A Phase 3 study to compare long-term efficacy and safety of macitentan 75 mg versus 10 mg in Pulmonary Arterial Hypertension.

• Register: EUCTR
• Last refreshed on: 12 August 2024
• Main ID: EUCTR2019-002533-11-HU
• Date of registration: 11/03/2020
• Prospective Registration: Yes
• Primary sponsor: ACTELION Pharmacteuticals Ltd.
• Public title: A Phase 3 study to compare long-term efficacy and safety of macitentan 75 mg versus 10 mg in Pulmonary Arterial Hypertension.
• Scientific title: A Phase 3, Prospective, Multicenter, Double-blind, Double-dummy, Randomized, Active-controlled, Parallel-group, Group-sequential, Adaptive, Event-driven Study to Compare Efficacy, Safety, and Tolerability of Macitentan 75 mg Versus Macitentan 10 mg in Patients with Pulmonary Arterial Hypertension, Followed by an Open-label Treatment Period With Macitentan 75 mg. - UNISUS
• Date of first enrolment: 10/05/2020
• Target sample size: 900
• Recruitment status: Not Recruiting
• URL: https://www.clinicaltrialsregister.eu/ctr-search/search?query=eudract_number:2019-002533-11
• Study type: Interventional clinical trial of medicinal product
• Study design: Controlled: yes Randomised: yes Open: no Single blind: no Double blind: yes Parallel group: yes Cross over: no Other: yes Other trial design description: single arm after the Double Blind period If controlled, specify comparator, Other Medicinial Product: yes Placebo: no Other: no Number of treatment arms in the trial: 2
• Phase: Human pharmacology (Phase I): no Therapeutic exploratory (Phase II): no Therapeutic confirmatory - (Phase III): yes Therapeutic use (Phase IV): no

Countries of recruitment

Argentina, Australia, Austria, Belgium, Brazil, Bulgaria, Canada, China, Czech Republic, Denmark, France, Germany, Hungary, Israel, Italy, Japan, Korea, Republic of, Malaysia, Mexico, Netherlands, Norway, Poland, Portugal, Romania, Russian Federation, Slovakia, Spain, Sweden, Taiwan, Thailand, Turkey, Ukraine, United Kingdom, United States

