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Non-operable Chronic Thromboembolic Pulmonary HypertensionPhase 3CTREPHNCT01416636

Efficacy and Tolerability of Subcutaneously Administered Treprostinil Sodium in Patients With Severe (Non-operable) Chronic Thromboembolic Pulmonary Hypertension (CTREPH)

A Phase 3 study testing Treprostinil sodium in people with Non-operable Chronic Thromboembolic Pulmonary Hypertension, run by SciPharm SàRL at 6 sites in 4 countries.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The primary purpose of this study is to determine the effect on six-minute walking test (6MWT) distance after 24 weeks treatment with subcutaneous (SC) Treprostinil Sodium in patients with Severe (inoperable) Chronic Thromboembolic Pulmonary Hypertension. Read more about this study

Who is it for?
Ages 18 to 100 years
What is being tested?
Treprostinil sodium
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
105 participants
Where
6 sitesin 4 countries
Study dates
Mar 2009to Apr 2021
Phase
Phase 3
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 100 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

None listed.

Who cannot join

  • Subject with any form of pulmonary arterial hypertension or any disease known to cause PAH (WHO Group I)
  • Subjects with a total lung capacity (TLC) of < 70% predicted or a forced expiratory volume/forced vital capacity (FEV1/FVC < 50%)
  • Subject who received any prostanoids, within the 30 days before screening or be scheduled to receive prostanoids during the course of the study
  • Subject with a new type of chronic therapy (a different category of vasodilator or diuretic) for PAH added within the last month, except anticoagulants
  • Subject with an increased risk for hemorrhage or stroke or with a major cardiovascular event during the past 6 months.
  • Unstable subjects for any reason (according to the investigators discretion)
Show all 14Show fewer
  • Subject who received any investigational medication within 30 days prior to the screening visit of this study or be scheduled to receive another investigational drug during the course of this study
  • Subject with a known intolerance to any drug relevant for this trial, especially to Treprostinil sodium or prostanoids
  • Subject with a history or suspicion of non compliance
  • Subject who has any musculoskeletal disease or any other disease that would limit ambulation
  • Subject with other cardiovascular, liver, renal, hematologic, gastrointestinal immunologic, endocrine, metabolic, or central nervous system disease that, in the opinion of the investigator, may adversely affect the safety of the subject and /or efficacy of the study drug or limit the lifespan of the subject
  • Female who is considering pregnancy or who is pregnant and/or lactating
  • Subject who is an investigator or any other team member involved directly or indirectly in the conduct of the clinical study.
  • Subject who is an inmate of a psychiatric ward, prison or is suspected not to be able to give consent of his free will

Trial locations and contacts

6 sites in 4 countries.

6 sites in 4 countries

Austria2 sites
  • Krankenhaus der Elisabethinen

    Linz, 4020

  • Medical University of Vienna AKH - Division Cardiology

    Vienna

Other trials in Austria

Poland2 sites
  • Department of Cardiac and Vascular Diseases Centre for Rare Cardiovascular Diseases John Paul II Hospital

    Krakow, 31-202

  • NZOZ Europejskie Centrum Zdrowia Otwock

    Otwock, 05-400

Other trials in Poland

Czechia1 site
  • II. interní klinika Všeobecná fakultní nemocnice

    Prague

Other trials in Czechia

Germany1 site
  • Medical University Carl Gustav Carus Medizinische Klinik und Poliklinik I Medizinische Fakultät der Technischen Universität Dresden

    Dresden

Other trials in Germany

About this study

Official title: A Double Blind Controlled Clinical Study to Investigate the Efficacy and Tolerability of Subcutaneous Treprostinil Sodium in Patients With Severe Non-operable Chronic Thromboembolic Pulmonary Hypertension (CTREPH)

The primary purpose of this study is to determine the effect on six-minute walking test (6MWT) distance after 24 weeks treatment with subcutaneous (SC) Treprostinil Sodium in patients with Severe (inoperable) Chronic Thromboembolic Pulmonary Hypertension.

Read the detailed description

Chronic thromboembolic pulmonary hypertension (CTEPH) is characterized by non-resolving organized thromboembolic obstructing the pulmonary vascular bed. These thrombi are resistant to thrombolytic therapy and chronic plasmatic anticoagulation. An increase in pulmonary vascular resistance (PVR), right ventricular overload, and eventually right ventricular failure ensue.

The treatment of choice for CTEPH is pulmonary endarterectomy (PEA), providing a potential cure for the disease. However, about 50 % of patients are not candidates for surgery, mainly because of distal location of thromboemboli. Despite recent advances in the treatment of pulmonary arterial hypertension (PAH), medical treatments have not been recommended for inoperable CTEPH, because of the concept that a predominantly major vessel obstructive arteriopathy would not be suitable for vasodilators. Furthermore, a major drawback of i.v. prostacyclin therapy is the need for a permanent central venous access that increases the risk of infection (0.22-0.68 per patient per year), thrombosis and new major vessel thromboembolism.

