A Multicenter Open Label Trial Using Ambrisentan in Patients with Porto-pulmonary Hypertension

Overview

About this study

This is an Open Label, Multicenter, pilot clinical trial to assess the efficacy and safety of an oral selective Endothelin Receptor Antagonist (ambrisentan) in patients with portopulmonary hypertension.

Preliminary evidence suggests that ambrisentan is safe and effective in patients with portopulmonary hypertension. The goal of therapy for these patients is to improve symptoms of dyspnea and to improve pulmonary hemodynamics to a mean pulmonary artery pressure <35 mm Hg in order to make patients eligible for liver transplantation. Therefore, the primary endpoints for this study will include 6 minute walk distance (6MWD) and pulmonary vascular resistance (PVR).

Eligible subjects will receive 5 mg ambrisentan once-daily for the first 4 weeks. After the initial 4-week period, investigators will increase study drug dose to 10 mg once daily (both 5 mg and 10 mg doses are FDA approved). If 10 mg is not tolerated in the opinion of investigator, then the investigator may decrease the dose back to 5 mg once daily. Primary outcome is a change in both the 6MWD and in PVR from baseline to Week 24. Subjects will be monitored with liver function tests (LFT) every 2 weeks for the first 8 weeks, then every 4 weeks thereafter. These safety laboratory tests may be performed at a local phlebotomy laboratory or at the Investigator clinic. In addition, the Investigator will assess each subject for safety and efficacy at Week 4, Week 12, and Week 24. Following Week 24, subjects will be assessed for safety and efficacy every 12 weeks. Patients will be followed for a total of 1 year. After 1 year, if the Investigator feels that continuing the treatment will be beneficial to the patients, they will be provided with ambrisentan by Gilead Pharmaceuticals, free of charge.

Participation eligibility

Participant eligibility includes age, gender, type and stage of disease, and previous treatments or health concerns. Guidelines differ from study to study, and identify who can or cannot participate. There is no guarantee that every individual who qualifies and wants to participate in a trial will be enrolled. Contact the study team to discuss study eligibility and potential participation.

Inclusion Criteria

Subjects need to fulfill all of the following 4 criteria
- Evidence of portal hypertension by
  - Hemodynamic measurement
  - Doppler flow of portal circulation
  - Clinical evidence of portal hypertension such as esophageal or gastric varices, evidenced by prior upper endoscopy
- Evidence of pulmonary arterial hypertension by right heart catheterization (all three criteria need to be present)
  - Mean PAP (pulmonary artery pressure) >25 mm Hg
  - PVR (pulmonary vascular resistance) >240 dynes/s/cm5
  - TPG (transpulmonary gradient = meanPAP -PAWP) >12 mm Hg
- Baseline AST, ALT < 5 times the upper limit of normal, total Bili < 3.0 mg/dl, and mild liver impairment with Child -Pugh class A or B
- Ages 18 years and above

Exclusion Criteria

Presence of any other etiology of pulmonary arterial hypertension
- HIV
- Connective tissue disease
- Sickle cell
- Left heart failure
- Chronic thromboembolic PH
Treatment with prostacyclins, other ERAs, or PDE5 inhibitors within 30 days of enrollment.
Moribund state or anticipated death within 1 month.
AST or ALT ≥ 5 times upper limit of normal
Total bilirubin ≥ 3.0 mg/dl
Significant lung disease (obstructive lung disease with FEV1 < 1L, or FEV1/FVC <50%
Restrictive lung disease with Total Lung Capacity < 60% predicted)
- PFTs may have been performed up to 6 months prior to enrollment.
Pregnancy
Age <18 years
Child -Pugh class C

Participating Mayo Clinic locations

Study statuses change often. Please contact the study team for the most up-to-date information regarding possible participation.

Mayo Clinic Location	Status
Jacksonville, Fla. Mayo Clinic principal investigator Charles Burger, M.D.	Closed for enrollment

Mayo Clinic Location

Status

Jacksonville, Fla.

Mayo Clinic principal investigator

Charles Burger, M.D.

Closed for enrollment

More information

Publications

Publications are currently not available

Clinical Trials