Acute Ischemic Stroke
Conditions
Brief summary
This study is designed to evaluate the safety, efficacy, and pharmacokinetics of balovaptan compared with placebo in participants with acute ischemic stroke (AIS) at risk of developing Malignant Cerebral Edema (MCE)
Interventions
DRUGBalovaptan
Intravenous Solution
DRUGPlacebo
Matching Intravenous Solution
Sponsors
Hoffmann-La Roche
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* Diagnosis of LVO in the anterior circulation such that study drug administration can be initiated within 12 hours of LKW and at risk of MCE development, as defined as follows: * Documented occlusion of terminus ICA and/or MCA on CTA or magnetic resonance angiogram and * ASPECTS score \</=5 on NCCT and * NIHSS \>15 for the non-dominant hemisphere and \>20 for the dominant hemisphere (or \> 20 if dominant/non-dominant hemisphere unknown) * Present with a WUS \</=8 hours from awakening provided the above criteria are met * Participants with a history of seizures on anti-epileptic medications may be included if they have been on stable doses of those medications for at least 12 weeks prior to LKW, they have not experienced seizures during that time frame, and their anti-epileptic medicines are continued during the study * For women of childbearing potential: participants who agree to remain abstinent (refrain from heterosexual intercourse) or use contraception and agree to refrain from donating eggs * No specific contraception methods for males are required.
Exclusion criteria
* Participants who are \>12 hours from LKW at the start of treatment with study drug or \>8 hours from awakening with WUS * Any MLS on brain imaging * Evidence of intracranial hemorrhage at screening based on NCCT * Contraindication to MRI examination * Evidence of additional anterior cerebral artery (ACA) infarction * Diagnosis of brain death * Planned surgical decompression prior to randomization * Participants with a known history of a hereditary bleeding disorder which increases bleeding risk * Chronic kidney disease stage III or higher * Hepatic injury * Diagnosis of diabetes insipidus * Participants who have received any prophylactic hyperosmolar therapy * Participants who have received treatment with any other V1a and/or V2 receptor-blocking agent or glyburide * A preexisting medical condition for which the participant is unlikely to survive the next 6 months * Planned limitation or withdrawal of life-sustaining treatment during hospital admission * Participants who are pregnant or breastfeeding, or intending to become pregnant
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Amount of midline shift (MLS) at 72 hours from Last Known Well (LKW) | 72 Hours from Last Known Well | Midline shift will be measured in millimeter on non-contrast computer tomography (NCCT) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Amount of MLS | At 48 hours and 96-120 hours from LKW | MLS will be measured in millimeter on NCCT |
| Percentage of Participants with Surgical DHC Performed | From Baseline up to Day 90 | — |
| Percentage of Participants Who Received Hyperosmolar therapy following initiation of study treatment | From Baseline up to Day 90 | — |
| National Institute of Health Stroke Scale (NIHSS) score | At Day 4 and Day 90 | — |
| Mortality | At Day 30 | Mortality in the first 30 days after the enrollment |
| mRS-SI score | At Day 30 | — |
| Functional Independence Measure (FIM) score | At Discharge or Day 10 and Day 90 | — |
| Glasgow Outcome Scale Extended (GOSE) Score | at Discharge or Day 10, Day 30 and Day 90 | — |
| Percentage of Participants with modified Rankin Scale-Structured Interview (mRS-SI) score </= 4 vs. >4 | At Day 90 | — |
| Length (in days) of ICU and Hospital Stay | From Baseline to Day 90 | — |
| Number of participants with adverse events and severity of adverse events | From Baseline to Day 90 | Severity will be determined according to the NCI CTCAE v5.0 |
| Plasma concentrations of balovaptan at specified timepoints | From Baseline to 120 Hours After the End of the Last Infusion (or at discharge) | — |
| Area under the concentration-time curve from Time 0 to 24 hours after a given dose (AUC24hr) | From Baseline to 120 Hours After the End of the Last Infusion (or at discharge)] | As calculated by NCA from measured concentration |
| Maximum observed concentration (Cmax) | From Baseline to 120 Hours After the End of the Last Infusion (or at discharge)] | As calculated by NCA or taken directly from measured concentration |
| Plasma drug concentration 24hours after the administration of a given dose (C24hr) | From Baseline to 120 Hours After the End of the Last Infusion (or at discharge)] | As calculated by NCA or taken directly from measured concentration |
| Number of participants with safety findings on brain imaging | From Baseline to Day 90 | — |
| Stroke Impact Scale-16 (SIS-16) score | At Day 30 and Day 90 | — |
Countries
United States
Outcome results
None listed