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Clopidogrel

Phase 3

Acute Coronary Disease | Small molecule | Cardiovascular |Sanofi|Last Updated: Jun 15, 2015

Target and mechanism

ModalitySmall molecule

Also known as Clopidogrel (SR25990), clopidogrel (SR25990C), clopidogrel (SR25990)

Success Probability

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Market & Valuation

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Trial Design

RandomizedDouble-BlindACTIVE_CONTROLLEDDMC
Total Trials1
Total Enrollment25,086

FDA Designations

No designations recorded

Clinical trial landscape

Clopidogrel · 20 trials · 18 indications

Phase 3 11Phase 2 2Phase 1 7
NCT00862420Safety Evaluation of Clopidogrel Sulfate in Patients With Peripheral Arterial DiseasePeripheral Arterial Disease (PAD)
COMPLETED431 Analytics
NCT00833703Long Term Safety of Clopidogrel in Neonates/Infants With Systemic to Pulmonary Artery Shunt PalliationHeart Defects, Congenital
COMPLETED49 Analytics
NCT00821834Safety Evaluation of Clopidogrel Sulfate in Patients With Stable Angina/Old Myocardial Infarction to Whom Percutaneous Coronary Intervention is Being PlannedStable Angina
COMPLETED1,003 Analytics
NCT00396877Efficacy And Safety Of Clopidogrel In Neonates /Infants With Systemic To Pulmonary Artery Shunt PalliationHeart Defects, Congenital
COMPLETED906 Analytics
NCT00335452Clopidogrel Optimal Loading Dose Usage to Reduce Recurrent EveNTs/Optimal Antiplatelet Strategy for InterventionSAcute Coronary Disease
COMPLETED25,086 Analytics
NCT00174759CASPAR : Clopidogrel and Acetyl Salicylic Acid in Bypass Surgery for Peripheral ARterial DiseaseArterial Occlusive Diseases
COMPLETED1,460 Analytics
NCT00325390Efficacy and Safety in Patients With Acute Coronary Syndrome Without ST-Segment ElevationPlatelet Aggregation Inhibitors
COMPLETED800 Analytics
NCT00716924CASTLE (Clopidogrel And Serum Troponin Level Elevation)Thrombosis
COMPLETED155 Analytics
NCT00249873Atrial Fibrillation Clopidogrel Trial With Irbesartan for Prevention of Vascular Events (ACTIVE A)Atrial Fibrillation
COMPLETED7,554 Analytics
NCT00714961Clopidogrel as Adjunctive Reperfusion Therapy - Thrombolysis in Myocardial InfarctionAcute Coronary Syndromes
COMPLETED3,491 Analytics
PHASE3COMPLETED
Safety Evaluation of Clopidogrel Sulfate in Patients With Peripheral Arterial Disease
Peripheral Arterial Disease (PAD)Unlock trial analytics
PHASE3COMPLETED
Long Term Safety of Clopidogrel in Neonates/Infants With Systemic to Pulmonary Artery Shunt Palliation
Heart Defects, CongenitalUnlock trial analytics
PHASE3COMPLETED
Safety Evaluation of Clopidogrel Sulfate in Patients With Stable Angina/Old Myocardial Infarction to Whom Percutaneous Coronary Intervention is Being Planned
Stable AnginaUnlock trial analytics
PHASE3COMPLETED
Efficacy And Safety Of Clopidogrel In Neonates /Infants With Systemic To Pulmonary Artery Shunt Palliation
Heart Defects, CongenitalUnlock trial analytics
PHASE3COMPLETED
Clopidogrel Optimal Loading Dose Usage to Reduce Recurrent EveNTs/Optimal Antiplatelet Strategy for InterventionS
Acute Coronary DiseaseUnlock trial analytics
PHASE3COMPLETED
CASPAR : Clopidogrel and Acetyl Salicylic Acid in Bypass Surgery for Peripheral ARterial Disease
Arterial Occlusive DiseasesUnlock trial analytics
PHASE3COMPLETED
Efficacy and Safety in Patients With Acute Coronary Syndrome Without ST-Segment Elevation
Platelet Aggregation InhibitorsUnlock trial analytics
PHASE3COMPLETED
CASTLE (Clopidogrel And Serum Troponin Level Elevation)
ThrombosisUnlock trial analytics
PHASE3COMPLETED
Atrial Fibrillation Clopidogrel Trial With Irbesartan for Prevention of Vascular Events (ACTIVE A)
Atrial FibrillationUnlock trial analytics
PHASE3COMPLETED
Clopidogrel as Adjunctive Reperfusion Therapy - Thrombolysis in Myocardial Infarction
Acute Coronary SyndromesUnlock trial analytics

