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Stroke, AcutePhase 3ESCAPE-NEXTNCT04462536

Efficacy and Safety of Nerinetide in Participants With Acute Ischemic Stroke Undergoing Endovascular Thrombectomy Excluding Thrombolysis

A Phase 3 study testing Nerinetide in people with Stroke, Acute, run by NoNO Inc. at 81 sites in 9 countries.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
Search all trials

Trial summary

The primary purpose of this study is to determine if a single dose of nerinetide can reduce global disability in people who have had a stroke and are selected for endovascular therapy without the use of a tissue plasminogen activator (alteplase, tenecteplase, or equivalent). Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Stroke, Acute
What is being tested?
Nerinetide
Type of treatment
Injection or infusion
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
850 participants
Where
81 sitesin 9 countries
Study dates
6 Dec 2020to 31 Aug 2023
Phase
Phase 3
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Acute ischemic stroke (AIS) selected for emergency endovascular treatment.
  • Age 18 years or greater.
  • Onset (last-known-well) time to randomization time within 12 hours.
  • Disabling stroke defined as a baseline National Institutes of Health Stroke Score (NIHSS):
  • NIHSS > 5 for internal carotid artery (ICA) and M1-middle cerebral artery (MCA) occlusion; or
  • NIHSS > 10 for M2-MCA occlusion.
Show all 10Show fewer
  • Confirmed symptomatic intracranial occlusion at one or more of the following locations: Intracranial carotid I/T/L, M1 or M2 segment MCA. Tandem extracranial carotid and intracranial occlusions are permitted.
  • Pre-stroke (24 hours prior to stroke onset) independent functional status in activities of daily living with modified Barthel Index (BI) ≥ 95. Patient must be living without requiring nursing care.
  • Qualifying imaging performed less than 2 hours prior to randomization.
  • Consent process completed as per national laws and regulation and the applicable ethics committee requirements.

Who cannot join

  • Treated with a tissue plasminogen activator (e.g., alteplase or tenecteplase) within 24 hours before randomization.
  • Determination by the treating physician, based on current treatment guidelines and medical evidence, that treatment with a plasminogen activator is indicated.
  • Large core of established infarction defined as ASPECTS 0-4.
  • Absent or poor collateral circulation on qualifying imaging (e.g. collateral score of 0 or 1).
  • Any intracranial hemorrhage on the qualifying imaging.
  • Planned use of an endovascular device not having approval or clearance by the relevant regulatory authority.
Show all 15Show fewer
  • Endovascular thrombectomy procedure is completed as defined by the presence of TICI 2c/3 reperfusion or completion of groin / arterial closure.
  • Clinical history, past imaging or clinical judgment suggesting that the intracranial occlusion is chronic or there is suspected intracranial dissection such that there is a predicted lack of success with endovascular intervention.
  • Estimated or known weight > 120 kg (264 lbs).
  • Pregnancy/Lactation; female, with positive urine or serum beta human chorionic gonadotropin (β-hCG) test, or breastfeeding.
  • Known prior receipt of nerinetide for any reason, including prior enrolment in this ESCAPE-NEXT trial.
  • Severe known renal impairment defined as requiring renal replacement therapy (hemo- or peritoneal dialysis).
  • Severe or fatal comorbid illness that will prevent improvement or follow up.
  • Inability to complete follow-up treatment to Day 90.
  • Participation in another clinical trial investigating a drug, medical device, or a medical procedure in the 30 days preceding trial inclusion.

Trial locations and contacts

81 sites in 9 countries.

