肺高血圧症:コンビネーション Rx の強化と個別化 (PHoenix)
肺動脈圧および心調律モニタリング装置(CardioMEMS/ConfirmRx)が埋め込まれた肺動脈高血圧症(PAH)患者における疾患特異的治療の多施設ランダム化クロスオーバー試験
調査の概要
詳細な説明
研究の種類
入学 (推定)
段階
- フェーズ 4
連絡先と場所
研究場所
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Sheffield、イギリス、S10 2JF
- Sheffield Teaching Hospitals NHS FT
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参加基準
適格基準
就学可能な年齢
- 大人
- 高齢者
健康ボランティアの受け入れ
説明
包含基準:
- インフォームドコンセントを提供できる
- 18~80歳
- 特発性、遺伝性、または薬物、毒素または結合組織疾患に関連するPAH
- -スクリーニング前の少なくとも1か月間、ERAとPDE5iの任意の組み合わせを含む安定したPAH治療レジメン(治療に耐えられない場合を除く)
- WHO機能クラスIII
- 安静時 mPAP ≥20 mmHg、肺毛細血管楔入圧 ≤15 mmHg、肺血管抵抗 ≥2 Wood Units 診断時に右心カテーテル検査で測定
- 入口で6MWT >50m
- 推定糸球体濾過率 (eGFR) >30 ml/分/1.73 入口のm²(付録C)
- 不十分な治療反応(臨床的に決定)
除外基準:
- インフォームドコンセントを提供できない
- 妊娠
- 誘発されない肺塞栓症(いつでも)
- スクリーニング時の急性感染症(再スクリーニング可)
- ヒト免疫不全ウイルスによるPAH、門脈圧亢進症、住血吸虫症、先天性心疾患
- -左心、肺、血栓塞栓性または不明確/多因子性疾患による肺高血圧症 (グループ II-V)
- アスピリンまたは P2Y12 阻害剤に耐えられない
- セレキシパグまたはリオシグアトに対する過敏症
- -臨床的に重要な腎疾患 (eGFR≤30 ml/分/1.73m2)
- 貧血 (ヘモグロビン < 10 g/dl)
- -左心疾患および/または臨床的に重要な心疾患には、以下のいずれかが含まれますが、これらに限定されません:軽度の大動脈狭窄;軽度の僧帽弁狭窄;または中等度の僧帽弁逆流
研究計画
研究はどのように設計されていますか?
デザインの詳細
- 主な目的:処理
- 割り当て:ランダム化
- 介入モデル:クロスオーバー割り当て
- マスキング:なし(オープンラベル)
武器と介入
参加者グループ / アーム |
介入・治療 |
|---|---|
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アクティブコンパレータ:アームA(セレキシパグ/リオシグアト)
ベースライン - 確立された PDE/ERA 療法 1 週目 - OPA の開始 (PDE/ERA/OPA 療法) 2~12 週目 - OPA の最大療法へのアップタイトレーション (PDE/ERA/OPA 療法) 13~14 週目 - OPA の減少 (PDE/ERA 療法) /OPA 療法) 15 週目 - OPA のウォッシュアウト (PDE/OPA 療法) 16 週目 - PDE のウォッシュアウト (ERA 療法) 17 週目 - sGCS の開始 (ERA/sGCS 療法)治療)
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アーム A の場合 - 最大耐用量までの漸増に続いて段階的緩和 アーム B の場合 - 最大耐用量までのアップ タイトレーションに続いて、必要に応じて責任あるケア チームの裁量で観察、変更、または移行。
他の名前:
アーム A の場合 - 最大耐用量までの漸増に続いて段階的緩和 アーム B の場合 - 最大耐用量までのアップ タイトレーションに続いて、必要に応じて責任あるケア チームの裁量で観察、変更、または移行。
他の名前:
患者が開始した毎日の測定値で確立された埋め込みとリモートモニタリング
自動化された毎日の読み取り/ダウンロードで確立された移植とリモートモニタリング
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アクティブコンパレータ:アームB(リオシグアト/セレキシパグ)
ベースライン - 確立された PDE/ERA 療法 1 週目 - PDE のウォッシュアウト (ERA 療法のみ) 2 週目 - sGCS の開始 (ERA/sGCS 療法) 3 ~ 12 週目 - 最大療法への sGCS のアップタイトレーション (ERA/sGCS 療法) 13 週目 - sGCS の減少(ERA/sGCS 療法) 14 週目 - sGCS の減少とウォッシュアウト (ERA 療法) 15 週目 - PDE の開始 (PDE/ERA 療法) 16 週目 - OPA の開始 (PDE/ERA/OPA 療法) 17 ~ 27 週目 - OPA のアップタイトレーション最大療法(PDE/ERA/OPA療法)
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アーム A の場合 - 最大耐用量までの漸増に続いて段階的緩和 アーム B の場合 - 最大耐用量までのアップ タイトレーションに続いて、必要に応じて責任あるケア チームの裁量で観察、変更、または移行。
他の名前:
アーム A の場合 - 最大耐用量までの漸増に続いて段階的緩和 アーム B の場合 - 最大耐用量までのアップ タイトレーションに続いて、必要に応じて責任あるケア チームの裁量で観察、変更、または移行。
他の名前:
患者が開始した毎日の測定値で確立された埋め込みとリモートモニタリング
自動化された毎日の読み取り/ダウンロードで確立された移植とリモートモニタリング
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アクティブコンパレータ:Arm C : Sotatercept
Baseline - established background therapy; initiate sotatercept 0.3 mg/kg Week 3 - evaluate safety parameters (Hb/platelets) & uptitrate sotatercept to target dose 0.7 mg/kg . Weeks 6, 9, 12, 15, 18, 21 - maintenance sotatercept 0.7 mg/kg every 3 weeks with safety monitoring Week 24 - final maintenance dose and endpoint assessments |
