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Trial details imported from ClinicalTrials.gov
For full trial details, please see the original record at
https://clinicaltrials.gov/study/NCT04732221
Registration number
NCT04732221
Ethics application status
Date submitted
27/01/2021
Date registered
1/02/2021
Titles & IDs
Public title
A Study of the Efficacy and Safety of MK-5475 in Participants With Pulmonary Arterial Hypertension (INSIGNIA-PAH: Phase 2/3 Study of an Inhaled sGC Stimulator in PAH) (MK-5475-007)
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Scientific title
A Phase 2/3, Multicenter, Randomized, Double-blind, Placebo-Controlled, Adaptive Design Study to Evaluate the Efficacy and Safety of MK-5475 in Adults With Pulmonary Arterial Hypertension
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Secondary ID [1]
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MK-5475-007
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Secondary ID [2]
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5475-007
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Universal Trial Number (UTN)
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Pulmonary Arterial Hypertension
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Hypertension, Pulmonary
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Condition category
Condition code
Respiratory
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0
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Other respiratory disorders / diseases
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Human Genetics and Inherited Disorders
0
0
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0
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Other human genetics and inherited disorders
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Cardiovascular
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0
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0
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Hypertension
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Treatment: Drugs - MK-5475
Treatment: Drugs - Placebo to MK-5475
Experimental: Phase 2 Cohort MK-5475 380 µg - Participants receive MK-5475 380 µg via oral inhalation once daily for 12 week base period and for optional 24 month extension period.
Experimental: Phase 2 Cohort MK-5475 100 µg - Participants receive MK-5475 100 µg via oral inhalation once daily for 12 week base period and for optional 24 month extension period.
Experimental: Phase 2 Cohort MK-5475 32 µg - Participants receive MK-5475 32 µg via oral inhalation once daily for 12 week base period and for optional 24 month extension period.
Placebo comparator: Phase 2 Cohort Placebo - Participants receive placebo via oral inhalation once daily for 12 week base period, and one of the MK-5475 doses (380, 100, or 32 µg) for the optional 24 month extension period.
Experimental: Phase 3 Cohort MK-5475 - Participants receive one of 3 MK-5475 doses (380, 100 or 32 µg) to be selected at end of the Phase 2 Cohort, administered via oral inhalation once daily for 12-week base period and up to 60 months in the extension period
Placebo comparator: Phase 3 Cohort Placebo - Participants receive placebo via oral inhalation once daily for 12 week base period and up to 60 months in the extension period.
Treatment: Drugs: MK-5475
MK-5475 (soluble guanylate cyclase stimulator) 380 µg, 100 µg or 32 µg administered as dry powder inhalation
Treatment: Drugs: Placebo to MK-5475
Placebo administered as dry powder inhalation
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Intervention code [1]
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Treatment: Drugs
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Comparator / control treatment
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Control group
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Outcomes
Primary outcome [1]
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Phase 2 Cohort: Change from Baseline in Pulmonary Vascular Resistance (PVR) at 12 Weeks
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Assessment method [1]
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PVR is assessed by right heart catheterization (RHC).
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Timepoint [1]
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At baseline and 12 weeks
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Primary outcome [2]
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Phase 3 Cohort: Change from Baseline in 6-Minute Walk Distance (6MWD) at 12 Weeks
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Assessment method [2]
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6MWD is assessed using the 6-minute walk test (6MWT).
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Timepoint [2]
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At baseline and 12 weeks
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Secondary outcome [1]
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Phase 2 Cohort: Change from Baseline in 6-Minute Walk Distance (6MWD) at 12 Weeks
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Assessment method [1]
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6MWD is assessed using the 6-minute walk test (6MWT).
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Timepoint [1]
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At baseline and 12 weeks
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Secondary outcome [2]
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Phase 2 Cohort: Change from Baseline in Mean Right Arterial Pressure (mRAP) at 12 Weeks
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Assessment method [2]
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mRAP is assessed by right heart catheterization (RHC).
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Timepoint [2]
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At baseline and 12 weeks
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Secondary outcome [3]
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Phase 2 Cohort: Change from Baseline in Cardiac Index (CI) at 12 weeks
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Assessment method [3]
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Cardiac index is assessed by right heart catheterization (RHC).
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Timepoint [3]
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At baseline and 12 weeks
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Secondary outcome [4]
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Phase 2 Cohort: Change from Baseline in Stroke Volume Index (SVI) at 12 weeks
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Assessment method [4]
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SVI is assessed by right heart catheterization (RHC).
