Pulmonary Arterial Hypertension
Conditions
Keywords
PAH-SYMPACT, psychometric instrument
Brief summary
Prospective, multi-center, open-label, single-arm, Phase 3b psychometric validation study. Primary objectives: To evaluate the psychometric characteristics of reliability and construct validity of the French, Italian and Spanish versions of the PAH-SYMPACT™. To evaluate the ability of the French, Italian and Spanish versions of the PAH SYMPACT™ to detect change. Secondary objective: To assess the safety of macitentan in patients with pulmonary arterial hypertension (PAH). Exploratory objective: To explore the effects of macitentan on PAH symptoms and their impact (as measured by the PAH-SYMPACT™) in patients with PAH in France, Italy and Spain.
Interventions
DRUGMacitentan
Macitentan tablet, dose of 10 mg, once daily
Sponsors
Actelion
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
1. Signed informed consent prior to initiation of any study-mandated procedure. 2. Patients with symptomatic PAH in WHO Functional Class (FC) II or III. 3. Patients with PAH belonging to one of the following subgroups of the Dana Point Clinical Classification Group 1: 1. Idiopathic, or, 2. Heritable, or, 3. Drug or toxin induced, or, 4. Associated with one of the following: i. Connective tissue disease, ii. Congenital heart disease with simple systemic-to-pulmonary shunt at least 1 year after surgical repair, iii. HIV infection. 4. Documented hemodynamic diagnosis of PAH by right heart catheterization - performed at any time prior to Screening showing: 1. Resting mean pulmonary arterial pressure (mPAP) ≥ 25 mmHg and, 2. Resting pulmonary vascular resitance (PVR) \> 240 dyn.s.cm-5 and, 3. Pulmonary capillary wede pressure (PCWP) or left ventricular end diastolic pressure (LVEDP) ≤ 15 mmHg. 5. 6-minute walk distance (6MWD) ≥ 150 m at Screening. 6. Able to fluently speak and read the local language. 7. Men or women aged 18-80; women of childbearing potential (as defined below) must: 1. Have a negative serum pregnancy test at Screening and a negative urine pregnancy test at Baseline and agree to perform monthly serum pregnancy tests, and, 2. Agree to use two reliable methods of contraception in parallel, from Screening Visit 1 until 1 month after study drug discontinuation (see details below). * A female is considered to have childbearing potential unless she meets at least one of the following criteria: * Previous bilateral salpingo and/or oophorectomy, or hysterectomy. * Premature ovarian failure confirmed by a specialist. * Pre-pubescence, XY genotype, Turner syndrome, uterine agenesis. * Postmenopausal, defined as 12 consecutive months with no menses without an alternative medical cause. * Of the two contraceptive methods that must be used, one must be from Group 1, and one must be from Group 2, defined as follows: * Group 1: Oral, implantable, transdermal or injectable hormonal contraceptives, intrauterine devices, female sterilization (tubal ligation or non surgical sterilization, e.g., permanent contraception with Essure procedure), or partner's sterilization (vasectomy). If a hormonal contraceptive is chosen from this group, it must be taken for at least 1 month prior to enrollment. Alternatively, if the Essure procedure is chosen as a contraceptive method, a hysterosalpingogram must have been performed to confirm correct location of the microinserts and tubal occlusion (as per manufacturer's recommendations). * Group 2: Female or male condoms, diaphragm or cervical cap, any of them in combination with a spermicide. * Sexual abstinence, rhythm methods, or contraception by the partner alone are not considered as acceptable methods of contraception for this study.
