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STRATEGIA PER MIGLIORARE LA RISPOSTA AL TRATTAMENTO DELL'ICTUS (SISTER)

13 ottobre 2026 aggiornato da: Translational Sciences, Inc.

SISTER is a Phase-II, prospective, randomized, placebo-controlled, blinded, dose finding trial that aims to determine the safety and preliminary efficacy of TS23, a monoclonal antibody against the alpha-2 antiplasmin (a2-AP), in acute ischemic stroke.

Panoramica dello studio

Stato

Reclutamento

Condizioni

Intervento / Trattamento

Descrizione dettagliata

SISTER is a Phase II, Bayesian, adaptive, randomized, dose-finding trial of TS23 in patients with acute ischemic stroke. Patients with an anterior cerebral circulation acute ischemic stroke and present between 4.5 to 24 hours of their last known well with a presenting NIH Stroke Scale Score >/=4 (with the patient having a clearly disabling deficit if the NIHSS is 4 or 5) and an imaging evidence of salvageable brain tissue will be eligible and will be approached for an informed consent for study participation. Patients with an NIHSS of 4-5 must have a new, disabling neuro-logic deficit to be eligible for the study. After informed consent is provided, the study will randomize to 4 doses of TS23 and placebo. The trial will enroll up to 150 subjects at up to 70 participating US sites.

The effects of TS23 will be evaluated on two following primary outcomes using a utility function: 1) primary safety outcome: any intracerebral hemorrhage at 30 (+/-4) hours and 2) primary efficacy outcome: NIH Stroke Scale score at 30 (+/-4) hours after drug administration. The study will follow participants for 90 (+/-7) days.

Primary Objective: To identify a dose of TS23 that is safe and more efficacious than placebo for the treatment of patients from 4.5 to 24 hours of last known well, who have evidence of core-penumbra mismatch on perfusion imaging and are not a candidate for standard of care reperfusion therapies.

Tipo di studio

Interventistico

Iscrizione (Stimato)

300

Fase

  • Fase 2

Contatti e Sedi

Questa sezione fornisce i recapiti di coloro che conducono lo studio e informazioni su dove viene condotto lo studio.

