This trial is active, not recruiting.

Condition hypertension, pulmonary
Treatments inhaled treprostinil, tadalafil
Phase phase 4
Sponsor Stanford University
Collaborator Northwestern University
Start date July 2010
End date September 2014
Trial size 30 participants
Trial identifier NCT01305252, IRB protocol # 18305, SU-07152010-6565


The Study Hypothesis:

Aggressive, upfront, dual therapy for treatment-naïve NYHA I/II/III PAH is superior to a traditional "step-up" approach.

The study will evaluate:

1. Impact of dual, upfront, therapy on cardiovascular parameters in PAH as gauged by cardiac magnetic resonance imaging (cMRI) at 24 weeks and event free survival at outcome at 48 weeks.

2. Value of novel biomarkers (NT-pro BNP, Mts1/S100A4, and insulin resistance) and cutting-edge imaging technologies (cardiac MRI) as newer endpoints for clinical trials in PAH.

3. Utility of longer clinical trial design with the use of combined clinical events as time to clinical worsening surrogate

United States No locations recruiting
Other countries No locations recruiting

Study Design

Allocation randomized
Endpoint classification efficacy study
Intervention model parallel assignment
Masking double blind (subject, caregiver, investigator)
Primary purpose treatment
(Active Comparator)
tadalafil 40mg QD
tadalafil Adcirca
tadalafil 20mg QD PO increasing to 40mg QD as tolerated
(Active Comparator)
inhaled treprostinil Tyvaso
Treprostinil inhalation QID starting at 3 breaths per inhalation & gradually increasing to 9 breaths. Each breath provides approximately 6mcg of treprostinil.
tadalafil Adcirca
tadalafil 20mg QD PO increasing to 40mg QD as tolerated

Primary Outcomes

Effect of dual-upfront therapies versus mono-therapy on parameters of right ventricular function as gauged by cMRI. Primary endpoint will be aimed at evaluating the mean change in RV end diastolic volume (RVEDV) at 24 weeks.
time frame: 24 weeks
Changed in RVEDV by cardiac MRI
time frame: 24 Weeks

Secondary Outcomes

NT-pro BNP
time frame: 24 weeks
Time to clinical worsening
time frame: 48 weeks

Eligibility Criteria

Male or female participants from 18 years up to 69 years old.

Inclusion criteria: 1. Age 18 and < 75 years at baseline visit. 2. Diagnosis of Idiopathic PAH, Heritable PAH (including Hereditary Hemorrhagic Telangiectasia), Associated PAH (including collagen vascular disorders, drug+toxin exposure, repaired congenital heart disease repaired > 5 years, portopulmonary disease, and human immunodeficiency virus (HIV) infection not on protease inhibitor). 3. PAH treatment naïve including any prostacycline, endothelin receptor antagonist, or phosphodiesterase inhibitors within 12 months prior to enrollment. 4. Previous Right Heart Catheterization that documented: 1. Mean PAP; 25 mmHg. 2. Pulmonary capillary wedge pressure < 15 mmHg. 3. Pulmonary Vascular Resistance; 3.0 Wood units or 240 dynes/sec/cm5 5.6MW distances; 150 m and < 450 meters. 6. WHO functional class II or III as judged by principal investigators. Exclusion Criteria: Exclusion criteria: 1. Group II - V pulmonary hypertension. 2. PAH with unrepaired congenital heart defect. 3. Current or prior PAH treatments within the last 6-12 months including experimental PAH therapies (including but not limited to tyrosine kinase inhibitors, rho-kinase inhibitors, phosphodiesterase inhibitors, prostacycline, or cGMP modulators). 4. TLC < 60% predicted; if TLC b/w 60 and 70% predicted, high resolution computed tomography must be available to exclude significant interstitial lung disease. 5. FEV1 / FVC < 70% predicted and FEV1 < 60% predicted 6. Significant left-sided heart disease (based on pre-trial Echocardiogram): 1. Significant aortic or mitral valve disease 2. Diastolic dysfunction ; Grade II C.LV systolic function < 45% d. Pericardial constriction e. Restrictive cardiomyopathy f. Significant coronary disease with demonstrable ischemia 7. Chronic renal insufficiency defined as an estimated creatinine clearance < 30 ml/min (by MDRD equation) 8. Current atrial arrhythmias 9. Uncontrolled systemic hypertension: SBP > 160 mm or DBP > 100mm 10. Severe hypotension: SBP < 80 mmHg. 11. Pregnant or breast-feeding 12. Psychiatric, addictive, or other disorder that compromises patient's ability to provide informed consent, follow study protocol, and adhere to treatment instructions 13. Co-morbid conditions that would impair a patient's exercise performance and ability to assess WHO functional class, including but not limited to chronic low-back pain or peripheral musculoskeletal problems. 14. Contraindications for magnetic resonance imaging, including significant claustrophobia, implanted metallic objects, or others as per Appendix X). 15. Known allergy to treprostinil or tadalafil. 16. Active oral nitrate use. 17. Diabetes mellitus. 18. Planned initiation of cardiac or pulmonary rehabilitation during period of study.

Additional Information

Official title CombinatiON Up-FRON t Therapy for PAH - A Phase 4, Randomized, Multicenter Study of Inhaled Treprostinil in Treatment naïve Pulmonary Arterial Hypertension Patients Starting on Tadalafil
Principal investigator Roham T. Zamanian
Trial information was received from ClinicalTrials.gov and was last updated in May 2014.
Information provided to ClinicalTrials.gov by Stanford University.