A Study to Assess the Safety and Efficacy of Sovateltide in Patients With Acute Cerebral Ischemic Stroke
Study Details
Study Description
Brief Summary
Extensive research is being conducted in search of neuroprotective agents for possible use in the acute phase of stroke and agents that can be used for neurorepair in later stages of stroke. Several trials have been conducted and are in progress using different pharmacological agents, but none of the studies involve the stimulation of ETB receptors to treat cerebral ischemic stroke. Sovateltide (IRL-1620, PMZ-1620) has been effective in animal models of cerebral ischemic stroke. Its safety and tolerability have been demonstrated in a human phase I study with 7 subjects. Clinical phase II and III results indicate that sovateltide is a novel, first-in-class, highly effective drug candidate for treating cerebral ischemic stroke. Safety and significant efficacy in improving the National Institutes of Health Stroke Scale (NIHSS), Modified Rankin scale (mRS), and Barthel index (BI) obtained in phase II and III studies in patients with cerebral ischemic stroke in India are convincing and encouraged us to investigate its safety and efficacy in cerebral ischemic stroke patients in the United States. Therefore, we now plan to conduct a phase III clinical study to evaluate the safety and efficacy of sovateltide therapy along with standard of care in patients of acute ischemic stroke.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
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Phase 3 |
Detailed Description
A stroke is a syndrome defined as an abrupt neurological outburst due to impaired blood flow to part of the brain. There are two types of stroke: hemorrhagic stroke and ischemic stroke. A hemorrhagic stroke follows the rupture of a weakened blood vessel in the brain causing accumulation of blood and compression of the surrounding brain tissue. An ischemic stroke follows a blocked blood vessel by a thrombus (blood clot) or embolism. In both types of strokes, the specific region of the brain supplied by the affected blood vessel is deprived of oxygenated blood, causing local hypoxia that damages the brain tissue and cells. Both types of stroke are very serious, however ischemic stroke is more common.
The global burden of ischemic stroke is nearly 4-fold greater than hemorrhagic stroke with close to 87% of the total incidence of stroke attributed to acute cerebral ischemic stroke (ACIS). ACIS is a critical care emergency caused by a significant reduction in blood flow to the brain by a blood clot or embolism. This nearly halts cerebral blood flow to the affected region leading to neuronal death. Neuronal cell death is followed by plasma membrane disruption, swelling of organelles, leaking of cell contents into extracellular space, and loss of neuronal function. Other events that take place include inflammation, excitotoxicity, free radical mediated toxicity, cytokine mediated cytotoxicity, impaired blood-brain-barrier, and oxidative stress.
Therapeutic management of ACIS is a multidisciplinary approach with a primary goal of revascularization and limiting neuronal injury. A stroke team consists of emergency medicine physicians, neurologists/neurosurgeons, radiologists, nurses and advanced care providers, clinical pharmacists, therapists, technicians, and laboratory personnel. Currently, the only FDA-approved pharmacological agent for ischemic stroke is tissue plasminogen activator (t-PA). It is a thrombolytic agent which restores blood flow by breaking down a clot. However, timing is crucial in administration of t-PA as the therapeutic time window is very narrow and the patient must receive it within 4.5 hours of onset of stroke symptoms. Therapeutic administration after this timeframe can result in hemorrhagic transformation, leading to additional brain damage. Nevertheless, even upon timely administration of t-PA in ACIS, only about 30% of patients obtain stroke resolution having minimal or no disability at the 90-day mark.
Sovateltide (PMZ-1620, IRL-1620) is a highly selective ETB receptor agonist and a synthetic analog of ET-1. We and others have conducted studies to determine the effects brought about by sovateltide upon its interaction with neural ETB receptors and have found that it enhances angiogenesis and neurogenesis as well as promotes neural repair and regeneration. In a rat model of ischemic stroke, sovateltide was found to be neuroprotective as well as enhance angiogenic and neurogenic remodeling. Sovateltide significantly improved survival, reduced neurological and motor function deficit, while effectively decreasing infarct volume, edema, and oxidative stress.
Sovateltide was also found to be safe and well tolerated in healthy human volunteers in a phase I clinical trial (CTRI/2016/11/007509). A phase II study was also conducted in patients with acute ischemic stroke where sovateltide demonstrated significant improvement when compared to standard of care (CTRI/2017/11/010654, NCT04046484). Our recent phase III study conducted in patients of acute ischemic stroke demonstrated improved favorable functional and neurological outcome at 3 months compared to standard of care (CTRI/2019/09/021373, NCT04047563).