Contatto studio

Backup dei contatti dello studio

Luoghi di studio

    • Alabama
      • Birmingham, Alabama, Stati Uniti, 35233
        • Reclutamento
        • University of Alabama Hospital
        • Contatto:
        • Investigatore principale:
          • Felix Guerra Castanon, MD
    • Arizona
      • Phoenix, Arizona, Stati Uniti, 85006
        • Reclutamento
        • Banner University Medical Center
        • Investigatore principale:
          • Savdeep Singh, MD
        • Contatto:
      • Phoenix, Arizona, Stati Uniti, 85054
        • Ritirato
        • Mayo Clinic Phoenix
      • Tucson, Arizona, Stati Uniti, 85719
        • Reclutamento
        • Banner University Medical Center - Tucson
        • Contatto:
        • Investigatore principale:
          • Firas Kaddouh, MD, MHS
    • California
      • La Jolla, California, Stati Uniti, 92093
      • Los Angeles, California, Stati Uniti, 90027
        • Reclutamento
        • Kaiser Permanente Los Angeles
        • Contatto:
        • Investigatore principale:
          • Navdeep Sangha, MD
      • Sacramento, California, Stati Uniti, 95816
        • Ritirato
        • Sutter Medical Center
      • San Diego, California, Stati Uniti, 92103
        • Reclutamento
        • UCSD Medical Center- Hillcrest Hospital
        • Contatto:
        • Investigatore principale:
          • Royya Modir, MD
        • Contatto:
    • Connecticut
      • Hartford, Connecticut, Stati Uniti, 06102
        • Reclutamento
        • Hartford Hospital
        • Investigatore principale:
          • Ajay Tunguturi, MD
        • Contatto:
      • New Haven, Connecticut, Stati Uniti, 06511
        • Reclutamento
        • Yale New Haven Hospital
        • Contatto:
        • Investigatore principale:
          • James Giles, MD, PhD
    • Delaware
      • Newark, Delaware, Stati Uniti, 19718
        • Ritirato
        • Christiana Hospital
    • Florida
      • Gainesville, Florida, Stati Uniti, 32608
        • Terminato
        • UF Health Shands Hospital
      • Miami, Florida, Stati Uniti, 33136
        • Reclutamento
        • Jackson Memorial Hospital
        • Contatto:
        • Contatto:
        • Investigatore principale:
          • Gillian Gordon Perue, MD, MBBS, DM
    • Georgia
      • Atlanta, Georgia, Stati Uniti, 30303
        • Reclutamento
        • Grady Memorial Hospital
        • Contatto:
        • Investigatore principale:
          • Nicolas Bianchi, MD
    • Illinois
      • Chicago, Illinois, Stati Uniti, 60637
        • Attivo, non reclutante
        • University of Chicago Medical Center
    • Iowa
      • Iowa City, Iowa, Stati Uniti, 52242
        • Ritirato
        • University of Iowa Hospitals & Clinics
    • Kentucky
      • Lexington, Kentucky, Stati Uniti, 40503
      • Louisville, Kentucky, Stati Uniti, 40202
        • Reclutamento
        • University of Louisville Hospital
        • Investigatore principale:
          • Isaac Abecassis, MD
        • Contatto:
    • Massachusetts
      • Boston, Massachusetts, Stati Uniti, 02115
        • Reclutamento
        • Brigham and Women's Hospital
        • Investigatore principale:
          • Rahul Mahajan, MD, PhD
        • Contatto:
      • Boston, Massachusetts, Stati Uniti, 02171
        • Reclutamento
        • Massachusetts General Hospital
        • Investigatore principale:
          • Aneesh Singhal, MD, MBBS
        • Contatto:
    • Minnesota
      • Burnsville, Minnesota, Stati Uniti, 55337
        • Reclutamento
        • M Health Fairview Ridges Hospital
        • Contatto:
        • Contatto:
        • Investigatore principale:
          • Muhammad Affan, MD, MBBS
      • Edina, Minnesota, Stati Uniti, 55435
        • Reclutamento
        • M Health Fairview Southdale Hospital
        • Contatto:
        • Investigatore principale:
          • Muhammad Affan, MD, MBBS
        • Contatto:
      • Minneapolis, Minnesota, Stati Uniti, 55455
        • Reclutamento
        • M Health Fairview University of Minnesota Medical Center
        • Contatto:
        • Contatto:
        • Investigatore principale:
          • Muhammad Affan, MD,MBBS
      • Saint Paul, Minnesota, Stati Uniti, 55102
