CADASILPhase 2SONICANCT01361763
Safety Study of Dabigatran in CADASIL
A Phase 2 study testing Dabigatran and Antiplatelets in people with CADASIL, run by S. Andrea Hospital at 2 sites in Italy.
Trial summary
This study is a Phase II, randomized, crossover trial designed to compare one fixed dose of dabigatran with open-label use of ASA in patients affected by CADASIL; the study is a safety trial, and the primary objective is to assess that dabigatran is not less safe than ASA in subjects with CADASIL. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- CADASIL
- What is being tested?
- Dabigatran and Antiplatelets
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 50 participants
- Where
- 2 sitesItaly
- Study dates
- Jun 2011to Feb 2015
- Phase
- Phase 2
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Patients aged 18 years or older diagnosed with CADASIL according genetic test will be eligible.
Who cannot join
- Treatment with antiplatelet drugs for a condition different from CADASIL;
- conditions associated with an increased risk of bleeding (major surgery within the previous month, planned surgery or intervention within the next 3 months;
- history of intracranial, intraocular, spinal, retroperitoneal or atraumatic intra-articular bleeding;
- gastrointestinal hemorrhage within the past year;
- symptomatic or endoscopically documented gastroduodenal ulcer disease in the previous 30 days; hemorrhagic disorder or bleeding diathesis;
- need for anticoagulant treatment of disorders other than atrial fibrillation; fibrinolytic agents within 48 hours of study entry; uncontrolled hypertension (systolic blood pressure greater than 180 mm Hg and/or diastolic blood pressure greater than 100 mm Hg);
Show all 11Show fewer
- recent malignancy or radiation therapy (within 6 months) and not expected to survive 3 years; severe renal impairment (estimated creatinine clearance 30 mL/min or less);
- active infective endocarditis;
- active liver disease (including but not limited to persistent ALT, AST, Alk Phos greater than twice the upper limit of the normal range; active hepatitis C (positive HCV RNA);
- active hepatitis B (HBs antigen +, anti HBc IgM +), active hepatitis A);
- women who are pregnant or of childbearing potential who refuse to use a medically acceptable form of contraception throughout the study.
Trial locations and contacts
2 sites in 1 country.
Italy2 sites, 2 recruiting
- Not yet recruiting
Emergency Department Stroke Unit, Umberto I Hospital
Rome, Rome, 00161
Danilo Toni, MD, +39-06-49979595, danilo.toni@uniroma1.it
Agata Correnti, MD
- Recruiting
NESMOS Department St. Andrea Hospital
Rome, Rome, 00189
Francesco Orzi, MD, +39-06-33775829, francesco.orzi@uniroma1.it
Giulio Caselli, MD, +39-347-8654946, giulio.caselli@gmail.com
About this study
Official title: Phase II, Randomized, Crossover, Single Blind, Safety Trial of DABIGATRAN Versus ASA for Preventing Ischaemic Brain Lesions in Patients Affected by CADASIL
This study is a Phase II, randomized, crossover trial designed to compare one fixed dose of dabigatran with open-label use of ASA in patients affected by CADASIL; the study is a safety trial, and the primary objective is to assess that dabigatran is not less safe than ASA in subjects with CADASIL.
Read the detailed description
The primary endpoint is the number of microbleeds, as measured by MRI, at 90 days of follow up.
The study is based on the hypothesis that drugs inhibitor of the thrombin is more effective than ASA in preventing vessel obstruction. The rationale behind the study is based on the assumption that: a) the formation of microthrombi is relevant to the clinical expression of the CADASIL disease, and b) thrombin inhibitors are more effective than antiplatelet drugs in preventing lesions by microvessel obstruction.
Eligible patients will be randomized into one of the 2 treatment groups:
- One week wash-out (W1), Dabigatran one tablet 100mg twice a day for 12 weeks, a second one week wash-out (W2), treatment with ASA one tablet of 100mg/day once a day for 12 weeks;
- The same scheme repeated with reversed sequence No initial wash-out week will be required for patients in group 2 already treated with ASA.
