This study enrolls patients with pulmonary arterial hypertension (PAH) treated with inhaled treprostinil. During the study, the treatment with inhaled treprostinil will be tapered off and simultaneously replaced with an oral treatment (selexipag) targeting the disease in a similar way. The purpose of the study is i) to investigate the safety and tolerability of oral selexipag in patients who transition from inhaled treprostinil, ii) to investigate the effects of oral selexipag on PAH severity and exercise ability before and after transition, and iii) to gain new information about the patients experience taking oral selexipag compared to inhaled treprostinil. Study participants may stay in the study until the FDA has granted marketing authorization.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
34
Tablets for oral administration containing 200 micrograms (mcg) of selexipag to be administered twice a day. The individual dose is to be established during the first 12 weeks of the study. Doses are in the range from 200 micrograms (1 tablet) to 1,600 micrograms (8 tablets).
UCSD Medical Center -La Jolla
La Jolla, California, United States
UCSF Medical Center
San Francisco, California, United States
Harbor UCLA Medical Center
Torrance, California, United States
Emory University
Atlanta, Georgia, United States
Piedmont Healthcare Research Institute
Austell, Georgia, United States
Kentuckiana Pulmonary Associates
Louisville, Kentucky, United States
University of Michigan Health System
Ann Arbor, Michigan, United States
Washington University School of Medicine
St Louis, Missouri, United States
Duke Unversity
Durham, North Carolina, United States
University of Pennsylvania
Philadelphia, Pennsylvania, United States
...and 5 more locations
Percentage of Subjects With Sustained Treatment Transition
A sustained treatment transition is considered if the 3 following criteria are met a) being on study treatment (selexipag) at Week 16, and b) not having a study treatment interruption(s) of a total of 8 days or more prior to Week 16, and c) absence of inhaled treprostinil or any prostanoid treatment after Week 8 up to Week 16. The percentage of subjects with a sustained treatment transition is calculated with 95% confidence interval (CI) using the Clopper-Pearson method.
Time frame: At Week 16
Percentage of Subjects With Treatment-emergent Adverse Events (AEs),
Percentage of subjects with treatment-emergent AEs (serious and non serious), regardless of relationship to selexipag
Time frame: 26 weeks on average (from the first dose of selexipag up to 30 days after the last dose of selexipag)
Number of Subjects With Adverse Events Leading to Premature Discontinuation of Selexipag
Number of subjects with adverse events leading to premature discontinuation of selexipag is determined from the first dose of selexipag up to the last dose of selexipag
Time frame: Up to 22 weeks on average
Absolute Change From Baseline Over Time in Blood Pressure
Both systolic(SBP) and diastolic (DBP) arterial blood pressure were measured in a sitting position after at least 5 minutes of rest at scheduled time points. Median change from baseline to pre-specified post-baseline visits are calculated
Time frame: Baseline, Week 4, Week 12, Week 16
Absolute Change From Baseline Over Time in Heart Rate (HR)
Pulse rate is measured after at least 5 minutes of rest in a sitting position. Median change from baseline to pre-specified post-baseline visits are calculated.
Time frame: Baseline, Week 4, Week 12, Week 16
Maximal Tolerated Dose
This is the individual maximal tolerated dose (MTD) observed at Week 12 in the subjects still on selexipag at Week 16. MTD is defined as the dose of selexipag reached with the last dose change up to Week 12
Time frame: At Week 12, in subjects still on selexipag at Week 16
Time to Discontinuation of Inhaled Treprostinil.
Median time from baseline (Day1) to the end of down-titration of inhaled treprostinil is calculated
Time frame: Baseline to Week 16
Percentage of Subjects With WHO Functional Class (FC) Change From Baseline
The World Health Organization (WHO) defines 4 classes to classify the functional status of patients with pulmonary hypertension: Class I (FC I): No limitation of physical activity. Class II (FC II): Slight limitation of physical activity. Class III (FC III): Marked limitation of physical activity. Class IV (FC IV): Inability to carry out any physical activity without symptoms. Number of patients with improvement (shift from a higher to a lower class), worsening (shift from a lower to a higher class) or no change in WHO functional class at end of study compared to baseline are determined.
Time frame: Baseline and Week 16
Absolute Change in 6-minute Walk Distance (6MWD) at Trough
The 6MWT is a non-encouraged test, which measures the distance (in meters) covered by the subject during a 6-minute walk. It is performed in a 30-meters long flat corridor, where the patient is instructed to walk as far as possible, back and forth around two cones, with the permission to slow down, rest, or stop if needed. Absolute change from baseline to Week 16 in 6MWD is measured at trough levels of inhaled treprostinil and/or selexipag. The trough level of inhaled treprostinil is defined as the last dose having been taken not less than 4 hours and not more than 48 hours prior to the 6MWT at Visit 1 (screening). The trough level of selexipag was defined as the last dose having been taken not less than 8 hours and not more than 7 days prior to the 6MWT at Visit 5 (Week 16).
Time frame: Baseline and Week 16
Percentage of Patients With Change in 6-minute Walk Distance (6MWD)
Percentage of patients with an increase (\> 8% of baseline), maintenance (+/- 8% of baseline), or decrease (\< -8% of baseline) in their 6MWD (at trough) from baseline to Week 16. The ± 8% boundaries for change in 6MWD reflect the approximately 8% coefficient of variation in the reproducibility of the 6MWD. The trough level of inhaled treprostinil is defined as the last dose having been taken not less than 4 hours and not more than 48 hours prior to the 6MWD test at Visit 1 (screening). The trough level of selexipag was defined as the last dose having been taken not less than 8 hours and not more than 7 days prior to the 6MWD test at Visit 5 (Week 16).
Time frame: Baseline and Week 16
Geometric Mean of the Ratio in N-terminal Pro B-type Natriuretic Peptide (NT-proBNP) of Week 16 to Baseline
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Changes in NT-proBNP levels in plasma are expressed by the geometric mean of the ratio of Week 16 to baseline
Time frame: Baseline and Week 16