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Timepoint [4]
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At baseline and 12 weeks
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Secondary outcome [5]
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Phase 3 Cohort: Change from Baseline in 6-Minute Walk Distance (6MWD) at 24 Weeks
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Assessment method [5]
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6MWD is assessed using the 6-minute walk test (6MWT).
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Timepoint [5]
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At baseline and 24 weeks
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Secondary outcome [6]
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Phase 3 Cohort: Change from Baseline in World Health Organization Functional Class (WHO-FC) at 12 Weeks
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Assessment method [6]
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Participants are assigned one of four WHO-FC, dependent on limits of physical activity. As WHO-FC increases from I to IV, limits of physical activity increase.
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Timepoint [6]
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At baseline and 12 weeks
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Secondary outcome [7]
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Phase 2 Cohort: Number of Participants Who Experience an Adverse Event
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Assessment method [7]
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An adverse event (AE) is any untoward medical occurrence in a clinical study participant, temporally associated with the use of study intervention, whether or not considered related to the study intervention. An AE can therefore be any unfavorable and unintended sign (including an abnormal laboratory finding), symptom, or disease (new or exacerbated) temporally associated with the use of a study intervention.
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Timepoint [7]
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Up to approximately 2.25 years
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Secondary outcome [8]
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Phase 2 Cohort: Number of Participants Who Discontinue Study Drug Due to an Adverse Event
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Assessment method [8]
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An adverse event (AE) is any untoward medical occurrence in a clinical study participant, temporally associated with the use of study intervention, whether or not considered related to the study intervention. An AE can therefore be any unfavorable and unintended sign (including an abnormal laboratory finding), symptom, or disease (new or exacerbated) temporally associated with the use of a study intervention.
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Timepoint [8]
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Up to approximately 2.25 years
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Secondary outcome [9]
0
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Phase 3 Cohort: Number of Participants who Experience an Adverse Event
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Assessment method [9]
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An adverse event (AE) is any untoward medical occurrence in a clinical study participant, temporally associated with the use of study intervention, whether or not considered related to the study intervention. An AE can therefore be any unfavorable and unintended sign (including an abnormal laboratory finding), symptom, or disease (new or exacerbated) temporally associated with the use of a study intervention.
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Timepoint [9]
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Up to approximately 5.5 years
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Secondary outcome [10]
0
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Phase 3 Cohort: Number of Participants who Discontinue Study Drug Due to an Adverse Event
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Assessment method [10]
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An adverse event (AE) is any untoward medical occurrence in a clinical study participant, temporally associated with the use of study intervention, whether or not considered related to the study intervention. An AE can therefore be any unfavorable and unintended sign (including an abnormal laboratory finding), symptom, or disease (new or exacerbated) temporally associated with the use of a study intervention.
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Timepoint [10]
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Up to approximately 5.5 years
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Eligibility
Key inclusion criteria
* Pulmonary arterial hypertension (PAH) in one of the following groups:
* Idiopathic PAH
* Heritable PAH
* Drug and toxin-induced PAH
* PAH associated with connective tissue disease, HIV infection, or congenital heart disease.
* Diagnosis of PAH documented by right heart catheterization (RHC).
* Eligibility RHC meeting all of the following criteria:
* Mean pulmonary artery pressure (mPAP) =25 mmHg
* Pulmonary vascular resistance (PVR) of =3 Wood units
* Pulmonary capillary wedge pressure (PCWP) or left ventricular end diastolic pressure (LVEDP) =15 mmHg.
* World Health Organization functional class (WHO-FC) symptoms between Class II and IV.
* Two 6-Minute walk distance (6MWD) measurements between 150 and 500 meters, one at screening and one at randomization.
* Stable concomitant background PAH-specific therapy.
* Body Mass Index (BMI) between 18.5 kg/m² and 40 kg/m² .
* Agree to be abstinent from heterosexual intercourse or use contraception during the intervention period and for at least 14 days after the last dose of study intervention.
* Female participants may not be pregnant or breastfeeding.
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Minimum age
18
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Maximum age
75
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
* Group 2 to 5 pulmonary hypertension.
* PAH in one of the following groups:
* Long term responders to calcium channel blockers
* Overt features of venous/capillary involvement
* Evidence of more-than-mild obstructive lung disease.
* Evidence of more-than-mild parenchymal lung disease.
* Evidence of more-than-mild obstructive sleep apnea (OSA) that is untreated.
