A Randomized, Open-Label, Parallel-Group, Multi-Center Study for the Evaluation of Efficacy and Safety of Edoxaban Monotherapy Versus Low Molecular Weight (LMW) Heparin/Warfarin in Subjects With Symptomatic Deep-Vein Thrombosis (eTRIS)
Primary Purpose
Deep Vein Thrombosis, Venous Thrombosis
Status
Completed
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
edoxaban tosylate
enoxaparin/unfractionated heparin
warfarin
Sponsored by
About this trial
This is an interventional treatment trial for Deep Vein Thrombosis
Eligibility Criteria
Inclusion Criteria:
- Male or female subjects older than the minimum legal adult age (country specific)
- Acute symptomatic proximal DVT involving the popliteal, femoral or iliac veins confirmed by compression ultrasonography (CUS) or other appropriate imaging techniques (such as venography or spiral/contrast CT) with symptom onset < or = 1week prior to randomization
- Able to provide signed informed consent
Exclusion Criteria:
- Concomitant pulmonary embolism known to the investigator at the time of randomization
- Thrombectomy, insertion of a caval filter, or use of a fibrinolytic agent to treat the current episode of DVT
- Indication for warfarin other than DVT
- More than 48 hours pre-treatment with therapeutic dosages of anti-coagulant treatment [low molecular weight heparin (LMWH), unfractionated heparin (UFH), fondaparinux, VKA, factor Xa inhibitor or other anti coagulant per local labeling] prior to randomization to treat the current episode
- Treatment with any investigational drug within 30 days prior to randomization
- Calculated creatinine clearance (CrCL) < 30 mL/min
- Significant liver disease (e.g., acute hepatitis, chronic active hepatitis, cirrhosis) or alanine aminotransferase (ALT) > or = 2 times the upper limit of normal (ULN), or total bilirubin (TBL) > or = to 1.5 times the ULN (however subjects whose elevated TBL is due to known Gilbert's syndrome may be included in the study)
- Subjects with active cancer for whom long term treatment with (LMW) heparin is anticipated
- Life expectancy < 3 months
- Active bleeding or high risk for bleeding contraindicating treatment with (LMW) heparin or warfarin
- Uncontrolled hypertension as judged by the Investigator (e.g., systolic blood pressure > 170 mmHg or diastolic blood pressure > 100 mmHg despite antihypertensive medications confirmed by repeat measurement)
- Women of childbearing potential without proper contraceptive measures (i.e., a method of contraception with a failure rate < 1 % during the course of the study including the observational period) and women who are pregnant or breast feeding
- Any contraindication listed in the local labeling of LMWH, UFH, or warfarin
- Chronic treatment with non-aspirin non-steroidal anti-inflammatory drugs (NSAIDs) including both cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX- 2) inhibitors for > or = 4 days/week anticipated to continue during the study.
- Treatment with aspirin in a dosage of more than 100 mg/per day or dual antiplatelet therapy (any two antiplatelet agents including aspirin plus any other oral or intravenous [IV] antiplatelet drug) anticipated to continue during the study
- Treatment with P-gp inhibitors is not permitted at the time of randomization; subsequent use is permitted, with a dose reduction in the edoxaban monotherapy treatment arm.
