The Effect of Additive On-Demand Sildenafil vs. Dextrose Candy on Maximum Exercise Capacity in Pulmonary Arterial Hypertension (Pocket-PH)
The Effect of Additive On-Demand Sildenafil vs. Dextrose Candy on Maximum Exercise Capacity in Pulmonary Arterial Hypertension: A Randomized, Cross-Over Trial.
Studienübersicht
Status
Status
Bedingungen
Bedingungen
Intervention / Behandlung
Intervention / Behandlung
Detaillierte Beschreibung
This study is a prospective, randomized, cross-over trial evaluating the effects of additive 20 mg sildenafil versus placebo/sham dextrose candy on exercise capacity in patients with previously diagnosed pulmonary arterial hypertension (PAH).
PAH is a progressive and debilitating disease characterized by increased mean pulmonary arterial pressure (mPAP) and pulmonary vascular resistance (PVR), leading to right ventricular overload, and ultimately right heart failure. Despite advancements in pharmacological therapy, treatment options remain limited and optimizing individualized approaches to improve exercise capacity and manage symptom burden remains a challenge.
Phosphodiesterase type 5 inhibitors, such as sildenafil, are cornerstones of PAH treatment, enhancing pulmonary vasodilation and improving haemodynamics. While three times daily dosing is standard with three time 20-80mg daily. On-demand additive sildenafil use before exercise has not been studied, but as recent trials have shown that dosing up to three times 80mg is as safe as 20mg, there is a potential that additive therapy may be beneficial. Given sildenafil's rapid onset of action with peak effects after 30-120 minutes, it may offer acute functional benefits regarding maximum workload (Wmax) when administered shortly beforehand, in the terms of a "pill-in-the pocket" intake.
After providing informed consent, eligible participants (aged 18 - 80 years, with PAH diagnosed according to the ESC/ERS 2022/2019 guidelines) will be randomly assigned to receive either 20 mg sildenafil or dextrose candy (Dextro Energy). 45 minutes post-intake, they will undergo incremental spiroergometry (10-20 W increases) and right heart focused stress-echocardiography on a cycle ergometer until exhaustion. After a rest phase of 30 minutes, patients will perform CWRET at 75% of achieved Wmax until exhaustion. Then, after a washout period of minimum 24 hours up to 12 weeks, participants will cross over to the opposite treatment, repeating the same protocol.
In case of a beneficial result, our study could support the use of an additive pill-in-the-pocket therapy strategy which may allow treatment to be tailored to the individual activity demands of patients.
Studientyp
Studientyp
Einschreibung (Geschätzt)
Einschreibung
Phase
Phase
- Phase 2
- Phase 3
Kontakte und Standorte
Studienkontakt
Studienkontakt
- Name: Arcangelo F Carta, MD
- Telefonnummer: +41 44 255 22 20
- E-Mail: arcangelo.carta@usz.ch
Studieren Sie die Kontaktsicherung
- Name: Silvia Ulrich, Prof. MD
- Telefonnummer: +41 44 255 22 21
- E-Mail: silvia.ulrich@usz.ch
Studienorte
-
-
Canton of Zurich
-
Zurich, Canton of Zurich, Schweiz, 8091
- Rekrutierung
- University Hospital of Zurich, Department of Pulmonology
-
Kontakt:
- Arcangelo F Carta, Dr. med.
- Telefonnummer: +41 44 255 22 20
- E-Mail: arcangelo.carta@usz.ch
-
-
Teilnahmekriterien
Zulassungskriterien
Zulassungskriterien
Studienberechtigtes Alter
- Erwachsene
- Älterer Erwachsener
Akzeptiert gesunde Freiwillige
Beschreibung
Inclusion Criteria:
- Signed Informed consent
- Age 18 - 80 years (both sexes)
- Pulmonary hypertension (PH) class I (PAH) previously diagnosed according to ESC/ERS 2022/2019 guidelines (mPAP ≥ 20 mmHg, PVR ≥ 2 WU, PAWP ≤ 15 mmHg) during diagnostic right-heart catheterization.
- Stable condition, on the same PH-medication for >4 weeks
Exclusion Criteria:
- Severe resting hypoxia (PaO2 <7.3 kPa)
- Moderate-to-severe chronic obstructive or restrictive pulmonary disease (FEV1 ≤ 60% predicted, FVC ≤ 60% predicted)
- Women with known pregnancy or breast feeding
- Other clinically significant concomitant disease states (e.g., severe renal or hepatic disease, unstable cardiovascular disease, etc.)
Concurrent medication with:
- Nitric oxide donors (molsidomine, nicrorandil, etc.)
