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Trial details imported from ClinicalTrials.gov
For full trial details, please see the original record at
https://clinicaltrials.gov/study/NCT00699998
Registration number
NCT00699998
Ethics application status
Date submitted
16/06/2008
Date registered
18/06/2008
Date last updated
7/05/2013
Titles & IDs
Public title
A Comparison of Prasugrel and Clopidogrel in Acute Coronary Syndrome Subjects
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Scientific title
A Comparison of Prasugrel and Clopidogrel in Acute Coronary Syndrome Subjects With Unstable Angina/Non-ST-Elevation Myocardial Infarction Who Are Medically Managed
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Secondary ID [1]
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H7T-MC-TABY(b)
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Secondary ID [2]
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11058
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Universal Trial Number (UTN)
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Trial acronym
TRILOGY ACS
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Acute Coronary Syndrome
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Condition category
Condition code
Cardiovascular
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Coronary heart disease
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Other
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Research that is not of generic health relevance and not applicable to specific health categories listed above
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Treatment: Drugs - Clopidogrel
Treatment: Drugs - Prasugrel
Treatment: Drugs - Commercially-available Aspirin
Experimental: Prasugrel - Prasugrel and Low-dose Commercially-available Aspirin
Active comparator: Clopidogrel - Clopidogrel and Low-Dose Commercially-available Aspirin
Treatment: Drugs: Clopidogrel
300 milligrams (mg), oral, once as loading dose (in those subjects who initiate study drug with a loading dose); and 75 mg, oral, once daily as maintenance dose through end of study
Treatment: Drugs: Prasugrel
30 milligrams (mg), oral, once as loading dose (in those subjects who initiate study drug with a loading dose); and either 5 mg or 10 mg (based upon weight and age), oral, once daily as maintenance dose through end of study
Treatment: Drugs: Commercially-available Aspirin
Low-dose aspirin, oral, as prescribed by physician through end of study
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Intervention code [1]
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Treatment: Drugs
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Comparator / control treatment
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Control group
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Outcomes
Primary outcome [1]
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Percentage of Participants With a Composite Endpoint of Cardiovascular (CV) Death, Myocardial Infarction (MI), or Stroke
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Assessment method [1]
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The percentage of participants is the total number of participants experiencing a CV death, nonfatal MI, or nonfatal stroke divided by number of participants in the treatment arm multiplied by 100. Endpoint events were adjudicated by the Clinical Endpoint Committee.
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Timepoint [1]
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Randomization through end of study (30-month visit)
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Secondary outcome [1]
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Percentage of Participants With a Composite Endpoint of CV Death and MI
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Assessment method [1]
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The percentage of participants is the total number of participants experiencing a CV death or nonfatal MI divided by number of participants in the treatment arm. Endpoint events were adjudicated by the Clinical Endpoint Committee.
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Timepoint [1]
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Randomization through end of study (30-month visit)
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Secondary outcome [2]
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Percentage of Participants With a Composite Endpoint of CV Death, MI, Stroke, or Re-hospitalization for Recurrent Unstable Angina (UA)
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Assessment method [2]
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The percentage of participants is the total number of participants experiencing a CV death, nonfatal MI, nonfatal stroke or re-hospitalization for a recurrent UA divided by number of participants in the treatment arm. Endpoints events were adjudicated by the Clinical Endpoint Committee.
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Timepoint [2]
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Randomization through end of study (30-month visit)
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Secondary outcome [3]
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Percentage of Participants With a Composite Endpoint of All-cause Death, MI, or Stroke
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Assessment method [3]
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The percentage of participants is the total number of participants experiencing an all-cause death, nonfatal MI, or nonfatal stroke divided by number of participants in the treatment arm. Endpoint events were adjudicated by the Clinical Endpoint Committee.
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Timepoint [3]
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Randomization through end of study (30-month visit)
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Secondary outcome [4]
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Platelet Aggregation Measures
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Assessment method [4]
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Platelet aggregation was measured by as measured by Accumetrics Verify Now™ P2Y12. Results were reported in P2Y12 Reaction Units (PRU). PRU represents the rate and extent of adenosine (ADP)-stimulated platelet aggregation. Lower values indicate greater P2Y12 platelet inhibition and lower platelet activity and aggregation. ANCOVA Model was used and values were corrected for treatment + baseline value + clopidogrel status at randomization.
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Timepoint [4]
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Day 30 and 12 Months
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Secondary outcome [5]
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Biomarker Measurements of Inflammation/Hemodynamic Stress: Brain Natriuretic Peptide (BNP)
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Assessment method [5]
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Brain natriuretic peptide (BNP) is secreted by the ventricles of the heart in response to hemodynamic stress and is a biomarker associated with increased CV risk. Results are presented as geometric least squares means (Geometric LS means). Geometric LS means were adjusted for treatment + baseline value + clopidogrel status at randomization.
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Timepoint [5]
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Day 30 and 6 Months
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Secondary outcome [6]
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Biomarker Measurements of Inflammation/Hemodynamic Stress: C-Reactive Protein (CRP)
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Assessment method [6]
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C-Reactive Protein (CRP) is a biomarker associated with inflammation and increased CV risk. Results are presented as geometric least squares means (Geometric LS means). Geometric LS means were adjusted for treatment + baseline value + clopidogrel status at randomization.
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Timepoint [6]
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Day 30 and Month 6
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Secondary outcome [7]
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Genotyping Related to Drug Metabolism
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Assessment method [7]
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Variation in the genes encoding the cytochrome P450 (CYP) enzymes (CYP2C19) can reduce the ability to metabolize clopidogrel and a reduced platelet response and have been associated with increased rates of CV events including CV death. Participants were classified as extensive metabolizers (EM); reduced metabolizers (RM); or unknown (UNK) metabolizers based on their CYP2C19 genotype. Possible extensive metabolizer (EM) phenotypes include EM=extensive metabolizer, UM=ultra-rapid metabolizer, and EM (non-UM) that are not UM. Possible reduced metabolizer (RM) phenotypes include IM=intermediate metabolizer and PM=poor metabolizer. Genotypes associated with each predicted phenotype are presented; predicted phenotype is presented first followed by the genotype. Percentage=(number of participants with the predicted phenotype and genotype divided by the total number of participants per arm) multiplied by 100.
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Timepoint [7]
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Baseline
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Secondary outcome [8]
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Economic and Quality of Life Outcomes
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Assessment method [8]
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Seattle Angina Questionnaire (SAQ) is a validated, disease-specific questionnaire containing 11 questions (Q) yielding 5 summary scales related to angina: physical limitations, angina stability, angina frequency, treatment satisfaction and disease perception. In this study only angina frequency and the physical limitations scales were assessed. Anginal Frequency was assessed using Q3 and Q4 which consists of a Likert scale ranging from 1 to 6 (higher values equals better quality of life) to assess how often a patient is having symptoms now. Physical limitations was assessed using Q1 which contains 9 items each assessed via Likert scale ranging from 1 to 6 (higher values equals better quality of life) to assess how much a participant's condition is hampering their ability to do what they want to do. Scale scores are transformed to a 0-100 by subtracting the lowest possible score, dividing by the range of the scale, and multiplying by 100. Higher values equal better quality of life.
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Timepoint [8]
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Baseline and follow-up (24 months)
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Secondary outcome [9]
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Summary of All Deaths
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Assessment method [9]
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All deaths, regardless of possible relatedness, with the exception of 1 event, were adjudicated by the Clinical Endpoint Committee (CEC) and are reported in this table. The 1 event which was not adjudicated was a result of the revocation of consent by the participant prior to their death. Deaths possibly related to study drug in the opinion of the investigator are also contained in the Serious Adverse Event (SAE) module.
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Timepoint [9]
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Randomization through end of study (30-month visit)
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Eligibility
Key inclusion criteria
Key
* Have had a Unstable Angina/Non-ST-Elevation Myocardial Infarction (UA/NSTEMI) index event within 10 days prior to randomization
* Had a medical management strategy decision made with reasonable certainty that neither percutaneous coronary intervention (PCI) nor coronary artery bypass graft (CABG) is planned for treatment of the index event
* Had at least 1 of 4 specified high-risk features at the time of the UA/NSTEMI event
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Minimum age
18
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
* Decision for medical management greater than 72 hours after onset of index event without commercial clopidogrel treatment within 72 hours following onset of the index event.
