Trial Outcomes & Findings for Hemodynamic Evaluation of Levosimendan in Patients With PH-HFpEF (NCT NCT03541603)

NCT ID: NCT03541603

Last Updated: 2024-11-20

Results Overview

Change from baseline Pulmonary Capillary Wedge Pressure (PCWP) with bicycle exercise at Week 6

Recruitment status

COMPLETED

Study phase

PHASE2

Target enrollment

44 participants

Primary outcome timeframe

Baseline, Week 6

Results posted on

2024-11-20

Participant Flow

44 patients satisfied entry criteria for enrollment and received lead-in open-label levosimendan. 37 of the 44 enrolled patients achieved responder criteria following 24hr lead-in open label levosimendan infusion and were randomized to study

Participant milestones

Participant milestones
Measure
Levosimendan 2.5mg/mL Injectable Solution
0.075 - 0.1µg/kg/min for 24 hrs (weekly) Levosimendan: A sterile 2.5 mg/mL concentrate solution that is diluted in 5% Dextrose or 0.9 Normal Saline to achieve a 50 microgram/min solution for infusion
Matching Placebo
0.075 - 0.1µg/kg/min for 24 hrs (weekly) Matching Placebo: A sterile 2.5mg/mL concentrate solution that is diluted in 5% Dextrose or 0.9 Normal Saline to achieve a 50 microgram/min solution for infusion
Overall Study
STARTED
18
19
Overall Study
COMPLETED
18
17
Overall Study
NOT COMPLETED
0
2

Reasons for withdrawal

Withdrawal data not reported

Baseline Characteristics

Hemodynamic Evaluation of Levosimendan in Patients With PH-HFpEF

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Levosimendan 2.5mg/mL Injectable Solution
n=18 Participants
0.075 - 0.1µg/kg/min for 24 hrs (weekly) Levosimendan: A sterile 2.5 mg/mL concentrate solution that is diluted in 5% Dextrose or 0.9 Normal Saline to achieve a 50 microgram/min solution for infusion
Matching Placebo
n=19 Participants
0.075 - 0.1µg/kg/min for 24 hrs (weekly) Matching Placebo: A sterile 2.5mg/mL concentrate solution that is diluted in 5% Dextrose or 0.9 Normal Saline to achieve a 50 microgram/min solution for infusion
Total
n=37 Participants
Total of all reporting groups
Age, Continuous
68.8 years
STANDARD_DEVIATION 7.5 • n=5 Participants
67.4 years
STANDARD_DEVIATION 11.0 • n=7 Participants
68.1 years
STANDARD_DEVIATION 9.3 • n=5 Participants
Sex: Female, Male
Female
10 Participants
n=5 Participants
12 Participants
n=7 Participants
22 Participants
n=5 Participants
Sex: Female, Male
Male
8 Participants
n=5 Participants
7 Participants
n=7 Participants
15 Participants
n=5 Participants
Race (NIH/OMB)
American Indian or Alaska Native
1 Participants
n=5 Participants
0 Participants
n=7 Participants
1 Participants
n=5 Participants
Race (NIH/OMB)
Asian
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
Race (NIH/OMB)
Black or African American
1 Participants
n=5 Participants
2 Participants
n=7 Participants
3 Participants
n=5 Participants
Race (NIH/OMB)
White
16 Participants
n=5 Participants
17 Participants
n=7 Participants
33 Participants
n=5 Participants
Race (NIH/OMB)
More than one race
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
Race (NIH/OMB)
Unknown or Not Reported
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
Region of Enrollment
United States
18 participants
n=5 Participants
19 participants
n=7 Participants
37 participants
n=5 Participants

PRIMARY outcome

Timeframe: Baseline, Week 6

Population: patients completing Baseline and Week 6 visit with hemodynamic data

Change from baseline Pulmonary Capillary Wedge Pressure (PCWP) with bicycle exercise at Week 6

