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    Clinical Trial Results:
    A Prospective, Multicenter, Single-arm, Open-label, Phase 4 Study of the Effects of Selexipag on Right Ventricular Remodeling in Pulmonary Arterial Hypertension Assessed by Cardiac Magnetic Resonance Imaging (RESTORE)

    Summary
    EudraCT number
    2019-004783-22
    Trial protocol
    NL   DE   GB   FR  
    Global end of trial date
    28 Jul 2023

    Results information
    Results version number
    v1(current)
    This version publication date
    02 Aug 2024
    First version publication date
    02 Aug 2024
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    67896049PAH4005
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT04435782
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Janssen-Cilag International NV
    Sponsor organisation address
    Turnhoutseweg 30, Beerse, Belgium,
    Public contact
    Clinical Registry Group, Janssen-Cilag International NV, ClinicalTrialsEU@its.jnj.com
    Scientific contact
    Clinical Registry Group, Janssen-Cilag International NV, ClinicalTrialsEU@its.jnj.com
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    13 Sep 2023
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    28 Jul 2023
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    Main objective of the trial was to assess the effects of selexipag on right ventricle (RV) function in subjects with pulmonary arterial hypertension (PAH).
    Protection of trial subjects
    This study was conducted in accordance with the ethical principles that have their origin in the Declaration of Helsinki and that are consistent with Good Clinical Practices and applicable regulatory requirements.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    07 Jul 2021
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    United Kingdom: 1
    Country: Number of subjects enrolled
    Korea, Republic of: 5
    Country: Number of subjects enrolled
    Malaysia: 1
    Country: Number of subjects enrolled
    Netherlands: 1
    Country: Number of subjects enrolled
    Singapore: 1
    Worldwide total number of subjects
    9
    EEA total number of subjects
    1
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    9
    From 65 to 84 years
    0
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    -

    Pre-assignment
    Screening details
    A total of 25 subjects were screened, out of which 9 subjects were enrolled and were treated with selexipag.

    Period 1
    Period 1 title
    Overall Study (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Not applicable
    Blinding used
    Not blinded

    Arms
    Arm title
    Selexipag
    Arm description
    Subjects with PAH received a 200 micrograms (mcg) selexipag tablet orally on the evening of Day 1, followed by twice-daily dosing starting from Day 2. The dose of selexipag was increased by 200 mcg each week to allow each subject to reach their individual maximum dose (iMD), up to 1600 mcg twice daily, by the end of Week 12. From Week 13 onwards, subjects received their iMD of 1600 mcg selexipag tablets orally twice daily until Week 52. Subjects were then followed for safety up to 30 days after the last dose of selexipag.
    Arm type
    Experimental

    Investigational medicinal product name
    Selexipag
    Investigational medicinal product code
    Other name
    ACT-293987, JNJ-67896049
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Subjects received selexipag 200 mcg tablet orally on Day 1 in the evening then twice daily starting from Day 2. Dose of selexipag was up-titrated every week by 200 mcg to allow each subject to reach their iMD to 1,600 mcg twice daily orally by end of Week 12. Starting from Week 13, subjects received iMD of selexipag 1600 mcg tablet orally twice daily up to Week 52.

    Number of subjects in period 1
    Selexipag
    Started
    9
    Completed
    5
    Not completed
    4
         Study terminated by sponsor
    4

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Selexipag
    Reporting group description
    Subjects with PAH received a 200 micrograms (mcg) selexipag tablet orally on the evening of Day 1, followed by twice-daily dosing starting from Day 2. The dose of selexipag was increased by 200 mcg each week to allow each subject to reach their individual maximum dose (iMD), up to 1600 mcg twice daily, by the end of Week 12. From Week 13 onwards, subjects received their iMD of 1600 mcg selexipag tablets orally twice daily until Week 52. Subjects were then followed for safety up to 30 days after the last dose of selexipag.

