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Pulmonary Arterial HypertensionPhase 4REPLACENCT02891850

Riociguat rEplacing PDE-5i Therapy evaLuated Against Continued PDE-5i thErapy

A Phase 4 study testing Riociguat (Adempas, BAY63-2521), Sildenafil and Tadalafil in people with Pulmonary Arterial Hypertension, run by Bayer at 81 sites in 21 countries.

Completed

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

Official record
Search all trials

Trial summary

To demonstrate the effectiveness of riociguat as replacement of phosphodiesterase-5 inhibitors (PDE-5i) therapy in pulmonary arterial hypertension (PAH) patients Read more about this study

Who is it for?
Ages 18 to 75 years
Conditions the study is for
Pulmonary Arterial Hypertension
What is being tested?
Riociguat (Adempas, BAY63-2521), Sildenafil and Tadalafil
Type of treatment
Pill or oral medicine
Could I receive a placebo?
No, everyone receives an active treatment
How many people
225 participants
Where
81 sitesin 21 countries
Study dates
11 Jan 2017to 3 Mar 2020
Phase
Phase 4
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 75 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Male and female patients aged 18 to 75 years.
  • Patients with symptomatic PAH with a pulmonary vascular resistance (PVR) > 400 dyn*sec*cm-5, mean pulmonary artery pressure ≥ 25 mmHg, and pulmonary capillary wedge pressure (PCWP) ≤ 15 mmHg as assessed by the most recent right heart catheterization (RHC) from medical history prior to screening to confirm the diagnosis. Alternatively, PCWP can be replaced by left ventricular end-diastolic pressure (≤ 15 mmHg). PAH of the following types:
  • Idiopathic
  • Hereditary
  • Drug and toxin induced PAH
  • Associated with PAH due to:
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  • Connective tissue disease (CTD)
  • Congenital heart disease, but only if the patient underwent surgical repair more than one year before enrolment
  • Portal hypertension with liver cirrhosis (Note: patients with clinical relevant hepatic dysfunction are excluded; see exclusions related to disorders in organ function)
  • Patients who are on stable doses of a PDE-5i and ERA combination therapy or on stable PDE-5i monotherapy 6 weeks prior to and at randomization but not at treatment goal (tadalafil 20 to 40 mg once daily or sildenafil at least 60 mg daily dose).
  • WHO FC III at screening and at randomization.
  • 6MWD test between 165 m and 440 m at screening and at randomization.
  • Stable dose of diuretics, if used, for at least 30 days prior to and at randomization.
  • Patients who are able to understand and follow instructions and who are able to participate in the study for the entire study.
  • Women of childbearing potential must agree to use adequate contraception when sexually active. Adequate contraception is defined as any combination of at least 2 effective methods of birth control, of which at least 1 is a physical barrier (e.g. condom with hormonal contraception like implants or combined oral contraceptives, condom with intrauterine devices). This applies beginning with signing of the informed consent form until 30 (+5) days after the last administration of study drug.
  • Patients must have given their written informed consent to participate in the study after having received adequate previous information and prior to any study-specific procedures.

Who cannot join

  • Participation in another interventional clinical study within 30 days prior to screening.
  • All types of PH (including PH-IIP) except subtypes of Dana Point Group I specified in the inclusion criteria.
  • Previous treatment with riociguat.
  • Pregnant women (i.e., positive serum ß-human-chorionic-gonadotropin test or other signs of pregnancy), or breast feeding women, or women with childbearing potential not using a combination of 2 effective contraception methods (as laid out in inclusion criterion) throughout the study.
  • Patients with a medical disorder, condition, or history of such that would impair the patient's ability to participate or complete this study, in the opinion of the investigator.
  • Relevant obstructive and restrictive or other lung diseases.
Show all 10Show fewer
  • Patients with underlying medical disorders with an anticipated life expectancy below 2 years (e.g., active cancer disease with localized and/or metastasized tumor mass).
  • Cardiovascular exclusion criteria like left ventricular disease, coronary heart disease or stroke within previous 3 months.
  • Patients with hypersensitivity to the investigational drug or any of the excipients.
  • Patients unable to perform a valid 6MWD test (e.g., orthopedic disease, peripheral artery occlusive disease, which affects the patient's ability to walk). Note: Patients, who require walking aids, may be included if in the opinion of the investigator the walking distance is not impaired. Patients with a variance of more than 15% between the screening and the randomization (i.e., baseline) 6MWD test.