* Insignificant coronary artery disease (CAD) on coronary angiography if performed for Index Event (absence of greater than or equal to 30% stenosis in at least one native vessel)
* Previous or planned PCI or CABG as treatment for the index event
* PCI/CABG within previous 30 days
* ST-segment elevation myocardial infarction (STEMI) as the index event
* Cardiogenic shock, Refractory ventricular arrhythmias, New York Heart Association (NYHA) Class IV congestive heart failure (CHF) within the previous 24 hours
* History of ischemic or hemorrhagic stroke, transient ischemic attack (TIA), Intracranial neoplasm, arteriovenous malformation, or aneurysm
* History of spontaneous gastrointestinal (GI) or non-GI bleeding requiring hospitalization for treatment, unless definitive treatment has occurred and there is low likelihood of recurrence
* Hemodialysis or peritoneal dialysis
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
The people receiving the treatment/s
The people administering the treatment/s
The people assessing the outcomes
The people analysing the results/data
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Intervention assignment
Parallel
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Other design features
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Phase
Phase 3
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Type of endpoint/s
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Statistical methods / analysis
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Recruitment
Recruitment status
Completed
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Data analysis
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Reason for early stopping/withdrawal
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Other reasons
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Date of first participant enrolment
Anticipated
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Actual
1/06/2008
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
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Actual
1/04/2012
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Sample size
Target
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Accrual to date
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Final
9326
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Recruitment in Australia
Recruitment state(s)
NSW,QLD,SA,TAS
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Recruitment hospital [1]
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For additional information regarding investigative sites for this trial, contact 1-877-CTLILLY (1-877-285-4559, 1-317-615-4559) Mon - Fri from 9 AM to 5 PM Eastern Time (UTC/GMT - 5 hours, EST), or speak with your personal physician. - Coffs Harbour
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Recruitment hospital [2]
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For additional information regarding investigative sites for this trial, contact 1-877-CTLILLY (1-877-285-4559, 1-317-615-4559) Mon - Fri from 9 AM to 5 PM Eastern Time (UTC/GMT - 5 hours, EST), or speak with your personal physician. - Lismore
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Recruitment hospital [3]
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For additional information regarding investigative sites for this trial, contact 1-877-CTLILLY (1-877-285-4559, 1-317-615-4559) Mon - Fri from 9 AM to 5 PM Eastern Time (UTC/GMT - 5 hours, EST), or speak with your personal physician. - Newcastle
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Recruitment hospital [4]
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For additional information regarding investigative sites for this trial, contact 1-877-CTLILLY (1-877-285-4559, 1-317-615-4559) Mon - Fri from 9 AM to 5 PM Eastern Time (UTC/GMT - 5 hours, EST), or speak with your personal physician. - Wollongong
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Recruitment hospital [5]
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For additional information regarding investigative sites for this trial, contact 1-877-CTLILLY (1-877-285-4559, 1-317-615-4559) Mon - Fri from 9 AM to 5 PM Eastern Time (UTC/GMT - 5 hours, EST), or speak with your personal physician. - Herston
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Recruitment hospital [6]
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For additional information regarding investigative sites for this trial, contact 1-877-CTLILLY (1-877-285-4559, 1-317-615-4559) Mon - Fri from 9 AM to 5 PM Eastern Time (UTC/GMT - 5 hours, EST), or speak with your personal physician. - Nambour
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Recruitment hospital [7]
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For additional information regarding investigative sites for this trial, contact 1-877-CTLILLY (1-877-285-4559, 1-317-615-4559) Mon - Fri from 9 AM to 5 PM Eastern Time (UTC/GMT - 5 hours, EST), or speak with your personal physician. - Redcliffe
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Recruitment hospital [8]
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For additional information regarding investigative sites for this trial, contact 1-877-CTLILLY (1-877-285-4559, 1-317-615-4559) Mon - Fri from 9 AM to 5 PM Eastern Time (UTC/GMT - 5 hours, EST), or speak with your personal physician. - Southport
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Recruitment hospital [9]
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For additional information regarding investigative sites for this trial, contact 1-877-CTLILLY (1-877-285-4559, 1-317-615-4559) Mon - Fri from 9 AM to 5 PM Eastern Time (UTC/GMT - 5 hours, EST), or speak with your personal physician. - Bedford Park
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Recruitment hospital [10]
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For additional information regarding investigative sites for this trial, contact 1-877-CTLILLY (1-877-285-4559, 1-317-615-4559) Mon - Fri from 9 AM to 5 PM Eastern Time (UTC/GMT - 5 hours, EST), or speak with your personal physician. - Elizabeth Vale
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Recruitment hospital [11]
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For additional information regarding investigative sites for this trial, contact 1-877-CTLILLY (1-877-285-4559, 1-317-615-4559) Mon - Fri from 9 AM to 5 PM Eastern Time (UTC/GMT - 5 hours, EST), or speak with your personal physician. - Hobart
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Recruitment postcode(s) [1]
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2450 - Coffs Harbour
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Recruitment postcode(s) [2]
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2480 - Lismore
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Recruitment postcode(s) [3]
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2305 - Newcastle
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Recruitment postcode(s) [4]
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2500 - Wollongong
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Recruitment postcode(s) [5]
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4029 - Herston
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Recruitment postcode(s) [6]
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4560 - Nambour
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Recruitment postcode(s) [7]
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4020 - Redcliffe
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Recruitment postcode(s) [8]
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4215 - Southport
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Recruitment postcode(s) [9]
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5042 - Bedford Park
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Recruitment postcode(s) [10]
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5112 - Elizabeth Vale
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Recruitment postcode(s) [11]
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7000 - Hobart
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Recruitment outside Australia
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Alabama
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Campinas
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Curitiba
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Country [77]
0
0
Brazil
Query!
State/province [77]
0
0
Passo Fundo
Query!
Country [78]
0
0
Brazil
Query!
State/province [78]
0
0
Piracicaba
Query!
Country [79]
0
0
Brazil
Query!
State/province [79]
0
0
Porto Alegre
Query!
Country [80]
0
0
Brazil
Query!
State/province [80]
0
0
Recife
Query!
Country [81]
0
0
Brazil
Query!
State/province [81]
0
0
Ribeirao Preto
Query!
Country [82]
0
0
Brazil
Query!
State/province [82]
0
0
Rio De Janeiro
Query!
Country [83]
0
0
Brazil
Query!
State/province [83]
0
0
Salvador
Query!
Country [84]
0
0
Brazil
Query!
State/province [84]
0
0
Santo Andre
Query!
Country [85]
0
0
Brazil
Query!
State/province [85]
0
0
Sao Caetano Do Sul
Query!
Country [86]
0
0
Brazil
Query!
State/province [86]
0
0
Sao Jose Rio Preto
Query!
Country [87]
0
0
Brazil
Query!
State/province [87]
0
0
Sao Jose
Query!
Country [88]
0
0
Brazil
Query!
State/province [88]
0
0
São Paulo
Query!
Country [89]
0
0
Brazil
Query!
State/province [89]
0
0
Uberlandia
Query!
Country [90]
0
0
Brazil
Query!
State/province [90]
0
0
Votuporanga
Query!
Country [91]
0
0
Bulgaria
Query!
State/province [91]
0
0
Dimitrovgrad
Query!
Country [92]
0
0
Bulgaria
Query!
State/province [92]
0
0
Haskovo
Query!
Country [93]
0
0
Bulgaria
Query!
State/province [93]
0
0
Kazanlak
Query!
Country [94]
0
0
Bulgaria
Query!
State/province [94]
0
0
Kjustendil
Query!
Country [95]
0
0
Bulgaria
Query!
State/province [95]
0
0
Pazardzhik
Query!
Country [96]
0
0
Bulgaria
Query!
State/province [96]
0
0
Pleven
Query!
