- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03803007
Acute Ischemic Stroke Interventional Study (ACTIMIS)
Randomized, Double Blind, Multi Center, Multinational, Placebo Controlled, Single Parallel Escalating Dose Safety and Efficacy Study of ACT017 Used as an Add on Therapy on Top of Standard of Care of Acute Ischemic Stroke
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
This first in-patient randomized, double blind, multicenter, multinational, placebo-controlled, parallel-dose 2-phase study combines a dose-escalation phase (1b) and a consolidation phase (2a).
Dose Escalation (Phase 1b):
Phase 1b was designed to (I) assess the dose- related safety and potential efficacy of glenzocimab administered as soon as possible and no later than 3 hours after the start of thrombolysis with tPA (itself administered within 4.5 hrs of the onset of acute ischemic stroke symptoms), and (II) identify the recommended phase 2 dose (RP2D).
During this phase, patients were unevenly randomized between groups, to obtain a total of 60 patients, 12 at each dose level. At the starting level, 8 patients received either glenzocimab at the lowest pharmacologically active dose of 125 mg (n=4) or the matching placebo(n=4). After real-time review by the DSMB of clinical safety and a CT scan (and where available MRI) and giving a favorable opinion, the next patients were randomized in the second cohort (n=8) with 4 patients under a higher dose of 250 mg, 2 patients remaining at the initial starting dose (125 mg), and 2 patients under placebo. Following the same process, and after favorable opinion from the DSMB, patients were randomized in the third cohort (n=10) and received glenzocimab 500 mg (n=4), randomized versus 250 mg (n=2), 125 mg (n=2) or placebo (n=2). Similarly, the fourth cohort (n=12) randomized patients between ahigher dose of 1000 mg (n=4), versus 500 mg (n=2), 250 mg (n=2), 125 mg (n=2), or placebo (n=2). Once this fourth cohort completed, the DSMB issued a further positive opinion and the fifth cohort (n=22) randomized patients to 1000 mg (n=8), versus 500 mg (n=6), 250 mg (n=4), 125 mg (n=2), or placebo (n=2).
Consolidation Phase with Final Dose (Phase 2a):
After having reviewed patient's safety data included in the first part of the study, the DSMB confirmed that the study can continue with the glenzocimab recommended dose of 1000 mg. During this phase, a group of 100 patients will be treated, 50 with glenzocimab and 50 with matching placebo to complete the group of 160 patients planned to participate in this study.
In addition, patients in each treatment arm will be stratified by type of Standard of Care (SOC) administered:
- Thrombolysis with tPA only;
- Thrombolysis with tPA AND mechanical thrombectomy Each treatment arm will contain 25 patients with one SOC, and 25 with the other SOC. The active glenzocimab dose will be that recommended after the last safety analysis has been performed.
Study Type
Enrollment (Actual)
Phase
- Phase 2
- Phase 1
Contacts and Locations
Study Locations
-
-
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Bordeau, France, 33404
- Centre Hospitalier Universitaire de Bordeaux,
-
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Adult male or female patients ≥ 18 years (i.e., at least 18 years old at time of randomization). Extreme caution should be exercised in patients over 80 years of age with regards their general health, neurological status and any concomitant diseases and treatments that are likely to be more common;
- Patients who have given written consent, legal representative consent or emergency consent (including e-consent) in accordance with local legal and IECs/IRBs requirements;
- Patients presenting with an acute disabling ischemic stroke in either the anterior or posterior circulation.The time of onset is known or if unknown, the last time the patient was seen well, was at most 4.5 hrs before confirmation of the diagnosis enabling the initiation of alteplase administration within this time-frame;
- Patients presenting at least a NIHSS ≥ 6 prior to thrombolysis with tPA;
- Patients eligible for, or administered thrombolysis treatment with tPA;
- Patients who can undergo mechanical thrombectomy if eligible;
- Patients affiliated to social security insurance (if applicable, in accordance to local regulations);
Effective birth control method should be used for at least the next 2 months by women, and 4 months by men after IMP administration; birth control methods considered to be highly effective include:
- intrauterine device
- intrauterine hormone-releasing system
- bilateral tubal occlusion
- vasectomized partner
- sexual abstinence (if applicable in accordance to local regulations)
- Women of child-bearing potential must undergo a urinary or plasma pregnancy test with negative results;
Exclusion Criteria:
- Coma, and/or NIHSS >25;
- Patients < 18 years of age;
- Prior ischemic stroke within the past 3 months with pre-stroke mRS known to be > 2;
- Baseline CT-scan evaluation: more than 1/3 of the middle cerebral artery) regions of clear hypodensity on the baseline imaging;
- Significant mass effect with midline shift;
- Stroke of hemorrhagic origin;
Contra-indications to thrombolysis with tPA:
- Patients with known hypersensitivity to the active substance alteplase or to any of its excipients;
Patients with a high risk of hemorrhages:
- significant bleeding disorder at present or within the past 6 months;
- known haemorrhagic diathesis (episodes within past 6 months);
- patients receiving effective oral anticoagulant treatment, e.g. warfarin sodium;
- manifest or recent severe or dangerous bleeding;
- known history of or suspected intra-cranial haemorrhage;
- any history of central nervous system lesion (i.e. trauma, intra-parenchymal neoplasm, unsecured aneurysm, intracranial or spinal surgery, vascular malformation etc..);
- recent (< 10 days) traumatic external heart massage, obstetrical delivery, or puncture of a non-compressible blood-vessel (e.g. subclavian or jugular vein puncture);
- bacterial endocarditis, pericarditis;
- acute pancreatitis;
- documented ulcerative gastrointestinal disease during the past 3 months, oesophageal varices, arterial-aneurysm, arterial/venous malformations;
- neoplasm involving an increased risk of bleeding;
- severe liver disease, including hepatic failure, cirrhosis, portal hypertension (esophageal varices) and active hepatitis;
- major surgery or significant trauma during the past 3 months;
patients receiving anti-coagulants prior to study: the inclusion may however be considered when the dose or time since the last intake of anticoagulant treatment makes residual efficacy unlikely. This should be confirmed by the appropriate tests of anticoagulant activity for the product(s) concerned to show no clinically relevant activity on the coagulation system defined as follows :
- INR ≤ 1.5 for vitamin K antagonists; .
- Low Molecular Weight Heparin (LMWH) and Unfractionated Heparin (UFH): aPPT/ACT/KCT ≤ 39 sec or their patient/witness ratio ≤ 1.2 and/or PT ≤ 16 sec (heparin at sub-therapeutic doses (≤ 50 IU/kg) during the mechanical thrombectomy procedure is authorized);
- Non-Vitamin-K or Direct Oral Anti-Coagulants (NOACs- DOACs) ≤ 50 ng/mL in patients with normal renal function;
- need for carotid stenting together with a dual anti-platelet treatment (on top of glenzocimab); this can be carried out 24 hrs after the initiation of treatment with glenzocimab;
- platelets count <100 × 103/μL (<100 000/ mm3)
- prior hemorrhagic stroke.
- Systolic blood pressure ≥ 185 mm Hg despite appropriate acute therapy to lower blood pressure therapy;
- Diastolic blood pressure ≥ 110 mm Hg; despite appropriate acute therapy to lower blood pressure therapy;
- Glucose >400 mg/dL (>4 g/L) despite treatment;
- Glycemia <50 mg/dL (<0,5 g/L);
- Patients receiving a dual antiplatelet treatment;
- Cardiopulmonary resuscitation within the past 10 days;
- Childbirth within the past 10 days,
- Epileptic seizure at the onset of symptoms;
- Life expectancy < 3 months
- Pregnant or breastfeeding;
- Females of childbearing potential not using effective birth control methods;
- Known severe (grade 3 and above) renal impairment or Glomerular Filtration Rate < 30 ml/min/1.73 m2 or Serum Creatinine > 2X ULN (1.2 mg/dL for men and 1.0 mg/dL for women) at screening;
- Known current participation
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Sequential Assignment
- Masking: Triple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Intravenous glenzocimab (ACT017) 1000 mg
Intravenous glenzocimab (ACT017) 1000 mg to be added to a tissue plasminogen activator +/- mechanical thrombectomy
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Add-on therapy to the standard of Care in the treatment of the acute ischemic stroke symptoms
Other Names:
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Placebo Comparator: Intravenous Placebo
Intravenous Placebo to be added to a tissue plasminogen activator +/- mechanical thrombectomy
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Add-on therapy to the standard of Care in the treatment of the acute ischemic stroke symptoms
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Symptomatic intracranial haemorrhages
Time Frame: 24 hours
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Number of participants experiencing a symptomatic haemorrhage defined by a secondary increase in National Institute Health Stroke Scale score by 4 points or greater, or death
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24 hours
|
Incidence of non-symptomatic intracranial haemorrhages
Time Frame: 24 hours
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Non-symptomatic haemorrhages are those detected by Computerized Tomography scan
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24 hours
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change from baseline of National Institute Health Stroke Scale score (7 minimum, 42 maximum), brain lesions and vessel recanalization
Time Frame: 24 hours
|
Absolute change from baseline of National Institute Health Stroke Scale score, change from baseline on brain lesions as assessed by Computerized Tomography scan or Magnetic Resonance Imaging or Magnetic Resonance Angiography, change from baseline on Recanalization as measured by the modified Thrombolysis In Cerebral Infarction score (0 minimum, 3 maximum) on Magnetic Resonance Angiography
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24 hours
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Change from baseline of National Institute Health Stroke Scale score (7 minimum, 42 maximum), brain lesions and vessel recanalization
Time Frame: 24 hours