    Reporting group values
    Selexipag Total
    Number of subjects
    9 9
    Age Categorical
    Units: Subjects
        In utero
    0 0
        Preterm newborn infants (gestational age < 37 wks)
    0 0
        Newborns (0-27 days)
    0 0
        Infants and toddlers (28 days-23 months)
    0 0
        Children (2-11 years)
    0 0
        Adolescents (12-17 years)
    0 0
        Adults (18-64 years)
    9 9
        From 65-84 years
    0 0
        85 years and over
    0 0
    Age Continuous
    Units: years
        arithmetic mean (standard deviation)
    42.2 ( 13.28 ) -
    Gender Categorical
    Units: Subjects
        Female
    6 6
        Male
    3 3

    End points

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    End points reporting groups
    Reporting group title
    Selexipag
    Reporting group description
    Subjects with PAH received a 200 micrograms (mcg) selexipag tablet orally on the evening of Day 1, followed by twice-daily dosing starting from Day 2. The dose of selexipag was increased by 200 mcg each week to allow each subject to reach their individual maximum dose (iMD), up to 1600 mcg twice daily, by the end of Week 12. From Week 13 onwards, subjects received their iMD of 1600 mcg selexipag tablets orally twice daily until Week 52. Subjects were then followed for safety up to 30 days after the last dose of selexipag.

    Primary: Change from Baseline to Week 26 in Right Ventricular Stroke Volume (RVSV) Assessed by Pulmonary Artery Flow Magnetic Resonance Imaging (MRI)

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    End point title
    Change from Baseline to Week 26 in Right Ventricular Stroke Volume (RVSV) Assessed by Pulmonary Artery Flow Magnetic Resonance Imaging (MRI) [1]
    End point description
    Change from baseline to Week 26 in RVSV assessed by pulmonary artery flow MRI was reported. Safety analysis set included all subjects who received at least 1 dose of study intervention. Here, N (number of subjects analysed) signifies subjects evaluable for this endpoint and "n" signifies subjects evaluable for specified rows. As pre-specified in the statistical analysis plan (SAP), subject wise data was collected and reported due to very limited number of subjects enrolled.
    End point type
    Primary
    End point timeframe
    Baseline, Week 26
    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: Only descriptive data was planned to be reported for this endpoint.
    End point values
    Selexipag
    Number of subjects analysed
    6
    Units: Millilitre (mL)
    number (not applicable)
        Subject 1 (n =1)
    38.35
        Subject 2 (n =1)
    -1.53
        Subject 3 (n =1)
    16.53
        Subject 4 (n =1)
    11
        Subject 5 (n =1)
    27.2
        Subject 6 (n =1)
    14.07
    No statistical analyses for this end point

    Secondary: Change from Baseline to Week 26 in Right Ventricular End-Diastolic Volume (RVEDV) Assessed by MRI

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    End point title
    Change from Baseline to Week 26 in Right Ventricular End-Diastolic Volume (RVEDV) Assessed by MRI
    End point description
    Change from baseline to Week 26 in RVEDV assessed by MRI was reported. Safety analysis set included all subjects who received at least 1 dose of study intervention. Here, N (number of subjects analysed) signifies subjects evaluable for this endpoint and "n" signifies subjects evaluable for specified rows. As pre-specified in the SAP, subject wise data was collected and reported due to very limited number of subjects enrolled.
    End point type
    Secondary
    End point timeframe
    Baseline, Week 26
    End point values
    Selexipag
    Number of subjects analysed
    6
    Units: millilitre
    number (not applicable)
        Subject 1 (n =1)
    40.57
        Subject 2 (n =1)
    -8.89
        Subject 3 (n =1)
    23.58
        Subject 4 (n =1)
    6.79
        Subject 5 (n =1)
    3.71
        Subject 6 (n =1)
    7.82
    No statistical analyses for this end point

    Secondary: Change from Baseline to Week 26 in Right Ventricular End-Systolic Volume (RVESV) Assessed by MRI