Country [97]
0
0
Bulgaria
Query!
State/province [97]
0
0
Plovdiv
Query!
Country [98]
0
0
Bulgaria
Query!
State/province [98]
0
0
Rousse
Query!
Country [99]
0
0
Bulgaria
Query!
State/province [99]
0
0
Sofia
Query!
Country [100]
0
0
Bulgaria
Query!
State/province [100]
0
0
Varna
Query!
Country [101]
0
0
Canada
Query!
State/province [101]
0
0
Alberta
Query!
Country [102]
0
0
Canada
Query!
State/province [102]
0
0
British Columbia
Query!
Country [103]
0
0
Canada
Query!
State/province [103]
0
0
Newfoundland and Labrador
Query!
Country [104]
0
0
Canada
Query!
State/province [104]
0
0
Nova Scotia
Query!
Country [105]
0
0
Canada
Query!
State/province [105]
0
0
Ontario
Query!
Country [106]
0
0
Canada
Query!
State/province [106]
0
0
Quebec
Query!
Country [107]
0
0
Chile
Query!
State/province [107]
0
0
La Serena
Query!
Country [108]
0
0
Chile
Query!
State/province [108]
0
0
Osorno
Query!
Country [109]
0
0
Chile
Query!
State/province [109]
0
0
Puente Alto
Query!
Country [110]
0
0
Chile
Query!
State/province [110]
0
0
Rancagua
Query!
Country [111]
0
0
Chile
Query!
State/province [111]
0
0
Santiago
Query!
Country [112]
0
0
Chile
Query!
State/province [112]
0
0
Temuco
Query!
Country [113]
0
0
Chile
Query!
State/province [113]
0
0
Vina Del Mar
Query!
Country [114]
0
0
China
Query!
State/province [114]
0
0
Beijing
Query!
Country [115]
0
0
China
Query!
State/province [115]
0
0
Bejing
Query!
Country [116]
0
0
China
Query!
State/province [116]
0
0
Changsha
Query!
Country [117]
0
0
China
Query!
State/province [117]
0
0
Fuzhou
Query!
Country [118]
0
0
China
Query!
State/province [118]
0
0
Guang Zhou
Query!
Country [119]
0
0
China
Query!
State/province [119]
0
0
Hangzhou
Query!
Country [120]
0
0
China
Query!
State/province [120]
0
0
Harbin
Query!
Country [121]
0
0
China
Query!
State/province [121]
0
0
Jiangsu
Query!
Country [122]
0
0
China
Query!
State/province [122]
0
0
Nanchang
Query!
Country [123]
0
0
China
Query!
State/province [123]
0
0
Nanjing
Query!
Country [124]
0
0
China
Query!
State/province [124]
0
0
Shanghai
Query!
Country [125]
0
0
China
Query!
State/province [125]
0
0
Shaoguan
Query!
Country [126]
0
0
China
Query!
State/province [126]
0
0
Shengyang
Query!
Country [127]
0
0
China
Query!
State/province [127]
0
0
Shenyang
Query!
Country [128]
0
0
China
Query!
State/province [128]
0
0
Shijiazhuang
Query!
Country [129]
0
0
China
Query!
State/province [129]
0
0
Suzhou City
Query!
Country [130]
0
0
China
Query!
State/province [130]
0
0
Wenzhou
Query!
Country [131]
0
0
China
Query!
State/province [131]
0
0
Wu Han
Query!
Country [132]
0
0
China
Query!
State/province [132]
0
0
Wuhan City
Query!
Country [133]
0
0
China
Query!
State/province [133]
0
0
Xian
Query!
Country [134]
0
0
China
Query!
State/province [134]
0
0
Xuzhou
Query!
Country [135]
0
0
China
Query!
State/province [135]
0
0
Zhengzhou
Query!
Country [136]
0
0
Colombia
Query!
State/province [136]
0
0
Armenia-Quindio
Query!
Country [137]
0
0
Colombia
Query!
State/province [137]
0
0
Barranquilla
Query!
Country [138]
0
0
Colombia
Query!
State/province [138]
0
0
Bogota
Query!
Country [139]
0
0
Colombia
Query!
State/province [139]
0
0
Cali
Query!
Country [140]
0
0
Colombia
Query!
State/province [140]
0
0
Floridablanca
Query!
Country [141]
0
0
Colombia
Query!
State/province [141]
0
0
Medellin
Query!
Country [142]
0
0
Costa Rica
Query!
State/province [142]
0
0
San Jose
Query!
Country [143]
0
0
Croatia
Query!
State/province [143]
0
0
Dubrovnik
Query!
Country [144]
0
0
Croatia
Query!
State/province [144]
0
0
Karlovac
Query!
Country [145]
0
0
Croatia
Query!
State/province [145]
0
0
Koprivnica
Query!
Country [146]
0
0
Croatia
Query!
State/province [146]
0
0
Krapinske Toplice
Query!
Country [147]
0
0
Croatia
Query!
State/province [147]
0
0
Rijeka
Query!
Country [148]
0
0
Croatia
Query!
State/province [148]
0
0
Slavonski Brod
Query!
Country [149]
0
0
Croatia
Query!
State/province [149]
0
0
Split
Query!
Country [150]
0
0
Croatia
Query!
State/province [150]
0
0
Varazdin
Query!
Country [151]
0
0
Croatia
Query!
State/province [151]
0
0
Zadar
Query!
Country [152]
0
0
Croatia
Query!
State/province [152]
0
0
Zagreb
Query!
Country [153]
0
0
Czech Republic
Query!
State/province [153]
0
0
Decin
Query!
Country [154]
0
0
Czech Republic
Query!
State/province [154]
0
0
Frydek-Mistek
Query!
Country [155]
0
0
Czech Republic
Query!
State/province [155]
0
0
Hradec Kralove
Query!
Country [156]
0
0
Czech Republic
Query!
State/province [156]
0
0
Karlovy Vary
Query!
Country [157]
0
0
Czech Republic
Query!
State/province [157]
0
0
Kromeriz
Query!
Country [158]
0
0
Czech Republic
Query!
State/province [158]
0
0
Liberec
Query!
Country [159]
0
0
Czech Republic
Query!
State/province [159]
0
0
Novy Jicin
Query!
Country [160]
0
0
Czech Republic
Query!
State/province [160]
0
0
Pardubice
Query!
Country [161]
0
0
Czech Republic
Query!
State/province [161]
0
0
Prague
Query!
Country [162]
0
0
Czech Republic
Query!
State/province [162]
0
0
Zlin
Query!
Country [163]
0
0
Denmark
Query!
State/province [163]
0
0
Copenhagen
Query!
Country [164]
0
0
Denmark
Query!
State/province [164]
0
0
Hellerup
Query!
Country [165]
0
0
Denmark
Query!
State/province [165]
0
0
Kobenhavn
Query!
Country [166]
0
0
Egypt
Query!
State/province [166]
0
0
Alexandria
Query!
Country [167]
0
0
Egypt
Query!
State/province [167]
0
0
Beni Sweif
Query!
Country [168]
0
0
Egypt
Query!
State/province [168]
0
0
Cairo
Query!
Country [169]
0
0
Egypt
Query!
State/province [169]
0
0
Ismailia
Query!
Country [170]
0
0
Egypt
Query!
State/province [170]
0
0
Menoufiya
Query!
Country [171]
0
0
Finland
Query!
State/province [171]
0
0
Jyvaskyla
Query!
Country [172]
0
0
France
Query!
State/province [172]
0
0
Angers
Query!
Country [173]
0
0
France
Query!
State/province [173]
0
0
Arras
Query!
Country [174]
0
0
France
Query!
State/province [174]
0
0
Besancon
Query!
Country [175]
0
0
France
Query!
State/province [175]
0
0
Cambrai
Query!
Country [176]
0
0
France
Query!
State/province [176]
0
0
Chartres Cedex
Query!
Country [177]
0
0
France
Query!
State/province [177]
0
0
Dijon
Query!
Country [178]
0
0
France
Query!
State/province [178]
0
0
Douai
Query!
Country [179]
0
0
France
Query!
