1. REACT: a randomized trial to assess the efficacy and safety of clazosentan for preventing clinical deterioration due to delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage
- Author
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Mayer, S, Bruder, N, Citerio, G, Defreyne, L, Dubois, C, Gupta, R, Higashida, R, Marr, A, Nguyen, T, Roux, S, Smrčka, M, Torné, R, Aldrich, E, Mayer, Stephan A, Bruder, Nicolas, Citerio, Giuseppe, Defreyne, Luc, Dubois, Cecile, Gupta, Rajiv, Higashida, Randall, Marr, Angelina, Nguyen, Thanh N, Roux, Sébastien, Smrčka, Martin, Torné, Ramon Torné, Aldrich, E François, Mayer, S, Bruder, N, Citerio, G, Defreyne, L, Dubois, C, Gupta, R, Higashida, R, Marr, A, Nguyen, T, Roux, S, Smrčka, M, Torné, R, Aldrich, E, Mayer, Stephan A, Bruder, Nicolas, Citerio, Giuseppe, Defreyne, Luc, Dubois, Cecile, Gupta, Rajiv, Higashida, Randall, Marr, Angelina, Nguyen, Thanh N, Roux, Sébastien, Smrčka, Martin, Torné, Ramon Torné, and Aldrich, E François
- Abstract
Objective: Ischemic complications account for significant patient morbidity following aneurysmal subarachnoid hemorrhage (aSAH). The Prevention and Treatment of Vasospasm with Clazosentan (REACT) study was designed to assess the safety and efficacy of clazosentan, an endothelin receptor antagonist, in preventing clinical deterioration due to delayed cerebral ischemia (DCI) in patients with aSAH. Methods: REACT was a prospective, multicenter, randomized, double-blind, phase 3 study. Eligible patients had aSAH secured by surgical clipping or endovascular coiling, and had presented with thick and diffuse clot on admission CT scan. Patients were randomized (1:1 ratio) to 15 mg/hour intravenous clazosentan or placebo within 96 hours of the aSAH for up to 14 days, in addition to standard of care treatment including oral or intravenous nimodipine. The primary efficacy endpoint was the occurrence of clinical deterioration due to DCI up to 14 days after initiation of the study drug. The main secondary endpoint was the occurrence of clinically relevant cerebral infarction at day 16 after study drug initiation. Other secondary endpoints included clinical outcome assessed on the modified Rankin Scale (mRS) and the Glasgow Outcome Scale-Extended (GOSE) at week 12 post-aSAH. Imaging and clinical endpoints were centrally adjudicated. Results: A total of 409 patients were randomized between February 2019 and May 2022 across 74 international sites. Three patients did not start study treatment and were not included in the analysis set. The occurrence of clinical deterioration due to DCI was 15.8% (32/202 patients) in the clazosentan group and 17.2% (35/204 patients) in the placebo group, and the difference was not statistically significant (relative risk reduction [RRR] 7.2%, 95% CI -42.6% to 39.6%, p = 0.734). A nonsignificant RRR of 34.1% (95% CI -21.3% to 64.2%, p = 0.177) was observed in clinically relevant cerebral infarcts treated with clazosentan (7.4%, 15/202) versus placebo
- Published
- 2024