Imatinib in Acute Ischaemic Stroke

NCT ID: NCT03639922

Last Updated: 2020-09-16

Basic Information

• Recruitment Status: UNKNOWN
• Clinical Phase: PHASE3
• Total Enrollment: 1260 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2018-10-01
• Study Completion Date: 2023-06-30

Brief Summary

A clinical trial comparing treatment with Imatinib to placebo when administered within 8 hours of stroke onset for 6 days, in addition to conventional stroke treatment after acute ischaemic stroke.

Detailed Description

The study aims to investigate if Imatinib reduces intracerebral haemorrhage and oedema in stroke patients after IV thrombolysis and/or trombectomy. Two important complications of ischaemic stroke and its acute treatment are haemorrhage into the infarcted tissue and cerebral oedema. Leading to worsening functional outcome in survivors. Both are caused by a disruption of the blood brain barrier (BBB) by ischemia of the brain vascular endothelium and associated cells involved in maintaining the BBB. Imatinib can reduce the damage to the BBB and hence reduce the formation of oedema and haemorrhage.

The study is a phase III randomised, double-blind placebo-controlled parallel-arm trilal of patents with acute ischaemic stroke. Assessing the Clinical variables at baseline and after 3 months.

Primary objective:

To investigate if Imatinib (800 mg / day) treatment initiated within 8 hours of symptom onset and given for 6 days improves functional outcome at three months after acute ischaemic stroke

Secondary objective:

1. Investigate if Imatinib treatment improves functional outcome at three months in acute ischaemic stroke patients treated with iv thrombolysis

2. Investigate if Imatinib treatment improves neurological outcome at three months after acute ischaemic stroke

3. Investigate if Imatinib treatment improves neurological outcome at three months in acute ischaemic stroke patients treated with iv thrombolysis

4. Investigate if Imatinib reduces the frequency and grade of ICH in patients with acute ischaemic stroke treated with iv thrombolysis

5. Investigate if Imatinib reduces the frequency and grade of cerebral oedema in patients with acute ischaemic stroke treated with iv thrombolysis

6. Examine serious and non-serious adverse events in patients treated with Imatinib

7. Investigate if Imatinib reduces mortality at 3 months after acute ischaemic stroke

8. Investigate if Imatinib reduces mortality at 3 months in acute ischaemic stroke patients treated with iv thrombolysis

Conditions

Acute Ischaemic Stroke

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: TRIPLE

Study Groups

Imatinib

Imatinib 400mg (2 tablets of 400mg) per day for 6 days

Group Type: ACTIVE_COMPARATOR

Imatinib 400mg

Intervention Type: DRUG

2 tablets of Imatinib 400mg per day for 6 days

Placebo

2 placebo tablets per day for 6 days

Group Type: PLACEBO_COMPARATOR

Placebo Oral Tablet

Intervention Type: DRUG

2 tablets of placebo per day for 6 days

Interventions

Imatinib 400mg

2 tablets of Imatinib 400mg per day for 6 days

Intervention Type: DRUG

Placebo Oral Tablet

2 tablets of placebo per day for 6 days

Intervention Type: DRUG

Eligibility Criteria

Inclusion Criteria

1. Clinical diagnosis of acute ischaemic stroke with a neurological deficit corresponding to 6 points or higher on the NIHSS score

1. at the time of randomization if no recanalisation therapy performed

2. prior to iv thrombolysis therapy alone or prior to thrombectomy alone if performed

3. prior to iv thrombolysis if both iv thrombolysis and thrombectomy performed Ischaemic stroke is defined as an event characterised by sudden onset of acute focal neurological deficit, presumed to be caused by cerebral ischaemia and an imaging scan excluding any intracranial haemorrhage.

2. Age 18-85 years

3. Patients should be randomized as soon as possible but not later than 8 hours of symptom onset.

1. If the patient receives iv thrombolysis alone, patient should be randomized and study drug should be given within one hour after completion of iv thrombolysis infusion

2. If the patient receives endovascular thrombectomy (with or without prior iv thrombolysis), patient should be randomized within two hours after completion of endovascular thrombectomy and study drug given as soon as possible after randomization.

4. iv thrombolysis, if performed, is done in agreement with European Stroke Organisation guidelines and has been initiated within 4.5 hours of stroke onset (see below separate criteria for indications / contraindications)

5. Endovascular thrombectomy, if performed, is done in agreement with recently published American Stroke Association guidelines, and fulfilling the following criteria

1. Confirmed diagnosis on Computed Tomography Angiography (CTA) or Magnetic Resonance Angiography (MRA) of acute occlusion of either of the first two segments of the Middle Cerebral Artery (M1 or M2), terminal Carotid Artery, first segment of the Anterior Cerebral Artery (A1), or Basilar Artery, consistent with the clinical symptoms.

2. thrombectomy has been initiated within 8 hours of symptom onset (defined as start with femoral artery (groin) puncture)

6. Patient is competent to make a decision and has provided informed consent with regard to participation in the study, retrieval and storage of data and follow up procedures

Exclusion Criteria

General

1. Imaging scans show signs of large current infarction as defined by more than 1/3 of the Middle Cerebral Artery territory or ½ of other vascular territories

2. ) Known significant pre-stroke disability (mRS ≥2)

3. Severe comorbidities such as advanced dementia (estimate pre-stroke if otherwise healthy), terminal illness, and other severe medical conditions with anticipated life expectancy less than 6 months.

