THERAPY TRIAL ESO CONFERENCE GLASGOW, SCOTLAND APRIL 17, 2015 J MOCCO 1, OSAMA ZAIDAT 2, RÜDIGER...
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Transcript of THERAPY TRIAL ESO CONFERENCE GLASGOW, SCOTLAND APRIL 17, 2015 J MOCCO 1, OSAMA ZAIDAT 2, RÜDIGER...
![Page 1: THERAPY TRIAL ESO CONFERENCE GLASGOW, SCOTLAND APRIL 17, 2015 J MOCCO 1, OSAMA ZAIDAT 2, RÜDIGER VON KUMMER 3, ALBERT YOO 4, RISHI GUPTA 5, DEMETRIUS LOPES.](https://reader034.fdocuments.in/reader034/viewer/2022051416/56649e305503460f94b21042/html5/thumbnails/1.jpg)
THERAPY TRIALESO CONFERENCEGLASGOW, SCOTLANDAPRIL 17, 2015
J MOCCO1, OSAMA ZAIDAT2, RÜDIGER VON KUMMER3, ALBERT YOO4, RISHI GUPTA5,
DEMETRIUS LOPES6, DON FREI7, POOJA KHATRI8
FOR THE PENUMBRA THERAPY TRIAL
INVESTIGATORS 1MOUNT SINAI HEALTH SYSTEM, NEW YORK, 2MEDICAL COLLEGE OF WISCONSIN, MILWAUKEE, WI,
3UNIVERSITÄTSKLINIKUM DRESDEN, DRESDEN, GERMANY, 4MASSACHUSETTS GENERAL HOSPITAL/HARVARD,
BOSTON, MA, 5WELLSTAR HEALTH SYSTEM, MARIETTA, GA, 6RUSH UNIVERSITY, CHICAGO, IL, 7SWEDISH
MEDICAL CENTER, DENVER, CO, 8UNIVERSITY OF CINCINNATI, CINCINNATI, OH.
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THERAPY Trial
Personal Disclosures
• NIH:• NIH 1U01NS086492-01 (CO-PI)• NIH 1R01NS078828-01A1 (CO-Inv)
• National/International PI/Co-PI:• COAST (Co-PI)• THERAPY (PI)• FEAT (PI)• LARGE (Co-PI)• POSITIVE (Co-PI)
• Steering Committee: MAPS• Consultant: Lazarus Effect, Medina, Pulsar, Edge Therapeutics• Investor: Blockade Medical, Medina Medical, Lazarus Effect• Advisory Board: Codman Neurovascular
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THERAPY Trial
Trial Disclosures
THERAPY funded by Penumbra, Inc.
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THERAPY Trial
THERAPY Background
THERAPY sought to evaluate the Penumbra System® in a population of LVO patients thought to be particularly at risk for poor outcome from IV tPA
Clot length > 8mm from thin-sliced NCCT
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THERAPY Trial
Study Design
Prospective, RCT, randomized 1:1Control: Monotherapy IV rtPA
Intervention: Combined IV rtPA + IA Penumbra System
692 patients to be enrolled at up to 75 centers
Powered by an expected 10.6% absolute difference in 90 day mRS 0-21, 2,
3
1.Bhatia R, Hill MD, Shobha N, et al. Low Rates of acute recanalization with intravenous recombinant tissue plasminogen activator in ischemic stroke: Real-world experience and a call for action. Stroke. 2010;41:2254-2258.
2.Tarr R, Hsu D, Kulcsar Z, et al. The POST Trial: Initial post-market experience of the Penumbra System. Revascularization of large vessel occlusion in acute ischemic stroke in the United States and Europe. J Neurointerv Surg. 2010;2:341-344.
3.Penumbra Pivotal Stroke Trial Investigators. The Penumbra Pivotal Stroke Trial: Safety and effectiveness of a new generation of mechanical devices for clot removal in intracranial large vessel occlusive disease. Stroke. 2009;40:2761-2768.
