dimethyl fumarate (dmf) in systemic sclerosis-associated pulmonary arterial hypertension

Conditions: Systemic Sclerosis; Pulmonary; Hypertension

Summary: a double-blinded, placebo-controlled study of dimethyl fumarate (dmf) in 34 systemic sclerosis-pulmonary hypertension (ssc-pah) patients. the study will determine safety and the primary outcome variability for dmf in treating ssc-pah; the primary outcome of clinical efficacy in this pilot trial will be improvement in 6-minute walk distance (6mwd).

a double-blinded, placebo-controlled study of dimethyl fumarate (dmf) in 34 systemic sclerosis-pulmonary hypertension (ssc-pah) patients. the study medication will be added to stable background pah medication(s). subjects will be dosed for 24 weeks, will undergo examination every 8 weeks, and will be finally evaluated 12 weeks after completion of treatment. dosage will begin at once daily oral doses of 120mg for the first 7 days and follow the up-titration schedule to a maintenance dose of 240mg twice a day (or highest tolerated dose of a minimum of 120mg twice a day by the start of week 8) for the remainder of the study. participation will be for a total of 40 weeks, including a 4-week screening period, 24 weeks of drug, and a safety follow-up 12 weeks after the last dose. the study will determine the safety and the primary outcome variability for dmf in treating ssc-pah; the primary outcome of clinical efficacy in this pilot trial will be improvement in 6-minute walk distance (6mwd).

Eligibility criteria:
inclusion criteria: 1. signed inform consent prior to any study-mandated procedures 2. adult patients 18-80 years of age 3. world health organization group 1 pah associated with scleroderma (ssc-pah) 4. who functional class ii-iii 5. 6mwd 150 to 450 meters 6. right heart catheterization demonstrating mpap≥ 25 mmhg and pcwp or left ventricular end diastolic pressure ≤15mm hg and pulmonary vascular resistance ≥240 dynes/cm-5 (3 wood units) within 12 weeks prior to study entry. 7. acr defined systemic sclerosis exclusion criteria: 1. pulmonary hypertension associated with * pah of any etiology other than scleroderma * ph of any etiology other than who group i pah * pulmonary venous hypertension defined as pcwp or lvedp \>15 mhg * untreated sleep apnea with ahi \>20 or sao2 nadir \<87% * chronic thromboembolic disease * sarcoidosis 2. participation in a clinical investigational study within the previous 30 days 3. moderate to severe hepatic impairment (e.g., child-pugh class b or c) 4. renal failure defined as: * estimated creatinine clearance \<30 m/min * serum creatinine\>2.5 mg/dl 5. serum aspartate aminotransferase (ast) and or alanine aminotransferase (alt) \> 1.5 times the upper limit of normal 6. systolic blood pressure \< 90mmhg 7. recently started (\< 8 weeks prior to randomization) or planned cardiopulmonary rehabilitation program based on exercise 8. pregnant or lactating women 9. need for haart therapy 10. planned treatment or treatment with another investigational drug within 1 month prior to start 11. moderate to severe interstitial lung disease, defined by fvc \< 80% or evidence on hrct of fibrosis or ground glass changes involving more than 30% of lung parenchyma

Keywords: systemic sclerosis, scleroderma, pah, pulmonary hypertension