Trial locations and contacts

81 sites in 21 countries.

81 sites in 21 countries

United States17 sites
  • Study site

    Cleveland, Ohio, 44195

  • Study site

    Dallas, Texas, 75390

  • Study site

    Detroit, Michigan, 48202

  • Study site

    Kansas City, Kansas, 66103

  • Study site

    Louisville, Kentucky, 40202

  • Study site

    Mineola, New York, 11501

  • Study site

    Nashville, Tennessee, 37232

  • Study site

    New York, New York, 10003

  • Study site

    Newark, New Jersey, 07112

  • Study site

    Orlando, Florida, 32803

  • Study site

    Phoenix, Arizona, 85012

  • Study site

    Richmond, Virginia, 23225

  • Study site

    Rochester, New York, 14623

  • Study site

    Sacramento, California, 95817

  • Study site

    Troy, Michigan, 48085

  • Study site

    Tucson, Arizona, 85724

  • Study site

    Weston, Florida, 33331

Other trials in United States

Germany13 sites
  • Study site

    Berlin, 14050

  • Study site

    Cologne, North Rhine-Westphalia, 50937

  • Study site

    Dresden, Saxony, 01307

  • Study site

    Giessen, 35390

  • Study site

    Hamburg, 20246

  • Study site

    Hanover, Lower Saxony, 30625

  • Study site

    Heidelberg, Baden-Wurttemberg, 69126

  • Study site

    Homburg, Saarland, 66421

  • Study site

    Leipzig, Saxony, 04103

  • Study site

    Lübeck, Schleswig-Holstein, 23538

  • Study site

    München, Bavaria, 80639

  • Study site

    München, Bavaria, 81377

  • Study site

    Würzburg, Bavaria, 97074

Other trials in Germany

Brazil6 sites
  • Study site

    Belo Horizonte, Minas Gerais, 30130-100

  • Study site

    Belo Horizonte, Minas Gerais, 30441-070

  • Study site

    Blumenal, Santa Catarina, 89030-101

  • Study site

    Porto Alegre, Rio Grande do Sul, 90050-170

  • Study site

    São Paulo, 04023-061

  • Study site

    São Paulo, 05403-000

Other trials in Brazil

Italy4 sites
  • Study site

    Naples, Campania, 80131

  • Study site

    Palermo, Sicily, 90127

  • Study site

    Pavia, Lombardy, 27100

  • Study site

    Rome, Lazio, 00161

Other trials in Italy

South Korea4 sites
  • Study site

    Seoul, 03722

  • Study site

    Seoul, 110-744

  • Study site

    Seoul, 135-710

  • Study site

    Seoul, 138-736

Other trials in South Korea

Spain4 sites
  • Study site

    Barcelona, 08035

  • Study site

    Barcelona, 08036

  • Study site

    Las Palmas de Gran Canaria, Las Palmas, 35020

  • Study site

    Toledo, 45004

Other trials in Spain

Turkey (Türkiye)4 sites
  • Study site

    Ankara, 06100

  • Study site

    Istanbul, 34-300

  • Study site

    Istanbul, 34093

  • Study site

    Izmir, 34098

Other trials in Turkey (Türkiye)

