Idiopathic Pulmonary Fibrosis, Interstitial Lung Disease
Conditions
Brief summary
Study RIN-PF-303 is a multinational study designed to evaluate the superiority of inhaled treprostinil against placebo for the change in absolute forced vital capacity (FVC) from baseline to Week 52.
Detailed description
Study RIN-PF-303 is a multinational, randomized, double-blind, placebo-controlled study to evaluate the superiority of inhaled treprostinil against placebo for the change in absolute FVC in subjects with idiopathic pulmonary fibrosis (IPF) over a 52-week period. Subjects will be randomly allocated 1:1 to receive inhaled treprostinil or placebo. All subjects will initiate inhaled treprostinil or placebo at a dose of 3 breaths administered 4 times daily (QID) and will titrate to a target dosing regimen of 12 breaths QID. Study drug doses may be titrated up as tolerated, until the target dose or maximum clinically tolerated dose is achieved. Once eligible, 6 Treatment Period visits to the clinic will be required at Weeks 4, 8, 16, 28, 40, and 52. Efficacy assessments include spirometry (FVC), time to clinical worsening, time to first acute exacerbation of IPF, overall survival, King's Brief Interstitial Lung Disease (K-BILD) questionnaire, plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) concentration, supplemental oxygen use, and lung diffusion capacity (DLCO). Safety assessments include the development of adverse events (AEs)/serious adverse events (SAEs), vital signs, clinical laboratory parameters, and electrocardiogram (ECG) parameters. Subjects who complete the Week 52 Visit may be offered the opportunity to enter an open-label extension (OLE) study after completing the final study visit.
Interventions
DRUGPlacebo
Placebo administered QID
Inhaled treprostinil (6 mcg/breath) administered QID
Treprostinil ultrasonic nebulizer which emits a dose of approximately 6 mcg per breath.
Sponsors
United Therapeutics
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
40 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Subject gives voluntary informed consent to participate in the study. 2. Subject is ≥40 years of age, inclusive, at the time of signing informed consent. 3. The subject has a diagnosis of IPF based on the 2018 ATS/ERS/JRS/ALAT Clinical Practice Guideline (Raghu 2018) and confirmed by central review of high-resolution computed tomography (HRCT) (performed within the previous 12 months), and if available, surgical lung biopsy. 4. FVC ≥45% predicted at Screening. 5. Subjects on pirfenidone or nintedanib must be on a stable and optimized dose for ≥30 days prior to Baseline. Concomitant use of both pirfenidone and nintedanib is not permitted. 6. Women of childbearing potential must be non-pregnant (as confirmed by a urine pregnancy test at Screening and Baseline) and non-lactating, and will abstain from intercourse (when it is in line with their preferred and usual lifestyle) or use 2 medically acceptable, highly effective forms of contraception for the duration of the study, and at least 30 days after discontinuing study drug. 7. Males with a partner of childbearing potential must use a condom for the duration of treatment and for at least 48 hours after discontinuing study drug. 8. In the opinion of the Investigator, the subject is able to communicate effectively with study personnel, and is considered reliable, willing, and likely to be cooperative with protocol requirements, including attending all study visits.
Exclusion criteria
1. Subject is pregnant or lactating. 2. Subject has primary obstructive airway physiology: FEV1/FVC \<0.70 at Screening. 3. The subject has shown intolerance or significant lack of efficacy to a prostacyclin or prostacyclin analogue that resulted in discontinuation or inability to effectively titrate that therapy. 4. The subject has received any PAH-approved therapy, including prostacyclin therapy (epoprostenol, treprostinil, iloprost, or beraprost; except for acute vasoreactivity testing), IP receptor agonists (selexipag), endothelin receptor antagonists, phosphodiesterase type 5 inhibitors (PDE5-Is), or soluble guanylate cyclase stimulators within 60 days prior to Baseline. As needed use of a PDE5-I for erectile dysfunction is permitted, provided no doses are taken within 48 hours of any study-related efficacy assessments. 5. Use of any of the following medications: azathioprine (AZA), cyclosporine, mycophenolate mofetil, tacrolimus, oral corticosteroids (OCS) \>20 mg/day or the combination of OCS+AZA+N-acetylcysteine within 30 days prior to Baseline; cyclophosphamide within 60 days prior to Baseline; or rituximab within 6 months prior to Baseline. 6. The subject is receiving \>10 L/min of oxygen supplementation by any mode of delivery at rest at Baseline. 7. Exacerbation of IPF or active pulmonary or upper respiratory infection within 30 days prior to Baseline. Subjects must have completed any antibiotic or steroid regimens for treatment of the infection or acute exacerbation more than 30 days prior to Baseline to be eligible. If hospitalized for an acute exacerbation of IPF or a pulmonary or upper respiratory infection, subjects must have been discharged more than 90 days prior to Baseline to be eligible. 8. Uncontrolled cardiac disease, defined as myocardial infarction within 6 months prior to Baseline or unstable angina within 30 days prior to Baseline. 9. In the opinion of the Investigator, the subject has any condition that would interfere with the interpretation of study assessments or would impair study participation or cooperation. 