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A study to learn if DM199 drug is safe and whether it works better than placebo for treating acute ischemic stroke
EU CTIS ID: 2024-513911-28-00
What this study is testing
The objective of this study is to evaluate the safety and efficacy of DM199 (rinvecalinase alfa) in participants with moderate stroke severity, who present within 24 hours of Acute Ischemic Stroke (AIS) onset/last known normal due to small and medium vessel occlusions. This study focuses on participants who have limited treatment options. Participants who have or will receive mechanical thrombectomy (MT) are not eligible for participation. Additionally, participants who have received fibrinolytics are excluded unless they experience a persistent neurological deficit of moderate severity six or more hours after fibrinolytic treatment. Participants considered for this trial should not be denied the use of standard of care (SoC) AIS therapies, such as fibrinolytics or MT, when appropriate.
- Phase II and Phase III (Integrated)
A plain-language read of the study's public EU CTIS listing. The study team confirms the details.
Who can take part
You may be able to join if
- Participant is between 18 and 90 years of age inclusive.
- Participant weight is 40 kg to 166 kg inclusive.
- Participant to be randomized and infusion with investigational product initiated within 24 hours of last known normal/AIS stroke onset.
- Participant has NIHSS ≥5 and ≤15 at approximately the time of randomization. This criterion also applies to participants who meet the following conditions: • The participant initially presents with an NIHSS score below 5, but clinically worsens, including cases of progressing stroke/stroke-in-evolution, resulting in a subsequent persistent NIHSS score of ≥5 and ≤15; and • Participant meets all other inclusion and exclusion criteria, including repeat brain imaging to rule out hemorrhagic transformation.
- Participant had a pre-morbid mRS score of 0 to 1 (mRS score prior to AIS) as stated by participant or participant’s representative.
- If participant has received fibrinolytic treatment for AIS within 4.5 hours of last known normal/AIS stroke onset and at least 6 hours after completing fibrinolytic treatment, and the participant meets all of the following criteria: • Participant’s initial NIHSS score prior to fibrinolytics was ≤15; and • At least six hours after fibrinolytics, the participant has NIHSS score of ≥5 and ≤15 with a persistent deficit; and • The participant's NIHSS score showed less than a 4-point improvement, or worsened, after receiving fibrinolytics; and • Participant meets all other inclusion and exclusion criteria including repeat brain imaging to rule out hemorrhagic transformation. Hemorrhagic transformation is defined as any of the following: ▪ PH1 or PH2 type hemorrhage based on Heidelberg Classification ▪ Hemorrhage resulting in neurologic deterioration Note: HI1 and HI2 type hemorrhages based on Heidelberg classification are not exclusionary.
You likely can't join if
- At screening, or with repeat imaging (see Inclusion 4 and 6), participant has imaging confirmed hemorrhagic stroke.
- Participant has a history of clinically significant allergic reactions such as angioedema or anaphylaxis requiring hospitalization.
- Participant has a diagnosis or suspected diagnosis of hereditary angioedema (HAE) or is taking or prescribed medications commonly used as prophylaxis/treatment of HAE, such as C1-esterase inhibitors (Cinryze, Berinert, Ruconest, Haegarda), Danazol, kallikrein inhibitors (Ecallantide, Berotralstat, Lanadelumab), Bradykinin B2 Receptor Antagonists (Icatibant), or other medication designed to influence the kallikrein-kinin system.
- Life expectancy estimated at ≤1 year prior to enrollment.
- Participant has clinical evidence of an active infection at the time of enrollment requiring parenteral treatment or hospitalization to monitor or manage the infection. NOTE: Treatment of uncomplicated infections with oral antibiotics would not be an exclusion (example treatment of an uncomplicated urinary tract infection or sinus infections with oral antibiotics would not be an exclusion).
- Participant has known alpha 1-antitrypsin deficiency (α1-antitrypsin deficiency).
See the full eligibility criteria
Who can join
- Participant is between 18 and 90 years of age inclusive.
- Participant weight is 40 kg to 166 kg inclusive.
- Participant to be randomized and infusion with investigational product initiated within 24 hours of last known normal/AIS stroke onset.
- Participant has NIHSS ≥5 and ≤15 at approximately the time of randomization. This criterion also applies to participants who meet the following conditions: • The participant initially presents with an NIHSS score below 5, but clinically worsens, including cases of progressing stroke/stroke-in-evolution, resulting in a subsequent persistent NIHSS score of ≥5 and ≤15; and • Participant meets all other inclusion and exclusion criteria, including repeat brain imaging to rule out hemorrhagic transformation.
- Participant had a pre-morbid mRS score of 0 to 1 (mRS score prior to AIS) as stated by participant or participant’s representative.
- If participant has received fibrinolytic treatment for AIS within 4.5 hours of last known normal/AIS stroke onset and at least 6 hours after completing fibrinolytic treatment, and the participant meets all of the following criteria: • Participant’s initial NIHSS score prior to fibrinolytics was ≤15; and • At least six hours after fibrinolytics, the participant has NIHSS score of ≥5 and ≤15 with a persistent deficit; and • The participant's NIHSS score showed less than a 4-point improvement, or worsened, after receiving fibrinolytics; and • Participant meets all other inclusion and exclusion criteria including repeat brain imaging to rule out hemorrhagic transformation. Hemorrhagic transformation is defined as any of the following: ▪ PH1 or PH2 type hemorrhage based on Heidelberg Classification ▪ Hemorrhage resulting in neurologic deterioration Note: HI1 and HI2 type hemorrhages based on Heidelberg classification are not exclusionary.
- Participant and/or legally authorized representative is able to provide informed consent.
- Participant is willing and able to comply with the study protocol, in the Investigator's judgment.
