A Study of the Effects of Multiple Doses of Dexlansoprazole, Lansoprazole, Omeprazole or Esomeprazole on the Pharmacokinetics and Pharmacodynamics of Clopidogrel in Healthy Participants.

Sponsor
Takeda (Industry)
Overall Status
Completed
CT.gov ID
NCT00942175
Collaborator
(none)
160
1
5
7
23

Study Details

Study Description

Brief Summary

The purpose of this study is to assess the potential effect and safety of multiple oral doses of dexlansoprazole, lansoprazole, omeprazole or esomeprazole, once daily (QD), on the steady-state pharmacokinetics and pharmacodynamics of clopidogrel, and to assess the safety of multiple doses of clopidogrel in healthy participants.

Condition or Disease Intervention/Treatment Phase
  • Drug: Clopidogrel
  • Drug: Clopidogrel and Lansoprazole
  • Drug: Clopidogrel and Dexlansoprazole
  • Drug: Clopidogrel and Omeprazole
  • Drug: Clopidogrel and Esomeprazole
Phase 1

Detailed Description

This is a Phase 1, randomized, open-label, single-center, multiple-dose, 2-period, crossover study to assess the effects of multiple oral doses of dexlansoprazole, lansoprazole, omeprazole or esomeprazole on the steady-state pharmacokinetics (PK) and pharmacodynamics (PD) of clopidogrel in healthy participants.

Participants were randomized equally into eight regimen sequence groups, 20 participants each. Participants randomized to Sequence Groups 1 and 2, 3 and 4, 5 and 6 and 7 and 8 were called proton pump inhibitor (PPI) Groups 1, 2, 3, and 4, respectively. Each sequence group consists of 2 regimens. Sequence Groups 1, 3, 5 and 7 dosed Regimen A (75 mg clopidogrel) for Days 1-9 of Period 1 and then crossed over to one of the following 4 regimens for Days 1-9 of Period 2: Regimen B (75 mg clopidogrel + 30 mg lansoprazole), Regimen C (75 mg clopidogrel + 60 mg dexlansoprazole), Regimen D (75 mg clopidogrel + 80 mg [2x40 mg] omeprazole), or Regimen E (75 mg clopidogrel + 40 mg esomeprazole). Sequence Groups 2, 4, 6 and 8 began with either Regimen B, C, D or E for Period 1 and then crossed over to Regimen A for Period 2.

On Day 9 of each period, blood samples were collected at predose and for 24 hours postdose to measure plasma concentrations of the active metabolite of clopidogrel. Platelet function was assessed daily prior to the dose of clopidogrel on Days 7-9 and 24-hours post Day 9 dose in each period. There was a washout interval of 10 to 14 days between the last dose of study drug in Period 1 and the first dose of study drug in Period 2.

Study participants were confined to the study center for 10 consecutive nights in Period 1, followed by a 10- to 14-day washout interval and confined for an additional 10 consecutive nights in Period 2.

Study Design

Study Type:
Interventional
Actual Enrollment :
160 participants
Allocation:
Randomized
Intervention Model:
Crossover Assignment
Masking:
None (Open Label)
Official Title:
A Phase 1, Randomized, Open-Label, 2-Period, Crossover Design Study to Assess the Effects of Multiple Oral Doses of Dexlansoprazole, Lansoprazole, Omeprazole or Esomeprazole on the Steady-State Pharmacokinetics and Pharmacodynamics of Clopidogrel in Healthy Subjects
Study Start Date :
Dec 1, 2009
Actual Primary Completion Date :
Jun 1, 2010
Actual Study Completion Date :
Jul 1, 2010

Arms and Interventions

Arm Intervention/Treatment
Other: Regimen A

Clopidogrel 75 mg QD

Drug: Clopidogrel
Clopidogrel 75 mg, tablets, orally, once daily days 1-9.
Other Names:
  • Plavix
  • Other: Regimen B

    Clopidogrel 75 mg QD and Lansoprazole 30 mg QD

    Drug: Clopidogrel and Lansoprazole
    Clopidogrel 75 mg, tablets, orally, once daily and Lansoprazole 30 mg, capsules, orally, once daily days 1-9.
    Other Names:
  • Plavix
  • Prevacid
  • AG-1749
  • Other: Regimen C

    Clopidogrel 75 mg QD and Dexlansoprazole 60 mg QD

    Drug: Clopidogrel and Dexlansoprazole
    Clopidogrel 75 mg, tablets, orally, once daily and Dexlansoprazole 60 mg, capsules, orally, once daily days 1-9.
    Other Names:
  • Plavix
  • Kapidex
  • TAK-390MR
  • Other: Regimen D

    Clopidogrel 75 mg QD and Omeprazole 80 mg QD

    Drug: Clopidogrel and Omeprazole
    Clopidogrel 75 mg, tablets, orally, once daily and Omeprazole 80 mg, capsules, orally, once daily days 1-9.
    Other Names:
  • Plavix
  • Other: Regimen E

    Clopidogrel 75 mg QD and Esomeprazole 40 mg QD

    Drug: Clopidogrel and Esomeprazole
    Clopidogrel 75 mg, tablets, orally, once daily and Esomeprazole 40 mg, capsules, orally, once daily days 1-9.
    Other Names:
  • Plavix
  • Nexium
  • Outcome Measures

    Primary Outcome Measures

    1. Pharmacokinetic Parameter Peak Plasma Concentration (Cmax) of Clopidogrel's Active Metabolite. [Day 9 of each period]

      Maximum observed plasma concentration (Cmax) is the peak plasma concentration of a drug after administration, obtained directly from the plasma concentration-time curve.

    2. Pharmacokinetic Parameter Area Under the Plasma Concentration Versus Time Curve (AUC) From Time 0 to Time of the Last Quantifiable Concentration (AUC[0-tlqc]) of Clopidogrel's Active Metabolite. [Day 9 of each period]

      Area under the plasma concentration versus time curve (AUC(0-tlqc)) is a measure of total plasma exposure to the drug from Time 0 to Time of the Last Quantifiable Concentration (AUC[0-tlqc]).

    3. Pharmacodynamic Parameter Platelet Reactivity Index (PRI) From Vasodilator-stimulated Phosphoprotein (VASP) Phosphorylation State (Flow Cytometry). [24-hour post Day 9 dose in each period.]

