Pulmonary Hypertension Clinical Trial
Official title:
A Multicenter, Randomized, Double-Blinded, Placebo-Controlled Trial to Evaluate the Safety and Efficacy of Inhaled Treprostinil in Subjects With Pulmonary Hypertension Due to Parenchymal Lung Disease
Verified date | July 2022 |
Source | United Therapeutics |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Interventional |
This was a multicenter, randomized (1:1 inhaled treprostinil: placebo), double-blinded, placebo-controlled trial to evaluate the safety and efficacy of inhaled treprostinil in subjects with pre-capillary pulmonary hypertension (PH) associated with interstitial lung disease (ILD) including combined pulmonary fibrosis and emphysema (CPFE). The study included 326 patients at approximately 120 clinical trial centers. The treatment phase of the study lasted approximately 16 weeks. Patients who completed all required assessments were eligible to enter an open-label, extension study (RIN-PH-202).
Status | Completed |
Enrollment | 326 |
Est. completion date | December 26, 2019 |
Est. primary completion date | December 26, 2019 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years and older |
Eligibility | Inclusion Criteria: 1. Subject voluntarily gave informed consent to participate in the study. 2. Males and females aged 18 years or older at the time of informed consent. a. Females of reproductive potential were non-pregnant (as confirmed by a urine pregnancy test at screening) and non-lactating, and: i. Abstained from intercourse (when in line with their preferred and usual lifestyle), or ii. Used 2 medically acceptable, highly effective forms of contraception for the duration of study, and at least 30 days after discontinuing study drug. b. Males with a partner of childbearing potential used condoms for the duration of treatment and for at least 48 hours after discontinuing study drug. 3. The subject had a confirmed diagnosis of WHO Group 3 PH based on computed tomography (CT) imaging which was performed within 6 months prior to randomization and demonstrated evidence of diffuse parenchymal lung disease. Subjects had any form of ILD or CPFE. 4. Subjects were required to have a right heart catheterization (RHC) within 1 year prior to randomization with the following documented parameters: 1. Pulmonary vascular resistance (PVR) >3 Wood Units (WU) and 2. A pulmonary capillary wedge pressure (PCWP) of <15 mmHg and 3. A mean pulmonary arterial pressure (mPAP) of >25 mmHg 5. Baseline 6MWD =100 m. 6. Subjects on a chronic medication for underlying lung disease (ie, pirfenidone, nintedanib, etc) were on a stable and optimized dose for =30 days prior to randomization. 7. In the opinion of the Investigator, the subject was able to communicate effectively with study personnel, and was considered reliable, willing and likely to be cooperative with protocol requirements, including attending all study visits. 8. Subjects with connective tissue disease (CTD) had a Baseline forced vital capacity (FVC) of <70%. Exclusion criteria: 1. The subject had a diagnosis of PAH or PH for reasons other than WHO Group 3 PH ILD as outlined in Inclusion Criterion 3. 2. The subject showed intolerance or significant lack of efficacy to a prostacyclin or prostacyclin analogue that resulted in discontinuation or inability to effectively titrate that therapy. 3. The subject received any PAH-approved therapy including: prostacyclin therapy (ie, epoprostenol, treprostinil, iloprost, or beraprost; except for acute vasoreactivity testing), prostacyclin (IP) receptor agonist (selexipag), endothelin receptor antagonist (ERA), phosphodiesterase type 5 inhibitor (PDE5-I), or soluble guanylate cyclase (sGC) stimulator within 60 days of randomization. 4. The subject had evidence of clinically significant left-sided heart disease as defined by: 1. PCWP >15 mmHg 2. Left ventricular ejection fraction <40%. Note: Subjects with abnormal left ventricular function attributable entirely to impaired left ventricular filling due to the effects of right ventricular overload (ie, right ventricular hypertrophy and/or dilatation) were not excluded. 5. The subject was receiving >10 L/min of oxygen supplementation by any mode of delivery at rest at Baseline. 6. Current use of any inhaled tobacco/marijuana products or significant history of drug abuse at the time of informed consent. 7. Exacerbation of underlying lung disease or active pulmonary or upper respiratory infection within 30 days of randomization. 8. Initiation of pulmonary rehabilitation within 12 weeks prior to randomization. 9. In the opinion of the Investigator, the subject had any condition that would interfere with the interpretation of study assessments or has any disease or condition (ie, peripheral vascular disease, musculoskeletal disorder, morbid obesity) that would likely be the primary limit to ambulation (as opposed to PH). 10. Use of any investigational drug/device, or participation in any investigational study with therapeutic intent within 30 days prior to randomization. 11. Severe concomitant illness limiting life expectancy (<6 months). 12. Acute pulmonary embolism within 90 days of randomization. |
Country | Name | City | State |
---|---|---|---|
Puerto Rico | Auxilio Mutuo Hospital | Guaynabo | |
United States | Albany Medical College | Albany | New York |