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    End point title
    Change from Baseline to Week 26 in Right Ventricular End-Systolic Volume (RVESV) Assessed by MRI
    End point description
    Change from baseline to Week 26 in right ventricular end-systolic volume (RVESV) assessed by MRI was reported. Safety analysis set included all subjects who received at least 1 dose of study intervention. Here, N (number of subjects analysed) signifies subjects evaluable for this endpoint and "n" signifies subjects evaluable for specified rows. As pre-specified in the SAP, subject wise data was collected and reported due to very limited number of subjects enrolled.
    End point type
    Secondary
    End point timeframe
    Baseline, Week 26
    End point values
    Selexipag
    Number of subjects analysed
    6
    Units: Millilitre
    number (not applicable)
        Subject 1 (n =1)
    2.23
        Subject 2 (n =1)
    -7.36
        Subject 3 (n =1)
    7.05
        Subject 4 (n =1)
    -4.22
        Subject 5 (n =1)
    -23.5
        Subject 6 (n =1)
    -6.25
    No statistical analyses for this end point

    Secondary: Change from Baseline to Week 26 in Right Ventricular Ejection Fraction (RVEF) Assessed by MRI

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    End point title
    Change from Baseline to Week 26 in Right Ventricular Ejection Fraction (RVEF) Assessed by MRI
    End point description
    Change from baseline to Week 26 in right ventricular ejection fraction (RVEF) assessed by MRI was reported. Right ventricular ejection fraction (RVEF) was the fraction of the end-diastolic volume (EDV) that is ejected out of right ventricle with each contraction. EDV is the volume of blood within a ventricle immediately before a contraction. Safety analysis set included all subjects who received at least 1 dose of study intervention. Here, N (number of subjects analysed) signifies subjects evaluable for this endpoint and "n" signifies subjects evaluable for specified rows. As pre-specified in the SAP, subject wise data was collected and reported due to very limited number of subjects enrolled.
    End point type
    Secondary
    End point timeframe
    Baseline, Week 26
    End point values
    Selexipag
    Number of subjects analysed
    6
    Units: Percentage of EDV
    number (not applicable)
        Subject 1 (n =1)
    9.65
        Subject 2 (n =1)
    0.42
        Subject 3 (n =1)
    6.96
        Subject 4 (n =1)
    5.01
        Subject 5 (n =1)
    19.12
        Subject 6 (n =1)
    7.62
    No statistical analyses for this end point

    Secondary: Change from Baseline to Week 26 in Right Ventricular (RV) Mass Index Assessed by MRI

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    End point title
    Change from Baseline to Week 26 in Right Ventricular (RV) Mass Index Assessed by MRI
    End point description
    Change from baseline to Week 26 in RV mass index assessed by MRI was reported. Safety analysis set included all subjects who received at least 1 dose of study intervention. Here, N (number of subjects analysed) signifies subjects evaluable for this endpoint and "n" signifies subjects evaluable for specified rows. As pre-specified in the SAP, subject wise data was collected and reported due to very limited number of subjects enrolled.
    End point type
    Secondary
    End point timeframe
    Baseline, Week 26
    End point values
    Selexipag
    Number of subjects analysed
    6
    Units: Grams per meter square (g/m^2)
    number (not applicable)
        Subject 1 (n =1)
    -11.03
        Subject 2 (n =1)
    2.72
        Subject 3 (n =1)
    -12.69
        Subject 4 (n =1)
    0.09
        Subject 5 (n =1)
    -16.56
        Subject 6 (n =1)
    -2.41
    No statistical analyses for this end point

    Secondary: Change from Baseline to Week 26 in RIght Ventricular Global Longitudinal Strain (RVGLS) Assessed by MRI

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    End point title
    Change from Baseline to Week 26 in RIght Ventricular Global Longitudinal Strain (RVGLS) Assessed by MRI
    End point description
    Change in RVGLS was a measure of longitudinal percent change in length of endocardium at Week 26 from baseline length assessed by MRI. Safety analysis set included all subjects who received at least 1 dose of study intervention. Here, N (number of subjects analysed) signifies subjects evaluable for this endpoint and "n" signifies subjects evaluable for specified rows. As pre-specified in the SAP, subject wise data was collected and reported due to very limited number of subjects enrolled.
    End point type
    Secondary
    End point timeframe
    Baseline, Week 26
    End point values
    Selexipag
    Number of subjects analysed
    6
    Units: Percent change in length of endocardium
    number (not applicable)
        Subject 1: RVGLS Endocardium (n =1)
    -4.26
        Subject 2: RVGLS Endocardium (n =1)
    -5.31
        Subject 3: RVGLS Endocardium (n =1)
    -12.8
        Subject 4: RVGLS Endocardium (n =1)
    -5.61
        Subject 5: RVGLS Endocardium (n =1)
    -14.45
        Subject 6: RVGLS Endocardium (n =1)
    -1.74
    No statistical analyses for this end point

