- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01976936
Neuroprotection With Statin Therapy for Acute Recovery Trial Phase 2 (NeuSTART2)
A Phase 2 Safety Study in Which Ischemic Stroke Patients Will be Randomized Within 24 Hours of Symptom Onset to Placebo or Oral Lovastatin 640 mg Per Day for 3 Days.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
This is a phase 2 randomized, blinded and controlled safety study in patients with ischemic stroke. The time window for enrollment will be within 0-24 hours of symptom onset. For patients who are found with the stroke on awakening, it will be assumed that the stroke occurred the last time that the patient was known to be normal. All patients will be identified by the stroke acute care team in the emergency room of the participating centers, or in some cases, on the floor services of the hospital (i.e., for patients with stroke occurring in hospital). If preliminary data indicate that the patient meets eligibility criteria the patient (or legally authorized representative) will be approached about participation in the study, and consent obtained. Surrogate consent will be allowed at centers at which this is permitted according to regulations. Patients who are consented through a surrogate and subsequently regain capacity, will be approached and reconsented to continue in the study.
The intervention chosen for this trial is either (1) placebo for patients not taking a statin at the time of admission OR lovastatin 80 mg in place of their regular statin for patients taking a statin (atorvastatin, simvastatin, rosuvastatin, pravastatin, fluvastatin, lovastatin) at time of enrolment VERSUS (2) oral lovastatin at dosage of 640 mg daily for 3 days. The time of first dose will be considered time 0. Patients will be administered the total daily dose in four daily divided doses (i.e., QID schedule). After the initial 3 days of acute dosage, all patients will receive statin therapy at the discretion of their treating physician.
Study Type
Enrollment (Actual)
Phase
- Phase 2
Contacts and Locations
Study Locations
-
-
California
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Los Angeles, California, United States, 90024
- University of California, Los Angeles Stroke Network
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Florida
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Miami, Florida, United States, 33136
- University of Miami Miller School of Medicine
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Miami, Florida, United States, 33136
- Jackson Memorial Hospital
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Georgia
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Atlanta, Georgia, United States, 30322
- Emory University
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Massachusetts
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Boston, Massachusetts, United States, 02115
- Brigham & Women'S Hospital
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New York
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New York, New York, United States, 10029
- Mount Sinai School of Medicine
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Pennsylvania
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Philadelphia, Pennsylvania, United States, 19104
- The Hospital of the University of Pennsylvania
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-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Age >18
- Satisfies the criteria for ischemic stroke: acute focal neurological deficit of likely ischemic vascular origin.
- Patient or legally authorized representative has provided written informed consent prior to study entry. Patient who regains capacity provides his/her written consent to remain in the study.
- Patient can receive the first treatment dose within 0-24 hours of stroke onset. For patients found with stroke on awakening, it will be assumed that the stroke occurred the last time that the patient was known to be normal.
- Patient has pretreatment brain CT scan compatible with ischemic stroke and excludes hemorrhagic and non-vascular etiologies of symptoms.
- Patients taking statins at time of stroke may be included.
- Patients receiving standard dose intravenous tPA or mechanical interventional procedures may be enrolled.
Exclusion Criteria:
- Brain imaging study shows a lesion other than ischemic stroke that could explain patient's symptoms (intracranial or subarachnoid hemorrhage, arteriovenous malformation, aneurysm, multiple sclerosis, tumor, abscess or other). Asymptomatic meningiomas are allowed.
- Mild stroke, defined as NIH Stroke Scale <2.
- Weight < 50 kg.
- Patient is comatose, regardless of etiology (> 4 points on the first three items of the NIHSS).
- History of intolerance or allergic reaction to any statins (myotoxicity, hepatic dysfunction, rash, etc.)
- Use of drugs within past 30 days that utilize the cytochrome CYP3A pathway (cyclosporine, itraconazole, ketoconazole, erythromycin, clarithromycin, nefazodone, posaconazole, voriconazole, dronedarone, diltiazem, colchicine and ranolazine).
- Use of drugs within past 30 days that increase risk of myotoxicity with statins (gemfibrozil, other fibrates, niacin, amiodarone, verapamil).
- Baseline major electrolyte disturbances (sodium <125 or >150, potassium <3.0 or >5.5).
- Recent major trauma (<3 months).
