This is a randomised, double-blind, placebo-controlled, multicentre, multinational, prospective study in patients with operable chronic thromboembolic pulmonary hypertension (CTEPH) prior to pulmonary endarterectomy (PEA) with high preoperative pulmonary vascular resistance (PVR). Patients will be randomised in a 1:1 ratio to receive riociguat or matching placebo for 3 months before undergoing PEA. The primary objective of this study is to assess the efficacy of riociguat on preoperative PVR compared to placebo in patients with operable CTEPH.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
14
Riociguat will be initiated at 1 mg tid. The dosage will be increased by 0.5 mg at 2 week intervals based on tolerability as assessed by systolic blood pressure up to a maximum dose of 2.5 mg tid. Downtitration to 0.5 mg tid is foreseen for patients with low optimal tolerability.
Placebo will be given analogue to riociguat with matching tablets.
PEA will be performed at the end of medical treatment (Day 90)
UC San Diego
La Jolla, California, United States
Hopital de Bicêtre
Paris, France
Kerckhoff-Klinik GmbH
Bad Nauheim, Germany
Papworth Hospital
Cambridge, United Kingdom
Change From Baseline in Pulmonary Vascular Resistance (PVR) to Immediately Before Pulmonary Endarterectomy (Pre-PEA)
Pulmonary vascular resistance (PVR) will be assessed at baseline and immediately before pulmonary endarterectomy. The change in PVR will be assessed as percentage.
Time frame: 90 days
Change From Baseline in Pulmonary Vascular Resistance (PVR) to 6 Months Post Pulmonary Endarterectomy (PEA)
Pulmonary vascular resistance (PVR) will be assessed at baseline and 6 months post pulmonary endarterectomy (PEA). The change in PVR will be assessed as percentage.
Time frame: 270 days
Number of Patients With Either All-cause Death, PH-related Hospitalization, Need for PAH-targeted Therapy or WHO Functional Class Unchanged or Worse Between Randomization and 6 Months Post Pulmonary Endarterectomy (Composite Endpoint)
All deaths occurring post-randomization until the last visit will be included. All PH-related hospitalizations except the in-hospital care during and after pulmonary endarterectomy (PEA) from randomization until 6 months after PEA will be included. The worst value for World Health Organization (WHO) functional class after treatment will be used.
Time frame: 270 days
Intraoperative Circulatory Arrest Time
Circulatory arrest time will be measured in minutes
Time frame: intraoperative
Number of Patients With Intraoperative Surgery-related Complications (Composite Endpoint)
The occurrence of any of the following complications will be assessed: * Bleeding and/or blood loss \>1 L in 12 hours * Airway bleed with need for extracorporeal membrane oxygenation * Any use of extracorporeal membrane oxygenation for respiratory or hemodynamic support, specified as veno-venous or veno-arterial * Prolonged ventilation \>96 hours * Need for tracheostomy * Need for drainage of pericardial effusion * Neurological complications, ie, stroke, cerebral, subdural bleeding * Reintubation or noninvasive ventilation for reperfusion response * Hemoptysis requiring any intervention * Renal failure requiring dialysis * Wound infections * Pneumonia * Prolonged need for inotropic support (≥ 5 days)
Time frame: intraoperative
Surgical Evaluation of Specimen: Stratification of Patients According to Ease of Dissection Plane
Classed as easier than normal (1); normal (2); more difficult than normal (3)
Time frame: intraoperative
Surgical Evaluation of Specimen: Stratification of Patients According to Completeness of Disease Clearance
Classed as better than expected (1); as expected (2); worse than expected (3)
Time frame: intraoperative
Surgical Evaluation of Specimen: Stratification of Patients According to Appearance of Clot and Vessel Wall
Classed as more solid than usual (1); normal (2); more friable than usual (3)
Time frame: intraoperative
Number of Patients Who Died During the Course of the Study
All deaths occurring during the whole course of the study
Time frame: 270 days
Patients Who Withdraw During the Randomized Treatment Phase
Only withdrawals after randomization but before PEA will be included
Time frame: 90 days
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