Outcome measures

Outcome measures
Measure
Levosimendan 2.5mg/mL Injectable Solution
n=18 Participants
0.075 - 0.1µg/kg/min for 24 hrs (weekly) Levosimendan: A sterile 2.5 mg/mL concentrate solution that is diluted in 5% Dextrose or 0.9 Normal Saline to achieve a 50 microgram/min solution for infusion
Matching Placebo
n=17 Participants
0.075 - 0.1µg/kg/min for 24 hrs (weekly) Matching Placebo: A sterile 2.5mg/mL concentrate solution that is diluted in 5% Dextrose or 0.9 Normal Saline to achieve a 50 microgram/min solution for infusion
Change From Baseline Pulmonary Capillary Wedge Pressure (PCWP) With Bicycle Exercise
-1.9 mmHg
Standard Deviation 10.07
-0.5 mmHg
Standard Deviation 7.87

SECONDARY outcome

Timeframe: Baseline, Week 6

Population: patients completing Baseline and Week 6 visit with hemodynamic data

Change in Cardiac Index (CI) at rest and with exercise at Week 6 (CI determined by thermodilution) (CI is a hemodynamic parameter that relates the cardiac output (CO) from left ventricle in one minute to body surface area (BSA))

Outcome measures

Outcome measures
Measure
Levosimendan 2.5mg/mL Injectable Solution
n=18 Participants
0.075 - 0.1µg/kg/min for 24 hrs (weekly) Levosimendan: A sterile 2.5 mg/mL concentrate solution that is diluted in 5% Dextrose or 0.9 Normal Saline to achieve a 50 microgram/min solution for infusion
Matching Placebo
n=17 Participants
0.075 - 0.1µg/kg/min for 24 hrs (weekly) Matching Placebo: A sterile 2.5mg/mL concentrate solution that is diluted in 5% Dextrose or 0.9 Normal Saline to achieve a 50 microgram/min solution for infusion
Change in Cardiac Index (CI) at Rest and With Exercise.
rest
0.05 L/min/m^2
Standard Deviation 0.699
-0.15 L/min/m^2
Standard Deviation 0.262
Change in Cardiac Index (CI) at Rest and With Exercise.
exercise
0.24 L/min/m^2
Standard Deviation 1.106
0.04 L/min/m^2
Standard Deviation 0.594

SECONDARY outcome

Timeframe: Baseline, Week 6

Population: patients completing Baseline and Week 6 visit with hemodynamic data

Change in Pulmonary Vascular Resistance (PVR) effect at rest and with exercise at Week 6

Outcome measures

Outcome measures
Measure
Levosimendan 2.5mg/mL Injectable Solution
n=18 Participants
0.075 - 0.1µg/kg/min for 24 hrs (weekly) Levosimendan: A sterile 2.5 mg/mL concentrate solution that is diluted in 5% Dextrose or 0.9 Normal Saline to achieve a 50 microgram/min solution for infusion
Matching Placebo
n=17 Participants
0.075 - 0.1µg/kg/min for 24 hrs (weekly) Matching Placebo: A sterile 2.5mg/mL concentrate solution that is diluted in 5% Dextrose or 0.9 Normal Saline to achieve a 50 microgram/min solution for infusion
Change in Pulmonary Vascular Resistance (PVR) Effect at Rest and With Exercise
rest
-0.09 mmHg.min/L
Standard Deviation 1.050
0.15 mmHg.min/L
Standard Deviation 2.238
Change in Pulmonary Vascular Resistance (PVR) Effect at Rest and With Exercise
exercise
-0.44 mmHg.min/L
Standard Deviation 1.539
-0.16 mmHg.min/L
Standard Deviation 1.81

SECONDARY outcome

Timeframe: Baseline, Week 6

Population: patients completing Baseline and Week 6 visit with hemodynamic data

Change in Pulmonary Capillary Wedge Pressure, Baseline to Week 6

Outcome measures

Outcome measures
Measure
Levosimendan 2.5mg/mL Injectable Solution
n=18 Participants
0.075 - 0.1µg/kg/min for 24 hrs (weekly) Levosimendan: A sterile 2.5 mg/mL concentrate solution that is diluted in 5% Dextrose or 0.9 Normal Saline to achieve a 50 microgram/min solution for infusion
Matching Placebo
n=17 Participants
0.075 - 0.1µg/kg/min for 24 hrs (weekly) Matching Placebo: A sterile 2.5mg/mL concentrate solution that is diluted in 5% Dextrose or 0.9 Normal Saline to achieve a 50 microgram/min solution for infusion
Change in PCWP When Supine and Legs Elevated
rest
-5.1 mmHg
Standard Deviation 5.26
-1.7 mmHg
Standard Deviation 6.14
Change in PCWP When Supine and Legs Elevated
legs elevated
-6.0 mmHg
Standard Deviation 7.75
-0.3 mmHg
Standard Deviation 5.45

