Strategy for Improving Stroke Treatment Response
- Registration Number
- NCT05948566
- Lead Sponsor
- Translational Sciences, Inc.
- Brief Summary
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.
- Detailed Description
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. After informed consent is provided, the study will randomize to 4 doses of TS23 and placebo. The trial will enroll 300 subjects at up to 50 participating 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.
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 300
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Age 18 years and older
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Suspected anterior circulation acute ischemic stroke
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NIH Stroke Scale score ≥4 prior to randomization
a. The participant must have a clearly disabling deficit if NIHSS is 4-5.
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Favorable baseline neuroimaging consisting of all of the following:
a. ASPECTS of 6 or more on CT (or ASPECTS of ≥7 on MRI) b. 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
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Able to receive assigned study drug within 4.5 to 24 hours of stroke onset or last known well.
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Able to receive assigned study drug within 120 minutes of qualifying perfusion imaging. *
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Informed consent for the study participation obtained from participant or their legally authorized representatives.
- Study drug administration is encouraged within 90 minutes after qualifying perfusion image but is allowed up to 120 minutes. After 120 minutes, another perfusion image to ensure that inclusion criteria are met is required.
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Received endovascular treatment with clot engagement.
- 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.
- Patients who undergo groin puncture but clot is not engaged due to reasons other than spontaneous distal migration are NOT permitted.
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Received or planned to receive intravenous thrombolysis.
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Pre-stroke modified Rankin score >2.
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Previous treatment with TS23 or known previous allergy to antibody therapy.
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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.
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Known previous stroke in the past 90 days.
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Known previous intracranial hemorrhage, intracranial neoplasm, subarachnoid hemorrhage, or arterial venous malformation.
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Known active diagnosis of intracranial neoplasm.
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Clinical presentation suggestive of a subarachnoid hemorrhage, even if initial CT scan was normal.
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Surgery or biopsy of parenchymal organ in the past 30 days.
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Known trauma with internal injuries or persistent ulcerative wounds in the past 30 days.
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Severe head trauma in the past 90 days.
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Persistent systolic blood pressure >180mmHg or diastolic blood pressure >105mmHg despite best medical management.
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Serious systemic hemorrhage in the past 30 days.
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Known hereditary or acquired hemorrhagic diathesis, coagulation factor deficiency, or oral anticoagulant therapy with International Normalized Ratio (INR) >1.7.
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Platelets <100,000/mm3.
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Hematocrit <25 %.
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Elevated aPTT above laboratory upper limit of normal.
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Creatinine > 4 mg/dl, or patients receiving renal dialysis, regardless of creatinine.
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Received the following within the previous 24 hours:
- If patient received unfractionated heparin within the last 24 hours, the patient must have an aPTT within normal range prior to enrollment.
- Low molecular weight heparins such as Dalteparin, enoxaparin, tinzaparin in full dose within the previous 24 hours.
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Received Factor Xa inhibitors (such as Fondaparinux, apixaban or rivaroxaban) within the past 48 hours.
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Received direct thrombin inhibitors (e.g., argatroban, dabigatran, bivalirudin, desirudin, lepirudin) within 48 hours.
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Received glycoprotein IIb/IIIa inhibitors within the past 14 days.
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Known pre-existing neurological or psychiatric disease which would confound the neurological/functional evaluations.
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Current participation in another research drug treatment protocol (i.e., participants could not start another experimental agent until after 90 days).
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Concurrent acute myocardial infarction, pulmonary embolism, deep venous thrombosis or other thrombotic event that requires anticoagulation or anti-platelet treatment.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Placebo TS23 Placebo Dose 4 TS23 TS23 highest dose Dose 2 TS23 TS23 next higher dose Dose 3 TS23 TS23 next higher dose Dose 1 TS23 TS23 low dose
- Primary Outcome Measures
Name Time Method Stroke severity as measured by the National Institutes of Health Stroke Scale (NIHSS) 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.
The proportion of patients with ANY intracerebral hemorrhage (ICH) At 30 (+/- 4) hours after study drug Any ICH visualized on the follow-up CT scan
- Secondary Outcome Measures
Name Time Method Improvement in level of global disability measured by modified Rankin Score (mRS distribution) 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.
Matrix metalloproteinase-9 level in plasma 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.
% brain tissue reperfusion 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 secondsEvaluation of anti-drug antibodies baseline and 90 (±7) days follow-up visit commonly used for characterization of therapeutic antibodies
Proportion of patients with symptomatic intracerebral hemorrhage 30 (±4) h of study drug administration a blood clot large enough to cause significant neurological deterioration.
Proportion of patients with non-intracerebral hemorrhage major or clinically relevant non-major bleeding 30 days of study drug administration. major and non-major events of bleeding that is not in the brain
Plasma fibrinogen level 3 (±1) h after completion of study drug Clotting factor
Proportion of patients with non-bleeding severe adverse events 90 (±7) days Assessment of untoward events
Proportion of patients with stroke-related and all-cause deaths 90 (±7) days measure of important patient outcomes
Frequency of Modified Rankin (mRS) score of 0-1 or returning to pre-stroke mRS. 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.
NIHSS 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.
α2-antiplasmin (a2AP) level in plasma at 3 (±1) h after completion of study drug administration A serine protease inhibitor responsible for inactivating plasmin.
Pharmacokinetic analyses at 3 (±1) h, and 30 (±4) h, 30 (±5) days, and 90 (±7) days, after completion of study drug administration. Measure of plasma concentrations of TS23
Trial Locations
- Locations (49)
University of Louisville Hospital
🇺🇸Louisville, Kentucky, United States
Providence St. Vincent Medical Center
🇺🇸Portland, Oregon, United States
Ascension Columbia St. Mary's Hospital
🇺🇸Milwaukee, Wisconsin, United States
University of Alabama Hospital
🇺🇸Birmingham, Alabama, United States
Banner University Medical Center
🇺🇸Phoenix, Arizona, United States
Mayo Clinic Phoenix
🇺🇸Phoenix, Arizona, United States
UCSD Health La Jolla
🇺🇸La Jolla, California, United States
Kaiser Permanente Los Angeles
🇺🇸Los Angeles, California, United States
Sutter Medical Center
🇺🇸Sacramento, California, United States
UCSD Medical Center- Hillcrest Hospital
🇺🇸San Diego, California, United States
Scroll for more (39 remaining)University of Louisville Hospital🇺🇸Louisville, Kentucky, United StatesAnn JerdeContactaljerd01@louisville.eduIsaac Abecassis, MDPrincipal Investigator