United States | The University of New Mexico Clinical and Translational Science Center | Albuquerque | New Mexico |
United States | AnMed Health Medical Center | Anderson | South Carolina |
United States | The Emory Clinic | Atlanta | Georgia |
United States | University of Colorado Hospital - Cardiac and Vascular Center | Aurora | Colorado |
United States | Piedmont - Georgia Lung Associates | Austell | Georgia |
United States | Johns Hopkins University Pulmonary and Critical Care Medicine | Baltimore | Maryland |
United States | University of Maryland Medical Center | Baltimore | Maryland |
United States | Cedars-Sinai Medical Center, Advanced Health Sciences Pavilion | Beverly Hills | California |
United States | University of Alabama at Birmingham | Birmingham | Alabama |
United States | Brigham & Women's Hospital | Boston | Massachusetts |
United States | Massachusetts General Hospital | Boston | Massachusetts |
United States | Tufts Medical Center | Boston | Massachusetts |
United States | New York Methodist Hospital | Brooklyn | New York |
United States | Florida Lung, Asthma & Sleep Specialists, P.A. | Celebration | Florida |
United States | University of North Carolina at Chapel Hill | Chapel Hill | North Carolina |
United States | Medical University of South Carolina | Charleston | South Carolina |
United States | Northwestern University School of Medicine | Chicago | Illinois |
United States | Rush University Medical Center | Chicago | Illinois |
United States | University of Chicago Medical Center | Chicago | Illinois |
United States | University of Illinois at Chicago Hospital | Chicago | Illinois |
United States | The Lindner Research Center at The Christ Hospital | Cincinnati | Ohio |
United States | University of Cincinnati Health | Cincinnati | Ohio |
United States | St. Francis Sleep, Allergy and Lung Institute | Clearwater | Florida |
United States | Cleveland Clinic | Cleveland | Ohio |
United States | University Hospitals Cleveland Medical Center | Cleveland | Ohio |
United States | Vermont Lung Center | Colchester | Vermont |
United States | The Ohio State University Medical Center | Columbus | Ohio |
United States | Baylor University Medical Center | Dallas | Texas |
United States | UT Southwestern Medical Center | Dallas | Texas |
United States | National Jewish Health | Denver | Colorado |
United States | Duke University Medical Center-Duke South Clinic | Durham | North Carolina |
United States | Texas Tech University Health Sciences Center | El Paso | Texas |
United States | Inova Fairfax Medical Campus | Fairfax | Virginia |
United States | University of California San Francisco - Fresno | Fresno | California |
United States | University of Florida Clinical Research Center | Gainesville | Florida |
United States | Spectrum Health Heart and Lung Specialized Care Clinic | Grand Rapids | Michigan |
United States | Houston Methodist | Houston | Texas |
United States | Memoral Hermann Hospital - Texas Medical Center | Houston | Texas |
United States | Michael E. DeBakey VA Medical Center | Houston | Texas |
United States | Community Heart and Vascular Hospital East | Indianapolis | Indiana |
United States | St. Vincent Medical Group, Inc. | Indianapolis | Indiana |
United States | U Health Physicians Advanced Heart and Lung Clinic | Indianapolis | Indiana |
United States | University of Iowa Hospitals & Clinics | Iowa City | Iowa |
United States | University of Mississippi Medical Center | Jackson | Mississippi |
United States | Mayo Clinic Jacksonville | Jacksonville | Florida |
United States | St. Vincent's Health System | Jacksonville | Florida |
United States | University of Florida College of Medicine, Jacksonville | Jacksonville | Florida |
United States | Saint Luke's Hospital of Kansas City | Kansas City | Missouri |
United States | University of Kansas Medical Center | Kansas City | Kansas |
United States | Statcare Pulmonary Consultants | Knoxville | Tennessee |
United States | University of California San Diego | La Jolla | California |
United States | University of Kentucky Medical Center | Lexington | Kentucky |
United States | VA Long Beach Healthcare System | Long Beach | California |
United States | Department of Veterans Affairs Greater Los Angeles Healthcare System | Los Angeles | California |
United States | University of Southern California Health Sciences | Los Angeles | California |
United States | University of Louisville Clinical Trials Unit | Louisville | Kentucky |
United States | University of Wisconsin School of Medicine and Public Health | Madison | Wisconsin |
United States | Wellstar Medical Group - Pulmonary Medicine | Marietta | Georgia |
United States | Loyola University Medical Center | Maywood | Illinois |
United States | University of Miami | Miami | Florida |
United States | Aurora St. Luke's Medical Center | Milwaukee | Wisconsin |
United States | Medical College of Wisconsin/Froedtert Hospital | Milwaukee | Wisconsin |
United States | University of Minnesota | Minneapolis | Minnesota |
United States | IMC-Diagnostic & Medical Clinic | Mobile | Alabama |
United States | Yale New Haven Hospital | New Haven | Connecticut |
United States | Northwell Health | New Hyde Park | New York |
United States | Louisiana State University Health Sciences Center New Orleans | New Orleans | Louisiana |
United States | Mount Sinai Medical Center | New York | New York |
