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.

Recruitment status

COMPLETED

Study phase

PHASE3

Target enrollment

105 participants

Primary outcome timeframe

Baseline and 24 weeks

Results posted on

2022-06-07

Participant Flow

Participant milestones

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

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 weeks

Population: 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

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 weeks

Population: 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

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 weeks

Population: 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

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 weeks

Class 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

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 weeks

This 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

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 weeks

baseline 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

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 weeks

baseline 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

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 weeks

baseline 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

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 weeks

baseline 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

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 weeks

baseline 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

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 weeks

baseline 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

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 weeks

baseline values, assessment after 24 weeks

Outcome measures

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

Serious events: 9 serious events
Other events: 53 other events
Deaths: 2 deaths

Low Dose

Serious events: 10 serious events
Other events: 51 other events
Deaths: 1 deaths

Serious adverse events

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

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

Bianca Tan

SciPharm SàRL

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place