A Phase 3 Adaptive Study to Evaluate the Safety and Efficacy of Inhaled Treprostinil in Participants With Pulmonary Hypertension (PH) Due to Chronic Obstructive Pulmonary Disease (COPD)

  • End date
    Jul 31, 2022
  • participants needed
  • sponsor
    United Therapeutics
Updated on 30 November 2021
pulmonary disease
forced expiratory volume
right heart catheterization
left ventricular end-diastolic pressure


The primary objective of this study is to demonstrate the efficacy of inhaled treprostinil compared to placebo in improving exercise ability as measured by change from baseline in 6-Minute Walk Distance (6MWD) following 12 weeks of active treatment in participants with PH-COPD.


This is a multicenter, randomized, double-blind, placebo-controlled, 34-week, cross-over study, with a Treatment Period of approximately 26 weeks under the Original Crossover Design or, if applicable, a 21-week parallel study, with a Treatment Period of approximately 14 weeks under the Contingent Parallel Design.

Condition Chronic Obstructive Lung Disease, Pulmonary Hypertension, Cancer Prevention, Surviving Abuse, Joint Injuries, Abdominal Surgery, Mental Disability, Pelvic Adhesions, Low Testosterone, Dental Filling, Habit Reversal, Complicated Grief, Chronic Pelvic Pain, Gambling Problems, Myopic Macular Degeneration, Nerve Injury, Severe Premenstrual Symptom, COPD (Chronic Obstructive Pulmonary Disease), Stasis Dermatitis, Pulmonary Arterial Hypertension, Open Heart Surgery, Recurrent Pregnancy Loss, Effects of Chemotherapy, Renal Anemia, Functional Dyspepsia, Catheter Complications, Serial Evaluation of Ductal Epithelium, Chronic Renal Anemia, Cancer Treatment, Anemic Cancer, Spinocerebellar Disorders, Pseudobulbar Affect, Spine Athroplasty, Indikation: Diabetes - Typ II, Partial Medial Meniscectomy, Primary Insulin Hypersecretion, Testotoxikose, Infantile Fibrosarcoma, Late Infantile Neuronal Ceroid Lipfuscinsosis, Memory Problems, chronic obstructive pulmonary disease, COPD, chronic obstructive pulmonary disease (copd)
Treatment Placebo solution, Inhaled treprostinil solution
Clinical Study IdentifierNCT03496623
SponsorUnited Therapeutics
Last Modified on30 November 2021


Yes No Not Sure

Inclusion Criteria

Participants who meet the following criteria may be included in the study
Participant voluntarily gives informed consent to participate in the study
Males and females 18 years of age and above at the time of informed consent
Women of childbearing potential (defined as less than 1 year post-menopausal and not surgically sterile) must agree to practice abstinence or use 2 highly effective methods of contraception (defined as a method of birth control that results in a low failure rate, [<1% per year], such as approved hormonal contraceptives, barrier methods [such as condom or diaphragm] used with a spermicide, or an intrauterine device) for the duration of study treatment and for 48 hours after discontinuing study drug. Participants must have a negative pregnancy test at the Screening Visit 1 (urine [prior to the first dose of study medication] and serum) and Baseline Visit (Study Week 1) (urine)
Males with a partner of childbearing potential must agree to use a barrier method (condom) with a spermicide for the duration of treatment and for at least 48 hours after discontinuing study drug
Diagnosis of PH-COPD (World Heath Organization [WHO] Group 3)
Clinical diagnosis of COPD will be made using the Global Initiative for Chronic
Obstructive Lung Disease (GOLD) diagnostic criteria (GOLD Criteria 2020) and
spirometry with the following documented parameters measured during Screening
Visit 1 (prior to start of low-dose inhaled treprostinil)
Forced expiratory volume in 1 second (FEV1) <80% predicted
FEV1/Forced vital capacity (FVC) <70
The participant has a resting saturation peripheral capillary oxygenation (SpO2) greater than or equal to 90%, with or without supplemental oxygen, but not to exceed 10 liters (L)/min oxygen supplementation by any mode of delivery during Screening Visit 1
During Screening Visit 1 prior to start of low-dose inhaled treprostinil, a 6MWD greater than or equal to 100 meters
Have a right heart catheterization (RHC) performed during Screening Visit 1. (A previous RHC obtained within 12 months prior to the start of Screening Visit 1 is acceptable for determining eligibility, even if done without oxygen or vasodilator challenge, and a repeat RHC is not required.) The following parameters must be documented for eligibility
Pulmonary vascular resistance (PVR) greater than or equal to 4 Wood units
A pulmonary artery wedge pressure (PAWP) or left ventricular end-diastolic pressure (LVEDP) of less than or equal to 15 millimeters of mercury (mmHg)
A Pulmonary artery pressure mean (PAPm) of greater than or equal to 30 mmHg
Participants must be on a stable and optimized dose of chronic COPD medications for greater than or equal to 30 days prior to start of Screening Visit 1 and remain on the same dose throughout the Screening Period
In the opinion of the Investigator, the participant can communicate effectively with study personnel and is considered reliable, willing, and likely to be cooperative with protocol requirements, including attending all study visits

