- ICH GCP
- US Clinical Trials Registry
- Klinisk utprøving NCT02066454
Evaluering av bruken av apixaban i forebygging av tromboemboliske sykdommer hos pasienter med myelom behandlet med iMiDs (MYELAXAT)
Evaluering av bruken av et oralt direkte anti-Xa-antikoagulant, apixaban, i forebygging av venøs tromboembolisk sykdom hos pasienter behandlet med IMiDs under myelom: en pilotstudie
Å evaluere:
- forekomsten av venøs tromboembolisk hendelse (VTE)
- forekomsten av hemorragiske komplikasjoner, i en populasjon av pasienter med myelom som behandles med IMiDs og krever tromboprofylakse i 6 måneder, ved bruk av en oral anti-Xa antikoagulant, Apixaban, i et forebyggende opplegg, 2,5 mg x2/dag
Studieoversikt
Detaljert beskrivelse
Studietype
Registrering (Faktiske)
Fase
- Fase 3
Kontakter og plasseringer
Studiesteder
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Annecy, Frankrike, 74374
- CHRA
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Bayonne, Frankrike, 64100
- Ch La Cote Basque
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Clamart, Frankrike, 92141
- HIA Percy
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Creteil, Frankrike, 94010
- CHU Hôpital Henri Mondor
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Dunkerque, Frankrike, 59385
- Centre Hospitalier
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Grenoble, Frankrike, 38043
- Chu Grenoble
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La Roche Sur Yon, Frankrike, 85925
- CHD Vendée
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Le Mans, Frankrike, 72000
- Clinique Victor Hugo
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Lille, Frankrike, 59037
- Chru Hopital Huriez
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Lille, Frankrike, 59020
- Hopital St Vincent - Ghicl
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Lyon, Frankrike, 69373
- Centre Léon Bérard
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Montivilliers, Frankrike, 76290
- Groupe Hospitalier Du Havre
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Nice, Frankrike, 06202
- Hôpital de l'Archet
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Paris, Frankrike, 75651
- Hôpital Pitie Salpétrière
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Perigueux, Frankrike, 24000
- CH de Périgueux
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Pessac, Frankrike, 33604
- CHU Bordeaux
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Pierre Benite, Frankrike, 69310
- CH Lyon sud
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Poitiers, Frankrike, 86021
- CHU Poitiers
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Tours, Frankrike, 37000
- CHRU de Tours
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Deltakelseskriterier
Kvalifikasjonskriterier
Alder som er kvalifisert for studier
Tar imot friske frivillige
Beskrivelse
Inklusjonskriterier:
- Pasienter (menn/kvinner) over 18 år
- Alle påfølgende pasienter, med myelom, i førstelinjebehandling eller i tilbakefall, som behandles - Med IMiDs (MPT, Melphalan -Prednison -Thalidomid ; Lenalidomid - Deksametason).
OG
- som krever forebygging av venøse tromboemboliske hendelser med aspirin eller lavmolekylært heparin (LMWH) i en minimumsvarighet på 6 måneder. Minst 2/3 av pasientene vil bli behandlet med lenalidomid-deksametason.
- Skriftlig informert samtykke
- Pasienter tilknyttet det franske trygdesystemet eller tilsvarende
Ekskluderingskriterier:
- Pasient som trenger kurativ antikoagulantbehandling (heparin, LMWH, vitamin K-antagonister, Dabigatran, Rivaroxaban, Apixaban) for en assosiert lidelse (mekanisk klaffe, atrieflimmer eller venøs tromboembolisk sykdom de siste 6 månedene).
