A Phase IV, Open-label, Randomized, Multicenter Study of the Safety, Tolerability,and Pharmacokinetics of ACT- 385781A Compared to Flolan® in Injectable Prostanoid Treatment-naïve Patients With Pulmonary Arterial Hypertension (PAH)
Overview
- Phase
- Phase 4
- Intervention
- ACT-385781A (Actelion Epoprostenol)
- Conditions
- Pulmonary Arterial Hypertension
- Sponsor
- Actelion
- Enrollment
- 30
- Primary Endpoint
- Dose Normalized Pharmacokinetics of 6,15-diketo-13,14-dihydro-Prostacyclin F1alpha at 2 ng/kg/Min
- Status
- Completed
- Last Updated
- last year
Overview
Brief Summary
This is a prospective, multi-center, open-label, randomized, Phase IV exploratory study comparing safety, tolerability, pharmacokinetics, and effectiveness of ACT-385781A and Flolan (epoprostenol sodium) in patients with pulmonary arterial hypertension who are naïve to injectable prostanoid treatment and in need of such treatment. Approximately 30 patients from 8 U.S. clinical sites will be randomized to receive either ACT-385781A or Flolan (2:1 respectively) for 28 days of treatment.
Investigators
Eligibility Criteria
Inclusion Criteria
- •Male or female subjects aged 18-65 years
- •Patients with the following types of pulmonary arterial hypertension (PAH) belonging to WHO Group I:
- •Idiopathic (IPAH)
- •Heritable (HPAH)
- •Associated (APAH) with
- •Connective tissue diseases
- •Drugs and toxins
- •Patients with PAH in modified NYHA functional class III or IV at the time of enrollment in need of injectable epoprostenol.
- •Patients must be injectable prostanoid treatment-naïve and either
- •newly diagnosed and not yet treated with specific PAH therapies or
Exclusion Criteria
- •Patients with respiratory and/or cardiovascular distress in need of emergency care including i.v. epoprostenol administration or any vasopressive i.v. drugs
- •Known pulmonary veno-occlusive disease (PVOD)
- •Current use of i.v. inotropic agents
- •Tachycardia with heart rate \> 120 beats/min
- •Pulmonary arterial hypertension related to any condition other than those specified in the inclusion criteria
- •Known hypersensitivity to the formulations of ACT-385781A or any of its excipients, and Flolan or any of its excipients
- •Use of inhaled iloprost or treprostinil during the week prior to screening
- •Cerebrovascular events (e.g., transient ischemic attack or stroke) within 6 months of screening
- •History of myocardial infarction
- •History of left-sided heart disease, including any of the following:
Arms & Interventions
1
ACT-385781A (Actelion Epoprostenol)
Intervention: ACT-385781A (Actelion Epoprostenol)
2
Flolan®
Intervention: Flolan®
Outcomes
Primary Outcomes
Dose Normalized Pharmacokinetics of 6,15-diketo-13,14-dihydro-Prostacyclin F1alpha at 2 ng/kg/Min
Time Frame: Day 1
The plasma concentration for the epoprostenol metabolite 6,15-diketo-13,14-dihydro-Prostacyclin F1alpha was measured at 2 ng/kg/min just prior to the next up-titration. Dose-normalized concentrations are used to summarize the results.
Dose Normalized Pharmacokinetics of 6,15-diketo-13,14-dihydro-Prostacyclin F1alpha at 4 ng/kg/Min
Time Frame: Day 1
The plasma concentration for the epoprostenol metabolite 6,15-diketo-13,14-dihydro-Prostacyclin F1alpha was measured at 4 ng/kg/min just prior to the next up-titration. Dose-normalized concentrations are used to summarize the results.
Dose Normalized Pharmacokinetics of 6-keto-Prostacyclin F1alpha at 2 ng/kg/Min
Time Frame: Day 1
The plasma concentration for the epoprostenol metabolite 6-keto-Prostacyclin F1alpha was measured at 2 ng/kg/min just prior to the next up-titration. Dose-normalized concentrations are used to summarize the results.
Dose Normalized Pharmacokinetics of 6-keto-Prostacyclin F1alpha at 4 ng/kg/Min
Time Frame: Day 1
The plasma concentration for the epoprostenol metabolite 6-keto-Prostacyclin F1alpha was measured at 4 ng/kg/min just prior to the next up-titration. Dose-normalized concentrations are used to summarize the results.
Six-minute Walk Distance (6MWD) - Baseline and Day 28
Time Frame: Baseline and 28 days (+3 days)
The 6-minute walk test (6MWT) was to be performed prior to initiating study treatment either during the screening visit or on Day 1 prior to drug initiation, and Day 28 (End of treatment (EOT)). This assessment is a non-encouraged test that measures the distance walked for a duration of 6 minutes. The 6MWD was recorded in the Case Report Form (CRF).
Patients With New York Heart Association (NYHA) Functional Class Change (Improved or Worsened) From Baseline to Day 28
Time Frame: From baseline to 28 days (+3 days)
Disease severity was assessed by NYHA classification of PAH criteria: Class I: no limitation of physical activity (PA). Ordinary PA: no undue dyspnea/fatigue, chest pain, near syncope. Class II: slight limitation of PA. Comfortable at rest. Ordinary PA: undue dyspnea/fatigue, chest pain, near syncope. Class III: marked limitation of PA. Comfortable at rest. Less than ordinary PA: undue dyspnea/fatigue, chest pain, near syncope. Class IV: inability to carry out PA without symptoms. Right heart failure. Dyspnea/fatigue may even have been present at rest. Discomfort increased by any PA.
Percentage Central Venous Blood Oxygen Saturation (ScVO2) - Baseline and Day 28
Time Frame: Baseline and 28 days
Central venous blood oxygen saturation assessment was performed only in specific centers. Measurements for ScVO2 were performed during the inpatient hospitalization period on Day 1 (prior to drug initiation) and on Day 28 (EOT). Samples for ScVO2 were obtained by aspirating blood from the indwelling central venous catheter. After the sample had been drawn, the catheter was primed with study drug in order to refill the lumen to avoid interruption in treatment and sudden decompensation.
Blood Pressure - Baseline and Day 28
Time Frame: Baseline and 28 days
Blood pressure (systolic and diastolic) were measured indirectly using an automatic oscillometric device, on the same arm for each measurement. The Blood Pressure was assessed at baseline and at Day 28 (End of Study Treatment visit).
Heart Rate - Baseline and Day 28
Time Frame: Baseline and 28 days
Heart rate was measured indirectly using an automatic oscillometric device, on the same arm for each measurement. The Heart Rate was assessed at Baseline and at Day 28 (End of Study Treatment visit).
Body Weight - Baseline and Day 28
Time Frame: Baseline and 28 days
Body weight was measured both at baseline and day 28.