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NCT05139615

A Study to Assess the Hemodynamic Effects, Safety, Tolerability, and Pharmacokinetics of Intravenous APD418 in Adult Participants With Heart Failure With Reduced Ejection Fraction

Terminated Phase 2 Results posted Last updated 9 November 2023
What this trial tests

Phase 2 trial testing APD418 in Acute Heart Failure With Reduced Ejection Fraction in 22 participants. Terminated before completion.

Timeline
28 December 2021
Primary endpoint
19 September 2022
19 September 2022

Quick facts

Lead sponsorPfizer
PhasePhase 2
StatusTerminated
Study typeINTERVENTIONAL
Allocationrandomized
Designparallel
Maskingdouble
Primary purposetreatment
Enrollment22
Start date28 December 2021
Primary completion19 September 2022
Estimated completion19 September 2022
Sites21 locations across Greece, Serbia, Germany, Poland, United States

Drugs / interventions tested

Conditions studied

Sponsor

Pfizer — full company profile →

Who can join

Adults 18 to 85, any sex, with Acute Heart Failure With Reduced Ejection Fraction. Patients with the condition only — healthy volunteers not accepted.

Results — posted to ClinicalTrials.gov

Per-arm endpoint measurements with 95% confidence intervals where reported. Source: trial results section.

Part A: Change in Cardiac Index (CI) Measured by Right Heart Catheterization (RHC) From Baseline to End of Intravenous (IV) Infusion at 6 Hours Primary · Baseline (within 2 hours prior to start of study treatment administration) up to 6 Hours (end of IV infusion)

Cardiac index (CI) is a hemodynamic parameter that relates the cardiac output (CO) from left ventricle in one minute to body surface area (BSA), thus relating heart performance to the body size of the participant. It was measured by RHC.

GroupValue95% CI
Cohort 1- 0.17 mg/kg/hr APD4180.33± 0.660
Cohort 1- Placebo0.10± 0.100
Cohort 2- 0.5 mg/kg/hr APD4180.25± 0.372
Cohort 2- Placebo0.10± 0.245
Part A: Change in Stroke Volume (SV), Left Ventricular End-Systolic Volume (LVESV) and Left Ventricular End-Diastolic Volume (LVEDV) Measured by Echocardiogram (ECHO) From Baseline to End of IV Infusion at 6 Hours Secondary · Baseline (within 2 hours prior to start of study treatment administration) up to 6 Hours (end of IV infusion)

SV is the volume of blood pumped from the left ventricle per beat. LVESV is the volume of blood in the left ventricle at the end of contraction and at diastole. LVEDV is the amount of blood in the heart's left ventricle just before the heart contracts. All these parameters were measured by ECHO.

Stroke Volume
GroupValue95% CI
Cohort 1- 0.17 mg/kg/hr APD4183.13± 10.623
Cohort 1- Placebo-0.80± NA
Cohort 2- 0.5 mg/kg/hr APD4185.94± 10.183
Cohort 2- Placebo-3.15± 7.152
LVESV
GroupValue95% CI
Cohort 1- 0.17 mg/kg/hr APD418-11.05± 22.837
Cohort 1- Placebo4.10± NA
Cohort 2- 0.5 mg/kg/hr APD4188.28± 25.689
Cohort 2- Placebo8.92± 29.804
LVEDV
GroupValue95% CI
Cohort 1- 0.17 mg/kg/hr APD418-7.92± 15.531
Cohort 1- Placebo3.30± NA
Cohort 2- 0.5 mg/kg/hr APD41814.20± 31.021
Cohort 2- Placebo7.30± 38.006
Part A: Change in Stroke Volume Index (SVI) Measured by ECHO From Baseline to End of IV Infusion at 6 Hours Secondary · Baseline (within 2 hours prior to start of study treatment administration) up to 6 Hours (end of IV infusion)

SVI was calculated as stroke volume divided by BSA. This was measured by ECHO.