State/province [179]
0
0
La Roche Sur Yon
Query!
Country [180]
0
0
France
Query!
State/province [180]
0
0
Lagny Sur Marne
Query!
Country [181]
0
0
France
Query!
State/province [181]
0
0
Nantes
Query!
Country [182]
0
0
France
Query!
State/province [182]
0
0
Nice
Query!
Country [183]
0
0
France
Query!
State/province [183]
0
0
Paris
Query!
Country [184]
0
0
France
Query!
State/province [184]
0
0
Pessac
Query!
Country [185]
0
0
France
Query!
State/province [185]
0
0
Poitiers
Query!
Country [186]
0
0
France
Query!
State/province [186]
0
0
Strasbourg
Query!
Country [187]
0
0
France
Query!
State/province [187]
0
0
Toulouse
Query!
Country [188]
0
0
France
Query!
State/province [188]
0
0
Valenciennes
Query!
Country [189]
0
0
France
Query!
State/province [189]
0
0
Vandoeuvre Les Nancy
Query!
Country [190]
0
0
Germany
Query!
State/province [190]
0
0
Bad Nauheim
Query!
Country [191]
0
0
Germany
Query!
State/province [191]
0
0
Darmstadt
Query!
Country [192]
0
0
Germany
Query!
State/province [192]
0
0
Dortmund
Query!
Country [193]
0
0
Germany
Query!
State/province [193]
0
0
Frankfurt
Query!
Country [194]
0
0
Germany
Query!
State/province [194]
0
0
Halle
Query!
Country [195]
0
0
Germany
Query!
State/province [195]
0
0
Idar-Oberstein
Query!
Country [196]
0
0
Germany
Query!
State/province [196]
0
0
Köln
Query!
Country [197]
0
0
Germany
Query!
State/province [197]
0
0
Leipzig
Query!
Country [198]
0
0
Germany
Query!
State/province [198]
0
0
Mainz
Query!
Country [199]
0
0
Germany
Query!
State/province [199]
0
0
Mannheim
Query!
Country [200]
0
0
Germany
Query!
State/province [200]
0
0
Stuttgart
Query!
Country [201]
0
0
Germany
Query!
State/province [201]
0
0
Tuebingen
Query!
Country [202]
0
0
Greece
Query!
State/province [202]
0
0
Athens
Query!
Country [203]
0
0
Greece
Query!
State/province [203]
0
0
Haidari/Athens
Query!
Country [204]
0
0
Greece
Query!
State/province [204]
0
0
Kallithea
Query!
Country [205]
0
0
Greece
Query!
State/province [205]
0
0
Magoula
Query!
Country [206]
0
0
Greece
Query!
State/province [206]
0
0
Patras
Query!
Country [207]
0
0
Greece
Query!
State/province [207]
0
0
Rhodos
Query!
Country [208]
0
0
Greece
Query!
State/province [208]
0
0
Trikala
Query!
Country [209]
0
0
Hungary
Query!
State/province [209]
0
0
Baja
Query!
Country [210]
0
0
Hungary
Query!
State/province [210]
0
0
Bekescsaba
Query!
Country [211]
0
0
Hungary
Query!
State/province [211]
0
0
Budapest
Query!
Country [212]
0
0
Hungary
Query!
State/province [212]
0
0
Kalocsa
Query!
Country [213]
0
0
Hungary
Query!
State/province [213]
0
0
Kecskemet
Query!
Country [214]
0
0
Hungary
Query!
State/province [214]
0
0
Komarom
Query!
Country [215]
0
0
Hungary
Query!
State/province [215]
0
0
Miskolc
Query!
Country [216]
0
0
Hungary
Query!
State/province [216]
0
0
Satoraljaujhely
Query!
Country [217]
0
0
Hungary
Query!
State/province [217]
0
0
Sopron
Query!
Country [218]
0
0
Hungary
Query!
State/province [218]
0
0
Szekszard
Query!
Country [219]
0
0
Hungary
Query!
State/province [219]
0
0
Zalaegerszeg
Query!
Country [220]
0
0
India
Query!
State/province [220]
0
0
Ahmedabad
Query!
Country [221]
0
0
India
Query!
State/province [221]
0
0
Anand
Query!
Country [222]
0
0
India
Query!
State/province [222]
0
0
Aurangabad
Query!
Country [223]
0
0
India
Query!
State/province [223]
0
0
Bangalore
Query!
Country [224]
0
0
India
Query!
State/province [224]
0
0
Baramati
Query!
Country [225]
0
0
India
Query!
State/province [225]
0
0
Bikaner
Query!
Country [226]
0
0
India
Query!
State/province [226]
0
0
Calicut
Query!
Country [227]
0
0
India
Query!
State/province [227]
0
0
Chidambaram
Query!
Country [228]
0
0
India
Query!
State/province [228]
0
0
Cochin
Query!
Country [229]
0
0
India
Query!
State/province [229]
0
0
Coimbatore
Query!
Country [230]
0
0
India
Query!
State/province [230]
0
0
Ernakulam
Query!
Country [231]
0
0
India
Query!
State/province [231]
0
0
Guntur
Query!
Country [232]
0
0
India
Query!
State/province [232]
0
0
Gurgaon
Query!
Country [233]
0
0
India
Query!
State/province [233]
0
0
Hyderabaad
Query!
Country [234]
0
0
India
Query!
State/province [234]
0
0
Indore
Query!
Country [235]
0
0
India
Query!
State/province [235]
0
0
Jaipur
Query!
Country [236]
0
0
India
Query!
State/province [236]
0
0
Jalandhar
Query!
Country [237]
0
0
India
Query!
State/province [237]
0
0
Kolkata
Query!
Country [238]
0
0
India
Query!
State/province [238]
0
0
Kottayam
Query!
Country [239]
0
0
India
Query!
State/province [239]
0
0
Lucknow
Query!
Country [240]
0
0
India
Query!
State/province [240]
0
0
Madurai
Query!
Country [241]
0
0
India
Query!
State/province [241]
0
0
Mumbai
Query!
Country [242]
0
0
India
Query!
State/province [242]
0
0
Mysore
Query!
Country [243]
0
0
India
Query!
State/province [243]
0
0
Nagpur
Query!
Country [244]
0
0
India
Query!
State/province [244]
0
0
Nashik
Query!
Country [245]
0
0
India
Query!
State/province [245]
0
0
New Delhi
Query!
Country [246]
0
0
India
Query!
State/province [246]
0
0
Patiala
Query!
Country [247]
0
0
India
Query!
State/province [247]
0
0
Pune
Query!
Country [248]
0
0
India
Query!
State/province [248]
0
0
Saket
Query!
Country [249]
0
0
India
Query!
State/province [249]
0
0
Secunderabad
Query!
Country [250]
0
0
India
Query!
State/province [250]
0
0
Shivamogga
Query!
Country [251]
0
0
India
Query!
State/province [251]
0
0
Solapur
Query!
Country [252]
0
0
India
Query!
State/province [252]
0
0
Surat
Query!
Country [253]
0
0
India
Query!
State/province [253]
0
0
Thrissur
Query!
Country [254]
0
0
India
Query!
State/province [254]
0
0
Tirupati
Query!
Country [255]
0
0
India
Query!
State/province [255]
0
0
Trivandrum
Query!
Country [256]
0
0
India
Query!
State/province [256]
0
0
Vadodara
Query!
Country [257]
0
0
India
Query!
State/province [257]
0
0
Vijayawada
Query!
Country [258]
0
0
India
Query!
State/province [258]
0
0
Visakhapatnam
Query!
Country [259]
0
0
Ireland
Query!
State/province [259]
0
0
Dublin
Query!
Country [260]
0
0
Ireland
Query!
State/province [260]
0
0
Galway
Query!
Country [261]
0
0
Israel
Query!
State/province [261]
0
0
Afula
Query!
Country [262]
0
0
Israel
Query!
State/province [262]
0
0
Ashkelon
Query!
Country [263]
0
0
Israel
Query!
State/province [263]
0
0
Beer Sheva
Query!
Country [264]
0
0
Israel
Query!
