rhPro-UK in Acute Ischaemic Stroke Within 4.5 Hours of Stroke Onset Trial 2(PROST-2)

Acute Ischemic Stroke Clinical Trial

— PROST-2  

Official title:

A Phase III Trial to Assess the Efficacy and Safety of Recombinant Human Prourokinase in the Treatment of Acute Acute Ischaemic Stroke in 4.5 Hours After Stroke Onset

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT05700591
• Other study ID #: TASLY-B1440-CTP-?c
• Status: Recruiting
• Phase: Phase 3
• Start date: January 29, 2023
• Est. completion date: July 2024

Study information

• Verified date: January 2023
• Source: Tasly Biopharmaceuticals Co., Ltd.
• Contact: Yongjun Wang, M.D.
• Phone: 13911172565
• Email: Yongjunwang111[@]aliyun.com
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Intravenous thrombolysis is the first-line therapy in patients with acute ischemic stroke within 4·5 hours of symptom onset, and recombinant tissue plasminogen activator (alteplase) is the preferred thrombolytic agent for this purpose. RhPro-UK is a specific plasminogen activator. rhPro-UK only acts on occlusive thrombus and has little effect on hemostatic thrombus. In addition, rhPro-UK does not form covalent complexes with protease inhibitors in plasma, so the concentrations of rhpro-UK and protease inhibitors in the blood do not decrease compared with alteplase. Therefore, rhPro-UK therapies have a potential advantage of less systemic bleeding in treated subjects. Data from several previous studies suggest that rhPro-UK is efficacious when used to treat patients with acute myocardial infarction. On April 2, 2011, rhPro-UK injection was approved by the National Medical Products Administration to treat acute myocardial infarction. Since then, rhPro-UK has been widely used to treat myocardial infarction in China. Since 2016, a phase 2 clinical trial was carried to explore the dosing of rhPro-UK in patients with acute ischemic stroke, followed by another study with a sample size of 680 patients to initially validate the efficacy and safety of the proposed dose of 35mg. The results of these studies suggested that rhPro-UK was effective, and there were no safety concerns. To further prove the efficacy and safety of rhPro-UK in patients with acute ischemic stroke, investigators conducted this phase 3 study (PROST-2).

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 1552
• Est. completion date: July 2024
• Est. primary completion date: May 2024
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

1. Clinically diagnosed as acute ischemic stroke (according to the Chinese Guidelines for the Diagnosis and Treatment of Acute Ischemic Stroke 2018).

2. 18 years or older, male or female.

3. NIH Stroke Scale(NIHSS)scores of 4 to 25.

4. Treatment within 4.5 hours after stroke onset.

5. The symptoms of stroke last at least 30 minutes without significant improvement before treatment.

6. Informed consent by patient or by patient's guardians.

Exclusion Criteria:

1. Prestroke modified rankin scale of =2.

2. Large areas of hypodense ischaemic changes on baseline CT(Infarction area> 1/3 of the middle cerebral artery feeding area).

3. Intracranial hemorrhage.

4. Previous history of intracranial hemorrhage.

5. Severe cerebral trauma or stroke history within 3 months.

6. Intracranial tumor or giant intracranial aneurysm.

7. Intracranial or intraspinal surgery within the past 3 months.

8. Gastrointestinal or urinary bleeding within the past 3 weeks.

9. History of major surgical procedures or severe trauma within the last 2 weeks (investigator evaluation).

10. Puncture in 1 week which can not be oppressed.

11. Active visceral hemorrhage.

12. Aortic arch dissection.

13. Bacterial endocarditis or pericarditis.

14. Planned for thrombectomy.

15. Patients with systolic blood pressure = 185 mmHg or diastolic blood pressure = 110 mmHg after anti-hypertension treatment.

16. High risk of acute hemorrhage include platelet count<10^9/L.

17. Received low molecular weight heparin or heparin within 24 hours.

18. Using of thrombin inhibitors or factor Xa inhibitor within the past 48 hours.

19. Using of oral anticoagulant drugs and PT >15s or INR >1.7.

20. Patients with epilepsy or other mental disorders that could not be adhered to at the beginning of stroke.

21. Blood glucose < 2.8 mmol/L or > 22.2 mmol/L.

22. Allergies to rhPro-UK or rt-PA active ingredients or other components.

23. Pregnant women or beastfeeding women.

24. Participants in other clinical trials within the past month.

25. The investigator believes that the patient is not suitable for the study.

Related Conditions & MeSH terms

• Acute Ischemic Stroke
• Cerebral Infarction
• Ischemia
• Ischemic Stroke
• Stroke

Intervention

Drug:
• rhPro-UK
35 mg, administered intravenously with a bolus of 15 mg within 3 minutes and the remainder by continuous infusion within 30 minutes
• rt-PA
0.9 mg/kg (maximum 90 mg), with 10% administered intravenously as a bolus, followed by 90% infusion within 1 hour

Locations

Country	Name	City	State
China	Beijing Tiantan Hospital, Capital Medical University	Beijing	Beijing
China	Beipiao Central Hospital	Chaoyang	Liaoning
China	Keahiketeng Banner Traditional Chinese Medicine Mongolian Medicine Hospital	Chifeng	Inner Mongolia
China	Nanyang Second General Hospital	Nanyang	Henan

Sponsors (1)

Lead Sponsor	Collaborator
Tasly Biopharmaceuticals Co., Ltd.

Country where clinical trial is conducted

China, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	The proportion of patients with excellent functional outcome at 90 days	A score of 0 or 1 on the modified Rankin scale(which ranges from 0 [no symptoms] to 6 [death]) at 90 days indicated an excellent functional outcome.	90±7 days
Secondary	The proportion of patients with independent functional outcome at 90 days	A score of 0-2 on the modified Rankin scale(which ranges from 0 [no symptoms] to 6 [death]) at 90 days indicated an independent functional outcome.	90±7 days
Secondary	Functional handicap	The distribution of the modified Rankin scale(which ranges from 0 [no symptoms] to 6 [death]) at 90 days	90±7 days
Secondary	The proportion of patients with neurological improvement at 24 hours	A reduction in NIHSS score of =4 or a score of 0-1 indicated neurological improvement. Total scores on the NIHSS range from 0 to 42, with higher values reflecting more severe cerebral infarcts.	22-36 hours
Secondary	The proportion of patients with neurological improvement at 7 days	A reduction in NIHSS score of =4 or a score of 0-1 indicated neurological improvement. Total scores on the NIHSS range from 0 to 42, with higher values reflecting more severe cerebral infarcts.	7 ±2 days
Secondary	The change of neurological function at 24 hours	NIHSS score was used to assess neurological function. Total scores on the NIHSS range from 0 to 42, with higher values reflecting more severe cerebral infarcts.	22-36 hours
Secondary	The change of neurological function at 7 days	NIHSS score was used to assess neurological function. Total scores on the NIHSS range from 0 to 42, with higher values reflecting more severe cerebral infarcts.	7 ±2 days
Secondary	Self-care ability in daily life	The Barthel Index(which ranges from 0[complete dependence on help with activities of daily living] to 100[independence]) of 95-100 at 90 days	90±7 days
Secondary	All-cause death within 7 days		7 days
Secondary	All-cause death within 90 days		90 days
Secondary	Symptomatic intracranial hemorrhage defined as SITS-MOST		22-36 hours
Secondary	Symptomatic intracranial hemorrhage defined as ECASSIII		7 days
Secondary	Any intracranial hemorrhage		7 days
Secondary	Any systematic bleeding event(defined as ISTH)		7 days