Contacts

• Name: Clinical Registry group
• Affiliation: Janssen-Cilag International NV

• Name: Clinical Registry group
• Affiliation: Janssen-Cilag International NV

Key inclusion & exclusion criteria

Inclusion criteria:
1. Restricted population: =18 (or the legal age of consent in the jurisdiction in which the study is taking place) and = 75 years of age.
Target population: = 18 (or the legal age of consent in the jurisdiction in which the study is taking place) years of age.
2. Restricted population: Symptomatic PAH in WHO FC II or III
Target population: Symptomatic PAH in WHO FC II, III, or IV
3. Must sign an ICF (or their legally acceptable representative must sign) indicating that he or she understands the purpose of, and procedures required for, the study and is willing to participate in the study.
4. Restricted population: PAH subtype falling in one of the below classifications:
- Idiopathic
- Heritable
- Drug- or toxin-induced
- Related to:
*Connective tissue disease,
* HIV infection,
* Congenital heart disease with simple systemic-to-pulmonary shunt (atrial septal defect, ventricular septal defect, patent ductus arteriosus) with persistent PH documented by an RHC = 1 year after surgical repair.
Target populationa: PAH subtype falling in one of the below classifications:
- Idiopathic
- Heritable
- Drug- or toxin-induced
- Related to:
*Connective tissue disease,
*HIV infection,
*Portal hypertension
*Congenital heart disease with simple systemic-to-pulmonary shunt (atrial septal defect, ventricular septal defect, patent ductus arteriosus) with persistent PH documented by an RHC = 1 year after surgical repair.
5. PAH diagnosis confirmed by hemodynamic evaluation at rest at any time prior to Screening:
- Mean pulmonary artery pressure (mPAP) > 20 mmHg, AND
- Pulmonary artery wedge pressure (PAWP) or left ventricular end diastolic pressure (LVEDP) = 15 mmHg, AND
- PVR = 3 Wood Units (ie, = 240 dyn·sec·cm-5).
6. Negative vasoreactivity test in idiopathic, heritable, and drug/toxin-induced PAH.
7. Able to perform the 6MWT with a minimum distance of 50 m and maximum distance of 440 m at Screening.
8. Patients already receiving PAH therapies (mono or combination therapies) should be on a stable regimen for at least 3 months prior to screening visit and planned to be:
- If on ERA therapy: discontinued at randomization or start of run-in (ie, last dose of ERA taken the day before initiating study intervention),
- If on PAH therapy other than ERA: maintained on top of the study intervention.
9. Must sign a separate informed consent form (or their legally-acceptable representative must sign) if he or she agrees to provide optional samples for biomarker research (where local regulations permit). Refusal to give consent for the optional biomarker research samples does not exclude a participant from participation in the study.
10. A woman of childbearing potential must have a negative highly sensitive serum (ß-human chorionic gonadotropin [ß-hCG]) test at Screening and a negative urine pregnancy test prior to receiving their first dose of study intervention (i.e. either at beginning of the run-in period or prior to randomization [see Section 4.1]).
11. A woman must be (as defined in Appendix 6)
a) Not of childbearing potential,
b) Of childbearing potential and
- Practicing a highly effective, preferably user-independent method of contraception (failure rate of < 1% per year when used consistently and correctly) and agrees to remain on a highly effective method while
receiving study intervention and un
Exclusion criteria:
1. Restricted population only: Subjects not yet exposed to any PAH treatment at Screening.
2. Restricted population only: Treatment with prostanoids (including oral, inhaled, or infused routes) at Screening. Prostacyclin receptor agonists are allowed, if on stable dose for at least 3 months.
3. Does meet any of the following run-in failure criteria (applies only to participants who are required to have a run-in period):
- Study intervention compliance < 80%,
- Central laboratory results showing a decrease in hemoglobin by > 20 g/L from Screening or hemoglobin < 100 g/L or need for transfusion not explained by other confounding factors,
- Significant fluid retention as evidenced by one of the following:
*Administration of iv diuretics due to fluid retention,
*Addition of high potency thiazide diuretic (metolazone, indapamide), = 100% increase in loop diuretic to a total oral dose = 120 mg of furosemide equivalents/day,
*Increase in body weight by = 5% or = 5 kg from the value at the start of the run-in period.
- The investigator considers that for safety reasons or tolerability reasons (eg, AE) it is in the best interests of the participant to discontinue the study.
Subjects who are run-in failures per the criteria described above will be considered screen failures (see Section 5.4).
4. Treatment with a strong CYP3A4 inducer (eg, rifabutin, rifampin, rifampicin, rifapentin, carbamazepine, phenobarbital, phenytoin, St. John’s Wort) within 1 month prior to Baseline.
5. Treatment with a strong CYP3A4 inhibitor (eg, ketoconazole, itraconazole, voriconazole, clarithromycin, telithromycin, nefazodone, ritonavir, and saquinavir) in the 1-month period prior to Baseline.
6. Treatment with a soluble guanylate cyclase stimulatorb within 1 month prior to Baseline, unless results of Drug-Drug Interaction (DDI) study allow its concomitant use with macitentan 75 mg during the course of the study, as communicated by the sponsor.
7. For participants involved in the cardiac remodeling and/or hemodynamic substudies only: Diuretic treatment initiated or dose changed within 1 week prior to the MRI or RHC assessment.
8. Known presence of three or more of the following risk factors for heart failure with preserved ejection fraction at Screening, based on records that confirm documented medical history:
- Body mass index (BMI) > 30 kg/m2,
- Diabetes mellitus of any type,
- Essential hypertension (even if well controlled),
- Coronary artery disease, ie, any of the following:
*History of stable angina, or
*Known more than 50% stenosis in a coronary artery, or
*History of myocardial infarction, or
*History of or planned coronary artery bypass grafting and/or coronary artery stenting.
9. Known presence of moderate or severe obstructive lung disease (forced expiratory volume in 1 second [FEV1] / forced vital capacity [FVC] < 70%; and FEV1 < 60% of predicted after bronchodilator administration) at any time prior to Screening.
10. Known presence of moderate or severe restrictive lung disease (total lung capacity [TLC] or FVC < 60% of normal predicted value) at any time prior to Screening.
11. Significant unrepaired structural valvular heart disease (ie, moderate or severe aortic or mitral stenosis or regurgitation); pericardial constriction; restrictive or congestive left-sided cardiomyopathy; life-threatening cardiac arrhythmias; significant left ventricular dysfunction; or left ventricular outflow obstruction.
12. Permanent atrial fibrillation or at

Age minimum:
Age maximum:
Gender:
Female: yes
Male: yes

Health Condition(s) or Problem(s) studied

Pulmonary arterial hypertension
MedDRA version: 21.1 Level: PT Classification code 10064911 Term: Pulmonary arterial hypertension System Organ Class: 10038738 - Respiratory, thoracic and mediastinal disorders

