Treprostinil Palmitil Inhalation Powder for Pulmonary Arterial Hypertension

Overview

Sponsor-declared trial summary

Key facts

Sponsor

Insmed Inc.

Participant type

Patients

Age range

18-64 years, 65+ years

Gender

Male and Female

Therapeutic area

Diseases [C] - Respiratory Tract Diseases [C08]

Trial duration

28 Jun 2022 → 5 Mar 2025

Decision date (initial)

2024-06-24

Transition trial

Yes

Low-intervention

No

Rare-disease indication

Yes

Vulnerable population

Yes

Funding sources

Insmed Incorporated

External identifiers

EU CT number

2023-505541-99-00

EudraCT number

2021-001528-16

ClinicalTrials.gov

NCT05147805

Trial design

CTIS Part I — objectives, methods, condition coding

Main objective

Scope: Pharmacokinetic, Others, Efficacy

To assess the effect of Treprostinil Palmitil Inhalation Powder (TPIP) compared with placebo on Pulmonary Vascular Resistance (PVR)

Secondary objectives 4

1. To assess the effect of TPIP compared with placebo on exercise capacity
2. To assess the safety and tolerability of TPIP compared with placebo
3. To evaluate the PK of TP and TRE in plasma
4. To evaluate the effect of TPIP compared with placebo on the concentration of NT-proBNP in blood

Conditions and MedDRA coding

Pulmonary Arterial Hypertension

Study design 3 periods

Regulatory references

Plan to share IPD

No

Eligibility criteria

Principal inclusion / exclusion criteria as submitted by sponsor

Inclusion criteria 17

1. Participants must be ≥ 18 to ≤ 75 years at the time of signing the ICF
2. Participants must have a diagnosis of WHO Group 1 PH (PAH) in any of the following subtypes: • idiopathic; • heritable or • drug/toxininduced or CTD-associated PAH • Congenital heart disease-related with simple systemic-to-pulmonary shunt at least 1 year following repair
3. PAH diagnosis for at least 3 months.
4. New York Heart Association (NYHA)/WHO functional class II or III
5. Medical history, physical examination, vital signs, ECG, and clinical laboratory results consistent with their degree of PAH and treatment.
6. Participants must be on stable PH therapy consisting of up to 2 medications from the following classes: • Endothelin receptor antagonists (eg, ambrisentan, bosentan, macitentan) • Phosphodiesterase type 5 inhibitors (eg, sildenafil, tadalafil) • Guanylate cyclase stimulator (eg, riociguat)"
7. No change in PH medications (eg, ambrisentan, bosentan, macitentan, sildenafil, tadalafil, riociguat) or dosage for at least 30 days prior to Screening.
8. No change in long-term diuretic use dosage for at least 30 days prior to Screening (single or rescue doses allowed, per the Investigator).
9. Documented pre-bronchodilator predicted FEV1 ≥70% and FEV1/FVC ratio ≥ 70% within 1 year of Screening. If documented spirometry is not available, pulmonary function testing will be performed during Screening.
10. At least two 6MWTs during Screening with a 6MWT distance between 150 and 450 meters in length where both values are within 15% of each other.
11. Right heart catheterization at Screening (or within 30 days prior to Screening, if available) with all the following hemodynamic findings: • Mean PAP ? 25 mmHg at rest • PCWP ? 15 mmHg • PVR of ? 5 WU"
12. BMI within the range 18.0-37.0 kg/m2 (inclusive).
13. Male and female participants must use contraceptives that are consistent with local regulations regarding the methods of contraception for those participating in clinical studies. • Male participants: Male participants who are not sterile and have female partners of childbearing potential, must be using effective contraception from Day 1 to at least 90 days after the last dose of study drug. Such methods include true abstinence (refraining from heterosexual intercourse during the study), combined (estrogen and progestogen containing) or progestogen-only hormonal contraception associated with inhibition of ovulation, intrauterine devices, intrauterine hormone-releasing systems. • Female participants: Women must be postmenopausal (defined as no menses for 12 months without an alternative medical cause), surgically sterile, (ie, hysterectomy and/or bilateral salpingo-oopherectomy), or using highly effective contraception methods (ie, methods that alone or in combination achieve <1% unintended pregnancy rates per year when used consistently and correctly) from Day 1 to at least 90 days after the last dose of study drug. Such methods include true abstinence (refraining from heterosexual intercourse during the study), combined (estrogen and progestogen containing) or progestogen-only hormonal contraception associated with inhibition of ovulation and supplemented with a double barrier (preferably male condom), intrauterine devices, intrauterine hormone-releasing systems, or vasectomized partner. For WOCBBP ≤45 years, an additional confirmatory testing of FSH level with a threshold of >40 mIU/mL should be performed to be considered infertile. All WOCBP must have a negative urine pregnancy test prior to randomization."
14. Female participants of childbearing potential must have a negative serum pregnancy test at Screening and a negative urine pregnancy test at Baseline.
15. Male participants with pregnant or non-pregnant WOCBP partner must use a condom in order to avoid potential exposure to embryo/fetus.
16. Capable of giving signed informed consent
17. Able to understand and comply with protocol requirements