        • Ritirato
        • United Hospital
    • Missouri
      • St Louis, Missouri, Stati Uniti, 63110
        • Reclutamento
        • Barnes Jewish Hospital
        • Investigatore principale:
          • Charles Kircher, MD
        • Contatto:
    • New Jersey
      • Edison, New Jersey, Stati Uniti, 08837
        • Reclutamento
        • JFK Medical Center
        • Investigatore principale:
          • Nancy Gadallah, DO
        • Contatto:
    • New York
      • Brooklyn, New York, Stati Uniti, 11220
      • Buffalo, New York, Stati Uniti, 14203
        • Ritirato
        • Buffalo General Medical Center
      • Manhasset, New York, Stati Uniti, 11030
      • New York, New York, Stati Uniti, 10029
        • Reclutamento
        • The Mount Sinai Hospital
        • Contatto:
        • Investigatore principale:
          • Laura Stein, MD, MPH
      • New York, New York, Stati Uniti, 10032
      • New York, New York, Stati Uniti, 10029
        • Ritirato
        • Mount Sinai West
      • Syracuse, New York, Stati Uniti, 13202
        • Reclutamento
        • SUNY Upstate Medical University
        • Contatto:
        • Investigatore principale:
          • Julius-Gene LaTorre, MD, MPH
        • Contatto:
      • Valhalla, New York, Stati Uniti, 10595
        • Ritirato
        • Westchester Medical Center
    • North Carolina
      • Durham, North Carolina, Stati Uniti, 27710
      • Winston-Salem, North Carolina, Stati Uniti, 27157
        • Terminato
        • Wake Forest Baptist Medical Center
    • Ohio
      • Cincinnati, Ohio, Stati Uniti, 45267
        • Reclutamento
        • University of Cincinnati Medical Center
        • Investigatore principale:
          • Yasmin Aziz, MD
        • Contatto:
      • Columbus, Ohio, Stati Uniti, 43210
        • Reclutamento
        • OSU Wexner Medical Center
        • Investigatore principale:
          • Jan Bittar, MD
        • Contatto:
    • Oklahoma
      • Tulsa, Oklahoma, Stati Uniti, 74104
    • Oregon
      • Portland, Oregon, Stati Uniti, 97225
        • Reclutamento
        • Providence St. Vincent Medical Center
        • Investigatore principale:
          • Kishan Patel, MD
        • Contatto:
    • Pennsylvania
      • Bethlehem, Pennsylvania, Stati Uniti, 18015
        • Reclutamento
        • Saint Luke's Hospital of Bethlehem Pennsylvania
        • Investigatore principale:
          • Daniel Ackerman, MD
        • Contatto:
      • Philadelphia, Pennsylvania, Stati Uniti, 19140
        • Reclutamento
        • Temple University Hospital
        • Contatto:
        • Investigatore principale:
          • Nina Gentile, MD
    • Rhode Island
      • Providence, Rhode Island, Stati Uniti, 02903
        • Reclutamento
        • Rhode Island Hospital
        • Investigatore principale:
          • Farhan Khan, MD
        • Contatto:
    • South Carolina
      • Charleston, South Carolina, Stati Uniti, 32608
        • Reclutamento
        • Medical University of South Carolina University Hospital
        • Contatto:
        • Contatto:
        • Investigatore principale:
          • Christine Holmstedt, DO
      • Greenville, South Carolina, Stati Uniti, 29605
        • Reclutamento
        • Prisma Health Greenville Memorial
        • Contatto:
        • Investigatore principale:
          • Sanjeev Sivakumar, MD
    • Tennessee
      • Memphis, Tennessee, Stati Uniti, 38104
        • Reclutamento
        • Methodist University Hospital
        • Contatto:
        • Investigatore principale:
          • Balaji Krishnaiah, MD
        • Contatto:
    • Texas
    • Utah
      • Salt Lake City, Utah, Stati Uniti, 84132
        • Ritirato
        • University of Utah Healthcare
    • Virginia
      • Charlottesville, Virginia, Stati Uniti, 22901
        • Reclutamento
        • UVA Medical Center
        • Investigatore principale:
          • Amna Sohail, MBBS, MD
        • Contatto:
      • Richmond, Virginia, Stati Uniti, 23298
        • Ritirato
        • VCU Medical Center
    • Washington
      • Seattle, Washington, Stati Uniti, 98104
        • Ritirato
        • Harborview Medical Center
    • Wisconsin

