Stabilization of vulnerable atherosclerotic carotid plaques by Rivaroxaban as evaluated by 3D contrast enhanced ultrasound (CEUS)

Overview

Sponsor-declared trial summary

Key facts

Sponsor

Rigshospitalet

Participant type

Patients

Age range

18-64 years, 65+ years

Gender

Male and Female

Therapeutic area

Diseases [C] - Cardiovascular Diseases [C14]

Decision date (initial)

2024-10-27

Transition trial

Yes

Low-intervention

No

Rare-disease indication

No

Vulnerable population

No

Funding sources

Bayer AG

External identifiers

EU CT number

2024-518539-13-00

EudraCT number

2020-001053-44

Trial design

CTIS Part I — objectives, methods, condition coding

Main objective

Scope: Safety, Therapy, Efficacy, Diagnosis, Prophylaxis

To observe the effect of rivaroxaban on atherosclerotic plaque
morphology in carotid artery over time, registered by 3D contrast
enhanced ultrasound.

Secondary objectives 1

1. 1) Secondary ultrasound endpoints: Reduction of carotis plaque volumen, thrombus volumen and intraplaque contrastfilling over time in the intervention-rivaroxaban group compared to placebo. 2) Secondary major events endpoints including but not necessary limited to: - Death (all cause mortality). - MACE (Major Adverse Cardiovascular Events): myocardial infarction, stroke, cardiovascular death. - MALE (Major Adverse Limb Events) e.g. acute og chronic critical limb ischaemia and including amputatio

Conditions and MedDRA coding

Patients with - Stable peripheral artery disease and - Asymptomatic, atherosclerotic plaque/stenosis in the carotid artery; asymptomatic regarding cerebral ischaemia including stroke and transient ischaemic attack (TIA) or amaurosis fugax.

Eligibility criteria

Principal inclusion / exclusion criteria as submitted by sponsor

Inclusion criteria 1

1. - Oral and written informed consent. - Adults > 18 years of age. - Acetylsalic acid (aspirin) therapy > 6 months. - Statin therapy > 6 months. - Asymptomatic carotid stenosis. - Hypoechoic carotid plaque with a thickness of 2.5 mm at least. - Stable peripheral artery disease (PAD) defined as at least one of the following: * Previous revascularization with aorta-femoral bypass, infrainguinal bypass, thrombendarterectomy, thrombectomy, endovascular procedures or farmeceutical with heparine and/or thrombolysis. * Previous amputation of food or leg due to arteriel insufficiency. * Current of previous intermittent claudication with one or more of the following: ankle/brachial (ABI) index < 0.9 and/or significant peripheral arterial stenosis > 50% verificed by angiography or duplex ultrasound.

Exclusion criteria 1

1. General exclusion criteria: - Subjects who are pregnant, breastfeeding, or are of childbearing potential and sexually active and not practicing an effective method of contraception. - Severe cardiac insufficiency with ejection fraction < 30% or New York Heart Association (NYHA) Class III or IV symptoms. - Current acute condition/disease. CEUS exclusion criteria: - Previous allergic reaction towards the contrast SonoVue® - Electronic implantation e.g. pacemaker, ICD, due to use of magnetic field ultrasound. - Patients who cannot cooperate to the ultrasound examination. Rivaroxaban exclusion criteria: - Concomitant participation in another study with investigational drug. XML File Identifier: odUcQ2bKM/VFeYJoaZs9/VmaD9k= Page 11/24 - History of hypersensitivity or known contraindication for rivaroxaban, aspirin (acetylsalicyl acid), pantoprazole, or excipients. - Need for other anticoagulant therapy e.g. warferin or other direct oral anticoagulants than rivaroxaban. - Already in treatment with rivaroxaban. - Need for dual antiplatelets therapy or other non-aspirin antiplatelet therapy. - High risk of bleeding e.g.: active significant bleeding, previous or current lesions or conditions with significant risk of major bleedings, recent cerebral, spinal or ocular surgery, recent intracranial bleeding, esophageal varices, arteriovenous malformations, vascular aneurysms or majour intraspinal og intracerebral vascular abnormalities. - Stroke within 1 year or previous haemorrhagic or lacunar stroke. - Any known hepatic disease associated with coagulopathy. - Estimated glomerular filtration rate < 30 mL/min/m2 - Other severe, non-cardiovascular condition/disease associated with poor prognosis (e.g. metastatic cancer) and limits life expectancy. - Systemic treatment with strong inhibitors of CYP3A4 as well as pglycoprotein (e.g., systemic azole antimycotics, such as ketoconazole, and HIV-protease inhibitors, such as ritonavir). - Strong inducers of CYP3A4 (i.e., rifampicin, rifabutin, phenobarbital, phenytoin, and carbamazepine).

Endpoints

Primary and secondary outcome measures (English text)

Primary endpoints 1

1. More hyperechoic carotid plaques in the intervention group, with 1 year rivaroxaban treatment, compared to placebo over time determined by increase in plaque echogenicity with at least 20 % in grey-median-scale (GSM) registered by ultrasound, as an expression of plaque stabilizaton by rivaroxaban.

Secondary endpoints 1

1. volumen, thrombus volumen and intraplaque contrastfilling over time in the intervention-rivaroxaban group compared to placebo. 2) Secondary major events endpoints including but not necessary limited to: - Death (all cause mortality). - MACE (Major Adverse Cardiovascular Events): myocardial infarction, stroke, cardiovascular death. - MALE (Major Adverse Limb Events) e.g. acute og chronic critical limb ischaemia and including amputation above the ankle. - Transient ischaemic attack (TIA) - Major b

Investigational products

Investigational medicinal products (IMPs), comparators, placebo, auxiliary

Test 1

Placebo 1

Sponsors and contacts

Sponsor organisations, regulatory contacts, third parties

Rigshospitalet

Sponsor organisation

Rigshospitalet

Address

Blegdamsvej 9

City

Copenhagen Oe

Postcode

2100

Country

Denmark

Scientific contact point

Organisation

Rigshospitalet

Contact name

Department of Vascular Surgery

Public contact point

Organisation

Rigshospitalet

Contact name

Department of Vascular Surgery

Third parties 1

Locations

1 EU/EEA country · 1 investigational sites

By country

Investigational sites

Results and documents

Annex IV summary of results, Annex V layperson summary, and all documents registered in CTIS for this trial

Documents 7 files

Public protocol annexes, IB summaries, regulatory submissions and post-authorisation documents registered in CTIS.

Application history

1 submissions — initial application plus substantial / non-substantial modifications