Being tested
Treprostinil sodium

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Treprostinil sodiumDrug

Study groups in NCT01416636
Study groupRoleWhat they receive
Treprostinil sodium low dose - Arm IActive comparatorArm I (low dose): Subject was treated with a low dose of Treprostinil sodium. Dose was escalated to an approximate target dose of 3 ng/kg/min after the first 12 weeks and was kept stable for another 12 weeks. Due to the predefined infusion rate setting schedule an interim dose of up to 6 ng/kg/min could be reached for few days at the end of the phases 1,2 and 3. This depended on the patient's exact weight and is caused by the limited infusion rate setting possibility of the infusion pump.
Receives: Drug: Treprostinil sodium
Treprostinil sodium high dose - Arm IIExperimentalSubject was treated with a low dose of Treprostinil sodium. Dose was escalated to an approximate target dose of 3 ng/kg/min after the first 12 weeks and kept stable for another 12 weeks. Due to the predefined infusion rate setting schedule an interim dose of up to 6 ng/kg/min could be reached for few days at the end of the phases 1,2 and 3. This depended on the patient's exact weight and is caused by the limited infusion rate setting possibility of the infusion pump.
Receives: Drug: Treprostinil sodium

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Change in 6-minute Walk Test Distance After 24 Weeks

    To determine the effect of subcutaneous Treprostinil sodium on 6-minute walk test distance after 24 weeks in patients with severe non-operable chronic thromboembolic pulmonary hypertension severe (inoperable) Chronic Thromboembolic Pulmonary Hypertension

    Time frame of the 6-minute walk test: The 6-minute walk test was conducted at the following visits:

    • baseline (day 1)
    • Visit 6 (day 168)

    In case of missing values, Last-Observation-Carried-Forward imputation method was used. In such cases values documented at Visit 4 (day84) were used.

    Measured: Baseline and 24 weeks

Secondary outcomes (11)
  1. Number of Participants With Clinical Worsening

    Clinical worsening defined as a decrease of 6-minute walk test distance of more than 20% from baseline due to Chronic Thromboembolic Pulmonary Hypertension, decrease of New York Heart Association functional class, hospitalization with the requirement for additional Pulmonary Hypertension specific treatment and/or death due to worsening Chronic Thromboembolic Pulmonary Hypertension.

    Clinical Worsening was assessed after 12 weeks and 24 weeks, participants experiencing clinical worsening at any time-point are reported.

    Measured: 12 weeks and 24 weeks

  2. Effect on Maximal Borg Score During 6-minutes Walk Test

    The Borg scale was used for rating of dyspnea during 6-minutes walk test. The scale is defined from 0 to > 10 (upper bound) (0 = NOTHING AT ALL; 0.5 = VERY VERY SLIGHT (just noticeable); 1 = VERY SLIGHT; 2 = SLIGHT; 3 = MODERATE; 4 = SOMEWHAT SEVERE; 5 = SEVERE; 6-9 = VERY SEVERE; 10 = VERY VERY SEVERE (almost maximum); >10 MAXIMUM).

    As can be seen with the scale, the higher scale values represent a worse outcome.

    As no imputation rule applied only full-data sets were evaluated. Complete data sets were available for 48 patients randomized to high dose group and 48 patients in low dose group.

    Measured: Baseline and 24 weeks

  3. Change in WHO/NYHA (World Health Organization - New York Heart Association) Functional Class

    Class I - Patients with pulmonary hypertension but without resulting limitation of physical activity. Ordinary physical activity does not cause undue dyspnea or fatigue, chest pain or near syncope.

    Class II - Patients with pulmonary hypertension resulting in slight limitation of physical activity. They are comfortable at rest. Ordinary physical activity causes undue dyspnea or fatigue, chest pain or near syncope.

    Class III - Patients with pulmonary hypertension resulting in marked limitation of physical activity. They are comfortable at rest. Less than ordinary activity causes undue dyspnea or fatigue, chest pain or near syncope

    Class IV - Patients with pulmonary hypertension in the inability to carry out any physical activity without symptoms. These patients manifest signs of right heart failure. Dyspnea and/or fatigue may even be present at rest. Discomfort is increased by any physical activity.

    Measured: Baseline and 24 weeks

  4. Effect on Quality of Life by the MINNESOTA Questionnaire

    This questionnaire is composed of 21 questions relating to limitations in lifestyle associated with Heart Failure. Respondents use a 5-point scale that ranges from 0 (none) to 5 (too much), with a score of 0 representing no limitation and a score of 5 representing maximum limitation. The change in individual score sum was evaluated and is displayed in the results, with a possible range of 0-105. Higher values indicate more limitations in Quality of Life.

    As no imputation rule applied only full-data sets were evaluated. Complete data sets were available for 50 patients randomized to high dose group and 46 patients in low dose group.

    Measured: Baseline and 24 weeks

  5. Effect on N-terminal Pro-BNP Levels

    baseline values, assessment after 12 and 24 weeks

    As no imputation rule applied only full-data sets were evaluated. Complete data sets were available for 46 patients randomized to high dose group and 46 patients in low dose group.

