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Efficacy and Safety of TAK-442 in Subjects Undergoing Total Knee Replacement

Primary Purpose

Venous Thromboembolism

Status
Completed
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
TAK-442
TAK-442
TAK-442
TAK-442
TAK-442
TAK-442
Enoxaparin
Sponsored by
Takeda
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Venous Thromboembolism focused on measuring venous thromboembolism, oral anticoagulant, direct factor Xa inhibitor, total knee replacement, drug therapy

Eligibility Criteria

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

Inclusion Criteria

  • Scheduled to undergo elective, unilateral, primary, total knee replacement.
  • Females of childbearing potential who are sexually active must agree to use adequate contraception, and can neither be pregnant nor lactating from Screening throughout the duration of the study.
  • Screening laboratory tests (including clinical chemistry, hematology, and complete urinalysis) are within the reference range for the testing laboratory or are determined not to compromise subject safety by the investigator.

Exclusion Criteria

  • Received TAK-442 in a previous clinical study or as a therapeutic agent.
  • Body weight greater than 150 kg.
  • Known bleeding diathesis (including Von Willebrand's disease or Hemophilia A or B).
  • History of intracerebral, intraocular, or gastrointestinal bleeding, or active gastric or duodenal ulceration, within the 6 months prior to Randomization.
  • Is required to take or continues taking any disallowed medication, prescription medication, herbal treatment or over-the counter medication that may interfere with evaluation of the study medication, including throughout the treatment period of the study due to an increased risk of bleeding, and should be stopped at least 5 days prior to surgery and in accordance with the product information:

    • Parenteral anticoagulants
    • Unfractionated heparin
    • Low molecular weight heparin (eg, dalteparin, non-study enoxaparin)
    • Direct thrombin inhibitors (eg, bivalirudin, argatroban)
    • Factor Xa inhibitors (eg, fondaparinux)
    • Oral anticoagulants
    • Warfarin
    • Anisindione
    • Antiplatelet drugs
    • Aspirin greater than 162 mg/day
    • Clopidogrel
    • Ticlopidine
    • Cilostazol
    • Dipyridamole
    • Glycoprotein IIb/IIIa inhibitors (eg, abciximab, eptifibatide)
    • NSAIDs with a half life greater than or equal to 17 hours
    • Meloxicam
    • Fibrinolytic agents
    • tPA (alteplase, reteplase, tenecteplase)
  • History of major surgery within 3 months prior to randomization; or deep vein thrombosis, pulmonary embolism, myocardial infarction, cerebrovascular accident, or transient ischemic attack within 6 months prior to randomization.
  • History of hypersensitivity or allergies to other activated factor X inhibitors or enoxaparin (or other low molecular weight heparins).
  • Condition prohibiting bilateral venography.
  • Has had multiple or traumatic epidural or spinal punctures immediately prior to randomization (defined as grossly bloody or greater than 3 attempted cannulations).
  • Requires use of an indwelling epidural catheter for post-operative analgesia.
  • Severe hypertension defined as systolic blood pressure greater than 180 mmHg or diastolic blood pressure greater than 110 mmHg at Screening.
  • Moderate to severe renal dysfunction or disease (based on calculated creatinine clearance less than 45 mL/min/1.73 m2) at Screening.
  • Alanine aminotransferase level greater than 2.0 times the upper limit of normal, active liver disease, or jaundice at Screening.
  • Anemia (hemoglobin less than 10.0 g per dL) or thrombocytopenia (platelet count less than 100 times 103 per uL) at screening.
  • Taking aspirin greater than 162 mg per day.
  • Abuses drugs (defined as any illicit drug use) or alcohol.
  • History of cancer that has not been in remission for at least 5 years prior to the first dose of study drug. (This criterion does not include those subjects with basal cell or Stage 1 squamous cell carcinoma of the skin.)
  • Currently participating in another investigational study or has participated in an investigational study within 30 days prior to Screening.
  • Any other serious disease or condition at Screening or Randomization that would compromise subject safety or make it difficult to successfully manage and follow the subject according to the protocol.
  • Requires the use of pneumatic compression post-operatively.
  • Known inherited thrombophilic disorder such as the factor V Leiden or prothrombin gene mutations or deficiencies of antithrombin, protein C, or protein S.

Sites / Locations

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm 5

Arm 6

Arm 7

Arm Type

Experimental

Experimental

Experimental

Experimental

Experimental

Experimental

Active Comparator

Arm Label

TAK-442 40 mg QD

TAK-442 80 mg QD

TAK-442 10 mg BID

TAK-442 20 mg BID

TAK-442 40 mg BID

TAK-442 80 mg BID

Enoxaparin 30 mg BID

Arm Description

Outcomes

Primary Outcome Measures

Composite evaluation of All-Cause Mortality, Symptomatic and Asymptomatic Deep Vein Thrombosis and Symptomatic Pulmonary Embolism.
Incidence of Major Bleeding.