Clinical and instrumental evaluations will be carried out during the first (W1) and second wash-out weeks (W2), and at the end of the study (during the week that follows the second treatment regimen (W3). Each evaluation will consist of physical examination, blood tests and MRI.
Safety is evaluated on the basis of brain microbleeds and severe haemorrhages.
- Conditions
- CADASIL
- Being tested
- Dabigatran, Antiplatelets
- Keywords
- Dabigatran, Microbleeds, Microthrombi, CADASIL, Small Vessel Disease
- Medical subject headings
- CADASIL
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
DabigatranDrug
110 mg twice daily
AntiplateletsDrug
100mg once a day
| Study group | Role | What they receive |
|---|---|---|
| Dabigatran | Experimental | Not described Receives: Drug: Dabigatran |
| Antiplatelets | Active comparator | Not described Receives: Drug: Antiplatelets |
What is being measured
The primary outcome is the main question the study is designed to answer.
Number of microbleeds on MRI
Primary endpoint is defined as the difference in number of microbleeds on MRI images taken at the end of the 2 treatments (i.e, during W2 and W3). Secondary endpoint is major bleeding. The neuroradiologists (or trained neurologists) who will examine the images on MRI will be blind to treatment.
Measured: Six Months
Secondary outcomes (1)
Major bleeding
Severe haemorrhages are defined as a reduction of the haemoglobin level by at least 20g per litre, need of a transfusion of at least 2 units of blood, or symptomatic bleeding of an organ or critical area. Life threatening haemorrhages are a subcategory of severe hemorrhages defined as: fatal haemorrhages, symptomatic intracranial haemorrhages, haemorrhages with a diminution of haemoglobin level of at least 50g per litre or that require transfusion of at least 4 blood units, or surgery. All the other haemorrhages are considered minor.
Measured: Six Months
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted27 May 2011 (estimated)
- Study startJun 2011
- Primary completionJan 2015 (estimated)
- Study completionFeb 2015 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (23)Papers the sponsor has linked to this study.
- Other trials for CADASILStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 2
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Crossover
- Masking
- Single blind
- Who is masked
- Outcomes assessor
- Enrolment
- 50 participants (estimated)
Sponsor and investigators
- Lead sponsor
- S. Andrea Hospital
- Sponsor type
- University, hospital or other
- Investigators
- Francesco Orzi, MD, Study chair, NESMOS Department, University of Rome "La Sapienza"; St. Andrea Hospital
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT01361763
- Sponsor's protocol ID
- DABCAD2010
- Acronym
- SONICA
- Status last verified
- Dec 2013
- First submitted
- 16 May 2011
- Last updated
- 11 Feb 2014
- Results posted
- No
- Data monitoring committee
- Yes
Publications
Bailey EL, McCulloch J, Sudlow C, Wardlaw JM. Potential animal models of lacunar stroke: a systematic review. Stroke. 2009 Jun;40(6):e451-8. doi: 10.1161/STROKEAHA.108.528430. Epub 2009 Apr 23.
PubMed 19390080Chen B, Cheng Q, Yang K, Lyden PD. Thrombin mediates severe neurovascular injury during ischemia. Stroke. 2010 Oct;41(10):2348-52. doi: 10.1161/STROKEAHA.110.584920. Epub 2010 Aug 12.
PubMed 20705928Chabriat H, Joutel A, Dichgans M, Tournier-Lasserve E, Bousser MG. Cadasil. Lancet Neurol. 2009 Jul;8(7):643-53. doi: 10.1016/S1474-4422(09)70127-9.
PubMed 19539236Connolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J, Parekh A, Pogue J, Reilly PA, Themeles E, Varrone J, Wang S, Alings M, Xavier D, Zhu J, Diaz R, Lewis BS, Darius H, Diener HC, Joyner CD, Wallentin L; RE-LY Steering Committee and Investigators. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009 Sep 17;361(12):1139-51. doi: 10.1056/NEJMoa0905561. Epub 2009 Aug 30.
