A MULTINATIONAL, MULTICENTRE, RANDOMIZED, DOUBLE-BLIND STUDY TO ASSESS THE EFFICACY AND SAFETY OF ORAL SILDENAFIL 20MG TID OR PLACEBO WHEN ADDED TO BOSENTAN IN THE TREATMENT OF SUBJECTS, AGED 18 YEARS AND ABOVE, WITH PULMONARY ARTERIAL HYPERTENSION PAH - ND

Conditions: Pulmonary Arterial Hypertension PAH .
MedDRA version: 6.1Level: PTClassification code 10037400

Registration Number: EUCTR2006-001464-23-IT

Lead Sponsor: PFIZER

Brief Summary: Not available

Detailed Description: Not available

Recruitment & Eligibility

Status: ot Recruiting

Sex: All

Target Recruitment: 106

Inclusion Criteria

. Subjects aged 18 and above at the time of the screening visit who have any of the following types of pulmonary arterial hypertension and functional class, and for which bosentan therapy is indicated according to national license Idiopathic Primary Pulmonary Arterial Hypertension PAH . Pulmonary Hypertension secondary to Scleroderma. Subjects with WHO functional class III prior to initiation of bosentan therapy Subjects must have been treated continually with a stable dose of bosentan 62.5mg bid or 125mg bid for a minimum of three months prior to randomization. . Subject with a mean pulmonary artery pressure / 25 mmHg and a pulmonary capillary wedge pressure of 15 mmHg at rest, via right heart catheterization within 12 months prior to randomization. . Subjects whose baseline 6-Minute Walk Test distance is / 100m and / 400m. . who have given written informed consent to participate in the study before being screened for the study. . All women of childbearing potential must use adequate contraception i.e. hormonal in conjunction with intrauterine device or barrier methods with spermicide throughout the study and for the duration of their bosentan therapy or must be celibate or their partner must have had vasectomy. The screening serum pregnancy test must be negative. Women who have been surgically sterilized or are at least two years postmenopausal may be enrolled and do not need to use birth control.
Are the trial subjects under 18? no
Number of subjects for this age range:
F.1.2 Adults (18-64 years) yes
F.1.2.1 Number of subjects for this age range
F.1.3 Elderly (>=65 years) yes
F.1.3.1 Number of subjects for this age range

Exclusion Criteria

. PAH secondary to any aetiology including congenital heart disease other than those specified in the inclusion criteria. .With the exception of bosentan therapy, subjects who are currently receiving any forms of chronic treatment for PAH such as any formulations of prostacyclin, PDE-5 inhibitors, other endothelin-receptor antagonists, nitrates or nitric oxide donors e.g. arginine supplements including nicorandil in any form or any potent CYP3A4 inhibitors e.g. Cyclosporin A and Glibenclamide . Note Acute vasodilator response testing with any short acting vasodilators such as prostacyclin or inhaled NO during right heart catherization is permitted. . Subjects with significant i.e. 2 valvular disease other than tricuspid regurgitation or pulmonary regurgitation. Subjects with previous surgical replacement of a valve may be eligible for entry into the study after consultation with a Pfizer study clinician provided the following conditions are satisfied That there was no evidence of PAH secondary to valvular disease prior to surgery. The prosthetic valve is functioning normally on echocardiography. The valve replacement occurred at least one year prior to randomization. .Subjects with acutely decompensated heart failure within 30 days prior to randomization. . Subjects with LV Ejection Fraction of 45 or LV shortening fraction of 0.2 within three months prior to randomization. . Subjects who have had a myocardial infarction or stroke within 6 months prior to randomization. . Subjects who have had a change of dose or class of standard background therapy used for treatment of PAH i.e. oxygen, calcium channel blockers, digoxin, diuretics used for the treatment of PAH within 30 days prior to randomization. Note a change in the dose or oral anticoagulant therapy within this timeframe to maintain the INR within the therapeutic range is acceptable. . Subjects with congenital heart disease unless they fulfill inclusion 4.1.1 , pulmonary hypertension due to thromboembolism, HIV or schistosomiasis. . Subjects who have undergone atrial septostomy within six months prior to randomization. . Subjects with uncontrolled brady- or tachyarrhythmias, placement of pacemakers or implantable defibrillators 60 days prior to randomization. . Subjects whose 6 Minute Walk Test distance may be limited by conditions other than PAH related dyspnoea or fatigue e.g. claudication from vascular insufficiency or arthritis. .Pregnant or lactating women. .Subjects with a history or pulmonary embolism verified by ventilation/perfusion scan, angiogram or spiral chest CT scan. .Subjects with hypotension defined as systolic arterial pressure 90 mm Hg after sitting for 5 minutes at either screening or baseline. .Subjects with known hereditary degenerative retinal disorders such as retinitis pigmentosa or history of non-arteritic ischemic optic neuropathy NAION . .Subjects with history of chronic lung diseases / restrictive lung disease e.g. COPD or scleroderma with impairment of lung function as defined by TLC 60 and/or FEV1 / 80 predicted within 30 days or randomization. . Subjects who have previously failed on bosentan or sildenafil therapy defined as those subjects who had no evidence of clinical improvement whilst on the medicines, and no worsening in symptoms or clinical status, on discontinuation of the medicines .