A Trial Using Double-Bolus THR-100 Versus Streptokinase
Condition: Acute Myocardial Infarction
MeSH terms: Myocardial Infarction; Infarction
Study type: Interventional
Phase: Phase 3

Summary: 
      This novel fibrinolytic agent is a 136 amino acid single chain protein secreted by some
      strains of Staphylococcus aureus and readily produced by recombinant DNA technology. Two
      natural variants of recombinant staphylokinase, THR-100 and SakSTAR, have been developed for
      investigational use in preliminary trials. Like SK, it forms an equimolar complex with
      plasmin which in turn activates plasminogen to plasmin. Unlike SK, the complexed, activated
      molecule (which undergoes proteolytic cleavage of the first ten amino acids to generate
      active staphylokinase) has a high degree of fibrin-selectivity in a human plasma milieu. This
      fibrin-selectivity is due in large measure to potent activation at the clot surface by trace
      amounts of plasmin, and rapid inactivation of the circulating complex by antiplasmin. Hence,
      it provides an interesting and promising alternative therapy.
    

Detailed description: 
      STUDY SUMMARY/PROTOCOL OUTLINE

      Protocol Number: BBIL/STA/O5/2007 Protocol Name: A PROSPECTIVE PHASE III PARALLEL, RANDOMISED
      CONTROLLED TRIAL USING DOUBLE-BOLUS THR-100 (RECOMBINANT STAPHYLOKINASE) Vs STREPTOKINASE IN
      PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

      Drug under Study: THR-100 (Recombinant Staphylokinase)

      Intended Indication: Acute Myocardial Infarction

      Study Design: Randomized, Parallel Group, Multicenter and Active-Comparator Trial.

      Patient Population: Patients aged 30 to ≤ 75 years presenting with acute myocardial
      infarction within 12 hours of onset of symptoms presumed secondary to an acute myocardial
      infarction.

      Number of Patients: 120 subjects are to be recruited into the trial, with patients randomized
      in a 1:1 allocation ratio to THR-100 and Streptokinase over three centers. This sample size
      of 120 subjects provides power of 0.90 with a significance level of 0.05 to yield a
      statistically significant early patency difference.

      Primary Objectives: To demonstrate efficacy of THR100 as compared with streptokinase by
      assessment of 12-lead Electrocardiogram, specific cardiac Enzymes levels, pain relief and
      TIMI-90. (Non-Inferiority study) Secondary Objectives: To evaluate the safety profile of
      recombinant SAK in comparison with Streptokinase.

      Dose Levels: Dose levels (all administered intravenously). THR-100: 15 mg double-bolus
      (15mg/15ml), separated by 30 minutes (total 30 mg) Streptokinase: Standard regimen (1.5
      million IU) is made up in 150 ml of physiological saline or glucose solution and administered
      intravenously over a period of 60 minutes.

      Study Parameters: Primary endpoint:

        1. 12-lead Electrocardiogram, ≥50% resolution of ST segment in single ECG lead of maximum
           deviation present at 90 minutes and 24 hours after start of thrombolytic therapy.

        2. Changes in cardiac Enzyme levels of CK-MB and Cardiac Troponin I or T at 6 hrs, 8 hrs,
           12-16 hrs and 24 hours after start of thrombolytic therapy.

        3. Significant Relief of pain (a 3 point reduction on a 0-5 subjective scale) at end of 2
           and 12 hrs after start of thrombolytic therapy. (0-No pain, 1-Slight pain, 2-Mild pain,
           3-Moderate pain, 4- Severe pain, 5-Very severe pain).

        4. Assessment of culprit coronary vessel patency (TIMI- grade 3) at 90 minutes. (TIMI-
           Thrombolysis in myocardial infarction). Angiography shall be performed only in patients
           who fulfil the following guidelines

      1. No WPW or LBBB or IV-conduction block or Pacemaker rhythm. 2. ≥0.2 mV ST elevation in ≥2
      leads V1-V6 and ≥0.3 mV ST elevation in ≥1 lead V1-V6 3. Sum of ST elevation in V1-V6 plus
      Sum of ST depression in II, III, aVF ≥0.8 mV (OR)

        1. No WPW or LBBB or IV-conduction block or Pacemaker rhythm.

        2. ≥0.1 mV ST elevation in ≥2 leads II, III,aVF and ≥0.2 mV ST elevation in ≥1 lead II,
           III, aVF 5). Sum of ST elevation in I-III, aVF plus Sum of ST depression in V1-V4 ≥0.6
           mV.

      Secondary endpoints:

      Assessment of net clinical benefit, defined as reduced mortality, non-fatal stroke,
      clinically-evident intracranial hemorrhage, or recurrent myocardial infarction at thirty (30)
      days.

      Assessment of the rates of the following in-hospital events as defined in Appendix 1:

        -  Heart failure,

        -  In-hospital death,

        -  Recurrent myocardial infarction,

        -  Refractory ischemia,

        -  need for urgent revascularization,

        -  Major complications (such as cardiogenic shock, major arrhythmias, pericarditis,
           tamponade, acute hemodynamically severe mitral regurgitation, acute ventricular septal
           defect),

      Safety considerations:

        -  Stroke,

        -  Intracranial hemorrhage (see stroke),

        -  Major bleeding (other than intracranial hemorrhage),

        -  Bleeding other than major,

        -  Serious and non-serious adverse events (see Section 14),

        -  Allergic reactions,

        -  Laboratory data. Other angiographic end point CTFC (Corrected TIMI Frame Count), if
           Angiography performed.
    

Intervention name(s): THR-100; Streptokinase
Intervention type(s): Drug; Drug
Intervention description(s): THR-100: 15 mg double-bolus (15mg/15ml), separated by 30 minutes (total 30 mg); Streptokinase: Standard regimen (1.5 million IU) is made up in 150 ml of physiological saline or glucose solution and administered intravenously over a period of 60 minutes.
Other intervention name(s): Staphylokinase; Streptase
Intervention MeSH terms: Streptokinase
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: THR 100