Secondary Outcome Measures

Evaluation of Major Venous Thromboembolism (composite of Symptomatic or Asymptomatic Proximal Deep Vein Thrombosis, Symptomatic Objectively Confirmed Pulmonary Embolism, and Venous Thromboembolism-Related Death).
Evaluation of Symptomatic Venous Thromboembolism.
Evaluation of Proximal Deep Vein Thrombosis.
Evaluation of Distal Deep Vein Thrombosis.
Evaluation of clinically significant Non-Major Bleeding events.
Evaluation of Minor Bleeding events.

Full Information

First Posted
March 18, 2008
Last Updated
March 13, 2016
Sponsor
Takeda
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1. Study Identification

Unique Protocol Identification Number
NCT00641732
Brief Title
Efficacy and Safety of TAK-442 in Subjects Undergoing Total Knee Replacement
Official Title
A Phase 2, Randomized, Active Comparator-Controlled, Dose-Ranging Study to Evaluate the Efficacy and Safety of TAK-442 in Subjects Undergoing Total Knee Replacement
Study Type
Interventional

2. Study Status

Record Verification Date
March 2016
Overall Recruitment Status
Completed
Study Start Date
October 2007 (undefined)
Primary Completion Date
October 2008 (Actual)
Study Completion Date
October 2008 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Takeda

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this study is to determine if TAK-442, once daily (QD) or twice daily (BID), is as safe and effective as enoxaparin in preventing the development of blood clots after knee replacement surgery.
Detailed Description
Takeda Global Research & Development Center, Inc. is developing the compound TAK-442 as a candidate for the secondary prevention of atherothrombotic events in patients with acute coronary syndromes. TAK-442 is an oral inhibitor of activated factor X within the blood coagulation cascade. Due to its critical role in propagating the coagulation cascade, activated factor X is now considered to be a therapeutic aim in the development of anticoagulant drugs. Therefore activated factor X inhibitors, are among the agents under investigation as treatments for the spectrum of thromboembolic diseases involving either the arterial or the venous system. Short term anticoagulation is often used for the prevention of venous thromboembolism. Patients undergoing major orthopedic surgery are at particularly high risk of venous thromboembolism after surgery. Consequently, such patients are routinely given anticoagulant medication after surgery. Although parenteral (injectable) drugs, such as enoxaparin or fondaparinux, can be used for this indication, the need for subcutaneous injection is problematic once patients are discharged from hospital. With the push for shorter hospital stays, this issue is of increasing concern. Therefore, there is a need for new oral anticoagulants. Although warfarin can be used for out of hospital prophylaxis, the need for coagulation monitoring and dose adjustments complicates its use. The new oral anticoagulants have the potential to overcome this problem because they can be given in fixed doses without the need for coagulation monitoring. The purpose of the current study is to evaluate the antithrombotic effect of TAK-442 in patients undergoing elective total knee replacement surgery. This study will be the first TAK-442 trial in patients. Individuals who want to participate in this study will be required to provide written informed consent. Study participation is anticipated to be approximately 2.25 months. Multiple procedures will occur at each visit which may include fasting, blood collection, urine collection, physical examinations, electrocardiograms and bilateral venogram. Outside of the study center, participants randomized to enoxaparin will be required to administer study medication subcutaneously with a syringe.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Venous Thromboembolism
Keywords
venous thromboembolism, oral anticoagulant, direct factor Xa inhibitor, total knee replacement, drug therapy

7. Study Design

Primary Purpose
Prevention
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
1045 (Actual)

