A Randomized, Double-Blind, Placebo-Controlled Study of Sildenafil in Children With Pulmonary Arterial Hypertension.

January 28, 2021 updated by: Pfizer's Upjohn has merged with Mylan to form Viatris Inc.

A Randomized, Double-Blind, Placebo Controlled, Dose Ranging, Parallel Group Study of Oral Sildenafil in the Treatment of Children, Aged 1-17 Years, With Pulmonary Arterial Hypertension.

This is a clinical research study designed to evaluate sildenafil for the treatment of Pulmonary Arterial Hypertension in children, aged 1 to 17 years. The purpose of the study is to assess the efficacy, safety, and pharmacokinetics of 16 weeks of chronic treatment with oral sildenafil given in three different doses, compared to placebo (inactive treatment). Efficacy will be measured by exercise and hemodynamics. Patients who complete this trial may be eligible to take part in an extension study, in which all patients will receive active treatment of sildenafil.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Study Type

Interventional

Enrollment (Actual)

235

Phase

  • Phase 3

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Brazil
    • SP
      • São Paulo, SP, Brazil, 04012-909
        • Pfizer Investigational Site
  • Canada
    • Alberta
      • Edmonton, Alberta, Canada, T6G 2B7
        • Pfizer Investigational Site
  • Chile
    • RM
      • Santiago, RM, Chile
        • Pfizer Investigational Site
  • Colombia
    • Antioquia
      • Medellin, Antioquia, Colombia
        • Pfizer Investigational Site
    • Cundinamarca
      • Bogota, Cundinamarca, Colombia
        • Pfizer Investigational Site
  • Guatemala
      • Guatemala, Guatemala
        • Pfizer Investigational Site
  • Hungary
      • Budapest, Hungary, 1083
        • Pfizer Investigational Site
      • Budapest, Hungary, 1096
        • Pfizer Investigational Site
      • Deszk, Hungary, 6722
        • Pfizer Investigational Site
      • Szeged, Hungary, 6720
        • Pfizer Investigational Site
      • Szeged, Hungary, 6726
        • Pfizer Investigational Site
  • India
    • Andra Pradesh
      • Hyderabad, Andra Pradesh, India, 500 001
        • Pfizer Investigational Site
    • Kochi,
      • Kerala, Kochi,, India, 682 026
        • Pfizer Investigational Site
  • Italy
      • Bologna, Italy, 40138
        • Pfizer Investigational Site
  • Japan
      • Tokyo, Japan
        • Pfizer Investigational Site
  • Malaysia
      • Penang, Malaysia, 10050
        • Pfizer Investigational Site
      • Penang, Malaysia, 10900
        • Pfizer Investigational Site
  • Mexico
    • Mexico D.F.
      • Del. Tlalpan, Mexico D.F., Mexico, 14080
        • Pfizer Investigational Site
    • Mexico DF
      • Tlalpan, Mexico DF, Mexico, 14080
        • Pfizer Investigational Site
  • Peru
      • Lima, Peru, L13
        • Pfizer Investigational Site
  • Poland
      • Krakow, Poland, 30-663
        • Pfizer Investigational Site
      • Krakow, Poland, 31-202
        • Pfizer Investigational Site
      • Warszawa, Poland, 04-730
        • Pfizer Investigational Site
      • Warszawa, Poland, 04-628
        • Pfizer Investigational Site
      • Zabrze, Poland, 41-800
        • Pfizer Investigational Site
  • Russian Federation
      • Moscow, Russian Federation, 121552
        • Pfizer Investigational Site
      • Moscow, Russian Federation, 127412
        • Pfizer Investigational Site
  • Sweden
      • Lund, Sweden, 221 85
        • Pfizer Investigational Site
  • Taiwan
      • Kaohsiung, Taiwan, 81346
        • Pfizer Investigational Site
      • Taipei, Taiwan, 100
        • Pfizer Investigational Site
      • Taipei, Taiwan, 11217
        • Pfizer Investigational Site
  • United States
    • California
      • Palo Alto, California, United States, 94304
        • Pfizer Investigational Site
      • Stanford, California, United States, 94305
        • Pfizer Investigational Site
    • Colorado
      • Aurora, Colorado, United States, 80045
        • Pfizer Investigational Site
    • Massachusetts
      • Boston, Massachusetts, United States, 02115
        • Pfizer Investigational Site
    • Michigan
      • Ann Arbor, Michigan, United States, 48109
        • Pfizer Investigational Site
    • Missouri
      • Saint Louis, Missouri, United States, 63110
        • Pfizer Investigational Site
    • New York
      • New York, New York, United States, 10032
        • Pfizer Investigational Site
    • Ohio
      • Columbus, Ohio, United States, 43205
        • Pfizer Investigational Site
    • South Carolina
      • Charleston, South Carolina, United States, 29425
        • Pfizer Investigational Site
    • Washington
      • Seattle, Washington, United States, 98105
        • Pfizer Investigational Site

