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| Name | Class |
|---|---|
| Merck Canada Inc. | INDUSTRY |
| Alberta Health services | OTHER |
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The goal of this clinical trial is to determine whether sotatercept is effective in improving diffusing capacity in patients with pulmonary arterial hypertension.
Participants will be asked to:
The main objectives of the study are:
Primary objective: To assess whether sotatercept will improve recruitment of diffusing membrane capacity (DM) with exercise.
Secondary objective: To identify components of the diffusing capacity that respond to treatment with sotatercept in pulmonary arterial hypertension.
Potential participants must provide their written informed consent before any study-specific procedures.
All screening procedures will be completed over two weeks during three separate visits. For participants from the Calgary site (site 2), all Visit 1 procedures except for PFT and CPET may be performed on a separate day in Calgary. Visits 2 and 3 will be performed in Edmonton (site 1). According to patient preference, visits 2 and 3 can be performed on the same day, with a minimum 3-hour break between visits. For participants from Calgary (site 2), the first drug administration will occur in Calgary within seven days of completion of Visit 3 procedures.
Screening will include reviewing the participant's medical, surgical, and family history, collecting demographics, race, and ethnicity, and requesting medical records for relevant external procedures.
Screening procedures include:
Visit 1:
Visit 2:
Visit 3:
Measurements/assessments taken during the Screening Period will be recorded as the baseline values for the study assessment of endpoints.
Treatment Period (Visit 4-14) All study procedures should be performed prior to the study drug administration. For participants at the Calgary site, Visits 4,8-14 occur at their home site. For participants from the Calgary site (site 2), Visit 5-7 will be performed in Edmonton (site 1). Visits 5-7 are to be performed before the administration of the 3rd dose of the study drug. According to the patient's preference, visits 6 and 7 may be combined.
Visit 4 (Week 3)
Visit 5 (Week 5-6):
Visit 6 (Week 5-6):
Visit 7 (Week 5-6):
Visit 8 (Week 6):
Visit 9 (Week 9):
Visit 10-14 (Week 12 - 24):
End-of-Study Period (Visits 13-14) End-of-Study period visits will start 1 week after the last dose of the study medication and will be completed over 2 weeks. Visits 15-17 will be performed in Edmonton (site 1). Visit 16 and 17 can be performed on the same day according to patient preference.
Visit 15:
Visit 16:
Visit 17:
Follow-up period (Visit 18) A follow-up visit will occur 3 weeks after the last dose of the study medication. For Edmonton participants (site 1), Visit 18 may happen on the same day after Visit 17 is completed.
Visit 18:
Following the last dose of study drug administration, participants have the option to continue with open label sotatercept supplied directly from the manufacturer until either the participant discontinues sotatercept or reimbursement through public or private insurance is in place. The treating physician will be responsible for ongoing monitoring and administration of sotatercept beyond the last dose.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Sotatercept Group | Experimental | Sotatercept 0.7mg/kg |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Sotatercept | Drug | 0.7mg/kg |
|
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| Measure | Description | Time Frame |
|---|---|---|
| Lung diffusing capacity | Lung diffusing capacity (DLCO) will be measured using six-second, advanced DLCO techniques | 6 weeks post starting treatment |
| Lung diffusing capacity | Lung diffusing capacity (DLCO) will be measured using six-second, advanced DLCO techniques | 23 weeks post starting treatment |
| Diffusing membrane capacity (Dm) | Diffusing membrane capacity will be measured using six-second, advanced DLCO | 6 weeks post starting treatment |
| Diffusing membrane capacity (Dm) | Diffusing membrane capacity will be measured using six-second, advanced DLCO | 23 weeks post starting treatment |
| Pulmonary capillary blood volume (Vc) | Pulmonary capillary blood volume (Vc) will be measured using six-second, advanced DLCO techniques | 6 weeks post starting treatment |
| Pulmonary capillary blood volume (Vc) | Pulmonary capillary blood volume (Vc) will be measured using six-second, advanced DLCO techniques | 23 weeks post starting treatment |
| Measure | Description | Time Frame |
|---|---|---|
| Cardiac structure and function | Cardiac structure will be measured using standard cardiac ultrasound | 6 weeks post starting treatment |
| Cardiac structure and function | Cardiac structure will be measured using standard cardiac ultrasound |
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Eligible participants must meet all of the following inclusion criteria to be enrolled in the study:
Age ≥ 18 years.
Documented diagnostic right heart catheterization (RHC) at any time prior to screening confirming the diagnosis of PAH Group 1 in any of the following subtypes:
Symptomatic PAH classified as WHO FC II or III.
On stable doses of ≥2 background PAH therapies for at least 60 days prior to screening; for infusion prostacyclins, dose adjustment within 10% of the optimal dose is allowed per medical practice. Patients on 1 background PAH therapy are eligible if there is documented intolerance or contraindication to use of the other 2 classes (e.g. liver enzyme elevation while taking an ERA).
