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Massive Pulmonary EmbolismPhase 3NCT04688320

Massive Pulmonary Embolism: Trial of Non-immunogenic Recombinant Staphylokinase VS Alteplase FORPE

A Phase 3 study testing Recombinant nonimmunogenic staphylokinase and Alteplase in people with Massive Pulmonary Embolism, run by Supergene, LLC at 23 sites in Russia.

Completed

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

Official record
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Trial summary

Objective: to evaluate the efficacy and safety of the Recombinant Non-immunogenic Staphylokinase with its single bolus administration in comparison with the bolus-infusion administration of the Alteplase in patients with massive pulmonary embolism Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Massive Pulmonary Embolism
What is being tested?
Recombinant nonimmunogenic staphylokinase and Alteplase
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
310 participants
Where
23 sitesRussia
Study dates
15 Dec 2020to 27 Jul 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

  • Men and women aged 18 and over
  • Verified diagnosis of massive PE (using MSCT with PA contrast)
  • Signs of overload / dysfunction of the right ventricle (at least one) in combination with persistent arterial hypotension or shock
  • Patient consent to use reliable contraceptive methods throughout the study and for 3 weeks after:
  • women who have a negative pregnancy test and use the following contraceptives: intrauterine devices, oral contraceptives, contraceptive patch, prolonged injectable contraceptives, double barrier method of contraception. Women who are not fertile can also take part in the study (documented conditions: hysterectomy, tubal ligation, infertility, menopause for more than 1 year);
  • men using barrier contraception. The study may also involve men who are not fertile (documented conditions: vasectomy, infertility)
  • Availability of signed and dated informed consent of the patient to participate in the study.

Who cannot join

  • • Increased risk of bleeding:
  • Extensive bleeding at present or within the previous 6 months, hemorrhagic diathesis;
  • Intracranial (including subarachnoid) hemorrhage at present or in history, suspected hemorrhagic stroke;
  • A history of hemorrhagic stroke or stroke of unknown etiology;
  • Ischemic stroke or transient ischemic attack within the last 6 months, except for the current acute ischemic stroke within 4.5 hours;
  • A history of diseases of the central nervous system (including neoplasms, aneurysms, surgery on the brain or spinal cord);
Show all 20Show fewer
  • Major surgery or major trauma within the previous 3 months, recent traumatic brain injury;
  • Long-term or traumatic cardiopulmonary resuscitation (> 2 min), delivery within the previous 10 days, recent puncture of an uncompressible blood vessel (eg, subclavian or jugular vein);
  • Severe liver disease, including liver failure, cirrhosis, portal hypertension (including esophageal varices) and active hepatitis;
  • Confirmed gastric or duodenal ulcer within the last three months;
  • Neoplasm with an increased risk of bleeding;
  • Concurrent administration of oral anticoagulants, for example, warfarin with an INR> 1.3;
  • Arterial aneurysms, developmental defects of arteries / veins;
  • Severe uncontrolled arterial hypertension;
  • Acute pancreatitis;
  • Bacterial endocarditis, pericarditis;
  • suspicion of aortic dissecting aneurysm;
  • any other conditions, in the opinion of the doctor, associated with a high risk of bleeding.
  • Lactation, pregnancy
  • Known hypersensitivity to Alteplase, Fortelizin.

Trial locations and contacts

23 sites in 1 country.