Study Endpoints

Primary Endpoints

Safety events of interest including clinical significant bleeding, blood disorders, hepatic dysfunction and other serious adverse drug reactions (death, hospitalization...)
Week 12 (on treatment)
Number of Participants With Bleeding Events
Up to a maximum of 6 months

All bleeding events experienced during the study period were collected as for any Adverse Event. The 'on-treatment' period was defined as the period from inclusion in the extension study up to 28 days after treatment discontinuation, and participants who experienced bleeding events during that period were counted.

Number of Participants According to Bleeding Type/Etiology
Up to a maximum of 6 months

For all reported bleeding events, the type and the etiology of the bleeding event were collected. Participants who experienced bleeding events during the 'on-treatment period' were counted by bleeding type and etiology.

Time from randomization to first safety events of interest
12 Weeks (duble blind treatment period)

Safety events of interest were: * Clinically significant bleeding, * Leukopenia, neutropenia or thrombocytopenia occurring as adverse drug reaction, * Elevated liver function values occurring as adverse drug reaction, * Permanent investigational product discontinuation due to skin disorders, gastrointestinal disorders, bleeding, hepatic disorders, or significant decreases in such tests as leukocytes, neutrophils or platelets occurring as adverse drug reaction.

Number of Participants Reaching Primary Endpoint Criteria (First Occurrence of Death / Shunt Thrombosis / Cardiac Procedure < 120 Days Considered of Thrombotic Nature)
Median follow-up of 5.8 months (up to a maximum of 12 months after randomization)

The primary endpoint was the first occurence of any of the following events: Death (including heart transplant); Shunt thrombosis requiring intervention; Hospitalization for bi-directional Glenn procedure or any cardiac related intervention prior to 120 days of age following an event or a shunt narrowing considered to be of thrombotic nature by the blinded adjudication committee. Only the first event was counted.

First Occurrence of CV Death / MI / Stroke - Clopidogrel Treatment Regimen Comparison
30 days

The primary endpoint is the first occurrence of any of the following events: * Cardiovascular death (any death with a clear cardiovascular or unknown cause), * Myocardial Infarction (diagnosis of new Myocardial Infarction (MI) - nonfatal or fatal) * Stroke (presence of a new focal neurologic deficit thought to be vascular in origin, with signs or symptoms lasting more than 24 hours - nonfatal or fatal) reported between the randomization and Day 30 (inclusive), and validated by the blinded Event Adjudication Committee (EAC).

First Occurrence of CV Death / MI / Stroke - ASA Dose Comparison
30 days
First Occurrence of CV Death / MI / Stroke - Interaction Clopidogrel Treatment Regimen and ASA Dose Level
30 days
First Occurrence of CV Death / MI / Stroke - Clopidogrel Treatment Regimen Comparison in PCI Subgroup
30 days
1st occurrence over the duration of follow-up of : index bypass graft occlusion based on imaging procedure, or graft replacement or endovascular intervention, or amputation above the ankle of the affected limb or death
Incidence of effficacy and safety events
Incidence of post-percutaneous coronary intervention elevation of troponin T.
At 6 and 12 months post-PCI
First Occurence of Any Component of the Composite of Stroke, Non-Central Nervous System (Non-CNS) Systemic Embolism, Myocardial Infarction or Vascular Death as Per Adjudication
expected median follow-up of approximately 3 years