GroupValue95% CI
Cohort 1- 0.17 mg/kg/hr APD4181.50± 5.518
Cohort 1- Placebo-0.30± NA
Cohort 2- 0.5 mg/kg/hr APD4182.62± 4.615
Cohort 2- Placebo-2.00± 4.492
Part A: Change in Left Ventricular Ejection Fraction (LVEF) Measured by ECHO From Baseline to End of IV Infusion at 6 Hours Secondary · Baseline (within 2 hours prior to start of study treatment administration) up to 6 Hours (end of IV infusion)

LVEF is the central measure of left ventricular systolic function. LVEF is the fraction of chamber volume ejected in systole (stroke volume) in relation to the volume of the blood in the ventricle at the end of diastole (end-diastolic volume). This was measured by ECHO.

GroupValue95% CI
Cohort 1- 0.17 mg/kg/hr APD4181.90± 6.009
Cohort 1- Placebo0.47± 1.457
Cohort 2- 0.5 mg/kg/hr APD4181.14± 3.204
Cohort 2- Placebo-1.68± 0.900
Part A: Change in Fractional Shortening (FS) Measured by ECHO From Baseline to End of IV Infusion at 6 Hours Secondary · Baseline (within 2 hours prior to start of study treatment administration) up to 6 Hours (end of IV infusion)

FS was calculated by measuring the percentage reduction in left ventricular diameter during systole. This was measured by ECHO.

GroupValue95% CI
Cohort 1- 0.17 mg/kg/hr APD418-2.60± 7.791
Cohort 1- Placebo0.47± 5.710
Cohort 2- 0.5 mg/kg/hr APD418-1.55± 1.924
Cohort 2- Placebo-4.50± 7.444
Part A: Change in Left Ventricular End-Systolic and Left Ventricular End-Diastolic Diameter Measured by ECHO From Baseline to End of IV Infusion at 6 Hours Secondary · Baseline (within 2 hours prior to start of study treatment administration) up to 6 Hours (end of IV infusion)

Left ventricular end-systolic diameter and left ventricular end-diastolic diameter were measured using ECHO.

Left ventricular end-systolic diameter
GroupValue95% CI
Cohort 1- 0.17 mg/kg/hr APD4180.10± 0.361
Cohort 1- Placebo-0.04± 0.384
Cohort 2- 0.5 mg/kg/hr APD4180.22± 0.321
Cohort 2- Placebo0.35± 0.544
Left ventricular end-diastolic diameter
GroupValue95% CI
Cohort 1- 0.17 mg/kg/hr APD418-0.04± 0.087
Cohort 1- Placebo-0.02± 0.098
Cohort 2- 0.5 mg/kg/hr APD4180.15± 0.363
Cohort 2- Placebo0.16± 0.243
Part A: Change in Left Ventricular Global Longitudinal Strain (LVGLS) and Left Ventricular Global Circumferential Strain (LVGCS) Measured by ECHO From Baseline to End of IV Infusion at 6 Hours Secondary · Baseline (within 2 hours prior to start of study treatment administration) up to 6 Hours (end of IV infusion)

Left ventricular global strain is the average strain of the cardiac chamber wall, where LVGLS presents longitudinal shortening as a percentage (change in length as a proportion to baseline length). LVGCS measures the chamber deformation along the circumference of the cardiac wall in a tangential xy-direction and similarly presents the circumferential shortening as a percentage. Both the parameters were measured by ECHO.

LVGLS
GroupValue95% CI
Cohort 1- 0.17 mg/kg/hr APD4180.30± NA
Cohort 1- Placebo-1.10± NA
Cohort 2- 0.5 mg/kg/hr APD4181.10± 1.337
Cohort 2- Placebo-1.29± 0.987
LVGCS
GroupValue95% CI
Cohort 1- 0.17 mg/kg/hr APD418-6.70± NA
Cohort 2- 0.5 mg/kg/hr APD4180.05± 2.105
Cohort 2- Placebo0.00± 3.111
Part A: Change in CI Measured by RHC at 0.5, 1, 2, 3, 4 and 5 Hours During 6 Hour IV Infusion Secondary · Baseline (within 2 hours prior to start of study treatment administration), 0.5, 1, 2, 3, 4 and 5 hours of IV infusion

CI is a hemodynamic parameter that relates the CO from left ventricle in one minute to BSA, thus relating heart performance to the body size of the participant. It was measured by RHC.