      PRI is the platelet reactivity index from VASP phosphorylation state (flow cytometry).

    4. Pharmacodynamic Parameter Maximum Platelet Aggregation (MPA) From Aggregometry (Turbidimetric) With 5 µM Adenosine Diphosphate. [24-hour post Day 9 dose in each period.]

      Maximum platelet aggregation (MPA) from aggregometry (turbidimetric) with 5 µM adenosine diphosphate.

    5. Pharmacodynamic Parameter MPA From Aggregometry (Turbidimetric) With 20 µM Adenosine Diphosphate. [24-hour post Day 9 dose in each period.]

      MPA from aggregometry (turbidimetric) with 20 µM adenosine diphosphate.

    Eligibility Criteria

    Criteria

    Ages Eligible for Study:
    18 Years to 55 Years
    Sexes Eligible for Study:
    All
    Accepts Healthy Volunteers:
    Yes
    Inclusion Criteria:
    1. The participant or the participant's legally acceptable representative signs a written, informed consent form prior to the initiation of any study procedures.

    2. Weighs at least 50 kg and has a body mass index (BMI) between 18 and 30 kg/m2, inclusive, at Screening and Check-in (Day -1 of Period 1) Visits.

    3. Must be a CYP2C19 extensive metabolizer (wt/wt).

    4. Females cannot be nursing and must have a negative urine pregnancy test at Day -1 or be of non-childbearing potential. If females are of child bearing potential, must have a negative serum human chorionic gonadotropin (hCG) pregnancy test during Screening and on an acceptable form of contraception, or have had bilateral tubal ligation if performed a minimum of 90 days prior to Day 1.

    5. At the Screening and Check-in (Day -1 of Period 1) Visits, must have an estimated creatinine clearance (CLcr) greater than or equal 90 mL/minute as determined from the Cockcroft-Gault formula.

    6. Is in good health as determined by a physician based upon medical history, electrocardiogram, and physical examination findings at the Screening and Check-in (Day -1 of Period 1) Visits.

    7. Participant's clinical laboratory evaluations (including hematology, clinical chemistry [fasted for a least 8 hours], and urinalysis) at the Screening and Check-in (Day -1 of Period 1) Visits are within the reference range for the testing laboratory or are deemed not clinically significant by the investigator and TGRD Medical Monitor.

    8. Participant's urine drug screen for selected substances of abuse is negative at the Screening and Check-in (Day -1 of Period 1) Visits.

    Exclusion Criteria:
    1. Has consumed products containing Seville oranges (sour), grapefruit or grapefruit juice within 14 days prior to the first dose of study drug or is unwilling to agree to abstain from products containing Seville oranges (sour), grapefruit or grapefruit juice while participating in the study.

    2. Has current or recent (within 6 months) gastrointestinal disease, a history of malabsorption, esophageal reflux, gastric bleeding or peptic ulcer disease, frequent (more than once per week) occurrence of heartburn, or any surgical intervention (eg, cholecystectomy), which would be expected to influence the absorption of drugs.

    3. Has a history of drug abuse (defined as any illicit drug use) or a history of alcohol abuse (defined as the consumption of more than 4 alcoholic beverages per day) within 1 year prior to the Screening Visit or is unwilling to agree to abstain from alcohol and drugs throughout the study.

    4. Is currently participating in another investigational study or has received any investigational compound within 30 days prior to the Check-in (Day -1 of Period 1) Visit.

    5. Has received any known hepatic or renal clearance altering agents (eg, erythromycin, cimetidine, barbiturates, phenothiazines, fluvoxamine, etc.) within 28 days prior to first dose of study drug.

    6. Has a history or clinical manifestations of significant metabolic, hematologic, pulmonary, cardiovascular, gastrointestinal, neurologic, hepatic, renal, urologic, immunologic, or psychiatric disorder as determined by the investigator which may impact the ability of the participant to take part in or potentially confound the trial results.

    7. Has a history of hypersensitivity or allergies to any drug or food or any excipients of clopidogrel, lansoprazole, dexlansoprazole, omeprazole, esomeprazole or other drug with the same mechanism of action or related compounds.

    8. Has had an acute, clinically significant illness within 30 days prior to the first dose of study drug.

    9. Has a systolic blood pressure greater than 140 mm Hg or has a diastolic blood pressure greater than 90 mm Hg at Screening or Check-in (Day -1 of Period 1).

    10. Has a positive test result for hepatitis B surface antigen (HBsAg) or antibody to hepatitis C virus (anti-HCV) at Screening, or a known history of infection with the human immunodeficiency virus (HIV).

    11. Has a Day -1 laboratory value assessed by the principal investigator and sponsor medical monitor as clinically significant underlying disease or condition that may prevent the participant from entering the study.

    12. Has an alanine aminotransferase, aspartate aminotransferase or Total Bilirubin level that exceeds the upper limit of normal at the Screening or Check-in (Day -1 of Period

    1. Visits.
    1. Has used nicotine-containing products (including but not limited to cigarettes, pipes, cigars, chewing tobacco, nicotine patch or nicotine gum) within 6 weeks prior to Check-in (Day -1 of Period 1) Visit, or has a positive cotinine screen at the Screening or Check-in (Day - 1 of Period 1) Visits or anticipates an inability to abstain from these products for the duration of the study.

    2. With the exception of acetaminophen, has taken any excluded medication, supplements or food products listed in the Excluded Dietary Items and Medications table located in the study protocol.

    3. Has donated blood products (such as plasma) within 30 days, or has donated whole blood or had a significant blood loss (500 mL) within 56 days of the first dose of study drug

    4. Has a positive test result for caffeine at the Check-in (Day -1 of Period 1) Visit.

    5. Has a history of cancer, except basal cell carcinoma, which has not been in remission for at least 5 years prior to the first dose of study drug.

    6. Has received clopidogrel or any PPIs or histamine2-receptor antagonists within 28 days of screening.

    7. Participant, in the opinion of the investigator, is unlikely to comply with the protocol or is unsuitable for any other reason.

