ClinicalTrials.gg
CompletedNCT03492931HESTIA4Updated May 10, 2021

PK Study of Ticagrelor in Children Aged Less Than 24 Months, With Sickle Cell Disease (HESTIA4)

A Phase 1 interventional study of Ticagrelor in Sickle Cell Disease, sponsored by AstraZeneca. Completed at 8 sites in 6 countries. Open to participants aged 1 Day to 23 Months. Per ClinicalTrials.gov, last updated 2021-05-10.

Sponsored by AstraZeneca · Phase 1, Interventional, and Other

From the registry’s dates

  • Primary completion was May 2019, 7 years 6 months ago, and no results have been posted to the registry.

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Phase
Phase 1
Study type
Interventional
Enrollment
21
Allocation
Not applicable
Ages
1 Day to 23 Months
Sex
All
01

Where this study stands

Counted across the records on this site · 2026-11-13

Among 25 studies in Anemia, Sickle Cell with a site in Kenya — 5 open to participants now, 9 under way, 6 of them phase 3. Anemia, Sickle Cell · Kenya.

Enrollment
25th of 25
21 · median 236
Started
2018
with 2 others
Phase 1
2 of 25
none open now
Registered
6th of 25
by date
Lead sponsor
4 of 25
AstraZeneca

Among the 25 studies in Anemia, Sickle Cell with a site in Kenya, this one is the 25th largest by enrollment, is one of 3 that started in 2018, is one of 2 in phase 1, and was the 6th registered.

Anemia, Sickle Cell

1,134 studies on the registry are indexed under Anemia, Sickle Cell; 238 are open to participants now.

Browse Anemia, Sickle Cell studies →

Open to participants now

5 of the 25 studies in Anemia, Sickle Cell with a site in Kenya are open now. Recruiting first, the newest first:

All 5 open studies →

A study can be open while its sites in Kenya have not opened yet or have stopped. Only those recruiting at a site in Kenya →

Who these studies take

Of the 177 Anemia, Sickle Cell studies recruiting now, 64 (36%) set no upper age limit and 97 (55%) stop at 75 or younger; 127 take children under 18; 29 take healthy volunteers.

This study: 1 Day to 23 Months · all sexes · no healthy volunteers.

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Watch this landscapeDownload CSVNarrow it in search →With an account: a weekly mail of what changed among 25 studies in Anemia, Sickle Cell with a site in Kenya, or all of them as a file.
02

Study summary

The purpose of this Phase I study is to investigate the pharmacokinetic properties of ticagrelor in pediatric patients from 0 to less than 24 months with sickle cell disease.

Ticagrelor dose level adjustment will require a Protocol amendment and regulatory approval.

Read the detailed description

Study design This Phase I paediatric study (in patients aged 0 to \<24 months) with ticagrelor is planned to be a multi-centre, open-label, single dose study.

Primary Objective:

To determine the PK properties of ticagrelor after a single oral dose

Secondary Objectives:

To determine the PK properties of the active metabolite (AR-C124910XX) after a single oral dose To assess the acceptability and the palatability of a single oral dose of ticagrelor

Safety Objective:

To assess safety and tolerability of a single oral dose of ticagrelor

Duration of treatment At least 20 eligible patients will receive a single open label oral dose of ticagrelor on Day 1.

Statistical methods A population PK analysis approach will be used to determine the PK parameters of ticagrelor and its metabolite AR-C124910XX in paediatric patients aged 0 to \<24 months eg, CL/F (oral clearance) (only for ticagrelor) and AUC.

The PK will also be described by presenting the observed plasma concentrations of Ticagrelor and its active metabolite for all individuals, as well as corresponding descriptive statistics.

No statistical comparisons are planned for the primary or secondary objectives, which will be summarised descriptively

03

Conditions studied

  • Sickle Cell Disease

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Keywords

  • Hb SS disease, Hb S Beta 0 Thalassemia
04

Who can participate

Ages eligible
1 Day to 23 Months
Sexes eligible
All
Accepts healthy volunteers
No

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

  1. Paediatric patients aged \<24 months, diagnosed with homozygous sickle cell (HbSS) or sickle beta-zero-thalassemia (HbS/β0), as confirmed by high performance liquid chromatography or electrophoresis.
  2. Body weight ≥5 kg at the time of screening.
  3. If treated with an anti-sickling agent such as hydroxyurea, the weight-adjusted dose must be stable for 3 months before screening/enrolment.
  4. Provision of signed and dated written from parents/legal guardians prior to any study specific procedures not part of standard medical care.

