- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03236818
Goal Oriented Strategy to Preserve Ejection Fraction Trial (GOSPEL)
Raising the Bars in the Treatment of Pulmonary Arterial Hypertension: Goal Oriented Strategy to Preserve Ejection Fraction Trial
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Rationale:
The current strategy in patients with pulmonary arterial hypertension (PAH)is to improve exercise capacity which can be achieved by decreasing pulmonary vascular resistance (PVR) and subsequently increasing cardiac output (CO). Despite this load reduction, a substantial proportion of patients show progressive right ventricular (RV) dysfunction leading to clinical worsening and death. A possible explanation is that current therapies show a relatively modest reduction in PVR, leaving mean pulmonary artery pressure (mPAP) unchanged. As a consequence RV work, defined as the product of CO and mPAP increases, contributing to progressive RV dysfunction.
Hypothesis:
A goal oriented therapeutic strategy that is able to preserve RV function will result in improved clinical outcome. RV function can only be preserved when early and aggressive combination therapy not only reduces PVR but also mPAP.
Study questions:
- Will a goal oriented strategy to preserve/improve RV function, measured by right ventricular ejection fraction (RVEF) be effective?
- Does early and aggressive combination therapy result in improved RV function and survival during long term follow-up?
- Does a strategy to preserve RVEF also translate into improvements of other clinically meaningful parameters?
- Can RVEF be replaced by more simple measures?
- Will a goal oriented strategy to improve RVEF also lead to improvement of myocardial performances and coupling of the RV to its load?
Study design and study population:
In this prospective longitudinal feasibility study, thirty newly diagnosed idiopathic or heritable PAH patients with New York Heart Association (NYHA) functional class II or III will be included. Maintenance/improvement of RVEF will be our primary outcome parameter and therefore cardiac magnetic resonance imaging (CMR) will be performed at baseline and at 4, 8 , 12 and 24 months of follow-up. Six-minute walk testing (6MWT), quality of life questionnaires and blood sampling (NT-proBNP) will be performed at similar follow-up intervals. In addition, right heart catheterization (RHC) will be performed at baseline, after 4, 12 and 24 months of follow-up.
NYHA II patients will start with single agent medical treatment whereas patients with NYHA III will start on combination therapy (2 treatments). In case of a stable/improved RVEF during each follow-up measurement (defined as no decrease in RVEF >3% compared to previous measurement), the treatment strategy will remain unchanged. In case of decreased RVEF >3%, additional medical therapy will be added. Our hypothesis will prove to be correct when the additional medical treatment result in improved RVEF during the subsequent follow-up measurement.
Study Type
Enrollment (Anticipated)
Phase
- Phase 4
Contacts and Locations
Study Locations
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Amsterdam, Netherlands, 1081 HV
- VU University Medical Center, dept Pulmonary diseases
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Idiopathic or heritable pulmonary arterial hypertension
- New York Heart Association (NYHA) functional class II or III
Exclusion Criteria:
- Other causes of pulmonary arterial hypertension (i.e. collagen vascular disease, congenital heart disease, chrono-thromboembolic pulmonary hypertension, pulmonary venous hypertension, left heart failure, hypoxemic lung disease)
- Pulmonary arterial hypertension targeted therapies before study inclusion
Study Plan
How is the study designed?
Design Details
- Primary Purpose: TREATMENT
- Allocation: NA
- Interventional Model: SINGLE_GROUP
- Masking: NONE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
OTHER: Upfront combination therapy
Combination of an ERA and PDE-5I (Sildenafil, Tadalafil, Bosentan, Macitentan)
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Combination of an ERA and PDE-5I (Sildenafil, Tadalafil, Bosentan, Macitentan)
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in right ventricular ejection fraction
Time Frame: 4,12, 24 months of follow-up
|
The primary endpoint will be change in right ventricular ejection fraction (RVEF) during 2 years of follow-up.
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4,12, 24 months of follow-up
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
pulmonary vascular resistance
Time Frame: 4,12, 24 months of follow-up
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Change in pulmonary vascular resistance
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4,12, 24 months of follow-up
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mPAP
Time Frame: 4,12, 24 months of follow-up
|
Change in mPAP
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4,12, 24 months of follow-up
|
Cardiac output in L/min (Thermodilution method)
Time Frame: 4,8, 12, 24 months of follow-up
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Change in cardiac output
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4,8, 12, 24 months of follow-up
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Exercise capacity
Time Frame: 4,8, 12, 24 months of follow-up
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Change in exercise capacity
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4,8, 12, 24 months of follow-up
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New York Heart Association functional class
Time Frame: 4,8, 12, 24 months of follow-up
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Change in New York Heart Association functional class
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4,8, 12, 24 months of follow-up
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
NT-proBNP
Time Frame: 4,8, 12, 24 months of follow-up
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Change in NT-proBNP
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4,8, 12, 24 months of follow-up
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Quality of Life by SF-36 questionnaire
Time Frame: 4,8, 12, 24 months of follow-up
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Change in Quality of Life
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4,8, 12, 24 months of follow-up
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Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Anton Vonk Noordegraaf, MD, PhD, VU University Medical Center, department of pulmonary diseases
Study record dates
Study Major Dates
Study Start
Primary Completion (ANTICIPATED)
Study Completion (ANTICIPATED)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (ACTUAL)
Study Record Updates
Last Update Posted (ACTUAL)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Cardiovascular Diseases
- Vascular Diseases
- Respiratory Tract Diseases
- Lung Diseases
- Hypertension, Pulmonary
- Hypertension
- Pulmonary Arterial Hypertension
- Familial Primary Pulmonary Hypertension
- Molecular Mechanisms of Pharmacological Action
- Antihypertensive Agents
- Vasodilator Agents
- Urological Agents
- Enzyme Inhibitors
- Phosphodiesterase Inhibitors
- Phosphodiesterase 5 Inhibitors
- Endothelin Receptor Antagonists
- Endothelin A Receptor Antagonists
- Endothelin B Receptor Antagonists
- Sildenafil Citrate
- Tadalafil
- Bosentan
- Macitentan
Other Study ID Numbers
- NL41878.029.13
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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