United Kingdom4 sites
  • Study site

    Clydebank, West Dunbartonshire, G81 4DY

  • Study site

    London, NW3 2QG

  • Study site

    London, SW3 6NP

  • Study site

    Sheffield, S10 2JF

Other trials in United Kingdom

Greece3 sites
  • Study site

    Chaïdári, 124 62

  • Study site

    Thessaloniki, 546 36

  • Study site

    Thessaloniki, 57010

Other trials in Greece

Japan3 sites
  • Study site

    Bunkyo-ku, Tokyo, 113-8655

  • Study site

    Nagoya, Aichi-ken, 467-8602

  • Study site

    Sendai, Miyagi, 980-8574

Other trials in Japan

Portugal3 sites
  • Study site

    Almada, Lisbon District, 2801-951

  • Study site

    Coimbra, 3000-075

  • Study site

    Lisbon, 1649-035

Other trials in Portugal

Taiwan3 sites
  • Study site

    Kaoshiung, 81346

  • Study site

    Tainan, 704

  • Study site

    Taipei, 10016

Other trials in Taiwan

Czechia2 sites
  • Study site

    Prague, 12808

  • Study site

    Prague, 140 21

Other trials in Czechia

France2 sites
  • Study site

    Le Kremlin-Bicêtre, 94270

  • Study site

    Rouen, 76031

Other trials in France

Mexico2 sites
  • Study site

    Culiacán, Sinaloa, 80020

  • Study site

    Mexico City, 14080

Other trials in Mexico

Netherlands2 sites
  • Study site

    Amsterdam, 1081 HV

  • Study site

    Nijmegen, 6500HB

Other trials in Netherlands

Austria1 site
  • Study site

    Graz, 8036

Other trials in Austria

Belgium1 site
  • Study site

    Leuven, 3000

Other trials in Belgium

Canada1 site
  • Study site

    Montreal, Quebec, H3T 1E2

Other trials in Canada

Denmark1 site
  • Study site

    Aarhus N, 8200

Other trials in Denmark

Poland1 site
  • Study site

    Wroclaw, 51-124

Other trials in Poland

About this study

Official title: A Prospective, Randomized, International, Multicenter, Double-arm, Controlled, Open-label Study of Riociguat in Patients With Pulmonary Arterial Hypertension (PAH) Who Are on a Stable Dose of Phosphodiesterase-5 Inhibitors (PDE-5i) With or Without Endothelin Receptor Antagonist (ERA), But Not at Treatment Goal

To demonstrate the effectiveness of riociguat as replacement of phosphodiesterase-5 inhibitors (PDE-5i) therapy in pulmonary arterial hypertension (PAH) patients

Read the detailed description

Data from a previous single arm study (RESPITE) indicate that transition from PDE5i to riociguat may be feasible, safe and beneficial in patients not adequately responding to PDE5i.

REPLACE is a randomized controlled study to confirm the potential clinical benefit of transition from PDE5i to riociguat. Satisfactory clinical response in patients who are on a stable dose of phosphodiesterase-5inhibitors (PDE-5i) with or without endothelin receptor antagonist (ERA), but not at treatment goal will be compared between one group of patients randomized to maintain current treatment and another group where the PDE5i is replaced by riociguat.

Being tested
Riociguat (Adempas, BAY63-2521), Sildenafil, Tadalafil
Medical subject headings
Pulmonary Arterial Hypertension

What participants receive

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

  • Riociguat (Adempas, BAY63-2521)Drug

    Film-coated tablets will be used in this study at a dosage of 0.5 mg, 1.0 mg, 1.5 mg, 2.0 mg and 2.5 mg. Tablets will be administered orally.The starting dose is 1 mg TID; the intervals between drug intakes should be 6 to 8 hours. The dosage should be increased by 0.5 mg increments in 2 week intervals to 1.5 mg, 2.0 mg, and 2.5 mg TID (maximal total daily dose).

  • SildenafilDrug

    Patients randomized to the control arm will continue to receive stable doses of tadalafil (daily dose 20 to 40 mg) or sildenafil (daily dose at least 60 mg) as well as other supportive treatments at the discretion of the investigator.

  • TadalafilDrug

    Patients randomized to the control arm will continue to receive stable doses of tadalafil (daily dose 20 to 40 mg) or sildenafil (daily dose at least 60 mg) as well as other supportive treatments at the discretion of the investigator.