* Evidence or history of left heart disease, including any of the following:
* Left ventricular ejection fraction (LVEF) =45%
* Moderate or severe left-sided valvular disease (aortic or mitral valve stenosis or regurgitation)
* Significant left ventricular diastolic dysfunction on echocardiographic evaluation
* Presence of 3 or more of the following risk factors for heart failure with preserved ejection fraction: BMI>30 kg/m², essential systemic hypertension, diabetes mellitus of any type, or coronary artery disease.
* Oxygen saturation measured by pulse oximetry (SpO2) <90%, despite supplemental oxygen therapy.
* Chronic renal insufficiency (eGFR <30 mL/min)
* Chronic liver disease (i.e., Child-Pugh B or C), portal hypertension, cirrhosis, or significant hepatic laboratory abnormalities.
* Current smoker or currently uses electronic cigarettes (vapes).
* History of cancer, except: nonmelanomatous skin carcinoma or carcinoma in situ of the cervix or other malignancies which have been successfully treated, with appropriate follow up, and unlikely to recur for the duration of the study.
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
The people receiving the treatment/s
The people assessing the outcomes
The people analysing the results/data
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Intervention assignment
Parallel
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Other design features
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Phase
Phase 2
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Type of endpoint/s
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Statistical methods / analysis
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Recruitment
Recruitment status
Completed
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Data analysis
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Reason for early stopping/withdrawal
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Other reasons
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Date of first participant enrolment
Anticipated
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Actual
19/05/2021
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
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Actual
2/07/2024
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Sample size
Target
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Accrual to date
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Final
168
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Recruitment in Australia
Recruitment state(s)
NSW
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Recruitment hospital [1]
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Nepean Hospital ( Site 0184) - Kingswood
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Recruitment hospital [2]
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Macquarie University ( Site 0180) - Macquarie University
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Recruitment hospital [3]
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John Hunter Hospital ( Site 0185) - Newcastle
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Recruitment postcode(s) [1]
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2747 - Kingswood
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Recruitment postcode(s) [2]
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2109 - Macquarie University
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Recruitment postcode(s) [3]
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2305 - Newcastle
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Recruitment outside Australia
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United States of America
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California
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Colorado
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Holon
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Israel
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Petah Tikva
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Campania
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Italy
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Italy
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Milano
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Italy
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Pavia
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Malopolskie
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Russian Federation
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Kemerovskaya Oblast
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Russian Federation
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Sankt-Peterburg
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Uppsala Lan
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Turkey
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Izmir
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Ankara
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Antalya
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Eskisehir
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Turkey
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Istanbul
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United Kingdom
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Glasgow City
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United Kingdom
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London, City Of
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United Kingdom
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Newcastle Upon Tyne
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Funding & Sponsors
Primary sponsor type
Commercial sector/industry
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Name
Merck Sharp & Dohme LLC
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Address
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Ethics approval
Ethics application status
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Summary
Brief summary
This is a two-part (Phase 2/Phase 3) study of MK-5475, an inhaled soluble guanylate cyclase stimulator, in participants with pulmonary arterial hypertension (PAH). The first part (Phase 2) will assess three different doses of MK-5475 compared to placebo in a base period of 12 weeks, followed by comparison of three different doses of MK-5475 during an optional 24 month extension period. The treatment dose with the best efficacy and safety profile in the phase 2 cohort base period will be selected for use in the second part (Phase 3) of the study. The primary hypothesis of Phase 2 is that at least one MK-5475 dose is superior to placebo in reducing pulmonary vascular resistance (PVR) from baseline at week 12. The purpose of the second part (Phase 3) of the study is to confirm the efficacy, safety, and tolerability of MK-5475 at the selected dose compared to placebo during a 12 week base period followed by an extension period of up to 5 years. The primary hypothesis of Phase 3 is that MK-5475 is superior to placebo in increasing 6-minute walk distance (6MWD) from baseline at week 12.
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Trial website
https://clinicaltrials.gov/study/NCT04732221
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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Medical Director
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Address
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Merck Sharp & Dohme LLC
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Phone
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Fax
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Email
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Contact person for public queries
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Address
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Contact person for scientific queries
Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
Yes
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What data in particular will be shared?
http://engagezone.msd.com/doc/ProcedureAccessClinicalTrialData.pdf
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When will data be available (start and end dates)?
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Available to whom?
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Available for what types of analyses?
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How or where can data be obtained?
IPD available at link: http://engagezone.msd.com/ds_documentation.php
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What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
No documents have been uploaded by study researchers.
Results not provided in
https://clinicaltrials.gov/study/NCT04732221