Exclusion criteria

Exclusion criteria

  1. History of or cerebrovascular event/accident (ischaemic or haemorrhagic), severe head trauma, intracranial haemorrhage, intracranial neoplasm, arteriovenous malformation, aneurysm, or proliferative retinopathy.
  2. Significantly underdeveloped with regards to height, weight or head circumference for age, as judged by the Investigator.
  3. Severe developmental delay (eg, cerebral palsy or mental retardation).
  4. Receiving chronic treatment (>3 days/week) with non-steroidal anti-inflammatory drugs (NSAIDs).
  5. Receiving chronic treatment with anticoagulants or antiplatelet drugs that cannot be discontinued.
  6. Moderate or severe hepatic impairment, defined as laboratory values of (ALT) >2 × (ULN), total >2 × ULN (unless judged by the Investigator to be caused by haemolysis), albumin \<35 g/L and (INR) >1.4, or symptoms of liver disease (eg, ascites).
  7. Renal failure requiring dialysis.
  8. Active pathological bleeding or increased risk of bleeding complications according to the Investigator.
  9. \<6 g/dL from test performed at Screening (Visit 1).
  10. \<100 × 10\^9/L from test performed at Screening (Visit 1).
  11. Patient considered to be at risk of bradycardic events (eg, known sick sinus syndrome or second or third degree atrioventricular block).
  12. Concomitant oral or intravenous therapy with moderate or strong inhibitors, CYP3A4 substrates with narrow therapeutic indices, or strong CYP3A4 inducers that have not been stopped at least 5 half-lives before dose administration.
  13. Patient breastfed by mother who is under treatment of strong CYP3A4 inhibitors,
  14. Active untreated malaria. Patients with suspected malaria at Screening (Visit 1) will be tested.
  15. Surgical procedure planned to occur during the study including 5 days after ticagrelor administration.
  16. Known or to ticagrelor.
  17. Concern for the inability of the patient or parents to comply with study procedures and/or follow-up.
  18. Any condition which, in the opinion of the Investigator, would make it unsafe or unsuitable for the patient to participate in this study.
  19. Previously administered ticagrelor in the present study.
  20. Participation in another clinical study with an medicinal product (IMP) or device during the last 30 days preceding screening/enrolment.
  21. Involvement of member of patient's family in planning and/or conduct of the study (applies to both AstraZeneca personnel and personnel at study centre).
Terms in these criteria, in plain language(12)

Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.

Hemoglobin (Hb)

The protein in red blood cells that carries oxygen. A low level is anaemia, which can cause tiredness and breathlessness. Measured in g/dL or g/L (9 g/dL is 90 g/L).

Informed consent

Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.

You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.

TIA (transient ischaemic attack)

A “mini-stroke”: temporary stroke-like symptoms caused by reduced blood flow to part of the brain, spinal cord or eye, without signs of a new stroke on a scan.

Stroke symptoms need emergency care at once, even if they go away.

ALT and AST (liver enzymes)

Two enzymes measured in a routine blood test of the liver. Higher levels can mean the liver is under strain or damaged. SGPT and SGOT are older names for ALT and AST.

Criteria usually give a limit as a multiple of the upper limit of normal (ULN), often higher when cancer has spread to the liver.

ULN (upper limit of normal)

The top of the normal range for a blood test, as set by the laboratory that runs it. Each lab prints its own range next to your result.

“≤ 2.5 × ULN” means the result can be up to two and a half times that top value.

Bilirubin

A yellow substance made when red blood cells are broken down, which the liver clears. A high level can mean a problem with the liver or the bile ducts.

Criteria often allow more for people with Gilbert’s syndrome, a harmless inherited condition that raises bilirubin.

INR, PT and aPTT (clotting tests)

Blood tests of how long blood takes to clot. The INR is the prothrombin time (PT) put on a common scale; about 1 is usual for someone not taking a blood thinner.

Criteria often make an exception for people on a blood thinner such as warfarin, whose INR is raised on purpose.

Platelets

Blood cells that help blood clot. Too few raises the risk of bleeding and bruising. A usual adult range is about 150–400 × 10⁹/L (150,000–400,000 per µL); each lab has its own reference range.

CYP3A (CYP3A4) inhibitors and inducers

CYP3A is a group of enzymes, mainly CYP3A4, in the liver and gut that break down many medicines. Some medicines, supplements and foods (grapefruit, St John’s wort) slow them down or speed them up, which changes how much of a study drug stays in the body.

Studies list them so they can be avoided or switched; bring a list of everything you take, including supplements.

Hypersensitivity

An allergy, or another reaction of the immune system, to a substance. “Hypersensitivity to the study drug” means a known allergic reaction to it — not every side effect a medicine can have.

Contraindication

A reason a treatment, test or procedure should not be given to a particular person, such as an allergy, another illness or a medicine they take.

Investigational drug or device

A drug or device being studied in a clinical trial.

