Effects of Sildenafil on CFTR-dependent Ion Transport Activity

This study is currently recruiting participants. (see Contacts and Locations)
Verified October 2015 by National Jewish Health
Sponsor:
Information provided by (Responsible Party):
Jennifer Taylor-Cousar, National Jewish Health
ClinicalTrials.gov Identifier:
NCT01132482
First received: April 16, 2010
Last updated: October 15, 2015
Last verified: October 2015

April 16, 2010
October 15, 2015
October 2015
October 2016   (final data collection date for primary outcome measure)
Sodium conductance by nasal potential difference (NPD) [ Time Frame: 5 visits over a 6-10 week period ] [ Designated as safety issue: No ]
Sodium conductance by nasal potential difference (NPD) [ Time Frame: 8 visits over a 10-12 week period ] [ Designated as safety issue: No ]
We will measure sodium movement in the nose using a test known as a nasal potential difference (NPD) measurement. A tiny wire and tube will be placed in the nose and liquids containing different medicines will run in through the tube. The short version of the test takes about 15 minutes, and the long version of the test takes about 45 minutes.
Complete list of historical versions of study NCT01132482 on ClinicalTrials.gov Archive Site
  • Chloride conductance by NPD [ Time Frame: 5 visits over a 6-10 week period ] [ Designated as safety issue: No ]
  • Sweat sodium concentration by pilocarpine iontophoresis [ Time Frame: 5 visits over a 6-10 week period ] [ Designated as safety issue: No ]
  • Sweat chloride concentration by pilocarpine iontophoresis [ Time Frame: 5 visits over a 6-10 week period ] [ Designated as safety issue: No ]
  • Pulmonary function by spirometry [ Time Frame: 5 visits over a 6-10 week period ] [ Designated as safety issue: No ]
  • Serum sildenafil pharmacokinetics [ Time Frame: 5 visits over a 6-10 week period ] [ Designated as safety issue: No ]
  • CF Heath Related Quality of Life Questionnaire (CFQ-R) [ Time Frame: 5 visits over a 6-10 week period ] [ Designated as safety issue: No ]
  • Safety and adverse events [ Time Frame: 5 visits over a 6-10 week period ] [ Designated as safety issue: Yes ]
  • Lung clearance index [ Time Frame: 5 visits over a 6-10 week period ] [ Designated as safety issue: No ]
  • Chloride conductance by NPD [ Time Frame: 8 visits over 10-12 weeks ] [ Designated as safety issue: No ]
    We will measure chloride movement in the nose using a test known as a nasal potential difference measurement. A tiny wire and tube will be placed in the nose and liquids containing different medicines will run in through the tube. The short version of the test takes about 15 minutes, and the long version of the test takes about 45 minutes.
  • Sweat sodium concentration by pilocarpine iontophoresis [ Time Frame: 8 visits over 10-12 weeks ] [ Designated as safety issue: No ]
    We will measure sodium in your sweat. The procedure to measure sodium in sweat is known as a sweat test. To collect the sweat, a sticky pad will be attached to the skin on the arm for 5 minutes. A gel containing a medicine called pilocarpine is put on the pads and causes the sweat glands to produce more sweat. The pads are then removed and replaced by a disc to collect sweat for about 30 minutes. The entire procedure will also be done on the other arm.
  • Sweat chloride concentration by pilocarpine iontophoresis [ Time Frame: 8 visits over 10-12 weeks ] [ Designated as safety issue: No ]
    We will measure chloride in your sweat. The procedure to measure chloride in sweat is known as a sweat test. To collect the sweat, a sticky pad will be attached to the skin on the arm for 5 minutes. A gel containing a medicine called pilocarpine is put on the pads and causes the sweat glands to produce more sweat. The pads are then removed and replaced by a disc to collect sweat for about 30 minutes. The entire procedure will also be done on the other arm.
  • Pulmonary function by spirometry [ Time Frame: 4 visits over 10-12 weeks ] [ Designated as safety issue: No ]
  • Serum sildenafil pharmacokinetics [ Time Frame: 8 visits over 10-12 weeks ] [ Designated as safety issue: No ]
    Blood will be drawn and the amount of sildenafil in the blood will be measured.
  • CF Heath Related Quality of Life Questionnaire (CFQ-R) [ Time Frame: 4 visits over 10-12 weeks ] [ Designated as safety issue: No ]
    This questionnaire asks about how CF affects your daily life. Examples of questions include: "How do you feel about eating? How difficult is it for you do your treatments (including medications) every day? How often does CF get in the way of meeting your school, work, or personal goals?"
  • Safety and adverse events [ Time Frame: 8 visits over 10-12 weeks ] [ Designated as safety issue: Yes ]
    The number of patients who experience adverse events will be recorded and reported.
Not Provided
Not Provided
 
