A Phase 4 interventional study of Bosentan administration in Eisenmenger Syndrome, sponsored by Competence Network for Congenital Heart Defects. Completed at 8 sites in Germany. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2008-05-07.
Sponsored by Competence Network for Congenital Heart Defects · Phase 4, Interventional, and Treatment
Eisenmenger's syndrome presents as a severe clinical picture of polymorbidity that constitutes a great burden at the individual as well as the familial and social level. The combination of critically increased pulmonary vascular resistance, progressive pressure load of the right ventricle and disturbance of pulmonary gas exchange result in long-term polymorbidity. The objective of this study is to look into the effects of medium-term pulmonary pressure-lowering treatment with oral bosentan in patients with congenital heart defects and clinically relevant pulmonary arterial hypertension (PAH), taking advantage of extensive diagnostic procedures.
Eisenmenger's syndrome presents as a severe clinical picture of polymorbidity that constitutes a great burden at the individual as well as the familial and social level. The combination of critically increased pulmonary vascular resistance, progressive pressure load of the right ventricle and disturbance of pulmonary gas exchange result in long-term polymorbidity. While the patient's ability to care for him-/ herself gets lost over time, the financial burden due to the need for medical consultations and hospital stays increases. This is distressing to both the patient and the family. Usually, death results from cardiac decompensation in the presence of gradually increasing pulmonary vascular resistance and hypoxic lesion of organs including the myocardium (Hopkins, AJC 2002).
With a better understanding of the pathophysiology underlying pulmonary hypertension, novel therapeutic approaches have been developed during the past few years. These include a) inhibition of the NO-cGMP-degrading type 5 phosphodiesterase (PDE-5) and b) antagonising the endothelin system (Krum, Curr Opin Investig Drugs 2003). The goal is a dilatation of the abnormally constricted pulmonary arterial vessels by relaxation of the vascular smooth muscle cells with a reversal of pulmonary vascular remodelling (Ghofrani, Pneumologie 2002).
Specific drugs affecting pulmonary vascular resistance have been studied. Intravenous prostacyclin has major disadvantages: high cost, tachyphylaxis, risk of infection and rebound hypertension upon discontinuation. Inhalative pulmonary vasodilators, in particular iloprost, may be effective in primary pulmonary hypertension (Olschewski, Ann Int Med 1996; Hoeper, Pneumologie 2001), but administration is time-consuming, and due to its mode of application its effects are intermittent, lasting only about 75 minutes (Hoeper, JACC 2000). Considering this, oral treatments appear preferable, because of easy administration and, hence, better patient compliance.
Bosentan (Tracleer®) is a non-selective endothelin receptor antagonist with dual binding (ETA and ETB) and complete blocking of endothelin-1. It is the first drug of this class that was approved for the lowering of pulmonary vascular resistance. Significant effects on haemodynamics and exercise tolerance were demonstrated for both monotherapy (Galie, J Am Coll Cardiol 2003; Rubin, N Engl J Med 2002) and add-on treatment with inhalational and parenteral prostanoids (Hoeper, Eur Respir J 2003). In children with at least 10 kg body weight, bosentan significantly improved pulomary haemodynamics, while pharmacokinetics was found to be comparable to that in adults (Bars, Clin Pharmacol Ther 2003). Good long-term tolerability and effectiveness over a period of one year were demonstrated (Sitbon, Chest 2003). Moreover, in animal models of increased pulmonary blood flow activation of the endothelin system was absent under bosentan treatment and both haemodynamic and morphological changes were prevented. Available data suggest that the effects of bosentan are not limited to primary pulmonary hypertension. Further studies are required to prove its effectiveness in pulmonary hypertension of various aetiologies.
The objective of this study is to look into the effects of medium-term pulmonary pressure-lowering treatment with oral bosentan in patients with congenital heart defects and clinically relevant pulmonary arterial hypertension (PAH), taking advantage of extensive diagnostic procedures. The data obtained are supposed to contribute to the development of guidelines for the treatment of PAH caused by congenital heart defects. The data will be further evaluated in terms of health economics (network subproject "Health Economics", project manager: Prof. Dr. med. Karl W. Lauterbach).
The hypotheses are:
These hypotheses will be tested by comparing findings of the following examinations before and immediately after the 24-week treatment with bosentan: clinical examination, ECG, echocardiography, CPX, MRT, cardiac catheterization with pulmonary artery manometry, and laboratory tests. As a secondary objective, the degree of concordance of findings of different invasive and non-invasive examinations and diagnostic procedures will be investigated.
23 studies on the registry are indexed under Eisenmenger Complex; 5 are open to participants now.
This study's enrollment of 60 is above the median of 40 across 15 interventional studies indexed under Eisenmenger Complex.
Browse Eisenmenger Complex studies →Competence Network for Congenital Heart Defects is the lead sponsor of 8 studies on the registry; none are open to participants now.
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Non-specific:
Specific:
One of the following diagnoses:
Exclusion Criteria:
Non-specific:
Specific:
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Ways of preventing pregnancy. “Highly effective” methods fail less than 1% of the time a year when used correctly — for example an IUD or an implant.
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The protein in red blood cells that carries oxygen. A low level is anaemia, which can cause tiredness and breathlessness. Measured in g/dL or g/L (9 g/dL is 90 g/L).
The human immunodeficiency virus, which weakens the immune system.
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CYP3A is a group of enzymes, mainly CYP3A4, in the liver and gut that break down many medicines. Some medicines, supplements and foods (grapefruit, St John’s wort) slow them down or speed them up, which changes how much of a study drug stays in the body.
Studies list them so they can be avoided or switched; bring a list of everything you take, including supplements.
Informed consent
Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.
You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Contraception
Ways of preventing pregnancy. “Highly effective” methods fail less than 1% of the time a year when used correctly — for example an IUD or an implant.
Criteria usually say which methods count and how long to keep using them after the last dose, sometimes for male participants too. Some studies accept a partner’s vasectomy if it was confirmed successful and that person is the participant’s only sexual partner.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Hemoglobin (Hb)
The protein in red blood cells that carries oxygen. A low level is anaemia, which can cause tiredness and breathlessness. Measured in g/dL or g/L (9 g/dL is 90 g/L).
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
HIV
The human immunodeficiency virus, which weakens the immune system.
Many studies now accept people whose HIV is controlled on treatment, judged by the viral load and the CD4 count. Check the limits this study sets.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Immunosuppression
A weakened immune system. It can come from an illness, such as HIV or some blood cancers, or from medicines that turn the immune system down, for example after an organ transplant or for an autoimmune disease; steroids at higher doses count.
Read whether the line is about a condition or about medicines, and which medicines and doses it means.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
CYP3A (CYP3A4) inhibitors and inducers
CYP3A is a group of enzymes, mainly CYP3A4, in the liver and gut that break down many medicines. Some medicines, supplements and foods (grapefruit, St John’s wort) slow them down or speed them up, which changes how much of a study drug stays in the body.
Studies list them so they can be avoided or switched; bring a list of everything you take, including supplements.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
maximal exercise tolerance (walking distance in the 6-minute walking test)
peripheral oxygen saturation (SatO2)
pulmonary-systemic ratio of arterial resistance (Rp:Rs)
NYHA class
increase in pulmonary reagibility by bosentan therapy
normalisation of vasoactive mediators by bosentan therapy
This study is completed, as verified in May 2008. You cannot join it, but the record below documents what was studied.
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Competence Network for Congenital Heart Defects