Criteri di partecipazione

I ricercatori cercano persone che corrispondano a una certa descrizione, chiamata criteri di ammissibilità. Alcuni esempi di questi criteri sono le condizioni generali di salute di una persona o trattamenti precedenti.

Criteri di ammissibilità

Età idonea allo studio

18 anni e precedenti (Adulto, Adulto più anziano)

Accetta volontari sani

No

Sessi ammissibili allo studio

Tutto

Descrizione

Inclusion Criteria:

  1. Age 18 years and older

  2. Suspected anterior circulation acute ischemic stroke

  3. NIH Stroke Scale score ≥4 prior to randomization

    a. The participant must have a clearly disabling deficit if NIHSS is 4-5.

  4. Favorable baseline neuroimaging consisting of all of the following:

    1. ASPECTS of 6 or more on CT (or ASPECTS of ≥7 on MRI)
    2. Favorable perfusion imaging on CT perfusion (CTP)/MR-perfusion weighted imaging (PWI) consisting of all of the following:

    i. Mismatch ratio of penumbra: core >1.2 ii. Mismatch volume >10 cc iii. Core <70 cc

    c. If CT hypodensity is present, then in the investigator's visual assessment, the total acute infarct volume combined area of (a) the CT hypodensity and (b) the perfusion-based core volume (CBF<30%) should be smaller than perfusion-based volume (area of Tmax>6s minus CBF<30%).

  5. Able to receive assigned study drug within 4.5 to 24 hours of stroke onset or last known well.

  6. Anticipate being able to receive assigned study drug within 120 minutes of qualifying perfusion imaging.

  7. Informed consent for the study participation obtained from participant or their legally authorized representatives.

Exclusion Criteria:

  1. Received endovascular treatment with clot engagement.

    1. Patients who undergo groin puncture but clot engagement is not attempted due to spontaneous distal migration are permitted to be enrolled in the trial if all other eligibility criteria are met.
    2. Patients who undergo groin puncture but clot is not engaged due to reasons other than spontaneous distal migration are NOT permitted.
  2. Received or planned to receive intravenous thrombolysis.

  3. Pre-stroke modified Rankin score >2.

  4. Previous treatment with TS23 or known previous allergy to antibody therapy.

  5. Known pregnancy, women who are breastfeeding or plan to breastfeed within 3 months of receiving TS23 or have a positive urine or serum pregnancy test for women of childbearing potential.

  6. Known previous stroke in the past 90 days.

  7. Known previous intracranial hemorrhage, intracranial neoplasm, subarachnoid hemorrhage, or arterial venous malformation.

  8. Known active diagnosis of intracranial neoplasm.

  9. Clinical presentation suggestive of a subarachnoid hemorrhage, even if initial CT scan was normal.

  10. Surgery or biopsy of parenchymal organ in the past 30 days.

  11. Known trauma with internal injuries or persistent ulcerative wounds in the past 30 days.

  12. Severe head trauma in the past 90 days.

  13. Persistent systolic blood pressure >180mmHg or diastolic blood pressure >105mmHg despite best medical management.

  14. Serious systemic hemorrhage in the past 30 days.

  15. Known hereditary or acquired hemorrhagic diathesis, coagulation factor deficiency, or oral anticoagulant therapy with International Normalized Ratio (INR) >1.7.

  16. Platelets <100,000/mm3.

  17. Hematocrit <25 %.

  18. Elevated aPTT above laboratory upper limit of normal.

  19. Creatinine > 4 mg/dl, or patients receiving renal dialysis, regardless of creatinine.

  20. Received the following within the previous 24 hours:

    1. If patient received unfractionated heparin within the last 24 hours, the patient must have an aPTT within normal range prior to enrollment.
    2. Low molecular weight heparins such as Dalteparin, enoxaparin, tinzaparin in full dose within the previous 24 hours.
  21. Received Factor Xa inhibitors (such as Fondaparinux, apixaban or rivaroxaban) within the past 48 hours.

  22. Received direct thrombin inhibitors (e.g., argatroban, dabigatran, bivalirudin, desirudin, lepirudin) within 48 hours.

  23. Received glycoprotein IIb/IIIa inhibitors within the past 14 days.

  24. Known pre-existing neurological or psychiatric disease which would confound the neurological/functional evaluations.

  25. Current participation in another research drug treatment protocol (i.e., participants could not start another experimental agent until after 90 days).

  26. Concurrent acute myocardial infarction, pulmonary embolism, deep venous thrombosis or other thrombotic event that requires anticoagulation or anti-platelet treatment.

Piano di studio

Questa sezione fornisce i dettagli del piano di studio, compreso il modo in cui lo studio è progettato e ciò che lo studio sta misurando.

Come è strutturato lo studio?

