Trial Outcomes & Findings for Efficacy and Tolerability of Subcutaneously Administered Treprostinil Sodium in Patients With Severe (Non-operable) Chronic Thromboembolic Pulmonary Hypertension (CTREPH) (NCT NCT01416636)
NCT ID: NCT01416636
Last Updated: 2022-06-07
Results Overview
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.
COMPLETED
PHASE3
105 participants
Baseline and 24 weeks
2022-06-07
Participant Flow
Participant milestones
| Measure |
Treprostinil Sodium High Dose (~30ng/kg/Min)
Treprostinil sodium was administered subcutaneously via an ambulatory infusion pump with continuous flow rate. Patients were uptitrated to a target dose of approx. 30ng/kg/min within the first 12 weeks and were kept on stable dose for the remaining 12 weeks study duration.
|
Treprostinil Sodium Low Dose (~3ng/kg/Min)
Treprostinil sodium was administered subcutaneously via an ambulatory infusion pump with continuous flow rate. Patients were uptitrated to a target dose of approx. 3ng/kg/min within the first 12 weeks and were kept on stable dose for the remaining 12 weeks study duration.
|
|---|---|---|
|
Overall Study
STARTED
|
53
|
52
|
|
Overall Study
COMPLETED
|
45
|
46
|
|
Overall Study
NOT COMPLETED
|
8
|
6
|
Reasons for withdrawal
Withdrawal data not reported
Baseline Characteristics
Efficacy and Tolerability of Subcutaneously Administered Treprostinil Sodium in Patients With Severe (Non-operable) Chronic Thromboembolic Pulmonary Hypertension (CTREPH)
Baseline characteristics by cohort
| Measure |
High Dose
n=53 Participants
Treprostinil sodium high dose
|
Low Dose
n=52 Participants
Treprostinil sodium low dose
|
Total
n=105 Participants
Total of all reporting groups
|
|---|---|---|---|
|
Age, Categorical
<=18 years
|
0 Participants
n=99 Participants
|
1 Participants
n=107 Participants
|
1 Participants
n=206 Participants
|
|
Age, Categorical
Between 18 and 65 years
|
15 Participants
n=99 Participants
|
26 Participants
n=107 Participants
|
41 Participants
n=206 Participants
|
|
Age, Categorical
>=65 years
|
38 Participants
n=99 Participants
|
25 Participants
n=107 Participants
|
63 Participants
n=206 Participants
|
|
Age, Continuous
|
68.06 years
STANDARD_DEVIATION 11.16 • n=99 Participants
|
60.58 years
STANDARD_DEVIATION 14.59 • n=107 Participants
|
64.35 years
STANDARD_DEVIATION 13.44 • n=206 Participants
|
|
Sex: Female, Male
Female
|
19 Participants
n=99 Participants
|
30 Participants
n=107 Participants
|
49 Participants
n=206 Participants
|
|
Sex: Female, Male
Male
|
34 Participants
n=99 Participants
|
22 Participants
n=107 Participants
|
56 Participants
n=206 Participants
|
|
Region of Enrollment
Austria
|
28 participants
n=99 Participants
|
26 participants
n=107 Participants
|
54 participants
n=206 Participants
|
|
Region of Enrollment
Czechia
|
17 participants
n=99 Participants
|
17 participants
n=107 Participants
|
34 participants
n=206 Participants
|
|
Region of Enrollment
Poland
|
8 participants
n=99 Participants
|
8 participants
n=107 Participants
|
16 participants
n=206 Participants
|
|
Region of Enrollment
Germany
|
0 participants
n=99 Participants
|
1 participants
n=107 Participants
|
1 participants
n=206 Participants
|
PRIMARY outcome
Timeframe: Baseline and 24 weeksPopulation: All randomized subjects who received at least one dose of study medication.
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.
Outcome measures
| Measure |
High Dose
n=53 Participants
Treprostinil sodium high dose
|
Low Dose
n=52 Participants
Treprostinil sodium low dose
|
|---|---|---|
|
Change in 6-minute Walk Test Distance After 24 Weeks
|
45.43 m
Standard Deviation 71.29
|
3.83 m
Standard Deviation 56.21
|
SECONDARY outcome
Timeframe: 12 weeks and 24 weeksPopulation: All randomized subjects who received at least one dose of study medication.
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.
