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A Study of Ralinepag to Evaluate Effects on Exercise Capacity by CPET in Subjects With WHO Group 1 PH (CAPACITY)

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ClinicalTrials.gov Identifier: NCT04084678
Recruitment Status : Recruiting
First Posted : September 10, 2019
Last Update Posted : October 19, 2021
Sponsor:
Information provided by (Responsible Party):
United Therapeutics

Brief Summary:
Study ROR-PH-302, ADVANCE CAPACITY, is designed to evaluate the effects of ralinepag therapy on exercise capacity as assessed by change in peak oxygen consumption (VO2) derived from cardiopulmonary exercise testing (CPET) after 28 weeks of treatment

Condition or disease Intervention/treatment Phase
PAH Pulmonary Hypertension Hypertension Connective Tissue Disease Familial Primary Pulmonary Hypertension Vascular Diseases Cardiovascular Diseases Hypertension, Pulmonary Lung Diseases Respiratory Tract Disease Pulmonary Arterial Hypertension Drug: Ralinepag Drug: Placebo Phase 3

Detailed Description:
ROR-PH-302 is a 28-week multicenter, randomized, double-blind, placebo-controlled study. Subjects who meet entry criteria will be randomly allocated 2:1 to receive ralinepag or placebo, in addition to their PAH-specific background therapy, as applicable. The primary endpoint is change from Baseline in peak VO2 (assessed by CPET) at Week 28. All subjects who complete the study on study drug through Week 28 will have the option to receive ralinepag in an open-label extension (OLE) study. Subjects who discontinue study drug prior to Week 28, as well as those who complete Week 28 on study drug but choose not to participate in the OLE study, will be contacted every 6 months and at the end of the study to determine their survival status. Subjects who prematurely discontinue study drug or withdraw from the study for any reason will not be eligible to enter the OLE study.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 193 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: A Phase 3, Randomized, Double-blind, Placebo-controlled Study of Ralinepag to Evaluate Safety and Effects on Exercise Capacity Assessed by CPET in Subjects With WHO Group 1 Pulmonary Hypertension Who Recently Initiated Therapy
Actual Study Start Date : October 29, 2020
Estimated Primary Completion Date : September 1, 2023
Estimated Study Completion Date : September 1, 2023


Arm Intervention/treatment
Experimental: Ralinepag
Ralinepag once daily extended-release tablets (oral) 50, 250, and 400 mcg titrated to the individual maximum tolerated dose (maximum dose of 1400 mcg)
Drug: Ralinepag
Oral ralinepag
Other Name: APD811

Placebo Comparator: Placebo
Matching placebo tablets (oral)
Drug: Placebo
Matching oral tablets




Primary Outcome Measures :
  1. Change from Baseline in peak VO2 assessed by CPET [ Time Frame: Baseline to Week 28 ]
    Peak VO2 by CPET was measured at Baseline (prior to starting study drug) and Week 28


Secondary Outcome Measures :
  1. Change from Baseline in N-terminal pro-brain natriuretic peptide (NT-proBNP) [ Time Frame: Baseline to Week 28 ]
    NT-proBNP was measured at Baseline (prior to starting study drug) and Weeks 4, 8, 12, 16, 20, 24 and 28

  2. Change from Baseline in Minute Ventilation (VE)/Carbon Dioxide output (VCO2) slope [ Time Frame: Baseline to Week 28 ]
    VE/VCO2 slope (from CPET) was calculated at Baseline (prior to starting study drug) and Week 28

  3. Change from Baseline in health-related quality of life measured by the Short Form Health Survey (SF-36) Scores [ Time Frame: Baseline to Week 28 ]
    SF-36 was assessed at Baseline (prior to starting study drug) and Weeks 16 and 28. The SF-36 consisted of 36 questions in 8 health categories (Vitality, Physical Functioning, Bodily Pain, General Health Perception, Role Physical, Role Emotional, Social Functioning, and Mental Health). Responses to the questions were graded on a numerical scale, with 1 as the best score and higher numbers as worse scores. The raw scores from the subscales were converted and summed by the Investigator to a total score between 0 and 100 to measure functional health and well-being from the patient's point of view. The final score range was 0 (representing the lowest possible score; worst health state) to 100 (representing the highest possible score; best health state).

  4. Time to First All-cause Non-elective Hospitalization [ Time Frame: Baseline to Week 28 ]
    The time to first all-cause nonelective hospitalization during the study period will be assessed.



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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Signed informed consent form.
  2. At least 18 years of age.
  3. Primary diagnosis of PAH .
  4. Has had a diagnostic RHC performed at or within 3 years before Screening (or at Screening if one is not available) that is consistent with the diagnosis of PAH.
  5. Has World Health Organization (WHO)/New York Heart Association (NYHA) Functional Class (FC) II to III symptoms
  6. Must be on a stable dose of PAH-specific oral therapy, defined as no change in dose or regimen for at least 120 days prior to randomization. Allowable PAH-specific therapy is an endothelin receptor antagonist and/or a phosphodiesterase type 5 inhibitor (PDE5-I) or a soluble guanylate cyclase (sGC) stimulator. Subjects may be on a stable dose of either a PDE5-I or a sGC stimulator, not both.
  7. Has a 6-minute walk distance (6MWD) of ≥150 meters at Screening.
  8. Has a VE/VCO2 slope ≥38 during the Screening CPET, as assessed by the CPET core laboratory.
  9. Has a peak VO2 of ≥10 to <18 mL·kg-1·min-1 during the Screening CPET, as assessed by the CPET core laboratory.
  10. If the subject is taking concomitant medications that may affect the clinical manifestations of PAH, the subject must be on a stable dose for at least 30 days prior to randomization. The exception is that the dose of diuretics should remain stable for at least the 10 days prior to randomization and the dosage maintained throughout the study.
  11. Both male and female subjects agree to use a highly effective method of birth control throughout the entire study period from informed consent through to the Week 28 Visit/28-day Follow-up Visit, if the possibility of conception exists. Eligible male and female subjects must also agree not to participate in a conception process during the study and for 30 days after the final dose of study drug. Eligible male subjects must agree not to participate in sperm donation for 90 days after the final dose of study drug.

