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Clazosentan in Preventing the Occurrence of Cerebral Vasospasm Following an Aneurysmal Subarachnoid Hemorrhage (aSAH) (CONSCIOUS-1)

Primary Purpose

Aneurysmal Subarachnoid Hemorrhage

Status
Completed
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
Clazosentan 1 mg/h
Clazosentan 5 mg/h
Clazosentan 15 mg/h
Placebo
Sponsored by
Idorsia Pharmaceuticals Ltd.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Aneurysmal Subarachnoid Hemorrhage focused on measuring delayed ischemic neurological deficits (DIND), vasospasm, clazosentan, cerebral vasospasm, computer tomography scan (CT scan), digital subtraction angiography (DSA), endothelin A receptor, aneurysmal subarachnoid hemorrhage (aSAH)

Eligibility Criteria

18 Years - 70 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion criteria: Male or female patients aged 18 to 70 years (inclusive) or male patients aged 45 to 70 (inclusive) or males aged 18 to 44 (inclusive) who are surgically or naturally sterile or can personally sign the core Informed Consent Patients with a ruptured saccular aneurysm that has been confirmed by digital subtraction angiography (DSA) and for which clipping or coiling (endovascular obliteration) is possible. Patients with a diffuse or localized thick subarachnoid clot on baseline CT scan. Measurements defining clot thickness and extension are as follows: Diffuse: Clot with long axis >= 20 mm, or any clot if present in both hemispheres Localized: Clot with long axis < 20 mm Thick: Clot with short axis >= 4 mm Thin: Clot with short axis < 4 mm Start of screening within 48 hours post onset of aSAH clinical symptoms World Federation of Neurological Surgeons (WFNS) Grades I-IV, and those Grade V patients who improve to Grade IV or less after ventriculostomy In the case of multiple aneurysms, the aneurysm that has ruptured is identified with a high likelihood during the screening period Women of childbearing potential with pre-treatment negative serum pregnancy test Patient is able to start the study drug infusion within 56 hours after the rupture of the aneurysm, and the procedure option (clipping or coiling) must either be started within a maximum of 12 hours after the start of study drug infusion or should have been already performed Written informed consent to participate in the study must be obtained from the patient or a legal representative prior to initiation of any study-related procedure and enrollment Exclusion criteria: Patients with SAH due to other causes (e.g., trauma or rupture of fusiform or mycotic aneurysms) Patients with intraventricular or intracerebral blood, in the absence of subarachnoid blood No visualized clot or presence of only localized thin clot on CT (< 20 mm x 4 mm) Presence of any degree of cerebral vasospasm on screening angiogram Patients with hypotension (systolic blood pressure (SBP) <=90 mmHg) refractory to fluid therapy Patients with neurogenic pulmonary edema or severe cardiac failure requiring inotropic support Any severe or unstable concomitant condition or disease (e.g., known significant neurological deficit, cancer, hematological, or coronary disease), or chronic condition (e.g., psychiatric disorder) which, in the opinion of the Investigator, would affect the assessment of the safety or efficacy of the study drug Advanced kidney and/or liver disease, as defined by plasma creatinine >=2 mg/dl (177 micromol/l) and/or total bilirubin > 3 mg/dl (51.3 micromol/l) Any known or CT evidence of previous major cerebral damage (e.g., stroke [> 2 cm], traumatic brain injury [> 2 cm], previously treated cerebral aneurysm, arterial venous malformation [AVM]), or other preexisting cerebrovascular disorders, which may affect accurate diagnosis and evaluation of SAH Patients receiving prophylactic i.v. nimodipine or i.v. nicardipine. If present, these must be stopped at least 4 hours prior to initiation of the study treatment Patients who have received thrombolytics, including intracisternal administration, intrathecal treatments and therapeutic hypothermia for treatment of the SAH Patients who have received an investigational product within 28 days prior to randomization Patients with current alcohol or drug abuse or dependence

Sites / Locations

  • Dr. Giuseppe Lanzino
  • Dr. Horner
  • Dr. Aldrich
  • Dr. Ogilvy
  • Dr. Zuccarello
  • Dr. Woo
  • Dr. Rosenwasser
  • Dr. Zager
  • Dr. George A. Lopez
  • Dr. Bullock
  • Dr. Wong
  • Dr. Findlay
  • Dr. Redekop
  • Dr. Ferguson
  • Dr. Bojanowski
  • Dr. Fleetwood

