PAH pulmonary arterial hypertension
Conditions
Interventions
All subjects will be randomized to the study drug Selexipag. Dosing with
selexipag will start at 200 µg twice daily (on Day 1, the participant will
receive only 1 dose, and at each dose change, the
Sponsors
Actelion Pharmaceuticals
Eligibility
Age
18 Years to 64 Years
Inclusion criteria
Inclusion criteria: 1.Signed informed consent prior to any study-mandated procedure 2.WHO FC II or III. Enrollment will be stratified by WHO FC II or III. Proportion of participants with WHO FC II and WHO FC III are expected to be approximately 40% and 60% respectively. 3.PAH etiology belonging to one of the following groups according to classification: • Idiopathic PAH • Heritable PAH • Drugs or toxins induced • PAH associated with connective tissue disease • PAH associated with congenital heart disease, with simple systemic-topulmonary shunt at least 1 year after surgical repair 4.First hemodynamic diagnosis of PAH by right heart catheterization (RHC) within 12 months prior to initiation of selexipag, showing: • mPAP >=25 mmHg and • PA wedge pressure (PAWP) or LV end-diastolic pressure 5 WU (400 dyn.s.cm-5) and • RVSV =300 ng/L at screening 7.Men or women >=18 years (or the legal age of consent in the jurisdiction in which the study is taking place if greater than 18) and =150 m during screening period
Exclusion criteria
Exclusion criteria: 1.Prior use of IP-receptor agonist, prostacyclin, or prostacyclin analog. Use of such treatments for vasoreactivity testing is not exclusionary; intermittent use of such treatments for digital ulcers or Raynaud's phenomenon is not exclusionary if stopped >6 months (180 days) prior to Day 1 2.Treatment with strong inhibitors of CYP2C8 (eg, gemfibrozil) within 28 days prior to Day 1 3.Treatment with another investigational drug planned or taken within 12 weeks (84 days) prior to Day 1 4.Cardiopulmonary rehabilitation programs based on exercise between informed consent and expected Week 26 visit date 5.Decompensated cardiac failure requiring hospitalization, emergency room visit or intravenous diuretics in the 6 weeks before informed consent 6.Severe coronary heart disease or unstable angina 7.Cerebrovascular events (eg, transient ischemic attack, stroke) within 3 months prior to Day 1 8.Left atrial volume indexed for body surface area >=43 mL/m2, assessed by Echo or cardiac MRI 9.Myocardial infarction within 6 months prior to Day 1 10.Body mass index >40 kg/m2 or body weight 2.5 mg/dL at screening) or ongoing or planned dialysis 16. Known and documented moderate or severe hepatic impairment (with or without cirrhosis) at screening, defined as Child-Pugh Class C 17.Known or suspected uncontrolled thyroid disease (hypo- or hyperthyroidism) 18.Any hospitalization within 6 weeks prior to informed consent (except elective hospitalizations for surgery or standard monitoring of preexisting conditions that did not worsen) 19.Concomitant life-threatening disease with a life expectancy of less than 12 months 20.Hemoglobin <80 g/L at screening 21.Hypersensitivity to selexipag or any study intervention excipient (mannitol, maize starch, hydroxypropylcellulose, magnesium stearate, hypromellose, propylene glycol, titanium dioxide, carnauba wax, iron oxide red, iron oxide yellow, iron oxide black) 22.Pregnancy, breastfeeding, or intention to become pregnant during the study. 23.Any factor or condition likely to affect compliance with study intervention or visit plan, as judged by the investigator 24.Claustrophobia 25.MRI-incompatible permanent cardiac pacemaker, automatic internal cardioverter 26.Metallic implant (eg, defibrillator, neurostimulator, hearing aid, permanent use of infusion device, dental brace, metal-containing tattoo ink) 27.Severe arrythmia, atrial fibrillation, multiple premature ventricular or atrial contractions, or any other condition that would interfere with proper cardiac gating du
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Change from baseline to Week 26 in RV stroke volume (RVSV) assessed by pulmonary artery flow magnetic resonance imaging (MRI). | — |
Secondary
| Measure | Time frame |
|---|---|
| Change from baseline to Week 26 assessed by MRI: • RV end-diastolic volume (RVEDV) • RV end-systolic volume (RVESV) • RV ejection fraction (RVEF) • RV mass • RV global longitudinal strain (RVGLS) Change from baseline to Week 26: • World Health Organization (WHO) Functional Class (FC) • N-terminal-pro-hormone brain natriuretic peptide (NT-proBNP) • 6-minute walk distance (6MWD) • Treatment-emergent adverse events (AEs) • Serious adverse events (SAEs) • AEs leading to premature discontinuation of study drug • AEs of special interest • Treatment-emergent marked laboratory abnormalities Change from baseline to Week 26 in number of non-invasive low-risk criteria among the following 8 variables: • Absence of clinical signs of right heart failure • Absence of symptoms progression • Absence of syncope • WHO FC I-II • 6MWD >440 m • NT-proBNP 440 m • NT-proBNP | — |
Countries
Netherlands
Outcome results
None listed