Pilot Study of the Safety and Efficacy of Anakinra in Pulmonary Arterial Hypertension

Study Overview
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Brief Summary
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Pulmonary arterial hypertension (PAH) can result in right ventricular failure and death. Anakinra has been used in patients with left sided heart failure, and the present study looks to determine if anakinra is safe and effective in patients with PAH. To accomplish this goal, we plan to evaluate for exercise improvement (as assessed by cardiopulmonary exercise testing) in 10 patients with PAH on anakinra.

Detailed Description
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Patients with pulmonary arterial hypertension will undergo cardiopulmonary exercise testing (CPET) at baseline and at 2 weeks. After the initial CPET, all patients will receive anakinra as a daily injection for 2 weeks. Patients will be instructed in the use of anakinra during their initial visit. Our primary outcome will be the difference in the exercise capacity of patients with PAH, as measured by maximal uptake of oxygen on CPET.

Official Title
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Pilot Study of the Safety and Efficacy of Anakinra in Pulmonary Arterial Hypertension

Conditions
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Pulmonary Arterial Hypertension

Intervention / Treatment
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* Drug: Anakinra


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: age over 18 functional class II or III symptoms of right ventricular failure despite optimal PAH therapy mean pulmonary artery pressure >25mmHg on previous right heart catheterization pulmonary arterial wedge pressure <15mmHg on previous right heart catheterization pulmonary vascular resistance >3 wood units on previous right heart catheterization Exclusion Criteria: PAH due to connective tissue disease angina or electrocardiograph changes that limit maximum exertion during cardiopulmonary exercise testing or baseline EKG changes that limit the ability to detect ischemia recent (<14 days) use of anti-inflammatory drugs (not including NSAIDs), chronic inflammatory disorder, malignancy, active infection, or any comorbidity limiting survival or ability to complete the study sever kidney dysfunction (eGFR <30mL/min) thrombocytopenia (<50,000/mm3), or neutropenia (absolute neutrophil count <1500/mm3) refusal by a woman of childbearing potential to use a medically acceptable form of birth control history of hypersensitivity to anakinra or E. coli products latex or rubber allergy inability to give informed consent non-English speaking

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Interventional Model Description: Open label treatment with Anakinra
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: anakinra<br>Patients will be treated with anakinra, injected SQ daily in a dose of 100mg for 14 days. Before and after this intervention, patients will undergo cardiopulmonary exercise testing (as well as echocardiography, EKG analysis, and serologic analysis). Subjects will be assessed for changes in exercise capacity, as determined by peak oxygen uptake and ventilatory efficiency to CO2 production slope. | Drug: Anakinra<br> <br> * Other names: Kineret;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in exercise capacity, as determined by peak oxygen consumption and ventilatory efficiency on cardiopulmonary exercise testing |  | 14 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Effect of anakinra on serum high sensitivity C-reactive protein |  | 14 days | 
| Effect of anakinra on serum NT-pro-BNP. |  | 14 days | 
| Effect of anakinra on serum interleukin-6 |  | 14 days | 
| Change in symptoms of heart failure (as assessed by questionnaire with the Duke Activity Status Index and Minnesota Living With Heart Failure Questionnaire). |  | 14 days | 
| Correlate between biomarkers (serum high sensitivity C reactive protein, interluekin-6, and NT-pro BNP) and measures of exercise capacity (peak oxygen consumption and ventilatory efficiency on cardiopulmonary exercise testing) |  | 14 days | 
| Number of patients with treatment related adverse events related to anakinra in patients with pulmonary arterial hypertension |  | 14 days |