    Contacts and Locations

    Locations

    Site City State Country Postal Code
    1 Tempe Arizona United States

    Sponsors and Collaborators

    • Takeda

    Investigators

    • Study Director: Medical Director Clinical Science, Takeda

    Study Documents (Full-Text)

    None provided.

    More Information

    Additional Information:

    Publications

    None provided.
    Responsible Party:
    Takeda
    ClinicalTrials.gov Identifier:
    NCT00942175
    Other Study ID Numbers:
    • TAK-390MR_101
    • U1111-1112-6792
    First Posted:
    Jul 20, 2009
    Last Update Posted:
    Feb 3, 2012
    Last Verified:
    Feb 1, 2012

    Study Results

    Participant Flow

    Recruitment Details Participants enrolled at one site in the United States from 15 December 2009 to 08 July 2010.
    Pre-assignment Detail Healthy participants were enrolled in one of 4, once-daily (QD), proton pump inhibitor (PPI) treatment groups.
    Arm/Group Title PPI Group 1 PPI Group 2 PPI Group 3 PPI Group 4
    Arm/Group Description Regimen A: Clopidogrel 75 mg, tablets, orally, once daily for up to 9 days. Regimen B: Clopidogrel 75 mg, tablets, orally, once daily and Lansoprazole 30 mg, capsules, orally, once daily for up to 9 days. Regimen A: Clopidogrel 75 mg, tablets, orally, once daily for up to 9 days. Regimen C: Clopidogrel 75 mg, tablets, orally, once daily and Dexlansoprazole 60 mg, capsules, orally, once daily for up to 9 days. Regimen A: Clopidogrel 75 mg, tablets, orally, once daily for up to 9 days. Regimen D: Clopidogrel 75 mg, tablets, orally, once daily and Omeprazole 80 mg, capsules, orally, once daily for up to 9 days. Regimen A: Clopidogrel 75 mg, tablets, orally, once daily for up to 9 days. Regimen E: Clopidogrel 75 mg, tablets, orally, once daily and Esomeprazole 40 mg, capsules, orally, once daily for up to 9 days.
    Period Title: Overall Study
    STARTED 40 40 40 40
    COMPLETED 38 36 38 38
    NOT COMPLETED 2 4 2 2

    Baseline Characteristics

    Arm/Group Title PPI Group 1 PPI Group 2 PPI Group 3 PPI Group 4 Total
    Arm/Group Description Regimen A: Clopidogrel 75 mg, tablets, orally, once daily for up to 9 days. Regimen B: Clopidogrel 75 mg, tablets, orally, once daily and Lansoprazole 30 mg, capsules, orally, once daily for up to 9 days. Regimen A: Clopidogrel 75 mg, tablets, orally, once daily for up to 9 days. Regimen C: Clopidogrel 75 mg, tablets, orally, once daily and Dexlansoprazole 60 mg, capsules, orally, once daily for up to 9 days. Regimen A: Clopidogrel 75 mg, tablets, orally, once daily for up to 9 days. Regimen D: Clopidogrel 75 mg, tablets, orally, once daily and Omeprazole 80 mg, capsules, orally, once daily for up to 9 days. Regimen A: Clopidogrel 75 mg, tablets, orally, once daily for up to 9 days. Regimen E: Clopidogrel 75 mg, tablets, orally, once daily and Esomeprazole 40 mg, capsules, orally, once daily for up to 9 days. Total of all reporting groups
    Overall Participants 40 40 40 40 160
    Age (years) [Mean (Standard Deviation) ]
    Mean (Standard Deviation) [years]
    32.8
    (6.48)
    35.7
    (7.92)
    34.0
    (7.40)
    33.3
    (7.10)
    33.9
    (7.26)
    Sex: Female, Male (Count of Participants)
    Female
    20
    50%
    20
    50%
    20
    50%
    20
    50%
    80
    50%
    Male
    20
    50%
    20
    50%
    20
    50%
    20
    50%
    80
    50%

    Outcome Measures

    1. Primary Outcome
    Title Pharmacokinetic Parameter Peak Plasma Concentration (Cmax) of Clopidogrel's Active Metabolite.
    Description Maximum observed plasma concentration (Cmax) is the peak plasma concentration of a drug after administration, obtained directly from the plasma concentration-time curve.
    Time Frame Day 9 of each period