8. Arms, Groups, and Interventions

Arm Title
TAK-442 40 mg QD
Arm Type
Experimental
Arm Title
TAK-442 80 mg QD
Arm Type
Experimental
Arm Title
TAK-442 10 mg BID
Arm Type
Experimental
Arm Title
TAK-442 20 mg BID
Arm Type
Experimental
Arm Title
TAK-442 40 mg BID
Arm Type
Experimental
Arm Title
TAK-442 80 mg BID
Arm Type
Experimental
Arm Title
Enoxaparin 30 mg BID
Arm Type
Active Comparator
Intervention Type
Drug
Intervention Name(s)
TAK-442
Intervention Description
TAK-442 40 mg, tablets, orally, once daily for up to 10 days.
Intervention Type
Drug
Intervention Name(s)
TAK-442
Intervention Description
TAK-442 80 mg, tablets, orally, once daily for up to 10 days.
Intervention Type
Drug
Intervention Name(s)
TAK-442
Intervention Description
TAK-442 10 mg, tablets, orally, twice daily for up to 10 days.
Intervention Type
Drug
Intervention Name(s)
TAK-442
Intervention Description
TAK-442 20 mg, tablets, orally, twice daily for up to 10 days.
Intervention Type
Drug
Intervention Name(s)
TAK-442
Intervention Description
TAK-442 40mg, tablets, orally, twice daily for up to 10 days.
Intervention Type
Drug
Intervention Name(s)
TAK-442
Intervention Description
TAK-442 80 mg, tablets, orally, twice daily for up to 10 days.
Intervention Type
Drug
Intervention Name(s)
Enoxaparin
Intervention Description
Enoxaparin 30 mg, syringe, subcutaneous injection, twice daily for up to 10 days.
Primary Outcome Measure Information:
Title
Composite evaluation of All-Cause Mortality, Symptomatic and Asymptomatic Deep Vein Thrombosis and Symptomatic Pulmonary Embolism.
Time Frame
Day 10.
Title
Incidence of Major Bleeding.
Time Frame
Day 10.
Secondary Outcome Measure Information:
Title
Evaluation of Major Venous Thromboembolism (composite of Symptomatic or Asymptomatic Proximal Deep Vein Thrombosis, Symptomatic Objectively Confirmed Pulmonary Embolism, and Venous Thromboembolism-Related Death).
Time Frame
Day 10.
Title
Evaluation of Symptomatic Venous Thromboembolism.
Time Frame
Day 10.
Title
Evaluation of Proximal Deep Vein Thrombosis.
Time Frame
Day 10.
Title
Evaluation of Distal Deep Vein Thrombosis.
Time Frame
Day 10.
Title
Evaluation of clinically significant Non-Major Bleeding events.
Time Frame
Day 10.
Title
Evaluation of Minor Bleeding events.
Time Frame
Day 10.

