Clinical Trial to Evaluate the Accuracy of [99mTc] ThromboView in the Detection of Deep Vein Thrombosis

Phase II Clinical Trial to Evaluate the Accuracy of Anti-Fibrin Humanized Monoclonal Antibody (DI-DD3B6/22-80B3) Fab' Protein Fragment (ThromboView) Conjugated With Technetium-99m in the Detection of Deep Vein Thrombosis

The assessment of patients with suspected deep vein thrombosis (DVT) is a common clinical scenario that, despite major advances in diagnostic testing, continues to be challenging.

The diagnosis of DVT remains problematic in:

• patients with suspected first DVT who have a moderate or high pre-test probability (PTP) for DVT and a normal compression ultrasound (CUS);
• patients with suspected recurrent DVT; and
• patients in whom CUS or contrast venography is technically difficult or not feasible due to patient characteristics.

In patients with suspected first DVT who have a moderate or high PTP and a normal CUS, DVT occurs in up to 10% of cases. Thus, additional diagnostic testing is required, such as venography or serial CUS, so that DVT is not missed, but these approaches are costly and invasive.

In patients with suspected recurrent DVT, currently used diagnostic approaches are problematic because they all have limitations in differentiating old disease from true recurrent disease.

CUS is technically difficult in selected patients, particularly those who are obese.

Contrast venography is the gold standard diagnostic test for DVT to which all other diagnostic venous imaging modalities for DVT are compared and judged. The Food and Drug Administration (FDA) requires that a new diagnostic test for DVT be assessed against venography.

[99mTc] ThromboView® is a novel diagnostic test based on a 99mTc-labeled monoclonal antibody specific for D-dimer fragments of cross-linked fibrin that are found in acute DVT. After intravenous injection of [99mTc] ThromboView®, there is uptake of the monoclonal antibody by acute, D-dimer rich, venous thrombi. This is visualized with nuclear medicine imaging as an area of increased radioisotope activity that corresponds to the location of DVT.

Based on the biologic and imaging characteristics of [99mTc] ThromboView®, this diagnostic test has the potential to:

• identify small non-occlusive proximal DVT or distal DVT in patients with a moderate or high PTP and normal CUS;
• differentiate old from new DVT in patients with suspected recurrent DVT;
• diagnose or exclude DVT in patients in whom CUS is not technically feasible; and
• provide an alternative to venography that is non-invasive, has no contrast-related toxicity and is easily administered.

The present study is the first phase II clinical trial of [99mTc] ThromboView® in patients with suspected initial or recurrent DVT in whom DVT has been confirmed or excluded by venography. A phase II clinical trial to investigate the diagnostic accuracy of [99mTc] ThromboView® is justified because:

• ThromboView® was well tolerated, with no significant toxicity in studies involving animals and healthy volunteers; and
• it has shown promise in Phase I trials as a non-invasive diagnostic test for acute DVT.

Study Overview

• Status: Completed
• Conditions: Deep Vein Thrombosis
• Intervention / Treatment: Drug: ThromboView

• Study Type: Interventional
• Enrollment (Actual): 94
• Phase: Phase 2

Contacts and Locations

Study Locations

• Canada
  • Ontario
    • Hamilton, Ontario, Canada, L8L 2X2
      • Hamilton General Hospital
    • Hamilton, Ontario, Canada, L8N4A6
      • St. Joseph's Healthcare
    • Hamilton, Ontario, Canada, L8N 3Z5
      • McMaster University, Hamilton Health Sciences
    • Hamilton, Ontario, Canada, L8V1C3
      • Henderson General Site
  • Quebec
    • Montreal, Quebec, Canada, H1T 2M4
      • Hôpital Maisonneuve-Rosemont
    • Montreal, Quebec, Canada, H2W1T8
      • Hotel-Dieu du CHUM
    • Sainte-Foy, Quebec, Canada, G1V 4G2
      • Centre Hospitalier de l'Université Laval
• United States
  • California
    • Sacramento, California, United States, 95817
      • UC Davis
    • San Diego, California, United States, 82103-9378
      • UCSD Medical Centre
  • Michigan
    • Detroit, Michigan, United States, 48202
      • Henry Ford Hospital
  • Ohio
    • Cleveland, Ohio, United States, 44195
      • Cleveland Clinic Foundation
  • Oklahoma
    • Oklahoma City, Oklahoma, United States, 73104
      • University of Oklahoma, Health Sciences Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Adult man or woman, aged ≥18 years, presenting with suspected lower-limb initial or recurrent DVT.
• Moderate or high pre-test probability (PTP) for DVT.
• Onset of symptoms occurred within the last 7 days.
• Women of childbearing potential to have a negative pregnancy test as determined by measuring serum β-hCG levels at time of study enrolment.