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm Type

Experimental

Experimental

Experimental

Placebo Comparator

Arm Label

Clazosentan 1 mg/h

Clazosentan 5 mg/h

Clazosentan 15 mg/h

Placebo

Arm Description

intravenous clazosentan at 1 mg/h starting within 56 hours maximum after aneurysm rupture and continuing until Day 14 post-aneurysm rupture

intravenous clazosentan at 5 mg/h starting within 56 hours maximum after aneurysm rupture and continuing until Day 14 post-aneurysm rupture

intravenous clazosentan at of 15 mg/h starting within 56 hours maximum after aneurysm rupture and continuing until Day 14 post-aneurysm rupture

intravenous placebo starting within 56 hours maximum after aneurysm rupture and continuing until Day 14 post-aneurysm rupture

Outcomes

Primary Outcome Measures

Occurrence of moderate or severe cerebral vasospasm, as measured by cerebral angiography
If the patient develops clinical or sonographic changes suggestive of vasospasm prior to or after Day 9 ± 2 and until Day 14 post-aneurysm rupture, an angiogram will be performed to confirm the vasospasm. If vasospasm is documented prior to Day 9 ± 2, the Day 9 ± 2 angiogram is no longer required. In the case that a patient only develops clinical symptoms suggestive of vasospasm later than Day 9 ± 2 and up to Day 14, an additional angiogram should be performed to confirm the diagnosis of vasospasm. If the latter shows a higher grade of vasospasm than the previous one, it will be used for comparison to the baseline angiogram for evaluation of the primary endpoint.

Secondary Outcome Measures

Occurrence of vasospasm-related morbidity, and mortality of all causes defined as the occurrence of death of any cause within the first 6 weeks post-aneurysm rupture OR
Occurrence of vasospasm-related morbidity, and mortality of all causes defined as the occurence of new cerebral infarct within first 6 weeks post-aneurysm rupture based on local investigator reading of post-baseline CT scans OR
Occurrence of vasospasm-related morbidity, and mortality of all causes defined as the occurence of delayed ischemic neurological deficits (DIND) due to vasospasm (based on investigator assessments) within 14 days post-aneurysm rupture OR
Occurrence of vasospasm-related morbidity, and mortality of all causes defined as occurrence of use of rescue medication due to vasospasm within 14 days post-aneurysm rupture
Clinical outcome at 12 weeks post-aneurysm rupture as measured by the Modified Rankin Scale (mRS) score
Clinical outcome at 12 weeks post-aneurysm rupture as measured bythe Glasgow Outcome Scale - Extended Version (GOSE) score

Full Information

First Posted
May 17, 2005
Last Updated
July 6, 2018
Sponsor
Idorsia Pharmaceuticals Ltd.
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1. Study Identification

Unique Protocol Identification Number
NCT00111085
Brief Title
Clazosentan in Preventing the Occurrence of Cerebral Vasospasm Following an Aneurysmal Subarachnoid Hemorrhage (aSAH)
Acronym
CONSCIOUS-1
Official Title
A Phase IIb, Multi-center, International, Double-blind, Randomized, Placebo-controlled, Parallel-group, Dose-finding Study for the Prevention of Cerebral Vasospasm After Aneurysmal Subarachnoid Hemorrhage (aSAH) by Intravenous Administration of Clazosentan, a Selective Endothelin A (ETA) Receptor Antagonist
Study Type
Interventional

2. Study Status

Record Verification Date
July 2018
Overall Recruitment Status
Completed
Study Start Date
January 10, 2005 (Actual)
Primary Completion Date
March 30, 2006 (Actual)
Study Completion Date
March 30, 2006 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Idorsia Pharmaceuticals Ltd.

4. Oversight

5. Study Description

Brief Summary
The purpose of the study is to measure how effective and safe three different doses of the drug clazosentan are in preventing vasospasm after subarachnoid hemorrhage.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Aneurysmal Subarachnoid Hemorrhage
Keywords
delayed ischemic neurological deficits (DIND), vasospasm, clazosentan, cerebral vasospasm, computer tomography scan (CT scan), digital subtraction angiography (DSA), endothelin A receptor, aneurysmal subarachnoid hemorrhage (aSAH)

