A Study of Tadalafil in Pediatric Participants With Pulmonary Arterial Hypertension (PAH)

NCT ID: NCT01824290

Last Updated: 2021-11-05

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: PHASE3
• Total Enrollment: 35 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2014-02-05
• Study Completion Date: 2021-03-10

Brief Summary

The main purpose of this study is to evaluate the safety and efficacy of tadalafil in pediatric participants with pulmonary arterial hypertension. Participants will receive study treatment for 6 months in the double-blind period (Period 1), and then will be eligible to enroll into an open-label 2 year extension period (Period 2) during which participants will receive tadalafil.

Conditions

Hypertension, Pulmonary

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: DOUBLE

Study Groups

Tadalafil

Period 1: 20 mg or 40 mg administered orally by tablets once a day.

Period 2: 20 mg for middle weight and 40 mg for heavy weight administered orally by tablets once a day.

Final tadalafil doses for Period 1 (6-month double-blind) were assigned after the weight cohort completion from H6D-MC-LVIG (NCT01484431).Tadalafil doses would range from 5 milligram (mg) to 40 mg depending on body weight cohorts. Heavy weight cohort ≥40 kilogram (kg), Middle weight cohort ≥25 kg to <40 kg: administered orally by tablets once a day. Light weight cohort <25 kg: administered orally by suspension once a day.

Participants receiving tadalafil in Period 1 continued to receive tadalafil during Period 2 (2-year open-label extension).

Group Type: EXPERIMENTAL

Tadalafil

Intervention Type: DRUG

Administered orally by tablet form for heavy and middle weight participants. Administered orally by suspension for light weight participants.

ERA as specific PAH treatment

Intervention Type: DRUG

All participants were taking endothelin receptor antagonist (ERA) (such as bosentan, ambrisentan and macitentan).

Placebo

Period 1: Participants received placebo orally by tablets once a day.

Period 2: 20 mg for middle weight and 40 mg for heavy weight administered orally by tablets once a day.

Final placebo dose for Period 1 (6-month double-blind) was be assigned after the weight cohort completion from H6D-MC-LVIG (NCT01484431) to maintain blinding depending on body weight cohort.

Participants receiving placebo in Period 1 Period 2 (2-year open-label extension) would receive tadalafil in Period 2 at the corresponding tadalafil dose in that participant's weight group.

Group Type: PLACEBO_COMPARATOR

Placebo

Intervention Type: DRUG

Administered orally by tablet for heavy and middle weight participants. Administered orally by suspension for light weight participants.

ERA as specific PAH treatment

Intervention Type: DRUG

All participants were taking endothelin receptor antagonist (ERA) (such as bosentan, ambrisentan and macitentan).

Interventions

Tadalafil

Administered orally by tablet form for heavy and middle weight participants. Administered orally by suspension for light weight participants.

Intervention Type: DRUG

Placebo

Administered orally by tablet for heavy and middle weight participants. Administered orally by suspension for light weight participants.

Intervention Type: DRUG

ERA as specific PAH treatment

All participants were taking endothelin receptor antagonist (ERA) (such as bosentan, ambrisentan and macitentan).

Intervention Type: DRUG

Other Intervention Names

LY450190; Cialis; Adcirca; IC351

Eligibility Criteria

Inclusion Criteria

• ≥6 months to <18 years of age at screening
• Currently have a diagnosis of PAH that is either:

• idiopathic, including hereditary
• related to connective tissue disease
• related to anorexigen use
• associated with surgical repair of at least 6-month duration of congenital systemic to pulmonary shunt (eg, atrial septal defect, ventricular septal defect, patent ductus arteriosus)
• Have a history of a diagnosis of PAH established by a resting mean pulmonary artery pressure (mPAP) ≥25 millimeter of mercury (mm Hg), pulmonary artery wedge pressure ≤15 mm Hg, and a pulmonary vascular resistance (PVR) ≥3 Wood units via right heart catheterization (RHC). In the event that a pulmonary artery wedge pressure cannot be obtained during RHC, participants with a left ventricular end diastolic pressure (LVEDP) <15 mm Hg, with normal left heart function, and absence of mitral stenosis on echocardiography can be eligible for enrollment
• Have a World Health Organization (WHO) functional class value of II or III at the time of screening
• All participants must be receiving an endothelin receptor antagonist (ERA) (such as bosentan or ambrisentan) and must be on a maintenance dose with no change in dose (other than weight-based adjustments) for at least 12 weeks prior to screening and have a screening aspartate transaminase (AST)/alanine transaminase (ALT) <3 times the upper limit of normal (ULN)
• If on conventional PAH medication, including but not restricted to, anticoagulants, diuretics, digoxin, and oxygen therapy, the participant must be on stable doses with no changes (other than weight-based adjustments) for at least 4 weeks before screening
• Female participants of childbearing potential must test negative for pregnancy during screening. Furthermore, female participants must agree to abstain from sexual activity or to use two different reliable methods of birth control as determined by the Investigator during the study. Examples of reliable birth control methods include true abstinence as a lifestyle choice (periodic sexual abstinence method is not acceptable); the use of oral contraceptives; a reliable barrier method of birth control (diaphragms with contraceptive jelly; cervical caps with contraceptive jelly; condoms with contraceptive foam; intrauterine devices)
• Written informed consent from parents (and written assent from appropriately aged participants) will be obtained prior to any study procedure being performed

