The purpose of this research study is to investigate the safety of pulsed, inhaled nitric oxide and how well it is tolerated in subjects with pulmonary hypertension (PH) associated with pulmonary fibrosis (PF) on long term oxygen therapy.
National Clinical Trial (NCT) identifier on clinicaltrials.gov: NCT03267108
Inova Heart and Vascular Institute
Advanced Lung Disease and Transplant Clinic
3300 Gallows Road, Falls Church, VA 22042
Christopher King, MD
- Signed Informed Consent Form (and assent as appropriate) prior to the initiation of any study mandated procedures or assessments.
- Diagnosed with pulmonary fibrosis by high resolution CT scan performed in the 6 months prior to screening associated with one of the following conditions and confirmed using guidelines, as per American Thoracic Society (ATS) / European Respiratory Society (-- ERS) / Japanese Respiratory Society (JRS) / Latin American Thoracic Association (ALAT):
- 2.1 Major IIPs (idiopathic interstitial pneumonias) diagnosis or suspected as one of the following:
- Idiopathic pulmonary fibrosis
Idiopathic nonspecific interstitial pneumonia
Respiratory bronchiolitis-interstitial lung disease
Desquamative interstitial pneumonia
Cryptogenic organizing pneumonia
Acute interstitial pneumonia
Rare IIPs diagnosis by one of the following:
- Idiopathic lymphoid interstitial pneumonia
- Idiopathic pleuroparenchymal fibroelastosis
- Unclassifiable idiopathic interstitial pneumonias
- 2.2 Chronic hypersensitivity pneumonitis
- 2.3 Occupational lung disease
- At least 50% of the subjects will have confirmed intermediate or high probability of pulmonary hypertension as determined by echocardiography according to the 2015 ESC/ERS Guidelines for Diagnosis and Treatment of Pulmonary Hypertension.
- Have been using oxygen therapy by nasal cannula for at least 4 weeks prior to the screening run-in period.
- 6MWD ≥ 100 meters and ≤ 450 meters prior to randomization.
- WHO Functional Class II-IV
- Forced Vital Capacity ≥ 40% predicted within last 6 months prior to the screening run-in period
- For at least 1 week prior to Baseline/Randomization, subjects must demonstrate the ability to consistently use the device greater than 12 hrs/day in the opinion of the Investigator.
- Subjects must have completed at least 1 week of activity monitoring prior to the Baseline/Randomization visit.
- Age between 18 and 80 years (inclusive)
- Demonstrate symptomatic rebound defined as significant cardiopulmonary instability, such as systemic arterial oxygen desaturation, hypoxemia, bradycardia, tachycardia, systemic hypotension, shortness of breath, near-syncope, and syncope, occurring within 1 hour of acute iNO during rebound testing
- Episodes of disease worsening within 1 month prior to Baseline/Randomization
- Use of any type of intravenous or subcutaneous prostacyclin therapies
- Subjects receiving riociguat
- Acute or chronic physical impairment (other than dyspnea due to PF) that would limit the ability to comply with study procedures or adherence to therapy (i.e., 6MWT), including carrying and wearing the pulsed delivery device per study protocol, or medical problem(s) likely to preclude completion of the study
- Administered L-arginine within 1 month prior to Screening
- The concurrent use of the INOpulse device with a continuous positive airway pressure (CPAP), Bilevel positive airway pressure (BPAP), or any other positive pressure device.
- Use of investigational drugs or devices within 1 month prior to Screening (other than acute vasodilator testing with iNO)
- Evidence of any connective tissue disease in the last 6 months prior to screening in the opinion of the Principal Investigator
- Evidence of clinically significant Combined Pulmonary Fibrosis and Emphysema (CPFE) in the opinion of the Investigator.