Effects of Sildenafil on CFTR-dependent Ion Transport Activity
Phase II Study of the Effects of Sildenafil on CFTR-dependent Ion Transport Activity
Dehydrated airway surfaces resulting from sodium hyperabsorption and lack of chloride secretion are critical to the pathology that leads to the morbidity and mortality from Cystic Fibrosis (CF) lung disease. Previously published work in CF cell lines has demonstrated that by increasing cGMP and restoring inhibition of ENaC, sodium hyperabsorption may be reversed following administration of a phosphodiesterase inhibitor (PDEi,) such as sildenafil. Additionally it has been shown in CF cell lines and animal models, that phosphodiesterase inhibitors/analogues can enhance chloride secretion and/or correct surface localization of ΔF508 CFTR. The goal of this project is to translate the results of this work from the laboratory into a clinical trial in patients with CF using an FDA-approved therapy. The Specific Aims of this project are to: 1) Evaluate the effect of systemically administered phosphodiesterase inhibitors on ion transport in CF by measurement of Na+ and Cl- conductance by NPD and Na+ and Cl- concentration in sweat utilizing pilocarpine iontophoresis 2) To establish appropriate dosing of sildenafil in CF by performing a dose-escalation study during which patients are carefully monitored for side effects, plasma sildenafil levels are obtained and outcome measures are compared based on the dose of sildenafil administered. The results of this study in conjunction with those from an ongoing study examining the role of sildenafil as an anti-inflammatory in CF will aid in establishing safety, pharmacokinetics and mechanism of action of sildenafil in the treatment of CF lung disease.
Not Provided
Interventional
Phase 2
Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Cystic Fibrosis
  • Drug: Sildenafil
    During the course of the study, patients will receive 4 weeks of therapy: 28 days of placebo orally t.i.d. or 28 days of days of sildenafil orally t.i.d. Dosing of sildenafil will be escalated after the first week (20 mg orally t.i.d for the first week, then subjects will take 40 mg orally t.i.d. for 3 weeks). Patients not tolerating dose escalation will be discontinued from the study.
    Other Name: Revatio
  • Drug: Placebo
    Patients receiving placebo will have sham dose escalation to maintain blinding.
  • Experimental: Sildenafil
    Subjects will receive escalating doses of sildenafil
    Intervention: Drug: Sildenafil
  • Placebo Comparator: Placebo
    During the placebo arm, subjects receiving placebo will have sham dose escalation to maintain blinding.
    Intervention: Drug: Placebo

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruiting
20
January 2017
October 2016   (final data collection date for primary outcome measure)

Inclusion Criteria:

  1. Confirmed diagnosis of CF based on the following criteria: Positive sweat chloride ≥60mEq/liter (by pilocarpine iontophoresis) and genotype with two F508del CFTR mutations, and accompanied by one or more clinical features consistent with the CF phenotype
  2. Male or female subjects ≥ 18 years of age
  3. FEV1 ≥ 50% predicted (Hankinson)
  4. Clinically stable without evidence of acute upper or lower respiratory tract infection or current pulmonary exacerbation within the 14 days prior to the screening visit
  5. Ability to reproducibly perform spirometry (according to ATS criteria)
  6. Ability to understand and sign a written informed consent or assent and comply with the requirements of the study
  7. Willing and able to perform nasal potential difference testing
  8. No changes in use of nasal medications within 2 weeks of screening visit
  9. If on Orkambi, has been on stable Orkambi dose for at least 4 weeks at day 1.

Exclusion Criteria:

  1. History of hypersensitivity to sildenafil
  2. Use of an investigational agent within the 4-week period prior to Visit 1 (Day 0)
  3. Breastfeeding, pregnant, or verbal expression of unwillingness to practice an acceptable birth control method (abstinence, hormonal or barrier methods, partner sterilization or intrauterine device) during participation in the study
  4. History of significant hepatic (SGOT or SGPT > 3 times the upper limit of normal at screening, documented biliary cirrhosis, or portal hypertension), cardiovascular (history of aortic stenosis, coronary artery disease, pulmonary hypertension with right ventricular systolic pressure >55 mmHg or life-threatening arrhythmia), neurological (history of stroke), hematologic (history of bleeding diathesis), ophthalmologic (history of retinal impairment or non-arteritic ischemic optic neuritis) or renal impairment (creatinine >1.8 mg/dL.)
  5. Inability to swallow pills
  6. Previous lung transplantation
  7. Use of concomitant nitrates, α-blocker, or Ca channel blocker
  8. Use of concomitant medications known to be potent inhibitors of CYP3A4 (e.g. ketoconazole, itraconazole, ritonavir, clarithromycin, erythromycin, rifampin, verapamil)
  9. Presence of a condition or abnormality that in the opinion of the investigator would compromise the safety of the subject or the quality of the data
  10. Weight less than 40 kg
  11. History of sputum or throat swab culture yielding Burkholderia cepacia within 2 years of screening
  12. History of nasal disease or nasal surgery that would, in the opinion of the investigator, impede accurate measurements of NPD
  13. Use of anticoagulant medication (e.g. heparin, coumadin)
  14. Resting room air oxygen saturation <93%
  15. Use of nighttime oxygen

15) History of migraine headaches 16) Baseline BP of < 90/50 mm Hg

Both
18 Years and older   (Adult, Senior)
No
Contact: Connie St. Clair, RN 303-270-2517 StclairC@NJHealth.org
Contact: Marion Jones, RN JonesM@NJHealth.org
United States
 
NCT01132482
Sildenafil CFTR
Yes
Not Provided
Not Provided
Jennifer Taylor-Cousar, National Jewish Health
National Jewish Health
Not Provided
Principal Investigator: Jennifer L Taylor-Cousar, MD National Jewish Health
National Jewish Health
October 2015

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP