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Goal-Directed Combination Therapy in Pulmonary Arterial Hypertension (PAH): Study Design of COMPASS-3

Myung Park

Fernando Torres

Himanshu Gupta

Francisco Soto

C. Lubeck

Raymond Benza

Srinivas Murali


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Conference: 2008 International PHA Conference and Scientific Sessions

Release Date: 06.20.2008

Presentation Type: Abstracts

Park M.1, Torres F.2, Gupta H.3, Soto F.4, Lubeck C.5, Benza R.L.3, Murali S.6

1. University of Maryland School of Medicine, Baltimore, MD, USA
2. University of Texas-Southwestern Medical Center, Dallas, TX, USA
3. University of Alabama at Birmingham, AL, USA
4. Medical College of Wisconsin, Milwaukee, WI, USA
5. Actelion Pharmaceuticals US, Inc., USA
6. Allegheny General Hospital, Pittsburgh, PA, USA

BACKGROUND: Reports suggest that patients with PAH have an improved survival if they achieve a 6-minute walk distance (6MWD) >380 m. In order to maximize therapeutic benefit, combination therapy is an option for patients who do not achieve certain therapeutic targets. The primary objective of this study is to determine the percentage of patients that achieve a target 6MWD utilizing a bosentan-based, stepped approach to therapy. A secondary objective is to assess the utility of MRI to monitor cardiac remodeling.

METHODSCOMPASS-3, an open-label, prospective, phase IV study, will enroll 100 patients at 20 centers in the U.S. Inclusion criteria include male and female patients aged >12 years who are symptomatic but naive to advanced PAH therapies. Patients will have PAH with a 6MWD ≥ 200 m and <360 m. Patients will be treated with bosentan monotherapy for 16 weeks (62.5 mg bid, 4 weeks; 125 mg bid, 12 weeks). At week 16, patients will either continue with bosentan monotherapy for an additional 12 weeks or will have sildenafil 20 mg tid added to bosentan if they have not reached a 6MWD ≥ 
380 m.

RESULTSAssessments will include 6MWD, MRI-derived parameters, Borg dyspnea index, echocardiogram parameters, biomarker measurements, right heart catheterization (RHC) parameters, WHO functional class, and patient global self-assessment. To test the validity of cardiac MRI in PAH, regression analysis will be used to compare changes to standard assessments such as 6MWD and RHC. Safety and tolerability will be assessed by laboratory tests, vital signs, and reports of adverse events.

CONCLUSIONSCOMPASS-3 will provide information about the utility of goal-oriented combination treatment. In addition, information on the use of noninvasive cardiac MRI to monitor the response to treatment will be obtained.