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Trial record 4 of 4 for:    Arena | Pulmonary Arterial Hypertension

A Study Evaluating the Efficacy and Safety of Ralinepag to Improve Treatment Outcomes in PAH Patients

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details. Identifier: NCT03626688
Recruitment Status : Recruiting
First Posted : August 13, 2018
Last Update Posted : October 23, 2018
Information provided by (Responsible Party):
Arena Pharmaceuticals

Brief Summary:
Study APD811-301, ADVANCE OUTCOMES, is designed to assess the efficacy and safety of ralinepag when added to pulmonary arterial hypertension (PAH) standard of care or PAH-specific background therapy in subjects with World Health Organization (WHO) Group 1 PAH.

Condition or disease Intervention/treatment Phase
PAH Pulmonary Hypertension Pulmonary Arterial Hypertension Hypertension Connective Tissue Diseases Familial Primary Pulmonary Hypertension Vascular Diseases Cardiovascular Diseases Hypertension, Pulmonary Lung Diseases Respiratory Tract Disease Drug: Placebo Tablet Drug: Ralinepag Tablet, Extended Release Phase 3

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 700 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: A Phase 3, Randomized, Double-blind, Placebo-controlled Study to Evaluate the Efficacy and Safety of Ralinepag When Added to Pulmonary Arterial Hypertension (PAH) Standard of Care or PAH Specific Background Therapy in Subjects With World Health Organization (WHO) Group 1 PAH
Actual Study Start Date : August 30, 2018
Estimated Primary Completion Date : December 2021
Estimated Study Completion Date : December 2021

Arm Intervention/treatment
Placebo Comparator: Placebo
Placebo once per day plus standard of care or PAH-specific background therapy
Drug: Placebo Tablet
Matching placebo

Active Comparator: Ralinepag
Ralinepag once daily, initiated at 50 mcg and titrated to the highest tolerated dose (maximum dose of 1450 mcg) plus standard of care or PAH-specific background therapy
Drug: Ralinepag Tablet, Extended Release
Ralinepag is a non-prostanoid, prostaglandin I2 (PGI2, prostacyclin, IP) receptor agonist
Other Name: APD811

Primary Outcome Measures :
  1. Time (in days) from randomization to the first adjudicated protocol-defined clinical failure event [ Time Frame: Up to a maximum of 42 months ]
    Clinical failure events are defined as death, hospital admission for worsening PAH, disease progression, or unsatisfactory long-term clinical response.

Secondary Outcome Measures :
  1. Change from baseline in NT-proBNP [ Time Frame: 28 weeks ]
  2. Change from baseline in 6-minute walk distance (6MWD) [ Time Frame: 28 weeks ]
  3. Change from baseline in WHO/New York Heart Association (NYHA) functional class [ Time Frame: 28 weeks ]
  4. Change from baseline in heart rate recovery (HRR) following completion of 6-minute walk test (6MWT) [ Time Frame: 28 weeks ]
  5. Proportion of participants who meet all three (composite endpoint) of the following: NT-proBNP level <300 pg/mL and 6MWD >440 meters and WHO/NYHA functional Class II status or better [ Time Frame: 28 weeks ]
  6. Change from baseline in health-related quality of life (HRQoL) as measured by SF-36 [ Time Frame: 28 weeks ]
  7. Change from baseline in HRQoL as measured by PAH-SYMPACT® [ Time Frame: 28 weeks ]

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 75 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Males or females aged 18-75 years, inclusive.
  • Evidence of a personally signed and dated informed consent document indicating that the subject has been informed of all pertinent aspects of the study prior to initiation of any study-related procedures.
  • Subjects who are willing and able to comply with scheduled visits, treatment plan, laboratory tests, and other study procedures.
  • Diagnosis of symptomatic WHO Group 1
  • Has had a right heart catheterization (RHC) performed at or within 365 days of Screening (RHC will be performed during Screening if not available) that is consistent with the diagnosis of PAH
  • Has WHO/ NYHA functional class II to IV symptoms.
  • If on PAH-specific background therapy, subject is on stable therapy with either an endothelin receptor antagonist (ERA) and/or an agent acting on the nitric oxide (NO) pathway, a phosphodiesterase type 5 (PDE5) inhibitor or a soluble guanylate cyclase (sGC) stimulator. Subjects may be naïve to PAH-specific treatments.

