Clinical Trial Results:
A Phase 3, Randomized, Double-blind, Placebo-controlled Study of Ralinepag to Evaluate Safety and Effects on Exercise Capacity Assessed by Cardiopulmonary Exercise Testing in Subjects with World Health Organization Group 1 Pulmonary Hypertension Who Recently Initiated Therapy
Summary
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EudraCT number |
2019-003309-88 |
Trial protocol |
GB AT DE ES PL BE IT PT |
Global end of trial date |
12 Apr 2023
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Results information
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Results version number |
v1(current) |
This version publication date |
28 Jun 2024
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First version publication date |
28 Jun 2024
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Other versions |
Trial Information
Subject Disposition
Baseline Characteristics
End Points
Adverse Events
More Information
Subject Disposition
Baseline Characteristics
End Points
Adverse Events
More Information
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Trial identification
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Sponsor protocol code |
ROR-PH-302
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Additional study identifiers
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ISRCTN number |
- | ||
US NCT number |
NCT04084678 | ||
WHO universal trial number (UTN) |
- | ||
Other trial identifiers |
IND Number: 109021 | ||
Sponsors
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Sponsor organisation name |
United Therapeutics Corp.
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Sponsor organisation address |
55 TW Alexander Drive, Durham, United States, 27709
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Public contact |
Global Medical Information, United Therapeutics Corp., 1 9194858350, clinicaltrials@unither.com
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Scientific contact |
Global Medical Information, United Therapeutics Corp., 1 9194858350, clinicaltrials@unither.com
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Paediatric regulatory details
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Is trial part of an agreed paediatric investigation plan (PIP) |
No
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Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial? |
No
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Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial? |
No
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Results analysis stage
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Analysis stage |
Final
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Date of interim/final analysis |
12 Apr 2023
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Is this the analysis of the primary completion data? |
Yes
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Primary completion date |
12 Apr 2023
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Global end of trial reached? |
Yes
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Global end of trial date |
12 Apr 2023
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Was the trial ended prematurely? |
Yes
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General information about the trial
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Main objective of the trial |
To evaluate the effects of ralinepag therapy on exercise capacity as assessed by change in peak oxygen consumption (VO2) derived from cardiopulmonary exercise testing (CPET) after 28 weeks of treatment
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Protection of trial subjects |
The study was conducted per the Declaration of Helsinki and sites were well-trained on the CPET procedures. The study protocol was approved by each site's IRB/IEC. Additionally, subjects were monitored continuously by ECG throughout the CPET testing and could request to terminate the exercise testing at any time.
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Background therapy |
Subjects could be treated with either 1 or 2 approved background PAH-specific therapies | ||
Evidence for comparator |
- | ||
Actual start date of recruitment |
20 Jan 2021
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Long term follow-up planned |
No
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Independent data monitoring committee (IDMC) involvement? |
Yes
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Population of trial subjects
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Number of subjects enrolled per country |
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Country: Number of subjects enrolled |
Australia: 1
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Country: Number of subjects enrolled |
Brazil: 3
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Country: Number of subjects enrolled |
United States: 2
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Country: Number of subjects enrolled |
Spain: 1
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Country: Number of subjects enrolled |
Germany: 1
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Country: Number of subjects enrolled |
Italy: 2
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Worldwide total number of subjects |
10
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EEA total number of subjects |
4
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Number of subjects enrolled per age group |
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In utero |
0
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Preterm newborn - gestational age < 37 wk |
0
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Newborns (0-27 days) |
0
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Infants and toddlers (28 days-23 months) |
0
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Children (2-11 years) |
0
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Adolescents (12-17 years) |
0
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Adults (18-64 years) |
7
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From 65 to 84 years |
3
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85 years and over |
0
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Recruitment
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Recruitment details |
This study was discontinued by the Sponsor on 27 February 2023 due to slow enrollment. This decision was not related to reasons of safety or efficacy. The study was planned for 50 centers; however, only 9 study centers randomized a total of 10 subjects in Australia, Brazil, Germany, Spain, Italy, and the United States. | |||||||||||||||||||||
Pre-assignment
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Screening details |
The Screening Visit(s) began no more than 28 days prior to randomization. Each subject must have met all the inclusion criteria and none of the exclusion criteria to be eligible for enrollment into the study. | |||||||||||||||||||||
Period 1
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Period 1 title |
Baseline
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Is this the baseline period? |
Yes | |||||||||||||||||||||
Allocation method |
Randomised - controlled
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Blinding used |
Double blind | |||||||||||||||||||||
Roles blinded |
Subject, Investigator | |||||||||||||||||||||
Arms
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Are arms mutually exclusive |
Yes
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Arm title
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Placebo | |||||||||||||||||||||
Arm description |
Matching placebo tablets (oral) | |||||||||||||||||||||
Arm type |
Placebo | |||||||||||||||||||||
Investigational medicinal product name |
Placebo
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Investigational medicinal product code |
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Other name |
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Pharmaceutical forms |
Tablet
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Routes of administration |
Oral use
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Dosage and administration details |
The study drug (ie, ralinepag or matching placebo) was supplied as 50, 250, and 400 mcg tablets for oral administration. The starting dose of study drug was 50 mcg once daily for 1 week. Up titration of study drug occurred in 50-mcg increments each week up to a dose of 1400 mcg once daily or until the individual maximum tolerated dose was achieved. The dose of study drug was not titrated in the 7 days prior to Week 28.