- Pasient som trenger forebyggende behandling med antikoagulant i postoperativ sammenheng
- Pasient som trenger anti-blodplatebehandling (Aspirin, Clopidogrel, Prasugrel, Ticagrelor eller dobbel anti-blodplatebehandling)
- Pasient med aktiv blødning eller høy risiko for blødning (sårsykdom, intrakraniell blødning de siste 6 månedene, ukontrollert hypertensjon)
- Pasienter som har gjennomgått et kirurgisk inngrep i løpet av de siste 30 dagene, vil sannsynligvis utsette dem for en blødningsrisiko
- Aktiv leversykdom (hepatitt, cirrhose)
- Alvorlig nyresvikt (kreatininclearance ved bruk av Cockcroft-ligningen < 30 ml/min)
- Kjent allergisk reaksjon på Apixaban
- Kontraindikasjon for bruk av antikoagulerende behandling
Forbudt samtidig behandling
- hemmere av CYP3A4 og P-gp: azolantimykotiske midler (ketokonazol, itrakonazol, vorikonazol, posakonazol), hemmere av HIV-protease (ritonavir, indinavir, nelfinavir, atazanavir, sakinavir), spesifikke makrolidantibiotika (klaritromycin)
- annen antitrombotisk behandling: salisylatderivater (aspirin, produkter som inneholder aspirin), antiplatebehandling, heparin (ufraksjonert heparin, lavmolekylært heparin, danaparoide sodique, fondaparinux), hirudiner, orale antikoagulantia (vitamin K-antagonister, rivaroksaban),
- Pasient med AST- eller ALAT-rate > 3 ganger øvre normalgrense
- Pasient med bilirubinrate > 1,5 ganger øvre normalgrense
- Pasient med blodplatefrekvens < 75 G/l
- Pasient med kreatininclearance (Cockcroft) < 30 ml/min
- Tilfeldig funn av en proksimal dyp venetrombose på screening-ultralyden
- Pasienter som nekter eller ikke kan gi skriftlig samtykke til informasjon
- Pasienten er ikke i stand til å overholde protokollkravet, etter utrederens mening
- Forventet levealder mindre enn 6 måneder
- Innsatte pasienter
- Graviditet eller mulighet for graviditet innen 6 måneder
- Kvinner i fertil alder uten pålitelig prevensjon
- Øko > 2
Studieplan
Hvordan er studiet utformet?
Designdetaljer
- Primært formål: Behandling
- Tildeling: N/A
- Intervensjonsmodell: Enkeltgruppeoppdrag
- Masking: Ingen (Open Label)
Våpen og intervensjoner
Deltakergruppe / Arm |
Intervensjon / Behandling |
|---|---|
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Eksperimentell: Apixaban
oral direkte anti-Xa antikoagulant
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2,5 mg x 2 per dag i 6 måneder
Andre navn:
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Hva måler studien?
Primære resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
|---|---|---|
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Total VTE og VTE-relatert død. Større og klinisk relevante ikke-større blødninger - Større og klinisk relevante ikke-større blødninger, definert i henhold til International Society of Thrombosis and Haemostasis
Tidsramme: 7 måneder
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Total VTE (fatal eller ikke-fatal lungeemboli, symptomatisk distal eller proksimal DVT i underekstremitetene og asymptomatisk proksimal DVT påvist ved bilateral kompresjonsultralyd) og VTE-relatert død. - Større og klinisk relevante ikke-større blødninger, definert i henhold til International Society of Thrombosis and Haemostasis |
7 måneder
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Sekundære resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
|---|---|---|
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forekomst av venøse tromboemboliske komplikasjoner
Tidsramme: 7 måneder
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forekomst av venøse tromboemboliske komplikasjoner, symptomatiske og asymptomatiske, i henhold til den trombotiske risikostratifiseringen av pasienter (lav eller høy risiko)
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7 måneder
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forekomst av venøse tromboemboliske komplikasjoner
Tidsramme: 7 måneder
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forekomst av venøse tromboemboliske komplikasjoner, symptomatiske og asymptomatiske, i henhold til tidspunktet for behandling med iMiDs (diagnose eller tilbakefall)
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7 måneder
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forekomst av større og klinisk relevante ikke-større blødninger
Tidsramme: 7 måneder
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forekomst av større og klinisk relevante ikke-større blødninger i henhold til den trombotiske risikoen hos pasienter (lav eller høy risiko)
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7 måneder
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forekomst av arterielle kardiovaskulære hendelser
Tidsramme: 7 måneder
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forekomst av arterielle kardiovaskulære hendelser (hjerteinfarkt, iskemisk hjerneslag, TIA)
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7 måneder
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Samarbeidspartnere og etterforskere
Sponsor
Samarbeidspartnere
Etterforskere
- Hovedetterforsker: Brigitte PEGOURIE, MD, Hospital University Grenoble
- Hovedetterforsker: Gilles PERNOD, PHD, Hospital University Grenoble
Publikasjoner og nyttige lenker
Generelle publikasjoner
- Rajkumar SV, Hayman SR, Lacy MQ, Dispenzieri A, Geyer SM, Kabat B, Zeldenrust SR, Kumar S, Greipp PR, Fonseca R, Lust JA, Russell SJ, Kyle RA, Witzig TE, Gertz MA. Combination therapy with lenalidomide plus dexamethasone (Rev/Dex) for newly diagnosed myeloma. Blood. 2005 Dec 15;106(13):4050-3. doi: 10.1182/blood-2005-07-2817. Epub 2005 Aug 23.