State/province [264]
0
0
Eilat
Query!
Country [265]
0
0
Israel
Query!
State/province [265]
0
0
Haifa
Query!
Country [266]
0
0
Israel
Query!
State/province [266]
0
0
Jerusalem
Query!
Country [267]
0
0
Israel
Query!
State/province [267]
0
0
Kfar Saba
Query!
Country [268]
0
0
Israel
Query!
State/province [268]
0
0
Nahariya
Query!
Country [269]
0
0
Israel
Query!
State/province [269]
0
0
Nazareth
Query!
Country [270]
0
0
Israel
Query!
State/province [270]
0
0
Rehovot
Query!
Country [271]
0
0
Israel
Query!
State/province [271]
0
0
Tel Aviv
Query!
Country [272]
0
0
Israel
Query!
State/province [272]
0
0
Tel Hashomer
Query!
Country [273]
0
0
Israel
Query!
State/province [273]
0
0
Tiberias
Query!
Country [274]
0
0
Israel
Query!
State/province [274]
0
0
Tzfat
Query!
Country [275]
0
0
Italy
Query!
State/province [275]
0
0
Albano Laziale
Query!
Country [276]
0
0
Italy
Query!
State/province [276]
0
0
Ascoli Piceno
Query!
Country [277]
0
0
Italy
Query!
State/province [277]
0
0
Bari
Query!
Country [278]
0
0
Italy
Query!
State/province [278]
0
0
Bergamo
Query!
Country [279]
0
0
Italy
Query!
State/province [279]
0
0
Brescia
Query!
Country [280]
0
0
Italy
Query!
State/province [280]
0
0
Caserta
Query!
Country [281]
0
0
Italy
Query!
State/province [281]
0
0
Forli
Query!
Country [282]
0
0
Italy
Query!
State/province [282]
0
0
Lecco
Query!
Country [283]
0
0
Italy
Query!
State/province [283]
0
0
Legnago
Query!
Country [284]
0
0
Italy
Query!
State/province [284]
0
0
Legnano
Query!
Country [285]
0
0
Italy
Query!
State/province [285]
0
0
Milano
Query!
Country [286]
0
0
Italy
Query!
State/province [286]
0
0
Novara
Query!
Country [287]
0
0
Italy
Query!
State/province [287]
0
0
Parma
Query!
Country [288]
0
0
Italy
Query!
State/province [288]
0
0
Perugia
Query!
Country [289]
0
0
Italy
Query!
State/province [289]
0
0
Pescara
Query!
Country [290]
0
0
Italy
Query!
State/province [290]
0
0
Reggio Emilia
Query!
Country [291]
0
0
Italy
Query!
State/province [291]
0
0
Rimini
Query!
Country [292]
0
0
Italy
Query!
State/province [292]
0
0
Rome
Query!
Country [293]
0
0
Italy
Query!
State/province [293]
0
0
San Daniele Del Friuli
Query!
Country [294]
0
0
Italy
Query!
State/province [294]
0
0
Santa Maria Capua Vetere
Query!
Country [295]
0
0
Italy
Query!
State/province [295]
0
0
Saronno
Query!
Country [296]
0
0
Italy
Query!
State/province [296]
0
0
Sorrento
Query!
Country [297]
0
0
Italy
Query!
State/province [297]
0
0
Terni
Query!
Country [298]
0
0
Italy
Query!
State/province [298]
0
0
Trieste
Query!
Country [299]
0
0
Korea, Republic of
Query!
State/province [299]
0
0
Busan
Query!
Country [300]
0
0
Korea, Republic of
Query!
State/province [300]
0
0
Daegu
Query!
Country [301]
0
0
Korea, Republic of
Query!
State/province [301]
0
0
Daejeon
Query!
Country [302]
0
0
Korea, Republic of
Query!
State/province [302]
0
0
Gangwon-Do
Query!
Country [303]
0
0
Korea, Republic of
Query!
State/province [303]
0
0
Gwangju
Query!
Country [304]
0
0
Korea, Republic of
Query!
State/province [304]
0
0
Incheon
Query!
Country [305]
0
0
Korea, Republic of
Query!
State/province [305]
0
0
Jeon Ju-City
Query!
Country [306]
0
0
Korea, Republic of
Query!
State/province [306]
0
0
Jin-Ju-Si
Query!
Country [307]
0
0
Korea, Republic of
Query!
State/province [307]
0
0
Seoul
Query!
Country [308]
0
0
Korea, Republic of
Query!
State/province [308]
0
0
Ulsan-Si
Query!
Country [309]
0
0
Lithuania
Query!
State/province [309]
0
0
Kaunas
Query!
Country [310]
0
0
Lithuania
Query!
State/province [310]
0
0
Klaipeda
Query!
Country [311]
0
0
Lithuania
Query!
State/province [311]
0
0
Siauliai
Query!
Country [312]
0
0
Lithuania
Query!
State/province [312]
0
0
Vilnius
Query!
Country [313]
0
0
Malaysia
Query!
State/province [313]
0
0
Cheras, Kuala Lumpur
Query!
Country [314]
0
0
Malaysia
Query!
State/province [314]
0
0
Johor Bahru
Query!
Country [315]
0
0
Malaysia
Query!
State/province [315]
0
0
Kelantan
Query!
Country [316]
0
0
Malaysia
Query!
State/province [316]
0
0
Kuala Lumpur
Query!
Country [317]
0
0
Malaysia
Query!
State/province [317]
0
0
Kuantan Pahang
Query!
Country [318]
0
0
Malaysia
Query!
State/province [318]
0
0
Perak
Query!
Country [319]
0
0
Malaysia
Query!
State/province [319]
0
0
Sarawak
Query!
Country [320]
0
0
Malaysia
Query!
State/province [320]
0
0
Selangor
Query!
Country [321]
0
0
Malaysia
Query!
State/province [321]
0
0
Taiping Perak
Query!
Country [322]
0
0
Malta
Query!
State/province [322]
0
0
Gozo
Query!
Country [323]
0
0
Malta
Query!
State/province [323]
0
0
Msida
Query!
Country [324]
0
0
Mexico
Query!
State/province [324]
0
0
Aguascalientes
Query!
Country [325]
0
0
Mexico
Query!
State/province [325]
0
0
Culiacan
Query!
Country [326]
0
0
Mexico
Query!
State/province [326]
0
0
Durango
Query!
Country [327]
0
0
Mexico
Query!
State/province [327]
0
0
Jalisco
Query!
Country [328]
0
0
Mexico
Query!
State/province [328]
0
0
Leon
Query!
Country [329]
0
0
Mexico
Query!
State/province [329]
0
0
Monterrey
Query!
Country [330]
0
0
Mexico
Query!
State/province [330]
0
0
Puebla
Query!
Country [331]
0
0
Mexico
Query!
State/province [331]
0
0
Queretaro
Query!
Country [332]
0
0
Mexico
Query!
State/province [332]
0
0
San Luis Potosi
Query!
Country [333]
0
0
Mexico
Query!
State/province [333]
0
0
Tijuana
Query!
Country [334]
0
0
Netherlands
Query!
State/province [334]
0
0
Alkmaar
Query!
Country [335]
0
0
Netherlands
Query!
State/province [335]
0
0
Almelo
Query!
Country [336]
0
0
Netherlands
Query!
State/province [336]
0
0
Amsterdam
Query!
Country [337]
0
0
Netherlands
Query!
State/province [337]
0
0
Apeldoorn
Query!
Country [338]
0
0
Netherlands
Query!
State/province [338]
0
0
Beverwijk
Query!
Country [339]
0
0
Netherlands
Query!
State/province [339]
0
0
Blaricum
Query!
Country [340]
0
0
Netherlands
Query!
State/province [340]
0
0
Delft
Query!
Country [341]
0
0
Netherlands
Query!
State/province [341]
0
0
Ede
Query!
Country [342]
0
0
Netherlands
Query!
State/province [342]
0
0
Eindhoven
Query!
Country [343]
0
0
Netherlands
Query!
State/province [343]
0
0
Gouda
Query!
Country [344]
0
0
Netherlands
Query!