SECONDARY outcome

Timeframe: Baseline, Week 6

Patient assessment of well-being based on 6 questions assessed on a 5-point Likert Scale ( 1 =worst, 5= best) (minimum total score 5pts, maximum total score 25 pts) (no comparison to baseline as no instrument used at baseline)

Outcome measures

Outcome measures
Measure
Levosimendan 2.5mg/mL Injectable Solution
n=18 Participants
0.075 - 0.1µg/kg/min for 24 hrs (weekly) Levosimendan: A sterile 2.5 mg/mL concentrate solution that is diluted in 5% Dextrose or 0.9 Normal Saline to achieve a 50 microgram/min solution for infusion
Matching Placebo
n=17 Participants
0.075 - 0.1µg/kg/min for 24 hrs (weekly) Matching Placebo: A sterile 2.5mg/mL concentrate solution that is diluted in 5% Dextrose or 0.9 Normal Saline to achieve a 50 microgram/min solution for infusion
Patient Global Assessment
3 units on a scale
Interval 3.0 to 4.0
3 units on a scale
Interval 3.0 to 4.0

SECONDARY outcome

Timeframe: Baseline, Week 6

Change in 6-minute walk test at Week 6 vs baseline

Outcome measures

Outcome measures
Measure
Levosimendan 2.5mg/mL Injectable Solution
n=18 Participants
0.075 - 0.1µg/kg/min for 24 hrs (weekly) Levosimendan: A sterile 2.5 mg/mL concentrate solution that is diluted in 5% Dextrose or 0.9 Normal Saline to achieve a 50 microgram/min solution for infusion
Matching Placebo
n=17 Participants
0.075 - 0.1µg/kg/min for 24 hrs (weekly) Matching Placebo: A sterile 2.5mg/mL concentrate solution that is diluted in 5% Dextrose or 0.9 Normal Saline to achieve a 50 microgram/min solution for infusion
Exercise Duration Via 6 Minute Walk Test
16.6 meters
Standard Deviation 40.03
-12.8 meters
Standard Deviation 35.08

SECONDARY outcome

Timeframe: Baseline, Week 6

Physician's Assessment of New York Heart Association (NYHA) Classification (one of four categories based on how much the patient is limited during physical activity. (Class I, no limitation of physical activity to Class IV, marked limitation of physical activity).

Outcome measures

Outcome measures
Measure
Levosimendan 2.5mg/mL Injectable Solution
n=18 Participants
0.075 - 0.1µg/kg/min for 24 hrs (weekly) Levosimendan: A sterile 2.5 mg/mL concentrate solution that is diluted in 5% Dextrose or 0.9 Normal Saline to achieve a 50 microgram/min solution for infusion
Matching Placebo
n=17 Participants
0.075 - 0.1µg/kg/min for 24 hrs (weekly) Matching Placebo: A sterile 2.5mg/mL concentrate solution that is diluted in 5% Dextrose or 0.9 Normal Saline to achieve a 50 microgram/min solution for infusion
Physician's Assessment of Functional Class
Baseline · Class III
16 Participants
14 Participants
Physician's Assessment of Functional Class
Baseline · Class IV
0 Participants
0 Participants
Physician's Assessment of Functional Class
Week 6 · Class I
0 Participants
0 Participants
Physician's Assessment of Functional Class
Week 6 · Class II
8 Participants
5 Participants
Physician's Assessment of Functional Class
Baseline · Class I
0 Participants
0 Participants
Physician's Assessment of Functional Class
Baseline · Class II
2 Participants
3 Participants
Physician's Assessment of Functional Class
Week 6 · Class III
10 Participants
12 Participants
Physician's Assessment of Functional Class
Week 6 · Class IV
0 Participants
0 Participants