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

1 year to 17 years (CHILD)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Male or female subjects aged from 1 to 17 years old and weighing >= 8 kg with a mean pulmonary artery pressure >= 25 mmHg at rest, PCWP <= 15 mmHg, and PVRI >= 3 Wood units x m2 (if PCWP is not available, then mean LA pressure <= 15 mmHg or LVEDP <= 15 mmHg in the absence of left atrial obstruction).
  • Females of child bearing potential who were sexually active must have been practicing a suitable method of birth control so that in the opinion of the investigator, they would not become pregnant during the study.
  • Subjects who have symptomatic pulmonary arterial hypertension due to: primary pulmonary hypertension; pulmonary arterial hypertension in the presence of a small or hemodynamically insignificant congenital systemic to pulmonary shunt lesion that in the opinion of the investigator is not the cause of pulmonary hypertension; collagen vascular disease; congenital systemic-to-pulmonary shunts with a baseline resting room air oxygen saturation >= 88% unrepaired or repaired at least 6 months prior to screening; d-transposition of the great arteries repaired within the first 30 days of life; or surgical repair of other congenital heart lesions at least 6 months prior to screening and do not have clinically significant residual left-sided heart disease consistent with the exclusion criteria.
  • Subjects, developmentally able to exercise, whose CPX exercise test functional capacity is within the following parameters: Peak VO2 >= 10 mL/kg/min and <= 28 mL/kg/min during screening CPX test;
  • Written informed consent and assent where applicable before the subject is screened for the study.
  • Subjects who undergo a large shift in altitude (defined as approximately 5000 feet or 1524 meters) in order to participate in the study must reside at the "in study" altitude for at least 90 days prior to baseline and during the study period.

Exclusion Criteria:

  • Subjects with pulmonary hypertension secondary to sickle cell disease, any other disease known to be associated with PAH, or any etiology other than those specified in the inclusion criteria.
  • Left-sided heart disease, including aortic or mitral valve disease (greater than mild), restrictive or congestive cardiomyopathy; PCWP or LVEDP > 15 mmHg; LVEF < 40% determined by MUGA, angiography or echocardiography; LV shortening fraction < 22% determined by echocardiography, symptomatic coronary disease (demonstrable ischemia).
  • Pericardial constriction; significant (2+ for regurgitation) valvular disease other than tricuspid or pulmonary regurgitation; acutely decompensated heart failure within previous 30 days from screening; atrial septostomy within previous 6 months of screening;
  • Hemodynamic instability or hypo- or hypertension at screening, i.e., SBP outside of 70-140 mmHg.
  • A history of stroke, myocardial infarction or life threatening arrhythmia within 6 months of screening.
  • Moderate to severe restrictive pulmonary disease (Total Lung Capacity or Forced Vital Capacity <= 60% of normal) or history of severe lung disease.
  • Subjects with bronchopulmonary dysplasia (BPD) and other chronic lung diseases.
  • History of pulmonary embolism.
  • Subjects whose CPX test is limited by conditions other than pulmonary hypertension-associated dyspnea or fatigue.
  • Subjects who are known to be HIV positive
  • Subjects with impairment of renal function (serum creatinine > 2.5x ULN ) or hepatic function (ALT and/or AST > 3x ULN; and/or bilirubin >= 2 mg/dL). Hematological abnormalities (e.g., severe anemia, Hgb < 10 g/dL, leukopenia, WBC < 2500/mL).
  • Subjects who previously received bosentan and whose liver function tests taken at screening are > 2x ULN.
  • Subjects with any medical condition which in the opinion of the investigator may interfere with treatment, evaluation of safety, and/or efficacy.
  • Change in class of medication for CHF or PAH within the 10 days prior to qualifying right heart catheterization.
  • Subjects who are currently prescribed and/or taking nitrates or nitric oxide donors in any form. Acute vasodilator testing with nitric oxide is permitted during hemodynamic evaluation; taking chronic arginine supplementation including Heart Bar; therapy involving parenteral inotropic medication or parenteral vasodilators within 3 months of screening; current therapy with alpha-blockers, potent cytochrome P450 3A4 inhibitors (e.g., erythromycin, ketoconazole, itraconazole and protease inhibitors), Ritonavir or Nicorandil; chronic treatment with off-label sildenafil, an endothelin antagonist or prostacyclin/prostacyclin analogue within 30 days of randomization.
  • Pregnant or lactating female.
  • Any medical or psychological condition or social circumstances that would impair their ability to participate reliably in the study or who were not likely to complete the study for any reason; current or past illicit drug use or alcoholism excepting if abstinence can be documented for >= 1 year.
  • Participation in another clinical trial of an investigational drug or device (including placebo) within 30 days of screening for entry into the present study.
  • Subjects with known hereditary degenerative retinal disorders (such as retinitis pigmentosa) or history of non-arteritic anterior ischemic optic neuropathy (NAION).