Women who are surgically sterile or postmenopausal are not considered to be of childbearing potential. If of childbearing potential, female partners of male study participants should agree to utilize medically acceptable methods of contraception for the duration of study participation.

Exclusion Criteria:

  1. For subjects with known human immunodeficiency virus-associated PAH, a cluster designation of differentiation 4 (CD4+) T-cell count <200/mm3 at Screening.
  2. Has 3 or more left ventricular disease dysfunction risk factors.
  3. Symptomatic coronary disease and/or myocardial infarction within past 6 months.
  4. Current symptomatic aortic or mitral valve disease.
  5. Has evidence of more than mild lung disease on pulmonary function tests performed within 1 year prior to, or during, Screening.
  6. Has evidence of thromboembolic disease as determined by ventilation-perfusion lung scan or local standard of care diagnostic evaluation at or after diagnosis of PAH.
  7. Current diagnosis of ongoing and clinically significant sleep apnea as defined by the Investigator.
  8. Requires use of supplemental oxygen during CPET.
  9. Respiratory exchange ratio <1.0 at Screening CPET as determined by the CPET core laboratory.
  10. Acute non-cardiac disorder that may affect exercise performance or be aggravated by exercise (eg, infection, renal failure, thyrotoxicosis).
  11. Male subjects with a QTcF >450 msec and female subjects with a QTcF >470 msec on electrocardiogram (ECG) recorded at Screening and analyzed by the central ECG laboratory. Subjects with evidence of intraventricular conduction delay, defined as a QRS interval >110 msec, will be excluded if QTcF is >500 msec for both males and females.
  12. Severe chronic liver disease (ie, Child-Pugh Class C), portal hypertension, cirrhosis, or complications of cirrhosis/portal hypertension (eg, history of variceal hemorrhage, encephalopathy).
  13. Confirmed active infection with hepatitis B virus or hepatitis C virus.
  14. Subjects with alanine aminotransferase or aspartate aminotransferase ≥3 times the upper limit of normal or total bilirubin ≥2 times the upper limit of normal at Screening.
  15. Chronic renal insufficiency as defined by an estimated glomerular filtration rate using the Modification of Diet in Renal Disease Study equation of <30 mL/min/1.73 m^2 or requiring dialysis at Screening.
  16. Hemoglobin concentration <9 g/dL at Screening.
  17. Subjects treated with an intravenous or subcutaneous prostacyclin pathway agent (eg, epoprostenol, treprostinil, or iloprost) for PAH at any time (use in vasoreactive testing is permitted).
  18. Subjects currently on or who have been treated with an inhaled or oral prostacyclin pathway agent (iloprost, treprostinil, beraprost, or selexipag) within 120 days prior to randomization.
  19. Subject has pulmonary veno-occlusive disease.
  20. Malignancy diagnosed and/or treated within 3 years of Screening, with the exception of localized non-metastatic basal cell or squamous cell carcinoma of the skin or in-situ carcinoma of the cervix excised with curative intent.
  21. Subject tests positive for amphetamine, cocaine, methamphetamine, methylenedioxymethamphetamine, or phencyclidine in urine drug screen performed at Screening, or has a recent history (6 months) of alcohol or drug abuse. Subjects will not be excluded due to a positive drug screen caused by prescribed medications.
  22. Initiation or discontinuation of a cardio-pulmonary rehabilitation program based upon exercise within 90 days prior to Screening and/or planned during study participation.
  23. Prior participation in any study of ralinepag or another interventional clinical study with medicinal products within 30 days prior to Screening. Concurrent participation in registry or observational studies is allowed, if the subject can fulfill all other entry criteria and comply with all study procedures.
  24. Any reason that, in the opinion of the Investigator, precludes the subject from participating in the study (eg, any previous or intercurrent medical condition) that may increase the risk associated with study participation or that would confound study analysis (eg, right-to-left shunt detected during CPET) or impair study participation or cooperation.
  25. Known hypersensitivity to ralinepag or any of the excipients.
  26. Life expectancy <12 months based on the Investigator's opinion.
  27. Women who are pregnant, lactating, or breast-feeding.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT04084678


Contacts
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Contact: United Therapeutics Global Medical Information 919-485-8350 clinicaltrials@unither.com

Locations
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Sponsors and Collaborators
United Therapeutics
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Responsible Party: United Therapeutics
ClinicalTrials.gov Identifier: NCT04084678    
Other Study ID Numbers: ROR-PH-302
First Posted: September 10, 2019    Key Record Dates
Last Update Posted: October 19, 2021
Last Verified: March 2021

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by United Therapeutics:
Prostacyclin
Connective Tissue Disease-Associated
Cardiopulmonary Exercise Capacity (CPET)
IP Receptor Agonist
Additional relevant MeSH terms:
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Lung Diseases
Hypertension, Pulmonary
Pulmonary Arterial Hypertension
Respiratory Tract Diseases
Familial Primary Pulmonary Hypertension
Hypertension
Cardiovascular Diseases
Vascular Diseases
Connective Tissue Diseases