Efficacy and Safety of Seralutinib in Adult Subjects With PAH (PROSERA)

Study Overview
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Brief Summary
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The primary objective of the study is to determine the effect of seralutinib on improving exercise capacity in subjects with WHO Group 1 PAH who are FC II or III. The secondary objective for this trial is to determine time to clinical worsening.

Official Title
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A Phase 3, Randomized, Double-Blind, Placebo-Controlled Study to Evaluate the Efficacy and Safety of Oral Inhalation of Seralutinib for the Treatment of Pulmonary Arterial Hypertension (PAH)

Conditions
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Pulmonary Arterial Hypertension

Intervention / Treatment
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* Drug: Placebo
* Drug: Seralutinib
* Device: Generic Dry Powder Inhaler


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adult subjects aged 18 to 75 years. Body mass index (BMI) ≥ 17 kg/m^2 and ≤ 40 kg/m^2. Diagnosis of PAH classified by one of the following: Idiopathic PAH (IPAH) or heritable PAH (HPAH). PAH associated with connective tissue disease (CTD-APAH); PAH associated with anorexigen or PAH associated with methamphetamine use. Congenital heart disease with simple systemic to pulmonary shunt at least 1 year after surgical repair. 6MWDs ≥ 150 meters and ≤ 450 meters at Screening. WHO FC II or III. US Registry to Evaluate Early and Long-term PAH Disease Management (REVEAL) Lite 2 Risk Score ≥ 5 OR NT-proBNP ≥ 300 ng/L. Cardiac catheterization within the screening period, or a standard of care right heart catheterization (RHC) (with pressure wave forms available for review) up to 24 weeks prior to Screening. Mean pulmonary arterial pressure (mPAP) > 20 mmHg (at rest), AND Pulmonary vascular resistance (PVR) ≥ 400 dyne·s/cm^5, AND Pulmonary capillary wedge pressure (PCWP) or left ventricle end-diastolic pressure (LVEDP) ≤ 12 mmHg if PVR ≥ 400 to < 500 dyne·s/cm^5 OR PCWP or LVEDP ≤ 15 mmHg if PVR ≥ 500 dyne·s/cm^5. Treatment with at least one allowed background PAH disease-specific medication prior to Screening, and on stable regimen and doses for at least 12 weeks. Pulmonary function tests (PFTs) at Screening or completed no more than 12 weeks prior to Screening. Women of childbearing potential (WOCBP) must have a negative pregnancy test at Screening and on Day 1 before first administration of Investigational Product (IP). WOCBP who are not abstinent and intend to be sexually active with a non-sterilized male partner must be willing to use a highly effective method of contraception from consent through 30 days following the last administration of IP. Male subjects: Non-sterilized male subjects who are not abstinent and intend to be sexually active with a female partner of childbearing potential must use a male condom from consent through 90 days after the last dose of IP. Exclusion Criteria: Evidence of chronic thromboembolic disease or acute pulmonary embolism. Uncontrolled systemic hypertension as evidenced by sitting systolic blood pressure > 160 mm Hg or sitting diastolic blood pressure > 100 mm Hg. Systolic blood pressure < 90 mm Hg during Screening. WHO Pulmonary Hypertension Group 2 - 5. Human immunodeficiency virus (HIV)-associated PAH, schistosomiasis associated PAH, PAH associated with portal hypertension, or pulmonary venous-occlusive disease (POVD). Recent history of left-sided heart disease and/or clinically significant cardiac disease within 48 weeks of Screening. Left ventricular ejection fraction (LVEF) ≤ 50% within 24 weeks of Screening. Hemodynamically significant valvular heart disease. History of atrial septostomy. Uncontrolled atrial fibrillation or paroxysmal atrial fibrillation. Untreated severe obstructive sleep apnea. Hepatic dysfunction defined as Child-Pugh Class A or higher, or as evidenced by one of the following at Screening: alanine aminotransferase (ALT) or aspartate aminotransferase (AST) > 2 x upper limit of normal (ULN) or total bilirubin ≥ 2 x ULN. Severe acute or chronic medical or laboratory abnormality that may increase the risk associated with study participation or IP administration (eg, history of intracranial hemorrhage, recurrent syncope). Any musculoskeletal disease, injury, or any other disease that limits evaluation of 6MWT. Initiation of an exercise program for cardiopulmonary rehabilitation within 12 weeks prior to Screening or planned during the study. Pregnant or nursing or intends to become pregnant during the duration of the study. Body weight < 40 kg at Screening. Estimated glomerular filtration rate (eGFR) < 45 mL/min/1.73m^2 Hemoglobin (Hgb) concentration < 8.5 g/dL at Screening. Evidence of active or latent Human immunodeficiency virus (HIV), Hepatitis B or Hepatitis C, or tuberculosis (TB) infection at Screening. Tyrosine kinase inhibitors within 12 weeks prior to Screening. Requirement of IV inotropes (ie, levosimendan, dopamine, dobutamine, milrinone, norepinephrine) or