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Safety and Optimal Neuroprotection of neu2000 in Ischemic Stroke With Endovascular reCanalizion (SONIC) (SONIC)

Primary Purpose

Ischemic Stroke

Status
Unknown status
Phase
Phase 2
Locations
Korea, Republic of
Study Type
Interventional
Intervention
Neu2000KWL High-does group
Neu2000KWL Low-does group
Placebo
Sponsored by
GNT Pharma
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Ischemic Stroke focused on measuring Neu2000KWL, Neuroprotection, endovascular therapy, glutamate, free radical

Eligibility Criteria

19 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Adults ≥19 years
  2. Patients who were presented to hospitals after onset of brain ischemic symptoms from the base of last normal state and can start Endovascular therapy in accordance with standard practice guidelines within 8 hours after the symptom onset.
  3. NIHSS scores on screening time point (admission) ≥ 8 points
  4. Patients whose activity is possible without the help of others in the gen-eral condition one day before the ischemic stroke onset. and whose Barthel index scores exceed 90 points
  5. Patients whose brain CT and CT angiography imaging confirmed acute ischemic stroke and symptomatic intracranial occlusion at screening and whose occlusion site considered the cause of acute ischemic stroke meets the following conditions:

    ① Carotid T or L type occlusion

    ② M1 MCA

    ③ M1-MCA equivalent (two or more M2-MCAs) However, anterior temporal artery is not regarded M2

  6. Patients with ASPECTS on Brain CT without early imaging hyper-enhancement ≥ 6
  7. Patients who spontaneously submitted a written informed consent to participation on this clinical study

Exclusion Criteria:

  1. a medical history of hypersensitivity against aspirin (salicylates), sulfasalazine or (5-ASA) at screening.
  2. Patients who meets the exclusion criteria on imaging in intra-arterial re-canalization therapy ① CTA

    Patients whose imaging shows that the site of occlusion considered the cause of acute ischemic stroke meets the following conditions:

    A. MCA + PCA or MCA+ACA occlusion in Carotid T/L B. occlusion of a bilateral large artery C. simultaneous infiltration of anterior and posterior circulation

    ② absence of the collateral circulation corresponding to one of the followings: A. On CT angiography (MIP-CTA) imaging, absence or minimal collateral circulation at ≥50% of MCA territories, compared with pial filling of contralateral side of the lesion.

  3. Patients whose heart diseases corresponding to following conditions were confirmed at screening:

    ① Patients who were diagnosed with myocardial infarction within 6 months at screening

    ② Patients who had severe arrhythmia evoking clinical symptoms (respiratory difficulties, tachycardia etc.) within 6 months at screening.

    Patients whose ECG measured at the stable state at emergency room confirmed the following results:

    A. pulse rate < 50 or >120 beats per minute B. 2nd or 3rd degree AV block is confirmed. C. congenital or acquired QT syndrome is confirmed D. ventricular pre-excitation syndrome is confirmed

  4. Patients who were diagnosed with heart failure ≥ class II according to "heart failure classification by NYHA (New York Heart Association)" before screening.

    "heart failure classification by NYHA (New York Heart Association)" Class I: patients with no limitation of activities; they suffer no symptoms from ordinary activities.

    Class II: patients with slight, mild limitation of activity; they are comfortable with rest or with mild exertion.

    Class III: patients with marked limitation of activity; they are comfortable only at rest.

    Class IV: patients who should be at complete rest, confined to bed or chair; any physical activity brings on.

  5. Patients who have contraindication to contrast media for brain imaging
  6. Patients who are receiving renal replacement therapy such as dialysis, due to acute or chronic renal failure, nephropathy, etc. at screening.
  7. Patients who were diagnosed with cancer or received cancer therapy within 6 months at screening or have recurrent or transitional cancer
  8. Patients who show high body temperature of 38℃ or more or who need antibiotic therapy due to medical opinion of infectious diseases at screening.
  9. Patients who take pharmacotherapy due to liver diseases such as hepatitis, liver cirrhosis etc. at screening.
  10. Patients who are pregnant or lactating. However, in case of a woman of child-bearing potential, only patients whose non-pregnancy was confirmed can participate in this clinical study.
  11. Patients who participated in other clinical studies within past 3 months at the screening time as a base. However, in case of participation in an observatory study without medication, the patients can participate in this clinical study.
  12. Patients who were determined unsuitable for participation in this clinical study due to other reasons.

