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Effects of the Combination of Bosentan and Sildenafil Versus Sildenafil Monotherapy on Pulmonary Arterial Hypertension (PAH) (Compass-2)

This study is ongoing, but not recruiting participants.
Information provided by (Responsible Party):
Actelion Identifier:
First received: March 16, 2006
Last updated: February 11, 2014
Last verified: February 2014

COMPASS-2 is a Phase 4, prospective, randomized, double-blind, placebo-controlled, event-driven study evaluating the effect of bosentan on the time to first confirmed morbidity/mortality event in patients with symptomatic PAH already receiving sildenafil therapy. Patients must have been receiving doses of sildenafil equal to or greater than 20 mg t.i.d. for at least 12 weeks prior to being randomized.

The study continued until the predefined target number of morbidity/mortality events was reached.

Condition Intervention Phase
Pulmonary Arterial Hypertension
Drug: bosentan
Drug: placebo
Phase 4

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Effects of Combination of Bosentan and Sildenafil Versus Sildenafil Monotherapy on Morbidity and Mortality in Symptomatic Patients With Pulmonary Arterial Hypertension - A Multicenter, Double-blind, Randomized, Placebo-controlled, Parallel Group, Prospective, Event Driven Phase IV Study

Resource links provided by NLM:

Further study details as provided by Actelion:

Primary Outcome Measures:
  • Time from baseline to first adjudicated morbidity/mortality event [ Time Frame: From baseline to end of study ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Change from baseline to Week 16 in 6 minute walk test (6MWT) [ Time Frame: From baseline to week 16 ] [ Designated as safety issue: No ]
  • Change from baseline to Week 16 in WHO functional [ Time Frame: From baseline to Week 16 ] [ Designated as safety issue: No ]
  • Change from baseline to Week 16 in Borg dyspnea index [ Time Frame: From baseline to Week 16 ] [ Designated as safety issue: No ]
  • Change from baseline to Week 16 in the EuroQol 5 Dimensions (EQ-5D) questionnaire [ Time Frame: From baseline to Week 16 ] [ Designated as safety issue: No ]
  • Patient Global Self Assessment at Week 16 [ Time Frame: Week 16 ] [ Designated as safety issue: No ]
  • Time to event for the first occurrence of Death, hospitalization for worsening or complication of PAH or initiation of IV prostanoids, Atrial Septostomy, or Lun Transplantation [ Time Frame: Baseline to end of study ] [ Designated as safety issue: No ]
  • Time to death of all causes from baseline to EOS [ Time Frame: Baseline to End of Study ] [ Designated as safety issue: No ]

Enrollment: 334
Study Start Date: May 2006
Estimated Study Completion Date: December 2014
Estimated Primary Completion Date: September 2014 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: A
Drug: bosentan
bosentan/62.5 mg tablet/b.i.d. for 4 weeks then bosentan/125 mg tablet/b.i.d.
Placebo Comparator: B
Drug: placebo
Matching bosentan placebo/b.i.d.


Ages Eligible for Study:   12 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  1. Signed informed consent prior to initiation of any study-mandated procedure
  2. Males or females >=12 years of age (except for countries where this age limit is contrary to specific regulatory requirements).

    - Women of childbearing potential must have a negative pretreatment pregnancy test and must use a reliable method of contraception during study treatment and for at least 3 months after study treatment termination.

    ·Reliable methods of contraception are:

    O Barrier type devices (e.g., female condom, diaphragm, contraceptive sponge) only in combination with a spermicide.

    O Intrauterine devices. O Oral, transdermal, injectable or implantable contraceptives only in combination with a barrier method.

    • Hormone-based contraceptives alone, regardless of the route of administration, are not considered as reliable methods of contraception.
    • Abstention, rhythm method, and contraception by the partner alone are not acceptable methods of contraception.

      • Women not of childbearing potential are defined as postmenopausal (i.e., amenorrhea for at least 1 year), or documented surgically or naturally sterile.
  3. Patients with symptomatic PAH
  4. Patients with the following types of PAH belonging to WHO Group I:

    • Idiopathic (IPAH)
    • Familial (FPAH)
    • Associated with (APAH):

      i. Collagen vascular disease with normal left ventricular function (ejection fraction (EF) > 50%) ii. Congenital systemic-to-pulmonary shunts at least 2 years post surgical repair iii. Drugs and toxins

  5. PAH diagnosed by right heart catheter showing:

    • Mean pulmonary arterial pressure (mPAP) >= 25 mm Hg AND
    • Pulmonary capillary wedge pressure (PCWP) =< 15 mm Hg or left ventricular end diastolic pressure (LVEDP) =< 15 mmHg If both PCWP and LVEDP are available then the LVEDP value is retained for inclusion.
  6. Treatment with a stable dose of sildenafil equal to or greater than 20 mg t.i.d. for at least 12 weeks prior to randomization (no sildenafil dosage adjustment should occur in this period) 7)150 m =< 6MWT =< 480 m, documented by 2 tests with second 6MWT within 15% of first 6MWT distance or a third test required