0.5 hours
GroupValue95% CI
Cohort 1- 0.17 mg/kg/hr APD418-0.05± 0.252
Cohort 1- Placebo0.27± 0.379
Cohort 2- 0.5 mg/kg/hr APD4180.10± 0.167
Cohort 2- Placebo-0.10± 0.183
1 hour
GroupValue95% CI
Cohort 1- 0.17 mg/kg/hr APD4180.35± 0.252
Cohort 1- Placebo0.27± 0.379
Cohort 2- 0.5 mg/kg/hr APD4180.06± 0.112
Cohort 2- Placebo0.05± 0.208
2 hours
GroupValue95% CI
Cohort 1- 0.17 mg/kg/hr APD4180.45± 0.370
Cohort 1- Placebo0.13± 0.058
Cohort 2- 0.5 mg/kg/hr APD4180.11± 0.104
Cohort 2- Placebo-0.08± 0.126
3 hours
GroupValue95% CI
Cohort 1- 0.17 mg/kg/hr APD4180.68± 0.427
Cohort 1- Placebo0.20± 0.265
Cohort 2- 0.5 mg/kg/hr APD4180.20± 0.279
Cohort 2- Placebo0.15± 0.129
4 hours
GroupValue95% CI
Cohort 1- 0.17 mg/kg/hr APD4180.25± 0.100
Cohort 1- Placebo0.10± 0.100
Cohort 2- 0.5 mg/kg/hr APD4180.09± 0.221
Cohort 2- Placebo0.10± 0.346
5 hours
GroupValue95% CI
Cohort 1- 0.17 mg/kg/hr APD4180.23± 0.457
Cohort 1- Placebo0.17± 0.153
Cohort 2- 0.5 mg/kg/hr APD4180.11± 0.274
Cohort 2- Placebo0.08± 0.096
Part A: Change in Cardiac Output (CO) Measured by RHC at 0.5, 1, 2, 3, 4, 5 and 6 Hours Secondary · Baseline (within 2 hours prior to start of study treatment administration), 0.5, 1, 2, 3, 4, 5 and 6 hours of IV infusion

Change in CO measured by RHC at 0.5, 1, 2, 3, 4, 5 and 6 hours during the 6-hour IV infusion was reported in this outcome measure.

0.5 hours
GroupValue95% CI
Cohort 1- 0.17 mg/kg/hr APD418-0.15± 0.420
Cohort 1- Placebo0.63± 0.777
Cohort 2- 0.5 mg/kg/hr APD4180.20± 0.329
Cohort 2- Placebo-0.15± 0.300
1 hour
GroupValue95% CI
Cohort 1- 0.17 mg/kg/hr APD4180.68± 0.457
Cohort 1- Placebo0.67± 0.907
Cohort 2- 0.5 mg/kg/hr APD4180.15± 0.230
Cohort 2- Placebo0.13± 0.340
2 hours
GroupValue95% CI
Cohort 1- 0.17 mg/kg/hr APD4180.90± 0.876
Cohort 1- Placebo0.43± 0.231
Cohort 2- 0.5 mg/kg/hr APD4180.21± 0.212
Cohort 2- Placebo-0.08± 0.189
3 hours
GroupValue95% CI
Cohort 1- 0.17 mg/kg/hr APD4181.28± 0.877
Cohort 1- Placebo0.47± 0.643
Cohort 2- 0.5 mg/kg/hr APD4180.41± 0.568
Cohort 2- Placebo0.33± 0.299
4 hours
GroupValue95% CI
Cohort 1- 0.17 mg/kg/hr APD4180.43± 0.222
Cohort 1- Placebo0.27± 0.231
Cohort 2- 0.5 mg/kg/hr APD4180.18± 0.467
Cohort 2- Placebo0.20± 0.560
5 hours
GroupValue95% CI
Cohort 1- 0.17 mg/kg/hr APD4180.43± 0.911
Cohort 1- Placebo0.43± 0.379
Cohort 2- 0.5 mg/kg/hr APD4180.25± 0.559
Cohort 2- Placebo0.15± 0.191
6 hours
GroupValue95% CI
Cohort 1- 0.17 mg/kg/hr APD4180.75± 1.420
Cohort 1- Placebo0.30± 0.346
Cohort 2- 0.5 mg/kg/hr APD4180.53± 0.742
Cohort 2- Placebo0.23± 0.499
Part A: Change in Pulmonary Capillary Wedge Pressure (PCWP), Right Atrial Pressure (RAP), Systolic Pulmonary Arterial Pressure/Diastolic Pulmonary Arterial Pressure (PAS/PAD) Measured by RHC at 0.5, 1, 2, 3, 4, 5 and 6 Hours Secondary · Baseline (within 2 hours prior to start of study treatment administration), 0.5, 1, 2, 3, 4, 5 and 6 hours of IV infusion

PCWP estimated the left atrial pressure and was the pressure measured by wedging a pulmonary artery catheter with an inflated balloon into a small pulmonary arterial branch. PCWP was assessed by 2 successive measurements at least 10 minutes apart. RAP is the blood pressure in the right atrium of the heart. Change in PCWP, RAP, PAS/PAD at 0.5, 1, 2, 3, 4, 5 and 6 hours during the 6-hour IV infusion was reported in this outcome measure. All the parameters were measured by RHC.

PCWP: 0.5 hours
GroupValue95% CI
Cohort 1- 0.17 mg/kg/hr APD4181.50± 2.887
Cohort 1- Placebo0.67± 3.055
Cohort 2- 0.5 mg/kg/hr APD418-0.78± 3.456
Cohort 2- Placebo-2.67± 4.726
PCWP: 1 hour
GroupValue95% CI
Cohort 1- 0.17 mg/kg/hr APD418-0.25± 8.808
Cohort 1- Placebo-2.33± 4.041
Cohort 2- 0.5 mg/kg/hr APD418-2.00± 2.828
Cohort 2- Placebo-2.67± 8.145
PCWP: 2 hours
GroupValue95% CI
Cohort 1- 0.17 mg/kg/hr APD418-1.50± 5.000
Cohort 1- Placebo-3.33± 1.528
Cohort 2- 0.5 mg/kg/hr APD4181.56± 3.609
Cohort 2- Placebo-0.67± 7.506
PCWP: 3 hours
GroupValue95% CI
Cohort 1- 0.17 mg/kg/hr APD418-3.75± 3.594
Cohort 1- Placebo-0.33± 4.509
Cohort 2- 0.5 mg/kg/hr APD418-3.67± 3.464
Cohort 2- Placebo-3.67± 7.506
PCWP: 4 hours
GroupValue95% CI
Cohort 1- 0.17 mg/kg/hr APD418-2.75± 3.948
Cohort 1- Placebo-0.67± 5.033
Cohort 2- 0.5 mg/kg/hr APD418-2.90± 5.384
Cohort 2- Placebo-5.00± 9.165
PCWP: 5 hours
GroupValue95% CI
Cohort 1- 0.17 mg/kg/hr APD418-0.50± 6.137
Cohort 1- Placebo-1.33± 6.110
Cohort 2- 0.5 mg/kg/hr APD418-1.56± 2.698
Cohort 2- Placebo-3.33± 9.018
PCWP: 6 hours
GroupValue95% CI
Cohort 1- 0.17 mg/kg/hr APD418-0.75± 7.411
Cohort 1- Placebo-1.67± 5.686
Cohort 2- 0.5 mg/kg/hr APD418-1.25± 2.315
Cohort 2- Placebo-1.67± 9.504
RAP: 0.5 hours
GroupValue95% CI
Cohort 1- 0.17 mg/kg/hr APD4180.50± 1.291
Cohort 1- Placebo0.00± 1.732
Cohort 2- 0.5 mg/kg/hr APD4181.40± 3.836
Cohort 2- Placebo-1.33± 2.517
Part A: Change in Pulmonary Artery Pulsatility Index (PAPi) Measured by RHC at 0.5, 1, 2, 3, 4, 5 and 6 Hours Secondary · Baseline (within 2 hours prior to start of study treatment administration), 0.5, 1, 2, 3, 4, 5 and 6 hours of IV infusion

