Phosphodiesterase Type 5 Inhibition With Tadalafil Changes Outcomes in Heart Failure

NCT ID: NCT01910389

Last Updated: 2015-05-04

Study Results

Results available

Outcome measurements, participant flow, baseline characteristics, and adverse events have been published for this study.

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Basic Information

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Recruitment Status

TERMINATED

Clinical Phase

PHASE3

Total Enrollment

23 participants

Study Classification

INTERVENTIONAL

Study Start Date

2013-11-30

Study Completion Date

2014-02-28

Brief Summary

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This study is a multi-center, prospective, randomized, double blind, placebo-controlled clinical trial. Subjects in the study will be adults with New York Heart Association (NYHA) Class II-IV heart failure (HF) due to left ventricular systolic dysfunction (LVSD), left ventricular ejection fraction (LVEF) \<0.40, and secondary pulmonary hypertension (PH). The purpose of the study is to evaluate the safety, effectiveness, and effects of tadalafil compared to placebo on the subjects' functional capacity / quality of life.

Detailed Description

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Conditions

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Heart Failure Pulmonary Hypertension

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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Tadalafil

Tadalafil is supplied in 20 mg tablets. Subjects will take 20 mg (one tablet) once per day and will be titrated to 40 mg (two tablets once per day) after one week. Subjects are on study drug for the duration of the trial.

Group Type ACTIVE_COMPARATOR

Tadalafil

Intervention Type DRUG

Placebo

Placebo of tadalafil. Subjects will take one tablet once per day and will be titrated to two tablets once per day after one week. Subjects are on study drug for the duration of the trial.

Group Type PLACEBO_COMPARATOR

Placebo for tadalafil

Intervention Type DRUG

Interventions

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Tadalafil

Intervention Type DRUG

Placebo for tadalafil

Intervention Type DRUG

Other Intervention Names

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Adcirca

Eligibility Criteria

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Inclusion Criteria

* Male or female age 21 years or older.
* NYHA Class II-IV HF with LVSD (most recent LVEF \< 0.40).
* At high risk of future clinical instability, indicated by EITHER:

a hospitalization for the primary reason of decompensated HF within the 12 months prior to screening; OR a plasma B-type Natriuretic Peptide (BNP) level ≥ 300 pg/ml or N-terminal prohormone of brain natriuretic peptide (NT-proBNP) ≥1800pg/ml measured during a period of clinical stability in the 3 months prior to screening.

* Documented secondary PH within the last 6 months
* Medication and device treatment according to current American Heart Association/American College of Cardiology (AHA/ACC) guidelines.
* Stable medical therapy for 30 days prior to randomization
* African-American patients intolerant of or otherwise unable or unwilling to utilize isosorbide dinitrate/hydralazine therapy will be included.
* Willingness to comply with protocol, attend follow-up appointments, complete all study assessments and provide written informed consent.

Exclusion Criteria

* Concurrent or anticipated nitrate use for any reason, or nitrate use within the 14 days prior to screening through the day of randomization.
* Known allergy, hypersensitivity (anaphylaxis), or adverse reaction to tadalafil or other Phosphodiesterase Type 5 (PDE5) inhibitor
* Erectile dysfunction treated with a PDE5 inhibitor.
* Severe renal dysfunction defined as an estimated glomerular filtration rate (GFR) \< 30 ml/min/1.73 m\^2 or requiring chronic dialysis
* Current use of alpha antagonists (except carvedilol or tamsulosin) or use of cytochrome P450 3A4 inhibitors (ketoconazole, itraconazole, erythromycin, or cimetidine). Patients who have used a protease inhibitor that is a P450 3A4 inhibitor for longer than one week can be enrolled.
* Pulmonary arterial hypertension (World Health Organization (WHO) Group I, III-V) for which PDE5 inhibitor therapy may be indicated
* Severe pulmonary disease requiring home oxygen therapy
* Comorbidities including clinically significant valvular stenosis (aortic valve area \< 0.8 cm\^2 or a mitral valve area \<1.0 cm\^2), uncontrolled hypertension (systolic blood pressure ≥180 mmHg or diastolic blood pressure ≥100 mmHg) or hypotension (systolic blood pressure \<85 mmHg)
* Chronic intravenous inotrope therapy
* Non-arteritic anterior ischemic optic neuropathy (NAION)
* ST elevation MI (STEMI) within 90 days prior to screening
* Coronary Artery Bypass Grafting (CABG) or mitral valve surgery, initiation of cardiac resynchronization (CRT) or initiation of β-blocker therapy within the 6 months prior to screening
* Infiltrative or inflammatory myocardial disease (e.g. amyloid, sarcoid)
* Heart transplant recipient
* United Network Organ Sharing (UNOS) status 1A or 1B
* Mechanical circulatory support (MCS) use or planned MCS use at time of consent
* Active malignancy (except non-melanoma skin cancer) requiring therapy other than observation.
* Severe non-cardiac illness resulting in life expectancy judged less than three years
* Known chronic hepatic disease defined as aspartate aminotransferase (AST) and alanine transaminase (ALT) levels \> 3.0 times the upper limit of normal
* Inability to walk even a few steps due to non-cardiac (e.g. orthopedic) reasons
* Participation in any clinical trial within the last 30 days (with exception of observational study)
* Previous randomization in PITCH-HF
Minimum Eligible Age

21 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Heart, Lung, and Blood Institute (NHLBI)

NIH

Sponsor Role collaborator

Massachusetts General Hospital

OTHER

Sponsor Role collaborator

Carelon Research

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Marc J. Semigran, MD

Role: PRINCIPAL_INVESTIGATOR

Massachusetts General Hospital

Susan F Assmann, PhD

Role: PRINCIPAL_INVESTIGATOR

New England Research Institutes, Inc.