Dettagli di progettazione

  • Scopo principale: Trattamento
  • Assegnazione: Randomizzato
  • Modello interventistico: Assegnazione parallela
  • Mascheramento: Quadruplicare

Armi e interventi

Gruppo di partecipanti / Arm
Intervento / Trattamento
Comparatore placebo: Placebo

Placebo

Monoclonal antibody

Sperimentale: Dose 1 TS23

low dose

Monoclonal antibody

Sperimentale: Dose 2 TS23

next higher dose

Monoclonal antibody

Sperimentale: Dose 3 TS23

next higher dose

Monoclonal antibody

Sperimentale: Dose 4 TS23

highest dose

Monoclonal antibody

Cosa sta misurando lo studio?

Misure di risultato primarie

Misura del risultato
Misura Descrizione
Lasso di tempo
The proportion of patients with ANY intracerebral hemorrhage (ICH)
Lasso di tempo: At 30 (+/- 4) hours after study drug

Any ICH visualized on the follow-up CT scan

At 30 (+/- 4) hours after study drug
Stroke severity as measured by the National Institutes of Health Stroke Scale (NIHSS)
Lasso di tempo: At 30 (+/- 4) hours after study drug

NIHSS is a stroke severity score that ranges from 0 to 42, with higher numbers indicating a more severe stroke. The NIHSS will be adjusted for the baseline value in analysis.

At 30 (+/- 4) hours after study drug

Misure di risultato secondarie

Misura del risultato
Misura Descrizione
Lasso di tempo
Improvement in level of global disability measured by modified Rankin Score (mRS distribution)
Lasso di tempo: 90 (±7) days

The modified Rankin Score assessment is a 7-level disability scale that measures the degree of disability or dependence in daily activities of people who have suffered a stroke. Range 0= no disability and 6=dead.

90 (±7) days
Frequency of Modified Rankin (mRS) score of 0-1 or returning to pre-stroke mRS.
Lasso di tempo: Proportion of patients with modified Rankin scale score 0-1 or return to pre-stroke mRS at 90 (+/-7) days.

Proportion of patients with modified Rankin scale score 0-1 or return to pre-stroke mRS.

Proportion of patients with modified Rankin scale score 0-1 or return to pre-stroke mRS at 90 (+/-7) days.
NIHSS
Lasso di tempo: 72 (±12) hours (or at discharge if sooner) after study drug administration.

NIHSS is a stroke severity score that ranges from 0 to 42, with higher numbers indicating a more severe stroke. The NIHSS will be adjusted for the baseline value in analysis.

72 (±12) hours (or at discharge if sooner) after study drug administration.
α2-antiplasmin (a2AP) level in plasma
Lasso di tempo: at 3 (±1) h after completion of study drug administration

A serine protease inhibitor responsible for inactivating plasmin.

at 3 (±1) h after completion of study drug administration
Matrix metalloproteinase-9 level in plasma
Lasso di tempo: 3 (±1) h after completion of study drug

An enzyme that regulates the pathological remodeling process that involve inflammation and fibrosis associated with cardiovascular disease.

3 (±1) h after completion of study drug
% brain tissue reperfusion
Lasso di tempo: 30 (±4) h after study drug administration

Proportion of brain tissue that is reperfused on the follow-up perfusion scan compared to the baseline, calculated as:

([baseline minus follow up perfusion imaging area of hypoperfusion]/ baseline area of hypoperfusion); hypoperfusion=T max>6 seconds

30 (±4) h after study drug administration
Pharmacokinetic analyses
Lasso di tempo: 3 (±1) h, 30 (±4) h, 30 (±5) days & 90 (±7) days after study drug administration. At 90 (±7) days for approximately 50 mITT participants. After approximately 50 mITT participants, it will be obtained at 72h(+12 hrs)/discharge visit, whichever comes 1st.

