Study of Macitentan (ACT-064992) on Morbidity and Mortality in Patients With Symptomatic Pulmonary Arterial Hypertension
Condition: Pulmonary Arterial Hypertension
MeSH terms: Pulmonary Arterial Hypertension; Familial Primary Pulmonary Hypertension; Hypertension
Intervention: macitentan (ACT-064992); macitentan (ACT-064992); placebo
Intervention description: Tablet, 3 mg dosage, once daily; Tablet, 10 mg dosage, once daily; Matching placebo, once daily
Intervention MeSH terms: Macitentan
Phase: Phase 3
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Enrollment: 742.0
Sex: All
Minimum age: 12 Years
Healthy volunteers: No
Keywords: pulmonary arterial hypertension SERAPHIN

Summary:

      The AC-055-302/SERAPHIN study will be an event-driven Phase III study, comparing two
      different doses of macitentan (ACT-064992) (3 and 10 mg) vs placebo in patients with
      symptomatic PAH. The main study objective is to demonstrate that macitentan (ACT-064992)
      prolongs time to the first morbidity or mortality event, and to evaluate the benefit/risk
      profile of macitentan (ACT-064992) in the treatment of patients with symptomatic PAH.
    

Eligibility criteria:

        Inclusion Criteria:

          1. Signed informed consent prior to initiation of any study mandated procedure.

          2. Patients with symptomatic pulmonary arterial hypertension (PAH) in modified World
             Health Organization (WHO) functional class II to IV.

          3. Patients with the following types of pulmonary arterial hypertension (PAH) belonging
             to groups 1.1 to 1.3 of the Venice classification:

               -  Idiopathic (IPAH);

               -  Familial (FPAH); or

               -  Related to:

                    -  Collagen vascular disease;

                    -  Simple, congenital systemic-to-pulmonary shunts at least 1 year post
                       surgical repair;

                    -  Human immunodeficiency virus (HIV) infection; or

                    -  Drugs and toxins.

          4. PAH diagnosis confirmed by hemodynamic evaluation performed prior to randomization and
             showing all of the following:

               -  Mean pulmonary artery pressure (mPAP) > 25 mmHg at rest;

               -  Pulmonary capillary wedge pressure (PCWP) or left ventricular end diastolic
                  pressure (LVEDP) < 15 mmHg; and

               -  Pulmonary vascular resistance (PVR) at rest >= 320 dyn×sec/cm^5.

          5. 6-minute walk distance (6MWD) >= 50 m.

          6. Men or women > 12 years of age (women of childbearing potential must have a negative
             pre-treatment serum pregnancy test and must use a reliable method of contraception).

        Exclusion Criteria:

          1. PAH associated with portal hypertension, thyroid disorders, glycogen storage disease,
             Gaucher''s disease, hereditary hemorrhagic telangiectasia, hemoglobinopathies,
             myeloproliferative disorders or splenectomy.

          2. PAH associated with non corrected simple congenital systemic-to-pulmonary shunts, and
             combined and complex systemic-to-pulmonary shunts, corrected or non corrected.

          3. PAH associated with significant venous or capillary involvement (PCWP > 15 mmHg),
             known pulmonary veno-occlusive disease, and pulmonary capillary hemangiomatosis.

          4. Persistent pulmonary hypertension of the newborn.

          5. Pulmonary Hypertension belonging to groups 2 to 5 of the Venice classification.

          6. Moderate to severe obstructive lung disease: forced expiratory volume in 1
             second/forced vital capacity (FEV1/FVC) < 70% and FEV1 < 65% of predicted value after
             bronchodilator administration.

          7. Moderate to severe restrictive lung disease: total lung capacity (TLC) < 60% of
             predicted value.

          8. Moderate to severe hepatic impairment, i.e., Child-Pugh Class B or C.

          9. Estimated creatinine clearance < 30 mL/min

         10. Serum aspartate aminotransferase (AST) and/or alanine aminotransferase (ALT) > 1.5
             times the upper limit of normal.

         11. Hemoglobin < 75% of the lower limit of the normal range.

         12. Systolic blood pressure < 100 mmHg.

         13. Acute or chronic physical impairment (other than dyspnea), limiting the ability to
             comply with study requirements.

         14. Pregnant or breast-feeding.

         15. Known concomitant life-threatening disease with a life expectancy < 12 months.

         16. Body weight < 40 kg.

         17. Any condition that prevents compliance with the protocol or adherence to therapy.

         18. Recently started (< 8 weeks prior to randomization) or planned cardio-pulmonary
             rehabilitation program based on exercise.

         19. Treatment with endothelin receptor antagonists (ERAs) within 3 months prior to
             randomization.

         20. Systemic treatment within 4 week prior to randomization with cyclosporine A or
             tacrolimus, everolimus, sirolimus (calcineurin or mammalian target of rapamycin (mTOR)
             inhibitors).

         21. Treatment with cytochrome P3A (CYP3A) inducers within 4 weeks prior to randomization

         22. Known hypersensitivity to drugs of the same class as the study drug, or any of their
             excipients.

         23. Planned treatment, or treatment, with another investigational drug within 1 month
             prior to randomization.