Brain IschemiaOPHELIE-COGNCT01713491
Pre-stroke Cognitive Status and Thrombolytic Therapy
An observational study of Brain Ischemia and Adverse Effect of Thrombolytic Drugs, run by University Hospital, Lille at 9 sites in 2 countries.
Trial summary
At the acute stage of cerebral ischaemia, the only effective drug that increases the proportion of patients who survive without dependency is thrombolytic therapy by intravenous (i.v.) tissue-plasminogen activator (t-PA). Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Brain Ischemia, Adverse Effect of Thrombolytic Drugs, Impaired Cognition
- How many people
- 205 participants
- Where
- 9 sitesin 2 countries
- Study dates
- Nov 2011to Mar 2015
- Phase
- Observational
- 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
Study population: Patients treated by iv tPA for acute cerebral ischaemia in routine practice
Who may be able to join
- All patients treated by iv tPA for cerebral ischaemia in routine practice in participating centres
Who cannot join
- index ischaemic stroke sparing MCA territory;
- thrombolytic therapy administered intra-arterially or combined with thrombectomy
- pre-stroke mRS of 2 or more
- impossibility to perform an IQCODE for any reason (no reliable informant available within 48 hours, not fluent in French or in Japanese or in a language spoken by the investigator), except when the patient had been diagnosed as demented by a specialist used to diagnose dementia (e.g. neurologist, psychiatrist, geriatrician) before stroke, or has a MMSE score of 30 at discharge.
Trial locations and contacts
9 sites in 2 countries.
9 sites in 2 countries
Japan8 sites
Fukuoka Redcross Hospital
Fukuoka
Fukuoka-Higashi Medical center
Fukuoka
Kyushu Medical Center
Fukuoka
Kyushu University
Fukuoka
Kyushu Rosai Hospital
Kitakyushu
Steel Memorial Yawata Hospital
Kitakyushu
Kawasaki Medical University
Kurashiki
St. Mary's Hospital
Kurume
About this study
Official title: Influence of the Pre-existing Cognitive Status on the Outcome in Patients Treated by Thrombolytic Therapy for Acute Cerebral Ischaemia
At the acute stage of cerebral ischaemia, the only effective drug that increases the proportion of patients who survive without dependency is thrombolytic therapy by intravenous (i.v.) tissue-plasminogen activator (t-PA). This treatment is entered into routine practice with similar results than in trials, in various places of the world including Europe and Japan.
Stroke and dementia are closely related. About one patient in ten has dementia before a first-ever stroke, and more than one in three has dementia after a recurrent stroke. Pre-existing dementia is associated with a worse outcome of stroke, and pre-existing cognitive impairment without dementia is associated with a higher rate of institutionalisation within 3 years. In many patients cognitive impairment is due to the summation of the effects of vascular and Alzheimer lesions of the brain.
Read more
More and more patients nowadays who are eligible for rt-PA are already known as demented at admission. A retrospective study conducted in a cohort of patients with dementia who had an ischaemic stroke and were treated by rtPA suggested that there is no increased risk of cerebral bleeding and death as compared with non demented patients. However, pre-existing cognitive impairment is possibly associated with (i) an increased risk of bleeding in patients with cognitive impairment, and (ii) a higher sensitivity to the neurotoxic effect of rt-PA on the brain tissue.
Japanese patients differ from European patients by a higher risk of spontaneous intracranial haemorrhage, and a higher proportion of patients with small-vessel diseases.
The primary objective of the OPHELIE-COG study is to determine whether ischaemic stroke patients who are treated with i.v. rt-PA are more likely to have a poor outcome (defined as a modified Rankin scale 2 to 6 at month 3) in the presence of pre-existing cognitive impairment or dementia. The secondary objectives are to determine whether (i) they have an increased risk of symptomatic intracerebral haemorrhages, (ii) the proportion of patients who have a poor outcome is lower than expected from the placebo group of randomised trials for patients with a similar range of baseline severity, and (iii) the influence of the cognitive state on outcome differs between Japanese and European patients.