Exclusion criteria
1. Known moderate-to-severe obstructive lung disease (i.e., forced expiratory volume in one second \[FEV1\] \< 80 % of predicted, with FEV1 / forced vital capacity \[FVC\] \< 70%) or known significant chronic lung disease diagnosed by chest imaging (e.g., interstitial lung disease, emphysema). 2. Known moderate-to-severe restrictive lung disease (i.e., total lung capacity \[TLC\] \< 60% of predicted value). 3. Hemoglobin \< 100g/L at Screening. 4. Serum aspartate aminotransferase (AST) and/or alanine aminotransferase (ALT) \> 3 X upper limit of the normal range (ULN) at Screening. 5. Patients undergoing dialysis. 6. Systolic blood pressure (SBP) \< 90 mmHg at Screening. 7. Body weight \< 40 kg at Screening. 8. Known concomitant life-threatening diseases with a life expectancy of \< 12 months. 9. Treatment with ERAs within 3 months prior to Visit 2, or scheduled to receive any of these compounds, other than macitentan, during the trial. 10. Treatment with intravenous or subcutaneous prostacyclin or prostacyclin analogs within 3 months prior to Visit 2, or scheduled to receive any of these compounds during the trial. 11. Treatment with soluble guanylate cyclase stimulator (riociguat) within 3 months prior to Visit 2, or scheduled to receive riociguat during the trial. 12. Patients who changed the dose of or discontinued phosphodiesterase type-5 inhibitor (PDE5i), inhaled prostacyclin analogues, or calcium channel blockers within 3 months prior to Visit 2. 13. Initiation of diuretics within 1 week prior to the Baseline period. 14. Patients on oral diuretics in whom the dose has not been stable for at least 1 week prior to the Baseline period. 15. Treatment with cytochrome P4500 (CYP) 3A inducers within 4 weeks prior to Visit 2. 16. Recently started (\< 8 weeks prior to Visit 2) or planned cardio-pulmonary rehabilitation program based on exercise. 17. Females who are lactating or pregnant (positive Screening or Baseline pregnancy test) or plan to become pregnant during the study. 18. Known hypersensitivity to macitentan or its excipients or drugs of the same class. 19. Treatment with another investigational drug within 3 months prior to Visit 2. 20. Any known factor or disease that might interfere with treatment compliance, study conduct or interpretation of the results such as drug or alcohol dependence or psychiatric disease.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Evaluation of the Reliability and the Construct Validity of the Cardiopulmonary Symptoms Domain of the PAH-SYMPACT | From Screening Visit (Visit 1) to End of Treatment (EOT) Visit (Visit 4, Week 16) | The Cardiopulmonary Symptoms domain consists of 6 items reported on a 5-point Likert scale (from 0 to 4). The value 0 means no symptom and value 4 corresponds to very severe symptoms.The symptoms part of the PAH-SYMPACT was administered daily over a 7 day period. The recall period of symptom items is the last 24 hours. An average Cardiopulmonary Symptoms domain score is determined based on the daily scores of the 6 items. It was administered two times (daily during 7 days each time) prior to administration of Macitentan (Visit 2, Baseline) and daily during the 7-day period in the treatment period prior to Visit 3 (Week 8) and Visit 4 (Week 16). |
| Evaluation of the Reliability and the Construct Validity of the Cardiovascular Symptoms Domain of the PAH-SYMPACT | From Screening Visit (Visit 1) to End of Treatment (EOT) Visit (Visit 4, Week 16) | The Cardiovascular Symptoms domain consists of 5 items reported on a 5-point Likert scale (from 0 to 4). The value 0 corresponds to no symptoms and value 4 corresponds to very severe symptoms. The symptoms part of the PAH-SYMPACT was administered daily over a 7 day period. The recall period of symptom items is the last 24 hours. An average Cardiovascular Symptoms domain score is determined based on the daily scores of the 5 items. It was administered two times (daily during 7 days each time) prior to administration of Macitentan (Visit 2, Baseline) and daily during the 7-day period in the treatment period prior to Visit 3 (Week 8) and Visit 4 (Week 16). |
| Evaluation of the Reliability and the Construct Validity of the Physical Impacts Domain of the PAH-SYMPACT | From Screening Visit (Visit 1) to End of Treatment (EOT) Visit (Visit 4, Week 16) | The Physical Impacts domain consists of 7 items reported on a 5-point Likert scale (from 0 to 4). The value 0 corresponds to not at all/with no difficulty at all and value 4 corresponds to very much/extremely/ not able at all. The impacts part of the PAH-SYMACT was administered on Day 7 of the symptoms part administration. Items in the impact part have a 7 day recall period. An average Physical Impacts domain score is determined based on the 7 items in the domain. It was administered two times prior to administration of Macitentan (Visit 2, Baseline) and during the 7-day period in the treatment period prior to Visit 3 (Week 8) and Visit 4 (Week 16). |
| Evaluation of the Reliability and the Construct Validity of the Cognitive/Emotional Impacts Domain of the PAH-SYMPACT | From Screening Visit (Visit 1) to End of Treatment (EOT) Visit (Visit 4, Week 16) | The Cognitive/Emotional Impacts domain consists of 4 items reported on a 5-point Likert scale (from 0 to 4). The value 0 corresponds to not at all/with no difficulty at all and value 4 corresponds to very much/extremely/ not able at all. The impacts part of the PAH-SYMACT was administered on Day 7 of the symptoms part administration. Items in the impact part have a 7 day recall period. An average Cognitive/Emotional Impacts domain score is determined based on the 4 items in the domain. It was administered two times prior to administration of Macitentan (Visit 2, Baseline) and during the 7-day period in the treatment period prior to Visit 3 (Week 8) and Visit 4 (Week 16). |
Countries
France, Italy, Spain
Participant flow
Recruitment details
The study was designed to recruit 160 male and female patients aged 18 to 80 years (inclusive) with PAH. A total of 93 patients were screened and 88 patients were enrolled at 37 recruitment sites. Due to slow recruitment, the sponsor decided to prematurely stop the study.