Exclusion Criteria

The following will exclude participants from the study
The participant has a diagnosis of either pulmonary arterial hypertension (PAH) or pulmonary hypertension (PH) due to reasons other than COPD. This would include, but is not limited to, chronic thromboembolic PH or acute/recent deep vein thrombosis or pulmonary embolism, untreated or inadequately treated obstructive sleep apnea, connective tissue disease (including but not limited to systemic sclerosis/scleroderma or systemic lupus erythematosus), sarcoidosis, human immunodeficiency virus-1 infection, and other conditions under WHO Group 1, 2, 4, and 5 classifications
Based on chest computed tomography (CT) imaging during Screening Visit 1, the participant has a confirmed diagnosis of WHO Group 3 PH, other than COPD, such as idiopathic pulmonary fibrosis, combined pulmonary fibrosis and emphysema, diffuse parenchymal lung disease or interstitial lung disease. A previous chest CT scan performed within the 6 months prior to the start of Screening Visit 1 is also acceptable, and a repeat assessment is not required
A redacted CT scan report (from Screening Visit 1 or dated within prior 6
months) should be provided to the Medical Monitor with the Pre-Baseline Review
Form to confirm eligibility
\. The participant has received any Food and Drug Administration
(FDA)-approved medication for the treatment of PAH (that is, prostacyclin
prostacyclin receptor agonist, endothelin receptor antagonist [ERA]
phosphodiesterase type 5 inhibitor [PDE5-I], or soluble guanylate cyclase
[sGC] stimulator) at Screening Visit 1 and thereafter, except if received for
acute vasoreactivity testing
\. The participant has a previous diagnosis of homozygous alpha-1 antitrypsin
\. The participant has any prior intolerance to inhaled prostanoid therapy
\. Inability to tolerate low-dose (3 breaths, 18 mcg) study drug and/or
inability to follow dosing regimen during the Screening Period (pre-
\. Unwilling or unable to use Sponsor-provided devices (actigraph
spirometer, or smart device)
\. The participant has evidence of clinically significant left-sided heart
disease (including but not limited to left ventricular ejection fraction <40%
left ventricular hypertrophy,) or clinically significant cardiologic
conditions, such as congestive heart failure, coronary artery disease, or
valvular heart disease. Note: Participants with abnormal left ventricular
function attributable to the effects of right ventricular overload will not be
excluded, but a discussion with and approval by the Sponsor Medical Monitor is
\. Any exacerbation of COPD (including hospitalization or outpatient therapy)
or active pulmonary or upper respiratory infection 60 days prior to start of
Screening Visit 1 through the Baseline Visit. This is defined as worsening of
respiratory symptoms that required treatment with corticosteroids and/or
\. Initiation of pulmonary rehabilitation within 12 weeks prior to start of
Screening Visit 1 or, in the opinion of the Investigator, pulmonary
rehabilitation is likely to be needed during the study Treatment Period
\. The participant has any form of congenital heart disease (repaired or
unrepaired; other than a patent foramen ovale)
\. The participant has any musculoskeletal disorder (severe arthritis of the
lower limbs which limits ambulation, recent hip or knee joint replacement
artificial leg) or any other condition that would likely be the primary
limitation to ambulation
\. Use of any other investigational drug or device within 30 days prior to
the start of Screening Visit 1
\. Any other clinically significant illness or abnormal laboratory value(s)
measured during the Screening Period that, in the opinion of the Investigator
might adversely affect the interpretation of the study data or safety of the
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