Read the detailed description
The French part of OPHELIE-COG is run as an ancillary study of OPHELIE, a multicenter French study conducted in the clinical centres of the Strokavenir research network (co-PI Didier Leys, Lille and Denis Vivien, Caen). OPHELIE has been approved by the ethical committee and is an investigator-driven study supported by the INSERM, the University Lille Nord de France and the Lille University hospital. OPHELIE includes prospectively all patients who are treated by i.v. rt-PA for an acute cerebral ischaemia in the participating centres and tests the hypothesis that the single/two chain-tPA ratio in the infusion influences the 3-month outcome, evaluated by a score 0 or 1 at the modified Rankin scale(mRS). OPHELIE-COG is conducted in the same cohort of patients as an ancillary analysis of OPHELIE.
The Japanese part of OPHELIE-COG will be conducted In patients who receive i.v. rt-PA for acute cerebral ischaemia in participating Japanese centres. Japanese centres will not be part of the OPHELIE study.
No specific investigation is necessary for the purpose of the study. There is no variable recorded that is not part of the usual management of stroke patients treated by i.v. rt-PA. Following-up patients at 3 months and having mRS is recommended to monitor the results of thrombolysis in all centres able to deliver the treatment. The informant Questionnaire on Cognitive Decline in the Elderly (IQCODE)is not part of the care in all centres but is however highly recommended because of the influence of the pre-existing cognitive state on stroke outcome in general.
The systematic assessment of pre-existing dementia is conducted within 48 hours of stroke onset by French or Japanese translations of the short version of the IQCODE. Patients who are already followed-up by a neurologist and diagnosed as demented before stroke are classified as previously demented irrespective of the IQCODE score. Patients who cannot have an IQCODE but have a MMSE score of 30 before discharge are classified as cognitively normal. Patients who cannot have an IQCODE and have a MMSE score of 29 or less are not eligible.
The sample size calculation for the French patients has been performed for the primary objective of OPHELIE assuming an expected difference of 5% for the primary end-point with alpha and beta risks of 5% and 20% respectively and a expected proportion of patients with a mRS score 0-1 of 40% at month-3, according to trials, observational registries and data published in the Lille centre for a baseline NIH score of 11: 900 patients will be necessary. To detect an absolute difference of 10 % for the primary end-point with an alpha risk of 5% and a power of 80%, a sample size of 1040 eligible patients is necessary, assuming that 12 to 16% of patients will have criteria for pre-existing dementia. This 10% absolute difference in the proportion of patients with mRS 0-1 at month 3 between those with and without pre-existing dementia corresponds to the difference below which the beneficial effect of rt-PA may be lost, taking into account that approximately 30% of patients under placebo, and 40% under rt-PA have a mRS 0-1 at month 3 for a median baseline NIH score of 11. Assuming that 20% of patients included in OPHELIE will not be eligible for OPHELIE-COG according to the proportion of exclusions found in previous studies with the IQCODE, we can expect a recruitment of 720 patients in the French arm of the study. The 320 other patients will be recruited in Japan, meaning that 400 patients have to be recruited to compensate the usual 20% rate of patients who cannot have an IQCODE in due time.
An intermediate analysis will be performed after inclusion of 500 patients arrived at 3 months of follow-up to re-evaluate the sample size.
- Keywords
- brain ischemia, thrombolytic therapy, Impaired cognition, dementia
- Medical subject headings
- Brain Ischemia, Cognition Disorders, Dementia
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
| Study group | Role | What they receive |
|---|---|---|
| Cognitively normal | Patients with IQCODE score of 52 or less | |
| Cognitively impaired - no dementia | IQCODE score 53 - 63 | |
| Demented | IQCODE score 64 or more |
What is being measured
The primary outcome is the main question the study is designed to answer.
