Phosphodiesterase Type 5 Inhibition With Tadalafil Changes Outcomes in Heart Failure (PITCH-HF)

Carelon Research

Status and phase: Terminated; Phase 3

Conditions: Heart Failure; Pulmonary Hypertension

Treatments: Drug: Tadalafil; Drug: Placebo for tadalafil

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT01910389

U01HL105463

Details and patient eligibility

About

This study is a multi-center, prospective, randomized, double blind, placebo-controlled clinical trial. Subjects in the study will be adults with New York Heart Association (NYHA) Class II-IV heart failure (HF) due to left ventricular systolic dysfunction (LVSD), left ventricular ejection fraction (LVEF) <0.40, and secondary pulmonary hypertension (PH). The purpose of the study is to evaluate the safety, effectiveness, and effects of tadalafil compared to placebo on the subjects' functional capacity / quality of life.

Enrollment: 23 patients

Sex: All

Ages: 21+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Male or female age 21 years or older.
• NYHA Class II-IV HF with LVSD (most recent LVEF < 0.40).
• At high risk of future clinical instability, indicated by EITHER:

a hospitalization for the primary reason of decompensated HF within the 12 months prior to screening; OR a plasma B-type Natriuretic Peptide (BNP) level ≥ 300 pg/ml or N-terminal prohormone of brain natriuretic peptide (NT-proBNP) ≥1800pg/ml measured during a period of clinical stability in the 3 months prior to screening.

• Documented secondary PH within the last 6 months
• Medication and device treatment according to current American Heart Association/American College of Cardiology (AHA/ACC) guidelines.
• Stable medical therapy for 30 days prior to randomization
• African-American patients intolerant of or otherwise unable or unwilling to utilize isosorbide dinitrate/hydralazine therapy will be included.
• Willingness to comply with protocol, attend follow-up appointments, complete all study assessments and provide written informed consent.

Exclusion criteria

• Concurrent or anticipated nitrate use for any reason, or nitrate use within the 14 days prior to screening through the day of randomization.
• Known allergy, hypersensitivity (anaphylaxis), or adverse reaction to tadalafil or other Phosphodiesterase Type 5 (PDE5) inhibitor
• Erectile dysfunction treated with a PDE5 inhibitor.
• Severe renal dysfunction defined as an estimated glomerular filtration rate (GFR) < 30 ml/min/1.73 m^2 or requiring chronic dialysis
• Current use of alpha antagonists (except carvedilol or tamsulosin) or use of cytochrome P450 3A4 inhibitors (ketoconazole, itraconazole, erythromycin, or cimetidine). Patients who have used a protease inhibitor that is a P450 3A4 inhibitor for longer than one week can be enrolled.
• Pulmonary arterial hypertension (World Health Organization (WHO) Group I, III-V) for which PDE5 inhibitor therapy may be indicated
• Severe pulmonary disease requiring home oxygen therapy
• Comorbidities including clinically significant valvular stenosis (aortic valve area < 0.8 cm^2 or a mitral valve area <1.0 cm^2), uncontrolled hypertension (systolic blood pressure ≥180 mmHg or diastolic blood pressure ≥100 mmHg) or hypotension (systolic blood pressure <85 mmHg)
• Chronic intravenous inotrope therapy
• Non-arteritic anterior ischemic optic neuropathy (NAION)
• ST elevation MI (STEMI) within 90 days prior to screening
• Coronary Artery Bypass Grafting (CABG) or mitral valve surgery, initiation of cardiac resynchronization (CRT) or initiation of β-blocker therapy within the 6 months prior to screening
• Infiltrative or inflammatory myocardial disease (e.g. amyloid, sarcoid)
• Heart transplant recipient
• United Network Organ Sharing (UNOS) status 1A or 1B
• Mechanical circulatory support (MCS) use or planned MCS use at time of consent
• Active malignancy (except non-melanoma skin cancer) requiring therapy other than observation.
• Severe non-cardiac illness resulting in life expectancy judged less than three years
• Known chronic hepatic disease defined as aspartate aminotransferase (AST) and alanine transaminase (ALT) levels > 3.0 times the upper limit of normal
• Inability to walk even a few steps due to non-cardiac (e.g. orthopedic) reasons
• Participation in any clinical trial within the last 30 days (with exception of observational study)
• Previous randomization in PITCH-HF

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Quadruple Blind

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23 participants in 2 patient groups, including a placebo group

Tadalafil

Active Comparator group

Description:

Tadalafil is supplied in 20 mg tablets. Subjects will take 20 mg (one tablet) once per day and will be titrated to 40 mg (two tablets once per day) after one week. Subjects are on study drug for the duration of the trial.

Treatment:

Drug: Tadalafil

Placebo

Placebo Comparator group

Description:

Placebo of tadalafil. Subjects will take one tablet once per day and will be titrated to two tablets once per day after one week. Subjects are on study drug for the duration of the trial.

Treatment:

Drug: Placebo for tadalafil