患者が開始した毎日の測定値で確立された埋め込みとリモートモニタリング
自動化された毎日の読み取り/ダウンロードで確立された移植とリモートモニタリング
Subcutaneous injection of sotatercept administered once every 3 weeks for 24 weeks.
Treatment is initiated at a starting dose of 0.3 mg/kg at Week 0 and escalated at Week 3 to a target maintenance dose of 0.7 mg/kg, contingent on body weight, clinical response, and pre-dose safety parameters (haematoglobin and platelet counts).
Maintenance dosing at 0.7 mg/kg continues every 3 weeks through Week 21, alongside continuous daily remote hemodynamic and physiological monitoring via implanted CardioMEMS and cardiac rhythm devices.
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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 |
|---|---|---|
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Right Ventricular Stroke Volume (RVSV) flow on each therapy measured by MRI RSVS (flow) on each therapy measured by MRI
時間枠:Baseline to Week 12 of each crossover period
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This provides a robust, objective assessment of clinical efficacy which, if met, will mean that a change in therapy has provided a clinically meaningful change in physiology
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Baseline to Week 12 of each crossover period
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Daily Hemodynamic Detection of Treatment Response During Sotatercept Escalation
時間枠:Baseline (Week 0) through Week 24
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Within-patient changes in continuous, remote-monitored Total Pulmonary Resistance (TPR), mean Pulmonary Artery Pressure (mPAP), Cardiac Output (CO), Stroke Volume (SV), and Heart Rate (HR) detected by the CardioMEMS sensor following treatment escalation with sotatercept, correlated with end-of-treatment RVSV measured by cardiac MRI.
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Baseline (Week 0) through Week 24
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二次結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
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Haemodynamics - Total Pulmonary Resistance (TPR)
時間枠:Part 1: From baseline and area under the curve to 4 weeks, 8 weeks and 12 weeks Part 2: From baseline and area under the curve to 3 weeks, 6 weeks, 12 weeks, 18 weeks, and 24 weeks.
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Change in TPR (Woods Units) on each therapy to determine clinical efficacy
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Part 1: From baseline and area under the curve to 4 weeks, 8 weeks and 12 weeks Part 2: From baseline and area under the curve to 3 weeks, 6 weeks, 12 weeks, 18 weeks, and 24 weeks.
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Haemodynamics - mean Pulmonary Artery Pressure (mPAP)
時間枠:Part 1: From baseline and area under the curve to 4 weeks, 8 weeks and 12 weeks Part 2: From baseline and area under the curve to 3 weeks, 6 weeks, 12 weeks, 18 weeks, and 24 weeks.
