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Efficacy Study of Combined Treatment With Uric Acid and rtPA in Acute Ischemic Stroke (Urico-Ictus)
This study is not yet open for participant recruitment.
Verified by Fundacion Clinic per a la Recerca Biomédica, March 2009
First Received: March 11, 2009   No Changes Posted
Sponsors and Collaborators: Fundacion Clinic per a la Recerca Biomédica
Carlos III Health Institute
Information provided by: Fundacion Clinic per a la Recerca Biomédica
ClinicalTrials.gov Identifier: NCT00860366
  Purpose

The purpose of this study is to determine whether the combined treatment with Uric Acid and rtPA is superior to rtPA alone in terms of clinical efficacy in acute ischemic stroke patients treated within the first 4.5 hours of symptoms onset.


Condition Intervention Phase
Acute Ischemic Stroke
Drug: Uric Acid
Other: Vehicle
Phase II
Phase III

Drug Information available for: Alteplase Tissue-type plasminogen activator
U.S. FDA Resources
Study Type: Interventional
Study Design: Treatment, Randomized, Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor), Placebo Control, Parallel Assignment, Efficacy Study
Official Title: Randomized, Double Blind Study Assessing the Clinical Efficacy of Combined Treatment With Uric Acid and rtPA Administered Intravenously in Acute Ischemic Stroke Patients Within the First 4.5 Hours of Symptoms Onset

Further study details as provided by Fundacion Clinic per a la Recerca Biomédica:

Primary Outcome Measures:
  • Proportion of patients achieving a mRS of 0 to 1 at 3 months after treatment, or 2 in those patients with a mRS 2 prior to the inclusion in the study [ Time Frame: 90 days after the inclusion. ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Proportion of patients with NIHSS <2 at 2 hours after completing the experimental treatment. [ Time Frame: 2 hours after completing the experimental treatment ] [ Designated as safety issue: No ]
  • Proportion of patients with NIHSS <1 at day 90. [ Time Frame: Day 90 ] [ Designated as safety issue: No ]
  • Proportion of patients achieving a Barthel scale of 95 to 100 at day 90 [ Time Frame: Day 90 ] [ Designated as safety issue: No ]
  • All-cause mortality within the first 90 days. [ Time Frame: Day 90 ] [ Designated as safety issue: Yes ]
  • Final Infarction Volume measured by means of MRI or multimodal CT at 72 hours of onset (in specific centers) [ Time Frame: 72 hours ] [ Designated as safety issue: No ]
  • Proportion of patients with an intracranial hemorrhage associated to a worsening of 4 points in the NIHSS within the first 36 hours of treatment. [ Time Frame: 36 hours. ] [ Designated as safety issue: Yes ]

Estimated Enrollment: 420
Study Start Date: September 2009
Estimated Study Completion Date: September 2012
Estimated Primary Completion Date: September 2012 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Uric Acid: Experimental
Single intravenous infusion of 1 gram of Uric Acid dissolved in vehicle (500 ml of 0'1% Lithium Carbonate and 5% Mannitol).
Drug: Uric Acid
1 gram dissolved in a vehicle containing 500 ml of 0'1% Lithium Carbonate and 5% Mannitol, IV (in the vein), single dose.
Vehicle: Placebo Comparator
Single intravenous infusion of a 500 ml vehicle containing 0'1% Lithium Carbonate and 5% Mannitol.
Other: Vehicle
Single intravenous infusion of a 500 ml vehicle containing 0'1% Lithium Carbonate and 5% Mannitol.

