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NCT Number: NCT00860366

Efficacy Study of Combined Treatment With Uric Acid and rtPA in Acute Ischemic Stroke

The purpose of this study is to determine whether the combined treatment with Uric Acid and rtPA is superior to rtPA alone in terms of clinical efficacy in acute ischemic stroke patients treated within the first 4.5 hours of symptoms onset.

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Key information

Conditions

Acute Ischemic Stroke Brain Diseases Cardiovascular Diseases Central Nervous System Diseases Cerebrovascular Disorders Ischemic Stroke Nervous System Diseases Stroke Vascular Diseases

Age range

18 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Phase 2 / Phase 3

Primary location

Hospital General Universitario de Albacete, Albacete, Spain

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About this study

Oxidative stress is a major contributor to brain damage in patients with ischemic stroke. Uric acid (UA) is an endogenous product derived from the metabolism of purins which in man is responsable of the 60% of the total antioxidant capacity of the organism. Recent experimental evidences gathered by our and other research groups have shown that the exogenous administration of UA is neuroprotective both in cortical and subcortical brain areas as the result of its antioxidant properties. In these studies, animals treated with UA disclosed smaller brain infarction after transient focal ischemia, both using the intraluminal model or after the injection of autologous clots. Moreover, our group first described greater neuroprotection in animals pretreated with rtPA (alteplase). Likewise, we have recently shown that the administration of UA was free of serious adverse effects in stroke patients receiving rtPA within 3 hours of stroke onset. Yet, preliminary data suggested that this intervention might translate into clinical benefits at 3 months follow-up. Based on these data, we aim to conduct a phase 3, randomized, double-blind, controlled trial assessing the clinical efficacy of UA administration in acute ischemic stroke patients. Currently, rtPA is the only approved therapy for stroke patients within the first hours of clinical onset, and oxidative stress is thought particularly relevant following ischemia/reperfusion. Based on this ground, we aim to conduct this phase 3 clinical trial in ischemic stroke patients which are currently treated with rtPA within the 4'5 hour window.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Age older than 18 years old.
  • Acute ischemic stroke treated with rtPA within the first 4.5 hours of clinical onset. Baseline National Institute of Health Stroke Scale (NIHSS) >6 and <25, and modified Rankin Scale (mRS) of 2 prior to the stroke.
  • Cranial CT disclosing the absence of blood in the CNS.
  • Informed consent.

Exclusion criteria

  • Presence of any of the valid exclusion criteria for the administration of rtPA in the current clinical practise.
  • History of gout with or without history of gouty nephropathy, or uric lithiasis. Asymptomatic hiperuricemia under chronic treatment with allopurinol, or chronic treatment with lithium.
  • Chronic renal insufficiency (baseline creatinine > 1,5mg/dl).

Treatment and study plan

Uric Acid

Drug

1 gram dissolved in a vehicle containing 500 ml of 0'1% Lithium Carbonate and 5% Mannitol, IV (in the vein), single dose.

Vehicle

Other

Single intravenous infusion of a 500 ml vehicle containing 0'1% Lithium Carbonate and 5% Mannitol.

Primary outcomes

  1. Proportion of patients achieving a mRS of 0 to 1 at 3 months after treatment, or 2 in those patients with a mRS 2 prior to the inclusion in the study

    Time frame: 90 days after the inclusion.

Secondary outcomes

  1. Proportion of patients with NIHSS <2 at 2 hours after completing the experimental treatment.

    Time frame: 2 hours after completing the experimental treatment

  2. Proportion of patients with NIHSS <1 at day 90.

    Time frame: Day 90

  3. Proportion of patients achieving a Barthel scale of 95 to 100 at day 90

    Time frame: Day 90

  4. All-cause mortality within the first 90 days.

    Time frame: Day 90

  5. Final Infarction Volume measured by means of MRI or multimodal CT at 72 hours of onset (in specific centers)

    Time frame: 72 hours

  6. Proportion of patients with an intracranial hemorrhage associated to a worsening of 4 points in the NIHSS within the first 36 hours of treatment.

    Time frame: 36 hours.

Sponsors and collaborators

Lead sponsor

Angel Chamorro, MD

Other

Collaborators

  • Carlos III Health Institute

Registry information

Official study title

Randomized, Double Blind Study Assessing the Clinical Efficacy of Combined Treatment With Uric Acid and rtPA Administered Intravenously in Acute Ischemic Stroke Patients Within the First 4.5 Hours of Symptoms Onset

Acronym: Urico-Ictus

Important dates

Study start
2011
Primary completion
2013
Study completion
2013
First posted
Mar 12, 2009
Registry last updated
Mar 10, 2015

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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