Pulmonary Arterial Hypertension
Conditions
Brief summary
Pulmonary arterial hypertension (PAH) can result in right ventricular failure and death. Anakinra has been used in patients with left sided heart failure, and the present study looks to determine if anakinra is safe and effective in patients with PAH. To accomplish this goal, we plan to evaluate for exercise improvement (as assessed by cardiopulmonary exercise testing) in 10 patients with PAH on anakinra.
Detailed description
Patients with pulmonary arterial hypertension will undergo cardiopulmonary exercise testing (CPET) at baseline and at 2 weeks. After the initial CPET, all patients will receive anakinra as a daily injection for 2 weeks. Patients will be instructed in the use of anakinra during their initial visit. Our primary outcome will be the difference in the exercise capacity of patients with PAH, as measured by maximal uptake of oxygen on CPET.
Interventions
DRUGAnakinra
Sponsors
Virginia Commonwealth University
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Open label treatment with Anakinra
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* age over 18 * functional class II or III symptoms of right ventricular failure despite optimal PAH therapy * mean pulmonary artery pressure \>25mmHg on previous right heart catheterization * pulmonary arterial wedge pressure \<15mmHg on previous right heart catheterization * pulmonary vascular resistance \>3 wood units on previous right heart catheterization
Exclusion criteria
* PAH due to connective tissue disease * angina or electrocardiograph changes that limit maximum exertion during cardiopulmonary exercise testing or baseline EKG changes that limit the ability to detect ischemia * recent (\<14 days) use of anti-inflammatory drugs (not including NSAIDs), chronic inflammatory disorder, malignancy, active infection, or any comorbidity limiting survival or ability to complete the study * sever kidney dysfunction (eGFR \<30mL/min) * thrombocytopenia (\<50,000/mm3), or neutropenia (absolute neutrophil count \<1500/mm3) * refusal by a woman of childbearing potential to use a medically acceptable form of birth control * history of hypersensitivity to anakinra or E. coli products * latex or rubber allergy * inability to give informed consent * non-English speaking
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Change in exercise capacity, as determined by peak oxygen consumption and ventilatory efficiency on cardiopulmonary exercise testing | 14 days |
Secondary
| Measure | Time frame |
|---|---|
| Effect of anakinra on serum NT-pro-BNP. | 14 days |
| Effect of anakinra on serum interleukin-6 | 14 days |
| Effect of anakinra on serum high sensitivity C-reactive protein | 14 days |
| Correlate between biomarkers (serum high sensitivity C reactive protein, interluekin-6, and NT-pro BNP) and measures of exercise capacity (peak oxygen consumption and ventilatory efficiency on cardiopulmonary exercise testing) | 14 days |
| Number of patients with treatment related adverse events related to anakinra in patients with pulmonary arterial hypertension | 14 days |
| Change in symptoms of heart failure (as assessed by questionnaire with the Duke Activity Status Index and Minnesota Living With Heart Failure Questionnaire). | 14 days |
Countries
United States
Outcome results
None listed