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THERAPY Trial
Study Design
Enrollment halted on October 29, 2014
108 patients enrolled
Trial halted by steering committee secondary to external evidence from MR CLEAN, EXTEND IA, and ESCAPE that indicated a lack of equipoise.
Not due to DSMB review of data for evaluation of stopping rules.
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THERAPY Trial
Patient presents with acute ischemic stroke from LVO within 4.5hrs from onset, treated
with IV rtPA
Informed Consent, Screened for eligibility, >8mm clot length from thin-sliced NCCT,
IA initiated within 5 hours, Randomized 1:1
Monotherapy IV rtPA
24 Hour and 7 Day/Discharge
30 Day Follow Up
90 Day Follow Up
Combined IV rtPA + IA Penumbra
24 Hour and 7 Day/Discharge
30 Day Follow Up
90 Day Follow Up
Study Design
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THERAPY Trial
Pre Specified Endpoints
Efficacy (ITT and PP)
PrimaryGood functional outcome at 90 days follow-up as defined by a mRS of 0-2
SecondaryOrdinal improvement in 90-day mRS
Good clinical outcome at 30 days post-procedure*
24-hour infarct volume
Safety
PrimaryIncidence of serious adverse events up to 90 days from enrollment
SecondaryMortality
Incidence of symptomatic and asymptomatic hemorrhage
Note: All primary and secondary efficacy endpoints pre-specified for both the intent-to-treat (ITT) population and per-protocol (PP) population.
*Good clinical outcome at 30 days post-procedure as defined by a 10 points or more improvement in the NIHSS at Discharge, NIHSS score or 0-1 at Discharge; or a 30-day mRS score of 0-2.
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THERAPY Trial
Blinded Core Lab Assessments
Imaging:• mTICI reperfusion scores• ASPECTS • MCA territory infarct size• Intracerebral hemorrhage (ICH)• Clot Length
Clinical Outcomes:• Video adjudication of Modified Rankin Score (mRS)
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THERAPY Trial
mRS Video Assessments• In-person visit recorded using study camcorder
• Standard interview questionnaire for data reliability
• Rankin Focused Assessment Tool (RFAT)1,2,3
• Independent blinded adjudication
• HIPAA compliant
1.Saver JL, Filip B, Hamilton S, et al. Improving the reliability of stroke disability grading in clinical trials and clinical practice: the Rankin Focused Assessment (RFA). Stroke. 2010;41:992-995.
2.Quinn TJ, McArthur K, Dawson J, Walters MR, Lees KR. Reliability of structured modified rankin scale assessment. Stroke. 2010;41:e602.
3.Quinn TJ, McArthur K, Dawson J, Walters MR, Lees KR. Reliability of structured modified rankin scale assessment. Stroke. 2010; 41:e603.
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THERAPY Trial
J Mocco, MD, MSMount Sinai Health System, USA
Pooja Khatri, MD, MScUniversity of Cincinnati, USA
Osama Zaidat, MD, MScMedical College of Wisconsin, USA
Prof. Dr. med. Rüdiger von Kummer
Universitätsklinikum Carl Gustav Carus Technical University of Dresden, Germany
Rishi Gupta, MD, MBAWellstar Health System, USA
Albert Yoo, MDImaging Core Lab
Massachusetts General Hospital, USA
Randy Edgell, MDUS mRS Adjudicator
The Univ of Texas HS Center, USA
Prof. Dr. med. E. Bernd Ringelstein
EU mRS AdjudicatorUniversity Hospital Münster, Germany
Academic Steering Committee Core Labs
Thanh Nguyen, MDBoston University, USA
