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Bedside Testing of CYP2C19 Gene for Treatment of Patients With PCI With Antiplatelet Therapy

20. januar 2016 opdateret af: Imam Abdulrahman Bin Faisal University

Bedside Testing of the CYP2C19 Gene to Asses Effectiveness of Clopidogrel in Coronary Artery Disease Patients Treated With Percutaneous Coronary Intervention : Individualized Antiplatelet Drugs Treatment to Improve Prognosis

Clopidogrel is crucial as antiplatelet treatment in patients undergoing percutaneous coronary intervention (PCI) with stent implantation and during one year after PCI, to prevent atherothrombotic complications. However, clopidogrel is ineffective in certain patients due to genetic mutation in CYP2C19 gene a specific enzyme in the liver required for metabolism of clopidogrel. Therefore, the purpose of this study is to test these patients genetically at bedside and prescribe an alternative drug such as Ticagrelor (90 mg twice daily) or prasugrel ( 10mg once daily or 5mg once daily if the patient older than 75 years or a body weight < 60kg) if they are carriers of the allele 2 or 3 of the mutated gene.

Studieoversigt

Status

Ukendt

Betingelser

Intervention / Behandling

Detaljeret beskrivelse

Clopidogrel is crucial as antiplatelet treatment in patients undergoing percutaneous coronary intervention (PCI) with stent implantation and during one year after PCI, to prevent atherothrombotic complications. Clopidogrel is converted into its active metabolite by Cytochrome P2C19 (CYP2C19). However 30 % of the Saudi population is carrier of the non functional CYP2C19*2 or *3 alleles having an impaired CYP2C19 capacity, resulting in decreased effectiveness of Clopidogrel. These patients have a 42% higher risk for major cardiovascular events (MACE) compared to non carriers. Further 50 % of the MACE occurs in the first 48 hours. Therefore Ticagrelor (90 mg twice daily) or prasugrel ( 10mg once daily or 5mg once daily if the patient older than 75 years or a body weight < 60kg) whose actions are not dependent on conversion by CYP2C19 may be an alternative only in carriers of the non functional CYP2C19*2 or *3 alleles. This might be cost effective and prevent patients form MACE. Therefore the objective of this study is to assess the efficacy, complication free survival, safety and cost-effectiveness of the CYP2C19 genotype guided antiplatelet treatment strategy, using clopidogrel or prasugrel (or Ticlid). All participants will be followed for one year using follow up questionnaires.

Undersøgelsestype

Interventionel

Tilmelding (Forventet)

1500

Fase

  • Fase 4

Kontakter og lokationer

Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.

Studiesteder

  • Saudi Arabien
      • Al-Hasa, Saudi Arabien, 31982
        • Rekruttering
        • Prince Sultan Cardiac Center
        • Underforsker:
          • Abdullah Alabdulgader, MD
      • Al-Khobar, Saudi Arabien, 31441
        • Rekruttering
        • King Fahd University Hospital
        • Ledende efterforsker:
          • Abdullah M Al-Rubaish, MD
        • Underforsker:
          • Fahd A Al-Muhanna, MD
        • Underforsker:
          • Emmanuel Larbi, MD, PhD
        • Underforsker:
          • Abdullah Al-Shehri, MD
        • Underforsker:
          • Akram Al-Khadra, MD
        • Underforsker:
          • Amein Al-Ali, PhD
        • Underforsker:
          • Mohammed Al-Mansory, MD
      • Dammam, Saudi Arabien, 31463
        • Rekruttering
        • Saud Al-Babtain Cardiac Center
        • Underforsker:
          • Hamid Al-Omran, MD
        • Underforsker:
          • Mustafa Al-Refaei, MD
        • Underforsker:
          • Najeeb Abdulhamid, MD
        • Underforsker:
          • Shukry Mirza, MD
        • Underforsker:
          • Yousef Alsabeet, MD
      • Dammam, Saudi Arabien, 31932
        • Rekruttering
        • King Fahd Military Medical Complex
        • Underforsker:
          • Khalid Al-Fraiedi, MD

