The purpose of this study is to determine if treating patients suffering from moderate to severe pulmonary arterial hypertension with BSF 208075 will improve the patients' ability to exercise.

Condition	Treatment or Intervention	Phase
Pulmonary Hypertension	Drug: BSF 208075	Phase II

Further Study Details: 

Expected Total Enrollment:  60

This is a randomized, double-blind study evaluating the effectiveness of BSF 208075 in treating patients with moderate to severe pulmonary hypertension. A four-week Screening Period will be followed by 12 weeks of Treatment. After a subject qualifies for the study, the subject will be randomized to one of four doses of BSF 208075 (1.0, 2.5, 5.0 or 10.0 mg po qd). Subjects randomized to the 1.0 or 2.5 mg dose groups will receive their respective doses of BSF 208075 each day throughout the 12-week Treatment Period. Subjects in the two other dose groups will begin treatment at 2.5 mg per day for two weeks and then their dose will be increased to 5.0 mg for an additional two weeks. After two weeks of treatment at 5.0 mg, subjects randomized to the 10.0 mg dose group will undergo a final up-titration. After reaching the randomized dose level, subjects will receive their assigned dose throughout the Treatment Period. Subjects will remain on the randomized treatment through Week 12. In the event that a subject is not tolerating study drug, dose adjustment is permitted during the Treatment Period. Upon completion of the 12-week Treatment Period subjects will either complete a four-week Down-titration Period or enter an optional 12-week Open-label Extension. All subjects that choose to participate in the Open-label Extension will be unblinded and have their dose of BSF 208075 optimized based on the subjects response during the Treatment Period.

Ages Eligible for Study:  18 Years and above,  Genders Eligible for Study:  Both

Criteria

--Disease Characteristics--

• Current diagnosis of either PPH or PAH secondary to the scleroderma spectrum of disease (e.g., mixed connective tissue disease, systemic lupus erythematosus, systemic sclerosis, or overlap syndrome), anorexigen use, or human immunodeficiency virus (HIV) infection at the time of screening
• By means of a right heart catheterization, completed prior to Screening Visit subjects must meet all of the following hemodynamic criteria:

* Mean pulmonary arterial pressure of >/= 25 mmHg

* Pulmonary vascular resistance >3 mmHg/L/min

* Pulmonary capillary wedge pressure or left ventricle end diastolic pressure of <15 mmHg

• Stable on conventional therapy for PAH, including diuretics, digoxin, or supplemental oxygen, for at least one month prior to the Screening Visit
• Subjects with a diagnosis of HIV must have stable disease status at the time of screening. The subject may be enrolled if they meet the definition of a stable HIV status defined as:

* No addition of medications for treatment of HIV in the last two months

* No active opportunistic infection at the time of screening

* No hospitalizations due to HIV within the past four weeks

• Able to walk at least 150 meters, but no more than 450 meters, in a six minute walk test at the time of the Screening Visit
• No pulmonary arterial hypertension due to or associated with congenital heart disease, interstitial lung disease, chronic obstructive pulmonary disease, or chronic thrombotic and/or embolic disease, as documented by a historical echocardiogram, chest X-ray, ventilation/perfusion (V/Q) scan, and/or pulmonary arteriogram
• No subjects who have, as measured by a historical pulmonary function test:

* Total lung capacity (TLC) <70% of predicted normal or;

* Forced expiratory volume in one second (FEV1) <65% of predicted normal

--Other Criteria--

- Subjects are excluded if they have:

* A serum ALT or AST lab value that is greater than 1.5 times the upper limit of normal at any time during the Screening Period

* Contraindication to treatment with an endothelin receptor antagonist

* Demonstrated noncompliance with previous medical regimens

* A recent history of abusing alcohol or illicit drugs

* Participated in a clinical study involving another investigational drug or device within four weeks before the Screening Visit or at any time during the study

--Patient Characteristics--

• Women of childbearing potential must:

* Have a negative serum pregnancy test at the Screening Visit and a negative urine pregnancy test at the Randomization Visit. Women who are surgically sterile or those who are post-menopausal for at least two years are not considered to be of childbearing potential

* Agree to use a reliable double barrier method of contraception until study completion and for at least four weeks following their final study visit

• All males must be informed of the potential risks of testicular tubular atrophy and infertility associated with taking this study drug and queried regarding his understanding of the potential risks as described in the Informed Consent Form

Excluded:

• Pregnant or breastfeeding
• Have a history of malignancies within the past five years, with the exception of basal cell carcinoma of the skin or in situ carcinoma of the cervix
• Any other disease which, in the investigators opinion, may adversely affect the safety of the subject and/or efficacy of the study drug or severely limit the lifespan of the subject

--Prior/Concurrent Therapy--

• Stable on conventional therapy for PAH, including diuretics, digoxin, or supplemental oxygen, for at least one month prior to the Screening Visit

Excluded Therapies:

• IV inotropes within two weeks prior to the Screening Visit
• Chronic prostanoid therapy (epoprostenol, treprostinil, iloprost, beraprost, or any other investigational prostacyclin derivative) within four weeks prior to the Screening Visit
• Bosentan within four weeks prior to the Screening Visit

California
      Los Angeles County Harbor-UCLA Medical Center, Torrance,  California,  90502,  United States
      Stanford University, Stanford,  California,  94305,  United States
      University of California - San Francisco, San Francisco,  California,  94143,  United States
      University of California San Diego Medical Center, San Diego,  California,  92037,  United States
      University of Southern California, Los Angeles,  California,  90089,  United States
Colorado
      University of Colorado Health Sciences Center, Denver,  Colorado,  80262,  United States
Illinois
      Rush Presbyterian, Chicago,  Illinois,  60612,  United States
Massachusetts
      Brigham and Women's Hospital, Boston,  Massachusetts,  02115,  United States
Minnesota
      Mayo Clinic, Rochester,  Minnesota,  55905,  United States
New York
      New York Presbyterian Hospital, New York,  New York,  10032,  United States
Ohio
      Case Western Reserve University, Cleveland,  Ohio,  44106,  United States
      Ohio State University, Columbus,  Ohio,  43210,  United States
Tennessee
      Vanderbilt University Medical Center, Nashville,  Tennessee,  37232,  United States
Texas
      Baylor College of Medicine, Houston,  Texas,  77030,  United States
Wisconsin
      Heart Care Associates, Milwaukee,  Wisconsin,  53215,  United States
Australia
      St. Vincent's Hospital, Sidney,  Australia
Belgium
      Erasmus University, Brussels,  Belgium
France, Cedex
      Hopital Antoine Beclere, Clamart,  Cedex,  92141,  France
Germany
      Hannover Medical School, Hannover,  30625,  Germany
      University of Giessen, Giessen,  35392,  Germany
Italy
      University of Bologna - Institute of Cardiology, Bologna,  40136,  Italy

Study chairs or principal investigators

Lewis Rubin, MD,  Principal Investigator,  UCSD Medical Center   

Study ID Numbers:  AMB-220
Record last reviewed:  March 2003
Last Updated:  October 13, 2004
Record first received:  September 26, 2002
ClinicalTrials.gov Identifier:  NCT00046319
Health Authority: United States: Food and Drug Administration
ClinicalTrials.gov processed this record on 2005-04-08