Exclusion Criteria:

• Receiving anticoagulant therapy at therapeutic doses for >3 days.
• Life expectancy <3 months.
• Patient with a renal transplant.
• Renal dysfunction: serum creatinine >1.5x upper limit of normal range.
• Hepatic dysfunction: serum transaminases >3x upper limit of normal range.
• Current pregnancy or lactation; or conception intended within 90 days of enrolment
• Of childbearing potential and unwilling to use adequate contraception for 30 days following enrolment
• Unable to undergo lower limb ascending venography on symptomatic leg(s).
• Allergy or other contraindication to intravenous contrast dye.
• Prior exposure to murine or humanized antibodies.
• Prior imaging studies with: I131 within the last month; In111 or Ga67 within the last 2 weeks; Tc99m labelled RBCs, WBCs or albumin within the last 48 hours; Tc99m or F18 within the last 24 hours; prior non-imaging, non-therapeutic nuclear medicine studies with I131 (eg., 24-hour RAI uptake) within the last 2 weeks.
• Previous participation in the present study.
• Geographic inaccessibility that precludes follow-up visits.
• Patient is unwilling or unable to provide informed consent.
• Patient is unsuitable for the study, at the Study Investigator's discretion.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Diagnostic
• Allocation: Non-Randomized
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
To Provide Estimates of the Specificity of [99mTc] ThromboView® in Patients With Excluded Initial DVT	May 2007
To Provide Estimates of the Sensitivity of [99mTc] ThromboView® in Patients With Confirmed Initial DVT.	September 2005

Secondary Outcome Measures

Outcome Measure	Time Frame
To Provide Estimates of the Specificity of [99mTc] ThromboView® in Patients With Suspected Recurrent DVT in Whom Disease Recurrence Has Been Excluded	May 2007
To Provide Estimates of the Specificity of [99mTc] ThromboView® for Imaging Suspected Proximal Initial DVT	May 2007
To Provide Estimates of the Sensitivity of [99mTc] ThromboView® for Imaging Suspected Proximal Initial DVT	May 2007
To Provide Estimates of the Specificity of [99mTc] ThromboView® for Imaging Suspected Distal Initial DVT	May 2007
To Provide Estimates of the Sensitivity of [99mTc] ThromboView® for Imaging Suspected Distal Initial DVT	May 2007
To Provide Estimates of the Sensitivity and Specificity of [99mTc] ThromboView® for DVT at the 1-hour and 3-hour Imaging Time Points	May 2007

Collaborators and Investigators

• Sponsor: Agen Biomedical
• Investigators: Principal Investigator: Jim Douketis, MD FRCPC, Hamilton Health Sciences Corporation; Principal Investigator: Jeff Ginsberg, MD FRCPC, Hamilton Health Sciences Corporation

Study record dates

Study Major Dates

• Study Start: March 1, 2005
• Study Completion: May 1, 2006

Study Registration Dates

• First Submitted: July 24, 2005
• First Submitted That Met QC Criteria: July 24, 2005
• First Posted (Estimate): July 26, 2005

Study Record Updates

• Last Update Posted (Estimate): August 24, 2009
• Last Update Submitted That Met QC Criteria: July 9, 2009
• Last Verified: July 1, 2009

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Cardiovascular Diseases; Vascular Diseases; Embolism and Thrombosis; Thrombosis; Venous Thrombosis
• Other Study ID Numbers: CAN/US-001-II-DVT