This Study Tests the Safety of Inhaled BAY1237592, How the Drug is Tolerated and How it Effects Patients With High Blood Pressure in the Arteries of the Lungs in the Two Different Disease Groups Pulmonary Arterial Hypertension (PAH) and Chronic Thromboembolic Pulmonary Hypertension (CTEPH)

Phase 1

Completed

Brief Summary: In this trial the effects of the inhaled drug BAY1237592 will be studied in patients with high blood pressure in the pulmonary blood vessels due to Pulmonary Arterial Hypertension (PAH) and due to Chronic Thromboembolic Pulmonary Hypertension (CTEPH). Pulmonary hypertension is characterized by the elevation of pressure in the pulmonary arteries (PAP) and of the pulmonary vascular resistance (PVR) leading to increased workload of the right chamber of the heart to eject blood against this elevated resistance. The goal of this study is to measure the safety and tolerability of the drug as well as the reduction of the PVR at different doses

In Part A patients without specific treatment for PH (untreated patients) will be tested. In Part B also patients stably pre-treated with specific PH drugs will be studied in combination with the new inhaled drug

Recruitment & Eligibility

Inclusion Criteria

Patients with PAH or CTEPH undergoing medically indicated routine invasive diagnostics
Men and women aged 18 to 80 years

Part A:

Untreated patients: Therapy-naïve patients (defined as off treatment with PDE-5 inhibitors, endothelin receptor antagonists, prostanoids, or other sGC stimulators/activators) with PAH or CTEPH or patients pre-treated with these medications who have to undergo a drug specific wash-out period at the discretion of the investigator for least 24 h prior to Day -1 if medically safe

Part B:

Untreated patients with PAH or CTEPH:

-- Group 1 (total will be summed up with corresponding dosage group from Part A)
Pre-treated patients with PAH or CTEPH:
- Group 2: Pre-treated patients with any kind of monotherapy* for PAH/CTEPH
- Group 3: Pre-treated patients with any kind of double combination therapy* for PAH/CTEPH * patients receiving inhaled Iloprost, and patients who are known responders to iNO are excluded

Main

Exclusion Criteria

Medical history indicating a different cause for PH than PAH or CTEPH according to the guidelines of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), such as significant left heart disease, valvular disease, or structural heart defects, as assessed by the investigator, significant pulmonary disease or clinical suspicion of pulmonary venoocclusive disease

Arm && Interventions

Group	Intervention	Description
Untreated patients (Part A and Part B)	BAY1237592	Part A: Untreated PAH and CTEPH patients will be enrolled to test 5 ascending doses of BAY1237592 with 4 patients per dose group up to a maximum dose of 4000 µg. Part B: The highest safe, well tolerated and effective dose of Part A will be tested in further untreated patients.
Monotherapy (Part B)	BAY1237592	The highest safe, well tolerated and effective dose chosen from Part A will be tested in pre-treated patients with any kind of monotherapy for PAH/CTEPH.
Combined therapy (Part B)	BAY1237592	The highest safe, well tolerated and effective dose from Part A will be tested in pre-treated patients with any kind of double combination treatment for PAH/CTEPH.

Primary Outcome Measures

Name	Time	Method
Peak percent reduction in PVR (Pulmonary vascular resistance) from "baseline 2" for untreated patients	Up to 5 hours post inhalation of BAY1237592 compared to "baseline 2"	PVR = 80\* (PAP - PCWP) / CO (dyn·sec·cm-5) * PAP = pulmonary arterial pressure * PCWP = pulmonary capillary wedge pressure * CO = cardiac output
Peak percent reduction in PVR from "baseline" for pre-treated patients	Up to 5 hours post inhalation of BAY1237592 compared to "baseline"	PVR = 80\* (PAP - PCWP) / CO (dyn·sec·cm-5)

Secondary Outcome Measures

Name	Time	Method
Incidence of treatment-emergent adverse events (TEAEs)	Up to 7 days after treatment

Locations (8): Vseobecna fakultni nemocnice v Praze
🇨🇿
Praha 2, Czechia
Medizinische Universität Graz
🇦🇹
Graz, Austria
Institut Klinicke a Experimentalni Mediciny
🇨🇿
Praha 4, Czechia
Krankenhaus Neuwittelsbach
🇩🇪
München, Bayern, Germany
Universitätsklinikum Regensburg
🇩🇪
Regensburg, Bayern, Germany
Universitätsklinikum Carl Gustav Carus Dresden
🇩🇪
Dresden, Sachsen, Germany
Szpital Specjalistyczny im. Jana Pawla II
🇵🇱
Krakow, Poland
Universitätsklinikum Giessen und Marburg
🇩🇪
Gießen, Hessen, Germany