The Effect of Bosentan and Pioglitazone on Insulin Resistance in Pulmonary Arterial Hypertension
试验速览
- 阶段
- 2 期
- 状态
- 终止
- 入组人数
- 2
- 试验地点
- 1
- 主要终点
- Insulin Resistance Profile Change - Triglyceride:HDL Cholesterol Ratio
研究概览
简要总结
The purpose of this study is to evaluate 1) the incidence of insulin resistance (a pre-diabetic state) in patients with pulmonary hypertension, and 2) test the utility of a validated PH therapy (Tracleer) versus Pioglitazone in the treatment of those patients found to have insulin resistance.
详细描述
The Effect of Bosentan and Pioglitazone on Insulin Resistance in Pulmonary Arterial Hypertension ,is a study evaluating the incidence of insulin resistance in patients with pulmonary hypertension and testing the utility of a validated PH therapy(Tracleer) versus Pioglitazone in the treatment of those patients found to have insulin resistance.Patients with PAH must be stable on therapy for at least 3 months are considered for enrollment in this study.With the exception of PAH, subjects must be free of major medical illnesses, including diabetes mellitus ,malignancy or significant hepatic or renal disease.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Triple (Participant, Care Provider, Investigator)
入排标准
- 年龄范围
- 18 Years 至 75 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Patients with Pulmonary Arterial Hypertension (PAH) must be stable on therapy for at least 3 months prior to enrollment in the trial. We will include patients with idiopathic PAH and Familial PAH as well as PAH associated with collagen vascular disease or drug or toxin exposure. With the exception of PAH, subjects must be free of major medical illnesses, including diabetes mellitus (must have fasting plasma glucose < 126 mg/dL and taking no anti-hyperglycemic agent), malignancy or significant hepatic or renal disease. Subjects may be hypertensive and on anti-hypertensive medications as long as blood pressure is < 150/100 mm Hg. Subjects may also be dyslipidemic and/or taking drugs to improve abnormalities of lipid metabolism, but they will be excluded if they are taking medications known to alter insulin sensitivity, including glucocorticoids, niacin, anti-retrovirals, thiazolidinediones, or metformin. Use of oral contraceptives or estrogen and/or progesterone replacement therapy is permitted. Weight must be stable and the subjects agree not to change their eating habits or exercise regimen during the study period. There will be no restrictions with regard to race or socioeconomic status, and the racial/ethnic composition of the study population will be reflective of the communities surrounding the Stanford University Medical Center.
排除标准
- •* Vulnerable subject status.
- •Concurrent Endothelin-1 antagonist therapy
- •Concurrent Thiazolidinedione therapy
- •New York Heart Class III or IV
- •PAH related to other etiologies.
- •Diabetes Mellitus with Fasting Glucose Levels > 126 mg/dL
- •Allergy or hypersensitivity to pioglitazone or bosentan administration.
- •Current treatment with statin therapy.
- •Initiation of PAH therapy (prostacyclin analogues, phosphodiesterase-5 inhibitors) within three months of enrollment.
- •Inability or unwillingness to avoid systemic steroid containing medications for four months. Inhaled steroid use is acceptable.
- •Current or recent use or planned treatment with: glyburide, cyclosporine, nilotinib, nisoldipine, ranolazine, thioridazine
- •Hepatic transaminases > 2x the upper limit of normal at the center at screening.
- •Current or recent (< 6 months) chronic heavy alcohol consumption.
- •Current use of another investigational drug (non-FDA approved) for PAH.
- •Lung transplant recipients.
- •History of myositis.
- •Renal failure (Cr 2.0).
- •Hospitalized or acutely ill.
- •Chronic liver disease (cirrhosis, chronic hepatitis, etc.).
- •Abnormalities of the arm or hand or radical mastectomy (preventing brachial artery ultrasound).
- •Pregnant or lactating women.
研究组 & 干预措施
bosentan
Bosentan 62.5 twice daily for 4 weeks, then 125 mg twice daily.
干预措施: bosentan (Drug)
Pioglitazone
Pioglitazone 15 mg a day for 4 weeks then Pioglitazone 30 mg a day for the duration of the study.
干预措施: Pioglitazone (Drug)
结局指标
主要结局
Insulin Resistance Profile Change - Triglyceride:HDL Cholesterol Ratio
时间窗: baseline and 16 weeks
insulin resistance measured -triglyceride: HDL cholesterol ratio measures at 16 weeks compared with baseline.
次要结局
- 6 Minute Walk Test(Baseline and 16 weeks)
- NYHA (New York Heart Association Classification) Changes(Baseline and 16 weeks)
研究者
Roham T. Zamanian
Principle Investigator
Stanford University