Therapeutic area: Diseases [C] - Cardiovascular Diseases [C14]

Intervention(s)

Trade Name: Opsumit®
Product Name: macitentan tablets
Product Code: JNJ-67896062 / ACT-064992
Pharmaceutical Form: Film-coated tablet
INN or Proposed INN: MACITENTAN
CAS Number: 441798-33-0
Concentration unit: mg milligram(s)
Concentration type: equal
Concentration number: 10-
Pharmaceutical form of the placebo: Film-coated tablet
Route of administration of the placebo: Oral use

Product Name: macitentan tablets
Product Code: JNJ-67896062 / ACT-064992
Pharmaceutical Form: Film-coated tablet
INN or Proposed INN: MACITENTAN
CAS Number: 441798-33-0
Concentration unit: mg milligram(s)
Concentration type: equal
Concentration number: 75-
Pharmaceutical form of the placebo: Film-coated tablet
Route of administration of the placebo: Oral use

Product Name: macitentan tablets
Product Code: JNJ-67896062 / ACT-064992
Pharmaceutical Form: Film-coated tablet
INN or Proposed INN: MACITENTAN
CAS Number: 441798-33-0
Concentration unit: mg milligram(s)
Concentration type: equal
Concentration number: 37.5-
Pharmaceutical form of the placebo: Film-coated tablet
Route of administration of the placebo: Oral use

Primary Outcome(s)

Main Objective: To demonstrate superiority of macitentan 75 mg in prolonging the time to the first CEC-adjudicated morbidity or mortality (M/M) event in patients with symptomatic pulmonary arterial hypertension (PAH) compared to macitentan 10 mg.

Timepoint(s) of evaluation of this end point: At each study visits, monthly and at any time in case of event occurrence, until 217 M/M events are reached

Secondary Objective: - To demonstrate that macitentan 75 mg improves exercise capacity compared to macitentan 10 mg
- To demonstrate that macitentan 75 mg prolongs the time to death or hospitalization due to PAH (adjudicated by an independent CEC) compared to macitentan 10 mg
- To demonstrate that macitentan 75 mg improves risk category for clinical worsening and death compared to macitentan 10 mg
- To assess the effect of macitentan 75 mg compared to macitentan 10 mg on PAH symptoms on participants' life
- To assess the effect on prolongation of the time to death of macitentan 75 mg compared to macitentan 10
mg

Primary end point(s): - Time to first CEC-adjudicated M/M event on-treatment (ie, up to 7 days after the last dose of study treatment), defined as time from baseline to the first of the following events:
- All-cause death, or onset of an interventionemergent AE with a fatal outcome occurring within 4 weeks of study treatment discontinuation
- PAH-related hospitalization (including for worsening of PAH, atrial septostomy, lung transplantation with or without heart transplantation, or initiation of parenteral prostacyclins)
- Worsening of PAH resulting in initiation of parenteral prostanoid therapy
- PAH-related disease progression, defined as (both criteria must be satisfied):
o More than 15% decrease in 6MWD from baseline, confirmed by two 6MWD tests performed on separate days within 2 weeks of each other
o Initiation of additional PAH therapy or Worsening of WHO FC

Secondary Outcome(s)

Timepoint(s) of evaluation of this end point: Screening, Day 1, Month 3, and all scheduled visits thereafter until EOLT or anytime in case of event, with the exception of PAH-SYMPACT

Secondary end point(s): - Change from baseline to Week 24 in 6MWD
- Time to death due to PAH or hospitalization for PAH, CEC adjudicated event on-treatment (ie, up to 7 days
after the last dose of study treatment), as defined hereafter:
- Death due to PAH, or onset of an interventionemergent AE due to PAH with a fatal outcome, occurring within 4 weeks of study treatment discontinuation OR
- Non-planned PAH-related hospitalization
- Change from Baseline to Week 24 in the number of low-risk non-invasive criteria based on WHO FC, 6MWD
and NT-proBNP
- Change from baseline to Week 24 in PAH-SYMPACT:
- Cardiopulmonary symptom domain score
- Cardiovascular symptom domain score
- Time to death occurring between baseline and end of double-blind (DB) treatment period as defined hereafter:
- All-cause death, or onset of an AE during the DB treatment period with a fatal outcome occurring within 4 weeks of end of DB treatment period

Secondary ID(s)

2019-002533-11-DE

AC-055-315

Source(s) of Monetary Support

Actelion Pharmaceuticals Ltd

Ethics review

Status: Approved
Approval date: 27/04/2020
Contact: