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A Study in Participants With Sarcoidosis-associated Pulmonary Hypertension (SAPH) to Assess the Efficacy and Safety of Oral Selexipag
Study Purpose
Oral selexipag is commercially available in several countries for the treatment of a
particular group of pulmonary hypertension (PH) called pulmonary arterial hypertension (PAH).
The aim of the present study is to investigate whether selexipag could be helpful to treat
patients with another form of PH called sarcoidosis-associated pulmonary hypertension (SAPH).
Recruitment Criteria
Accepts Healthy Volunteers
Healthy volunteers are participants who do not have a disease or condition, or related conditions or symptoms
No
Study Type
An interventional clinical study is where participants are assigned to receive one or more interventions (or no intervention) so that researchers can evaluate the effects of the interventions on biomedical or health-related outcomes.
An observational clinical study is where participants identified as belonging to study groups are assessed for biomedical or health outcomes.
Searching Both is inclusive of interventional and observational studies.
Interventional
Eligible Ages
18 Years - 75 Years
Gender
All
More Inclusion & Exclusion Criteria
Main
Inclusion Criteria:
- Confirmed diagnosis of sarcoidosis as per American Thoracic Society (ATS) criteria.
- Sarcoidosis-associated precapillary PH, confirmed by RHC (at rest) within 90 days
prior to randomization.
- PH severity according to modified WHO FC II-IV at Screening and randomization;
participants in WHO FC IV must be in a stable condition and able to perform a 6MWT.
- Either not receiving treatment with PH-specific treatment or oral PH-specific
monotherapy (ie, riociguat or PDE5i or ERA); if on oral PH-specific monotherapy then
treatment had to be stable (ie, no introduction of new therapies or changes in dose)
for at least 90 days prior to both and the RHC qualifying for enrollment and
randomization.
- Stable sarcoidosis treatment regimen, ie, no new specific anti-inflammatory treatment
for sarcoidosis for at least 90 days, and stable dose(s) for at least 30 days prior to
both the RHC qualifying for enrollment and randomization.
- 6-minute walk distance (6MWD) greater than or equal to (>=) 50 meters both at
Screening and at the time of randomization.
Participants can use their usual walking
aids during the test (example, cane, crutches). The same walking aid should be used
for all 6-minute walk test (6MWTs). Walkers are not allowed.
- Forced Vital Capacity (FVC) greater than (>) 50 percent (%) and Forced Expiratory
Volume (in 1 second) (FEV1) > 50% of predicted at Screening.
- Diffusing capacity of the lung for carbon monoxide (DLCO) >= 40% of predicted.
If DLCO
less than (<) 40% of predicted, the extent of emphysema should not be greater than
that of fibrosis as assessed by high resolution computerized tomography (CT) scan.
- Women of childbearing potential must have a negative pregnancy test at screening and
randomization, must agree to undertake monthly urine pregnancy tests, and to practice
an acceptable method of contraception and agreeing to remain on an acceptable method
while receiving study intervention and until 30 days after last dose of study
intervention.
- A woman only using hormonal contraceptives must have been using this method for at
least 30 days prior to randomization.
Main
Exclusion Criteria:
- PH due to left heart disease (PAWP >15 mmHg).
- History of left heart failure (LHF) as assessed by the investigator including
cardiomyopathies, and cardiac sarcoidosis, with a left ventricular ejection fraction
(LVEF) <40%.
- Treatment with prostacyclin, prostacyclin analogues or IP receptor agonists (ie,
selexipag) within 90 days prior to randomization and/or prior to the RHC qualifying
for enrollment, except those given at vasodilator testing during RHC.
- SBP <90 mmHg at Screening or at randomization.
- Included on a lung transplant list or planned to be included until Visit 6 / Week 39.
- Change in dose or initiation of new diuretics and/or calcium channel blockers within 1
week prior to RHC qualifying for enrollment.
- Any condition for which, in the opinion of the investigator, participation would not
be in the best interests of the participant (eg, compromise well-being), or that could
prevent, limit, or confound the protocol-specified assessments.
- Any acute or chronic impairment that may influence the ability to comply with study
requirements such as to perform RHC, a reliable and reproducible 6MWT, or lung
function tests.
- Any other criteria as per selexipag Summary of Product Characteristics (SmPC)
Trial Details
Trial ID:
This trial id was obtained from ClinicalTrials.gov, a service of the U.S. National Institutes of Health, providing information on publicly and privately supported clinical studies of human participants with locations in all 50 States and in 196 countries.
Phase 1: Studies that emphasize safety and how the drug is metabolized and excreted in humans.
Phase 2: Studies that gather preliminary data on effectiveness (whether the drug works in people who have a certain disease or condition) and additional safety data.
Phase 3: Studies that gather more information about safety and effectiveness by studying different populations and different dosages and by using the drug in combination with other drugs.
Phase 4: Studies occurring after FDA has approved a drug for marketing, efficacy, or optimal use.