- Known history of positive Hepatitis B antigen or Hepatitis C antibody
- Subjects with any condition that, as judged by the investigator, would put the subject at increased risk of harm if he/she participated in the study; including, but not limited to, subjects at increased risk of harm if given a gadolinium-based contrast agent such as gadofosveset trisodium (Ablavar®)
- Subjects for whom MRI would be contraindicated (e.g., subjects with metal implants) or for whom the use of a gadolinium-based contrast agent such as gadofosveset trisodium (Ablavar®) would be contraindicated
- Subject has previously entered this study or another edoxaban study
Sites / Locations
Arms of the Study
Arm 1
Arm 2
Arm Type
Experimental
Active Comparator
Arm Label
edoxaban tosylate
heparin/warfarin
Arm Description
Outcomes
Primary Outcome Measures
Relative Change From Baseline in Thrombus Volume Assessed by MRI [Using the Magnetic Resonance Venography (MRV) Method]
Thrombus Volume (mm^3) was measured at baseline and between days 14 to 21 using MRI results as determined by Magnetic Resonance Venography (MRV) method, and the relative percentage change from baseline was calculated
Secondary Outcome Measures
Number of Participants With Clinically Relevant Bleeding
Clinically relevant bleeding was defined as major or clinically relevant non-major bleeding
Number of Participants With Recurrence of Venous Thromboembolism (VTE)
Number of participants with investigator-confirmed recurrent VTE events that start or worsen after the first dose of study drug and prior to the date of the final visit or telephone contact (inclusive)
Number of Participants With Major Adverse Cardiovascular Events (MACE)
MACE is defined as a composite of non-fatal myocardial infarction (MI), non-fatal stroke, non-fatal systemic embolic event (SEE) and cardiovascular death
Number of Participants With Change From Baseline in the Presence or Absence of Thrombus by Vessel
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT01662908
Brief Title
A Randomized, Open-Label, Parallel-Group, Multi-Center Study for the Evaluation of Efficacy and Safety of Edoxaban Monotherapy Versus Low Molecular Weight (LMW) Heparin/Warfarin in Subjects With Symptomatic Deep-Vein Thrombosis
Acronym
eTRIS
Official Title
A Randomized, Open-Label, Parallel-Group, Multi-Center Study for the Evaluation of Efficacy and Safety of Edoxaban Monotherapy Versus (LMW) Heparin/Warfarin in Subjects With Symptomatic Deep-Vein Thrombosis - Edoxaban Thrombus Reduction Imaging Study
Study Type
Interventional
2. Study Status
Record Verification Date
May 2017
Overall Recruitment Status
Completed
Study Start Date
August 2012 (Actual)
Primary Completion Date
January 2014 (Actual)
Study Completion Date
March 2014 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Daiichi Sankyo, Inc.
4. Oversight
Data Monitoring Committee
No
5. Study Description
Brief Summary
Assess the relative change in thrombus volume as determined by two assessments (Baseline and Day 14-21) with magnetic resonance venography (MRV) in subjects with deep-vein thrombosis (DVT) treated with either an edoxaban monotherapy regimen or a low molecular weight (LMW) heparin/warfarin regimen.
Detailed Description
The classical management of patients with venous thromboembolism (VTE) consists of an initial treatment of at least five days of a (LMW) heparin followed by long-term treatment with a vitamin K antagonist (VKA), such as warfarin. The eTRIS study will address the clinically important question of whether edoxaban monotherapy, without concomitant (LMW) heparin at the time of treatment initiation is comparable to or better than standard treatment with (LMW) heparin/warfarin therapy in subjects with acute symptomatic DVT as assessed by the relative change from baseline in thrombus volume (measured by MRI) at Day 14-21.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Deep Vein Thrombosis, Venous Thrombosis
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
85 (Actual)
8. Arms, Groups, and Interventions
Arm Title
edoxaban tosylate
Arm Type
Experimental
Arm Title
heparin/warfarin
Arm Type
Active Comparator
Intervention Type
Drug
Intervention Name(s)
edoxaban tosylate
Intervention Description
edoxaban tosylate (DU-176b), film-coated for oral use, 90 mg once daily (QD) for 10 days (±2 days) followed by 60 mg QD for a total of approximately 90 days of edoxaban treatment
Intervention Type
Drug
Intervention Name(s)
enoxaparin/unfractionated heparin
Intervention Description
enoxaparin - administered by subcutaneous injection;1 mg/kg/ twice daily or 1.5 mg/kg once daily unfractionated heparin - started with 5000 IU bolus intravenous administration, 1300 IU/h continuous infusion, minimum of 5 days of treatment and stopped when target INR (2.0 - 3.0) is achieved.
Intervention Type
Drug
Intervention Name(s)
warfarin
Intervention Description
tablet for oral use; daily dosage, adjusted to maintain international normalized ratio (INR) between 2.0 and 3.0; 90 days treatment.