- Soluble guanylate cyclase stimulators (riociguat)
- Potent CYP3A4 inhibitors (azoles, clarithromycin, protease inhibitors)
- History of anterior ischemic optic neuropathy or hereditary retinal disease
- Participation in another study with investigational drug with potential influence the study data within the 30 days preceding and during the present study.
- Known allergies or hypersensitivity to sildenafil 20mg (Revatio 20mg) or dextrose candy (Dextroenergy) including any of its components
Studienplan
Wie ist die Studie aufgebaut?
Designdetails
- Hauptzweck: Behandlung
- Zuteilung: Zufällig
- Interventionsmodell: Crossover-Aufgabe
- Maskierung: Single
Anzahl der Arme
Waffen und Interventionen
Teilnehmergruppe / ArmTeilnehmergruppe / Arm |
Intervention / BehandlungIntervention / Behandlung |
|---|---|
|
Sonstiges: Intervention Order A
Group A will receive the active comparator first (Sildenafil 20mg) in accordance with the Cross-Over trial design.
|
Administration of Dextrose Candy by mouth as a tablet.
Andere Namen:
Administration of Sildenafil 20mg by mouth as a tablet.
Andere Namen:
|
|
Sonstiges: Intervention Order B
Group B will receive the placebo comparator first (Dextrose Candy) in accordance with the Cross-Over trial design.
|
Administration of Dextrose Candy by mouth as a tablet.
Andere Namen:
Administration of Sildenafil 20mg by mouth as a tablet.
Andere Namen:
|
Was misst die Studie?
Primäre Ergebnismessungen
Primäre Ergebnismessungen
Ergebnis Maßnahme |
Maßnahmenbeschreibung |
Zeitfenster |
|---|---|---|
|
Maximum workload (Wmax)
Zeitfenster: Within 1 - 90 days
|
The difference in maximum workload (Wmax) attained during maximum spiroergometry 45 minutes after treatment with Sildenafil 20mg (Revatio 20mg) versus dextrose candy (Dextro Energy).
|
Within 1 - 90 days
|
Sekundäre Ergebnismessungen
Sekundäre Ergebnismessungen
Ergebnis Maßnahme |
Maßnahmenbeschreibung |
Zeitfenster |
|---|---|---|
|
Time to Exhaustion (Tmax)
Zeitfenster: Within 1 - 90 days
|
Difference in Time to Exhaustion (Tmax)attained during CWRET after treatment with Sildenafil 20mg (Revatio 20mg) versus dextrose candy (Dextro Energy)
|
Within 1 - 90 days
|
|
Cardiometabolic parameters (CPET, CWRET): Oxygen Saturation (SpO2)
Zeitfenster: Within 1 - 90 days
|
Change in Oxygen Saturation (SpO2) during CPET / CWRET
|
Within 1 - 90 days
|
|
Focused Stress-Echocardiography (Right Heart): Stroke Volume (SV)
Zeitfenster: Within 1 - 90 days
|
Change in Stroke Volume (SV) during CPET
|
Within 1 - 90 days
|
|
Arterial blood gases: Arterial Partial Pressure of Oxygen (PaO2)
Zeitfenster: Within 1 - 90 days
|
Change in Arterial Partial Pressure of Oxygen (PaO2) during CPET.
|
Within 1 - 90 days
|
|
Borg CR10 (Borg Category-Ratio 10 Scale)
Zeitfenster: Within 1 - 90 days
|
Changes in Borg CR10 questionnaire (Borg Category-Ratio 10 Scale) after CPET / CWRET (0-10, higher values indicate more severe symptoms)
|
Within 1 - 90 days
|
|
Focused Stress-Echocardiography (Right Heart): Tricuspid Regurgitation Pressure Gradient (TRPG)
Zeitfenster: Within 1 - 90 days
|
Change in Tricuspid Regurgitation Pressure Gradient (TRPG) during CPET
