The current study aims to evaluate the safety of SP-8203, designing in two stages (stage-1, stage-2) to evaluate the safety and efficacy of the combination therapy of SP-8203 and rtPA for the occurrence of cerebral hemorrhage in patients with acute ischemic stroke receiving rtPA standard of care.
As the standard procedure of rtPA therapy, rtPA will be injected intravenously using a device like infusion pump. When reperfusion is not achieved in spite of rtPA therapy, endovascular therapy can be performed according to the judgment of a site investigator. Stage 1-The trial will be conducted with 11 subjects participating in an open label design manner. Subjects with neurologic deficit of ≥4 point and ≤10 points on NIHSS score will be given SP-8203, 80mg/dose, a total of 6 times at intervals of 12 hours. For the first administration of SP-8203, it should be administered within 30 minutes from the initiation of rtPA administration via a vein route different from one via which rtPA is injected. Thereafter, the subject will be transferred to MRI scanning room to have brain MRI and MRA performed, and brain CT will be performed to check the occurrence of intracranial hemorrhage at 24 hours after complete administration of the first dose of SP-8203. The subject will be closely monitored by research staff daily from the day of first administration of SP-8203 (Day 0) to Day 5. Brain MRI and MRA will be followed up after the last administration of SP-8203 on Day 5. The subject will make a visit on Day 14 to have his/her neurologic symptoms checked, after which subject's participation in the trial will be completed. \*The DSMB (Date Safety Monitoring Board) meeting will be held, to decide whether to proceed with Stage 2 or not, based on the results of Stage 1. Stage 2- A total of 69 subjects will be enrolled in double-blind, randomized and parallel design with 23 subjects assigned to low-dose (40mg/dose, 80mg/ day) SP-8203 group, high-dose (80mg/dose, 160mg/day) SP-8203 group or placebo group, respectively. If a subject, who is able to be enrolled in Stage 2, has neurological deficit of ≥4 point on NIHSS score and give patient's consent to participate in the trial, randomization will be performed and each treatment arm (one of three) will be assigned. The subject will receive the Investigational products a total of 6 times, with 12 hours intervals. Blood sample will be taken after the sixth administration of the Investigational product for pharmacokinetic and pharmacodynamics analysis. For pharmacokinetic analysis , blood sample will be taken at 0, 30, and 120 minutes after the complete sixth administration of the investigational products. For pharmacodynamics analysis, blood sample will be taken at between 24 to 48 hours after the first administration, at 0 minute after the sixth administration and at 4th week visit. As with Stage 1, the subject will have brain MRI and MRA performed after the administration of investigational product, and brain CT will be performed at 24 hours after completion of the first administration of investigational products. Brain MRI and MRA will be followed-up on Day 5, similarly to Stage 1. However, in Stage 2, the subject will make a visit for close monitoring for patient's neurological condition at 4th week and 12th week. Thereafter, all the procedures of the clinical trial will be completed.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
80
High-dose group: 160mg will be intravenously administered as 80mg/dose twice daily (intervals of 12 hours).
Low dose group: 80mg will be intravenously administered as 40mg/dose twice daily (intervals of 12 hours).
Same dosage of SP8203. Placebo will be intravenously administered twice daily (intervals of 12 hours)
Pusan National University Hospital
Busan, South Korea
Kyungpook National University Hospital
Daegu, South Korea
Myongji Hospital
Gyeonggi-do, South Korea
Inje University Busan Paik Hospital
Pusan, South Korea
The ratio of the incidence of parenchymal hematoma observed on brain CT
Incidence of parenchymal hematoma observed on brain CT performed at 24 hours in accordance with European Cooperative Acute Stroke Study (ECASS) I and II criteria
Time frame: Brain CT should be performed at 24 ± 3 hours after the complete administration of the first dose of IP. (Screening, Baseline ,Day 0, Day 1)
Incidence rate of serious adverse events
Incidence rate of serious adverse events
Time frame: Follow up period is 30 days after the last visit.
Neurologic outcomes evaluated by modified Rankin Scale (mRS)
Neurologic outcomes evaluated by modified Rankin Scale (mRS)
Time frame: Screening, Baseline, Day 0, Day 5, Week 12, Early Termination
Incidence rate symptomatic intracranial hemorrhage (sICH) occuring within 5 days
Incidence rate symptomatic intracranial hemorrhage (sICH) occuring within 5 days
Time frame: Day 1 Brain CT, Day 5 Brain MRI
Neurologic outcomes evaluated by NIHSS
Neurologic outcomes evaluated by NIHSS
Time frame: NIHSS should be scored every visit
Neurologic outcomes evaluated by Barthel Index
Neurologic outcomes evaluated by Barthel Index
Time frame: Day 0, Day 5, Week 12, Early Termination
The rate of death due to any cause
The rate of death due to any cause
Time frame: it is expected that a follow-up for up to 30 days after the last visit.
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Asan Medical Center, University of Ulsan
Seoul, South Korea
Korea University Guro Hospital
Seoul, South Korea
KyungHee University Medical Center
Seoul, South Korea
Soonchunhyang University Hospital
Seoul, South Korea
Incidence rate of adverse events and adverse drug reactions
Incidence rate of adverse events and adverse drug reactions
Time frame: it is expected that a follow-up for up to 30 days after the last visit.
Incidence rate of major systemic bleeding according to the International Society on Thrombosis and Hemostasis (ISTH
Incidence rate of major systemic bleeding according to the International Society on Thrombosis and Hemostasis (ISTH
Time frame: Laboratory tests (hematological test, clinical chemistry test, urinalysis etc.)- Day 1, Day 3, Day-5, Week 4, Week 12