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Change in mPAP (mmHg) on each therapy to determine clinical efficacy
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Part 1: From baseline and area under the curve to 4 weeks, 8 weeks and 12 weeks Part 2: From baseline and area under the curve to 3 weeks, 6 weeks, 12 weeks, 18 weeks, and 24 weeks.
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Haemodynamics - Cardiac Output (CO)
時間枠:Part 1 : From baseline and area under the curve to 4 weeks, 8 weeks and 12 weeks Part 2: From baseline and area under the curve to 3 weeks, 6 weeks, 12 weeks, 18 weeks, and 24 weeks.
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Change in CO (L/min) on each therapy to determine clinical efficacy
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Part 1 : From baseline and area under the curve to 4 weeks, 8 weeks and 12 weeks Part 2: From baseline and area under the curve to 3 weeks, 6 weeks, 12 weeks, 18 weeks, and 24 weeks.
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Haemodynamics - Cardiac Index
時間枠:Part 1 : From baseline and area under the curve to 4 weeks, 8 weeks and 12 weeks Part 2: From baseline and area under the curve to 3 weeks, 6 weeks, 12 weeks, 18 weeks, and 24 weeks
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Change in cardiac index (L/min/m^2) on each therapy to determine clinical efficacy
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Part 1 : From baseline and area under the curve to 4 weeks, 8 weeks and 12 weeks Part 2: From baseline and area under the curve to 3 weeks, 6 weeks, 12 weeks, 18 weeks, and 24 weeks
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Haemodynamics - Stroke Volume (SV)
時間枠:Part 1: From baseline and area under the curve to 4 weeks, 8 weeks and 12 weeks Part 2: From baseline and area under the curve to 3 weeks, 6 weeks, 12 weeks, 18 weeks, and 24 weeks.
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Change in SV (mL) on each therapy to determine clinical efficacy
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Part 1: From baseline and area under the curve to 4 weeks, 8 weeks and 12 weeks Part 2: From baseline and area under the curve to 3 weeks, 6 weeks, 12 weeks, 18 weeks, and 24 weeks.
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Haemodynamics - Heart Rate (HR)
時間枠:Part 1: From baseline and area under the curve to 4 weeks, 8 weeks and 12 weeks Part 2: From baseline and area under the curve to 3 weeks, 6 weeks, 12 weeks, 18 weeks, and 24 weeks.
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Change in HR (bpm) on each therapy to determine clinical efficacy
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Part 1: From baseline and area under the curve to 4 weeks, 8 weeks and 12 weeks Part 2: From baseline and area under the curve to 3 weeks, 6 weeks, 12 weeks, 18 weeks, and 24 weeks.
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6 Minute Walk Test
時間枠:Part 1: From baseline and area under the curve to 4 weeks, 8 weeks and 12 weeks Part 2: From baseline and area under the curve to 3 weeks, 6 weeks, 12 weeks, 18 weeks, and 24 weeks.
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Change on each therapy to determine clinical efficacy
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Part 1: From baseline and area under the curve to 4 weeks, 8 weeks and 12 weeks Part 2: From baseline and area under the curve to 3 weeks, 6 weeks, 12 weeks, 18 weeks, and 24 weeks.
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NTpro-BNP
時間枠:Part 1: From baseline and area under the curve to 4 weeks, 8 weeks and 12 weeks Part 2: From baseline and area under the curve to 3 weeks, 6 weeks, 12 weeks, 18 weeks, and 24 weeks.
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Change on each therapy to determine clinical efficacy
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Part 1: From baseline and area under the curve to 4 weeks, 8 weeks and 12 weeks Part 2: From baseline and area under the curve to 3 weeks, 6 weeks, 12 weeks, 18 weeks, and 24 weeks.
