A Phase 1 interventional study of prasugrel and clopidogrel in Coronary Artery Disease, sponsored by Eli Lilly and Company. Completed at 6 sites in 4 countries. Open to participants aged 18 Years to 74 Years. Per ClinicalTrials.gov, last updated 2012-08-30.
Sponsored by Eli Lilly and Company · Phase 1, Interventional, and Treatment
The 5-milligram (mg) dose of prasugrel in low body weight (LBW) patients with coronary artery disease produces a pharmacodynamic response within the same therapeutic range as 10-mg dose in higher body weight (HBW) patients.
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Drug: prasugrel
Drug: prasugrel
Drug: clopidogrel
Administered orally, daily for 12 days
Also known as: Efient, Effient, LY640315, CS747
Administered orally, daily for 12 days
Change From Baseline in Maximum Platelet Aggregation (MPA) to 20 Micromolar (µM) Adenosine Diphosphate (ADP) at Day 12 (Period 1)
MPA to 20 micromolar (μM) ADP was assessed by light transmission aggregometry (LTA), an assay that measures platelet aggregation by determining the amount of light transmitted through a cuvette containing platelet-rich plasma stimulated with a platelet activator, such as ADP, relative to platelet-poor plasma (100% light transmittance). A lower MPA reflects stronger platelet inhibition, whereas a higher MPA reflects weaker inhibition.
Time frame: Baseline, Day 12
Change From Baseline in Vasodilator-Associated Stimulated Phosphoprotein (VASP) at Day 12 of Therapy
VASP phosphorylation levels, expressed as the platelet reactivity index (PRI), reflect the degree of thienopyridine-mediated P2Y12 receptor inhibition and were used to compare prasugrel versus clopidogrel, in low body weight (LBW) participants compared to higher body weight (HBW) participants. PRI was calculated by VASP. The PRI indicates the level of P2Y12 receptor inhibition. A lower PRI reflects stronger inhibition of P2Y12 receptor thus stronger platelet inhibition, whereas a higher PRI reflects weaker inhibition of P2Y12 receptor and weaker platelet inhibition.
Time frame: Baseline, Day 12
Change From Baseline in VerifyNow® P2Y12 Reaction Units (PRU) at Day 12 of Therapy
The Accumetrics VerifyNow® P2Y12 assay measures platelet aggregation in whole blood and is reported in PRU. PRU indicates the extent of P2Y12 receptor-mediated platelet aggregation calculated as a function of rate and extent of platelet aggregation in an adenosine phosphate (ADP)-containing channel of the device. A lower PRU reflects stronger inhibition of platelet aggregation, whereas a higher PRU reflects weaker inhibition of platelet aggregation.
Time frame: Baseline, Day 12
Pharmacokinetic (PK) Analysis of the Concentration-Time Curve (AUC)
A pharmacokinetic-pharmacodynamic (PK-PD) analysis comparing MPA (LTA) and AUC was conducted as originally intended, however the graphic output is not possible here. Therefore, the PK portion is presented here as AUC and the PD portion is presented in Secondary Outcome Measure #5. AUC was calculated through the last scheduled sampling time of 4 hours \[AUC (0-4)\] or through the sampling time of the last quantifiable concentration prior to 4 hours. AUC values were denoted AUC(0-tlast) in both instances.
Time frame: baseline (pre-dose) up to 4 hours post-dose
Change From Baseline in Maximum Platelet Aggregation (MPA) as Measured by Light Transmission Aggregometry (LTA) at Day 12 of Therapy
MPA to 20 micromolar (μM) adenosine diphosphate (ADP) was assessed by LTA, an assay that measures platelet aggregation by determining the amount of light transmitted through a cuvette containing platelet-rich plasma stimulated with a platelet activator, such as ADP, relative to platelet-poor plasma (100% light transmittance). A lower MPA reflects stronger platelet inhibition, whereas a higher MPA reflects weaker inhibition.