Darren Orbach, MD, PhDBoston Children’s Hospital, USA
William Mack, MDUniversity of Southern California, USA
Scott Hamilton, PhDStanford University School
of Medicine, USA
CEC and DSMB
Trial Organization
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THERAPY Trial
US Centers EU Centers
Patients enrolled / planned sample size 108 / 692
Enrolling / Activated 36 / 48
Participating Centers
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THERAPY Trial
Inclusion Criteria
• 18 - 85 years of age
• IV tPA treated
• CTA confirmed Large Vessel Occlusion (LVO)
• Clot length > 8mm
• Anterior circulation (ICA, M1, M2)
• NIHSS > 8
• Signed informed consent
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THERAPY Trial
Exclusion Criteria• History of stroke in the past 3 months • Females who are pregnant• Pre-stroke mRS score >2• Known severe allergy to contrast media• Uncontrolled hypertension (systolic blood pressure >185 mmHg
or diastolic blood pressure >110 mmHg)
• CT evidence of the following conditions at randomization:• Significant mass effect with midline shift• Acute ischemic changes in >1/3 of the affected middle cerebral
artery territory • Evidence of intracranial hemorrhage
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THERAPY Trial
Exclusion Criteria
• Angiographic evidence of tandem extracranial occlusion or an arterial stenosis proximal to the occlusion that requires treatment prior to thrombus removal
• Angiographic evidence of preexisting arterial injury• Rapidly improving neurological status prior to randomization
• Bilateral stroke• Intracranial tumors• Known history of cerebral aneurysm or arteriovenous malformation
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THERAPY Trial
RESULTS
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THERAPY Trial
Allocation:Penumbra System + IV tPA (n=55)
90 Day Follow-Up
Final Evaluation n=50:
Final Evaluation not available n=5:
- Lost to follow-up* n=3
- Withdrew consent n=2
Allocation:IV tPA alone (n=53)
90 Day Follow-Up
Final Evaluation n=46:
Final Evaluation not available n=7:
- Lost to follow-up* n=5
- Withdrew consent n=2
Randomized(n=108)
*If there is no response after 3 failed attempts to contact the patient, the site mails a certified letter to the patient’s last known address.
Randomization and Follow-up
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THERAPY Trial
Baseline Characteristics: Demographics
Variable IA + IV IV Alone p-value
Age, mean (SD)
67.4 (11.4)
70.1 (10.3)
0.2257
Female38.2%(21/55)
56.6%(30/53)
0.0823
Admission NIHSS, median [IQR]
17[13,22]
18 [14,22]
0.4254
Glucose mg/dL, median [IQR]
110.5 [99.0,151.0]
116.0 [103.0,133.0]
0.9305
Systolic BP mmHg, mean (SD)
148.2 (22.3)
150.4 (19.1)
0.4664
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THERAPY Trial
Baseline Characteristics: Medical History
CharacteristicsIA + IV(N=55)
IV Alone(N=53)
p-value
Previous stroke 9.6% 7.5% 0.7415Previous transient ischemic attack (TIA)
6.1% 3.8% 0.6692
Myocardial infarction 8.0% 1.9% 0.1964Angina/CAD 29.1% 15.1% 0.1058Hypertension 77.8% 78.8% 1.0CHF (congestive heart failure) 13.2% 7.7% 0.5260Dyslipidemia 43.4% 49.0% 0.6942Diabetes 32.1% 37.3% 0.6810Atrial fibrillation 30.9% 49.1% 0.0765Peripheral artery disease 2.0% 3.8% 1.0Extracranial cerebral artery disease
8.3% 11.5% 0.7429
Current or former smoker 59.6% 38.8% 0.0655
