9. Mean score on EQ-5D at 30 (±5) days. 10. Presence of ocular neovascularisation at 90 (±15) days. Safety endpoints: 11. All-cause and stroke-related death at discharge, 30 (±5) and 90 (±15) days. 12. Proportion of patients with any intracranial haemorrhage at 24 hrs. 13. Proportion of patients with symptomatic intracranial haemorrhage until discharge. 14. Proportion of patients with complications such as systemic bleeding at 24 hrs, discharge and 30 (±5) days. 15. Other serious adverse events. 16. Occurrence of adverse events.
Exploratory endpoints: 17. Retrobulbar spot sign detection using Duplex/Doppler ultrasound at baseline, point-of-care ultrasound (POCUS). 18. Retrobulbar spot sign and central retinal artery recanalisation using Duplex/Doppler ultrasound at 24h and discharge. 19. Macular optical coherence tomography (OCT) volume scan and OCT angiography (OCTA) at 30 days.
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
24 hours Discharge 30 days 90 days |
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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 | 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) | Yes |
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 | 3 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 30 |
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 | 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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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 4 |
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 | 4 |
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 |