A Clinical Study of to Confirm the Doses of Selexipag in Children With Pulmonary Arterial Hypertension

Phase 2

Active, not recruiting

Conditions: Pulmonary Arterial Hypertension

Interventions: Drug: selexipag (Uptravi)

Registration Number: NCT03492177

Lead Sponsor: Actelion

Brief Summary: The purpose of this study to confirm the selexipag starting dose(s), selected based on pharmacokinetic (PK) extrapolation from adults, that leads to similar exposure as adults doses in children from greater than or equal to (\>=) 2 to less than (˂) 18 years of age with Pulmonary Arterial Hypertension (PAH), by investigating the PK of selexipag and its active metabolite ACT-333679 in this population.

Detailed Description: The selection of the starting dose for pediatric participants is based on the PK extrapolation from adults, taking into account the children body weight category, in order to lead to an exposure similar to that in adult PAH participants at a starting dose of 200 micrograms (mcg). As in adults, selexipag will be up-titrated to the individual maximum tolerated dose (iMTD) during the first 12 weeks. Approximately 60 participants will be enrolled in 3 different age cohorts to obtain at least 45 participants with evaluable PK profiles: Cohort 1: \>= 12 to \< 18 years of age, Cohort 2: \>= 6 to \< 12 years of age, Cohort 3: \>= 2 to \< 6 years of age. In each age cohort the starting dose will depend on the body weight. Enrollment will start with both Cohort 1 and Cohort 2. After completion of PK assessments in at least 15 participants from Cohort 1 at Week 12, a first interim analysis will be conducted to establish the dose-exposure relationship using a population PK model. The PK data from any participants in Cohort 2 who have completed their PK assessments at this time will be included in this first interim analysis. Results of this model-based analysis will be used to confirm or adjust the selexipag doses initially selected. Enrollment of Cohort 3 (children \>= 2 to \< 6 years of age) will start once the appropriate doses have been confirmed in a second interim analysis of PK data from Cohorts 1 and 2, and if there is no safety concern based on review by an Independent Data Monitoring Committee (IDMC).

Recruitment & Eligibility

Status: ACTIVE_NOT_RECRUITING

Sex: All

Target Recruitment: 63

Inclusion Criteria

Signed and dated informed consent by the parent(s) or Legally authorized representative(s) AND assent from developmentally capable children
Males or females between greater than or equal to (>=) 2 and less than (<) 18 years of age with weight >= 9 kilograms (kg)
Pulmonary arterial hypertension (PAH) diagnosis confirmed by documented historical right heart catheterization (RHC) performed at any time before participant's enrollment
PAH with one of the following etiologies:
- idiopathic (iPAH),
- heritable (hPAH),
- associated with congenital heart disease (CHD): PAH with co-incidental CHD; post-operative PAH (persisting/ recurring/ developing >= 6 months after repair of CHD)
- Drug or toxin-induced
- PAH associated with HIV
- PAH associated with connective tissue disease
Word Health Organization functional class (WHO FC) II to III
Participants treated with an endothelin receptor antagonist (ERA) and/or a phosphodiesterase type 5 (PDE-5) inhibitor provided that the treatment dose(s) has been stable for at least 3 months prior to enrollment, or participants who are not candidates for these therapies
Females of childbearing potential must have a negative pregnancy test at Screening and at Enrollment, and must agree to undertake monthly pregnancy tests, and to use a reliable method of contraception (if sexually active) from screening up to study drug discontinuation plus 30 days (EOS)

Key

Exclusion Criteria

Participants with PAH due to portal hypertension, schistosomiasis, pulmonary veno-occlusive disease (PVOD) and/or pulmonary capillary hemangiomatosis
Participants with PAH associated with Eisenmenger syndrome
Participants with moderate to large left-to-right shunts
Participants with cyanotic congenital cardiac lesions such as transposition of the great arteries, truncus arteriosus, univentricular heart or pulmonary atresia with ventricular septal defect, as well as Participants with Fontan-palliation
Participants with pulmonary hypertension due to lung disease
Previous treatment with Uptravi (selexipag) within 2 weeks prior to enrollment
Participants having received prostacyclin (epoprostenol) or prostacyclin analogs (that is, treprostinil, iloprost, beraprost) within 2 months prior to enrollment or are scheduled to receive any of these compounds during the trial
Treatment with another investigational drug within 4 weeks prior to enrollment
History, or current suspicion of intussusception or ileus or gastrointestinal obstruction as per investigator's judgment
Uncontrolled thyroid disease as per investigator judgment
Hemoglobin or hematocrit < 75 percentage (%) of the lower limit of normal range
Known severe or moderate hepatic impairment
Clinical signs of hypotension that in the investigator's judgment would preclude initiation of a PAH-specific therapy
Participants with severe renal insufficiency
Known hypersensitivity to the investigational treatment or to any of the excipients of the drug formulations