Time frame: Baseline , Day 12
| Milestone | 5 mg Prasugrel (LBW) | 10 mg Prasugrel (LBW) | 75 mg Clopidogrel (LBW) | 5 mg Prasugrel (HBW) | 10 mg Prasugrel (HBW) | 75 mg Clopidogrel (HBW) |
|---|---|---|---|---|---|---|
| Started | 34 | 0 | 0 | 0 | 38 | 0 |
| Took at least 1 dose of study drug | 34 | 0 | 0 | 0 | 38 | 0 |
| Completed | 33 | 0 | 0 | 0 | 37 | 0 |
| Not completed | 1 | 0 | 0 | 0 | 1 | 0 |
| Withdrew: Withdrawal by subject | 1 | 0 | 0 | 0 | 1 | 0 |
| Milestone | 5 mg Prasugrel (LBW) | 10 mg Prasugrel (LBW) | 75 mg Clopidogrel (LBW) | 5 mg Prasugrel (HBW) | 10 mg Prasugrel (HBW) | 75 mg Clopidogrel (HBW) |
|---|---|---|---|---|---|---|
| Started | 0 | 16 | 17 | 20 | 0 | 17 |
| Took at least 1 dose of study drug | 0 | 16 | 17 | 20 | 0 | 17 |
| Completed | 0 | 15 | 17 | 20 | 0 | 16 |
| Not completed | 0 | 1 | 0 | 0 | 0 | 1 |
| Withdrew: Withdrawal by subject | 0 | 1 | 0 | 0 | 0 | 1 |
| Milestone | 5 mg Prasugrel (LBW) | 10 mg Prasugrel (LBW) | 75 mg Clopidogrel (LBW) | 5 mg Prasugrel (HBW) | 10 mg Prasugrel (HBW) | 75 mg Clopidogrel (HBW) |
|---|---|---|---|---|---|---|
| Started | 0 | 17 | 15 | 16 | 0 | 20 |
| Took at least 1 dose of study drug | 0 | 17 | 15 | 16 | 0 | 20 |
| Completed | 0 | 17 | 15 | 16 | 0 | 20 |
| Not completed | 0 | 0 | 0 | 0 | 0 | 0 |
MPA to 20 micromolar (μM) ADP was assessed by light transmission aggregometry (LTA), an assay that measures platelet aggregation by determining the amount of light transmitted through a cuvette containing platelet-rich plasma stimulated with a platelet activator, such as ADP, relative to platelet-poor plasma (100% light transmittance). A lower MPA reflects stronger platelet inhibition, whereas a higher MPA reflects weaker inhibition.
| percent aggregation | Prasugrel 5 mg (LBW) | Prasugrel 10 mg (HBW) |
|---|---|---|
| Baseline | 75.00 (70.00 to 80.00) | 76.40 (71.00 to 84.10) |
| Day 12 (n=32, 37) | 47.00 (37.70 to 56.45) | 47.00 (39.00 to 57.10) |
VASP phosphorylation levels, expressed as the platelet reactivity index (PRI), reflect the degree of thienopyridine-mediated P2Y12 receptor inhibition and were used to compare prasugrel versus clopidogrel, in low body weight (LBW) participants compared to higher body weight (HBW) participants. PRI was calculated by VASP. The PRI indicates the level of P2Y12 receptor inhibition. A lower PRI reflects stronger inhibition of P2Y12 receptor thus stronger platelet inhibition, whereas a higher PRI reflects weaker inhibition of P2Y12 receptor and weaker platelet inhibition.