PAPi is a hemodynamic parameter that is derived from right atrial and pulmonary artery pulse pressures. PAPi = (PAS - PAD)/right atrial pressure. Change in PAPi measured by RHC at 0.5, 1, 2, 3, 4, 5 and 6 hours during the 6-hour IV infusion was reported in this outcome measure.

PAPi: 0.5 hours
GroupValue95% CI
Cohort 1- 0.17 mg/kg/hr APD4180.28± 0.411
Cohort 1- Placebo-0.17± 0.833
Cohort 2- 0.5 mg/kg/hr APD418-0.11± 0.713
Cohort 2- Placebo0.37± 1.343
PAPi: 1 hour
GroupValue95% CI
Cohort 1- 0.17 mg/kg/hr APD418-0.08± 0.562
Cohort 1- Placebo0.17± 0.306
Cohort 2- 0.5 mg/kg/hr APD418-0.21± 0.835
Cohort 2- Placebo-0.17± 0.603
PAPi: 2 hours
GroupValue95% CI
Cohort 1- 0.17 mg/kg/hr APD4180.38± 0.435
Cohort 1- Placebo0.33± 0.058
Cohort 2- 0.5 mg/kg/hr APD418-0.14± 1.011
Cohort 2- Placebo0.20± 0.900
PAPi: 3 hours
GroupValue95% CI
Cohort 1- 0.17 mg/kg/hr APD4180.65± 0.624
Cohort 1- Placebo0.43± 0.777
Cohort 2- 0.5 mg/kg/hr APD4180.03± 0.897
Cohort 2- Placebo-0.33± 0.611
PAPi: 4 hours
GroupValue95% CI
Cohort 1- 0.17 mg/kg/hr APD4181.35± 1.838
Cohort 1- Placebo0.83± 1.834
Cohort 2- 0.5 mg/kg/hr APD4180.27± 1.203
Cohort 2- Placebo-1.03± 0.907
PAPi: 5 hours
GroupValue95% CI
Cohort 1- 0.17 mg/kg/hr APD4180.95± 0.597
Cohort 1- Placebo2.33± 1.818
Cohort 2- 0.5 mg/kg/hr APD418-0.01± 0.872
Cohort 2- Placebo0.87± 2.639
PAPi: 6 hours
GroupValue95% CI
Cohort 1- 0.17 mg/kg/hr APD4180.93± 0.929
Cohort 1- Placebo1.27± 0.929
Cohort 2- 0.5 mg/kg/hr APD4180.77± 2.470
Cohort 2- Placebo-0.90± 0.173
Part A: Change in Systemic Vascular Resistance Measured by RHC at 0.5, 1, 2, 3, 4, 5 and 6 Hours Secondary · Baseline (within 2 hours prior to start of study treatment administration), 0.5, 1, 2, 3, 4, 5 and 6 hours of IV infusion

Systemic vascular resistance (SVR) is the amount of force exerted on circulating blood by the vasculature of the body. SVR was calculated as 80\*(mean arterial pressure - mean venous pressure) divided by cardiac output. Change in SVR measured by RHC at 0.5, 1, 2, 3, 4, 5 and 6 hours during the 6-hour IV infusion was reported in this outcome measure.

