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- Essai clinique 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.
Aperçu de l'étude
Statut
Les conditions
Intervention / Traitement
Description détaillée
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.
Type d'étude
Inscription (Réel)
Phase
- Phase 4
Contacts et emplacements
Lieux d'étude
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Kujawsko-pomorskie
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Bydgoszcz, Kujawsko-pomorskie, Pologne, 85-094
- Cardiology Department, Dr. A. Jurasz University Hospital
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Critères de participation
Critère d'éligibilité
Âges éligibles pour étudier
Accepte les volontaires sains
Sexes éligibles pour l'étude
La description
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 d'étude
Comment l'étude est-elle conçue ?
Détails de conception
- Objectif principal: Traitement
- Répartition: Randomisé
- Modèle interventionnel: Affectation parallèle
- Masquage: Quadruple
Armes et Interventions
Groupe de participants / Bras |
Intervention / Traitement |
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Comparateur actif: Morphine
morphine sulfate 5 mg IV followed by 180 mg loading dose of ticagrelor
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Dose de charge de 180 mg
Autres noms:
IV bolus injection
Autres noms:
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Comparateur placebo: Placebo
sodium chloride 0,9% 5 mg IV followed by 180 mg loading dose of ticagrelor
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Dose de charge de 180 mg
Autres noms:
IV bolus injection
Autres noms:
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Que mesure l'étude ?
Principaux critères de jugement
Mesure des résultats |
Description de la mesure |
Délai |
---|---|---|
Area Under the Plasma Concentration-time Curve for Ticagrelor (AUC 0-12h)
Délai: 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
|
Mesures de résultats secondaires
Mesure des résultats |
Description de la mesure |
Délai |
---|---|---|
Area Under the Plasma Concentration-time Curve for AR-C124910XX (AUC 0-12h)
Délai: 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
Délai: 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
Délai: 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
Délai: 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
Délai: 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)
Délai: prior to the initial dose and 30min, 1h, 2h, 3h, 4h, 6h post dose
|
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)
Délai: 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
|
Platelet Reactivity Index Assessed by VASP Assay
Délai: 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%)
|
prior to the initial ticagrelor dose
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Platelet Reactivity Index Assessed by VASP Assay
Délai: 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%)
|
30 minutes post ticagrelor dose
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Platelet Reactivity Index Assessed by VASP Assay
Délai: 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%)
|
1 hour post ticagrelor dose
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Platelet Reactivity Index Assessed by VASP Assay
Délai: 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%)
|
2 hours post ticagrelor dose
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Platelet Reactivity Index Assessed by VASP Assay
Délai: 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%)
|
3 hours post ticagrelor dose
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Platelet Reactivity Index Assessed by VASP Assay
Délai: 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%)
|
4 hours post ticagrelor dose
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Platelet Reactivity Index Assessed by VASP Assay
Délai: 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%)
|
6 hours post ticagrelor dose
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Platelet Reactivity Index Assessed by VASP Assay
Délai: 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
Délai: 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
Délai: 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)
|
30 minutes post ticagrelor dose
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Platelet Arbitrary Aggregation Units Assessed by Multiple Electrode Aggregometry
Délai: 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)
|
1 hour post ticagrelor dose
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Platelet Arbitrary Aggregation Units Assessed by Multiple Electrode Aggregometry
Délai: 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)
|
2 hours post ticagrelor dose
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Platelet Arbitrary Aggregation Units Assessed by Multiple Electrode Aggregometry
Délai: 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)
|
3 hours post ticagrelor dose
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Platelet Arbitrary Aggregation Units Assessed by Multiple Electrode Aggregometry
