A Study of Ubenimex in Patients With Pulmonary Arterial Hypertension (WHO Group 1)
Condition: Pulmonary Arterial Hypertension
MeSH terms: Pulmonary Arterial Hypertension; Familial Primary Pulmonary Hypertension; Hypertension
Intervention: ubenimex; placebo
Intervention MeSH terms: Ubenimex
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Enrollment: 61.0
Sex: All
Minimum age: 18 Years
Maximum age: 75 Years
Healthy volunteers: No

Summary:

      This proof-of-concept study is designed as a Phase 2, multicenter, randomized, double-blind,
      placebo controlled study comparing ubenimex with placebo in patients with pulmonary arterial
      hypertension (PAH) (World Health Organization [WHO] Group 1) and have a WHO/New York Heart
      Association (NYHA) Functional Classification (WHO/NYHA-FC) of II or III.
    

Eligibility criteria:

        Inclusion Criteria:

          1. Male or female, 18-75 years old.

          2. Has a diagnosis of WHO Group 1 PAH.

          3. Right heart catheterization performed at Screening with results that are:

               1. Mean pulmonary arterial pressure ≥25 mmHg (at rest) and

               2. Pulmonary venous hypertension (measured as pulmonary capillary wedge pressure
                  (PCWP) ≤15 mmHg. If PCWP is not available, then mean left atrial pressure or left
                  ventricular end-diastolic pressure ≤15 mmHg in the absence of left atrial
                  obstruction. and

               3. Pulmonary vascular resistance (PVR) ≥300 dyn•s/cm5 (3.75 Wood units)

          4. Has WHO/NYHA-FC of II or III.

          5. Be on stable dose of at least one of the following PAH-specific therapies: endothelin
             receptor antagonist, an agent acting on the nitric oxide pathway (phosphodiesterase
             type 5 inhibitor or soluble guanylate cyclase stimulator), and/or a prostacyclin or
             prostacyclin analog.

          6. Has a 6-minute walk distance that is ≥150 and ≤500 meters.

          7. Have a ventilation-perfusion scan that rules out thromboembolic disease.

        Exclusion Criteria:

        Exclusions Related to Cardiovascular Disease

          1. History of uncontrolled hypertension

          2. Persistent hypotension at Screening.

          3. Evidence or history of left-sided heart disease and/or clinically significant cardiac
             disease in which pulmonary hypertension is more likely WHO Group 2.

          4. Acute decompensated heart failure within 1 month of Screening.

          5. Recent initiation (<8 weeks from Screening) or planned initiation of cardiopulmonary
             rehabilitation exercise program.

             Exclusions Related to Pulmonary Disease

          6. Newly diagnosed with PAH and not on PAH-specific therapy.

          7. Pulmonary hypertension due to:

               1. Uncorrected congenital systemic-to-pulmonary shunt.

               2. Pulmonary veno-occlusive disease and/or pulmonary capillary hemangiomatosis

               3. Persistent pulmonary hypertension of the newborn

               4. WHO clinical classification Groups 2-5

          8. Evidence of significant airway and/or parenchymal lung disease.

          9. Chronic infection related to tuberculosis or fungal or mycobacterial disease.

             Exclusions Based on Other Medical Conditions

         10. Chronic infections including, but not limited to tuberculosis (TB), hepatitis B virus
             (HBV) or hepatitis C virus (HCV).

         11. History of portal hypertension or chronic liver disease, including positive serology
             for infection with HCV and/or HBV.

         12. Evidence of active infection requiring intravenous or oral antibiotics within 4 weeks
             of Screening.

         13. Body mass index ≥35.0 at Screening.

         14. History of obstructive sleep apnea.

         15. History of malignancy within the last 5 years, except nonmelanoma skin cancer and
             cervical carcinoma in situ treated with curative intent.

         16. Neuropsychiatric disorders/symptoms or psychological conditions.

         17. Pregnancy or breast-feeding

         18. Prior treatment with B cell or lymphocyte-depleting agents (eg, rituximab, Campath)

             Exclusions Based on Concomitant Medication Use

         19. Concurrent regular use of another leukotriene pathway inhibitor, including
             over-the-counter medications or herbal remedies.

             Exclusions Based on Laboratory Values

         20. Significant/chronic renal insufficiency.

         21. Transaminases (alanine transaminase, aspartate transaminase) levels >3 × upper limit
             of normal (ULN) and/or bilirubin level >2 × ULN.

         22. Absolute neutrophil count <1500 mm3.

         23. Hemoglobin concentration <9 g/dL at Screening.

         24. Hepatic dysfunction as defined by Child-Pugh Class B or C