Outcome measures
| Measure |
High Dose
n=53 Participants
Treprostinil sodium high dose
|
Low Dose
n=52 Participants
Treprostinil sodium low dose
|
|---|---|---|
|
Number of Participants With Clinical Worsening
|
7 Participants
|
12 Participants
|
SECONDARY outcome
Timeframe: Baseline and 24 weeksPopulation: For this endpoint no imputation role was applied. For 48 patients of the high dose group, as well as for the low dose group, baseline data and also 24 week data are available.
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.
Outcome measures
| Measure |
High Dose
n=48 Participants
Treprostinil sodium high dose
|
Low Dose
n=48 Participants
Treprostinil sodium low dose
|
|---|---|---|
|
Effect on Maximal Borg Score During 6-minutes Walk Test
|
-0.44 units on a scale
Standard Deviation 2.21
|
-0.13 units on a scale
Standard Deviation 2.43
|
SECONDARY outcome
Timeframe: Baseline and 24 weeksClass 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.
Outcome measures
| Measure |
High Dose
n=53 Participants
Treprostinil sodium high dose
|
Low Dose
n=52 Participants
Treprostinil sodium low dose
|
|---|---|---|
|
Change in WHO/NYHA (World Health Organization - New York Heart Association) Functional Class
Improved
|
27 Participants
|
9 Participants
|
|
Change in WHO/NYHA (World Health Organization - New York Heart Association) Functional Class
No change
|
22 Participants
|
36 Participants
|
|
Change in WHO/NYHA (World Health Organization - New York Heart Association) Functional Class
Worse
|
2 Participants
|
3 Participants
|
|
Change in WHO/NYHA (World Health Organization - New York Heart Association) Functional Class
Not done
|
2 Participants
|
4 Participants
|
SECONDARY outcome
Timeframe: Baseline and 24 weeksThis 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.
Outcome measures
| Measure |
High Dose
n=50 Participants
Treprostinil sodium high dose
|
Low Dose
n=46 Participants
Treprostinil sodium low dose
|
|---|---|---|
|
Effect on Quality of Life by the MINNESOTA Questionnaire
|
-6.36 units on a scale
Standard Deviation 22.9
|
-4.63 units on a scale
Standard Deviation 19.34
|
SECONDARY outcome
Timeframe: Baseline and 24 weeksbaseline 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.
Outcome measures
| Measure |
High Dose
n=46 Participants
Treprostinil sodium high dose
|
Low Dose
n=46 Participants
Treprostinil sodium low dose
|
|---|---|---|
|
Effect on N-terminal Pro-BNP Levels
|
0.84 percentage change to baseline
Standard Deviation 63.32
|
41.68 percentage change to baseline
Standard Deviation 104.2
|
SECONDARY outcome
Timeframe: Baseline and 24 weeksbaseline 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.
Outcome measures
| Measure |
High Dose
n=48 Participants
Treprostinil sodium high dose
|
Low Dose
n=47 Participants
Treprostinil sodium low dose
|
|---|---|---|
|
Effect on Hemodynamic Parameter (PVR - Pulmonary Vascular Resistance)
|
-214.23 dyn.s.cm^-5
Standard Deviation 324.28
|
72.96 dyn.s.cm^-5
Standard Deviation 284.95
|
SECONDARY outcome
Timeframe: Baseline and 24 weeksbaseline 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.
Outcome measures
| Measure |
High Dose
n=48 Participants
Treprostinil sodium high dose
|
Low Dose
n=47 Participants
Treprostinil sodium low dose
|
|---|---|---|
|
Effect on Hemodynamic Parameter (CI - Cardiac Index)
|
0.42 L/min/m2
Standard Deviation 0.9
|
-0.16 L/min/m2
Standard Deviation 0.54
|
SECONDARY outcome
Timeframe: Baseline and 24 weeksbaseline 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.
Outcome measures
| Measure |
High Dose
n=48 Participants
Treprostinil sodium high dose
|
Low Dose
n=47 Participants
Treprostinil sodium low dose
|
|---|---|---|
|
Effect on Hemodynamic Parameter (CO - Cardiac Output)
|
0.63 L/min
Standard Deviation 1.47
|
-0.22 L/min
Standard Deviation 1.06
|
SECONDARY outcome
Timeframe: Baseline and 24 weeksbaseline 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.
Outcome measures
| Measure |
High Dose
n=47 Participants
Treprostinil sodium high dose
|
Low Dose
n=47 Participants
Treprostinil sodium low dose
|
|---|---|---|
|
Effect on Hemodynamic Parameter (mPAP - Mean Pulmonary Arterial Pressure)
|
-3.36 mmHg
Standard Deviation 8.04
|
-0.4 mmHg
Standard Deviation 6.87
|
SECONDARY outcome
Timeframe: Baseline and 24 weeksbaseline 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.