Exclusion criteria 34

1. History of PH other than idiopathic, hereditary, drug/toxin-induced, repaired simple congenital heart disease, or CTD-associated PAH (eg, complex congenital heart disease-associated PAH, portal hypertensionassociated PAH, PH belonging to Groups 2 through 5).
2. Allergy, or documented hypersensitivity or contraindication, to TPIP or TRE or mannitol (an excipient of the TPIP formulation).
3. Per the Investigator's discretion, previous intolerance to prostacyclin analogues or receptor agonists or previous chronic use (>30 days) of a prostacyclin analogue or receptor agonist within 30 days of the Screening Visit.
4. QTcF interval > 480 ms on resting ECG at Screening, not including participants with right bundle branch block (RBBB) leading to a prolongation of the QRS.
5. Any known ventricular or supraventricular tachyarrhythmia except for paroxysmal atrial fibrillation and any symptomatic bradycardia.
6. History of heart disease including left ventricular ejection fraction (LVEF) ? 40% or clinically significant valvular, constrictive, or symptomatic atherosclerotic heart disease.
7. Systolic BP < 90 mm Hg at Screening
8. Participation in a cardio-pulmonary rehabilitation program within 30 days of Screening Visit.
9. Evidence of thromboembolic disease as assessed by VQ scan, pulmonary angiography, or pulmonary CT scan.
10. Acutely decompensated heart failure within 30 days of Screening Visit.
11. Abnormal renal function (estimated glomerular filtration rate < 30 mL/min/1.73m2) at Screening.
12. Active liver disease or hepatic dysfunction manifested as: in • Elevated liver function test results (ALT or AST > 2 × ULN) • Bilirubin > 1.5 × ULN (isolated bilirubin > 1.5 × ULN; ULN is acceptable if bilirubin is fractionated and direct bilirubin < 35%) • Known hepatic or biliary abnormalities, not including Gilbert's syndrome or asymptomatic gallstones"
13. History of HIV infection
14. Established diagnosis of hepatitis B viral infection, or positive for HBsAg at the time of Screening. • Participants who have gained immunity for hepatitis B virus infection after vaccination are eligible for the study. • Participants with positive HBcAbs are eligible for the study only if the hepatitis B virus DNA level is undetectable."
15. Established diagnosis of hepatitis C viral infection at the time of screening. Participants positive for hepatitis C antibody are eligible for the study only if hepatitis C virus RNA is negative.
16. Active and current symptomatic COVID-19 or previous severe disease and/or hospitalization due to COVID-19
17. Use of live attenuated vaccines within 30 Days of the Screening Visit.
18. Participants with Down's Syndrome.
19. History of abnormal bleeding or bruising with a platelet count of <100,000/?L at Screening.
20. History of organ transplantation.
21. Known or suspected immunodeficiency disorder
22. Severe concomitant illness(es) that, in the Investigator's judgment, would adversely affect the participant's participation in the study.
23. Any clinically significant abnormal laboratory values at Screening or diseases or disorders (eg, cardiovascular, pulmonary, gastrointestinal, liver, kidney, neurological, musculoskeletal, endocrine, metabolic, psychiatric, physical impairment) that, in the opinion of the Investigator, may put the participant at risk by participating in the study, or interfere with the participant's treatment, assessment, or influence the results of the study, or have compliance issues with the study or have a planned or anticipated major surgical procedure during the study.
24. History of alcohol or drug abuse within 6 months prior to Screening.
25. Any other medical or psychological condition including relevant laboratory abnormalities at Screening that, in the opinion of the Investigator, suggest a new and/or insufficiently understood disease.
26. Acute or chronic impairment (other than dyspnea), limiting the ability to comply with study requirements, in particular with 6MWT.
27. Participants with current or recent (past 30 days) lower respiratory tract infection
28. History of malignancy in the past 5 years, with exception of completely treated in situ carcinoma of the cervix and completely treated non-metastatic squamous or basal cell carcinoma of the skin.
29. Change in PH medication (endothelin receptor agonists, phosphodiesterase type 5 inhibitors, and guanylate cyclase stimulators or diuretics) between Screening and Baseline.
30. Use of any investigational drug/device or participation in any investigational study within 30 days prior to the screening
31. Current use of cigarettes (as defined by CDC) or e-cigarettes: An adult who has smoked at least 100 cigarettes in his or her lifetime, and who currently smokes either every day or somedays.
32. Participants who currently inhale marijuana (recreational or medical).
33. Pregnant or breastfeeding.
34. Absolute neutrophil count ? 1000/?L at Screening.

Endpoints

Primary and secondary outcome measures (English text)

Primary endpoints 1

1. Change from Baseline in PVR at Week 16

Secondary endpoints 5

1. Change from Baseline in 6MWT distance at Week 5, Week 10, and Week 16
2. Percent change from Baseline in 6MWT distance at Week 5, Week 10 and Week 16
3. Frequency of AEs and changes from Baseline in clinical laboratory evaluations, vital signs, ECG, and physical examination over the 16-week treatment period
4. Plasma PK parameters of TP and TRE, including Cmax, tmax, AUC24, AUC∞, AUClast, CL/F, Vd/F, and t½, on Day 1 and at Week 10
5. Change from Baseline in the concentration of NT-proBNP at Week 5, Week 10 and Week 16

Investigational products

Investigational medicinal products (IMPs), comparators, placebo, auxiliary

Test 3

Placebo 1

Sponsors and contacts

Sponsor organisations, regulatory contacts, third parties

Insmed Inc.

Sponsor organisation

Insmed Inc.

Address

700 Us Highway 202/206

City

Bridgewater

Postcode

08807-1704

Country

United States

Scientific contact point

Organisation

Insmed Inc.

Contact name

Fraz Ismat

Public contact point

Organisation

Insmed Inc.

Contact name

Medical Information

Third parties 10

Locations

6 EU/EEA countries · 23 investigational sites

By country

Investigational sites

Country notifications

Trial-start, recruitment-start, end and early-termination notifications submitted per Member State

Results and documents

Annex IV summary of results, Annex V layperson summary, and all documents registered in CTIS for this trial

Summary of results Art. 37(4) CTR

Layperson summary Annex V

Documents 63 files

Public protocol annexes, IB summaries, regulatory submissions and post-authorisation documents registered in CTIS.

Application history

2 submissions — initial application plus substantial / non-substantial modifications