Study in Subjects With PAH and PH Secondary to IPF Using Inhaled NITROsyl (PHiano)

INCLUSION CRITERIA:

PAH and PH-IPF

• WHO Functional Class (or equivalent classification) II - IV.
• Subjects using supplemental oxygen must be receiving a stable course of therapy for a minimum of 14 days prior to study drug administration.
• All subjects' oxygen saturation must be > or = to 88% at time of treatment
• Echocardiogram within 6 months of baseline showing no signs of clinically significant left sided heart disease
• Females of child-bearing potential with a negative urine pregnancy test, or a documented surgical sterilization, or is post-menopausal prior to administration of investigational product. Females of childbearing potential must be practicing adequate birth control.

PAH (WHO Group 1) ONLY-Inclusion

• Documented diagnosis of WHO Group 1 PAH, (limited to, idiopathic, heritable, drug and toxin induced, associated with connective tissue disease, portal hypertension, repaired congenital heart disease, HIV); documented by a previous RHC and hemodynamics consistent with PAH, WHO Group 1
• Pulmonary Function Testing within 6 months prior to screening/enrollment shows no evidence of interstitial lung disease (TLC<70%) or obstructive lung disease (FEV1/FVC ratio <50%)
• Receiving a stable course of approved PAH oral mono therapies for a minimum of 14 days prior to treatment period
• Must be 18-80 year of age

PH-IPF (WHO Group 3) ONLY-Inclusion

• Documented diagnosis of probable or definite IPF using ATS/ERS criteria
• Previous transbronchial biopsy, if performed, shows no features to support a definitive alternative diagnosis
• Previous bronchoalveolar lavage, if performed, shows no features that provides an alternative diagnosis
• FVC > or = 40% within 6 months of baseline visit
• Diagnosis of PH based on hemodynamic requirements
• Age 40-85.
• Diagnosis of IPF > or = 3 months prior to study drug administration
• Diagnosis of PH based on the following hemodynamic criteria (PAPm > or = 25 mmHg (at rest) / PCWP or LVED < or =15 mmHg and / PVR >3 Wood Units)

EXCLUSION CRITERIA:

PAH and PH-IPF

• Have any other disease associated with pulmonary hypertension (i.e. Group II, IV or V).
• Documented uncontrolled systemic hypertension.
• Left ventricular ejection fraction (LVEF) < 40%.
• Have chronic kidney disease stage IV or worse, or requires dialysis.
• Be receiving an investigational drug, have in place an investigational device, or have participated in an investigational drug study within past 30 days.
• Have had an atrial septostomy.
• Have anemia or any other ongoing condition that would interfere with the interpretation of study assessments.
• Have any serious or life-threatening disease other than conditions associated with PAH or PH-IPF (e.g. malignancy requiring aggressive chemotherapy, renal dialysis, etc.)
• Significant, ongoing alcohol or drug abuse, or unstable psychiatric status.
• Receiving inhaled or parenteral prostacyclins or a non-approved combination of approved oral PAH therapy.
• Pregnant or lactating subjects

PAH (WHO Group 1) ONLY-Exclusion

• Have had any changes to chronic therapy (including but not limited to oxygen, a different category of vasodilator, a diuretic, digoxin) for PAH added within 14 days of study drug administration. Anticoagulants are allowed to be discontinued per institutional standard of care.
• History of untreated sleep apnea within three months of study drug administration.
• History of hemodynamically significant left-sided heart disease or evidence of left-sided heart disease.

PH-IPF (WHO Group 3) ONLY-Exclusion

• Diagnosis of PH primarily due to etiology other than IPF.
• FEV/FVC ratio < 60% documented within 6 months of baseline visit.
• Hospitalization for acute exacerbation of IPF within 30 days of baseline visit.
• Recent active pulmonary or upper respiratory tract infection.
• Receiving any approved PAH therapy within 30 days of study drug administration.