Study & Design

Study Type: INTERVENTIONAL

Study Design: SINGLE_GROUP

Arm && Interventions

Group	Intervention	Description
open label selexipag	selexipag (Uptravi)	The first dose of selexipag (Uptravi) will be administered in the evening of Day 1 and will be based on the body weight. Thereafter selexipag will be administered twice daily (morning and evening). Selexipag will be up-titrated during the first 12 weeks, with weekly increments equal to the starting dose until the participants reach their individual maximum tolerated dose (iMTD) or until a maximum dose corresponding to their baseline weight category is achieved (which will be 8-fold of the corresponding starting dose). Up-titration is followed by a stable maintenance treatment period from Week 12 to Week 16, at the maximum tolerated dose. Thereafter, participants will be treated with selexipag as long as the treatment is beneficial to the participants, as per investigator's decision.

Primary Outcome Measures

Name	Time	Method
Area Under the Plasma Concentration-time Curve Over a Dose Interval at Steady State of Selexipag and Its Metabolite ACT-333679 Combined (AUCτ, ss, Combined)	Week 1,Week 12: pre-dose, 1, 2, 4, 6, 8 and 12 h post-morning dose. Week 2, 4 and 6: pre-dose (Up to Week 12)	AUCτ, ss, combined was defined as the area under the plasma concentration-time curve over one dosing interval at steady state. AUCτ,ss,combined was calculated as 1/38 AUCτ,ss,selexipag plus 37/38 AUCτ,ss,ACT-333679.

Secondary Outcome Measures

Name	Time	Method
Change From Baseline in Hematology Parameters (EOT + 3 Days)	EOT+3 days (Up to Week 17)
Time to Reach the Maximum Observed Plasma Concentration of ACT-333679 at Steady State (Tmax,ss)	Week 1,Week 12: pre-dose, 1, 2, 4, 6, 8 and 12 h post-morning dose. Week 2, 4 and 6: pre-dose (Up to Week 12)
Trough Concentration of ACT-333679 at Steady State (Ctrough,ss)	Week 1,Week 12: pre-dose, 1, 2, 4, 6, 8 and 12 h post-morning dose. Week 2, 4 and 6: pre-dose (Up to Week 12)
Number of Participants With Treatment-emergent Marked Laboratory Abnormalities (EOT + 3 Days)	EOT+3 days (Up to Week 17)
Number of Participants With Treatment-emergent Electrocardiogram (ECG) Abnormalities (EOT + 3 Days)	EOT+3 days (Up to Week 17)
Change From Baseline in Thyroid Stimulating Hormone (TSH) up to EOT + 3 Days	EOT+3 days (Up to Week 17)
Change From Baseline in Blood Pressure	Up to 7 years
Change From Baseline in Heart Rate	Up to 7 years
Change From Baseline Over Time in Height up to EOT+3 Days	EOT+3 days (Up to Week 17)
Area Under the Plasma Concentration-time Curve Over a Dose Interval of Selexipag at Steady State (AUCτ,ss)	Week 1,Week 12: pre-dose, 1, 2, 4, 6, 8 and 12 h post-morning dose. Week 2, 4 and 6: pre-dose (Up to Week 12)
Maximum Observed Plasma Concentration of Selexipag at Steady State (Cmax,ss)	Week 1,Week 12: pre-dose, 1, 2, 4, 6, 8 and 12 h post-morning dose. Week 2, 4 and 6: pre-dose (Up to Week 12)
Number of Participants With Treatment-emergent Adverse Events (TEAEs) (End of Treatment [EOT] + 3 Days)	EOT+3 days (Up to Week 17)
Number of Participants With Treatment-emergent Serious Adverse Events (TESAEs) (EOT + 3 Days)	EOT+3 days (Up to Week 17)
Change From Baseline in Chemistry Parameters (EOT + 3 Days)	EOT+3 days (Up to Week 17)
Time to Reach the Maximum Observed Plasma Concentration of Selexipag at Steady State (Tmax,ss)	Week 1,Week 12: pre-dose, 1, 2, 4, 6, 8 and 12 h post-morning dose. Week 2, 4 and 6: pre-dose (Up to Week 12)
Area Under the Plasma Concentration-Time Curve Over a Dose Interval of ACT-333679 at Steady State (AUCτ,ss)	Week 1,Week 12: pre-dose, 1, 2, 4, 6, 8 and 12 h post-morning dose. Week 2, 4 and 6: pre-dose (Up to Week 12)
Maximum Observed Plasma Concentration of ACT-333679 at Steady State (Cmax,ss)	Week 1,Week 12: pre-dose, 1, 2, 4, 6, 8 and 12 h post-morning dose. Week 2, 4 and 6: pre-dose (Up to Week 12)
Trough Concentration of Selexipag at Steady State (Ctrough,ss)	Week 1,Week 12: pre-dose, 1, 2, 4, 6, 8 and 12 h post-morning dose. Week 2, 4 and 6: pre-dose (Up to Week 12)
Number of Participants With Adverse Events (AEs) Leading to Permanent Discontinuation of Study Drug	Up to 7 years
Number of Participants With Treatment-emergent Deaths (EOT + 3 Days)	EOT+3 days (Up to Week 17)
Change From Baseline Over Time in Body Mass Index (BMI) up to EOT + 3 Days	EOT+ 3 days (Up to Week 17)
Change From Baseline in Sexual Maturation (Tanner Stage) up to End of Treatment (EOT + 3 Days)	EOT+ 3 days (Up to Week 17)