    Outcome Measure Data

    Analysis Population Description
    All participants who had valid parameter estimates for both regimens within a PPI group were included in the pharmacokinetics (PK) statistical analyses for this parameter.
    Arm/Group Title PPI Group 1: Regimen A PPI Group 1: Regimen B PPI Group 2: Regimen A PPI Group 2: Regimen C PPI Group 3: Regimen A PPI Group 3: Regimen D PPI Group 4: Regimen A PPI Group 4: Regimen E
    Arm/Group Description Clopidogrel 75 mg, tablets, orally, once daily for up to 9 days. Clopidogrel 75 mg, tablets, orally, once daily and Lansoprazole 30 mg, capsules, orally, once daily for up to 9 days. Clopidogrel 75 mg, tablets, orally, once daily for up to 9 days. Clopidogrel 75 mg, tablets, orally, once daily and Dexlansoprazole 60 mg, capsules, orally, once daily for up to 9 days. Clopidogrel 75 mg, tablets, orally, once daily for up to 9 days. Clopidogrel 75 mg, tablets, orally, once daily and Omeprazole 80 mg, capsules, orally, once daily for up to 9 days. Clopidogrel 75 mg, tablets, orally, once daily for up to 9 days. Clopidogrel 75 mg, tablets, orally, once daily and Esomeprazole 40 mg, capsules, orally, once daily for up to 9 days.
    Measure Participants 38 38 36 36 38 38 38 38
    Mean (Standard Deviation) [ng/mL]
    39.14
    (12.553)
    30.01
    (15.264)
    38.85
    (15.699)
    29.33
    (12.400)
    38.25
    (12.461)
    22.55
    (10.682)
    40.98
    (22.908)
    24.69
    (10.641)
    Statistical Analysis 1
    Statistical Analysis Overview Comparison Group Selection PPI Group 1: Regimen A, PPI Group 1: Regimen B
    Comments
    Type of Statistical Test Superiority or Other
    Comments
    Statistical Test of Hypothesis p-Value
    Comments
    Method
    Comments
    Method of Estimation Estimation Parameter Mean Difference (Final Values)
    Estimated Value 0.7000
    Confidence Interval (2-Sided) 90%
    0.6106 to 0.8026
    Parameter Dispersion Type:
    Value:
    Estimation Comments The mean difference refers to the point estimates of the relative bioavailability. With its confidence intervals, it was obtained from the ANOVA model on the natural logarithm transformed data.
    Statistical Analysis 2
    Statistical Analysis Overview Comparison Group Selection PPI Group 2: Regimen A, PPI Group 2: Regimen C
    Comments
    Type of Statistical Test Superiority or Other
    Comments
    Statistical Test of Hypothesis p-Value
    Comments
    Method
    Comments
    Method of Estimation Estimation Parameter Mean Difference (Final Values)
    Estimated Value 0.7340
    Confidence Interval (2-Sided) 90%
    0.6516 to 0.8269
    Parameter Dispersion Type:
    Value:
    Estimation Comments The mean difference refers to the point estimates of the relative bioavailability. With its confidence intervals, it was obtained from the ANOVA model on the natural logarithm transformed data.
    Statistical Analysis 3
    Statistical Analysis Overview Comparison Group Selection PPI Group 3: Regimen A, PPI Group 3: Regimen D
    Comments
    Type of Statistical Test Superiority or Other
    Comments
    Statistical Test of Hypothesis p-Value
    Comments
    Method
    Comments
    Method of Estimation Estimation Parameter Mean Difference (Final Values)
    Estimated Value 0.5564
    Confidence Interval (2-Sided) 90%
    0.4877 to 0.6347
    Parameter Dispersion Type:
    Value:
    Estimation Comments The mean difference refers to the point estimates of the relative bioavailability. With its confidence intervals, it was obtained from the ANOVA model on the natural logarithm transformed data.
    Statistical Analysis 4
    Statistical Analysis Overview Comparison Group Selection PPI Group 4: Regimen A, PPI Group 4: Regimen E
    Comments
    Type of Statistical Test Superiority or Other
    Comments
    Statistical Test of Hypothesis p-Value
    Comments
    Method
    Comments
    Method of Estimation Estimation Parameter Mean Difference (Final Values)
    Estimated Value 0.6783
    Confidence Interval (2-Sided) 90%
    0.5063 to 0.9087
    Parameter Dispersion Type:
    Value:
    Estimation Comments The mean difference refers to the point estimates of the relative bioavailability. With its confidence intervals, it was obtained from the ANOVA model on the natural logarithm transformed data.
    2. Primary Outcome
    Title Pharmacokinetic Parameter Area Under the Plasma Concentration Versus Time Curve (AUC) From Time 0 to Time of the Last Quantifiable Concentration (AUC[0-tlqc]) of Clopidogrel's Active Metabolite.
    Description Area under the plasma concentration versus time curve (AUC(0-tlqc)) is a measure of total plasma exposure to the drug from Time 0 to Time of the Last Quantifiable Concentration (AUC[0-tlqc]).
    Time Frame Day 9 of each period

    Outcome Measure Data

    Analysis Population Description
    All participants who had valid parameter estimates for both formulations within PPI groups were included in the PK statistical analyses for those parameters.
    Arm/Group Title PPI Group 1: Regimen A PPI Group 1: Regimen B PPI Group 2: Regimen A PPI Group 2: Regimen C PPI Group 3: Regimen A PPI Group 3: Regimen D PPI Group 4: Regimen A PPI Group 4: Regimen E
    Arm/Group Description Clopidogrel 75 mg, tablets, orally, once daily for up to 9 days. Clopidogrel 75 mg, tablets, orally, once daily and Lansoprazole 30 mg, capsules, orally, once daily for up to 9 days. Clopidogrel 75 mg, tablets, orally, once daily for up to 9 days. Clopidogrel 75 mg, tablets, orally, once daily and Dexlansoprazole 60 mg, capsules, orally, once daily for up to 9 days. Clopidogrel 75 mg, tablets, orally, once daily for up to 9 days. Clopidogrel 75 mg, tablets, orally, once daily and Omeprazole 80 mg, capsules, orally, once daily for up to 9 days. Clopidogrel 75 mg, tablets, orally, once daily for up to 9 days. Clopidogrel 75 mg, tablets, orally, once daily and Esomeprazole 40 mg, capsules, orally, once daily for up to 9 days.
    Measure Participants 38 38 36 36 38 38 38 38
    Mean (Standard Deviation) [ng*hr/ML]
    41.69
    (10.020)
    36.42
    (10.825)
    41.25
    (14.690)
    37.75
    (13.132)
    37.78
    (12.043)
    26.28
    (8.800)
    42.35
    (18.785)
    31.23
    (9.938)
    Statistical Analysis 1
    Statistical Analysis Overview Comparison Group Selection PPI Group 1: Regimen A, PPI Group 1: Regimen B
    Comments
    Type of Statistical Test Superiority or Other
    Comments
    Statistical Test of Hypothesis p-Value
    Comments
    Method
    Comments
    Method of Estimation Estimation Parameter Mean Difference (Final Values)
    Estimated Value 0.8573
    Confidence Interval (2-Sided) 90%
    0.8020 to 0.9165
    Parameter Dispersion Type:
    Value:
    Estimation Comments The mean difference refers to the point estimates of the relative bioavailability. With its confidence intervals, it was obtained from the ANOVA model on the natural logarithm transformed data.
    Statistical Analysis 2
    Statistical Analysis Overview Comparison Group Selection PPI Group 2: Regimen A, PPI Group 2: Regimen C
    Comments
    Type of Statistical Test Superiority or Other
    Comments
    Statistical Test of Hypothesis p-Value
    Comments
    Method
    Comments
    Method of Estimation Estimation Parameter Mean Difference (Final Values)
    Estimated Value 0.9103
    Confidence Interval (2-Sided) 90%
    0.8567 to 0.9672
    Parameter Dispersion Type:
    Value:
    Estimation Comments The mean difference refers to the point estimates of the relative bioavailability. With its confidence intervals, it was obtained from the ANOVA model on the natural logarithm transformed data.
    Statistical Analysis 3
    Statistical Analysis Overview Comparison Group Selection PPI Group 3: Regimen A, PPI Group 3: Regimen D
    Comments
    Type of Statistical Test Superiority or Other
    Comments
    Statistical Test of Hypothesis p-Value
    Comments
    Method
    Comments
    Method of Estimation Estimation Parameter Mean Difference (Final Values)
    Estimated Value 0.6943
    Confidence Interval (2-Sided) 90%
    0.6438 to 0.7487
    Parameter Dispersion Type:
    Value:
    Estimation Comments The mean difference refers to the point estimates of the relative bioavailability. With its confidence intervals, it was obtained from the ANOVA model on the natural logarithm transformed data.
    Statistical Analysis 4
    Statistical Analysis Overview Comparison Group Selection PPI Group 4: Regimen A, PPI Group 4: Regimen E
    Comments
    Type of Statistical Test Superiority or Other
    Comments
    Statistical Test of Hypothesis p-Value
    Comments
    Method
    Comments
    Method of Estimation Estimation Parameter Mean Difference (Final Values)
    Estimated Value 0.8389
    Confidence Interval (2-Sided) 90%
    0.6440 to 1.0928
    Parameter Dispersion Type:
    Value:
    Estimation Comments The mean difference refers to the point estimates of the relative bioavailability. With its confidence intervals, it was obtained from the ANOVA model on the natural logarithm transformed data.
    3. Primary Outcome
    Title Pharmacodynamic Parameter Platelet Reactivity Index (PRI) From Vasodilator-stimulated Phosphoprotein (VASP) Phosphorylation State (Flow Cytometry).
    Description PRI is the platelet reactivity index from VASP phosphorylation state (flow cytometry).
    Time Frame 24-hour post Day 9 dose in each period.