PubMed 19717844Cumurciuc R, Guichard JP, Reizine D, Gray F, Bousser MG, Chabriat H. Dilation of Virchow-Robin spaces in CADASIL. Eur J Neurol. 2006 Feb;13(2):187-90. doi: 10.1111/j.1468-1331.2006.01113.x.
PubMed 16490051Dichgans M, Holtmannspotter M, Herzog J, Peters N, Bergmann M, Yousry TA. Cerebral microbleeds in CADASIL: a gradient-echo magnetic resonance imaging and autopsy study. Stroke. 2002 Jan;33(1):67-71. doi: 10.1161/hs0102.100885.
PubMed 11779891Heye N, Paetzold C, Steinberg R, Cervos-Navarro J. The topography of microthrombi in ischemic brain infarct. Acta Neurol Scand. 1992 Nov;86(5):450-4. doi: 10.1111/j.1600-0404.1992.tb05122.x.
PubMed 1481626Hills M, Armitage P. The two-period cross-over clinical trial. Br J Clin Pharmacol. 1979 Jul;8(1):7-20. doi: 10.1111/j.1365-2125.1979.tb05903.x. No abstract available.
PubMed 552299Bokura H, Kobayashi S, Yamaguchi S. Distinguishing silent lacunar infarction from enlarged Virchow-Robin spaces: a magnetic resonance imaging and pathological study. J Neurol. 1998 Feb;245(2):116-22. doi: 10.1007/s004150050189.
PubMed 9507419Oh JH, Lee JS, Kang SY, Kang JH, Choi JC. Aspirin-associated intracerebral hemorrhage in a patient with CADASIL. Clin Neurol Neurosurg. 2008 Apr;110(4):384-6. doi: 10.1016/j.clineuro.2007.12.001. Epub 2008 Jan 22.
PubMed 18207319Kario K, Matsuo T, Hoshide S, Umeda Y, Shimada K. Effect of thrombin inhibition in vascular dementia and silent cerebrovascular disease. An MR spectroscopy study. Stroke. 1999 May;30(5):1033-7. doi: 10.1161/01.str.30.5.1033.
PubMed 10229740Lesnik Oberstein SA, van den Boom R, van Buchem MA, van Houwelingen HC, Bakker E, Vollebregt E, Ferrari MD, Breuning MH, Haan J; Dutch CADASIL Research Group. Cerebral microbleeds in CADASIL. Neurology. 2001 Sep 25;57(6):1066-70. doi: 10.1212/wnl.57.6.1066.
PubMed 11571335Pfefferkorn T, von Stuckrad-Barre S, Herzog J, Gasser T, Hamann GF, Dichgans M. Reduced cerebrovascular CO(2) reactivity in CADASIL: A transcranial Doppler sonography study. Stroke. 2001 Jan;32(1):17-21. doi: 10.1161/01.str.32.1.17.
PubMed 11136908Rouhl RP, van Oostenbrugge RJ, Knottnerus IL, Staals JE, Lodder J. Virchow-Robin spaces relate to cerebral small vessel disease severity. J Neurol. 2008 May;255(5):692-6. doi: 10.1007/s00415-008-0777-y. Epub 2008 Feb 21.
PubMed 18286319Stenborg A, Kalimo H, Viitanen M, Terent A, Lind L. Impaired endothelial function of forearm resistance arteries in CADASIL patients. Stroke. 2007 Oct;38(10):2692-7. doi: 10.1161/STROKEAHA.107.490029. Epub 2007 Aug 30.