Our clinical phase II and III results indicate that sovateltide is a first-in-class neuronal progenitor cell therapeutic that promotes quick recovery and significantly improves neurological outcomes in cerebral ischemic stroke patients. With this convincing evidence, we plan to conduct a multicentric, randomized, double-blind, parallel, placebo-controlled phase III clinical study in the United States, Canada, United Kingdom and Europe (the demographics and standard of treatment being similar in these countries) to further assess the safety and efficacy of sovateltide in patients with acute cerebral ischemic stroke.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Active Comparator: Normal Saline + Standard of care Normal saline will be used as a comparator. It will be available in a 5.0 mL vial. Three doses will be administered as an IV bolus over one minute every 3 hours ± 1 hour on day 1. The dose will be repeated on days 3 and 6 post randomization. The study drug will be administered as an IV bolus dose over 1 minute within 24 hours of the stroke onset. |
Drug: Drug: Normal Saline
Normal saline to be used as vehicle in the phase-III study to assess efficacy of sovateltide in patients with acute cerebral ischemic stroke.
Other Names:
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| Experimental: Sovateltide + Standard of care The test product is sovateltide. It is available as a lyophilized injection containing 30 µg of sovateltide in a 5.0 mL vial. Three doses of 0.3 μg/kg will be administered as an IV bolus over one minute every 3 hours ± 1 hour on day 1. The dose will be repeated on days 3 and 6 post randomization. The study drug will be administered as an IV bolus dose over 1 minute within 24 hours of the stroke onset. |
Drug: Sovateltide
Phase-III study to assess efficacy of sovateltide in patients with acute cerebral ischemic stroke.
Other Names:
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Outcome Measures
Primary Outcome Measures
- To determine the efficacy of sovateltide in patients with acute cerebral ischemic stroke assessed by modified Rankin Scale (mRS) score at day 90 post randomization [Day 1 through Day 90]
The proportion of acute cerebral ischemic stroke patients with modified Rankin Scale score of > 2 on day 90 post randomization
Secondary Outcome Measures
- Increase in the proportion of acute cerebral ischemic stroke patients with National Institute of Health Stroke Scale (NIHSS) score < 6, mRS ≤ 2, Barthel Index (BI) score > 60 on day 6, day 30, and day 90 post-randomization [Day 1 through Day 90]
Proportion of cerebral ischemic stroke patients with NIHSS score ≥ 6, mRS > 2, and BI score ≤ 60 on day 6, day 30, and day 90 post-randomization
- Improvement in the functional outcome of cerebral ischemic stroke patients as assessed by NIHSS, mRS, and BI scores at day 6, day 30, and day 90 post-randomization [Day 1 through Day 90]
Change in NIHSS score ≥ 6, mRS score > 2, and BI score ≥ 40 from baseline to day 6, day 30, and day 90 post-randomization
- Improvement in the overall clinical outcome as assessed by the global statistical test of mRS, NIHSS, and BI scores at day 6, day 30, and day 90 post-randomization. [Day 1 through Day 90]
Proportion of patients with overall clinical outcome as assessed by the global statistical test of NIHSS, mRS, and BI scores at day 6, day 30, and day 90 post-randomization
- Change in Quality-of-life (QoL) as assessed by EuroQol-EQ-5D and by Stroke-Specific Quality of Life (SSQOL) at day 30, day 60, and day 90 post- randomization [Day 1 through Day 90]
Change in QoL as assessed by EuroQol-EQ-5D and by SSQOL from baseline to day 30, day 60, and day 90 post-randomization
- Incidence of recurrent cerebral ischemic stroke within day 30 and day 90 post-randomization, as assessed by Questionnaire to Validate Stroke-Free Status (QVSFS) [Day 1 through Day 90]
Proportion of patients with recurrent ischemic stroke within day 30 and day 90 post-randomization as assessed by Questionnaire to Validate Stroke-Free Status (QVSFS)
- Incidence of mortality within 90 days post-randomization [Day 1 through Day 90]
Number of deaths within day 90 post-randomization
- Incidence of radiographic or symptomatic Intra Cerebral Hemorrhage (ICH) within 24 (± 6) hours of randomization [Day 1 through Day 90]
Proportion of patients with radiographic or symptomatic ICH within 24 (± 6) hours of randomization
- Alteration in cognition at day 30 and day 90 measured by Montreal Cognitive Assessment (MoCA) Test [Day 1 through Day 90]
Change in MoCA score at day 30 and 90 post-randomization
- Any adverse events (AE) or serious adverse events (SAEs) are associated with sovateltide [Day 1 through Day 90]
Proportion of patients with adverse events (AEs) and serious adverse events (SAEs)
Eligibility Criteria
Criteria
Inclusion Criteria:
A patient will be eligible for inclusion in the study if he/she fulfils the following criteria:
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Adult males or females aged 18 - 80 years of age
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Patient or Legally Acceptable Representative (LAR) willing to give informed consent before study procedure
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Stroke is ischemic in origin and radiologically confirmed Computed Tomography (CT) scan or diagnostic magnetic resonance imaging (MRI) prior to enrolment. No hemorrhage as proved by cerebral CT/MRI scan.
