Ignite Creation Date:
2024-05-05 @ 4:53 PM
Last Modification Date:
2024-10-26 @ 9:25 AM
Study NCT ID:
NCT00331890
Status:
TERMINATED
Last Update Posted:
2012-06-20
First Post:
2006-05-30
Brief Title:
ICTUS Study International Citicoline Trial on Acute Stroke
Sponsor:
Ferrer Internacional SA
Organization:
Ferrer Internacional SA
Study Overview
Official Title:
Citicoline in the Treatment of Acute Ischemic Stroke An International Randomized Multicenter Placebo-controlled Study
Status:
TERMINATED
Status Verified Date:
2012-06
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
With 2078 patients a statistical stopping boundary has now been crossed
Has Expanded Access:
False
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
ICTUS
Brief Summary:
Citicoline is a safe drug approved in some countries for the treatment of acute ischemic stroke The drug has shown some evidence of efficacy in a pooled analysis based on four clinical trials done in USA with oral citicolineThe purpose of the study is confirm the results obtained in the pooled analysis that is evidence of efficacy in the treatment of acute ischemic stroke
Detailed Description:
The stroke or brain attack is one of the main health problems in developed countries It is the third cause for death and the main cause of disability in adults Cerebral infarction makes up 80 of all the types of strokes
After a stroke different evolutions and outcomes can be observed and there are several factors that may influence the outcome such as age cognitive impairment and psycho-social factors The most important prognostic factors for acute ischemic stroke are the volume of the cerebral infarction and the severity of the baseline neurological deficit
In recent years stroke has been considered a real medical emergency and for this reason several clinical trials have been conducted to find effective therapies Among pharmacological therapies there are two possible ways to treat ischemic strokes treatments directed to recanalize the occluded artery such as thrombolysis and the neuroprotective drugs
None of the neuroprotective drugs have attained the international approval for this indication Among the reasons for the failures obtained with the different drugs tested we must highlight the problems derived from the toxicity of the drugs and from the evaluation criteria as well as the therapeutic window used
To evaluate a drug in the treatment of acute ischemic stroke one must be very careful when defining the schedule of the clinical trial and which variable or variables may be considered as primary endpoints Several endpoints have been used in the different clinical trials developed although the most used are those referring to the functional status and the degree of disability of the patients normally set at 3 months after the stroke
After the onset of an ischemic stroke in the brain there is a cascade of events that are responsible for neuronal disruption neuronal membrane breakdown andor neuronal apoptosis specifically in the penumbra area Therapies acting by blocking the ischemic cascade at least partially andor stabilizing neuronal membranes are believed to be beneficial protecting the brain from the progressive effects of ischemia Among the neuroprotective drugs there is a new class of drugs of which the main representative is citicoline Citicoline monosodium is an exogenous form of CDP-Choline which is essential for the biosynthesis of membrane phospholipids The mechanisms of action of citicoline include the stimulation of the biosynthesis of phospholipids of the neuronal membrane the inhibition of the activity of some phospholipases the restoration of some enzymatic activities bound to neuronal membranes and the elevation of brain levels of some catecholamines
The previous clinical trials performed with citicoline were no conclusive with some positive results In all these studies citicoline was found to have a similar safety profile as compared with placebo
The variety of outcomes and results of the different trials made it difficult to arrive at a consensus on the efficacy of the drug That is the reason why a Pooling Data Analysis using updated individual patient data was done with the main objective to determine the effects of citicoline on the improvement functional and neurological of patients with acute ischemic stroke treated with different doses of citicoline for 6 weeks and with a follow-up period of 6 weeks The results obtained in this Pooling Data Analysis showed that the odds ratio of achieving a complete recovery was 33 higher in citicoline-treated patients than in placebo-treated patients with the best response obtained with the dose of 2000 mgd6 weeks
The primary objective of this study is to determine the effects on recovery at 3 months of oral citicoline 2000 mgd6 weeks after 6 weeks of treatment and 6 weeks of follow-up in patients with moderate-to-severe acute ischemic strokes baseline NIHSS equal or higher than 8 in comparison with placebo
After a stroke different evolutions and outcomes can be observed and there are several factors that may influence the outcome such as age cognitive impairment and psycho-social factors The most important prognostic factors for acute ischemic stroke are the volume of the cerebral infarction and the severity of the baseline neurological deficit
In recent years stroke has been considered a real medical emergency and for this reason several clinical trials have been conducted to find effective therapies Among pharmacological therapies there are two possible ways to treat ischemic strokes treatments directed to recanalize the occluded artery such as thrombolysis and the neuroprotective drugs
None of the neuroprotective drugs have attained the international approval for this indication Among the reasons for the failures obtained with the different drugs tested we must highlight the problems derived from the toxicity of the drugs and from the evaluation criteria as well as the therapeutic window used
To evaluate a drug in the treatment of acute ischemic stroke one must be very careful when defining the schedule of the clinical trial and which variable or variables may be considered as primary endpoints Several endpoints have been used in the different clinical trials developed although the most used are those referring to the functional status and the degree of disability of the patients normally set at 3 months after the stroke
After the onset of an ischemic stroke in the brain there is a cascade of events that are responsible for neuronal disruption neuronal membrane breakdown andor neuronal apoptosis specifically in the penumbra area Therapies acting by blocking the ischemic cascade at least partially andor stabilizing neuronal membranes are believed to be beneficial protecting the brain from the progressive effects of ischemia Among the neuroprotective drugs there is a new class of drugs of which the main representative is citicoline Citicoline monosodium is an exogenous form of CDP-Choline which is essential for the biosynthesis of membrane phospholipids The mechanisms of action of citicoline include the stimulation of the biosynthesis of phospholipids of the neuronal membrane the inhibition of the activity of some phospholipases the restoration of some enzymatic activities bound to neuronal membranes and the elevation of brain levels of some catecholamines
The previous clinical trials performed with citicoline were no conclusive with some positive results In all these studies citicoline was found to have a similar safety profile as compared with placebo
The variety of outcomes and results of the different trials made it difficult to arrive at a consensus on the efficacy of the drug That is the reason why a Pooling Data Analysis using updated individual patient data was done with the main objective to determine the effects of citicoline on the improvement functional and neurological of patients with acute ischemic stroke treated with different doses of citicoline for 6 weeks and with a follow-up period of 6 weeks The results obtained in this Pooling Data Analysis showed that the odds ratio of achieving a complete recovery was 33 higher in citicoline-treated patients than in placebo-treated patients with the best response obtained with the dose of 2000 mgd6 weeks
The primary objective of this study is to determine the effects on recovery at 3 months of oral citicoline 2000 mgd6 weeks after 6 weeks of treatment and 6 weeks of follow-up in patients with moderate-to-severe acute ischemic strokes baseline NIHSS equal or higher than 8 in comparison with placebo
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
None
Is a FDA Regulated Device?:
None
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None