Open-label, Clinical Study to Evaluate the Safety and Tolerability of TreT in Subjects With PAH Currently Using Tyvaso (BREEZE)

An Open-label, Clinical Study to Evaluate the Safety and Tolerability of Treprostinil Inhalation Powder (TreT) in Subjects With Pulmonary Arterial Hypertension Currently Using Tyvaso

This is a Phase 1b safety and tolerability single-sequence study in which PAH subjects on a stable regimen of Tyvaso will switch to a corresponding dose of TreT.

Study Overview

• Status: Completed
• Conditions: Pulmonary Arterial Hypertension
• Intervention / Treatment: Drug: Treprostinil Inhalation Powder

Detailed Description

United Therapeutics Corporation (UTC) is developing a combination drug-device product which is comprised of a dry powder formulation of Treprostinil Inhalation Powder (TreT) and a small, portable, dry powder inhaler. In this Phase 1b safety and tolerability study, patients with PAH on a stable dose of Tyvaso (6 to 12 breaths 4 times daily [QID]) will be evaluated after switching to a corresponding dose of TreT. Patients will undergo PK assessments, safety assessments, a 6-Minute Walk Test (6MWT), and questionnaires for satisfaction/preference for inhaled devices and patient-reported PAH symptoms and impact. Following 3 weeks of treatment with TreT, patients will be offered the opportunity to participate in the Optional Extension Phase until the study terminates or the drug/device becomes commercially available.

• Study Type: Interventional
• Enrollment (Actual): 51
• Phase: Phase 1

Contacts and Locations

Study Locations

• United States
  • Alabama
    • Birmingham, Alabama, United States, 35233
      • University of Alabama at Birmingham
  • California
    • Los Angeles, California, United States, 90073
      • Department of Veterans Affairs Greater Los Angeles Healthcare System
  • Florida
    • Jacksonville, Florida, United States, 32224
      • Mayo Clinic Jacksonville
    • Jacksonville, Florida, United States, 32204
      • Ascension/ St. Vincent's Lung Institute
    • Tampa, Florida, United States, 33606
      • University of South Florida
    • Weston, Florida, United States, 33331
      • Cleveland Clinic Florida
  • Georgia
    • Atlanta, Georgia, United States, 30322
      • Emory University Hospital
  • Kansas
    • Kansas City, Kansas, United States, 66160
      • The University of Kansas Medical Center
  • Kentucky
    • Louisville, Kentucky, United States, 40202
      • University of Louisville Pulmonary Research
  • Louisiana
    • New Orleans, Louisiana, United States, 70121
      • Ochsner Medical Center
  • Maryland
    • Baltimore, Maryland, United States, 21201
      • Univ of MD Medical Center
  • Pennsylvania
    • Philadelphia, Pennsylvania, United States, 19104
      • Penn Medicine University City
  • Texas
    • Dallas, Texas, United States, 75390
      • UT Southwestern Medical Center
    • Houston, Texas, United States, 77030
      • Houston Methodist
  • Virginia
    • Norfolk, Virginia, United States, 23507
      • Sentara Norfolk General Hospital
    • Richmond, Virginia, United States, 23230
      • Pulmonary Associates of Richmond

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Subject voluntarily gives informed consent to participate in the study.
2. Subject is aged 18 years or older at the time of signing informed consent.

3. Women of childbearing potential are those who have experienced menarche and who have not undergone successful surgical sterilization (hysterectomy, bilateral tubal ligation, or bilateral oophorectomy) or are not postmenopausal (defined as amenorrhea for at least 12 consecutive months). WOCBP must be nonpregnant (as confirmed by a urine pregnancy test at Screening prior to initiating study medication), nonlactating, and will do 1 of the following:

   1. Abstain from intercourse (when it is in line with their preferred and usual lifestyle), or
   2. Use 2 medically acceptable, highly effective forms of contraception for the duration of study, and at least 30 days after discontinuing TreT. Medically acceptable, highly effective forms of contraception can include approved hormonal contraceptives (oral, injectable, and implantable), intrauterine devices or systems, and barrier methods (such as a condom or diaphragm) when used with a spermicide.
4. Males with a partner of childbearing potential must use a condom for the duration of treatment and for at least 48 hours after discontinuing TreT.

5. Subject is diagnosed with PAH as defined by the following World Health Organization (WHO) Group 1 categories:

   1. Idiopathic/familial
   2. Associated with unrepaired or repaired congenital systemic-to-pulmonary shunts (repaired ≥5 years prior to screening)
   3. Associated with collagen vascular disease
   4. Associated with human immunodeficiency virus
   5. Associated with appetite suppressant/other drug or toxin use
6. Subject must have started Tyvaso ≥3 months prior to the Baseline Visit and must currently be on a stable regimen (no change in dose within 30 days of Baseline Visit) of Tyvaso (6 to 12 breaths QID).
7. Baseline 6MWD ≥150 m.
8. If currently receiving other approved background therapy (eg, endothelin receptor antagonist or phosphodiesterase type 5 inhibitor or both), the subject must be on a stable dose with no additions or discontinuations for a minimum of 30 days prior to Screening.
9. The subject has had evidence of forced expiratory volume in 1 second (FEV1) ≥60% and FEV1/forced vital capacity ratio ≥60% during the 6 months prior to enrollment.
10. In the opinion of the Investigator, the subject is able to communicate effectively with study personnel, and is considered reliable, willing, and likely to be cooperative with protocol requirements, including all study visits.