| percentage PRI | 5 mg Prasugrel (LBW) | 10 mg Prasugrel (LBW) | 75 mg Clopidogrel (LBW) | 5 mg Prasugrel (HBW) | 10 mg Prasugrel (HBW) | 75 mg Clopidogrel (HBW) |
|---|---|---|---|---|---|---|
| Baseline | 86.57 ± 4.44 | 86.44 ± 4.45 | 86.44 ± 4.45 | 86.77 ± 3.42 | 86.76 ± 3.37 | 86.77 ± 3.42 |
| Day 12 (n=32,31,30,32,36,34) | 33.54 ± 15.77 | 15.09 ± 11.71 | 39.01 ± 17.49 | 56.87 ± 15.47 | 27.79 ± 18.13 | 56.35 ± 18.33 |
The Accumetrics VerifyNow® P2Y12 assay measures platelet aggregation in whole blood and is reported in PRU. PRU indicates the extent of P2Y12 receptor-mediated platelet aggregation calculated as a function of rate and extent of platelet aggregation in an adenosine phosphate (ADP)-containing channel of the device. A lower PRU reflects stronger inhibition of platelet aggregation, whereas a higher PRU reflects weaker inhibition of platelet aggregation.
| P2Y12 reaction units (PRU) | 5 mg Prasugrel (LBW) | 10 mg Prasugrel (LBW) | 75 mg Clopidogrel (LBW) | 5 mg Prasugrel (HBW) | 10 mg Prasugrel (HBW) | 75 mg Clopidogrel (HBW) |
|---|---|---|---|---|---|---|
| Baseline | 317.9 ± 46.10 | 315.3 ± 44.26 | 315.3 ± 44.26 | 312.8 ± 43.01 | 311.0 ± 43.76 | 312.8 ± 43.01 |
| Day 12 (n=32,31,32,35,34,34) | 129.5 ± 62.14 | 55.9 ± 38.08 | 151.7 ± 57.46 | 193.9 ± 74.09 | 102.1 ± 69.49 | 207.0 ± 67.62 |
A pharmacokinetic-pharmacodynamic (PK-PD) analysis comparing MPA (LTA) and AUC was conducted as originally intended, however the graphic output is not possible here. Therefore, the PK portion is presented here as AUC and the PD portion is presented in Secondary Outcome Measure #5. AUC was calculated through the last scheduled sampling time of 4 hours \[AUC (0-4)\] or through the sampling time of the last quantifiable concentration prior to 4 hours. AUC values were denoted AUC(0-tlast) in both instances.
| nanogram•hour/milliliter (ng•hr/mL) | Prasugrel 5 mg (LBW) | Prasugrel 10 mg (LBW) | Clopidogrel 75 mg (LBW) | Prasugrel 5 mg (HBW) | Prasugrel 10 mg (HBW) | Clopidogrel 75 mg (HBW) |
|---|---|---|---|---|---|---|
| Pharmacokinetic (PK) Analysis of the Concentration-Time Curve (AUC) | 28.9 ± 37 | 59.3 ± 40 | 18.4 ± 38 | 19.4 ± 46 | 46.7 ± 44 | 12.7 ± 60 |
MPA to 20 micromolar (μM) adenosine diphosphate (ADP) was assessed by LTA, an assay that measures platelet aggregation by determining the amount of light transmitted through a cuvette containing platelet-rich plasma stimulated with a platelet activator, such as ADP, relative to platelet-poor plasma (100% light transmittance). A lower MPA reflects stronger platelet inhibition, whereas a higher MPA reflects weaker inhibition.