Sites / Locations

  • Chungbuk National University HospitalRecruiting
  • Keimyung University Dongsan Medical CenterRecruiting
  • Kyungpook National University HospitalRecruiting
  • Chosun University HospitalRecruiting
  • Gachon University Gil Medical CenterRecruiting
  • Ajou University HospitalRecruiting

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Experimental

Placebo Comparator

Arm Label

Neu2000KWL High-dose group

Neu2000KWL Low-dose group

Placebo

Arm Description

Outcomes

Primary Outcome Measures

Proportional Ratios of study subjects with mRS 0-2 scores at 12 weeks after Neu2000KWL treatment
Occurrence rate of cerebral hemorrhagic transformation occurring within 48 hours based on parenchymal hematoma (PH) criteria by ECASS (European Co-operative Acute Stroke Study)-I and II

Secondary Outcome Measures

Distribution changes of mRS scores at 1, 4 and 12 weeks vs baseline (shift analysis)
Ratios of NIHSS 0-2 scores at 1, 4 and 12 weeks vs baseline
Ratios of Barthel index >90 (≥ 95) at 1, 4 and 12 weeks vs baseline
Occurrence rate of cerebral hemorrhagic transformation occurring within Day 4 or Day 5 (Day of the last treatment of the study drug)
based on parenchymal hematoma (PH) criteria by ECASS (European Co-operative Acute Stroke Study)-I and II
Occurrence rate of symptomatic intracranial hemorrhage (SICH) described and defined by this study protocol occurring within Day 4 or Day 5 (Day of the last treatment of the study drug)
It is defined as SICH of intracranial hemorrhage by brain imaging is confirmed and any one of the following conditions is accompanied: A. in case that NIHSS scores become worse 2 points or more B. in case that NIHSS scores become worse 1 point or more, accompanying decreased consciousness C. in case that neurological deficits persist 24 hours or more (and), D. in case of recurrence of stroke and progress deterioration, or in case that other medical causes are not related.

Full Information

First Posted
July 3, 2016
Last Updated
July 11, 2017
Sponsor
GNT Pharma
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1. Study Identification

Unique Protocol Identification Number
NCT02831088
Brief Title
Safety and Optimal Neuroprotection of neu2000 in Ischemic Stroke With Endovascular reCanalizion (SONIC)
Acronym
SONIC
Official Title
A Phase II, Double-blind, Randomized, Placebo-controlled, Multi-center Study to Assess Efficacy and Safety of Neu2000KWL in Patients With Acute Ischemic Stroke Receiving Endovascular Therapy
Study Type
Interventional

2. Study Status

Record Verification Date
December 2016
Overall Recruitment Status
Unknown status
Study Start Date
July 2016 (undefined)
Primary Completion Date
December 30, 2018 (Anticipated)
Study Completion Date
December 30, 2018 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
GNT Pharma

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Efficacy and safety of Neu2000, a multi-target drug designed to prevent both NMDA receptor-mediated excitotoxicity and free radical toxicity, will be investigated in acute ischemic stroke patients receiving endovascular treatment to remove clot within 8 hours following stroke onset. Neu2000KWL will be administered before endovascular treatment.
Detailed Description
Neu2000 was designed as a multi-target neuroprotectant preventing both the NMDA receptor, a Ca2+-permeable glutamate receptor, and free radicals, two major routes of brain cell death in stroke. Neu2000 is a moderate NR2B-selective NMDA receptor antagonist and spin trapping molecule (=free radical scavenger or antioxidant). Therapeutic potential of Neu2000 has been well demonstrated in four animal models of stroke with better efficacy and therapeutic time windows than either NMDA receptor antagonist or anti-oxidant advanced to clinical trials. In human phase I studies of 165 healthy subjects conducted in the United States and China, Neu2000KWL showed promising safety profiles without any serious adverse events up to a single intravenous infusion of 6000 mg that is far beyond the therapeutic target dose determined in animal models of transient ischemic stroke. Very recently, acute endovascular recanalization therapy has been introduced as the new standard care of care in acute ischemic stroke. The present study is aimed to examine efficacy and safety of Neu2000KWL in acute ischemic stroke patients receiving endovascular thrombectomy within 8 hours of stroke onset.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Ischemic Stroke
Keywords
Neu2000KWL, Neuroprotection, endovascular therapy, glutamate, free radical