81 sites in 9 countries

Germany23 sites
  • Universitätsklinikum RWTH Aachen

    Aachen

  • Klinikum Altenburger Land GmbH

    Altenburg

  • Universitätsklinikum Augsburg

    Augsburg

  • Universitätsklinikum Knappschaftskrankenhaus Bochum

    Bochum

  • Universitätsklinikum Bonn

    Bonn

  • Klinikum Dortmund gGmbH

    Dortmund

  • University of Dresden

    Dresden

  • Alfried-Krupp-Krankenhaus

    Essen

  • Universitätsklinikum Frankfurt

    Frankfurt

  • Universitätsklinikum Freiburg

    Freiburg im Breisgau

  • Göttingen University Hospital

    Göttingen

  • Universitätsklinikum Hamburg-Eppendorf

    Hamburg

  • Heidelberg University Hospital

    Heidelberg

  • University Hospital Schleswig-Holstein

    Kiel

  • Universitätsklinikum Leipzig - Klinik und Poliklinik für Neurologie

    Leipzig

  • Klinikum rechts der Isar Technical University of Munich

    München

  • LMU Klinikum München

    München

  • Universitätsklinikum Münster

    Münster

  • Nürnberg Hospital South Campus

    Nuremberg

  • Evangelisches Krankenhaus Oldenburg

    Oldenburg

  • Klinikum Stuttgart

    Stuttgart

  • Universitätsklinikum Tübingen

    Tübingen

  • Würzburg University Hospital

    Würzburg

Other trials in Germany

United States17 sites
  • Abington Memorial Hospital

    Abington, Pennsylvania, 19001

  • Grady Memorial Hospital

    Atlanta, Georgia, 30303

  • University of Maryland Medical Center

    Baltimore, Maryland, 21201

  • NYU Langone Hospital Brooklyn

    Brooklyn, New York, 11220

  • The Ohio State University, Wexner Medical Center Neurological Surgery

    Columbus, Ohio, 43203

  • Swedish Medical Center

    Englewood, Colorado, 80113

  • Valley Baptist Medical Center - Harlingen

    Harlingen, Texas, 78550

  • Baptist Health Research Institute

    Jacksonville, Florida, 32207

  • University of Miami, Jackson Memorial Hospital

    Miami, Florida, 33136

  • St. Joseph's Hospital & Medical Center

    Phoenix, Arizona, 85013

  • UPMC Stroke Institute

    Pittsburgh, Pennsylvania, 15213

  • Providence St. Vincent Medical Center

    Portland, Oregon, 97225

  • Rhode Island Hospital

    Providence, Rhode Island, 02903-4923

  • Swedish Medical Center - Cherry Hill Campus

    Seattle, Washington, 98122

  • Montefiore Medical Center

    The Bronx, New York, 10467

  • Providence Little Company of Mary Medical Center - Torrance

    Torrance, California, 90503

  • University of Massachusetts Medical School

    Worcester, Massachusetts, 01655

Other trials in United States

Canada16 sites
  • Foothills Medical Centre - University of Calgary

    Calgary, Alberta

  • University of Alberta Hospital

    Edmonton, Alberta

  • Queen Elizabeth II Health Science Centre

    Halifax, Nova Scotia

  • Hamilton Health Sciences

    Hamilton, Ontario

  • Kingston Health Sciences Centre

    Kingston, Ontario

  • London Health Sciences Centre (LHSC)

    London, Ontario

  • Montreal Neurological Institute and Hospital

    Montreal, Quebec

  • University Hospital of Montreal

    Montreal, Quebec

  • Ottawa Hospital Research Institute (OHRI)

    Ottawa, Ontario

  • CHU de Quebec-Universite Laval

    Québec, Quebec

  • Royal University Hospital

    Saskatoon, Saskatchewan

  • St. Michael's Hospital, Unity Health Toronto

    Toronto, Ontario

  • Sunnybrook Health Science Centre

    Toronto, Ontario

  • Toronto Western Hospital

    Toronto, Ontario

  • Vancouver General Hospital

    Vancouver, British Columbia

  • Health Sciences Centre

    Winnipeg, Manitoba

Other trials in Canada

Australia8 sites
  • Royal Adelaide Hospital

    Adelaide

  • Princess Alexandra Hospital

    Brisbane

  • Monash Medical Centre

    Clayton

  • Gold Coast University Hospital

    Gold Coast

  • Fiona Stanley Hospital

    Murdoch

  • Sir Charles Gairdner Hospital

    Nedlands

  • John Hunter Hospital

    Newcastle

  • Royal Melbourne Hospital

    Parkville

Other trials in Australia

Italy5 sites
  • Ospedale Maggiore di Bologna "Carlo Alberto Pizzardi"