    Secondary: Number of Subjects With Change from Baseline to Week 26 in World Health Organization (WHO) Functional Class

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    End point title
    Number of Subjects With Change from Baseline to Week 26 in World Health Organization (WHO) Functional Class
    End point description
    WHO functional classification for PAH ranged from Class I (no limitation in physical activity, ordinary physical activity does not cause undue dyspnea or fatigue, chest pain or near syncope), Class II (slight limitation of physical activity, ordinary physical activity cause undue dyspnea or fatigue, chest pain or near syncope), Class III (marked limitation of physical activity, less than ordinary activity cause undue dyspnea or fatigue, chest pain or near syncope) & Class IV (cannot perform a physical activity without any symptoms, dyspnea and/or fatigue may even be present at rest). Change from baseline in WHO functional class was classified into "Improved", "No change" and "Worsened". Improvement =reduction in functional class; worsened =increase in functional class; and no change = no change in functional class. Safety set included all subjects who received at least 1 dose of study intervention. Here, N (number of subjects analysed) signifies subjects evaluable for this endpoint.
    End point type
    Secondary
    End point timeframe
    Baseline to Week 26
    End point values
    Selexipag
    Number of subjects analysed
    8
    Units: Subjects
        Baseline: Class I
    0
        Baseline: Class II
    4
        Baseline: Class III
    4
        Baseline: Class IV
    0
        Week 26: Improved
    3
        Week 26: Unchanged
    5
        Week 26: Worsened
    0
    No statistical analyses for this end point

    Secondary: Change from Baseline to Week 26 in N-terminal-Pro-Hormone Brain Natriuretic Peptide (NT-proBNP)

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    End point title
    Change from Baseline to Week 26 in N-terminal-Pro-Hormone Brain Natriuretic Peptide (NT-proBNP)
    End point description
    NT pro-BNP is a cardiac biomarker that is released in the blood in response to changes in the pressure inside of the heart. Levels go up when heart failure develops or gets worse, and levels go down when heart failure is stable or improves. This biomarker helps to measure the changes in the severity of heart failure over time in response to therapy. Safety analysis set included all subjects who received at least 1 dose of study intervention. Here, N (number of subjects analysed) signifies subjects evaluable for this endpoint and "n" signifies subjects evaluable for specified rows. As pre-specified in the SAP, subject wise data was collected and reported due to very limited number of subjects enrolled.
    End point type
    Secondary
    End point timeframe
    Baseline, Week 26
    End point values
    Selexipag
    Number of subjects analysed
    6
    Units: nanograms/litre (ng/L)
    number (not applicable)
        Subject 1 (n =1)
    -202.376
        Subject 2 (n =1)
    142.9233
        Subject 3 (n =1)
    -261.4904
        Subject 4 (n =1)
    78.6501
        Subject 5 (n =1)
    -215.8226
        Subject 6 (n =1)
    -762.5677
    No statistical analyses for this end point

    Secondary: Change from Baseline to Week 26 in 6-Minute Walk Distance (6MWD)

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    End point title
    Change from Baseline to Week 26 in 6-Minute Walk Distance (6MWD)
    End point description
    6MWD was the distance that a subjects could walk in 6 minutes. Subjects were asked to perform the test at a pace that was comfortable to them, with as many breaks as they needed. Safety analysis set included all subjects who received at least 1 dose of study intervention. Here, N (number of subjects analysed) signifies subjects evaluable for this endpoint and "n" signifies subjects evaluable for specified rows. As pre-specified in the SAP, subject wise data was collected and reported due to very limited number of subjects enrolled.
    End point type
    Secondary
    End point timeframe
    Baseline, Week 26
    End point values
    Selexipag
    Number of subjects analysed
    6
    Units: Metre
    number (not applicable)
        Subject 1 (n =1)
    -72
        Subject 2 (n =1)
    0
        Subject 3 (n =1)
    275
        Subject 4 (n =1)
    14
        Subject 5 (n =1)
    17
        Subject 6 (n =1)
    16
    No statistical analyses for this end point