7. Study Design

Primary Purpose
Prevention
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Allocation
Randomized
Enrollment
413 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Clazosentan 1 mg/h
Arm Type
Experimental
Arm Description
intravenous clazosentan at 1 mg/h starting within 56 hours maximum after aneurysm rupture and continuing until Day 14 post-aneurysm rupture
Arm Title
Clazosentan 5 mg/h
Arm Type
Experimental
Arm Description
intravenous clazosentan at 5 mg/h starting within 56 hours maximum after aneurysm rupture and continuing until Day 14 post-aneurysm rupture
Arm Title
Clazosentan 15 mg/h
Arm Type
Experimental
Arm Description
intravenous clazosentan at of 15 mg/h starting within 56 hours maximum after aneurysm rupture and continuing until Day 14 post-aneurysm rupture
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
intravenous placebo starting within 56 hours maximum after aneurysm rupture and continuing until Day 14 post-aneurysm rupture
Intervention Type
Drug
Intervention Name(s)
Clazosentan 1 mg/h
Other Intervention Name(s)
ACT-108475
Intervention Description
Subjects receive intravenous clazosentan at a rate of 1 mg/h starting within 56 hours maximum after aneurysm rupture and continuing until Day 14 post-aneurysm rupture
Intervention Type
Drug
Intervention Name(s)
Clazosentan 5 mg/h
Other Intervention Name(s)
ACT-108475
Intervention Description
Subjects receive intravenous clazosentan at a rate of 5 mg/h starting within 56 hours maximum after aneurysm rupture and continuing until Day 14 post-aneurysm rupture
Intervention Type
Drug
Intervention Name(s)
Clazosentan 15 mg/h
Other Intervention Name(s)
ACT-108475
Intervention Description
Subjects receive intravenous clazosentan at a rate of 15 mg/h starting within 56 hours maximum after aneurysm rupture and continuing until Day 14 post-aneurysm rupture
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Subjects receive intravenous placebo starting within 56 hours maximum after aneurysm rupture and continuing until Day 14 post-aneurysm rupture
Primary Outcome Measure Information:
Title
Occurrence of moderate or severe cerebral vasospasm, as measured by cerebral angiography
Description
If the patient develops clinical or sonographic changes suggestive of vasospasm prior to or after Day 9 ± 2 and until Day 14 post-aneurysm rupture, an angiogram will be performed to confirm the vasospasm. If vasospasm is documented prior to Day 9 ± 2, the Day 9 ± 2 angiogram is no longer required. In the case that a patient only develops clinical symptoms suggestive of vasospasm later than Day 9 ± 2 and up to Day 14, an additional angiogram should be performed to confirm the diagnosis of vasospasm. If the latter shows a higher grade of vasospasm than the previous one, it will be used for comparison to the baseline angiogram for evaluation of the primary endpoint.
Time Frame
Up to day 14
Secondary Outcome Measure Information:
Title
Occurrence of vasospasm-related morbidity, and mortality of all causes defined as the occurrence of death of any cause within the first 6 weeks post-aneurysm rupture OR
Time Frame
Within 6 weeks
Title
Occurrence of vasospasm-related morbidity, and mortality of all causes defined as the occurence of new cerebral infarct within first 6 weeks post-aneurysm rupture based on local investigator reading of post-baseline CT scans OR
Time Frame
Within 6 weeks
Title
Occurrence of vasospasm-related morbidity, and mortality of all causes defined as the occurence of delayed ischemic neurological deficits (DIND) due to vasospasm (based on investigator assessments) within 14 days post-aneurysm rupture OR
Time Frame
Within 14 days
Title
Occurrence of vasospasm-related morbidity, and mortality of all causes defined as occurrence of use of rescue medication due to vasospasm within 14 days post-aneurysm rupture
Time Frame
Within 14 days
Title
Clinical outcome at 12 weeks post-aneurysm rupture as measured by the Modified Rankin Scale (mRS) score
Time Frame
At 12 weeks
Title
Clinical outcome at 12 weeks post-aneurysm rupture as measured bythe Glasgow Outcome Scale - Extended Version (GOSE) score
Time Frame
At 12 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