Primary Outcome Measure Information:
Title
Relative Change From Baseline in Thrombus Volume Assessed by MRI [Using the Magnetic Resonance Venography (MRV) Method]
Description
Thrombus Volume (mm^3) was measured at baseline and between days 14 to 21 using MRI results as determined by Magnetic Resonance Venography (MRV) method, and the relative percentage change from baseline was calculated
Time Frame
Baseline to final visit (Day 14-21)
Secondary Outcome Measure Information:
Title
Number of Participants With Clinically Relevant Bleeding
Description
Clinically relevant bleeding was defined as major or clinically relevant non-major bleeding
Time Frame
Initial dose of study drug up to 3 days after last dose
Title
Number of Participants With Recurrence of Venous Thromboembolism (VTE)
Description
Number of participants with investigator-confirmed recurrent VTE events that start or worsen after the first dose of study drug and prior to the date of the final visit or telephone contact (inclusive)
Time Frame
Baseline to final visit (Day 14-21)
Title
Number of Participants With Major Adverse Cardiovascular Events (MACE)
Description
MACE is defined as a composite of non-fatal myocardial infarction (MI), non-fatal stroke, non-fatal systemic embolic event (SEE) and cardiovascular death
Time Frame
Initial dose of study drug up to 3 days after last dose
Title
Number of Participants With Change From Baseline in the Presence or Absence of Thrombus by Vessel
Time Frame
Baseline to final visit (Day 14-21)
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Male or female subjects older than the minimum legal adult age (country specific)
Acute symptomatic proximal DVT involving the popliteal, femoral or iliac veins confirmed by compression ultrasonography (CUS) or other appropriate imaging techniques (such as venography or spiral/contrast CT) with symptom onset < or = 1week prior to randomization
Able to provide signed informed consent
Exclusion Criteria:
Concomitant pulmonary embolism known to the investigator at the time of randomization
Thrombectomy, insertion of a caval filter, or use of a fibrinolytic agent to treat the current episode of DVT
Indication for warfarin other than DVT
More than 48 hours pre-treatment with therapeutic dosages of anti-coagulant treatment [low molecular weight heparin (LMWH), unfractionated heparin (UFH), fondaparinux, VKA, factor Xa inhibitor or other anti coagulant per local labeling] prior to randomization to treat the current episode
Treatment with any investigational drug within 30 days prior to randomization
Calculated creatinine clearance (CrCL) < 30 mL/min
Significant liver disease (e.g., acute hepatitis, chronic active hepatitis, cirrhosis) or alanine aminotransferase (ALT) > or = 2 times the upper limit of normal (ULN), or total bilirubin (TBL) > or = to 1.5 times the ULN (however subjects whose elevated TBL is due to known Gilbert's syndrome may be included in the study)
Subjects with active cancer for whom long term treatment with (LMW) heparin is anticipated
Life expectancy < 3 months
Active bleeding or high risk for bleeding contraindicating treatment with (LMW) heparin or warfarin
Uncontrolled hypertension as judged by the Investigator (e.g., systolic blood pressure > 170 mmHg or diastolic blood pressure > 100 mmHg despite antihypertensive medications confirmed by repeat measurement)
Women of childbearing potential without proper contraceptive measures (i.e., a method of contraception with a failure rate < 1 % during the course of the study including the observational period) and women who are pregnant or breast feeding
Any contraindication listed in the local labeling of LMWH, UFH, or warfarin
Chronic treatment with non-aspirin non-steroidal anti-inflammatory drugs (NSAIDs) including both cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX- 2) inhibitors for > or = 4 days/week anticipated to continue during the study.
Treatment with aspirin in a dosage of more than 100 mg/per day or dual antiplatelet therapy (any two antiplatelet agents including aspirin plus any other oral or intravenous [IV] antiplatelet drug) anticipated to continue during the study
Treatment with P-gp inhibitors is not permitted at the time of randomization; subsequent use is permitted, with a dose reduction in the edoxaban monotherapy treatment arm.