United States | New York Presbyterian - Weill Cornell Medical Center | New York | New York |
United States | NYU Langone Medical Center | New York | New York |
United States | Sentara Norfolk General Hospital | Norfolk | Virginia |
United States | INTEGRIS Baptist Medical Center | Oklahoma City | Oklahoma |
United States | Florida Hospital | Orlando | Florida |
United States | Penn Medicine University City | Philadelphia | Pennsylvania |
United States | Arizona Pulmonary Specialists, Ltd. | Phoenix | Arizona |
United States | St. Joseph's Hospital and Medical Center | Phoenix | Arizona |
United States | Pinehurst Medical Clinic, Inc. | Pinehurst | North Carolina |
United States | Allegheny General Hospital | Pittsburgh | Pennsylvania |
United States | UPMC Montifiore University Hospital | Pittsburgh | Pennsylvania |
United States | Pulmonary Associates of Richmond | Richmond | Virginia |
United States | Pacific Pulmonary Medical Group | Riverside | California |
United States | Mayo Clinic | Rochester | Minnesota |
United States | Kaiser Permanente - Roseville | Roseville | California |
United States | University of California Davis Medical Center | Sacramento | California |
United States | Washington University School of Medicine | Saint Louis | Missouri |
United States | The University of Texas Health Science Center at San Antonio | San Antonio | Texas |
United States | Kaiser Permanente | San Francisco | California |
United States | University of Washington Medical Center | Seattle | Washington |
United States | South Miami Heart Specialists | South Miami | Florida |
United States | Chest Medicine Associates | South Portland | Maine |
United States | Tampa General Hospital Center of Research Excellence | Tampa | Florida |
United States | University of Arizona | Tucson | Arizona |
United States | Medstar Georgetown University Hospital | Washington | District of Columbia |
United States | MedStar Washington Hospital Center | Washington | District of Columbia |
United States | Cleveland Clinic Florida | Weston | Florida |
Lead Sponsor | Collaborator |
---|---|
United Therapeutics |
United States, Puerto Rico,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Change in 6-minute Walk Distance (6MWD) Measured at Peak Exposure From Baseline to Week 16 | The intent of the 6MWD test is to evaluate exercise capacity associated with carrying out activities of daily living. Change in 6MWD from Baseline to Week 16, correlates with the current clinical standard for assessing patient functional status in the treatment of PH and is considered an objective measure of patient functional status. Subjects will be instructed to walk down a corridor at a comfortable speed as far as they can manage for six minutes. Peak exposure 6MWD will occur by conducting 6-minute walk test (6MWT) within 10 to 60 minutes after the most recent dose of study drug dose. | Baseline and Week 16 | |
Secondary | Change in Plasma Concentration of N-terminal Pro-Brain Natriuretic Peptide (NT-proBNP) From Baseline to Week 16 | The NT-proBNP serum concentration is a useful biomarker associated with changes in right heart morphology and function. NT-proBNP serum concentration will be assessed to compare the severity of heart failure at Baseline and Week 16. Blood for NT-proBNP assessment must be drawn prior to conducting the 6MWT. | Baseline and Week 16 | |
Secondary | Incidence of Clinical Worsening | Subjects were monitored for clinical worsening from the time of randomization until 1 of the following criteria were met: hospitalization due to a cardiopulmonary indication; decrease in 6MWD >15% from Baseline directly related to the disease under study, at 2 consecutive visits and at least 24 hours apart; death (all causes); or lung transplantation. | Baseline to Week 16 | |
Secondary | Change in Peak 6-minute Walk Distance (6MWD) From Baseline to Week 12 | The intent of the 6MWD test is to evaluate exercise capacity associated with carrying out activities of daily living. Change in 6MWD from Baseline to Week 12, correlates with the current clinical standard for assessing patient functional status in the treatment of PH and is considered an objective measure of patient functional status. Subjects will be instructed to walk down a corridor at a comfortable speed as far as they can manage for six minutes. Peak exposure 6MWD will occur by conducting 6MWT within 10 to 60 minutes after the most recent dose of study drug dose. | Baseline and Week 12 | |
Secondary | Change in Trough 6-minute Walk Distance (6MWD) From Baseline to Week 15 | The intent of the 6MWD test is to evaluate exercise capacity associated with carrying out activities of daily living. Change in 6MWD from Baseline to Week 15, correlates with the current clinical standard for assessing patient functional status in the treatment of PH and is considered an objective measure of patient functional status. Subjects will be instructed to walk down a corridor at a comfortable speed as far as they can manage for six minutes. Distance <500 meters suggests considerable exercise limitation; Distance 500-800 meters suggests moderate limitation; Distance >800 meters (with no rests) suggests mild or no limitation. Trough exposure 6MWD will occur by conducting 6-minute walk test (6MWT) at least four hours after the most recent study drug dose. | Baseline and Week 15 |
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