Exclusion Criteria :

  1. PAH belonging to WHO group II-V
  2. PAH associated with portal hypertension and HIV infection
  3. PAH associated with thyroid disorders, glycogen storage disease, Gaucher disease, hereditary hemorrhagic telangiectasia, hemoglobinopathies, myeloproliferative disorders and splenectomy
  4. PAH associated with significant venous or capillary involvement (PCWP > 15 mmHg): pulmonary veno-occlusive disease and pulmonary capillary hemangiomatosis
  5. Persistent pulmonary hypertension of the newborn
  6. Significant valvular disease with valvular lesions to be excluded by echocardiogram within 2 years prior to randomization (i.e. patients with tricuspid or pulmonary insufficiency secondary to PAH can be included)
  7. Restrictive lung disease: total lung capacity (TLC) < 60% of normal predicted value (see Appendix 3)
  8. Obstructive lung disease: forced expiratory volume/forced vital capacity (FEV1/FVC) < 0.5
  9. Moderate to severe hepatic impairment, i.e., Child-Pugh Class B or C
  10. Known HIV infection
  11. Acute or chronic impairment (other than dyspnea), limiting the ability to comply with study requirements or that may interfere with the safety or the evaluation of the study, such as chronic infection, chronic renal failure etc.
  12. Psychotic, addictive or other disorder limiting the ability to provide informed consent or to comply with study requirements
  13. Pregnancy or breast-feeding
  14. Condition that prevents compliance with the protocol or adherence to therapy
  15. Systolic blood pressure < 85 mmHg
  16. Body weight < 40 kg
  17. Hemoglobin <75% of the lower limit of the normal range
  18. Aspartate aminotransferase (AST) and/or alanine aminotransferase ALT > 1.5 times the upper limit of normal ranges
  19. Known hypersensitivity or history of drug-related adverse events with bosentan (e.g. increase in liver function test results [LFTs]), or any of the excipients of its formulation
  20. Receipt of an investigational product other than sildenafil within 3 months before start of study treatment
  21. Treatment with endothelin receptor antagonists (ERAs), prostanoids or phosphodiesterase (PDE) 5 inhibitors other than sildenafil within 3 months prior to randomization
  22. Concomitant systemic treatment within 1 week prior to randomization with

    • calcineurin inhibitors (e.g., cyclosporine A and tacrolimus), sirolimus and everolimus
    • glibenclamide (glyburide)
    • both CYP2C9 and CYP3A4 (e.g., fluconazole, amiodarone, voriconazole)
    • combination of drugs that inhibit CYP2C9 and CYP3A4
  23. Treatment with nitrates and alpha-blockers at time of randomization
  24. In the opinion of the investigator - patients in need for treatment with any prostanoid up to Visit 4
  25. Significant left ventricular dysfunction
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its identifier: NCT00303459