|
Within 1 - 90 days
|
|
Cardiometabolic parameters (CPET / CWRET): Blood Pressure (BP)
Zeitfenster: Within 1 - 90 days
|
Change in Blood Pressure (BP) during CPET / CWRET
|
Within 1 - 90 days
|
|
Cardiometabolic parameters (CPET / CWRET): Heart Rate (HR)
Zeitfenster: Within 1 - 90 days
|
Change in Heart Rate (HR) during CPET / CWRET
|
Within 1 - 90 days
|
|
Cardiometabolic parameters (CPET / CWRET): Rate Pressure Product (RPP)
Zeitfenster: Within 1 - 90 days
|
Change in Rate Pressure Product (RPP) during CPET / CWRET
|
Within 1 - 90 days
|
|
Cardiometabolic parameters (CPET / CWRET): Maximum Uptake of Oxygen (V'O2max)
Zeitfenster: Within 1 - 90 days
|
Change Maximum Uptake of Oxygen (V'O2max) during CPET / CWRET
|
Within 1 - 90 days
|
|
Cardiometabolic parameters (CPET / CWRET): Maximum Carbon Dioxide Production (V'CO2max)
Zeitfenster: Within 1 - 90 days
|
Change in Maximum Carbon Dioxide Production (V'CO2max) during CPET / CWRET
|
Within 1 - 90 days
|
|
Cardiometabolic parameters (CPET / CWRET): Maximum Minute Ventilation (V'Emax)
Zeitfenster: Within 1 - 90 days
|
Change in Maximum Minute Ventilation (V'Emax) during CPET / CWRET
|
Within 1 - 90 days
|
|
Cardiometabolic parameters (CPET / CWRET): Maximum Ventilatory Equivalent for Oxygen (V'E/VO2)
Zeitfenster: Within 1 - 90 days
|
Change in Maximum Ventilatory Equivalent for Oxygen (V'E/VO2) during CPET / CWRET
|
Within 1 - 90 days
|
|
Cardiometabolic parameters (CPET / CWRET): Maximum Ventilatory Equivalent for Carbon Dioxide (V'E/VCO2)
Zeitfenster: Within 1 - 90 days
|
Change in Maximum Ventilatory Equivalent for Carbon Dioxide (V'E/VCO2) during CPET / CWRET
|
Within 1 - 90 days
|
|
Cardiometabolic parameters (CPET / CWRET): Breathing Frequency (BF)
Zeitfenster: Within 1 - 90 days
|
Change in Breathing Frequency (BF) during CPET / CWRET
|
Within 1 - 90 days
|
|
Cardiometabolic parameters (CPET / CWRET): Breathing Reserve (BR)
Zeitfenster: Within 1 - 90 days
|
Change in Breathing Reserve (BR) during CPET / CWRET
|
Within 1 - 90 days
|
|
Arterial blood gases: Arterial Partial Pressure of Carbon Dioxide (PaCO2)
Zeitfenster: Within 1 - 90 days
|
Change in Arterial Partial Pressure of Carbon Dioxide (PaCO2) during CPET.
|
Within 1 - 90 days
|
|
Arterial blood gases: Bicarbonate (HCO3-)
Zeitfenster: Within 1 - 90 days
|
Change in Bicarbonate HCO3- before and after CPET.
|
Within 1 - 90 days
|
|
Arterial blood gases: Arterial Oxygen Saturation (SaO2)
Zeitfenster: Within 1 - 90 days
|
Change in Arterial Oxygen Saturation (SaO2) before and after CPET.
|
Within 1 - 90 days
|
|
Arterial blood gases: Base Excess (BE)
Zeitfenster: Within 1 - 90 days
|
Change in Base Excess (BE) before and after CPET.
|
Within 1 - 90 days
|
|
Arterial blood gases: Lactate (lac)
Zeitfenster: Within 1 - 90 days
|
Change in Lactate (lac) concentration before and after CPET.
|
Within 1 - 90 days
|
|
Arterial blood gases: Hemoglobin (Hb)
Zeitfenster: Within 1 - 90 days
|
Change in Hemoglobin (Hb) before and after CPET.
|
Within 1 - 90 days
|
|
Arterial blood gases: Hematocrit (Hct)
Zeitfenster: Within 1 - 90 days
|
Change in Hematocrit (Hct) before and after CPET.