SECONDARY outcome

Timeframe: Baseline, Week 6

Number of Participants with Composite Events of death or hospitalization through Week 6

Outcome measures

Outcome measures
Measure
Levosimendan 2.5mg/mL Injectable Solution
n=18 Participants
0.075 - 0.1µg/kg/min for 24 hrs (weekly) Levosimendan: A sterile 2.5 mg/mL concentrate solution that is diluted in 5% Dextrose or 0.9 Normal Saline to achieve a 50 microgram/min solution for infusion
Matching Placebo
n=17 Participants
0.075 - 0.1µg/kg/min for 24 hrs (weekly) Matching Placebo: A sterile 2.5mg/mL concentrate solution that is diluted in 5% Dextrose or 0.9 Normal Saline to achieve a 50 microgram/min solution for infusion
Number of Participants With Composite Events of Death or Hospitalization
3 Participants
1 Participants

Adverse Events

Levosimendan 2.5mg/mL Injectable Solution

Serious events: 3 serious events
Other events: 13 other events
Deaths: 0 deaths

Matching Placebo

Serious events: 1 serious events
Other events: 8 other events
Deaths: 0 deaths

Serious adverse events

Serious adverse events
Measure
Levosimendan 2.5mg/mL Injectable Solution
n=18 participants at risk
0.075 - 0.1µg/kg/min for 24 hrs (weekly) Levosimendan: A sterile 2.5 mg/mL concentrate solution that is diluted in 5% Dextrose or 0.9 Normal Saline to achieve a 50 microgram/min solution for infusion
Matching Placebo
n=19 participants at risk
0.075 - 0.1µg/kg/min for 24 hrs (weekly) Matching Placebo: A sterile 2.5mg/mL concentrate solution that is diluted in 5% Dextrose or 0.9 Normal Saline to achieve a 50 microgram/min solution for infusion
Infections and infestations
Device related infection
5.6%
1/18 • Number of events 1 • 6 weeks
0.00%
0/19 • 6 weeks
Infections and infestations
Bacteremia
5.6%
1/18 • Number of events 1 • 6 weeks
0.00%
0/19 • 6 weeks
Cardiac disorders
Cardiac failure acute
11.1%
2/18 • Number of events 2 • 6 weeks
0.00%
0/19 • 6 weeks
Cardiac disorders
Cardiogenic Shock
0.00%
0/18 • 6 weeks
5.3%
1/19 • Number of events 1 • 6 weeks
Cardiac disorders
Right ventricular failure
0.00%
0/18 • 6 weeks
5.3%
1/19 • Number of events 1 • 6 weeks

Other adverse events

Other adverse events
Measure
Levosimendan 2.5mg/mL Injectable Solution
n=18 participants at risk
0.075 - 0.1µg/kg/min for 24 hrs (weekly) Levosimendan: A sterile 2.5 mg/mL concentrate solution that is diluted in 5% Dextrose or 0.9 Normal Saline to achieve a 50 microgram/min solution for infusion
Matching Placebo
n=19 participants at risk
0.075 - 0.1µg/kg/min for 24 hrs (weekly) Matching Placebo: A sterile 2.5mg/mL concentrate solution that is diluted in 5% Dextrose or 0.9 Normal Saline to achieve a 50 microgram/min solution for infusion
General disorders
Fatigue
5.6%
1/18 • Number of events 1 • 6 weeks
10.5%
2/19 • Number of events 2 • 6 weeks
General disorders
Chills
5.6%
1/18 • Number of events 1 • 6 weeks
5.3%
1/19 • Number of events 1 • 6 weeks
General disorders
Infusion site hemorrhage
5.6%
1/18 • Number of events 1 • 6 weeks
5.3%
1/19 • Number of events 1 • 6 weeks
General disorders
Infusion site erythema
5.6%
1/18 • Number of events 1 • 6 weeks
0.00%
0/19 • 6 weeks
General disorders
Edema
5.6%
1/18 • Number of events 1 • 6 weeks
0.00%
0/19 • 6 weeks
General disorders
Peripheral swelling
5.6%
1/18 • Number of events 1 • 6 weeks
0.00%
0/19 • 6 weeks
General disorders
Pyrexia
5.6%
1/18 • Number of events 1 • 6 weeks
0.00%
0/19 • 6 weeks
Cardiac disorders
Cardiac failure acute
11.1%
2/18 • Number of events 2 • 6 weeks
5.3%
1/19 • Number of events 1 • 6 weeks
Cardiac disorders
Cardiogenic shock
0.00%
0/18 • 6 weeks
5.3%
1/19 • Number of events 1 • 6 weeks
Cardiac disorders
Extrasystoles
5.6%
1/18 • Number of events 1 • 6 weeks
0.00%
0/19 • 6 weeks
Cardiac disorders
Palpitations
5.6%
1/18 • Number of events 1 • 6 weeks
0.00%
0/19 • 6 weeks
Cardiac disorders
Right ventricular failure
0.00%
0/18 • 6 weeks
5.3%
1/19 • Number of events 1 • 6 weeks
Cardiac disorders
Tachycardia
0.00%
0/18 • 6 weeks
5.3%
1/19 • Number of events 1 • 6 weeks
Cardiac disorders
Ventricular tachycardia
0.00%
0/18 • 6 weeks
5.3%
1/19 • Number of events 1 • 6 weeks
Infections and infestations
Cellulitis
5.6%
1/18 • Number of events 1 • 6 weeks
5.3%
1/19 • Number of events 1 • 6 weeks
Infections and infestations
Atypical pneumonia
0.00%
0/18 • 6 weeks
5.3%
1/19 • Number of events 1 • 6 weeks
Infections and infestations
Bacteremia
5.6%
1/18 • Number of events 1 • 6 weeks
0.00%
0/19 • 6 weeks
Infections and infestations
Bronchitis viral
0.00%
0/18 • 6 weeks
5.3%
1/19 • Number of events 1 • 6 weeks
Infections and infestations
Device-related infection
5.6%
1/18 • Number of events 1 • 6 weeks
0.00%
0/19 • 6 weeks
Infections and infestations
Influenza
5.6%
1/18 • Number of events 1 • 6 weeks
0.00%
0/19 • 6 weeks
Infections and infestations
Tooth abscess
5.6%
1/18 • Number of events 1 • 6 weeks
0.00%
0/19 • 6 weeks
Nervous system disorders
Headache
16.7%
3/18 • Number of events 3 • 6 weeks
5.3%
1/19 • Number of events 1 • 6 weeks
Nervous system disorders
Balance disorder
5.6%
1/18 • Number of events 1 • 6 weeks
0.00%
0/19 • 6 weeks
Nervous system disorders
Dizziness
5.6%
1/18 • Number of events 1 • 6 weeks
0.00%
0/19 • 6 weeks
Nervous system disorders
Dizziness postural
0.00%
0/18 • 6 weeks
5.3%
1/19 • Number of events 1 • 6 weeks
Respiratory, thoracic and mediastinal disorders
Dyspnea
11.1%
2/18 • Number of events 2 • 6 weeks
5.3%
1/19 • Number of events 1 • 6 weeks
Respiratory, thoracic and mediastinal disorders
Asthma
5.6%
1/18 • Number of events 1 • 6 weeks