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THERAPY Trial
ASPECTS, median (IQR)
7.5 [6.0,9.0]
8.0 [7.0,9.0]
0.4867
0 to 4 11.1%(6/54)
7.5%(4/53)
0.7140 5 to 7 38.9%(21/54)
35.8%(19/53)
8 to 10 50.0%(27/54)
56.6%(30/53)
Clot length, median (IQR)
12.9 [9.4,22.2]
14.1 [10.1,18.6]
0.8925
Characteristica IA + IV IV Alone p-value
Location of stroke: Left hemisphere 60.0%(33/55)
58.5% (31/53) 1.0
Site of primary occlusion
Intracranial ICA 32.7%(18/55)
22.6%(12/53)
0.4365 MCA M1 56.4%(31/55)
67.9%(36/53)
MCA M2 10.9%(6/55)
9.4%(5/53)
a As adjudicated by the core laboratory; imaging ASPECTS not available for 1 subject
Imaging Characteristics
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THERAPY Trial
Onset to Groin Puncture
CT to Groin Puncture
Onset to Randomization
Onset to IV tPA
Onset to ED
0 50 100 150 200 250
IA+IV IV Alone
64 [40,133] a
57 [30,118] a
108 [86,138] a
102 [80,154] a
181 [129,221] a
123 [80,166] a
226 [184,263] a
169 [132,224] a
Key Time Metrics (minutes)
a Median [IQR] b Initial protocol allowed up to 8 hours, protocol revision for up to 5 hours (6.5% were > 5 hours)
b
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THERAPY Trial
Devices Used
Separator: 54%
Separator 3D: 25%
Ace: 27%
Ace64: 0%
Other: 13%
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THERAPY Trial
0 1 2a 2b 30%
10%
20%
30%
40%
50%
60%
7% 7%
16%
51%
19%
mTICI after Penumbra System
mTICI Score IA + IV
mTICI 2/3 after Penumbra System®
86%
mTICI 2b/3 after Penumbra System
70%
Final mTICI 2b/3 after additional treatment
73%
Patients with additional treatmenta
13%
a Use of Solitaire or Trevo in 7 patients
Pat
ien
ts (
%)
Core Lab Assessed Reperfusion Results
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THERAPY Trial
SAFETY OUTCOME
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THERAPY Trial
Safety Outcomes: As TreatedOutcome IA + IV IV Alone p-value
Primary Endpoint:
Serious Adverse Event at 90 days 42%(18/43)
48%(30/62)
0.55
Pre-Specified Secondary Endpoints:
Mortality at 90 days (ITT) 12.0%(6/50)
23.9%(11/46)
0.1811
Symptomatic ICH - Core Lab with ≥ 4 point change in NIHSS
9.3%(4/43)
9.7%(6/62)
1.0
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THERAPY Trial
INTENT TO TREAT EFFICACY: PRE-SPECIFIED
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THERAPY Trial
Efficacy Outcomes: Intent to TreatOutcome IA + IV IV Alone p-value
Primary Endpoint: mRS 0-2 at 90 days 38%
(19/50)30%(14/46)
0.44
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THERAPY Trial
Efficacy Outcomes: Intent to TreatOutcome IA + IV IV Alone p-value
Primary Endpoint: mRS 0-2 at 90 days 38.0%
(19/50)30.4%(14/46)
0.5206
Pre-Specified Secondary Endpoint: Ordinal mRS
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THERAPY Trial
Efficacy Outcomes: Intent to TreatOutcome IA + IV IV Alone p-value
Primary Endpoint: mRS 0-2 at 90 days 38.0%
(19/50)30.4%(14/46)
0.5206
Pre-specified Secondary Endpoint:
Good outcome at 30 daysa 45.3%(24/53)
32.1%(17/53)
0.2313
Additional Outcomes:
mRS 0-1 at 90 days 26.0%(13/50)
15.2%(7/46)
0.2182
NIHSS improvement at 24 hours, median [IQR]
6.0[-3.0,11.0]
1.0[-1.0,9.0]
0.3036
NIHSS 0 to 2 at 90 days 40.9%(18/44)
29.5%(13/44)
0.3722
a. Good clinical outcome at 30 days post-procedure as defined by a 10 points or more improvement in the NIHSS at Discharge, NIHSS score or 0-1 at Discharge; or a 30-day mRS score of 0-2.