    Outcome Measure Data

    Analysis Population Description
    All participants who had valid parameter estimates for both regimens within a PPI group were included in the pharmacodynamics (PD) statistical analyses for this parameter.
    Arm/Group Title PPI Group 1: Regimen A PPI Group 1: Regimen B PPI Group 2: Regimen A PPI Group 2: Regimen C PPI Group 3: Regimen A PPI Group 3: Regimen D PPI Group 4: Regimen A PPI Group 4: Regimen E
    Arm/Group Description Clopidogrel 75 mg, tablets, orally, once daily for up to 9 days. Clopidogrel 75 mg, tablets, orally, once daily and Lansoprazole 30 mg, capsules, orally, once daily for up to 9 days. Clopidogrel 75 mg, tablets, orally, once daily for up to 9 days. Clopidogrel 75 mg, tablets, orally, once daily and Dexlansoprazole 60 mg, capsules, orally, once daily for up to 9 days. Clopidogrel 75 mg, tablets, orally, once daily for up to 9 days. Clopidogrel 75 mg, tablets, orally, once daily and Omeprazole 80 mg, capsules, orally, once daily for up to 9 days. Clopidogrel 75 mg, tablets, orally, once daily for up to 9 days. Clopidogrel 75 mg, tablets, orally, once daily and Esomeprazole 40 mg, capsules, orally, once daily for up to 9 days.
    Measure Participants 38 38 36 36 38 38 38 38
    Mean (Standard Deviation) [percent inhibition]
    42.3
    (14.61)
    46.4
    (16.44)
    41.3
    (15.45)
    43.0
    (16.47)
    47.9
    (15.70)
    59.1
    (17.87)
    46.5
    (17.28)
    58.0
    (14.64)
    Statistical Analysis 1
    Statistical Analysis Overview Comparison Group Selection PPI Group 1: Regimen A, PPI Group 1: Regimen B
    Comments
    Type of Statistical Test Superiority or Other
    Comments
    Statistical Test of Hypothesis p-Value
    Comments
    Method
    Comments
    Method of Estimation Estimation Parameter Mean Difference (Final Values)
    Estimated Value 4.1016
    Confidence Interval (2-Sided) 90%
    0.0348 to 8.1684
    Parameter Dispersion Type:
    Value:
    Estimation Comments Included only participants with complete data for both regimens. Values are least squares mean difference.
    Statistical Analysis 2
    Statistical Analysis Overview Comparison Group Selection PPI Group 2: Regimen A, PPI Group 2: Regimen C
    Comments
    Type of Statistical Test Superiority or Other
    Comments
    Statistical Test of Hypothesis p-Value
    Comments
    Method
    Comments
    Method of Estimation Estimation Parameter Mean Difference (Final Values)
    Estimated Value 2.0474
    Confidence Interval (2-Sided) 90%
    -0.8555 to 4.9503
    Parameter Dispersion Type:
    Value:
    Estimation Comments Included only participants with complete data for both regimens. Values are least squares mean difference.
    Statistical Analysis 3
    Statistical Analysis Overview Comparison Group Selection PPI Group 3: Regimen A, PPI Group 3: Regimen D
    Comments
    Type of Statistical Test Superiority or Other
    Comments
    Statistical Test of Hypothesis p-Value
    Comments
    Method
    Comments
    Method of Estimation Estimation Parameter Mean Difference (Final Values)
    Estimated Value 11.0407
    Confidence Interval (2-Sided) 90%
    6.5219 to 15.5595
    Parameter Dispersion Type:
    Value:
    Estimation Comments Included only participants with complete data for both regimens. Values are least squares mean difference.
    Statistical Analysis 4
    Statistical Analysis Overview Comparison Group Selection PPI Group 4: Regimen A, PPI Group 4: Regimen E
    Comments
    Type of Statistical Test Superiority or Other
    Comments
    Statistical Test of Hypothesis p-Value
    Comments
    Method
    Comments
    Method of Estimation Estimation Parameter Mean Difference (Final Values)
    Estimated Value 11.4437
    Confidence Interval (2-Sided) 90%
    7.1791 to 15.7083
    Parameter Dispersion Type:
    Value:
    Estimation Comments Included only participants with complete data for both regimens. Values are least squares mean difference.
    4. Primary Outcome
    Title Pharmacodynamic Parameter Maximum Platelet Aggregation (MPA) From Aggregometry (Turbidimetric) With 5 µM Adenosine Diphosphate.
    Description Maximum platelet aggregation (MPA) from aggregometry (turbidimetric) with 5 µM adenosine diphosphate.
    Time Frame 24-hour post Day 9 dose in each period.

    Outcome Measure Data

    Analysis Population Description
    All participants who had valid parameter estimates for both formulations within PPI groups were included in the PD statistical analyses for those parameters.
    Arm/Group Title PPI Group 1: Regimen A PPI Group 1: Regimen B PPI Group 2: Regimen A PPI Group 2: Regimen C PPI Group 3: Regimen A PPI Group 3: Regimen D PPI Group 4: Regimen A PPI Group 4: Regimen E
    Arm/Group Description Clopidogrel 75 mg, tablets, orally, once daily for up to 9 days. Clopidogrel 75 mg, tablets, orally, once daily and Lansoprazole 30 mg, capsules, orally, once daily for up to 9 days. Clopidogrel 75 mg, tablets, orally, once daily for up to 9 days. Clopidogrel 75 mg, tablets, orally, once daily and Dexlansoprazole 60 mg, capsules, orally, once daily for up to 9 days. Clopidogrel 75 mg, tablets, orally, once daily for up to 9 days. Clopidogrel 75 mg, tablets, orally, once daily and Omeprazole 80 mg, capsules, orally, once daily for up to 9 days. Clopidogrel 75 mg, tablets, orally, once daily for up to 9 days. Clopidogrel 75 mg, tablets, orally, once daily and Esomeprazole 40 mg, capsules, orally, once daily for up to 9 days.
    Measure Participants 38 38 36 36 37 37 38 38
    Mean (Standard Deviation) [percentage of MPA]
    28.1
    (6.76)
    30.8
    (9.35)
    34.6
    (14.23)
    36.2
    (16.87)
    34.2
    (12.32)
    42.5
    (14.74)
    29.3
    (10.41)
    38.2
    (17.77)
    Statistical Analysis 1
    Statistical Analysis Overview Comparison Group Selection PPI Group 1: Regimen A, PPI Group 1: Regimen B
    Comments
    Type of Statistical Test Superiority or Other
    Comments
    Statistical Test of Hypothesis p-Value 0.035
    Comments From ANOVA models in which the least-square means between two regimens are compared.
    Method ANOVA
    Comments
    Statistical Analysis 2
    Statistical Analysis Overview Comparison Group Selection PPI Group 2: Regimen A, PPI Group 2: Regimen C
    Comments
    Type of Statistical Test Superiority or Other
    Comments
    Statistical Test of Hypothesis p-Value 0.445
    Comments From ANOVA models in which the least-square means between two regimens are compared.
    Method ANOVA
    Comments
    Statistical Analysis 3
    Statistical Analysis Overview Comparison Group Selection PPI Group 3: Regimen A, PPI Group 3: Regimen D
    Comments
    Type of Statistical Test Superiority or Other
    Comments
    Statistical Test of Hypothesis p-Value <0.001
    Comments From ANOVA models in which the least-square means between two regimens are compared.
    Method ANOVA
    Comments
    Statistical Analysis 4
    Statistical Analysis Overview Comparison Group Selection PPI Group 4: Regimen A, PPI Group 4: Regimen E
    Comments
    Type of Statistical Test Superiority or Other
    Comments
    Statistical Test of Hypothesis p-Value <0.001
    Comments From ANOVA models in which the least-square means between two regimens are compared.
    Method ANOVA
    Comments
    5. Primary Outcome
    Title Pharmacodynamic Parameter MPA From Aggregometry (Turbidimetric) With 20 µM Adenosine Diphosphate.
    Description MPA from aggregometry (turbidimetric) with 20 µM adenosine diphosphate.
    Time Frame 24-hour post Day 9 dose in each period.

    Outcome Measure Data

    Analysis Population Description
    All participants who had valid parameter estimates for both formulations within PPI groups were included in the PK and PD statistical analyses for those parameters.
    Arm/Group Title PPI Group 1: Regimen A PPI Group 1: Regimen B PPI Group 2: Regimen A PPI Group 2: Regimen C PPI Group 3: Regimen A PPI Group 3: Regimen D PPI Group 4: Regimen A PPI Group 4: Regimen E
    Arm/Group Description Clopidogrel 75 mg, tablets, orally, once daily for up to 9 days. Clopidogrel 75 mg, tablets, orally, once daily and Lansoprazole 30 mg, capsules, orally, once daily for up to 9 days. Clopidogrel 75 mg, tablets, orally, once daily for up to 9 days. Clopidogrel 75 mg, tablets, orally, once daily and Dexlansoprazole 60 mg, capsules, orally, once daily for up to 9 days. Clopidogrel 75 mg, tablets, orally, once daily for up to 9 days. Clopidogrel 75 mg, tablets, orally, once daily and Omeprazole 80 mg, capsules, orally, once daily for up to 9 days. Clopidogrel 75 mg, tablets, orally, once daily for up to 9 days. Clopidogrel 75 mg, tablets, orally, once daily and Esomeprazole 40 mg, capsules, orally, once daily for up to 9 days.
    Measure Participants 38 38 36 36 37 37 38 38
    Mean (Standard Deviation) [percentage of MPA]
    36.7
    (9.11)
    41.6
    (12.65)
    43.1
    (13.24)
    46.3
    (16.93)
    43.5
    (14.00)
    53.5
    (13.75)
    39.3
    (13.22)
    47.9
    (15.77)
    Statistical Analysis 1
    Statistical Analysis Overview Comparison Group Selection PPI Group 1: Regimen A, PPI Group 1: Regimen B
    Comments
    Type of Statistical Test Superiority or Other
    Comments
    Statistical Test of Hypothesis p-Value 0.004
    Comments From ANOVA models in which the least-square means between two regimens are compared.
    Method ANOVA
    Comments
    Statistical Analysis 2
    Statistical Analysis Overview Comparison Group Selection PPI Group 2: Regimen A, PPI Group 2: Regimen C
    Comments
    Type of Statistical Test Superiority or Other
    Comments
    Statistical Test of Hypothesis p-Value 0.148
    Comments From ANOVA models in which the least-square means between two regimens are compared.
    Method ANOVA
    Comments
    Statistical Analysis 3
    Statistical Analysis Overview Comparison Group Selection PPI Group 3: Regimen A, PPI Group 3: Regimen D
    Comments
    Type of Statistical Test Superiority or Other
    Comments
    Statistical Test of Hypothesis p-Value <0.001
    Comments From ANOVA models in which the least-square means between two regimens are compared.
    Method ANOVA
    Comments
    Statistical Analysis 4
    Statistical Analysis Overview Comparison Group Selection PPI Group 4: Regimen A, PPI Group 4: Regimen E
    Comments
    Type of Statistical Test Superiority or Other
    Comments
    Statistical Test of Hypothesis p-Value <.0001
    Comments From ANOVA models in which the least-square means between two regimens are compared.
    Method ANOVA
    Comments

    Adverse Events

    Time Frame Treatment-emergent adverse events are adverse events that started or worsened after the first dose of study drug and within 30 days after the last dose of study drug.
    Adverse Event Reporting Description At each visit the investigator had to document any occurrence of adverse events and abnormal laboratory findings. Any event spontaneously reported by the participant or observed by the investigator was recorded, irrespective of the relation to study drug.
    Arm/Group Title PPI Group 1: Regimen A PPI Group 1: Regimen B PPI Group 2: Regimen A PPI Group 2: Regimen C PPI Group 3: Regimen A PPI Group 3: Regimen D PPI Group 4: Regimen A PPI Group 4: Regimen E
    Arm/Group Description Clopidogrel 75 mg, tablets, orally, once daily for up to 9 days. Clopidogrel 75 mg, tablets, orally, once daily and Lansoprazole 30 mg, capsules, orally, once daily for up to 9 days. Clopidogrel 75 mg, tablets, orally, once daily for up to 9 days. Clopidogrel 75 mg, tablets, orally, once daily and Dexlansoprazole 60 mg, capsules, orally, once daily for up to 9 days. Clopidogrel 75 mg, tablets, orally, once daily for up to 9 days. Clopidogrel 75 mg, tablets, orally, once daily and Omeprazole 80 mg, capsules, orally, once daily for up to 9 days. Clopidogrel 75 mg, tablets, orally, once daily for up to 9 days. Clopidogrel 75 mg, tablets, orally, once daily and Esomeprazole 40 mg, capsules, orally, once daily for up to 9 days.
    All Cause Mortality
    PPI Group 1: Regimen A PPI Group 1: Regimen B PPI Group 2: Regimen A PPI Group 2: Regimen C PPI Group 3: Regimen A PPI Group 3: Regimen D PPI Group 4: Regimen A PPI Group 4: Regimen E
    Affected / at Risk (%) # Events Affected / at Risk (%) # Events Affected / at Risk (%) # Events Affected / at Risk (%) # Events Affected / at Risk (%) # Events Affected / at Risk (%) # Events Affected / at Risk (%) # Events Affected / at Risk (%) # Events
    Total / (NaN) / (NaN) / (NaN) / (NaN) / (NaN) / (NaN) / (NaN) / (NaN)
    Serious Adverse Events
    PPI Group 1: Regimen A PPI Group 1: Regimen B PPI Group 2: Regimen A PPI Group 2: Regimen C PPI Group 3: Regimen A PPI Group 3: Regimen D PPI Group 4: Regimen A PPI Group 4: Regimen E
    Affected / at Risk (%) # Events Affected / at Risk (%) # Events Affected / at Risk (%) # Events Affected / at Risk (%) # Events Affected / at Risk (%) # Events Affected / at Risk (%) # Events Affected / at Risk (%) # Events Affected / at Risk (%) # Events
    Total 0/40 (0%) 0/40 (0%) 0/40 (0%) 1/40 (2.5%) 0/40 (0%) 0/40 (0%) 0/40 (0%) 0/40 (0%)
    Investigations
    Serum sickness-like reaction 0/40 (0%) 0/40 (0%) 0/40 (0%) 1/40 (2.5%) 0/40 (0%) 0/40 (0%) 0/40 (0%) 0/40 (0%)
    Other (Not Including Serious) Adverse Events
    PPI Group 1: Regimen A PPI Group 1: Regimen B PPI Group 2: Regimen A PPI Group 2: Regimen C PPI Group 3: Regimen A PPI Group 3: Regimen D PPI Group 4: Regimen A PPI Group 4: Regimen E
    Affected / at Risk (%) # Events Affected / at Risk (%) # Events Affected / at Risk (%) # Events Affected / at Risk (%) # Events Affected / at Risk (%) # Events Affected / at Risk (%) # Events Affected / at Risk (%) # Events Affected / at Risk (%) # Events
    Total 13/39 (33.3%) 16/39 (41%) 19/39 (48.7%) 16/38 (42.1%) 14/40 (35%) 11/38 (28.9%) 17/39 (43.6%) 15/39 (38.5%)
    Eye disorders
    Ocular hyperaemia 0/39 (0%) 0/39 (0%) 0/39 (0%) 2/38 (5.3%) 0/40 (0%) 0/38 (0%) 1/39 (2.6%) 0/39 (0%)
    Lacrimation increased 0/39 (0%) 0/39 (0%) 0/39 (0%) 0/38 (0%) 2/40 (5%) 0/38 (0%) 0/39 (0%) 0/39 (0%)
    Gastrointestinal disorders
    Abdominal pain upper 0/39 (0%) 2/39 (5.1%) 1/39 (2.6%) 1/38 (2.6%) 0/40 (0%) 0/38 (0%) 0/39 (0%) 2/39 (5.1%)
    Nausea 3/39 (7.7%) 3/39 (7.7%) 5/39 (12.8%) 1/38 (2.6%) 1/40 (2.5%) 0/38 (0%) 0/39 (0%) 1/39 (2.6%)
    Abdominal pain lower 0/39 (0%) 0/39 (0%) 1/39 (2.6%) 2/38 (5.3%) 1/40 (2.5%) 1/38 (2.6%) 3/39 (7.7%) 0/39 (0%)
    Constipation 1/39 (2.6%) 0/39 (0%) 2/39 (5.1%) 1/38 (2.6%) 1/40 (2.5%) 1/38 (2.6%) 1/39 (2.6%) 2/39 (5.1%)
    Toothache 0/39 (0%) 1/39 (2.6%) 1/39 (2.6%) 2/38 (5.3%) 0/40 (0%) 0/38 (0%) 0/39 (0%) 0/39 (0%)
    Abdominal pain 0/39 (0%) 1/39 (2.6%) 0/39 (0%) 2/38 (5.3%) 2/40 (5%) 1/38 (2.6%) 3/39 (7.7%) 1/39 (2.6%)
    Abdominal distension 0/39 (0%) 1/39 (2.6%) 1/39 (2.6%) 1/38 (2.6%) 0/40 (0%) 0/38 (0%) 0/39 (0%) 2/39 (5.1%)
    General disorders
    Feeling Hot 2/39 (5.1%) 1/39 (2.6%) 0/39 (0%) 0/38 (0%) 0/40 (0%) 0/38 (0%) 0/39 (0%) 0/39 (0%)
    Vessel puncture site pain 0/39 (0%) 0/39 (0%) 0/39 (0%) 0/38 (0%) 0/40 (0%) 2/38 (5.3%) 0/39 (0%) 0/39 (0%)
    Infections and infestations
    Upper respiratory tract infection 0/39 (0%) 2/39 (5.1%) 1/39 (2.6%) 0/38 (0%) 1/40 (2.5%) 0/38 (0%) 0/39 (0%) 1/39 (2.6%)
    Musculoskeletal and connective tissue disorders
    Back pain 3/39 (7.7%) 1/39 (2.6%) 0/39 (0%) 1/38 (2.6%) 2/40 (5%) 1/38 (2.6%) 2/39 (5.1%) 0/39 (0%)
    Arthralgia 0/39 (0%) 0/39 (0%) 2/39 (5.1%) 0/38 (0%) 0/40 (0%) 1/38 (2.6%) 0/39 (0%) 1/39 (2.6%)
    Myalgia 1/39 (2.6%) 0/39 (0%) 1/39 (2.6%) 0/38 (0%) 0/40 (0%) 0/38 (0%) 1/39 (2.6%) 2/39 (5.1%)
    Pain in extremity 1/39 (2.6%) 0/39 (0%) 0/39 (0%) 1/38 (2.6%) 1/40 (2.5%) 0/38 (0%) 0/39 (0%) 4/39 (10.3%)
    Nervous system disorders
    Headache 3/39 (7.7%) 4/39 (10.3%) 5/39 (12.8%) 7/38 (18.4%) 2/40 (5%) 6/38 (15.8%) 6/39 (15.4%) 4/39 (10.3%)
    Dizziness 1/39 (2.6%) 1/39 (2.6%) 0/39 (0%) 3/38 (7.9%) 1/40 (2.5%) 0/38 (0%) 2/39 (5.1%) 2/39 (5.1%)
    Somnolence 1/39 (2.6%) 1/39 (2.6%) 2/39 (5.1%) 1/38 (2.6%) 1/40 (2.5%) 2/38 (5.3%) 0/39 (0%) 0/39 (0%)
    Psychiatric disorders
    Anxiety 1/39 (2.6%) 0/39 (0%) 1/39 (2.6%) 1/38 (2.6%) 0/40 (0%) 0/38 (0%) 0/39 (0%) 2/39 (5.1%)
    Reproductive system and breast disorders
    Menorrhagia 0/39 (0%) 0/39 (0%) 0/39 (0%) 1/38 (2.6%) 1/40 (2.5%) 0/38 (0%) 2/39 (5.1%) 0/39 (0%)
    Respiratory, thoracic and mediastinal disorders
    Epistaxis 1/39 (2.6%) 0/39 (0%) 2/39 (5.1%) 1/38 (2.6%) 2/40 (5%) 0/38 (0%) 3/39 (7.7%) 2/39 (5.1%)
    Oropharyngeal pain 1/39 (2.6%) 1/39 (2.6%) 0/39 (0%) 2/38 (5.3%) 0/40 (0%) 0/38 (0%) 1/39 (2.6%) 0/39 (0%)
    Skin and subcutaneous tissue disorders
    Ecchymosis 3/39 (7.7%) 1/39 (2.6%) 3/39 (7.7%) 3/38 (7.9%) 4/40 (10%) 2/38 (5.3%) 2/39 (5.1%) 0/39 (0%)
    Pruritus generalized 2/39 (5.1%) 1/39 (2.6%) 0/39 (0%) 1/38 (2.6%) 1/40 (2.5%) 1/38 (2.6%) 2/39 (5.1%) 1/39 (2.6%)
    Acne 0/39 (0%) 1/39 (2.6%) 1/39 (2.6%) 2/38 (5.3%) 0/40 (0%) 0/38 (0%) 1/39 (2.6%) 1/39 (2.6%)
    Pruritus 1/39 (2.6%) 0/39 (0%) 4/39 (10.3%) 0/38 (0%) 1/40 (2.5%) 0/38 (0%) 1/39 (2.6%) 0/39 (0%)
    Rash papular 1/39 (2.6%) 1/39 (2.6%) 2/39 (5.1%) 0/38 (0%) 0/40 (0%) 0/38 (0%) 0/39 (0%) 0/39 (0%)

    Limitations/Caveats

    [Not Specified]

    More Information

    Certain Agreements

    Principal Investigators are NOT employed by the organization sponsoring the study.

    Research Organization shall not publish any articles or papers nor make any presentations, nor assist any other person in publishing any articles or papers or in making any presentations relating or referring to the Study or any results, data or insights therefrom or any data, information or materials obtained or generated in the performance of it's obligations without the prior written consent of Takeda, which consent may be granted or withheld in Takeda's sole discretion.

    Results Point of Contact

    Name/Title Sr. VP, Clinical Science
    Organization Takeda Global Research and Development Center, Inc.
    Phone 800-778-2860
    Email clinicaltrialregistry@tpna.com
    Responsible Party:
    Takeda
    ClinicalTrials.gov Identifier:
    NCT00942175
    Other Study ID Numbers:
    • TAK-390MR_101
    • U1111-1112-6792
    First Posted:
    Jul 20, 2009
    Last Update Posted:
    Feb 3, 2012
    Last Verified:
    Feb 1, 2012