LEVosimendan to Improve Exercise Limitation in Patients With PH-HFpEF

Phase 3

Recruiting

• Conditions: Pulmonary Hypertension
• Interventions: Drug: Placebo; Drug: TNX-103

• Registration Number: NCT05983250
• Lead Sponsor: Tenax Therapeutics, Inc.

Brief Summary

This study will evaluate the efficacy of TNX-103 (levosimendan) compared with placebo in subjects with PH-HFpEF as measured by the change in 6-Minute Walk Distance (6 MWD; Day 1 to Week 12).

Detailed Description

This is a Phase 3, double-blind, randomized, placebo-controlled study of levosimendan in patients with PH-HFpEF. There will be a Screening Period of up to 30 days. Subjects will provide written informed consent prior to completing any study procedures. Upon meeting all eligibility criteria, patients will continue to the 12-week randomized, double-blind treatment phase. Approximately 152 subjects will be randomized in a 1:1 ratio to receive an oral dose of levosimendan or placebo 2 mg/day for Weeks 1 to 4 and 3 mg/day for Weeks 5 to 12. Subjects will return to the clinical site at Weeks 4, 8, and 12.

All randomized subjects will have the option to enter the 92-week OLE following the completion of all study events at Week 12.

Study Timeline

• Study First Submitted: 2023-08-01
• Study First Submitted QC: 2023-08-01
• Study First Posted: 2023-08-09
• Study Start: 2024-01-10
• Status Verified: 2024-09
• Last Update Submitted: 2024-10-11
• Last Update Posted: 2024-10-14
• Primary Completion: 2027-03
• Study Completion: 2027-07

Recruitment & Eligibility

• Status: RECRUITING
• Sex: All
• Target Recruitment: 152

Inclusion Criteria

1. Men or women, greater than or equal to18 to 85 years of age.
2. NYHA Class II or III or ambulatory NYHA class IV symptoms.
3. A diagnosis of World Health Organization (WHO) Group 2 PH-HFpEF with qualifying hemodynamics
4. A qualifying Baseline RHC performed within 120 days. The RHC can be a historical RHC done prior to study consent.
5. A qualifying echocardiogram performed within 30 days showing an LVEF greater than or equal to 40%
6. A qualifying 6-MWD of at least 100 meters, but not more than 450 meters at Screening
7. A 48-hour ambulatory cardiac rhythm monitor during the Screening Period to establish the resting heart rate (HR) and rhythm.
8. Chronic medications for heart failure with preserved ejection fraction (HFpEF) or other serious underlying cardiac or pulmonary conditions should be administered at a stable dose for greater than or equal to 30 days prior to the day of the Baseline 6-MWT.
9. Female subjects of childbearing potential must have a negative urine pregnancy test result at the Screening Visit and a negative urine pregnancy test and must not be pregnant, lactating, or planning a pregnancy from the Screening Visit to 7 months after the last dose of study drug.
10. Female subjects of childbearing potential will be included if they are either sexually inactive (abstinent) for 90 days prior to the first dose of study drug, or are using a highly effective birth control method
11. Female subjects of nonchildbearing potential will be included if they meet the following definition of nonchildbearing potential: are either surgically sterile or postmenopausal.
12. Male patients with female partners of childbearing potential must use highly effective methods of birth control during their participation in the study and for a period of 4 months after the last dose of study drug.
13. Patients must agree to abstain from egg or sperm donation through 7 months for female patients and 4 months for male patients after administration of the last dose of study drug.
14. Ability to adhere to study visit schedule and understand and comply with all protocol requirements.
15. Signed informed consent document indicating that they understand the purpose and procedures required for the study and are willing to participate in the study.

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Exclusion Criteria

1. A diagnosis of PH WHO Groups 1, 3, 4, or 5.

2. Walking activity that is limited by anything other than shortness of breath or fatigue attributed to PH-HFpEF.

3. Echocardiographic evidence for hypertrophic cardiomyopathy, restrictive cardiomyopathy, constrictive pericarditis, cardiac amyloidosis, or infiltrative cardiomyopathy

4. Structural heart repair or replacement of the aortic valve or mitral valve (surgical or percutaneous) within the past 12 months. OR, planned valve intervention in the next 6 months. OR, the presence of echocardiographic findings of significant valve disease as assessed from the qualifying echocardiogram

5. Any of the following clinical laboratory values within 30 days as specified:

   1. Hemoglobin <10 g/dL
   2. Serum alanine aminotransferase or aspartate aminotransferase levels >3× upper limit of normal (ULN) or total bilirubin >3× ULN.
   3. Electrocardiogram (ECG) with a QTcF >450 msec for males and >470 msec for females at Screening and Baseline in the absence of right bundle branch block.
   4. Platelet count <75,000/mm3.