10. Use of any other investigational drug/device or participation in any investigational study in which the subject received a medical intervention (ie, procedure, device, medication/supplement) within 30 days prior to Screening. Subjects participating in non-interventional, observational, or registry studies are eligible. 11. Life expectancy \<6 months due to IPF or a concomitant illness. 12. Acute pulmonary embolism within 90 days prior to Baseline.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Absolute FVC From Baseline to Week 52 | Baseline to Week 52 | The FVC measurement indicates the amount of air a person can forcefully and quickly exhale after taking a deep breath. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time to Clinical Worsening | Baseline to Week 52 | Clinical worsening was monitored from randomization until 1 of the following criteria were met: death (all causes), hospitalization due to a respiratory indication, or 10% relative decline in % predicted FVC. The number of participants with clinical worsening was reported. The time to first clinical worsening event was analyzed by stratified log-rank test (p-value) and presented with the hazard ratio calculated by proportional hazards model with treatment and baseline background therapy as explanatory variables. |
| Time to First Acute Exacerbation of IPF | Baseline to Week 52 | An acute exacerbation of IPF is defined as an acute, clinically significant, respiratory deterioration characterized by evidence of new widespread alveolar abnormality. The number of participants with an exacerbation of IPF was reported. The time to first acute exacerbation of IPF was analyzed by stratified log-rank test (p-value) and presented with the hazard ratio calculated by proportional hazards model with treatment and baseline background therapy as explanatory variables. |
| Overall Survival at Week 52 | Baseline to Week 52 | Vital status was assessed for all subjects at Week 52, including those who discontinued the study prematurely. The number of deaths by Week 52 was reported. The time to death was analyzed by stratified log-rank test (p-value) and presented with the hazard ratio calculated by proportional hazards model with treatment and baseline background therapy as explanatory variables. Note: Participants who discontinued from the study early had their time to death censored at Day 373 or last contact date when known to be alive (whichever occurred first), and participants with lung transplantation had their time to death censored at lung transplant date. Therefore, the number of deaths for this outcome measure differ from the overall number on deaths (reported in the Adverse Events section). |
| Change in % Predicted FVC From Baseline to Week 52 | Baseline to Week 52 | The FVC measurement indicates the amount of air a person can forcefully and quickly exhale after taking a deep breath. Percent predicted FVC is calculated based on factors such as ethnicity, sex, age, height, and weight. |
| Change in K-BILD Total Score From Baseline to Week 52 | Baseline to Week 52 | The King's Brief Interstitial Lung Disease Questionnaire (K-BILD) is a self-administered, 15-item questionnaire validated for patients with interstitial lung disease (ILD) consisting of 3 domains (breathlessness and activities, psychological, and chest symptoms). Each of the 15 questions is scored from 1 (worst score) to 7 (best score). The scores for the 15 questions are added together and converted into a Total Score from 0 to 100. Higher scores indicate a better quality of life. |
| Change in DLCO From Baseline to Week 52 | Baseline to Week 52 | The DLCO measurement measures how well oxygen moves from the lungs to the blood. |
Countries
Argentina, Australia, Belgium, Chile, Denmark, France, Germany, Israel, Italy, Mexico, Netherlands, New Zealand, Peru, South Korea, Spain, Taiwan
Baseline characteristics
| Characteristic | — |
|---|---|
| Age, Continuous | 72.0 years |
| Background Therapy at Randomization Nintedanib | 109 Participants |
| Background Therapy at Randomization No Background Therapy | 146 Participants |
| Background Therapy at Randomization Pirfenidone | 113 Participants |
| Diffusion capacity of lungs for carbon monoxide (DLCO) | 3.350 mmol/min/kPa |
| Ethnicity (NIH/OMB) Hispanic or Latino | 85 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 203 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 11 Participants |
| Forced Vital Capacity (FVC) | 2652.0 mL |
| N-terminal pro-brain natriuretic peptide (NT-proBNP) | 84.0 pg/mL |
| % Predicted DLCO | 49.40 percentage of predicted |
| % Predicted FVC | 75.60 percentage of predicted |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants |
| Race (NIH/OMB) Asian | 39 Participants |
| Race (NIH/OMB) Black or African American | 1 Participants |
| Race (NIH/OMB) More than one race | 1 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 1 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 5 Participants |
| Race (NIH/OMB) White | 497 Participants |
| Sex: Female, Male Female | 58 Participants |
| Sex: Female, Male Male | 475 Participants |
| Time Since IPF Diagnosis | 3.375 years |
| Use of Supplemental Oxygen No | 264 Participants |
| Use of Supplemental Oxygen Yes | 77 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 21 / 298 | 25 / 295 |
| other Total, other adverse events | 268 / 298 | 259 / 295 |
| serious Total, serious adverse events | 75 / 298 | 68 / 295 |
Outcome results
None listed