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- Ensayo clínico NCT02217878
Influence of Morphine on Pharmacokinetics and Pharmacodynamics of Ticagrelor in Patients With Acute Myocardial Infarction (IMPRESSION)
A Randomized, Double-blind Study Evaluating the Influence of Morphine on Pharmacokinetics and Pharmacodynamics of Ticagrelor and Its Active Metabolite (AR-C124910XX) in Patients With ST-segment Elevation Myocardial Infarction and Non-ST-segment Elevation Myocardial Infarction.
Descripción general del estudio
Estado
Condiciones
Intervención / Tratamiento
Descripción detallada
The European Society of Cardiology and American Heart Association guidelines recommend use of morphine as a treatment of choice for pain relief in STEMI patients. However, this recommendation, although strong, is only based on expert consensus (class of recommendation I, level of evidence C). Morphine, apart from its analgesic effects, also alleviates the work of breathing and reduces anxiety. On the other hand, despite its favorable analgesic and sedative actions, morphine also exerts adverse effects, which include hypotension, bradycardia, respiratory depression, vomiting and reduction of gastrointestinal motility. Some of the previously listed morphine's side effects could affect the intestinal absorption and thus pharmacokinetics and pharmacodynamics of orally administered drugs which are concomitantly used with morphine. At present, no pharmacokinetic and pharmacodynamic data regarding the concurrent use of morphine and P2Y12 blockers in the STEMI or NSTEMI setting are available. Therefore, evidence-based verification of morphine's influence on pharmacokinetics and pharmacodynamics of ticagrelor and its active metabolite (AR-C124910XX) could provide a valuable insight in the knowledge regarding modern acute myocardial infarction management.
Predefined subanalysis: aimed to investigate which one of platelet reactivity assessment methods utilized in the study (VASP assay, MEA, LTA, VerifyNow) best reflects concentration of ticagrelor and its active metabolite (AR-C124910XX).
Since there is no reference study examining pharmacokinetics of ticagrelor in STEMI or NSTEMI patients, we decided to perform an internal pilot study of approximately 30 patients (15 patients for each arm) for estimating the final sample size.
Tipo de estudio
Inscripción (Actual)
Fase
- Fase 4
Contactos y Ubicaciones
Ubicaciones de estudio
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Kujawsko-pomorskie
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Bydgoszcz, Kujawsko-pomorskie, Polonia, 85-094
- Cardiology Department, Dr. A. Jurasz University Hospital
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Criterios de participación
Criterio de elegibilidad
Edades elegibles para estudiar
Acepta Voluntarios Saludables
Géneros elegibles para el estudio
Descripción
Inclusion Criteria:
- provision of informed consent prior to any study specific procedures
- diagnosis of acute ST-segment elevation myocardial infarction or acute non-ST-segment elevation myocardial infarction
- male or non-pregnant female, aged 18-80 years old
- provision of informed consent for angiography and PCI
Exclusion Criteria:
- chest pain described by the patient as unbearable or patient's request for analgesics
- prior morphine administration during the current STEMI or NSTEMI
- treatment with ticlopidine, clopidogrel, prasugrel or ticagrelor within 14 days before the study enrollment
- hypersensitivity to ticagrelor
- current treatment with oral anticoagulant or chronic therapy with low-molecular-weight heparin
- active bleeding
- history of intracranial hemorrhage
- recent gastrointestinal bleeding (within 30 days)
- history of coagulation disorders
- platelet count less than <100 x10^3/mcl
- hemoglobin concentration less than 10.0 g/dl
- history of moderate or severe hepatic impairment
- history of major surgery or severe trauma (within 3 months)
- patients considered by the investigator to be at risk of bradycardic events
- second or third degree atrioventricular block during screening for eligibility
- history of asthma or severe chronic obstructive pulmonary disease
- patient required dialysis
- manifest infection or inflammatory state
- Killip class III or IV during screening for eligibility
- respiratory failure
- history of severe chronic heart failure (NYHA class III or IV)
- concomitant therapy with strong CYP3A inhibitors (ketoconazole, itraconazole, voriconazole, telithromycin, clarithromycin, nefazadone, ritonavir, saquinavir, nelfinavir, indinavir, atazanavir) or strong CYP3A inducers (rifampicin, phenytoin, carbamazepine, dexamethasone, phenobarbital) within 14 days and during study treatment
- body weight below 50 kg
Plan de estudios
¿Cómo está diseñado el estudio?
Detalles de diseño
- Propósito principal: Tratamiento
- Asignación: Aleatorizado
- Modelo Intervencionista: Asignación paralela
- Enmascaramiento: Cuadruplicar
Armas e Intervenciones
Grupo de participantes/brazo |
Intervención / Tratamiento |
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Comparador activo: Morphine
morphine sulfate 5 mg IV followed by 180 mg loading dose of ticagrelor
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Dosis de carga de 180 mg
Otros nombres:
IV bolus injection
Otros nombres:
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Comparador de placebos: Placebo
sodium chloride 0,9% 5 mg IV followed by 180 mg loading dose of ticagrelor
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Dosis de carga de 180 mg
Otros nombres:
IV bolus injection
Otros nombres:
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¿Qué mide el estudio?
Medidas de resultado primarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
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Area Under the Plasma Concentration-time Curve for Ticagrelor (AUC 0-12h)
Periodo de tiempo: prior to the initial dose and 30min, 1h, 2h, 3h, 4h, 6h, 12h post dose
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Exposure to ticagrelor during the first 12 hours after ticagrelor loading dose
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prior to the initial dose and 30min, 1h, 2h, 3h, 4h, 6h, 12h post dose
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Medidas de resultado secundarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
---|---|---|
Area Under the Plasma Concentration-time Curve for AR-C124910XX (AUC 0-12h)
Periodo de tiempo: prior to the initial dose and 30min, 1h, 2h, 3h, 4h, 6h, 12h post dose
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Exposure to ticagrelor metabolite during the first 12 hours after ticagrelor loading dose
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prior to the initial dose and 30min, 1h, 2h, 3h, 4h, 6h, 12h post dose
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Maximum Concentration of Ticagrelor
Periodo de tiempo: 12 hours
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Maximum concentration (Cmax) of ticagrelor
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12 hours
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Maximum Concentration of AR-C124910XX
Periodo de tiempo: 12 hours
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Maximum concentration (Cmax) of AR-C124910XX
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12 hours
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Time to Maximum Concentration for Ticagrelor
Periodo de tiempo: 12 hours
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Time to maximum concentration (Tmax) for ticagrelor
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12 hours
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Time to Maximum Concentration for AR-C124910XX
Periodo de tiempo: 12 hours
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Time to maximum concentration (Tmax) for AR-C124910XX
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12 hours
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Area Under the Plasma Concentration-time Curve for Ticagrelor (AUC 0-6h)
Periodo de tiempo: prior to the initial dose and 30min, 1h, 2h, 3h, 4h, 6h post dose
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Exposure to ticagrelor during the first 6 hours after ticagrelor loading dose
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prior to the initial dose and 30min, 1h, 2h, 3h, 4h, 6h post dose
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Area Under the Plasma Concentration-time Curve for AR-C124910XX (AUC 0-6)
Periodo de tiempo: prior to the initial dose and 30min, 1h, 2h, 3h, 4h, 6h post dose
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Exposure to ticagrelor metabolite during the first 6 hours after ticagrelor loading dose
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prior to the initial dose and 30min, 1h, 2h, 3h, 4h, 6h post dose
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Platelet Reactivity Index Assessed by VASP Assay
Periodo de tiempo: prior to the initial ticagrelor dose
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Platelet Reactivity Index (PRI) evaluated by VASP assay (cut-off value for high platelet reactivity: PRI >50%)
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prior to the initial ticagrelor dose
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Platelet Reactivity Index Assessed by VASP Assay
Periodo de tiempo: 30 minutes post ticagrelor dose
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Platelet Reactivity Index (PRI) evaluated by VASP assay (cut-off value for high platelet reactivity: PRI >50%)
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30 minutes post ticagrelor dose
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Platelet Reactivity Index Assessed by VASP Assay
Periodo de tiempo: 1 hour post ticagrelor dose
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Platelet Reactivity Index (PRI) evaluated by VASP assay (cut-off value for high platelet reactivity: PRI >50%)
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1 hour post ticagrelor dose
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Platelet Reactivity Index Assessed by VASP Assay
Periodo de tiempo: 2 hours post ticagrelor dose
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Platelet Reactivity Index (PRI) evaluated by VASP assay (cut-off value for high platelet reactivity: PRI >50%)
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2 hours post ticagrelor dose
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Platelet Reactivity Index Assessed by VASP Assay