- Hypothermia (body temperature < 96F).
- Baseline hypoxia (defined as oxygen saturation <92% on room air).
- History of likely or proven systemic viral infection within 30 days.
- Known HIV infection or use of protease inhibitors.
- Endocarditis likely as cause of stroke.
- Mitochondrial disorder likely as cause of stroke.
- Pregnancy or lactation.
- History of rhabdomyolysis, myopathy, or other severe muscle disease.
- History of hepatitis, decompensated liver disease (ascites, bleeding varices or encephalopathy), or liver failure.
- Liver function tests (ALT, AST) > 2 X upper limit of normal.
- Unstable cardiovascular (includes uncontrolled hypertension), pulmonary, gastrointestinal, hepatic or musculoskeletal disease.
- Patient has evidence of severe congestive heart failure or has history of end-stage cardiovascular disease (e.g. CHF NYHA Class III or IV or unstable angina).
- Abnormal ECG showing: Hemodynamically significant arrhythmia or frequent PVCs (>5/minute) (controlled atrial arrhythmia will not be an exclusion); evidence of acute myocardial infarction; Mobitz Type II 2nd degree AV block or 3rd degree AV block; ventricular tachycardia or ventricular fibrillation.
- Significant renal insufficiency, indicated by serum creatinine >2.0 mg/dl.
- Hypoglycemia (glucose < 60 mg/dl) or diabetic ketoacidosis unresponsive to therapy.
- Any of these hematologic abnormalities: WBC <3.0 x 103/mm3; Platelet count <50,000/mm3
- Received an investigational drug within 30 days.
- Severe behavioral or social problems that may interfere with the conduct of clinical study procedures.
- Patient unlikely, in the investigator's opinion, to complete the study and return for follow-up visits for any reason.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Triple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: High Dose Lovastatin
High dose lovastatin (640 mg daily for three days) will be administered orally
|
640 mg daily for 3 days
Other Names:
|
Active Comparator: Low Dose Lovastatin
Lovastatin 80 mg daily for three days will be administered orally to patients who were taking statin therapy at the time of enrolment
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80 mg daily for 3 days
Other Names:
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Placebo Comparator: Placebo
Placebo will be administered orally to patients who were NOT taking statin therapy at the time of enrolment
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Placebo for 3 days
Other Names:
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Increase in Liver Function Tests (LFTs)
Time Frame: 90 Days
|
Primary safety outcome: the development of clinical or laboratory evidence of major hepatic toxicity within 7 days of treatment onset or the development of clinical or laboratory evidence of rhabdomyolysis within 7 days of treatment onset. The primary safety outcome will be defined as: Liver toxicity: LFT increase at any time point > 3X upper limit of normal or development of jaundice, otherwise unexplained coagulopathy, or other clinical evidence of hepatitis or liver failure; or Muscle toxicity: An increase in CK (Creatine Kinase) at any time point > 10 X upper limit of normal, or clinical evidence of muscle pain or weakness not related to the stroke and associated with CK > 5 X upper limit of normal. |
90 Days
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Score on NIH Stroke Scale
Time Frame: 90 days
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Measure of neurological outcomes.
|
90 days
|
Barthel Index Score
Time Frame: 90 days
|
Measure of functional outcomes.
|
90 days
|
Modified Rankin scores
Time Frame: 90 days
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Measure of handicap.
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90 days
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Mitchell S Elkind, MD, MS, Columbia University
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Pathologic Processes
- Cardiovascular Diseases
- Vascular Diseases
- Cerebrovascular Disorders
- Brain Diseases
- Central Nervous System Diseases
- Nervous System Diseases
- Musculoskeletal Diseases
- Muscular Diseases
- Skin Manifestations
- Hyperbilirubinemia
- Stroke
- Jaundice
- Rhabdomyolysis
- Molecular Mechanisms of Pharmacological Action
- Enzyme Inhibitors
- Antimetabolites
- Anticholesteremic Agents
- Hypolipidemic Agents
- Lipid Regulating Agents
- Hydroxymethylglutaryl-CoA Reductase Inhibitors
- Lovastatin
- L 647318
- Dihydromevinolin
Other Study ID Numbers
- AAAD9004
- 2P50NS049060 (U.S. NIH Grant/Contract)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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