|
Within 1 - 90 days
|
|
Focused Stress-Echocardiography (Right Heart): Tricuspid Regurgitation Velocity (TRV)
Zeitfenster: Within 1 - 90 days
|
Change in Tricuspid Regurgitation Velocity (TRV) during CPET
|
Within 1 - 90 days
|
|
Focused Stress-Echocardiography (Right Heart): Right Atrial Pressure (RAP)
Zeitfenster: Within 1 - 90 days
|
Change in Right Atrial Pressure (RAP) during CPET
|
Within 1 - 90 days
|
|
Focused Stress-Echocardiography (Right Heart): Systolic Pulmonary Arterial Pressure (sPAP)
Zeitfenster: Within 1 - 90 days
|
Change in Systolic Pulmonary Arterial Pressure (sPAP) during CPET
|
Within 1 - 90 days
|
|
Focused Stress-Echocardiography (Right Heart): Fractional Area Change (FAC)
Zeitfenster: Within 1 - 90 days
|
Change in Fractional Area Change (FAC) during CPET
|
Within 1 - 90 days
|
|
Focused Stress-Echocardiography (Right Heart): Tricuspid Annular Plane Systolic Excursion (TAPSE)
Zeitfenster: Within 1 - 90 days
|
Change in Tricuspid Annular Plane Systolic Excursion (TAPSE) during CPET
|
Within 1 - 90 days
|
|
Focused Stress-Echocardiography (Right Heart): Ratio of Tricuspid Regurgitation Pressure Gradient to Cardiac Output (TRPG/CO)
Zeitfenster: Within 1 - 90 days
|
Change in Ratio of Tricuspid Regurgitation Pressure Gradient to Cardiac Output (TRPG/CO) during CPET
|
Within 1 - 90 days
|
|
Focused Stress-Echocardiography (Right Heart): Cardiac Output (CO)
Zeitfenster: Within 1 - 90 days
|
Change in Cardiac Output (CO) during CPET
|
Within 1 - 90 days
|
|
Focused Stress-Echocardiography (Right Heart): Pulmonary Vascular Resistance (PVR)
Zeitfenster: Within 1 - 90 days
|
Change in Pulmonary Vascular Resistance (PVR) during CPET
|
Within 1 - 90 days
|
Andere Ergebnismessungen
Andere Ergebnismessungen
Ergebnis Maßnahme |
Maßnahmenbeschreibung |
Zeitfenster |
|---|---|---|
|
Safety Profile / (S)AEs
Zeitfenster: (S)AEs will be assessed immediately after each intervention (A or B) during the corresponding study visits (1 and 2).
|
Safety and (S)AEs of each Intervention [sildenafil 20mg (Revatio 20mg) and dextrose candy (Dextro Energy)] will be assessed.
|
(S)AEs will be assessed immediately after each intervention (A or B) during the corresponding study visits (1 and 2).
|
Mitarbeiter und Ermittler
Sponsor
Sponsor
Ermittler
Ermittler
- Hauptermittler: Silvia Ulrich, Prof. Dr. med., University of Zurich
- Hauptermittler: Arcangelo F Carta, Dr. med., University of Zurich
Studienaufzeichnungsdaten
Haupttermine studieren
Studienbeginn (Geschätzt)
Studienbeginn
Primärer Abschluss (Geschätzt)
Primärer Abschluss
Studienabschluss (Geschätzt)
Studienabschluss
Studienanmeldedaten
Zuerst eingereicht
Zuerst eingereicht
Zuerst eingereicht, das die QC-Kriterien erfüllt hat
Zuerst eingereicht, das die QC-Kriterien erfüllt hat
Zuerst gepostet (Tatsächlich)
Zuerst gepostet
Studienaufzeichnungsaktualisierungen
Letztes Update gepostet (Tatsächlich)
Letztes Update gepostet
Letztes eingereichtes Update, das die QC-Kriterien erfüllt
Letztes eingereichtes Update, das die QC-Kriterien erfüllt
Zuletzt verifiziert
Zuletzt verifiziert
Mehr Informationen
Begriffe im Zusammenhang mit dieser Studie
Schlüsselwörter
Zusätzliche relevante MeSH-Bedingungen
- Erkrankungen der Atemwege
- Lungenkrankheit
- Bluthochdruck, Lungen
- Pulmonale Hypertonie
- Schwefelverbindungen
- Organische Chemikalien
- Heterocyclische Verbindungen, 1-Ring
- Heterocyclische Verbindungen
- Heterocyclische Verbindungen, 2-Ring
- Heterocyclische Verbindungen, Fusionsring
- Kohlenhydrate
- Amides
- Purines
- Zucker
- Sulfonamide
- Sulfone
- Piperazines
- Hexosen
- Monosaccharide
- Sildenafil Citrat
- Glucose
Andere Studien-ID-Nummern
Andere Studien-ID-Nummern
- KEK-ZH-Nr. 2025-02557
Plan für individuelle Teilnehmerdaten (IPD)
Planen Sie, individuelle Teilnehmerdaten (IPD) zu teilen?
Beschreibung des IPD-Plans
Arzneimittel- und Geräteinformationen, Studienunterlagen
Studiert ein von der US-amerikanischen FDA reguliertes Arzneimittelprodukt
Studiert ein von der US-amerikanischen FDA reguliertes Geräteprodukt
Produkt, das in den USA hergestellt und aus den USA exportiert wird
Diese Informationen wurden ohne Änderungen direkt von der Website clinicaltrials.gov abgerufen. Wenn Sie Ihre Studiendaten ändern, entfernen oder aktualisieren möchten, wenden Sie sich bitte an register@clinicaltrials.gov. Sobald eine Änderung auf clinicaltrials.gov implementiert wird, wird diese automatisch auch auf unserer Website aktualisiert .