0.00%
0/19 • 6 weeks
Respiratory, thoracic and mediastinal disorders
Cough
0.00%
0/18 • 6 weeks
5.3%
1/19 • Number of events 1 • 6 weeks
Injury, poisoning and procedural complications
Vascular access site pain
0.00%
0/18 • 6 weeks
10.5%
2/19 • Number of events 2 • 6 weeks
Injury, poisoning and procedural complications
Accidental overdose
5.6%
1/18 • Number of events 1 • 6 weeks
0.00%
0/19 • 6 weeks
Injury, poisoning and procedural complications
Overdose
5.6%
1/18 • Number of events 1 • 6 weeks
0.00%
0/19 • 6 weeks
Injury, poisoning and procedural complications
Underdose
0.00%
0/18 • 6 weeks
5.3%
1/19 • Number of events 1 • 6 weeks
Investigations
Heart rate increased
11.1%
2/18 • Number of events 2 • 6 weeks
0.00%
0/19 • 6 weeks
Investigations
Blood creatinine increased
5.6%
1/18 • Number of events 1 • 6 weeks
0.00%
0/19 • 6 weeks
Investigations
Body temperature increased
5.6%
1/18 • Number of events 1 • 6 weeks
0.00%
0/19 • 6 weeks
Musculoskeletal and connective tissue disorders
Muscle spasms
11.1%
2/18 • Number of events 2 • 6 weeks
0.00%
0/19 • 6 weeks
Musculoskeletal and connective tissue disorders
Arthralgia
5.6%
1/18 • Number of events 1 • 6 weeks
0.00%
0/19 • 6 weeks
Musculoskeletal and connective tissue disorders
Pain in extremity
0.00%
0/18 • 6 weeks
5.3%
1/19 • Number of events 1 • 6 weeks
Product Issues
Device infusion issue
5.6%
1/18 • Number of events 1 • 6 weeks
5.3%
1/19 • Number of events 1 • 6 weeks
Product Issues
Device dislocation
5.6%
1/18 • Number of events 1 • 6 weeks
0.00%
0/19 • 6 weeks
Product Issues
Device occlusion
0.00%
0/18 • 6 weeks
5.3%
1/19 • Number of events 1 • 6 weeks
Metabolism and nutrition disorders
Hypokalemia
11.1%
2/18 • Number of events 2 • 6 weeks
5.3%
1/19 • Number of events 1 • 6 weeks
Metabolism and nutrition disorders
Hypomagnesemia
0.00%
0/18 • 6 weeks
5.3%
1/19 • Number of events 1 • 6 weeks
Metabolism and nutrition disorders
Lactic acidosis
0.00%
0/18 • 6 weeks
5.3%
1/19 • Number of events 1 • 6 weeks
Skin and subcutaneous tissue disorders
Alopecia
0.00%
0/18 • 6 weeks
5.3%
1/19 • Number of events 1 • 6 weeks
Skin and subcutaneous tissue disorders
Blister
0.00%
0/18 • 6 weeks
5.3%
1/19 • Number of events 1 • 6 weeks
Skin and subcutaneous tissue disorders
Dry skin
0.00%
0/18 • 6 weeks
5.3%
1/19 • Number of events 1 • 6 weeks
Skin and subcutaneous tissue disorders
Skin necrosis
0.00%
0/18 • 6 weeks
5.3%
1/19 • Number of events 1 • 6 weeks
Gastrointestinal disorders
Diarrhea
5.6%
1/18 • Number of events 1 • 6 weeks
0.00%
0/19 • 6 weeks
Gastrointestinal disorders
Nausea
5.6%
1/18 • Number of events 1 • 6 weeks
0.00%
0/19 • 6 weeks
Vascular disorders
Peripheral artery stenosis
0.00%
0/18 • 6 weeks
5.3%
1/19 • Number of events 1 • 6 weeks
Vascular disorders
Thrombophlebitis
5.6%
1/18 • Number of events 1 • 6 weeks
0.00%
0/19 • 6 weeks
Vascular disorders
Venous thrombosis limb
5.6%
1/18 • Number of events 1 • 6 weeks
0.00%
0/19 • 6 weeks
Eye disorders
Vison blurred
5.6%
1/18 • Number of events 1 • 6 weeks
0.00%
0/19 • 6 weeks
Psychiatric disorders
Delirium
0.00%
0/18 • 6 weeks
5.3%
1/19 • Number of events 1 • 6 weeks
Renal and urinary disorders
Acute kidney injury
0.00%
0/18 • 6 weeks
5.3%
1/19 • Number of events 1 • 6 weeks

Additional Information

Stuart Rich, MD; Chief Medical Officer

Tenax Therapeutics, Inc.

Phone: 919 855 2100

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place