IV diuretics for more than 24 hours within 4 weeks prior to Screening. Subjects currently receiving oral anticoagulants (ie, warfarin/other vitamin K antagonists or direct-acting oral anticoagulants [DOACs]) if any of the following criteria are met: a. History within 24 weeks of Screening of: i. Syncope, or ii. Symptomatic bleeding in a critical area or organ iii. Intramuscular with compartment syndrome, or iv. Bleeding causing a fall in hemoglobin levels of 1.24 mmol/L (20 g/L or greater) or more, or v. Leading to a transfusion of 2 U or more of whole blood or red blood cells. b. History of central nervous system pathology. c. History of clinically significant (massive) hemoptysis. d. If on warfarin/other vitamin K antagonist, uncontrolled International normalized ratio (eg, INR > 3) as assessed. e. Platelet count < 150 x 10^9/L at Screening. f. Concomitant use of antiplatelet agents. Prior participation in seralutinib studies and/or prior treatment with seralutinib. Currently participating in or has participated in a study of an investigational agent or has used an investigational device for the treatment of PAH within 8 weeks or 5 half-lives of the investigational agent, whichever is longer, prior to Screening. Current use of inhaled tobacco- or nicotine-containing products (including e-vapor products) and/or inhaled marijuana. Current alcohol use disorder based on the opinion of the Investigator, and/or a positive test for drugs of abuse. Subjects with a history of severe milk protein allergy or known intolerance to lactose. QT interval corrected for heart rate using Fridericia's formula (QTcF) of > 500 msec. Have any other condition or reason that, in the opinion of the Investigator or in the opinion of the Sponsor's Medical Monitor (MM) (or designee) in consultation with the Investigator, would prohibit the subject from participating in the study.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 75 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
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Placebo Comparator: Placebo<br>Placebo inhaled orally twice daily (BID) up to 48 weeks | Drug: Placebo<br>* Matching capsule containing placebo<br>Device: Generic Dry Powder Inhaler<br>* Generic dry powder inhaler for seralutinib or placebo delivery<br>|
| Experimental: Seralutinib 90 mg<br>Seralutinib inhaled orally BID up to 48 weeks | Drug: Seralutinib<br>* Capsule containing seralutinib<br>Device: Generic Dry Powder Inhaler<br>* Generic dry powder inhaler for seralutinib or placebo delivery<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in distance achieved on the six-minute walk test (6MWT), six-minute walk distance (Δ6MWD) from baseline to Week 24 |  | Baseline to 24 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Time to first event of Clinical Worsening from first dose of Investigational Product (IP) through end of study |  | Baseline to 48 weeks | 
| Proportion of subjects who achieve all of the following components of clinical improvement at Week 24, in the absence of clinical worsening: | Improvement from baseline in World Health Organization (WHO) functional class (FC) or maintenance of WHO FC II Decrease from baseline in N-terminal pro b-type natriuretic peptide (NT-proBNP) of ≥ 30% or decrease and maintenance at < 300 ng/L Increase from baseline in 6MWD of ≥ 10% or ≥ 30 m | Baseline to 24 weeks | 
| Change in NT-proBNP from baseline to Week 24 |  | Baseline to 24 weeks | 
| Proportion of subjects with ≥ 1 point decrease from baseline in US Registry to Evaluate Early and Long-term PAH Disease Management (REVEAL) Lite 2 Risk Score at Week 24 |  | Baseline to 24 weeks | 
| Proportion of subjects with each of the Clinical Worsening Outcomes: | Death (all causes) Hospitalization for signs and symptoms of worsening PAH (≥ 24 hours) Worsening-related listing for or receipt of lung and/or heart/lung transplantation Atrial septostomy performed Initiation of therapy with an additional approved background PAH disease-specific medication or the need to increase the dose of parenteral (IV or subcutaneous infusion) prostacyclin by 10% or more due to worsening PAH Disease progression, defined by both of the following events occurring at any time, even if they began at different times, as compared to their baseline values: Decrease in 6MWD of ≥ 15% on two consecutive tests, performed a minimum of 4 hours but no more than 1 week apart AND Worsened WHO FC | Baseline to 52 weeks | 
| Proportion of subjects who improve from baseline in WHO FC or maintain WHO FC II |  | Baseline to 48 weeks | 
| Change in PAH-SYMPACT™ from baseline to Week 24 |  | Baseline to 24 weeks | 
| Change in Euro-QoL - 5 Dimensions - 5 Levels (EQ-5D-5L) from baseline to Week 24 |  | Baseline to 24 weeks | 
| Incidence of treatment-emergent adverse events (TEAEs), serious TEAEs (SAEs), and treatment-emergent adverse events of special interest (AESIs) |  | Baseline to 52 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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seralutinib, GB002, PROSERA