This study assessed the safety and treatment effect of intravenous (IV) Remodulin as an add-on therapy in neonates with persistent pulmonary hypertension of the newborn (PPHN).
This study was designed to investigate if the addition of Remodulin reduced the rate of clinical worsening (defined as the need for additional treatment targeting PPHN, need for extracorporeal mechanical oxygenation \[ECMO\], or death) in neonatal subjects with PPHN who did not show an adequate response to inhaled nitric oxide (iNO). This study was part of a pediatric investigation plan agreed upon by the EMA (EMEA 000207-PIP01-08-M08).
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
42
Treprostinil is a chemically stable tricyclic analogue of prostacyclin.
Sodium citrate, sodium chloride, sodium hydroxide pellets, metacresol, and citric acid (anhydrous).
Arkansas Children's Hospital
Little Rock, Arkansas, United States
Children's Hospital of Los Angeles
Los Angeles, California, United States
Number of Subjects Experiencing Clinical Worsening
Clinical worsening was a composite endpoint defined by the occurrence of 1 of the following: death, initiation of ECMO per institutional policies, or need for additional treatment (initiation of additional targeted pulmonary vasodilator therapy).
Time frame: From Baseline to Day 14
Change in Oxygenation Index (OI)
OI is an assessment of how much oxygen from the lungs enters the blood when a subject inhales, calculated as: mean airway pressure (MAP) multiplied by fraction of inspired oxygen (FiO2) divided by partial pressure of oxygen in the arterial blood (PaO2), then multiplying by 100. An OI of 15 or less indicates mild hypoxia, 16 to 25 indicates moderate hypoxia, 26 to 40 indicates severe hypoxia, and more than 40 indicates very severe hypoxia.
Time frame: From Baseline to Hours 12, 24, and 72; Days 7 and 14; and/or prior to study drug discontinuation/weaning
Change in P/F Ratio
PaO2/FiO2 ratio, also referred to as P/F Ratio, is a calculation used to assess the severity of hypoxemia, which is a condition characterized by low levels of oxygen in the blood. A low P/F ratio suggests that the patient's oxygen levels are compromised relative to the amount of oxygen being provided.
Time frame: From Baseline to Hours 12, 24, and 72
Change in Pre- and Post-ductal Oxygen Saturation (SpO2)
SpO2 is an assessment of how much oxygen is in the blood, measured by a pulse oximeter. Pre-ductal SpO2 is measured in the right hand or foot and is a reflection of the amount of oxygen flowing to the brain. Post-ductal SpO2 is measured in the left hand or foot, after the blood has mixed with less oxygenated blood from the rest of the body.
Time frame: From Baseline to Hours 6, 12, 24, and 72
Change in N-terminal Pro-Brain Natriuretic Peptide (NT-proBNP)
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
Stanford Children's Hospital
Palo Alto, California, United States
All Children's Hospital
St. Petersburg, Florida, United States
Ann and Robert H. Lurie Children's Hospital of Chicago
Chicago, Illinois, United States
Johns Hopkins Hospital
Baltimore, Maryland, United States
University of Mississippi Medical Center - Baston Children's Hospital
Jackson, Mississippi, United States
Children's Mercy Hospital
Kansas City, Missouri, United States
Columbia University Medical Center
New York, New York, United States
Nationwide Childrens Hospital
Columbus, Ohio, United States
...and 4 more locations
NT-proBNP is a hormone produced by the heart. Increased NT-proBNP concentration is associated with changes in right heart morphology and function. The main purpose of NT-proBNP testing is to see if the blood levels of this protein are within the expected range for a healthy individual.
Time frame: From Baseline to Days 1, 2, 3, 7, and 14 (or prior to hospital discharge)
Time to Clinical Worsening
Clinical worsening was assessed continuously during the study. Clinical worsening was a composite endpoint defined by the occurrence of 1 of the following: death, initiation of ECMO per institutional policies, or need for additional treatment (initiation of additional targeted pulmonary vasodilator therapy).
Time frame: From Baseline to Day 56
Time to Initiation of ECMO
Start of ECMO was assessed continuously during the study. ECMO is a life-support therapy that oxygenates blood by passing it through an artificial lung. The start time of ECMO, if needed, was recorded for each subject.
Time frame: From Baseline to Day 56
Time to Discontinuation of Inhaled Nitric Oxide (iNO)
Discontinuation of iNO was assessed continuously during the study. iNO works by relaxing the blood vessels in the lungs, which makes it easier for oxygen to be delivered to the body. The stop time of iNO was recorded for each subject.
Time frame: From Baseline to Day 56