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THERAPY Trial
PER-PROTOCOL EFFICACY:PRE-SPECIFIED
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THERAPY Trial
Per-Protocol Enrollment
Allocation:Penumbra System + IV tPA (n=55)
Per-Protocol Enrollment n=43
Excluded from Per-Protocol analysis n=12
- Stenosis proximal to occlusion that requires treatment prior to thrombus removal (n=5)
- Infarct > 1/3 MCA territory (n=5)
- Pre-existing neurologic deficit (n=1)
- Clot length < 8mm (n=1)
90 Day Follow-Up
Final endpoint data available n=41
Final endpoint data not available n=2
- Lost to follow-up n=2
Allocation:IV tPA alone (n=53)
Per-Protocol Enrollment n=47
Excluded from Per-Protocol analysis n=6
- Stenosis proximal to occlusion that requires treatment prior to thrombus removal (n=1)
- Infarct > 1/3 MCA territory (n=4)
- Pre-existing neurologic deficit (n=1)
90 Day Follow-Up
Final endpoint data available n=41
Final endpoint data not available n=6
- Lost to follow-up n=4
- Withdrew consent n=2
Randomized(n=108)
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THERAPY Trial
Efficacy Outcomes: Per-Protocol Outcome IA + IV IV Alone p-value
Primary Endpoint:
mRS 0-2 at 90 days 41.5%(17/41)
29.3%(12/41)
0.3557
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THERAPY Trial
Efficacy Outcomes: Per-Protocol
Pre-Specified Secondary Endpoint: Ordinal mRS
Outcome IA + IV IV Alone p-value
Primary Endpoint:
mRS 0-2 at 90 days 41.5%(17/41)
29.3%(12/41)
0.3557
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THERAPY Trial
Efficacy Outcomes: Per-Protocol Outcome IA + IV IV Alone p-value
Primary Endpoint:
mRS 0-2 at 90 days 41.5%(17/41)
29.3%(12/41)
0.3557
Pre-Specified Secondary Endpoint:
Good outcome at 30 daysa 51.2%(22/43)
34.0%(16/47)
0.1352
Additional Outcomes:
mRS 0-1 at 90 days 29.3%(12/41)
14.6%(6/41)
0.1813
NIHSS improvement at 24 hours, median [IQR]
6.0 [-2.0,10.5]
1.0 [-2.0,9.0]
0.2359
NIHSS 0 to 2 at 90 days 47.2%(17/36)
30.0%(12/40)
0.1580
a. Good clinical outcome at 30 days post-procedure as defined by a 10 points or more improvement in the NIHSS at Discharge, NIHSS score or 0-1 at Discharge; or a 30-day mRS score of 0-2.
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THERAPY Trial
Discussion
Early termination secondary to MR CLEAN, ESCAPE, EXTEND-IA severely limits data interpretation
Natural imbalances occur in small cohorts
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THERAPY Trial
Discussion
Early termination secondary to MR CLEAN, ESCAPE, EXTEND-IA severely limits data interpretation
Natural imbalances occur in small cohorts
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THERAPY Trial
Discussion
Early termination secondary to MR CLEAN, ESCAPE, EXTEND-IA severely limits data interpretation
Natural imbalances occur in small cohorts
Pre-specified Secondary Outcome:Multivariable adjusted ordinal analysis
ITT: OR 2.4, 95% CI 1.1,5.1; p-value=0.02
PP: OR 2.4, 95%CI: 1.1,5.8; p-value=0.03
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THERAPY Trial
Discussion
THERAPY used unique selection criteria
Impact is difficult to asses across this small population
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THERAPY Trial
Discussion
StudySymptomatic ICH
IA + IVSymptomatic ICH
IV Alone
ESCAPE (n=315) 3.6% 2.7%
SWIFT-PRIME (n=196) 1% 3.1%
EXTEND IA (n=70) 0% 6%
MR CLEAN (n=500) 7.7% 6.4%
THERAPY (n=108) 10.9% 11.3%