Trial Locations

Locations (34): Children'S Hospital Cardiac Care Center University Of Colorado
🇺🇸
Aurora, Colorado, United States
University of Iowa Hospital
🇺🇸
Iowa City, Iowa, United States
Seattle Children's Hospital
🇺🇸
Seattle, Washington, United States
State Institution Republican Scientific And Practical Center For Pediatric Surgery
🇧🇾
Minsk, Belarus
Health Institution 4Th City Children'S Clinical Hospital
🇧🇾
Minsk, Belarus
UZ Gent
🇧🇪
Gent, Belgium
Shanghai Childrens Medical Center
🇨🇳
Shanghai, China
Universitätsklinikum Freiburg Zentrum
🇩🇪
Freiburg, Germany
Centre Hospitalier Sainte Justine
🇨🇦
Montreal, Quebec, Canada
Beijing Anzhen Hospital
🇨🇳
Beijing, China
CHU Arnaud de Villeneuve
🇫🇷
Montpellier Cedex 5, France
Hôpital Necker - Enfants Malades
🇫🇷
Paris, France
Chu Hopital Des Enfants
🇫🇷
Toulouse Cedex 9, France
Schneider Children's Medical Center
🇮🇱
Petach Tikvah, Israel
Gottsegen György Országos Kardiológiai Intézet, Felnőtt kardiológiai osztály
🇭🇺
Budapest, Hungary
Sheba Medical Center
🇮🇱
Ramat Gan, Israel
Sarawak General Hospital
🇲🇾
Kota Samarahan, Malaysia
Institut Jantung Negara (National Heart Institute)
🇲🇾
Kuala Lumpur, Malaysia
Wojewodzki Szpital Specjalistyczny We Wroclawiu
🇵🇱
Wroclaw, Poland
Kazan State Medical University
🇷🇺
Kazan, Russian Federation
Federal State Budget Scientific Institution
🇷🇺
Kemerovo, Russian Federation
Moscow Scientific Research Institute For Pediatrics And Childrens Surgery Of Rosmedtechnologies
🇷🇺
Moscow, Russian Federation
Samara Regional Clinical Cardiological Dispensary
🇷🇺
Samara, Russian Federation
Municipal Enterprise Of The Dnipropetrovsk Regional Council
🇺🇦
Dnipro, Ukraine
State Institution Of The Ministry Of Health Of Ukraine
🇺🇦
Kiev, Ukraine
Municipal Institution Of The Zaporizhzhya Regional Council
🇺🇦
Zaporizhzhya, Ukraine
Federal State Budgetary Institution
🇷🇺
St Petersburg, Russian Federation
Saint Petersburg State Pediatric Medical University
🇷🇺
St. Petersburg, Russian Federation
National Taiwan University Hospital
🇨🇳
Taipei, Taiwan
Univerzitetska Dečja Klinika
🇷🇸
Belgrade, Serbia
Institut Za Zdravstvenu Zastitu Majke I Deteta Srbije Dr Vukan Cupic
🇷🇸
Belgrade, Serbia
National Cheng Kung University Hospital
🇨🇳
Tainan, Taiwan
Lviv Regional Clinical Hospital
🇺🇦
Lviv, Ukraine
Great Ormond Street Hospital
🇬🇧
London, United Kingdom