| percent aggregation | 5 mg Prasugrel (LBW) | 10 mg Prasugrel (LBW) | 75 mg Clopidogrel (LBW) | 5 mg Prasugrel (HBW) | 10 mg Prasugrel (HBW) | 75 mg Clopidogrel (HBW) |
|---|---|---|---|---|---|---|
| Baseline | 76.27 ± 9.49 | 76.20 ± 9.63 | 76.20 ± 9.63 | 77.63 ± 12.29 | 77.93 ± 12.27 | 77.63 ± 12.29 |
| Day 12 ( n= 32,32,31,35,37,35) | 48.10 ± 13.89 | 38.11 ± 14.17 | 51.41 ± 13.56 | 61.90 ± 18.93 | 47.92 ± 15.18 | 65.28 ± 17.83 |
Non-serious events are listed at a 2% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| 5 mg Prasugrel (LBW) | — | 0/34 (0%) | 20/34 (58.8%) |
| 10 mg Prasugrel (LBW) | — | 1/33 (3%) | 21/33 (63.6%) |
| 75 mg Clopidogrel (LBW) | — | 0/32 (0%) | 14/32 (43.8%) |
| 5 mg Prasugrel (HBW) | — | 0/36 (0%) | 10/36 (27.8%) |
| 10 mg Prasugrel (HBW) | — | 0/38 (0%) | 12/38 (31.6%) |
| 75 mg Clopidogrel (HBW) | — | 0/37 (0%) | 14/37 (37.8%) |
| Event | 5 mg Prasugrel (LBW) | 10 mg Prasugrel (LBW) | 75 mg Clopidogrel (LBW) | 5 mg Prasugrel (HBW) | 10 mg Prasugrel (HBW) | 75 mg Clopidogrel (HBW) |
|---|---|---|---|---|---|---|
| Subarachnoid haemorrhageNervous system disorders | 0/34 | 1/33 | 0/32 | 0/36 | 0/38 | 0/37 |
| Event | 5 mg Prasugrel (LBW) | 10 mg Prasugrel (LBW) | 75 mg Clopidogrel (LBW) | 5 mg Prasugrel (HBW) | 10 mg Prasugrel (HBW) | 75 mg Clopidogrel (HBW) |
|---|---|---|---|---|---|---|
| ContusionInjury, poisoning and procedural complications | 6/34 | 9/33 | 1/32 | 0/36 | 3/38 | 2/37 |
| HaematomaVascular disorders | 3/34 | 5/33 | 3/32 | 5/36 | 3/38 | 1/37 |
| NasopharyngitisInfections and infestations | 3/34 | 0/33 | 0/32 | 0/36 | 0/38 | 0/37 |
| Traumatic haematomaInjury, poisoning and procedural complications | 1/34 | 1/33 | 2/32 | 0/36 | 0/38 | 0/37 |
| EpistaxisRespiratory, thoracic and mediastinal disorders | 1/34 | 2/33 | 1/32 | 1/36 | 1/38 | 2/37 |
| NauseaGastrointestinal disorders | 2/34 | 0/33 | 1/32 | 0/36 | 2/38 | 2/37 |
| PyrexiaGeneral disorders | 2/34 | 0/33 | 0/32 | 0/36 | 0/38 | 0/37 |
| CoughRespiratory, thoracic and mediastinal disorders | 2/34 | 0/33 | 0/32 | 0/36 | 0/38 | 0/37 |
| HeadacheNervous system disorders | 0/34 | 0/33 | 1/32 | 1/36 | 2/38 | 1/37 |
| Abdominal pain upperGastrointestinal disorders | 0/34 | 0/33 | 1/32 | 0/36 | 1/38 | 0/37 |
| Age Continuous(years) | Dose Sequence: Pras 5mg, Pras 10mg, Clop 75mg (LBW) | Dose Sequence: Pras 5mg, Clop 75 mg, Pras 10mg (LBW) | Dose Sequence: Pras 10mg, Pras 5mg, Clop 75 mg (HBW) | Dose Sequence: Pras 10mg, Clop 75 mg, Pras 5mg (HBW) | Total |
|---|---|---|---|---|---|
| Mean | 61.3 ± 8.07 | 63.2 ± 7.65 | 61.4 ± 9.57 | 64.6 ± 6.91 | 62.6 ± 8.15 |
