Sildenafil to Improve Exercise Capacity in People With Thalassemia and Pulmonary Hypertension

• Six-minute walk test (6MWT) distance [ Time Frame: Measured at Week 12 ] [ Designated as safety issue: Yes ]
  

• Improved hemodynamics, pulmonary function and structure, hemolysis, arginine-nitric oxide dysregulation, hypercoagulability, inflammation, and cardiac load [ Time Frame: Measured at Week 12 ] [ Designated as safety issue: Yes ]
  
• Characterization of pulmonary hypertension in thalassemia with respect to exercise capacity, hemodynamics, pulmonary function and structure, hemolysis, arginine-nitric oxide dysregulation, hypercoagulability, inflammation, and cardiac load [ Time Frame: Measured at Week 12 ] [ Designated as safety issue: Yes ]
  

Thalassemia is an inherited blood disorder in which the body makes an abnormal form of hemoglobin—the protein in red blood cells that carries oxygen. A potential complication of thalassemia is pulmonary hypertension, which is a condition characterized by abnormally high blood pressure in the arteries of the lungs. People with thalassemia who have pulmonary hypertension tend to experience more health complications, including shortness of breath and a reduced exercise capacity, than people with thalassemia who do not have pulmonary hypertension. Sildenafil is a medication that is used to treat pulmonary hypertension; however, it has not yet been studied in people with thalassemia. The purpose of this study is to evaluate the safety and effectiveness of sildenafil at reducing blood pressure in the lungs of people who have thalassemia and pulmonary hypertension. Study researchers will also further compare the differences between people with thalassemia who have pulmonary hypertension and those who do not have pulmonary hypertension.

This study will enroll people with thalassemia who have pulmonary hypertension and a control group of people with thalassemia who do not have pulmonary hypertension. People with thalassemia and pulmonary hypertension will attend a baseline study visit at which time they will undergo the following procedures: medical history and medical record review; physical exam; a 6-minute walk test, which will measure how far participants can walk in 6 minutes; an echocardiogram to obtain images of the heart; blood collection; and for females, a urine collection. Participants will then begin taking sildenafil three times a day for 12 weeks. At study visits at Weeks 2, 4, and 8, participants will undergo repeat baseline testing, and some participants will take part in an exhaled nitric oxide test. At Week 12, participants will also undergo lung function testing and a chest magnetic resonance imaging (MRI) procedure.

Participants in the control group will attend one to three study visits at baseline, which will include the same baseline study procedures listed above, plus lung function testing, a chest MRI, a chest computed tomography (CAT) scan, and exhaled nitric oxide testing. They will not receive any medication or have any further study visits.