23 sites in 1 country

Russia23 sites
  • Belgorod Regional Clinical Hospital of St. Joseph

    Belgorod, 308007

  • Kuzbass Cardiology center

    Kemerovo, 650002

  • Krasnoyarsk Regional Clinical Hospital

    Krasnoyarsk, 660022

  • Kursk Regional Clinical Hospital

    Kursk, 305007

  • D.D. Pletnev City Clinical Hospital

    Moscow, 105077

  • I.V. Davydovskii City Clinical Hospital

    Moscow, 109240

  • S.S. Yudin City Clinical Hospital

    Moscow, 115446

  • V.V. Vinogradov City Clinical Hospital

    Moscow, 117292

  • V.V. Veresaev City Clinical Hospital

    Moscow, 127644

  • N.V. Sklifosovsky Research Institute for Emergency Medicine

    Moscow, 129090

  • S.P. Botkin City Clinical Hospital

    Moscow

  • Murmansk Regional Clinical Hospital

    Murmansk, 183047

  • N.N. Burdenko Penza Regional Clinical hospital

    Penza, 440026

  • G.A. Zakharyin Clinical hospital №6

    Penza, 440071

  • Saint Petersburg "Mariinskaya" City Hospital

    Saint Petersburg, 191014

  • Holy Martyr Elizabeth Saint Petersburg City Hospital

    Saint Petersburg, 195257

  • V.P. Polyakov Samara Regional Clinical Cardiology Dispensary

    Samara, 443070

  • Saratov Regional Clinical Cardiology Dispensary

    Saratov, 410039

  • Sergiyev Posad Regional Clinical Hospital

    Sergiyev Posad, Moscow Oblast, 141301

  • Tver Regional Clinical Hospital

    Tver', 170036

  • City Clinical hospital №4

    Vladimir, 600009

  • City Clinical Hospital of Emergency №25

    Volgograd, 400138

  • V.F. Dolgopolov Vyselki Central District Hospital

    Vyselki, Krasnodarskiy Kray, 353100

Other trials in Russia

About this study

Official title: Multicenter, Open Label, Randomized Comparative Trial of the Efficacy and Safety of a Single Bolus Recombinant Non-immunogenic Staphylokinase and Bolus-infusion of Alteplase in Patients With Massive Pulmonary Embolism (FORPE)

Objective: to evaluate the efficacy and safety of the Recombinant Non-immunogenic Staphylokinase with its single bolus administration in comparison with the bolus-infusion administration of the Alteplase in patients with massive pulmonary embolism

Read the detailed description

The main goal of treating massive PE is to save the lives of patients by restoring pulmonary perfusion, preventing the development of chronic postembolic pulmonary hypertension and recurrent PE. According to data of clinical trials, with timely initiation of therapy for massive pulmonary embolism, mortality can be significantly reduced.

Recombinant protein which contains aminoacid sequence of staphylokinase - Fortelizin® (the active substance is Forteplase). It is single chain molecula, consists of 138 aminoacids, weight 15.5 kDa. When staphylokinase is added to human plasma containing a fibrin clot, it preferentially reacts with plasmin at the clot surface, forming a plasmin-staphylokinase complex. This complex activates plasminogen trapped in the thrombus. The plasmin-staphylokinase complex and plasmin bound to fibrin are protected from inhibition by alpha2-antiplasmin. Once liberated from the clot (or generated in plasma), however, they are rapidly inhibited by alpha2-antiplasmin. This selectivity of action confines the process of plasminogen activation to the thrombus, preventing excessive plasmin generation, alpha2-antiplasmin depletion, and fibrinogen degradation in plasma. In rabbits anti forteplase antibodies are not produced. It was achieved by replacement of amino acids in immunogenic epitop of molecule staphylokinase. Blood fibrinogen decrease after i.v. injection of Fortelyzin less 10% within first 24 hours. Angiographic data suggests that restoration of coronary blood flow appears in up to 80% of patients with STEMI after i.v. injection of Fortelyzin.

The main objectives of the study: to assess the efficacy, safety and possible adverse events of the drug Recombinant Non-immunogenic Staphylokinase with its single bolus administration in comparison with the bolus-infusion administration of the drug Alteplase® in patients with massive pulmonary embolism.

Study Design. Multicenter, open-label, randomized, comparative clinical study of non-inferiority study of efficacy and safety in parallel groups. At clinical centers, patients will be equally randomly distributed by the "envelope" method into two groups of 155 patients each (310 people in total, including 10% of those who may have dropped out)to receive Recombinant Non-immunogenic Staphylokinase or Alteplase®.

The drugs will be administered after the signed informed consent. Recombinant Non-immunogenic Staphylokinase will be administered intravenously at a dose of 15 mg as a single bolus for 10-15 seconds. Alteplase® will be administered in accordance with the instructions for use.

Patients will be monitored for 30 days from the moment of randomization: in the intensive care unit up to 7 days, after it in the hospital until discharge - an average of 14 days and an outpatient visits on the 30th day. The recruitment of patients for the study will be competitive.

Being tested
Recombinant nonimmunogenic staphylokinase, Alteplase
Keywords
Massive pulmonary embolism, Fibrinolysis, Recombinant Non-immunogenic Staphylokinase

What participants receive

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

  • Recombinant nonimmunogenic staphylokinaseDrug

    Also called Fortelyzin

    15 mg of drug reconstituted in 10 ml of 0.9% solution of NaCl given as single i.v. bolus over 10-15 seconds

  • AlteplaseDrug

    Also called Actillyze

    Alteplase® is administered in accordance with the instructions for use for pulmonary embolism ( 10 mg bolus and 90 mg as IV infusion over 2 hours, maximum 100 mg). In patients weighing less than 65 kg, the total dose should not exceed 1.5 mg / kg.