| Sex: Female, Male(Participants) | Dose Sequence: Pras 5mg, Pras 10mg, Clop 75mg (LBW) | Dose Sequence: Pras 5mg, Clop 75 mg, Pras 10mg (LBW) | Dose Sequence: Pras 10mg, Pras 5mg, Clop 75 mg (HBW) | Dose Sequence: Pras 10mg, Clop 75 mg, Pras 5mg (HBW) | Total |
|---|---|---|---|---|---|
| Female | 15 | 14 | 7 | 5 | 41 |
| Male | 2 | 3 | 14 | 12 | 31 |
| Ethnicity (NIH/OMB)(Participants) | Dose Sequence: Pras 5mg, Pras 10mg, Clop 75mg (LBW) | Dose Sequence: Pras 5mg, Clop 75 mg, Pras 10mg (LBW) | Dose Sequence: Pras 10mg, Pras 5mg, Clop 75 mg (HBW) | Dose Sequence: Pras 10mg, Clop 75 mg, Pras 5mg (HBW) | Total |
|---|---|---|---|---|---|
| Hispanic or Latino | 0 | 0 | 0 | 0 | 0 |
| Not Hispanic or Latino | 10 | 8 | 11 | 8 | 37 |
| Unknown or Not Reported | 7 | 9 | 10 | 9 | 35 |
| Race (NIH/OMB)(Participants) | Dose Sequence: Pras 5mg, Pras 10mg, Clop 75mg (LBW) | Dose Sequence: Pras 5mg, Clop 75 mg, Pras 10mg (LBW) | Dose Sequence: Pras 10mg, Pras 5mg, Clop 75 mg (HBW) | Dose Sequence: Pras 10mg, Clop 75 mg, Pras 5mg (HBW) | Total |
|---|---|---|---|---|---|
| American Indian or Alaska Native | 0 | 0 | 0 | 0 | 0 |
| Asian | 0 | 1 | 0 | 0 | 1 |
| Native Hawaiian or Other Pacific Islander | 0 | 0 | 0 | 0 | 0 |
| Black or African American | 0 | 0 | 1 | 3 | 4 |
| White | 17 | 16 | 20 | 14 | 67 |
| More than one race | 0 | 0 | 0 | 0 | 0 |
| Unknown or Not Reported | 0 | 0 | 0 | 0 | 0 |
| Region of Enrollment(participants) | Dose Sequence: Pras 5mg, Pras 10mg, Clop 75mg (LBW) | Dose Sequence: Pras 5mg, Clop 75 mg, Pras 10mg (LBW) | Dose Sequence: Pras 10mg, Pras 5mg, Clop 75 mg (HBW) | Dose Sequence: Pras 10mg, Clop 75 mg, Pras 5mg (HBW) | Total |
|---|---|---|---|---|---|
| United States | 0 | 0 | 2 | 2 | 4 |
| Ireland | 2 | 2 | 8 | 6 | 18 |
| Netherlands | 9 | 8 | 5 | 5 | 27 |
| Sweden | 6 | 7 | 6 | 4 | 23 |
| Weight(kilograms (kg)) | Dose Sequence: Pras 5mg, Pras 10mg, Clop 75mg (LBW) | Dose Sequence: Pras 5mg, Clop 75 mg, Pras 10mg (LBW) | Dose Sequence: Pras 10mg, Pras 5mg, Clop 75 mg (HBW) | Dose Sequence: Pras 10mg, Clop 75 mg, Pras 5mg (HBW) | Total |
|---|---|---|---|---|---|
| Mean | 56.06 ± 4.575 | 56.78 ± 2.619 | 83.60 ± 17.146 | 85.96 ± 11.898 | 71.33 ± 17.980 |
| Tobacco Use Status(participants) | Dose Sequence: Pras 5mg, Pras 10mg, Clop 75mg (LBW) | Dose Sequence: Pras 5mg, Clop 75 mg, Pras 10mg (LBW) | Dose Sequence: Pras 10mg, Pras 5mg, Clop 75 mg (HBW) | Dose Sequence: Pras 10mg, Clop 75 mg, Pras 5mg (HBW) | Total |
|---|---|---|---|---|---|
| Tobacco Use Yes | 7 | 8 | 5 | 4 | 24 |
| Tobacco Use No | 10 | 9 | 16 | 13 | 48 |
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