The primary event is the first occurence of any adjudicated component of the following cluster over the duration of follow-up : * stroke (nonfatal or fatal) * myocardial infarction (nonfatal or fatal) * non-CNS systemic embolism * vascular death The primary efficacy analysis is performed on the time from randomization to this primary event. Numbers of patients with the composite event over the duration of the follow-up are presented by arm group.

efficacy: composite of an included infarct-related artery on the pre-discharge angiogram, or death or recurrent MI by the time of the start of coronary angiography
safety: TIMI major bleeding
Occurrence of myocardial infarction,stroke or cardiovascular death.
Maximum intensity of platelet aggregation induced by ADP 5 µmol/L.
Percent inhibition of maximum extent and rate of aggregation of 5 µM ADP-induced platelet aggregation
Maximum platelet aggregation intensity (MAI) induced by Adenosine diphosphate (ADP) 5µM after 5 days treatment
Day 5 of each period
Clopidogrel active metabolite pharmacokinetic parameters (maximum plasma concentration (Cmax) and area under the plasma concentration curve (AUC0-24)) after 5 days treatment
Up to 24 hours postdose on Day 5 of each period
Maximum platelet aggregation intensity (MAI) induced by Adenosine diphosphate (ADP) 5 µM after 5 days treatment
Day 5 of each period
Clopidogrel pharmacokinetic parameters (Maximum plasma concentration (Cmax), Area under the plasma concentration curve (AUClast and AUC))
Up to 48 hours postdose for each period
Clopidogrel active metabolite pharmacokinetic parameters (Cmax, AUClast and AUC)
Up to 48 hours postdose for each period

Secondary Endpoints

Bleeding adverse events, Serious adverse events, Overall safety
Week 12, 52 (on treatment)
Vascular events
Week 12, 52 (on study)
Safety events of interest (see above)
Week 52 (on treatment)
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Study Design & Arms

AllocationRANDOMIZED
MaskingQUADRUPLE
ModelPARALLEL
PurposePREVENTION

Treatment Arms

ArmTypeDescription
ClopidogrelEXPERIMENTAL75 mg clopidogrel once daily from Day 1 to Week 12
TiclopidineACTIVE_COMPARATOR200 mg ticlopidine once daily from Day 1 to Week 12
PlaceboPLACEBO_COMPARATOR0.2 mL/kg/day matching placebo solution once daily.
Clopidogrel 0.2 mg/kg/dayEXPERIMENTAL0.2 mL/kg/day Clopidogrel reconstituted solution at 1mg/mL once daily.
Clopidogrel high dose treatment regimen + ASA high doseEXPERIMENTAL -
Clopidogrel high dose treatment regimen + ASA low doseEXPERIMENTAL -
Clopidogrel standard treatment regimen + ASA high doseACTIVE_COMPARATOR -
Clopidogrel standard treatment regimen + ASA low doseACTIVE_COMPARATOR -
1EXPERIMENTAL300-mg loading dose of clopidogrel given ≥ 6 and ≤ 24 hours before PCI
2EXPERIMENTAL600-mg loading dose of clopidogrel given ≥ 6 hours and ≤ 24 before PCI.
3EXPERIMENTAL600-mg loading dose of clopidogrel given immediately (≤ 45 minutes) before PCI.
Clopidogrel + ASAEXPERIMENTALClopidogrel 75 mg once daily (od) plus acetylsalicyclic acid (ASA) 75 to 100 mg od recommended (dose at the investigators' discretion)
Placebo + ASAPLACEBO_COMPARATORMatching placebo of clopidogrel 75 mg od plus acetylsalicyclic acid (ASA) 75 to 100 mg od recommended (dose at the investigators' discretion)
Group clopidogrel - clopidogrel + pantoprazoleEXPERIMENTALPeriod 1: * Day 1: clopidogrel 300 mg loading dose * Day 2 to Day 5: clopidogrel 75 mg, once daily Period 2: * Day -7 to Day -1: pantoprazole 80 mg, once daily * Day 1: clopidogrel 300 mg loading dose + pantoprazole 80 mg concomitantly * Day 2 to Day 5: clopidogrel 75 mg + pantoprazole 80 mg concomitantly, once daily Each intake is under fasted conditions.
Group placebo - placebo + pantoprazolePLACEBO_COMPARATORPeriod 1: * Day 1: placebo loading dose * Day 2 to Day 5: placebo, once daily Period 2: * Day -7 to Day -1: pantoprazole 80 mg, once daily * Day 1: placebo loading dose + pantoprazole 80 mg concomitantly * Day 2 to Day 5: placebo + pantoprazole 80 mg concomitantly, once daily Each intake is under fasted conditions.
Group clopidogrel + pantoprazole - clopidogrelEXPERIMENTALPeriod 1: * Day -7 to Day -1: pantoprazole 80 mg, once daily * Day 1: clopidogrel 300 mg loading dose + pantoprazole 80 mg concomitantly * Day 2 to Day 5: clopidogrel 75 mg + pantoprazole 80 mg concomitantly, once daily Period 2: * Day 1: clopidogrel 300 mg loading dose * Day 2 to Day 5: clopidogrel 75 mg, once daily Each intake is under fasted conditions.
Group placebo + pantoprazole placeboPLACEBO_COMPARATORPeriod 1: * Day -7 to Day -1: pantoprazole 80 mg, once daily * Day 1: placebo loading dose + pantoprazole 80 mg concomitantly * Day 2 to Day 5: placebo + pantoprazole 80 mg concomitantly, once daily Period 2: * Day 1: placebo loading dose * Day 2 to Day 5: placebo, once daily Each intake is under fasted conditions.
Group clopidogrel - clopidogrel + omeprazoleEXPERIMENTALPeriod 1: * Day 1: clopidogrel 600 mg loading dose * Day 2 to Day 5: clopidogrel 150 mg, once daily Period 2: * Day -5 to Day -1: omeprazole 80 mg, once daily * Day 1: clopidogrel 600 mg loading dose + omeprazole 80 mg concomitantly * Day 2 to Day 5: clopidogrel 150 mg + omeprazole 80 mg concomitantly, once daily Each intake is under fasted conditions
Group placebo - placebo + omeprazolePLACEBO_COMPARATORPeriod 1: * Day 1: placebo loading dose * Day 2 to Day 5: placebo, once daily Period 2: * Day -5 to Day -1: omeprazole 80 mg, once daily * Day 1: placebo loading dose + omeprazole 80 mg concomitantly * Day 2 to Day 5: placebo + omeprazole 80 mg concomitantly, once daily Each intake is under fasted conditions
Group clopidogrel + omeprazole - clopidogrelEXPERIMENTALPeriod 1: * Day -5 to Day -1: omeprazole 80 mg, once daily * Day 1: clopidogrel 600 mg loading dose + omeprazole 80 mg concomitantly * Day 2 to Day 5: clopidogrel 150 mg + omeprazole 80 mg concomitantly, once daily Period 2: * Day 1: clopidogrel 600 mg loading dose * Day 2 to Day 5: clopidogrel 150 mg, once daily Each intake is under fasted conditions