Study groups in NCT02891850
Study groupRoleWhat they receive
RiociguatExperimentalPDE5i treatment will be stopped and riociguat treatment initiated following a defined washout period with a starting dose of 1 mg riociguat TID followed by an 8 weeks dose adjustment phase according to the approved riociguat dose adjustment scheme.
Receives: Drug: Riociguat (Adempas, BAY63-2521)
PDE-5iActive comparatorPatients will continue to receive PDE5i treatment as well as other standard of care treatments at the discretion of the investigator up to Week 24. Patients in the experimental and active comparator treatment arms follow the same visit schedule.
Receives: Drug: Sildenafil; Drug: Tadalafil

What is being measured

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

  1. Number of Participants With Satisfactory Clinical Response at Week 24

    The treatment is assessed as efficient (participants with satisfactory clinical response) in case at least 2 out of the following 3 criteria were fulfilled

    • 6 Minute Walking Distance increase by ≥ 10% or ≥ 30 m from baseline to Week 24
    • World Health Organization Functional Class (WHO FC) I or II at Week 24
    • N-terminal pro-brain natriuretic peptide (NT-proBNP) reduction ≥ 30% from baseline to Week 24 (NT-proBNP ratio Week 24/baseline ≤ 0.7) and in absence of the defined criteria of clinical worsening

    Measured: At Week 24

Secondary outcomes (4)
  1. Change in 6 Minute Walking Distance (6MWD) With Last Observation Carried Forward From Baseline to 24 Weeks

    Six-minute walk distance (6MWD) was conducted to test the physical limitations of the participant by assessing the participant's exercise capacity. The distance walked by the participant in 6 minutes was measured.

    Measured: From baseline and up to 24 weeks

  2. Change in N-terminal Pro-Brain Natriuretic Peptide (NT-proBNP) With Last Observation Carried Forward at Week 24

    N-terminal pro-brain natriuretic peptide (NT-proBNP) levels in the blood are used for screening, diagnosis of acute congestive heart failure (CHF) and may be useful to establish prognosis in heart failure.

    Measured: From baseline and up to 24 weeks

  3. Change in World Health Organization Functional Class (WHO FC) With Last Observation Carried Forward From Baseline to Week 24

    The participant's functional class was determined by using the WHO classification. Possible classes range from I (patients with pulmonary hypertension (PH) but without resulting limitation of physical activity) to IV (patients with PH with inability to carry out any physical activity without symptoms).

    Measured: From baseline and up to 24 weeks

  4. Number of Participants With Adjudicated Clinical Worsening at Week 24

    Clinical worsening was defined as death of any cause, hospitalization due to worsening pulmonary arterial hypertension (PAH) (adjudicated) or disease progression (adjudicated).

    Measured: Up to 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 posted8 Sep 2016 (estimated)
  2. Study start11 Jan 2017
  3. Primary completion29 Jan 2020
  4. Study completion3 Mar 2020

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 4
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
225 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02891850
Sponsor's protocol ID
18588
Other IDs
2016-001067-36, 2016
Acronym
REPLACE
Status last verified
Jan 2021
First submitted
26 Aug 2016
Last updated
26 Feb 2021
Data monitoring committee
No
FDA-regulated device
No

Publications

  • Hoeper MM, Al-Hiti H, Benza RL, Chang SA, Corris PA, Gibbs JSR, Grunig E, Jansa P, Klinger JR, Langleben D, McLaughlin VV, Meyer GMB, Ota-Arakaki J, Peacock AJ, Pulido T, Rosenkranz S, Vizza CD, Vonk-Noordegraaf A, White RJ, Chang M, Kleinjung F, Meier C, Paraschin K, Ghofrani HA, Simonneau G; REPLACE investigators. Switching to riociguat versus maintenance therapy with phosphodiesterase-5 inhibitors in patients with pulmonary arterial hypertension (REPLACE): a multicentre, open-label, randomised controlled trial. Lancet Respir Med. 2021 Jun;9(6):573-584. doi: 10.1016/S2213-2600(20)30532-4. Epub 2021 Mar 24.

    PubMed 33773120

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing Riociguat (Adempas, BAY63-2521), Sildenafil and Tadalafil in people with Pulmonary Arterial Hypertension, run by Bayer at 81 sites in 21 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 16 inclusion and 10 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 26 Feb 2021. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 81 sites in United States, Germany, Brazil, Italy, South Korea and 16 more countries. 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 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

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 22 Jan 2021). 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?

Number of Participants With Satisfactory Clinical Response at Week 24 (time frame: At Week 24). 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 NCT02891850, which also lists 1 linked publication.

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 26 Feb 2021.

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