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Study to Evaluate Efficacy and Safety of Oral Treprostinil in Subjects With Pulmonary Hypertension (PH) Associated With Sickle Cell Disease (SCD)

Primary Purpose

Pulmonary Hypertension Associated With Sickle Cell Disease

Status
Withdrawn
Phase
Phase 3
Locations
Study Type
Interventional
Intervention
Oral Treprostinil
Placebo
Sponsored by
United Therapeutics
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Pulmonary Hypertension Associated With Sickle Cell Disease focused on measuring Oral treprostinil, 6-Minute Walk Distance, PH, sickle cell

Eligibility Criteria

12 Years - undefined (Child, Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. The subject must have a diagnosis of SCD confirmed by hemoglobin electrophoresis.
  2. The subject has a diagnosis of symptomatic World Health Organization (WHO) Group 5.1 chronic hemolytic anemia PH.
  3. The subject must have a Baseline 6MWD greater than 150 meters, in the absence of a concurrent injury, illness, or other confounding factor.
  4. The subject has pulmonary function tests conducted within 6 months of Screening or during the Screening period.
  5. The subject must be on stable doses of other medical therapy for at least 30 days prior to randomization with no dose adjustments, additions, or discontinuations.
  6. The subject must be optimally treated with conventional PH therapy for at least 10 days prior to randomization with no additions, discontinuations, or dose changes.
  7. Subjects receiving an endothelin receptor antagonist (ERA) must have been receiving therapy for greater than 90 days, and have reached and maintained a stable dose for a minimum of 30 days prior to randomization.
  8. Subjects receiving calcium channel blockers must have been on a stable dose for a minimum of 3 months prior to randomization.

Exclusion Criteria:

  1. The subject is pregnant or lactating.
  2. The subject has previously received oral treprostinil or is receiving a phosphodiesterase type 5 inhibitor (PDE5-I).
  3. The subject has received a prostacyclin within 30 days prior to start of the study, or had previous intolerance or significant lack of efficacy to any prostacyclin or prostacyclin analogue that resulted in discontinuation or inability to titrate that therapy effectively.
  4. The subject has had any other background conventional therapies for PH added, removed, or doses adjusted within 10 days prior to randomization.
  5. The subject has any disease associated with pulmonary arterial hypertension (PAH).
  6. The subject has had a vaso-occlusive crisis, acute chest syndrome event, or unscheduled transfusion within 30 days of randomization.
  7. The subject has a history of ischemic heart disease, including a previous myocardial infarction or symptomatic coronary artery disease, within 6 months prior to Screening or a left ventricular ejection fraction less than 40% assessed by either multigated angiogram (MUGA), angiography, or echocardiogram.
  8. The subject has alanine aminotransferase (ALT) or aspartate aminotransferase (AST) levels 3 times or greater than the upper limit of normal, clinically significant liver disease/dysfunction, or known Child-Pugh Class B or C hepatic disease at Screening.
  9. The subject has chronic renal insufficiency, as defined by the requirement for dialysis.
  10. The subject has a musculoskeletal disorder, any disease that is likely to limit ambulation, or is connected to a machine that is not portable.
  11. The subject has an unstable psychiatric condition or is mentally incapable of understanding the objectives, nature, or consequences of the study, or has any condition which in the Investigator's opinion would constitute an unacceptable risk to the subject's safety.
  12. The subject is receiving an investigational drug, has an investigational device in place, or has participated in an investigational drug or device study within 30 days prior to Screening.

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm Type

    Experimental

    Placebo Comparator

    Arm Label

    Oral Treprostinil

    Placebo

    Arm Description

    Extended-release oral tablet for three times daily (TID) administration

    Placebo (sugar pill) for TID administration

    Outcomes

    Primary Outcome Measures

    Effect of oral treprostinil compared with placebo on time to first adjudicated PH clinical worsening (morbidity or mortality) event in subjects with PH associated with SCD
    Clinical worsening is defined as the occurrence of any 1 of the following events: hospitalization related to PH and/or right heart failure, initiation of an infused prostacyclin to treat worsening PH, decrease in 6-Minute Walk Distance (6MWD) >15% from Baseline directly related to disease under study.

    Secondary Outcome Measures

    Effect of oral treprostinil compared with placebo on exercise capacity as assessed by 6-Minute Walk Distance (6MWD)
    Effect of oral treprostinil compared with placebo on combined 6MWD/Borg dyspnea score
    Effect of oral treprostinil compared with placebo on Borg dyspnea score
    Effect of oral treprostinil compared with placebo on N-Terminal pro-brain natriuretic peptide (NT-proBNP) levels
    Effect of oral treprostinil compared with placebo on maximal tricuspid regurgitant velocity (TRV) assessed by transthoracic Doppler echocardiography

    Full Information

    First Posted
    January 27, 2017
    Last Updated
    April 7, 2017
    Sponsor
    United Therapeutics
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    1. Study Identification

    Unique Protocol Identification Number
    NCT03055234
    Brief Title
    Study to Evaluate Efficacy and Safety of Oral Treprostinil in Subjects With Pulmonary Hypertension (PH) Associated With Sickle Cell Disease (SCD)
    Official Title
    A Phase 3, Multicenter, Randomized, Placebo-controlled Study to Evaluate Efficacy and Safety of Oral Treprostinil in Subjects With Pulmonary Hypertension Associated With Sickle Cell Disease
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    April 2017
    Overall Recruitment Status
    Withdrawn
    Why Stopped
    Business decision
    Study Start Date
    June 2017 (Anticipated)
    Primary Completion Date
    December 2021 (Anticipated)
    Study Completion Date
    December 2022 (Anticipated)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Sponsor
    Name of the Sponsor
    United Therapeutics