State/province [344]
0
0
Hoorn
Query!
Country [345]
0
0
Netherlands
Query!
State/province [345]
0
0
Leeuwarden
Query!
Country [346]
0
0
Netherlands
Query!
State/province [346]
0
0
Leiden
Query!
Country [347]
0
0
Netherlands
Query!
State/province [347]
0
0
Leiderdorp
Query!
Country [348]
0
0
Netherlands
Query!
State/province [348]
0
0
Meppel
Query!
Country [349]
0
0
Netherlands
Query!
State/province [349]
0
0
Oss
Query!
Country [350]
0
0
Netherlands
Query!
State/province [350]
0
0
Roosendaal
Query!
Country [351]
0
0
Netherlands
Query!
State/province [351]
0
0
Venlo
Query!
Country [352]
0
0
New Zealand
Query!
State/province [352]
0
0
Auckland
Query!
Country [353]
0
0
New Zealand
Query!
State/province [353]
0
0
Christchurch
Query!
Country [354]
0
0
New Zealand
Query!
State/province [354]
0
0
Nelson
Query!
Country [355]
0
0
New Zealand
Query!
State/province [355]
0
0
Wellington
Query!
Country [356]
0
0
Panama
Query!
State/province [356]
0
0
Cocle
Query!
Country [357]
0
0
Panama
Query!
State/province [357]
0
0
David
Query!
Country [358]
0
0
Panama
Query!
State/province [358]
0
0
Panama
Query!
Country [359]
0
0
Peru
Query!
State/province [359]
0
0
Arequipa
Query!
Country [360]
0
0
Peru
Query!
State/province [360]
0
0
Callao
Query!
Country [361]
0
0
Peru
Query!
State/province [361]
0
0
Cuzco
Query!
Country [362]
0
0
Peru
Query!
State/province [362]
0
0
Lima
Query!
Country [363]
0
0
Philippines
Query!
State/province [363]
0
0
Cagayan De De Oro
Query!
Country [364]
0
0
Philippines
Query!
State/province [364]
0
0
Cavite City
Query!
Country [365]
0
0
Philippines
Query!
State/province [365]
0
0
Davao City
Query!
Country [366]
0
0
Philippines
Query!
State/province [366]
0
0
Iloilo City
Query!
Country [367]
0
0
Philippines
Query!
State/province [367]
0
0
Manila
Query!
Country [368]
0
0
Philippines
Query!
State/province [368]
0
0
Marikina City
Query!
Country [369]
0
0
Philippines
Query!
State/province [369]
0
0
Metro Manila
Query!
Country [370]
0
0
Philippines
Query!
State/province [370]
0
0
Pasig City
Query!
Country [371]
0
0
Philippines
Query!
State/province [371]
0
0
Quezon City
Query!
Country [372]
0
0
Poland
Query!
State/province [372]
0
0
Bydgoszcz
Query!
Country [373]
0
0
Poland
Query!
State/province [373]
0
0
Elblag
Query!
Country [374]
0
0
Poland
Query!
State/province [374]
0
0
Gdansk
Query!
Country [375]
0
0
Poland
Query!
State/province [375]
0
0
Katowice
Query!
Country [376]
0
0
Poland
Query!
State/province [376]
0
0
Koszalin
Query!
Country [377]
0
0
Poland
Query!
State/province [377]
0
0
Krakow
Query!
Country [378]
0
0
Poland
Query!
State/province [378]
0
0
Kutno
Query!
Country [379]
0
0
Poland
Query!
State/province [379]
0
0
Lodz
Query!
Country [380]
0
0
Poland
Query!
State/province [380]
0
0
Lubin
Query!
Country [381]
0
0
Poland
Query!
State/province [381]
0
0
Lublin
Query!
Country [382]
0
0
Poland
Query!
State/province [382]
0
0
Myslenice
Query!
Country [383]
0
0
Poland
Query!
State/province [383]
0
0
Nowy Sacz
Query!
Country [384]
0
0
Poland
Query!
State/province [384]
0
0
Olawa
Query!
Country [385]
0
0
Poland
Query!
State/province [385]
0
0
Piotrkow Trybunalski
Query!
Country [386]
0
0
Poland
Query!
State/province [386]
0
0
Pulawy
Query!
Country [387]
0
0
Poland
Query!
State/province [387]
0
0
Ruda Slaska
Query!
Country [388]
0
0
Poland
Query!
State/province [388]
0
0
Skierniewice
Query!
Country [389]
0
0
Poland
Query!
State/province [389]
0
0
Szczecin
Query!
Country [390]
0
0
Poland
Query!
State/province [390]
0
0
Walbrzych
Query!
Country [391]
0
0
Poland
Query!
State/province [391]
0
0
Warsaw
Query!
Country [392]
0
0
Poland
Query!
State/province [392]
0
0
Wejherowo
Query!
Country [393]
0
0
Poland
Query!
State/province [393]
0
0
Wroclaw
Query!
Country [394]
0
0
Portugal
Query!
State/province [394]
0
0
Aveiro
Query!
Country [395]
0
0
Portugal
Query!
State/province [395]
0
0
Carnaxide
Query!
Country [396]
0
0
Portugal
Query!
State/province [396]
0
0
Coimbra
Query!
Country [397]
0
0
Portugal
Query!
State/province [397]
0
0
Leiria
Query!
Country [398]
0
0
Portugal
Query!
State/province [398]
0
0
Ponta Delgada
Query!
Country [399]
0
0
Portugal
Query!
State/province [399]
0
0
Santarem
Query!
Country [400]
0
0
Portugal
Query!
State/province [400]
0
0
Setubal
Query!
Country [401]
0
0
Portugal
Query!
State/province [401]
0
0
Vila Franca De Xira
Query!
Country [402]
0
0
Puerto Rico
Query!
State/province [402]
0
0
Caguas
Query!
Country [403]
0
0
Puerto Rico
Query!
State/province [403]
0
0
Mayaguez
Query!
Country [404]
0
0
Puerto Rico
Query!
State/province [404]
0
0
San Juan
Query!
Country [405]
0
0
Romania
Query!
State/province [405]
0
0
Bacau
Query!
Country [406]
0
0
Romania
Query!
State/province [406]
0
0
Baia Mare
Query!
Country [407]
0
0
Romania
Query!
State/province [407]
0
0
Braila
Query!
Country [408]
0
0
Romania
Query!
State/province [408]
0
0
Brasov
Query!
Country [409]
0
0
Romania
Query!
State/province [409]
0
0
Bucharest
Query!
Country [410]
0
0
Romania
Query!
State/province [410]
0
0
Buzau
Query!
Country [411]
0
0
Romania
Query!
State/province [411]
0
0
Cluj-Napoca
Query!
Country [412]
0
0
Romania
Query!
State/province [412]
0
0
Focsani
Query!
Country [413]
0
0
Romania
Query!
State/province [413]
0
0
Pitesti
Query!
Country [414]
0
0
Romania
Query!
State/province [414]
0
0
Suceava
Query!
Country [415]
0
0
Romania
Query!
State/province [415]
0
0
Targoviste
Query!
Country [416]
0
0
Russian Federation
Query!
State/province [416]
0
0
Arkhangelsk
Query!
Country [417]
0
0
Russian Federation
Query!
State/province [417]
0
0
Gatchina
Query!
Country [418]
0
0
Russian Federation
Query!
State/province [418]
0
0
Kazan
Query!
Country [419]
0
0
Russian Federation
Query!
State/province [419]
0
0
Kemerovo
Query!
Country [420]
0
0
Russian Federation
Query!
State/province [420]
0
0
Krasnoyarsk
Query!
Country [421]
0
0
Russian Federation
Query!
State/province [421]
0
0
Moscow
Query!
Country [422]
0
0
Russian Federation
Query!
State/province [422]
0
0
Nizhny Novgorod
Query!
Country [423]
0
0
Russian Federation
Query!
State/province [423]
0
0
Novokuznetsk
Query!
Country [424]
0
0
Russian Federation
Query!
State/province [424]
0
0
Novosibirsk
Query!
Country [425]
0
0
Russian Federation
Query!