PubMed 17761910
Study at a glance
From the registry record, last updated by the sponsor on 11 Feb 2014. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Phase II, Randomized, Crossover, Single Blind, Safety Trial of DABIGATRAN Versus ASA for Preventing Ischaemic Brain Lesions in Patients Affected by CADASIL
- ClinicalTrials.gov ID
- NCT01361763
- Acronym / sponsor ID
- SONICA / DABCAD2010
- Conditions
- CADASIL
- Keywords
- Dabigatran, Microbleeds, Microthrombi, CADASIL, Small Vessel Disease
- Phase
- Phase 2
- Study type
- Interventional
- Recruitment status
- Unknown status
- Enrolment
- 50 participants (estimated)
- Lead sponsor
- S. Andrea HospitalUniversity, hospital or other
- Study start
- Jun 2011
- Primary completion
- Jan 2015 (estimated)
- Study completion
- Feb 2015 (estimated)
- First posted
- 27 May 2011 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This study is a Phase II, randomized, crossover trial designed to compare one fixed dose of dabigatran with open-label use of ASA in patients affected by CADASIL; the study is a safety trial, and the primary objective is to assess that dabigatran is not less safe than ASA in subjects with CADASIL.
Detailed description
The primary endpoint is the number of microbleeds, as measured by MRI, at 90 days of follow up.
The study is based on the hypothesis that drugs inhibitor of the thrombin is more effective than ASA in preventing vessel obstruction. The rationale behind the study is based on the assumption that: a) the formation of microthrombi is relevant to the clinical expression of the CADASIL disease, and b) thrombin inhibitors are more effective than antiplatelet drugs in preventing lesions by microvessel obstruction.
Eligible patients will be randomized into one of the 2 treatment groups:
- One week wash-out (W1), Dabigatran one tablet 100mg twice a day for 12 weeks, a second one week wash-out (W2), treatment with ASA one tablet of 100mg/day once a day for 12 weeks;
- The same scheme repeated with reversed sequence No initial wash-out week will be required for patients in group 2 already treated with ASA.
Clinical and instrumental evaluations will be carried out during the first (W1) and second wash-out weeks (W2), and at the end of the study (during the week that follows the second treatment regimen (W3). Each evaluation will consist of physical examination, blood tests and MRI.
Safety is evaluated on the basis of brain microbleeds and severe haemorrhages.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Crossover
- Masking
- Single blind (outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Dabigatran | Experimental | Drug: Dabigatran |
| Antiplatelets | Active comparator | Drug: Antiplatelets |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (1 listed)
- Patients aged 18 years or older diagnosed with CADASIL according genetic test will be eligible.
Key exclusion criteria (11 listed)
- Treatment with antiplatelet drugs for a condition different from CADASIL;
- conditions associated with an increased risk of bleeding (major surgery within the previous month, planned surgery or intervention within the next 3 months;
- history of intracranial, intraocular, spinal, retroperitoneal or atraumatic intra-articular bleeding;
- gastrointestinal hemorrhage within the past year;
- symptomatic or endoscopically documented gastroduodenal ulcer disease in the previous 30 days; hemorrhagic disorder or bleeding diathesis;
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Dabigatran110 mg twice daily | Drug | Dabigatran |
| Antiplatelets100mg once a day | Drug | Antiplatelets |
Primary outcome
Number of microbleeds on MRI
Time frame: Six Months
Primary endpoint is defined as the difference in number of microbleeds on MRI images taken at the end of the 2 treatments (i.e, during W2 and W3). Secondary endpoint is major bleeding. The neuroradiologists (or trained neurologists) who will examine the images on MRI will be blind to treatment.
1 secondary outcome
Major bleeding
Time frame: Six Months
Results and safety
Results are not available in the source record.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 11 Feb 2014.
- Background: PubMed 19390080Bailey EL, McCulloch J, Sudlow C, Wardlaw JM. Potential animal models of lacunar stroke: a systematic review. Stroke. 2009 Jun;40(6):e451-8. doi: 10.1161/STROKEAHA.108.528430. Epub 2009 Apr 23.
- Background: PubMed 20705928Chen B, Cheng Q, Yang K, Lyden PD. Thrombin mediates severe neurovascular injury during ischemia. Stroke. 2010 Oct;41(10):2348-52. doi: 10.1161/STROKEAHA.110.584920. Epub 2010 Aug 12.