    Bologna

  • Azienda Ospedaliero Universitaria Careggi

    Florence

  • Ospedale Policlinico San Martino

    Genoa

  • ASST Grande Ospedale Metropolitano Niguarda

    Milan

  • Azienda Ospedaliera Antonio Cardarelli

    Naples

Other trials in Italy

Norway4 sites
  • Oslo University Hospital Rikshospitalet

    Oslo

  • Oslo University Hospital Ulleval

    Oslo

  • Stavanger University Hospital

    Stavanger

  • University Hospital of North-Norway

    Tromsø

Other trials in Norway

Netherlands3 sites
  • Amsterdam UMC

    Amsterdam

  • Maastricht University Medical Center

    Maastricht

  • Erasmus University Medical Center

    Rotterdam

Other trials in Netherlands

Switzerland3 sites
  • Kantonsspital Aarau

    Aarau

  • Universitätsspital Basel

    Basel

  • Universitatsklinik fur Neurologie, Inselspital

    Bern

Other trials in Switzerland

Singapore2 sites
  • National Neuroscience Institute

    Singapore

  • National University Hospital

    Singapore

Other trials in Singapore

About this study

Official title: A Multicentre, Randomized, Double-blinded, Placebo-controlled, Parallel Group, Single-dose Design to Determine the Efficacy and Safety of Nerinetide in Participants With Acute Ischemic Stroke Undergoing Endovascular Thrombectomy Excluding Thrombolysis

The primary purpose of this study is to determine if a single dose of nerinetide can reduce global disability in people who have had a stroke and are selected for endovascular therapy without the use of a tissue plasminogen activator (alteplase, tenecteplase, or equivalent).

Read the detailed description

This study is a Phase 3, randomized, multicentre, blinded, placebo-controlled, parallel group, single-dose with a single interim analysis. Because AIS (acute ischemic stroke) is a medical emergency, the trial is designed to enable the administration of standard-of-care treatments without delay in order to save the life of the person concerned, restore good health or alleviate suffering.

Participants harboring an acute ischemic stroke who are selected for endovascular revascularization without intravenous or intra-arterial thrombolytic therapy will be given a single, 2.6 mg/kg (up to a maximum dose of 270 mg) intravenous dose of nerinetide or placebo. Outcomes of the main trial will be evaluated throughout a 90 day observation period.

Participants will be followed at 1-Year for the analytic sub-trial for further outcome assessment by telemedicine or telephone interview conducted by individuals blinded to the outcome of the main trial. This sub-trial will be conducted to explore the independent functioning and quality of life at 1-Year.

Conditions
Stroke, Acute
Being tested
Placebo, Nerinetide
Medical subject headings
Stroke

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • PlaceboDrug

    Vehicle only

  • NerinetideDrug

    Also called NA-1

    Single intravenous infusion of nerinetide 2.6 mg/kg (up to a maximum dose of 270 mg) over 10 ± 1 minutes

Study groups in NCT04462536
Study groupRoleWhat they receive
PlaceboPlacebo comparatorVehicle only
Receives: Drug: Placebo
NerinetideExperimentalSingle intravenous infusion of nerinetide 2.6 mg/kg (up to a maximum dose of 270 mg) over 10 ± 1 minutes
Receives: Drug: Nerinetide

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Number of Participants With Independent Functioning on the Modified Rankin Scale (mRS), as Defined by a Score of 0-2

    The modified Rankin Scale (mRS) is a valid and reliable clinician-reported measure of global disability that has been widely applied for evaluating recovery from stroke. It is a scale used to measure functional recovery (the degree of disability or dependence in daily activities) of people who have suffered a stroke. mRS scores range from 0 (best outcome) to 6 (worst outcome), with 0 indicating no residual symptoms; 5 indicating bedbound, requiring constant care; and 6 indicating death.

    Measured: 90 days

Secondary outcomes (3)
  1. Mortality Rate, as Defined by Event Rate (Percent) for Mortality Over the 90-day Study Period.