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 til 70 år (Voksen, Ældre voksen)

Tager imod sunde frivillige

Ingen

Køn, der er berettiget til at studere

Alle

Beskrivelse

Male & female age 18-70 years

Inclusion Criteria:

  • Patient presents with acute myocardial infarction of more than 30 minutes and less than 12 hours
  • Patient eligible for PCI

Exclusion Criteria:

  • Life expectancy of less than one year
  • Previously Known genotype
  • Receiving chemotherapy for malignancy
  • On dialysis or receiving immunosuppressive therapy or have autoimmune disease
  • Hepatic impairment
  • History of bleeding diathesis
  • Receiving vitamin K antagonist therapy
  • Confirmed hypertension
  • Out of normal range platelet count
  • History of major surgery
  • Severe trauma or fracture
  • Pregnancy and lactation
  • Concomitant use of simvastatin, cytochrome P450 3A4 inhibitors or inducers
  • Hypersensitivity to clopidogrel or ticagrelor or prasugrel

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: Ikke-randomiseret
  • Interventionel model: Parallel tildeling
  • Maskning: Ingen (Åben etiket)

Våben og indgreb

Deltagergruppe / Arm
Intervention / Behandling
Aktiv komparator: Clopidogrel
CYP2C19 genotyping will be carried out at the end of the study period. Clopidogrel will be used for treatment for one year according to local protocol. Patients will receive clopidogrel 75 mg per day.
Medicin: clopidogrel
Genotyping will be carried out using Spartan genotyping System on all intervention group and those patients who do not carry the CYP2C19 allele 2 or 3 will be given clopidogrel (75 mg per day) while all patients who carry the CYP2C19 allele 2 or 3 will be prescribed Ticagrelor (90 mg twice daily) or prasugrel ( 10mg once daily or 5mg once daily if the patient older than 75 years or a body weight < 60kg) according to local protocol.
Andre navne:
  • Clavix
Eksperimentel: Ticagrelor or prasugrel
Ticagrelor (90 mg twice daily) or prasugrel ( 10mg once daily or 5mg once daily if the patient older than 75 years or a body weight < 60kg) according to local protocol.
Medicin: Ticagrelor or prasugrel
ticagrelor (90 mg twice daily) or prasugrel ( 10mg once daily or 5mg once daily if the patient older than 75 years or a body weight < 60kg) according to local protocol.
Andre navne:
  • Brilinta
  • Prasuvas

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
cardiovascular event
Tidsramme: 1 year
The primary end point is the number of patients who develop adverse major cardiovascular event which include recurrent myocardial infarction, non-fatal stroke, cardiovascular mortality, severe ischemia, major bleeding at 30days after PCI.
1 year

Sekundære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Mortality
Tidsramme: 30 days and 1 year
Secondary efficacy endpoints are the number of patients who either died , died from cardiovascular death, from cerebrovascular death, developed recurrent MI, stent thrombosis, underwent urgent target vessel revascularization, developed stroke or combination of above
30 days and 1 year

Samarbejdspartnere og efterforskere

Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.

Sponsor

Imam Abdulrahman Bin Faisal University

Samarbejdspartnere

King Fahad Armed Forces Hospital
Dammam Central Hospital

Efterforskere

  • Ledende efterforsker: Abdullah M Al-Rubaish, MD, Imam Abdulrahman bin Faisal University
  • Studieleder: Amein K Al-Ali, PhD, Imam Abdulrahman bin Faisal University

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

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. marts 2013

Primær færdiggørelse (Forventet)

1. januar 2016

Studieafslutning (Forventet)

1. marts 2016

Datoer for studieregistrering

Først indsendt

19. marts 2013

Først indsendt, der opfyldte QC-kriterier

2. april 2013

Først opslået (Skøn)

4. april 2013

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Skøn)

22. januar 2016

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

20. januar 2016

Sidst verificeret

1. januar 2016

Mere information

Begreber relateret til denne undersøgelse

Nøgleord

Yderligere relevante MeSH-vilkår

Andre undersøgelses-id-numre

  • STGUD005

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 .

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