State/province [425]
0
0
Omsk
Query!
Country [426]
0
0
Russian Federation
Query!
State/province [426]
0
0
Rostov-On-Don
Query!
Country [427]
0
0
Russian Federation
Query!
State/province [427]
0
0
Saint Petersburg
Query!
Country [428]
0
0
Russian Federation
Query!
State/province [428]
0
0
Saratov
Query!
Country [429]
0
0
Russian Federation
Query!
State/province [429]
0
0
Tomsk
Query!
Country [430]
0
0
Russian Federation
Query!
State/province [430]
0
0
Tyumen
Query!
Country [431]
0
0
Serbia
Query!
State/province [431]
0
0
Belgrade
Query!
Country [432]
0
0
Serbia
Query!
State/province [432]
0
0
Kragujevac
Query!
Country [433]
0
0
Serbia
Query!
State/province [433]
0
0
Niska Banja
Query!
Country [434]
0
0
Serbia
Query!
State/province [434]
0
0
Nis
Query!
Country [435]
0
0
Serbia
Query!
State/province [435]
0
0
Zemun
Query!
Country [436]
0
0
Singapore
Query!
State/province [436]
0
0
Singapore
Query!
Country [437]
0
0
Slovakia
Query!
State/province [437]
0
0
Bratislava
Query!
Country [438]
0
0
Slovakia
Query!
State/province [438]
0
0
Levice
Query!
Country [439]
0
0
Slovakia
Query!
State/province [439]
0
0
Martin
Query!
Country [440]
0
0
Slovakia
Query!
State/province [440]
0
0
Nitra
Query!
Country [441]
0
0
Slovakia
Query!
State/province [441]
0
0
Nove Zamky
Query!
Country [442]
0
0
Slovakia
Query!
State/province [442]
0
0
Presov
Query!
Country [443]
0
0
Slovakia
Query!
State/province [443]
0
0
Ruzomberok
Query!
Country [444]
0
0
Slovakia
Query!
State/province [444]
0
0
Zilina
Query!
Country [445]
0
0
South Africa
Query!
State/province [445]
0
0
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Sunderland
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Funding & Sponsors
Primary sponsor type
Commercial sector/industry
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Name
Eli Lilly and Company
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Other collaborator category [1]
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Commercial sector/industry
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Daiichi Sankyo Co., Ltd.
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Other
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Duke Clinical Research Institute
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Ethics approval
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Summary
Brief summary
This study will evaluate the relative efficacy and safety of prasugrel and clopidogrel in a medically managed Unstable Angina/Non-ST-Elevation Myocardial Infarction (UA/NSTEMI) acute coronary syndrome (ACS) population (that is, patients who are not managed with acute coronary revascularization).
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Trial website
https://clinicaltrials.gov/study/NCT00699998
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Trial related presentations / publications
Natale P, Palmer SC, Saglimbene VM, Ruospo M, Razavian M, Craig JC, Jardine MJ, Webster AC, Strippoli GF. Antiplatelet agents for chronic kidney disease. Cochrane Database Syst Rev. 2022 Feb 28;2(2):CD008834. doi: 10.1002/14651858.CD008834.pub4. Marquis-Gravel G, Neely ML, Valgimigli M, Costa F, Van Klaveren D, Altner R, Bhatt DL, Armstrong PW, Fox KAA, White HD, Ohman EM, Roe MT. Long-Term Bleeding Risk Prediction with Dual Antiplatelet Therapy After Acute Coronary Syndromes Treated Without Revascularization. Circ Cardiovasc Qual Outcomes. 2020 Sep;13(9):e006582. doi: 10.1161/CIRCOUTCOMES.120.006582. Epub 2020 Aug 31. Kaul P, Alexander KP, Ohman EM, Savu A, Roe MT, Goodman SG, Fox KA, White HD, Prabhakaran D, Hochman JS, Clemmensen P, Armstrong PW. Sex And Prognostic Significance of Self-Reported Frailty in Non-ST-Segment Elevation Acute Coronary Syndromes: Insights From the TRILOGY ACS Trial. Can J Cardiol. 2019 Apr;35(4):430-437. doi: 10.1016/j.cjca.2018.12.035. Epub 2018 Dec 31. Fanaroff AC, Cyr D, Neely ML, Bakal J, White HD, Fox KAA, Armstrong PW, Lopes RD, Ohman EM, Roe MT. Days Alive and Out of Hospital: Exploring a Patient-Centered, Pragmatic Outcome in a Clinical Trial of Patients With Acute Coronary Syndromes. Circ Cardiovasc Qual Outcomes. 2018 Dec;11(12):e004755. doi: 10.1161/CIRCOUTCOMES.118.004755. Inohara T, Pieper K, Wojdyla DM, Patel MR, Jones WS, Tricoci P, Mahaffey KW, James SK, Alexander JH, Lopes RD, Wallentin L, Ohman EM, Roe MT, Vemulapalli S. Incidence, timing, and type of first and recurrent ischemic events in patients with and without peripheral artery disease after an acute coronary syndrome. Am Heart J. 2018 Jul;201:25-32. doi: 10.1016/j.ahj.2018.03.013. Epub 2018 Mar 28. Chan MY, Neely ML, Roe MT, Goodman SG, Erlinge D, Cornel JH, Winters KJ, Jakubowski JA, Zhou C, Fox KAA, Armstrong PW, White HD, Prabhakaran D, Ohman EM, Huber K; TRILOGY ACS Investigators. Temporal Biomarker Profiling Reveals Longitudinal Changes in Risk of Death or Myocardial Infarction in Non-ST-Segment Elevation Acute Coronary Syndrome. Clin Chem. 2017 Jul;63(7):1214-1226. doi: 10.1373/clinchem.2016.265272. Epub 2017 May 17. Goldstein SA, Newby LK, Cyr DD, Neely M, Luscher TF, Brown EB, White HD, Ohman EM, Roe MT, Hamm CW. Relationship Between Peak Troponin Values and Long-Term Ischemic Events Among Medically Managed Patients With Acute Coronary Syndromes. J Am Heart Assoc. 2017 Apr 11;6(4):e005334. doi: 10.1161/JAHA.116.005334. Alfredsson J, Neely B, Neely ML, Bhatt DL, Goodman SG, Tricoci P, Mahaffey KW, Cornel JH, White HD, Fox KA, Prabhakaran D, Winters KJ, Armstrong PW, Ohman EM, Roe MT; TRILOGY ACS Investigators. Predicting the risk of bleeding during dual antiplatelet therapy after acute coronary syndromes. Heart. 2017 Aug;103(15):1168-1176. doi: 10.1136/heartjnl-2016-310090. Epub 2017 Apr 5. Cornel JH, Ohman EM, Neely B, Jakubowski JA, Bhatt DL, White HD, Ardissino D, Fox KA, Prabhakaran D, Armstrong PW, Erlinge D, Tantry US, Gurbel PA, Roe MT. Relationship of Platelet Reactivity With Bleeding Outcomes During Long-Term Treatment With Dual Antiplatelet Therapy for Medically Managed Patients With Non-ST-Segment Elevation Acute Coronary Syndromes. J Am Heart Assoc. 2016 Nov 4;5(11):e003977. doi: 10.1161/JAHA.116.003977. Chin CT, Boden WE, Roe MT, Neely B, Neely ML, Leiva-Pons JL, Corbalan R, Gottlieb S, Dalby AJ, Armstrong PW, Prabhakaran D, Fox KA, White HD, Ohman EM, Winters KJ, Schiele F. Effect of prior clopidogrel use on outcomes in medically managed acute coronary syndrome patients. Heart. 