    • Stable is defined as no change in dose or regimen within 90 days of Screening and for the duration of the study.
    • Subjects may be on 1 agent active in the NO pathway, i.e., either a PDE5 inhibitor or an sGC stimulator at stable dose (but not both).
    • If the subject's disease-specific PAH therapy does not include a PDE5 inhibitor, the use of PDE5 inhibitor as needed for erectile dysfunction (ED) is permitted as long as the subject has not taken a dose within 48-hours of any Baseline or study related efficacy assessment. In addition, the subject must not take more than 8 sildenafil tablets, 6 vardenafil, or 4 tadalafil tablets per month for ED.
  • Has a 6MWD of ≥50 meters on two consecutive tests, within 15% of each other, preferably performed on different days during Screening. If both tests are done on the same day, then they must be completed >4 hours apart.
  • Both male and female subjects agree to use a medically acceptable method of contraception throughout the entire study period from informed consent through to the Follow-up Visit, if the possibility of conception exists. Eligible male and female subjects must also agree not to participate in a conception process (i.e., actively attempt to become pregnant or to impregnate, sperm donation, in vitro fertilization) during the study and for 30 days after the last dose of IMP. Medically acceptable methods of contraception include the following:

    • oral, implantable, or injectable contraceptives (starting ≥60 days before dosing) and diaphragm with vaginal spermicide, cervical cap with vaginal spermicide, or male condom; male condom and partner using diaphragm with vaginal spermicide or cervical cap with vaginal spermicide;
    • standard intrauterine device (IUD; e.g., Copper T 380A IUD), intrauterine system (IUS; e.g., LNg 20 IUS - progesterone IUD), progesterone implant, or tubal sterilization (≥180 days after surgery);
    • post vasectomy and male condom, partner using diaphragm with spermicide, cervical cap with spermicide, estrogen and progesterone oral contraceptives ("the pill"), estrogen and progesterone transdermal patch, vaginal ring, or progesterone injection. Women who are surgically sterile or postmenopausal for at least 12 months are not considered to be of childbearing potential. If of childbearing potential, female partners of male study participants should agree to utilize medically acceptable methods of contraception for the duration of study participation.

Exclusion Criteria:

  • Body weight <40 kg.
  • Body mass index (BMI) ≥40 kg/m2.
  • Group 2 to 5 pulmonary hypertension.
  • PAH diagnosis ≥5 years at Screening.
  • For subjects with HIV-associated PAH, any of the following:

    • concomitant active opportunistic infections within 180 days of Screening.
    • detectable viral load at Screening.
    • cluster designation 4 (CD4+) T-cell count <200/mm3 within 90 days of Screening.
    • changes in antiretroviral regimen within 90 days of Screening.
  • Presence of 3 or more of the following risk factors for heart failure with preserved ejection fraction at Screening:

    • BMI >30 kg/m2.
    • Diabetes mellitus of any type.
    • Systemic hypertension.
    • Significant coronary artery disease, i.e., any of the following:

      • Angina
      • More than 50% stenosis in a coronary artery (by coronary angiography)
      • Previous myocardial infarction
      • Previous or planned coronary artery bypass grafting and/or coronary artery stenting
    • Left atrial volume index (LAVi) >30 mL/m2.
  • Diagnosis of Down syndrome. Subjects with Down syndrome are excluded due to the high potential of undiagnosed or poorly managed obstructive sleep apnea in this population.
  • Malignancy within 5 years of Screening, with the exception of localized non-metastatic basal cell carcinoma of the skin and in-situ carcinoma of the cervix excised with curative intent.
  • Recent history (i.e., within 1 year prior to Screening) of alcohol or drug abuse.
  • Initiation of a cardio-pulmonary rehabilitation program based upon exercise within 90 days prior to Screening and/or planned during study participation.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT03626688

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Contact: Maria M Joshi, MS 1 858 210 4539

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United States, Florida
Central Florida Pulmonary Recruiting
Orlando, Florida, United States, 32803
Principal Investigator: Daniel Layish, MD         
United States, Kentucky
Kentuckiana Pulmonary Research Center Recruiting
Louisville, Kentucky, United States, 40202
Principal Investigator: John McConnell, MD         
United States, Maryland
University of Maryland Medical Center Recruiting
Baltimore, Maryland, United States, 21201
Principal Investigator: Stacy Fisher, MD         
United States, Oregon
The Oregon Clinic Recruiting
Portland, Oregon, United States, 97225
Principal Investigator: Jeffrey Robinson         
United States, Virginia
Sentara Cardiovascular Research Institute Recruiting
Norfolk, Virginia, United States, 23507
Principal Investigator: Michael Eggert, MD         
Sponsors and Collaborators
Arena Pharmaceuticals
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Study Director: Chris Cabell, MD Arena Pharmaceuticals

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Responsible Party: Arena Pharmaceuticals Identifier: NCT03626688     History of Changes
Other Study ID Numbers: APD811-301
First Posted: August 13, 2018    Key Record Dates
Last Update Posted: October 23, 2018
Last Verified: October 2018

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No

Keywords provided by Arena Pharmaceuticals:
Connective Tissue Disease-Associated
6 Minute Walk Test
6 Minute Walk Distance
Pulmonary Vascular Resistance
Right Ventricular Function

Additional relevant MeSH terms:
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Cardiovascular Diseases
Lung Diseases
Hypertension, Pulmonary
Familial Primary Pulmonary Hypertension
Vascular Diseases
Respiratory Tract Diseases
Connective Tissue Diseases