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.
Panoramica dello studio
Stato
Stato
Condizioni
Condizioni
Intervento / Trattamento
Intervento / Trattamento
Descrizione dettagliata
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.
Tipo di studio
Tipo di studio
Iscrizione (Stimato)
Iscrizione
Fase
Fase
- Fase 2
- Fase 3
Contatti e Sedi
Contatto studio
Contatto studio
- Nome: Arcangelo F Carta, MD
- Numero di telefono: +41 44 255 22 20
- Email: arcangelo.carta@usz.ch
Backup dei contatti dello studio
- Nome: Silvia Ulrich, Prof. MD
- Numero di telefono: +41 44 255 22 21
- Email: silvia.ulrich@usz.ch
Luoghi di studio
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Canton of Zurich
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Zurich, Canton of Zurich, Svizzera, 8091
- Reclutamento
- University Hospital of Zurich, Department of Pulmonology
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Contatto:
- Arcangelo F Carta, Dr. med.
- Numero di telefono: +41 44 255 22 20
- Email: arcangelo.carta@usz.ch
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-
Criteri di partecipazione
Criteri di ammissibilità
Criteri di ammissibilità
Età idonea allo studio
- Adulto
- Adulto più anziano
Accetta volontari sani
Descrizione
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
Piano di studio
Come è strutturato lo studio?
Dettagli di progettazione
- Scopo principale: Trattamento
- Assegnazione: Randomizzato
- Modello interventistico: Assegnazione incrociata
- Mascheramento: Separare
Numero di armi
Armi e interventi
Gruppo di partecipanti / ArmGruppo di partecipanti / Arm |
Intervento / TrattamentoIntervento / Trattamento |
|---|---|
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Altro: Intervention Order A
Group A will receive the active comparator first (Sildenafil 20mg) in accordance with the Cross-Over trial design.
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Administration of Dextrose Candy by mouth as a tablet.
Altri nomi:
Administration of Sildenafil 20mg by mouth as a tablet.
Altri nomi:
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Altro: Intervention Order B
Group B will receive the placebo comparator first (Dextrose Candy) in accordance with the Cross-Over trial design.
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Administration of Dextrose Candy by mouth as a tablet.
Altri nomi:
Administration of Sildenafil 20mg by mouth as a tablet.
Altri nomi:
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Cosa sta misurando lo studio?
Misure di risultato primarie
Misure di risultato primarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
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Maximum workload (Wmax)
Lasso di tempo: Within 1 - 90 days
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The difference in maximum workload (Wmax) attained during maximum spiroergometry 45 minutes after treatment with Sildenafil 20mg (Revatio 20mg) versus dextrose candy (Dextro Energy).
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Within 1 - 90 days
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Misure di risultato secondarie
Misure di risultato secondarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
|
Time to Exhaustion (Tmax)
Lasso di tempo: 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)
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Within 1 - 90 days
|
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Cardiometabolic parameters (CPET, CWRET): Oxygen Saturation (SpO2)
Lasso di tempo: Within 1 - 90 days
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Change in Oxygen Saturation (SpO2) during CPET / CWRET
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Within 1 - 90 days
|
|
Focused Stress-Echocardiography (Right Heart): Stroke Volume (SV)
Lasso di tempo: Within 1 - 90 days
|
Change in Stroke Volume (SV) during CPET
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Within 1 - 90 days
|
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Arterial blood gases: Arterial Partial Pressure of Oxygen (PaO2)
Lasso di tempo: Within 1 - 90 days
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Change in Arterial Partial Pressure of Oxygen (PaO2) during CPET.
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Within 1 - 90 days
|
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Borg CR10 (Borg Category-Ratio 10 Scale)
Lasso di tempo: Within 1 - 90 days
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Changes in Borg CR10 questionnaire (Borg Category-Ratio 10 Scale) after CPET / CWRET (0-10, higher values indicate more severe symptoms)
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Within 1 - 90 days
|
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Focused Stress-Echocardiography (Right Heart): Tricuspid Regurgitation Pressure Gradient (TRPG)
Lasso di tempo: Within 1 - 90 days
|
Change in Tricuspid Regurgitation Pressure Gradient (TRPG) during CPET
|
Within 1 - 90 days
|
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Cardiometabolic parameters (CPET / CWRET): Blood Pressure (BP)
Lasso di tempo: Within 1 - 90 days
|
Change in Blood Pressure (BP) during CPET / CWRET
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Within 1 - 90 days
|
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Cardiometabolic parameters (CPET / CWRET): Heart Rate (HR)
Lasso di tempo: Within 1 - 90 days
|
Change in Heart Rate (HR) during CPET / CWRET
|
Within 1 - 90 days
|
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Cardiometabolic parameters (CPET / CWRET): Rate Pressure Product (RPP)
Lasso di tempo: Within 1 - 90 days
|
Change in Rate Pressure Product (RPP) during CPET / CWRET
|
Within 1 - 90 days
|
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Cardiometabolic parameters (CPET / CWRET): Maximum Uptake of Oxygen (V'O2max)
Lasso di tempo: Within 1 - 90 days
|
Change Maximum Uptake of Oxygen (V'O2max) during CPET / CWRET
|
Within 1 - 90 days
|
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Cardiometabolic parameters (CPET / CWRET): Maximum Carbon Dioxide Production (V'CO2max)
Lasso di tempo: Within 1 - 90 days
|
Change in Maximum Carbon Dioxide Production (V'CO2max) during CPET / CWRET
|
Within 1 - 90 days
|
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Cardiometabolic parameters (CPET / CWRET): Maximum Minute Ventilation (V'Emax)
Lasso di tempo: Within 1 - 90 days
|
Change in Maximum Minute Ventilation (V'Emax) during CPET / CWRET
|
Within 1 - 90 days
|
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Cardiometabolic parameters (CPET / CWRET): Maximum Ventilatory Equivalent for Oxygen (V'E/VO2)
Lasso di tempo: Within 1 - 90 days
|
Change in Maximum Ventilatory Equivalent for Oxygen (V'E/VO2) during CPET / CWRET
|
Within 1 - 90 days
|
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Cardiometabolic parameters (CPET / CWRET): Maximum Ventilatory Equivalent for Carbon Dioxide (V'E/VCO2)
Lasso di tempo: Within 1 - 90 days
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Change in Maximum Ventilatory Equivalent for Carbon Dioxide (V'E/VCO2) during CPET / CWRET
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Within 1 - 90 days
|
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Cardiometabolic parameters (CPET / CWRET): Breathing Frequency (BF)
Lasso di tempo: Within 1 - 90 days
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Change in Breathing Frequency (BF) during CPET / CWRET
|
Within 1 - 90 days
|
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Cardiometabolic parameters (CPET / CWRET): Breathing Reserve (BR)
Lasso di tempo: Within 1 - 90 days
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Change in Breathing Reserve (BR) during CPET / CWRET
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Within 1 - 90 days
|
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Arterial blood gases: Arterial Partial Pressure of Carbon Dioxide (PaCO2)
Lasso di tempo: Within 1 - 90 days
|
Change in Arterial Partial Pressure of Carbon Dioxide (PaCO2) during CPET.
|
Within 1 - 90 days
|
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Arterial blood gases: Bicarbonate (HCO3-)
Lasso di tempo: Within 1 - 90 days
|
Change in Bicarbonate HCO3- before and after CPET.
|
Within 1 - 90 days
|
|
Arterial blood gases: Arterial Oxygen Saturation (SaO2)
Lasso di tempo: Within 1 - 90 days
|
Change in Arterial Oxygen Saturation (SaO2) before and after CPET.
|
Within 1 - 90 days
|
|
Arterial blood gases: Base Excess (BE)
Lasso di tempo: Within 1 - 90 days
|
Change in Base Excess (BE) before and after CPET.