Periodo de tiempo: 3 hours post ticagrelor dose
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Platelet Reactivity Index (PRI) evaluated by VASP assay (cut-off value for high platelet reactivity: PRI >50%)
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3 hours post ticagrelor dose
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Platelet Reactivity Index Assessed by VASP Assay
Periodo de tiempo: 4 hours post ticagrelor dose
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Platelet Reactivity Index (PRI) evaluated by VASP assay (cut-off value for high platelet reactivity: PRI >50%)
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4 hours post ticagrelor dose
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Platelet Reactivity Index Assessed by VASP Assay
Periodo de tiempo: 6 hours post ticagrelor dose
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Platelet Reactivity Index (PRI) evaluated by VASP assay (cut-off value for high platelet reactivity: PRI >50%)
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6 hours post ticagrelor dose
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Platelet Reactivity Index Assessed by VASP Assay
Periodo de tiempo: 12 hours post ticagrelor dose
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Platelet Reactivity Index (PRI) evaluated by VASP assay (cut-off value for high platelet reactivity: PRI >50%)
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12 hours post ticagrelor dose
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Platelet Arbitrary Aggregation Units Assessed by Multiple Electrode Aggregometry
Periodo de tiempo: prior to the initial ticagrelor dose
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Platelet reactivity assessed by Multiple Electrode Aggregometry (cut-off value for high platelet reactivity: AUC >46 Platelet Arbitrary Aggregation Units)
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prior to the initial ticagrelor dose
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Platelet Arbitrary Aggregation Units Assessed by Multiple Electrode Aggregometry
Periodo de tiempo: 30 minutes post ticagrelor dose
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Platelet reactivity assessed by Multiple Electrode Aggregometry (cut-off value for high platelet reactivity: AUC >46 Platelet Arbitrary Aggregation Units)
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30 minutes post ticagrelor dose
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Platelet Arbitrary Aggregation Units Assessed by Multiple Electrode Aggregometry
Periodo de tiempo: 1 hour post ticagrelor dose
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Platelet reactivity assessed by Multiple Electrode Aggregometry (cut-off value for high platelet reactivity: AUC >46 Platelet Arbitrary Aggregation Units)
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1 hour post ticagrelor dose
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Platelet Arbitrary Aggregation Units Assessed by Multiple Electrode Aggregometry
Periodo de tiempo: 2 hours post ticagrelor dose
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Platelet reactivity assessed by Multiple Electrode Aggregometry (cut-off value for high platelet reactivity: AUC >46 Platelet Arbitrary Aggregation Units)
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2 hours post ticagrelor dose
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Platelet Arbitrary Aggregation Units Assessed by Multiple Electrode Aggregometry
Periodo de tiempo: 3 hours post ticagrelor dose
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Platelet reactivity assessed by Multiple Electrode Aggregometry (cut-off value for high platelet reactivity: AUC >46 Platelet Arbitrary Aggregation Units)
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3 hours post ticagrelor dose
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Platelet Arbitrary Aggregation Units Assessed by Multiple Electrode Aggregometry
Periodo de tiempo: 4 hours post ticagrelor dose
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Platelet reactivity assessed by Multiple Electrode Aggregometry (cut-off value for high platelet reactivity: AUC >46 Platelet Arbitrary Aggregation Units)
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4 hours post ticagrelor dose
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Platelet Arbitrary Aggregation Units Assessed by Multiple Electrode Aggregometry
Periodo de tiempo: 6 hours post ticagrelor dose
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Platelet reactivity assessed by Multiple Electrode Aggregometry (cut-off value for high platelet reactivity: AUC >46 Platelet Arbitrary Aggregation Units)
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6 hours post ticagrelor dose
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Platelet Arbitrary Aggregation Units Assessed by Multiple Electrode Aggregometry
Periodo de tiempo: 12 hours post ticagrelor dose
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Platelet reactivity assessed by Multiple Electrode Aggregometry (cut-off value for high platelet reactivity: AUC >46 Platelet Arbitrary Aggregation Units)
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12 hours post ticagrelor dose
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P2Y12 Reaction Units Assessed by VerifyNow
Periodo de tiempo: prior to the initial ticagrelor dose
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P2Y12 Reaction Units (PRU) Assessed by VerifyNow (cut-off value for high platelet reactivity: PRU >208)
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prior to the initial ticagrelor dose
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P2Y12 Reaction Units Assessed by VerifyNow
Periodo de tiempo: 30 minutes post ticagrelor dose