Phase 2
Lead Sponsor
The sponsor is the organization or person who oversees the clinical study and is responsible for analyzing the study data.
Actelion
Principal Investigator
The person who is responsible for the scientific and technical direction of the entire clinical study.
Rainer Zimmermann
Principal Investigator Affiliation
Actelion
Agency Class
Category of organization(s) involved as sponsor (and collaborator) supporting the trial.
Industry
Overall Status
Active, not recruiting
Countries
Belgium, Brazil, Canada, France, Germany, Italy, Netherlands, Spain, United Kingdom, United States
Conditions
The disease, disorder, syndrome, illness, or injury that is being studied.
Sarcoidosis-associated Pulmonary Hypertension
Additional Details
Pulmonary hypertension (PH) is a pathophysiological disorder that may involve multiple
clinical conditions and can complicate several cardiovascular and respiratory diseases.
Sarcoidosis is a multisystemic disorder that is characterized by non-caseating granulomas
which are present in multiple tissues, particularly in the lung and lymphatic system. Severe
untreated pulmonary hypertension (PH) carries a poor prognosis and is associated with higher
mortality in participants with interstitial lung diseases and sarcoidosis. While there is no
approved treatment for SAPH, PH-specific treatments are frequently used. Selexipag is a
selective, orally available and long-acting non-prostanoid agonist of the prostacyclin
receptor (prostacyclin [IP] receptor) for the treatment of patients with PAH. The rationale
for this study is based on the unmet medical need for new therapeutic options for patients
with SAPH and is supported by the established efficacy and safety of selexipag in the PAH
indication, the shared pathomechanism between SAPH and PAH, and the available data on the
efficacy and safety of PH-specific therapies in SAPH. This study consists of screening
period, main observation period and double blind extension period and safety follow-up
period. The duration of individual participation in the study will be different for each
individual participant (between approximately 15 months and up to approximately 3.5 years)
and will depend on the time of each participant's individual date of entering the study and
the total recruitment time. The efficacy assessments include right heart catheterization
(RHC), assessment of exercise capacity, dyspnea, pulmonary function tests, etc. Safety and
tolerability will be evaluated throughout the study and includes review of concomitant
medications and adverse events (AEs), clinical laboratory tests, 12-lead electrocardiogram
(ECG), vital signs, physical examination, and pregnancy testing.
Arms & Interventions
Arms
Experimental: Selexipag 200 micro gram (μg)
Study intervention will be up-titrated to allow each participant to reach their individual maximum tolerated dose (iMTD), in the range of 200 μg to1600 μg (ie, 1 to 8 tablets) twice daily/once daily. Dosing frequency will be twice daily, except for participants with moderate hepatic impairment (Child-Pugh Class B) or who are concomitantly taking (a) moderate CYP2C8 inhibitor(s), who receive study intervention once daily. The dose will be up-titrated by the investigator/delegate in 200 μg twice daily/once daily increments at weekly intervals during scheduled TCs until reaching the iMTD. If the dose regimen is not well tolerated or symptoms cannot be fully managed with symptomatic treatment, the duration of the titration step can be prolonged to 2 weeks. If needed, the dose can be reduced by 200 μg twice daily/once daily.
Placebo Comparator: Placebo
The comparator will be administered similarly to the experimental intervention.
Interventions
Drug: - Selexipag
Oral tablets containing 200 µg of selexipag. Depending on the iMTD, participants will receive 1 (200 µg) to 8 (1600 µg) tablets at each administration
Drug: - Placebo
Oral tablets without active compound. Participants can receive 1 to 8 tablets at each administration.
Contact a Trial Team
If you are interested in learning more about this trial, find the trial site nearest to your location and contact the site coordinator via email or phone. We also strongly recommend that you consult with your healthcare provider about the trials that may interest you and refer to our terms of service below.
St. Vincent Medical Group, Inc., Indianapolis, Indiana
Status
Address
St. Vincent Medical Group, Inc.
Indianapolis, Indiana, 46260
LSU Health Sciences Center New Orleans, New Orleans, Louisiana
Status
Address
LSU Health Sciences Center New Orleans
New Orleans, Louisiana, 70112
Icahn School of Medicine at Mount Sinai, New York, New York
Status
Address
Icahn School of Medicine at Mount Sinai
New York, New York, 10029
Chapel Hill, North Carolina
Status
Address
University of North Carolina at Chapel Hill
Chapel Hill, North Carolina, 27514
Duke University Medical Center, Durham, North Carolina
Status
Address
Duke University Medical Center
Durham, North Carolina, 27710
University of Cincinnati, Cincinnati, Ohio
Status
Address
University of Cincinnati
Cincinnati, Ohio, 45267
Cleveland Clinic, Cleveland, Ohio
Status
Address
Cleveland Clinic
Cleveland, Ohio, 44195-0001
Charleston, South Carolina
Status
Address
Medical University of South Carolina (MUSC) - College of Medicine (COM)