It may be new, or already approved and being studied for another use, dose or form. Criteria often leave out people who took part in another study of one within a recent period, commonly 30 days or five half-lives.

05

Study design

Phase
Phase 1
Primary purpose
Other
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrollment
21 participants (actual)

Study arms

  • Experimental
    Treatment arm

    Single dose of ticagrelor based on age

    Drug: Ticagrelor

Interventions

  • Patients will receive a single dose of ticagrelor

    Also known as: AR-C124910XX is an active metabolite of ticagrelor given orally in a single dose. It will be measured, but it won't be given directly to subjects.

06

What researchers measure

Primary outcomes

  1. Peak Plasma Concentration (Cmax) of Ticagrelor

    This measure is obtained from observed plasma concentrations

    Time frame: 1,2,4,6 hours post dose

  2. Area under plasma concentration curve

    This measure is obtained from the population PK analysis

    Time frame: 1,2,4,6 hours post dose

  3. CL/F (Oral clearance)

    This measure is obtained from the population PK analysis.

    Time frame: 1,2,4,6 hours post dose

Secondary outcomes

  1. Peak Plasma Concentration (Cmax) for active metabolite (AR-C124910XX)

    Time frame: 1,2,4,6 hours post dose

  2. Area under plasma concentration curve

    Time frame: 1,2,4,6 hours post dose

  3. Assessment of ticagrelor suspension for palatability

    Questionnaire with one five-options question reflecting different degrees of patients willingness to swallow, from "swallowed without problem" to "vomited up medication".

    Time frame: Day 1, single timepoint assessment

07

Study locations

8 sites
  • Research Site
    Edegem, 2650, Belgium
  • Research Site
    Genova, 16100, Italy
  • Research Site
    Kisumu, 40100, Kenya
  • Research Site
    Nairobi, 00100, Kenya
  • Research Site
    Beirut, 11-0236, Lebanon
  • Research Site
    Tripoli, 1434, Lebanon
  • Research Site
    Madrid, 28007, Spain
  • Research Site
    London, SE1 7EH, United Kingdom
08

References and documents

Publications

  • Duniva Inusa BP, Inati A, Maes P, Githanga J, Ogutu B, Abboud MR, Miano M, Cela E, Nduba V, Niazi M, Astrand M, Persson K, Berggren A, Carlson G. Pharmacokinetics and safety of ticagrelor in infants and toddlers with sickle cell disease aged <24 months. Pediatr Blood Cancer. 2021 May;68(5):e28977. doi: 10.1002/pbc.28977. Epub 2021 Feb 25. PubMed 33629819 ↗
09

Timeline

Tracking since Sep 25, 2026
ElapsedEstimatedEstimated, not yet reachedSimilar studies: half by the dot; the band is the middle halfHalf of similar studies reached it by the dot; the band is the middle half, from a quarter to three quarters

Ran from Mar 2018 to primary completion in May 2019, 13 months.

Of 28 industry-sponsored phase 1 interventional studies under Anemia, Sickle Cell, half reached primary completion within 24 months of starting (the median), counting those still running; a quarter within 9 and three quarters within 41. This study's 13 months is below that.

Counting every sponsor, half of 58 studies reached it within 36 months; a quarter within 18 and three quarters within 65.

How these figures are worked out, and which studies are left out of them.

Registered
Mar 16, 2018
First posted
Apr 10, 2018
StartActual
Mar 28, 2018
Primary completionActual
May 7, 2019
CompletionActual
May 7, 2019
Last update
May 10, 2021
What these dates mean
Start.
When the first participant enrolled; while estimated, when the study expects to open to recruitment.
Primary completion.
When the last participant was examined or treated to collect data for the study's main question, its primary outcome. A study that stopped early gives the date its data collection stopped.
Completion.
When the last participant's last visit took place, for every outcome, secondary ones and side effects included: the end of the study. Often later than primary completion, sometimes the same day.
Actual and Est.
Actual means the registry says the date has happened. Est. (estimated) is a date the sponsor plans or expects. It can still move, and the sponsor is expected to change it to actual once it has passed.
No changes since tracking began. The registry record was last updated on May 10, 2021, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
10

Registry details

Key details

Study ID
NCT03492931
Lead sponsor
AstraZeneca
Responsible party
Sponsor
First posted
Apr 10, 2018
Start date
Mar 28, 2018
Primary completion
May 7, 2019
Completion
May 7, 2019
Last update
May 10, 2021

Oversight

Data monitoring committee
No
FDA-regulated drug
Yes
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

Not currently enrolling

This study is completed, as verified in May 2021. You cannot join it, but the record below documents what was studied.

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Discussion

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Studies of the drug tested here: Ticagrelor

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