Riociguat for pulmonary arterial hypertension associated with congenital heart disease

Abstract

Objective: The Pulmonary Arterial hyperTENsion sGC-stimulator Trial-1 (PATENT-1) was a randomised, double-blind, placebo-controlled phase III trial evaluating riociguat in patients with pulmonary arterial hypertension (PAH). PATENT-2 was an open-label long-term extension to PATENT-1. Here, we explore the efficacy and safety of riociguat in the subgroup of patients with persistent/recurrent PAH after correction of congenital heart disease (PAH-CHD) from the PATENT studies.

Methods: In PATENT-1, patients received riociguat (maximum 2.5 or 1.5 mg three times daily) or placebo for 12 weeks; efficacy assessments included change from baseline to study end in 6-min walking distance (6MWD; primary), pulmonary vascular resistance (PVR), N-terminal of the prohormone of brain natriuretic peptide (NT-proBNP), WHO functional class (WHO FC) and time to clinical worsening. In PATENT-2, eligible patients from PATENT-1 received long-term riociguat (maximum 2.5 mg three times daily); the primary assessment was safety and tolerability. All PAH-CHD patients had a corrected cardiac defect.

Results: In PATENT-1, riociguat increased mean±SD 6MWD from baseline to week 12 by 39±60 m in patients with PAH-CHD versus 0±42 m for placebo. Riociguat also improved several secondary variables versus placebo, including PVR (-250±410 vs -66±632 dyn·s/cm(5)), NT-proBNP (-164±317 vs -46±697 pg/mL) and WHO FC (21%/79%/0% vs 8%/83%/8% improved/stabilised/worsened). One patient experienced clinical worsening (riociguat 1.5 mg group). Riociguat was well tolerated. In PATENT-2, riociguat showed sustained efficacy and tolerability in patients with PAH-CHD at 2 years.

Conclusions: Riociguat was well tolerated in patients with PAH-CHD and improved clinical outcomes including 6MWD, PVR, WHO FC and NT-proBNP.

Trial registration number: The clinical trials numbers are NCT00810693 for PATENT-1 and NCT00863681 for PATENT-2.

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Figures

Figure 1

Change from baseline in 6-min walking distance (6MWD) in the subgroup of patients with pulmonary arterial hypertension associated with congenital heart disease in Pulmonary Arterial hyperTENsion sGC-stimulator Trial-1 (PATENT-1; A) and PATENT-2 (B). Data are observed values (mean±SEM).

Figure 2

Change from baseline in 6-min walking distance (6MWD) in treatment-naïve and pretreated patients with pulmonary arterial hypertension associated with congenital heart disease in Pulmonary Arterial hyperTENsion sGC-stimulator Trial-1. Data are observed values (mean±SEM).

Figure 3

Box plots for dose-normalised area under the plasma concentration–time curve (AUC; A) and maximum riociguat plasma concentration (Cmax; B) in patients with pulmonary arterial hypertension associated with congenital heart disease (PAH-CHD) and patients with other PAH aetiologies in the Pulmonary Arterial hyperTENsion sGC-stimulator Trial-1 population. Plots show the fifth, 25th, 50th, 75th and 95th percentiles. Grey boxes represent patients with PAH-CHD and black boxes represent patients with other PAH aetiologies.