A Study to Assess the Safety and Efficacy of Treprostinil to Facilitate Liver Transplantation in Patients With Portopulmonary Hypertension

United Therapeutics13 enrolled

Overview

This was a multicenter, prospective, observational, open-label study. Patients meeting inclusion/exclusion criteria received treatment with treprostinil as recommended by their treating physicians and were followed according to standard of care. This observational study collected clinical data and biologic specimens from patients who were treated for portopulmonary hypertension (PoPH), with a goal of achieving hemodynamic parameters appropriate for orthotopic liver transplantation candidacy, including mean pulmonary arterial pressure (mPAP) less than 35 mmHg and pulmonary vascular resistance (PVR) less than 3 Wood-units (WU) at Week 24 in patients with severe PoPH.

Treprostinil is approved as a continuous subcutaneous (SC) or intravenous (IV) infusion by the FDA for the treatment of WHO group I PAH with New York Heart Association (NYHA) Functional Class II, III or IV symptomatology. To date, treprostinil has not been studied in the setting of PoPH; however, it is commonly prescribed in this setting. This was an observational, open-label, multicenter study which documented the safety and efficacy profile of this agent in PoPH to facilitate orthotopic liver transplantation (OLT).

Study Type

OBSERVATIONAL

Enrollment

Conditions

Portopulmonary Hypertension Pulmonary Arterial Hypertension Pulmonary Hypertension

Interventions

TreprostinilDRUG

Remodulin is supplied in concentrations of 1, 2.5 , 5, and 10 mg/mL and can be administered as supplied or diluted for intravenous (IV) infusion prior to administration. Remodulin is indicated for subcutaneous (SC) or IV use only as a continuous infusion. Remodulin is preferably infused subcutaneously, but can be administered by a central IV line if the SC route is not tolerated. The infusion rate is initiated at 1.25 ng/kg/min. If this initial dose cannot be tolerated because of systemic effects, the infusion rate should be reduced to 0.625 ng/kg/min.

Eligibility

Sex: ALL

Medical Language ↔ Plain English

Inclusion Criteria: * Patients must: 1. Had portal hypertension. 2. Be otherwise suitable candidates for OLT. 3. Had severe pulmonary arterial hypertension (PAH) defined as a resting mean pulmonary arterial pressure (mPAP) \>35 mmHg and pulmonary vascular resistance (PVR) ≥3 Wood Units (WU) by right heart catheterization (RHC) performed as part of standard of care evaluation within 90 days of enrollment. 4. Treprostinil therapy must be recommended by the treating physician per standard of care. 5. Be NYHA Functional Class II, III, or IV. 6. Had pulmonary capillary wedge (PCW) pressure ≤18 mmHg and transpulmonary gradient (TPG) ≥15 mmHg. Exclusion Criteria: * Patients must not: 1. Had received any any investigational therapy as part of a clinical trial for any indication within 30 days prior to enrollment. 2. Had a change in dose of treatment for PAH (bosentan \[Tracleer\], ambrisentan \[Letairis\], tadalafil \[Adcirca\], or sildenafil \[Revatio\]), within 30 days prior to enrollment. That is, subjects may have been treated with any of these agents provided the dose was stable for at least 30 days prior to enrollment. 3. Had renal failure requiring hemodialysis.

Locations (4)

University of California, Los Angeles

Los Angeles, California, United States

Emory Univeristy

Atlanta, Georgia, United States

Brigham and Women's Hospital

Boston, Massachusetts, United States

University of Texas, Southwestern Medical Center

Dallas, Texas, United States

Outcomes

Primary Outcomes

Number of Subjects Who Achieved Hemodynamic Parameters Appropriate for Orthotopic Liver Transplantation Candidacy at Week 24.

The primary efficacy endpoint was the number of subjects who achieved a mean pulmonary arterial pressure (mPAP) less than 35 mmHg and a pulmonary vascular resistance (PVR) less than 3 Wood units (WU) at Week 24 in patients with severe portopulmonary hypertension (PoPH).

Time frame: 24 Weeks

Secondary Outcomes

Change in Hemodynamic Parameters (Via Right Heart Catheterization [RHC]) at Rest From Baseline to Week 24

The change in hemodynamic parameters (including systolic pulmonary arterial pressure \[PAPs\], diastolic pulmonary arterial pressure \[PAPd\], mean pulmonary arterial pressure \[mPAP\], and transpulmonary gradient \[TPG\]) was evaluated at rest from Baseline to Week 24. The median change in hemodynamic parameters from Baseline to Week 24 via right-heart catheterization (RHC) is presented.

Time frame: 24 weeks

Change in Heart Rate at Rest From Baseline to Week 24

The change in heart rate was evaluated at rest from Baseline to Week 24.

Time frame: 24 weeks

Change in Cardiac Output at Rest From Baseline to Week 24

The change in cardiac output was evaluated at rest from Baseline to Week 24. The median change in cardiac output from Baseline to Week 24 is presented.

Time frame: 24 weeks

Change in Arterial and Venous Oxygen Saturation at Rest From Baseline to Week 24

The change in arterial and venous oxygen saturation was evaluated at rest from Baseline to Week 24.

Time frame: 24 weeks

Change in Pulmonary Vascular Resistance (PVR) at Rest From Baseline to Week 24

The change in pulmonary vascular resistance (PVR) was evaluated at rest from Baseline to Week 24.

Time frame: 24 weeks

Change in 6-minute Walk Distance (6MWD) From Baseline to Weeks 12 and 24.

The 6-Minute Walk Test was conducted at Screening, Baseline prior to starting study drug and at least 24 hours after the Screening test, and during the Treatment Phase at Weeks 12 and 24.