Modified Rankin Scale score 0 or 1
Measured: Month-3
Secondary outcomes (4)
Symptomatic intracerebral haemorrhage defined according to the ECASS2 definition
Measured: 7 days
Death
Measured: Day 7
Modified Rankin Scale 0-2
Measured: Month-3
Death
Measured: Month-3
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted24 Oct 2012 (estimated)
- Study startNov 2011
- Primary completionDec 2014
- Study completionMar 2015
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Brain IschemiaStudies 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
- Observational
- Observational model
- Cohort
- Time perspective
- Prospective
- Enrolment
- 205 participants (actual)
Sponsor and investigators
- Lead sponsor
- University Hospital, Lille
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Kei Murao, MD, Study director, University Hospital, Lille
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT01713491
- Sponsor's protocol ID
- 2010_04
- Other IDs
- 912079
- Acronym
- OPHELIE-COG
- Status last verified
- Oct 2016
- First submitted
- 22 Oct 2012
- Last updated
- 27 Oct 2016
- Results posted
- No
- Data monitoring committee
- Yes
- Individual data sharing
- No
Study at a glance
From the registry record, last updated by the sponsor on 27 Oct 2016. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Influence of the Pre-existing Cognitive Status on the Outcome in Patients Treated by Thrombolytic Therapy for Acute Cerebral Ischaemia
- ClinicalTrials.gov ID
- NCT01713491
- Acronym / sponsor ID
- OPHELIE-COG / 2010_04
- Keywords
- brain ischemia, thrombolytic therapy, Impaired cognition, dementia
- Study type
- Observational
- Recruitment status
- Completed
- Enrolment
- 205 participants (actual)
- Lead sponsor
- University Hospital, LilleUniversity, hospital or other
- Study start
- Nov 2011
- Primary completion
- Dec 2014 (actual)
- Study completion
- Mar 2015 (actual)
- First posted
- 24 Oct 2012 (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.
At the acute stage of cerebral ischaemia, the only effective drug that increases the proportion of patients who survive without dependency is thrombolytic therapy by intravenous (i.v.) tissue-plasminogen activator (t-PA). This treatment is entered into routine practice with similar results than in trials, in various places of the world including Europe and Japan.
Stroke and dementia are closely related. About one patient in ten has dementia before a first-ever stroke, and more than one in three has dementia after a recurrent stroke. Pre-existing dementia is associated with a worse outcome of stroke, and pre-existing cognitive impairment without dementia is associated with a higher rate of institutionalisation within 3 years. In many patients cognitive impairment is due to the summation of the effects of vascular and Alzheimer lesions of the brain.
More and more patients nowadays who are eligible for rt-PA are already known as demented at admission. A retrospective study conducted in a cohort of patients with dementia who had an ischaemic stroke and were treated by rtPA suggested that there is no increased risk of cerebral bleeding and death as compared with non demented patients. However, pre-existing cognitive impairment is possibly associated with (i) an increased risk of bleeding in patients with cognitive impairment, and (ii) a higher sensitivity to the neurotoxic effect of rt-PA on the brain tissue.
Japanese patients differ from European patients by a higher risk of spontaneous intracranial haemorrhage, and a higher proportion of patients with small-vessel diseases.
The primary objective of the OPHELIE-COG study is to determine whether ischaemic stroke patients who are treated with i.v. rt-PA are more likely to have a poor outcome (defined as a modified Rankin scale 2 to 6 at month 3) in the presence of pre-existing cognitive impairment or dementia. The secondary objectives are to determine whether (i) they have an increased risk of symptomatic intracerebral haemorrhages, (ii) the proportion of patients who have a poor outcome is lower than expected from the placebo group of randomised trials for patients with a similar range of baseline severity, and (iii) the influence of the cognitive state on outcome differs between Japanese and European patients.
Detailed description
The French part of OPHELIE-COG is run as an ancillary study of OPHELIE, a multicenter French study conducted in the clinical centres of the Strokavenir research network (co-PI Didier Leys, Lille and Denis Vivien, Caen). OPHELIE has been approved by the ethical committee and is an investigator-driven study supported by the INSERM, the University Lille Nord de France and the Lille University hospital. OPHELIE includes prospectively all patients who are treated by i.v. rt-PA for an acute cerebral ischaemia in the participating centres and tests the hypothesis that the single/two chain-tPA ratio in the infusion influences the 3-month outcome, evaluated by a score 0 or 1 at the modified Rankin scale(mRS). OPHELIE-COG is conducted in the same cohort of patients as an ancillary analysis of OPHELIE.
The Japanese part of OPHELIE-COG will be conducted In patients who receive i.v. rt-PA for acute cerebral ischaemia in participating Japanese centres. Japanese centres will not be part of the OPHELIE study.