- Schulman S, Kearon C; Subcommittee on Control of Anticoagulation of the Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients. J Thromb Haemost. 2005 Apr;3(4):692-4. doi: 10.1111/j.1538-7836.2005.01204.x.
- Facon T, Mary JY, Hulin C, Benboubker L, Attal M, Pegourie B, Renaud M, Harousseau JL, Guillerm G, Chaleteix C, Dib M, Voillat L, Maisonneuve H, Troncy J, Dorvaux V, Monconduit M, Martin C, Casassus P, Jaubert J, Jardel H, Doyen C, Kolb B, Anglaret B, Grosbois B, Yakoub-Agha I, Mathiot C, Avet-Loiseau H; Intergroupe Francophone du Myelome. Melphalan and prednisone plus thalidomide versus melphalan and prednisone alone or reduced-intensity autologous stem cell transplantation in elderly patients with multiple myeloma (IFM 99-06): a randomised trial. Lancet. 2007 Oct 6;370(9594):1209-18. doi: 10.1016/S0140-6736(07)61537-2.
- Pernod G, Albaladejo P, Godier A, Samama CM, Susen S, Gruel Y, Blais N, Fontana P, Cohen A, Llau JV, Rosencher N, Schved JF, de Maistre E, Samama MM, Mismetti P, Sie P; Working Group on Perioperative Haemostasis. Management of major bleeding complications and emergency surgery in patients on long-term treatment with direct oral anticoagulants, thrombin or factor-Xa inhibitors: proposals of the working group on perioperative haemostasis (GIHP) - March 2013. Arch Cardiovasc Dis. 2013 Jun-Jul;106(6-7):382-93. doi: 10.1016/j.acvd.2013.04.009. Epub 2013 Jun 25.
- Sie P, Samama CM, Godier A, Rosencher N, Steib A, Llau JV, Van der Linden P, Pernod G, Lecompte T, Gouin-Thibault I, Albaladejo P; Working Group on Perioperative Haemostasis; French Study Group on Thrombosis and Haemostasis. Surgery and invasive procedures in patients on long-term treatment with direct oral anticoagulants: thrombin or factor-Xa inhibitors. Recommendations of the Working Group on Perioperative Haemostasis and the French Study Group on Thrombosis and Haemostasis. Arch Cardiovasc Dis. 2011 Dec;104(12):669-76. doi: 10.1016/j.acvd.2011.09.001. Epub 2011 Oct 29.
- Rajkumar SV, Blood E, Vesole D, Fonseca R, Greipp PR; Eastern Cooperative Oncology Group. Phase III clinical trial of thalidomide plus dexamethasone compared with dexamethasone alone in newly diagnosed multiple myeloma: a clinical trial coordinated by the Eastern Cooperative Oncology Group. J Clin Oncol. 2006 Jan 20;24(3):431-6. doi: 10.1200/JCO.2005.03.0221. Epub 2005 Dec 19.