THERAPY used unique selection criteria
Impact is difficult to asses across this small population
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THERAPY Trial
Discussion
StudySymptomatic ICH
IA + IVSymptomatic ICH
IV Alone
ESCAPE (n=315) 3.6% 2.7%
SWIFT-PRIME (n=196) 1% 3.1%
EXTEND IA (n=70) 0% 6%
MR CLEAN (n=500) 7.7% 6.4%
THERAPY (n=108) 10.9% 11.3%
THERAPY used unique selection criteria
Impact is difficult to asses across this small population
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THERAPY Trial
Discussion
StudySymptomatic ICH
IA + IVSymptomatic ICH
IV Alone
ESCAPE (n=315) 3.6% 2.7%
SWIFT-PRIME (n=196) 1% 3.1%
EXTEND IA (n=70) 0% 6%
MR CLEAN (n=500) 7.7% 6.4%
THERAPY (n=108) 10.9% 11.3%
THERAPY used unique selection criteria
Impact is difficult to asses across this small population
THERAPY using Swift Prime Definition 2.3%4.8%
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THERAPY Trial
Discussion
However, despite being underpowered THERAPY demonstrates consistent suggestion of superiority for the endovascular arm
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THERAPY Trial
Discussion
Pre-specified PP analysis of ordinal mRS OR 2.25 95% CI (1.0, 5.0) p-value=0.047
Pre-specified adjusted ITT analysis of ordinal mRS OR 2.4 95% CI (1.1, 5.1) p-value=0.02
Pre-specified adjusted PP analysis of ordinal mRS OR 2.4 95% CI (1.1, 5.8) p-value=0.03
Data demonstrate an effect size indicating benefit for the endovascular arm across all measured parameters
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THERAPY Trial
Internal Validity: general trend in dataIA BetterIA Worse
Prespecified Primary and Secondary Endpoints
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THERAPY Trial
External Validity
THERAPY’s relative effect size is consistent with MR CLEAN and other
recent early-terminated trials
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THERAPY Trial
Endovascular Trials: Mortality (ITT)
ESCAPE
SWIF
T PRIM
E
EXTEND-IA
REVASCAT
MR C
LEAN
THERAPY0%
5%
10%
15%
20%
25%
30%
10% 9% 9%
18% 19%
12%
19%
12%
20%
16%18%
24%
IA+IV IV Alonea ESCAPE adjusted analysis p<0.05
a
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THERAPY Trial
Endovascular Trials: Mortality (ITT)
ESCAPE
SWIF
T PRIM
E
EXTEND-IA
REVASCAT
MR C
LEAN
THERAPY0%
5%
10%
15%
20%
25%
30%
10% 9% 9%
18% 19%
12%
19%
12%
20%
16%18%
24%
IA+IV IV Alonea ESCAPE adjusted analysis p<0.05
a
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THERAPY Trial
Endovascular Trials: Ordinal mRSIA BetterIA Worse
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THERAPY Trial
Endovascular Trials: Ordinal mRSIA BetterIA Worse
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THERAPY Trial
Endovascular Trials: Ordinal mRSIA BetterIA Worse
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THERAPY Trial
Conclusion
While limited due to small sample size following early termination, THERAPY demonstrates a consistent direction towards benefit across all outcome measures and an effect size comparable with current modern thrombectomy trials
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THERAPY Trial
Enrolling CentersSite Investigator