Exclusion Criteria

• Have pulmonary hypertension related to conditions other than specified above, including but not limited to chronic thromboembolic disease, portal pulmonary hypertension, left-sided heart disease or lung disease and hypoxia
• History of left-sided heart disease, including any of the following:

• clinically significant [pulmonary artery occlusion pressure (PAOP) 15-18 mm Hg] aortic or mitral valve disease (ie, aortic stenosis, aortic insufficiency, mitral stenosis, moderate or greater mitral regurgitation)
• pericardial constriction
• restrictive or congestive cardiomyopathy
• left ventricular ejection fraction <40% by multigated radionucleotide angiogram (MUGA), angiography, or echocardiography
• left ventricular shortening fraction <22% by echocardiography
• life-threatening cardiac arrhythmias
• symptomatic coronary artery disease within 5 years of study entry
• Unrepaired congenital heart disease
• Have a history of angina pectoris or other condition that was treated with long- or short-acting nitrates within 12 weeks before administration of study drug
• Have severe hepatic impairment, Child-Pugh Grade C
• Have severe renal insufficiency, defined as receiving renal dialysis or having a measured or estimated creatinine clearance (CC) <30 millimeter per minute (mL/min) (Schwartz Formula)
• Diagnosed with a retinal disorder (eg, hereditary retinal disorders, retinopathy of the preterm participant and other retinal disorders)
• Have severe hypotension or uncontrolled hypertension as determined by the Investigator
• Have significant parenchymal lung disease
• Have bronchopulmonary dysplasia
• Concurrent phosphodiesterase type 5 (PDE5) inhibitor therapy (sildenafil or vardenafil) or has received PDE5 inhibitor therapy within 12 weeks prior to the first study drug dosing
• Concurrent therapy with prostacyclin or its analogues within 12 weeks of screening
• Commenced or discontinued a chronic conventional PAH medication including but not restricted to: diuretics, anti-coagulants, digoxin, and oxygen therapy within 4 weeks of screening
• Currently receiving treatment with doxazosin, nitrates, or cancer therapy
• Current treatment with potent Cytochrome P450 3A4 (CYP3A4) inhibitors, such as antiretroviral therapy (protease inhibitor), systemic ketoconazole, or systemic itraconazole, or chronic use of potent CYP3A4 inducers, such as rifampicin
• Are nursing or pregnant
• Have previously completed or withdrawn from this study (LVHV), or any other study investigating tadalafil
• Have received tadalafil therapy within 12 weeks prior to the first study drug dosing or are hypersensitive to tadalafil
• Have allergy to the excipients, notably lactose
• Are currently enrolled in, or discontinued within the last 30 days from, a clinical trial involving an investigational product or non-approved use of a drug or device, or concurrently enrolled in any other type of medical research judged not to be scientifically or medically compatible with this study by the Sponsor
• Unable to take orally administered tablets (without chewing, crushing or breaking) or suspension
• Are Investigator site personnel directly affiliated with this study or their immediate families. Immediate family is defined as a spouse, parent, child or sibling, whether biological or legally adopted
• Diagnosis of Down syndrome

• Minimum Eligible Age: 6 Months
• Maximum Eligible Age: 17 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Eli Lilly and Company

INDUSTRY

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Call 1-877-CTLILLY (1-877-285-4559) or 1-317-615-4559 Mon - Fri 9AM - 5 PM Eastern time (UTC/GMT - 5 hours, EST)

Role: STUDY_DIRECTOR

Eli Lilly and Company

Locations

Children's Heathcare of Atlanta, Inc. at Egleston

Atlanta, Georgia, United States

Childrens Hospital of Michigan

Detroit, Michigan, United States

Cincinnati Childrens Hospital Medical Center

Cincinnati, Ohio, United States

Nationwide Children's Hosp

Columbus, Ohio, United States

Vanderbilt Univeristy School of Medicine

Nashville, Tennessee, United States

Texas Childrens Hospital

Houston, Texas, United States

Primary Childrens Medical Center

Salt Lake City, Utah, United States

AKH

Vienna, , Austria

Universitaire Ziekenhuizen Leuven - Campus Gasthuisberg

Leuven, , Belgium

Pronto Socorro Cardiologico de Pernambuco-PROCAPE

Recife, Pernambuco, Brazil

Irmandade da Santa Casa de Misericordia de Porto Alegre

Porto Alegre, Rio Grande do Sul, Brazil

Instituto Dante Pazzanese de Cardiologia

São Paulo, São Paulo, Brazil

UNIFESP - Escola Paulista de Medicina

São Paulo, São Paulo, Brazil

CHU Hopital d'enfants de la Timone

Marseille, , France

GH Necker - Enfants Malades

Paris, , France

Hopital Haut Leveque - Group hospitalier Sud

Pessac, , France

Chu de Toulouse - Hopital des Enfants

Toulouse, , France

Universitätsklinikum Heidelberg

Heidelberg, Baden-Wurttemberg, Germany

Universitätsklinikum Ulm

Ulm, Baden-Wurttemberg, Germany

Sheba Medical Center

Tel Litwinsky, Ramat Gan, Israel

Schneider Medical Center

Petah Tikva, , Israel

Istituto Giannina Gaslini Ospedale Pediatrico I.R.C.C.S.

Genova, GE, Italy

Ospedale V. Monaldi

Napoli, , Italy

Ospedale Bambino Gesu

Roma, , Italy

Gunma Children's Medical Center

Shibukawa, Gunma, Japan

Asahikawa Medical College Hospital

Asahikawa, Hokkaido, Japan

Mie University Hospital

Tsu, Mie-ken, Japan

Okinawa Prefectural Nanbu Medical Center & Children's Med Ct

Haebaru-cho, Shimajiri-gun, Okinawa, Japan

Tokyo Metropolitan Children's Medical Center

Fuchū, Tokyo, Japan

Toho University Omori Medical Center

Ohta-Ku, Tokyo, Japan

National Center For Child Health And Development

Setagaya-ku, Tokyo, Japan

Shizuoka Prefectural Children's Hospital

Shizuoka, , Japan

Instituto Nacional de Cardiologia Ignacio Chavez

Mexico City, Mexico City, Mexico

Universitair Medisch Centrum Groningen

Groningen, , Netherlands

Instytut Pomnik-Centrum Zdrowia Dziecka

Warsaw, Woj Mazowieckie, Poland

Uniwersyteckie Centrum Kliniczne

Gdansk, , Poland

Uniwersytecki Szpital Dzieciecy w Krakowie-Prokocimiu

Krakow, , Poland

Wojewódzki Szpital Specjalistyczny we Wrocławiu

Wroclaw, , Poland

Hospital Universitari Vall d'Hebron

Barcelona, , Spain

Hospital Universitario Ramon y Cajal

Madrid, , Spain

Hospital Universitario 12 de Octubre

Madrid, , Spain

Hacettepe University Faculty of Medicine

Ankara, , Turkey (Türkiye)

Gazi University Medical Faculty

Besevler/Ankara, , Turkey (Türkiye)

Countries

Canada; Romania; Switzerland; United States; Austria; Belgium; Brazil; France; Germany; Israel; Italy; Japan; Mexico; Netherlands; Poland; Spain; Turkey (Türkiye)

Provided Documents

Document Type: Study Protocol

View Document

Document Type: Statistical Analysis Plan

View Document

Related Links

https://trials.lillytrialguide.com/en-US/trial/5ejOJO01mwK2euskWAUoeu

A Study of Tadalafil in Pediatric Participants With Pulmonary Arterial Hypertension (PAH)

Other Identifiers

H6D-MC-LVHV

Identifier Type: OTHER

Identifier Source: secondary_id

2012-002354-23

Identifier Type: EUDRACT_NUMBER

Identifier Source: secondary_id

10609

Identifier Type: -

Identifier Source: org_study_id