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Arm title
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Ralinepag | |||||||||||||||||||||
Arm description |
Ralinepag once daily extended-release tablets (oral) 50, 250, and 400 mcg titrated to the individual maximum tolerated dose (maximum dose of 1400 mcg) | |||||||||||||||||||||
Arm type |
Experimental | |||||||||||||||||||||
Investigational medicinal product name |
Ralinepag
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Investigational medicinal product code |
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Other name |
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Pharmaceutical forms |
Tablet
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Routes of administration |
Oral use
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Dosage and administration details |
The study drug (ie, ralinepag or matching placebo) was supplied as 50, 250, and 400 mcg tablets for oral administration. The starting dose of study drug was 50 mcg once daily for 1 week. Up titration of study drug occurred in 50-mcg increments each week up to a dose of 1400 mcg once daily or until the individual maximum tolerated dose was achieved. The dose of study drug was not titrated in the 7 days prior to Week 28.
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Period 2
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Period 2 title |
Treatment Period
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Is this the baseline period? |
No | |||||||||||||||||||||
Allocation method |
Randomised - controlled
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Blinding used |
Double blind | |||||||||||||||||||||
Roles blinded |
Subject, Investigator | |||||||||||||||||||||
Arms
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Are arms mutually exclusive |
Yes
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Arm title
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Placebo | |||||||||||||||||||||
Arm description |
Matching placebo tablets (oral) | |||||||||||||||||||||
Arm type |
Placebo | |||||||||||||||||||||
Investigational medicinal product name |
Placebo
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Investigational medicinal product code |
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Other name |
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Pharmaceutical forms |
Tablet
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Routes of administration |
Oral use
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Dosage and administration details |
The study drug (ie, ralinepag or matching placebo) was supplied as 50, 250, and 400 mcg tablets for oral administration. The starting dose of study drug was 50 mcg once daily for 1 week. Up titration of study drug occurred in 50-mcg increments each week up to a dose of 1400 mcg once daily or until the individual maximum tolerated dose was achieved. The dose of study drug was not titrated in the 7 days prior to Week 28.
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Arm title
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Ralinepag | |||||||||||||||||||||
Arm description |
Ralinepag once daily extended-release tablets (oral) 50, 250, and 400 mcg titrated to the individual maximum tolerated dose (maximum dose of 1400 mcg) | |||||||||||||||||||||
Arm type |
Experimental | |||||||||||||||||||||
Investigational medicinal product name |
Ralinepag
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Investigational medicinal product code |
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Other name |
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Pharmaceutical forms |
Tablet
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Routes of administration |
Oral use
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Dosage and administration details |
The study drug (ie, ralinepag or matching placebo) was supplied as 50, 250, and 400 mcg tablets for oral administration. The starting dose of study drug was 50 mcg once daily for 1 week. Up titration of study drug occurred in 50-mcg increments each week up to a dose of 1400 mcg once daily or until the individual maximum tolerated dose was achieved. The dose of study drug was not titrated in the 7 days prior to Week 28.
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Baseline characteristics reporting groups
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Reporting group title |
Placebo
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Reporting group description |
Matching placebo tablets (oral) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reporting group title |
Ralinepag
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Reporting group description |
Ralinepag once daily extended-release tablets (oral) 50, 250, and 400 mcg titrated to the individual maximum tolerated dose (maximum dose of 1400 mcg) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Subject analysis sets
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Subject analysis set title |
Safety Population
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Subject analysis set type |
Safety analysis | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Subject analysis set description |
All 10 subjects randomized into the study received at least 1 dose of study drug and were included in the Safety Population as part of this report.
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End points reporting groups
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Reporting group title |
Placebo
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Reporting group description |
Matching placebo tablets (oral) | ||
Reporting group title |
Ralinepag
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Reporting group description |
Ralinepag once daily extended-release tablets (oral) 50, 250, and 400 mcg titrated to the individual maximum tolerated dose (maximum dose of 1400 mcg) | ||
Reporting group title |
Placebo
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Reporting group description |
Matching placebo tablets (oral) | ||
Reporting group title |
Ralinepag
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Reporting group description |
Ralinepag once daily extended-release tablets (oral) 50, 250, and 400 mcg titrated to the individual maximum tolerated dose (maximum dose of 1400 mcg) | ||
Subject analysis set title |
Safety Population
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Subject analysis set type |
Safety analysis | ||
Subject analysis set description |
All 10 subjects randomized into the study received at least 1 dose of study drug and were included in the Safety Population as part of this report.