SVR: 0.5 hours
GroupValue95% CI
Cohort 1- 0.17 mg/kg/hr APD41810.30± 74.776
Cohort 1- Placebo-71.27± 55.492
Cohort 2- 0.5 mg/kg/hr APD418-47.30± 139.874
Cohort 2- Placebo74.13± 198.427
SVR: 1 hour
GroupValue95% CI
Cohort 1- 0.17 mg/kg/hr APD418-80.50± 57.295
Cohort 1- Placebo-86.30± 80.694
Cohort 2- 0.5 mg/kg/hr APD41816.71± 231.657
Cohort 2- Placebo-131.93± 91.886
SVR: 2 hours
GroupValue95% CI
Cohort 1- 0.17 mg/kg/hr APD418-48.83± 71.811
Cohort 1- Placebo-46.23± 28.762
Cohort 2- 0.5 mg/kg/hr APD418-42.16± 205.772
Cohort 2- Placebo-49.40± 136.124
SVR: 3 hours
GroupValue95% CI
Cohort 1- 0.17 mg/kg/hr APD418-67.63± 56.169
Cohort 1- Placebo-8.10± 102.327
Cohort 2- 0.5 mg/kg/hr APD418-101.20± 188.863
Cohort 2- Placebo-195.77± 101.041
SVR: 4 hours
GroupValue95% CI
Cohort 1- 0.17 mg/kg/hr APD418-27.20± 104.351
Cohort 1- Placebo73.90± 136.245
Cohort 2- 0.5 mg/kg/hr APD418-33.91± 241.040
Cohort 2- Placebo-311.03± 145.094
SVR: 5 hours
GroupValue95% CI
Cohort 1- 0.17 mg/kg/hr APD41821.10± 112.824
Cohort 1- Placebo132.63± 171.630
Cohort 2- 0.5 mg/kg/hr APD418-92.29± 94.834
Cohort 2- Placebo-110.57± 222.498
SVR: 6 hours
GroupValue95% CI
Cohort 1- 0.17 mg/kg/hr APD41833.10± 106.652
Cohort 1- Placebo90.37± 137.576
Cohort 2- 0.5 mg/kg/hr APD418-70.00± 116.681
Cohort 2- Placebo-104.23± 90.537

Adverse events — posted to ClinicalTrials.gov

Time frame: From start of study treatment on Day 1 up to Day 9. Reporting threshold: 0%. Adverse-event reports describe events observed during the trial — not all are caused by the drug.

Cohort 1- 0.17 mg/kg/hr APD418
Serious: 0/4 (0%)
Deaths: 0/4
Cohort 1- Placebo
Serious: 0/3 (0%)
Deaths: 0/3
Cohort 2- 0.5 mg/kg/hr APD418
Serious: 0/11 (0%)
Deaths: 0/11
Cohort 2- Placebo
Serious: 0/4 (0%)
Deaths: 0/4
Other adverse events (7 terms — click to expand)

ReactionSystemCohort 1- 0.17 mg/kg/hr AP…Cohort 1- PlaceboCohort 2- 0.5 mg/kg/hr APD…Cohort 2- Placebo
HaematuriaRenal and urinary disorders
Ventricular extrasystolesCardiac disorders
FatigueGeneral disorders
N-terminal prohormone brain natriuretic peptide increasedInvestigations
Back painMusculoskeletal and connective tissue disorders
DyspnoeaRespiratory, thoracic and mediastinal disorders
Vein ruptureVascular disorders

Data from ClinicalTrials.gov NCT05139615 adverse events section.

Sponsor's own description

The purpose of this study is to evaluate the safety, pharmacokinetics, and effect on cardiac function of intravenous APD418 in adult participants with heart failure with reduced ejection fraction (HFrEF).

Publications & conference data

1 peer-reviewed publication reference this trial (live from Europe PMC):

  1. Vericiguat, a novel sGC stimulator: Mechanism of action, clinical, and translational science.
    Trujillo ME, Ayalasomayajula S, Blaustein RO, Gheyas F. · · 2023 · cited 32× · PMID 37997225 · DOI 10.1111/cts.13677

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