  Hide Study Locations
United States, California
UCSD Medical Center, Thornton Hospital
La Jolla, California, United States, 92037
Greater Los Angeles VA Medical Center
Los Angeles, California, United States, 90073
University of California (UC) Davis Health System
Sacramento, California, United States, 95817
Harbor-UCLA Medical Center
Torrance, California, United States, 90502
United States, Colorado
University of Colorado Health Sciences Center
Denver, Colorado, United States, 80220
United States, Connecticut
Yale University School of Medicine, Dept. of Internal Medicine, Pulmonary & Critical Care
New Haven, Connecticut, United States, 06520-8057
United States, Florida
Bay Area Chest Physicians
Clearwater, Florida, United States, 33756
Shands Hospital at the University of Florida
Gainesville, Florida, United States, 32610
Mayo Clinic Jacksonville
Jacksonville, Florida, United States, 32224
University of Florida - Jacksonville
Jacksonville, Florida, United States, 32209
United States, Iowa
University of Iowa Pulmonary Hypertension Program
Iowa City, Iowa, United States, 52242
United States, Kansas
University of Kansas Medical Center
Kansas City, Kansas, United States, 66160
United States, Kentucky
UK Medical Center - University of Kentucky
Lexington, Kentucky, United States, 40536-0294
United States, Maryland
University of Maryland - School of Medicine
Baltimore, Maryland, United States, 21201-1595
Johns Hopkins University
Baltimore, Maryland, United States, 21205
United States, Massachusetts
Tufts - New England Medical Center
Boston, Massachusetts, United States, 02111
United States, Michigan
University of Michigan Cardiology
Ann Arbor, Michigan, United States, 48109
Harper University Hospital - Wayne State University
Detroit, Michigan, United States, 48201
Spectrum Health Research Department
Grand Rapids, Michigan, United States, 49503
United States, Minnesota
University of Minnesota Department of Medicine - Cardiovascular Division
Minneapolis, Minnesota, United States, 55455
Mayo Clinic Jacksonville
Rochester, Minnesota, United States, 55905
United States, Missouri
St. Luke's Hospital
Chesterfield, Missouri, United States, 63017
Washington University
St. Louis, Missouri, United States, 63110
United States, New Hampshire
Dartmouth Hitchcock Medical Center
Lebanon, New Hampshire, United States, 03756-0001
United States, North Carolina
Duke University Medical Center (DUMC)
Durham, North Carolina, United States, 27710
United States, Ohio
Lindner Clinical Trials Center
Cincinnati, Ohio, United States, 45219
The Cleveland Clinic Foundation
Cleveland, Ohio, United States, 44195
Ohio State University - Pulmonary Clinical Trials Office - Martha Morehouse Medical Plaza
Columbus, Ohio, United States, 43210
United States, Oregon
The Oregon Clinic - Pulmonary and Critical Care Medicine
Portland, Oregon, United States, 97220
United States, Pennsylvania
Allegheny General Hospital
Pittsburgh, Pennsylvania, United States, 15213
University of Pittsburgh Medical Center - Presbyterian Cardiovascular Institute
Pittsburgh, Pennsylvania, United States, 15213
United States, South Carolina
Medical University of South Carolina (MUSC)
Charleston, South Carolina, United States, 29425
South Carolina Pharmaceutical Research
Spartanburg, South Carolina, United States, 29303
Mid Carolina Internal Medicine
West Columbia, South Carolina, United States, 29169
United States, Texas
Baylor Clinic
Houston, Texas, United States, 77005
United States, Virginia
University of Virginia (UVA) Division of Pulmonary and Critical Medicine
Charlottesville, Virginia, United States, 22908
Inova Fairfax Hospital
Falls Church, Virginia, United States, 22042-3300
United States, Wisconsin
Froedtert Memorial Lutheran Hospital
Milwaukee, Wisconsin, United States, 53226
Hospital Madre Teresa
Belo Horizonte, Brazil, 30430-142
Porto Alegre, Brazil, 90020-090
Hospital das Clínicas - FMUSP
Sao Paulo, Brazil, 05403-000
Instituto Dante Pazzanese
Sao Paulo, Brazil, 04012-909
UNIFESP - Pneumologia
Sao Paulo, Brazil, 04023-062
Copenhagen, Denmark, 2100
Universitätsklinikum Giessen und Marburg, Standort Giessen Zentrum für Innere Medizin
Giessen, Germany, 35392
Medizinische Hochschule Hannover
Hannover, Germany, 30625
Medizinische Klinik der Universitat Innere Medizin III
Heidelberg, Germany, 69120
Klinik Lowenstein GmbH
Loewenstein, Germany, 74245
Universitatsklinikum Regensburg
Regensburg, Germany, 93053
General Hospital Alexandra
Athens, Greece, 11528
University General Hospital "Attikon"
Athens, Greece, 12462
Rio University Hospital
Patras, Greece
Universidade de Coimbra
Coimbra, Portugal, 3000-076
Hospital de Santa Maria
Lisbon, Portugal, 1649-035
Saudi Arabia
Riyadh Military Hospital
Riyadh, Saudi Arabia, 11159
NUSCH, a.s.
Bratislava, Slovakia
Vychodoslovensky ustav srdcovych a cievnych chorob, a.s.
Kosice, Slovakia
Hospital Universitario 12 Octubre
Madrid, Spain, 28041
Sahlgrenska University Hospital
Gothenburg, Sweden
United Kingdom
Royal Hallamshire Hospital
Sheffield, United Kingdom, S102JF
Sponsors and Collaborators
  More Information

Additional Information:
No publications provided

Responsible Party: Actelion Identifier: NCT00303459     History of Changes
Other Study ID Numbers: AC-052-414, COMPASS-2
Study First Received: March 16, 2006
Last Updated: February 11, 2014
Health Authority: United States: Food and Drug Administration
European Union: European Medicines Agency
Brazil: National Health Surveillance Agency

Keywords provided by Actelion:
Pulmonary Arterial Hypertension
Pulmonary Hypertension
Antihypertensive Agents
endothelin receptor antagonist
Combination Drug Therapy
Outcome Assessment
Randomized Controlled Trial
Multicenter Study

Additional relevant MeSH terms:
Hypertension, Pulmonary
Cardiovascular Diseases
Lung Diseases
Respiratory Tract Diseases
Vascular Diseases
Antihypertensive Agents
Cardiovascular Agents
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Pharmacologic Actions
Phosphodiesterase 5 Inhibitors
Phosphodiesterase Inhibitors
Therapeutic Uses
Urological Agents
Vasodilator Agents processed this record on November 27, 2014