Outcome measures
| Measure |
High Dose
n=48 Participants
Treprostinil sodium high dose
|
Low Dose
n=47 Participants
Treprostinil sodium low dose
|
|---|---|---|
|
Effect on Hemodynamic Parameter (mRap - Mean Right Atrial Pressure)
|
0.65 mmHg
Standard Deviation 5.08
|
2.87 mmHg
Standard Deviation 6.82
|
SECONDARY outcome
Timeframe: Baseline and 24 weeksbaseline values, assessment after 24 weeks
Outcome measures
| Measure |
High Dose
n=53 Participants
Treprostinil sodium high dose
|
Low Dose
n=52 Participants
Treprostinil sodium low dose
|
|---|---|---|
|
Effect on Signs & Symptoms of the CTEPH
Nausea/Vomiting : Week 24
|
5 participants
|
9 participants
|
|
Effect on Signs & Symptoms of the CTEPH
Chest pain : Baseline
|
13 participants
|
11 participants
|
|
Effect on Signs & Symptoms of the CTEPH
Chest pain : Week 24
|
8 participants
|
3 participants
|
|
Effect on Signs & Symptoms of the CTEPH
Fatigue : Week 24
|
26 participants
|
27 participants
|
|
Effect on Signs & Symptoms of the CTEPH
Ascites : Baseline
|
2 participants
|
3 participants
|
|
Effect on Signs & Symptoms of the CTEPH
Ascites : Week 24
|
1 participants
|
3 participants
|
|
Effect on Signs & Symptoms of the CTEPH
Nausea/Vomiting : Baseline
|
4 participants
|
9 participants
|
|
Effect on Signs & Symptoms of the CTEPH
Orthopnoea : Baseline
|
9 participants
|
9 participants
|
|
Effect on Signs & Symptoms of the CTEPH
Orthopnoea : Week 24
|
3 participants
|
5 participants
|
|
Effect on Signs & Symptoms of the CTEPH
Dizziness : Baseline
|
25 participants
|
21 participants
|
|
Effect on Signs & Symptoms of the CTEPH
Dizziness : Week 24
|
11 participants
|
10 participants
|
|
Effect on Signs & Symptoms of the CTEPH
Palpitations : Baseline
|
19 participants
|
18 participants
|
|
Effect on Signs & Symptoms of the CTEPH
Palpitations : Week 24
|
9 participants
|
11 participants
|
|
Effect on Signs & Symptoms of the CTEPH
Dyspnoea at rest : Baseline
|
7 participants
|
10 participants
|
|
Effect on Signs & Symptoms of the CTEPH
Dyspnoea at rest : Week 24
|
3 participants
|
10 participants
|
|
Effect on Signs & Symptoms of the CTEPH
Paroxysmal nocturnal dyspnoea : Baseline
|
7 participants
|
1 participants
|
|
Effect on Signs & Symptoms of the CTEPH
Paroxysmal nocturnal dyspnoea : Week 24
|
4 participants
|
3 participants
|
|
Effect on Signs & Symptoms of the CTEPH
Dyspnoea on exertion : Baseline
|
53 participants
|
51 participants
|
|
Effect on Signs & Symptoms of the CTEPH
Dyspnoea on exertion : Week 24
|
46 participants
|
43 participants
|
|
Effect on Signs & Symptoms of the CTEPH
Syncope : Baseline
|
3 participants
|
6 participants
|
|
Effect on Signs & Symptoms of the CTEPH
Syncope : Week 24
|
1 participants
|
2 participants
|
|
Effect on Signs & Symptoms of the CTEPH
Fatigue : Baseline
|
33 participants
|
37 participants
|
|
Effect on Signs & Symptoms of the CTEPH
Thirst : Baseline
|
12 participants
|
21 participants
|
|
Effect on Signs & Symptoms of the CTEPH
Thirst : Week 24
|
12 participants
|
13 participants
|
Adverse Events
High Dose
Low Dose
Serious adverse events
| Measure |
High Dose
n=53 participants at risk
Treprostinil sodium high dose