4. Acute pancreatitis

5. Severe hepatic dysfunction, including hepatic failure, cirrhosis, portal hypertension (oesophageal varices) and active hepatitis

6. Ongoing treatment with chemotherapy

7. Drugs which may increase the plasma concentration of Imatinib - ketokonazol, itrakonazol, erythromycin and claritomycin

8. Drugs which may decrease the plasma concentration of Imatinib: Dexametason, phenytoin, karbamazepin, rifampizin, phenobarbital, fosphenytoin, primidon, Hypericum perforatum (Johannesört, St John's wort)

9. Female patients with childbearing potential, if pregnancy cannot be excluded by pregnancy test (urine point-of-care pregnancy test).

10. Patient is participating in other interventional study

1. Severe stroke as assessed clinically by NIHSS>25

2. Administration of heparin within the previous 48 hours preceding the onset of stroke with an elevated activated thromboplastin time (aPTT) at presentation, or corresponding low-molecular heparin.

3. Patients receiving oral anticoagulants, e.g. warfarin sodium (INR>1.7) or direct oral anticoagulation: dabigatran ( aPTT>40s), apixaban, rivaroxaban.

4. Platelet count below 100,000/mm3. Significant bleeding disorder at present or within the past 6 months, known haemorrhagic diathesis.

5. History or evidence or suspicion of intracranial haemorrhage including sub-arachnoid haemorrhage

6. Systolic blood pressure >185 mmHg or diastolic blood pressure >110 mmHg, in spite of repeated doses of i.v. medication to reduce blood pressure below these limits.

7. History of the following conditions: prior ischemic stroke within 3 months, intra-axial neoplasm, intracranial or spinal surgery within the prior 3 months, recent severe head trauma within 3 months or unruptured intracranial aneurysm>5 mm.

8. Major surgery or significant trauma in the past 10 days

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 85 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Niaz Ahmed

OTHER

Sponsor Role: lead

Responsible Party

Niaz Ahmed

Sponsor, Coordinating investigator

Responsibility Role: SPONSOR_INVESTIGATOR

Principal Investigators

Niaz Ahmed, MD PhD

Role: STUDY_DIRECTOR

Karolinska Institutet

Locations

Mälarsjukhuset Eskilstuna

Eskilstuna, , Sweden

Site Status: NOT_YET_RECRUITING

Sahlgrenska Universitetssjukhuset

Gothenburg, , Sweden

Site Status: RECRUITING

Hässleholms sjukhus

Hässleholm, , Sweden

Site Status: RECRUITING

Centralsjukhuset Karlstad

Karlstad, , Sweden

Site Status: RECRUITING

Centralsjukhuset Kristianstad

Kristianstad, , Sweden

Site Status: RECRUITING

Skånes Universitetssjukhus Lund

Lund, , Sweden

Site Status: NOT_YET_RECRUITING

Skånes Universitetssjukhus Malmö

Malmo, , Sweden

Site Status: NOT_YET_RECRUITING

Skaraborgs sjukhus Skövde

Skövde, , Sweden

Site Status: RECRUITING

Capio S:t Görans Hospital

Stockholm, , Sweden

Site Status: RECRUITING

Södersjukhuset

Stockholm, , Sweden

Site Status: RECRUITING

Karolinska Universitetssjukhuset Huddinge

Stockholm, , Sweden

Site Status: RECRUITING

Karolinska Universitetssjukhuset Solna

Stockholm, , Sweden

Site Status: RECRUITING

Danderyds sjukhus

Stockholm, , Sweden

Site Status: RECRUITING

Sundsvalls Sjukhus

Sundsvall, , Sweden

Site Status: NOT_YET_RECRUITING

Umeå University Hospital

Umeå, , Sweden

Site Status: NOT_YET_RECRUITING

Uppsala Akademiska Sjukhus

Uppsala, , Sweden

Site Status: RECRUITING

Västmanlands sjukhus Västerås

Västerås, , Sweden

Site Status: RECRUITING

Countries

Sweden

Central Contacts

Niaz Ahmed, MD PhD

Role: CONTACT

niaz.ahmed@ki.se

+ 46 8-517 72026

Marie Westman, PhD

Role: CONTACT

marie.westman@sll.se

+ 46 8-517 75034

Facility Contacts

Christina Widhe Qvist, MD

Role: primary

christina.widhe.qvist@dll.se

Jan-Erik Karlsson, MD

Role: primary

Jan-erik.karlsson@vgregion.se

Magnus Esbjörnsson, DR

Role: primary

Magnus.Esbjornsson@skane.se

Felix Andler

Role: primary

Felix.Andler@regionvarmland.se

Axel Andersson, MD

Role: primary

axel.p.andersson@skane.se

Jesper Pettersson, MD

Role: primary

jesper.pettersson@skane.se

Jesper Pettersson, MD

Role: primary

jesper.pettersson@skane.se

Björn Cederin, MD

Role: primary

bjorn.cederin@vgregion.se

Ulrika Löfmark Höjeberg

Role: primary

ulrika.lofmark@capiostgoran.se

Mihaela Romanitan

Role: primary

mihaela.romanitan@sodersjukhuset.se

Linda Säll, MD

Role: primary

linda.sall@sll.se

Magnus Thorén, MD

Role: primary

magnus.thoren@sll.se

Ann-Charlotte Laska, MD

Role: primary

ann-charlotte.laska@ds.se

Fredrik Björk, MD

Role: primary

fredrik.bjorck@rvn.se

Elias Johansson

Role: primary

elias.johansson@umu.se

Lars Sjöblom

Role: primary

Lars.sjoblom@akademiska.se

Andreas Ranhem, MD

Role: primary

andreas.ranhem@ltv.se

Other Identifiers

2017-000075-85

Identifier Type: EUDRACT_NUMBER

Identifier Source: secondary_id

I-StrokeII2016

Identifier Type: -

Identifier Source: org_study_id