2016 Aug 1;102(15):1221-9. doi: 10.1136/heartjnl-2015-308840. Epub 2016 Mar 30. Lopes RD, Leonardi S, Neely B, Neely ML, Ohman EM, Ardissino D, Hamm CW, Goodman SG, Bhatt DL, White HD, Prabhakaran D, Martinez F, Nicolau JC, Winters KJ, Fox KA, Armstrong PW, Roe MT. Spontaneous MI After Non-ST-Segment Elevation Acute Coronary Syndrome Managed Without Revascularization: The TRILOGY ACS Trial. J Am Coll Cardiol. 2016 Mar 22;67(11):1289-97. doi: 10.1016/j.jacc.2016.01.034. Doll JA, Neely ML, Roe MT, Armstrong PW, White HD, Prabhakaran D, Winters KJ, Duvvuru S, Sundseth SS, Jakubowski JA, Gurbel PA, Bhatt DL, Ohman EM, Fox KAA; TRILOGY ACS Investigators. Impact of CYP2C19 Metabolizer Status on Patients With ACS Treated With Prasugrel Versus Clopidogrel. J Am Coll Cardiol. 2016 Mar 1;67(8):936-947. doi: 10.1016/j.jacc.2015.12.036. Chin CT, Neely B, Magnus Ohman E, Armstrong PW, Corbalan R, White HD, Prabhakaran D, Winters KJ, Fox KA, Roe MT; TRILOGY ACS Investigators. Time-Varying Effects of Prasugrel Versus Clopidogrel on the Long-Term Risks of Stroke After Acute Coronary Syndromes: Results From the TRILOGY ACS Trial. Stroke. 2016 Apr;47(4):1135-9. doi: 10.1161/STROKEAHA.115.012454. Epub 2016 Feb 16. Roe MT, Cyr DD, Eckart D, Schulte PJ, Morse MA, Blackwell KL, Ready NE, Zafar SY, Beaven AW, Strickler JH, Onken JE, Winters KJ, Houterloot L, Zamoryakhin D, Wiviott SD, White HD, Prabhakaran D, Fox KA, Armstrong PW, Ohman EM; TRILOGY ACS Investigators. Ascertainment, classification, and impact of neoplasm detection during prolonged treatment with dual antiplatelet therapy with prasugrel vs. clopidogrel following acute coronary syndrome. Eur Heart J. 2016 Jan 21;37(4):412-22. doi: 10.1093/eurheartj/ehv611. Epub 2015 Dec 5. Clemmensen P, Roe MT, Hochman JS, Cyr DD, Neely ML, McGuire DK, Cornel JH, Huber K, Zamoryakhin D, White HD, Armstrong PW, Fox KA, Prabhakaran D, Ohman EM; TRILOGY ACS Investigators. Long-term outcomes for women versus men with unstable angina/non-ST-segment elevation myocardial infarction managed medically without revascularization: insights from the TaRgeted platelet Inhibition to cLarify the Optimal strateGy to medicallY manage Acute Coronary Syndromes trial. Am Heart J. 2015 Oct;170(4):695-705.e5. doi: 10.1016/j.ahj.2015.06.011. Epub 2015 Jun 20. Mahaffey KW, Hager R, Wojdyla D, White HD, Armstrong PW, Alexander JH, Tricoci P, Lopes RD, Ohman EM, Roe MT, Harrington RA, Wallentin L. Meta-analysis of intracranial hemorrhage in acute coronary syndromes: incidence, predictors, and clinical outcomes. J Am Heart Assoc. 2015 Jun 18;4(6):e001512. doi: 10.1161/JAHA.114.001512. Roy A, Roe MT, Neely ML, Cyr DD, Zamoryakhin D, Fox KA, White HD, Armstrong PW, Ohman EM, Prabhakaran D. Impact of Human Development Index on the profile and outcomes of patients with acute coronary syndrome. Heart. 2015 Feb;101(4):279-86. doi: 10.1136/heartjnl-2014-306389. Epub 2014 Dec 23. Bakal JA, Roe MT, Ohman EM, Goodman SG, Fox KA, Zheng Y, Westerhout CM, Hochman JS, Lokhnygina Y, Brown EB, Armstrong PW. Applying novel methods to assess clinical outcomes: insights from the TRILOGY ACS trial. Eur Heart J. 2015 Feb 7;36(6):385-92a. doi: 10.1093/eurheartj/ehu262. Epub 2014 Jul 10. Cornel JH, Ohman EM, Neely B, Clemmensen P, Sritara P, Zamoryakhin D, Armstrong PW, Prabhakaran D, White HD, Fox KA, Gurbel PA, Roe MT; TRILOGY ACS Investigators. Impact of smoking status on platelet function and clinical outcomes with prasugrel vs. clopidogrel in patients with acute coronary syndromes managed without revascularization: Insights from the TRILOGY ACS trial. Am Heart J. 2014 Jul;168(1):76-87.e1. doi: 10.1016/j.ahj.2014.04.011. Epub 2014 Apr 24. Erratum In: Am Heart J. 2014 Oct;168(4):605. Wiviott SD, White HD, Ohman EM, Fox KA, Armstrong PW, Prabhakaran D, Hafley G, Lokhnygina Y, Boden WE, Hamm C, Clemmensen P, Nicolau JC, Menozzi A, Ruzyllo W, Widimsky P, Oto A, Leiva-Pons J, Pavlides G, Winters KJ, Roe MT, Bhatt DL. Prasugrel versus clopidogrel for patients with unstable angina or non-ST-segment elevation myocardial infarction with or without angiography: a secondary, prespecified analysis of the TRILOGY ACS trial. Lancet. 2013 Aug 17;382(9892):605-13. doi: 10.1016/S0140-6736(13)61451-8. Erratum In: Lancet. 2013 Aug 31;382(9894):768. Gurbel PA, Erlinge D, Ohman EM, Neely B, Neely M, Goodman SG, Huber K, Chan MY, Cornel JH, Brown E, Zhou C, Jakubowski JA, White HD, Fox KA, Prabhakaran D, Armstrong PW, Tantry US, Roe MT; TRILOGY ACS Platelet Function Substudy Investigators. Platelet function during extended prasugrel and clopidogrel therapy for patients with ACS treated without revascularization: the TRILOGY ACS platelet function substudy. JAMA. 2012 Nov 7;308(17):1785-94. doi: 10.1001/jama.2012.17312. Roe MT, Armstrong PW, Fox KA, White HD, Prabhakaran D, Goodman SG, Cornel JH, Bhatt DL, Clemmensen P, Martinez F, Ardissino D, Nicolau JC, Boden WE, Gurbel PA, Ruzyllo W, Dalby AJ, McGuire DK, Leiva-Pons JL, Parkhomenko A, Gottlieb S, Topacio GO, Hamm C, Pavlides G, Goudev AR, Oto A, Tseng CD, Merkely B, Gasparovic V, Corbalan R, Cinteza M, McLendon RC, Winters KJ, Brown EB, Lokhnygina Y, Aylward PE, Huber K, Hochman JS, Ohman EM; TRILOGY ACS Investigators. Prasugrel versus clopidogrel for acute coronary syndromes without revascularization. N Engl J Med. 2012 Oct 4;367(14):1297-309. doi: 10.1056/NEJMoa1205512. Epub 2012 Aug 25. Jeong YH, Tantry US, Gurbel PA. Importance of potent P2Y(12) receptor blockade in acute myocardial infarction: focus on prasugrel. Expert Opin Pharmacother. 2012 Aug;13(12):1771-96. doi: 10.1517/14656566.2012.704909. Epub 2012 Jul 12. Chin CT, Roe MT, Fox KA, Prabhakaran D, Marshall DA, Petitjean H, Lokhnygina Y, Brown E, Armstrong PW, White HD, Ohman EM; TRILOGY ACS Steering Committee. Study design and rationale of a comparison of prasugrel and clopidogrel in medically managed patients with unstable angina/non-ST-segment elevation myocardial infarction: the TaRgeted platelet Inhibition to cLarify the Optimal strateGy to medicallY manage Acute Coronary Syndromes (TRILOGY ACS) trial. Am Heart J. 2010 Jul;160(1):16-22.e1. doi: 10.1016/j.ahj.2010.04.022.
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Public notes
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Contacts
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Call 1-877-CTLILLY (1-877-285-4559) or 1-317-615-4559 Mon - Fri 9 AM - 5 PM Eastern time (UC/GMT - 5 hours, EST)
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Eli Lilly and Company
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https://clinicaltrials.gov/study/NCT00699998
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