No specific investigation is necessary for the purpose of the study. There is no variable recorded that is not part of the usual management of stroke patients treated by i.v. rt-PA. Following-up patients at 3 months and having mRS is recommended to monitor the results of thrombolysis in all centres able to deliver the treatment. The informant Questionnaire on Cognitive Decline in the Elderly (IQCODE)is not part of the care in all centres but is however highly recommended because of the influence of the pre-existing cognitive state on stroke outcome in general.
The systematic assessment of pre-existing dementia is conducted within 48 hours of stroke onset by French or Japanese translations of the short version of the IQCODE. Patients who are already followed-up by a neurologist and diagnosed as demented before stroke are classified as previously demented irrespective of the IQCODE score. Patients who cannot have an IQCODE but have a MMSE score of 30 before discharge are classified as cognitively normal. Patients who cannot have an IQCODE and have a MMSE score of 29 or less are not eligible.
The sample size calculation for the French patients has been performed for the primary objective of OPHELIE assuming an expected difference of 5% for the primary end-point with alpha and beta risks of 5% and 20% respectively and a expected proportion of patients with a mRS score 0-1 of 40% at month-3, according to trials, observational registries and data published in the Lille centre for a baseline NIH score of 11: 900 patients will be necessary. To detect an absolute difference of 10 % for the primary end-point with an alpha risk of 5% and a power of 80%, a sample size of 1040 eligible patients is necessary, assuming that 12 to 16% of patients will have criteria for pre-existing dementia. This 10% absolute difference in the proportion of patients with mRS 0-1 at month 3 between those with and without pre-existing dementia corresponds to the difference below which the beneficial effect of rt-PA may be lost, taking into account that approximately 30% of patients under placebo, and 40% under rt-PA have a mRS 0-1 at month 3 for a median baseline NIH score of 11. Assuming that 20% of patients included in OPHELIE will not be eligible for OPHELIE-COG according to the proportion of exclusions found in previous studies with the IQCODE, we can expect a recruitment of 720 patients in the French arm of the study. The 320 other patients will be recruited in Japan, meaning that 400 patients have to be recruited to compensate the usual 20% rate of patients who cannot have an IQCODE in due time.
An intermediate analysis will be performed after inclusion of 500 patients arrived at 3 months of follow-up to re-evaluate the sample size.
Study design
- Observational model
- Cohort
- Time perspective
- Prospective
- Number of arms
- 3
| Arm | Type | Receives |
|---|---|---|
| Cognitively normal | – | –Patients with IQCODE score of 52 or less |
| Cognitively impaired - no dementia | – | –IQCODE score 53 - 63 |
| Demented | – | –IQCODE score 64 or more |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
- Study population
- Patients treated by iv tPA for acute cerebral ischaemia in routine practice
Key inclusion criteria (1 listed)
- All patients treated by iv tPA for cerebral ischaemia in routine practice in participating centres
Key exclusion criteria (4 listed)
- index ischaemic stroke sparing MCA territory;
- thrombolytic therapy administered intra-arterially or combined with thrombectomy
- pre-stroke mRS of 2 or more
- impossibility to perform an IQCODE for any reason (no reliable informant available within 48 hours, not fluent in French or in Japanese or in a language spoken by the investigator), except when the patient had been diagnosed as demented by a specialist used to diagnose dementia (e.g. neurologist, psychiatrist, geriatrician) before stroke, or has a MMSE score of 30 at discharge.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Primary outcome
Modified Rankin Scale score 0 or 1
Time frame: Month-3
4 secondary outcomes
Symptomatic intracerebral haemorrhage defined according to the ECASS2 definition
Time frame: 7 days
Death
Time frame: Day 7
Modified Rankin Scale 0-2
Time frame: Month-3
Death
Time frame: Month-3
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 27 Oct 2016.
- Individual participant dataSharing planned: No
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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.
Kei Murao, MD study director
University Hospital, Lille
9 sites in 2 countries: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of Brain Ischemia and Adverse Effect of Thrombolytic Drugs, run by University Hospital, Lille at 9 sites in 2 countries.
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 4 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: finished, as of the sponsor's last update on 27 Oct 2016. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 9 sites in Japan, France. 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.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Modified Rankin Scale score 0 or 1 (time frame: Month-3). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
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 27 Oct 2016.