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CompletedNCT03329261IDASCOP 1Updated Dec 23, 2019

Incidence of Major Cardiovascular Events in Diabetic Patients With ACS Undergoing Coronary Angioplasty and Treated With Clopidogrel 150 mg Versus 75 mg

A Phase 4 interventional study of Clopidogrel in Diabetes Mellitus, Type 2, NSTEMI - Non-ST Segment Elevation MI and Coronary Angioplasty, sponsored by Laboratoires Teriak. Completed at 1 site in Tunisia. Open to participants aged 18 Years to 75 Years. Per ClinicalTrials.gov, last updated 2019-12-23.

Sponsored by Laboratoires Teriak · Phase 4, Interventional, and Treatment

Phase
Phase 4
Study type
Interventional
Enrollment
167
Allocation
Randomized
Ages
18 Years to 75 Years
Sex
All
01

Study summary

Acute Coronary Syndrome (ACS) is triggered by the rupture of an atherosclerotic plaque that results in a platelet aggregation reaction in the coronary artery. The administration of antiplatelet agents starting from the acute phase of the disease has helped reduce the risk of ischemic relapse both during initial and long-term hospitalization.

Management of clopidogrel following an ischemic event has been the subject of several treatment regimens ranging from a single continuous dose to a sequential double dose of between 7 and 30 days. The CURRENT-OASIS 7 therapeutic trial showed a benefit of clopidogrel double dose in reducing the risk of myocardial intervention (MI) and the composite outcome: cardiovascular mortality, MI, or stroke (CVA/TIA) at 30 days. However, the study protocol was interested in all ACSs, regardless of the Type 2 Diabetes Mellitus (T2DM) status in selected patients. Also, doubling of clopidogrel dose was maintained over 7 days after angioplasty. The literature describes an increased cardiovascular risk in type II diabetics in secondary prevention. No previous study has evaluated the effect of clopidogrel double dose given for 1 month on the reduction of this risk in the long-term in diabetic patients.

Thus, the objective of this study is to evaluate the efficacy and safety of clopidogrel double dose, given for 1 month in ACS in the diabetic patient.

Read the detailed description

The study is an open label, multicentric clinical trial. Collected data are managed by the DACIMA Clinical Suite®, the electronic data capture platform which complies with the FDA 21 CFR part 11 requirements (Food and Drug Administration 21 Code of Federal Regulations part 11), the HIPAA specifications (Health Insurance Portability and Accountability Act), and the ICH standards (International Conference on Harmonisation).

02

Conditions studied

  • Diabetes Mellitus, Type 2
  • NSTEMI - Non-ST Segment Elevation MI
  • Coronary Angioplasty
03

Who can participate

Ages eligible
18 Years to 75 Years
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  • Male or female aged between 18 to 75 years old.
  • Proven ACS requiring PTCA within 1 week of inclusion. The ACS should be without ST-segment elevation (presence of chest pain with ST-segment or T-wave changes without sustained ST segment elevation) with elevation of cardiac biomarkers of MI (positive troponins).
  • Coronary angiography showing at least one coronary lesion, whether mono, bi or multi-truncate
  • Type 2 diabetes confirmed for at least one year
  • Patient candidate for treatment with Clopidogrel
  • Informed consent of patients

Non-Inclusion Criteria:

  • Non-consenting patient and/or participating in another clinical study
  • ACS with ST segment elevation (STEMI)
  • History of digestive or cerebral bleeding with antiplatelet agents or anticoagulants
  • Insulin-dependent diabetes mellitus (IDDM)
  • Diabetic requiring insulin
  • Patient in cardiogenic shock
  • Patient under treatment with anti-glycoprotein IIb/IIIa or stopped less than 72 hours prior to inclusion
  • Previously treated with clopidogrel or thrombolytics
  • Patients programmed for surgery in less than 6 months
  • Ischemic stroke less than 6 weeks old
  • History of haemorrhagic stroke (regardless of time)
  • Patients under or candidates for Vitamin K antagonist (VKA)
  • Patients under another antiplatelet agent (Ticlopidine, Prasugrel)
  • Patients with a contraindication to clopidogrel (hypersensitivity to the active substance or to any of the excipients, severe hepatic impairment, progressive hemorrhagic lesion such as peptic ulcer or intracranial hemorrhage)
  • Under omeprazole treatment, or considered during the study
  • Anemia (Hb \<12g/dl)
  • Thrombocytopenia with less than 100000 cells/mm3
  • Serum creatinine greater than 200 μmol/l
  • Pregnancy and/or breast-feeding
  • Severe renal impairment

Exclusion criteria

Exclusion criteria:

  • Non-compliance with treatment (treatment compliance \<80%)
  • AE/SAE requiring cessation of treatment
  • Planning a CABG
  • Occurrence of pregnancy during the study
04

Study design

Phase
Phase 4
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
None (open label)
Enrollment
167 participants (actual)

Study arms

  • Active comparator
    Arm 1 (single dose)

    Will receive a clopidogrel loading dose of 600 mg PO, then a daily dose of clopidogrel 75 mg PO until the angioplasty is performed. After coronary intervention, a daily dose of clopidogrel 150 mg PO for 7 days will be given, followed by a daily single dose of clopidogrel (75 mg PO) for 21 days. Maintenance therapy will be clopidogrel daily dose of 75 mg PO thereafter, until the end of the study.

    Drug: Clopidogrel

  • Active comparator
    Arm 2 (double dose)

    Will receive a clopidogrel loading dose of 600 mg PO, then a daily dose of clopidogrel 75 mg PO until the angioplasty is performed. After coronary intervention, a daily dose of clopidogrel 150 mg PO for 7 days will be given, followed by a daily double dose of clopidogrel (150 mg PO) for 21 days. Maintenance therapy will be clopidogrel daily dose of 75 mg PO thereafter, until the end of the study.

    Drug: Clopidogrel

Interventions

  • DrugClopidogrel

    COPIGREL® - clopidogrel dosed at 75 mg per tablet

    Also known as: COPIGREL®

05

What researchers measure

Primary outcomes

  1. Major Cardiovascular Events (MACE)

    Incidence of major cardiovascular events including cardiac death, MI, cerebrovascular accident (CVA), revascularization (PTCA, GABG), stent thrombosis.

    Time frame: 1 year after coronary intervention

Secondary outcomes

  1. Bleeding Events

    All bleeding events (digestive, cerebral, other locations)

    Time frame: At 1, 3, 6, 9 and 12 months from patient enrollment

  2. Heart Failure Readmission

    Incidence of heart failure hospital readmissions

    Time frame: At 1, 3, 6, 9 and 12 months from patient enrollment

  3. Global Death

    Incidence of death of all causes (death of cardiovascular origin and death of non-cardiovascular origin)

    Time frame: At 1, 3, 6, 9 and 12 months from patient enrollment

  4. Incidence of Adverse Events

    Incidence of Adverse Events (AE) including Serious Adverse Events (SAE)

    Time frame: At 1, 3, 6, 9 and 12 months from patient enrollment

06

Study locations

1 site
  • HMPIT
    Ben Arous, Tunisia
07

Registry details

Key details

Study ID
NCT03329261
Lead sponsor
Laboratoires Teriak
Responsible party
Sponsor
First posted
Nov 1, 2017
Start date
Dec 7, 2017
Primary completion
Mar 24, 2019
Completion
Dec 20, 2019
Last update
Dec 23, 2019

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
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