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ESTRATÉGIA PARA MELHORAR A RESPOSTA AO TRATAMENTO DE AVC (SISTER)

13 de outubro de 2026 atualizado por: 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.

Visão geral do estudo

Status

Recrutamento

Condições

Intervenção / Tratamento

Descrição detalhada

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 de estudo

Intervencional

Inscrição (Estimado)

300

Estágio

  • Fase 2

Contactos e Locais

Esta seção fornece os detalhes de contato para aqueles que conduzem o estudo e informações sobre onde este estudo está sendo realizado.

Contato de estudo

Estude backup de contato

Locais de estudo

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

Critérios de participação

Os pesquisadores procuram pessoas que se encaixem em uma determinada descrição, chamada de critérios de elegibilidade. Alguns exemplos desses critérios são a condição geral de saúde de uma pessoa ou tratamentos anteriores.

Critérios de elegibilidade

Idades elegíveis para estudo

18 anos e mais velhos (Adulto, Adulto mais velho)

Aceita Voluntários Saudáveis

Não

Gêneros Elegíveis para o Estudo

Tudo

Descrição

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.

Plano de estudo

Esta seção fornece detalhes do plano de estudo, incluindo como o estudo é projetado e o que o estudo está medindo.

Como o estudo é projetado?

Detalhes do projeto

  • Finalidade Principal: Tratamento
  • Alocação: Randomizado
  • Modelo Intervencional: Atribuição Paralela
  • Mascaramento: Quadruplicar

Armas e Intervenções

Grupo de Participantes / Braço
Intervenção / Tratamento
Comparador de Placebo: Placebo

Placebo

Monoclonal antibody

Experimental: Dose 1 TS23

low dose

Monoclonal antibody

Experimental: Dose 2 TS23

next higher dose

Monoclonal antibody

Experimental: Dose 3 TS23

next higher dose

Monoclonal antibody

Experimental: Dose 4 TS23

highest dose

Monoclonal antibody

O que o estudo está medindo?

Medidas de resultados primários

Medida de resultado
Descrição da medida
Prazo
The proportion of patients with ANY intracerebral hemorrhage (ICH)
Prazo: 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)
Prazo: 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

Medidas de resultados secundários

Medida de resultado
Descrição da medida
Prazo
Improvement in level of global disability measured by modified Rankin Score (mRS distribution)
Prazo: 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.
Prazo: 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
Prazo: 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
Prazo: 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
Prazo: 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
Prazo: 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
Prazo: 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
Prazo: 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
Prazo: 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
Prazo: 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
Prazo: 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
Prazo: 90 (±7) days

Assessment of untoward events

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

measure of important patient outcomes

90 (±7) days

Colaboradores e Investigadores

É aqui que você encontrará pessoas e organizações envolvidas com este estudo.

Patrocinador

Colaboradores

Investigadores

  • Investigador principal: Eva Mistry, MBBS, University of Cincinnati

Datas de registro do estudo

Essas datas acompanham o progresso do registro do estudo e os envios de resumo dos resultados para ClinicalTrials.gov. Os registros do estudo e os resultados relatados são revisados ​​pela National Library of Medicine (NLM) para garantir que atendam aos padrões específicos de controle de qualidade antes de serem publicados no site público.

Datas Principais do Estudo

Início do estudo (Real)

18 de março de 2024

Conclusão Primária (Estimado)

1 de julho de 2028

Conclusão do estudo (Estimado)

1 de dezembro de 2028

Datas de inscrição no estudo

Enviado pela primeira vez

8 de julho de 2023

Enviado pela primeira vez que atendeu aos critérios de CQ

8 de julho de 2023

Primeira postagem (Real)

17 de julho de 2023

Atualizações de registro de estudo

Última Atualização Postada (Real)

19 de outubro de 2026

Última atualização enviada que atendeu aos critérios de controle de qualidade

13 de outubro de 2026

Última verificação

1 de outubro de 2026

Mais Informações

Termos relacionados a este estudo

Outros números de identificação do estudo

  • TS23-U202
  • UH3NS125023 (Concessão/Contrato do NIH dos EUA)

Plano para dados de participantes individuais (IPD)

Planeja compartilhar dados de participantes individuais (IPD)?

SIM

Descrição do plano 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."

Informações sobre medicamentos e dispositivos, documentos de estudo

Estuda um medicamento regulamentado pela FDA dos EUA

Sim

Estuda um produto de dispositivo regulamentado pela FDA dos EUA

Não

Essas informações foram obtidas diretamente do site clinicaltrials.gov sem nenhuma alteração. Se você tiver alguma solicitação para alterar, remover ou atualizar os detalhes do seu estudo, entre em contato com register@clinicaltrials.gov. Assim que uma alteração for implementada em clinicaltrials.gov, ela também será atualizada automaticamente em nosso site .