    Measured: Baseline and 24 weeks

  6. Effect on Hemodynamic Parameter (PVR - Pulmonary Vascular Resistance)

    baseline values, assessment after 24 weeks

    As no imputation rule applied only full-data sets were evaluated. Complete data sets were available for 48 patients randomized to high dose group and 47 patients in low dose group.

    Measured: Baseline and 24 weeks

  7. Effect on Hemodynamic Parameter (CI - Cardiac Index)

    baseline values, assessment after 24 weeks

    As no imputation rule applied only full-data sets were evaluated. Complete data sets were available for 48 patients randomized to high dose group and 47 patients in low dose group.

    Measured: Baseline and 24 weeks

  8. Effect on Hemodynamic Parameter (CO - Cardiac Output)

    baseline values, assessment after 24 weeks

    As no imputation rule applied only full-data sets were evaluated. Complete data sets were available for 48 patients randomized to high dose group and 47 patients in low dose group.

    Measured: Baseline and 24 weeks

  9. Effect on Hemodynamic Parameter (mPAP - Mean Pulmonary Arterial Pressure)

    baseline values, assessment after 24 weeks

    As no imputation rule applied only full-data sets were evaluated. Complete data sets were available for 47 patients randomized to high dose group and 47 patients in low dose group.

    Measured: Baseline and 24 weeks

  10. Effect on Hemodynamic Parameter (mRap - Mean Right Atrial Pressure)

    baseline values, assessment after 24 weeks

    As no imputation rule applied only full-data sets were evaluated. Complete data sets were available for 48 patients randomized to high dose group and 47 patients in low dose group.

    Measured: Baseline and 24 weeks

  11. Effect on Signs & Symptoms of the CTEPH

    baseline values, assessment after 24 weeks

    Measured: Baseline and 24 weeks

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted15 Aug 2011 (estimated)
  2. Study startMar 2009
  3. Primary completionNov 2016
  4. Study completionApr 2021

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
105 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT01416636
Sponsor's protocol ID
116-02
Acronym
CTREPH
Status last verified
May 2022
First submitted
12 Aug 2011
Last updated
7 Jun 2022
Data monitoring committee
No

Publications

  • Lang IM, Marsh JJ, Olman MA, Moser KM, Loskutoff DJ, Schleef RR. Expression of type 1 plasminogen activator inhibitor in chronic pulmonary thromboemboli. Circulation. 1994 Jun;89(6):2715-21. doi: 10.1161/01.cir.89.6.2715.

    PubMed 8205686
  • Klepetko W, Mayer E, Sandoval J, Trulock EP, Vachiery JL, Dartevelle P, Pepke-Zaba J, Jamieson SW, Lang I, Corris P. Interventional and surgical modalities of treatment for pulmonary arterial hypertension. J Am Coll Cardiol. 2004 Jun 16;43(12 Suppl S):73S-80S. doi: 10.1016/j.jacc.2004.02.039.

    PubMed 15194182
  • McLaughlin VV, Presberg KW, Doyle RL, Abman SH, McCrory DC, Fortin T, Ahearn G; American College of Chest Physicians. Prognosis of pulmonary arterial hypertension: ACCP evidence-based clinical practice guidelines. Chest. 2004 Jul;126(1 Suppl):78S-92S. doi: 10.1378/chest.126.1_suppl.78S.

    PubMed 15249497
  • Kuhn KP, Byrne DW, Arbogast PG, Doyle TP, Loyd JE, Robbins IM. Outcome in 91 consecutive patients with pulmonary arterial hypertension receiving epoprostenol. Am J Respir Crit Care Med. 2003 Feb 15;167(4):580-6. doi: 10.1164/rccm.200204-333OC. Epub 2002 Nov 21.

    PubMed 12446266
  • Sadushi-Kolici R, Jansa P, Kopec G, Torbicki A, Skoro-Sajer N, Campean IA, Halank M, Simkova I, Karlocai K, Steringer-Mascherbauer R, Samarzija M, Salobir B, Klepetko W, Lindner J, Lang IM. Subcutaneous treprostinil for the treatment of severe non-operable chronic thromboembolic pulmonary hypertension (CTREPH): a double-blind, phase 3, randomised controlled trial. Lancet Respir Med. 2019 Mar;7(3):239-248. doi: 10.1016/S2213-2600(18)30367-9. Epub 2018 Nov 23.

    PubMed 30477763

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Treprostinil sodium in people with Non-operable Chronic Thromboembolic Pulmonary Hypertension, run by SciPharm SàRL at 6 sites in 4 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 0 inclusion and 14 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 7 Jun 2022. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 6 sites in Austria, Poland, Czechia, Germany. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 10 Jun 2019). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Change in 6-minute Walk Test Distance After 24 Weeks (time frame: Baseline and 24 weeks). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT01416636, which also lists 5 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 7 Jun 2022.

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