Females of childbearing potential must:
Male participants must:
Ability to adhere to study visit schedule and understand and comply with all protocol requirements.
Ability to understand and provide written informed consent.
Exclusion Criteria
1. Diagnosis of pulmonary hypertension WHO Groups 2, 3, 4, or 5
Musculoskeletal limitation that precludes participation in cycle ergometry
Resting oxygen saturation < 88%. (Note: patients on oxygen can be included in the study if they can maintain a resting saturation of ≥ 88 % after 3 minutes off oxygen).
Diagnosis of the following PAH Group 1 subtypes: human immunodeficiency virus (HIV)-associated PAH and PAH associated with portal hypertension, schistosomiasis-associated PAH and pulmonary veno-occlusive disease.
Hemoglobin (Hgb) at screening above the gender-specific upper limit of normal (ULN), per local laboratory test.
Baseline platelet count < 50,000/mm3 (< 50.0 × 109/L) in the enrollment period.
Uncontrolled systemic hypertension as evidenced by sitting systolic blood pressure > 160 mmHg or sitting diastolic blood pressure > 100 mmHg during a screening visit after a period of rest.
Baseline systolic blood pressure < 90 mmHg at screening.
Pregnant or breastfeeding women.
Any of the following clinical laboratory values at the screening visit:
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.
History of full pneumonectomy.
Pulmonary function test (PFT) values of forced vital capacity (FVC) < 60% predicted and/or FEV1/FVC < lower limit of normal at the screening visit or within 6 months prior to the screening visit.
Smoking history of ≥ 20 pack-years or any tobacco smoking or vaping within the previous 3 months.
Body mass index ≥ 40 kg/m2.
Planned initiation of an exercise program for cardiopulmonary rehabilitation during the study (participants who are stable in the maintenance phase of a program and who will continue for the duration of the study are eligible).
Known history of portal hypertension or chronic liver disease, including hepatitis B and/or hepatitis C (with evidence of recent infection and/or active virus replication), defined as mild to severe hepatic impairment (Child-Pugh Class A-C).
History of restrictive, constrictive, or congestive cardiomyopathy.
History of atrial septostomy within 180 days prior to the screening visit.
Electrocardiogram (ECG) with Fridericia's corrected QT interval (QTcF) > 500 ms during the Screening Period
Personal or family history of long QT syndrome (LQTS) or sudden cardiac death.
Left ventricular ejection fraction < 45% on historical echocardiogram within 6 months prior to the screening visit.
Any symptomatic coronary disease events (prior myocardial infarction, percutaneous coronary intervention, coronary artery bypass graft surgery, or cardiac anginal chest pain) within 6 months prior to the screening visit. Note: Anginal pain can be ignored as an exclusion criterion if coronary angiography shows no obstructions.
Cerebrovascular accident within 3 months prior to the Screening Visit.
Significant mitral or aortic valve dysfunction (greater than moderate mitral regurgitation or aortic regurgitation, or greater than mild mitral stenosis or aortic stenosis).
Received intravenous inotropes (e.g., dobutamine, dopamine, norepinephrine, vasopressin) within 30 days prior to the screening visit.
Known hypersensitivity to sotatercept or to any ingredient in the formulation or component of the container.
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Desi Fuhr, MSc | Contact | 7804921121 | fuhr@ualberta.ca | |
| Kostia Dmytriiev, MD | Contact | 7804928027 | kdmytrii@ualberta.ca |
| Name | Affiliation | Role |
|---|---|---|
| Jason Weatherald, MD | University of Alberta | Principal Investigator |
| Michael Stickland, PhD | University of Alberta | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Clinical Physiology Laboratory | Recruiting | Edmonton | Alberta | T6G2R3 | Canada |
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| ID | Term |
|---|---|
| D065627 | Familial Primary Pulmonary Hypertension |
| ID | Term |
|---|---|
| D006976 | Hypertension, Pulmonary |
| D008171 | Lung Diseases |
| D012140 | Respiratory Tract Diseases |
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| ID | Term |
|---|---|
| C542017 | ACE-011 |
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| 23 weeks post starting treatment |
| Cardiac function | Cardiac function will be measured using standard cardiac ultrasound | 6 weeks post starting treatment |
| Cardiac function | Cardiac function will be measured using standard cardiac ultrasound | 23 weeks post starting treatment |
| Peripheral muscle microcirculation | Peripheral muscle microcirculation will be measured using continuous-wave near-infrared spectroscopy | 6 weeks post starting treatment |
| Peripheral muscle microcirculation | Peripheral muscle microcirculation will be measured using continuous-wave near-infrared spectroscopy | 23 weeks post starting treatment |