Detailed Description:

Oxidative stress is a major contributor to brain damage in patients with ischemic stroke. Uric acid (UA) is an endogenous product derived from the metabolism of purins which in man is responsable of the 60% of the total antioxidant capacity of the organism. Recent experimental evidences gathered by our and other research groups have shown that the exogenous administration of UA is neuroprotective both in cortical and subcortical brain areas as the result of its antioxidant properties. In these studies, animals treated with UA disclosed smaller brain infarction after transient focal ischemia, both using the intraluminal model or after the injection of autologous clots. Moreover, our group first described greater neuroprotection in animals pretreated with rtPA (alteplase). Likewise, we have recently shown that the administration of UA was free of serious adverse effects in stroke patients receiving rtPA within 3 hours of stroke onset. Yet, preliminary data suggested that this intervention might translate into clinical benefits at 3 months follow-up. Based on these data, we aim to conduct a phase 3, randomized, double-blind, controlled trial assessing the clinical efficacy of UA administration in acute ischemic stroke patients. Currently, rtPA is the only approved therapy for stroke patients within the first hours of clinical onset, and oxidative stress is thought particularly relevant following ischemia/reperfusion. Based on this ground, we aim to conduct this phase 3 clinical trial in ischemic stroke patients which are currently treated with rtPA within the 4'5 hour window.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion criteria:

  • Age older than 18 years old.
  • Acute ischemic stroke treated with rtPA within the first 4.5 hours of clinical onset. Baseline National Institute of Health Stroke Scale (NIHSS) >6 and <25, and modified Rankin Scale (mRS) of 2 prior to the stroke.
  • Cranial CT disclosing the absence of blood in the CNS.
  • Informed consent.

Exclusion criteria:

  • Presence of any of the valid exclusion criteria for the administration of rtPA in the current clinical practise.
  • History of gout with or without history of gouty nephropathy, or uric lithiasis. Asymptomatic hiperuricemia under chronic treatment with allopurinol, or chronic treatment with lithium.
  • Chronic renal insufficiency (baseline creatinine > 1,5mg/dl).
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00860366

Contacts
Contact: Ángel Chamorro, MD, PhD. +34 932275400 ext 2424 mvargas@clinic.ub.es

Locations
Spain
Hospital General Universitario de Albacete
Albacete, Spain, 02006
Hospital Clínic de Barcelona
Barcelona, Spain, 08036
Hospital de la Santa Creu y Sant Pau
Barcelona, Spain, 08025
Hospital Dr Josep Trueta
Girona, Spain, 17007
Spain, Barcelona
Corporació Sanitària del Parc Taulí
Sabadell, Barcelona, Spain, 08208
Spain, Navarra
Hospital de Navarra
Pamplona, Navarra, Spain, 31008
Sponsors and Collaborators
Fundacion Clinic per a la Recerca Biomédica
Carlos III Health Institute
Investigators
Study Director: Angel Chamorro, MD, PhD. Comprehensive Stroke Center, Hospital Clínic Barcelona, Spain.
  More Information

Publications:
Responsible Party: Comprehensive Stroke Center, Hospital Clínic Barcelona, Spain ( Ángel Chamorro Sánchez; MD, PhD )
Study ID Numbers: URICOICTUS-1-2007, EudraCT 2007-002687-95, FIS EC07-90276
Study First Received: March 11, 2009
Last Updated: March 11, 2009
ClinicalTrials.gov Identifier: NCT00860366     History of Changes
Health Authority: Spain: Spanish Agency of Medicines

Keywords provided by Fundacion Clinic per a la Recerca Biomédica:
Acute ischemic stroke
thrombolysis
alteplase
uric acid
neuroprotection
oxidative stress

Study placed in the following topic categories:
Antioxidants
Cerebral Infarction
Stroke
Vascular Diseases
Tissue Plasminogen Activator
Stress
Central Nervous System Diseases
Lithium Carbonate
Ischemia
Brain Diseases
Cerebrovascular Disorders
Uric Acid
Mannitol
Brain Ischemia
Brain Infarction
Infarction
Lithium

Additional relevant MeSH terms:
Antioxidants
Molecular Mechanisms of Pharmacological Action
Cerebral Infarction
Physiological Effects of Drugs
Stroke
Nervous System Diseases
Vascular Diseases
Central Nervous System Diseases
Ischemia
Brain Diseases
Protective Agents
Cerebrovascular Disorders
Pharmacologic Actions
Uric Acid
Pathologic Processes
Brain Ischemia
Cardiovascular Diseases
Brain Infarction

ClinicalTrials.gov processed this record on May 07, 2009