Efficacy and Safety of Upfront Combination of ΒΟsentan and ΤΑdalafil in Pulmonary Arterial Hypertension (BOTA-PAH)
2018年1月24日 更新者：Elpen Pharmaceutical Co. Inc.
An Observational, Non-interventional, Multicenter Study to Evaluate the Efficacy and Safety of Upfront Combination of Bosentan and Tadalafil in Pulmonary Arterial Hypertension in Greek Patients
The development of disease-targeted drugs for the treatment of pulmonary arterial hypertension (PAH) has significantly improved within the last years.
Combining drug products with different mechanisms of action such as Endothelin-Receptor-Antagonists (ERAs) and Phosphodiesterase-Type-5-inhibitors (PDE-5-Inhibitors) has become increasingly important for the treatment of PAH.
Recently, the results of the AMBITION study reported that an upfront combination treatment of ambrisentan and tadalafil immediately after diagnosis leads to a delayed disease progression.
On the other hand, the sequential combination of bosentan and sildenafil did not show a similar positive clinical effect and this was attributed to a negative clinically relevant pharmacodynamic drug-drug interaction.
Although, recent guidelines have extrapolated that initial upfront combination treatment follows a class effect in terms of efficacy and safety, there is an imperative need to support this notion with other combinations of ERAs and PDE-5-Inhibitors.
調査の概要
状態
引きこもった
条件
詳細な説明
The primary objective of BOTA study is to compare the change in clinical and hemodynamic measures of PAH after the initiation of first line combination therapy with bosentan and tadalafil in adult patients with PAH. The safety and tolerability of first line combination therapy will also be evaluated.
In patients with PAH initial upfront combination treatment with bosentan and tadalafil
Improves
- Exercise capacity as expressed by distance walked in six minute walk test and WHO functional class
- Hemodynamics in terms of pulmonary vascular resistance (PVR), mean pulmonary artery pressure (mPAP) reduction and cardiac index (CI) elevation
- Quality of life
- NTproBNP serum levels
- Echocardiographic prognostic parameters such as right atrial area and presence of pericardial effusion.
Is safe as assessed by
- Liver function markers such as serum SGOT and SGPT levels
- Hemoglobin levels
研究の種類
観察的
参加基準
研究者は、適格基準と呼ばれる特定の説明に適合する人を探します。これらの基準のいくつかの例は、人の一般的な健康状態または以前の治療です。
適格基準
就学可能な年齢
18年～75年 (大人、高齢者)
健康ボランティアの受け入れ
なし
受講資格のある性別
全て
サンプリング方法
非確率サンプル
調査対象母集団
Newly diagnosed patients with PAH
説明
Inclusion Criteria:
Male or females between 18 to 75 years of age at inclusion
Diagnosis of PAH due to the following:
- Idiopathic Primary Pulmonary Arterial Hypertension (IPAH)
- Hereditary PAH
- PAH secondary to connective tissue disease
- PAH diagnosis confirmed by right heart catheterization performed within 3 months prior to study enrolment Subjects must weigh at least 40 kg at inclusion Subject must have a current diagnosis of being in World Health Organisation (WHO) Functional Class II or III.
Treatment PAH naïve subjects PAH documented by
- mPAP ≥25mmHg,
- pulmonary capillary wedge pressure (PCWP) or
- left ventricular end-diastolic pressure (LVEDP) ≤15mmHg and
- PVR ≥3 Wood Units. Subject must walk a distance of ≥125m and ≤500m at the screening visit
Exclusion Criteria:
- History of pulmonary embolism
- No prior treatment with PDE-5 inhibitors
- History of chronic lung disease / restrictive lung disease (eg, chronic obstructive pulmonary disease (COPD) or scleroderma) with impairment of lung function
- Current treatment with nitrates or nitric oxide
- Significant (ie, >2+) valvular disease other than tricuspid regurgitation or pulmonary regurgitation
- History of cardiac arrest, respiratory arrest, hemodynamic collapse, CPR, ventricular tachycardia, ventricular fibrillation, or uncontrolled atrial fibrillation
研究計画
このセクションでは、研究がどのように設計され、研究が何を測定しているかなど、研究計画の詳細を提供します。
研究はどのように設計されていますか？
デザインの詳細
この研究は何を測定していますか？
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
|
Change From Baseline in the N-Terminal Pro-B-Type Natriuretic Peptide at Month 6
時間枠：6 months
|
N-Terminal Pro-B-Type Natriuretic Peptide (NT-proBNP) is a surrogate marker of heart failure.
The geometric mean ratio will be calculated as the ratio between the month 6 value and the Baseline value and presented as percent change = 100 * (geometric mean ratio - 1).
The Baseline value is the last value prior to administration of study drug; this may be prior to or on the day of study drug initiation.
|
6 months
|
二次結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
|
Number of Participants With First Adjudicated Clinical Failure (CF) Event
時間枠：6 months
|
Hospitalisation for Worsening PAH, Disease Progression, Unsatisfactory Clinical Response
|
6 months
|
|
Time to first clinical worsening (TTCW) event
時間枠：6 months
|
TTCW defined as the number of days between first dose of study drug and the occurrence of a predefined clinical worsening event.
|
6 months
|
|
Percentage of Participants With a Satisfactory Clinical Response at Month 6
時間枠：6 months
|
A satisfactory clinical response at month 6 is defined as a participant who meets all of the following criteria: 10% improvement in 6MWD compared with Baseline;
|
6 months
|
|
Change From Baseline in the World Health Organization Functional Class at month 6
時間枠：6 months
|
Change From Baseline in the World Health Organization Functional Class Time Frame: Baseline and Month 6 The WHO Functional Class (FC) indicates the severity of PAH and is an adaptation of the New York Heart Association classification.
|
6 months
|
|
Change From Baseline in the 6 Minute Walk Distance (6MWD) Test at month 6
時間枠：6 months
|
Change From Baseline in the 6 Minute Walk Distance (6MWD) Test at month 6 MWD is the distance a participant can walk in 6 minutes. The 6-minute walk distance (6MWD) test measures the distance that a participant can walk in a period of 6 minutes. |
6 months
|
|
Change From Baseline in Borg Dyspnea Index at month 6
時間枠：6 months
|
Borg Dyspnea Index (BDI) indicates the degree of breathlessness after completion of the 6 minute walk test.
|
6 months
|
|
Quality of Life
時間枠：6 moths
|
Change in emPHasis-10 questionnaire score
|
6 moths
|
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出版物と役立つリンク
研究に関する情報を入力する責任者は、自発的にこれらの出版物を提供します。これらは、研究に関連するあらゆるものに関するものである可能性があります。
一般刊行物
- Galie N, Humbert M, Vachiery JL, Gibbs S, Lang I, Torbicki A, Simonneau G, Peacock A, Vonk Noordegraaf A, Beghetti M, Ghofrani A, Gomez Sanchez MA, Hansmann G, Klepetko W, Lancellotti P, Matucci M, McDonagh T, Pierard LA, Trindade PT, Zompatori M, Hoeper M; ESC Scientific Document Group. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J. 2016 Jan 1;37(1):67-119. doi: 10.1093/eurheartj/ehv317. Epub 2015 Aug 29. No abstract available.
- Galie N, Barbera JA, Frost AE, Ghofrani HA, Hoeper MM, McLaughlin VV, Peacock AJ, Simonneau G, Vachiery JL, Grunig E, Oudiz RJ, Vonk-Noordegraaf A, White RJ, Blair C, Gillies H, Miller KL, Harris JH, Langley J, Rubin LJ; AMBITION Investigators. Initial Use of Ambrisentan plus Tadalafil in Pulmonary Arterial Hypertension. N Engl J Med. 2015 Aug 27;373(9):834-44. doi: 10.1056/NEJMoa1413687.
- McLaughlin V, Channick RN, Ghofrani HA, Lemarie JC, Naeije R, Packer M, Souza R, Tapson VF, Tolson J, Al Hiti H, Meyer G, Hoeper MM. Bosentan added to sildenafil therapy in patients with pulmonary arterial hypertension. Eur Respir J. 2015 Aug;46(2):405-13. doi: 10.1183/13993003.02044-2014. Epub 2015 Jun 25.
研究記録日
これらの日付は、ClinicalTrials.gov への研究記録と要約結果の提出の進捗状況を追跡します。研究記録と報告された結果は、国立医学図書館 (NLM) によって審査され、公開 Web サイトに掲載される前に、特定の品質管理基準を満たしていることが確認されます。
主要日程の研究
研究開始 (予想される)
2017年12月1日
一次修了 (予想される)
2019年12月1日
研究の完了 (予想される)
2019年12月1日
試験登録日
最初に提出
2017年4月28日
QC基準を満たした最初の提出物
2017年5月2日
最初の投稿 (実際)
2017年5月3日
学習記録の更新
投稿された最後の更新 (実際)
2018年1月26日
QC基準を満たした最後の更新が送信されました
2018年1月24日
最終確認日
2017年8月1日
詳しくは
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