Rush UniversitySwedish Medical CenterCentral DuPage HospitalUniversity of CincinnatiKaiser Los AngelesSt. Joseph's Regional Medical CenterRiverside Methodist HospitalVanderbiltSunrise Hospital and Medical CenterSt. Joseph’s BNIErlanger Health System Lutheran Medical CenterMedical College of WisconsinUniversity of Chicago Medical CenterMiami ValleyJackson Memorial HospitalCedars-SinaiThe Valley HospitalMethodist HospitalForsyth Medical CenterSparrow HospitalJFK Medical CenterAlexian BrothersHoly CrossWellStar Research InstituteShands at University of FloridaAbbott NorthwesternUCSDKaleida HealthGrady Memorial HospitalLehigh Valley HospitalStony Brook Medical Center
Demetrius LopesDon FreiHarish ShownkeenAaron GrossmanZahra A. AjaniDorothea AltschulRon BudzikJ.MoccoLindsey BlakeCameron McDougallBlaise BaxterJeffrey FarkasBrian Fred FitzsimmonsSeon Kyu LeeJohn TerryDileep YavagalMichael AlexanderDorothea AltschulDavid ChiuDon HeckSyed HussainJawad KirmaniTim MalischLaszlo MiskolcziRishi GuptaSpiros BlackburnJosser DelgadoAlexander KhalessiElad LevyRaul NogueiraChristian SchumacherHenry Woo
Site Investigator
Universitätsklinikum DresdenUniversitätsmedizin GöttingenUniversitätsklinikum AachenCharité Berlin
Rüdiger von KummerMichael KnauthMartin WiesmannChristian Nolte
United States Europe
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THERAPY Trial
THANK YOU
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THERAPY Trial
ASPECTS AnalysisCore Lab Determined (ITT)
VariableIA + IV
Day 90 mRS 0-2IV Alone
Day 90 mRS 0-2p-value*
ASPECTS 0 to 4 0% (0/4)
33.3% (1/3)
0.2514
ASPECTS 5 to 1042.2%
(19/45)
30.2% (13/43)
*p-value from logistic regression treatment interaction**IA+IV group unable to read ASPECTS in 1 subject
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THERAPY Trial
mTICIaIA + IV
Day 90 mRS 0-2p-value
mTICI 0 to 2a after Penumbra System
9%
0.0668
mTICI 2b to 3 after Penumbra System
42%
a As adjudicated by the core laboratory
Exploratory Analysis: mTICI and Outcome (ITT)
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THERAPY Trial
GroupIA + IV
Day 90 mRS 0-2N = 50
IV AloneDay 90 mRS 0-2
N = 46p-valuea
Age< 65 41.2% (7/17) 45.5% (5/11) 0.3101≥ 65 36.4% (12/33) 25.7% (9/35)
NIHSS< 20 32.3% (10/31) 38.5% (10/26) 0.1793≥ 20 47.4% (9/19) 20.0% (4/20)
Occlusion LocationICA 26.7% (4/15) 10.0% (1/10) 0.4946 M1 34.5% (10/29) 33.3% (11/33) M2 83.3% (5/6) 66.7% (2/3)
Geographic LocationUS 36.4% (16/44) 27.9% (12/43) 0.9958Europe 50.0% (3/6) 66.7% (2/3)
a p-value from logistic regression treatment interaction
Pre-specified Subgroups (ITT)
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THERAPY Trial
Intracranial ICA occlusion percentage
StudyIntracranial ICA
IA + IVIntracranial ICA
IV Alone
ESCAPE (n=315) 27.6% (with M1) 26.5% (with M1)
SWIFT-PRIME (n=196) 18.3% 16%
EXTEND IA (n=70) 31% 31%
MR CLEAN (n=500) 25.7% (with/without M1) 29.3% (with/without M1)
THERAPY (n=108) 32.7% 22.6%
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THERAPY Trial
IA + IV
IV Alone
0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 100.0%
6.0%
2.2%
20.0%
13.0%
12.0%
15.2%
16.0%
15.2%
30.0%
21.7%
4.0%
8.7%
12.0%
23.9%
mRS 0 mRS 1 mRS 2 mRS 3 mRS 4 mRS 5 mRS 6
a OR 1.76 (95% CI: 0.86 to 3.59)
mRS at 90 days
Pre-specified Endpoint: Ordinal mRS (ITT)
a
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THERAPY Trial
IA + IV
IV Alone
0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 100.0%
7.3%
2.4%
22.0%
12.2%
12.2%
14.6%
19.5%
17.1%
26.8%
19.5%
4.9%
9.8%
7.3%
24.4%
a 2.28 OR 95% CI (1.05, 4.96) p value = 0.0384
mRS 0 mRS 1 mRS 2 mRS 3 mRS 4 mRS 5 mRS 6
Pre-specified Endpoint: Ordinal mRS (PP)
a
mRS at 90 days