Group placebo + omeprazole placeboPLACEBO_COMPARATORPeriod 1: * Day -5 to Day -1: omeprazole 80 mg, once daily * Day 1: placebo loading dose + omeprazole 80 mg concomitantly * Day 2 to Day 5: placebo + omeprazole 80 mg concomitantly, once daily Period 2: * Day 1: placebo loading dose * Day 2 to Day 5: placebo, once daily Each intake is under fasted conditions
Group clopidogrel fed - fastingEXPERIMENTALPeriod 1: * Day 1: clopidogrel 300 mg loading dose with high fat breakfast * Day 2 to Day 5: clopidogrel 75 mg/day with standard breakfast, once daily Period 2: * Day 1: clopidogrel 300 mg loading dose under fasted conditions * Day 2 to Day 5: clopidogrel 75 mg/day under fasted conditions, once daily
Group placebo fed - fastingPLACEBO_COMPARATORPeriod 1: * Day 1: placebo loading dose with high fat breakfast * Day 2 to Day 5: placebo with standard breakfast, once daily Period 2: * Day 1: placebo loading dose under fasted conditions * Day 2 to Day 5: placebo under fasted conditions, once daily
Group clopidogrel fasting - fedEXPERIMENTALPeriod 1: * Day 1: clopidogrel 300 mg loading dose under fasted conditions * Day 2 to Day 5: clopidogrel 75 mg/day under fasted conditions, once daily Period 2: * Day 1: clopidogrel 300 mg loading dose with high fat breakfast * Day 2 to Day 5: clopidogrel 75 mg/day with standard breakfast, once daily
group placebo fasting -fedPLACEBO_COMPARATORPeriod 1: * Day 1: placebo loading dose under fasted conditions * Day 2 to Day 5: placebo in fasted conditions, once daily Period 2: * Day 1: placebo loading dose with high fat breakfast * Day 2 to Day 5: placebo with standard breakfast, once daily
Sequence clopidogrel 300/75 mg - 600/150 mgEXPERIMENTALPeriod 1: * Day 1: clopidogrel, 300 mg loading dose + placebo * Day 2 to Day 5: clopidogrel, 75 mg + placebo, once daily Period 2: * Day 1: clopidogrel, 600 mg loading dose * Day 2 to Day 5: clopidogrel, 150 mg, once daily Each intake is at around 8:00 AM fasted for at least 10 hours
Sequence clopidogrel 600/150 mg - 300/75 mgEXPERIMENTALPeriod 1: * Day 1: clopidogrel, 600 mg loading dose * Day 2 to Day 5: clopidogrel, 150 mg, once daily Period 2: * Day 1: clopidogrel, 300 mg loading dose + placebo * Day 2 to Day 5: clopidogrel, 75 mg + placebo, once daily Each intake is at around 8:00 AM fasted for at least 10 hours
Sequence clopidogrel 75 / 75 / 300 mgEXPERIMENTALPeriod 1: clopidogrel 75 mg single dose Period 2: clopidogrel 75 mg single dose Period 3: clopidogrel 300 mg single dose Each intake is at around 8:00 AM under fasted conditions.

Interventions

NameTypeDescription
clopidogrel (SR25990)DRUGoral administration (tablets)
ticlopidineDRUGoral administration (tablets)
ClopidogrelDRUGForm: reconstituted solution using Clopidogrel powder Route: oral or enteric Frequency: once daily Dose: daily dose adjusted for weight
placeboDRUGForm: reconstituted solution using matching placebo powder Route: oral or enteric Frequency: once daily Dose: daily dose adjusted for weight
acetylsalicyclic acid (ASA)DRUGoral administration
clopidogrel (SR25990C)DRUG -
PantoprazoleDRUGPharmaceutical form: delayed-release tablet Route of administration: oral
OmeprazoleDRUGPharmaceutical form: delayed-release capsule Route of administration: oral
Matching placeboDRUGPharmaceutical form: tablet Route of administration: oral
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Eligibility Criteria

Age Range20 Years to N/A
SexALL
Healthy VolunteersNo
Study Sites1

Inclusion Criteria: Documented symptomatic peripheral arterial disease (one or both of the following two primary criteria must be satisfied): * Current intermittent claudication with Ankle Brachial Index (ABI) \< 0.90 * A history of intermittent claudication together with previous related interven...

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