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MRI - Right Ventricular Ejection Fraction (RVEF)
時間枠:Part 1: From baseline and area under the curve to 4 weeks, 8 weeks and 12 weeks Part 2: From baseline and area under the curve to 3 weeks, 6 weeks, 12 weeks, 18 weeks, and 24 weeks
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RVEF (%) on each therapy to determine clinical efficacy
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Part 1: From baseline and area under the curve to 4 weeks, 8 weeks and 12 weeks Part 2: From baseline and area under the curve to 3 weeks, 6 weeks, 12 weeks, 18 weeks, and 24 weeks
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MRI - Right Ventricular End Systolic Volume (RVESV)
時間枠:Part 1: From baseline and area under the curve to 4 weeks, 8 weeks and 12 weeks Part 2: From baseline and area under the curve to 3 weeks, 6 weeks, 12 weeks, 18 weeks, and 24 weeks
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RVESV (mL/m^2) on each therapy to determine clinical efficacy
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Part 1: From baseline and area under the curve to 4 weeks, 8 weeks and 12 weeks Part 2: From baseline and area under the curve to 3 weeks, 6 weeks, 12 weeks, 18 weeks, and 24 weeks
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MRI - Right Ventricular End Diastolic Volume (RVEDV)
時間枠:Part 1: From baseline and area under the curve to 4 weeks, 8 weeks and 12 weeks Part 2: From baseline and area under the curve to 3 weeks, 6 weeks, 12 weeks, 18 weeks, and 24 weeks
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RVEDV (mL/m^2) on each therapy to determine clinical efficacy
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Part 1: From baseline and area under the curve to 4 weeks, 8 weeks and 12 weeks Part 2: From baseline and area under the curve to 3 weeks, 6 weeks, 12 weeks, 18 weeks, and 24 weeks
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MRI - Right Ventricular Stroke Volume (RVSV)
時間枠:Part 1: From baseline and area under the curve to 4 weeks, 8 weeks and 12 weeks Part 2: From baseline and area under the curve to 3 weeks, 6 weeks, 12 weeks, 18 weeks, and 24 weeks
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RVSV (mL) on each therapy to determine clinical efficacy
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Part 1: From baseline and area under the curve to 4 weeks, 8 weeks and 12 weeks Part 2: From baseline and area under the curve to 3 weeks, 6 weeks, 12 weeks, 18 weeks, and 24 weeks
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MRI - Left Ventricular Volume Fraction (LVEF)
時間枠:Part 1: From baseline and area under the curve to 4 weeks, 8 weeks and 12 weeks Part 2: From baseline and area under the curve to 3 weeks, 6 weeks, 12 weeks, 18 weeks, and 24 weeks
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LVEF (%) on each therapy to determine clinical efficacy
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Part 1: From baseline and area under the curve to 4 weeks, 8 weeks and 12 weeks Part 2: From baseline and area under the curve to 3 weeks, 6 weeks, 12 weeks, 18 weeks, and 24 weeks
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MRI - Left Ventricular End Systolic Volume (LVESV)
時間枠:Part 1: From baseline and area under the curve to 4 weeks, 8 weeks and 12 weeks Part 2: From baseline and area under the curve to 3 weeks, 6 weeks, 12 weeks, 18 weeks, and 24 weeks
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LVESV (mL/m^2) on each therapy to determine clinical efficacy
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Part 1: From baseline and area under the curve to 4 weeks, 8 weeks and 12 weeks Part 2: From baseline and area under the curve to 3 weeks, 6 weeks, 12 weeks, 18 weeks, and 24 weeks
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MRI - Left Ventricular End Diastolic Volume LVEDV
時間枠:Part 1: From baseline and area under the curve to 4 weeks, 8 weeks and 12 weeks Part 2: From baseline and area under the curve to 3 weeks, 6 weeks, 12 weeks, 18 weeks, and 24 weeks
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LVEDV (mL/m^2) on each therapy to determine clinical efficacy
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Part 1: From baseline and area under the curve to 4 weeks, 8 weeks and 12 weeks Part 2: From baseline and area under the curve to 3 weeks, 6 weeks, 12 weeks, 18 weeks, and 24 weeks
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MRI - Left Ventricular Stroke Volume (LVSV)
時間枠:Part 1: From baseline and area under the curve to 4 weeks, 8 weeks and 12 weeks Part 2: From baseline and area under the curve to 3 weeks, 6 weeks, 12 weeks, 18 weeks, and 24 weeks
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LVSV (mL) on each therapy to determine clinical efficacy
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Part 1: From baseline and area under the curve to 4 weeks, 8 weeks and 12 weeks Part 2: From baseline and area under the curve to 3 weeks, 6 weeks, 12 weeks, 18 weeks, and 24 weeks
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MRI - Left Ventricular Stroke Volume (LVSV) flow
時間枠:Part 1: From baseline and area under the curve to 4 weeks, 8 weeks and 12 weeks Part 2: From baseline and area under the curve to 3 weeks, 6 weeks, 12 weeks, 18 weeks, and 24 weeks
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LVSV flow on each therapy to determine clinical efficacy
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Part 1: From baseline and area under the curve to 4 weeks, 8 weeks and 12 weeks Part 2: From baseline and area under the curve to 3 weeks, 6 weeks, 12 weeks, 18 weeks, and 24 weeks
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Patient Reported Outcomes (PRO) - Quality of Life (QoL) (EmPHasis-10)
時間枠:Part 1: From baseline and area under the curve to 4 weeks, 8 weeks and 12 weeks Part 2: From baseline and area under the curve to 3 weeks, 6 weeks, 12 weeks, 18 weeks, and 24 weeks
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Change of QoL score on each therapy to determine clinical efficacy.