- Background: PubMed 19539236Chabriat H, Joutel A, Dichgans M, Tournier-Lasserve E, Bousser MG. Cadasil. Lancet Neurol. 2009 Jul;8(7):643-53. doi: 10.1016/S1474-4422(09)70127-9.
- Background: PubMed 19717844Connolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J, Parekh A, Pogue J, Reilly PA, Themeles E, Varrone J, Wang S, Alings M, Xavier D, Zhu J, Diaz R, Lewis BS, Darius H, Diener HC, Joyner CD, Wallentin L; RE-LY Steering Committee and Investigators. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009 Sep 17;361(12):1139-51. doi: 10.1056/NEJMoa0905561. Epub 2009 Aug 30.
- Background: PubMed 16490051Cumurciuc R, Guichard JP, Reizine D, Gray F, Bousser MG, Chabriat H. Dilation of Virchow-Robin spaces in CADASIL. Eur J Neurol. 2006 Feb;13(2):187-90. doi: 10.1111/j.1468-1331.2006.01113.x.
- Background: PubMed 11779891Dichgans M, Holtmannspotter M, Herzog J, Peters N, Bergmann M, Yousry TA. Cerebral microbleeds in CADASIL: a gradient-echo magnetic resonance imaging and autopsy study. Stroke. 2002 Jan;33(1):67-71. doi: 10.1161/hs0102.100885.
- Background: PubMed 1481626Heye N, Paetzold C, Steinberg R, Cervos-Navarro J. The topography of microthrombi in ischemic brain infarct. Acta Neurol Scand. 1992 Nov;86(5):450-4. doi: 10.1111/j.1600-0404.1992.tb05122.x.
- Background: PubMed 552299Hills M, Armitage P. The two-period cross-over clinical trial. Br J Clin Pharmacol. 1979 Jul;8(1):7-20. doi: 10.1111/j.1365-2125.1979.tb05903.x. No abstract available.
- Background: PubMed 9507419Bokura H, Kobayashi S, Yamaguchi S. Distinguishing silent lacunar infarction from enlarged Virchow-Robin spaces: a magnetic resonance imaging and pathological study. J Neurol. 1998 Feb;245(2):116-22. doi: 10.1007/s004150050189.
- Background: PubMed 18207319Oh JH, Lee JS, Kang SY, Kang JH, Choi JC. Aspirin-associated intracerebral hemorrhage in a patient with CADASIL. Clin Neurol Neurosurg. 2008 Apr;110(4):384-6. doi: 10.1016/j.clineuro.2007.12.001. Epub 2008 Jan 22.
- Background: PubMed 10229740Kario K, Matsuo T, Hoshide S, Umeda Y, Shimada K. Effect of thrombin inhibition in vascular dementia and silent cerebrovascular disease. An MR spectroscopy study. Stroke. 1999 May;30(5):1033-7. doi: 10.1161/01.str.30.5.1033.
- Background: PubMed 11571335Lesnik Oberstein SA, van den Boom R, van Buchem MA, van Houwelingen HC, Bakker E, Vollebregt E, Ferrari MD, Breuning MH, Haan J; Dutch CADASIL Research Group. Cerebral microbleeds in CADASIL. Neurology. 2001 Sep 25;57(6):1066-70. doi: 10.1212/wnl.57.6.1066.
- Center for experimental neurological therapies.Link provided by the sponsor.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Francesco Orzi, MD study chair
NESMOS Department, University of Rome "La Sapienza"; St. Andrea Hospital
2 sites in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 2 study testing Dabigatran and Antiplatelets in people with CADASIL, run by S. Andrea Hospital at 2 sites in Italy.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 1 inclusion and 11 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: status not confirmed, as of the sponsor's last update on 11 Feb 2014. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 2 sites in Italy. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this phase mean?
Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
Results are not available in the source record.
How can a doctor refer a patient or contact the research team?
Contact Francesco Orzi, MD (+3933775829, francesco.orzi@uniroma1.it), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Number of microbleeds on MRI (time frame: Six Months). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT01361763, which also lists 23 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 11 Feb 2014.