Participants by arm
| Arm | Count |
|---|---|
| Macitentan Macitentan tablet, dose of 10 mg, once daily | 88 |
| Total | 88 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Death | 3 |
| Overall Study | Physician Decision | 3 |
| Overall Study | Withdrawal by Subject | 1 |
Baseline characteristics
| Characteristic | Macitentan |
|---|---|
| Age, Continuous | 57.5 Years |
| Sex: Female, Male Female | 58 Participants |
| Sex: Female, Male Male | 30 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 3 / 88 |
| other Total, other adverse events | 21 / 88 |
| serious Total, serious adverse events | 13 / 88 |
Outcome results
Primary
Evaluation of the Reliability and the Construct Validity of the Cardiopulmonary Symptoms Domain of the PAH-SYMPACT
The Cardiopulmonary Symptoms domain consists of 6 items reported on a 5-point Likert scale (from 0 to 4). The value 0 means no symptom and value 4 corresponds to very severe symptoms.The symptoms part of the PAH-SYMPACT was administered daily over a 7 day period. The recall period of symptom items is the last 24 hours. An average Cardiopulmonary Symptoms domain score is determined based on the daily scores of the 6 items. It was administered two times (daily during 7 days each time) prior to administration of Macitentan (Visit 2, Baseline) and daily during the 7-day period in the treatment period prior to Visit 3 (Week 8) and Visit 4 (Week 16).
Time frame: From Screening Visit (Visit 1) to End of Treatment (EOT) Visit (Visit 4, Week 16)
Population: Validation set
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Macitentan | Evaluation of the Reliability and the Construct Validity of the Cardiopulmonary Symptoms Domain of the PAH-SYMPACT | Cardiopulmonary Symptoms domain score at baseline | 0.90 Score on a scale | Standard Deviation 0.58 |
| Macitentan | Evaluation of the Reliability and the Construct Validity of the Cardiopulmonary Symptoms Domain of the PAH-SYMPACT | Cardiopulmonary Symptoms domain score at week 8 | 0.89 Score on a scale | Standard Deviation 0.63 |
| Macitentan | Evaluation of the Reliability and the Construct Validity of the Cardiopulmonary Symptoms Domain of the PAH-SYMPACT | Cardiopulmonary Symptoms domain score at week 16 | 0.89 Score on a scale | Standard Deviation 0.68 |
Primary
Evaluation of the Reliability and the Construct Validity of the Cardiovascular Symptoms Domain of the PAH-SYMPACT
The Cardiovascular Symptoms domain consists of 5 items reported on a 5-point Likert scale (from 0 to 4). The value 0 corresponds to no symptoms and value 4 corresponds to very severe symptoms. The symptoms part of the PAH-SYMPACT was administered daily over a 7 day period. The recall period of symptom items is the last 24 hours. An average Cardiovascular Symptoms domain score is determined based on the daily scores of the 5 items. It was administered two times (daily during 7 days each time) prior to administration of Macitentan (Visit 2, Baseline) and daily during the 7-day period in the treatment period prior to Visit 3 (Week 8) and Visit 4 (Week 16).