Known history of positive Hepatitis B antigen or Hepatitis C antibody
Subjects with any condition that, as judged by the investigator, would put the subject at increased risk of harm if he/she participated in the study; including, but not limited to, subjects at increased risk of harm if given a gadolinium-based contrast agent such as gadofosveset trisodium (Ablavar®)
Subjects for whom MRI would be contraindicated (e.g., subjects with metal implants) or for whom the use of a gadolinium-based contrast agent such as gadofosveset trisodium (Ablavar®) would be contraindicated
Subject has previously entered this study or another edoxaban study
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Samuel Z Goldhaber, MD
Organizational Affiliation
Brigham and Women's Hospital
Official's Role
Principal Investigator
Facility Information:
City
Dothan
State/Province
Alabama
Country
United States
City
Montgomery
State/Province
Alabama
Country
United States
City
Sacramento
State/Province
California
Country
United States
City
Atlantis
State/Province
Florida
Country
United States
City
Clearwater
State/Province
Florida
Country
United States
City
Fort Myers
State/Province
Florida
Country
United States
City
Jacksonville
State/Province
Florida
Country
United States
City
Sarasota
State/Province
Florida
Country
United States
City
Tampa
State/Province
Florida
Country
United States
City
Jonesboro
State/Province
Georgia
Country
United States
City
Lafayette
State/Province
Indiana
Country
United States
City
Paducah
State/Province
Kentucky
Country
United States
City
Covington
State/Province
Louisiana
Country
United States
City
Annapolis
State/Province
Maryland
Country
United States
City
Baltimore
State/Province
Maryland
Country
United States
City
Randallstown
State/Province
Maryland
Country
United States
City
Butte
State/Province
Montana
Country
United States
City
Grand Island
State/Province
Nebraska
Country
United States
City
Rochester
State/Province
New York
Country
United States
City
Durham
State/Province
North Carolina
Country
United States
City
Greensboro
State/Province
North Carolina
Country
United States
City
Wilmington
State/Province
North Carolina
Country
United States
City
Maumee
State/Province
Ohio
Country
United States
City
Camp Hill
State/Province
Pennsylvania
Country
United States
City
Ephrata
State/Province
Pennsylvania
Country
United States
City
Sellersville
State/Province
Pennsylvania
Country
United States
City
Rapid City
State/Province
South Dakota
Country
United States
City
Fredericksburg
State/Province
Virginia
Country
United States
City
Tacoma
State/Province
Washington
Country
United States
City
Edmonton
State/Province
Alberta
Country
Canada
City
London
State/Province
Ontario
Country
Canada
City
New Market
State/Province
Ontario
Country
Canada
City
Greenfield Park
State/Province
Quebec
Country
Canada
City
Montreal
State/Province
Quebec
Country
Canada
12. IPD Sharing Statement
Plan to Share IPD
Yes
IPD Sharing Plan Description
De-identified individual participant data (IPD) and applicable supporting clinical trial documents may be available upon request at https://vivli.org/. In cases where clinical trial data and supporting documents are provided pursuant to our company policies and procedures, Daiichi Sankyo will continue to protect the privacy of our clinical trial participants. Details on data sharing criteria and the procedure for requesting access can be found at this web address: https://vivli.org/ourmember/daiichi-sankyo/
IPD Sharing Time Frame
Studies for which the medicine and indication have received European Union (EU) and United States (US), and/or Japan (JP) marketing approval on or after 01 January 2014 or by the US or EU or JP Health Authorities when regulatory submissions in all regions are not planned and after the primary study results have been accepted for publication.
IPD Sharing Access Criteria
Formal request from qualified scientific and medical researchers on IPD and clinical study documents from clinical trials supporting products submitted and licensed in the United States, the European Union and/or Japan from 01 January 2014 and beyond for the purpose of conducting legitimate research. This must be consistent with the principle of safeguarding study participants' privacy and consistent with provision of informed consent.
IPD Sharing URL
https://vivli.org/ourmember/daiichi-sankyo/
Citations:
PubMed Identifier
27165711
Citation
Piazza G, Mani V, Goldhaber SZ, Grosso MA, Mercuri M, Lanz HJ, Schussler S, Hsu C, Chinigo A, Ritchie B, Nadar V, Cannon K, Pullman J, Concha M, Schul M, Fayad ZA; edoxaban Thrombus Reduction Imaging Study (eTRIS) Investigators. Magnetic resonance venography to assess thrombus resolution with edoxaban monotherapy versus parenteral anticoagulation/warfarin for symptomatic deep vein thrombosis: A multicenter feasibility study. Vasc Med. 2016 Aug;21(4):361-8. doi: 10.1177/1358863X16645853. Epub 2016 May 10.
Results Reference
derived
Learn more about this trial
A Randomized, Open-Label, Parallel-Group, Multi-Center Study for the Evaluation of Efficacy and Safety of Edoxaban Monotherapy Versus Low Molecular Weight (LMW) Heparin/Warfarin in Subjects With Symptomatic Deep-Vein Thrombosis
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