Potassium-Competitive Acid Blocker Versus pROton-Pump Inhibitor for GastroproTECTion Strategies In Patients at High Gastro-Intestinal Bleeding Risk Receiving Antithrombotic Therapy

Launched by DUK-WOO PARK, MD · Jun 1, 2020

Keywords

ClinConnect Summary

This clinical trial is studying a new medication called tegoprazan, which is designed to protect the stomach from bleeding in patients at high risk, particularly those with heart-related conditions. The trial compares the effectiveness and safety of tegoprazan to a standard treatment called rabeprazole in people who are taking blood-thinning medications (antithrombotics) for various heart issues, such as coronary artery disease or a history of heart attacks. Researchers aim to see if tegoprazan is just as good as the standard treatment in preventing stomach problems over 12 months.

To be eligible for this trial, participants need to be at least 19 years old and have a known heart or blood vessel disease, while regularly taking blood-thinning medications. They should also have at least one risk factor for stomach bleeding, such as being over 65 years old, a history of stomach ulcers, or using certain pain medications. Participants will receive either the new medication or the standard treatment and will be monitored for any stomach-related issues over the year. It's important to note that anyone with recent active bleeding, certain severe health conditions, or other specific exclusions won't be able to join this study.

Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• • 1. Patients 19 years of age or older with known cardiac and vascular disease who are receiving chronic use of antithrombotic drugs (either antiplatelets, oral anticoagulant (OAC), and its combinations). Specific clinical conditions that may confer a need for long-term antithrombotic therapy may include documented coronary artery disease (stable or unstable angina, acute coronary syndrome, a history of myocardial infarction, or any coronary revascularization), documented cerebrovascular disease (stroke or transient ischemic attack), known peripheral arterial disease or a history of peripheral arterial revascularization, atrial fibrillation, or valvular heart disease requiring interventions (transcatheter aortic valve replacement or transcatheter mitral-valve repair). Concomitant use of a proton pump inhibitor is strongly recommended in patients receiving aspirin monotherapy, DAPT (dual antiplatelet therapy; aspirin plus any P2Y12 inhibitors), DAT (dual antithrombotic therapy; antiplatelet drug plus OAC), TAT (triple antithrombotic therapy; DAPT plus OAC), or OAC monotherapy (warfarin or direct oral anticoagulants) who are at high risk of GI bleeding in order to reduce the risk of gastric bleed or GI events. Based on clinical guidelines, the use of P2Y12 inhibitor monotherapy (i.e. clopidogrel, ticagrelor, or prasugrel) is not considered in trial enrollment.
• 2. On the basis of clinical guidelines and expert consensus documents, we defined a study population with an increased risk of gastrointestinal bleeding if they had a least 1 or more criteria of the following characteristics. Eligible patients for randomization must meet at least 1 characteristic of these criteria:
• • \*Definition of patients who are at high risk of gastrointestinal bleeding
• • 1. Age ≥65 years
• • 2. Concomitant use of OAC and any antiplatelet therapy (mono or DAPT) (i.e., DAT or TAT)
• • 3. Long-term use of oral NSAIDs (non-steroidal anti-inflammatory drugs) or steroids or high-dose NSAID therapy even during a relatively short-term period.
• • 4. History of prior GI bleeding events at any time
• • 5. History of a previously complicated ulcer
• • 6. History of peptic ulcer disease or a previously uncomplicated ulcer
• • 7. Documented Helicobacter pylori infection
• • 3. Patients who voluntarily participated in the written agreement
• Exclusion Criteria:
• • 1. Active bleeding at the time of inclusion or a history of hereditary or acquired hemostatic disorder
• • 2. Any clinical contraindication to using of antithrombotic therapies (antiplatelet agents or OAC)
• • 3. Concurrent use of PPI or P-CAB within 4 weeks before randomization
• • 4. Hemodynamically unstable conditions at the time of inclusion: cardiogenic shock at the time of randomization, refractory ventricular arrhythmias, or congestive heart failure (New York Heart Association class IV).
• • 5. Baseline severe anemia (Hgb \<8 g/dl at baseline) or transfusion within 4 weeks before randomization
• • 6. Baseline severe thrombocytopenia (platelet count \<50,000/mm3)
• • 7. Renal failure dependent on dialysis or severe renal insufficiency (creatinine clearance \<15 ml/min)
• • 8. Severe chronic liver disease (defined as variceal haemorrhage, ascites, hepatic encephalopathy, or jaundice)
• • 9. Hypersensitivity or contraindication to PPI, P-CAB, any of the product components, or substituted benzimidazoles
• • 10. Use of clarithromycin and hypersensitivity to macrolide antibiotics for Helicobacter pylori eradication
• • 11. Concomitant use of clarithromycin with terfenadine, cisapride, astemizole, or pimozide for Helicobacter pylori eradication
• • 12. Systemic treatment with strong CYP 3A4 and p-glycoprotein (P-GP) inhibitors (e.g., systemic azole antimycotics, such as ketoconazole, and human immunodeficiency virus \[HIV\]-protease inhibitors, such as ritonavir)
• • 13. Patients who take atazanavir, nelfinavir, or rilpivirine-containing products (see Drug-Drug interaction section)
• • 14. Clinically significant laboratory abnormality at screening (estimated glomerular filtration rate (eGFR) \<15 mL/min or elevated liver enzyme \[AST, ALT, ALP, total bilirubin\] \> 3 times upper normal limit \[UNL\] or any other condition that, in the opinion of the Investigator, precludes participation in the study
• • 15. Any known or suspected malignancy
• • 16. Patients with non-cardiac co-morbidities with a life expectancy of less than 12 months
• • 17. Patients with active treatment for H-pylori infection
• • 18. Women who are pregnant or breastfeeding or female subjects, premenopausal who are not surgically sterile, or, if sexually active not practicing an effective method of birth control (e.g., prescription oral contraceptives, contraceptive injections, intrauterine device, double-barrier method, contraceptive patch, male partner sterilization) before entry and throughout the study; and, for those of childbearing potential, who have a positive pregnancy test at screening
• • 19. Participation in another clinical study within 12 months. However, where at least one or more conditions are satisfied, it could be an exception according to an investigator's discretion;
• • 1. Participated in the observational study expected no effect on the safety and/or effectiveness evaluation of this trial
• • 2. Screening failed before any interventional factor is involved
• • 3. Participated in academic trials like strategic or medical device comparison studies conducted under standard therapy provided that there is no additional risk or a specific procedure to a subject and no interference between this trial and other studies