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| Name | Class |
|---|---|
| Beijing Tiantan Hospital | OTHER |
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The primary purpose of this trial is to compare the efficacy of different doses of investigator product and comparator product in patients with acute ischemic stroke in 4.5 Hours after stroke onset, and provide a basis of drug administration for phase ā ¢ clinical trial.
The secondary purpose of this trial is to compare the safety of different dose of investigational product and comparator product in patients with acute ischemic stroke in 4.5 hours afterstroke onset .
This study is a multicenter, prospective randomised, open blinded endpoint study.
Patients with acute ischemic stroke need to undergo CT or MRI to exclude intracranial hemorrhage and perform NIHSS score before enrollment. Subjects who have passed the screening criteria according to the inclusion and exclusion criteria will be randomly assigned to low-dose test drugs, high-dose test drugs or reference drugs for thrombolytic therapy at a ratio of 1:1:1. The random stratification factor is the thrombolysis time window ("ā¤3h" vs "3~4.5h").
The start of administration of the study drug is recorded as 0h, CT or MRI and NIHSS score, laboratory test, and electrocardiogram were performed at 24 hours; NIHSS score was performed at 72 hours; NIHSS scoreļ¼laboratory test and electrocardiogram were performed on the14th day(the start of administration is recorded as Day 1 ,then the 14th day after administration should be recorded as Day 15 ); mRS score and Barthel index score were performed on the 30th day (Day 31); mRS score and Barthel index score were performed on the 90th day (Day 91).
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| The high-dose group | Experimental | Experimental: r-PA Dose: stick 18 mg; Mode of admin: The high-dose group (18 mg + 18 mg) was divided into two intravenous injections. the first intravenous bolus injection of 18mg,after 30mins, the second intravenous bolus injection of 18 mg, Push slowly for more than 2mins each time.Subjects were closely monitored during the medication and within 24 hours of administration. |
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| The low-dose group | Experimental | Experimental: r-PA Dose: stick 18 mg; Mode of admin: The low-dose group (12 mg + 12 mg) was divided into two intravenous injections, the first intravenous bolus injection of 12 mg, after 30mins, the second intravenous bolus injection of 12 mg, Push slowly for more than 2mins each time.Subjects were closely monitored during the medication and within 24 hours of administration. |
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| Active Comparator: Alteplase | Experimental | Active Comparator: Alteplase Drug: Alteplase for Injection Dose:50mg;20mg Mode of admin: 0.9 mg/kg (maximum dose of 90 mg) intravenous, 10% of which was injected intravenously within the first 1min, and the rest continued intravenous infusion for 1 h. Subjects should be closely monitored during the treatment period and within 24 hours of medication.Subjects were monitored according to the "Guidelines for the Diagnosis and Treatment of Acute Ischemic Stroke in China 2018". |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| r-PA | Drug | Drug: r-PA Dose: stick 18 mg; Mode of admin: The high-dose group (18 mg + 18 mg) was divided into two intravenous injections. the first intravenous bolus injection of 18mg,after 30mins, the second intravenous bolus injection of 18 mg, Push slowly for more than 2mins each time. |
| Measure | Description | Time Frame |
|---|---|---|
| The proportion of subjects with NIHSS score ā¤1 or the decrease of 4 points or more from the baseline on the 14th day after treatment; | The National Institutes of Health Stroke Scale (NIHSS) is a 15-item neurologic examination stroke scale used to evaluate the effect of acute cerebral infarction on the levels of consciousness, language, neglect, visual-field loss, extraocular movement, motor strength, ataxia, dysarthria, and sensory loss. A trained observer rates the patent's ability to answer questions and perform activities. Ratings for each item are scored with 3 to 5 grades with 0 as normal, and there is an allowance for untestable items. The range of scores is from 0 (normal) to 42 (profound effect of stroke on patient). | on the 14th day after treatment |
| Measure | Description | Time Frame |
|---|---|---|
| The proportion of subjects with NIHSS score ā¤1 or the decrease of 4 points or more from the baseline at 72 hours after treatment; | Proportion of patients with ā„4 point reduction in NIHSS or reaching 0-1 at 3 days (favourable clinical response) adjusted for baseline NIHSS and age. | at 72 hours after treatment; |
| Measure | Description | Time Frame |
|---|---|---|