|
Low Dose
n=52 participants at risk
Treprostinil sodium low dose
|
|---|---|---|
|
Cardiac disorders
Cardiac failure
|
3.8%
2/53
|
1.9%
1/52
|
|
Cardiac disorders
Dyspnea
|
0.00%
0/53
|
1.9%
1/52
|
|
Cardiac disorders
Right ventricular failure
|
11.3%
6/53
|
1.9%
1/52
|
|
Cardiac disorders
Syncope
|
0.00%
0/53
|
1.9%
1/52
|
|
Gastrointestinal disorders
Diarrhoea
|
0.00%
0/53
|
1.9%
1/52
|
|
Gastrointestinal disorders
Nausea
|
0.00%
0/53
|
1.9%
1/52
|
|
General disorders
General physical health deterioration
|
1.9%
1/53
|
0.00%
0/52
|
|
General disorders
Incarcerated hernia
|
0.00%
0/53
|
1.9%
1/52
|
|
Infections and infestations
Appendicitis
|
0.00%
0/53
|
1.9%
1/52
|
|
Infections and infestations
Escherichia bacteraemia
|
0.00%
0/53
|
1.9%
1/52
|
|
Infections and infestations
Sepsis
|
1.9%
1/53
|
0.00%
0/52
|
|
Metabolism and nutrition disorders
Hypokalaemia
|
0.00%
0/53
|
1.9%
1/52
|
|
Neoplasms benign, malignant and unspecified (incl cysts and polyps)
Polycythaemia vera
|
1.9%
1/53
|
0.00%
0/52
|
|
Nervous system disorders
Syncope
|
1.9%
1/53
|
0.00%
0/52
|
|
Renal and urinary disorders
Accute kidney injury
|
0.00%
0/53
|
1.9%
1/52
|
|
Respiratory, thoracic and mediastinal disorders
Haemoptysis
|
1.9%
1/53
|
0.00%
0/52
|
|
Vascular disorders
Aortic stenosis
|
1.9%
1/53
|
0.00%
0/52
|
|
Vascular disorders
Haematoma
|
1.9%
1/53
|
0.00%
0/52
|
|
Vascular disorders
Worsening of pulmonary hypertension
|
1.9%
1/53
|
1.9%
1/52
|
Other adverse events
| Measure |
High Dose
n=53 participants at risk
Treprostinil sodium high dose
|
Low Dose
n=52 participants at risk
Treprostinil sodium low dose
|
|---|---|---|
|
Cardiac disorders
Oedema peripheral
|
13.2%
7/53
|
19.2%
10/52
|
|
Gastrointestinal disorders
Diarrhoea
|
62.3%
33/53
|
23.1%
12/52
|
|
Gastrointestinal disorders
Nausea
|
7.5%
4/53
|
5.8%
3/52
|
|
Gastrointestinal disorders
Vomiting
|
5.7%
3/53
|
5.8%
3/52
|
|
General disorders
Decreased appetite
|
13.2%
7/53
|
0.00%
0/52
|
|
General disorders
Flushing
|
7.5%
4/53
|
7.7%
4/52
|
|
General disorders
Infusion site reactions
|
47.2%
25/53
|
46.2%
24/52
|
|
General disorders
Infusion site pain
|
73.6%
39/53
|
80.8%
42/52
|
|
Infections and infestations
Nasopharyngitis
|
7.5%
4/53
|
19.2%
10/52
|
|
Metabolism and nutrition disorders
Hypokalaemia
|
7.5%
4/53
|
9.6%
5/52
|
|
Musculoskeletal and connective tissue disorders
Arthralgia
|
7.5%
4/53
|
3.8%
2/52
|
|
Musculoskeletal and connective tissue disorders
Back pain
|
1.9%
1/53
|
7.7%
4/52
|
|
Musculoskeletal and connective tissue disorders
Pain in extremities
|
20.8%
11/53
|
1.9%
1/52
|
|
Nervous system disorders
Headache
|
22.6%
12/53
|
7.7%
4/52
|
|
Respiratory, thoracic and mediastinal disorders
Cough
|
5.7%
3/53
|
7.7%
4/52
|
|
Skin and subcutaneous tissue disorders
Pruritus
|
5.7%
3/53
|
5.8%
3/52
|
|
Skin and subcutaneous tissue disorders
Rash
|
3.8%
2/53
|
5.8%
3/52
|
|
Vascular disorders
Epistaxis
|
1.9%
1/53
|
5.8%
3/52
|
|
Vascular disorders
Worsening of Pulmonary Hypertension
|
5.7%
3/53
|
15.4%
8/52
|
Additional Information
Results disclosure agreements
- Principal investigator is a sponsor employee
- Publication restrictions are in place