    4. Oversight

    Studies a U.S. FDA-regulated Drug Product
    Yes
    Studies a U.S. FDA-regulated Device Product
    No
    Data Monitoring Committee
    Yes

    5. Study Description

    Brief Summary
    This is a multicenter, randomized (2:1; oral treprostinil:placebo), double-blind, placebo-controlled event-driven (time to pulmonary hypertension [PH] clinical worsening) study in subjects with PH associated with sickle cell disease (SCD). Once enrolled, subjects will be evaluated at Weeks 6, 12, 24, and then every 12 weeks for the duration of the study. Subjects will be permitted to enter a 48-week open-label extension period if they experience a PH clinical worsening event.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Pulmonary Hypertension Associated With Sickle Cell Disease
    Keywords
    Oral treprostinil, 6-Minute Walk Distance, PH, sickle cell

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Phase 3
    Interventional Study Model
    Parallel Assignment
    Masking
    ParticipantCare ProviderInvestigatorOutcomes Assessor
    Allocation
    Randomized
    Enrollment
    0 (Actual)

    8. Arms, Groups, and Interventions

    Arm Title
    Oral Treprostinil
    Arm Type
    Experimental
    Arm Description
    Extended-release oral tablet for three times daily (TID) administration
    Arm Title
    Placebo
    Arm Type
    Placebo Comparator
    Arm Description
    Placebo (sugar pill) for TID administration
    Intervention Type
    Drug
    Intervention Name(s)
    Oral Treprostinil
    Intervention Description
    Extended-release oral tablet for TID administration
    Intervention Type
    Drug
    Intervention Name(s)
    Placebo
    Intervention Description
    Matching placebo for TID administration
    Primary Outcome Measure Information:
    Title
    Effect of oral treprostinil compared with placebo on time to first adjudicated PH clinical worsening (morbidity or mortality) event in subjects with PH associated with SCD
    Description
    Clinical worsening is defined as the occurrence of any 1 of the following events: hospitalization related to PH and/or right heart failure, initiation of an infused prostacyclin to treat worsening PH, decrease in 6-Minute Walk Distance (6MWD) >15% from Baseline directly related to disease under study.
    Time Frame
    Baseline until the first adjudicated PH clinical worsening event, assessed up to approximately 4 years
    Secondary Outcome Measure Information:
    Title
    Effect of oral treprostinil compared with placebo on exercise capacity as assessed by 6-Minute Walk Distance (6MWD)
    Time Frame
    Baseline to Week 24
    Title
    Effect of oral treprostinil compared with placebo on combined 6MWD/Borg dyspnea score
    Time Frame
    Baseline to Week 24
    Title
    Effect of oral treprostinil compared with placebo on Borg dyspnea score
    Time Frame
    Baseline to Week 24
    Title
    Effect of oral treprostinil compared with placebo on N-Terminal pro-brain natriuretic peptide (NT-proBNP) levels
    Time Frame
    Baseline to Week 24
    Title
    Effect of oral treprostinil compared with placebo on maximal tricuspid regurgitant velocity (TRV) assessed by transthoracic Doppler echocardiography
    Time Frame
    Baseline to Week 24

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    12 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: The subject must have a diagnosis of SCD confirmed by hemoglobin electrophoresis. The subject has a diagnosis of symptomatic World Health Organization (WHO) Group 5.1 chronic hemolytic anemia PH. The subject must have a Baseline 6MWD greater than 150 meters, in the absence of a concurrent injury, illness, or other confounding factor. The subject has pulmonary function tests conducted within 6 months of Screening or during the Screening period. The subject must be on stable doses of other medical therapy for at least 30 days prior to randomization with no dose adjustments, additions, or discontinuations. The subject must be optimally treated with conventional PH therapy for at least 10 days prior to randomization with no additions, discontinuations, or dose changes. Subjects receiving an endothelin receptor antagonist (ERA) must have been receiving therapy for greater than 90 days, and have reached and maintained a stable dose for a minimum of 30 days prior to randomization. Subjects receiving calcium channel blockers must have been on a stable dose for a minimum of 3 months prior to randomization. Exclusion Criteria: The subject is pregnant or lactating. The subject has previously received oral treprostinil or is receiving a phosphodiesterase type 5 inhibitor (PDE5-I). The subject has received a prostacyclin within 30 days prior to start of the study, or had previous intolerance or significant lack of efficacy to any prostacyclin or prostacyclin analogue that resulted in discontinuation or inability to titrate that therapy effectively. The subject has had any other background conventional therapies for PH added, removed, or doses adjusted within 10 days prior to randomization. The subject has any disease associated with pulmonary arterial hypertension (PAH). The subject has had a vaso-occlusive crisis, acute chest syndrome event, or unscheduled transfusion within 30 days of randomization. The subject has a history of ischemic heart disease, including a previous myocardial infarction or symptomatic coronary artery disease, within 6 months prior to Screening or a left ventricular ejection fraction less than 40% assessed by either multigated angiogram (MUGA), angiography, or echocardiogram. The subject has alanine aminotransferase (ALT) or aspartate aminotransferase (AST) levels 3 times or greater than the upper limit of normal, clinically significant liver disease/dysfunction, or known Child-Pugh Class B or C hepatic disease at Screening. The subject has chronic renal insufficiency, as defined by the requirement for dialysis. The subject has a musculoskeletal disorder, any disease that is likely to limit ambulation, or is connected to a machine that is not portable. The subject has an unstable psychiatric condition or is mentally incapable of understanding the objectives, nature, or consequences of the study, or has any condition which in the Investigator's opinion would constitute an unacceptable risk to the subject's safety. The subject is receiving an investigational drug, has an investigational device in place, or has participated in an investigational drug or device study within 30 days prior to Screening.

    12. IPD Sharing Statement

    Plan to Share IPD
    No

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