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Sildenafil Study to Treat Idiopathic Pulmonary Fibrosis

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ClinicalTrials.gov Identifier: NCT00359736
Recruitment Status : Completed
First Posted : August 2, 2006
Results First Posted : October 6, 2014
Last Update Posted : November 1, 2017
Information provided by (Responsible Party):
VA Office of Research and Development

Brief Summary:
Medicines that decrease blood pressure in the lungs may help idiopathic pulmonary fibrosis (IPF) patients function better. This study will test whether sildenafil improves the ability to exercise in patients with pulmonary fibrosis of unknown cause.

Condition or disease Intervention/treatment Phase
Alveolitis, Fibrosing Fibrosis, Pulmonary Hypertension, Pulmonary Drug: sildenafil Phase 2

Detailed Description:

Idiopathic pulmonary fibrosis (IPF) is recognized as a predominantly noninflammatory paradigm of lung fibrosis, characterized by heterogeneous myofibroblast proliferation (usual interstitial pneumonia [UIP]) and a poor clinical prognosis. To date no therapies have been demonstrated in well-designed, randomized, controlled trials (RCT) to favorably influence functional status or survival of IPF patients. The need for effective therapies for VA patients with IPF is thus obvious and urgent.

The overall goal of this VA Merit Review clinical research is to generate rigorous preliminary data for evaluation of a new and potentially effective therapy for IPF. The established, combined Miami Veterans Affairs Medical Center (VAMC) - University of Miami (UM) IPF program has participated productively in a number of clinical trials to assess new agents for the therapy of IPF (e.g., interferon gamma-lb, imatinib mesylate, etanercept, bosentan). Our program is uniquely qualified to enroll large numbers of IPF patients in clinical trials, because of its large metropolitan population base (>5,000,000 people) and extensive referral network throughout South and Central America. The Veteran population of South Florida (Dade, Broward and Monroe Counties) is approximately 236,000 (U.S. Census Bureau). Of that number 39% are 65 years of age or older, making them at high risk for IPF. Because of its large Veteran and civilian population base, international referral network and previous experience as a "high enrollment center" in IPF clinical trials, the Miami VAMC-UM IPF program is uniquely qualified to anticipate the role of a CSP lead center.

Our central hypothesis is that sildenafil, a vasodilator, will have a beneficial effect compared to placebo on disease progression, defined as a significant change in the 6-minute walk distance or dyspnea index, in patients with IPF.

Specifically, we will test effects of sildenafil on IPF patients' exercise tolerance and level of dyspnea in a double blind, randomized, placebo controlled (one to one assignment) pilot study. Upon completion of this trial, it will be possible to assess efficacy of sildenafil on progression of disease in IPF and possibly introduce this agent into translational practice. Our specific objectives are:

Specific Objectives 1: To assess the possible therapeutic benefit of a vasodilator, sildenafil, on exercise tolerance in IPF patients.

The working hypothesis is that, compared to placebo, sildenafil will favorably affect rate of decline from baseline in exercise capacity (6-minutes walk).

Specific Objective 2: To assess and compare changes from baseline in pre- and post-exercise dyspnea in sildenafil and placebo control groups.

The working hypothesis is that application of this agent will lead to more sustained exercise and a more favorable clinical outcome in addition to a decrease in the degree of limiting dyspnea after exercise.

The application of vasodilator therapy in IPF is unique in that it directly targets key pathophysiologic mechanisms of functional limitation: Increased pulmonary vascular resistance and dyspnea due to exercise. This novel approach will have a significant impact on field, because it promises both additional insight into mechanisms of disease and immediate therapeutic options.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 29 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Vasodilator Therapy and Exercise Tolerance in IPF Patients
Study Start Date : July 2006
Actual Primary Completion Date : October 2008
Actual Study Completion Date : June 2009

Arm Intervention/treatment
Experimental: Sildenafil
Sildenafil 20 mg tid orally
Drug: sildenafil
Assessing the possible therapeutic benefit of sildenafil on exercise tolerance in IPF patients.
Other Name: Revatio

Placebo Comparator: Placebo
Identical Placebo 20 mg tid orally
Drug: sildenafil
Assessing the possible therapeutic benefit of sildenafil on exercise tolerance in IPF patients.
Other Name: Revatio

Primary Outcome Measures :
  1. Change in 6-minute Walk Test [ Time Frame: 0 - 6 months ]
    Distance in meters -- Distance (meters) walked in 6 minutes

Secondary Outcome Measures :
  1. Dyspnea Score (Borg Scale) [ Time Frame: 0 - 6 months ]

    The Dyspnea score or Borg Rating of Perceived Exertion (RPE) Scale score is a subjective rating of perceived exertion. In medicine this is used to document the patient's effort and exertion, breathlessness and fatigue during a physical test.

    The Dyspnea score ranges from 0 (No breathlessness at all) to 10 (Maximum or extremely strong breathlessness).

    IN this study the Specific Objective 2 was to assess and compare changes from baseline in pre- and post-exercise dyspnea in the sildenafil and placebo control groups.

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Ages Eligible for Study:   40 Years to 85 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Clinical diagnosis of IPF
  • 40-85 years of age
  • 6-minute walk distance 150-500 m
  • FVC 40-90% predicted
  • DLCO 30-90% predicted

Exclusion Criteria:

  • Severe pulmonary hypertension
  • Severe heart failure
  • FEV1/FVC < 0.7

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 ClinicalTrials.gov identifier (NCT number): NCT00359736

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United States, Florida
VA Medical Center, Miami
Miami, Florida, United States, 33125
Sponsors and Collaborators
VA Office of Research and Development
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Principal Investigator: Robert M Jackson, MD VA Medical Center, Miami
Publications of Results:
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Responsible Party: VA Office of Research and Development
ClinicalTrials.gov Identifier: NCT00359736    
Other Study ID Numbers: CLIN-009-05F
First Posted: August 2, 2006    Key Record Dates
Results First Posted: October 6, 2014
Last Update Posted: November 1, 2017
Last Verified: September 2017
Keywords provided by VA Office of Research and Development:
alveolitis, fibrosing
exercise, aerobic
fibrosis, pulmonary
hypertension, pulmonary
Additional relevant MeSH terms:
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Hypertension, Pulmonary
Pulmonary Fibrosis
Vascular Diseases
Cardiovascular Diseases
Pathologic Processes
Lung Diseases
Respiratory Tract Diseases
Sildenafil Citrate
Vasodilator Agents
Phosphodiesterase 5 Inhibitors
Phosphodiesterase Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Urological Agents