Clevidipine (Cleviprex®) Compared With Urapidil (Ebrantil®) (Clevidipine)

Clevidipine (Cleviprex®) Compared With Urapidil (Ebrantil®) for Blood Pressure Reduction in Patients With Primary Intracerebral Hemorrhage: A Randomized Controlled Trial

Intracerebral hemorrhage (ICH) is responsible for 10-15% of primary strokes. ICH is a dynamic process with three phases: initial hemorrhage, followed by hematoma expansion and perihematoma edema formation. Hematoma volume is correlated with disease progression and outcome. Contemporary evidence proposes that elevated blood pressure is associated with hematoma expansion while more than 90% of patients with ICH present with acute hypertension. Uncontrolled blood pressure is a leading cause of ICH and it seems also to be a factor of poorer outcomes. Therefore, rapid reduction and control of blood pressure might ease disease progression and improve the outcome. Clevidipine (Cleviprex®), an ultrashort-acting dihydropyridine calcium channel antagonist, with its rapid onset and short duration might be more effective than conventional antihypertensives to achieve rapid blood pressure control in patients with acute ICH.

Study Overview

• Status: Withdrawn
• Conditions: Nontraumatic Intracerebral Hemorrhage, Multiple Localized
• Intervention / Treatment: Drug: Clevidipine; Drug: Urapidil

Detailed Description

After admission to the ICU the patients presenting with primary intracerebral hemorrhage (ICH) are evaluated for enrollment. If systolic blood pressure (SBP) is higher than 160 mmHg or SBP <160 mmHg under intravenous antihypertensive drug (e.g. Urapidil), started less than 3 h before randomization, the patient will be randomized in one of the two study groups and intravenous therapy with Clevidipine (Cleviprex®) or Urapidil (Ebrantil®) will start immediately. Data of systemic haemodynamics will be collected continuously by online monitoring, starting at baseline and ending after 24h (study data measurements). In particular, all blood pressure measurements are extracted via an arterial line, which is placed as standard of care in these patients. If the target values are not attained within 30 minutes, the investigators can add or switch to alternative antihypertensive drugs of their choice. 24h after initiation of Clevidipine (Cleviprex®) or Urapidil (Ebrantil®), all patients receive Nicardipine (Cardene®) (standard care in daily clinical routine) for another 24h followed by orally administered antihypertensive medication.

Intracerebral hematoma volume will be determined by readings of noncontrast brain computed tomography (CT) scans using the ABC/2 rule to calculate the volume. As a standard in these patients a CT scan is performed 6 hours after admission to the ICU.

• Study Type: Interventional
• Phase: Phase 4

Contacts and Locations

Study Locations

• Switzerland
  • Zurich, Switzerland, 8091
    • University Hospital Zurich

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:

• Primary intracerebral hemorrhage (ICH)
• Systolic blood pressure (SBP) > 160 mmHg at screening
• Systolic blood pressure (SBP) <160 mmHg under intravenous antihypertensive drug (e.g. Urapidil), started less than 3 h before randomization
• 18 to unlimited years of age
• Signed informed consent obtained

Exclusion Criteria:

• Patients with secondary hemorrhage (bleeding source as aneurysm, arteriovenous malformation or traumatic)
• Patients with concomitant severe critical illness (e.g. sepsis, multi-organ failure)
• Positive pregnancy test for any female of childbearing potential or breast feeding female
• Known allergy to any component of Clevidipine (Cleviprex®), Urapidil Ebrantil®), soya bean oil or severe egg protein allergy
• Contraindications for Clevidipine (Cleviprex®): defect in the lipid metabolism, critical aortic stenosis
• Contraindications for Urapidil (Ebrantil®): aortic coarctation, arterio-venous shunt, breastfeeding period
• Patients with pre-existing disability and legal representative
• Patients participating in a interventional clinical trial within the last 30 days before Start of Treatment

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Clevidipine; The treatment starts at admission to the ICU for 24 hours with 2 mg to a maximum of 16 mg Clevidipine per hour infused intravenously and continuously to reach the systolic target pressure < 160 mmHg (>120 mmHg).	Drug: Clevidipine; Intravenous antihypertensive therapy with Clevidipine for the first 24 hours in patients with nontraumatic intracerebral hemorrhage (ICH).; Other Names: Cleviprex®
Active Comparator: Urapidil; The treatment starts at admission to the ICU for 24 hours with 5 mg to a maximum of 40 mg Urapidil per hour infused intravenously and continuously to reach the systolic target pressure < 160 mmHg (>120 mmHg).	Drug: Urapidil; We compare the therapy with Urapidil to Clevidipine for the acute phase (24 hours) in patients with ICH. We would like to show the efficacy and safety of Clevidipine in this special situation.; Other Names: Ebrantil®

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Achieving the target systolic blood pressure	Number of patients achieving the target systolic blood pressure (SBP) values (160 -120 mmHg) within 30 minutes after initiation of Clevidipine (Cleviprex®) or Urapidil (Ebrantil®)	1/2 hours

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Hypertensive burden - time	• Hypertensive burden - time out of target range (SBP > 160 mmHg) multiplied with the numeric difference to 160mmHg	24 hours
Hypotensive burden - time	• Hypotensive burden - time out of target range (SBP < 120 mmHg) multiplied with the numeric difference to 120mmHg	24 hours
Cumulative time out	• Cumulative time out of target systolic blood pressure range (>160 or <120 mmHg)	24 hours
Blood pressure variability	• Blood pressure variability (determined as Standard Deviation (SD) of SBP over time)	48 hours
Hematoma growth	• Hematoma growth within 6 hours after admission (CCT scan)	6 hours
Neurological state 1	• Glasgow Coma Scale (GCS)	48 hours
Neurological state 2	• modified Ranking Scale (mRS)	48 hours

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Costs	• Cost of study drugs	24 hours

Collaborators and Investigators

• Sponsor: University of Zurich
• Investigators: Principal Investigator: Emanuela Keller, MD Prof, University of Zurich

Study record dates

Study Major Dates

• Study Start (Actual): June 15, 2017
• Primary Completion (Actual): May 14, 2021
• Study Completion (Actual): May 14, 2021

Study Registration Dates

• First Submitted: September 8, 2017
• First Submitted That Met QC Criteria: October 2, 2017
• First Posted (Actual): October 3, 2017

Study Record Updates

• Last Update Posted (Actual): November 8, 2021
• Last Update Submitted That Met QC Criteria: November 2, 2021
• Last Verified: November 1, 2021

More Information

Terms related to this study

• Keywords: Systolic blood pressure; nontraumatic intracerebral hemorrhage; Cleviprex®; Ebrantil®
• Additional Relevant MeSH Terms: Pathologic Processes; Cardiovascular Diseases; Vascular Diseases; Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Intracranial Hemorrhages; Hemorrhage; Cerebral Hemorrhage; Physiological Effects of Drugs; Adrenergic Antagonists; Adrenergic Agents; Neurotransmitter Agents; Molecular Mechanisms of Pharmacological Action; Antihypertensive Agents; Vasodilator Agents; Membrane Transport Modulators; Serotonin Agents; Serotonin Receptor Agonists; Calcium-Regulating Hormones and Agents; Calcium Channel Blockers; Adrenergic alpha-1 Receptor Antagonists; Adrenergic alpha-Antagonists; Urapidil; Clevidipine
• Other Study ID Numbers: 2017-00379

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No