Time frame: From Screening Visit (Visit 1) to End of Treatment (EOT) Visit (Visit 4, Week 16)
Population: Validation set
| Arm | Measure | Group | Value (MEDIAN) | Dispersion |
|---|---|---|---|---|
| Macitentan | Evaluation of the Reliability and the Construct Validity of the Cardiovascular Symptoms Domain of the PAH-SYMPACT | Cardiovascular Symptoms domain score at baseline | 0.58 Score on a scale | Standard Deviation 0.62 |
| Macitentan | Evaluation of the Reliability and the Construct Validity of the Cardiovascular Symptoms Domain of the PAH-SYMPACT | Cardiovascular Symptoms domain score at week 8 | 0.54 Score on a scale | Standard Deviation 0.62 |
| Macitentan | Evaluation of the Reliability and the Construct Validity of the Cardiovascular Symptoms Domain of the PAH-SYMPACT | Cardiovascular Symptoms domain score at week 16 | 0.54 Score on a scale | Standard Deviation 0.65 |
Primary
Evaluation of the Reliability and the Construct Validity of the Cognitive/Emotional Impacts Domain of the PAH-SYMPACT
The Cognitive/Emotional Impacts domain consists of 4 items reported on a 5-point Likert scale (from 0 to 4). The value 0 corresponds to not at all/with no difficulty at all and value 4 corresponds to very much/extremely/ not able at all. The impacts part of the PAH-SYMACT was administered on Day 7 of the symptoms part administration. Items in the impact part have a 7 day recall period. An average Cognitive/Emotional Impacts domain score is determined based on the 4 items in the domain. It was administered two times prior to administration of Macitentan (Visit 2, Baseline) and during the 7-day period in the treatment period prior to Visit 3 (Week 8) and Visit 4 (Week 16).
Time frame: From Screening Visit (Visit 1) to End of Treatment (EOT) Visit (Visit 4, Week 16)
Population: Validation set
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Macitentan | Evaluation of the Reliability and the Construct Validity of the Cognitive/Emotional Impacts Domain of the PAH-SYMPACT | Cogn/Emotional Impacts domain score at baseline | 0.87 Score on a scale | Standard Deviation 0.77 |
| Macitentan | Evaluation of the Reliability and the Construct Validity of the Cognitive/Emotional Impacts Domain of the PAH-SYMPACT | Cogn/Emotional Impacts domain score at week 8 | 0.88 Score on a scale | Standard Deviation 0.91 |
| Macitentan | Evaluation of the Reliability and the Construct Validity of the Cognitive/Emotional Impacts Domain of the PAH-SYMPACT | Cogn/Emotional Impacts domain score at week 16 | 0.91 Score on a scale | Standard Deviation 0.96 |
Primary
Evaluation of the Reliability and the Construct Validity of the Physical Impacts Domain of the PAH-SYMPACT
The Physical Impacts domain consists of 7 items reported on a 5-point Likert scale (from 0 to 4). The value 0 corresponds to not at all/with no difficulty at all and value 4 corresponds to very much/extremely/ not able at all. The impacts part of the PAH-SYMACT was administered on Day 7 of the symptoms part administration. Items in the impact part have a 7 day recall period. An average Physical Impacts domain score is determined based on the 7 items in the domain. It was administered two times prior to administration of Macitentan (Visit 2, Baseline) and during the 7-day period in the treatment period prior to Visit 3 (Week 8) and Visit 4 (Week 16).
Time frame: From Screening Visit (Visit 1) to End of Treatment (EOT) Visit (Visit 4, Week 16)
Population: Validation set
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Macitentan | Evaluation of the Reliability and the Construct Validity of the Physical Impacts Domain of the PAH-SYMPACT | Physical Impacts domain score at baseline | 1.13 Score on a scale | Standard Deviation 0.88 |
| Macitentan | Evaluation of the Reliability and the Construct Validity of the Physical Impacts Domain of the PAH-SYMPACT | Physical Impacts domain score at week 8 | 1.15 Score on a scale | Standard Deviation 0.97 |
| Macitentan | Evaluation of the Reliability and the Construct Validity of the Physical Impacts Domain of the PAH-SYMPACT | Physical Impacts domain score at week 16 | 1.25 Score on a scale | Standard Deviation 1 |