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End point title |
Comparison of reported AEs [1] | ||||||||||||||||||||||||
End point description |
Due to the early termination of the study, efficacy results were not summarized or discussed in the final abbreviated clinical study report. Safety event results were reported as the primary study result.
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End point type |
Primary
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End point timeframe |
Baseline to 28 weeks
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Notes [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point. Justification: Safety events were not analyzed statistically. Event totals in each treatment group were used for comparison. |
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No statistical analyses for this end point |
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Adverse events information
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Timeframe for reporting adverse events |
Subjects were instructed that they may report AEs at any time. AEs should be reported beyond this period if per the Investigator, they are considered possibly or probably related to the study drug.
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Adverse event reporting additional description |
Monitoring of nonserious AEs will be continued to 28 days after the last dose of study drug or until the 28-day Follow-up Visit, whichever is later. In the event that a nonserious AE is not resolved or stabilized by this time, the Sponsor in consultation with the Investigator will decide whether to continue to monitor the AE.
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Assessment type |
Systematic | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary used for adverse event reporting
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Dictionary name |
MedDRA | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary version |
26.0
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Reporting groups
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Reporting group title |
Ralinepag
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Reporting group description |
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Reporting group title |
Placebo
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Reporting group description |
- | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Frequency threshold for reporting non-serious adverse events: 0% | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Substantial protocol amendments (globally) |
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Were there any global substantial amendments to the protocol? Yes | |||
Date |
Amendment |
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17 Jun 2021 |
• Clarified that when a Study Drug Termination Visit occurred close in time to the next regular visit, the Study Drug Termination Visit could take the place of the next regularly scheduled visit.
• Clarified CPET procedures and variables and the scope of the CPET core laboratory.
• Added details around the full physical examination.
• Removed echocardiogram as a required assessment.
• Added CD4+ test to list of laboratory tests.
• Added language to ensure subjects were not excluded due to a positive drug screen caused by prescription medication.
• Changed timeframe of diagnostic right heart catheterization from 1 to 3 years before Screening.
• Removed time restriction of ventilation-perfusion lung scan.
• Updated number of centers to “50 to 60”.
• Updated inclusion criterion for stable dose(s) of PAH-specific oral therapy to be defined as no change in dose or regimen for at least 120 days prior to Randomization.
• Added that eligible male subjects must agree not to participate in sperm donation for 90 days after the last dose of study drug, and changed the timeframe for the prohibition on conception from 28 to 30 days.
• Removed current unstable angina as an exclusion criterion.
• Updated chronic renal insufficiency to be defined using estimated glomerular filtration rate using the Modification of Diet in Renal Disease Study equation instead of creatinine.
• Updated exclusion criterion timeframe for diagnosed and/or treated malignancy from within 5 to 3 years of Screening.
• Added clarification around how to deal with contact between scheduled clinic visits (timing of calls, what to do after Week 16, etc).
• Added description that the Investigator would attempt to discuss unblinding with the Sponsor prior to unblinding.
• Removed electrocardiogram response to exercise and duration of exercise from additional endpoints. |
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29 Nov 2022 |
• Aligned definition of PAH and risk categories with current European Society of Cardiology/European Respiratory Society guidelines.
• Changed pulmonary vascular resistance requirement from ≥3 (240 dynes/sec/cm5) to >2 (160 dynes/sec/cm5) Wood units.
• Clarified that the study would end when all subjects completed their final study visit.
• Clarified that subjects did not need to have newly initiated therapy to be eligible.
• Added that subjects must have completed ROR-PH-302 on study drug to be eligible for the OLE study.
• Removed limitation of only 1 re-test for re-screened subjects.
• Clarified that subjects who discontinued study drug after Week 24 would attend the Follow-up Visit.
• Removed specifics for biological quality control test timing from protocol.
• Clarified that only 1 CPET was required prior to randomization.
• Clarified that electrocardiograms were recorded in triplicate using a device provided by the Sponsor unless not allowed by local regulations.
• Clarified AE collection procedures. Updated nonserious AE monitoring procedures.
• Revised urine human chorionic gonadotropin analysis for females of childbearing potential instead of only postmenopausal females.
• Revised the requirement for stable doses of PAH-specific oral therapy prior to randomization from 120 days to 90 days.
• Removed VE/VCO2 slope requirement for study entry.
• Amended required peak VO2 from ≥10 to ≥9 mL/min/kg (upper limit remained <18 mL/min/kg).
• Removed requirement for dosage of concomitant medications to remain unchanged throughout the study.
• Updated exclusion criteria to allow prostacyclin pathway agents for PAH within 90 days of randomization.
• Clarified that PAH-specific medications are not to be added or changed during the study.
• Added that if study was terminated early for safety reasons, the Sponsor would inform regulatory authorities without delay in accordance with local reporting requirements. |
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Interruptions (globally) |
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Were there any global interruptions to the trial? No | |||
Limitations and caveats |
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Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data. | |||
None reported |