Open AccessSupplementation of Iron in Pulmonary Hypertension: Rationale and Design of a Phase II Clinical Trial in Idiopathic Pulmonary Arterial Hypertension
Author(s) -
Howard Luke S.G.E.,
Watson Geoffrey M.J.,
Wharton John,
Rhodes Christopher J.,
Chan Kakit,
Khengar Rajeshree,
Robbins Peter A.,
Kiely David G.,
Condliffe Robin,
Elliott Charlie A.,
PepkeZaba Joanna,
Sheares Karen,
Morrell Nicholas W.,
Davies Rachel,
Ashby Deborah,
Gibbs J. Simon R.,
Wilkins Martin R.
Publication year - 2013
Publication title -
pulmonary circulation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.791
H-Index - 40
ISSN - 2045-8940
DOI - 10.4103/2045-8932.109923
Subject(s) - medicine , vascular resistance , hepcidin , pulmonary hypertension , cardiology , crossover study , clinical endpoint , placebo , iron deficiency , anemia , hemodynamics , clinical trial , pathology , alternative medicine
Our aim is to assess the safety and potential clinical benefit of intravenous iron (Ferinject) infusion in iron deficient patients with idiopathic pulmonary arterial hypertension (IPAH). Iron deficiency in the absence of anemia (1) is common in patients with IPAH; (2) is associated with inappropriately raised levels of hepcidin, the key regulator of iron homeostasis; and (3) correlates with disease severity and worse clinical outcomes. Oral iron absorption may be impeded by reduced absorption due to elevated hepcidin levels. The safety and benefits of parenteral iron replacement in IPAH are unknown. Supplementation of Iron in Pulmonary Hypertension (SIPHON) is a Phase II, multicenter, double‐blind, randomized, placebo‐controlled, crossover clinical trial of iron in IPAH. At least 60 patients will be randomized to intravenous ferric carboxymaltose (Ferinject) or saline placebo with a crossover point after 12 weeks of treatment. The primary outcome will be the change in resting pulmonary vascular resistance from baseline at 12 weeks, measured by cardiac catheterization. Secondary measures include resting and exercise hemodynamics and exercise performance from serial bicycle incremental and endurance cardiopulmonary exercise tests. Other secondary measurements include serum iron indices, 6‐Minute Walk Distance, WHO functional class, quality of life score, N‐terminal pro‐brain natriuretic peptide (NT‐proBNP), and cardiac anatomy and function from cardiac magnetic resonance. We propose that intravenous iron replacement will improve hemodynamics and clinical outcomes in IPAH. If the data supports a potentially useful therapeutic effect and suggest this drug is safe, the study will be used to power a Phase III study to address efficacy.