| Percentage of subjects with symptomatic intracranial hemorrhage (sICH); | sICH definition: 1ćNINDS criteria: Any clinical deterioration within 36h after thrombolysis (NIHSS score point increase ā„ 1 point), imaging suggests intracranial hemorrhage; 2 ćECASS-II criteria: within 36h after thrombolysis, relative baseline or minimum NIHSS score point increase ā„ 4 points, The image suggests intracranial hemorrhage; 3ćSITS criteria: within 36 hours after thrombolysis, the relative baseline or minimum NIHSS score point increased by ā„ 4 points, The image shows > 30% of the infarct area, there is a cerebral hematoma (PH-2 type). (This study will be evaluated and recorded according to the above three standards. |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| YongJun Wang, Professor | Contact | +8613911172565 | yongjunwang1962@gmail.com |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Beijing Tiantan Hospital, Capital Medical University | Beijing | Beijing Municipality | 100055 | China |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 38152962 | Derived | Li S, Wang X, Jin A, Liu G, Gu H, Li H, Campbell BCV, Fisher M, Yang Y, Wei Y, Wang J, Wang Y, Zhao X, Liu L, Li Z, Meng X, Wang Y. Safety and Efficacy of Reteplase Versus Alteplase for Acute Ischemic Stroke: A Phase 2 Randomized Controlled Trial. Stroke. 2024 Feb;55(2):366-375. doi: 10.1161/STROKEAHA.123.045193. Epub 2023 Dec 28. |
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| ID | Term |
|---|---|
| D000083242 | Ischemic Stroke |
| ID | Term |
|---|---|
| D020521 | Stroke |
| D002561 | Cerebrovascular Disorders |
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
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| ID | Term |
|---|---|
| D007267 | Injections |
| D010959 | Tissue Plasminogen Activator |
| ID | Term |
|---|---|
| D004333 | Drug Administration Routes |
| D004358 | Drug Therapy |
| D013812 | Therapeutics |
| D012697 | Serine Endopeptidases |
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| r-PA | Drug | Drug: r-PA Dose: stick 18 mg; Mode of admin: The low-dose group (12 mg + 12 mg) was divided into two intravenous injections, the first intravenous bolus injection of 12 mg, after 30mins, the second intravenous bolus injection of 12 mg, Push slowly for more than 2mins each time. |
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| Alteplase for Injection | Drug | Drug: Alteplase for Injection Dose:50mg; 20mg Mode of admin: 0.9 mg/kg (maximum dose of 90 mg) intravenous, 10% of which was injected intravenously within the first 1min, and the rest continued intravenous infusion for 1 h. |
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| The proportion of subjects with mRS score of 0-1 on the 30th day and 90th day after treatment; |
The Modified Rankin Score (mRS) is a 6 point disability scale with possible scores ranging from 0-5. A separate category of 6 is usually added for patients who expire. Standardized interviews to obtain a mRS score are recommended at 3 months (90 days) following hospital discharge. The scale runs from 0-5, running from perfect health without symptoms to Severe disability 0. -No symptoms. 1. -No significant disability. Able to carry out all usual activities, despite some symptoms. 2 .-Slight disability. Able to look after own affairs without assistance, but unable to carry out all previous activities. 3. -Moderate disability. Requires some help, but able to walk unassisted. 4. -Moderately severe disability. Unable to attend to own bodily needs without assistance, and unable to walk unassisted. 5. -Severe disability. Requires constant nursing care and attention, bedridden, incontinent. |
| on the 30th day and 90th day after treatment; |
| The proportion of subjects with mRS score of 0-2 on the 30th day and 90th day after treatment; | on the 30th day and 90th day after treatment; |
| Continuous changes of mRS scores on the 30th and 90th days after treatment; | on the 30th and 90th days after treatment; |
| The proportion of subjects with Barthel index scoreā„95 on the 30th day and 90th day after treatment; | The Barthel Index of Activities of Daily Living (ADLs) measures functional disability by quantifying patient performance in 10 activities of daily life. These activities can be grouped according to self-care (feeding, grooming, bathing, dressing, bowel and bladder care, and toilet use) and mobility (ambulation, transfers, and stair climbing). 5-point increments are used in scoring, with a maximal score of 100 indicating that a patient is fully independent in physical functioning, and a lowest score of 0 representing a totally dependent bed-ridden state. | on the 30th day and 90th day after treatment; |
| within 36h after thrombolysis |
| Mortality within 90 days after treatment; | within 90 days after treatment; |
| The Proportion of subjects with adverse events/serious adverse events within 90 days after treatment. | within 90 days after treatment |
| D009422 |
| Nervous System Diseases |
| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |
| D010450 |
| Endopeptidases |
| D010447 | Peptide Hydrolases |
| D006867 | Hydrolases |
| D004798 | Enzymes |
| D045762 | Enzymes and Coenzymes |
| D057057 | Serine Proteases |
| D010960 | Plasminogen Activators |
| D001779 | Blood Coagulation Factors |
| D001798 | Blood Proteins |
| D011506 | Proteins |
| D000602 | Amino Acids, Peptides, and Proteins |
| D001685 | Biological Factors |