E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Pulmonary Arterial Hypertension (PAH) |
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E.1.1.1 | Medical condition in easily understood language |
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E.1.1.2 | Therapeutic area | Diseases [C] - Cardiovascular Diseases [C14] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 21.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10064911 |
E.1.2 | Term | Pulmonary arterial hypertension |
E.1.2 | System Organ Class | 10038738 - Respiratory, thoracic and mediastinal disorders |
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E.1.3 | Condition being studied is a rare disease | Yes |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
The objective of this study is to evaluate the effects of sotatercept treatment (plus maximum tolerated background PAH therapy) versus placebo (plus maximum tolerated background PAH therapy) on time to first event of all-cause death, lung transplantation, or PAH worsening related hospitalization of ≥ 24 hours, in participants with WHO FC III or FC IV PAH at high risk of mortality. |
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E.2.2 | Secondary objectives of the trial |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
Eligible participants must meet all of the following inclusion criteria to be enrolled in the study: 1. Age 18 to 75 years, inclusive 2. Documented diagnostic right heart catheterization prior to screening confirming the diagnosis of WHO PAH Group 1 in any of the following subtypes: • Idiopathic PAH • Heritable PAH • Drug/toxin-induced PAH • PAH associated with CTD • PAH associated with simple, congenital systemic-to-pulmonary shunts at least 1 year following repair 3. Symptomatic PAH classified as WHO FC III or IV 4. REVEAL Lite 2.0 risk score of ≥ 9 5. Right heart catheterization performed during screening (or within 2 weeks prior to screening, if done at the clinical study site) documenting a minimum PVR of ≥ 5 Wood units and a pulmonary capillary wedge pressure (PCWP) or left ventricular end-diastolic pressure (LVEDP) of ≤ 15 mmHg 6. Clinically stable and on stable doses of maximum tolerated (per investigator’s judgment) double or triple background PAH therapies for at least 30 days prior to screening 7. Females of childbearing potential must: • Have 2 negative urine or serum pregnancy tests as verified by the investigator prior to starting study therapy; must agree to ongoing urine or serum pregnancy testing during the course of the study and until 8 weeks after the last dose of the study drug •If sexually active with a male partner - Used highly effective contraception without interruption; for at least 28 days prior to starting the investigational product AND - Agree to use the same highly effective contraception in combination with a barrier method during the study (including dose interruptions), and for 16 weeks (112 days) after discontinuation of study treatment 8. Male participants must: • Agree to use a condom, defined as a male latex condom or nonlatex condom NOT made out of natural (animal) membrane (e.g., polyurethane), during sexual contact with a pregnant female or a female of childbearing potential while participating in the study, during dose interruptions, and for at least 16 weeks (112 days) following investigational product discontinuation, even if he has undergone a successful vasectomy • Refrain from donating blood or sperm for the duration of the study and for 16 weeks (112 days) after the last dose of study treatment 9. Ability to adhere to study visit schedule and understand and comply with all protocol requirements 10. Ability to understand and provide written informed consent |
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E.4 | Principal exclusion criteria |
1. Diagnosis of PH WHO Groups 2, 3, 4, or 5 2. Diagnosis of the following PAH Group 1 subtypes: human immunodeficiency virus-associated PAH and PAH associated with portal hypertension 3. Diagnosis of pulmonary veno-occlusive diseases or pulmonary capillary hemangiomatosis or overt signs of capillary and/or venous involvement 4. Hemoglobin at screening above gender-specific upper limit of normal (ULN), per local laboratory test 5. Baseline platelet count < 50,000/mm3 (< 50.0 x 109/L) at screening 6. Baseline systolic blood pressure < 85 mmHg at screening 7. Pregnant or breastfeeding women 8. Serum alanine aminotransferase, aspartate aminotransferase, or total bilirubin levels > 3.0 × ULN 9. Currently enrolled in or have completed any other investigational product study within 30 days for small-molecule drugs or within 5 half-lives for biologics prior to the date of signed informed consent 10.Prior exposure to sotatercept or known allergic reaction to sotatercept, its excipients, or luspatercept 11. History of pneumonectomy 12.This criterion has been removed 13.Untreated more than mild obstructive sleep apnea 14.History of known pericardial constriction 15.History of restrictive or congestive cardiomyopathy 16.Electrocardiogram (ECG) with Fridericia’s corrected QT interval (QTcF) > 500 ms during the Screening Period 17.Personal or family history of long QT syndrome or sudden cardiac death 18.Left ventricular ejection fraction < 45% on historical echocardiogram within 1 year prior to the Screening Visit 19.Any current or prior history of symptomatic coronary disease (prior myocardial infarction, percutaneous coronary intervention, coronary artery bypass graft surgery, or cardiac anginal chest pain) in the past 6 months prior to the Screening Visit 20.Cerebrovascular accident within 3 months prior to the Screening Visit 21.Significant (≥ 2+ regurgitation) mitral regurgitation or aortic regurgitation valvular disease 22.Currently on dialysis or anticipated need for dialysis within the next 12 months |
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E.5 End points |
E.5.1 | Primary end point(s) |
The primary efficacy endpoint is the time to first event of all-cause death, lung transplantation, or PAH worsening-related hospitalization of ≥ 24 hours. |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
An IA of the primary efficacy endpoint is planned to occur when approximately 59 participants have experienced a primary endpoint even (roughly 50% of the required number of events) have occurred. |
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E.5.2 | Secondary end point(s) |
The secondary endpoints are ranked as follows: 1. Overall survival 2. Transplant-free survival 3. Proportion of participants who experienced a mortality event at EOS 4. Change from baseline in REVEAL Lite 2.0 risk score at Week 24 5. Proportion of participants achieving a low or intermediate (≤ 7) REVEAL Lite 2.0 risk score at Week 24 6. Change from baseline in NT-proBNP levels at Week 24 7. Change from baseline in mean pulmonary artery pressure (mPAP) at Week 24 8. Change from baseline in PVR at Week 24 9. Proportion of participants who improve in WHO FC at the end of the DBPC Treatment Period 10. Change from baseline in 6MWD at Week 24 11. Change from baseline in cardiac output (CO) at Week 24 12. Change from baseline in EuroQoL-5 dimensions scale 5 levels (EQ-5D-5L) index score at Week 24 |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
If the efficacy boundary is crossed for the primary endpoint at the IA, then analyses of secondary endpoints will be performed using a gatekeeping method. The 1-sided Type 1 error rate for the evaluation of secondary endpoints should be 0.025. |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | Yes |
E.6.7 | Pharmacodynamic | Yes |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | Yes |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | Yes |
E.8.1.5 | Parallel group | Yes |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | Yes |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 2 |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 1 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 28 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
Australia |
Canada |
Israel |
Mexico |
United Kingdom |
United States |
Belgium |
France |
Germany |
Italy |
Netherlands |
Spain |
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E.8.7 | Trial has a data monitoring committee | Yes |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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A participant is considered to have completed the study if he/she has completed all phases of the study, including the EOT and/or EOS Visits. Participants who discontinue the study early or decline enrollment into the LTFU Study A011-12 (SOTERIA) will be asked to return to the clinic for the EOS Visit. The end of the study is defined as when the last participant completes the last visit. |
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 3 |
E.8.9.1 | In the Member State concerned months | 0 |
E.8.9.1 | In the Member State concerned days | |
E.8.9.2 | In all countries concerned by the trial years | 3 |
E.8.9.2 | In all countries concerned by the trial months | 6 |