The Effect of Ticagrelor on the Inflammatory Response to Human Endotoxemia
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 40
- 试验地点
- 1
- 主要终点
- concentration plasma TNFalpha (pg/ml)
研究概览
简要总结
Rationale:
In patients suffering a myocardial infarction the P2Y12 receptor antagonists prasugrel and ticagrelor improve outcome and prognosis compared to clopidogrel. Moreover, ticagrelor lowers mortality from pulmonary infections and sepsis, which cannot solely be explained by its platelet-inhibiting effect. An effect on the inflammatory response in the setting of acute myocardial might underlie this phenomenon and if substantiated support a novel beneficial mechanism of the new the P2Y12 receptor antagonists.
Objective:
To study whether ticagrelor, added to acetylsalicylic acid, modulates the inflammatory response to the administration of lipopolysaccharide (LPS) in humans in vivo, and to compare this effect with the P2Y12 antagonist clopidogrel.
Study design:
Prospective randomized placebo-controlled trial, according to a PROBE design (prospective randomized open blinded-endpoint study).
Study population:
Forty healthy male volunteers aged ≥ 18 and ≤ 35 years. Intervention (if applicable): Participants will be randomized to receive either placebo (twice daily), acetylsalicylic acid (80 mg once daily, after a loading dose of 160 mg) + placebo (once daily), acetylsalicylic acid (80 mg once daily, after a loading dose of 160 mg) + ticagrelor (90 mg twice daily, after a loading dose of 180 mg) or acetylsalicylic acid (80 mg once daily, after a loading dose of 160 mg)+ clopidogrel (75 mg once daily, after a loading dose of 300mg).
Main study parameters/endpoints:
Endpoints: area under the curve of the proinflammatory cytokines TNF-alpha, IL6, IL-10, IL1ra IL-8, IL-1β, MCP-1 MIP-1a, MIP-1b en IFN; peak concentrations of the various cytokines; plasma concentration of HMGP1; platelet-monocyte complex formation and markers of platelet function; plasma concentration of adenosine.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Basic Science
- 盲法
- Single (Outcomes Assessor)
入排标准
- 年龄范围
- 18 Years 至 35 Years（Adult）
- 性别
- Male
- 接受健康志愿者
- 是
入选标准
- •Age ≥ 18 and ≤ 35 years
- •No known current medical/psychiatric diseases
排除标准
- •History, signs or symptoms of any cardiovascular disease
- •History of chronic obstructive pulmonary disease (COPD) or asthma
- •History of hemorrhagic diathesis, or any other disorder associated with increased risk of bleeding
- •Previous spontaneous vagal collapse
- •Use of any medication
- •Liver enzyme abnormalities (defined as ALAT and/or ASAT > twice upper limit of normality)
- •Thrombocytopenia (<150*109
- •/ml) or anemia (haemoglobin < 8.0 mmol/L)
- •Any obvious disease associated with immune deficiency
- •Febrile illness in the week before the LPS challenge
- •Hypersensitivity to ticagrelor or any excipients
- •Active pathological bleeding
- •History of intracranial haemorrhage
- •History of dyspepsia
- •quantitative bleeding assessment tool (BAT) score >3 (see Appendix 1)
- •Participation in another drug trial or donation of blood 3 months prior, until 3 months after the planned LPS challenge
- •Cardiac conduction abnormalities on the ECG consisting of a 2nd degree atrioventricular block, third degree atrioventricular block or a complex bundle branch block
- •Hypertension (defined as RR systolic > 160 or RR diastolic > 90)
- •Hypotension (defined as RR systolic < 100 or RR diastolic < 50)
- •Renal impairment (defined as MDRD < 60 ml/min)
研究组 & 干预措施
Ticagrelor and acetylsalicylic acid
7 day treatment with ticagrelor 2x90mg after a loading dose of 180 mg and acetylsalicyclic acid 1x80mg after a loading dose of 160 mg.
干预措施: ticagrelor (Drug)
Ticagrelor and acetylsalicylic acid
7 day treatment with ticagrelor 2x90mg after a loading dose of 180 mg and acetylsalicyclic acid 1x80mg after a loading dose of 160 mg.
干预措施: Acetylsalicylic acid lysinate (Drug)
Clopidogrel and acetylsalicylic acid
7 day treatment with clopidogrel x75 mg after a loading dose of 300 mg and acetylsalicyclic acid 1x80mg after a loading dose of 160 mg
干预措施: Clopidogrel (Drug)
Clopidogrel and acetylsalicylic acid
7 day treatment with clopidogrel x75 mg after a loading dose of 300 mg and acetylsalicyclic acid 1x80mg after a loading dose of 160 mg
干预措施: Acetylsalicylic acid lysinate (Drug)
Placebo and acetylsalicylic acid
7 day treatment with placebo and acetylsalicyclic acid 1x80mg after a loading dose of 160 mg
干预措施: Acetylsalicylic acid lysinate (Drug)
Placebo and acetylsalicylic acid
7 day treatment with placebo and acetylsalicyclic acid 1x80mg after a loading dose of 160 mg
干预措施: Placebo (Drug)
Placebo
7 day treatment with 2 placebos
干预措施: Placebo (Drug)
结局指标
主要结局
concentration plasma TNFalpha (pg/ml)
时间窗: measured after challenge with endotoxin at day 7 of medication
measured with Luminex assay
次要结局
- platelet von Willebrandfactor expression(measured after challenge with endotoxin at day 7 of medication)
- VASP-P(difference between measurement prior to start of study drug after challenge with endotoxin at day 7 of medication)
- blood pressure(measured after challenge with endotoxin at day 7 of medication)
- concentration plasma IL-10 (pg/ml)(measured after challenge with endotoxin at day 7 of medication)
- concentration plasma IL-1RA (pg/ml)(measured after challenge with endotoxin at day 7 of medication)
- concentration plasma MCP-1(pg/ml)(measured after challenge with endotoxin at day 7 of medication)
- platelet reactivity(measured after challenge with endotoxin at day 7 of medication)
- concentration plasma MIP-1b(pg/ml)(measured after challenge with endotoxin at day 7 of medication)
- concentration plasma IFNgamma(pg/ml)(measured after challenge with endotoxin at day 7 of medication)
- plasma adenosine(measured after challenge with endotoxin at day 7 of medication)
- platelet monocyte complexes(measured after challenge with endotoxin at day 7 of medication)
- concentration plasma IL-6 (pg/ml)(measured after challenge with endotoxin at day 7 of medication)
- concentration plasma IL-8 (pg/ml)(measured after challenge with endotoxin at day 7 of medication)
- concentration plasma IL-1beta (pg/ml)(measured after challenge with endotoxin at day 7 of medication)
- concentration plasma MIP-1a(pg/ml)(measured after challenge with endotoxin at day 7 of medication)
- monocytic tissue factor expression(measured after challenge with endotoxin at day 7 of medication)
- temperature(measured after challenge with endotoxin at day 7 of medication)
- platelet neutrophil complexes(measured after challenge with endotoxin at day 7 of medication)
- monocytic HLA-DR expression(measured after challenge with endotoxin at day 7 of medication)
- CD14/16 ratio(measured after challenge with endotoxin at day 7 of medication)
- symptoms during endotoxin day(measured after challenge with endotoxin at day 7 of medication)
研究者
Peter Pickkers
Prof. Dr. Peter Pickkers
Radboud University Medical Center