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Cerebral ischemic stroke patients presenting within 24 hours after onset of symptoms with NIHSS score of ≥ 8 and < 20 as well as NIHSS Level of Consciousness (1A) score < 2 at the time of screening. This includes cerebral ischemic stroke patients who completely recovered from earlier episodes before having a new or fresh stroke.
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The patient is < 24 hours from time of stroke onset when the first dose of sovateltide is administered. Time of onset is when symptoms began; for stroke that occurred during sleep, time of onset is when the patient was last seen or was self- reported to be normal
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Reasonable expectation of availability to receive the full sovateltide course of therapy, and to be available for subsequent follow-up visits
Exclusion Criteria:
A patient will not be eligible for inclusion in this study if they meet any of the following exclusion criteria:
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Patients receiving endovascular therapy or is a candidate for any surgical intervention for the treatment of stroke, which may include but not limited to endovascular techniques.
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Patients classified as comatose are defined as a patient who requires repeated stimulation to attend or is obtunded and requires strong or painful stimulation to make movements (NIHSS Level of Consciousness (1A) score ≥ 2)
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Evidence of intracranial hemorrhage (intracerebral hematoma, intraventricular hemorrhage, subarachnoid hemorrhage (SAH), epidural hemorrhage, acute or chronic subdural hematoma (SDH) on the baseline CT or MRI scan
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Known pregnancy and lactating women
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Confounding pre-existing neurological or psychiatric disease
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Concurrent participation in any other therapeutic clinical trial
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Evidence of any other major life-threatening or serious medical condition that would prevent completion of the study protocol, impair the assessment of outcome, or in which sovateltide therapy would be contraindicated or might cause harm to the patient
Contacts and Locations
Locations
No locations specified.Sponsors and Collaborators
- Pharmazz, Inc.
Investigators
None specified.Study Documents (Full-Text)
None provided.More Information
Publications
- Briyal S, Nguyen C, Leonard M, Gulati A. Stimulation of endothelin B receptors by IRL-1620 decreases the progression of Alzheimer's disease. Neuroscience. 2015 Aug 20;301:1-11. doi: 10.1016/j.neuroscience.2015.05.044. Epub 2015 May 27.
- Briyal S, Shepard C, Gulati A. Endothelin receptor type B agonist, IRL-1620, prevents beta amyloid (Abeta) induced oxidative stress and cognitive impairment in normal and diabetic rats. Pharmacol Biochem Behav. 2014 May;120:65-72. doi: 10.1016/j.pbb.2014.02.008. Epub 2014 Feb 20.
- Leonard MG, Prazad P, Puppala B, Gulati A. Selective Endothelin-B Receptor Stimulation Increases Vascular Endothelial Growth Factor in the Rat Brain during Postnatal Development. Drug Res (Stuttg). 2015 Nov;65(11):607-13. doi: 10.1055/s-0034-1398688. Epub 2015 Mar 25.
- Ramos MD, Briyal S, Prazad P, Gulati A. Neuroprotective Effect of Sovateltide (IRL 1620, PMZ 1620) in a Neonatal Rat Model of Hypoxic-Ischemic Encephalopathy. Neuroscience. 2022 Jan 1;480:194-202. doi: 10.1016/j.neuroscience.2021.11.027. Epub 2021 Nov 23.
- Sovateltide/ACIS/IND2022