    Secondary: Number of Subjects With Treatment Emergent Adverse Events (AEs) and Serious Adverse Events (SAEs)

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    End point title
    Number of Subjects With Treatment Emergent Adverse Events (AEs) and Serious Adverse Events (SAEs)
    End point description
    An AE was any untoward medical occurrence in a subject who received study drug without regard to possibility of causal relationship. Serious adverse event (SAE) was any untoward medical occurrence that at any dose resulted in death, was life-threatening, requires inpatient hospitalization or prolongation of existing hospitalization, resulted in persistent or significant disability/incapacity, was a congenital anomaly/birth defect, was a suspected transmission of any infectious agent via a medicinal product. Any AE occurring at or after the initial administration of study intervention through the day of last dose plus 3 days was considered as treatment emergent. Safety analysis set included all subjects who received at least 1 dose of study intervention.
    End point type
    Secondary
    End point timeframe
    Day 1 up to 3 days after last dose of study drug (up to 52 weeks and 3 days that is 367 days)
    End point values
    Selexipag
    Number of subjects analysed
    9
    Units: Subjects
        AEs
    9
        SAEs
    1
    No statistical analyses for this end point

    Secondary: Number of Subjects With Adverse Events (AEs) Leading to Premature Discontinuation of Study Drug

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    End point title
    Number of Subjects With Adverse Events (AEs) Leading to Premature Discontinuation of Study Drug
    End point description
    Number of subjects with AEs leading to premature discontinuation of study drug were reported. An AE was any untoward medical occurrence in a subject who received study drug without regard to possibility of causal relationship. Safety analysis set included all subjects who received at least 1 dose of study intervention.
    End point type
    Secondary
    End point timeframe
    Day 1 up to last dose of study drug (up to Week 52)
    End point values
    Selexipag
    Number of subjects analysed
    9
    Units: Subjects
    0
    No statistical analyses for this end point

    Secondary: Number of Subjects With Adverse Events Adverse Events of Special Interest (AESI)

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    End point title
    Number of Subjects With Adverse Events Adverse Events of Special Interest (AESI)
    End point description
    Number of subjects with AESI were reported. An AE was any untoward medical occurrence in a subject who received study drug without regard to possibility of causal relationship. AESI were anaemia, bleeding events, gastrointestinal disturbances denoting intestinal intussusception (manifested as ileus or obstruction), hyperthyroidism, hypotension, light-dependent non-melanoma skin malignancies, major adverse cardiovascular events (MACE), medication errors, ophthalmological effects associated to retinal vascular system, pregnancy, pulmonary venoocclusive disease associated with pulmonary oedema, renal function impairment / acute renal failure. Safety analysis set included all subjects who received at least 1 dose of study intervention.
    End point type
    Secondary
    End point timeframe
    Day 1 up to 3 days after last dose of study drug (up to 52 weeks and 3 days that is 367 days)
    End point values
    Selexipag
    Number of subjects analysed
    9
    Units: Subjects
    3
    No statistical analyses for this end point

    Secondary: Number of Subjects With Treatment-Emergent Marked Laboratory Abnormalities

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    End point title
    Number of Subjects With Treatment-Emergent Marked Laboratory Abnormalities
    End point description
    Number of subjects with treatment-emergent marked laboratory abnormalities in alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, total bilirubin, creatinine, sodium, potassium, hemoglobin, hematocrit; EVF; PCV (male), hematocrit; EVF; PCV (female), platelets (assuming no platelet cluster), leukocytes; white blood cells, Neutrophils (Abs), Eosinophils (Abs), lymphocytes (Abs) were reported. Abnormalities that occurred after study treatment start and up to last dose, that were not present at baseline, were treatment-emergent. Treatment-emergent marked laboratory abnormalities were determined at the investigator's discretion. Safety analysis set included all subjects who received at least 1 dose of study intervention.
    End point type
    Secondary
    End point timeframe
    Day 1 up to 3 days after last dose of study drug (up to 52 weeks and 3 days that is 367 days)
    End point values
    Selexipag
    Number of subjects analysed
    9
    Units: Subjects
    3
    No statistical analyses for this end point