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: TREATMENT
  • Allocation: RANDOMIZED
  • Interventional Model: PARALLEL
  • Masking: TRIPLE

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
PLACEBO_COMPARATOR: Placebo
Drug: Placebo
oral; 3 times a day(TID)
EXPERIMENTAL: Sildenafil Low dose
Drug: Sildenafil citrate
oral; 20mg, 40mg and 80 mg; 3 times a day(TID)
Drug: Sildenafil citrate
oral; 10mg, 20mg and 40mg; 3 times a day(TID)
Drug: Sildenafil citrate
oral; 10 mg; 3 times a day(TID)
EXPERIMENTAL: Sildenafil Medium dose
Drug: Sildenafil citrate
oral; 20mg, 40mg and 80 mg; 3 times a day(TID)
Drug: Sildenafil citrate
oral; 10mg, 20mg and 40mg; 3 times a day(TID)
Drug: Sildenafil citrate
oral; 10 mg; 3 times a day(TID)
EXPERIMENTAL: Sildenafil High dose
Drug: Sildenafil citrate
oral; 20mg, 40mg and 80 mg; 3 times a day(TID)
Drug: Sildenafil citrate
oral; 10mg, 20mg and 40mg; 3 times a day(TID)
Drug: Sildenafil citrate
oral; 10 mg; 3 times a day(TID)

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Percent Change From Baseline in Peak Volume of Oxygen (VO2) Consumed : Intent To Treat Population
Time Frame: Baseline, Week 16
Peak VO2 (normalized for body weight) at trough plasma levels assessed by CPX testing (bicycle ergometry)at the end of treatment (Week 16 for those who completed the study). Mean Percent change = [(week 16 value minus baseline mean)/mean at baseline]*100%.
Baseline, Week 16
Percent Change From Baseline in Peak Volume of Oxygen (VO2) Consumed : Per Protocol Population
Time Frame: Baseline, Week 16
Peak VO2 (normalized for body weight) at trough plasma levels assessed by CPX testing (bicycle ergometry)at the end of treatment (Week 16 for those who completed the study). Mean Percent change = [(week 16 value minus baseline mean)/mean at baseline]*100%.
Baseline, Week 16