70 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion criteria: Male or female patients aged 18 to 70 years (inclusive) or male patients aged 45 to 70 (inclusive) or males aged 18 to 44 (inclusive) who are surgically or naturally sterile or can personally sign the core Informed Consent Patients with a ruptured saccular aneurysm that has been confirmed by digital subtraction angiography (DSA) and for which clipping or coiling (endovascular obliteration) is possible. Patients with a diffuse or localized thick subarachnoid clot on baseline CT scan. Measurements defining clot thickness and extension are as follows: Diffuse: Clot with long axis >= 20 mm, or any clot if present in both hemispheres Localized: Clot with long axis < 20 mm Thick: Clot with short axis >= 4 mm Thin: Clot with short axis < 4 mm Start of screening within 48 hours post onset of aSAH clinical symptoms World Federation of Neurological Surgeons (WFNS) Grades I-IV, and those Grade V patients who improve to Grade IV or less after ventriculostomy In the case of multiple aneurysms, the aneurysm that has ruptured is identified with a high likelihood during the screening period Women of childbearing potential with pre-treatment negative serum pregnancy test Patient is able to start the study drug infusion within 56 hours after the rupture of the aneurysm, and the procedure option (clipping or coiling) must either be started within a maximum of 12 hours after the start of study drug infusion or should have been already performed Written informed consent to participate in the study must be obtained from the patient or a legal representative prior to initiation of any study-related procedure and enrollment Exclusion criteria: Patients with SAH due to other causes (e.g., trauma or rupture of fusiform or mycotic aneurysms) Patients with intraventricular or intracerebral blood, in the absence of subarachnoid blood No visualized clot or presence of only localized thin clot on CT (< 20 mm x 4 mm) Presence of any degree of cerebral vasospasm on screening angiogram Patients with hypotension (systolic blood pressure (SBP) <=90 mmHg) refractory to fluid therapy Patients with neurogenic pulmonary edema or severe cardiac failure requiring inotropic support Any severe or unstable concomitant condition or disease (e.g., known significant neurological deficit, cancer, hematological, or coronary disease), or chronic condition (e.g., psychiatric disorder) which, in the opinion of the Investigator, would affect the assessment of the safety or efficacy of the study drug Advanced kidney and/or liver disease, as defined by plasma creatinine >=2 mg/dl (177 micromol/l) and/or total bilirubin > 3 mg/dl (51.3 micromol/l) Any known or CT evidence of previous major cerebral damage (e.g., stroke [> 2 cm], traumatic brain injury [> 2 cm], previously treated cerebral aneurysm, arterial venous malformation [AVM]), or other preexisting cerebrovascular disorders, which may affect accurate diagnosis and evaluation of SAH Patients receiving prophylactic i.v. nimodipine or i.v. nicardipine. If present, these must be stopped at least 4 hours prior to initiation of the study treatment Patients who have received thrombolytics, including intracisternal administration, intrathecal treatments and therapeutic hypothermia for treatment of the SAH Patients who have received an investigational product within 28 days prior to randomization Patients with current alcohol or drug abuse or dependence
Facility Information:
Facility Name
Dr. Giuseppe Lanzino
City
Peoria
State/Province
Illinois
Country
United States
Facility Name
Dr. Horner
City
Indianapolis
State/Province
Indiana
Country
United States
Facility Name
Dr. Aldrich
City
Baltimore
State/Province
Maryland
Country
United States
Facility Name
Dr. Ogilvy
City
Boston
State/Province
Massachusetts
Country
United States
Facility Name
Dr. Zuccarello
City
Cincinnati
State/Province
Ohio
Country
United States
Facility Name
Dr. Woo
City
Cleveland
State/Province
Ohio
Country
United States
Facility Name
Dr. Rosenwasser
City
Philadelphia
State/Province
Pennsylvania
Country
United States
Facility Name
Dr. Zager
City
Philadelphia
State/Province
Pennsylvania
Country
United States
Facility Name
Dr. George A. Lopez
City
Houston
State/Province
Texas
Country
United States
Facility Name
Dr. Bullock
City
Richmond
State/Province
Virginia
Country
United States
Facility Name
Dr. Wong
City
Calgary
State/Province
Alberta
Country
Canada
Facility Name
Dr. Findlay
City
Edmonton
State/Province
Alberta
Country
Canada
Facility Name
Dr. Redekop
City
Vancouver
State/Province
British Columbia
Country
Canada
Facility Name
Dr. Ferguson
City
Toronto
State/Province
Ontario
Country
Canada
Facility Name
Dr. Bojanowski
City
Montreal
State/Province
Quebec
Country
Canada
Facility Name
Dr. Fleetwood
City
Halifax, Nova Scotia
Country
Canada

12. IPD Sharing Statement

Citations:
PubMed Identifier
31299650
Citation
Eagles ME, Powell MF, Ayling OGS, Tso MK, Macdonald RL. Acute kidney injury after aneurysmal subarachnoid hemorrhage and its effect on patient outcome: an exploratory analysis. J Neurosurg. 2019 Jul 12:1-8. doi: 10.3171/2019.4.JNS19103. Online ahead of print.
Results Reference
derived
PubMed Identifier
29946013
Citation
Ayling OGS, Ibrahim GM, Alotaibi NM, Gooderham PA, Macdonald RL. Anemia After Aneurysmal Subarachnoid Hemorrhage Is Associated With Poor Outcome and Death. Stroke. 2018 Aug;49(8):1859-1865. doi: 10.1161/STROKEAHA.117.020260.
Results Reference
derived
PubMed Identifier
27827324
Citation
Ayling OG, Ibrahim GM, Alotaibi NM, Gooderham PA, Macdonald RL. Dissociation of Early and Delayed Cerebral Infarction After Aneurysmal Subarachnoid Hemorrhage. Stroke. 2016 Dec;47(12):2945-2951. doi: 10.1161/STROKEAHA.116.014794. Epub 2016 Nov 8.
Results Reference
derived
PubMed Identifier
27000643
Citation
Nassiri F, Ibrahim GM, Badhiwala JH, Witiw CD, Mansouri A, Alotaibi NM, Macdonald RL. A Propensity Score-Matched Study of the Use of Non-steroidal Anti-inflammatory Agents Following Aneurysmal Subarachnoid Hemorrhage. Neurocrit Care. 2016 Dec;25(3):351-358. doi: 10.1007/s12028-016-0266-6.
Results Reference
derived
PubMed Identifier
26428322
Citation
Tso MK, Ibrahim GM, Macdonald RL. Predictors of Shunt-Dependent Hydrocephalus Following Aneurysmal Subarachnoid Hemorrhage. World Neurosurg. 2016 Feb;86:226-32. doi: 10.1016/j.wneu.2015.09.056. Epub 2015 Sep 30.
Results Reference
derived
PubMed Identifier
26248048
Citation
Young JM, Morgan BR, Misic B, Schweizer TA, Ibrahim GM, Macdonald RL. A Partial Least-Squares Analysis of Health-Related Quality-of-Life Outcomes After Aneurysmal Subarachnoid Hemorrhage. Neurosurgery. 2015 Dec;77(6):908-15; discussion 915. doi: 10.1227/NEU.0000000000000928.
Results Reference
derived
PubMed Identifier
25280913
Citation
Ibrahim GM, Macdonald RL. The network topology of aneurysmal subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry. 2015 Aug;86(8):895-901. doi: 10.1136/jnnp-2014-308992. Epub 2014 Oct 3.
Results Reference
derived
PubMed Identifier
24425125
Citation
Ibrahim GM, Morgan BR, Macdonald RL. Patient phenotypes associated with outcomes after aneurysmal subarachnoid hemorrhage: a principal component analysis. Stroke. 2014 Mar;45(3):670-6. doi: 10.1161/STROKEAHA.113.003078. Epub 2014 Jan 14.
Results Reference
derived
PubMed Identifier
23581590
Citation
Ibrahim GM, Fallah A, Macdonald RL. Clinical, laboratory, and radiographic predictors of the occurrence of seizures following aneurysmal subarachnoid hemorrhage. J Neurosurg. 2013 Aug;119(2):347-52. doi: 10.3171/2013.3.JNS122097. Epub 2013 Apr 12.
Results Reference
derived
PubMed Identifier
22678087
Citation
Ibrahim GM, Macdonald RL. Electrocardiographic changes predict angiographic vasospasm after aneurysmal subarachnoid hemorrhage. Stroke. 2012 Aug;43(8):2102-7. doi: 10.1161/STROKEAHA.112.658153. Epub 2012 Jun 7.
Results Reference
derived
PubMed Identifier
21998061
Citation
Ibrahim GM, Weidauer S, Vatter H, Raabe A, Macdonald RL. Attributing hypodensities on CT to angiographic vasospasm is not sensitive and unreliable. Stroke. 2012 Jan;43(1):109-12. doi: 10.1161/STROKEAHA.111.632745. Epub 2011 Oct 13.
Results Reference
derived

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Clazosentan in Preventing the Occurrence of Cerebral Vasospasm Following an Aneurysmal Subarachnoid Hemorrhage (aSAH)

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