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P2Y12 Reaction Units (PRU) Assessed by VerifyNow (cut-off value for high platelet reactivity: PRU >208)
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30 minutes post ticagrelor dose
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P2Y12 Reaction Units Assessed by VerifyNow
Periodo de tiempo: 1 hour post ticagrelor dose
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P2Y12 Reaction Units (PRU) Assessed by VerifyNow (cut-off value for high platelet reactivity: PRU >208)
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1 hour post ticagrelor dose
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P2Y12 Reaction Units Assessed by VerifyNow
Periodo de tiempo: 2 hours post ticagrelor dose
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P2Y12 Reaction Units (PRU) Assessed by VerifyNow (cut-off value for high platelet reactivity: PRU >208)
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2 hours post ticagrelor dose
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P2Y12 Reaction Units Assessed by VerifyNow
Periodo de tiempo: 3 hours post ticagrelor dose
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P2Y12 Reaction Units (PRU) Assessed by VerifyNow (cut-off value for high platelet reactivity: PRU >208)
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3 hours post ticagrelor dose
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P2Y12 Reaction Units Assessed by VerifyNow
Periodo de tiempo: 4 hours post ticagrelor dose
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P2Y12 Reaction Units (PRU) Assessed by VerifyNow (cut-off value for high platelet reactivity: PRU >208)
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4 hours post ticagrelor dose
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P2Y12 Reaction Units Assessed by VerifyNow
Periodo de tiempo: 6 hours post ticagrelor dose
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P2Y12 Reaction Units (PRU) Assessed by VerifyNow (cut-off value for high platelet reactivity: PRU >208)
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6 hours post ticagrelor dose
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P2Y12 Reaction Units Assessed by VerifyNow
Periodo de tiempo: 12 hours post ticagrelor dose
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P2Y12 Reaction Units (PRU) Assessed by VerifyNow (cut-off value for high platelet reactivity: PRU >208)
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12 hours post ticagrelor dose
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Percentage of Patients With High Platelet Reactivity After the Loading Dose of Ticagrelor Assessed With VASP
Periodo de tiempo: 2 hours
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Percentage of Patients With High Platelet Reactivity (HPR) After the Loading Dose of Ticagrelor Assessed With VASP
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2 hours
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Percentage of Patients With High Platelet Reactivity After the Loading Dose of Ticagrelor Assessed With MEA
Periodo de tiempo: 2 hours
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Percentage of Patients With High Platelet Reactivity (HPR) After the Loading Dose of Ticagrelor Assessed With MEA
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2 hours
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Percentage of Patients With High Platelet Reactivity After the Loading Dose of Ticagrelor Assessed With VerifyNow
Periodo de tiempo: 2 hours
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Percentage of Patients With High Platelet Reactivity (HPR) After the Loading Dose of Ticagrelor Assessed With VerifyNow
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2 hours
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Time to Reach Platelet Reactivity Below the Cut-off Value for High Platelet Reactivity Evaluated With VASP
Periodo de tiempo: 12 hours
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Time to Reach Platelet Reactivity Below the Cut-off Value for High Platelet Reactivity (HPR) Evaluated With VASP
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12 hours
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Time to Reach Platelet Reactivity Below the Cut-off Value for High Platelet Reactivity Evaluated With MEA
Periodo de tiempo: 12 hours
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Time to Reach Platelet Reactivity Below the Cut-off Value for High Platelet Reactivity (HPR) Evaluated With MEA
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12 hours
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Time to Reach Platelet Reactivity Below the Cut-off Value for High Platelet Reactivity Evaluated With VerifyNow
Periodo de tiempo: 12 hours
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Time to Reach Platelet Reactivity Below the Cut-off Value for High Platelet Reactivity (HPR) Evaluated With VerifyNow
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12 hours
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Colaboradores e Investigadores
Patrocinador
Investigadores
- Investigador principal: Prof. Jacek Kubica, MD, PhD, Collegium Medicum im. Ludwika Rydygiera w Bydgoszczy, Uniwersytet Mikołaja Kopernika w Toruniu
Publicaciones y enlaces útiles
Publicaciones Generales
- Kubica J, Adamski P, Ostrowska M, Sikora J, Kubica JM, Sroka WD, Stankowska K, Buszko K, Navarese EP, Jilma B, Siller-Matula JM, Marszall MP, Rosc D, Kozinski M. Morphine delays and attenuates ticagrelor exposure and action in patients with myocardial infarction: the randomized, double-blind, placebo-controlled IMPRESSION trial. Eur Heart J. 2016 Jan 14;37(3):245-52. doi: 10.1093/eurheartj/ehv547. Epub 2015 Oct 21.