6. A diagnosis of pre-existing lung disease

7. Recent documentation of significant underlying lung disease

8. Documentation of pulmonary thromboembolism in the last 12 months

9. Cardiovascular co-morbidities

10. Receipt of any approved pulmonary arterial hypertension-specific therapies

11. Hospitalization for any indication within 30 days

12. Receipt of any intravenous (IV) inotropes within 30 days

13. Body mass index greater than or equal to 45 kg/m2.

14. Estimated glomerular filtration rate (eGFR) <30 mL/min/1.73m2

15. Known history of chronic liver disease

16. Prior exposure to levosimendan

17. Current enrollment in or completion of any other investigational product study within 30 days of Screening.

18. Initiation of an exercise program for cardiopulmonary rehabilitation within 45 days

19. History of severe allergic or anaphylactic reaction or hypersensitivity to the excipients in the investigational product.

20. Major surgery within 60 days. Subjects must have completely recovered from any previous surgery.

21. Prior heart, lung, or heart-lung transplants or life expectancy of <12 months

22. Pregnancy or breastfeeding in females

23. History of active malignancy, with the exception of fully treated basal cell carcinoma, cervical carcinoma in situ, or squamous cell carcinomas of the skin.

24. History of clinically significant other diseases that may limit or complicate participation in the study.

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Placebo	Placebo	Placebo
TNX-103	TNX-103	oral levosimendan

Primary Outcome Measures

Name	Time	Method
Six-minute walk distance from Baseline to Week 12	12 weeks

Secondary Outcome Measures

Name	Time	Method
KCCQ	12 weeks	Change in KCCQ
Clinical Worsening Events	12 weeks
Change in NT-proBNP	12 weeks	Decreases in NT-proBNP may indicate an improvement insymptoms
Change NYHA functional class	12 weeks	On a scale of I-IV. Lower scores may indicate improvement in symptoms

Trial Locations

Locations (38)

University of California; 🇺🇸 San Francisco, California, United States

U. of Minnesota; 🇺🇸 Minneapolis, Minnesota, United States

Moses H. Cone Memorial Hospital; 🇺🇸 Greensboro, North Carolina, United States

Prisma Health Cardiology; 🇺🇸 Columbia, South Carolina, United States

Intermountain Medical Center; 🇺🇸 Murray, Utah, United States

University of Alabama at Birmingham; 🇺🇸 Birmingham, Alabama, United States

UC Davis Health Medical Center; 🇺🇸 Sacramento, California, United States

University of California- Davis Medical Center; 🇺🇸 Sacramento, California, United States

Medstar Washington Hospital Center; 🇺🇸 Washington, District of Columbia, United States

Mayo Clinic; 🇺🇸 Rochester, Minnesota, United States

Winter Haven Hospital; 🇺🇸 Winter Haven, Florida, United States

Emory University Hospital; 🇺🇸 Atlanta, Georgia, United States

Northwestern University; 🇺🇸 Chicago, Illinois, United States

University of Chicago; 🇺🇸 Chicago, Illinois, United States

Advocate Christ Medical Center; 🇺🇸 Oak Lawn, Illinois, United States

Indiana University School of Medicine; 🇺🇸 Indianapolis, Indiana, United States

Ascension Medical Group; 🇺🇸 Indianapolis, Indiana, United States

University of Kansas Medical Center; 🇺🇸 Kansas City, Kansas, United States

Norton Pulmonary Specialists; 🇺🇸 Louisville, Kentucky, United States

Tufts Medical Center; 🇺🇸 Boston, Massachusetts, United States

Massachusetts General Hospital; 🇺🇸 Boston, Massachusetts, United States

Henry Ford Hospital; 🇺🇸 Detroit, Michigan, United States

St. Louis Heart and Vascular; 🇺🇸 Saint Louis, Missouri, United States

University of Nebraska Medical Center; 🇺🇸 Omaha, Nebraska, United States

Weill Cornell Medicine; 🇺🇸 New York, New York, United States

Mount Sinai Hospital; 🇺🇸 New York, New York, United States

Duke University Medical Center; 🇺🇸 Durham, North Carolina, United States

University of Cincinnati Medical Center; 🇺🇸 Cincinnati, Ohio, United States

Ohio Health Research Institute; 🇺🇸 Columbus, Ohio, United States

Temple University Hospital; 🇺🇸 Philadelphia, Pennsylvania, United States

Allegheny General Hospital; 🇺🇸 Pittsburgh, Pennsylvania, United States

Medical University of South Carolina; 🇺🇸 Charleston, South Carolina, United States

University of Texas Southwestern Medical Center; 🇺🇸 Dallas, Texas, United States

Texas Tech Physicians of El Paso; 🇺🇸 El Paso, Texas, United States

Revival Research Institute; 🇺🇸 Sherman, Texas, United States

University of Wisconsin Hospital; 🇺🇸 Madison, Wisconsin, United States

St. Boniface Hospital; 🇨🇦 Winnipeg, Manitoba, Canada

London Health Sciences Center; 🇨🇦 London, Ontario, Canada