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change From Baseline to Week 16 in Mean Pulmonary Artery Pressure (mPAP)
Time Frame: Baseline, Week 16
mPAP, a hemodynamic parameter, was measured using a pressure transducer positioned at the mid-axillary line with the patient in the supine position. Change is observed value at Week 16 minus Baseline value.
Baseline, Week 16
Change From Baseline to Week 16 in Pulmonary Vascular Resistance Index (PVRI)
Time Frame: Baseline, Week 16
PVRI equals Pulmonary Vascular Resistance (PVR) times Body Surface Area (BSA). Wood unit = 80dyn•s/cm5. Change is observed value at Week 16 minus Baseline value.
Baseline, Week 16
Percent Change From Baseline to Week 16 in: Respiratory Exchange Ratio (RER)
Time Frame: Baseline, Week 16
RER is the ratio of carbon dioxide produced to oxygen consumed [VCO2/VO2]). Percent change is [(Week 16 value minus Baseline value)/Baseline value] * 100%
Baseline, Week 16
Percent Change From Baseline to Week 16 in Time to Maximum Volume of Oxygen Consumed (VO2)
Time Frame: Baseline, Week 16
Time to maximum VO2 was assessed on the subset of subjects who are developmentally able to perform the exercise test. Percent change is [(value at Week 16 minus Baseline value)/Baseline value] * 100%
Baseline, Week 16
Change From Baseline to Week 16 in Pulmonary Vascular Resistance (PVR)
Time Frame: Baseline, Week 16
Change calculated as (mean PAP - PCWP)/COpulm in PVR is observed value at Week 16 minus Baseline value.
Baseline, Week 16
Change From Baseline to Week 16 in Cardiac Index (CI)
Time Frame: Baseline, Week 16
CI is observed value at Week 16 minus Baseline value. Calculated as cardiac output in systemic circulation (COsys) / body surface area (BSA).
Baseline, Week 16
Change From Baseline to Week 16 in Right Atrial Pressure (RAP)
Time Frame: Baseline, Week 16
RAP was measured using a pressure transducer positioned at the mid-axillary line with the patient in the supine position. Change is observed value at Week 16 minus Baseline value.
Baseline, Week 16
Change From Baseline to Week 16 in Child Health Questionnaire Parent Form (CHQ-PF28), Physical Scale
Time Frame: Baseline, Week 16
CHQ-PF28: validated generic Quality of Life (QoL) questionnaire for subjects >= 5 years. Includes 12 domain scores of QoL concepts including physical functioning, social & school activities, mental health, parent/family concepts. Scores range 0-100: lower scores = lower QoL. Change is observed value at Week 16 minus Baseline value.
Baseline, Week 16
Change From Baseline to Week 16 in Child Health Questionnaire Parent Form (CHQ-PF28), Psychosocial Scales
Time Frame: Baseline, Week 16
CHQ-PF28: validated generic Quality of Life (QoL) questionnaire for subjects >= 5 years. Includes 12 domain scores of QoL concepts including physical functioning, social & school activities, mental health, parent/family concepts. Scores range 0-100: lower scores = lower QoL. Change is observed value at Week 16 minus Baseline value.
Baseline, Week 16
Change From Baseline to Week 16 in World Health Organization (WHO) Pulmonary Hypertension (PH) Functional Class
Time Frame: Baseline, Week 16
WHO PH functional class definitions adapted from New York Heart Association Criteria for Functional Capacity and Therapeutic Class Definitions. Class I = PH without resulting limitation of physical activity, Class II = PH resulting in slight limitation of physical activity, Class III = PH resulting in marked limitation of physical activity, Class IV = PH with inability to carry out any physical activity without symptoms. Improved by 1 class = Class 4 to 3, Class 3 to 2, Class 2 to 1. Improved by 2 classes = Class 4 to 2, Class 3 to 1. Change is observed value at Week 16 minus Baseline value.
Baseline, Week 16

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Pfizer's Upjohn has merged with Mylan to form Viatris Inc.

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Helpful Links

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

August 1, 2003

Primary Completion (ACTUAL)

June 1, 2008

Study Completion (ACTUAL)

June 1, 2008

Study Registration Dates

First Submitted

September 8, 2005

First Submitted That Met QC Criteria

September 8, 2005

First Posted (ESTIMATE)

September 12, 2005

Study Record Updates

Last Update Posted (ACTUAL)

February 18, 2021

Last Update Submitted That Met QC Criteria

January 28, 2021

Last Verified

January 1, 2021

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

  • A1481131

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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