This will be done using EmPHasis-10 questionnaire (10 questions using a 0 (poor) - 5 (good) scale)
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Part 1: From baseline and area under the curve to 4 weeks, 8 weeks and 12 weeks Part 2: From baseline and area under the curve to 3 weeks, 6 weeks, 12 weeks, 18 weeks, and 24 weeks
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Patient Reported Outcomes (PRO) - Medication Compliance (PHoenix PRO)
時間枠:Part 1: From baseline and area under the curve to 4 weeks, 8 weeks and 12 weeks
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Change of medication compliance score on each therapy to determine clinical efficacy.
This will be done using PHoenix PRO questionnaire (10 questions using a 0 (poor) - 5 (good) scale)
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Part 1: From baseline and area under the curve to 4 weeks, 8 weeks and 12 weeks
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Patient Reported Outcomes (PRO) - Medication Side Effects
時間枠:Part 1: From baseline and area under the curve to 4 weeks, 8 weeks and 12 weeks Part 2: From baseline and area under the curve to 3 weeks, 6 weeks, 12 weeks, 18 weeks, and 24 weeks
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Change of medication side effects on each therapy to determine clinical efficacy.
This will be done using PHoenix Medication side effects questionnaires (4 Yes/No or Better/Worse style questions)
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Part 1: From baseline and area under the curve to 4 weeks, 8 weeks and 12 weeks Part 2: From baseline and area under the curve to 3 weeks, 6 weeks, 12 weeks, 18 weeks, and 24 weeks
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Patient Reported Outcomes (PRO) - Depression symptoms (GAD-2/7)
時間枠:Part 1: From baseline and area under the curve to 4 weeks, 8 weeks and 12 weeks Part 2: From baseline and area under the curve to 3 weeks, 6 weeks, 12 weeks, 18 weeks, and 24 weeks
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Change of depression symptoms on each therapy to determine clinical efficacy.
This will be done using the GAD-2/7 questionnaire (2 screening questions to determine if symptoms present.
If present, 7 additional questions to determine level of depression using a 0 (not at all) - 3 (nearly every day) scale)
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Part 1: From baseline and area under the curve to 4 weeks, 8 weeks and 12 weeks Part 2: From baseline and area under the curve to 3 weeks, 6 weeks, 12 weeks, 18 weeks, and 24 weeks
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Patient Reported Outcomes (PRO) - Anxiety symptoms (PHQ-2/9)
時間枠:Part 1: From baseline and area under the curve to 4 weeks, 8 weeks and 12 weeks Part 2: From baseline and area under the curve to 3 weeks, 6 weeks, 12 weeks, 18 weeks, and 24 weeks
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Change of anxiety symptoms on each therapy to determine clinical efficacy.
This will be done using the PHQ-2/9 questionnaire (2 screening questions to determine if symptoms present.
If present, 9 additional questions to determine level of anxiety using a 0 (not at all) - 3 (nearly every day) scale)
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Part 1: From baseline and area under the curve to 4 weeks, 8 weeks and 12 weeks Part 2: From baseline and area under the curve to 3 weeks, 6 weeks, 12 weeks, 18 weeks, and 24 weeks
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WHO functional class
時間枠:Part 1: From baseline and area under the curve to 4 weeks, 8 weeks and 12 weeks Part 2: From baseline and area under the curve to 3 weeks, 6 weeks, 12 weeks, 18 weeks, and 24 weeks
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Change on each therapy to determine clinical efficacy.