- Kubica J, Adamski P, Ostrowska M, Kozinski M, Obonska K, Laskowska E, Obonska E, Grzesk G, Winiarski P, Paciorek P. Influence of Morphine on Pharmacokinetics and Pharmacodynamics of Ticagrelor in Patients with Acute Myocardial Infarction (IMPRESSION): study protocol for a randomized controlled trial. Trials. 2015 Apr 29;16:198. doi: 10.1186/s13063-015-0724-z.
Fechas de registro del estudio
Fechas importantes del estudio
Inicio del estudio
Finalización primaria (Actual)
Finalización del estudio (Actual)
Fechas de registro del estudio
Enviado por primera vez
Primero enviado que cumplió con los criterios de control de calidad
Publicado por primera vez (Estimar)
Actualizaciones de registros de estudio
Última actualización publicada (Actual)
Última actualización enviada que cumplió con los criterios de control de calidad
Última verificación
Más información
Términos relacionados con este estudio
Palabras clave
Términos MeSH relevantes adicionales
- Isquemia
- Procesos Patológicos
- Necrosis
- Isquemia miocardica
- Enfermedades cardíacas
- Enfermedades cardiovasculares
- Enfermedades Vasculares
- Infarto de miocardio
- Infarto
- Infarto de miocardio con elevación del ST
- Efectos fisiológicos de las drogas
- Agentes neurotransmisores
- Mecanismos moleculares de acción farmacológica
- Depresores del sistema nervioso central
- Agentes del sistema nervioso periférico
- Analgésicos
- Agentes del sistema sensorial
- Inhibidores de la agregación plaquetaria
- Antagonistas del receptor P2Y purinérgico
- Antagonistas del receptor P2 purinérgico
- Antagonistas purinérgicos
- Agentes Purinérgicos
- Analgésicos Opiáceos
- Estupefacientes
- Ticagrelor
- Morfina
Otros números de identificación del estudio
- CMUMK202
Plan de datos de participantes individuales (IPD)
¿Planea compartir datos de participantes individuales (IPD)?
Esta información se obtuvo directamente del sitio web clinicaltrials.gov sin cambios. Si tiene alguna solicitud para cambiar, eliminar o actualizar los detalles de su estudio, comuníquese con register@clinicaltrials.gov. Tan pronto como se implemente un cambio en clinicaltrials.gov, también se actualizará automáticamente en nuestro sitio web. .
Ensayos clínicos sobre Ticagrelor
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University of FloridaTerminado
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Collegium Medicum w BydgoszczyTerminado
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AstraZenecaParexelTerminadoAnemia drepanocíticaAlemania
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AstraZenecaTerminadoInfarto de miocardio | Carrera | Aterotrombosis | Muerte cardiovascularSuecia, Estados Unidos, Australia, Brasil, Bulgaria, República Checa, Francia, Italia, Corea, república de, Perú, Polonia, Federación Rusa, Sudáfrica, España, Pavo, Reino Unido, Alemania, Filipinas, Porcelana, Hungría, Rumania, Ucrania, Países Bajos y más
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Federico II UniversityAdvicePharma GroupTerminadoInfarto de miocardio | Enfermedad de la arteria coronaria | El síndrome coronario agudo | STEMI | IAMSESTItalia
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University of FloridaAstraZenecaTerminadoEnfermedad de la arteria coronariaEstados Unidos
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University of FloridaThe Medicines CompanyTerminadoEnfermedad de la arteria coronariaEstados Unidos
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Centro Hospitalario La ConcepcionReclutamiento
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Sheba Medical CenterTerminadoInfarto de miocardio con elevación del ST | Síndromes coronarios agudosIsrael
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University of KarachiPharmEvo Private Limited., PakistanTerminado