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria Scheduled to undergo elective, unilateral, primary, total knee replacement. Females of childbearing potential who are sexually active must agree to use adequate contraception, and can neither be pregnant nor lactating from Screening throughout the duration of the study. Screening laboratory tests (including clinical chemistry, hematology, and complete urinalysis) are within the reference range for the testing laboratory or are determined not to compromise subject safety by the investigator. Exclusion Criteria Received TAK-442 in a previous clinical study or as a therapeutic agent. Body weight greater than 150 kg. Known bleeding diathesis (including Von Willebrand's disease or Hemophilia A or B). History of intracerebral, intraocular, or gastrointestinal bleeding, or active gastric or duodenal ulceration, within the 6 months prior to Randomization. Is required to take or continues taking any disallowed medication, prescription medication, herbal treatment or over-the counter medication that may interfere with evaluation of the study medication, including throughout the treatment period of the study due to an increased risk of bleeding, and should be stopped at least 5 days prior to surgery and in accordance with the product information: Parenteral anticoagulants Unfractionated heparin Low molecular weight heparin (eg, dalteparin, non-study enoxaparin) Direct thrombin inhibitors (eg, bivalirudin, argatroban) Factor Xa inhibitors (eg, fondaparinux) Oral anticoagulants Warfarin Anisindione Antiplatelet drugs Aspirin greater than 162 mg/day Clopidogrel Ticlopidine Cilostazol Dipyridamole Glycoprotein IIb/IIIa inhibitors (eg, abciximab, eptifibatide) NSAIDs with a half life greater than or equal to 17 hours Meloxicam Fibrinolytic agents tPA (alteplase, reteplase, tenecteplase) History of major surgery within 3 months prior to randomization; or deep vein thrombosis, pulmonary embolism, myocardial infarction, cerebrovascular accident, or transient ischemic attack within 6 months prior to randomization. History of hypersensitivity or allergies to other activated factor X inhibitors or enoxaparin (or other low molecular weight heparins). Condition prohibiting bilateral venography. Has had multiple or traumatic epidural or spinal punctures immediately prior to randomization (defined as grossly bloody or greater than 3 attempted cannulations). Requires use of an indwelling epidural catheter for post-operative analgesia. Severe hypertension defined as systolic blood pressure greater than 180 mmHg or diastolic blood pressure greater than 110 mmHg at Screening. Moderate to severe renal dysfunction or disease (based on calculated creatinine clearance less than 45 mL/min/1.73 m2) at Screening. Alanine aminotransferase level greater than 2.0 times the upper limit of normal, active liver disease, or jaundice at Screening. Anemia (hemoglobin less than 10.0 g per dL) or thrombocytopenia (platelet count less than 100 times 103 per uL) at screening. Taking aspirin greater than 162 mg per day. Abuses drugs (defined as any illicit drug use) or alcohol. History of cancer that has not been in remission for at least 5 years prior to the first dose of study drug. (This criterion does not include those subjects with basal cell or Stage 1 squamous cell carcinoma of the skin.) Currently participating in another investigational study or has participated in an investigational study within 30 days prior to Screening. Any other serious disease or condition at Screening or Randomization that would compromise subject safety or make it difficult to successfully manage and follow the subject according to the protocol. Requires the use of pneumatic compression post-operatively. Known inherited thrombophilic disorder such as the factor V Leiden or prothrombin gene mutations or deficiencies of antithrombin, protein C, or protein S.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Executive Medical Director Clinical Science
Organizational Affiliation
Takeda
Official's Role
Study Director
Facility Information:
City
Birmingham
State/Province
Alabama
Country
United States
City
Tuscaloosa
State/Province
Alabama
Country
United States
City
Phoenix
State/Province
Arizona
Country
United States
City
Little Rock
State/Province
Arkansas
Country
United States
City
Bakersfield
State/Province
California
Country
United States
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Fountain Valley
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California
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United States
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Long Beach
State/Province
California
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United States
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Montclair
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California
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United States
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Oceanside
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California
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United States
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Vista
State/Province
California
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United States
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Yuba City
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California
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United States
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Aurora
State/Province
Colorado
Country
United States
City
Centennial
State/Province
Colorado
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United States
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Denver
State/Province
Colorado
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United States
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Bay Pines
State/Province
Florida
Country
United States
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Clearwater
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Florida
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United States
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DeLand
State/Province
Florida
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United States
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Gulf Breeze
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Florida
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United States
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Hollywood
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Florida
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United States
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Pinellas Park
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Florida
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United States
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Tamarac
State/Province
Florida
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United States
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Atlanta
State/Province
Georgia
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United States
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Boise
State/Province
Idaho
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United States
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Meridian
State/Province
Idaho
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United States
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Springfield
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Illinois
Country
United States
City
Towson
State/Province
Maryland
Country
United States
City
Charlotte
State/Province
North Carolina
Country
United States
City
Greensboro
State/Province
North Carolina
Country
United States
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Cincinnati
State/Province
Ohio
Country
United States
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Tulsa
State/Province
Oklahoma
Country
United States
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Altoona
State/Province
Pennsylvania
Country
United States
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Johnstown
State/Province
Pennsylvania
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United States
City
Charleston
State/Province
South Carolina
Country
United States
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Dallas
State/Province
Texas
Country
United States
City
Grapenne
State/Province
Texas
Country
United States
City
Lubbock
State/Province
Texas
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United States
City
San Antonio
State/Province
Texas
Country
United States
City
Spokane
State/Province
Washington
Country
United States
City
Edmonton
State/Province
Alberta
Country
Canada
City
Red Deer
State/Province
Alberta
Country
Canada
City
Kelowna
State/Province
British Columbia
Country
Canada
City
Winnipeg
State/Province
Manitoba
Country
Canada
City
Fredericton
State/Province
New Brunswick
Country
Canada
City
St. John
State/Province
New Brunswick
Country
Canada
City
Dartmouth
State/Province
Nova Scotia
Country
Canada
City
Ajax
State/Province
Ontario
Country
Canada
City
Burlington
State/Province
Ontario
Country
Canada
City
Cambridge
State/Province
Ontario
Country
Canada
City
Chatham
State/Province
Ontario
Country
Canada
City
Guelph
State/Province
Ontario
Country
Canada
City
Kitchener
State/Province
Ontario
Country
Canada
City
Newmarket
State/Province
Ontario
Country
Canada
City
Niagra Falls
State/Province
Ontario
Country
Canada
City
Oakville
State/Province
Ontario
Country
Canada
City
Oshawa
State/Province
Ontario
Country
Canada
City
Ottawa
State/Province
Ontario
Country
Canada
City
Sarnia
State/Province
Ontario
Country
Canada
City
Scarborough
State/Province
Ontario
Country
Canada
City
St. Catherines
State/Province
Ontario
Country
Canada
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Sudbury
State/Province
Ontario
Country
Canada
City
Thunder Bay
State/Province
Ontario
Country
Canada
City
Windsor
State/Province
Ontario
Country
Canada
City
Montreal
State/Province
Quebec
Country
Canada
City
Charlottetown
Country
Canada

12. IPD Sharing Statement

Citations:
PubMed Identifier
20886185
Citation
Weitz JI, Cao C, Eriksson BI, Fisher W, Kupfer S, Raskob G, Spaeder J, Turpie AG. A dose-finding study with TAK-442, an oral factor Xa inhibitor, in patients undergoing elective total knee replacement surgery. Thromb Haemost. 2010 Dec;104(6):1150-7. doi: 10.1160/TH10-05-0273. Epub 2010 Sep 30.
Results Reference
result

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Efficacy and Safety of TAK-442 in Subjects Undergoing Total Knee Replacement

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