Flora S Siami, MPH

Role: PRINCIPAL_INVESTIGATOR

New England Research Institutes, Inc.

Locations

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Heart Center Inc - Research

Huntsville, Alabama, United States

Site Status

Baptist Health Transplant Institute

Little Rock, Arkansas, United States

Site Status

Allianz Medical and Research Center

Fountain Valley, California, United States

Site Status

Christiana Care Health System

Newark, Delaware, United States

Site Status

Broward Health

Fort Lauderdale, Florida, United States

Site Status

Miller School of Medicine University of Miami

Miami, Florida, United States

Site Status

Orlando Health

Orlando, Florida, United States

Site Status

Charlotte Heart Group Research Center

Port Charlotte, Florida, United States

Site Status

Brevard Cardiovascular Research Associates

Rockledge, Florida, United States

Site Status

University Cardiology Associates LLC

Augusta, Georgia, United States

Site Status

Eisenhower Army Medical Center

Fort Gordon, Georgia, United States

Site Status

Northwestern University

Chicago, Illinois, United States

Site Status

University of Illinois Hospital

Chicago, Illinois, United States

Site Status

Methodist Medical Group Cardiology

Peoria, Illinois, United States

Site Status

Baptist Hospital East

Louisville, Kentucky, United States

Site Status

Research Integrity LLC

Owensboro, Kentucky, United States

Site Status

LSU Health Sciences Center

New Orleans, Louisiana, United States

Site Status

Maine Research Associates

Auburn, Maine, United States

Site Status

Johns Hopkins Hospital

Baltimore, Maryland, United States

Site Status

Primary Care Cardiology Research, Inc.

Ayer, Massachusetts, United States

Site Status

Brigham and Women's Hospital

Boston, Massachusetts, United States

Site Status

Massachusetts General Hospital

Boston, Massachusetts, United States

Site Status

MGH West

Waltham, Massachusetts, United States

Site Status

University of Michigan Health System

Ann Arbor, Michigan, United States

Site Status

Oakwood Hospital and Medical Center

Dearborn, Michigan, United States

Site Status

Henry Ford Hospital

Detroit, Michigan, United States

Site Status

William Beaumont Hospital

Royal Oak, Michigan, United States

Site Status

Covenant Center for the Heart

Saginaw, Michigan, United States

Site Status

Essentia Health East

Duluth, Minnesota, United States

Site Status

Metropolitan Heart and Vascular Institute

Minneapolis, Minnesota, United States

Site Status

Mayo Clinic

Rochester, Minnesota, United States

Site Status

Missouri Cardiovascular Specialists

Columbia, Missouri, United States

Site Status

St. Luke's Health System

Kansas City, Missouri, United States

Site Status

Glacier View Research Institute

Kalispell, Montana, United States

Site Status

Advanced Heart Care, LLC

Bridgewater, New Jersey, United States

Site Status

Hackensack University Medical Center

Hackensack, New Jersey, United States

Site Status

Newark Beth Israel Medical Center

Newark, New Jersey, United States

Site Status

Heart & Vascular Center of NJ/Cardio Metabolic Institute

Somerset, New Jersey, United States

Site Status

New York Methodist Hospital

Brooklyn, New York, United States

Site Status

Columbia University Medical Center

New York, New York, United States

Site Status

Mount Sinai Medical Center

New York, New York, United States

Site Status

Cardiology Associates of Schenectady

Schenectady, New York, United States

Site Status

Stony Brook University Hospital

Stony Brook, New York, United States

Site Status

SUNY Upstate Medical University

Syracuse, New York, United States

Site Status

Bronx - Lebanon Hospital Center

The Bronx, New York, United States

Site Status

LeBauer Cardiovascular Research Foundation

Greensboro, North Carolina, United States

Site Status

The Lindner Center for Research & Education at The Christ Hospital

Cincinnati, Ohio, United States

Site Status

Cleveland Clinic

Cleveland, Ohio, United States

Site Status

Dayton VA Medical Center

Dayton, Ohio, United States

Site Status

Oklahoma City VA

Oklahoma City, Oklahoma, United States

Site Status

Warren Cancer Research Foundation

Tulsa, Oklahoma, United States

Site Status

Lancaster Heart and Stroke Foundation

Lancaster, Pennsylvania, United States

Site Status

Drexel University College of Medicine

Philadelphia, Pennsylvania, United States

Site Status

Temple University

Philadelphia, Pennsylvania, United States

Site Status

Grand View - Lehigh Valley Health Service

Sellersville, Pennsylvania, United States

Site Status

Lankenau Medical Center

Wynnewood, Pennsylvania, United States

Site Status

Stern Cardiovascular Foundation, Inc.

Germantown, Tennessee, United States

Site Status

CIVA/CArdiovascular Research Institute of Dallas

Dallas, Texas, United States

Site Status

Michael E. Debakey VA Medical Center

Houston, Texas, United States

Site Status

University of Utah

Salt Lake City, Utah, United States

Site Status

Aurora St. Luke's Medical Center

Milwaukee, Wisconsin, United States

Site Status

Aspirus Wausau Hospital

Wausau, Wisconsin, United States

Site Status

Jewish General Hospital

Montreal, Quebec, Canada

Site Status

Countries

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United States Canada

Other Identifiers

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U01HL105463

Identifier Type: NIH

Identifier Source: org_study_id

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