Multicenter, Open Label, Randomized Comparative Trial of the Efficacy and Safety of a Single Bolus Recombinant Non-immunogenic Staphylokinase and Bolus-infusion of Alteplase in Patients With Massive Pulmonary Embolism (FORPE)

  • STATUS
    Recruiting
  • End date
    Dec 1, 2023
  • participants needed
    310
  • sponsor
    Supergene, LLC
Updated on 22 September 2022

Summary

Objective: to evaluate the efficacy and safety of the Recombinant Non-immunogenic Staphylokinase with its single bolus administration in comparison with the bolus-infusion administration of the Alteplase in patients with massive pulmonary embolism

Description

The main goal of treating massive PE is to save the lives of patients by restoring pulmonary perfusion, preventing the development of chronic postembolic pulmonary hypertension and recurrent PE. According to data of clinical trials, with timely initiation of therapy for massive pulmonary embolism, mortality can be significantly reduced.

Recombinant protein which contains aminoacid sequence of staphylokinase - Fortelizin® (the active substance is Forteplase). It is single chain molecula, consists of 138 aminoacids, weight 15.5 kDa. When staphylokinase is added to human plasma containing a fibrin clot, it preferentially reacts with plasmin at the clot surface, forming a plasmin-staphylokinase complex. This complex activates plasminogen trapped in the thrombus. The plasmin-staphylokinase complex and plasmin bound to fibrin are protected from inhibition by alpha2-antiplasmin. Once liberated from the clot (or generated in plasma), however, they are rapidly inhibited by alpha2-antiplasmin. This selectivity of action confines the process of plasminogen activation to the thrombus, preventing excessive plasmin generation, alpha2-antiplasmin depletion, and fibrinogen degradation in plasma. In rabbits anti forteplase antibodies are not produced. It was achieved by replacement of amino acids in immunogenic epitop of molecule staphylokinase. Blood fibrinogen decrease after i.v. injection of Fortelyzin less 10% within first 24 hours. Angiographic data suggests that restoration of coronary blood flow appears in up to 80% of patients with STEMI after i.v. injection of Fortelyzin.

The main objectives of the study: to assess the efficacy, safety and possible adverse events of the drug Recombinant Non-immunogenic Staphylokinase with its single bolus administration in comparison with the bolus-infusion administration of the drug Alteplase® in patients with massive pulmonary embolism.

Study Design. Multicenter, open-label, randomized, comparative clinical study of non-inferiority study of efficacy and safety in parallel groups. At clinical centers, patients will be equally randomly distributed by the "envelope" method into two groups of 155 patients each (310 people in total, including 10% of those who may have dropped out)to receive Recombinant Non-immunogenic Staphylokinase or Alteplase®.

The drugs will be administered after the signed informed consent. Recombinant Non-immunogenic Staphylokinase will be administered intravenously at a dose of 15 mg as a single bolus for 10-15 seconds. Alteplase® will be administered in accordance with the instructions for use.

Patients will be monitored for 30 days from the moment of randomization: in the intensive care unit up to 7 days, after it in the hospital until discharge - an average of 14 days and an outpatient visits on the 30th day. The recruitment of patients for the study will be competitive.

Details
Condition Massive Pulmonary Embolism
Treatment Alteplase, Recombinant nonimmunogenic staphylokinase
Clinical Study IdentifierNCT04688320
SponsorSupergene, LLC
Last Modified on22 September 2022

Eligibility

Yes No Not Sure

Inclusion Criteria

Men and women aged 18 and over
Verified diagnosis of massive PE (using MSCT with PA contrast)
Signs of overload / dysfunction of the right ventricle (at least one) in combination with persistent arterial hypotension or shock
Patient consent to use reliable contraceptive methods throughout the study and for 3 weeks after
women who have a negative pregnancy test and use the following contraceptives: intrauterine devices, oral contraceptives, contraceptive patch, prolonged injectable contraceptives, double barrier method of contraception. Women who are not fertile can also take part in the study (documented conditions: hysterectomy, tubal ligation, infertility, menopause for more than 1 year)
men using barrier contraception. The study may also involve men who are not fertile (documented conditions: vasectomy, infertility)
Availability of signed and dated informed consent of the patient to participate in the
study

Exclusion Criteria

• Increased risk of bleeding
Extensive bleeding at present or within the previous 6 months, hemorrhagic diathesis
Intracranial (including subarachnoid) hemorrhage at present or in history, suspected hemorrhagic stroke
A history of hemorrhagic stroke or stroke of unknown etiology
Ischemic stroke or transient ischemic attack within the last 6 months, except for the current acute ischemic stroke within 4.5 hours
A history of diseases of the central nervous system (including neoplasms, aneurysms, surgery on the brain or spinal cord)
Major surgery or major trauma within the previous 3 months, recent traumatic brain injury
Long-term or traumatic cardiopulmonary resuscitation (> 2 min), delivery within the previous 10 days, recent puncture of an uncompressible blood vessel (eg, subclavian or jugular vein)
Severe liver disease, including liver failure, cirrhosis, portal hypertension (including esophageal varices) and active hepatitis
Confirmed gastric or duodenal ulcer within the last three months
Neoplasm with an increased risk of bleeding
Concurrent administration of oral anticoagulants, for example, warfarin with an INR> 1.3
Arterial aneurysms, developmental defects of arteries / veins
Severe uncontrolled arterial hypertension
Acute pancreatitis
Bacterial endocarditis, pericarditis
suspicion of aortic dissecting aneurysm
any other conditions, in the opinion of the doctor, associated with a high risk of bleeding
Lactation, pregnancy
Known hypersensitivity to Alteplase, Fortelizin
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