What rules you out
- At screening, or with repeat imaging (see Inclusion 4 and 6), participant has imaging confirmed hemorrhagic stroke.
- Participant has a history of clinically significant allergic reactions such as angioedema or anaphylaxis requiring hospitalization.
- Participant has a diagnosis or suspected diagnosis of hereditary angioedema (HAE) or is taking or prescribed medications commonly used as prophylaxis/treatment of HAE, such as C1-esterase inhibitors (Cinryze, Berinert, Ruconest, Haegarda), Danazol, kallikrein inhibitors (Ecallantide, Berotralstat, Lanadelumab), Bradykinin B2 Receptor Antagonists (Icatibant), or other medication designed to influence the kallikrein-kinin system.
- Life expectancy estimated at ≤1 year prior to enrollment.
- Participant has clinical evidence of an active infection at the time of enrollment requiring parenteral treatment or hospitalization to monitor or manage the infection. NOTE: Treatment of uncomplicated infections with oral antibiotics would not be an exclusion (example treatment of an uncomplicated urinary tract infection or sinus infections with oral antibiotics would not be an exclusion).
- Participant has known alpha 1-antitrypsin deficiency (α1-antitrypsin deficiency).
- Participant is pregnant or nursing. NOTE: Participants who agree to stop nursing may be considered for inclusion at the discretion of the Investigator.
- Participants of child-bearing potential who do not agree to use medically acceptable contraceptive measures to prevent pregnancy. All participants of childbearing potential (defined as sexually mature participants who have had menses within the preceding 24 months and have not undergone permanent sterilization methods such as hysterectomy, bilateral oophorectomy, bilateral salpingectomy, etc.) must have a negative serum pregnancy test performed locally at screening. Participants of childbearing potential must agree not to attempt to become pregnant or undergo in vitro fertilization. If participating in sexual activity that could lead to pregnancy, participants must use 2 reliable methods (1 per partner is acceptable) of contraception simultaneously while receiving protocol-specified medication and during the study follow-up period. Participants participating in sexual activity must agree to use, or for their partner to use highly effective birth control methods (those with a failure rate of less than 1% per year when used consistently and correctly) until they have completed the study (after the Day 90 visit). Such methods include: • Combined (estrogen and progesterone containing) hormonal oral, intravaginal, or transdermal contraception associated with the inhibition of ovulation • Progesterone-only oral, injectable, or implantable hormonal contraception associated with the inhibition of ovulation • Intrauterine device (IUD) • Intrauterine hormone-releasing system (IUS) • Bilateral tubal occlusion • Vasectomized partner • Sexual abstinence Participants who are not of reproductive potential (who have been postmenopausal for more than 24 consecutive months or have undergone hysterectomy, bilateral oophorectomy) are not required to use contraception. Participants are prohibited from sperm donation. NOTE: A negative serum pregnancy test will be documented during screening if a participant is of child-bearing potential.
- Participant is currently participating in or has participated in a study using an investigational device or drug or received an investigational drug or investigational use of a licensed drug within 30 days prior to screening.
- Participant does not have sufficient venous access for infusion of investigational product or blood sampling.
- Participant is unable or unwilling to comply with protocol requirements, including assessments, tests, and follow-up visits.
- Participant has image findings with symptomatic large vessel occlusion at one or more of the following locations: Intracranial carotid I/T/L or M1 segment MCA, vertebral or basilar artery (BA).
- Participant has any other medical condition (such as hemodialysis) which in the opinion of the Investigator will make participation medically unsafe or interfere with the study results.
- Participant has large core of established infarction defined as ASPECTS 0-5.
- Participant has or will receive MT for their current AIS. Diagnostic angiogram without proceeding to MT is not exclusionary
- Participant has suspected or confirmed extracranial arterial dissection.
- Participant has imaging findings and symptoms consistent with a brain stem or cerebellar stroke. Posterior cerebral artery strokes without any associated brain stem or cerebellar involvement are allowable.
- Participant has 2 consecutive recorded measurements of SBP < 100 mm Hg or MAP <65 mm Hg; MAP = DBP + [1/3 (SBP – DBP)] after stroke symptom onset and within 6 hours prior to randomization.
- Participant is currently prescribed angiotensin-converting enzyme inhibitor (ACEi) and is unable or unwilling to convert to another antihypertensive pharmacological treatment through Day 29 ±1 day (8 days after last treatment).
- Participant is currently prescribed an ACEi, and the last reported dose by the participant or their representative: • was taken less than 24 hours prior to the start of IV IP infusion for participants with normal or mild kidney disease (CKD 1-3a [eGFR ≥ 45 mL/min/1.73 m²]), or • was taken less than 48 hours prior to the start of IV IP infusion for participants with significant kidney disease (CKD 3b or higher [eGFR < 45 mL/min/1.73 m²])
The study team makes the final eligibility decision.
Where it's taking place
- United Kingdom
- Georgia
- Canada
- United States
Questions & answers
Do participants get paid in this trial?
This listing doesn't specify compensation. Many trials still reimburse travel or offer a stipend, so it's worth asking the study team when you connect.
Is it free to join, and do I need insurance?
Searching and applying through BridgeMD is free. In clinical trials the study-related treatment and visits are generally provided at no cost to you. You usually don't need insurance to take part - confirm specifics with the study team.
How long does this study last?
The listing doesn't state an exact length. The study team walks you through the schedule and number of visits before you decide to enroll.
Who can join this trial?
This study is enrolling all sexes, 18-64 years, 65+ years. The study team makes the final eligibility decision.
Where is this trial taking place?
Study sites include United Kingdom; Georgia; Canada; United States. Enter your location above to see the nearest site and check your eligibility.
Explore other conditions
BridgeMD is an information and trial-matching tool - not medical advice, and not the study sponsor. Details come from EU CTIS; the study team decides eligibility.