Effects and Mechanisms of Celecoxib on Intracerebral Hemorrhage

National Taiwan University

Status and phase

Enrolling

Phase 2

Conditions

Intracerebral Hemorrhage

Treatments

Drug: Celecoxib 200mg

Study type

Interventional

Funder types

Other

Identifiers

NCT05434065

202112193MINB

Details and patient eligibility

About

This trial is a phase IIa human clinical study, in which 60 patients with intracerebral hemorrhage (ICH) at basal ganglion or thalamus within 6 h after onset will be enrolled. Patients will be randomly assigned as treatment group or control group as 1:1 distribution. Early initiation of celecoxib within 6 h after ICH and treatment for 21 days will be performed. The safety will be evaluated by drug adverse effects. The efficacy will be assessed by hematoma expansion, brain edema, and 3-month modified Rankin scale.

Full description

A phase IIa human clinical trial will be performed to clarify the safety and efficacy of using usual dose of celecoxib (200 mg/day) for 21 days starting within 6 hours after onset of ICH. Totally 60 patients will be enrolled prospectively, and the case number was estimated by statistical methods for the percentage of participants with increased perihematomal edema volume shown in the previous clinical trial (Lee et al., 2013) (estimated by G-power software, settings as: exact test, one sample test, α = 0.05, power = 0.95). Patients will be randomly assigned as treatment group or control group as 1:1 distribution.

Intervention: Celecoxib 200 mg per dose, started within 6 h after onset, then one dose per day for 21 days in the treatment group. The low dose of Celecoxib will be used to minimize the side effect of Celecoxib. No trial medication will be given for the control group. Pregnancy will be excluded at enrollment and prevented throughout the treatment period in female cases at reproductive ages.

Evaluations:

Brain CT:
1. Initial brain CT: for initial hematoma volume (length * width * height /2)
2. Brain CT on day 2 for final hematoma volume and hematoma expansion
3. Brain CT on day 7±1 for perihematomal edema and hematoma resolution
Neurological functions: NIHSS score, GCS score, modified Rankin scale (mRS) on day 1, 2, 7±2, 14±2, 21±2, and mRS at 3 months
Renal function (creatinine) on day 1, then once per week during day 2-7, day 8-14 and 15-21
Gastrointestinal bleeding evens within 21 days
Myocardial infarction evens within 21 days
Blood sampling on day 1, 7±2, and 21±2

Patient enrollment: If the patient's consciousness is not clear before the enrollment of this study, his (her) family can decide the enrollment for this patient. Once the patient regains his (her) consciousness, we will reconfirm with the patient about the enrollment of this study.

Data checks: The data recorded of this study will be double-checked for their accuracy and compared with predefined ranges to avoid typing error.

Plan for missing data: Missing data include those data which are reported as missing, unavailable, uninterpretable, or considered missing because of data inconsistency or out-of-range results. This study will try to minimize missing data by limiting the collection of data to essential information and minimizing the number of follow-up visits, develop a documentation of this study for the methods to screen the participants and the procedures to follow up, appropriate training for all personnel related to this study, and data will be reviewed as close to real-time as possible.

Statistical analysis plan: The continuous variables between Celecoxib group and control group will be compared using Mann-Whitney U test if these data are not with normal distribution, or t-test if these data are with normal distribution. Categorical data will be compared using Fisher's exact test.

Enrollment

60 estimated patients

Sex

All

Ages

20 to 80 years old

Volunteers

No Healthy Volunteers

Inclusion criteria

Acute ICH patients able to take the first dose within 6 hours after onset
ICH location at basal ganglion or thalamus
ICH volume < 30 mL
Normal renal function (creatinine [Cr] ≤ 1.3 mg/dL)
No surgical indication
Signed informed consent
Consciousness clear or mild drowsiness
Age 20-80 years old

Exclusion criteria

Allergy to celecoxib or other non-steroid anti-inflammatory drugs (NSAIDs)
Post-coronary artery bypass graft (CABG) within 14 days
Previous myocardial infarction
Previous peptic ulcer disease
Abnormal renal function (Cr > 1.3 mg/dL)
Surgery for this ICH
Pregnancy or under breast feeding (If the female case is not sure about pregnancy, pregnancy test will be performed)
Premorbid mRS > or = 3
Previous ICH not at basal ganglia or thalamus
Coagulation abnormality (abnormal PT/PTT), or taking anticoagulant or antiplatelet
Abnormal liver function (ALT > 3x upper limit)
History of severe bleeding event, requiring admission or blood transfusion
History of stenting or valve replacement, requiring long-term using antithrombotics