|
Within 1 - 90 days
|
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Arterial blood gases: Lactate (lac)
Lasso di tempo: Within 1 - 90 days
|
Change in Lactate (lac) concentration before and after CPET.
|
Within 1 - 90 days
|
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Arterial blood gases: Hemoglobin (Hb)
Lasso di tempo: Within 1 - 90 days
|
Change in Hemoglobin (Hb) before and after CPET.
|
Within 1 - 90 days
|
|
Arterial blood gases: Hematocrit (Hct)
Lasso di tempo: 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)
Lasso di tempo: 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)
Lasso di tempo: 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)
Lasso di tempo: 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)
Lasso di tempo: 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)
Lasso di tempo: Within 1 - 90 days
|
Change in Tricuspid Annular Plane Systolic Excursion (TAPSE) during CPET
|
Within 1 - 90 days
|
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Focused Stress-Echocardiography (Right Heart): Ratio of Tricuspid Regurgitation Pressure Gradient to Cardiac Output (TRPG/CO)
Lasso di tempo: Within 1 - 90 days
|
Change in Ratio of Tricuspid Regurgitation Pressure Gradient to Cardiac Output (TRPG/CO) during CPET
|
Within 1 - 90 days
|
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Focused Stress-Echocardiography (Right Heart): Cardiac Output (CO)
Lasso di tempo: Within 1 - 90 days
|
Change in Cardiac Output (CO) during CPET
|
Within 1 - 90 days
|
|
Focused Stress-Echocardiography (Right Heart): Pulmonary Vascular Resistance (PVR)
Lasso di tempo: Within 1 - 90 days
|
Change in Pulmonary Vascular Resistance (PVR) during CPET
|
Within 1 - 90 days
|
Altre misure di risultato
Altre misure di risultato
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
|
Safety Profile / (S)AEs
Lasso di tempo: (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).
|
Collaboratori e investigatori
Sponsor
Sponsor
Investigatori
Investigatori
- Investigatore principale: Silvia Ulrich, Prof. Dr. med., University of Zurich
- Investigatore principale: Arcangelo F Carta, Dr. med., University of Zurich
Studiare le date dei record
Studia le date principali
Inizio studio (Stimato)
Inizio studio
Completamento primario (Stimato)
Completamento primario
Completamento dello studio (Stimato)
Completamento dello studio
Date di iscrizione allo studio
Primo inviato
Primo inviato
Primo inviato che soddisfa i criteri di controllo qualità
Primo inviato che soddisfa i criteri di controllo qualità
Primo Inserito (Effettivo)
Primo Inserito
Aggiornamenti dei record di studio
Ultimo aggiornamento pubblicato (Effettivo)
Ultimo aggiornamento pubblicato
Ultimo aggiornamento inviato che soddisfa i criteri QC
Ultimo aggiornamento inviato che soddisfa i criteri QC
Ultimo verificato
Ultimo verificato
Maggiori informazioni
Termini relativi a questo studio
Parole chiave
Termini MeSH pertinenti aggiuntivi
- Malattie delle vie respiratorie
- Malattie polmonari
- Ipertensione, polmonare
- Ipertensione arteriosa polmonare
- Composti di zolfo
- Prodotti chimici organici
- Composti eterociclici, 1-anello
- Composti eterociclici
- Composti eterociclici, 2 anelli
- Composti eterociclici, anello fuso
- Carboidrati
- Amides
- Purine
- Zuccheri
- Sulfonamidi
- Solfoni
- Piperazines
- Esosi
- Monosaccaridi
- Citrato di sildenafil
- Glucosio
Altri numeri di identificazione dello studio
Altri numeri di identificazione dello studio
- KEK-ZH-Nr. 2025-02557
Piano per i dati dei singoli partecipanti (IPD)
Hai intenzione di condividere i dati dei singoli partecipanti (IPD)?
Descrizione del piano IPD
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