Functional assessment of PAH will be made according to the WHO classification system: Class I - Patients with PAH without limitation of physical activity.
Ordinary physical activity does not cause increased dyspnoea or fatigue, chest pain, or near syncope / Class II - Patients with PAH resulting in slight limitation of physical activity.
No discomfort at rest.
Normal physical activity causes increased dyspnoea or fatigue, chest pain, or near syncope / Class III - Patients with PAH resulting in marked limitation of physical activity.
There is no discomfort at rest.
Less than ordinary activity causes increased dyspnoea or fatigue, chest pain, or near syncope / Class IV - Patients with PAH with inability to carry out any physical activity without discomfort.
Indications of manifest right heart failure.
Dyspnoea and/or fatigue may even be present at rest.
Discomfort is increased by the least physical activity.
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Part 1: From baseline and area under the curve to 4 weeks, 8 weeks and 12 weeks Part 2: From baseline and area under the curve to 3 weeks, 6 weeks, 12 weeks, 18 weeks, and 24 weeks
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EuroQoL-5D-5L
時間枠:Part 2 only : From baseline and area under the curve to 3 weeks, 6 weeks, 12 weeks, 18 weeks, and 24 weeks
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The EuroQoL-5D-5L is included for future health economic evaluation of sotatercept.
(free for non-commercial use
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Part 2 only : From baseline and area under the curve to 3 weeks, 6 weeks, 12 weeks, 18 weeks, and 24 weeks
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PHoenix UTAUT questionnaire
時間枠:Part 1 only: From baseline and area under the curve to 4 weeks, 8 weeks and 12 weeks
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Evaluation of remote monitoring technology and devices.
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Part 1 only: From baseline and area under the curve to 4 weeks, 8 weeks and 12 weeks
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協力者と研究者
協力者
捜査官
- 主任研究者:Alexander Rothman, MD / PhD、University of Sheffield
出版物と役立つリンク
研究記録日
主要日程の研究
研究開始 (実際)
一次修了 (推定)
研究の完了 (推定)
試験登録日
最初に提出
QC基準を満たした最初の提出物
最初の投稿 (実際)
学習記録の更新
投稿された最後の更新 (実際)
QC基準を満たした最後の更新が送信されました
最終確認日
詳しくは
本研究に関する用語
その他の研究ID番号
- STH21653
- MR/W026279/1 (その他の助成金/資金番号:UKRI Medical Research Council)
- 325120 (その他の識別子:IRAS)
- MISP 102663 (その他の助成金/資金番号:MERCK SHARP & DOHME(UK) LIMITED [MSD])
個々の参加者データ (IPD) の計画
個々の参加者データ (IPD) を共有する予定はありますか?
IPD プランの説明
研究サンプルは、特定可能な個人データなしでシェフィールド バイオレポジトリに転送されます。
データは、オックスフォード大学 (データ提供者) によって収集、ホスト、処理されます。 承認されたデータ発信者には、PI および委任されたスタッフが含まれますが、これらに限定されません。参加者;およびコアイメージング研究所。 治験マネージャーがデータ検証プロセスを主導します。 リモート監視データは、Merlin.net を通じて管理されます。 システム (デバイス サプライヤー - Abbott)。 仮名化されたデータは、グラスゴー大学 (処理者) で安全に転送、保持、分析、アーカイブされます。 データは、研究分析のためにシェフィールド大学とニューカッスル大学 (プロセッサ) にも転送されます。
シェフィールド大学は、シェフィールド大学のすべてのデータに対するすべての権利、権原、および利益を所有するものとします。 データ保護法の目的上、Sheffield Teaching Hospitals (スポンサー) がデータ管理者です。
医薬品およびデバイス情報、研究文書
米国FDA規制医薬品の研究
米国FDA規制機器製品の研究
米国で製造され、米国から輸出された製品。
この情報は、Web サイト clinicaltrials.gov から変更なしで直接取得したものです。研究の詳細を変更、削除、または更新するリクエストがある場合は、register@clinicaltrials.gov。 までご連絡ください。 clinicaltrials.gov に変更が加えられるとすぐに、ウェブサイトでも自動的に更新されます。