Phase 2 Proof-of-Concept Study of the Safety and Efficacy of Alfimeprase to Rapidly Open Arteries and Restore Brain Function Following a Stroke

Acute Ischemic Stroke Clinical Trial

Official title:

Phase 2, Multicenter, Open-Label, Two-Stage Study to Evaluate the Safety and Efficacy of Intra-Arterial Catheter-Directed Alfimeprase for Restoration of Neurologic Function and Rapid Opening of Arteries in Stroke (CARNEROS-1)

Clinical Trial Details — Status: Terminated

Administrative data

• NCT number: NCT00499902
• Other study ID #: HA009
• Status: Terminated
• Phase: Phase 2
• First received: July 10, 2007
• Last updated: April 22, 2008
• Start date: June 2007
• Est. completion date: May 2008

Study information

• Verified date: April 2008
• Source: ARCA Biopharma, Inc.
• Contact: n/a
• Is FDA regulated: No
• Health authority: United States: Food and Drug AdministrationCanada: Health Canada
• Study type: Interventional

Clinical Trial Summary

The purpose of this study is to identify a safe and effective bolus dose of intra-arterial/intra-thrombus alfimeprase in acute ischemic stroke (AIS) 3 to 9 hours from symptom onset.

Description:

Currently approved drug therapy for AIS is limited by the need to treat within 3 hours of symptom onset. Alfimeprase acts to degrade fibrin directly and is inactivated locally by circulating alpha-2 macroglobulin. This study will determine whether treatment with alfimeprase facilitates rapid restoration of arterial blood flow with avoidance of symptomatic hemorrhagic conversion in subjects with AIS within 3 to 9 hours of symptom onset.

Recruitment information / eligibility

• Status: Terminated
• Enrollment: 7
• Est. completion date: May 2008
• Est. primary completion date: May 2008
• Accepts healthy volunteers: No
• Gender: Both
• Age group: 18 Years to 85 Years

Eligibility

Inclusion Criteria:

• Clinical diagnosis of AIS defined as the sudden onset of an acute focal neurological deficit presumed to be due to cerebral ischemia

• Arterial occlusion of the carotid T or a M1, M2, or M1-M2 branch of the middle cerebral artery (MCA) as documented by CT angiography or magnetic resonance angiography

• Arteriographically confirmed occlusion of the carotid T or a M1, M2, or M1-M2 branch of the MCA

• The subject (or legally acceptable representative) must give written informed consent

• Age 18 years to 85 years

• Onset of symptoms of AIS (i.e., last known well time) within 3-9 hours

• Baseline NIHSS of 4 to 25

• Available for follow-up assessments at 30 and 90 days

Exclusion Criteria:

• Contraindication to systemic anticoagulation including any history of prior intracranial hemorrhage

• Uncontrolled hypertension at study entry as defined by systolic blood pressure greater than 180 mmHg or diastolic blood pressure greater than or equal to 100 mmHg on repeated measures prior to study entry despite the use of IV antihypertensive agents

• Expectation based on timing of presentation that alfimeprase administration will not be able to be completed by 9 hours after stroke onset

• Inability to initiate alfimeprase within 120 minutes of the qualifying imaging scan

• Coma

• Rapidly improving neurological symptoms at the time of screening

• Brain CT or MRI evidence of intracranial bleeding of any age

• High clinical suspicion for subarachnoid hemorrhage despite a negative baseline CT or MRI

• CT evidence of an acute and/or evolving hypodensity greater than 1/3 of the MCA territory in the vascular territory to be treated or Alberta Stroke Program Early CT Score (ASPECTS) of less than or equal to 5

• MRI diffusion weighted imaging lesion greater than 1/3 of the MCA territory in the vascular distribution to be treated

• Carotid artery and/or intracranial artery stenosis that precludes safe passage of a microcatheter to treat the primary AOL

• Life expectancy of less than 6 months

• History of significant acute or chronic kidney disease, including known nephrotic syndrome, that would preclude safe contrast angiography

• Known allergy to contrast agents

• History of immune deficiency

• History of heparin-induced thrombocytopenia

• Participation in any study of an investigational device, medication, biologic, or other agent within 30 days prior to enrollment (Stage I)/randomization (Stage II)

• Any stroke, myocardial infarction, or use of thrombolytic therapy (including investigational thrombolytic therapy) within 3 months prior to enrollment (Stage I)/randomization (Stage II)

• Past participation in any alfimeprase clinical trial

• Pregnant, lactating, or actively menstruating women and women of child-bearing potential who are not using adequate contraceptive precautions