Measure of plasma concentrations of TS23

3 (±1) h, 30 (±4) h, 30 (±5) days & 90 (±7) days after study drug administration. At 90 (±7) days for approximately 50 mITT participants. After approximately 50 mITT participants, it will be obtained at 72h(+12 hrs)/discharge visit, whichever comes 1st.
Evaluation of anti-drug antibodies
Lasso di tempo: will be measured at baseline and 90 (±7) days follow-up visit for approximately 50 mITT participants.

commonly used for characterization of therapeutic antibodies

will be measured at baseline and 90 (±7) days follow-up visit for approximately 50 mITT participants.
Proportion of patients with symptomatic intracerebral hemorrhage
Lasso di tempo: 30 (±4) h of study drug administration

a blood clot large enough to cause significant neurological deterioration.

30 (±4) h of study drug administration
Proportion of patients with non-intracerebral hemorrhage major or clinically relevant non-major bleeding
Lasso di tempo: 30 days of study drug administration.

major and non-major events of bleeding that is not in the brain

30 days of study drug administration.
Plasma fibrinogen level
Lasso di tempo: 3 (±1) h after completion of study drug

Clotting factor

3 (±1) h after completion of study drug
Proportion of patients with non-bleeding severe adverse events
Lasso di tempo: 90 (±7) days

Assessment of untoward events

90 (±7) days
Proportion of patients with stroke-related and all-cause deaths
Lasso di tempo: 90 (±7) days

measure of important patient outcomes

90 (±7) days

Collaboratori e investigatori

Qui è dove troverai le persone e le organizzazioni coinvolte in questo studio.

Sponsor

Collaboratori

Investigatori

  • Investigatore principale: Eva Mistry, MBBS, University of Cincinnati

Studiare le date dei record

Queste date tengono traccia dell'avanzamento della registrazione dello studio e dell'invio dei risultati di sintesi a ClinicalTrials.gov. I record degli studi e i risultati riportati vengono esaminati dalla National Library of Medicine (NLM) per assicurarsi che soddisfino specifici standard di controllo della qualità prima di essere pubblicati sul sito Web pubblico.

Studia le date principali

Inizio studio (Effettivo)

18 marzo 2024

Completamento primario (Stimato)

1 luglio 2028

Completamento dello studio (Stimato)

1 dicembre 2028

Date di iscrizione allo studio

Primo inviato

8 luglio 2023

Primo inviato che soddisfa i criteri di controllo qualità

8 luglio 2023

Primo Inserito (Effettivo)

17 luglio 2023

Aggiornamenti dei record di studio

Ultimo aggiornamento pubblicato (Effettivo)

19 ottobre 2026

Ultimo aggiornamento inviato che soddisfa i criteri QC

13 ottobre 2026

Ultimo verificato

1 ottobre 2026

Maggiori informazioni

Termini relativi a questo studio

Altri numeri di identificazione dello studio

  • TS23-U202
  • UH3NS125023 (Sovvenzione/contratto NIH degli Stati Uniti)

Piano per i dati dei singoli partecipanti (IPD)

Hai intenzione di condividere i dati dei singoli partecipanti (IPD)?

SÌ

Descrizione del piano IPD

The SISTER trial will comply with the NIH Public Access Policy, which ensures that the public has access to the published results of NIH funded research, and the StrokeNet SOP (ADM 03) regarding results publication. Manuscripts and abstracts that use data from SISTER require approval from the Publication Committee of an original proposal before the concept may proceed. All publications will include this acknowledgement: "Research reported in this publication was supported by the National Institute of Neurological Disorders and Stroke of the National Institutes of Health under Award Number [to be determined]. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health."

Informazioni su farmaci e dispositivi, documenti di studio

Studia un prodotto farmaceutico regolamentato dalla FDA degli Stati Uniti

Sì

Studia un dispositivo regolamentato dalla FDA degli Stati Uniti

No

Queste informazioni sono state recuperate direttamente dal sito web clinicaltrials.gov senza alcuna modifica. In caso di richieste di modifica, rimozione o aggiornamento dei dettagli dello studio, contattare register@clinicaltrials.gov. Non appena verrà implementata una modifica su clinicaltrials.gov, questa verrà aggiornata automaticamente anche sul nostro sito web .