Phase 2 Proof-of-Concept Study of the Safety and Efficacy of Alfimeprase to Rapidly Open Arteries and Restore Brain Function Following a Stroke

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00499902
Recruitment Status : Terminated (CO Phase 2 data did not show sufficient improvement in cath opening at higher dose/concentration evaluated. Nuvelo ended further clinical dev of alfimeprase.)
First Posted : July 12, 2007
Last Update Posted : April 24, 2008
Information provided by:
ARCA Biopharma, Inc.

Brief Summary:
The purpose of this study is to identify a safe and effective bolus dose of intra-arterial/intra-thrombus alfimeprase in acute ischemic stroke (AIS) 3 to 9 hours from symptom onset.

Condition or disease Intervention/treatment Phase
Acute Ischemic Stroke Drug: alfimeprase Phase 2

Detailed Description:
Currently approved drug therapy for AIS is limited by the need to treat within 3 hours of symptom onset. Alfimeprase acts to degrade fibrin directly and is inactivated locally by circulating alpha-2 macroglobulin. This study will determine whether treatment with alfimeprase facilitates rapid restoration of arterial blood flow with avoidance of symptomatic hemorrhagic conversion in subjects with AIS within 3 to 9 hours of symptom onset.

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 7 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Phase 2, Multicenter, Open-Label, Two-Stage Study to Evaluate the Safety and Efficacy of Intra-Arterial Catheter-Directed Alfimeprase for Restoration of Neurologic Function and Rapid Opening of Arteries in Stroke (CARNEROS-1)
Study Start Date : June 2007
Estimated Primary Completion Date : May 2008
Estimated Study Completion Date : May 2008

Arm Intervention/treatment
2 stages
This is a two-stage study. The first stage is in a three-tier dose escalation format, followed by a second stage during which subjects will be randomized in an equal proportion to up to 3 qualifying dose arms.
Drug: alfimeprase
Alfimeprase will be given as a single bolus of 1mg/2mL, or a split bolus of 5mg/2mL or 10mg/2mL in a three-tier dose escalation format. The 5mg and 10mg doses will be administered as split doses with 1/2 of the total dose given initially and 1/2 of the total dose given 30 minutes after the initial dose.

Primary Outcome Measures :
  1. Symptomatic intracerebral hemorrhage (ICH) defined as a greater than or equal to 4-point increase in NIHSS compared to baseline at the time of CT evidence of ICH within 24 hours of study drug administration.
  2. Recanalization of primary arterial occlusive lesion (AOL) using the Thrombolysis in Myocardial Infarction (TIMI) classification; a score of II or III will be considered success.

Secondary Outcome Measures :
  1. Relative hypotension requiring treatment (i.e. volume expanders and/or vasopressors)
  2. New cardiac events (e.g., cardiac ischemia, congestive heart failure, and dysrhythmia)
  3. Relative hypotension not requiring treatment
  4. Major bleeding events (TIMI definition)
  5. Hemorrhagic transformation: hemorrhagic infarction (Type 1 and 2), parenchymal hematoma formation (Type 1 and 2)
  6. Intracerebral hemorrhage outside of the stroke territory
  7. New AIS
  8. AEs/SAEs/All cause mortality
  9. Changes in chemistry, hematology, coagulation, and alpha-2-macroglobulin parameters based on central laboratory measurements
  10. Anti-alfimeprase antibody detection based on central laboratory measurements
  11. Recanalization of the primary AOL
  12. Global reperfusion of the primary AOL distal vascular bed defined by the Thrombolysis in Cerebral Infarction (TICI) score
  13. Neurological benefit as assessed by individual and combined analysis of NIHSS, mRS, and BI

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 85 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Clinical diagnosis of AIS defined as the sudden onset of an acute focal neurological deficit presumed to be due to cerebral ischemia
  • Arterial occlusion of the carotid T or a M1, M2, or M1-M2 branch of the middle cerebral artery (MCA) as documented by CT angiography or magnetic resonance angiography
  • Arteriographically confirmed occlusion of the carotid T or a M1, M2, or M1-M2 branch of the MCA
  • The subject (or legally acceptable representative) must give written informed consent
  • Age 18 years to 85 years
  • Onset of symptoms of AIS (i.e., last known well time) within 3-9 hours
  • Baseline NIHSS of 4 to 25
  • Available for follow-up assessments at 30 and 90 days

Exclusion Criteria:

  • Contraindication to systemic anticoagulation including any history of prior intracranial hemorrhage
  • Uncontrolled hypertension at study entry as defined by systolic blood pressure greater than 180 mmHg or diastolic blood pressure greater than or equal to 100 mmHg on repeated measures prior to study entry despite the use of IV antihypertensive agents
  • Expectation based on timing of presentation that alfimeprase administration will not be able to be completed by 9 hours after stroke onset
  • Inability to initiate alfimeprase within 120 minutes of the qualifying imaging scan
  • Coma
  • Rapidly improving neurological symptoms at the time of screening
  • Brain CT or MRI evidence of intracranial bleeding of any age
  • High clinical suspicion for subarachnoid hemorrhage despite a negative baseline CT or MRI
  • CT evidence of an acute and/or evolving hypodensity greater than 1/3 of the MCA territory in the vascular territory to be treated or Alberta Stroke Program Early CT Score (ASPECTS) of less than or equal to 5
  • MRI diffusion weighted imaging lesion greater than 1/3 of the MCA territory in the vascular distribution to be treated
  • Carotid artery and/or intracranial artery stenosis that precludes safe passage of a microcatheter to treat the primary AOL
  • Life expectancy of less than 6 months
  • History of significant acute or chronic kidney disease, including known nephrotic syndrome, that would preclude safe contrast angiography
  • Known allergy to contrast agents
  • History of immune deficiency
  • History of heparin-induced thrombocytopenia
  • Participation in any study of an investigational device, medication, biologic, or other agent within 30 days prior to enrollment (Stage I)/randomization (Stage II)
  • Any stroke, myocardial infarction, or use of thrombolytic therapy (including investigational thrombolytic therapy) within 3 months prior to enrollment (Stage I)/randomization (Stage II)
  • Past participation in any alfimeprase clinical trial
  • Pregnant, lactating, or actively menstruating women and women of child-bearing potential who are not using adequate contraceptive precautions
  • Current use of oral anticoagulants or an international normalized ratio (INR) greater than 1.4
  • Any non-atherosclerotic arteriopathy
  • Any prior neurologic event that would obscure the radiographic or clinical evaluation of the new index neurological deficits
  • Subjects with known renal insufficiency defined as a serum creatinine >2 mg/dL (>180 mmoL/L)
  • Subjects with known clinically significant hepatic disease defined as transaminase values > 3x upper limit of normal
  • Subjects with any malignant neoplasm diagnosed within five years prior to screening, with the exception of basal cell carcinoma of the skin and fully resected squamous cell carcinoma of the skin
  • Subjects with a platelet count less than 100,000/mm3
  • Subjects with a baseline serum glucose level less than 50 mg/dL or greater than 300 mg/dL
  • Subjects receiving any dose of a heparinoid or a non-prophylactic intensity dose of a low molecular weight heparin within the 24-hour period prior to study drug administration
  • Any other subject feature that in the opinion of the investigator should preclude study participation

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00499902

  Hide Study Locations
United States, California
UCLA Medical Center
Los Angeles, California, United States, 90024
United States, Illinois
Northwestern Medical Center
Chicago, Illinois, United States, 60611
United States, Iowa
Ruan Neurology & Clinical Research Center
Des Moines, Iowa, United States, 50314
University of Iowa Hospital
Iowa City, Iowa, United States, 52242
University of Iowa Hospital
Iowa City, Iowa, United States, 53342
United States, Kansas
University of Kansas School of Medicine, Via Christi Regional Medical Center
Wichita, Kansas, United States, 67214
United States, Kentucky
Norton Hospital
Louisville, Kentucky, United States, 40202
United States, Michigan
Michigan State University, Sparrow Hospital
Lansing, Michigan, United States, 48912
United States, New York
Albany Medical Center Hospital
Albany, New York, United States, 12208
Kalieda Health, MFH
Buffalo, New York, United States, 14203
Columbia Presbyterian Medical Center
New York, New York, United States, 10032
United States, Ohio
University of Cincinnati
Cincinnati, Ohio, United States, 45243
Riverside Methodist Hospital
Columbus, Ohio, United States, 43214
United States, Oregon
Oregon Stroke Center
Portland, Oregon, United States, 97239
United States, Pennsylvania
University of Pittsburg Medical Center
Pittsburg, Pennsylvania, United States, 15213
United States, Texas
Baylor College of Medicine
Houston, Texas, United States, 77030
United States, Wisconsin
St. Luke's Medical Center
Milwaukee, Wisconsin, United States, 53215
Canada, Alberta
University of Calgary, Foothills Medical Centre
Calgary, Alberta, Canada, T2N 2T9
Canada, British Columbia
Vancouver General Hospital
Vancouver, British Columbia, Canada, V52 1M9
Canada, Ontario
Trilium Health Center
Mississauga, Ontario, Canada, L5B4A2
University Health Network Toronto
Toronto, Ontario, Canada, M5T 258
Canada, Quebec
Montreal Neurological Institute
Montreal, Quebec, Canada, H3A 2B4
Sponsors and Collaborators
ARCA Biopharma, Inc.
Study Director: Susan M Begelman, MD ARCA Biopharma, Inc.

Responsible Party: Brian Kersten, PhD, Nuvelo, Inc. Identifier: NCT00499902     History of Changes
Other Study ID Numbers: HA009
First Posted: July 12, 2007    Key Record Dates
Last Update Posted: April 24, 2008
Last Verified: April 2008

Keywords provided by ARCA Biopharma, Inc.:
acute ischemic stroke
blood clot
plasminogen activator
arterial flow
symptomatic ICH
arterial occlusive lesion

Additional relevant MeSH terms:
Cerebrovascular Disorders
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases
Vascular Diseases
Cardiovascular Diseases