- ICH GCP
- US Clinical Trials Registry
- Klinisk forsøg NCT00887328
Extending the Time for Thrombolysis in Emergency Neurological Deficits (EXTEND)
30. august 2018 opdateret af: Neuroscience Trials Australia
The primary hypothesis being tested in this trial is that ischaemic stroke patients selected with significant penumbral mismatch (measured by MRI criteria) at 3 - 9 hours post onset of stroke will have improved clinical outcomes when given intravenous tissue plasminogen activator (tPA) compared to placebo.
Studieoversigt
Status
Afsluttet
Betingelser
Intervention / Behandling
Undersøgelsestype
Interventionel
Tilmelding (Faktiske)
180
Fase
- Fase 3
Kontakter og lokationer
Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.
Studiesteder
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New South Wales
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Kanwal, New South Wales, Australien, 2259
- Gosford Hospital
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Newcastle, New South Wales, Australien
- John Hunter Hospital
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St. Leonards, New South Wales, Australien, 2065
- Royal North Shore Hospital
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Sydney, New South Wales, Australien, 6009
- St. Vincent's Hospital
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Westmead, New South Wales, Australien, 2145
- Westmead Hospital
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Queensland
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Brisbane, Queensland, Australien, 4029
- Royal Brisbane & Women's Hospital
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Gold Coast, Queensland, Australien
- Gold Coast University Hospital
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Nambour, Queensland, Australien, 4560
- Sunshine Coast University Hospital
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South Australia
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Adelaide, South Australia, Australien, 5000
- Royal Adelaide Hospital
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Bedford Park, South Australia, Australien, 5042
- Flinders Medical Centre
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Elizabeth Vale, South Australia, Australien, 5112
- Lyell McEwin Hospital
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Victoria
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Box Hill, Victoria, Australien, 3128
- Box Hill Hospital
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Clayton, Victoria, Australien, 3168
- Monash Medical Centre
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Footscray, Victoria, Australien, 3011
- Western Hospital
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Geelong, Victoria, Australien, 3220
- Geelong Hospital
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Heidelberg, Victoria, Australien
- Austin Hospital
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Melbourne, Victoria, Australien, 3050
- Royal Melbourne Hospital
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Richmond, Victoria, Australien, 3121
- Epworth Healthcare
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Western Australia
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Nedlands, Western Australia, Australien, 6009
- Sir Charles Gairdner Hospital
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Perth, Western Australia, Australien, 6000
- Royal Perth Hospital
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Helsinki, Finland
- Helsinki University Central Hospital
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Auckland, New Zealand, 1001
- Auckland Hospital
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Deltagelseskriterier
Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.
Berettigelseskriterier
Aldre berettiget til at studere
18 år og ældre (Voksen, Ældre voksen)
Tager imod sunde frivillige
Ingen
Køn, der er berettiget til at studere
Alle
Beskrivelse
Inclusion Criteria:
- Patients presenting with hemispheric acute ischaemic stroke
- Patient, family member or legally responsible person depending on local ethics requirements has given informed consent
- Patient's age is ≥18 years
Treatment onset can commence within ≥ 3 - 9 hours after stroke onset according to registered product information, or within 4.5 - 9 hours according to locally accepted guidelines*.
(*Guidelines are currently under international review - advisory statement issued by the Stroke Council, American Heart Association and American Stroke Association)
- Patients who wake with stroke may be included if neurological and other exclusion criteria are satisfied. These 'wake up' strokes are defined as having no symptoms at sleep onset, but stroke symptoms on waking. The time of stroke onset is to be taken as the mid-point between sleep onset (or last known to be normal) and time of waking. The maximum time window for randomisation is then 9 hours from the mid-point as described.
- NIHSS score of ≥ 4 - 26 with clinical signs of hemispheric infarction.
- Penumbral mismatch - A "hypo-perfusion to core" volume ratio of greater than 1.2 and an absolute difference greater than 10mL (using a MR or CT Tmax > 6 second delay) between perfusion lesion and MR-DWI or CT-CBF core lesion.