• Current use of oral anticoagulants or an international normalized ratio (INR) greater than 1.4

• Any non-atherosclerotic arteriopathy

• Any prior neurologic event that would obscure the radiographic or clinical evaluation of the new index neurological deficits

• Subjects with known renal insufficiency defined as a serum creatinine >2 mg/dL (>180 mmoL/L)

• Subjects with known clinically significant hepatic disease defined as transaminase values > 3x upper limit of normal

• Subjects with any malignant neoplasm diagnosed within five years prior to screening, with the exception of basal cell carcinoma of the skin and fully resected squamous cell carcinoma of the skin

• Subjects with a platelet count less than 100,000/mm3

• Subjects with a baseline serum glucose level less than 50 mg/dL or greater than 300 mg/dL

• Subjects receiving any dose of a heparinoid or a non-prophylactic intensity dose of a low molecular weight heparin within the 24-hour period prior to study drug administration

• Any other subject feature that in the opinion of the investigator should preclude study participation

Study Design

Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment

Related Conditions & MeSH terms

• Acute Ischemic Stroke
• Stroke

Intervention

Drug:
• alfimeprase
Alfimeprase will be given as a single bolus of 1mg/2mL, or a split bolus of 5mg/2mL or 10mg/2mL in a three-tier dose escalation format. The 5mg and 10mg doses will be administered as split doses with 1/2 of the total dose given initially and 1/2 of the total dose given 30 minutes after the initial dose.

Locations

Country	Name	City	State
Canada	University of Calgary, Foothills Medical Centre	Calgary	Alberta
Canada	Trilium Health Center	Mississauga	Ontario
Canada	Montreal Neurological Institute	Montreal	Quebec
Canada	University Health Network Toronto	Toronto	Ontario
Canada	Vancouver General Hospital	Vancouver	British Columbia
United States	Albany Medical Center Hospital	Albany	New York
United States	Kalieda Health, MFH	Buffalo	New York
United States	Northwestern Medical Center	Chicago	Illinois
United States	University of Cincinnati	Cincinnati	Ohio
United States	Riverside Methodist Hospital	Columbus	Ohio
United States	Ruan Neurology & Clinical Research Center	Des Moines	Iowa
United States	Baylor College of Medicine	Houston	Texas
United States	University of Iowa Hospital	Iowa City	Iowa
United States	University of Iowa Hospital	Iowa City	Iowa
United States	Michigan State University, Sparrow Hospital	Lansing	Michigan
United States	UCLA Medical Center	Los Angeles	California
United States	Norton Hospital	Louisville	Kentucky
United States	St. Luke's Medical Center	Milwaukee	Wisconsin
United States	Columbia Presbyterian Medical Center	New York	New York
United States	University of Pittsburg Medical Center	Pittsburg	Pennsylvania
United States	Oregon Stroke Center	Portland	Oregon
United States	University of Kansas School of Medicine, Via Christi Regional Medical Center	Wichita	Kansas

Sponsors (1)

Lead Sponsor	Collaborator
ARCA Biopharma, Inc.

Countries where clinical trial is conducted

United States,  Canada, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Symptomatic intracerebral hemorrhage (ICH) defined as a greater than or equal to 4-point increase in NIHSS compared to baseline at the time of CT evidence of ICH within 24 hours of study drug administration.
Primary	Recanalization of primary arterial occlusive lesion (AOL) using the Thrombolysis in Myocardial Infarction (TIMI) classification; a score of II or III will be considered success.
Secondary	Relative hypotension requiring treatment (i.e. volume expanders and/or vasopressors)
Secondary	New cardiac events (e.g., cardiac ischemia, congestive heart failure, and dysrhythmia)
Secondary	Relative hypotension not requiring treatment
Secondary	Major bleeding events (TIMI definition)
Secondary	Hemorrhagic transformation: hemorrhagic infarction (Type 1 and 2), parenchymal hematoma formation (Type 1 and 2)
Secondary	Intracerebral hemorrhage outside of the stroke territory
Secondary	New AIS
Secondary	AEs/SAEs/All cause mortality
Secondary	Changes in chemistry, hematology, coagulation, and alpha-2-macroglobulin parameters based on central laboratory measurements
Secondary	Anti-alfimeprase antibody detection based on central laboratory measurements
Secondary	Recanalization of the primary AOL
Secondary	Global reperfusion of the primary AOL distal vascular bed defined by the Thrombolysis in Cerebral Infarction (TICI) score
Secondary	Neurological benefit as assessed by individual and combined analysis of NIHSS, mRS, and BI