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Exercise Induced Pulmonary Hypertension in Systemic Sclerosis and Treatment With Ambrisentan

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ClinicalTrials.gov Identifier: NCT01051960
Recruitment Status : Unknown
Verified February 2009 by University of California, Los Angeles.
Recruitment status was:  Recruiting
First Posted : January 20, 2010
Last Update Posted : January 20, 2010
Information provided by:

Study Description
Brief Summary:
The purpose of this study is to determine the clinical characteristics and hemodynamic profiles that predict exercise induced pulmonary hypertension in 15 patients with systemic sclerosis. The study also aims to determine the effectiveness of Ambrisentan for subjects with exercise induced Pulmonary Arterial Hypertension (PAH) with scleroderma

Condition or disease Intervention/treatment Phase
Systemic Sclerosis Shortness of Breath Pulmonary Hypertension Drug: Ambrisentan Phase 4

Detailed Description:
The current literature addresses therapies for patients with resting PAH only, diagnosed by right heart catheterization. However, the World Health Organization (WHO) also recognizes and defines exercise induced pulmonary arterial hypertension (ex-PAH), which may precede the development of resting PAH. The natural progression of PAH, especially during exercise, has not been well delineated. An exercise hemodynamic study previously showed that in normal healthy subjects the mean pulmonary pressure does not exceed 30mmHg even at maximal cardiac outputs. A prior study evaluated exercise Doppler echocardiography systemic sclerosis patients with normal resting echocardiograms, finding an abnormal response which was defined as an estimated right ventricular systolic pressure greater than 40 mmHg. In the same study, 6.6% of the patients progressed to resting PAH over the followup period of 12 months. Limited data is available regarding the prevalence of ex-PAH in systemic sclerosis using right heart catheterization.

Study Design

Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 15 participants
Allocation: Non-Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Exercise Induced Pulmonary Hypertension in Systemic Sclerosis and Treatment With Ambrisentan: A Prospective Single Center, Open Label, Pilot Study
Study Start Date : March 2009
Estimated Primary Completion Date : June 2010
Estimated Study Completion Date : December 2010

Arms and Interventions

Intervention Details:
    Drug: Ambrisentan
    Ambrisentan 5mg or 10mg once daily
    Other Name: Letairis

Outcome Measures

Primary Outcome Measures :
  1. Change in multipoint exercise total pulmonary resistance (TPR)from baseline to week 24. [ Time Frame: 24 weeks ]

Secondary Outcome Measures :
  1. Change in distance walked in six minutes from baseline to 24 week [ Time Frame: 24 weeks ]
  2. SF-36, HAQ-DI, and St. George's respiratory questionnaire total score from baseline to 24 weeks of therapy [ Time Frame: 24 weeks ]

Eligibility Criteria

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 80 Years   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  1. Systemic Sclerosis diagnosed by the American College of Rheumatology consensus statement including any of the following:

    • Limited
    • Diffuse
    • Sine Scleroderma
  2. Patients must be willing and able to undergo right heart catheterization with lower extremity cycle ergometry
  3. Mean pulmonary artery pressure (mPAP) > 30mmHg with exercise; PCWP ≤ 15mmHg on RHC at rest
  4. Men and women, ages 18 years of age or older
  5. Standard adjunctive medications will be allowed concurrently in this study at the discretion of the treating pulmonologist and rheumatologist, including digoxin, diuretics, anticoagulants (e.g. warfarin), stable immunosuppression or other anti-fibrotic therapy for at least one month prior to enrollment

Exclusion Criteria:

  1. Resting PAH (mPAP > 25mmHg) on right heart catheterization
  2. Other known causes of PAH including prior venous thromboembolism, HIV infection, chronic liver disease with portal hypertension, left ventricular systolic dysfunction (e.g. LVEF < 40%), and congenital causes of PAH
  3. Severe hepatic disease precluding the use of ambrisentan (AST/ALT ≥3x ULN).
  4. Women who are pregnant or breastfeeding.
  5. Concurrent therapy with a prostanoid or prostanoid analogue, PDE5 inhibitors, or enrolled in another active clinical study.
  6. Use of any prostacyclin or endothelial receptor antagonist (ERA) within 30 days before study entry.
  7. Bed or wheel chair bound or a baseline 6-Minute Walk distance (6MWD) less than 150 meters.
  8. Childbearing capable women who are unwilling or unable to use an acceptable method to avoid pregnancy for the entire study period.
  9. New York Heart Association (NYHA) Classification: Class IV
  10. Renal dysfunction (serum creatinine >2.5mg/dL).
  11. Uncontrolled sleep apnea.
Contacts and Locations

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): NCT01051960

Contact: Rajeev Saggar, MD 310-825-5635 rasaggar@mednet.ucla.edu
Contact: Amber Betchel 310-825-0425 ABechtel@mednet.ucla.edu

United States, California
David Geffen School of Medicine, University of California, Los Angeles Recruiting
Los Angeles, California, United States, 90095
Contact: Amber Betchel    310-825-0425    abetchel@mednet.ucla.edu   
Contact: Rajeev Saggar, MD    310-825-5635    rasaggar@mednet.ucla.edu   
Sub-Investigator: Daniel Furst, MD         
Sub-Investigator: Shelley Shapiro, MD         
Sub-Investigator: Rajan Saggar, MD         
Sub-Investigator: Philip Clements, MD         
Sponsors and Collaborators
University of California, Los Angeles
Gilead Sciences
Principal Investigator: Rajeev Saggar, MD University of California, Los Angeles
Principal Investigator: Dinesh Khanna, MD University of California, Los Angeles
More Information

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: Rajeev Saggar, MD, David Geffen School of Medicine, University of California, Los Angeles
ClinicalTrials.gov Identifier: NCT01051960     History of Changes
Other Study ID Numbers: 08-05-003
First Posted: January 20, 2010    Key Record Dates
Last Update Posted: January 20, 2010
Last Verified: February 2009

Keywords provided by University of California, Los Angeles:
Systemic Sclerosis
connective tissue disease
Shortness of breath
Pulmonary Hypertension

Additional relevant MeSH terms:
Hypertension, Pulmonary
Scleroderma, Systemic
Scleroderma, Diffuse
Vascular Diseases
Cardiovascular Diseases
Pathologic Processes
Lung Diseases
Respiratory Tract Diseases
Connective Tissue Diseases
Skin Diseases
Respiration Disorders
Signs and Symptoms, Respiratory
Signs and Symptoms
Antihypertensive Agents