- An ischaemic core lesion volume of less than or equal to 70 ml using MR-DWI or CT-CBF ** Patients may be consented before or after penumbral screening depending upon local practice. The entire cohort of patients consented onto the study will be followed up with clinical assessments and biomarker studies regardless of eligibility for randomisation to treatment based on penumbral mismatch criteria
Exclusion Criteria:
- Intracranial haemorrhage (ICH) identified by CT or MRI
- Rapidly improving symptoms, particularly if in the judgment of the managing clinician that the improvement is likely to result in the patient having an NIHSS score of < 4 at randomization
- Pre-stroke MRS score of ≥ 2 (indicating previous disability)
- Contra indication to imaging with MR with contrast agents
- Infarct core >1/3 MCA territory qualitatively
- Participation in any investigational study in the previous 30 days
- Any terminal illness such that patient would not be expected to survive more than 1 year
- Any condition that could impose hazards to the patient if study therapy is initiated or affect the participation of the patient in the study (this applies to patients with severe microangiopathy such as haemolytic uremic syndrome or thrombotic thrombocytopenic purpura). The judgment is left to the discretion of the Investigator.
- Pregnant women (clinically evident)
- Previous stroke within last three months
- Recent past history or clinical presentation of ICH, subarachnoid haemorrhage (SAH), arterio-venous (AV) malformation, aneurysm, or cerebral neoplasm. At the discretion of each Investigator.
- Current use of oral anticoagulants or a prolonged prothrombin time (INR > 1.7) if the patient is on warfarin
- Use of heparin, except for low dose subcutaneous heparin, in the previous 48 hours and an activated prolonged partial thromboplastin time exceeding the upper limit of the local laboratory normal range.
- Use of glycoprotein IIb - IIIa inhibitors within the past 72 hours. Use of single or dual agent oral platelet inhibitors (clopidogrel and/or low-dose aspirin) prior to study entry is permitted.
- Clinically significant hypoglycaemia.
- Uncontrolled hypertension defined by a blood pressure > 185 mmHg systolic or >110 mmHg diastolic on at least 2 separate occasions at least 10 minutes apart, or requiring aggressive treatment to reduce the blood pressure to within these limits. The definition of "aggressive treatment" is left to the discretion of the responsible Investigator.
- Hereditary or acquired haemorrhagic diathesis
- Gastrointestinal or urinary bleeding within the preceding 21 days
- Major surgery within the preceding 14 days which poses risk in the opinion of the investigator.
- Exposure to a thrombolytic agent within the previous 72 hours
- Clinically deemed eligible for Endovascular Clot Retrieval (ECR) treatment by the treating team
Studieplan
Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Behandling
- Tildeling: Randomiseret
- Interventionel model: Parallel tildeling
- Maskning: Tredobbelt
Våben og indgreb
Deltagergruppe / Arm |
Intervention / Behandling |
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Placebo komparator: Placebo
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placebo leveret som 50 mg frysetørret pulver, der skal rekonstitueres med sterilt vand i hætteglas, der ikke kan skelnes fra aktivt lægemiddel
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Eksperimentel: IV tPA
intravenous tissue plasminogen activator
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0,9 mg/kg op til et maksimum på 90 mg, intravenøst, 10 % som bolus og resten over 1 time
Andre navne:
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Hvad måler undersøgelsen?
Primære resultatmål
Resultatmål |
Tidsramme |
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Modificeret Rankin-skala (mRS) 0-1
Tidsramme: 3 måneder
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3 måneder
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Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
---|---|---|
Kategorisk skift i modificeret Rankin Score (mRS)
Tidsramme: 3 måneder
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3 måneder
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Død på grund af enhver årsag
Tidsramme: 3 måneder
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3 måneder
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Reperfusion
Tidsramme: 24 timer
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24 timer
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Rekanalisering
Tidsramme: 24 timer
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24 timer
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Tilbagevendende slagtilfælde
Tidsramme: 3 og 12 måneder
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3 og 12 måneder
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Change in ≥ 8 NIHSS points or reaching ≤ 1 on this scale
Tidsramme: 3 months
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3 months
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Symptomatic ICH
Tidsramme: 24 hours
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Symptomatic hemorrhage defined by SITS-MOST criteria: type 2 parenchymal hematoma associated with ≥4 point increase in NIHSS
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24 hours
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Infarct growth
Tidsramme: 24 hours
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Difference in volumetric DWI volume between baseline and 24 hour MRI
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24 hours
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Depression (Montgomery-Asberg Depression Rating Scale [MADRS])
Tidsramme: 3 and 12 months
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3 and 12 months
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Quality of life (Stroke Impact Scale)
Tidsramme: 3 and 12 months
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3 and 12 months
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Samarbejdspartnere og efterforskere
Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.
Sponsor
Samarbejdspartnere
Efterforskere
- Ledende efterforsker: Stephen Davis, MD FRACP, University of Melbourne
- Ledende efterforsker: Geoffrey Donnan, MD FRACP, The Florey Institute of Neuroscence and Mental Health
Publikationer og nyttige links
Den person, der er ansvarlig for at indtaste oplysninger om undersøgelsen, leverer frivilligt disse publikationer. Disse kan handle om alt relateret til undersøgelsen.
Generelle publikationer
- Bivard A, Churilov L, Ma H, Levi C, Campbell B, Yassi N, Meretoja A, Zhao H, Sharma G, Chen C, Davis S, Donnan G, Yan B, Parsons M; EXTEND investigators. Does variability in automated perfusion software outputs for acute ischemic stroke matter? Reanalysis of EXTEND perfusion imaging. CNS Neurosci Ther. 2022 Jan;28(1):139-144. doi: 10.1111/cns.13756. Epub 2021 Nov 16.
- Ma H, Campbell BCV, Parsons MW, Churilov L, Levi CR, Hsu C, Kleinig TJ, Wijeratne T, Curtze S, Dewey HM, Miteff F, Tsai CH, Lee JT, Phan TG, Mahant N, Sun MC, Krause M, Sturm J, Grimley R, Chen CH, Hu CJ, Wong AA, Field D, Sun Y, Barber PA, Sabet A, Jannes J, Jeng JS, Clissold B, Markus R, Lin CH, Lien LM, Bladin CF, Christensen S, Yassi N, Sharma G, Bivard A, Desmond PM, Yan B, Mitchell PJ, Thijs V, Carey L, Meretoja A, Davis SM, Donnan GA; EXTEND Investigators. Thrombolysis Guided by Perfusion Imaging up to 9 Hours after Onset of Stroke. N Engl J Med. 2019 May 9;380(19):1795-1803. doi: 10.1056/NEJMoa1813046. Erratum In: N Engl J Med. 2021 Apr 1;384(13):1278.
- Churilov L, Ma H, Campbell BC, Davis SM, Donnan GA. Statistical Analysis Plan for EXtending the time for Thrombolysis in Emergency Neurological Deficits (EXTEND) trial. Int J Stroke. 2020 Feb;15(2):231-238. doi: 10.1177/1747493018816101. Epub 2018 Dec 7.
- Goodin P, Lamp G, Vidyasagar R, Connelly A, Rose S, Campbell BCV, Tse T, Ma H, Howells D, Hankey GJ, Davis S, Donnan G, Carey LM. Correlated Resting-State Functional MRI Activity of Frontostriatal, Thalamic, Temporal, and Cerebellar Brain Regions Differentiates Stroke Survivors with High Compared to Low Depressive Symptom Scores. Neural Plast. 2019 Jul 28;2019:2357107. doi: 10.1155/2019/2357107. eCollection 2019.
- Tse T, Binte Yusoff SZ, Churilov L, Ma H, Davis S, Donnan GA, Carey LM; START research team. Increased work and social engagement is associated with increased stroke specific quality of life in stroke survivors at 3 months and 12 months post-stroke: a longitudinal study of an Australian stroke cohort. Top Stroke Rehabil. 2017 Sep;24(6):405-414. doi: 10.1080/10749357.2017.1318339. Epub 2017 Apr 24.
Datoer for undersøgelser
Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.
Studer store datoer
Studiestart
1. juni 2010
Primær færdiggørelse (Faktiske)
27. august 2018
Studieafslutning (Faktiske)
27. august 2018
Datoer for studieregistrering
Først indsendt
22. april 2009
Først indsendt, der opfyldte QC-kriterier
22. april 2009
Først opslået (Skøn)
23. april 2009
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
31. august 2018
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
30. august 2018
Sidst verificeret
1. august 2018
Mere information
Begreber relateret til denne undersøgelse
Nøgleord
Yderligere relevante MeSH-vilkår
Andre undersøgelses-id-numre
- NTA0901
Disse oplysninger blev hentet direkte fra webstedet clinicaltrials.gov uden ændringer. Hvis du har nogen anmodninger om at ændre, fjerne eller opdatere dine undersøgelsesoplysninger, bedes du kontakte register@clinicaltrials.gov. Så snart en ændring er implementeret på clinicaltrials.gov, vil denne også blive opdateret automatisk på vores hjemmeside .