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Relative (%) change from baseline of National Institute Health Stroke Scale score, change from baseline on brain lesions as assessed by Computerized Tomography scan or Magnetic Resonance Imaging or Magnetic Resonance Angiography, change from baseline on Recanalization as measured by the modified Thrombolysis In Cerebral Infarction score (0 minimum, 3 maximum) on Magnetic Resonance Angiography
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24 hours
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Change from baseline of modified Ranking Scale score assessment
Time Frame: Day 90
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modified Ranking Scale score (0 minimum and 6 maximum): number of patients with favorable outcome (score 0-2)
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Day 90
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Change from baseline of modified Ranking Scale score assessment
Time Frame: Day 90
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modified Ranking Scale score (0 minimum and 6 maximum): percentage of patients with favorable outcome (score 0-2)
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Day 90
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Change from baseline on size of infarct zone
Time Frame: Day 7
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Change from baseline on size of infarct zone assessed by a central Magnetic Resonance Imaging review
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Day 7
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Change from baseline on vital signs
Time Frame: 6 hours, 24 hours, Day 7, Day 30 and Day 90
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Change from baseline on systolic and diastolic blood pressure
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6 hours, 24 hours, Day 7, Day 30 and Day 90
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Change from baseline on vital signs
Time Frame: 6 hours, 24 hours, Day 7, Day 30 and Day 90
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Change from baseline on heart rate
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6 hours, 24 hours, Day 7, Day 30 and Day 90
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Change from baseline on clinical laboratory assessments
Time Frame: Day 90
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Change from baseline on plasma haemoglobin level
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Day 90
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Change from baseline on clinical laboratory assessments
Time Frame: Day 90
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Change from baseline on platelet count
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Day 90
|
Change from baseline on clinical laboratory assessments
Time Frame: Day 90
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Change from baseline on serum glucose concentration
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Day 90
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Change from baseline on clinical laboratory assessments
Time Frame: Day 90
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Change from baseline on serum creatinine concentration
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Day 90
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Change from baseline on ElectroCardioGram (ECG)
Time Frame: 24 hours and Day 90
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Change from baseline on 12-lead ElectroCardioGram (ECG)
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24 hours and Day 90
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Evidence of anti-ACT017 antibodies (ADA)
Time Frame: Day 30 and Day 90
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To assess evidence of anti-ACT017 antibodies (ADA) as a possible to ACT017 administration
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Day 30 and Day 90
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Pharmacokinetics on ACT017 plasma concentration
Time Frame: 30 minutes, 9 hours and 24 hours
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Change from baseline on ACT017 plasma concentration
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30 minutes, 9 hours and 24 hours
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Collaborators and Investigators
Sponsor
Investigators
- Study Director: Andrea Comenducci, MD, Acticor Biotech
Publications and helpful links
General Publications
- Renaud L, Lebozec K, Voors-Pette C, Dogterom P, Billiald P, Jandrot Perrus M, Pletan Y, Machacek M. Population Pharmacokinetic/Pharmacodynamic Modeling of Glenzocimab (ACT017) a Glycoprotein VI Inhibitor of Collagen-Induced Platelet Aggregation. J Clin Pharmacol. 2020 Sep;60(9):1198-1208. doi: 10.1002/jcph.1616. Epub 2020 Jun 4.
- Voors-Pette C, Lebozec K, Dogterom P, Jullien L, Billiald P, Ferlan P, Renaud L, Favre-Bulle O, Avenard G, Machacek M, Pletan Y, Jandrot-Perrus M. Safety and Tolerability, Pharmacokinetics, and Pharmacodynamics of ACT017, an Antiplatelet GPVI (Glycoprotein VI) Fab. Arterioscler Thromb Vasc Biol. 2019 May;39(5):956-964. doi: 10.1161/ATVBAHA.118.312314.
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 (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- ACT-CS-002
- 2018-002855-13 (EudraCT Number)
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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