    The estimand of mortality rate was the adjusted unconditional population difference in the number of deaths observed divided by the number of participants observed over the 90-day study period (mortality proportions) between treatment conditions (nerinetide vs. placebo) in the target patient population at Day 90. Deaths occurring over the Day 90 period were considered as non-responses.

    Measured: 90 days

  2. Number of Participants Exhibiting a Worsening of Their Index Stroke.

    Worsening of stroke is defined as (A) progression, or hemorrhagic transformation of the index stroke, as documented by medical imaging that is (a) life-threatening requiring intervention and/or (b) results in increased disability as gauged by a ≥4 point increase from lowest NIHSS during hospitalization or (B) results in death from the index stroke.

    Measured: 90 days

  3. Number of Participants With Good Neurological Outcome, as Defined by a Score of 0-2 on the NIHSS at Day 90 Post Randomization.

    The National Institutes of Health Stroke Scale (NIHSS) is a standardized neurological examination score that is a valid and reliable measure of disability and recovery after acute stroke. Scores range from 0 to 42, with higher scores indicating increasing severity.

    Measured: 90 days

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted8 Jul 2020
  2. Study start6 Dec 2020
  3. Primary completion31 Aug 2023
  4. Study completion31 Aug 2023

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
850 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04462536
Sponsor's protocol ID
NA-1-009
Acronym
ESCAPE-NEXT
Status last verified
Sep 2023
First submitted
2 Jul 2020
Last updated
22 Jun 2025
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No

Publications

  • Hill MD, Goyal M, Demchuk AM, Menon BK, Field TS, Guest WC, Berrouschot J, Bormann A, Pham M, Haeusler KG, Dippel DWJ, van Doormaal PJ, Dorn F, Bode FJ, van Adel BA, Sahlas DJ, Swartz RH, Da Costa L, Ospel JM, McDonough RV, Ryckborst KJ, Almekhlafi MA, Heard KJ, Garman DJ, Adams C, Kohli Y, Schoon BA, Buck BH, Muto M, Zafar A, Schneider H, Grossberg JA, Yeo LLL, Tarpley JW, Psychogios MN, Coutinho JM, Limbucci N, Puetz V, Kelly ME, Campbell BCV, Poli S, Poppe AY, Shankar JJ, Chandra R, Dowlatshahi D, Lopez GA, Cirillo L, Moussaddy A, Devlin M, Garcia-Bermejo P, Mandzia JL, Skjelland M, Aamodt AH, Silver FL, Kleinig TJ, Pero G, Minnerup J, McTaggart RA, Puri AS, Chiu AHY, Reimann G, Gubitz GJ, Camden MC, Lee SK, Sauvageau E, Mundiyanapurath S, Frei DF, Choe H, Rocha M, Gralla J, Bailey P, Fischer S, Liebig T, Dimitriadis K, Gandhi D, Chapot R, Jin A, Hassan AE, Zwam WV, Maier IL, Wiesmann M, Niesen WD, Advani R, Eltoft A, Asdaghi N, Murphy C, Remonda L, Ghia D, Jansen O, Holtmannspoetter M, Hellstern V, Witt K, Fromme A, Nimjee SM, Turkel-Parella D, Michalski D, Maegerlein C, Tham CH, Tymianski M; ESCAPE-NEXT Investigators. Efficacy and safety of nerinetide in acute ischaemic stroke in patients undergoing endovascular thrombectomy without previous thrombolysis (ESCAPE-NEXT): a multicentre, double-blind, randomised controlled trial. Lancet. 2025 Feb 15;405(10478):560-570. doi: 10.1016/S0140-6736(25)00194-1.

    PubMed 39955119

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Nerinetide in people with Stroke, Acute, run by NoNO Inc. at 81 sites in 9 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 10 inclusion and 15 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 22 Jun 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 81 sites in Germany, United States, Canada, Australia, Italy and 4 more countries. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 22 Jun 2025). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Number of Participants With Independent Functioning on the Modified Rankin Scale (mRS), as Defined by a Score of 0-2 (time frame: 90 days). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04462536, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 22 Jun 2025.

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