    Secondary: Change from Baseline to Week 26 in Number of Non-invasive Low-risk Criteria Among the 8 Variables

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    End point title
    Change from Baseline to Week 26 in Number of Non-invasive Low-risk Criteria Among the 8 Variables
    End point description
    Risk score is derived for each subject considering following non-invasive low-risk criteria among 8 variables: absence of clinical signs of right heart failure, absence of symptoms progression, absence of syncope, WHO FC I-II, 6MWD >440 meter, NT-proBNP <300 ng/L, Right atrial (RA) area <18 centimeter square (cm^2) as determined by echocardiography (Echo), absence of pericardial effusion, as determined by Echo. Number of low-risk criteria at baseline & Week 26 constitutes risk score & were derived for each subject by adding ‘1’ for each of above criteria met. Number of low-risk criteria among 8 variables for each subject can vary from 0 (worse subjects) to 8 (healthier subjects). Higher score indicated healthier subjects. Safety set. Here, N (number of subjects analysed) =subjects evaluable for this endpoint & "n" signifies subjects evaluable for specified rows. As pre-specified in SAP, subject wise data was collected and reported due to very limited number of subjects enrolled.
    End point type
    Secondary
    End point timeframe
    Baseline, Week 26
    End point values
    Selexipag
    Number of subjects analysed
    6
    Units: Score on a scale
    number (not applicable)
        Subject 1 (n =1)
    1
        Subject 2 (n =1)
    1
        Subject 3 (n =1)
    3
        Subject 4 (n =1)
    1
        Subject 5 (n =1)
    1
        Subject 6 (n =1)
    1
    No statistical analyses for this end point

    Secondary: Change from Baseline to Week 26 in Number of Non-invasive Low-risk Criteria Among the 3 Variables

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    End point title
    Change from Baseline to Week 26 in Number of Non-invasive Low-risk Criteria Among the 3 Variables
    End point description
    The risk score is derived for each subject considering the following non-invasive low-risk criteria among the 3 variables: WHO FC I-II, 6MWD >440 m, NT-proBNP < 300 ng/L. Number of low-risk criteria at baseline and Week 26 constitutes risk score and were derived for each subject by adding ‘1’ for each of above criteria met. Number of low-risk criteria among the 3 variables for each subject can vary from 0 (worse subjects) to 3 (healthier subjects). Higher score indicated healthier subjects. Safety analysis set included all subjects who received at least 1 dose of study intervention. Here, N (number of subjects analysed) signifies subjects evaluable for this endpoint and "n" signifies subjects evaluable for specified rows. As pre-specified in the SAP, subject wise data was collected and reported due to very limited number of subjects enrolled.
    End point type
    Secondary
    End point timeframe
    Baseline, Week 26
    End point values
    Selexipag
    Number of subjects analysed
    6
    Units: Score on a scale
    number (not applicable)
        Subject 1 (n =1)
    1
        Subject 2 (n =1)
    0
        Subject 3 (n =1)
    2
        Subject 4 (n =1)
    1
        Subject 5 (n =1)
    1
        Subject 6 (n =1)
    1
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    All Cause Mortality: Day 1 up to 30 days after last dose of drug (up to Week 56), SAEs and non-SAEs: Day 1 up to 3 days after last dose of study drug (up to 52 weeks and 3 days that is 367 days)
    Adverse event reporting additional description
    Safety analysis set included all subjects who received at least 1 dose of study intervention.
    Assessment type
    Non-systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    25.0
    Reporting groups
    Reporting group title
    Selexipag
    Reporting group description
    Subjects with PAH received a 200 micrograms (mcg) selexipag tablet orally on the evening of Day 1, followed by twice-daily dosing starting from Day 2. The dose of selexipag was increased by 200 mcg each week to allow each subject to reach their individual maximum dose (iMD), up to 1600 mcg twice daily, by the end of Week 12. From Week 13 onwards, subjects received their iMD of 1600 mcg selexipag tablets orally twice daily until Week 52. Subjects were then followed for safety up to 30 days after the last dose of selexipag.