Exclusion Criteria:

1. Subject is pregnant or lactating.
2. Subject has been diagnosed with pulmonary hypertension for reasons other than WHO Group 1 as outlined in Inclusion Criterion 5 (including but not limited to portal hypertension, chronic thromboembolic disease, pulmonary veno-occlusive disease, hemolytic anemia, sarcoidosis).
3. Subject has a history of uncontrolled sleep apnea, parenchymal lung disease, or hemodynamically significant left-sided heart disease (including but not limited to aortic or mitral valve disease, pericardial constriction, restrictive or congestive cardiomyopathy, or coronary artery disease).
4. Subject is currently taking any other prostacyclin analogue or agonist, including but not limited to selexipag, epoprostenol, iloprost, or beraprost; except for acute vasoreactivity testing.
5. Subject experienced an acute exacerbation of disease or hospitalization for any reason within 30 days of the Screening Visit or between Screening and Baseline.
6. Subject is WHO Functional Class IV at Screening.
7. Subject has used any investigational drug/device or participated in any other investigational study with therapeutic intent within 30 days prior to the Screening Visit.
8. Subject has a history of anaphylaxis, a documented hypersensitivity reaction, or a clinically significant idiosyncratic reaction to treprostinil or excipients in the investigational product.
9. Subject has conditions that, in the opinion of the Investigator, would make the subject ineligible.
10. Subject is not able to perform inhalation maneuvers that meet inspiratory training criteria.
11. Subject has a musculoskeletal disorder (eg, arthritis affecting the lower limbs, recent hip or knee joint replacement) or any disease that would likely be the primary limit to ambulation, or is connected to a machine that is not portable enough to allow for a 6MWT.
12. Subject has had a new type of chronic therapy (including but not limited to oxygen, a different class of vasodilator, diuretic, and digoxin) for pulmonary hypertension added within 30 days of the Screening Phase.
13. Initiation of pulmonary rehabilitation within 12 weeks prior to the Baseline Visit.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Tyvaso to TreT; Each subject will receive a corresponding dose of TreT for 3 weeks during the Treatment Phase based on the subject's current stable Tyvaso dose.	Drug: Treprostinil Inhalation Powder; Treprostinil inhalation powder single-use cartridges containing either 32 or 48 micrograms of treprostinil per cartridge (QID); Other Names: TreT

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of subjects with treatment-emergent adverse events [Safety and Tolerability]	The safety and tolerability of TreT in subjects with PAH currently treated with Tyvaso will be evaluated by the number of subjects with treatment-emergent adverse events	3 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Analysis of treprostinil plasma concentration (pharmacokinetics [PK])	Systemic exposure of treprostinil will be evaluated in subjects with PAH when delivered as Tyvaso and TreT	Serial PK measurements at Baseline and Week 3
Change in 6-Minute Walk Distance (6MWD) from Baseline to Week 3	6MWD will be evaluated at study entry and after 3 weeks of treatment with TreT	After 3 weeks of treatment with TreT
Number of subjects with treatment-emergent adverse events [Long-term Safety and Tolerability] during an Optional Extension Phase	The long-term safety and tolerability of TreT in subjects with PAH currently treated with Tyvaso will be evaluated by the number of subjects with treatment-emergent adverse events during an Optional Extension Phase of the study	Every 4 weeks beginning on Week 7 until study termination, an average of 1 year
Subject satisfaction with and preference for inhaled treprostinil devices	Subject satisfaction with and preference for inhaled treprostinil devices will be evaluated with the Preference Questionnaire for Inhaled Treprostinil Devices (PQ-ITD)	At Baseline (Tyvaso Inhalation System) and after 3 weeks of treatment (TreT Inhaler)
Patient-reported PAH symptoms and impact	Patient-reported PAH symptoms and impact will be evaluated with the PAH Symptoms and Impact (PAH-SYMPACT) Questionnaire	After 3 weeks and 11 weeks (for subjects participating in the Optional Extension Phase) of treatment with TreT

Collaborators and Investigators

• Sponsor: United Therapeutics

Publications and helpful links

General Publications

• Spikes LA, Bajwa AA, Burger CD, Desai SV, Eggert MS, El-Kersh KA, Fisher MR, Johri S, Joly JM, Mehta J, Palevsky HI, Ramani GV, Restrepo-Jaramillo R, Sahay S, Shah TG, Deng C, Miceli M, Smith P, Shapiro SM. BREEZE: Open-label clinical study to evaluate the safety and tolerability of treprostinil inhalation powder as Tyvaso DPI in patients with pulmonary arterial hypertension. Pulm Circ. 2022 Apr 7;12(2):e12063. doi: 10.1002/pul2.12063. eCollection 2022 Apr.

Study record dates

Study Major Dates

• Study Start (Actual): September 17, 2019
• Primary Completion (Actual): August 22, 2023
• Study Completion (Actual): August 22, 2023

Study Registration Dates

• First Submitted: May 9, 2019
• First Submitted That Met QC Criteria: May 13, 2019
• First Posted (Actual): May 15, 2019

Study Record Updates

• Last Update Posted (Estimated): January 24, 2024
• Last Update Submitted That Met QC Criteria: January 23, 2024
• Last Verified: January 1, 2024

More Information

Terms related to this study

• Keywords: prostacyclin
• Additional Relevant MeSH Terms: Cardiovascular Diseases; Vascular Diseases; Respiratory Tract Diseases; Lung Diseases; Hypertension, Pulmonary; Hypertension; Pulmonary Arterial Hypertension; Familial Primary Pulmonary Hypertension; Antihypertensive Agents; Treprostinil
• Other Study ID Numbers: TIP-PH-101

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No