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigator
Allocation
Randomized
Enrollment
210 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Neu2000KWL High-dose group
Arm Type
Experimental
Arm Title
Neu2000KWL Low-dose group
Arm Type
Experimental
Arm Title
Placebo
Arm Type
Placebo Comparator
Intervention Type
Drug
Intervention Name(s)
Neu2000KWL High-does group
Other Intervention Name(s)
Neu2000KWL is produced by GNT Pharma Pharmaceutical company
Intervention Description
1st infusion of 750mg in patients receiving endovascular therapy within 8 hours following ischemic stroke onset followed by 9 consecutive infusions of 500 mg at intervals of 12 hours
Intervention Type
Drug
Intervention Name(s)
Neu2000KWL Low-does group
Other Intervention Name(s)
Neu2000KWL is produced by GNT Pharma Pharmaceutical company
Intervention Description
1st infusion of 500mg in patients receiving endovascular therapy within 8 hours following ischemic stroke onset followed by 9 consecutive infusions of 250 mg at intervals of 12 hours
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
1st infusion of the same volume of saline in patients receiving endovascular therapy within 8 hours following ischemic stroke onset followed by 9 consecutive infusions of same volume of saline at intervals of 12 hours
Primary Outcome Measure Information:
Title
Proportional Ratios of study subjects with mRS 0-2 scores at 12 weeks after Neu2000KWL treatment
Time Frame
12weeks
Title
Occurrence rate of cerebral hemorrhagic transformation occurring within 48 hours based on parenchymal hematoma (PH) criteria by ECASS (European Co-operative Acute Stroke Study)-I and II
Time Frame
12weeks
Secondary Outcome Measure Information:
Title
Distribution changes of mRS scores at 1, 4 and 12 weeks vs baseline (shift analysis)
Time Frame
1week, 4weeks, 12weeks
Title
Ratios of NIHSS 0-2 scores at 1, 4 and 12 weeks vs baseline
Time Frame
1week, 4weeks, 12weeks
Title
Ratios of Barthel index >90 (≥ 95) at 1, 4 and 12 weeks vs baseline
Time Frame
1week, 4weeks, 12weeks
Title
Occurrence rate of cerebral hemorrhagic transformation occurring within Day 4 or Day 5 (Day of the last treatment of the study drug)
Description
based on parenchymal hematoma (PH) criteria by ECASS (European Co-operative Acute Stroke Study)-I and II
Time Frame
4-5days
Title
Occurrence rate of symptomatic intracranial hemorrhage (SICH) described and defined by this study protocol occurring within Day 4 or Day 5 (Day of the last treatment of the study drug)
Description
It is defined as SICH of intracranial hemorrhage by brain imaging is confirmed and any one of the following conditions is accompanied: A. in case that NIHSS scores become worse 2 points or more B. in case that NIHSS scores become worse 1 point or more, accompanying decreased consciousness C. in case that neurological deficits persist 24 hours or more (and), D. in case of recurrence of stroke and progress deterioration, or in case that other medical causes are not related.
Time Frame
4-5days

10. Eligibility

Sex
All
Minimum Age & Unit of Time
19 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Adults ≥19 years Patients who were presented to hospitals after onset of brain ischemic symptoms from the base of last normal state and can start Endovascular therapy in accordance with standard practice guidelines within 8 hours after the symptom onset. NIHSS scores on screening time point (admission) ≥ 8 points Patients whose activity is possible without the help of others in the gen-eral condition one day before the ischemic stroke onset. and whose Barthel index scores exceed 90 points Patients whose brain CT and CT angiography imaging confirmed acute ischemic stroke and symptomatic intracranial occlusion at screening and whose occlusion site considered the cause of acute ischemic stroke meets the following conditions: ① Carotid T or L type occlusion ② M1 MCA ③ M1-MCA equivalent (two or more M2-MCAs) However, anterior temporal artery is not regarded M2 Patients with ASPECTS on Brain CT without early imaging hyper-enhancement ≥ 6 Patients who spontaneously submitted a written informed consent to participation on this clinical study Exclusion Criteria: a medical history of hypersensitivity against aspirin (salicylates), sulfasalazine or (5-ASA) at screening. Patients who meets the exclusion criteria on imaging in intra-arterial re-canalization therapy ① CTA Patients whose imaging shows that the site of occlusion considered the cause of acute ischemic stroke meets the following conditions: A. MCA + PCA or MCA+ACA occlusion in Carotid T/L B. occlusion of a bilateral large artery C. simultaneous infiltration of anterior and posterior circulation ② absence of the collateral circulation corresponding to one of the followings: A. On CT angiography (MIP-CTA) imaging, absence or minimal collateral circulation at ≥50% of MCA territories, compared with pial filling of contralateral side of the lesion. Patients whose heart diseases corresponding to following conditions were confirmed at screening: ① Patients who were diagnosed with myocardial infarction within 6 months at screening ② Patients who had severe arrhythmia evoking clinical symptoms (respiratory difficulties, tachycardia etc.) within 6 months at screening. Patients whose ECG measured at the stable state at emergency room confirmed the following results: A. pulse rate < 50 or >120 beats per minute B. 2nd or 3rd degree AV block is confirmed. C. congenital or acquired QT syndrome is confirmed D. ventricular pre-excitation syndrome is confirmed Patients who were diagnosed with heart failure ≥ class II according to "heart failure classification by NYHA (New York Heart Association)" before screening. "heart failure classification by NYHA (New York Heart Association)" Class I: patients with no limitation of activities; they suffer no symptoms from ordinary activities. Class II: patients with slight, mild limitation of activity; they are comfortable with rest or with mild exertion. Class III: patients with marked limitation of activity; they are comfortable only at rest. Class IV: patients who should be at complete rest, confined to bed or chair; any physical activity brings on. Patients who have contraindication to contrast media for brain imaging Patients who are receiving renal replacement therapy such as dialysis, due to acute or chronic renal failure, nephropathy, etc. at screening. Patients who were diagnosed with cancer or received cancer therapy within 6 months at screening or have recurrent or transitional cancer Patients who show high body temperature of 38℃ or more or who need antibiotic therapy due to medical opinion of infectious diseases at screening. Patients who take pharmacotherapy due to liver diseases such as hepatitis, liver cirrhosis etc. at screening. Patients who are pregnant or lactating. However, in case of a woman of child-bearing potential, only patients whose non-pregnancy was confirmed can participate in this clinical study. Patients who participated in other clinical studies within past 3 months at the screening time as a base. However, in case of participation in an observatory study without medication, the patients can participate in this clinical study. Patients who were determined unsuitable for participation in this clinical study due to other reasons.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Chun San An
Phone
82-31-8005-9910
Email
csan@gntpharma.com
First Name & Middle Initial & Last Name or Official Title & Degree
Sung Ig Cho
Phone
82-31-8005-9910
Email
sicho@gntpharma.com
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Ji Man Hong, MD, PhD
Organizational Affiliation
Ajou University Medical Centre
Official's Role
Principal Investigator
Facility Information:
Facility Name
Chungbuk National University Hospital
City
Cheongju
ZIP/Postal Code
28644
Country
Korea, Republic of
Individual Site Status
Recruiting
Facility Name
Keimyung University Dongsan Medical Center
City
Daegu
ZIP/Postal Code
41931
Country
Korea, Republic of
Individual Site Status
Recruiting
Facility Name
Kyungpook National University Hospital
City
Daegu
ZIP/Postal Code
41944
Country
Korea, Republic of
Individual Site Status
Recruiting
Facility Name
Chosun University Hospital
City
Gwangju
ZIP/Postal Code
61453
Country
Korea, Republic of
Individual Site Status
Recruiting
Facility Name
Gachon University Gil Medical Center
City
Incheon
ZIP/Postal Code
21565
Country
Korea, Republic of
Individual Site Status
Recruiting
Facility Name
Ajou University Hospital
City
Seoul
ZIP/Postal Code
16499
Country
Korea, Republic of
Individual Site Status
Recruiting

12. IPD Sharing Statement

Plan to Share IPD
Undecided
Citations:
PubMed Identifier
36065810
Citation
Hong JM, Lee JS, Lee YB, Shin DH, Shin DI, Hwang YH, Ahn SH, Kim JG, Sohn SI, Kwon SU, Lee JS, Gwag BJ, Chamorro A, Choi DW; SONIC Investigators. Nelonemdaz for Patients With Acute Ischemic Stroke Undergoing Endovascular Reperfusion Therapy: A Randomized Phase II Trial. Stroke. 2022 Nov;53(11):3250-3259. doi: 10.1161/STROKEAHA.122.039649. Epub 2022 Sep 6.
Results Reference
derived
PubMed Identifier
30005644
Citation
Hong JM, Choi MH, Sohn SI, Hwang YH, Ahn SH, Lee YB, Shin DI, Chamorro A, Choi DW; on the behalf of the SONIC investigators. Safety and Optimal Neuroprotection of neu2000 in acute Ischemic stroke with reCanalization: study protocol for a randomized, double-blinded, placebo-controlled, phase-II trial. Trials. 2018 Jul 13;19(1):375. doi: 10.1186/s13063-018-2746-9.
Results Reference
derived

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Safety and Optimal Neuroprotection of neu2000 in Ischemic Stroke With Endovascular reCanalizion (SONIC)

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