    Serious adverse events
    Selexipag
    Total subjects affected by serious adverse events
         subjects affected / exposed
    1 / 9 (11.11%)
         number of deaths (all causes)
    0
         number of deaths resulting from adverse events
    Cardiac disorders
    Cardiac Failure
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Reproductive system and breast disorders
    Vaginal Haemorrhage
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Selexipag
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    9 / 9 (100.00%)
    Vascular disorders
    Flushing
         subjects affected / exposed
    2 / 9 (22.22%)
         occurrences all number
    2
    Hot Flush
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    1
    Hypotension
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    1
    General disorders and administration site conditions
    Fatigue
         subjects affected / exposed
    2 / 9 (22.22%)
         occurrences all number
    2
    Face Oedema
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    1
    Chest Pain
         subjects affected / exposed
    2 / 9 (22.22%)
         occurrences all number
    2
    Pyrexia
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    1
    Oedema Peripheral
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    1
    Reproductive system and breast disorders
    Uterine Polyp
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    1
    Respiratory, thoracic and mediastinal disorders
    Dyspnoea
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    1
    Dyspnoea Exertional
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    1
    Oropharyngeal Pain
         subjects affected / exposed
    2 / 9 (22.22%)
         occurrences all number
    2
    Investigations
    Weight Decreased
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    1
    Body Temperature Increased
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    1
    Aspartate Aminotransferase Increased
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    1
    Alanine Aminotransferase Increased
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    1
    Vitamin D Decreased
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    1
    Nervous system disorders
    Dizziness Exertional
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    1
    Headache
         subjects affected / exposed
    6 / 9 (66.67%)
         occurrences all number
    7
    Hypoaesthesia
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    1
    Paraesthesia
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    1
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    1
    Ear and labyrinth disorders
    Vertigo
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    1
    Eye disorders
    Xerophthalmia
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    1
    Gastrointestinal disorders
    Diarrhoea
         subjects affected / exposed
    5 / 9 (55.56%)
         occurrences all number
    8
    Dental Caries
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    1
    Abdominal Discomfort
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    1
    Dyspepsia
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    2
    Vomiting
         subjects affected / exposed
    2 / 9 (22.22%)
         occurrences all number
    3
    Nausea
         subjects affected / exposed
    7 / 9 (77.78%)
         occurrences all number
    8
    Skin and subcutaneous tissue disorders
    Rash
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    2
    Renal and urinary disorders
    Haematuria
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    2
    Renal Pain
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    1
    Musculoskeletal and connective tissue disorders
    Back Pain
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    1
    Joint Swelling
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    1
    Myalgia
         subjects affected / exposed
    5 / 9 (55.56%)
         occurrences all number
    6
    Pain in Jaw
         subjects affected / exposed
    4 / 9 (44.44%)
         occurrences all number
    4
    Infections and infestations
    Urinary Tract Infection
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    1
    Nasopharyngitis
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    1
    Fungal Skin Infection
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    2
    Covid-19
         subjects affected / exposed
    3 / 9 (33.33%)
         occurrences all number
    3
    Metabolism and nutrition disorders
    Iron Deficiency
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    1
    Decreased Appetite
         subjects affected / exposed
    1 / 9 (11.11%)
         occurrences all number
    1

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    08 Jan 2021
    The overall reason for this protocol amendment was to provide clarification for several inclusion and exclusion criteria to better define the target population that may benefit from the study intervention, to add exploratory objectives and endpoints for long-term outcomes, to adapt to changed internal safety language and reporting processes, to align with TransCelerate template and to implement minor corrections and editorial revisions.
    25 Mar 2022
    Overall reasons for this protocol amendment was to clarify selected inclusion and exclusion criteria to better define the target population that might benefit from the study intervention and to clarify the definition of end of study (EOS) for the subjects continuing selexipag treatment in a continued access program.

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported
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