Study groups in NCT04688320
Study groupRoleWhat they receive
Recombinant nonimmunogenic staphylokinaseExperimentallyophilisate for preparation of a solution for intravenous administration, 5 mg (745,000 IU) complete with a solvent. 15 mg (2,235,000 IU) - 3 vials, intravenously as a quick single bolus injection for 10-15 seconds, regardless of body weight.
Receives: Drug: Recombinant nonimmunogenic staphylokinase
AlteplaseExperimentalAlteplase® is administered in accordance with the instructions for use for pulmonary embolism( 10 mg bolus and 90 mg as IV infusion over 2 hours, maximum 100 mg). In patients weighing less than 65 kg, the total dose should not exceed 1.5 mg / kg.
Receives: Drug: Alteplase

What is being measured

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

  1. Death From All Causes

    The efficacy is evaluated in terms of the number of deaths from all causes

    Measured: within 7 days

Secondary outcomes (9)
  1. Systolic Pulmonary Artery Pressure Measures (V1, V2, V4, V5)

    The efficacy is evaluated in terms of systolic pulmonary artery pressure values

    Measured: baseline and day 1, 7, 14 after randomisation

  2. Haemodynamic Collapse

    The efficacy is evaluated in terms of the number of haemodynamic collapse

    Measured: within 7 days

  3. Recurrent Pulmonary Embolism (PE)

    The efficacy is evaluated in terms of the number of recurrent PE

    Measured: within 7 days

  4. Death From PE

    The efficacy is evaluated in terms of the number of deaths from PE

    Measured: within 30 days

  5. Death From All Causes

    The efficacy is evaluated in terms of the number of deaths from all causes

    Measured: within 30 days

  6. Haemodynamic Collapse Within 7 Days + Recurrent PE Within 7 Days + Death From All Causes Within 30 Days

    The efficacy is evaluated in terms of the number of haemodynamic collapse + recurrent PE + deaths from all causes

    Measured: within 30 days

  7. Safety Endpoint - Haemorrhagic Stroke

    The safety is evaluated in terms of the number of haemorrhagic stroke within 7 days of randomisation

    Measured: within 7 days

  8. Safety Endpoint - BARC Type 3+5 Bleeding

    The safety is evaluated in terms of the number of BARC type 3+5 bleeding. Type 3a: overt bleeding plus a hemoglobin drop of 3 to 5 g/dL; any transfusion with overt bleeding.

    Type 3b: overt bleeding plus a hemoglobin drop of 5 g/dL; cardiac tamponade; bleeding requiring surgical intervention for control; bleeding requiring intravenous vasoactive agents.

    Type 3c: intracranial hemorrhage (does not include microbleeds or hemorrhagic transformation, does include intraspinal); subcategories confirmed by autopsy or imaging, or lumbar puncture; intraocular bleed compromising vision.

    Type 5a: probable fatal bleeding; no autopsy or imaging confirmation but clinically suspicious.

    Type 5b: definite fatal bleeding; overt bleeding or autopsy, or imaging confirmation.

    Measured: within 30 days

  9. Safety Endpoint - Number and Severity of Serious Adverse Events (SAEs)

    The safety is evaluated in terms of the number and severity of serious adverse events (SAEs)

    Measured: within 30 days

Timeline

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

  1. First posted29 Dec 2020
  2. Study start15 Dec 2020
  3. Primary completion27 Jul 2023
  4. Study completion27 Jul 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
Model description
At clinical centers, patients will be equally randomly distributed by the "envelope method" into two groups to receive Fortelizin® or Alteplase®. The drugs will be administered after the signed informed consent. Fortelizin® will be administered intravenously at a dose of 15 mg as a single bolus for 10-15 seconds. Alteplase® will be administered in accordance with the instructions for use. All patients will be examination for 30 days.
Masking
None (open label)
Enrolment
310 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04688320
Sponsor's protocol ID
FORPE
Status last verified
Mar 2025
First submitted
18 Dec 2020
Last updated
2 Apr 2025
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No

Publications

  • Leontyev SG, Yarovaya EB, Kutsenko VA, Ivlev OE, Soplenkova AG, Semenov AM, Semenov MP, Ivanov SV, Romashova YA, Markin SS. The Safety of Non-immunogenic Recombinant Staphylokinase in Elderly Patients With Massive Pulmonary Embolism: A Randomized Clinical Trial FORPE. Health Sci Rep. 2025 May 19;8(5):e70826. doi: 10.1002/hsr2.70826. eCollection 2025 May.

    PubMed 40391253

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Recombinant nonimmunogenic staphylokinase and Alteplase in people with Massive Pulmonary Embolism, run by Supergene, LLC at 23 sites in Russia.

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 7 inclusion and 20 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 2 Apr 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 23 sites in Russia. 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. 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 2 Apr 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?

Death From All Causes (time frame: within 7 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 NCT04688320, 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 2 Apr 2025.

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