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- Palumbo A, Bringhen S, Liberati AM, Caravita T, Falcone A, Callea V, Montanaro M, Ria R, Capaldi A, Zambello R, Benevolo G, Derudas D, Dore F, Cavallo F, Gay F, Falco P, Ciccone G, Musto P, Cavo M, Boccadoro M. Oral melphalan, prednisone, and thalidomide in elderly patients with multiple myeloma: updated results of a randomized controlled trial. Blood. 2008 Oct 15;112(8):3107-14. doi: 10.1182/blood-2008-04-149427. Epub 2008 May 27.
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- Weber D, Rankin K, Gavino M, Delasalle K, Alexanian R. Thalidomide alone or with dexamethasone for previously untreated multiple myeloma. J Clin Oncol. 2003 Jan 1;21(1):16-9. doi: 10.1200/JCO.2003.03.139.
- Attal M, Lauwers-Cances V, Marit G, Caillot D, Moreau P, Facon T, Stoppa AM, Hulin C, Benboubker L, Garderet L, Decaux O, Leyvraz S, Vekemans MC, Voillat L, Michallet M, Pegourie B, Dumontet C, Roussel M, Leleu X, Mathiot C, Payen C, Avet-Loiseau H, Harousseau JL; IFM Investigators. Lenalidomide maintenance after stem-cell transplantation for multiple myeloma. N Engl J Med. 2012 May 10;366(19):1782-91. doi: 10.1056/NEJMoa1114138.
- Barlogie B, Desikan R, Eddlemon P, Spencer T, Zeldis J, Munshi N, Badros A, Zangari M, Anaissie E, Epstein J, Shaughnessy J, Ayers D, Spoon D, Tricot G. Extended survival in advanced and refractory multiple myeloma after single-agent thalidomide: identification of prognostic factors in a phase 2 study of 169 patients. Blood. 2001 Jul 15;98(2):492-4. doi: 10.1182/blood.v98.2.492.
- Baz R, Li L, Kottke-Marchant K, Srkalovic G, McGowan B, Yiannaki E, Karam MA, Faiman B, Jawde RA, Andresen S, Zeldis J, Hussein MA. The role of aspirin in the prevention of thrombotic complications of thalidomide and anthracycline-based chemotherapy for multiple myeloma. Mayo Clin Proc. 2005 Dec;80(12):1568-74. doi: 10.4065/80.12.1568.
- Blom JW, Doggen CJ, Osanto S, Rosendaal FR. Malignancies, prothrombotic mutations, and the risk of venous thrombosis. JAMA. 2005 Feb 9;293(6):715-22. doi: 10.1001/jama.293.6.715.
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Studierekorddatoer
Studer hoveddatoer
Studiestart (Faktiske)
Primær fullføring (Faktiske)
Studiet fullført (Faktiske)
Datoer for studieregistrering
Først innsendt
Først innsendt som oppfylte QC-kriteriene
Først lagt ut (Antatt)
Oppdateringer av studieposter
Sist oppdatering lagt ut (Faktiske)
Siste oppdatering sendt inn som oppfylte QC-kriteriene
Sist bekreftet
Mer informasjon
Begreper knyttet til denne studien
Ytterligere relevante MeSH-vilkår
- Vaskulære sykdommer
- Kardiovaskulære sykdommer
- Neoplasmer
- Sykdommer i immunsystemet
- Neoplasmer etter histologisk type
- Hematologiske sykdommer
- Embolisme og trombose
- Lymfoproliferative lidelser
- Immunproliferative lidelser
- Hemostatiske lidelser
- Paraproteinemier
- Blodproteinforstyrrelser
- Hemoragiske lidelser
- Multippelt myelom
- Neoplasmer, plasmacelle
- Tromboemboli
- Venøs tromboembolisme
- Molekylære mekanismer for farmakologisk virkning
- Proteasehemmere
- Enzymhemmere
- Faktor Xa-hemmere
- Antitrombiner
- Serinproteinasehemmere
- Apixaban
- Antikoagulanter
Andre studie-ID-numre
- DCIC 1320
- 2013-003190-99 (EudraCT-nummer)
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