Délai: 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)
|
4 hours post ticagrelor dose
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Platelet Arbitrary Aggregation Units Assessed by Multiple Electrode Aggregometry
Délai: 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)
|
6 hours post ticagrelor dose
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Platelet Arbitrary Aggregation Units Assessed by Multiple Electrode Aggregometry
Délai: 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)
|
12 hours post ticagrelor dose
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P2Y12 Reaction Units Assessed by VerifyNow
Délai: 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
Délai: 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)
|
30 minutes post ticagrelor dose
|
P2Y12 Reaction Units Assessed by VerifyNow
Délai: 1 hour post ticagrelor dose
|
P2Y12 Reaction Units (PRU) Assessed by VerifyNow (cut-off value for high platelet reactivity: PRU >208)
|
1 hour post ticagrelor dose
|
P2Y12 Reaction Units Assessed by VerifyNow
Délai: 2 hours post ticagrelor dose
|
P2Y12 Reaction Units (PRU) Assessed by VerifyNow (cut-off value for high platelet reactivity: PRU >208)
|
2 hours post ticagrelor dose
|
P2Y12 Reaction Units Assessed by VerifyNow
Délai: 3 hours post ticagrelor dose
|
P2Y12 Reaction Units (PRU) Assessed by VerifyNow (cut-off value for high platelet reactivity: PRU >208)
|
3 hours post ticagrelor dose
|
P2Y12 Reaction Units Assessed by VerifyNow
Délai: 4 hours post ticagrelor dose
|
P2Y12 Reaction Units (PRU) Assessed by VerifyNow (cut-off value for high platelet reactivity: PRU >208)
|
4 hours post ticagrelor dose
|
P2Y12 Reaction Units Assessed by VerifyNow
Délai: 6 hours post ticagrelor dose
|
P2Y12 Reaction Units (PRU) Assessed by VerifyNow (cut-off value for high platelet reactivity: PRU >208)
|
6 hours post ticagrelor dose
|
P2Y12 Reaction Units Assessed by VerifyNow
Délai: 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
Délai: 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
Délai: 2 hours
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Percentage of Patients With High Platelet Reactivity (HPR) After the Loading Dose of Ticagrelor Assessed With MEA
|
2 hours
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Percentage of Patients With High Platelet Reactivity After the Loading Dose of Ticagrelor Assessed With VerifyNow
Délai: 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
Délai: 12 hours
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Time to Reach Platelet Reactivity Below the Cut-off Value for High Platelet Reactivity (HPR) Evaluated With VASP
|
12 hours
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Time to Reach Platelet Reactivity Below the Cut-off Value for High Platelet Reactivity Evaluated With MEA
Délai: 12 hours
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Time to Reach Platelet Reactivity Below the Cut-off Value for High Platelet Reactivity (HPR) Evaluated With MEA
|
12 hours
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Time to Reach Platelet Reactivity Below the Cut-off Value for High Platelet Reactivity Evaluated With VerifyNow
Délai: 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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Collaborateurs et enquêteurs
Parrainer
Les enquêteurs
- Chercheur principal: Prof. Jacek Kubica, MD, PhD, Collegium Medicum im. Ludwika Rydygiera w Bydgoszczy, Uniwersytet Mikołaja Kopernika w Toruniu
Publications et liens utiles
Publications générales
- 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.
Dates d'enregistrement des études
Dates principales de l'étude
Début de l'étude
Achèvement primaire (Réel)
Achèvement de l'étude (Réel)
Dates d'inscription aux études
Première soumission
Première soumission répondant aux critères de contrôle qualité
Première publication (Estimation)
Mises à jour des dossiers d'étude
Dernière mise à jour publiée (Réel)
Dernière mise à jour soumise répondant aux critères de contrôle qualité
Dernière vérification
Plus d'information
Termes liés à cette étude
Mots clés
Termes MeSH pertinents supplémentaires
- Ischémie
- Processus pathologiques
- Nécrose
- Ischémie myocardique
- Maladies cardiaques
- Maladies cardiovasculaires
- Maladies vasculaires
- Infarctus du myocarde
- Infarctus
- Infarctus du myocarde avec sus-décalage du segment ST
- Effets physiologiques des médicaments
- Agents neurotransmetteurs
- Mécanismes moléculaires de l'action pharmacologique
- Dépresseurs du système nerveux central
- Agents du système nerveux périphérique
- Analgésiques
- Agents du système sensoriel
- Inhibiteurs de l'agrégation plaquettaire
- Antagonistes des récepteurs purinergiques P2Y
- Antagonistes des récepteurs purinergiques P2
- Antagonistes purinergiques
- Agents purinergiques
- Analgésiques, Opioïdes
- Stupéfiants
- Ticagrélor
- Morphine
Autres numéros d'identification d'étude
- CMUMK202
Plan pour les données individuelles des participants (IPD)
Prévoyez-vous de partager les données individuelles des participants (DPI) ?
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