The Combination Ambrisentan Plus Spironolactone in Pulmonary Arterial Hypertension Study

Phase 4

Terminated

• Conditions: Pulmonary Arterial Hypertension
• Interventions: Drug: Ambrisentan plus Spironolactone; Drug: Ambrisentan plus Placebo

• Registration Number: NCT02253394
• Lead Sponsor: Brigham and Women's Hospital

Brief Summary

The purpose of this study is to find out if spironolactone added to ambrisentan for Pulmonary Arterial Hypertension (PAH) will increase exercise capacity. We also want to find out if spironolactone and ambrisentan effect the cardiac output (amount of blood the heart pumps every minute), right ventricle function and quality of life.

Detailed Description

A prospective, double blind, placebo-controlled clinical study involving 30 patients with World Health Organization (WHO) Group 1 pulmonary arterial hypertension being treated with ambrisentan randomized to receive placebo or spironolactone (50 mg/d) for 90 days using a cross-over trial design.

Eligible participants will be randomized to receive placebo or spironolactone (50 mg/d) for 90 days (Phase I). At the completion of Phase I, participants will undergo repeat end-point assessment followed by a 21-day drug washout period. Then, the 90 day crossover phase of the trial will occur (Phase II), in which participants randomized to placebo in Phase I will be treated with spironolactone (50 mg/d) in Phase II and vice versa. At the conclusion of Phase II, end-point measures are reassessed.

Spironolactone is a diuretic used in treatment of PAH patients. Spironolactone is usually added to medical treatment when doses of Lasix/Torsemide are increased and patients are at risk for hypokalemia.

Study procedures being done for this research study are the standard procedures performed on all PAH patients when they are in clinic for follow-up except for the Cardiopulmonary Exercise Test (CPET) with Innocor.

Study Timeline

• Study First Submitted: 2014-09-17
• Study First Submitted QC: 2014-09-27
• Study First Posted: 2014-10-01
• Study Start: 2015-09
• Primary Completion: 2018-02
• Study Completion: 2018-02
• Results First Submitted: 2019-08-28
• Status Verified: 2019-11
• Results First Submitted QC: 2019-11-13
• Last Update Submitted: 2019-11-13
• Results First Posted: 2019-11-15
• Last Update Posted: 2019-11-15

Recruitment & Eligibility

• Status: TERMINATED
• Sex: All
• Target Recruitment: 2

Inclusion Criteria

1. Voluntarily gives informed consent to participate in the study.
2. Right heart catheterization demonstrating conventional mean pulmonary artery pressure (mPAP) >25, pulmonary vascular resistance (PVR) >3.0 Wood Units, pulmonary capillary wedge pressure (PCWP) <16 mmHg within two years of enrollment
3. Subject is 18 years of age or older at Screening.
4. Diagnosis of symptomatic idiopathic or heritable PAH, PAH associated with Connective Tissue Disease (CTD), PAH associated with repaired/unrepaired congenital systemic-to-pulmonary shunt, Portopulmonary hypertension or PAH associated with HIV infection.
5. New York Heart Association Functional Class II or III
6. Stable therapy with ambrisentan 5 or 10 mg every day for > 90 days.
7. Baseline 6-Minute Walk Distance 50-450m

Exclusion Criteria

1. Substantial Primary Lung disease

   • forced expiratory volume at one second (FEV-1)/forced vital capacity (FVC) <0.6 and FEV-1 <70% predicted
   • diffusing capacity of lung for carbon monoxide (DLCO) <30% predicted
   • Pulmonary fibrosis

2. Left ventricular ejection fraction < 50%

3. Pulmonary capillary wedge pressure > 16 mm Hg

4. Aortic valve disease

5. Ischemic heart disease

6. Systemic hypotension (SBP <90 mm Hg)

7. Co-existing treatment with other endothelin receptor antagonists or prostacyclin analogues

8. New York Heart Association Functional Class IV

9. Chronic thromboembolic pulmonary hypertension

10. Known or suspected pulmonary veno-occlusive disease

11. Serum creatinine >2.0 mg/dL in women, Serum creatinine >2.5 mg/dL in men

12. Baseline serum potassium >5.0 milliequivalent (mEq)/L

13. Participation in ongoing drug/intervention-based clinical trial

14. Pregnancy

15. Unable to provide consent

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: CROSSOVER

Arm && Interventions

Group	Intervention	Description
AMB + Spiro, Cardiopulmonary fitness	Ambrisentan plus Spironolactone	Ambrisentan 5 or 10 mg every day (QD) Spironolactone 50 mg QD
Placebo Cardiopulmonary fitness	Ambrisentan plus Placebo	Placebo mimics spironolactone 50 mg and will be taken QD

Primary Outcome Measures

Name	Time	Method
Effect of Combination Ambrisentan + Spironolactone on Peak Volume of Oxygen Consumption (pVO2) and Cardiac Output	Up to average of 20 min	Study the effect of combination ambrisentan (5-10 mg/d) + spironolactone (50 mg/d) on pVO2 and cardiac output. The pVO2 refers to a measure of general physical fitness measured during exercise.

Trial Locations

Locations (1)

Brigham & Women's Hospital; 🇺🇸 Boston, Massachusetts, United States